Khalid N. Haque  ( Neonatal Medicine, California, USA. )

Madam, I have read with interest the article "Neural Tube defects, their implications and solutions in Muslim society" by Fayyaz M et al (JPMA, Vol 71, No-1A, January 2021). The authors raise very important issue of neural tube defects (NTD) in Pakistan.

I am in full agreement with the authors about the need for folic acid fortification, however I disagree with their statement regarding Islamic law on termination of pregnancy; "When abortion (medical interruption) is not absolutely immoral, then, carrying a known malformed foetus to term and push the women for accepting it, is an immoral act". They base their argument on the fact that if Islam allows (most schools of thought though not all) abortion (interrupt pregnancy) prior to ensoulment i.e., 120 days it should be allowed beyond that period because. "It would also be unethical to knowingly act in a way which increases the suffering for life and bleed the scarce resources as well".

The Quran deplores killing of children for want, or fear of want: "Kill not your children on a plea of want. We provide sustenance for you and for them" (Al Anaam 6:151; Al Isra 17:31). This Quranic verse clearly negates their argument about bleeding 'scarce resources'.

Using the argument of suffering of the mother knowing that she is carrying a foetus with neural tube defect or other anomalies is negated by the fact that if to taken its logical conclusion then today it is NTD tomorrow it might be congenital heart defect or a metabolic disorder (both common in Pakistan) where will this end and who will decide "suffering". Tunisia and Turkey are the only two Muslim countries (to my knowledge) who allow termination of pregnancy beyond 120 days for social including suffering and some medical conditions. This has led to rise in the rate of terminations for dubious reasons as we have seen in many western countries. I was recently asked to council a mother who wanted termination because the foetus was diagnosed to have mild talipes. Other than Tunisia and Turkey most Muslim countries allow termination of pregnancy only to safeguard the mother from any serious risk imposed on her by pregnancy and some permit abortion beyond 120 days when there is a seriously malformed foetus or where the futility of life of the foetus can be established beyond doubt.

It is also important to note that the suggested screening with Alpha fetoprotein (AFP) has a sensitivity of only 75% (much lower for closed NTD) and sensitivity of antenatal scan is very much operator dependent. Plus the fact that one is not quite sure how universally it is available in Pakistan.

I would strongly support the authors contention that religious scholars, Council of Islamic Ideology, obstetricians, neonatologists, experts in medical ethics and members of the lay public in Pakistan should deliberate on this important issue.

Reference

1.      Fayyaz M et al;. JPMA, Vol 71, No-1A, January 2021.

2.      The Glorious Quran. Sura Al Anaam 6:151.

3.      The Glorious Quran. Sura Al Isra 17:31.

4.      Haque KN. Pakistan Paediatric Journal 2019; 43: 3-9.

5.      Albar M. J Family and Community Medicine 2001; 8: 25-35.