The Aborted Truth: How India Deals with MTP

India and Indians were quick to condemn Ireland for denying Savita Halappanavar an abortion, which led to her death. But what are the ground realities in India on the medical termination of pregnancy? The abortion landscape is riddled with lack of education about laws, illegal procedures, maternal deaths, social stigmas, and – something no one talks about – post-abortion psychological trauma. Are we being pro-choice when we deny abortions after 20 weeks? Are we being pro-life when we abort female foetuses? Whose life is more important, the mother or the baby? What would you want for yourself and your unborn? Atelier Diva raises these questions.

In the global outcry following the death of 31-year-old Indian dentist Savita Halappanavar after being denied an abortion in Ireland due to its strict laws on the subject, an online news report’s comments section featured a lone voice trying to defend his country’s stance: “Indians are hypocrites (for criticising Ireland). How have they used their own abortion laws? By killing six million baby girls.”

Seven weeks after Halappanavar’s unfortunate death, Ireland announced that it would amend its abortion laws to allow termination of pregnancy in case the mother’s life was at risk. In India, however, we continue to live in the grey area between the law and ground reality.

How well have we used our ‘progressive’ abortion laws, really? How far have they helped women and our cause? How effective are we in disseminating information about safe abortion and in empowering women about their maternal health rights? When it comes to the wall between pro-choice and pro-life, where do we stand?

THE NUMBERS

Abortion is legal under most circumstances in India. And according to the Consortium on National Consensus for Medical Abortion in India, 11 million abortions are carried out every year here. But these facts hide disturbing truths amongst the numbers.

First, every year, despite legalised medical termination of pregnancy (MTP), about six million abortions (that is, two out of three abortions) are done in unsafe and illegal settings, without a doctor’s supervision, leading to nearly 13 per cent of all maternal deaths (50 per cent in the 15–19 year age group). The Ministry of Health and Family Welfare attributes this to social stigma, lack of awareness and lack of access to health facilities that offer technically competent services.

Second, as the lone Irish ranger rallied, we have certainly put our legal rights to illegal uses in the past two decades. The United Nations Children’s Fund has estimated that up to 50 million girls and women are ‘missing’ from India’s population because of termination of the female foetus or high mortality of the girl child due to lack of proper care. The chilling effect of these missing girls is already being seen in the trafficking and ‘trade’ of brides in the northern belt of the country.

Third, the law only allows for medical termination of pregnancy up to 20 weeks, roughly five months. After this point and up to 37 weeks, if the pregnancy is culled for any reason, it is called ‘preterm’ birth, in which the mother goes through a kind of labour and a birth certificate needs to be made out. According to WHO, India has the highest number of preterm births in the world – 3.5 million in 2010. Which leaves one guessing: how many of these were spontaneous ‘miscarriages’ and how many were asked-for, induced ‘abortions’?

THE DANGERS

There’s no getting around it: Any kind of abortion at any stage of pregnancy and at any age comes with certain health risks. If the benefit of abortion is greater than the risk to the mother, however, most doctors would not hesitate in recommending it. Almost all cases that come to urban medical centres are those of ‘unwanted’ conception involving minor schoolgirls, unmarried women, married women who already have kids or those whose contraception failed. While all these cases can be covered under the ambit of current Indian laws under some category or the other, the fear of social stigma ensures that the first two on this list are the ones most likely to take extreme action and operate from desperation or ignorance. Which explains why half of all abortion complications occur in women under 20 years of age.

“In India, abortion has been legal for more than 40 years but even now a strong pre-conceived notion lingers amongst the general public that abortion is illegal,” says Dr Suneeta Mittal, director and head of the gynaecology department, FMRI Hospital, Gurgaon. “There is evidence that the earlier it is done, the safer it is and of course, there’s lesser pain.” She rues the fact that medical abortion pills are sold off the counter and many young women tend to pop these pills without medical supervision – a dangerous practice that can endanger their health and even future pregnancies. She’s also witnessed many traumatic abortions in her career, mostly when women go to quacks and then come to her with “half their intestines pulled out, large uterus perforations, sticks and pencils inserted in the uterus, and worse.”

There are other kinds of abortion requests: Those made when the foetus has been detected with an anomaly. “In cases of congenital malformations, we recommend abortions as early as possible,” says Dr Madhu Gairola, senior consultant of gynaecology and obstetrics for the UP government. “In cities like Lucknow, parents are better educated and make early antenatal-clinic visits, so anomalies can be detected sooner. But in villages, they come to us in the seventh or eighth month. Even then, if I detect an anomaly, such as missing head, spine or abdominal wall, I would still recommend induced labour and preterm delivery,” she says. “Why put the parents through all that trauma of waiting another month or two to deliver a baby that may or may not survive in the outside world anyway?”

THE DEBATE

The question of aborting deformed foetuses became a national debate following Nikita and Haresh Mehta’s case in 2008. The Mehta couple, in their 30s, approached the Mumbai High Court for permission to abort their 24-week foetus after it was detected with a heart condition. The court refused their request citing lack of enough evidence that the baby would indeed be born with a disability. Their case led to much debate in the medico-legal world, with various pro-abortion advocates calling for an increase in the limit of legal abortion to 24 weeks, as is the case in many other parts of the world. In many cases, serious defects can only be detected after 20 weeks, argued the editorial in The Indian Journal of Medical Ethics, and the mother should have the right to decide. Even if there is no risk to her own life, the mother may be apprehensive about the social, financial and logistical impact of bringing up a disabled child, and it is she who should be able to choose what’s in her and her unborn child’s best interests, it said.

But as Dr Gairola admits, even with current laws, the reality on the ground is that compassionate doctors would help a mother with a medical problem (such as a cardiac or renal issue), or one carrying a deformed foetus, by recommending and executing a ‘preterm’ delivery anyway. These are cases in which the baby is not ‘unwanted’; the parents tenderly take the dead, malformed foetuses home and bury or cremate them with all rites.

In the vast no-woman’s land between the law and life, Nikita Mehta, who suffered a miscarriage later, would have been better off approaching one of those doctors, not a court.

THE RELIGION

The other side of abortion – the side that the pro-life lobby in the Western world is most preoccupied with – is the one of the morality of it. The point they raise is that even an embryo is a form of human life and thus should have its own rights. It was this mindset that led to Savita Halappanavar’s death: According to her husband, when they requested for an abortion following her miscarriage, they were told there was still a heartbeat present and that “Ireland is a Catholic country”. Dino Raj Paul, pro-life Core Member at Jesus Youth Bangalore, elaborates, “Based on the values of the Catholic Church, abortion is a murder, but people are not aware of it. A child in the womb is equal to the child outside and giving life or killing someone is fairly God’s decision and not that of human beings.”

Asked about her organisation’s stance to the Halappanavar’s case, Bangalore-based Sister M Annunciata, RGS, secretary cum treasurer at Respect For Life India, responds, “Although we strive to speak for those who are voiceless, particularly the unborn, we value the life of the life-giver, that is the mother, as well. We believe that as per the case’s validity, practical and moral decisions must be taken by an appropriate, unbiased medical and ethical team that decides what and when the best course of action should be taken, to preserve life, and most importantly to reconcile with the physical, emotional, moral and spiritual conscience and consequence of the act.”

Other religions too oppose abortion in theory but allow for it in certain cases. According to Dr Sheikh Mansour Leghaei, founder of the Imam Husain Islamic Centre and the School of Islamic Theology in Earlwood, Australia, abortion is haram (forbidden) in Islam and a prophetic tradition states that on the Day of Judgment, the terminated foetus will confront its killer (the mother or whoever compelled the mother to abort) saying: “For what sin, was I killed?” Even so, Islam allows abortion before 120 days, and even later, if the life of the mother is at risk, because it sees this as the ‘lesser of two evils’. The doer, however, will be liable to pay a fiscal penalty depending on the stage of pregnancy. According to Dr Leghaei, contraception is permitted if it does not harm the woman.

According to India’s majority religion, Hinduism, which believes in the concept of karma and reincarnation, the foetus is a bio-psycho-socio-cosmological and spiritual being and as such the abortion debate transcends individual ethics, raising social and cosmological concerns, says scholar Ravin Kumar Ramdass. In his study titled Hinduism and Abortion: A Traditional View (2004), he concludes Hinduism is opposed to abortion except in very specific circumstances, for example, severe congenital abnormalities in the foetus; where the continued pregnancy is life-threatening for the mother; rape; and incest. The traditional Hindu standpoint is pro-life and the Hindu scriptures provide a comprehensive argument against abortion. “The foetus is considered sacrosanct from the moment of conception,” he writes.

THE GIRLS

But questions of morality and theology are far from anyone’s mind in the hinterlands of Punjab where, fostered in an atmosphere of criminally patriarchal mindsets and access to new technologies, abortions of a subversive kind are gaining impetus and, one could say, popularity: That of female foetuses. Religious bans on abortion are overruled by a cultural preference for sons, and the sex ratio here is 893 females per 1000 males, the worst in the country with an average of 940. According to a 2007 UNICEF report, foetal sex determination and sex selective abortion by medical professionals is a Rs 1,000-crore industry. The Preconception and Prenatal Diagnostic Techniques Act 1994, which was modified in 2003 to include penal action against the medical profession in cases of sex selection, has largely been a toothless legislation. In Punjab, only 122 cases were registered in almost two decades, of which only 20 pertained to sex-determination tests. Only five of the total were actually convicted, their ‘punishment’ being fines ranging from Rs 300 to Rs 4,000.

The new social trend of smaller families has done little to abate the disturbing practice. Couples, especially in the north of India, aim to have two children, but when both turn out to be girls, the problem begins. Rohini Chaddha (name changed), a housewife from Delhi, had two daughters by her mid-20s. The third time she got pregnant, her husband insisted she get the gender checked through ultrasound, and had it aborted when it turned out to be female. This was in 1995. From then until 2006, Chaddha had five more abortions for the same reason, changing doctors whenever one complained or showed a reluctance to abort, paying big sums of money to get rid of their future burden. In her seventh pregnancy, however, an ultrasound revealed a little penis. Disbelieving, the Chaddhas got a second ultrasound; it said the same thing. They went ahead with the pregnancy.

Their third daughter was born in early 2007, 18 years after the first one.

THE WOMEN

“Can you imagine the trauma this woman must have gone through?” frowns Dr Reena Nath, family counsellor (see ‘A Private Trauma), who says that the grief of losing a child through abortion can sometimes be even more acute than even that of losing a fully grown baby because of the lack of closure and mourning. This is the kind of trauma that goes unaddressed and repressed, eating up at the woman in unknown ways all her life.

Unlike the rumours of the late eighties when certain Eastern European women athletes were accused of ‘abortion doping’ – harnessing the hormones released by abortion to enhance their performance – in reality, an abortion can come with more lows than highs. The sense of loss is not just emotional or psychological – it is literally a physical void in the core of one’s being. Not many women would take it lightly.

Severing a tie with a life growing inside her is an intimate, personal decision for a woman. No matter what the laws says, what the husband demands, what debates take place in the online or offline world, what the religious authorities decree, ultimately, it is her body and her heart that will bleed. Let’s at least spare her our judgement, both inside and outside the court room.

First published in the January 2013 issue of Atelier Diva, with inputs by Team Diva

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