Tuesday, August 4, 2009

MEDICAL TERMINATION OF PREGNANCY IN INDIA

Few years ago I had heard of an Irish girl seeking the court’s permission to travel to the United Kingdom for terminating her pregnancy following a rape. Here are some case reports of how the issue of abortion is handled in India:

Case I

A mentally challenged woman conceives through rape. A high court in India approves abortion. She has a counsel. (I do not know how she put across her views to the lawyer if she indeed was significantly challenged mentally). They appeal against the verdict citing the victim’s right to maternity. A person who doesn’t have any biological relative should be allowed to have one, the lawyer argued.

The Supreme Court allowed the woman to maintain her pregnancy. I am not sure if she understands the consequences.

Case II

A couple sought the intervention of the court in Mumbai when they learnt their unborn child may have congenital cardiac abnormalities. The court turns down the appeal as the pregnancy is at a rather advanced stage & the likelihood of congenital defects only a possibility that is not established beyond doubt.

The couple is dejected but later has a “spontaneous abortion”.

Case III

A Pediatric intensivist from Delhi’s Escort’s heart institute & research centre (EHIRC) informally shares with me a case of a Gynecologist who went ahead with medical termination of a very advanced (8 months’ plus) pregnancy when she learnt the baby (fetus) had a “patent foramen ovale” reported on an ultrasound!

Foramen ovale is a natural passage meant to support the blood circulation in a fetus: it closes spontaneously after birth. A student of anatomy (subject taught in the first year of MBBS) is supposed to know this elementary fact.

No violation of law, since nothing is official about it!

Case IV

In my own town a prominent clinic resorted to MTP after a triple test (read about the ambiguity of the test in special circumstances in my comments) suggested a possibility of Down’s syndrome. Incidentally, the woman had been treated with certain hormonal preparations including the human chorionic gonadotriphins for her recurrent fetal loss. Whether this could have skewed the test result was not looked into.
Interestingly, the said MTP was undertaken as the pregnancy was at an advanced age!!

In a suspected case of Down’s syndrome, there are better ways than a triple test to determine the risk: chorionic villi sampling (CVS) and amniocentesis.

But such is never the practice in tier II or III cities in India! I seldom see physicians sending in their patients for such screening or genetic counseling.

Why refer when you can have an abortion in the city is the norm for most.

As father of a child with congenital disease, I feel the law needs to be reviewed.
What do you feel?

Please put across your views.

1 comment:

  1. The triple screen test is a maternal blood screening test that looks for three specific substances: alpha feto protein or AFP, human chorionic gonadotrophin or hCG, and Estriol. Abnormal levels of hCG & estriol may indicate that the baby has trisomy 21, or Down’s syndrome. But the fallacy lies in that hCG is administered to patients with recurrent or threatened abortions.

    Recently an Orthopedician’s wife from my town went for amniocentasis under a similar scenario: they had earlier scoffed at the utility of amniocentasis. They now have a baby without Down’s syndrome. It's pleasant to see them, referring patients for the test now.

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