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Yet another dastardly sex crime has rocked the country. A 10-year-old girl, repeatedly raped by her maternal uncle, was found to be pregnant when the child was taken to the hospital on account of a stomach ache. What makes this crime lie heavy on the public conscience is the fact that a court in Chandigarh has rejected the family's plea for abortion. Ultrasound reports of the child confirm that she was 26 weeks into the pregnancy, which makes it unviable for abortion. The Medical Termination of Pregnancy Act, 1971, draws the line for abortion of foetus at 20 weeks.
(Read: What drives men to rape?)
The shock and anger of the public against this ruling is palpable, mainly because in May another pregnant 10-year-old from Rohtak raped by her stepfather underwent an abortion. Her pregnancy was ascertained to be anywhere between 18 and 22 weeks. When the case was referred to a court, it gave the doctors two choices: to go to term with the pregnancy or to abort. Since carrying the baby to term would have been fatal for the girl child, the board of doctors decided to go ahead with the abortion.
The recent case is in marked contrast with the Rohtak case. The judge in this case ruled against abortion because the child has crossed the 20-week mark prescribed by the MTP. This has caused many to question WHY the 10-year-old should be burdened with this unwanted pregnancy and why shouldn't abortion be an option. Here's addressing some of the niggling questions associated with this case.
What could have caused the delay in detecting the pregnancy?
Timely detection of pregnancy is possible because women usually watch out for missed periods and seek timely intervention. When it is a young child in question, they do not understand what missed periods mean. "In this case, the poor child may not be aware of it. Technically, at 10 years old, she still comes under the paediatric category," says Dr Bandita Sinha gynaecologist and fertility specialist, director, World of Women, Vashi, Mumbai as she explains the medical complications of the case in great detail.
"There is negligence at the hands of the parents as well. They should have noticed the changes happening in the child's body. Mothers are generally more aware of their child's physical development and should have kept track of her periods," adds the doctor. Administrative delay is commonplace in India; there is also the chance that the case was protracted at the court, leading to wastage of precious time.
Is an abortion at week 26 risky?
Yes says Dr Bandita. But she adds, "Conducting a termination this late into the pregnancy is as risky as carrying the pregnancy to term." Even for a grown up woman, abortion at 26 weeks could pose a lot of risks; it's unimaginable what a young child will go through. Some of the risks associated at this stage are:
Chances of cervical injuries are more compared to older women, owing to the smaller cervix. 
More risks of post-abortion infections like pelvic inflammatory disease (PID) and endometritis. 
Late-term abortions also increase chances of intrauterine adhesions, PID, cervical incompetence, uterine tears, eventual miscarriages and ectopic pregnancies, and even death. 
What are the risks of carrying the pregnancy to term?
The chances of a normal delivery at such a young age are also very slim. The child may not be physically equipped to push a baby out of her birth canal, owing to her callow pelvic bones. Even a c-section at such a young age is not without its challenges. Some of the risks involved with carrying to pregnancy to term include:
High chances of preterm delivery since the 10-year-old's reproductive organs may not be strong enough to hold the baby through the term
High pressure on the internal organs such as the heart, which will be ill-equipped to help the 10-year-old push the baby out
Haemodynamic changes during pregnancy can make the girl severely anemic
Internal organs will be under incredible duress
Increase chances of preeclampsia or high blood pressure, which can be very risky 
Apart from the young mother, the new born will also be at tremendous risk of low birth weight and perinatal death. "Since such cases of pre-teenage pregnancy are very rare, it is difficult even for health care professionals to gauge what could transpire during the delivery. Also, the child's socio-economic status also matters. If her family cannot afford quality nutrition and prenatal and antenatal care for her, the risks during delivery can increase," says Dr Sinha.
Heart-wrenching as it is, Dr Sinha opines that since it is a rarest of cases, a multidisciplinary team of experts would be required to ensure that the 10-year-old sails through the predicament without any big risks.
1. Burkman, R. T., Atienza, M. F., & King, T. M. (1984). Morbidity risk among young adolescents undergoing elective abortion. Contraception, 30(2), 99-105.
2. Burkman, R. T., Atienza, M. F., & King, T. M. (1977). Culture and treatment results in endometritis following elective abortion. American journal of obstetrics and gynecology, 128(5), 556-559.
3. Lurie, S., & Shoham, Z. (1995). Induced midtrimester abortion and future fertility--where are we today?. International journal of fertility and menopausal studies, 40(6), 311-315.
4. Straton JA, Stanley FJ. Medical risks of teenage pregnancy. Aust Fam Physician. 1983 Jun;12(6):474, 477-8, 480. PubMed PMID: 6684911.
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