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Death of baby with anencephaly after mother was refused an abortion sparks controversy in India

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7320 (Published 01 November 2012) Cite this as: BMJ 2012;345:e7320
  1. Mohuya Chaudhuri
  1. 1New Delhi

A recent case of a 22 year old pregnant woman whose baby had anencephaly and who had been denied an abortion by several doctors has sparked a debate about the upper time limit for abortion in India.

Usha Jethwa approached clinics for an abortion after she learnt in July this year that she was carrying a malformed fetus but she was turned away from all of them because she was 26 weeks pregnant at the time the defect was discovered. The baby was born in October and died within hours.

In India abortion is legal but is permitted only in certain circumstances. The Medical Termination of Pregnancy or MTP Act (1971), amended in 2003, allows a woman to abort a fetus up to 20 weeks of pregnancy.

A similar case to that of Jethwa had been reported in 2008 when Niketa Mehta wanted to abort her fetus at 24 weeks because it had congenital complete heart block. She had filed a case in the Mumbai High Court, but her appeal was rejected.

Even before these cases had arisen, the Ministry of Health and Family Welfare had decided to review the MTP Act to try to prevent illegal abortions (an estimated 4.5 million illegal abortions are carried out every year in India) and to ensure that the procedure is carried out only by trained personnel. An expert committee was set up in 2006 to produce recommendations to tackle these issues.

Vinoj Manning, country leader for Ipas, an international non-governmental organisation that works to end unsafe abortion, and a member of the expert group, said that one of the key objectives was to broaden the base of service providers to prevent women going to unqualified abortionists. At the moment abortions can be done only by trained gynaecologists and obstetricians in registered institutions. For abortions in the second trimester, two doctors are required.

Many believe that this restrictive provision forces women to take quick fix measures because of the complicated protocol, which causes delay. One of the proposed amendments recommended by the committee is to train auxiliary nurse midwives to do abortions, as they are already trained to deliver babies.

When the issue of birth defects hit the headlines recently, the committee debated the issue. However, no decision was taken because health ministry officials charged with detecting sex selection, a big problem in India, and who were taking part in the consultations on the abortion law, opposed the proposed change. They said that relaxing the abortion law would not only increase the risks for the mother but would also fuel sex selection.

But doctors in progressive states such as Kerala said that relaxing the law to allow late abortions would not have any significant effect on sex selection. Hari Kumar, a gynaecologist who is based near Trivandrum, Kerala’s capital, said, “The gender of the fetus is known by 14 to 16 weeks, and most abortions are done by then. Besides, the risks of a late abortion are approximately the same as that of a delivery. But the decision should be left to the parents.”

Padma Deosthali, of the Centre for Enquiry Into Health and Allied Themes (CEHAT), a public health research institution, said that the abortion limit should be extended to allow safe abortions for women who reach health facilities late.

But the complexity of the issue and the strong objections held by some groups have led to the stalling of the amendments to the MTP Act.

Notes

Cite this as: BMJ 2012;345:e7320