SC allows two rape victims to abort, orders preservation of fetus for DNA test to help nail accused


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HIGHLIGHTS

  • The bench directed preservation of the terminated fetus for DNA sampling during the investigation
  • SC medical expense of process of termination of pregnancy would be borne by the respective states

Representative photoRepresentative photo

NEW DELHI: The Supreme Court on Thursday permitted two minor girls to terminate their pregnancies caused by rapes and added a new dimension by ordering preservation of the foetuses to help nail the accused during the sexual assault case trial.

One is a 13-year-old from Delhi and another a 17-year-old from Bengaluru and both are rape survivors. A bench of Chief Justice Dipak Misra and Justices Amitava Roy and A M Khanwilkar ordered termination of their pregnancies, which were beyond the permissible period of 20 weeks under the Medical Termination of Pregnancy Act, 1971.

The Delhi girl will undergo the MTP in AIIMS on Friday and the Bengaluru girl will terminate her pregnancy in Bangalore Medical College and Research Institute (BMCRI). The court directed AIIMS and the Karnataka government to bear the expense of the medical procedures required for termination of the pregnancies and food and medicines required by the girls.

Counsel in the two cases — Nikhil Nayyar and Divyesh Pratap Singh — requested the court that since both the pregnancies were caused by sexual assault, it would be helpful if the aborted foetuses were preserved for DNA test to assist the prosecution in nailing the guilt of the accused.

SC passed the orders after medical boards in AIIMS and BMCRI recommendation.

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Malformed baby born to Mumbai woman denied abortion by SC dies


Representative image Representative image
MUMBAI: A 28-year-old Diva resident who was denied permission by the Supreme Court in March to abort her severely malformed foetus, watched her baby die, said family friends. The news of the child’s death comes just as a 13-year-old rape survivor’s plea for abortion beyond the permissible 20-week time limit was filed in the SC on Wednesday. Last month, the Supreme Court had turned down a plea for a 10-year-old rape survivor to terminate her 32-week pregnancy.

“The child passed away around a fortnight back,” they said. The child was born on July 1 at civic-run KEM Hospital, Parel, which gave a medical report that formed the basis of the court’s refusal. The woman is said to be in anguish and away in her native village at the moment. Her distraught father said he no longer wanted to speak on the issue.

The Diva woman’s plea was turned down on a technicality that the child would be born alive. In her petition, she mentioned the plight of her severely handicapped and bed-ridden brother as one of the reasons for seeking abortion. She told TOI in March she had helped her parents, who live in Dahisar, take care of her brother. She used to carry her brother to and from the bathroom. He was so sensitive to sounds that Diwali would be a no-fun period for the entire family; even sounds of crackers bursting would trigger seizures in him. She even told the KEM medical team that she didn’t want a disabled child as she saw the sacrifices and troubles her family has been through.

Gynaecologist Dr Nikhil Datar, who helped the woman move the SC, confirmed the baby’s death. Underlining the need to extend the deadline for medical termination beyond the present 20 weeks, Dr Datar said, “An abnormality, whether detected early or late, carries the same prognosis. Just because an arbitrary or unscientific deadline has been crossed doesn’t mean the outcome will change. There is no point in further traumatising a woman, the baby as well as an entire family by prolonging life.”

The medical fraternity has been demanding an increase in the abortion limit to 24 weeks. Dr. Bipin Pandit, a gynaecologist, said, “Many foetal abnormalities can be diagnosed only after 20 weeks. Certain deformities can be diagnosed earlier, but by the time the family comes to terms with the issue, they near the 20-week deadline. The only way to resolve such situations is to increase the abortion limit to 24 weeks.” Dr. Pandit added that the drugs to induce abortion in the second trimester have considerably improved and have become safe and more accessible.

Dr. Pandit said women who are forced to deliver malformed babies and undergo the trauma of seeing them die, are vulnerable to postpartum depression.

He said, “It is very simple. They are expecting a bundle of joy and suddenly someone tells them that there is a problem. But after diagnosing the problem, the solution has been denied to the woman. Is it fair?”

Dr Subha Sri B, chairperson of Chennai-based NGO CommonHealth, pointed out when a woman decides to terminate a pregnancy, it is not a frivolous decision. “It is not as if a woman wakes up one morning and decides to terminate. She may be forced by circumstances, but she is ultimately the one who will face consequences of the birth,” she said. Moreover, the state doesn’t provide any support for women and their special needs children-a point the Diva woman, who hails from a humble background, had raised.

TOI and The Hindu

Beti Bachao: The Declining Sex Ratios Of Indian Cities


Tarun Amarnath

sex ratio_620

 

Contrary to popular perception that the deeply rooted prejudice against girls, reflected in the country’s sex ratio, is mostly present in rural areas, some of the largest cities in India–including Delhi and Mumbai–had imbalanced sex ratios in 2011, according to an analysis of government data.

 

In 2011, for every 1,000 boys aged 0-6 years, there were 852 girls in Mumbai, 832 girls in Delhi, and 942 girls in Hyderabad, according to data put together by Kanya.Life, an initiative founded by Tarun Amarnath, a United States-based high school student, that analyses large and openly accessible data sets on gender provided by the Government of India’s Office of the Registrar General and Census Commissioner.

 

Data from 2011 is the latest publicly available on sex ratios of Indian cities.

 

The worst child sex ratio was in Mahesana (762 girls per 1,000 boys) in Gujarat, followed by Agra (772) in Uttar Pradesh (UP), Modinagar (778) in UP, and English Bazaar (781) in West bengal (WB), data show. Bally, in WB had more girls (1,185) per 1,000 boys , as did Nagaon (1,043) in Assam, and Tambaram (1,019) in Tamil Nadu.

 

A normal gender ratio at birth is between 102-106 boys per 100 girls, which would be equivalent to 943-980 girls per 1,000 boys, according to a report by organizations working on gender issues. This ratio is not 1,000 boys for every 1,000 girls because it is nature’s way of balancing a higher risk of death for boys as they grow older, according to the World Health Organization.

 

The child sex ratio, which is based on the number of boys and girls between 0 and 6 years of age registered at the time of the census, shows whether sex selection is prevalent in the country. A sex ratio less than the normal range of 943-980 girls per 1,000 boys, suggests discrimination against girls, and the presence of female infanticide, which is the killing of girls after birth, or of female foeticide, sex-selective abortion of the foetus.

 

An adverse child sex ratio is also reflected in the distorted gender makeup of the entire population. In 2031, India will have 936 females per 1,000 males, lower than the sex ratio in 1951 of 946 females per 1,000 males, the World Bank predicts.

 

 

For this story, Kanya.Life used data for India, each of its states, and its 500 most populous cities from 2011, the latest available city-level data. The largest municipality at the time of the census, Greater Mumbai, had a population of 12 million, while the smallest, Nagda in Madhya Pradesh, had a population of 100,000.

 

The average child sex ratio in the largest 500 Indian cities–the total population (221 million) of which is nearly equal to that of the United Kingdom, France, Germany, and Spain combined–was 902. Ratios in Indian cities were as bad or worse than those found in rural India in 2011, which has an average child sex ratio of about 923 females per 1,000 males.

 

India’s sex ratio at birth–the number of girls born for every 1,000 boys–since 2011 has slightly improved, from 902 girls per 1,000 boys in 2011 to 903 girls in 2015, according to data from the World Bank. But this ratio is still the fifth worst in the world, better than only Liechtenstein (794), China (867), Azerbaijan (879), and Armenia (883). India’s sex ratio is worse than Pakistan (920), South Korea (952), Nigeria (944), and Nepal (939), according to the World Bank.

 

https://docs.google.com/spreadsheets/d/1W0pj7hjXwXg_0PQRJT1wzbGkPZ8byQ1TOpklJcUX2Jo/pubchart?oid=309934495&format=interactive

Source: World Bank

 

How analysing city-level data could help

 

Analysis, when taken down to the level of cities and towns, could help identify trends on gender discrimination which could aid the government and non-governmental organisations combat female foeticide and infanticide.

 

Further, research at a local level could also be used to make communities aware about the problem, and empower them to act.

 

Governments and organisations working on these issues could also learn from cities that have a healthy gender ratio such as Puducherry (Puducherry), Aizawl (Mizoram), Kolar (Karnataka), Kumbakonam (Tamil Nadu), and Nagercoil (Tamil Nadu).

 

Why India’s fight against foeticide, infanticide has failed

 

India’s national child gender ratio has fallen over the past three decades from 945 in 1991 to 918 per 1,000 boys in 2011, according to census data. The states of Haryana, Punjab, Jammu & Kashmir, Rajasthan, Gujarat, Uttarakhand, and Maharashtra have a ratio lower than 900 girls per 1,000, which could imperil the future gender balance and demographics of the country.

 

In the mid-1960s, new technology that allowed for prenatal gender determination, and thus sex-selective abortion, such as the ultrasound, was brought into India, reported the Times of India in October 2011.

 

The liberalization of the Indian economy in the 1990s made ultrasound technology more easily available, according to a 2012 discussion paper by researchers at the Institute for the Study of Labor (IZA) in Germany. “The number of ultrasound machines manufactured in India increased rapidly between 1988 and 2003 with an especially marked increase after 1994,” found the study, which said that the “initial introduction of ultrasound led to sex-selection,” but the rate of sex-selective abortion did not increase more with the rapid expansion of the technology in the 2000s.

 

The Indian government has implemented regulations to prevent female foeticide arising because of these new technologies. One of the main laws, the Pre-Conception and Pre-Natal Diagnostic Techniques Act (PC & PNDT) of 1994 prohibits sex selection, before or after conception, and regulates diagnostic techniques to prevent misuse of sex determination techniques.

 

But these laws are often implemented poorly. For instance, in Maharashtra officials failed to complete 55% of inspections of sonography centers in 2014-2015, the Comptroller and Auditor General (CAG) found, as IndiaSpend reported in June 2015. In Gujarat, the shortfall in inspections of sonography center was 73%.

 

Further, In violation of Supreme Court directions to prosecute cases filed under the PC & PNDT Act within six months, cases in Maharashtra and Gujarat continued from one to 12 years.

 

The Uttar Pradesh government has left unspent about half the funds it was allocated to curb female foeticide, according to the CAG, as IndiaSpend reported in October 2016. None of the diagnostic centres followed all mandatory rules of preserving image records or backups taken during the ultrasonography of pregnant women, the CAG audit found. In 68% of cases, women did not even hold the necessary referral slips from their doctors.

 

Disempowered women, culture of dowry, smaller family size, might lead to sex selection

 

Despite significant economic and scientific growth over the past few decades, female infanticide and foeticide remain major issues in India, data show.

 

Reasons for female infanticide include anti-female bias, as women are often seen as subservient to men, who often employ positions of power, according to information from the United Nations Population Fund.

 

In addition, parents believe they will be better taken care of in their old age by men, as men are perceived as the principal wage earners of the family. Parents of girls are usually expected to pay a dowry, which could be a massive expense, avoided by raising males.

 

Coupled with son preference, smaller family sizes might also lead to greater gender selection, as IndiaSpend reported in December 2016. “Sex ratio at birth becomes skewed in favour of boys when fertility rates are low “by choice or coercion”, according to a 2006 article published by the National Academy of Sciences, USA. “Female births must be prevented to allow for the desired number of sons within the family size norm”.

 

India’s sex ratio at birth declined even as per capita income increased nearly 10 times over the last 65 years, according to an IndiaSpend analysis of government data. This could be because rising income, which results in increased literacy, makes it easier for families to access sex-selective procedures such as amniocentesis, or sex determination by using the amniotic fluid, as IndiaSpend reported in June 2015.

 

Though education could help reduce son-preference in India, women need to be empowered more broadly, according to research, as reported by IndiaSpend in May 2016. Education, travel, the freedom to grow and make decisions, and the opportunity to use education just like men are the key ingredients for changing gender perceptions, not education or economic development alone or jointly, as IndiaSpend reported in December 2016.

 

(Amarnath is a high school student and the founder of Kanya.Life. He has a deep interest in applying data science to address large problems in society.)

KEM hospital panel that ruled out abortion of foetus with neurological problems did not have subject specialist


 Child born after Supreme Court turned down plea to abort pregnancy in critical condition at KEM hospital

Mumbai city news
(HT File)

Last Saturday, a 28-year-old woman gave birth to a boy with Arnold Chiari Syndrome Type-II — fluid accumulation in the brain and spinal deformities that leave him little chance of survival. She and her husband had moved the Supreme Court to be allowed to abort her pregnancy in the 27th week once they knew about the problems the foetus had, but the court had on March 27 turned down their plea based on the report of an expert team of doctors from Mumbai’s KEM hospital. The child is now in a critical condition at the KEM hospital where he was born. The law now prohibits abortion of foetus beyond 20th weeks, unless otherwise advised by a medical panel.

It now transpires that the expert panel did not have a neurologist on it though the foetus had a complex neurological condition. Chiari malformations cause structural defects in the cerebellum (part of the brain that regulates muscular activity) and children with Type-II re usually born with incomplete development of the spinal cord and its protective covering.

“There should be a neurologist on board while preparing reports on such cases because he will know the condition of the woman and foetus better. A neonatologist or general surgeon, based on hearsay evidence, cannot offer an accurate prognosis,” said a senior doctor from KEM Hospital who was involved in the case. The doctor spoke on condition of anonymity.

 

The KEM hospital dean, Dr Avinash Supe, said, “The law doesn’t permit us to advise the SC on whether the abortion should or shouldn’t be permitted. We can only analyse the medical condition of woman and foetus and offer a clinical suggestion on whether the child is ‘incompatible with life’.”

The committee had reported that if the mother was allowed to abort, the child might be born alive. “Complications could’ve been much worse then. Right now, they are at least clinically treatable,” Dr Supe added.

Dr Devi Shetty, founder and chairman of Narayana Health, who recently submitted a report based on which a woman from West Bengal was allowed to abort in the 27th week of pregnancy, told HT that an expert committee did not need doctors from specialities such as neurology or cardiology.

“If the foetus is diagnosed with any structural deformities, related to heart, brain or other vital organs which will limit its lifespan or the deformity itself is incurable, then the woman should be allowed to abort until week 26 or 27 of gestation. In today’s world, technology does the diagnosis and anyone with a post-graduate medical degree can be called upon as an expert by the courts,” said Dr Shetty.

 

The Mumbai woman underwent a scan at a civic-run maternity home in Borivli in the 15th week of her pregnancy, but the neurological malformation was not picked up then. The second scan was done in the 24th week, when doctors finally diagnosed the anomalies.The rate of survival is as weak as 1.2-2 per 1,000 births.

Solicitor General Ranjit Kumar had told the Supreme Court bench that as per the report of the medical board of KEM Hospital, the foetus has severe physical abnormalities but the doctors have advised against termination as the mother was in the 27th week of pregnancy.

Dr Nikhil Datar, gynaecologist and obstetrician who is a prime petitioner in the case before the Supreme Court seeking extension of the pregnancy termination limit to 24 weeks, blamed the civic-run clinic’s inability to detect the malformation in time for the couple’s present predicament.

Rajasthan- At 861 girls, sex ratio slides alarmingly


Image used for representation
JAIPUR: Despite several initiatives taken by the state government to increase the sex ratio, the number of girls born in the state against 1,000 boys has gone down to 861 during 2013-15 in the state. This was constant 893 from 2010-12 to 2012-14.

For the past few years, the sex ratio at birth was a constant 893. This has slipped to 861. Despite several initiatives taken by the state government to bring down the ratio at birth, it has fallen drastically between 2013 and 2015.

This is a fall by a whopping 32 points, as per the latest sample registration system (SRS) statistical report 2015 released by the Centre.

The three consecutive SRS statistical reports 2012, 2013 and 2014, had shown that the sex ratio was constant at 893, but the latest SRS 2015 report has shocked the state as it shows that it has slipped noticeably.

“The sex ratio at birth for the country for the period 2013-15 (3-year average) has been estimated as 900. At the national level, it is 903 in rural areas and 890 in urban areas. Among the bigger states/UTs, the sex ratio at birth varies from 967 in Kerala to 831 in Haryana. In rural areas, the highest and the lowest sex ratio at birth are in the states of Chhattisgarh (9870 and Haryana (836), respectively. The sex ratio in urban areas varies from 954 in Madhya Pradesh to 821 in Haryana,” the report says.

Health authorities claimed that the situation was much better in terms of sex ratio at birth now. “At present, the sex ratio at birth is above 940 girls per 1,000 boys born in the state. We collect figures of births from across the state through our online pregnancy and child tracking system (PCTS). We register each and every birth (100% births) on PCTS,” Navin Jain, state head (mission director), National Health Mission (NHM), said.

He said that according to registries in PCTS, the sex ratio at birth in the state was 939 in 2016.

Over the past few years, health authorities have stepped up efforts to curb female foeticide in the state. There are 2,760 sonography centers in the state. Officials said that they have conducted more than 11,000 inspections at sonography centres till date. In 2014, they have conducted 837 inspections. In 2015, this increased to 1,430 and, in 2016, the officials conducted 2,468 inspections. This year, till May, they have conducted 473 inspections. During inspections, they suspended registrations of 196 centres for flouting provisions of the PCPNDT Act. They also cancelled 472 registrations of sonography centres.

Officials said that 652 cases were undergoing trail in different courts in the state for flouting the PCPNDT Act.

Doctor to lose license if C-Section rate exceeds 25 percent: MP State Woman Commission


abortionLAWS

 

 

Madhya Pradesh: If in a private or a government hospital, any doctor is found performing more than 25% of all deliveries by Caeserean Section in a period of 5 years, his/her license should be cancelled- Such is the recommendation made by the  MP State Woman Commission to the state government, recently. The commission was seen responding to the rising rates of  deliveries through Caeserean Section in the state and also rising complaints that gynecologists are indulging in the practice of unnecessary C-sections …

State commission, after going through figures of normal and Caesarean deliveries in MP, made certain recommendations including initiating action against doctors that indulge in this practice. The major recommendation stated that All the hospitals shall have to display figures of Caesarean deliveries of the hospital so that a pregnant woman could decide about the treating doctor.

For the Purpose of Action in case of violations, the Committee suggested a analysis of deliveries done during a 5 – year period, and  actions would be according to the following

Sno % of Delivery Done by C-Section in a 5 year period        Recommended Action

1  Upto 15% This is acceptable.                                              No Action will be initiated

2 More than 15%, but less than 20%                                       Warning shall be issued

3 More than 20% but less than 25%                                        Fine upto Rs 5 lakhs

4 More than 25%                                      Cancellation of Licence and Blacklisting of Doctor

Speaking to Medical Dialogues Team, Mr.Pramod Dube, chief advisor to the committee that brought about the recommendations said, ” These has been a sharp rise in deliveries through C-section in the past recent past. With this, even the thinking pattern of the public has changed. In earlier days people used to congratulate on Birth of baby .Now people hesitantly are seen asking whether delivery is Caesarean or normal.” “These are our recommendations to the state.

The government may act as it deems it deemed fit. The complaints are rising by the day and our insistence is that, this issue of unwanted c-section be addressed by the government. ” he added.

Private hospitals perform more than thrice the number of c-section deliveries as compared to government hospitals, showed the data from National Family Health Survey-4 (2015-16), released by the Union health ministry in the month of March 2017

 

The data showed that Private hospitals carried out 40.9% caesarean sections (C-sections) as compared to 11.9% performed in government hospitals. The figures were a sharp rise from the previous survey figures which were 27.7% and 15.2% respectively. World Health Organisation recommends the “ideal rate” for caesarean sections to be between 10% and 15%

Read more at Medical Dialogues: Doctor to lose license if C-Section rate exceeds 25 percent: MP State Woman Commission http://medicaldialogues.in/doctor-to-lose-license-if-c-section-rate-exceeds-25-percent-mp-state-woman-commission/

Indian court allows 10-year-old rape victim to have an abortion


Girl had crossed 20-week legal limit after which terminations are usually only allowed if there is danger to life of mother or baby

A 10-year-old girl who was raped will be allowed to have an abortion even though she has crossed the 20-week limit for terminations in India, police in the country said on Wednesday.

The child has said she was repeatedly raped by her stepfather, who has since been arrested.

Her case only came to light last week, by which time she had crossed the 20-week legal limit after which terminations are only allowed where there is a danger to the life of the mother or the baby.

“The court had asked the medical board to take a call and doctors have decided to go ahead with the abortion,” Garima Devi, the police investigation officer assigned to the case, told AFP.

“The board has not said when they are planning it (abortion) but it will be any time soon.”

In recent months India’s top court has received a number of petitions from women – including rape survivors and trafficking victims – seeking abortions where pregnancies had gone beyond 20 weeks.

Activists say the restriction should be extended to 24 weeks as victims of rape are often late to report their pregnancies.

The Indian Express said the victim’s mother wanted the accused to be set free as he had apologised and that she had other children to take care of.

“The girl’s life is destroyed but what will happen to my other children? I need to think about their future too,” the daily quoted the mother as saying from a hospital in Rohtak, a district in northern Haryana state.

India has a gruesome record on rape, with the capital New Delhi alone registering 2,199 rape cases in 2015 – an average of six a day.

A UN Committee on the Rights of the Child in 2014 expressed alarm over the widespread sexual abuse of children and said one in three rape victims in India was a minor.

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