Asia-Pacific, Development & Aid, Headlines, Health, Human Rights, Population

HEALTH-ASIA: Legal Abortion Does Not Necessarily Mean Safe Abortions

Diana Cariboni

LONDON, Sep 1 2004 (IPS) - The legalisation of abortion is necessary but not sufficient to put an end to the myriad deaths and injuries caused by unsafe abortions, says a study on six Asian countries released Wednesday in the British capital.

Every year, 10 million women undergo unsafe abortions in Asia, where 50 percent of maternal deaths can be blamed on that practice, says the study “Advancing Reproductive Health as a Human Right”, by IPAS, a U.S.-based international organisation dedicated to preventing deaths and injuries of women from unsafe abortion.

For the report, IPAS compiled data, carried out interviews and studied research from various sources in India, Indonesia, the Philippines, Malaysia, Nepal and Thailand.

Samita, a 35-year-old mother of two, lives near Calcutta, India. Since the birth of her first son 10 years ago, she has had three abortions.

Each time, she inserted a small grape vine stalk into her womb, as she had been shown by the midwife. On each occasion, she bled heavily and suffered intense pain.

The last time, the pain continued for more than 10 days. Her family took her to the nearest hospital, 35 km away, where she received blood transfusions and was treated with heavy doses of antibiotics. If she had delayed coming in by just one more day, she would have died, said the doctor.

“She would have joined the 15,000 to 20,000 women who die from unsafe abortion in India each year -even though abortion has been legal in that country for 30 years,” said Indonesian activist Ninuk Widyantoro at the presentation of the study, in the international conference “Countdown 2015: Sexual and Reproductive Health and Rights for All”.

She said the largest number of unsafe abortions – five million, or one-quarter of the global total – occur in India.

Only in theory do women in India, a country of 1.1 billion, have access to safe, affordable abortions in public hospitals, where women seeking abortions are often forcibly sterilised, the staff tries to charge a fee for the abortion, which is supposed to be free of charge, or the husband’s consent is demanded, even though it is not required by law, says the IPAS study.

But while much more than a law is needed to curb the deaths caused by unsafe abortions, activists continue fighting for the decriminalisation of abortion, which they see as the first essential step.

In 1994, the action plan adopted at the International Conference on Population and Development (ICPD), in Cairo, recognised that unsafe abortions were a public health problem. In 1999, the international community agreed that “in circumstances where abortion is not against the law,” it should be “safe and accessible.”

“Now, in 2004, we must decide that abortion has to be safe, accessible and legal,” urged IPAS president Elizabeth Maguire at the Tuesday through Thursday conference in London.

But such a move would also require funding. None of the six Asian nations covered by the study come anywhere near to earmarking five percent of Gross Domestic Product (GDP) to public health, as recommended by the World Health Organisation (WHO).

The six countries “reflect great diversity with respect to reproductive health and rights,” said Widyantoro, the head of the Women’s Health Foundation in Indonesia.

In Nepal, abortion has been legal under a wide range of circumstances since 2002. In the Philippines it is a crime, and under the constitution the foetus has the same right to life as the expectant mother. In Malaysia, Thailand and Indonesia there are intense debates on reforming the highly restrictive laws.

Nepal decriminalised abortion by modifying a chapter of the penal code, which had been reformed in 1963. The original version of the code, which dated back to 1854, combined ancient Hindu law, customary law, and common law based on the Indian and British legal codes.

That nation of 24 million people has one of the highest maternal mortality rates in the world: 540 maternal deaths per 100,000 births.

Up to 50 percent of maternal deaths in Nepali hospitals are attributed to complications from unsafe abortions.

In Indonesia, a country of more than 200 million, abortion is illegal.

A broad draft law promoted by civil society and passed by parliament is pending a final decision by President Megawati Sukarnoputri, who hopes to win a second term in the Sep. 20 elections.

“This is a very sensitive issue still in Indonesia. So we – civil society, the NGOs – together with medical groups began to process this project through the houses of parliament. After three years, all the political parties agreed” to back the bill, Widyantoro told IPS.

“Before I came to London I was invited to talk to the president….(She) said at first that there was not enough time to discuss and implement the law with the Ministry of Health (because of the looming elections), even if she signed the decree” immediately.

But “after our meeting,” she promised to think it over again, the activist added.

The bill “has a chapter on reproductive health mentioning the ICPD agreements and goals, and establishing” the need for education and information, said Widyantoro.

In addition, it “says the government has the responsibility to protect women from unsafe abortion,” and explains how a safe abortion service should function, while underlining the need to make safe abortion accessible to women.

According to a survey carried out in 2002 and 2003 by the Foundation that Widyantoro heads, 87 percent of women who undergo unsafe abortions in Asia are married, nearly half have at least two children, and 58 percent are over 30.

This “defies stereotypes and expectations” with regards to who resorts to unsafe abortions, she said.

There are also other stereotypes to challenge. Although the religious promotion of patriarchal values has contributed to stigmatising abortion in many places, in others progressive religious leaders have become a force for change, said Widyantoro.

Religious opposition to abortion receives heavy coverage in the news, but there are many untold stories of efforts by religious groups to save the lives of women who undergo abortions, she added.

In Indonesia, the country with the largest number of Muslims in the world, the bill approved by parliament states that abortion would only be allowed in the first 12 weeks of pregnancy, an aspect that was negotiated with the Muslim leaders, said Widyantoro.