Muhammad Fayyaz  ( Sindh Institute of Urology & Transplantation (SIUT), Karachi, Pakistan )
Arshad Khushdil  ( Department of Paediatrics, Army Medical College, Rawalpindi, Pakistan )
Shehla Baqai  ( Department of Gynecology Obstetrics, Army Medical College, Rawalpindi, Pakistan )

Madam, the response on the comments is as under:

1. Quranic verses quoted mentions killing of children for the want of food and related poverty, which does not correspond well in the situation under discussion. The article is not suggesting to interrupt the pregnancy because of scarcity of food and family financial crunch and that too after 19.1 weeks mark. The situation under discussion is related to a malformed foetus and termination is medically indicated as a full para in article suggests "Additionally, religious scholars in general and Council of Islamic Ideology in particular are needed to deliberate on the issue of public importance. They need to consider the legitimate problem of foetus, which medical science is able to diagnose now, as a case of interruption of pregnancy after the 120-day period. After all, human sufferings and hardships have been considered as a valid reason to re- consider many of rulings for different situations including Haj. 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. It would also be unethical to knowingly act in a way which increases the suffering for life and bleed the scarce resources as well."

2. The commentator alludes to "slippery slope" line of argument, when it the said that today NTDs and tomorrow Congenital Cardiac Disease and it may not stop. This line of argument implies that allowing termination for NTDs is may be fine but may spill into more terminations on reasons, which does not constitute a "medical need". Slippery slope line suggests inherent belief system which may not correspond well with situation in hand. As a matter of fact, the article is not suggesting interruption of pregnancy on social reasons at all, before or after 120 days. All diseases which are incompatible to life (which NTDs is & Talipes is not) or leads to a severely malformed foetus are under discussion. This article indicates that Physicians have to take their role diligently and learn it well. Being custodian of the rights of the patients, they don't have to let the women and family suffer when their is clear indication of termination. This is the very aim of the article, to push the physicians to do their workup and diagnose well in time so that, if indicated, termination can happen before 120 days mark. As far as less sensitivity/availability of AFP and Anomaly scan are concerned, this also support the argument that things may be diagnosed late, beyond 120 days, and we need to think over it.

3. The contentions shown are real and may lead to conscientious objections in such situations, by different stake holders. More discussions and deliberations are needed and subject specialists have to take the lead role by understanding the true essence of problem and feeling the burden of responsibility.