debate on abortion limit should be increased to 24 weeks

Abortion limits to be

raised to 24 weeksDr Rajesh Gajbhiye

Consultant Gynecologist and Laparoscopic Surgeon

Mauli Women’s Hospital,Nagpur

Clinical Scenario

• Scan at 18 wks normal Quad was normal

• 2d echo at 22 wks

• Echo-Complex type of heart disease

• Not ready to continue

• Unmarried pregnancies present at 22 wks

• continuation of pregnancy mental trauma

• Quadruple test at 18wks-unfavourable results

• Amnicentecis-costly,arrange for funds

• Unfavourable results come

• Surpassed the limits

• Some anomalies are not diagnosed early like

cardiac anomalies,CNS anomalies,Skeletal

abnormality some renal abnormalities etc.

• ACOG, writes that variable-onset and late-

onset anomalies are difficult to diagnose before

20 weeks.

• Imagine the mental trauma to these patients to

carry the pregnancy till term

• Physical stress to her

• Clear medical evidence shows that abortion is

many times safer for a woman than carrying a

pregnancy to term and giving birth

Access

• Antenatal care poor,USG facility not available

• Data on detection rates using ultrasound for

screening for fetal malformations do vary

widely, showing a range from 8.7% to 85%.

• Detection is directly proportional to operator

skill and equipment resolution-not available to

many.

• Bound to get cases cong abn. detected late.

MTP Act

• Disability-related abortion is actually built into

the Indian law which permits abortion up to 20

weeks if there is a pre-natal diagnosis of

congenital defects;

• Once abortion following prenatal diagnosis of

foetal abnormalities is legal, a gestational age

limit is meaningless.

Social context• Unlike other countries, no comprehensive social

support system for people with special needs exists in

India.

• The family of the disabled child bears almost all the

burden of care, support and even financial costs.

• As a result, disability is looked upon with a sense of

fear and a lack of understanding.

• Population is more -there is stiff competition to

survive,Cannot Think of giving birth to disable

who will suffer life long.

• The family will also suffer mentally and

economically.

Ethical issues

• he extension of the gestational age is likely to engender ethical debates, as

it did when Niketa Mehta's plea for an abortion at 24 weeks was discussed

in the Bombay High Court in 2008 (19).

• While the court denied her plea, the National Commission for Women

reviewed the case and in 2013, recommended that abortion be allowed up

to 24 weeks, keeping in view that modern medical technology can detect

some foetal anomalies only after the 20th week .

• While it is important to acknowledge the concerns about eugenic abortions,

it can also be argued that it is unethical for a society to prevent individual

women from accessing abortions, since it is the woman and her family and

not the society that is expected to provide for the physical, emotional and

mental well-being of the child.

Women’s Right

• I believe that no law or

person can ethically compel a

woman to carry on a

pregnancy that she does not

want.

• However, when the

pregnancy has progressed to

a point where the foetus has

become viable, one is

compelled to view the

situation from the point of the

woman as well as the

potential child.

Viability?

• Studies, including one

published in the British

Medical Journal, show that

while survival rates have

increased significantly for

babies born at 24 and 25

weeks, they have not risen for

babies born 23 weeks or less.

Sex selective abortions?

• Stronger enforcement of the PCPNDT Act is already in place.

Rights of disabled?

• Living persons cannot be

equated with the foetus which

is not a person.

• Thus, the right of a woman to

decide on the fate of her

pregnancy does not conflict

with, or interfere with, the

human rights of the disabled.

•

Illegal abortion

• Current scenario when we deny abortion after

20 wks - may resort to illegal providers.

• Keeping abortion limit to 24 wks will mean that

abortions will be carried out safely with legal

providers

Safety

• Increase in the limit of abortion to 24 wk is

much needed which is ethical,Safe and good

for the patients and clinicians.

• prevent the mental trauma of undergoing an

unwanted pregnancy .