Could We Have Saved Gulabi by Dr. Basab Mukherjee


Kolkata, I can never forget the joy and happiness on Gulabi’s face when she first told me that she was getting married. Gulabi was one of those hardworking housemaids full of hopes and aspirations dreaming of a happy family life inspite of the hard life they endure. But her life soon took another turn when late into her pregnancy she learnt that her child would be born with severe kidney deformities. Since it was a late term pregnancy, she was advised against abortion as per the existing Medical Termination of Pregnancy (MTP) Act. As predicted, the child underwent unimaginable sufferings-repeated hospitalizations, costly and painful interventions.  Gulabi did whatever possible. However, within four years of its birth, the child succumbed to its deformities. Gulabi was made to leave her martial home. She lost not only her child, her martial family, her financial savings but most importantly her own self. She has become a broken, bitter woman with vacant eyes searching for answers to her miseries. She is a vitctim of her fate as well as her restricted access to arbortion due to existing law. 

The existing MTP Act, first introduced way back in 1971, outlined the criteria for provision of safe abortion services to women. It specifies about who, what, where and how services would be provided for termination under certain conditions. Termination is permitted if the pregnancy is a danger to the life to the woman, if it is a grave injury to the physical or mental health of the pregnant woman, if pregnancy is caused by rape, if substantial risk of a serious handicap in child exists or when it is due to failure of contraception in a married woman. 

Even close to fifty years after the inception of the MTP Act& Rules, ignorance of the law, stigma related to abortion and procedures done by unqualified providers in undesirable settings are prevalent. There are other instances where both health care providers and women seeking abortion are restricted by the rules and regulations of the MTP Act. The fallouts of these have been a denial of services to women, engagement in legal wrangles, a distraught medical community and increased frustration among the abortion seekers like Gulabi.

The recent amendments proposed in the MTP Act fall in line with the goal of Ministry of Health and Family Welfare -‘leaving no woman behind’. It reaches out to the women who desperately need safe abortion services. The amendment will greatly help not only the abortion seekers but also the service providers in a big way.

The upper limit of gestation age till 20 weeks, have proven to be one of major hurdles in accessing abortion services for women like Gulabi. Also, women sometimes present late when pregnancies follow rape, incest or occur in differently abled women. Keeping in mind the mental trauma these vulnerable women undergo, the upper limit has been proposed to be extended to 24 weeks of pregnancy. 

Usually a sonography , as a part of  antenatal care, is undertaken to detect abnormalities in the growing fetus  at around 18-20 weeks. There are some anomalies especially those of the heart which are best detected after 20 weeks. Some of these late detected abnormalities are life threatening and can seriously debilitate the baby after birth. In the new proposed amendments, these restrictions on gestational limits in cases of substantial foetal abnormalities have been lifted provided these are decided upon by a Medical Board. This will be of an immense boon for women like Gulabi, sparing them the mental agony or the legal hassles.

A persistent barrier to the provision of safe abortion services was the requirement of approval of two medical practitioners between 12 to 20 weeks of gestation. In smaller facilities , especially in rural areas, availability of two registered medical providers was a challenge limiting services. In the proposed amendment, only one medical practitioner is necessary till 20 weeks. However, for the approval of abortions performed in the increased period of 20 to 24 weeks, two RMPs will still be required. The new amendments seriously look into the confidentiality issues of the client. The name and other particulars of the woman seeking abortion will be not be revealed if necessary only to a person authorized by law . The clause of ‘failure of contraception’ which was so far limited to married women may now be extended to unmarried women as well.

The proposed amendments once enacted by Parliament will remove various barriers in the provision of safe abortion services thus empowering our women. The medical community welcomes the proposed measures and believes it will make a significant dent on abortion-related morbidity and mortality in the country.  It will help a large group of abortion seekers like Gulabi who desparately want to terminate their unwanted pregnancies.

(Dr. Basab Mukherjee, MD(ObGyn), FRCOG, FICOG and Consultant Obstetrician & Gynaecologist, Calcutta Medical Research Institute, Kolkata & Columbia Asia Hospital, Salt Lake, Kolkata)

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