The Bombay High Court order today rejecting a city couple’s petition to abort pregnancy in the 26th week as the foetus had a complete heart blockage has reignited the debate among doctors about allowing medical termination of pregnancy (MTP) after the 20th week.

The HC refused to give permission to 31-year-old first-time mother Niketa Mehta who wanted to terminate her pregnancy, in a case torn between trauma and ethical issues. Mehta was told in the 24th week of her pregnancy that her foetus had complete heart block and would require a pacemaker to pull through life. But the MTP Act does not allow termination after 20 weeks.

Niketa appealed to the court to make an exception in her case, saying that since medical advances allow detection of congenital health problems in unborn children, shouldn’t the law keep up and allow termination of pregnancy?

Now that the HC has rejected her appeal, the Federation of Obstetrics and Gynaecology Society of India (FOGSI) wants to increase the cut-off time to 26 weeks as in the United States and Britain and also wants a degree of flexibility in the time limit. This is the second attempt by the group to get the cut-off limit raised after the 2002 amendment of the MTP Act.

“I am a little disappointed, because ultimately it is the woman’s right to choose. However taking this case, the High Court could have given directives to draft fresh guidelines,” said Dr Jaydeep Tank, MTP committee chairperson at FOGSI.

“The PCPNDT act was passed when a PIL was filed and when action was demanded by the court. Today, the act is working in a regressive manner. This matter was important enough for the judiciary to look beyond legislation,” he said.

“I honestly feel justice would have only been served if termination was allowed. According to the report submitted by the expert committee, both paediatrics as well as cardiologists, all suggested termination,” he added.

Adds Dr Duru Shah, former president of FOGSI: “It is only the team from JJ hospital which said that there is no need for termination. As of now, the law does not permit termination after 20 weeks unless there is a risk to the mother’s health. But the fact is that certain condition cannot be picked up at 20 weeks. Congenital heart problems surface only after 22 to 24 weeks on foetal echocardiography. The law was made to cut down on sex selection, but sex of the child can be detected by the 16th or 17th week.”

According to Dr Snehal Kulkarni, chief paediatric cardiologist at Wockhardt Hospital and also a member of the committee set up to detect the exact heart condition of the foetus and how it would translate over the long term, “The mother had undergone a couple of foetal echocardiography tests, the foetus had corrective transposition of great vassals with complete heart blockage. The heart beat was 40 per minute whereas normal foetal heart beat is 160 per minute, this is significantly less.”

“Implanting pacemakers in a newborn is not new but has its own risk. Also, due to the abnormal heart structure, the quality of life of the child will not be so good. Again, once the baby grows, the pacemaker will have to be changed every two to three years initially and then every five years,” added Dr Kulkarni. The pacemaker costs Rs 1 lakh, besides surgery charges and hospitalisation.

“I believe the apprehension is that if one allows abortion beyond the stipulated time, it will abuse the current law. MTP Act is a terrific act, the best abortion law in the world, but it needs to be updated. The current act is based on the technology used in 1971. With newer techniques, the law should be amended,” said Dr Tank.

Experts say
“Ultimately it is the woman’s right to choose. The HC could have given directives to draft fresh guidelines”

Dr Jaydeep Tank, MTP committee chairperson, Federation of Obstetric and Gynaecological Societies of India (FOGSI)

“The fact is that certain condition cannot be picked up at 20 weeks. Congenital heart problems surface only after 22 to 24 weeks on pregnancy”

Dr Duru Shah, former president, FOGSI