|Year : 2020 | Volume
| Issue : 2 | Page : 53-55
Raising the abortion limit to 24 weeks: A welcome step, but with ethical challenges
Editor-in-Chief, MGM Journal of Medical Sciences (MGMJMS), Department of Obstetrics and Gynecology, MGM Medical College and Hospital, MGM Institute of Health Sciences (Deemed to be University), Navi Mumbai, Maharashtra, India
|Date of Submission||28-May-2020|
|Date of Acceptance||28-May-2020|
|Date of Web Publication||19-Jun-2020|
Dr. Sushil Kumar
Department of Obstetrics and Gynecology, MGM Medical College and Hospital, MGM Institute of Health Sciences (Deemed to be University), Navi Mumbai 410209, Maharashtra.
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kumar S. Raising the abortion limit to 24 weeks: A welcome step, but with ethical challenges. MGM J Med Sci 2020;7:53-5
On 17th of March 2020, Lok Sabha (Indian Parliament) passed the bill extending the legal limit of abortion to 24 weeks of pregnancy. It was an important social reform for millions of women in India but the importance of the bill was overshadowed by Covid-19 pandemic. The bill was sitting in parliament since 2014. Probably the bill was not considered politically important by the law makers or they had many other more important bills in their mind. Then suddenly the things changed, the bill “Raising the abortion limit” got approval from the cabinet and within short period of time it was passed by the Indian parliament. I presume that probably my request, apart from so many other requests to Prime Minister worked. Here I have an incident to tell.
Just 3 months back I had a case of 13 years old girl who got pregnant through incestuous relationship. By the time she was brought to us by her mother, she was about 22 weeks pregnant. The mother of the girl wanted medical termination of pregnancy (MTP). As per the existing law at that time, the MTP could be done up to 20 weeks of pregnancy only. Therefore we had to refuse her MTP though we could understand the mental and physical torture the mother and the daughter were going through. In our minds too, the consequences of carrying on with the pregnancy were worse than MTP. The pain and sadness I could see in her mother’s eyes was so intense that I thought I should do something. I was aware that the bill is lying in parliament waiting to be introduced for last few years. I used the app, down loaded from internet and asked Prime Minister (PM) for his intervention in getting the bill passed. I wrote to him that this reform is urgently needed to avoid humiliation and adverse mental and physical effect on health of innocent teen age girls. Few months later, to my utter surprise the bill was passed by the parliament. Should I take the credit? Well, I in fact don’t know if my writing to PM was the action that helped. Like me many others must have also tried. One person I do remember is Dr Nikhil Datar from Mumbai who had been in forefront in taking the cases of these unfortunate women to High courts and Supreme Court of India. He also piloted famous case of Mrs. Nikita Mehta, who was 24 weeks pregnant with abnormal fetus and wanted MTP. However one question always troubled me 'Why should women go to court seeking permission for MTP'. May be in absence of supporting law they had no choice. Supreme Court had 26 petitions asking for MTP beyond the legal limit of 20 weeks and more than 100 women were pleading in various ‘High courts’ of India for the similar permission. The majority of court judgments indicate that the MTP beyond 20 weeks was permitted in most of the cases. Therefore it was obvious that amendment to existing law was needed.
The bill passed without much resistance from its members. Presenting the bill to the Indian Parliament, the health minister Dr. Harsh Vardhan said that “the proposed law allows termination of pregnancies in cases related to rape, incest, minor girls, and pregnancy with substantial fetal anomalies. It is progressive legislation.” I think he was right. As per the MTP Act 1971, MTP is permissible for up to 20 weeks. Anomaly scans of current prenatal practice are advised for between 18 and 20 weeks. There is very little time with the patient if a fetal anomaly is picked up on the scan and the couple decides on MTP.
| Mtp act|| |
To understand the MTP Act, we must go back to the history. The MTP Act was enacted in India in 1971. Before that inducing abortion was a crime, and the punishment was jail for both the doctor and the patient. Fearing the law, the trained doctors avoided performing MTPs. Therefore, a large number of illegal MTPs were carried out by the quacks. This led to very high complication rates and mortality among women. MTP Act 1971 legalizes MTP for up to 20 weeks of pregnancy under certain conditions. In 2002, another amendment was made to permit private health-care providers to carry out MTP under certain regulatory provisions. This made the accessibility of the MTP easier, and the patients’ privacy was maintained. Even after making the MTP legal, as per rough estimates, 15.6 million MTPs take place in India, and 80% of these take place outside the registered areas. The current amendment to MTP law, or what we call “Abortion law 2020” permits abortion (MTP) in up to 24 weeks of pregnancy under certain conditions. For the MTP beyond 20 weeks, two doctors are required to certify and one of them has to be a government doctor. The name of the woman undergoing an abortion should not be disclosed.
| Abortion laws in other countries|| |
At present, 26 countries including Egypt, Angola, Thailand, and the Philippines do not permit abortion. Some other countries such as Brazil and Indonesia permit abortion only when lives are at risk. Abortion at request is available in Russia, Canada, Australia, and China. Countries such as Ireland, which has a very strong antiabortion law, also made an amendment in 2018 making abortion legal. The death of Indian dentist Savita Halppanavar, who died of sepsis after being denied an abortion during a protracted miscarriage, changed the public opinion in favor of abortion. There are different limits on abortion in different countries. The United Kingdom allows up to 24 weeks, Germany up to 12 weeks, and different states of United States have different gestational ages varying from 6 to 24 weeks. Religions across continents have a different take. Catholic Christian priests are against the loss of any life, and therefore against MTP. US President Donald Trump also made it an issue in his last presidential election. Under Shariat law, abortion after 120 days of conception is illegal (Hanafi legal school), whereas Maliki legal school forbids abortion at any gestational age (similar to the Catholic Church). The Hindu religion does not condemn abortion but advises against it. The very philosophy of soul never dies, meaning one does not kill a fetus even in MTP at any gestational age. However, irrespective of religion, many activists calling themselves “pro-life” are often responsible for the closure of “Abortion Clinics” around the world.
| UNANSWERED QUESTIONS: SOME OF THESE QUESTIONS ARE RELATED TO ABORTION IN GENERAL|| |
Mismatch with the definition of abortion
World Health Organization (WHO) and the Centers for Disease Control (CDC) define abortion as pregnancy termination before 20 weeks or a baby weighing less than 500g. The definition needs to be modified in the Indian context, in view of the present law. Gestational age of more than 24 weeks or baby weighing more than 650g may be more appropriate (average weight at 24 weeks is 580g).
What should be done if the baby is born alive?
There is a possibility that baby of 20–24 weeks being born alive. Some of the 500-g babies also survive. In our country, we do not have laws to protect the rights of newborns. Can we terminate or kill the baby if born alive? Would it be a crime then? What should we do if parents refuse to take the child? Who should pay for neonatal intensive care unit (NICU) expenses? At the moment, there are no legal answers to these questions.
Rights of the fetus versus rights of the mother
Does the fetus have some rights? Can a mother overrule these rights? Does carrying pregnancy against her wishes interfere with the “reproductive rights of women”? Fetal rights are a debatable issue. Pro-life advocates and antiabortion lobby, including former US President Ronald Reagan, said “Isn’t it strange that the same woman could have taken the life of her unborn child and it was abortion, not murder, but if somebody else does it, that’s the murder.” Like him, many legal theorists tried to build a case for fetal rights. However, one must realize that fetal rights infringe on women’s reproductive rights and her rights as an individual. In case, we legalize fetal rights, it will require more policing, and the offender and her doctor will be put on trial by court. It will also infringe on women’s rights to privacy. In my opinion, mother’s rights should take precedence over fetal rights.
Is the MTP process painful for the baby? When does the fetal heart start beating?
These are two factors that are often taken into account when a country or a state decides about the gestational limit of abortion. The rudimentary nervous system in the fetus forms by 28 days after fertilization. The neuronal structures used to detect pain are in place by 8–10 weeks. In all probability, the fetus starts feeling pain by the end of the first trimester. Extension of MTP to the second trimester may be painful for the fetus. Question is “does any individual have the right to inflict pain on others”? With advances in science, the fetal heart can now be picked up by ultrasound at 6 weeks of pregnancy. Can this be taken as a sign of life, and will no MTP be allowed after that?
Protection of children from sexual offences act (POCSO Act) and pregnancy
Pregnancy in girls less than 18 years of age requires legal scrutiny. The fact is that 50% of the women in India get married before 18 years of age. If a married woman who is less than 18 years of age wants MTP, “will it be an offense”? As per current practice, we do inform the local police. Police involvement interferes with the privacy of the patient and is an embarrassment for the family.
To sum up, the legal issues concerning abortion have been changing for centuries. Advances in technology, development of the robust legal system, and pro-life activism are responsible for frequent changes in the law in different countries.
In the current scenario in India, I think the extension of the abortion limit to 24 weeks is the need of the hour. As more and more girls get educated and aware of the use of contraceptives, termination of pregnancy at advanced stages may not be needed.
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Conflicts of interest
There are no conflicts of interest.