Sunday Times 2
Abortion: Reform the obsolete laws now
Of about 35 million induced abortions that take place each year around the globe, more than half of them are illegal and carried out by unqualified, untrained people and that, too, in unhygienic settings. Although no official figures are available, it is estimated that around 1,000 cases of illegal abortions take place each day in Sri Lanka. Other studies have shown that induced abortions and complications arising from them account for almost 6 per cent of maternal deaths and 7-16 per cent of admissions of females to public hospitals in Sri Lanka.
Abortion means the termination of pregnancy by any technique either spontaneous or induced before the mother’s foetus is adequately developed to survive autonomously. As a rule, the foetus should be less than 24-28 weeks old from the time of pregnancy for abortion to take place.
In February this year, I examined a 12-year-old girl brought to me by the police, who suspected she was sexually abused by a known person. The girl had grown up in the care of her grandmother. The girl in her statement said she was abused by her brother-in-law several times. He had threatened her not to reveal it. As the child was looking ill, her grandmother had taken her to a doctor, who had referred her to be examined by a judicial medical officer.
My examination findings were compatible with hymenal penetration and a long-standing hymenal tissue rubbing. The ultrasound examination confirmed that she had been bearing a foetus of 14 weeks. This was compatible with her statement. As I noticed that the child was depressed, I decided to refer her to two independent psychiatrists and gynecologists for their opinions regarding the continuation of pregnancy and the risk to the life of the child.
According to one of the gynecologists, the pregnancy could be continued as she was not suffering from any physical illness, which hinders the pregnancy. The other gynecologist said that the pregnancy could be allowed to continue if her mental state was stable. Two psychiatrists were of the opinion that she was suffering from depression and suicidal thoughts.
According to the existing law, unchanged since it was enacted by the British in 1883, termination of pregnancy can be carried out, only if the pregnancy causes threat to the life of the mother and with the intention of saving the life of the mother.
Considering the psychiatrist’s opinion, I inquired from court whether there was legal provision for the termination of pregnancy, but, its view was to allow doctors to decide and carry out, if it was warranted. Then, I sought the opinion of the Attorney General. He also held a similar view.
As there was no justifiable reason for termination of pregnancy, even if the doctors identified the unpredictable threat of mental illness, we cannot carry out medical termination, except by following the criteria.
This was just another case of sexual assault I examined. In my career, I have examined many cases, where children and women have become pregnant following rape (rape is a legal definition) or incest. In some cases, the women had tried to have an illegal termination of the pregnancy because of the failure of the contraceptives. I have conducted autopsies in cases where women have died following complications of illegal termination of pregnancy.
Even when a child is abused when she is in her early teens, the trial is taken up and verdict given when she is an adult, at the age of marriage. court procedures are a long process. Perpetrators are punished or go free; but the victims suffer throughout their life with a fatherless child or complications of illegal termination of pregnancy. Nevertheless, the lifelong suffering which a victim has to go through is seldom assessed.
When the parents or the women have no option other than the termination of pregnancy, in terms of the strict law, many cannot afford the high costs charged by a well-equipped clinic. So they go to places which use unsterile instruments, toxic substances like castor (endaru) stem and dirty bicycle spokes. Abortions re done in unhygienic conditions even with no basic life support system in case of an emergency. These abortions often result in serious complications such as septicaemia, haemorrhage, permanent disability, infertility or even death.
Recently I conducted an autopsy of a woman who had died due to bleeding following an illegal abortion inside a three wheeler.
The social impact on women and the new born children in cases involving sexual assault is often horrible. The woman with the child will be condemned by the family and society. The ultimate result would be the shattering of the family. The woman will live as a single mother or end up as a sex worker. In the case of teenage pregnancy, her education will also crash. The newborn may be ill-treated by the mother, left in a toilet pit, thrown into a canal or buried alive.
As part of the solution, we need to reflect on the abortion laws in India and Briain.
In terms of India’s Medical Termination of Pregnancy (MTP) Act:
1. A pregnancy may be terminated by a registered medical practitioner,-
(a) where the length of the pregnancy does not exceed twelve weeks if such medical practitioner is of the opinion, formed in good faith, that,
i. the continuance of the pregnancy would involve a risk to the life of the pregnant woman or of grave injury to her physical or mental health; or
ii. there is a substantial risk that if the child were born, it would suffer from such physical or mental abnormalities as to be seriously handicapped.
However, when the pregnancy exceeds 12 weeks but is below 20 weeks, the consultation of two registered medical practitioners is required.
2. A pregnancy occurring as a result of rape (the term rape is a legal interpretation)
3. Failure of contraceptive device used by a couple.
In terms of Britain’s Medical Termination of Pregnancy (MTP) Act
If two registered medical practitioners are of the opinion, formed in good faith -
It is high time, if not too late, to reform the obsolete nominal law of abortion
a. that the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family; or
b. that the termination of the pregnancy is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman; or
c. that there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.
However, if there is a substantial risk to the woman’s life or foetal abnormalities, there is no time limit.
Sri Lanka’s law covers only the acute life threats during the period of pregnancy – that is only for the purpose of saving the life of the pregnant woman. It does not allow for consideration of other issues, such as, the unborn child with severe malformation, pregnancy following rape, incest or contraceptive failure.
The newer technologies in other countries help to diagnose various foetal malformations so that the termination can be done before the foetus is fully developed or before the child is born. In Sri Lanka, the early diagnosis of foetal malformation is of no use, as there is no legal provision for abortion, unless the mother’s life is in danger due to bearing the foetus.
Rape, incest or being pregnant as a result of these is a suffering that the victim must bear. If such a pregnancy is terminated at an early stage, the suffering also can be terminated or minimised within a short period. But, in Sri Lanka the woman has two choices. That is either go for an illegal termination or continue the pregnancy till the delivery.
With my experience, I know that many of the illegal abortions are due to unexpected pregnancies or pregnancy following failed contraceptives. Cases of legal terminations due to the risk to the life of the mother are rare. The cases of induced abortions following rape are even rarer. In the case of rape, post-coital contraceptive pills can be prescribed at an early stage or when symptoms ofpregnancy are visible. Therefore, parents do not to try an illegal termination, probably thinking that it would affect the life of the teenage girl.
There are various organisations, which campaign against the abortion. I agree that termination of pregnancy cannot be carried out like killing animals. We need strict laws to prevent the misuse of the abortion process. But, who would like to bear an abnormal child or a foetus with severe congenital abnormalities? Does anyone, who gets pregnant following rape, like to bear the pregnancy? Contraceptives are used to prevent getting pregnant. But in case, the pill fails, what could the couple do? Do the people who campaign against the amendments to the abortion law, like to bear an abnormal, unwanted or unacceptable foetus in the womb of their wife or daughter? Can they guarantee the life of the mother?
It is high time, if not too late, to reform the obsolete nominal law of abortion. But, it’s better late than never. We have had lengthy discussions, which have often collapsed as a result of various objections. In a multicultural, multi-religious country like Sri Lanka, we understand the difficulties in amending the abortion laws. I believe a just solution could be found if an open dialogue is held among lawmakers, doctors, religious leaders, law enforcement authorities and others.
As a doctor, who has examined thousands of victims of sexual assaults and seen their pain and the pain of family members, I strongly believe that we have no option but to amend the laws immediately. Lawmakers must give priority to the abortion law reforms on the basis of:
1. pregnancy causing mental/ physical risk to the life of the mother (already exists, but has to be specified)
2. congenital foetal abnormalities
3. pregnancy following rape/ incest
4. pregnancy following failed contraceptives
As I was completing this article, the police brought to me another 15-year-old chid who had allegedly been sexually abused by her brother-in-law. Before, this article is published there will be several other such cases, emphasising the urgent need for reforms. In addition, reform of the abortion law will be a investment for the country. This is the bitter truth
(The writer is Consultant judicial Medical Officer at the District General Hospital, Embilipitiya)