Doctors favour changes in India’s abortion law
BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1273 (Published 14 August 2008) Cite this as: BMJ 2008;337:a1273An Indian court has turned down a plea by a Bombay couple to be allowed to abort a 25 week old fetus, stirring a nationwide clamour for changes in India’s 37 year old abortion law.
Niketa and Harsh Mehta, had approached the Bombay High Court to seek permission to abort their fetus after diagnostic tests showed a congenital heart block and transposition of the great arteries. India’s Medical Termination of Pregnancy Act, passed in 1971, allows abortion up to only 20 weeks’ gestation.
The court had asked a panel of doctors from the Jamsetji Jeejebhoy Hospital to examine the test results, and rejected the plea last week after the panel predicted little chance that the child would be born too disabled to survive.
The court observed that the existing law allows termination of pregnancy after 20 weeks only if the pregnant woman faces a health risk. It said that it could not make an exception to this case given the medical opinion it had heard and added that it was for the legislature to amend the abortion law.
Sections of India’s medical community have reacted to the court ruling with dismay. “The law needs to keep pace with advances in medical technology,” said Jaydeep Tank, chairman of the committee for medical termination of pregnancy at the Federation of Obstetrics and Gynaecological Societies of India.
“We believe that the cut-off date should be extended to 24 weeks,” Dr Tank said. “Certain fetal abnormalities are best detected only in the 20 to 24 week window.”
In a letter of support for the couple’s plea submitted to the court, he said, the federation had cited the law in the United Kingdom, where abortion is permitted up to 24 weeks.
Independent gynaecologists and members of the federation argue that the 1971 law was enacted at a time when prenatal diagnosis was not conducted in India. “There’s no strict medical reason for the 20 week cut-off,” said Dilip Walke, the chairman of the ethics and medicolegal committee of the federation.
“Abortion procedures have changed significantly since 1971,” Dr Walke said. “The risk from abortion to the pregnant woman at 20 weeks is today the same as the risk at 24 weeks.”
“This case highlights the dilemma that doctors in India face,” said Nikhil Datar, the couple’s doctor who is a consultant obstetrician and gynaecologist at the Nanavati Hospital, Bombay.
Doctors say they are forced to turn away parents who seek abortion after their fetuses are diagnosed with severe anomalies after 20 weeks of gestation.
“An abortion after 20 weeks may appear to some doctors as morally and ethically the right thing to do, but it is also illegal,” Dr Datar told the BMJ. Some parents just don’t want to see their child suffer, and others seem to have economic reasons for seeking termination of pregnancy, one obstetrician said.
India allows abortion after prenatal diagnosis of genetic disorders or congenital abnormalities as long as pregnancy is terminated by 20 weeks. A few leading hospitals across India provide prenatal diagnosis of a range of illnesses—for example, muscular dystrophy, Down’s syndrome, and congenital blood disorders.
“Our experience is that almost all parents choose to abort the fetus when they get a diagnosis of a severe physical or mental handicap,” said Deepika Deka, professor of fetal medicine at the All India Institute of Medical Sciences, New Delhi. The genetic tests are done between 10 and 20 weeks, Dr Deka said.
In internal discussions, some members of the Federation of Obstetrics and Gynaecological Societies of India have expressed concern that extending the cut-off to 24 weeks may increase the number of female feticides. But Dr Deka said that amendments to the law could include safeguards that prevent its abuse.
“A specific set of institutions, such as medical colleges, could be identified for conducting the termination of pregnancy after 20 weeks,” she said.
Notes
Cite this as: BMJ 2008;337:a1273
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