Doctors see flaws in Pregnancy Bill

The lobby by the non-governmental organisation Advocates for Safe Parent-hood Improving Reproductive Equity (ASPIRE) to get abortion legalised in TT has evoked lively and passionate debate in the society. Some see it as legalising the murder of babies, others think that the law is one way to deal with the abortions done in unsafe, unhygienic conditions causing death or women having to seek medical treatment at hospital. Those promoting a law to decriminalise abortion also see it as a gender and equity issue because some women, especially the poor, have no control in relationships where they rely on men for support, and cannot afford to get safe abortions.

Abortion is also a medical issue. Sunday Newsday solicited the views of doctors on the draft bill — “Women’s Choice on Pregnancy Bill” which seeks to legalise the termination of pregnancy during the first 14 weeks, at more than 14 weeks and not more than 24 weeks, and termination of a pregnancy of more than 24 weeks duration. Dr Victor Wheeler, president of the Medical Association, said discussion has not taken place on abortion, so he could not give a view for the medical group. He said the topic will be included on the agenda when the association meets at the end of this month. Dr Wheeler, an obstetrician/gynaecologist, did express his own concerns about a few aspects of the proposal. At present, there are conditions in which pregnancy is terminated: When the foetus is “grossly abnormal” — in a condition where it is “not compatible with life”; the mother is seriously ill, and if the baby is already dead.

Dr Wheeler is concerned with terminations falling outside 24 weeks. The Bill proposes the termination of pregnancy of more than 24 weeks duration. Dr Wheeler said at 24 weeks the baby is “viable” and a certain percentage will live. He said the term abortion is applied to pregnancies which are terminated before 24 weeks. “With modern advances in particular neonatal care, we are able to keep babies who are 24 weeks old alive. Some live without serious medical problems.” He acknowledged that the majority will not live and those that do live can have breathing difficulties and mental abnormalities. Terminating pregnancy does have medical risks. Dr Wheeler said the uterus can be punctured resulting in a hole, the cervix can be damaged, resulting in problems with fertility.

Terminations using a scraping method are done before 14 weeks and at 24 weeks, labour is induced to expel the baby. Dr Wheeler said “very often” babies between 14-22 weeks are born alive. At 24 weeks the baby is fully formed. He said there can be “serious psychological effects on the mother” in cases where the baby is alive. In some foreign countries, medication is used so the baby will be dead when it is delivered. He referred to the section of the proposal dealing with grounds for termination during the first 14 weeks which states “there is clear evidence that the pregnancy resulted in spite of the use in good faith of a recognised contraceptive method by the pregnant woman or her partner.” Dr Wheeler said this is open to abuse. Dr Kong Sheik Achong Low, another obstetrician/gynaecologist, thinks the law being proposed by ASPIRE is attempting to have “abortion on demand, anytime, anywhere.”

He said if abortion is legalised in TT, there are perimeters which must be observed. He reiterated the view made by Dr Wheeler, saying the Bill did not recognise the fact that a foetus born after a certain gestation period may survive. He said the “cut-off” period in other countries vary — in Canada it is 20 weeks, while in some parts of the US abortions are legal up to 28 weeks. He said gestation is decided by deciding the point of viability of a baby. “Some babies born at 500 grammes, 20 weeks can survive.” Dr Achong Low said as a Roman Catholic he does not support abortion. He admitted, however, that he also does not have the answer to this complex issue. As a physician he understood the unforeseen situations such as rape and incest that can leave people damaged and scarred for life. “I can understand why people would request an abortion.” Dr Achong Low referred to the old adage that prevention is better than cure and said ASPIRE  should instead be lobbying much more for contraception and sterilisation.

He knew these procedures also went against church teachings. “It does not matter which side you take, you are going to run afoul of religion.” Dr Achong Low said contraception and sterilisation may be more palatable, however, he quickly added “maybe.” Dr Achong Low said women in the lower socio-economic groups ask to have their tubes tied but  medical personnel in the public health institutions and even private agencies are dissuading from doing so. He gave the example of a 28-year-old with eight children who was told by nurses that she was too young to have her tubes tied. He said the nurses at the Family Planning Association also dissuaded women under a certain age not to tie their tubes “regardless of how many children they have.” Dr Achong Low said Government agencies must lead the way in educating the public and medical personnel about sterilisation. Critiquing the Bill, he referred to the section dealing with “Termination of Pregnancy” which states that it can be done during the first 14 weeks by a medical practitioner or an authorised medical midwife in an approved institution. “You can’t say this is legal to do and you can do it anywhere and a midwife can do it. That is nonsense. There are complications, morbidity and mortality with these procedures. This is not a benign procedure.”

Dr Achong Low referred to specific clauses under Section 6, which outlined the conditions under which pregnancy can be terminated at more than 14 weeks and no more than 24 weeks duration. One of them is the failure of “a recognised contraceptive method.” Dr Achong Law described this clause as nonsense. Under the Section on Request and Consent, he criticised clauses (2) and (3) in which mentally competent minors can request abortions. The authorised midwife, medical practitioner or authorised medical practitioner may encourage the minor to inform her parents or guardian, but she is not required to get their consent or notify them. Dr Achong Low said this is abortion on demand. He said Section 10 is unacceptable and totally flawed. It states that counselling and consent do not apply where treatment to terminate the pregnancy is immediately necessary to save a pregnant woman’s life or prevent permanent injury to her physical or mental health. It can be done by “any medical practitioner.” “You never have a situation where the person is going to die so quickly you are going to put somebody without the necessary expertise to perform a procedure.”

Dr Achong Low said Section 11 Clauses 2 and 3 were utter nonsense. These deal with “Conscientious objection to participate in treatment” in which persons can be penalised for failure to refer someone to another medical practitioner for abortion. Section 14 Clauses 2 and 3 refer to authority given to police officers to investigate any complaint or information relating to the commission of an offence. “A police officer has no jurisdiction over that. He can’t say if anything is going wrong. It doesn’t matter if they try and make it palatable by saying ‘the authority conferred is limited to observation and evidence taking and does not include the power to obstruct any procedures observed.’ In other words it’s like saying I think you are doing something wrong, but go ahead and I will deal with you later.” The Medical Professionals Association of TT declined comment on the issue while calls to get comment from the president of the TT Association of Obstetricians and Gynaecologists were not returned.