“Unsafe abortion is a major public health issue, even in countries where it is legal. By legalizing or liberalizing restrictive abortion laws, and investing in safe abortion services, governments can save the lives of thousands of women each year. This would minimise the risk of death of the mother.”____________________________
(April 08, Colombo, Sri Lanka Guardian) About 46 million abortions are performed every year. 20 million of them are illegal, said Dr. Sriani Basnayake Medical Director Family Planning Association of Sri Lanka at a workshop held at the Family Planning Association recently. According to the World Health Organisation (WHO) unsafe abortion is a procedure for terminating an unwanted pregnancy either by person lacking the necessary skills or in an environment lacking the minimal standard or both!
In Sri Lanka illegal abortion clinics have come up all over the country from quack doctors to vedamahattayas. Illegal abortions are performed in Sri Lanka putting the women in the worse kinds of physical torture. Sometimes a certain plant stem is used to bring on bleeding. Horrible methods like introducing bicycle spokes, knitting needles are used and the number of maternal deaths have increased due to unsafe abortion.
According to the World Health Organization (WHO), unsafe abortion is "a procedure for terminating an unwanted pregnancy, either by persons lacking the necessary skills, or in an environment lacking the minimal standards, or both".
* WHO estimates that approximately one third of maternal deaths are due to complications of illegally induced abortions.
* Each year an estimated 20 million unsafe abortions are performed worldwide, 95% of which are performed in low-income countries.
* As abortion is still illegal in many countries, two out of every five abortions in the world are performed unsafely, by an untrained provider or in unclean setting.
* Every year about 78,000 women die from unsafe and illegal abortions. For every death caused by unsafe abortion, several women are injured or left infertile.
* One third of the world’s women do not have access to legal or safe abortion, and these women die at the rate of 330 deaths per hundred thousand abortion procedures. In contrast the death rate from legal abortion is under one death per 100,000 procedures.
* Hundreds of thousands of women suffer long or short-term disabilities due to complications of unsafe abortions. In low-income countries, mainly in the developing world, approximately 200 women die each day as a result of unsafe abortion. These are starkling facts which are alarming, said Mrs. Basnayake.
For many years, the issue of unsafe abortion and reproductive health has been clouded by cultural, religious and political opposition to safe abortion. In many developing countries abortion is illegal, and yet this does not prevent it from occurring.
Unsafe abortion is a major public health issue, even in countries where it is legal. By legalizing or liberalizing restrictive abortion laws, and investing in safe abortion services, governments can save the lives of thousands of women each year. This would minimise the risk of death of the mother.
It is a known fact that women in any part of the world, when faced with unwanted pregnancies, resort to abortion regardless of the legality of the procedure. Many have no choice but to undergo abortions performed by unqualified people in unhygienic settings, said Mrs. Basnayake.
The legal status of abortion:
I. There are laws pertaining to abortion, summarized below:
Abortion is not allowed on any grounds, except for if the pregnancy poses a threat to the woman’s life (e.g. Sri Lanka).
II. Moderate to strict:
Only some narrowly defined circumstances justify performing an abortion: for example, threat to the woman’s physical or mental health, foetal defects, and legal indicators such as rape or incest.
III. Moderate:
Abortion is not only permitted for medical reasons, but also for socio-medical or social reasons: for example, low income, poor housing, young or old age, and already having a certain number of children.
IV. On request:
Women have the legal right to decide the termination of pregnancy. In most cases this right only applies to the first three months of pregnancy.
The complications are
• Haemorrhage, sepsis and uterine perforation, all of which may be fatal if left untreated. Even when treated, these may give rise to infertility and/or chronic morbidity.
• Chronic pelvic pain, pelvic inflammatory disease and consequent infertility.
• Reproductive tract infections, of which 20-40% lead to pelvic inflammatory disease and consequent infertility.
• Acute renal failure and gas gangrene, which may contribute to abortion deaths as secondary complications. In most cases, legalising abortion could eradicate the need for a woman to seek the services of a quack.
In countries where abortion is legal, death rates are less than one per 100,000 procedures. The primary factors explaining this increase in safety are:
• Medical doctors, instead of unskilled practitioners, perform the abortion.
• Proper facilities and sterile equipment is used.
• Doctors can be trained in performing the procedure.
• Services tend to be more accessible to women, thereby reducing the duration of pregnancy at the time of abortion.
• Proper information can be given to women, which encourages them to access services earlier in their pregnancy.
The most active opponent of legalising abortion in the Roman Catholic Church.
Where do we go from here?
We can begin by building on the recommendations made at the International Conference on Population and Development (ICPD) in Cairo in 1994, and reconfirmed at ICPD+5 in New York in 1999. At ICPD, governments recognized unsafe abortion as a major public health issue, and called for the following actions, said Mrs. Basnayake.
• Prompt high quality and humane medical services to treat the complications of unsafe abortion.
• Compassionate post-abortion counselling and family planning services to promote reproductive health, and prevent repeated unsafe abortions.
• Safe induced abortion services where they are not against the law.
• In countries where induced abortion is legal, efforts should be made ensure that women have access to safe abortion services by adequately trained staff.
• Ensure universal access to client-sensitive family planning services, especially for young people.
• Ensure that high quality services for treating and managing complications of abortion are readily accessible through the health system.
• Offer family planning counselling and services to all women who have had an abortion, and educate them on reproductive health and unsafe abortion.
Many abortions are caused by unplanned or unprotected acts of sexual intercourse, resulting in an unwanted pregnancy. The recent developments promoting the use of Emergency Contraceptive Pills could play a major role in reducing abortion rates throughout the world. The introduction of the new Emergency Contraceptive Pill ‘Postinor 2’ to Sri Lanka, and the ever increasing demand is a good example of such a programme, said Mrs. Basnayake.
She also said that the Family Planning Associations (FPAs) should continue to lobby parliamentarians and opinion leaders on the need for legalising or liberalising abortion in countries where it is still prohibited, and inform them of the dangers of unsafe abortions. She said the FPAs should highlight the crucial benefits of liberalisation to their respective countries in general, and to women in particular, that providing safe abortion services brings.
She pointed out that legalising abortion decreases the rate of abortion-related deaths. In the United States, it was observed that death rates due to abortion decreased 85% in the five years following its legalisation. Also in Romania, prior to legalisation of abortion in 1989, the country had an abortion-related death rate of 150 per 100,000 births. By the end of 1990, however, deaths caused by abortion had dropped to approximately 60 per 100,000 births.
She pointed out that governments should invest in making abortion safe and accessible. The benefits of ensuring access to safe abortion far outweigh the costs. In some developing countries, nearly one third of hospital budgets are used to treat complications of unsafe abortions. This treatment uses a disproportionate share of (already limited) resources, including hospital beds, blood, antibiotics, analgesics, operating theatre facilities, and the precious time of medical specialists. Treatment of complications of unsafe abortion can require as much as two weeks hospitalisation. In contrast, a woman needs just one day to undergo a safe abortion when the procedure is performed by a trained service provider in a medical facility, said Mrs. Basnayake.
About two thirds of the world’s women live in countries with fairly liberal abortion laws, where women are allowed abortion to preserve their mental or physical health, or for social and economic reasons, or upon request without regard to reason, pointed out Mrs. Basnayake.
In the Netherlands, abortion is freely available on demand. Yet, the Netherlands boasts the lowest abortion rate in the world, about 6 abortions per thousand women per year, and the complications and death rates for abortion are miniscule. How do they do it? First of all, contraception is widely available and free. They also carry out extensive public education on contraception, family planning and sexuality.
"An important message that we can learn from the Netherlands and other European countries is that the most comprehensive family planning programmes and widespread contraceptive use, will never completely eliminate the need for abortion. Abortion is a critical backstop to contraception, which is not 100% effective. People do make mistakes - they sometimes forget to use their contraception, or they use it wrong. Motherhood should never be a punishment for human error," said Mrs. Basnayake.
She said that high rates of death and serious injury associated with unsafe and illegal abortions has proved that governments and certain religious groups are blind and indifferent to the realities of women’s lives. She said that these people continue to believe that laws against abortion will stop abortions, in spite of obvious contrary evidence. The only thing that laws against abortion do, is to make abortions dangerous, turn women into criminals, produce thousands of disadvantaged children and create wide disrespect for the law. We see thousands of women willingly risk their lives to end an unwanted pregnancy, the hypocrisy of those in power is nothing less than criminal.
We probably won’t be able to change the laws against abortion without some kind of universal consensus, and I believe that we are getting closer to that universal consensus. The day may soon come, when women all around the world will have the legal right to decide for themselves when and whether to have children, and the means to exercise that right safely, said Mrs. Basnayake.
Children will have the fundamental right to be wanted, to grow up safe, happy and healthy. On that day the world will become truly civilised. The mass media can play a major role in achieving this goal, asserted Mrs. Basnayake.
- Sri Lanka Guardian
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