There is much at stake in the US abortion debate

 The Statesman, 11th May

The Roe versus Wade 1973 judgement, which helped legalize abortion in the United States, is in danger of being overturned by their Supreme Court justices. This is rightfully causing great consternation. If reversed, it would deprive women of the right over their own bodies, thereby infringing their constitutional right to liberty. It also impinges on their right to life; pregnancy-induced physiological changes render a woman more vulnerable to morbidity and death; therefore, the choice to be a mother must be hers. Criminalizing abortion forces women who seek it (for a multitude of compelling social and personal reasons) to get it done quietly in unsafe conditions thus putting their lives in danger (4.7% - 13.2% of the maternal mortality which currently stands at 152/100000 live births internationally is due to unsafe abortions). As per WHO research, 45% of the overall abortions performed are unsafe as they are carried out surreptitiously, in countries that have officially made it illegal. This cohort of women therefore unfairly gets excluded from the excellent advances in medical science that all other citizens enjoy. The right to an abortion (medical termination of pregnancy) on demand is available in only about 27% countries though many do allow it on various medical and social grounds and almost all countries allow it as a life-saving measure. In Ireland, the right to abortion was introduced only in 2018, after the public outcry following the preventable death of Savita Halappanavar who was not allowed even a life-saving abortion. The upper time limit of legal abortion ranges from 12 till 24 weeks (these decisions are based on age of viability of the foetus and maternal safety). In India it is thankfully allowed till 28 weeks (with some caveats).

Rescinding any hard-won welfare measure for women is grossly unjust as it forces women to keep going in circles, while men progress forward linearly. Once born, a human is protected under several human rights laws. Insistence on special rights for a foetus before its birth creates unnecessary judicial tension and confusion. For example, no such ‘rights’ are accorded to the artificially fertilized eggs in petri dishes in medical establishments (which are thrown away/ used for medical research after one amongst them is implanted in the woman) for childless couples availing of in-vitro fertilization. Also, a law aided coercion of women to carry pregnancies resulting from rape or incest, totally ignores them as being a victim of a heinous crime. The Geneva convention unequivocally categorizes sexual assault and rape as war crimes. Today there is conflict (and assaults by army soldiers/guerrillas/terror groups on native women) everywhere. Is it ethical to force women to give birth to the children of enemy soldiers?

There is blatant gender inequality in not having any legal binding on fathers (who are at liberty to abandon their pregnant girlfriends or the idea of fatherhood), yet not allowing a woman to change her mind about a lifelong commitment such as motherhood. The anti-abortion lobby must not ignore the enhanced risk of teenage pregnancies (a Lancet meta-analysis highlights that those mothers in the 15-19 age group have a 28% increased risk of dying as compared with those in the 20-24 age group and this is even higher for mothers aged below 15 years). Also,the courts are silent on the critical issue of the foetus’s rights on its biological father. It is imperative to put a legal onus on the father for lifelong parenting and fiscal responsibility when talking about the ‘rights’ of the unborn child.

The anti–abortion lobby focuses on the ‘right to life’ of the foetus. It is noteworthy that the earliest age that a foetus can survive independently is after 28 weeks when the lungs are somewhat capable of gas exchange (modern medicine can accelerate this somewhat). The lobby however wants a total full stop on abortion at any stage. Some believe that a ‘soul’ inhabits the foetus even when it is not physically viable. This is highly presumptuous given that no human can claim to be aware of what happens in the realm beyond life.

 Pro-lifers ignore the human right of women to choose what happens to their body and do not take into account situations where women may be mentally and financially ill-suited to raise a child. The quality of life of a woman changes with conception. Even before that, the overwhelming burden of contraception in most societies falls on the woman. Few men use the simple and widely available condoms with responsibility. Oral contraceptive pills for women can have side effects ranging from relatively milder nausea, weight gain and mood swings to the more serious susceptibility to blood clots (and the effects of embolism).

When a woman does conceive, there is a risk of morbidity and death before, during and just after her delivery. Pregnancy-induced nausea and vomiting, and gestational hypertension and diabetes are fairly common. Peripartum complications can have a lifelong impact such as Sheehan’s syndrome where many endocrine functions may be lost due to the blood supply to the master endocrine gland, the pituitary, being cut off. The mental anguish of those mothers that fall prey to severe post-partum depression is terrifying to behold. When women’s bodies and lives undergo such major changes after conception, is it fair or reasonable to deprive them of agency over their own bodies?

12-24% of all pregnancies end in spontaneous abortions, a majority of which are due to genetic malformations of the foetus. The parental contribution to this genetic pool is equal. Another factor is active and passive inhalation of tobacco smoke. How many family members give up smoking when their wives are pregnant? Some other factors are the mother’s ill health and lesser education levels, poor access to medical care and lack of proper rest. How many pregnant women are encouraged to stop tilling their fields or have the water from the well carried for them by men? When spontaneous abortions can be brought on by the actions of others or prevalent social mores, then why deny just the woman the right to safe abortion when she herself needs it?

Female foeticide is a flourishing evil and our country accounts for 40% of the females that go missing out of 1.2 million per year (China is ahead at 50%). It is no secret that women are sometimes subjected to clumsy abortion attempts by their own relatives. A patient I once attended to in the army MI room gave me a graphic account of how her mother-in-law tried to abort her pregnancy using the thorn studded stem of a rose plant. Relatives who indulge in such barbaric practices have hardly ever been arrested but if a woman legally seeks abortion herself, she falls foul of the law. Is that just?

These biased rulings denying women control over their bodies stem from patriarchal thinking. They are neither conducive to gender just order nor are they rooted in logic. They also are in total contravention to two of the four pillars of medical ethics -namely autonomy of the patient and beneficence. Why should pregnant women be excluded from receiving the benefit of two central tenets of medicine as well as its advances at a most vulnerable stage of their lives?

I sincerely hope the justices will acknowledge the risks a woman goes through to bring forth life, and support her wholeheartedly in her pregnancy-related choices. Most importantly, she cannot be forced to spend her entire life dealing with the outcomes of sexual assault on her body rather than realizing her own potential and dreams.