It is with surprise and disappointment that we read two articles published recently on the The Island that opposed the proposed amendments to abortion law. These much needed amendments, if passed in parliament, will permit abortion in instances of “underage” rape and incest. The existing law on abortion, a legacy from colonial times, permits abortion only to save a woman’s life.
The article titled “The case against abortion” (The Island, May 30, 2012) is unworthy of any kind of serious consideration. The author’s bigotry blatantly surfaces in statements like “rape and incest are often the result of ignorance” and “rape is difficult to define and incest difficult to prove”. The numerous examples and historical perspectives the author draws from anti-abortion propaganda in the West have little or no relevance to the Sri Lankan context.
Although the authors of the other article, “Don’t relax laws preventing abortion in Sri Lanka” (The Island, May 17, 2012), seemed to recognize the stigma experienced by a woman going through a socially unsanctioned pregnancy, a casual reader may have got the impression that almost everything might be resolved by “concealing” the pregnant woman in a convent and relaxing the laws on adoption so that the “hundreds of married couples who cannot have a baby” may adopt these unwanted children. They seemed to have little understanding of the ramifications of an unwanted pregnancy.
Statistics show that unsafe abortion topped the list of causes for maternal mortality in Sri Lanka in 2008, together with post-partum bleeding and heart disease; each cause contributed 17 deaths to a total of 134 maternal deaths (Senanayake et al., 2011). For every woman who dies, hundreds of women are admitted to hospital following unsafe abortion with complications that could be near fatal. We do not hear their stories, except when a friend or a family member experiences something terrible. Clearly, something needs to be done in Sri Lanka to deal with this social issue.
One approach, presently advocated by the Ministry of Health, might be to prevent unwanted pregnancies by improving access to contraception and making people more knowledgeable on sex and reproduction so that they can take the necessary steps to avert a pregnancy. But this approach places the responsibility on the individual. Such an approach is convenient for any government to take because it does not require talking about abortion, a contentious issue in Sri Lanka and all over the world. An important point that is often glossed over in efforts to promote contraceptive use as a solution to unsafe abortion is their failure rates. For example, the failure rates of the condom and the pill, without accounting for human error (i.e. “perfect use”), are 3% and 0.1% respectively. When accounting for human error (i.e. “typical use”), the failure rates rise to 14% and 5% (WHO, 2003). These rates may be even higher for those lacking access to resources and knowledge. Contraception alone cannot realistically provide a solution.
A second approach, the solution advocated by the authors of “Don’t relax laws preventing abortion in Sri Lanka”, might be to convince all women with unwanted pregnancies to complete their pregnancies and give up their children for adoption. The authors specifically propose this alternative for pregnant children for whom the legislation is to be amended. This strategy requires that these women be cloistered in convents till they complete their pregnancies. Practically speaking, this might mean the end of their education, loss of support from their families during this difficult time and a precarious future overall. This approach, we feel, is rather unfair and simplistic. Granted the authors acknowledge, although rather half-heartedly, the social stigma the pregnant women may encounter, their solutions do not in any way provide relief to these women. Recent research has demonstrated that most women who seek abortion in Sri Lanka do so to limit or space their families (contradicting the stereotypical image of the “unmarried” woman seeking an abortion) (Thalagala, 2003). This second approach is unlikely to be a reasonable alternative for these women who seek abortions for economic and other reasons.
A third and final approach would be to provide safe abortion services so that women would not be compelled to access unsafe alternatives. The legal status of abortion in Sri Lanka precludes the provision of safe abortion services to women except in life saving circumstances. In South Asia, the only other countries that have as restrictive an abortion law are Bangladesh and Afghanistan. In Bangladesh, however, a family planning policy that recognizes an intervention as an “abortion” only after the 10th week of pregnancy provides some leeway to women who want a termination earlier on in pregnancy. Both in Pakistan and the Maldives abortion is permitted to preserve physical health – laws less restrictive than in Sri Lanka where abortion can be performed only to save a woman’s life. In Bhutan, abortion is permitted to save a woman’s life as well as for instances of rape and incest. Additionally, this law considers grounds relating to factors like a woman’s age and capacity to care for a child. In India, the law permits abortion for socio-economic reasons to preserve health as well as for instances where there are fetal abnormalities. The most progressive abortion law in South Asia comes from Nepal where abortion is permitted in the first trimester without restriction except for a prohibition on sex-selective abortion (Asia Safe Abortion Partnership, 2008; Center for Reproductive Rights, 2009).
Admittedly these are merely legal frameworks that do not say anything about their implementation or their effectiveness. Opponents of law reform argue that Sri Lanka is doing well in maternal health – in fact much better than other South Asian countries – and that such achievements have been made with the restrictive abortion laws that are in place today. Others argue that Sri Lanka has achieved a low maternal mortality rate and that providing safe abortion services is not a burning issue at present. Many remain worried that expanding abortion law would result in increasing rates of “promiscuity” and indiscriminate use of abortion services. The authors of the two articles cited above were mostly concerned about the morality of abortion vis-à-vis the preservation of foetal life. Those pontificating on the morality of abortion and opposing law reform in Sri Lanka consistently overlook the fact that abortion services are available, albeit unequally accessible or unsafe, similar to other countries with restrictive legislation. Criminalizing abortion only increases a woman’s vulnerability to exploitation and dangerous complications.
The lack of recent data on abortion in Sri Lanka makes any kind of surmising on the issue difficult. We have no recent national level data on the prevalence of abortion; we have no idea who is affected most by the problem today. All we know is that women do access abortion in Sri Lanka, as they do elsewhere. Service providers thrive in the private sector. Research suggests that over 40% of abortions in Sri Lanka are provided by medically qualified providers – 21% by Gynaecologists and 23% by MBBS qualified doctors (FPA, 1993). Research from the 90s found a very high abortion rate in Sri Lanka (Rajapaksa, 2002). Some analysts argue that abortion contributes to a large proportion of fertility control in Sri Lanka (Thalagala, 2003), a point that is not addressed or overlooked by those who claim that the success story of family planning in Sri Lanka negates the need for abortion services. More recently, the Drug Regulatory Authority of Sri Lanka expressed concern over the widespread use of abortion medicines even when the drugs are unregistered and their use illegal.
Then it is not so much a question of access versus none, but rather an issue of who gets access and who doesn’t. The current status quo privileges certain women and families who can afford a safe termination in the private sector, where they are performed quite routinely, and discriminates against those whom poverty and class bars from accessing the very same services. It is surprisingly in this context that four professionals wrote the articles calling for Sri Lanka to maintain its status quo and silence on abortion. Three medical doctors went to the extent of condemning the use of the condom as a family planning method. Shouldn’t professionals be more responsible when making such unsubstantiated pronouncements, especially when their positions clearly contradict the views shared by the profession they belong to?
While we fully endorse attempts to promote access to contraception and strengthen alternative services for women who desire to continue with their pregnancies, we believe that women in Sri Lanka should have access to safe abortion services when they need them. As the authorities in Sri Lanka are considering abortion law reform for instances of ‘underage’ rape and incest, it is critical for us to rethink our positions on this important issue.