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The Abortion Debate March 8, 2006

Posted by scan man in Ethics, Medicine, News, Politics.
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I’m back after a long hiatus to write about something that has fascinated me since my days in medical college.

When going through this weeks Grand Rounds at Emergiblog, I came across an interesting post by Pediatrician Flea that you can read here. If you go there, please read through all the comments and follow the links which pretty much sum up the entire debate.

There are two aspects of this debate that I find intriguing.

The first concerns the intense public debate and the medical, ethical, political and religious stances that this issue has generated in the US over the last 50 years. The second concerns my perspective on the issue which I believe is common to most of my friends and colleagues in the Medical profession in India.

The ‘Abortion Debate’ has been part of the American mainstream for the past 33 years – since the landmark US Supreme Court judgement in Roe v. Wade in 1973. (you can read more about Roe v. Wade at Wikipedia).

To us in India, abortion is almost a non-issue. The Medical Termination of Pregnancy Act which was passed in the Indian Parliament in 1971 ‘guarantees the Right of Women in India to terminate an unintended pregnancy by a registered medical practitioner in a hospital established or maintained by the Government or a place being approved for the purpose of this Act by the Government’.

The declared objects and reasons of the Act state that pregnancy can be terminated:

  1. As a health measure when there is danger to the life or risk to physical or mental health of the women;
  2. On humanitarian grounds – such as when pregnancy arises from a sex crime like rape or intercourse with a lunatic woman, etc. and
  3. Eugenic grounds – where there is a substantial risk that the child, if born, would suffer from deformities and diseases.

These cover almost all possible reasons for an abortion. I had written ‘abortion is almost a non-issue’, because we do have issues related to abortion. But they are fundamentally different from the ‘pro-life’ versus ‘pro-choice’ debate in the US.

To most of us in India, the justification for legislation such as the MTP Act of 1971 is obvious. In a developing nation where a large proportion of the population is illiterate and poor, medical abortion is a necessary measure to control population growth – though the Government’s official line differs. For those who require hard facts as proof – try this as a sample: our population at the last census (2001) was 1.1 billion and it is increasing at an annual rate of 1.4% – one child is born every 1.25 seconds; the fertility rate (births per woman) is 2.3; contraceptive usage among women ranges from 40 to 45%.

Justified and legalized abortions do not mean that there are no problems. Despite gains in women’s health realized by the MTP Act, the number of illegal and unsafe abortions in India continues to be very high with a large number of abortions being performed every year by untrained persons in totally unhygienic conditions. Complications of unsafe abortions remain a major factor in contributing to high rates of maternal mortality throughout the country. The MTP Act was recently amended (in 2002). The amendment was aimed at reducing the rate of unsafe abortions by making legal abortion more widely accessible.

The law stipulates that records should be maintained and submitted to the Government periodically. This is more easily said than done. Records are usually maintained in Government-run hospitals and maternal health centers. But a large proportion of legal abortions in India are carried out in privately owned hospitals that are licensed under the MTP Act. Most of these centers do not maintain proper records nor do they furnish the Government with the correct numbers.

The law states that ‘pregnancy can be terminated as a health measure when there is danger to the life or risk to physical or mental health of the woman’. This vague and all encompassing statement is a godsend is a ploy used by people who abuse the system.

There is no doubt that the system has been abused. It is one particular way in which it has been abused that I find abhorrent. I refer to what has now acquired a scientific tag ‘Selective Female Foeticide’. This is a problem peculiar to India and few other countries in West Asia and Southeast Asia. (You can read more about sex-selective abortion here in Wikipedia).

The rapid development of medical ultrasonography in India in the 1980s and the availability of an easily abused law with no effective safeguards accelerated the selective female foeticide ‘boom’. So much so that now there are regions in India where the female:male ratio among children less than 6 years of age is as low as 800:1000 (against a national average of 993:1000).

To give credit where it is due, the policy-makers recognized the potential catastrophe quite early. The Government passed the ‘Prenatal Diagnostic Techniques (Regulation and Prevention of Misuse) Act’ in 1994. This again proved to be a well-intentioned but toothless legislation. It is only recently – over the past 5 to 6 years – that the law has been implemented in a meaningful way. The PNDT Act as it is known was amended in 2003 to include prenatal genetic testing and its implementation was regularized with effective safeguards. (read more about the PNDT Act here).

I just realized that I lost the thread of my argument quite some time ago!

Living in India I find the whole ‘abortion debate’ thing in the US funny. I’ll hasten to add that I agree totally with Dr. Flea ‘there’s nothing funny about the abortion debate at all’. The humor, if any, is black and is directed at the sad state of affairs in India.

It is surely a sign of a developed nation (I mean that in all the right senses) that a considerable amount of time and human effort is being spent to protect even the unborn child. To quote Rabindranath Tagore‘s Gitanjali – ‘Into that heaven of freedom, my Father, let my country awake’. (you can read and hear Martin Sheen read the poem ‘My Country Awake’ here)

Comments»

1. Moof - March 8, 2006

Welcome to the Blogging world, Scan Man. Thank you for your comment on my blog, and for letting me know about your very interesting post. I will blogroll you, and also mention your new blog in a post before the day is over, and try to send some readers in your direction.

Scan Man, I’m not at all familiar with the abortion policies of India, beyond what you’ve written here, and the information provided from the links you’ve so helpfully included.

Frankly, as a pro-life person, I’m horrified at the thought of aborting an infant for something as simple as its sex. I already knew that some Eastern countries utilize this sort of eugenics … for example, China, but I didn’t realize that it was also an issue in India. That sort of policy, as you’ve noted, will come back and take a large bite out of your national purity when all of the young men born during the “female foeticide ‘boom'” grow up and are unable to find wives at home.

I believe that abortion is not the answer to a population which is out of control – whether in your coutry – or in my own. Education … common sense … self control … a sense of responsibility for our actions … a sense of being a part of each other, responsible for more than just ourselves … those are what will make our nations and our peoples strong.

I look forward to becoming a frequent guest on your blog. If you need any help or information, please don’t hesitate to ask.

2. Flea - March 9, 2006

Thank you for your contribution, scan man,

The sad state of affairs in India is the worst-case scenario of abortion-on-demand that is feared by both the pro-life and the pro-choice camps in the U.S.

best,

Flea

3. It's me, T.J. - March 9, 2006

Hi there…

Nice piece.

After reading your article, it has left me with some unanswered questions. I am not asking these questions to offend you, and I certainly know that they may appear to be blunt and straightforward, but I am trying to understand your feelings, and the citizens of India, concerning abortion.

If you would rather not answer the questions, or consider me rude in asking them, that’s ok.

My questions:

Is abortion then considered as ‘okay’ by most of the citizens?

How about the doctors?

Is abortion viewed as a form of birth control?

Are you religious, what is your religion, and does your religion support abortion or not?

Does your religion take a stance concerning abortion?

What is the make-up of the family unit in India? Are the children considered ‘precious’, a necessity, or as a component of biological life?

4. Flea - March 9, 2006

Did you take down my comment?

Why?

5. scan man - March 9, 2006

Moof: Thanks for your encouragement. I understand your lack of knowledge about our abortion policies but I was a little surprised that you didn’t know about the preference for a male child in India. I’ll probably post something about that later.
Education … common sense … self control … a sense of responsibility for our actions … a sense of being a part of each other, responsible for more than just ourselves … those are what will make our nations and our peoples strong.” I agree.
I think the only thing you left out is a morally responsible government. Our political leadership seems to be mostly involved in projecting India as a global player in terms of nuclear power, IT, and as a potentially huge market rivalling China – rather than looking after the basic needs of its people. More about this too later.
Thanks for the offer to help. I’ll probably bother you once in a while about technical matters related to customizing my blog.

Flea: Your comment is up. The time gap between us is about 10 to 13 hours (I’m at GMT +5.5 hours) depending on where you are in the US. I was sleeping when your comment was posted. I got to see it only now.

TJ: No offence taken. I put up a post to invite comments and start a discussion. Extremely thought-provoking questions. I probably didn’t think about it all the way through before I posted my piece :)
It would take me some time to answer all your questions. But I will answer them, I promise. Please check in later. I’ll reserve my post for today as an answer to your questions – but probably not in any particular order.

6. Moof - March 9, 2006

Yes, Scan Man, you’re right – I did miss morally responsible government. That’s a real consideration … one that will probably go lacking in both of our countries.

As far as blogs are concerned, I also use Word Press, and have been working pretty hard at customizing blogs … I have another blog I’ve been building for the sake of trying out different templates: http://themes.blogsplot.net … I have about 40 WP themes up there now. If you need any help, I’ll be more than happy to oblige. Just let me know. What I don’t already know, we can learn together.

7. Dr John Crippen - March 10, 2006

Hi Scan Man, just picked this up via Flea et al.

Thought provoking blog. We have abortion more or less on demand in the UK and I must say, the older I get, the more troubled I am by it. Tried to cover it at:

http://nhsblogdoc.blogspot.com/2006/02/abortion-in-south-dakota-pro-lifers.html

Sadly, I have no easy answers

John

8. tada - July 2, 2006

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