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Abortion in India

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Abortion in India has been legal since 1971 and there are about 11 million abortions performed per year. Legalizing abortion has not ensured its accessibility to the poor nor been an effective method for curtailing population growth. Legal abortion was introduced in 1971, when concern about burgeoning population growth became an issue for India. Although abortion is legal, it is estimated that four million Indian women a year still resort to illegal abortions because of social taboos, misconceptions about the law, and the lack of skilled practitioners and medical facilities. Giving or taking prenatal tests solely to determine the sex of the fetus is being criminalized by the Indian parliament. Female children are still widely considered to be a social and financial liability in a country where the dowry system is still a part of marriage. The prenatal tests have been used to detect female fetuses, which are then aborted. Under Indian law, ending a pregnancy only because a fetus is female has already been outlawed, although the practice is common. Poor women who cannot afford the cost of either prenatal testing or abortion often resort to female infanticide. Abortion became legal in India in 1971 in order to prevent overpopulation. However, this appears to have been unsuccessful as India now has 1.1 billion people and is the second most populus country in the world, after China. In 1994, under pressure from a coalition of activists, the Indian government changed course, outlawing the use of ultrasound machines to reveal fetus gender. In 2002, the penalties were stiffened: up to three years in jail and a $230 fine for the first offense and five years imprisonment and $1,160 for the second.

Statistics
Abortions are a major cause of maternal morbidity and mortality in India. Because most of the abortions are not reported and the sex selective abortions are carried out secretly the statistics of abortions in India is of varying reliability. The available statistics are grossly inadequate as hospitals keep records of only legal and reported abortions.

[edit] Number of abortions in India
According to the Consortium on National Consensus for Medical Abortion in India, every year an average of about 11 million abortions take place annually and around 20,000 women die every year due to abortion related complications.[1] Most abortion-related maternal deaths are attributable to illegal abortions.[2] In the following table Number of abortions reported includes legal reported induced abortions.[3] Year 1972 1975 1980 1985 1990 1995 2000

Number of abortions 24300 214197 388405 583704 581215 570914 723142 reported

Abortion by selection of gender
The Lancet study seemed to confirm that laws were not deterring families from sex selection. By analyzing national birth records and fertility histories from a 1998 Indian government survey of 1 million households, the study estimated that at least 500,000 female fetuses in 1997 were aborted. Based on that one year, they came to the 10 million figure. The study also found that families whose first child was a girl were 30 percent less likely overall to produce another girl. And if the mothers had at least a 10th-grade education, the gap was twice as large as that for illiterate mothers. Having gender-based abortions have been illegal since 1994.

[edit] Female abortion
A lot of people in India are turning more towards abortion for girls because In India, there are less than 93 women for every 100 men in the population. The accepted reason for such a disparity is the practice of female infanticide in India, prompted by the existence of a dowry system which requires the family to pay out a great deal of money when a female child is married. For a poor family, the birth of a girl child can signal the beginning of financial ruin and extreme hardship. Which then they choose to have an ultrasound so they can make sure if they are having a male or female. The implication is that by avoiding a girl, a family will avoid paying a large dowry on the marriage of her daughter. According to UNICEF, the problem is getting worse as scientific methods of detecting the sex of a baby and of performing abortions are improving. Experts say that sex-selective abortions in India reduced the number of girls per 1,000 boys from 945 in 1991 to 927 in 2001.

[edit] Medical abortion and the law
In order to prevent the misuse of induced abortions, most countries in the world have created strict abortion laws and so has India. As per India’s abortion laws only qualified doctors, under stipulated conditions, can perform abortion on a woman in a clinic or a hospital that has been approved of doing so. The Indian abortion laws fall under the Medical Termination of Pregnancy (MTP) Act, which was enacted by the Indian Parliament in the year 1971. The MTP Act came into effect from April 1st, 1972 and was once amended in 1975. The Medical Termination of Pregnancy (MTP) Act of India clearly states the conditions under which a pregnancy can be ended or aborted, the persons who are qualified to conduct the abortion and the place of implementation.[4]

[edit] Indications for early medical abortion
[edit] General condition to be fulfilled

All women coming to a health facility seeking termination of pregnancy up to 7 weeks period of gestation (49 days from the first day of the last menstrual period in women with regular cycle of 28 days) provided the following aspects have been assessed and found appropriate:[5]
• • • • •

frame of the mind of patient and her acceptability of minimum three follow-up visits ready for surgical procedure if failure or excessive bleeding occurs family support permission of guardian in case of minor as per MTP Act 1971 easy access to appropriate health care facility

Only registered medical practitioners as prescribed by the MTP Act are authorized to prescribe mifepristone with misoprostol for medical abortion (Definition 2(d) of section 2 and MTP rule 3). Mifepristone with misoprostol for termination of early pregnancy not exceeding seven weeks, may be prescribed by a registered medical practitioner as prescribed under section 2 (d) and rule 3, having access to a place approved by the Government under section 4 (b) and rule (1), for surgical and emergency back-up when such a back-up is indicated. This may include primary health care-clinic or hospital-based set-up. Initial workup, counseling, prescription and administration could be in a clinic or in the consulting room. Home administration of misoprostol may be advised at discretion in certain cases with an access to 24-hours emergency services.

[edit] Choice between Medical and Surgical Abortion

• • •

Vacuum Aspiration (Suction evacuation) is the most commonly-used method for termination of early pregnancies. However, being a surgical technique, it is associated with risks of infection, perforation of uterus, incomplete abortion and post-procedure uterine synechiae formation (Asherman’s Syndrome). The success of abortion with drugs depends on multiple factors including the regimen used,dosage schedule, route of administration and gestational age. However, after counseling, the woman should be allowed to make an informed decision. Mifepristone with misoprostol is favourable if pregnancy is = 7 weeks. Surgical abortion is preferred if patient desires concurrent tubal ligation. If a woman fulfills the criteria for selecting either method, final choice to be given to the woman.

[edit] Contraindications for medical abortion
Where a pregnant woman has a serious medical disease and continuation of pregnancy could endanger her life. Indian MTP act lay a clear guideline under which medical abortion is contra indicated

[edit] Contraindications due to Medical Reasons
• • •

smoking > 35 years anemia – hemoglobin < 8 gm % suspected /confirmed ectopic pregnancy / undiagnosed adnexal mass

• • • • • • • • •

coagulopathy or women on anticoagulant therapy chronic adrenal failure or current use of systemic corticosteroids uncontrolled hypertension with BP >160/100mmHg cardio-vascular diseases such as angina, valvular disease, arrhythmia severe renal, liver or respiratory diseases glaucoma uncontrolled seizure disorder allergy or intolerance to mifepristone / misoprostol or other prostaglandins lack of access to 24-hours emergency services.

[edit] Psycho-social situations
This include the cases when
• • • •

women unable to take responsibility anxious women wanting quick abortion language or comprehension barrier not willing for surgical abortion in case of failure

[edit] References
1. ^ "Introduction". Consortium on National Consensus for Medical Abortion in India. 2.
http://www.aiims.edu/aiims/events/Gynaewebsite/ma_finalsite/introduction.html. Retrieved on 2008-12-03. ^ "Current status of abortion in India". Consortium on National Consensus for Medical Abortion in India. http://www.aiims.ac.in/aiims/events/Gynaewebsite/ma_finalsite/report/1_1_1.htm. Retrieved on 2008-10-11. ^ Historical abortion statistics, India Historical abortion statistics, India ^ "Medical Termination of Pregnancy, 1971". Medindia.com. http://www.medindia.net/Indian_Health_Act/the-medical-termination-of-pregnancyact-1971-introduction.htm. Retrieved on 2008-12-10. ^ Guidelines for Medical Abortion in India

3. 4. 5.

Law of Abortion in India 04-12-2008 Blogs.expressindia.com PanchajanyaBatraSingh

The Nikita Mehta case has given rise to a raging debate on abortion laws in the country. The key issue is whether the statutory time limit for abortion must be increased from the currently permitted twenty weeks of gestation to twenty four weeks or above? The answer is not easy to arrive at. The issue involves complex questions of law, morality, theology, medicine and philosophy. A pregnancy when carried to term may stretch to about forty

weeks. The Medical Termination of Pregnancy Act, 1971 permits abortion to be performed only when the pregnancy poses a risk to the life of the pregnant woman, or, of grave injury to her physical or mental health, or, when there is a substantial risk of the child being born with physical or mental abnormalities so as to be seriously handicapped. A registered medical practitioner may terminate the pregnancy up to twelve weeks of gestation but where the period is between twelve to twenty weeks, the opinion of two registered medical practitioners is required. The limit of twenty weeks may be crossed only when the procedure is performed to save the life of the woman. Importantly, pregnancy that results from rape or failure of a contraceptive device between a married couple is viewed as causing grave injury to the mental health of the woman. Facts: In the Nikita Mehta case the gestational period had progressed much beyond the prescribed period and was past twenty five weeks. The petitioners pleaded that the defect in the heart of the unborn child was detected at a late stage. They expressed their inability to bear the psychological and monetary burden of giving birth to a child that may suffer from severe health problems. The anguish of such parents is understandable. It may neither have been an easy life for the child on birth nor a comfortable situation for the parents to raise a child with such a disability. Existing mechanisms of state support are negligible for such parents and individuals. The burden of providing special care falls overwhelmingly on the immediate family. It may be useful at this stage to examine the laws in other countries on this issue. Many countries like Canada, Korea, China, Germany, France and several other European countries have comparatively liberal laws on abortion. Canada goes to the extent of not interfering with the issue at all and leaves it entirely to the woman and her physician. The woman is perceived as having complete liberty upon her person and the foetus is seen as a part of her body, acquiring the status of a person only after birth. Korea permits abortions till twenty-eight weeks but spousal consent is mandatory for married women. The Abortion Act, 1967 of U.K. permits abortions till twenty four weeks but there is no upper limit if the pregnancy poses a threat to a woman’s life or if the foetus is likely to be born with severe physical or mental deformity. There are countries that place more severe restrictions upon abortions. While El Salvador and Chile have endorsed a complete

ban on abortions, Afghanistan, Bangladesh, Brazil and a few others permit abortion only in cases of rape. India, by comparison, has chosen a middle path instead of a this-way-or-that-way approach. Rightly so perhaps, given the sensitivity of the issue. A balanced approach appears suitable; a balance between the respective interests of the woman, the unborn, her family and the state. The ‘balance approach’ is immaculately discussed in an American case decided in 1973 wherein the court held that an expecting woman has absolute right to privacy in respect of her body till the first twelve weeks of pregnancy. At this stage the state must not interfere with her decision about continuation or termination of pregnancy while the foetus is but a part of her body. Between twelve and twenty weeks the state may place limited restrictions to permit abortions only when direly necessitated, for example to save the life of a pregnant woman or on eugenic grounds to prevent birth of severely malformed babies. But where the period of gestation crosses twenty weeks the state may step in to curtail abortions completely on grounds of compelling state interest to protect and preserve potential life for the future of the society. The next question that arises is why the cut-off must be marked at twenty weeks? The answer lies in the fact that the baby becomes viable at this stage. In other words, the baby is no longer indispensably dependant on its mother’s body and stands a chance of survival upon delivery, albeit with suitable aids at this premature stage. As it grows, it becomes more and more capable of independent survival and from seven months of gestation onwards, the chances of its survival upon birth become bright. Thus, in addition to state interest, the interests of the fully formed unborn child at this stage become noteworthy. The unborn find explicit or implicit protection through many international and national laws. The Convention on the Rights of the Child recognized the need for special protection of children before and after birth on account of their physical and mental immaturity. The Convention on Elimination of Discrimination Against Women views maternity as a social function thereby ratifying the idea that apart from individual rights like right to privacy, we also have corresponding duties that must be performed to sustain and nurture society. Indian legislations on family and succession have provided explicit statutory protection to rights of the unborn by guarding their interests in property, amongst others. Courts have begun to

recognize the worth of the unborn in deciding cases of compensation for road accidents. The Indian Penal Code prescribes imprisonment and fines as punishment for offences against expectant women and unborn children. The severity of punishment increases if the offence is caused to the detriment of a ‘quick child’ or an unborn baby that begins to move, usually around five months of gestational age. Even the Code of Medical Ethics urges doctors to respect human life from the point of conception onwards. Before considering any extension in the statutory time limit for abortion, factors like possible abuse of law must be examined carefully. One of the goals of enacting the Medical Termination of Pregnancy Act was to contain the population explosion in the country. It is however a grim reality that the legislation is also being rampantly misused to cover and carry out sex-selective abortions as evident from the highly skewed sex ratios in the country. It is surprising that affluent and relatively educated parts of the country, including the capital have persistently shown a bias against the girl child. Would it be justified under such circumstances to give further time to parents to consider gender based termination of pregnancy and provide an enlarged legal umbrella towards acts that are detrimental to the society? Decision: Coming back to the Nikita Mehta case, the Mumbai high court held that no categorical opinion of experts had emerged to state that the child would be born with serious handicaps. The court thus denied recourse to medical termination of the pregnancy and an opinion emerged that terminating the life of a viable unborn on grounds of possible handicap is akin to mercy killing. We also need to consider whether a further extension would lead to a possibility of obnoxious agreements between the woman, her family and the physician to terminate the pregnancy if the baby is likely to be born less than perfect, even if such imperfection may be accommodated with little effort and is not life threatening? It must be appreciated that a civilized society and welfare state must consider the rights of the unborn who are defenseless individuals incapable of taking decisions or making informed choices about their right to life. In fact the state must act as its parent to step in and protect its life. The society certainly does not suggest termination of the life of handicapped adults, then why must it take a harsh stand against vulnerable individuals who are unborn babies?

* The next issue is the precise determination of what constitutes a malformation and what may be termed as a severe mental or physical deformity. With the growth of science and medicine newer conditions are being described as diseases or deformities. At the same time, new cures are also emerging. So what needs to be viewed as a handicap and what need not becomes important. Let us not forget those people who despite being severely handicapped have made outstanding contributions to society, for example Dr. Stephen Hawking, the world renowned scientist who suffers from extremely debilitating motor neuron disease and Ludwig van Beethoven, one of the greatest music composers of all times despite his deafness. In both cases, the physical disabilities emerged well into their adulthood. At that time, had there been mechanisms to detect such future ‘handicaps’ in the feotus, these people may never have been born. In other words, we cannot completely ignore the possibility of committing grave mistakes by extinguishing potentially great life with our limited understanding of the future and our exaggerated fear of deformity. Further, cases like Nikita Mehta are relatively few and it is questionable if the time limit for abortion must be generally extended on this account, particularly when such a solution may turn out to be more a malady than a remedy. Moreover, most life threatening and serious abnormalities are detected nowadays within the prescribed twenty weeks. The adverse ramifications of giving birth to handicapped children may be minimized by creating effective state mechanisms for adequate support to such children and families, both financial and otherwise. Instead of giving a blanket cover to all cases, expert committees may be constituted to evaluate cases beyond twenty weeks on merit so that selective sanction for abortion at this stage is given. It would also be important to define clearly what constitutes a handicap severe enough to qualify for an abortion after twenty weeks, for example cases of anencephaly wherein there is absolutely no point in carrying the pregnancy to term. To conclude it can be said that the discretion to extinguish life, potential or existing, must be exercised with extreme caution. Advancement in medical science bestows great power on humanity that must be used for noble causes. Unfettered or arbitrary misuse of such power may lead to grave consequences for the society on multiple fronts. Our traditional inclination towards non-violence, tolerance and perseverance must be remembered to arrive at a decision that raises the standards of society and sets an

example for others to follow. The author is a practicing lawyer and a member of the Bar Council of Delhi

Abortion in India : Ground Realities
Book Details Author: Vimala Ramachandran & Leela Visaria (Eds.) Year: 2007 ISBN: 0415424127 [ pp. xviii+352, figs. ] [ Price: RS. 795.00, US$ 17.28 ]

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About the Book :
Abortion in India : Ground Realities

India was a pioneer in legalizing induced abortion, or Medical Termination of Pregnancy (MTP) in 1971. Yet, after three decades, morbidity and mortality due to unsafe abortion remain a serious problem. There is little public debate on the issue despite several national campaigns on safe motherhood. Instead, discussion on abortion has mainly centred around declining sex ratio, sex-selective abortion , and the proliferation of abortion clinics in urban areas. Adding to the problem is that abortion continues to be a sensitive, private matter, often with ethical/moral/religious connotations that sets it apart from other reproductive health-seeking behaviour. This book fills a gap in our understanding of the ground realities with respect to induced abortion in India to create an evidence-based body of knowledge. Using both quantitative and qualitative research methods, the case studies show why and under what circumstances women seek abortion and the quality of services available to them. They also explore intergenerational differences in attitudes and practices, the perceptions and selection of providers, female-selective abortion, and informal abortion practioners. Among other issues, the contributors show that strong preference for sons, availability of modern techniques for diagnostic tests, widespread acceptance of the small family norm, and heavy reliance on female sterilisation as the primary method of contraception lead women to abort unwanted pregnancies. A book that goes beyond the smokescreen of data and regulation to unravel the human story behind elective abortion, it will be of interest to those studying health, public policy, and gender, apart from the general reader.

Early Medical Abortion in India: Three Studies and Their Implications for Abortion Services
Kurus Coyaji, MD Although legal in India, abortion is frequently performed under unsafe or undesirable conditions. Moreover, the advancements required to make surgical abortion safe in India appear insurmountable in the near future. Because it requires a less extensive infrastructure than surgical abortion, medical abortion offers great potential for improving abortion access and safety now. To examine the feasibility of introducing medical abortion and to assess its potential as an alternative to surgical abortion, we conducted three separate studies on the use of 600 mg mifepristone and 400 µg oral misoprostol for medical abortion. Study 1 focused on the safety, efficacy, and feasibility of the standard French, three-visit protocol and was conducted in urban research centers in China, Cuba, and India. Study 2 liberalized the protocol to collect information from women using the method under more "real life" conditions in urban family planning clinics in India. Lastly, study 3 extended the trial to rural Indian villages to examine feasibility in settings typical of where the majority of the population resides. In all three settings in India mifepristonemisoprostol proved to be not only feasible, but safe and acceptable as well. With some changes to current protocols, medical abortion could now be safely phased into the existing health care infrastructure in India. Yet, medical abortion will bring its own set of service delivery challenges to address.
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Wisdom too often never comes, and so one ought not to reject it merely because it comes late” Felix Frankfurter quotes (American Jurist, 1882-1965) Similar Quotes. About: Wisdom quotes.
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It is the woman who chooses the man who will choose her.”

The first symptom of love in a young man is shyness; the first symptom in a woman, it's boldness.” Men forget but never forgive. Women forgive but never forget.” We have the duty to protect the life of an unborn child.” Ronald Reagan quotes (American 40th US President (1981- 89), 1911-2004) Similar Quotes.
“Unborn children can experience pain even more so than adults as the baby has more pain receptors per square inch than at any other time in its life.” Sam Brownback quotes

It puts limits on criminals' rights to destroy unborn children without the permission of the woman.” Lindsey Graham quotes

* Abolition of a woman's right to abortion, when and if she wants it, amounts to compulsory maternity: a form of rape by the State.” jennifer239543 Edward Abbey quotes (American Writer whose works, set primarily in the southwestern United States, reflect an uncompromising environmentalist philosophy. 1927-1989) Similar Quotes.
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Because I believe that abortion is murder, I also believe that force is justified in an attempt to stop it.” Eric Rudolph quotes

It is a poverty to decide that a child must die so that you may live as you wish. Mother Teresa The greatest destroyer of peace is abortion because if a mother can kill her own child, what is left for me to kill you and you to kill me? There is nothing between. Mother Teresa

“Republicans are against abortion until their daughters need one, Democrats are for abortion until their daughter wants one” - Grace McGarvie

The Mehta Case – Decoding the Indian Legal System
Nikita Mehta, with a protruding belly, seems to be a familiar picture now. All of us have been watching her and her husband on TV, doing the rounds of hospitals and the Mumbai High Court. Her plea for the abortion of her 24 week old foetus has been rejected. Her basis for the plea was that her unborn child suffers from a congenital heart blockage and misplacement of arteries. The Indian abortion law says that a foetus cannot be aborted after 20 weeks of pregnancy. But how fair is it to bring such a child into this world who would just not need air, water and food but also a pacemaker to survive, right from the time of birth? Did the judge even imagine the sight of an infant, who has just opened his eyes, moving his tiny hands and feet in excitement, waiting to see the world? An infant, who is rather than being handed over in the warm hands of his mother, is laid on a cold operation theatre table and his puny body is torn apart with the merciless clinical instruments, to insert an artificial pacemaker? Now that’s a wonderful welcome for a new born into this kind and caring world!! And isn’t it amazing to bring into this world a child who is already on a life supporting machine? When god created this world, he gave his most precious power to women. The power to give birth, bring new lives to this world. But along with that he filled a mother’s heart with bounty of emotions, care and affection to look after that new life. So much so that if there exists a bond of selfless love in the world, that’s between a mother and child. A mother starts feeling for her child right from the time she conceives it in her

womb. She caresses it, loves it, feeds it and nurtures it. So how can anyone think that a mother who wants to abort her first child is doing that for selfish reasons and accuse her of being a criminal? Isn’t it fair to abort such a child who will be handicapped for life and will have to live on a pacemaker for all his life? A pacemaker costs Rs 1 lakh and has a life of about 5 years. Nikita and Haresh Mehta, parents of the unborn child belong to middle class. They would not be able to bear these expenses and the endless medical bills. This would leave them arranging for funds and resources throughout their lives to sustain the child. Still, let’s be optimistic and hope that some charity institution takes up the child’s responsibility and promise to bear his medical expenses, considering that the unborn child is already famous in the world, thanks to our 24 hour news channels and endless debates have been happening on this topic. But who bears the emotional trauma that the family will go through every single day watching their child? Every parent wishes to write their child’s fate in golden letters, blessing them with all the happiness and success in the world. So how can a parent bring a child into this world when they know that their child’s future will be doomed? I agree that we have examples like Stephen Hawkins who have made it big, despite their severe physical disabilities but isn’t the scenario in foreign countries different from a developing nation like India? There they have the facilities, options and the technology. The authorities make sure that such children get the right kind of facilities. But the Indian legislative doesn’t take any responsibility for such children. The media will cover the child’s birth, entire world will watch, worry for a while and then? Everybody forgets it; nobody will come when the child is in excruciating pain, going through harsh medical procedures. The only two persons watching him would be his parents! So if a couple does not want to face such a sight in their lives and save their child from such a fate by aborting it, then why is the law stopping it? This is a perfect case of mercy killing and I believe that the parents should be allowed to decide what they want to do with their child. If they do not think that they are ready to accept such a child and can not take care of him then they should be allowed to abort it. Nobody wants the law to be changed, but an exception can be made on humanitarian grounds! After all how many Nikitas do we have going to court for such a case everyday? By rejecting her plea, court has not only acted ruthless but also discouraged all those citizens who act responsible and approach the law to make exceptions rather than do the deeds surreptitiously! Nirmalraja.wordpress.com/…./the-mehta-case—decoding-the-indian-legalsystem

HIGH COURT REJECTS NIKITA MEHTA’S PLEA FOR ABORTION
The Bombay High Court on Monday refused Harish and Nikita Mehta's plea seeking an abortion. The HC said that there was no medical evidence to support the Mehtas' abortion plea for their 25-week-old foetus. It also said that the case is not exceptional to use discretionary powers. The Mumbai High Court rejected a plea by Niketa Mehta to get her foetus aborted after discovering that the unborn child had

blockages in heart. The court had earlier held that the report on which the couple Niketa and Haresh, both 31, were seeking the abortion was not satisfying, and hence ordered a special committee from JJ Hospital to “give an additional confirmed opinion”. The case has garnered much attention as the couple had decided to tread the legal path against the country’s 37-year-old abortion law that does not allow termination of pregnancy beyond 20 weeks unless it harms mother’s life or health. They were pleading the case on the basis that the child is suffering from a congenital heart block that would require a permanent pace-maker, meaning that the child would have a disabled life and would also hurt them financially which they would not be able to afford in the long run. They were also citing doctor’s report that asserts that the child will suffer critical problems even with a pace-maker. But the Mumbai High Court said that it was up to parliament and not the court to change the provisions of Indian law, which specifies that a pregnancy cannot be terminated after 20 weeks. It said that there was no evidence of abnormalities with the foetus. Abortions are legal in India until the 12th week of pregnancy. Between 12 and 20 weeks abortions are allowed if either the mother or the fetus faces a health risk. Nikita’s lawyer Amit Kharkhanis said that the plea of the parents was justified. He said that the High Court’s decision will somewhere encourage illegal abortions. With cameraperson Abhay Prasad, Rajeev Mishra for NMTV News.

1. www.nmtv.tv/shownews.php?id=3026

The Niketa Mehta case:does the right to abortion threaten disability rights? Neha Madhiwalla The secular public discussion on abortion in India has generally been centred around the need to prevent sex selective abortion because of its social consequences. Abortion has also been discussed in the context of maternal health, where it is feared that contraception use is substituted by repeated induced abortions. Another concern has been that induced abortions are resorted to by unmarried girls. In all the above circumstances, the key ethical issues are related to gender inequality and the presence of subtle or overt coercion. It needed a person like Niketa Mehta to initiate the ethical discussion surrounding the question of abortion per se in India. Coercion does not seem to be an issue in the case of Niketa Mehta. An educated, middleclass woman, with a supportive husband, having a much longed-for first pregnancy, she was arguably better placed than most women to take a decision about her pregnancy. She was equipped with sufficient information on the foetus` health condition and apparently did not face any coercion from her family. She wanted to terminate a pregnancy which had a high probability of resulting in a miscarriage or the birth of a child with a serious heart defect. This could have been a routine decision, had it not been for the fact that Niketa`s pregnancy had advanced beyond the 20 weeks during which medical termination of pregnancy is permitted in India. Rather than resort to an illegal abortion, Niketa and her husband, along with the specialist who diagnosed a congenital anomaly in the foetus, filed a petition in the Mumbai High Court asking for permission for an abortion in the 23rd week, which was when the problem was detected (1). The argument supporting them is that in several countries, including the United Kingdom, there is no gestational age limit set for abortion in the case of foetal abnormalities (2). Niketa`s personal reason for wanting an abortion was that she did not want to give birth to a severely disabled infant and witness its suffering; the trauma caused to her and her family was an additional reason (3). While Niketa failed to obtain a favourable judgement from the court, her case has prompted the government to announce that it will be considering a review of the law (4). Further, this case raises several ethical dilemmas related to abortion, and also to disability and the role of medical intervention. Disability and the Medical Termination of Pregnancy Act Disability-related abortion is actually built into the Indian law (5) which permits abortion up to 20 weeks if there is a pre-natal diagnosis of congenital defects; a pre-natal diagnostic test would be meaningless without the possibility of correcting the problem in utero or terminating the pregnancy. Some would argue that once abortion following prenatal diagnosis of foetal abnormalities is legal, a gestational age limit is meaningless. And if we start from the premise that it is a woman`s right to terminate a pregnancy that she does not want, even a planned

pregnancy can become unwanted once foetal abnormalities are detected, regardless of how far the pregnancy has progressed. Further, a logical consequence of the provision for abortion in the case of foetal abnormalities is that each development in pre-natal diagnostics will necessarily be followed by revisions in the law that the development necessitates. In Nikita Mehta`s case, the foetal heart defect could only have been detected after 20 weeks` gestation. Third, there may be a social context to the choice to undergo an abortion rather than carry a pregnancy to term. Niketa was remarkably unequivocal in her views. Regardless of the offers to support and care for her child when born, she was categorical in the assertion that her decision was a private matter. This is not surprising as disability has remained largely a private concern in India. The family of the disabled child bears almost all the burden of care, support and even financial costs. Unlike other countries, no comprehensive social support system for people with special needs exists in India. As a result, disability is looked upon with a sense of fear and a lack of understanding, which is perpetuated through images in the popular media. However, removing the social barriers to care, stigma and discrimination would not automatically make disability a "non issue". The decision to give birth to a child who is disabled can never be easy, even in the best of circumstances, though several women choose to continue a pregnancy even when they know that they will give birth to a disabled child, and many willingly adopt a disabled child. I believe that no law or person can ethically compel a woman to carry on a pregnancy that she does not want. However, when the pregnancy has progressed to a point where the foetus has become viable, one is compelled to view the situation from the point of the woman as well as the potential child. Thus, while a woman`s choice not to continue a pregnancy which harms her sense of well-being remains at any point in the pregnancy, it may be impossible to fulfil her choice when a late abortion could amount to a prematurely induced birth of a child. The only exception is when the pregnancy poses a grave danger to the woman`s lifeher interests take precedence over all other considerations. The problem arises when the reason for abortion is not the risk posed by the pregnancy but the perceived consequences of giving birth to that child. These risks are not physical but social. It would be incorrect to posit this as a conflict between woman and foetus. One would have to explore the woman`s reasons for wanting an abortion. In this case, Niketa was as concerned about the possible suffering of the future child as her own suffering. This position also runs counter to the legal and political position that has long been accepted in the context of sex selection, where the pregnant woman`s own choice is ignored in order to protect the rights of women as a group. I have also been a participant in the campaign which resulted in legislation to ban sex selection, and its amendment. At best, this contradictory position could be defended by arguing, as I had done, in an earlier article in this journal (6), that the disadvantages that girls face are completely socially constructed and, hence, there is space for and obligation on society at large to intervene in the matter. In contrast, disability poses inherent disadvantages, which although they can be ameliorated by social measures, cannot be removed altogether. In such a situation, one must give the woman the right to decide in her best interest. Does the right to abortion threaten disability rights? The question remains: does one`s endorsement of the right to abortion on grounds of disability at any point in the pregnancy weaken one`s commitment to the rights of the disabled? I argue that the value of living persons cannot be equated with the foetus which is not a person. Thus, the right of a woman to decide on the fate of her pregnancy does not conflict with, or interfere with, the human rights of the disabled. The decision to abort a foetus for no other reason but congenital defects is largely based on the parents` prediction of the

quality of life that such a child would have, and their own emotional response to it. These in turn are mostly determined by the existing condition of the disabled. There is little acceptance of the rights of the disabled in society, and scant attention paid to their needs, making disability appear to be a greater tragedy than it needs to be. There is a role for society and the state to minimise the disadvantages that the disabled face due to institutional rules and infrastructural arrangements. This is a question of not merely providing services and resources for rehabilitation, but also of acknowledging the right of the disabled to be part of society, and accepting different definitions of success and fulfilment in life. The response of parents, and their experiences, after the child is born can be different; at least some parents of disabled children note that the experience of parenthood with that child was as rewarding as with any other child. However, their experiences have still failed to challenge the dominant image of disability, which is also shared by a large part of the medical profession which is responsible for guiding and supporting women such as Niketa. In this case, one is inclined to vote in favour of Niketa, as an endorsement of her right as a woman to choose whether to give birth or not. There was speculation and there were unsubtle hints that she had eventually induced the abortion on failing to obtain a favourable judgment. This was not deserved by a woman who had no need to come out in public with her predicament in the first place, had she not wanted to draw attention to the larger issue at stake. The development of diagnostic technology which enables better detection of foetal abnormalities will take its own course and have its momentum, as it is well entrenched in the logic of the private medical sector, which is patronised by the middle and upper class. However, the movement for disability rights needs the support of the larger collective, and more comprehensive measures on the part of the state and society, which cannot be commodified as easily. While each family finds its own way of coping with the burden of care, in the search for individual solutions to seemingly personal tragedies, the larger struggle may be lost even before it is begun. This is only symptomatic of the larger situation of healthcare in India, where the more influential middle class has migrated entirely out of the public sector and sees no benefit in devoting its energies to the development of social and comprehensive solutions which would benefit the people at large.

References: 1. Kher S. Niketa's miscarriage brings back focus on legal cut off for abortion. Indian Express 2008 Aug 15 (online edition) [cited 2008 Sep 30]. Available from: http://www.expressindia.com/latest-news/Niketas-miscarriage-brings-focus-back-on-legalcutoff-for-abortion/349199 2. Ministry of Justice (United Kingdom). The UK Law statute database. Abortion Act 1967 (c.87). [cited 2008 Sep 30]. Available from: http://www.statutelaw.gov.uk/content.aspx? activeTextDocId=1181037 3. Kilpady N. CNN/IBN. Abortion debate: Bombay HC verdict today. IBNlive.com . 2008 Aug [cited 2008 Sep 30]. Available from: http://www.ibnlive.com/news/abortion-debate-bombay-hcverdict-today--your-say/70368-3.html?from=search-relatedstories 4. Sharma S. Niketa effect, government to review abortion laws. Hindustan Times. 2008 Sep 4. [cited 2008 Sep 30]. Available from: http://www.hindustantimes.com/StoryPage/StoryPage.aspx?sectionName=&id=61ed03777d6f-4f0a-8f0a-a33a06f99550&&Headline=Niketa+effect%3a+Govt+to+review+abortion+laws 5. Ministry of Health and Family Welfare, government of India. The Medical Termination of Pregnancy Act, 1971 (Act No.34 of 1971). [cited 2008 Sep 30].Available from: http://mohfw.nic.in/MTP%20Act%201971.htm

6. Madhiwalla N. Sex selection: ethics in the context of development. Issues Med Ethics 2001; 9(4): 125-6.

While Niketa failed to obtain a favourable judgement from the court, her case has ... In Nikita Mehta`s case, the foetal heart defect could only have been ... www.issuesinmedicalethics.org/164ed152.html Cached Similar by N Madhiwalla