Death of Catholic mother of 8 who delayed cancer treatment, and the abortion debate

A Malayali nurse who worked at AIIMS in Delhi breathed her last on Christmas Day after a prolonged battle with breast cancer. 43-year-old Sapna Tracy, who had been working at the pulmonary ward at AIIMS for the last 19 years, was diagnosed with third stage breast cancer in 2015 – but Sapna and her family chose to delay the treatment that could have saved her life. The reason: Sapna was pregnant for the eighth time when she was diagnosed, and as a pro-life nurse from a catholic family, she decided to keep the foetus, putting her life at risk, instead of opting for an abortion.

On Saturday, as Sapna’s eighth child Philomena turns two, she and her siblings don’t have their mother with them to celebrate. The family is in mourning, and grief hangs in every corner of their family home in Thrissur.

But even as he mourns his wife along with his eight children, Sapna’s husband Joju Chittilappilly says that abortion was never a choice for his family – not even to save Sapna’s life for the sake of their children.

Sapna’s diagnosis and treatment

Sapna was in the fourth month of her pregnancy when the doctors who diagnosed her with cancer told her that she needed to terminate her pregnancy and undergo a surgery at the earliest. A staunch Catholic who was part of several pro-life and anti-abortion campaigns and seminars over the years, Sapna decided that she would not terminate the pregnancy at any cost.

A native of Thaliyolaparambu, Sapna moved to Delhi 19 years ago to work as a nurse – a profession she believed was her calling. In 2001, Sapna got married to Thrissur native Joju Chittilappilly, who was working with a spiritual NGO doing humanitarian work.

Religion, Joju tells TNM, was a big part of their life, and as Catholics, the family was pro-life and anti-abortion. (The Catholic church does not believe in the use of contraception and is anti-abortion.) In addition, Joju says, that while Sapna had studied abortion objectively as a nurse, she was later influenced by religious texts that spoke against it.

"Sapna was a nurse, she already knew that she had breast cancer, but did not share it with anyone else including me. At the time, she was carrying our eighth child and she feared that if people knew about her illness, they would pressurise her to terminate the pregnancy. But I found her behaviour odd at times, and I once found that she wasn't breastfeeding our seventh child, who was two years old then. Upon my insistence, she took medical tests," Joju says.

While the doctor advised Sapna to terminate her pregnancy and undergo treatment, she refused, citing that the foetus inside her had an equal right to live.

"Both of us are against abortion and so it was never an option for us at all. While my views against abortion are deeply rooted in my religious beliefs, in Sapna's case, she realised that the procedure was cruel and that the foetus is put through immense pain during the procedure. Being a nurse, she took a stand against abortion after learning of these realities,” Joju says.

The law in India allows abortion up to 20 weeks into the pregnancy, and an adult woman seeking an abortion can legally get one without needing ‘permission’ of anyone, including her husband or her family. While ‘pro-lifers’ believe that life begins at conception, and that abortion is equal to ‘killing’, the pro-choice voices around the debate have maintained that abortion is an important reproductive right and that the rights of the woman must not be considered secondary to that of the foetus.

“While the doctor asked her to undergo surgery immediately, she delayed it saying that the baby was still premature during the fourth month of pregnancy. Finally she underwent the surgery in the sixth month of her pregnancy,” Joju recounts.

Months later, she gave birth to her eighth child Philomena, after which she underwent chemotherapy and radiation. However, a few months later, the cancer had spread to her lungs. This time, Sapna was resigned, quickly accepting the reality that her days were numbered, Joju says.

Anti-abortion, anti-contraception

Would Sapna have chosen to terminate her pregnancy if she knew then that delaying the treatment could one day take her life? No, says Joju.

"Everyone including friends, family and doctors told her that if she is gone, she will leave her seven children motherless. But Sapna's bold answer to them was that anyone who has a good mind will take care of her seven children, but only she can give birth to the life inside her,” Joju says.

He adds: “If she had asked me for permission to abort, I would never have given it. I would even have tried to convince her against doing it. But if she had still wanted to terminate it, I would have stood by her. But I am sure she would never have wanted it in the first place.”

Over the years, Sapna joined Joju in conducting seminars and speaking at spiritual gatherings against abortion and the need to welcome “as many children a couple is blessed with.”

A mother's sacrifice or neglect for one's own health?

While Sapna and her family made a choice to put her foetus above her own health and life, what is curious is the media coverage around the issue in Kerala. Although several media reports stopped with the ‘5Ws and 1H’, there were also many that painted Sapna as the “ultimate embodiment of motherhood” for having “sacrificed her own life to save her child” – feeding into the patriarchal narrative that to be a good woman and a good mother, a woman has to put her priorities last.

Manorama Online headlined the story as "Cancer-stricken woman, who risked life to save her unborn baby, dies." The article lauded Sapna's courage to "firmly refuse to terminate the pregnancy and start treatment."

Shalom TV, a catholic organisation, even had a 29-minute long show glorifying what many term a poor health choice.

‘Personal choice’ vs religious belief

While it is Sapna's personal choice to not terminate the pregnancy and take immediate treatment, it is wrong to glorify her act as the ultimate sacrifice of a mother, senior journalist and writer Gita Aravamudan tells TNM.

"Sapna was a nurse and I believe it was her decision to do what she did. It is at the end of the day, her personal choice. This is a grown up woman and it is up to her to decide. While I certainly do not approve of the fact that she had to sacrifice her life for a child, clearly she did not think so. In her eyes, she was responsible for that life. This is a complex situation," Gita says.

However, Gita says that it is difficult to assess what influenced Sapna to take the decision.

"Now that she is no more, we wouldn't even know. We don't know how much of it came from within her. We do not know under what preconceptions she decided to do so. Did she think delaying the treatment wouldn't affect her? For me the ultimate thing would be to live and look after my children. Why would you want to die for an unborn child, thereby leaving the other kids motherless? Would you not be sacrificing the lives of the other children then?" she asks.

While the government is bound to intervene in cases where people refuse to vaccinate their children citing religious beliefs, Sapna’s case is not as simple, Gita points out.

"Here we do not know to what extent the woman was under the control of the society and her beliefs. I am sure the Church would have sanctioned an abortion if the mother's life was in danger. So what motivated Sapna to refuse treatment at that time? May be she had faith that even though she postponed treatment, it would not be fatal. That is why this is a complex matter," she says.

‘More important to care for one’s children’

Malappuram-based doctor Shimna Azeez, part of Info Clinic, says that the media ought to be more responsible while covering such sensitive issues.

"How the media is dealing with this issue is pathetic, there is no need to glorify her at all. They are sending the wrong message by doing so. Here, it is not just about a woman's right to choose, but it is about religion. And that is a sensitive area. Instead of spreading awareness about the need to seek healthcare, certain media outlets are in fact cashing in on a highly saleable story," Dr Shimna feels.

She says that she cannot see Sapna's act in a good light at all.

"It might sound fancy when you say a woman sacrificed her life for the sake of her child, but at the end of the day, it's a life that is lost. Her decision seems strongly grounded in religious beliefs that term medical termination of pregnancy as a sin, and advocates heavily against the use of contraception,” she says.

“It is well-known that at premarital courses at the Church, contraception is heavily discouraged and termination of pregnancy considered a sin. Because of her blind faith, she had already given birth to seven children at the time she was diagnosed, and pregnant with her eighth child. Is a woman a machine to give birth?" Dr Shimna asks.

Questioning why any religious institution must dictate what its followers must do in their personal lives, Dr Shimna says, "By refusing to terminate the pregnancy and take treatment immediately, she put her own life at risk. Now, I don't see a woman who sacrificed her life for an unborn child, but I see eight little children who are motherless because their mother decided to delay seeking medical care. There is no two ways about that. Giving birth is not a mother's duty, but taking care of her children is."

Can doctors intervene?

Asked about the role of doctors in dealing with such situations, Dr Shimna says that there is a limit in the extent to which doctors can intervene. In this case, Sapna chose not to terminate the pregnancy owing to her religious beliefs which cannot be justified, Dr Shimna feels.

Speaking about the role of doctors in cases like these, Gita echoes Dr Shimna's thoughts:

"There are cases where doctors become helpless. In cancer treatment specifically, there are patients who leave the hospital at one point and turn to alternate treatment, although there is no proof that it will work," she says.

However, Joju continues to believe what he preaches to many others, that abortion is not acceptable.

"When we got married, I was of the opinion that we shouldn't have kids at all. But Sapna was clear in her mind that she wanted children. We decided to have our first child and then thought we will think about family planning later. It was when she conceived a second time, that we took the decision that we will have as many kids as god pleases," Joju says.

(Edited by Ragamalika Karthikeyan)