By Puneet Bedi, IANS,
Every time I look at the ultrasound monitor to see the foetus from various angles, mothers read my face to see a twitch or a smile to suggest the baby is normal. Unfortunately their simple question “Is my baby alright?” can only be answered in maybes. Diagnosis of foetal abnormality is not easy and is not always accurate.
When an abnormality is suspected the couple is bombarded with possibilities and incomprehensible statistics. Initial shock is followed by harassment of varied opinions, expensive tests and hectic travel. Diagnosis or a strong possibility of an abnormality often leads to advice to terminate the pregnancy as any treatment available currently before birth is experimental. The aim of prenatal diagnosis remains prevention of birth of an abnormal child. All this is made worse by a legal limit of 20 weeks. This puts undue pressure on doctors making a diagnosis and on couples making difficult decisions, sometimes leading to errors.
Law, ethics and science often cross in medical practice, but no issue is as contentious as abortion as it generates passionate opinions at both extremes.
While abortion as a right is debatable, very few people outside religious extremes would argue against aborting an obviously abnormal foetus. A very strict law only leads to illegal abortions or ‘abortion tourism’. Laws have been amended therefore in some countries to allow late abortions (after 20 weeks). In Britain, an abnormal foetus can be aborted at any stage of pregnancy provided specialists agree that there is a possibility that the foetus if born would have a significant disability.
Laws made in the nineteenth century make abortion in India illegal to this day. In 1971, the Medical Termination of Pregnancy act allowed abortions under special circumstances. The act was brought to facilitate abortion in the Family Planning programme as birth control was a national priority then. The limit of 20 weeks was imposed as abortion after this was considered a risk to the mother.
Subsequent studies, however, have shown that abortion at any stage of pregnancy if performed properly is at least as safe as a normal delivery. Foetal abnormality was considered a reason to allow abortion under this act but no real prenatal diagnosis was available in 1971. All techniques of prenatal diagnosis including blood tests like triple test, ultrasound, foetal monitors, chromosomal tests, DNA analysis and cultures to detect prenatal infections came in much later. These are complicated and expensive tests and take weeks to complete.
More often than not the pregnancy is over 20 weeks by the time a firm diagnosis can be made. The law, however, has not been amended to accommodate these late abortions of an abnormal foetus.
In a country where nearly a million female foetuses are aborted every year illegally, without any medical reason, why would anyone seek legal recourse in a foetus with abnormality?
The Mehta couple from Mumbai showed unusual courage in approaching the court. However, it would be unfair to expect the courts to give a judgment contrary to the existing laws especially in view of the conflicting medical opinions. Neither the court nor individual couples and medical practitioners have the resources to find all answers.
Ethicists, social scientists, lawmakers and medical specialists should discuss these issues on a common platform until a consensus is reached. A new liberal abortion law is urgently required but there is a genuine fear that this may be abused to perform female foeticide. The medical profession has taken no responsibility of this genocide and has a poor record in ensuring ethics of the doctors. It thus does not have any credibility and cannot be trusted to enforce any self-regulation.
The law therefore must have very strict check mechanisms in itself and must be transparent. It should be able to curb crimes like female foeticide while making aborting grossly abnormal foetuses legal after a firm diagnosis, even when the diagnosis has been made after 20 weeks. This can be done by a maintaining a strict nationwide ‘abnormality registry’. This could allow late abortions for abnormal foetuses under specialist supervision, ensuring that all these late abortions are followed by autopsies, and any abuse of the law is caught and punished.
Unlike other choices we make in life, couples that are carrying an abnormal foetus do not have the luxury of the ‘best possible choice’ as all choices available are terrible. They may abort a foetus that may live with minimal or no handicap. They may, on the other hand, allow a child with a known abnormality to grow and regret it if he/she were to live with a severe handicap.
The Mehtas are in an unenviable situation and whatever happens now, they may live to regret this day. While we must admire their courage they deserve the nation’s sympathy and best wishes. This case may not have helped them and their baby but it has sparked a countrywide debate.
This is perhaps a bit late, over 30 years after diagnostic techniques like ultrasound and genetic labs doing DNA and chromosomal analysis were introduced in this country. We as a nation must stand up and decide on this very important issue. The abortion laws must be urgently amended to accommodate late abortions of abnormal foetuses or indeed all prenatal diagnosis in late pregnancy be somehow banned as it has no meaning if abortion after 20 weeks is not allowed.
(Puneet Bedi is a leading gynaecologist based in New Delhi. He can be reached at [email protected])