presented at AMF annual academic acivity

1. Abortion limits to be
raised to 24 weeks
Dr Rajesh Gajbhiye
Consultant Gynecologist and Laparoscopic Surgeon
Mauli Women’s Hospital,Nagpur

3. 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

4. • Unmarried pregnancies present at 22 wks
• continuation of pregnancy mental trauma

5. • Quadruple test at 18wks-unfavourable results
• Amnicentecis-costly,arrange for funds
• Unfavourable results come
• Surpassed the limits

6. • 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.

8. • 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

9. 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.

10. 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.

11. 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.

12. • 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.

13. 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.

16. 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.

17. 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.

18. Sex selective abortions?
• Stronger enforcement of the PCPNDT Act is already in

19. 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.
•

21. 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

22. Safety

25. • 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 .