Foetus malformed but abortion denied

Full-Term Baby Dies Soon After Birth

Pratibha Masand | TNN 

    In a throwback to the 2008 Niketa Mehta case that questioned the 20-week legal limit for medical termination of pregnancy and created a debate over the sensitive issue, another woman in the city was recently faced with a similar dilemma. 
    Usha Jethwa was 26 weeks pregnant when she realized that her foetus was abnormal. An ultrasound revealed that it had anencephaly, a condition in which the foetus has no brain and hardly any skull. For three months since the report, the 22-year-old went to three clinics to abort the pregnancy, but could not as the law does not allow it (See: ‘What the law says’). Jethwa delivered a full-term baby on Sunday; the baby died within hours. 
    The Borivli-based wife of a tailor was told by doctors that she would either have a miscarriage, a stillbirth or the baby would die soon after birth. “It was terrible to hear that my baby would suffer such a fate. When my family and I thought about it, we realized it was better to abort as there was no point carrying it for another three months,” said Jethwa. 
    She appealedtotwo private nursing homes for abortion and even approached a municipal maternity home. “But all the doctors refused to do it citing the law.” 
    There is a growing line of thought among doctors, though, that abortion laws in our country mustbe amended. According to the Medical Termination of Pregnancy (MTP) Act, 1971, abortion may be performed after 20 weeks of pregnancy only to save the woman’s life. Several medical experts told TOI that abnormalities like the ones Usha’s baby suffered should be included as a valid reason after 20 weeks.
    Dr Nozer Sheriar, secretary general of The Federation of Obstetric and Gynaecological Societies of India (FOGSI), said a central government committee was set up some time ago to come up with recommendations for amendment to the MTP Act, to provide for solutions to such problems. But because these clash with provisions under the Pre-Natal Diagnostic Techniques (PNDT) Act, the government has been going slow on the issue.” 
    Reacting to Jethwa’s dilemma, Sheriar said, “The MTP Act needs to be modified since not everything is included in it. Doctors are being over-cautious because there are cases where the Act is misused. Certain doctors perform abortions in the name of threat to a mother’s life when, in reality, they practise female foeticide.” 
    A sizeable number of doctors are therefore “deeply concerned” about the possibility of misuse if the 20-week limit is pushed further. 
    Dr Rekha Daver, head of gynecology at state-run J J Hospital, said that most congenital malformation, can be detected in the 14th to 16th week of gestation. “The majority of women—especially from the lower socio-economic strata—do not consult a gynecologist until there is a complication or they have to register for delivery. The ideal first ultrasound should be done in the fourth month.”  

MTP & LEGAL DEBATE THE 2008 CASE OF NIKETA MEHTA 
    In July 2008, Bhayander’s Haresh and Niketa Mehta approached Bombay high court questioning abortion laws that do not permit medical termination of pregnancy beyond 20 weeks even when a child’s health is at risk. Niketa was 24 weeks into her pregnancy. The foetus had a congenital heart blockage and malpositioned arteries. The Mehtas and Dr Nikhil Datar, Niketa’s gynaecologist and a co-petitioner in the case, wanted to challenge the Medical Termination of Pregnancy Act.
    They urged the court to ensure that the Act permit abortion beyond 20 weeks not just when a pregnant woman’s life was at risk but also when the newborn may have a severe congenital disability.
    Section 3 of the Act allows for abortion between 12 and 20 weeks if the baby’s health is at risk, after two doctors certify this On August 4, the HC dismissed their plea seeking permission to abort.
The HC said the couple and doctors could not establish grounds fit enough for the court to step in and make an exception by exercising its extraordinary jurisdiction 
Niketa had a miscarriage in the 27th week of her pregnancy.

WHAT THE LAW SAYS 
    The Medical Termination of Pregnancy Act, 1971, permits abortion only if the pregnancy poses a risk to the woman’s life or grave injury to her health or when there is a substantial risk of the child being born with abnormalities. A medical practitioner may terminate the pregnancy up to 12 weeks. But between 12 to 20 weeks, opinion of two medical practitioners is required. The limit may be crossed only when the procedure is performed to save the woman’s life 
 
THE CURRENT CASE 
In the 26th week of her pregnancy, Usha Jethwa underwent an ultrasound 
The results revealed that her baby suffered from anencephaly, a condition in which the baby’s brain and skull are not formed 
She approached three clinics but was denied abortion 
Usha delivered a full-term baby; the baby died soon after  

Times View: Let the mother decide 
 It happened to Niketa Mehta in 2008. Now another Mumbaikar, Usha Jethwa, has suffered similarly. Both women had found out during their pregnancy that their unborn child had such severe physical problems that he or she wouldn’t be able to live normally. Yet their pleas for abortion were turned down on the technicality their pregnancy was over the stipulated 20-week period for abortion. But the medical fraternity is now of the view that if the mother wishes to end her pregnancy after learning about some severe health problem to herself or the foetus, she should be allowed to do so. In countries such as the UK, abortions are allowed up to 24 weeks of pregnancy. Medically speaking, terminations beyond 20 weeks are hence possible. It is perhaps time to look at the law and make special provisions to ensure that there are no more Niketa Mehtas or Usha Jethwas. While there is no denying that issues involving medical ethics are difficult to answer, the law can weave in stringent protocols to ensure that concessions are not exploited.


Source::: The Times of India, 23-10-2012, p.02. http://epaper.timesofindia.com/Default/Client.asp?Daily=TOIM&showST=true&login=default&pub=TOI&Enter=true&Skin=TOINEW