Jane Roe aka Norma McCorvey was the litigant in the famous Roe versus Wade case that led to legalisation of abortion in the US. McCorvey passed away last Saturday, leaving behind a life that depicted the abortion dilemma. McCorvey became an advocate of the pro-choice movement that argued for a woman’s right to decide on whether to carry on or terminate her pregnancy. Mid-way, McCorvey became a pro-life advocate, arguing against abortion, and for the rights of the unborn foetus. Pro-choice versus pro-life remain at the centre of an often acrimonious ethical, legal, theological and political debate in the US.
In India, pro-life versus pro-choice debates are confined primarily to academia, as the abortion narrative has been determined by the Medical Termination of Pregnancy (MTP) Act. This pro-choice endowment was a utilitarian public health strategy aimed at the alarming increase in the population growth before the 1970s. It was also targeted towards preventing maternal deaths from illegal abortions, carried out by back-alley abortionists. India was the first country to launch a family planning programme in 1952. The idea of this programme was to promote the use of contraceptives to delay or space out a pregnancy. Whatever the family planning programme has tried over the years through different marketing strategies has only made a small dent. Sterilisation remains the permanent method of contraception, after she or the family has decided on the desired number of children. Unfortunately, legalised abortion has become a convenient standby, as a woman can cite contraceptive failure to abort an unwanted pregnancy. Beyond the actual cases of true contraceptive failure, the easy access to abortion services has perhaps promoted a certain amount of irresponsibility, with women’s rights often over-riding discussions on the rights of the unborn child.
The next saga in India’s abortion narrative was the mis-utilisation of the pro-choice endowment provided by the MTP Act. Son-preference saw voiceless women being coerced to determine the sex of the baby. The upsurge of selective abortion of female foetuses was accompanied by an explosion of imaging technology. Indian towns without life-saving healthcare services invariably have at least one ultrasound clinic. The profusion of ultrasound clinics and sex-selective abortion hastened the decline of the sex-ratio. So alarming was the decline that the Pre-Conception and Pre-natal Diagnostic Techniques Act (PCPNDT) had to be legislated.
The PCPNDT denunciated the use of ultrasound scans, and placed regulations that often superseded the medical utility of ultrasound during pregnancy. For millions of women, the ultrasound revolution contributed to providing her one of the treasured moments during her pregnancy. It provided an opportunity to see her growing baby. Nowhere were guidelines prepared for pre-test counselling, to prepare her for an adverse report when the ultrasound detected an abnormality in the baby.
In the evolution of the down-to-earth public health strategy on abortion in India, the rights of the unborn child emerge in the ethically disturbing and medically unresolved issue that a pregnancy cannot be terminated after 20 weeks. The 20-week line is drawn on the understanding that there is a possibility of the foetus to survive and be viable outside the womb after this period. The line is from Western data, and might be absolutely irrelevant to a woman in a remote area in India. But this line places women in trouble, as it is not widely publicised. Few women and families are aware that a pregnancy cannot be terminated after this period, unless it is likely to threaten the life of the mother. As a significant number of Indian women register late for ante-natal care, there is no option to terminate a pregnancy if something wrong is detected. In the same way, several birth defects are detected after 20 weeks. Women are left unprepared for the consequences, frequently carrying a pregnancy to term, with the distressing knowledge that something could be wrong with the baby.
The benefits of the MTP Act to women in India are precious, but they have to be backed up with an appropriate socio-cultural and regulatory environment. There is a need for aggressive education on planned parenthood, and on the risk that women undergo when they use abortion as a means of contraception. Sonologists have to get together to ensure that counselling is provided to a mother before she undergoes a scan. Underlying all these initiatives has to be the primary message, that each pregnancy is a potential human being. Even as the provisions of the MTP Act have to be treasured by Indian women, it has to be used with responsibility and respect towards the unborn life.