Prenatal testing and medical termination of pregnancy

A test before birth

A baby grows in the uterus inside a bag of fluid. The bag is the amniotic sac, and the fluid is the amniotic fluid. The fluid holds cells that the foetus has shed. The chromosomes of these cells can be studied.

The test is called amniocentesis. A needle is passed through the wall of the abdomen into the sac, and a small sample of fluid is taken. NCERT describes it as a test based on the chromosomal pattern in the fluid around the developing embryo.

What can the test find? It can detect disorders such as Down syndrome, haemophilia and sickle-cell anaemia. This is useful to a family that is at risk of such a disorder.

The misuse of the test

The same test can also show the sex of the foetus. Some people misused it to find the sex of the unborn child, and then to end the pregnancy of a girl. This is called female foeticide. It is a crime, and it harms the balance of the numbers of females and males in the population.

So there is a statutory ban on amniocentesis for sex determination. In India the law that controls this is the Pre-Conception and Pre-Natal Diagnostic Techniques Act, which began as an Act of 1994. The Census of India of 2011 gave 943 females for every 1000 males.

The test is allowed for its real medical purposes, in recognised centres, with the rules of the law.

Medical termination of pregnancy

Medical termination of pregnancy (MTP) is the intentional, voluntary ending of a pregnancy before it reaches full term. It is also called induced abortion.

People come to such a decision for many personal reasons. This lesson gives only the science and the law as the syllabus states them. The decision belongs to the person and to a qualified doctor.

• NCERT says that nearly 45 to 50 million MTPs are carried out in the world in a year. This is about one fifth of all the pregnancies that are conceived in the year.
• MTPs are needed to avoid unwanted pregnancies, for example after rape, after casual unprotected coitus, or when a contraceptive has failed.
• They are also essential when the continuation of a pregnancy could be harmful, or even fatal, to the mother, to the foetus, or to both.

A note on newer numbers. Studies for the years 2015 to 2019 estimate about 73 million induced abortions a year in the world, which is about 3 in every 10 pregnancies. Counts differ from one study to another. If a question follows NCERT, use the NCERT numbers.

The law and the timing

The Government of India legalised MTP in 1971. It did so with strict conditions, to prevent its misuse. It must be done by a registered doctor, in a place that the law approves.

The time matters. NCERT says that MTP is considered relatively safe up to the first trimester, which is 12 weeks of pregnancy. The second trimester is very risky.

A matter of concern is that many MTPs are done by persons who are not qualified. These are illegal. They are unsafe, and they can cost a life.

A note on the law. India amended its MTP Act in 2021. It now allows a longer time in some stated cases, with the opinion of doctors. The amendment is not part of the NCERT text. For an exam that follows NCERT, the limit to remember is 12 weeks.

You should find that week 12 is still in the first trimester, and week 13 is not.

Try it in Python

The program sorts a list of weeks into those inside the first trimester and those outside it. It also finds the number of conceived pregnancies from the number of MTPs.

Practise with new numbers

Common mistakes

• Saying that amniocentesis may be used to find the sex of the baby. The law bans its use for sex determination. Its medical use is to find disorders.
• Saying that MTP was legalised in 1951. The family planning programmes began in 1951. MTP was legalised in 1971.
• Saying that MTP is safest in the second trimester. NCERT says that the first trimester, up to 12 weeks, is relatively safe, and that the second is very risky.
• Saying that MTP is freely allowed. The law gives strict conditions.
• Mixing up the numbers. The 45 to 50 million is the yearly number of MTPs in the world. It is about one fifth of the conceived pregnancies, not of the population.

Remember these

• Amniocentesis: a test of the amniotic fluid for the chromosomal pattern. It can detect Down syndrome, haemophilia and sickle-cell anaemia.
• A statutory ban exists on its use for finding the sex of the unborn child.
• MTP (induced abortion): voluntary ending of a pregnancy before full term. Legalised in India in 1971, with strict conditions.
• Relatively safe in the first trimester, up to 12 weeks. The second trimester is very risky.
• Nearly 45 to 50 million MTPs a year in the world, about one fifth of the conceived pregnancies.

Check yourself

Try each one on your own first. If you are stuck, open a hint. Then check with Show the answer.

1. What is tested in amniocentesis, and what can the test find?

2. Why is there a ban on its use for sex determination?

3. What is MTP, and in which year did India legalise it?

4. Name two reasons for which MTP may be needed.

5. In which period is MTP considered relatively safe?

References

• NCERT (2023). Biology, Textbook for Class XII, chapter 3, Reproductive Health.
• Ministry of Law and Justice, India (1971). The Medical Termination of Pregnancy Act, and its amendment of 2021.
• Bearak J. et al. (2020). Unintended pregnancy and abortion by income, region, and the legal status of abortion. The Lancet Global Health, 8, e1152 to e1161.