The Abortion Debate March 8, 2006Posted by scan man in Ethics, Medicine, News, Politics.
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:
- As a health measure when there is danger to the life or risk to physical or mental health of the women;
- On humanitarian grounds – such as when pregnancy arises from a sex crime like rape or intercourse with a lunatic woman, etc. and
- 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)