India has been the beacon of liberalization when it comes to acts and policies on safe abortion services. The Medical Termination of Pregnancy (MTP) Act was enacted as early as 1971 making India one of the very first few countries to legalise abortion. Internationally, only fifteen countries legalized abortion at that time. Even now, 26 countries in the world do not permit abortion even under dire circumstances where the mother’s life is in peril. Many countries permit only for saving the life of the mother, some other only on health grounds. The MTP Act , 1971 legalised abortion on a broad range of therapeutic, eugenic and humanitarian grounds. With the amendments suggested in the Medical Termination of Pregnancy (Amendment) Bill, 2020 introduced in Loksabha, once again the country has proven its commitment to concerns and issues with reproductive health and rights of women.
Currently abortion can be legally offered to women till 20 weeks. With changing times, improving technology, better in-utero detection of fetal anomalies and a changing socio cultural milieu, the 20 weeks deadline seems almost an impediment amounting injustice to many hapless women.
I have been involved in this entire movement for change from every possible angle, as an obstetrician, as a member of the hospital Medical Board on the request of the court and even as an external expert for the court to help them decide upon such cases.
Once, a woman came to me at 22 weeks of pregnancy with diagnosis of bilateral renal agenesis (both kidneys not formed). This baby might not die in the womb but would not live after birth. I had to refuse termination because it was too late legally. The couple was distraught at the prospect of carrying the pregnancy. A happy dream of new arrival had turned into a nightmare for her.
Another lady had a history of X-linked hydrocephalus. She had previous two boys who had the same problem and both had neurological disability. Although prenatal diagnosis is possible in such cases, she came quite late. A termination would have been ideal along with counselling and a prenatal diagnosis in the next pregnancy. But she had to carry on this pregnancy to have a third child with neurological disability. As a health care provider I feel the law makers have to keep up with the technological advancements. If we are able to make a diagnosis of hydrocephalus on ultrasound before birth, if we have the genetic tests to rule it out in the next baby, then the law should be conducive to take advantage of such progress which is what will be possible now once the amendments are enacted.
I have been a member of the Medical Board deciding upon various cases of late termination that have been referred to AIIMS, New Delhi by Hon’ble Courts. Although I must confess, I did feel helpless to refuse many cases where the pregnancies were too advanced to terminate. The process of filing court cases, decision whether to file or not, accessibility and other factors took a few weeks at least which made all the differences. Whereas an abortion of less than 24 weeks is safer and easier, after 28 weeks it is like a preterm delivery with a viability issue and would need a consideration for feticide before delivery. Now with these amendments, I feel, abortion would so much more accessible to the deserving patients.
I have called upon many a time as an expert by the courts for testifying on the need, feasibility and risk of a late abortion. I strongly feel that legal matters should be left to court and the medical issues to the doctors. A simple question like “Is there a risk to the mother” can have an answer extending to pages. It cannot be a simple yes or a no. The clinical decision making should be best left to the doctors for benefit of all concerned -the medical fraternity, our legal colleagues and the patients.
The timely changes in the bill reflect the progressive thought of our law makers. This is an effort to make abortion safe, widely available and more humanitarian. This will increase the ambit of women who need to terminate unwanted pregnancies. Motherhood should be by choice and not by chance.
(*Dr K Aparna Sharma
Dept of Obs Gynae
AIIMS, New Delhi )