Contrasting laws on abortion in India, US

Medical termination of pregnancy is legal in India if done by a registered medical practitioner, in a place registered by the government, for certain conditions. These include pregnancy caused by rape, grave injury to physical or mental health of the woman, foetal abnormalities and failure of contraception.

IRONY: Those who want to abort unwanted pregnancies will find ways to do it in the US, just as those who want to get rid of a girl child continue to do so in India. AP

Amrinder Bajaj

Senior Gynaecologist

WHILE the Indian Government amended the Medical Termination of Pregnancy (MTP) Act of 1971 in 2021 to increase the gestational age of abortion from 20 to 24 weeks (in special circumstances), the US Supreme Court recently overturned the Roe vs Wade decision of 1973 that had provided a constitutional right to abortion. While abortion is considered to be a right in our ‘regressive’ country, it is being banned in one of the most progressive countries in the world. The paradox cannot but amaze.

Medical termination of pregnancy is legal in India if done by a registered medical practitioner, in a place registered by the government, for certain conditions. These include pregnancy caused by rape, grave injury to physical or mental health of the woman, foetal abnormalities and failure of contraception. The last option is a loophole which most women avail of to get rid of an unwanted pregnancy. The mindset of the people has to change and laws have to be enforced, not just passed, to bring about a change.

The MTP Act was passed in India when I had just become a doctor and was doing my house job in the obstetrics & gynaecology department. On the one hand, taking life was considered a universal sin, but on the other, it had just obtained legal sanction. A doctor taught to save lives was now being asked to take lives as part of her duty. I was troubled by questions like: Who was the sinner in such a situation — the woman/couple who wanted to get rid of the pregnancy, the doctor or both? Was this how a soldier felt on the battlefield? If you killed the ‘enemy’, an unknown person, who did you no harm, you were a hero, though killing another under normal circumstances was murder. Was this the only method the government had at its disposal to control our exploding population?

Going by the number of women lined up for this procedure, it seemed that the only mode of birth control they practised was MTP! While performing an early abortion, I could pretend that it was not a human being that I had sucked out of the mother’s womb for the material collected in the bottle of the suction apparatus was just a blob of blood mixed with some mince. With the advent of MTP pills, it has become that much

easier and patient-oriented. The woman takes the pill after requisite signatures and precautions, while the doctor takes action only if the abortion is incomplete.

Abortions conducted at about 12 weeks of pregnancy trouble me the most. An ultrasound during this procedure depicted a horror tale. No hired assassin would murder his victim in such a gruesome manner as we do. After opening the mouth of the uterus, an instrument is inserted in its cavity to grasp whichever part of the foetus it can catch. As the poor thing backs away in terror, its mouth opens in a silent scream, a leg or an arm is torn asunder and pulled out! At times, the abdominal wall bursts open to spill out tiny worm-like guts. Finally, the head is crushed and the brain floats, soft and pale, butter-like, on a stream of blood while the eyes pop out like papaya seeds. One can imagine the effect this had on a newly minted doctor. I could not sleep for nights on end.

As MTP was legal till the 20th week (now 24 weeks under special circumstances), a baby at this stage is ‘delivered’ by inducing labour pains. What troubled me was the fact that the foetus came out ‘alive’ at times, gasping and twitching! It was left in the kidney tray to breathe its last, before being handed over to the relatives.

My perspective changed entirely when I saw a half-dead young girl wheeled into the emergency for a ‘snake’ that had come out of her private parts! It turned out be a loop of intestines that an untrained dai had pulled out after perforating the uterus while trying to remove an illegitimate pregnancy! Needless to say, we could not save the teenager. Another woman came on a bullock cart with a stick stuck inside her; yet another had cotton and grass inserted deep within that led to septicaemia and a lingering, painful death. Centres for illegal abortions had sprung up in slums, even in so-called respectable city clinics, for it was a great money-spinning enterprise. Here, untrained personnel performed surreptitious abortions under unhygienic conditions, leading to the loss of young lives; of mothers, who left orphaned offspring behind. An entire family could be destroyed by the death of one woman. Those who survived did not come out of these dingy premises unscathed. They suffered from long-term gynaecological issues ranging from PID (pelvic inflammatory disease) characterised by chronic lower abdomen pain, painful intercourse, painful periods, heavy bleeding and infertility which wrecked their marital lives. It was to save the lives of women, to decrease the ensuing morbidity, that the Act was passed. This assuaged my conscience somewhat.

MTP is legal in India if done by a registered medical practitioner, in a place registered by the government, for certain conditions. These include pregnancy caused by rape, grave injury to physical or mental health of the woman, foetal abnormalities and failure of contraception. The last option is a loophole which most women avail of to get rid of an unwanted pregnancy.

If the graphic description has hurt the sensibilities of the lay public, I do hope that it induces at least some of them to take precautions before conceiving and not use MTP as a means of limiting their family.

As the world swings from one end of the pendulum to the other, from a ban in one country to further liberalisation in another, from protests about violation of a woman’s rights to protests over violations of human rights (a foetus is a human being), from morality to legislature, it has become difficult to distinguish right from wrong. In India, stringent laws have been passed against female foeticide that is done after sex determination, but does that deter the determined? One thing is for sure: those who want to abort unwanted pregnancies will find ways to do it in the US just as those who want to get rid of a girl child continue to do so in India, despite laws to the contrary. It is but a question of demand and supply. The mindset of the people has to change and laws have to be enforced, not just passed, to bring about a change.