Termination of pregnancy: should we raise the bar?
Termination pregnancy (TOP) has been a controversy in many aspects especially religious points of view as well as ethical and legislation. The abortion itself contributed to total 13% of maternal mortality.
This topic has been extensively well explained by an excellent obstetrician and gynycologist at the link here.
Revision from Dr Murizah’s definition of termination of pregnancy is the expulsion of an embryo or fetus from uterus. The issue here is, should we raise our bar on the elaboration or definition of mental injury? Especially in our current situation where pre marital conception is a worrisome. Mental injury maybe misused by either the pregnant woman or the health practitioner for their own benefit outweigh the child’s best interest.
In Islamic teaching, we protect the fetus equally as protecting other living human being[i]. And I am afraid that with the spread of liberalism and equality, our threshold of TOP has lowered or perhaps misused. Since this issue is very sensitive as it is not just a simple act instead it is an act of killing and maybe charged under criminal act of 574.
To recap on the act for termination of pregnancy, according to Malaysian law, induce abortion is illegal under Act 574, exception clause added to section 312; abortion is legal if’;
1) a medical officer registered under the Medical 1971 undertakes the procedure
2) the practituioner is of the opinion formed in good faith, that the continuence of the pregnancy would involve risk to the life of pregnant woman, or injury to the mental or physical health of the pregnant woman greater than if the pregnancy is terminated.
In a formal meeting of health practitioners that I have attended recently, there were weak points that I noticed which allow the term of mental injury be manipulated as a reason for TOP.
As I re-illustrate scenarios that were given as examples during the meeting, I would like to bring your attention in analyzing them:
1) A 16 years old, unmarried, school going teenager who found out that she is pregnant and she complaint of unable to cope with the stress due to being pregnant at early age and no social support; will you as a medical practitioner grants her TOP?
2) A lady with 10 children noted that she is pregnant again and she did not want that baby and her husband will divorce her if she still continuing with the pregnancy. Is it fair to allow TOP?
Of course, an unwanted pregnancy will invite emotional turbulence but it is not just as simple as that to perform TOP. And what is the definition or elaboration of mental injury? What criteria it is based on? Is the bar too low?
I am regret and sad with how lightly people look at TOP in another words killing a fetus. And I believe that most hospitals are nowadays only referring those depressed woman to a psychologist and no more to Islamic bodies to provide support in term of Islamic view.
I would like to emphasis here the importance of respecting and including Islamic point of views in coming to a decision for Muslims’ patients especially in a country where majority of Malaysian are Muslims.
I would also need further clarification from the authority with regards to the ‘hukum makruh’ in terminating pregnancy before day 40. I would like to suggest addition of explanation in what situation it is makruh because the word makruh may be taken lightly and may easily be misused if no criteria is set for this purposes.
 Guideline for TOP for Hospital in MOH
[i] Dr Ahmad Taha, “Kedoktoran Islam”