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India: Abortion Dilemmas: Perfect Baby, Imperfect Society

By Geeta Seshu

Stunned at the intense publicity that surrounded her plea, filed in the Mumbai High Court, to abort her 25-week-old foetus, Mumbai-based Nikita Mehta never imagined the case would draw such a welter of responses from people from all walks of life. The Mehtas had appealed to the court for allowing abortion, despite the fact that they were four weeks into the permissible 20-week deadline under the Medical Termination of Pregnancy (MTP) Act, 1971. After this, the law only allows an abortion if the mother's life is endangered by a continued pregnancy and if the foetus would suffer a permanent disability.

Today, despite the rejection of her plea, the issue shows no signs of abating. Doctors, women's rights activists, bloggers, television chat shows and even local train commuters are debating the issue furiously. There are a whole host of questions that the case throws up: Is individual liberty more important than social responsibility? Would this not mean a back-door acceptance for sex pre-selection and genetic engineering? Would it not lead to a further devaluation of differently-abled people in an uncaring society? Would it not lead to the weeding out of potentially "abnormal" babies?

Public opinion has ranged from those in favour of abortion, irrespective of the time factor, to those who completely reject the move. A middle ground, favouring a relaxation of the rules in very exceptional cases, has also been voiced, not specifically in the case of the Mehtas but perhaps applicable in other, severe cases.

For several people, the issue hinged around the individual right of the parents to determine the fate of the foetus. Bloggers, newspaper readers and television viewers, who participated in SMS polls, were overwhelmingly of the opinion that the right of parents to decide to abort was an absolute. Medical health activist Dr Kamaxi Bhate wondered how the courts could interfere in this matter. Echoing the empathy expressed by many towards the plight of parents who take care of disabled children, she says, "There is hardly any support system for women to bring up 'normal' children, so what happens to people who have children with congenital defects or disabilities?"

However, this line of thinking is disturbing for activists like Chayanika Shah, who has been at the forefront of the movement against sex determination tests. "I have very mixed feelings about this controversy. I think we need to re-examine our stand on the entire issue. We also need to look at issues raised by the disability rights movement," she says.

In the mid-1980s, women's organisations in Mumbai had launched a campaign against the misuse of sex determination tests, hitherto used to detect certain gender-specific genetic abnormalities in the foetus, to determine the sex of the foetus and then selectively abort female foetuses. The campaign, spearheaded by the Forum Against Sex Determination and Sex Preselection (FASDSP), led to the passage of the Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, in 1987 in Maharashtra, which was, subsequently, extended to the entire country.

Despite the stringent provisions of the Act, it is clear that the rampant abortion of female foetuses has continued, albeit underground. The child sex ratio in India is an alarming 927 girls to 1,000 boys, according to the 2001 Census. Correspondingly, there has also been a veritable explosion in new reproductive technologies, with in-vitro fertilisations - the test-tube babies, and surrogate motherhood becoming commonplace and genetic engineering waiting in the wings.

But what does this have to do with the plight of the Mehtas? Ammu Abraham of Women's Centre, a Mumbai-based shelter and counselling organisation, says that for several years the FOGSI (Federation of Obstetric and Gynaecological Societies of India) has been supportive of public interest litigations and other efforts to test the limits of the law governing abortions and has extend the powers of doctors within the framework of reproductive and contraceptive rights. The present controversy should also be seen in this light, she felt.

"When women's organisations and health activists debated the sex determination tests, there were three strands of opinion - those that took the stand of free choice to abort, irrespective of sex, genetic abnormality or time; those that wanted a complete ban on all tests; and those that sought a partial ban, saying that working women, who delayed pregnancies, should get a fair chance to determine whether the, usually single, child they wished to bear was free of abnormalities. Today, unfortunately, gender itself is seen as a 'genetic abnormality' and the cultural devaluation of the female foetus is rampant," she rued.

FOGSI head Dr Narendra Malhotra has gone on record to state that the federation would discuss the issues raised by the Mehta's plea and seek an amendment to the MTP Act. However, not all doctors are in favour of this. Observes well-known gynaecologist Dr Kiran Coelho, "I do feel sorry for the couple. Certain kinds of cardiac malfunctions are made out between the 20th-24th week and sometimes later, when it is too late for an abortion. But after the 24th week, it is really dangerous for the mother to undergo an abortion. And what of the ethical issues? Suppose the foetus, which is viable outside the womb after the 20th week, is born alive? What are doctors going to do with it?"

Besides, Coelho says, medical science has advanced greatly and foetal therapy has helped doctors to intervene and save many a mother and child. In a case she handled where the foetal heartbeat was irregular in the 26th week, cardiac surgeon Dr Yash Lokhandwala successfully administered foetal therapy to correct the malfunction. "The baby is now nine months old. In several other instances, we detect abnormalities but they correct themselves by the time the baby is born," she says, expressing apprehensions that any amendment to the MTP Act to allow for an extension in the time-limit for abortions would be liable to be misused. "As it is, we are seeing a pathetic male-female ratio. The warped mindset against the girl child has made selective abortions of female foetuses rampant," she says.

But the jury is still out on the justification to abort because the child may be born handicapped or with congenital abnormalities. "This is a disturbing trend in today's society. While it is very hard for individuals to bring up children who are handicapped, society cannot shirk from its responsibility to take care of them," feels Shah.

Reproductive technologies, like preimplantation genetic diagnosis, that fiddle with genes to isolate and eliminate problem genes and selectively encourage 'positive' genetic traits and features are a distinct possibility in the near future. Abraham, who feels that the overriding competition for excellence has now entered the pre-natal stage, is apprehensive. "How far can one fiddle with the foetus. We are fooling ourselves that only the medical profession is responsible for this. They are only fulfilling a demand from the market. Ultimately, who defines what is perfect?"

Lawyer and health rights activist, Kamayani Bali Mahabal, says, antenatal screening has 'medicalised' pregnancy by raising the expectation that medical expertise is capable of providing a baby free from impairment or illness, and that it would be 'selfish' or even 'antisocial' for parents not to avail themselves of this service. Mahabal, also the South Asia Advocacy Coordinator of Women's Health and Rights Advocacy Partnership (WHRAP), adds that technology has had the effect of encouraging a mother to distance herself from the child she carries.

But no technology can really guarantee the 'perfect' healthy child, she says, stating that non-coercive, unbiased reproductive counselling was necessary to provide parents with the right perspective on possible disabilities. Perhaps this will help parents understand the potential of all human life, rather than its limits.

(Courtesy: Women's Feature Service)