Kaisar Ahmad Malla
Medical Termination of Pregnancy (MTP)is often reduced to a chapter in textbooks, pages filled with medical terminology, legal clauses and procedural guidelines. But the reality of MTP extends far beyond the sterile lines of legislation and clinical protocols. It is a deeply human issue that touches the core of women’s rights, health and dignity. While laws like the Medical Termination of Pregnancy Act provide the framework for safe abortion services, they do not tell the full story. They do not capture the emotional struggles, societal pressures or the everyday challenges women face when making this difficult choice. Understanding MTP demands that we look beyond textbooks and appreciate the lived experiences behind every decision.
It is not just a procedure, it is a woman holding two futures in her hands, knowing only one can survive. Sometimes it is the heartbreak of sparing a child from a life of pain, sometimes it is the fight to save her own. Made in silence, with tears or with courage, it is a deeply human moment no law or textbook can truly hold.
I learned this truth not from a lecture hall, but from a corridor. It was nearly a decade ago, during my third year of BSc Nursing. As part of our curriculum, I had been assigned to deliver a health awareness talk at Govt Lala Ded Hospital Srinagar. That morning, I found myself in the antenatal corridors of LD Hospital, one of the busiest maternity hospitals in the Valley. The air was thick with the mingling scents of antiseptic. Long queues of expectant mothers sat on benches, their hands resting on swollen bellies, some accompanied by sisters or mothers who clutched medical files wrapped in polythene to protect them from the winter damp. An announcement crackled through the loudspeaker, calling out names in a monotone rhythm. I could see the tired eyes of women who had travelled since dawn from far-off villages, their clothes still carrying the dust of the journey. Many of them were illiterate, the words ‘antenatal care’ and ‘balanced diet’ meant little to them. My task was to bridge that gap, to explain medical ideas in Kashmiri, words that would reach not just their ears but their hearts. I still remember my voice trembling at first and then finding its strength as I spoke about the importance of check-ups, nutrition and rest. I used examples from their own kitchens, I still remember using the simplest examples I could think of. I told them, Think of vitamins like the ingredients of a good wazwan, if even one dish is missing, it just does not feel complete. I explained folic acid as ‘the gentle guard’ that shapes your baby’s brain and backbone and calcium that is what builds your baby’s bones, so strong that one day those tiny feet will run towards you calling you ‘mummy’, with the same love you are feeling right now.
Some women nodded, some whispered to each other and one elderly grandmother raised her hand to ask if meat once a month counted as a balanced diet. We laughed together, but inside I felt a deep ache, realising how much of pregnancy health depends on knowledge and access, not just medical care. That day taught me that in healthcare, language is as important as medicine and listening is as vital as speaking. It has been almost ten years, but those faces still visit my memory when I think about maternal health.
Today, in Jammu & Kashmir, those antenatal corridors may look the same, but the realities have shifted. Over the last four years, the number of medical terminations of pregnancy (MTP) has risen from around 3,500 to nearly 9,000.On one hand, this may reflect improved access to safe and legal abortion services. On the other, it raises urgent questions, are more women facing unplanned pregnancies? Are congenital birth defects becoming more common? Or are economic hardships, social pressures and environmental changes silently shaping these numbers? Behind every statistic is a personal journey, as complex as the women I once stood before in that hospital.
Medical Termination of Pregnancy in India is regulated by the Medical Termination of Pregnancy Act, 1971,amended in 2021.It allows termination up to 20 weeks with the opinion of one doctor. For 20–24 weeks, the consent of two doctors is required and only for specific categories such as rape survivors, minors, widows, women with disabilities and cases with severe fetal anomalies. Beyond 24 weeks, termination is permitted only if a State Medical Board confirms the presence of life threatening or severely disabling defects in the fetus. These laws are not just lines on paper, they exist to balance a woman’s health and autonomy with the need to protect life, while preventing unsafe abortions.
The reasons for MTP are varied. Some women face immediate threats to their lives, others receive devastating prenatal diagnoses and many are influenced by poverty, domestic violence, sexual assault or lack of family support. Among the most difficult cases are those involving congenital or intranatal birth defects, heart malformations, neural tube defects, cleft palate and severe brain anomalies. While genetics plays a role, many of these can be prevented through adequate nutrition, especially folic acid and iodine intake before and during pregnancy. Other risk factors include maternal obesity, uncontrolled diabetes, smoking, alcohol, substance abuse and exposure to environmental toxins like pesticides, industrial chemicals and polluted air or water. Advanced maternal age and inadequate antenatal care add further risk.
Lifestyle changes over the past two decades have intensified these problems. Processed food has replaced fresh meals, sedentary habits are more common and environmental degradation has entered even the remotest villages. The result is not just higher rates of birth defects, but also increased stress on mothers and families, often leading to decisions they never thought they would face. If we want to reduce the number of MTPs, we must look beyond hospital walls. Contraception should be widely available and free of stigma. Pre-conception counselling must become a routine part of healthcare. Nutrition awareness should be taught in schools and reinforced through community health workers. Environmental policies should actively reduce pregnant women’s exposure to harmful chemicals. And most importantly, healthcare communication must be in the language and context people live in, not just the one we write in textbooks.
The MTP Act safeguards a woman’s right to decide her future, but our aim should be to ensure that fewer women are forced into making that choice. The jump from 3,500 to 9,000 terminations in J&K is not simply a health statistic, it is a mirror reflecting our gaps in prevention, awareness and support. When I think back to that day in LD Hospital, speaking in Kashmiri to women whose lives were far from my own yet deeply connected by the thread of motherhood, I realise this, the real work of healthcare begins long before a pregnancy, and its success is measured not in procedures performed, but in healthy lives lived.
Every number in the rising statistics is not just a figure, it is a story of a woman, her dreams, her fears and her silent struggles. Behind every decision is someone who once imagined holding a child, naming them and watching them take their first steps, yet found herself at a point where survival, health or circumstances left no other choice. Some decisions are made in pain, others in fear and many in love, the kind of love that protects even when it means letting go. If we truly wish to understand these realities, we must go beyond judging and start listening, beyond blaming and start supporting. That support begins with the basics, ensuring every mother has access to proper nutrition, regular antenatal check-ups and timely diagnosis of complications.
Our government, through initiatives like Janani Suraksha Yojana, Pradhan Mantri Matru Vandana Yojana and Ayushman Bharat, is making every possible effort to ensure that even the most remote villages are not left behind. These schemes, with their focus on maternal health and safe deliveries, have given countless mothers a chance to embrace motherhood with dignity and safety. Iron, folic acid, calcium supplements and other essential nutrients along with necessary diagnostic tests are provided free of cost at government maternity clinics. However, despite these vital services, a significant lack of awareness among many prevents them from accessing or benefiting fully. Increasing public knowledge about the importance of these supplements and regular antenatal checkups could prevent many complications, thereby reducing the need for MTPs. When a mother eats well, visits her doctor on time and receives the care she deserves, we are not just saving a pregnancy, we are nurturing a future. And every heartbeat, whether it stays or fades deserves dignity and every woman deserves the right to be heard without shame.
(The author is a health worker and can be reached at [email protected])
