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CHROMOSOMAL ABNORMALITY-RELATED CHILD ABORTION

INTRODUCTION

Abortion is certainly a difficult subject of conversation in our day-to-day lives. It is a complicated procedure that directly impacts life and death. Recently, with the new developments and plethora of discussions surrounding the topic, it has been thrown into the limelight and has become quite a controversial topic of discussion.

The word "abortion" has Latin roots in the most primitive sense because it is derived from the Latin word "aboriri," which means "to perish."

In literal terms, abortion is “the termination of a pregnancy after, accompanied by, resulting in, or closely followed by the death of the embryo or fetus: such as

a)spontaneous expulsion of a human fetus during the first 12 weeks of gestation,

b)induced expulsion of a human fetus,

c) expulsion of a fetus by a domestic animal often due to infection at any time before completion of pregnancy.”[1]


Abortions are commonly used to end one’s pregnancies since it gives rise to fewer complications, provided it is performed using correct and safe measures. Abortion which happens without utilizing clinically approved techniques, is stated to be a miscarriage. It is fairly common to suffer from one. Nearly 30% to 50% of pregnancies end in abortions. Adverse effects on the mother’s health leading to severe circumstances like maternal death also become a real possibility when clinical interventions are avoided.


PRENATAL GENETIC TESTING

The last two decades in India have witnessed a significant downfall in the number of girl children born in the country. The leading factor for the same is the discovery of methods of sex selection which often allows many families to selectively abort girl-child owing to their backward mentality of women being perceived as burdens on the family, whose only job is to tend the family and raise children.

However, another factor that is examined using prenatal genetic testing is the presence of chromosomal aberrations, which directly affect the development of the fetus, often leading to genetic disorders which can or cannot be a product of inheritance from the birth parents and their ancestors.

Now, what does one mean by a chromosomal abnormality, “A chromosomal abnormality, or chromosomal aberration, is a disorder characterized by a morphological or numerical alteration in single or multiple chromosomes, affecting autosomes, sex chromosomes, or both.[2] In the typical human karyotype, 46 chromosomes made up of nearly two metres of DNA are organised into 22 pairs of homologous autosomal chromosomes and a set of sex chromosomes made up of two X chromosomes in females or an X and a Y chromosome in males. Chromosomes comprising nearly 20 to 25 thousand genes are the source of all the genetic material required for growth and development.

Any undesirable mutation during mitosis or meiosis can cause chromosomal abnormalities and can happen during prenatal, postnatal, or preimplantation stages. Significant clinical outcomes from these changes consist of unplanned pregnancies, perinatal mortality, neonatal deaths/hospitalizations, deformities, intellectual disability, etc. For effective treatment of the same, genetic counseling, accurate identification and prevention strategies of these chromosomal errors is crucial.


PROCEDURES IN USE

In order to operate prevention strategies, the first step is the identification of fetal abnormality. For this, prenatal genetic testing procedures are utilized, which comprise amniocentesis and chorionic villus sampling (CVS).


▪ Amniocentesis

It can identify some genetic and chromosomal disorders, including Down syndrome (such as cystic fibrosis). Your healthcare provider will perform an amniocentesis during which they will extract a tiny portion of the sac's amniotic fluid surrounding the foetus. The fluid sample is then examined in a lab. The fetus develops inside the amniotic sac throughout pregnancy. The fetus is encased and shielded by amniotic fluid inside the amniotic sac. Additionally, some of the fetus' cells are present. These cells hold genetic data that aids in the identification of genetic disorders. Between 15 and 20 weeks of gestation, the majority of amniocentesis procedures are performed (during the second trimester of pregnancy). The risks of an amniocentesis earlier in pregnancy include miscarriage.[3]


▪ Chorionic villus sampling (CVS)

The chorionic villus sampling (CVS), also referred to as chorionic villus biopsy, is a prenatal test that involves taking a sample of placental tissue to look for chromosomal abnormalities and other genetic problems. The placenta, a component of the uterus, carries blood and nutrients from the mother to the foetus. The chorionic villi are minuscule, finger-like extensions of the placenta that are genetically identical to the developing foetus. Testing may be available for additional genetic disorders and defects, depending on the family history and the state of the lab at the time of the procedure. CVS is typically carried out between the tenth and twelfth weeks of pregnancy. A different type of prenatal test called amniocentesis does not reveal neural development, but CVS does. Women who receive CVS must also get a follow-up blood test between 16 and 18 weeks of pregnancy to look for neural tube defects.


ABOUT DOWN’S

The genetic condition known as Down syndrome is brought on by abnormal cell division, which results in the production of a second full or partial copy of chromosome 21. This extra genetic material results in the physical traits and developmental abnormalities of Down syndrome.

There are different levels of intellectual disability and developmental delays among people with down syndrome. It is the most common chromosomal genetic disorder and the cause of learning disabilities in kids. It frequently causes additional medical abnormalities as well, like heart and digestive issues. Both children and adults with Down syndrome have unique facial features. “Although not all people with Down syndrome have the same traits, the following are some of the more typical ones:

Flattened Face

Tiny Head And Short Neck

Erupting Tongue

Eyelids That Are Inclined Upward (Palpebral Fissures)

Small Or Unusually Shaped Ears

Muscle Tone Issues

Hands That Are Short And Broad With Just One Crease In The Palm

Fingers That Are Relatively Short And Small Hands And Feet.”[4]


LEGAL RELATIONS

A recent judgment in the year 2020 by the Supreme Court stated that beyond 20 weeks, fetuses could not be aborted unless it adversely affects the life of the mother and puts it in danger.

In the case of Komal Hiwale v. State of Maharashtra (2017)[5], the supreme court on subsequent deliberation, went against the high court ruling by disallowing the mother to abort her twin fetuses in the 26th week of pregnancy based on the fact that one of the fetuses was expected to be affected with Down’s syndrome, based on the results of prenatal testing. This was confirmed by the medical board as well. One of the fetuses had down syndrome, while the other was chromosomally normal, according to Dr. Purnima Satoskar, head of the medical board. However, the Supreme Court bench had a different outlook. "It is sad that the child may suffer from physical mental challenges and it's unfortunate for the mother but we can't allow an abortion...We have a life in our hands," the court said. On the basis of this decision, the woman did not go ahead with the selective abortion of the Down Syndrome baby.

An important thing to note here is that these tests are not always a hundred percent accurate and have a window for errors as well.

CONCLUSION

This type of situation brings intriguing questions before society and especially the lawmakers since it forces them to devise laws that, on the one hand, protect the lives of children diagnosed with chromosomal abnormalities like Down’s and, on the other hand, respect and understand the point of view of the apprehensive parents. This calls for support from family, friends, neighbors, and well-wishers who stand by the couple during such crucial choices. Moreover, proper care for the mother is salient for maintaining both mental and physical health. Such situations call for proper policy-making and enlightening discussions among the major stakeholders. Last but not least, following ethical standards, when associated with the medical industry, is also very important and should be encouraged among up-and-coming lawyers. More specializations in the field of law pertaining to the health industry should be created that are capable of teaching the nuances of scientific techniques in a proper way.


-- [1] Merriam-Webster, https://www.merriam-webster.com/dictionary/abortion (last visited Dec, 22, 2022). [2] Daniel A. Queremel Milani, Prasanna Tadi, Genetics, Chromosome Abnormalities, NIH- National Center for Biotechnology Information, (April. 28, 2022), https://www.ncbi.nlm.nih.gov/books/NBK557691/#:~:text=A%20 chromosomal%20 abnormality%2C%20 or%20 chromosomal,%2C%20sex%20chromosomes%2C%20or%20both. [3] Cleveland Clinic, https://my.clevelandclinic.org/health/treatments/4206-genetic-amniocentesis (last visited Dec, 22, 2022). [4]Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/down-syndrome/symptoms-causes/syc-20355977#:~:text=Down%20syndrome%20is%20a%20 genetic,physical%20future%20of%20 Down%20 syndrome (last visited Dec, 22, 2022). [5] Komal Hiwale v. State of Maharashtra, (2020) MANU/SCORE/29843/2020 (India).


This article is written by Snigdha Ghose of Gujarat National Law University.

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