A couple expecting their baby cherishes especially the last few months before it is born. The woman, having got over her morning sickness, regains her appetite, can feel the baby kicking, and is confident of her impending motherhood. The excitement of making plans is exhilarating. Niketa and Harsh Mehta are one such middle-class Indian couple, who, when the pregnancy was 24 weeks old, were told that the foetus is likely to be born with a serious heart defect. The Bombay High Court has turned down their petition seeking a provision to permit termination of pregnancy. What can the Mehtas do?
A congenital heart block is a potentially serious condition. It is caused by a defective electrical circuit which hampers the rhythmic pumping action of the heart, thus interfering with the supply of oxygenated blood to the body. Depending on its severity, it might require the use of an artificial pacemaker, which is a mechanical device inserted in the body to take over the function of the electrical circuit.
The Mehtas did not take long to decide that they wanted an abortion. Their reasons are understandable: the pacemaker, costing about a lakh, might be required soon after birth; it will need to be replaced every five years or so; the child will require constant supervision by a cardiologist and might have to lead a severely incapacitated life. The physical and emotional stress involved, along with the severe financial pressures, will affect every aspect of family life.
The Mehtas sought an amendment of the Medical Termination of Pregnancy Act to allow the abortion of the foetus. In turning down the case, the high court has cited the opinion of "medical experts". The first report said there is a "fair likelihood" of the child suffering from the cardiac defect. This was later changed and the report now says the abnormality "is less likely". Given this rather unclear testimony by the expert panel, the high court pronounced the only verdict that was legal. A foetus that is more than 20 weeks old cannot be aborted unless there is a fatal risk to the mother.
Thanks to the publicity that now surrounds the case, the Mehtas are presumed to be callous and uncaring. No doubt television channels are busy thrusting mikes at passers-by: "Would you want your child to die just because he/she has a weak heart?" "Are the Mehtas lacking in compassion and love?" No doubt someone will come forward to bear the cost of little Mehta's pacemaker and we will feel cheered. This in a country where we let 10,000 children die every day from lack of food. And where recently a village woman in her late 60s gave birth to twins after a very expensive fertility treatment because she and her 76-year-old husband wanted a boy.
The dilemma of the unborn child is more common than ordinarily perceived. My own obstetric practice has been a part of the reward and punishment for being a rural surgeon. Of the many medical terminations of pregnancy I have performed, I recall two difficult decisions. One, that of a 32-year-old mentally challenged woman brought by her parents in a fairly advanced state of pregnancy, after having been "used" by a relative. And the other, a 13-year-old schoolgirl who had "pain in the tummy and something moving inside". I decided my course of action after sitting with the girl and her parents and discussing every detail, including her future.
The Mehtas deserve such a chance. The Medical Termination of Pregnancy Act should have a provision to take a second look at cases that are "outside the legal limits" under special circumstances. The guidelines must be stringent so that no false cases slip through. Especially in our country where female children are unwanted and where doctors have shamefully abetted the practice of aborting female foetuses, it will be easy to fudge reports and claim serious congenital defects as the reason for abortion. All investigations and tests must, therefore, be double-checked or repeated. The doctor treating the patient, a panel of experts, a social worker and a psychology counsellor should be involved. There is a high chance that the Mehtas are very confused about the outcome of this case and an empathetic, closed house discussion would be a great help.
Till such a provision comes into play, many children will be born against their parents' desire. What future does the child have then?
(Kavery Nambisan is a surgeon and novelist.)
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