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By Anjali Deshpande The Union Ministry of Health is examining the Medical Termination of Pregnancy (MTP) Act with a view to raising the time limit for abortion from 20 weeks to 24 weeks. What would the moral and ethical implications of this move be? And why has the women’s movement in India been strangely silent on these important developments?
At a time when the law on abortion in India is about to see some changes, women’s groups are strangely silent. Though feminists have long stressed the right to abortion as part of the right to their bodies, the Ministry of Health’s recent moves have met with silence, even indifference. Around two months ago, a couple, the Mehtas, approached the Bombay High Court seeking permission to abort their disabled foetus that was over 20 weeks old. (The Act allows termination of pregnancy only up to 20 weeks of pregnancy.) The high court refused to grant permission, honouring the limits set in the law. The Medical Termination of Pregnancy (MTP) Act allows termination of pregnancy on medical grounds including abnormalities in the foetus, contraceptive failure and risk to social and mental health. Earlier, abortions under it could be performed only till 12 weeks of the pregnancy. In 1971, this was raised to 20 weeks and if the Union Ministry of Health has its way the limit could be further raised to 24 weeks which will make it possible for a six-month-old foetus to be aborted legally. In a country where abortion clinics operate overtime to provide services to people, without bothering much about time limits or other conditions prescribed by law, the Mehtas’ attempt to get a direction from the court was widely perceived as an attempt to start a debate on abortion rights in the country, a debate that has never taken place. But any hopes of women’s groups joining such a debate have now begun to evaporate. There are other relaxations too on the anvil. The health ministry is in the process of finalising several amendments to the Medical Termination of Pregnancy Act in the light of upgrades in technology. Now that the abortion pill Metoprosal is available, the MTP law may allow ayurvedic and homoeopathic physicians to administer the pill. The MTP Act was passed, among other things, to regulate abortions and minimise unsafe practices. Therefore, under the law, other practitioners like midwives and homeopathic doctors are not allowed to carry out abortions. Similarly, only those allopathic doctors registered under the Act can perform an abortion. Doctors admit, however, that many of these regulations are not strictly enforced. Many have welcomed the proposed changes. Eminent south Delhi gynaecologist, Dr Puneet Bedi, calls the imposition of a time limit “arbitrary” and asserts that when performed by a specialist, an abortion, even a late one, is as safe as a normal delivery. But that brings us uncomfortably close to the foetus being almost a child. Seven-month-olds have been known to survive. We then have to confront the difference between foeticide and infanticide. Several doctors, including Bedi, assert that abnormalities often manifest themselves late and that many tests will have to be carried out before it is confirmed that the unborn child is indeed abnormal. Parents then need time to think about what they want to do. The imposition of a 20-week limit only puts pressure on doctors and technicians to hasten the diagnostic procedure, and that might not be good. It could lead to many wrong decisions. Then there’s the question: Are these changes the natural response to technology upgrades? Or are they a response to growing demands for a relaxed abortion regime? In the public space there is hardly any evidence of campaigning by women’s groups for a more relaxed abortion law. Even after the health ministry began its recent moves, women’s groups chose to be silent or engage only in small group discussions. There was never any concerted attempt to enter into the debate. “It must have been done under pressure from the gynaecologists lobby that wanted to extend the period of abortion. They will continue to do tests till late into the pregnancy, and then get a chance to abort too,” says Dr Mira Shiva from the Initiative for Health Equity and Society. That makes good business sense. The industry has put a lot of money into developing diagnostic techniques; it should earn some profits now! Not everybody agrees with this viewpoint though. Dr Bedi argues that a State that cannot provide public funds to children with special needs does not have the right to dictate to individuals what kind of children they should or should not have. There are many who are disturbed by the extremely clinical tone of the debate; they believe there are several moral and social questions that have to be addressed first. “The plane of the debate shifts if you agree to accept the extended period for MTP, because you can now abort a foetus that is viable or close to viable,” says public health specialist Dr Imrana Qadeer. “If you have this right and you exercise it, what does it essentially mean? That you are getting rid of a foetus that you cannot look after. It can apply to the old and sick too. Do you get rid of them because you can’t look after them? What is the moral position of the movement here?” Dr Qadeer also cautions against the tendency to extend choice limitlessly. “Despite everything, it is a fact that sometimes during delivery things go wrong and a child can get cerebral palsy. This whole thing must be debated at length and a stand evolved,” she says. The women’s movement must take a stand on this important moral question. To have or not to have a disabled child, or a child with special needs if one is to use politically correct language. It is not an easy decision. Whatever language you use, the facts stay the same. In cases of severe abnormalities it is not easy to look away from the situation. To have a child with special needs in the family means that one adult at least has to be totally devoted to that child and must give up his/her ‘normal’ life, aspirations and ambitions to look after the child. The responsibility generally falls on the woman, the mother, or the sister. Sometimes men too shoulder it. These issues must be taken into consideration before arriving at a standpoint. Why do you want to get rid of such a foetus? For your own convenience? Is this not a form of discrimination? The moment the debate enters this area other related questions start to arise. If discrimination against the disabled is to be allowed, why is discrimination against female foeticide not allowed? If parental convenience can be a legitimate reason for aborting an abnormal foetus, why can the argument not legitimately be applied to female foetuses? After all, parents do cite dowry and other future expenses as reasons for wanting to get rid of a female foetus... Questions are being asked about whether a relaxation in the time period during which MTP can be performed can be misused for female foeticide. “I don’t think so,” says Kalpana Mehta of Saheli. “The sex of the child is diagnosed by the 16th week. I don’t think people will wait long after that. They will abort much before the 20th week. They don’t need to go up to the 24th week.” “If there is any possibility of misuse it should be taken care of by the PNDT (Pre-Natal Diagnostic Techniques [Regulation and Prevention of Misuse] Act,” says Kirti Singh, a high court lawyer and president of the Delhi unit of AIDWA (All-India Democratic Women's Association). “In case of abnormalities, two doctors have to certify. If the law is enforced properly, the chances of misuse can be minimised. We must look at the regulatory mechanisms.” Questions are also being raised about the safety of the procedure for pregnant women, the need for it and the pressures operating behind it. Dr Mira Shiva sees the industry that produces all gadgets and chemicals as being behind the pressure to relax the limits. “They first allowed MTPs only up to 12 weeks. Then they said it can be done till 20 weeks; beyond that it was supposed to be risky for the mother. The more technology you have, the further the relaxation. The industry is producing diagnostic equipment; they need people to use it on. And why will people use it if they don’t have the option of carrying the child or not,” she asks. Dr Shiva adds: “There has been tremendous trivialisation of abortion in this country. When it comes to female foeticide, doctors were happily doing it in the second trimester. Who bothered what the law said? Many Acts are never implemented. What we need is proper implementation and checks.” Dr Bedi asserts that the MTP Act now gives the discretion to doctors. When women go to doctors seeking an abortion they cite some grounds allowed under the Act, like contraceptive failure or risk to social health, to carry out the abortion. Most doctors do this for financial gain. However, in principle, women do not have the right to walk up to a registered practitioner and seek an abortion. “Women do not have the choice. Doctors have the choice. And doctors can refuse to oblige a woman,” he says. The time has come to make a distinction between rights in principle and rights in practice. In principle, women have no right to abortion. The MTP Act, passed mainly with an eye on keeping family size small, gave many women access to abortion services. With prosperity, and private nursing homes springing up in practically every third alley in cities and small towns, the scene, at least in urban areas, has changed dramatically. There is hardly any girl or woman who is denied an abortion in the city. Doctors claim that, by and large, even government facilities do not refuse abortions to women who come to their MTP clinics. In practice, however, women do have the right and that is what we need to guard right now. Dr Ritu Priya, faculty, Centre of Social Medicine and Community Health, JNU, agrees that in practice women can get an abortion done quite easily. “Some areas should remain grey. Why do we have to paint them black or white? What difference does it make that women do not have the right to an abortion? They have the service available, and that is enough.” She also says the PNDT Act must guard against possible misuse. This Act is not linked to the MTP Act, she says, it only diagnoses. The patient follows it up elsewhere. “Even if women had the legal right to demand an abortion, any doctor can refuse her the service on grounds of conscience. So what we have here is a situation in which if a doctor refuses to provide the service to a woman she can go to another. In practice we have the right. Let it be like that.” (Anjali Deshpande is a freelance journalist and an activist with an interest in many issues especially those concerned with women, dalits and the environment) InfoChange News & Features, November 2008 |
