Happy to share my article published in Times of India on 28th july 2016
While this article reaches the readers, doctors would have safely terminated the severely abnormal foetus of Miss X. It is a moment of pride that Miss X has been permitted access to legal abortion (despite crossing the cut off limit of 20 weeks) by the honourable Supreme Court of India. Transgressing beyond the literal interpretation, the judges have delivered progressive and path breaking judgement. It is indeed a big boost to the women’s rights movement in the country. Miss X approached the court and got justice, but what next?
How many women will require seeking judicial intervention? How many pregnancies are detected to have substantial anomalies after 20 weeks? How many women seek termination? We don’t have statistics. Many will be compelled to undergo illegal termination as it will amount to criminal act under section 312 of Indian penal code. Any Indian gynaecologist if asked will say that situation like Miss X is not so uncommon. Medically the chance of severe abnormality is around 1%. If we guess that only 1% abnormal pregnancies are detected after 20 weeks and given that many women give birth every year, we reach an astounding figure! It is almost like a public health hazard.
A pregnant woman develops an emotional bond with the unborn foetus by five months. It is a brutal shock to her when she is informed that the foetus in her womb has some serious abnormality and bears poor prognosis. It is a disaster when her brave decision to discontinue the pregnancy is overturned by doctors due to the legal limit of 20 weeks. So now we expect her to run to judiciary, appoint a lawyer, stay in the glare of the media (I must commend the sensitive handling by the Indian media here). Had she been below the limit of 20 weeks she would have exercised her right in a doctor’s clinic. So why punish her to run around? How many women will be brave enough to take such steps? Aren’t we compelling them to continue such an unwanted pregnancy risking their mental and physical health?
Miss X was lucky in a way. The abnormality was extremely serious and incompatible with life. The medical report given by me and KEM committee depicted it clearly. Imagine Mrs Y’s case (Mrs X and Mrs Y Vs Government of India) was in front of the court. I must give a brief about the case. Mrs Y was told just few days prior to 20 weeks cut off that there is some deviation in the brain structure of the foetus. The problem and severity could only be ascertained after removing the amniotic fluid (fluid around the baby). The report could take few weeks. Had she continued the pregnancy and then got the rude shock that the foetus was grossly abnormal, she would have had no choice but to approach the court like Miss X. The court would have appointed another board. The board would have again conducted fresh reports (the way KEM hospital reconfirmed all the facts again) and could have required another three weeks to opine.
It will be ideal if the parliament takes proactive stance in the matter. The directives from the apex court will go long way till then. In the recent past such directives have been issued in Aruna Shanbhag’s case in relation to passive euthanasia. These directives are being followed across the country and helping so many patients. The courts may be able to provide the frame work on appropriate interpretation of “substantial risk of handicap” as mentioned in the MTP Act. International guidelines from the Royal College of Obstetrics and Gynaecology in the UK, FIGO and many other international best practices can be ready reference points.
Abuse of such relaxations for sex determination (as feared by honourable Attorney general) is more perceived than real. Still to ensure safety and prevent abuse, medical boards can be set up. Needless to say, these provisions must be used only in exceptional situations.<br ?–>In light of modern medicine the cut off limit of 20 weeks also needs to be re-examined. In medical ethics there is a concept called “viability of the foetus”. It means capacity of independent existence. When the foetus is naturally expelled out before the age of viability, it is termed as “miscarriage”. When the same thing happens after the age of viability is termed as “delivery or labour”. Indian birth and death registration Act recognises birth when it occurs after 28 weeks of pregnancy. Just handful of babies have survived when born at 24 weeks… that too only when born in state of art premier institutes in the country. It can be construed that foetus expelled before 24 weeks is not “viable”. Thus raising the limit of termination to 24 weeks in general shall not make any difference from ethical or legal standpoint. The medicines and the method of termination of pregnancy remains the same at 18 weeks as well as 24 weeks. Besides, it is a well know medical fact that by 24 weeks of gestation woman can be provided with complete diagnosis as well as prognosis of abnormality. Thus women can make informed choices and decisions about terminations. Only upon crossing the limit women will need to approach the medical boards.
I think that it is just and fair that women in our country make informed choices and have the capacity of making decisions without pressure of arbitrary legal limits. Ultimately they and only they can deliver, breastfeed and raise the child.
Link: It’s time for India to reconsider 20-week cut-off for abortions