Couples like the Mehtas look forward to an ultrasound examination as an opportunity to meet their unborn child. That is how the health-care industry
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has oversold the role of ultrasound in pregnancy. The seductive 'come and see your baby’ on one hand and threatening horror stories of foetal abnormalities on the other are spread to ensure business. A casual visit, however, as the Mehtas discovered, can turn into a nightmare.
The simple question, "Is our baby OK?", is answered with maybes and incomprehensible statistics. Indeed, ultrasound is useful in pregnancy but prenatal diagnosis is a complex process and can be inaccurate. For couples, an unending process of specialist 'opinions' and expensive tests follows the initial shock of a possible abnormal baby.
Once abnormality is confirmed the only option in most cases is to terminate the pregnancy. Any treatment currently available to correct foetal abnormalities before birth is at best experimental. The limit of 20 weeks puts undue pressure on the doctors making a diagnosis and on the couples making difficult choices. The haste may lead to grave mistakes, or even worse couples may choose to abort on a suggestion or a doubt, rather than wait for confirmatory tests which may take the pregnancy beyond 20 weeks.
The aim of prenatal diagnosis is to prevent the birth of an abnormal child. The whole science of prenatal diagnosis is meaningless if abortion is not allowed even when gross abnormality is confirmed. Unfortunately abortion is still illegal in India under laws enacted in the 19th century. Some abortions are allowed now under the euphemistic Medical Termination of Pregnancy Act, 1971. The Act was made to facilitate abortion for birth control considered a national priority then, and not quite the 'enlightened legislation' one hoped for. It does not empower women but allows medical practitioners to perform abortion whenever they want, for 'family planning' or for money in private practice.
The limit of 20 weeks was imposed in 1971 as abortion after this was considered a risk to the mother. Abortion performed by specialists at any stage has now been shown to be at least as safe as a normal delivery and we need to re-look at this arbitrary limit.
Foetal abnormality was considered a reason to abort in the 1971 Act but little was available then in terms of prenatal diagnosis. All techniques of prenatal diagnosis including 'triple TEST', ultrasounds, chromosomal and DNA analysis and tests for foetal infections came much later. These are complicated and expensive tests and take weeks. In many cases, the pregnancy crosses 20 weeks by the time a diagnosis is confirmed. The limited access to health care further delays diagnosis in India. The law, however, has not been amended to accommodate these late abortions of the abnormal
foetus if required.
Law, ethics, religion, politics and science cross paths in medical practice everyday, but no issue is as contentious as abortion. It generates passionate opinions at both extremes. While abortion as a right is debatable, nobody except those with extreme pro-life views argue against aborting an obviously abnormal foetus. Laws have been amended in most countries to allow late abortions since prenatal diagnostic techniques became available. In the UK, a grossly abnormal foetus can be aborted at any stage of pregnancy. Even countries where special needs children are provided for by the state, strict laws only lead to illegal abortions and 'abortion tourism'. In a country like ours, with little social support and no public funding to look after special children, the government's right to dictate to individual couples by legislation is questionable.
In a country where at least 80,000 female foetuses are aborted every year without any medical reason at all, the Mehtas could have easily got an abortion done outside the public glare. Instead this couple from Mumbai showed courage in approaching the court. It is, however, unfair to expect the courts to give a judgment contrary to the existing laws, especially in view of the conflicting medical opinions. Individual couples and medical practitioners cannot be expected to find all the answers.
Ethicists, social scientists, lawmakers and medical specialists should discuss such issues on a common platform until a consensus is reached. A new and liberal abortion law is urgently required but we need to be careful as it may be abused to perform female foeticide. The medical profession in the past has refused to accept collective responsibility for this genocide and has a poor record in ensuring ethical conduct of doctors . It does not have any credibility and has failed to self-regulate. All future laws must be transparent and have built-in checks and mechanisms to curb female foeticide, while accommodating late abortions of grossly abnormal foetuses. This can be done by maintaining a nationwide 'abnormality registry'. This could allow late abortions for abnormal foetuses provided all these are followed by autopsies, and any abuse of the law is checked.
Couples who are carrying an abnormal foetus do not have the luxury of the 'best possible choice' as all choices available are terrible. Late abortion is terrible, and so is allowing the birth of a child with a known abnormality. The Mehtas were thus in the unenviable situation of having to make the 'least terrible' choice. Now they need careful counselling and support. This case may not have helped them but has sparked a countrywide debate. We must now urgently demand an 'enlightened legislation' on abortion.
The simple question, "Is our baby OK?", is answered with maybes and incomprehensible statistics. Indeed, ultrasound is useful in pregnancy but prenatal diagnosis is a complex process and can be inaccurate. For couples, an unending process of specialist 'opinions' and expensive tests follows the initial shock of a possible abnormal baby.
Once abnormality is confirmed the only option in most cases is to terminate the pregnancy. Any treatment currently available to correct foetal abnormalities before birth is at best experimental. The limit of 20 weeks puts undue pressure on the doctors making a diagnosis and on the couples making difficult choices. The haste may lead to grave mistakes, or even worse couples may choose to abort on a suggestion or a doubt, rather than wait for confirmatory tests which may take the pregnancy beyond 20 weeks.
The aim of prenatal diagnosis is to prevent the birth of an abnormal child. The whole science of prenatal diagnosis is meaningless if abortion is not allowed even when gross abnormality is confirmed. Unfortunately abortion is still illegal in India under laws enacted in the 19th century. Some abortions are allowed now under the euphemistic Medical Termination of Pregnancy Act, 1971. The Act was made to facilitate abortion for birth control considered a national priority then, and not quite the 'enlightened legislation' one hoped for. It does not empower women but allows medical practitioners to perform abortion whenever they want, for 'family planning' or for money in private practice.
The limit of 20 weeks was imposed in 1971 as abortion after this was considered a risk to the mother. Abortion performed by specialists at any stage has now been shown to be at least as safe as a normal delivery and we need to re-look at this arbitrary limit.
Foetal abnormality was considered a reason to abort in the 1971 Act but little was available then in terms of prenatal diagnosis. All techniques of prenatal diagnosis including 'triple TEST', ultrasounds, chromosomal and DNA analysis and tests for foetal infections came much later. These are complicated and expensive tests and take weeks. In many cases, the pregnancy crosses 20 weeks by the time a diagnosis is confirmed. The limited access to health care further delays diagnosis in India. The law, however, has not been amended to accommodate these late abortions of the abnormal
foetus if required.
Law, ethics, religion, politics and science cross paths in medical practice everyday, but no issue is as contentious as abortion. It generates passionate opinions at both extremes. While abortion as a right is debatable, nobody except those with extreme pro-life views argue against aborting an obviously abnormal foetus. Laws have been amended in most countries to allow late abortions since prenatal diagnostic techniques became available. In the UK, a grossly abnormal foetus can be aborted at any stage of pregnancy. Even countries where special needs children are provided for by the state, strict laws only lead to illegal abortions and 'abortion tourism'. In a country like ours, with little social support and no public funding to look after special children, the government's right to dictate to individual couples by legislation is questionable.
In a country where at least 80,000 female foetuses are aborted every year without any medical reason at all, the Mehtas could have easily got an abortion done outside the public glare. Instead this couple from Mumbai showed courage in approaching the court. It is, however, unfair to expect the courts to give a judgment contrary to the existing laws, especially in view of the conflicting medical opinions. Individual couples and medical practitioners cannot be expected to find all the answers.
Ethicists, social scientists, lawmakers and medical specialists should discuss such issues on a common platform until a consensus is reached. A new and liberal abortion law is urgently required but we need to be careful as it may be abused to perform female foeticide. The medical profession in the past has refused to accept collective responsibility for this genocide and has a poor record in ensuring ethical conduct of doctors . It does not have any credibility and has failed to self-regulate. All future laws must be transparent and have built-in checks and mechanisms to curb female foeticide, while accommodating late abortions of grossly abnormal foetuses. This can be done by maintaining a nationwide 'abnormality registry'. This could allow late abortions for abnormal foetuses provided all these are followed by autopsies, and any abuse of the law is checked.
Couples who are carrying an abnormal foetus do not have the luxury of the 'best possible choice' as all choices available are terrible. Late abortion is terrible, and so is allowing the birth of a child with a known abnormality. The Mehtas were thus in the unenviable situation of having to make the 'least terrible' choice. Now they need careful counselling and support. This case may not have helped them but has sparked a countrywide debate. We must now urgently demand an 'enlightened legislation' on abortion.
ABHISHEK SINGLA
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