Unsafe abortions and experimental excessesS G Kabra
Unsafe abortions, criminal or illegal, are a cause of excessive maternal morbidity, mortality and misery. Human experimentation with new methods of abortion in contravention of stipulations and guidelines fall in the same category.
Anybody who inflicts, encourages or condones unsafe abortion in contravention of the law commits a crime. Yet, articles in journals describe unsafe abortions and identify the person who conducted it, and the place where it was performed. The articles published in the Journal of Obstetrics and Gynecology of India (1-6) give graphic details of the horrors inflicted by criminal acts of illegal abortionists. None of these mention the steps taken against the culprits.All cases of maternal mortality due to unsafe and unlicensed abortions are cases of double homicide (murder) and are required under law (CrPC. Section 39 and 174 read with IPC Sections 201, 299, 312 and 314) to be reported to the police, subjected to inquest, and criminal prosecutions launched. By not doing so, the authors are presumed to be siding with the criminals. The documentation of these murders should not be published as research articles. Such publications amount to documented defiance of law and criminal justice.
As regards the editor's responsibilities, they must be satisfied that authors reporting a crime through their journal have done all that they were legally required to do in that particular case.Research in the cases of septic and unsafe abortion has to cover two aspects: injuries and their treatment, and the possible cause of the injury. A properly done medical termination of pregnancy (MTP) should not cause injury to the bladder or gut. If this occurs, there must be either some unrecognised abnormality in the patient or a lapse in the procedure. The researcher must try to elucidate it to prevent its occurrence in future.However, illegal abortions are apparently not considered criminal and are not reported to the police, even when they prove fatal. This attitude is exemplified by the observations of the attending doctors in the report of an illegal abortion done by a 'dai' with a stick that resulted in gas gangrene. The abortion was done by an unauthorised person and it was an unnatural death with manifest evidence of foul play on the record. Exactly the same assertion has been made (1), when the authors state 'Autopsy was advised in all these cases, but refused by relatives', exemplifying the attitude of medical professionals not to report unnatural deaths in women.
Chemical abortificeant paste As a result of an unhealthy enthusiasm to popularise abortions for population control, Fetex paste was licensed and publicised as an abortificient. This paste has been reported to cause severe peritonitis, gangrene of organs and kidney failure in many patients. In a 1985 report of three cases (7), two died and the third survived renal failure but her 'whole vagina and cervix were sloughed and necrosed' after the illegal abortion with 'Fetex paste'. The authors pleaded 'Advertisements...should be stopped and the product should be withdrawn...'. The Journal of Obstetrics and Gynecology of India was one such journal advertising the Fetex paste. Following these reports, this preparation by Gambers Laboratory, was 'withdrawn' and 'banned'. However, in a recent report of the death of 34 women who died of septic abortion, in 25 'kutchi' was used by 'dai/quack', Fetex paste was used in 3 patients by general practitioners (GPs) (3).What can be a worse reflection on the prevailing professional standards, ethics and the role of drugs control machinery than the fact that year after year of reports of severe adverse effects and fatal outcomes from the use of the chemical abortificeant paste, nobody questions how this obviously dangerous paste was permitted to be licensed as an abortificeant paste? Was it ethical for the practitioners of medicine to use this Ayurvedic preparation? Was it ethical to advertise it in the Journal of Obstetrics and Gynecology of India, the official organ of the Federation?
MTP: saga of inhuman experimentsAny form of physical or chemical interference with the fetus is potentially noxious enough to cause abortion up to 20 weeks of pregnancy during which MTP is permitted. Even introduction of a fine needle for aspiration of amniotic fluid may result in abortion. But simply because MTP is permitted does not mean one can experiment with any substance or method. Yet, some studies (8-13) report the use of rubber catheters for intra- and extra-amniotic injection of distilled water, normal saline, hypertonic saline, boiling water, various chemicals including corrosive substances that formed 'Fetex paste'. These have been used to experiment and re-experiment upon thousands of women and have been reported as research publications.All these are human experiments. No good journal today publishes a report unless the authors provide a proof of ethics committee clearance. Recruitment of patients has to be on the basis of informed and free consent. Any substance or device used in the human body is a drug. Even an approved drug when used for a different purpose or by a different route or different dose schedule or combination constitutes a new drug, the human trial of which needs prior approval of the drugs controller.None of the aforesaid 'studies' appear to conform to the ethical standards for human experiments. How could instillation of distilled water (9), boiling water, a powdered tablet (13) or rubber catheter (12) be permitted? Imagine the indignity and discomfort of a Foley's catheter introduced in the uterus, its balloon inflated and left in a pregnant woman for 6-18 hours. How does it differ from the use of a sterile stick and cow's urine by quacks?In my book 'Miscarriage of Medicine' (Panchsheel Prakashan, Jaipur, 1993, chapter entitled 'Merciless assault on mother's womb' p. 34), I had quoted papers from the early 1980s which gave data on similar studies.
What is the rationale of repeating these experiments when the disadvantages of many of them have already been adequately evaluated? There is no evidence that any thought has been given to plan these trials to obviate biased inferences. As a result, most of the studies are exercises in futility. Why increase the risk to the women undergoing these trials? There is no evidence that clearance of the ethics committee was taken before conducting the trials. No informed consent was taken. And worse, the Indian Council of Medical Research is a party to it all by commission and omission.Anybody doing anything to terminate pregnancy is not only permitted to do so but the act goes unchallenged even if it kills or cripples the woman. It is no exaggeration to state that medical termination of pregnancy has come to be a 'pragmatic termination of maternity'.
References1. Sinha R, Bara MM. Maternal mortality in unsafe abortion. J Obstet Gynecol India 2001;51:123-125. 2. Sharma JB, Manaktala U, Kumar A, Malhotra M. Complications and management of septic abortions: a five year study. J Obstet Gynecol India 2001;51:74-763. Reddi Rani P, Bupathy A, Balsubramanian S. Maternal mortality due to septic abortion. J Obstet Gynecol India 1996;46:73-76. 4. Rao AA. Ischiorectal abscess-sequalae to criminal abortion. J Obstet Gynecol India 1996;46:165-166.5. Biswas C, Bhattacharya N, Maity AK, Goswami BK, Mukherji. Bowel injury-a menace in the era of liberalisation of abortion. J Obstet Gynecol India 1997;47:419-424.6. Patel BS, Pandya NC, Jadav MM, Bhatt MK, Ankleshwaria BS. Deaths attibutable to tubal sterilization-1979 to 1999. J Obstet Gynecol India 2001;51:127.7. Bhatt S, Bandi S. The dangerous Fetex paste. J Obstet Gynecal India 1985;35:27-29.8. Desai P, Patel P. Prospective comparative evaluation of intra-amniotic versus extra-amniotic routes for ethacridine lactate for second trimester MTP: no difference. J Obstet Gynecol India 2001;51:158-160.9. Kaur D, Shergill S, Saini S, Singh N. Comparative evaluation of ethacridine lactate, normal saline and distilled water in mid-trimester abortions. J Obstet Gynecol India 1997;47:160-163.10. Pravin K M and Rajgopal N. Medically induced (non-surgical) early first trimester abortion with mifepristone (RU 486) and multidose misoprostol. J Obstet Gynecol India 1996;46:470-476.11. Jayaram VK and Ratna G. Mid-trimester temination of pregancy with extra amniotic PGF 2 ALFA and comparative study with normal saline and iodine saline. J Obstet Gynecol India 1996;46:614-617.12. Singh A, Roy H, Dixit P, Manav N, Roy S. Termination of pregnancy by combined intrauterine catheter and laminaria tent. J Obstet Gynecol India 1996;46:618-623.13. Nayak AH, Shah BP, Alwani CM. Extra-amniotic instil lation of tablet primprost with ethacridine lactate for termination of second trimester pregnancy. J Obstet Gynecol India 1996;46:753-758.
Tuesday, May 20, 2008
Monday, April 28, 2008
Health Legislations India: their impact
Health legislation and its impact
S.G. Kabra
There is a large number of laws related to health care delivery systems in India. But if non-implementation of legal provisions is lawlessness, the health sector is the most lawless of them all.
The basic law to regulate and maintain the professional standards of the medical profession was the Indian Medical Council Act. However, in the zeal to encourage 'Indian systems of medicines' and 'traditional systems of medicines', these essentially complementary systems have been projected and established as alternative systems of medicine. In the name of 'integrated medicine', a totally chaotic, unregulated and unregulatable system has come to exist.
Worse still, in the name of providing 'barefoot doctors' for the suffering 'rural poor', anybody, irrespective of their basic qualifications or capability, can be provided with a legal license, after the so-called 'basic training', to practice as a Registered Medical Practitioner (RMP). An RMP, legally, can do anything that a regularly trained physician is permitted to do. And, a trained doctor can do anything that he chooses. There is no question of any norms, standards or ethics.
Contradictions in the laws and their implementationPlacing jaggery inside a woman's uterine cavity to stop severe bleeding after she has given birth is a criminal act for a doctor registered under Medical Council Act. The same act would be termed 'life saving' for a registered practitioner of traditional medicine. To instill anything unsterile in an eye after a cataract operation would be gross criminal negligence on the part of a modern opthalmologist, but using cow's urine after a couching operation for cataract would be a fully justified procedure under the Indian system of medicine. An acupuncturist is permitted to attempt to cure a cleft palate case by assuring the parents that electric stimulation from a needle 'strategically' placed in the body will stimulate growth of issue across the cleft, though such a promise by others would attract penal provisions.
In the case of malignancies that are today identified as treatable or eminently controllable, not giving approved drug therapy would render a modern oncologist (cancer specialist) liable to legal action, but a practitioner of any other system of medicine claiming himself to be a 'cancer specialist' could give anything or deny anything to 'cure' patients, without any consequence of law.
Institutionalised quackeryIf acting beyond one's training, competence and skill is quackery, in India today we have virtually institutionalised quackery, where, irrespective of which system of medicine one is trained in, including self-training in the name of traditional medicine, one may do what appeals to whim and fancy.
It is no surprise that the Medical Council of India and other medical councils are ineffective and dead as far as their function of regulating the standards of different systems of medicine is concerned.
The Drugs and Cosmetics Act, with all its provisions to regulate the manufacture, distribution and safe use of the myriad products of one of the largest industries in the country - the pharmaceutical industry - is followed only for its money-spinning licensing provisions. Even this is in a distorted form. The state drug controllers, the implementing agencies of the Act, operate only as licensers. Under the loan licensing provisions, the State Drugs Controller can license anybody to prepare and market a medicine. As a result, one can see 'tonics', 'herbal medicines' and other such substances being prepared inkadhaiin the streets of Jaipur and Indore.
Spurious drugsAccording to a report of the drug control authorities, 20 per cent of such medicines were found to be spurious. It is anybody's guess what the actual extent of spurious drugs in the market is. Concoctions under the label of traditional and home remedies are now being marketed by organised national and international pharmaceutical companies. For herbal, ayurvedic, siddha and other such preparations, there is no method of quality control.
There is no evolved method of post- market surveillance, not even for newly licensed drugs. A licensed abortificent paste, the 'Fetex paste', killed hundreds of women, without the Drugs Controller being aware of it, let alone having to account for it, as the licensing authority.
Yet another Act is the Drugs and Magic Remedies (Objectionable) Advertisement Act. This Act makes advertising of sex tonics and sex stimulants, uterine tonics and menstrual disorder regulators a cognisable offence. It also prohibits advertisements about the diagnosis, cure, mitigation or prevention of 54 diseases and disorders listed in the Act such as cancer, diabetes, epilepsy, leucoderma, paralysis, sexual impotence. However, billboards in Delhi, the local train compartments in Mumbai, advertisements in newspapers and glossy and not so glossy magazines, and now the electronic media, openly mock the law-making and law-enforcing agencies.
Reproductive 'rights'Another Act that has permitted mass butchery in the killing fields of medicare is the Medical Termination of Pregnancy Act. Intended to provide women the reproductive right of safe abortion (upto 12 weeks of pregnancy), the time span within which a legal pregnancy could be performed was increased to 20 weeks to accommodate population planners, though it was specifically stated that the Act was not meant for population control. The elaborate safety provisions of the Act and the Rules and the Regulations framed under it are overlooked with impunity.
As a result, induced abortions are one of the main killers of pregnant women in the country. Thousands of women become its victims every year. This has been going on for over the last 20 years. And of course it not only legalises 5 million foeticides every year but also makes it a laudable effort in nation building. The whole cultural ethos of the family and value for human life is shaken. Sects that used to abhor even killing an ant today think nothing when a foetus is dumped in the bucket to die.
Pesticides for household useThe Insecticides Act is intended to provide access to safe pesticides. Yet thousands of persons die every year, 20 per cent of them children, due to just one pesticide - aluminium phosphide, a product which is not to be sold in the market or be available as a household pesticide. Deaths by this pesticide have been reported in the medical literature, by forensic experts and in the lay press in the country. However, no authority has felt the need to act under the Act.
The Dangerous Machines (Regulation) Act is intended to prevent maiming of farm workers by agricultural machinery. Though thousands of labourers get their limbs chopped and mutilated by thrashers and chaff cutters and hundreds of women get descalped, the provisions of this central Act have not been implemented almost a decade since its passing by Parliament.
Amongst the silent killers are radiation-induced cancers, congenital defects and body damage caused by X- ray radiation. The thousands of improperly used X-ray units in the country, functioning without the mandatory safety provisions prescribed under the Atomic Energy Act, are collectively and continuously doing what the atomic bomb once did. But since the ill effects of X-ray radiation manifest after 10-15 years, or manifest in the progeny, they cannot be traced to the X-ray radiation that caused it. An X-ray exposure in woman's childhood may lead to cancer of the breast when she is a mother. Radiation of a man's gonads may cause acute childhood blood cancer in his son or daughter.
The Atomic Energy Act is a central Act but is to be implemented by the state governments. They just have not done it.
The rule of lawThe rule of law apparently does not include welfare law. Bypassing a law is not breaking a law. Indifference of statutes is not statutory indifference. Welfare of people is good for public posturing; otherwise, to fare well is the bureau-politician's overwhelming instinct.
There are several other laws that aid and abet activities in the killing fields, by default or design. Non- implementation of laws is no contempt of the parliament or the judiciary, and litigation leave little scope for the law enforcing authorities to effectively monitor and implement welfare laws.
Dr S G Kabra,
S.G. Kabra
There is a large number of laws related to health care delivery systems in India. But if non-implementation of legal provisions is lawlessness, the health sector is the most lawless of them all.
The basic law to regulate and maintain the professional standards of the medical profession was the Indian Medical Council Act. However, in the zeal to encourage 'Indian systems of medicines' and 'traditional systems of medicines', these essentially complementary systems have been projected and established as alternative systems of medicine. In the name of 'integrated medicine', a totally chaotic, unregulated and unregulatable system has come to exist.
Worse still, in the name of providing 'barefoot doctors' for the suffering 'rural poor', anybody, irrespective of their basic qualifications or capability, can be provided with a legal license, after the so-called 'basic training', to practice as a Registered Medical Practitioner (RMP). An RMP, legally, can do anything that a regularly trained physician is permitted to do. And, a trained doctor can do anything that he chooses. There is no question of any norms, standards or ethics.
Contradictions in the laws and their implementationPlacing jaggery inside a woman's uterine cavity to stop severe bleeding after she has given birth is a criminal act for a doctor registered under Medical Council Act. The same act would be termed 'life saving' for a registered practitioner of traditional medicine. To instill anything unsterile in an eye after a cataract operation would be gross criminal negligence on the part of a modern opthalmologist, but using cow's urine after a couching operation for cataract would be a fully justified procedure under the Indian system of medicine. An acupuncturist is permitted to attempt to cure a cleft palate case by assuring the parents that electric stimulation from a needle 'strategically' placed in the body will stimulate growth of issue across the cleft, though such a promise by others would attract penal provisions.
In the case of malignancies that are today identified as treatable or eminently controllable, not giving approved drug therapy would render a modern oncologist (cancer specialist) liable to legal action, but a practitioner of any other system of medicine claiming himself to be a 'cancer specialist' could give anything or deny anything to 'cure' patients, without any consequence of law.
Institutionalised quackeryIf acting beyond one's training, competence and skill is quackery, in India today we have virtually institutionalised quackery, where, irrespective of which system of medicine one is trained in, including self-training in the name of traditional medicine, one may do what appeals to whim and fancy.
It is no surprise that the Medical Council of India and other medical councils are ineffective and dead as far as their function of regulating the standards of different systems of medicine is concerned.
The Drugs and Cosmetics Act, with all its provisions to regulate the manufacture, distribution and safe use of the myriad products of one of the largest industries in the country - the pharmaceutical industry - is followed only for its money-spinning licensing provisions. Even this is in a distorted form. The state drug controllers, the implementing agencies of the Act, operate only as licensers. Under the loan licensing provisions, the State Drugs Controller can license anybody to prepare and market a medicine. As a result, one can see 'tonics', 'herbal medicines' and other such substances being prepared inkadhaiin the streets of Jaipur and Indore.
Spurious drugsAccording to a report of the drug control authorities, 20 per cent of such medicines were found to be spurious. It is anybody's guess what the actual extent of spurious drugs in the market is. Concoctions under the label of traditional and home remedies are now being marketed by organised national and international pharmaceutical companies. For herbal, ayurvedic, siddha and other such preparations, there is no method of quality control.
There is no evolved method of post- market surveillance, not even for newly licensed drugs. A licensed abortificent paste, the 'Fetex paste', killed hundreds of women, without the Drugs Controller being aware of it, let alone having to account for it, as the licensing authority.
Yet another Act is the Drugs and Magic Remedies (Objectionable) Advertisement Act. This Act makes advertising of sex tonics and sex stimulants, uterine tonics and menstrual disorder regulators a cognisable offence. It also prohibits advertisements about the diagnosis, cure, mitigation or prevention of 54 diseases and disorders listed in the Act such as cancer, diabetes, epilepsy, leucoderma, paralysis, sexual impotence. However, billboards in Delhi, the local train compartments in Mumbai, advertisements in newspapers and glossy and not so glossy magazines, and now the electronic media, openly mock the law-making and law-enforcing agencies.
Reproductive 'rights'Another Act that has permitted mass butchery in the killing fields of medicare is the Medical Termination of Pregnancy Act. Intended to provide women the reproductive right of safe abortion (upto 12 weeks of pregnancy), the time span within which a legal pregnancy could be performed was increased to 20 weeks to accommodate population planners, though it was specifically stated that the Act was not meant for population control. The elaborate safety provisions of the Act and the Rules and the Regulations framed under it are overlooked with impunity.
As a result, induced abortions are one of the main killers of pregnant women in the country. Thousands of women become its victims every year. This has been going on for over the last 20 years. And of course it not only legalises 5 million foeticides every year but also makes it a laudable effort in nation building. The whole cultural ethos of the family and value for human life is shaken. Sects that used to abhor even killing an ant today think nothing when a foetus is dumped in the bucket to die.
Pesticides for household useThe Insecticides Act is intended to provide access to safe pesticides. Yet thousands of persons die every year, 20 per cent of them children, due to just one pesticide - aluminium phosphide, a product which is not to be sold in the market or be available as a household pesticide. Deaths by this pesticide have been reported in the medical literature, by forensic experts and in the lay press in the country. However, no authority has felt the need to act under the Act.
The Dangerous Machines (Regulation) Act is intended to prevent maiming of farm workers by agricultural machinery. Though thousands of labourers get their limbs chopped and mutilated by thrashers and chaff cutters and hundreds of women get descalped, the provisions of this central Act have not been implemented almost a decade since its passing by Parliament.
Amongst the silent killers are radiation-induced cancers, congenital defects and body damage caused by X- ray radiation. The thousands of improperly used X-ray units in the country, functioning without the mandatory safety provisions prescribed under the Atomic Energy Act, are collectively and continuously doing what the atomic bomb once did. But since the ill effects of X-ray radiation manifest after 10-15 years, or manifest in the progeny, they cannot be traced to the X-ray radiation that caused it. An X-ray exposure in woman's childhood may lead to cancer of the breast when she is a mother. Radiation of a man's gonads may cause acute childhood blood cancer in his son or daughter.
The Atomic Energy Act is a central Act but is to be implemented by the state governments. They just have not done it.
The rule of lawThe rule of law apparently does not include welfare law. Bypassing a law is not breaking a law. Indifference of statutes is not statutory indifference. Welfare of people is good for public posturing; otherwise, to fare well is the bureau-politician's overwhelming instinct.
There are several other laws that aid and abet activities in the killing fields, by default or design. Non- implementation of laws is no contempt of the parliament or the judiciary, and litigation leave little scope for the law enforcing authorities to effectively monitor and implement welfare laws.
Dr S G Kabra,
Wednesday, March 19, 2008
NON-THERPEUTIC SECOND TRIMESTER TERMINATION OF PREGNANCIES IS GROSS HUMAN RIGHTS VIOLATION
ABATTOIRS AND ABETTORS
MERCENARIES AND MISSIONARIES
On the occasion of signing the Partial Birth Abortion Act 2003 on November 5, 2003, President Bush stated, “For years, a terrible form of violence has been directed against children who are inches from birth, while the law looked the other way. Today, at last, the American people and our government have confronted the violence and come to the defense of the innocent child.”
What is to be noted is that the implied distinction between infanticide and partial birth abortion is “children who are inches from birth’.
Alluding to the compelling evidence that led the members of the House and Senate to pass the legislation, President Bush stated:-.
“The best case against partial birth abortion is a simple description of what happens and to whom it happens. It involves the partial delivery of a live boy or girl, and a sudden, violent end of that life. Our nation owes its children a different and better welcome.”
The description of partial birth abortion in terms of what happens and to whom it happens is illustrated in the following pictures:-
MERCENARIES AND MISSIONARIES
On the occasion of signing the Partial Birth Abortion Act 2003 on November 5, 2003, President Bush stated, “For years, a terrible form of violence has been directed against children who are inches from birth, while the law looked the other way. Today, at last, the American people and our government have confronted the violence and come to the defense of the innocent child.”
What is to be noted is that the implied distinction between infanticide and partial birth abortion is “children who are inches from birth’.
Alluding to the compelling evidence that led the members of the House and Senate to pass the legislation, President Bush stated:-.
“The best case against partial birth abortion is a simple description of what happens and to whom it happens. It involves the partial delivery of a live boy or girl, and a sudden, violent end of that life. Our nation owes its children a different and better welcome.”
The description of partial birth abortion in terms of what happens and to whom it happens is illustrated in the following pictures:-
A parallel Second-trimester termination-of-pregnancy permitted by law upto the 20th week of pregnancy and practiced in the country is Dilatation & Evacuation. A medical doctor who practiced the procedure for long describes it in graphic details thus:-
“Imagine for a moment that you are a "pro-choice" obstetrician-gynecologist as I once was. Your patient today is seventeen years old and she is twenty weeks pregnant. At twenty weeks, her uterus is up to her umbilicus and she has been feeling her baby kick for the last two weeks. If you could see her baby, she would be as long as your hand from the top of her head to the bottom of her rump not counting the legs. Your patient is now asleep on an operating room table with her legs in stirrups. Upon entering the room after scrubbing, you dry your hands with a sterile towel and are gowned and gloved by the scrub nurse.”
“The first task is remove the laminaria that had earlier been placed in the cervix to dilate it sufficiently to allow the procedure you are about to perform. With that accomplished, direct your attention to the surgical instruments arranged on a small table to your right. The first instrument you reach for is a 14-French suction catheter. It is clear plastic and about nine inches long. It has a bore through the center approximately ¾ of an inch in diameter. Picture yourself introducing the catheter through the cervix and instructing the circulating nurse to turn on the suction machine which is connected through clear plastic tubing to the catheter. What you will see is a pale yellow fluid the looks a lot like urine coming through the catheter into a glass bottle on the suction machine. This amniotic fluid surrounded the baby to protect her.”
“With suction complete, look for your Sopher clamp. This instrument is about thirteen inches long and made of stainless steel. At one end are located jaws about 2 ½ inches long and about ¾ on an inch wide with rows of sharp ridges or teeth. This instrument is for grasping and crushing tissue. When it gets hold of something, it does not let go.”
“A second trimester D&E abortion is a blind procedure. The baby can be in any orientation or position inside the uterus. Picture yourself reaching in with the Sopher clamp and grasping anything you can. At twenty weeks gestation, the uterus is thin and soft so be careful not to perforate or puncture the walls. Once you have grasped something inside, squeeze on the clamp to set the jaws and pull hard – really hard. You feel something let go and out pops a fully formed leg about 4 to 5 inches long. Reach in again and grasp whatever you can. Set the jaw and pull really hard once again and out pops an arm about the same length. Reach in again and again with that clamp and tear out the spine, intestines, heart and lungs.”
“The toughest part of a D&E abortion is extracting the baby’s head. The head of a baby that age is about the size of a plum and is now free floating inside the uterine cavity. You can be pretty sure you have hold of it if the Sopher clamp is spread about as far as your fingers will allow. You will know you have it right when you crush down on the clamp and see a pure white gelatinous material issue from the cervix. That was the baby’s brains. You can then extract the skull pieces. If you have a really bad day like I often did, a little face may come out and stare back at you.”
“Congratulations! You have just successfully performed a Suction D&E abortion. You just affirmed her right to choose. You just made $600 cash in fifteen minutes.”
Dr. Tony Levatino, M.D.
For more medical information on D&E abortion, see the following texts:
Abortion Practice, by Warren M. Hern, M.D., M.P.H. (1990: Alpenglo Graphics, Inc., 1130 Alpine, Boulder, CO 80304), ISBN 0-9625728-0-2.
Second Trimester Abortion: Perspectives After a Decade of Experience, Edited by Gary S. Berger, William E. Brenner, and Louis G. Keith (1981: Martinus Nijhoff Publishers, PO Box 566, 2501 CN The Hague, The Netherlands and John Wright, PSG, Inc., 545 Great Road, Littleton, MA 01460), ISBN 90-247-2487-2.
A pictorial presentation of D & E procedure is reproduced below for you to visualize and understand the same.
“Imagine for a moment that you are a "pro-choice" obstetrician-gynecologist as I once was. Your patient today is seventeen years old and she is twenty weeks pregnant. At twenty weeks, her uterus is up to her umbilicus and she has been feeling her baby kick for the last two weeks. If you could see her baby, she would be as long as your hand from the top of her head to the bottom of her rump not counting the legs. Your patient is now asleep on an operating room table with her legs in stirrups. Upon entering the room after scrubbing, you dry your hands with a sterile towel and are gowned and gloved by the scrub nurse.”
“The first task is remove the laminaria that had earlier been placed in the cervix to dilate it sufficiently to allow the procedure you are about to perform. With that accomplished, direct your attention to the surgical instruments arranged on a small table to your right. The first instrument you reach for is a 14-French suction catheter. It is clear plastic and about nine inches long. It has a bore through the center approximately ¾ of an inch in diameter. Picture yourself introducing the catheter through the cervix and instructing the circulating nurse to turn on the suction machine which is connected through clear plastic tubing to the catheter. What you will see is a pale yellow fluid the looks a lot like urine coming through the catheter into a glass bottle on the suction machine. This amniotic fluid surrounded the baby to protect her.”
“With suction complete, look for your Sopher clamp. This instrument is about thirteen inches long and made of stainless steel. At one end are located jaws about 2 ½ inches long and about ¾ on an inch wide with rows of sharp ridges or teeth. This instrument is for grasping and crushing tissue. When it gets hold of something, it does not let go.”
“A second trimester D&E abortion is a blind procedure. The baby can be in any orientation or position inside the uterus. Picture yourself reaching in with the Sopher clamp and grasping anything you can. At twenty weeks gestation, the uterus is thin and soft so be careful not to perforate or puncture the walls. Once you have grasped something inside, squeeze on the clamp to set the jaws and pull hard – really hard. You feel something let go and out pops a fully formed leg about 4 to 5 inches long. Reach in again and grasp whatever you can. Set the jaw and pull really hard once again and out pops an arm about the same length. Reach in again and again with that clamp and tear out the spine, intestines, heart and lungs.”
“The toughest part of a D&E abortion is extracting the baby’s head. The head of a baby that age is about the size of a plum and is now free floating inside the uterine cavity. You can be pretty sure you have hold of it if the Sopher clamp is spread about as far as your fingers will allow. You will know you have it right when you crush down on the clamp and see a pure white gelatinous material issue from the cervix. That was the baby’s brains. You can then extract the skull pieces. If you have a really bad day like I often did, a little face may come out and stare back at you.”
“Congratulations! You have just successfully performed a Suction D&E abortion. You just affirmed her right to choose. You just made $600 cash in fifteen minutes.”
Dr. Tony Levatino, M.D.
For more medical information on D&E abortion, see the following texts:
Abortion Practice, by Warren M. Hern, M.D., M.P.H. (1990: Alpenglo Graphics, Inc., 1130 Alpine, Boulder, CO 80304), ISBN 0-9625728-0-2.
Second Trimester Abortion: Perspectives After a Decade of Experience, Edited by Gary S. Berger, William E. Brenner, and Louis G. Keith (1981: Martinus Nijhoff Publishers, PO Box 566, 2501 CN The Hague, The Netherlands and John Wright, PSG, Inc., 545 Great Road, Littleton, MA 01460), ISBN 90-247-2487-2.
A pictorial presentation of D & E procedure is reproduced below for you to visualize and understand the same.
Obviously, an obstetrician or other physician who is required to, or opts to do the aforesaid procedures has to be desensitized to the tender feelings one expects for a tender life in the womb. One has to be totally indifferent, if not callous, to the life in the womb. Over enthusiastic and zealous abortionists are likely to be totally dehumanized.
Of the total of 96,79,84 registered Medical Terminations of Pregnancy done and reported since the MTP Act came into being, in a period from 1977 – 1997, 13 lakh 39 thousand i.e. approximately 14 % were performed for second trimester abortion. Presently it is estimated that 4 0 to 50 lakh pregnancy terminations, registered and reported, unreported and clandestine, are being done in the country. All methods for second trimester abortion cause violent death of the live child in the womb.
Of the total of 96,79,84 registered Medical Terminations of Pregnancy done and reported since the MTP Act came into being, in a period from 1977 – 1997, 13 lakh 39 thousand i.e. approximately 14 % were performed for second trimester abortion. Presently it is estimated that 4 0 to 50 lakh pregnancy terminations, registered and reported, unreported and clandestine, are being done in the country. All methods for second trimester abortion cause violent death of the live child in the womb.
Thursday, January 31, 2008
dr s g kabra publications
Issues Med Ethics. ;10 (2):24 16334925
Gender disparity: need to look beyond 'female foeticide'.
[My paper] S G Kabra
[Pubmed] [Scholar] [EndNote] [BibTex]
Other papers by authors:
Issues Med Ethics. ;11 (3):79-80 16335513
Unsafe abortions and experimental excesses.
[My paper] S G Kabra
Issues Med Ethics. ;8 (3):70 16323365
Abortion in India: not a right but a state-sponsored programme.
[My paper] S G Kabra
Health Millions. ;22 (4):21-3 12320666
Violence against the silent most.
[My paper] S G Kabra
Health Millions. 1993 Apr ;1 (2):10-1 12286465
The myth of brain tonics.
[My paper] S G Kabra
Lancet. 1994 Jan 15;343 (8890):179-80 7904030
What is happening to caesarean section rates?
[My paper] S G Kabra , R Narayanan , M Chaturvedi , P Anand , G Mathur
Indian J Exp Biol. 1981 Nov ;19 (11):1050-3 7338361
Histochemical analysis of urinary stone: part I--specificity & sensitivity of microchemical staining reactions to identify chemical constituents.
[My paper] V Kabra , S G Kabra , R P Chaturvedi , A P Bhargava , P Banerji , A Bhargava , M S Rathore
Indian J Ophthalmol. 1982 Jul ;30 (4):367-9 7166421
Tear glucose in uncontrolled and chemical diabetics.
[My paper] M S Gaur , G K Sharma , S G Kabra , P K Sharma , L K Nepalia
J Bone Joint Surg Br. 1983 Mar ;65 (2):195-8 6826630
The trabecular pattern of the calcaneum as an index of osteoporosis.
[My paper] N L Jhamaria , K B Lal , M Udawat , P Banerji , S G Kabra
Indian J Ophthalmol. 1983 Jul ;31 (4):447-9 6677607
Estimation of trimethoprim and sulfamethoxazole levels in tears after systemic administration.
[My paper] G K Sharma , S G Kabra , R P Garg , P K Sharma , L K Nepalia
Indian J Ophthalmol. 1983 Sep ;31 (5):563-5 6671761
Tear glucose in ocular inflammations and its enzymatic lysis as a possible therapeutic adjunct in treatment of ocular infections.
[My paper] G K Sharma , S G Kabra , P K Sharma , L K Nepalia , S Bharadwaj , A Mehra
Gender disparity: need to look beyond 'female foeticide'.
[My paper] S G Kabra
[Pubmed] [Scholar] [EndNote] [BibTex]
Other papers by authors:
Issues Med Ethics. ;11 (3):79-80 16335513
Unsafe abortions and experimental excesses.
[My paper] S G Kabra
Issues Med Ethics. ;8 (3):70 16323365
Abortion in India: not a right but a state-sponsored programme.
[My paper] S G Kabra
Health Millions. ;22 (4):21-3 12320666
Violence against the silent most.
[My paper] S G Kabra
Health Millions. 1993 Apr ;1 (2):10-1 12286465
The myth of brain tonics.
[My paper] S G Kabra
Lancet. 1994 Jan 15;343 (8890):179-80 7904030
What is happening to caesarean section rates?
[My paper] S G Kabra , R Narayanan , M Chaturvedi , P Anand , G Mathur
Indian J Exp Biol. 1981 Nov ;19 (11):1050-3 7338361
Histochemical analysis of urinary stone: part I--specificity & sensitivity of microchemical staining reactions to identify chemical constituents.
[My paper] V Kabra , S G Kabra , R P Chaturvedi , A P Bhargava , P Banerji , A Bhargava , M S Rathore
Indian J Ophthalmol. 1982 Jul ;30 (4):367-9 7166421
Tear glucose in uncontrolled and chemical diabetics.
[My paper] M S Gaur , G K Sharma , S G Kabra , P K Sharma , L K Nepalia
J Bone Joint Surg Br. 1983 Mar ;65 (2):195-8 6826630
The trabecular pattern of the calcaneum as an index of osteoporosis.
[My paper] N L Jhamaria , K B Lal , M Udawat , P Banerji , S G Kabra
Indian J Ophthalmol. 1983 Jul ;31 (4):447-9 6677607
Estimation of trimethoprim and sulfamethoxazole levels in tears after systemic administration.
[My paper] G K Sharma , S G Kabra , R P Garg , P K Sharma , L K Nepalia
Indian J Ophthalmol. 1983 Sep ;31 (5):563-5 6671761
Tear glucose in ocular inflammations and its enzymatic lysis as a possible therapeutic adjunct in treatment of ocular infections.
[My paper] G K Sharma , S G Kabra , P K Sharma , L K Nepalia , S Bharadwaj , A Mehra
Friday, January 18, 2008
Female feticide & Neural Tube Defects
Dear Dr. Meeta Singh,
Please consider the following and favor with an early reply
NEURAL TUBE DEFECT
4 Dr. Kabra’s study ( Medicine Deranged 1998) Panchsheel Prakashan, Jaipur
4 May 1992—April 1993 Zanana and Mahila Chikatsalya, Med. Coll. Jaipur
4 Total Births-- 15346
4 Live Births 14,682
4 Still Births 724 (50/1000 live births)
4 Cong. Anomalies 115 (8/1000 live births)
4 Neural Tube Defect (NTD) 96 (83%) F = 62(65%)
4 M = 30(31%)
4 NR = 4
4 Other 19(17%)
I. There is prevalent rate of 50 still births per 1000 live births in the premier hospitals.
- Intra uterine death occurs in late third trimester.
- The dead child is aborted and disposed off.
- Almost half of them are female fetuses.
- Does it constitute female feticide under the MTP Act. ?
II. About 100 children are born with gross neural tube defect (NTD) i.e. brainlessness (anencephaly)
- They die after birth and are allowed to die.
- Almost 70 of them are females.
- Does delivering and disposing off these brainless female feticides constitute female feticide under the MTP Act.
CONG. ANOMALY & NTD.
4 24 Maternity Centre Jaipur including Zanana and Mahila Chikitsalya
4 Total Deliveries 23450
4 Live Births 22618
4 Still Births 832(37/1000 live births)
4 Cong. Anomalies 143(6/1000 live births)
4 Ultra Sound May 1992-April 1993
4 Total 111,127
4 Cong. Anomalies 55 (5/1000 Ultra Sound)
4 Neural Tube Defect 52
4 Other 3
- At the two premier zanana hospitals of the state, for about 1 lakh sonography
examinations done every year, about 50 NTDs (mostly brainless) are detected in
second trimester of pregnancy.
- 70-80% of them are known on ultrasound examination to be females.
- Does the medical termination of these known female fetuses constitute violation
of the PCPNDT Act/ the MTP Act/ IPC 312 ?
Since you have a very powerful legal cell in your organization advising state authorities in the matter I seek your clarification so that the doctors authorized to undertake MTPs are advised accordingly.
Thanking you
Yours truly,
Dr.S.G.Kabra
Please consider the following and favor with an early reply
NEURAL TUBE DEFECT
4 Dr. Kabra’s study ( Medicine Deranged 1998) Panchsheel Prakashan, Jaipur
4 May 1992—April 1993 Zanana and Mahila Chikatsalya, Med. Coll. Jaipur
4 Total Births-- 15346
4 Live Births 14,682
4 Still Births 724 (50/1000 live births)
4 Cong. Anomalies 115 (8/1000 live births)
4 Neural Tube Defect (NTD) 96 (83%) F = 62(65%)
4 M = 30(31%)
4 NR = 4
4 Other 19(17%)
I. There is prevalent rate of 50 still births per 1000 live births in the premier hospitals.
- Intra uterine death occurs in late third trimester.
- The dead child is aborted and disposed off.
- Almost half of them are female fetuses.
- Does it constitute female feticide under the MTP Act. ?
II. About 100 children are born with gross neural tube defect (NTD) i.e. brainlessness (anencephaly)
- They die after birth and are allowed to die.
- Almost 70 of them are females.
- Does delivering and disposing off these brainless female feticides constitute female feticide under the MTP Act.
CONG. ANOMALY & NTD.
4 24 Maternity Centre Jaipur including Zanana and Mahila Chikitsalya
4 Total Deliveries 23450
4 Live Births 22618
4 Still Births 832(37/1000 live births)
4 Cong. Anomalies 143(6/1000 live births)
4 Ultra Sound May 1992-April 1993
4 Total 111,127
4 Cong. Anomalies 55 (5/1000 Ultra Sound)
4 Neural Tube Defect 52
4 Other 3
- At the two premier zanana hospitals of the state, for about 1 lakh sonography
examinations done every year, about 50 NTDs (mostly brainless) are detected in
second trimester of pregnancy.
- 70-80% of them are known on ultrasound examination to be females.
- Does the medical termination of these known female fetuses constitute violation
of the PCPNDT Act/ the MTP Act/ IPC 312 ?
Since you have a very powerful legal cell in your organization advising state authorities in the matter I seek your clarification so that the doctors authorized to undertake MTPs are advised accordingly.
Thanking you
Yours truly,
Dr.S.G.Kabra
AIDS programme in whose aid
AIDS PROGRAM IN WHOSE AID
S.G.Kabra
Senior Scientist, IIHMR, Jaipur
-----------------------------------------------------------------
Of late, there has been a great deal of activity on AIDS awareness and control. Anybody who is somebody in the health sector, NGOs et al., appears to be concerned about AIDS.. Yet, it seems that all sponsored, funded and media hyped activities concretize to no specific guidelines or mandatory protocols when a seropositive HIV case is identified. Identification of such a case takes place in a hospital or, more specifically, in a testing laboratory. And there is no mechanism that the identifying doctor can put in motion to prevent the identified HIV positive person from spreading it. What is more, seropositivity with HIV is not even declared a notifiable condition about which it is mandatory to inform a designated nodal agency. A medical man confronted with an HIV positive case finds all the hyped awareness and prevention campaign measures farcical, and ends up just counseling the carrier, hoping against hope that good sense will prevail. Here are the details of a recent case to substantiate the point.
A 21 year old young man suffering from low grade fever, loss of body weight and generalized lymph node enlargement of the body was suspected to be a case of lymphoma (a type of cancer of lymph nodes). He had been referred to a reputed hospital laboratory for histopathological examination of his lymph node that had been removed (biopsied) elsewhere.
The pathologist did not find evidence of lymphoma in the lymph node. But, by the microscopic changes seen in the section of the node, he got suspicious of the possibility of HIV infection in the case.
The young man was taken into confidence and it was suggested that the pathologist would like to rule out the possibility of HIV, and for this he would need to do a blood test on him. The young man's blood was tested for HIV by the Elisa Method. It turned out to be positive.
When the patient returned after a couple of days to learn about the test findings, he was informed that he had tested positive for HIV. Being an educated person, he immediately understood what it meant and implied.
When asked about his sex life, he flatly denied any exposure and said he was unmarried. He was asked if he had had any transfusion of blood; he said had not. He was asked about any injections that he had taken, and he had taken no injections.
The young man was told about the Elisa method by which the test had been done in the laboratory. It was explained to him that the test gave false positive results in 3 - 5 % cases. To be certain that the test result in his case was correct, he was advised to get the test done by a more specific method i.e. the Western Blot Test.
The young man returned after a week. He apologized to the doctor and said he was sorry he had lied. He admitted that he along with four of his friends had visited “a place” and had sex with a girl. He further confided to the doctor that he had also lied about his marital status. He was married. However, he told the doctor that as yet `Gauna'(*) ceremony had not been performed and, therefore, his `wife' had not yet come to his place. He also confided that the girl (wife) was still studying and only on completion of her study would Gauna take place.
He asked the doctor for his advice. He wanted to know what his fate would be . "Is it certain that I am doomed to die of the disease ?", was his specific question. To this, the doctor's reply was that it usually took 5 - 10 years for the disease to manifest itself in its fatal form, and hopefully, by that time a cure for the disease would be found out. He was apprised of the likely course and progress of the disease. The possibility of his transmitting the disease to his sex partner was explained to him. He was told to disclose the fact of his HIV positivity to his `wife-to-be' and take her informed consent. He was advised about safe and protected sex life, and was warned not to donate his blood for anybody. He was also informed about transmission of infection through unsterilised needles.
The identifying doctor had done all that the was required to do. The farce of the situation is that this is all that he was required to do. Consider the following points in this regard :
1. Did the doctor do all that he was required to do ethically, morally and legally?
2. Was the doctor ethically, morally, legally and socially responsible to ensure that his patient did not transmit the disease to innocent persons ? If yes, how was the doctor to ensure it ?
3. Considering the nature of the infection , the doctor should have found out about the patient’s friends who had visited the source of infection and subjected them to the same test. Did he have the power to do it ? Could the boy be compelled to disclose the names of his friends ?
4. The doctor should have found out the source of the infection and then conducted the test on that woman. Was he empowered to do it ? Could the woman be compelled to submit to the test ?
5. Supposing the doctor did locate the source of the infection and confirm that the woman was HIV positive, how was he, then, to ensure that she did not transmit the disease any further ?
6. Did the doctor have any duty towards the girl betrothed to the HIV positive patient, whose name and address he had not been told ? Knowing that the girl was at prime risk what should he do ?
7. What about the implications of the recent Supreme Court Judgment ( (1998) 8 SCC 296) declaring that transmission by a seropositive HIV person to another (in the instant case his wife-to-be), would amount to be an offence under Sections 269 and 270 of the IPC ? Also to be considered is the relevance and import of Sec. 39 of Cr.P.C. in this context. Having come to know that a person is going to commit a cognizable offence, not informing the appropriate authority about it is a crime. __________________________________________________________________
P.S.
IPC Section 269 and 270 are excluded from the purview of Sec. 39 Cr.P.C.
However, Sec. 116 of IPC and other sections of IPC related to abatement, are relevant in the context of offence committed or to be committed under Ss.269 & 270 of IPC. Where does the physician having knowledge of the patient's intention to commit offence under IPC 269 and 270 stand in the light of the Supreme Court judgment ? What should he do to avoid becoming an abettor in the crime ?
Gauna = A mandatory ceremony essential to be performed to complete the marriage ritual (including child marriage) before the bride is sent to the bridegroom’s place and cohabitation is permitted. It is performed after the girl has attained puberty ( in case of child marriage), and when the parents of the girl consider it fit and appropriate.
Dr.S.G.Kabra
MBBS,LLB,MSc,MS (Anat.),MS (Gen.Surg)
Senior Scientist
IIHMR
Jaipur
S.G.Kabra
Senior Scientist, IIHMR, Jaipur
-----------------------------------------------------------------
Of late, there has been a great deal of activity on AIDS awareness and control. Anybody who is somebody in the health sector, NGOs et al., appears to be concerned about AIDS.. Yet, it seems that all sponsored, funded and media hyped activities concretize to no specific guidelines or mandatory protocols when a seropositive HIV case is identified. Identification of such a case takes place in a hospital or, more specifically, in a testing laboratory. And there is no mechanism that the identifying doctor can put in motion to prevent the identified HIV positive person from spreading it. What is more, seropositivity with HIV is not even declared a notifiable condition about which it is mandatory to inform a designated nodal agency. A medical man confronted with an HIV positive case finds all the hyped awareness and prevention campaign measures farcical, and ends up just counseling the carrier, hoping against hope that good sense will prevail. Here are the details of a recent case to substantiate the point.
A 21 year old young man suffering from low grade fever, loss of body weight and generalized lymph node enlargement of the body was suspected to be a case of lymphoma (a type of cancer of lymph nodes). He had been referred to a reputed hospital laboratory for histopathological examination of his lymph node that had been removed (biopsied) elsewhere.
The pathologist did not find evidence of lymphoma in the lymph node. But, by the microscopic changes seen in the section of the node, he got suspicious of the possibility of HIV infection in the case.
The young man was taken into confidence and it was suggested that the pathologist would like to rule out the possibility of HIV, and for this he would need to do a blood test on him. The young man's blood was tested for HIV by the Elisa Method. It turned out to be positive.
When the patient returned after a couple of days to learn about the test findings, he was informed that he had tested positive for HIV. Being an educated person, he immediately understood what it meant and implied.
When asked about his sex life, he flatly denied any exposure and said he was unmarried. He was asked if he had had any transfusion of blood; he said had not. He was asked about any injections that he had taken, and he had taken no injections.
The young man was told about the Elisa method by which the test had been done in the laboratory. It was explained to him that the test gave false positive results in 3 - 5 % cases. To be certain that the test result in his case was correct, he was advised to get the test done by a more specific method i.e. the Western Blot Test.
The young man returned after a week. He apologized to the doctor and said he was sorry he had lied. He admitted that he along with four of his friends had visited “a place” and had sex with a girl. He further confided to the doctor that he had also lied about his marital status. He was married. However, he told the doctor that as yet `Gauna'(*) ceremony had not been performed and, therefore, his `wife' had not yet come to his place. He also confided that the girl (wife) was still studying and only on completion of her study would Gauna take place.
He asked the doctor for his advice. He wanted to know what his fate would be . "Is it certain that I am doomed to die of the disease ?", was his specific question. To this, the doctor's reply was that it usually took 5 - 10 years for the disease to manifest itself in its fatal form, and hopefully, by that time a cure for the disease would be found out. He was apprised of the likely course and progress of the disease. The possibility of his transmitting the disease to his sex partner was explained to him. He was told to disclose the fact of his HIV positivity to his `wife-to-be' and take her informed consent. He was advised about safe and protected sex life, and was warned not to donate his blood for anybody. He was also informed about transmission of infection through unsterilised needles.
The identifying doctor had done all that the was required to do. The farce of the situation is that this is all that he was required to do. Consider the following points in this regard :
1. Did the doctor do all that he was required to do ethically, morally and legally?
2. Was the doctor ethically, morally, legally and socially responsible to ensure that his patient did not transmit the disease to innocent persons ? If yes, how was the doctor to ensure it ?
3. Considering the nature of the infection , the doctor should have found out about the patient’s friends who had visited the source of infection and subjected them to the same test. Did he have the power to do it ? Could the boy be compelled to disclose the names of his friends ?
4. The doctor should have found out the source of the infection and then conducted the test on that woman. Was he empowered to do it ? Could the woman be compelled to submit to the test ?
5. Supposing the doctor did locate the source of the infection and confirm that the woman was HIV positive, how was he, then, to ensure that she did not transmit the disease any further ?
6. Did the doctor have any duty towards the girl betrothed to the HIV positive patient, whose name and address he had not been told ? Knowing that the girl was at prime risk what should he do ?
7. What about the implications of the recent Supreme Court Judgment ( (1998) 8 SCC 296) declaring that transmission by a seropositive HIV person to another (in the instant case his wife-to-be), would amount to be an offence under Sections 269 and 270 of the IPC ? Also to be considered is the relevance and import of Sec. 39 of Cr.P.C. in this context. Having come to know that a person is going to commit a cognizable offence, not informing the appropriate authority about it is a crime. __________________________________________________________________
P.S.
IPC Section 269 and 270 are excluded from the purview of Sec. 39 Cr.P.C.
However, Sec. 116 of IPC and other sections of IPC related to abatement, are relevant in the context of offence committed or to be committed under Ss.269 & 270 of IPC. Where does the physician having knowledge of the patient's intention to commit offence under IPC 269 and 270 stand in the light of the Supreme Court judgment ? What should he do to avoid becoming an abettor in the crime ?
Gauna = A mandatory ceremony essential to be performed to complete the marriage ritual (including child marriage) before the bride is sent to the bridegroom’s place and cohabitation is permitted. It is performed after the girl has attained puberty ( in case of child marriage), and when the parents of the girl consider it fit and appropriate.
Dr.S.G.Kabra
MBBS,LLB,MSc,MS (Anat.),MS (Gen.Surg)
Senior Scientist
IIHMR
Jaipur
Second Trimester Abortions are Cruel Violation of Human Rights
NON-THERPEUTIC SECOND TRIMESTER TERMINATION OF PREGNANCIES IS GROSS HUMAN RIGHTS VIOLATION.
ABATTOIRS AND ABETTORS
MERCENARIES AND MISSIONARIES
On the occasion of signing the Partial Birth Abortion Act 2003 on November 5, 2003, President Bush stated, “For years, a terrible form of violence has been directed against children who are inches from birth, while the law looked the other way. Today, at last, the American people and our government have confronted the violence and come to the defense of the innocent child.”
It may be noted that the implied distinction between infanticide and partial birth abortion is “children who are inches from birth’.
Alluding to the compelling evidence that led the members of the House and Senate to pass the legislation, President Bush stated:-.
“The best case against partial birth abortion is a simple description of what happens and to whom it happens. It involves the partial delivery of a live boy or girl, and a sudden, violent end of that life. Our nation owes its children a different and better welcome.”
The description of partial birth abortion in terms of what happens and to whom it happens is:-
A parallel Second-trimester termination-of-pregnancy permitted by law upto the 20th week of pregnancy and practiced in the country is Dilatation & Evacuation. A medical doctor who practised the procedure for long describes it in graphic details thus:-
A Medical Doctor describes the Dilation and Evacuation Procedure
-- Dr. Tony Levatino, M.D.
Imagine for a moment that you are a "pro-choice" obstetrician-gynecologist as I once was. Your patient today is seventeen years old and she is twenty weeks pregnant. At twenty weeks, her uterus is up to her umbilicus and she has been feeling her baby kick for the last two weeks. If you could see her baby, she would be as long as your hand from the top of her head to the bottom of her rump not counting the legs. Your patient is now asleep on an operating room table with her legs in stirrups. Upon entering the room after scrubbing, you dry your hands with a sterile towel and are gowned and gloved by the scrub nurse.
The first task is remove the laminaria that had earlier been placed in the cervix to dilate it sufficiently to allow the procedure you are about to perform. With that accomplished, direct your attention to the surgical instruments arranged on a small table to your right. The first instrument you reach for is a 14-French suction catheter. It is clear plastic and about nine inches long. It has a bore through the center approximately ¾ of an inch in diameter. Picture yourself introducing the catheter through the cervix and instructing the circulating nurse to turn on the suction machine which is connected through clear plastic tubing to the catheter. What you will see is a pale yellow fluid the looks a lot like urine coming through the catheter into a glass bottle on the suction machine. This amniotic fluid surrounded the baby to protect her.
With suction complete, look for your Sopher clamp. This instrument is about thirteen inches long and made of stainless steel. At one end are located jaws about 2 ½ inches long and about ¾ on an inch wide with rows of sharp ridges or teeth. This instrument is for grasping and crushing tissue. When it gets hold of something, it does not let go.
A second trimester D&E abortion is a blind procedure. The baby can be in any orientation or position inside the uterus. Picture yourself reaching in with the Sopher clamp and grasping anything you can. At twenty weeks gestation, the uterus is thin and soft so be careful not to perforate or puncture the walls. Once you have grasped something inside, squeeze on the clamp to set the jaws and pull hard – really hard. You feel something let go and out pops a fully formed leg about 4 to 5 inches long. Reach in again and grasp whatever you can. Set the jaw and pull really hard once again and out pops an arm about the same length. Reach in again and again with that clamp and tear out the spine, intestines, heart and lungs.
The toughest part of a D&E abortion is extracting the baby’s head. The head of a baby that age is about the size of a plum and is now free floating inside the uterine cavity. You can be pretty sure you have hold of it if the Sopher clamp is spread about as far as your fingers will allow. You will know you have it right when you crush down on the clamp and see a pure white gelatinous material issue from the cervix. That was the baby’s brains. You can then extract the skull pieces. If you have a really bad day like I often did, a little face may come out and stare back at you.
Congratulations! You have just successfully performed a Suction D&E abortion. You just affirmed her right to choose. You just made $600 cash in fifteen minutes.
For more medical information on D&E abortion, see the following texts:
Abortion Practice, by Warren M. Hern, M.D., M.P.H. (1990: Alpenglo Graphics, Inc., 1130 Alpine, Boulder, CO 80304), ISBN 0-9625728-0-2.
Second Trimester Abortion: Perspectives After a Decade of Experience, Edited by Gary S. Berger, William E. Brenner, and Louis G. Keith (1981: Martinus Nijhoff Publishers, PO Box 566, 2501 CN The Hague, The Netherlands and John Wright, PSG, Inc., 545 Great Road, Littleton, MA 01460), ISBN 90-247-2487-2.
A pictorial presentation of D & E procedure is reproduced below for you to visualize and understand the same.
Obviously, an obstetrician or other physician who is required to, or opts to do the aforesaid procedures has to be desensitized to the tender feelings one expects for a tender life in the womb. One has to be totally indifferent, if not callous, to the life in the womb. Over enthusiastic and zealous abortionists are likely to be totally dehumanized.
Of the total of 96,79,484 registered Medical Terminations of Pregnancy done and reported since the MTP Act came into being, in a period from 1977 to 1997, 13 lakh 39 thousand i.e. approximately 14 % were performed for second trimester abortion. Presently it is estimated that 40 to 50 lakh pregnancy terminations, registered and reported, unreported and clandestine, are being done in the country every year. All methods for second trimester abortion cause violent death of the live child in the womb.
ABATTOIRS AND ABETTORS
MERCENARIES AND MISSIONARIES
On the occasion of signing the Partial Birth Abortion Act 2003 on November 5, 2003, President Bush stated, “For years, a terrible form of violence has been directed against children who are inches from birth, while the law looked the other way. Today, at last, the American people and our government have confronted the violence and come to the defense of the innocent child.”
It may be noted that the implied distinction between infanticide and partial birth abortion is “children who are inches from birth’.
Alluding to the compelling evidence that led the members of the House and Senate to pass the legislation, President Bush stated:-.
“The best case against partial birth abortion is a simple description of what happens and to whom it happens. It involves the partial delivery of a live boy or girl, and a sudden, violent end of that life. Our nation owes its children a different and better welcome.”
The description of partial birth abortion in terms of what happens and to whom it happens is:-
A parallel Second-trimester termination-of-pregnancy permitted by law upto the 20th week of pregnancy and practiced in the country is Dilatation & Evacuation. A medical doctor who practised the procedure for long describes it in graphic details thus:-
A Medical Doctor describes the Dilation and Evacuation Procedure
-- Dr. Tony Levatino, M.D.
Imagine for a moment that you are a "pro-choice" obstetrician-gynecologist as I once was. Your patient today is seventeen years old and she is twenty weeks pregnant. At twenty weeks, her uterus is up to her umbilicus and she has been feeling her baby kick for the last two weeks. If you could see her baby, she would be as long as your hand from the top of her head to the bottom of her rump not counting the legs. Your patient is now asleep on an operating room table with her legs in stirrups. Upon entering the room after scrubbing, you dry your hands with a sterile towel and are gowned and gloved by the scrub nurse.
The first task is remove the laminaria that had earlier been placed in the cervix to dilate it sufficiently to allow the procedure you are about to perform. With that accomplished, direct your attention to the surgical instruments arranged on a small table to your right. The first instrument you reach for is a 14-French suction catheter. It is clear plastic and about nine inches long. It has a bore through the center approximately ¾ of an inch in diameter. Picture yourself introducing the catheter through the cervix and instructing the circulating nurse to turn on the suction machine which is connected through clear plastic tubing to the catheter. What you will see is a pale yellow fluid the looks a lot like urine coming through the catheter into a glass bottle on the suction machine. This amniotic fluid surrounded the baby to protect her.
With suction complete, look for your Sopher clamp. This instrument is about thirteen inches long and made of stainless steel. At one end are located jaws about 2 ½ inches long and about ¾ on an inch wide with rows of sharp ridges or teeth. This instrument is for grasping and crushing tissue. When it gets hold of something, it does not let go.
A second trimester D&E abortion is a blind procedure. The baby can be in any orientation or position inside the uterus. Picture yourself reaching in with the Sopher clamp and grasping anything you can. At twenty weeks gestation, the uterus is thin and soft so be careful not to perforate or puncture the walls. Once you have grasped something inside, squeeze on the clamp to set the jaws and pull hard – really hard. You feel something let go and out pops a fully formed leg about 4 to 5 inches long. Reach in again and grasp whatever you can. Set the jaw and pull really hard once again and out pops an arm about the same length. Reach in again and again with that clamp and tear out the spine, intestines, heart and lungs.
The toughest part of a D&E abortion is extracting the baby’s head. The head of a baby that age is about the size of a plum and is now free floating inside the uterine cavity. You can be pretty sure you have hold of it if the Sopher clamp is spread about as far as your fingers will allow. You will know you have it right when you crush down on the clamp and see a pure white gelatinous material issue from the cervix. That was the baby’s brains. You can then extract the skull pieces. If you have a really bad day like I often did, a little face may come out and stare back at you.
Congratulations! You have just successfully performed a Suction D&E abortion. You just affirmed her right to choose. You just made $600 cash in fifteen minutes.
For more medical information on D&E abortion, see the following texts:
Abortion Practice, by Warren M. Hern, M.D., M.P.H. (1990: Alpenglo Graphics, Inc., 1130 Alpine, Boulder, CO 80304), ISBN 0-9625728-0-2.
Second Trimester Abortion: Perspectives After a Decade of Experience, Edited by Gary S. Berger, William E. Brenner, and Louis G. Keith (1981: Martinus Nijhoff Publishers, PO Box 566, 2501 CN The Hague, The Netherlands and John Wright, PSG, Inc., 545 Great Road, Littleton, MA 01460), ISBN 90-247-2487-2.
A pictorial presentation of D & E procedure is reproduced below for you to visualize and understand the same.
Obviously, an obstetrician or other physician who is required to, or opts to do the aforesaid procedures has to be desensitized to the tender feelings one expects for a tender life in the womb. One has to be totally indifferent, if not callous, to the life in the womb. Over enthusiastic and zealous abortionists are likely to be totally dehumanized.
Of the total of 96,79,484 registered Medical Terminations of Pregnancy done and reported since the MTP Act came into being, in a period from 1977 to 1997, 13 lakh 39 thousand i.e. approximately 14 % were performed for second trimester abortion. Presently it is estimated that 40 to 50 lakh pregnancy terminations, registered and reported, unreported and clandestine, are being done in the country every year. All methods for second trimester abortion cause violent death of the live child in the womb.
Tuesday, January 15, 2008
Female feticide
Femal feticide and abortion
Legal termination of pregnancy is ‘abortion’.
Illegal termination of ‘pregnancy’ is feticide.
Destruction of fetus is precondition of pregnancy termination.
Feticides and female feticides take place by contravention of the MTP Act.
Statutory authority to implement the provisions of MTP Act is the Chief Medical Officer.
CMOs are to ensure that feticides and female feticides do not take place by contravention of the MTP Act.
They are not doing it and hence the feticides and female feticides.
To prevent female feticides the MTP Act must be rigorously implement, supervised and monitored.
Female feticides take place in second trimester abortions i.e. between 13 to 20 weeks.
Second trimester abortions are riskier and violent methods of termination and are permitted in law only for medically assessed and certified life threatening or grave injuring causing conditions.
Second trimester abortion is not permitted for pregnancy due to contraceptive failure.
Irresponsible second trimester abortions are a grave human rights violations.
Abortion and Feticide
Therapeutic and Non-therapeutic abortions
Abortion on medical grounds and on non-medical grounds
Legal abortion and illegal or criminal abortion
Abortion as a personal (fundamental) right of woman
Dr.S.G.Kabra, SDM Hospital and IIHMR, Jaipur
Legal termination of pregnancy is ‘abortion’.
Illegal termination of ‘pregnancy’ is feticide.
Destruction of fetus is precondition of pregnancy termination.
Feticides and female feticides take place by contravention of the MTP Act.
Statutory authority to implement the provisions of MTP Act is the Chief Medical Officer.
CMOs are to ensure that feticides and female feticides do not take place by contravention of the MTP Act.
They are not doing it and hence the feticides and female feticides.
To prevent female feticides the MTP Act must be rigorously implement, supervised and monitored.
Female feticides take place in second trimester abortions i.e. between 13 to 20 weeks.
Second trimester abortions are riskier and violent methods of termination and are permitted in law only for medically assessed and certified life threatening or grave injuring causing conditions.
Second trimester abortion is not permitted for pregnancy due to contraceptive failure.
Irresponsible second trimester abortions are a grave human rights violations.
Abortion and Feticide
Therapeutic and Non-therapeutic abortions
Abortion on medical grounds and on non-medical grounds
Legal abortion and illegal or criminal abortion
Abortion as a personal (fundamental) right of woman
Dr.S.G.Kabra, SDM Hospital and IIHMR, Jaipur
Monday, January 7, 2008
Criminal Abortions and Professional Ethics
CRIMINAL ABORTIONS AND PROFESSIONAL ETHICS
All cases of maternal mortality due to unsafe and unlicensed abortions are
cases of double homicide (murder) and are required under law (Criminal Procedure Code Section 39 and 174 read with Indian Penal Code Sections 201, 299, 312 and 314) to be reported to the police, subjected to inquest and criminal prosecutions launched. Although a doctor’s primary duty is towards her patient and nothing she does should interfere with or delay treatment, it is her public duty, once the patient is under treatment, to report the incidence to the authorities at the earliest so that the perpetrator of a criminal abortion is prevented from repeating it. If she fails in this duty, the doctor is presumed, in the eyes of the law, to be siding with the criminal with a view to shielding him.
If a doctor submits any case material connected with the criminal abortion for publication in a professional journal, the details of criminal investigation and the action, if any, taken against the criminals must be mentioned. The editor of the journal also has a special responsibility here. He must be satisfied that the author(s) reporting the case study have done all that they were legally required to do in that particular case. How they ensure this will depend on the journal's policy and their concern and commitment to prevent criminal
abortions. They certainly should not publish a report whose tone suggests concealing the criminal or condoning the crime. A professional medical journals cannot publish reports, singly or as compilations, of these cases without such details. If it does so, it would amount to documented defiance of law (having identified the crime, the criminal and the place of its occurrence in the report neither the doctor nor the journal can plead ignorance and innocence). Yet, in what may be construed as defiance of the law, the Journal of Obstetrics and Gynaecology of India has been regularly publishing compiled or single accounts of these ghastly murders as “rare”, “unusual”, and interesting” case reports.
"There are graphic details of the horrors inflicted by the criminal acts of
the illegal abortionists in the individual reports from Muzaffarpur,
Murshidabad, Patna, Guahati, Madras, Thanjavur and Ranchi, published in the
last two years of The Journal of Obstetrics and Gynaecology of India, but in
none of the reports is there any mention of the steps taken against the
culprits." (SG Kabra: Miscarriage of Medicine)
However, illegal abortions are apparently not considered criminal and are not
reported to the police as required by the law, even when they prove fatal. The law, further, requires that all unnatural deaths of women within 7 years of their marriage should be reported. This attitude is exemplified by the observations of the attending doctors in a case where an illegal abortion done by a 'dai' with the help of stick resulted in deadly gas gangrene sepsis. The case was reported in the Journal of Obstetrics and Gynaecology of India and the author, Shakuntala Sahey, states: "As her relatives were not willing, autopsy could not be done". This is despite the fact that that the abortion was done by an unauthorized person and it was a case of unnatural death with manifest evidence of foul play. Exactly the same assertion has been made a recent publication: "Autopsy was advised in all these cases, but refused by relatives”.
All cases of maternal mortality due to unsafe and unlicensed abortions are
cases of double homicide (murder) and are required under law (Criminal Procedure Code Section 39 and 174 read with Indian Penal Code Sections 201, 299, 312 and 314) to be reported to the police, subjected to inquest and criminal prosecutions launched. Although a doctor’s primary duty is towards her patient and nothing she does should interfere with or delay treatment, it is her public duty, once the patient is under treatment, to report the incidence to the authorities at the earliest so that the perpetrator of a criminal abortion is prevented from repeating it. If she fails in this duty, the doctor is presumed, in the eyes of the law, to be siding with the criminal with a view to shielding him.
If a doctor submits any case material connected with the criminal abortion for publication in a professional journal, the details of criminal investigation and the action, if any, taken against the criminals must be mentioned. The editor of the journal also has a special responsibility here. He must be satisfied that the author(s) reporting the case study have done all that they were legally required to do in that particular case. How they ensure this will depend on the journal's policy and their concern and commitment to prevent criminal
abortions. They certainly should not publish a report whose tone suggests concealing the criminal or condoning the crime. A professional medical journals cannot publish reports, singly or as compilations, of these cases without such details. If it does so, it would amount to documented defiance of law (having identified the crime, the criminal and the place of its occurrence in the report neither the doctor nor the journal can plead ignorance and innocence). Yet, in what may be construed as defiance of the law, the Journal of Obstetrics and Gynaecology of India has been regularly publishing compiled or single accounts of these ghastly murders as “rare”, “unusual”, and interesting” case reports.
"There are graphic details of the horrors inflicted by the criminal acts of
the illegal abortionists in the individual reports from Muzaffarpur,
Murshidabad, Patna, Guahati, Madras, Thanjavur and Ranchi, published in the
last two years of The Journal of Obstetrics and Gynaecology of India, but in
none of the reports is there any mention of the steps taken against the
culprits." (SG Kabra: Miscarriage of Medicine)
However, illegal abortions are apparently not considered criminal and are not
reported to the police as required by the law, even when they prove fatal. The law, further, requires that all unnatural deaths of women within 7 years of their marriage should be reported. This attitude is exemplified by the observations of the attending doctors in a case where an illegal abortion done by a 'dai' with the help of stick resulted in deadly gas gangrene sepsis. The case was reported in the Journal of Obstetrics and Gynaecology of India and the author, Shakuntala Sahey, states: "As her relatives were not willing, autopsy could not be done". This is despite the fact that that the abortion was done by an unauthorized person and it was a case of unnatural death with manifest evidence of foul play. Exactly the same assertion has been made a recent publication: "Autopsy was advised in all these cases, but refused by relatives”.
Thursday, January 3, 2008
Medicine Deranged: Indian Statism and Nazism-A Saga of Human Rights Violations in Reproductive Health.
Medicine Deranged: Indian Statism and Nazism-A Saga of Human Rights Violations in Reproductive Health.
Dr.S.G.Kabra
Successive governments in India have insidiously co-opted the medical profession to implement its socioeconomic policies. The medical profession, on its part, has silently acquiesced in compromising its standards of care and subjected Indian women to the barbaric and horrific procedures. The totality of this medical violence inflicted on a helpless population might shame even the Nazis.
Thanks to the pressure of the “International Community” (read “Developed Nations”), India has been converted into a concentration camp for women of reproductive age. To live their reproductive lives they are at the mercy of the State and the state-co-opted-NGOs. For the great cause of population control, promoted and financed by international agencies, no means are improper and no holds are barred. Ethical considerations are considered senseless niceties for the fast multiplying natives. Safety norms, for the same reason and for reasons of urgency, are impractical. Preventive depopulation by contraception and promotive depopulation by medical termination of pregnancy (the births ‘averted’ and the births ‘prevented’ of population controllers) are State enforced medical solutions to the social problem of poverty. Infanticides for reasons of poverty, though sporadic and few, were considered barbarous, and justly so. But, elimination of five million fetuses through medical termination of pregnancy (MTPs), brings international acclaim and huge funds (the reward). The deaths of thousands of women from septic abortions and tubectomies, are overlooked with impunity. This is nothing but preventive elimination of the poor as a part of the poverty control programme.
De-population is a Nazi concept of development. While Hitler practiced it in Germany, developed countries are practicing it in India. The liability to become pregnant is a deadly illness and eugenic preventive medicine is geared to eradicate it as far as possible. For women in the reproductive age group, India is a large concentration camp where neo-Nazis operating as population experts eliminate fetuses and females in the name of welfare.
Non-therapeutic abortions (abortions other than those performed to save the live of the mother) are freely promoted, aggressively marketed and effectively enforced by state-co-opted medical professionals. The unabashed enthusiasm to undertake non-therapeutic interventions is unethical, to say the least. But then, ethics are the first casualty when the State drafts medical men to correct social pathologies.
Contraception is not a choice; it is a State demand. Medical termination of pregnancy is not a reproductive right of women for unwanted pregnancies (to be exercised in the first 12 weeks of pregnancy), but an aggressively pursued state policy of de-population (upto 20 weeks of pregnancy by law and thereafter by default).
LAPAROSCOPY DEATHS
The following account of laparoscopic deaths published in the official journal of the Federation of Obstetrics and Gynaecology of India illustrates the utter disregard shown to women as patient and persons. (1)
“ Number of cases attending each camp varied from 25 to 500 cases per day per two surgeons. Therefore, thorough clinical screening of all the patients before operation could not be done.”
“One case expired following sedation only. Half-an-hour after sedation (Inj.Pethidine-100 mg,Phenargan25-50 mg and Inj. Atropine I.M.) she was put to O.T.(operation table?) where uterus was found to be 24 weeks size due to pregnancy, which she concealed; she was sent back to pre-operative room where she fell asleep. During sleep she expired which was detected after four hours, the exact time of death was unnoticed.”
The cause of death according to the authors was: -
“ In the first case, who was moderately anaemic, pethidine and phenargan might have produced hypotension and respiratory depression (Parikh, 1985) which was unnoticed until her death. Moreover she was starving for almost 24 hours causing hypoglycaemia resulting in less uptake of oxygen by the vital centres of medulla (respiratory, cardiac and vasomotor), which became subnormal in their function. Brain-stem reticular formation also became less active resulting in a stuporous condition which probably became worse by the depressive action of the sedative applied on the reticular activating system (R.A.S.).”
The doctor-authors provide the following details of the other three cases that died:
“Other three cases expired within 2-3 minutes following the completion of pneumo-peritonium. Series of events were like this: sub umbilical infiltration of 1% lignocaine was given in one case and no local anaesthesia was given in other two cases. Pneumo-peritonium was done without any difficulty by about two litters (sic) of oxygen at a rate of one litter per minute.”
“ Immediately after the withdrawal of the Veress needle whole body of the patient went into convulsive movements with rigidity for a short while; they became unconscious; veins of the lower extremities unto the hips were engorged. Respiration, heart sounds and peripheral pulse were gradually slowing down in both rate and volume and ultimately stopped within 2-3 minutes.”
“ In present series oxygen was used as the insufflating agent in all the cases, which was used directly from the oxygen cylinder to the Veress needle through polythene tubing. Oxygen was used because of its easier availability than CO2 or N2O. But as the oxygen cylinder can not be used in the carbon di-oxide pneumo apparatus because of absence of fitting arrangement, increased intraperitoneal pressure could not be read.”
Should the medical professionals undertake more cases than they can handle ?
Should not all patients be fully examined before intervention ?
Why was no anaesthetic employed in the case ?
On what grounds was it permissible to use oxygen instead of carbon dioxide for fcreating pneumoperitonium ?
Why did the attendant doctors not take active steps to try and save the lives of the patients who convulsed and died ?
Why was no proper apparatus used to deliver gas to the abdomen ?
Why were autopsies not performed ?
Should the doctors or the State or both be held responsible for the deaths ?
Do not the editors and publishers of the journal have an ethical liability for publishing such a report as a research paper?
A recent article in the same journal shows that the attitude of the professionals has not changed since 1989 whence the above report was published. (2)
The authors report 16 deaths. It is indeed commendable for the authors to report tubal ligation deaths at their hands. In the summary they state: "Deaths due to family welfare programme is tragic, painful and unbearable as it (sic)is always premature & preventable."In any paper on therapeutic misadventures, the authors are expected to suggest the casue of the complications and how best they can be avoided. This has not been the case in the present paper.On the other hand, the authors make a platitudinal general statement (obviously culled from a text book):-"Use of endotracheal intubation for general anesthesia, particularly for laparoscopic sterilization, careful insertion of needle & trocar, strict follow up of standard infection control measure in & outside operation theatres, prophylactic use of broad spectrum antibiotics & discontinuation of oral contraceptive prior to sterilization may help to prevent sterilization attributable deaths." Is it to be presumed that in the aforesaid cases these norms were not followed? If so, the authors must explain why. Otherwise, these deaths would amount to gross negligence or even homicide. The editors have permitted them to gloss over these essential issues.The appropriateness of the treatment of injury and the final event that caused death are based on biased interpretations, presumptions and conjectures and are not based on independent investigation. This is not how hospital deaths are investigated and certainly not deaths of healthy women in whom a non-therapeutic interference has been done. No one would be wiser by reading these reports.Finally the statement of the authors:"Autopsy was advised in all these cases,(pulmonary embolism)but refused by relatives."Autopsy in these cases (death of married women within seven years of marriage) is part of a mandatory inquest by a magistrate.This report may not be as crude as the 1989 report but it is far from an ethical presentation fit for publication in the official journal of a professional association.
Medical Termination of Pregnancy (MTP)
The right to safe abortion has been granted to women as a fundamental right to life and personal liberty under Article 21 of the Constitution of India and codified in the MTP Act, MTP Rules and MTP Regulations.
Anybody who inflicts, encourages or condones unsafe abortion in contravention of the codified law commits a crime. Yet articles in academic journals describe unsafe, and therefore criminal, abortions and identify the person who conducted it, and the place where it is performed. Legally, they are required to report these to the police, at least after treatment is given and certainly if the woman dies. The articles published in the Journal of Obstetrics and Gynecology of India (1-6) give graphic details of the horrors inflicted by criminal acts of illegal abortionists. None of these mention the steps taken against the culprits.
All cases of maternal mortality due to unsafe and unlicensed abortions are cases of double homicide (murder) and are required under law ( CrPC. Section 39 and 174 read with IPC Sections 201, 299, 312and 314) to be reported to the police and subjected to inquest. Prosecutions may follow. By not doing it, the authors (the treating doctors), in law, are presumed to be siding with the criminals with a view to shield them.
Doctors’ primary duty is to treat the patient. They should do nothing that they feel will interfere with or delay treatment. Once the patient is treated it is their public duty to report the incident to the authorities so that the perpetrator of a criminal abortion is prevented from repeat the crime.
The documentation of these murders should not be published as research articles. Such publications amount to documented defiance of law and criminal justice.
Research into the cases of septic and unsafe abortion has to cover two aspects: the cause of injuries and their treatment. A properly done MTP should not cause injury to other organs like the bladder or intestine. If it has occurred there must be either some unrecognized abnormality in the patient or some lapse in the procedure itself. A properly conducted research may help clrify matters and help doctors avoid such mishaps in future.
Editors must be satisfied that authors reporting a crime through their journal have done all that they were legally required to do in that particular case. How they ensure this will depend on the journal’s policy. They certainly should not publish a report the tone of which is to condone or conceal the crime.
However illegal abortions are apparently not considered criminal and are not reported to the police as required by the law, even when they prove fatal. This attitude is exemplified by the observations of the attending doctors in the report of an illegal abortion done by a 'dai' with the help of stick that resulted in deadly infection of gas gangrene, where Shakuntala Sahey stated (J Obst Gynec India, 1984) "As her relatives were not willing, autopsy could not be done", even though the fact that that the abortion was done by an unauthorized person and it was a case of unnatural death with manifest evidence of foul play is on the record. Exactly the same assertion has been made in the recent publications (1), where the authors state "Autopsy was advised in all these cases, but refused by relatives", exemplifying the attitude of medical professionals not to report unnatural deaths in women (specifically within 7 years of marriage).
Chemical abortificeant paste
As a result of an unhealthy enthusiasm to popularise abortions for population control, a chemical paste, “Fetex Paste”, was licensed, publicized and popularised as an abortificient. This paste has been reported to cause severe peritonitis, gangrene of various organs, kidney failure etc. in a large number of patients in whom it was used to terminate pregnancy. In a 1985 report (7) titled The Dangerous Fetex Paste, of 3 patients, two died. The third survived renal failure but her "whole vagina and cervix were sloughed and necrosed" after the illegal abortion with 'Fetex paste' proved disastrous. The authors had pleaded: "Advertisements in Journals should be stopped and the product should be withdrawn from the market". The Journal of Obstetrics and Gynecology of India was one such journal advertising the Fetex Paste. Following spate of these reports in medical journals and the lay press, this presumably Ayurvedic preparation by Gambers Laboratory, was 'withdrawn' or was 'banned'. However, in a recent report of the 34 women who died of septic abortion, in 25 a 'kutchi' (stick) was used by 'dai/quack'; Fetex Paste was used in 3 patients by 'G.P's.(3).
there can be no worse reflection on the prevailing professional standards, ethics and the role of the drugs control machinery than the fact that despite years of reports of severe adverse effects and fatal outcomes from the use of the chemical abortificieant paste, nobody questions how this obviously dangerous paste was permitted to be licensed as an abortificeant paste. Was it ethical for the practitioners of modern medicine to use this Ayurvedic preparation ? Was it ethical to advertise it in the Journal of Obstetrics and Gynecology of India, the official journal of the Federation ?
MTP: saga of inhuman experiments (8-13)
Any form of physical or chemical interference with the conceptus in the womb is potentially noxious enough to cause abortion, especially in the early stage of pregnancy up to 20 weeks during which period MTP is permitted. Even introduction of a fine needle for aspiration of amniotic fluid may result in abortion. But simply because MTP is permitted it does not mean one can experiment with any substance or method. Yet, studies (8-13) report the use of distilled water, normal saline, hypertonic saline, boiling water, various chemicals including corrosive substances similar to 'fetex paste' and rubber catheters. These were injected intra- or extra-amniotically. These injected singly or in various combinations, have been used to experiment and re-experiment upon thousands of women and have been reported as research publications.
These are all human experiments. No standard medical journal today publishes a report unless the authors provide the editor written documentation that a competent ethical committee's clearance was obtained and the study was conducted under their supervision. The ethics committee is supposed to give clearance as per the guidelines of the ICMR. It has to conform to a very strict protocol. Recruitment of patients, especially captive patients, has to be on the basis of informed and free consent. It may also be remembered that any substance or device used in the human body is a drug in the eyes of law. Even an approved drug when used for a different purpose or by a different route or different dose schedule or combination constitutes a new drug, the human trial of which needs prior approval of the Drugs Controller.
None of the aforesaid "studies" appear to conform to ethical standards for human experiments. How could instillation of distilled water(9), boiling water, a powdered tablet (13) or rubber catheter(12) be permitted? Imagine the indignity and discomfort of a Foley's catheter introduced in the uterus, its balloon inflated and left in a pregnant lady for 6-18 hours. How does it differ from the use of a sterile stick and cow's urine by quacks?
One must read the details of the aforesaid reports to understand the gross indignities inflicted and human rights violations involved.
Let an independent body of medical and social professionals assess if these studies meet ethical criteria.
I reproduce hereunder text from my book to substantiate my above submissions and show how the things have just not changed.(Miscarriage of Medicine (Panchsheel Prakashan, Jaipur.1993): Merciless Assault on Mothers Womb p.34)
"Miss Nupur Lauria and Miss Arpita Bhargave of SMS Medical College, Jaipur, have compiled the data of the eleven research papers published in the Journal of Obstetrics and Gynecology of India in 1984 and 1985. Various research groups conducted MTP trials on 2303 women in second trimester of pregnancy. One research group used intra-amniotic injection of hypertonic saline in 500 cases, another used distilled water in 250 cases, third used urea with prostaglandin in 25 cases, fourth extended the method of suction evacuation to 320 cases in their mid trimester, the fifth tried combination of prostaglandin intra-muscular injection with mechanical dilatation of cervix on three groups of 200 cases, the sixth has tried his hand at all types of methods in rural women using hypertonic saline in 200 cases, manittol in 9, ethacridine lactate in 5 and prostaglandin analogue in 2 cases.
The Seventh uses prostaglandin alone and with dilatation in 120 cases, the eighth tries the same using catheter and prostaglandins in 200 women, the ninth researcher group tries vaginal prostaglandin in 62 cases, the tenth group tries the introduction of hypertonic saline through cervical canal in 120 cases and compares the results with introduction of rubber catheter in 120 cases and the eleventh group studies mid trimester abortions with intra-muscular injection of prostaglandin."
What is the rationality of repeating these various experiments when the disadvantages of many of them have already been adequately evaluated? There is no evidence that any thought has been given to plan these trials to obviate biased inferences. As a result, most of the studies are exercises in futility. Why then increase the risk to the women undergoing these trials? There is no evidence that clearance of the ethical committee was taken before conducting the trials. No informed consent of the women subjected to these trials was taken. And worse still, the Indian Council of Medical Research is a party to it all by commission and omission.
In conclusion, therefore, anybody doing anything to terminate pregnancy is not only permitted to do so but the act goes unchallenged even if it kills or cripples the woman. It is no exaggeration to state that Medical termination of Pregnancy has come to be a Pragmatic Termination of Maternity.
References
(1) 1. Sarkar, B. and Bhadra, R.N. (1989) Sudden Deaths during Laparoscopic Sterilisation in Camps. Journal of Obstetrics and Gynaecology of India Vol.39, p.231-235
(2) Deaths Attributable to Tubal Sterilization - 1979 to 1999 Babu S. Patel, Nimish C. Pandya, Manish M. Jadav, Malvika K. Bhatt, and B.S.Ankleshwaria J. Obst. & Gyn. of India, 2001 Vol. 51 page 126-129
1. Renuka Sinha and Manju M. Bara. Maternal mortality in unsafe abortion. J. of Obstet. & Gyn. of India 2001; Vol.51(2):123-125
2. J.B.Sharma, U.Manaktala, Ashok Kumar, M.Malhotra. Complications and management of septic abortions: a five year study. J. of Obst. & Gyn. Of India 2001; Vol.51(6):74-76
3. P. Reddi Rani, A.Bupathy and S. Balsubramanian. Maternal mortality due to septic abortion. J. of Obst. & Gyn of India 1996; Vol.46:73-76.
4. A.Arun Rao. Ischiorectal abscess -sequalae to criminal abortion J. of Obst. & Gyn. Of India 1996; Vol.46: 165-166
5. C.Biswas, N.Bhattacharya, A.K.Maity, B.K.Goswami and Mukherji. Bowel injury - a menace in the era of liberalisation of abortion. J. of Obst & Gyn of India 1997; Vol.47:419-424.
6. Babu S. Patel, Nimish C. Pandya, Manish M. Jadav, Malvika K. Bhatt, B.S. Ankleshwaria. Deaths Attibutable to Tubal Sterilization - 1979 to 1999. J of Obst &Gyn of India 2001;Vol.51(2) p.127.
7. S.Bhatt and S.Bandi. The Dangerous Fetex Paste. J Obst & Gynec of India 1985; 35:27-29
8. Pankaj Desai and Purvi Patel. Prospective comparative evaluation of intra-amniotic versus extra-amniotic routes for Ethacridine Lactate for second trimester MTP: no difference. J. of Obst. & Gyn. Of India 2001; Vol. 51(6):158-160
9. Devinder Kaur, Sukhvider Shergill, AS Saini and Navdeep Singh. Comparative evaluation of Ethacridine Lactate, normal saline and distilled water in mid-trimester abortions. J. of Obst. & Gyn. of India 1997; Vol 47:160-163.
10. Pravin Kini M. and Rajgopal N. Medically Induced (Non-Surgical) Early First Trimester Abortion With Mifepristone (RU 486) and Multidose Misoprostol. J. of Obst. & Gyn of India 1996; Vol. 46:470-476.
11. V.Kamla Jayaram and G.Ratna. Mid-trimester temination of pregancy with extra amniotic PGF 2 ALFA and comparative study with normal saline and iodine saline. J. of Obst. & Gyn. Of India 1996; Vol 46:614-617.
12 Anita Singh, Himanshu Roy, Punam Dixit, Neelam Manav, Shipra Roy and Shanti Roy. Termination of pregnancy by combined intrauterine catheter and laminaria tent. J. of Obst. & Gyn. Of India 1996; Vol. 46:618-623.
13. Arun H. Nayak Bhavana P. Shah and Chandni M. Alwani. Extra-amniotic instillation of tablet Primprost with Ethacridine Lactate for termination of second trimester pregnancy. J. of Obst. & Gyn. Of India 1996; Vol. 46:753-758.
Dr.S.G.Kabra
Successive governments in India have insidiously co-opted the medical profession to implement its socioeconomic policies. The medical profession, on its part, has silently acquiesced in compromising its standards of care and subjected Indian women to the barbaric and horrific procedures. The totality of this medical violence inflicted on a helpless population might shame even the Nazis.
Thanks to the pressure of the “International Community” (read “Developed Nations”), India has been converted into a concentration camp for women of reproductive age. To live their reproductive lives they are at the mercy of the State and the state-co-opted-NGOs. For the great cause of population control, promoted and financed by international agencies, no means are improper and no holds are barred. Ethical considerations are considered senseless niceties for the fast multiplying natives. Safety norms, for the same reason and for reasons of urgency, are impractical. Preventive depopulation by contraception and promotive depopulation by medical termination of pregnancy (the births ‘averted’ and the births ‘prevented’ of population controllers) are State enforced medical solutions to the social problem of poverty. Infanticides for reasons of poverty, though sporadic and few, were considered barbarous, and justly so. But, elimination of five million fetuses through medical termination of pregnancy (MTPs), brings international acclaim and huge funds (the reward). The deaths of thousands of women from septic abortions and tubectomies, are overlooked with impunity. This is nothing but preventive elimination of the poor as a part of the poverty control programme.
De-population is a Nazi concept of development. While Hitler practiced it in Germany, developed countries are practicing it in India. The liability to become pregnant is a deadly illness and eugenic preventive medicine is geared to eradicate it as far as possible. For women in the reproductive age group, India is a large concentration camp where neo-Nazis operating as population experts eliminate fetuses and females in the name of welfare.
Non-therapeutic abortions (abortions other than those performed to save the live of the mother) are freely promoted, aggressively marketed and effectively enforced by state-co-opted medical professionals. The unabashed enthusiasm to undertake non-therapeutic interventions is unethical, to say the least. But then, ethics are the first casualty when the State drafts medical men to correct social pathologies.
Contraception is not a choice; it is a State demand. Medical termination of pregnancy is not a reproductive right of women for unwanted pregnancies (to be exercised in the first 12 weeks of pregnancy), but an aggressively pursued state policy of de-population (upto 20 weeks of pregnancy by law and thereafter by default).
LAPAROSCOPY DEATHS
The following account of laparoscopic deaths published in the official journal of the Federation of Obstetrics and Gynaecology of India illustrates the utter disregard shown to women as patient and persons. (1)
“ Number of cases attending each camp varied from 25 to 500 cases per day per two surgeons. Therefore, thorough clinical screening of all the patients before operation could not be done.”
“One case expired following sedation only. Half-an-hour after sedation (Inj.Pethidine-100 mg,Phenargan25-50 mg and Inj. Atropine I.M.) she was put to O.T.(operation table?) where uterus was found to be 24 weeks size due to pregnancy, which she concealed; she was sent back to pre-operative room where she fell asleep. During sleep she expired which was detected after four hours, the exact time of death was unnoticed.”
The cause of death according to the authors was: -
“ In the first case, who was moderately anaemic, pethidine and phenargan might have produced hypotension and respiratory depression (Parikh, 1985) which was unnoticed until her death. Moreover she was starving for almost 24 hours causing hypoglycaemia resulting in less uptake of oxygen by the vital centres of medulla (respiratory, cardiac and vasomotor), which became subnormal in their function. Brain-stem reticular formation also became less active resulting in a stuporous condition which probably became worse by the depressive action of the sedative applied on the reticular activating system (R.A.S.).”
The doctor-authors provide the following details of the other three cases that died:
“Other three cases expired within 2-3 minutes following the completion of pneumo-peritonium. Series of events were like this: sub umbilical infiltration of 1% lignocaine was given in one case and no local anaesthesia was given in other two cases. Pneumo-peritonium was done without any difficulty by about two litters (sic) of oxygen at a rate of one litter per minute.”
“ Immediately after the withdrawal of the Veress needle whole body of the patient went into convulsive movements with rigidity for a short while; they became unconscious; veins of the lower extremities unto the hips were engorged. Respiration, heart sounds and peripheral pulse were gradually slowing down in both rate and volume and ultimately stopped within 2-3 minutes.”
“ In present series oxygen was used as the insufflating agent in all the cases, which was used directly from the oxygen cylinder to the Veress needle through polythene tubing. Oxygen was used because of its easier availability than CO2 or N2O. But as the oxygen cylinder can not be used in the carbon di-oxide pneumo apparatus because of absence of fitting arrangement, increased intraperitoneal pressure could not be read.”
Should the medical professionals undertake more cases than they can handle ?
Should not all patients be fully examined before intervention ?
Why was no anaesthetic employed in the case ?
On what grounds was it permissible to use oxygen instead of carbon dioxide for fcreating pneumoperitonium ?
Why did the attendant doctors not take active steps to try and save the lives of the patients who convulsed and died ?
Why was no proper apparatus used to deliver gas to the abdomen ?
Why were autopsies not performed ?
Should the doctors or the State or both be held responsible for the deaths ?
Do not the editors and publishers of the journal have an ethical liability for publishing such a report as a research paper?
A recent article in the same journal shows that the attitude of the professionals has not changed since 1989 whence the above report was published. (2)
The authors report 16 deaths. It is indeed commendable for the authors to report tubal ligation deaths at their hands. In the summary they state: "Deaths due to family welfare programme is tragic, painful and unbearable as it (sic)is always premature & preventable."In any paper on therapeutic misadventures, the authors are expected to suggest the casue of the complications and how best they can be avoided. This has not been the case in the present paper.On the other hand, the authors make a platitudinal general statement (obviously culled from a text book):-"Use of endotracheal intubation for general anesthesia, particularly for laparoscopic sterilization, careful insertion of needle & trocar, strict follow up of standard infection control measure in & outside operation theatres, prophylactic use of broad spectrum antibiotics & discontinuation of oral contraceptive prior to sterilization may help to prevent sterilization attributable deaths." Is it to be presumed that in the aforesaid cases these norms were not followed? If so, the authors must explain why. Otherwise, these deaths would amount to gross negligence or even homicide. The editors have permitted them to gloss over these essential issues.The appropriateness of the treatment of injury and the final event that caused death are based on biased interpretations, presumptions and conjectures and are not based on independent investigation. This is not how hospital deaths are investigated and certainly not deaths of healthy women in whom a non-therapeutic interference has been done. No one would be wiser by reading these reports.Finally the statement of the authors:"Autopsy was advised in all these cases,(pulmonary embolism)but refused by relatives."Autopsy in these cases (death of married women within seven years of marriage) is part of a mandatory inquest by a magistrate.This report may not be as crude as the 1989 report but it is far from an ethical presentation fit for publication in the official journal of a professional association.
Medical Termination of Pregnancy (MTP)
The right to safe abortion has been granted to women as a fundamental right to life and personal liberty under Article 21 of the Constitution of India and codified in the MTP Act, MTP Rules and MTP Regulations.
Anybody who inflicts, encourages or condones unsafe abortion in contravention of the codified law commits a crime. Yet articles in academic journals describe unsafe, and therefore criminal, abortions and identify the person who conducted it, and the place where it is performed. Legally, they are required to report these to the police, at least after treatment is given and certainly if the woman dies. The articles published in the Journal of Obstetrics and Gynecology of India (1-6) give graphic details of the horrors inflicted by criminal acts of illegal abortionists. None of these mention the steps taken against the culprits.
All cases of maternal mortality due to unsafe and unlicensed abortions are cases of double homicide (murder) and are required under law ( CrPC. Section 39 and 174 read with IPC Sections 201, 299, 312and 314) to be reported to the police and subjected to inquest. Prosecutions may follow. By not doing it, the authors (the treating doctors), in law, are presumed to be siding with the criminals with a view to shield them.
Doctors’ primary duty is to treat the patient. They should do nothing that they feel will interfere with or delay treatment. Once the patient is treated it is their public duty to report the incident to the authorities so that the perpetrator of a criminal abortion is prevented from repeat the crime.
The documentation of these murders should not be published as research articles. Such publications amount to documented defiance of law and criminal justice.
Research into the cases of septic and unsafe abortion has to cover two aspects: the cause of injuries and their treatment. A properly done MTP should not cause injury to other organs like the bladder or intestine. If it has occurred there must be either some unrecognized abnormality in the patient or some lapse in the procedure itself. A properly conducted research may help clrify matters and help doctors avoid such mishaps in future.
Editors must be satisfied that authors reporting a crime through their journal have done all that they were legally required to do in that particular case. How they ensure this will depend on the journal’s policy. They certainly should not publish a report the tone of which is to condone or conceal the crime.
However illegal abortions are apparently not considered criminal and are not reported to the police as required by the law, even when they prove fatal. This attitude is exemplified by the observations of the attending doctors in the report of an illegal abortion done by a 'dai' with the help of stick that resulted in deadly infection of gas gangrene, where Shakuntala Sahey stated (J Obst Gynec India, 1984) "As her relatives were not willing, autopsy could not be done", even though the fact that that the abortion was done by an unauthorized person and it was a case of unnatural death with manifest evidence of foul play is on the record. Exactly the same assertion has been made in the recent publications (1), where the authors state "Autopsy was advised in all these cases, but refused by relatives", exemplifying the attitude of medical professionals not to report unnatural deaths in women (specifically within 7 years of marriage).
Chemical abortificeant paste
As a result of an unhealthy enthusiasm to popularise abortions for population control, a chemical paste, “Fetex Paste”, was licensed, publicized and popularised as an abortificient. This paste has been reported to cause severe peritonitis, gangrene of various organs, kidney failure etc. in a large number of patients in whom it was used to terminate pregnancy. In a 1985 report (7) titled The Dangerous Fetex Paste, of 3 patients, two died. The third survived renal failure but her "whole vagina and cervix were sloughed and necrosed" after the illegal abortion with 'Fetex paste' proved disastrous. The authors had pleaded: "Advertisements in Journals should be stopped and the product should be withdrawn from the market". The Journal of Obstetrics and Gynecology of India was one such journal advertising the Fetex Paste. Following spate of these reports in medical journals and the lay press, this presumably Ayurvedic preparation by Gambers Laboratory, was 'withdrawn' or was 'banned'. However, in a recent report of the 34 women who died of septic abortion, in 25 a 'kutchi' (stick) was used by 'dai/quack'; Fetex Paste was used in 3 patients by 'G.P's.(3).
there can be no worse reflection on the prevailing professional standards, ethics and the role of the drugs control machinery than the fact that despite years of reports of severe adverse effects and fatal outcomes from the use of the chemical abortificieant paste, nobody questions how this obviously dangerous paste was permitted to be licensed as an abortificeant paste. Was it ethical for the practitioners of modern medicine to use this Ayurvedic preparation ? Was it ethical to advertise it in the Journal of Obstetrics and Gynecology of India, the official journal of the Federation ?
MTP: saga of inhuman experiments (8-13)
Any form of physical or chemical interference with the conceptus in the womb is potentially noxious enough to cause abortion, especially in the early stage of pregnancy up to 20 weeks during which period MTP is permitted. Even introduction of a fine needle for aspiration of amniotic fluid may result in abortion. But simply because MTP is permitted it does not mean one can experiment with any substance or method. Yet, studies (8-13) report the use of distilled water, normal saline, hypertonic saline, boiling water, various chemicals including corrosive substances similar to 'fetex paste' and rubber catheters. These were injected intra- or extra-amniotically. These injected singly or in various combinations, have been used to experiment and re-experiment upon thousands of women and have been reported as research publications.
These are all human experiments. No standard medical journal today publishes a report unless the authors provide the editor written documentation that a competent ethical committee's clearance was obtained and the study was conducted under their supervision. The ethics committee is supposed to give clearance as per the guidelines of the ICMR. It has to conform to a very strict protocol. Recruitment of patients, especially captive patients, has to be on the basis of informed and free consent. It may also be remembered that any substance or device used in the human body is a drug in the eyes of law. Even an approved drug when used for a different purpose or by a different route or different dose schedule or combination constitutes a new drug, the human trial of which needs prior approval of the Drugs Controller.
None of the aforesaid "studies" appear to conform to ethical standards for human experiments. How could instillation of distilled water(9), boiling water, a powdered tablet (13) or rubber catheter(12) be permitted? Imagine the indignity and discomfort of a Foley's catheter introduced in the uterus, its balloon inflated and left in a pregnant lady for 6-18 hours. How does it differ from the use of a sterile stick and cow's urine by quacks?
One must read the details of the aforesaid reports to understand the gross indignities inflicted and human rights violations involved.
Let an independent body of medical and social professionals assess if these studies meet ethical criteria.
I reproduce hereunder text from my book to substantiate my above submissions and show how the things have just not changed.(Miscarriage of Medicine (Panchsheel Prakashan, Jaipur.1993): Merciless Assault on Mothers Womb p.34)
"Miss Nupur Lauria and Miss Arpita Bhargave of SMS Medical College, Jaipur, have compiled the data of the eleven research papers published in the Journal of Obstetrics and Gynecology of India in 1984 and 1985. Various research groups conducted MTP trials on 2303 women in second trimester of pregnancy. One research group used intra-amniotic injection of hypertonic saline in 500 cases, another used distilled water in 250 cases, third used urea with prostaglandin in 25 cases, fourth extended the method of suction evacuation to 320 cases in their mid trimester, the fifth tried combination of prostaglandin intra-muscular injection with mechanical dilatation of cervix on three groups of 200 cases, the sixth has tried his hand at all types of methods in rural women using hypertonic saline in 200 cases, manittol in 9, ethacridine lactate in 5 and prostaglandin analogue in 2 cases.
The Seventh uses prostaglandin alone and with dilatation in 120 cases, the eighth tries the same using catheter and prostaglandins in 200 women, the ninth researcher group tries vaginal prostaglandin in 62 cases, the tenth group tries the introduction of hypertonic saline through cervical canal in 120 cases and compares the results with introduction of rubber catheter in 120 cases and the eleventh group studies mid trimester abortions with intra-muscular injection of prostaglandin."
What is the rationality of repeating these various experiments when the disadvantages of many of them have already been adequately evaluated? There is no evidence that any thought has been given to plan these trials to obviate biased inferences. As a result, most of the studies are exercises in futility. Why then increase the risk to the women undergoing these trials? There is no evidence that clearance of the ethical committee was taken before conducting the trials. No informed consent of the women subjected to these trials was taken. And worse still, the Indian Council of Medical Research is a party to it all by commission and omission.
In conclusion, therefore, anybody doing anything to terminate pregnancy is not only permitted to do so but the act goes unchallenged even if it kills or cripples the woman. It is no exaggeration to state that Medical termination of Pregnancy has come to be a Pragmatic Termination of Maternity.
References
(1) 1. Sarkar, B. and Bhadra, R.N. (1989) Sudden Deaths during Laparoscopic Sterilisation in Camps. Journal of Obstetrics and Gynaecology of India Vol.39, p.231-235
(2) Deaths Attributable to Tubal Sterilization - 1979 to 1999 Babu S. Patel, Nimish C. Pandya, Manish M. Jadav, Malvika K. Bhatt, and B.S.Ankleshwaria J. Obst. & Gyn. of India, 2001 Vol. 51 page 126-129
1. Renuka Sinha and Manju M. Bara. Maternal mortality in unsafe abortion. J. of Obstet. & Gyn. of India 2001; Vol.51(2):123-125
2. J.B.Sharma, U.Manaktala, Ashok Kumar, M.Malhotra. Complications and management of septic abortions: a five year study. J. of Obst. & Gyn. Of India 2001; Vol.51(6):74-76
3. P. Reddi Rani, A.Bupathy and S. Balsubramanian. Maternal mortality due to septic abortion. J. of Obst. & Gyn of India 1996; Vol.46:73-76.
4. A.Arun Rao. Ischiorectal abscess -sequalae to criminal abortion J. of Obst. & Gyn. Of India 1996; Vol.46: 165-166
5. C.Biswas, N.Bhattacharya, A.K.Maity, B.K.Goswami and Mukherji. Bowel injury - a menace in the era of liberalisation of abortion. J. of Obst & Gyn of India 1997; Vol.47:419-424.
6. Babu S. Patel, Nimish C. Pandya, Manish M. Jadav, Malvika K. Bhatt, B.S. Ankleshwaria. Deaths Attibutable to Tubal Sterilization - 1979 to 1999. J of Obst &Gyn of India 2001;Vol.51(2) p.127.
7. S.Bhatt and S.Bandi. The Dangerous Fetex Paste. J Obst & Gynec of India 1985; 35:27-29
8. Pankaj Desai and Purvi Patel. Prospective comparative evaluation of intra-amniotic versus extra-amniotic routes for Ethacridine Lactate for second trimester MTP: no difference. J. of Obst. & Gyn. Of India 2001; Vol. 51(6):158-160
9. Devinder Kaur, Sukhvider Shergill, AS Saini and Navdeep Singh. Comparative evaluation of Ethacridine Lactate, normal saline and distilled water in mid-trimester abortions. J. of Obst. & Gyn. of India 1997; Vol 47:160-163.
10. Pravin Kini M. and Rajgopal N. Medically Induced (Non-Surgical) Early First Trimester Abortion With Mifepristone (RU 486) and Multidose Misoprostol. J. of Obst. & Gyn of India 1996; Vol. 46:470-476.
11. V.Kamla Jayaram and G.Ratna. Mid-trimester temination of pregancy with extra amniotic PGF 2 ALFA and comparative study with normal saline and iodine saline. J. of Obst. & Gyn. Of India 1996; Vol 46:614-617.
12 Anita Singh, Himanshu Roy, Punam Dixit, Neelam Manav, Shipra Roy and Shanti Roy. Termination of pregnancy by combined intrauterine catheter and laminaria tent. J. of Obst. & Gyn. Of India 1996; Vol. 46:618-623.
13. Arun H. Nayak Bhavana P. Shah and Chandni M. Alwani. Extra-amniotic instillation of tablet Primprost with Ethacridine Lactate for termination of second trimester pregnancy. J. of Obst. & Gyn. Of India 1996; Vol. 46:753-758.
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