The country of back-alley abortions
By Nethmini Medawala
A couple of days before Christmas, just as we thought things couldn’t get worse, we heard of the unfortunate and untimely passing of a 13-year-old girl from Mullaitivu because of a botched domestic abortion performed by her mother. This girl’s name is added to a long list of fatalities resulting from back-alley abortions in Sri Lanka, bringing to life, once again, a centuries old ideological battle feminists have been having over safe access to abortions.
In this particular case, no doubt that the 13-year-old girl was raped. As the law stands at present, causing a miscarriage (Section 303 of the Penal Code) is only allowed for the purpose of saving the life of the mother – simply put, unless there is a threat to life of the pregnant woman, any abortion caused is considered to be a criminal offence that could result in a three year imprisonment. The practice is such that three doctors should agree for an abortion, verifying that the mother’s life is actually at risk.
There are many other reasons – apart from threat to life – why a woman would want to consider getting an abortion. It could be for her physical health, mental health, because the pregnancy could be a result of rape or incest, fetal impairment, for economic and social reasons, or just because she just doesn’t want to have a child and the contraceptives didn’t work.
When living in a society run on patriarchal norms, where a woman’s ultimate reason for existence is motherhood, none of these really matter. Our society always prioritises the life of an unborn foetus over the needs and wishes of a fully grown woman, illustrating how women were, are, and continue to be, second class citizens in this country.
Given the restrictive abortion environment in the country, there is lack of credible data around abortion rates in Sri Lanka. A study undertaken in the late 1990s indicated that about 125,000 to 175,000 induced abortions are performed annually in Sri Lanka. Another study conducted in the late 1990s, found 650 abortions were performed daily. According to reports, induced abortions increased from a low level in the early 1990s to a peak level by the end of the decade and thereafter has gradually declined to a low level by the 2000s (1).
The country’s stance on abortion stands in contrast to its record on maternal heath, an area for which Sri Lanka is known globally as a success story. Our maternal mortality is among the lowest in the world and even the more rural parts of Sri Lanka have access to trained midwives. Despite all this progress achieved over decades, abortion remains taboo. The gatekeepers of the archaic Victorian law refuse to acknowledge women’s right to bodily autonomy and choice, using religion, morality, and culture as justification.
This narrative sustained on a moral high ground is not new. Until access to safe and legal abortion was recognised as a constitutional right in 1973 by the landmark Roe vs. Wade judgement, it was the case in the US as well. The judgement recognised an implied right to personal privacy of the woman. It was held that a foetus is not a person but “potential life”, and does not have constitutional rights of its own. As a result of this case, many women were safe from dying of unsafe, illegal abortions (2).
Prohibition or criminalisation of abortion particularly affects people with low income. People who can afford to pay for an abortion abroad, in a private hospital, or a private clinic will have access to a safe procedure. The ones who don’t, like this little girl, are forced to risk their lives to get the procedure done in unsafe conditions or have to go through with a pregnancy that they cannot afford, manage, or do not want.
Despite the secrecy surrounding this issue, accessing abortion-inducing drugs such as mifepristone and misoprostol is relatively simple. Both these drugs are illegal in Sri Lanka unless prescribed by a medical doctor when a pregnancy threatens the life of the woman. Yet, these drugs are available in doses that are arbitrary and unregulated. Once the pills are swallowed and the bleeding begins, women are asked to access these illegal abortion clinics functioning under the radar, in unhygienic places managed by unqualified self-proclaimed medical professionals, to remove any residuals from the uterus. Most of the time, the procedure is done in such a hurry in the shadows, women are not even given pain relief and they risk not being able to conceive for the rest of their lives. As statistics show, the mortality rate for abortion stands at about 15%.
In 2015, the Ministry of Health issued the National Guidelines on post-abortion care. The guidelines stipulate that any woman who undergoes an illegal abortion can seek medical care for complications, if needed, at any government facility without fearing prosecution. The providers at the health facilities are not permitted to withhold post-abortion care services citing personal, moral, and/or religious beliefs. Further, the guidelines recognise various methods for management of incomplete abortions, including manual vacuum aspiration, dilatation, and evacuation, or drugs. This is a significant step from the health sector, as it officially recognises abortions that take place outside the law that are unsafe and life-threatening.
In 2017, a Special Committee on Penal reforms recommended that abortion be permitted in cases of serious fetal impairments, incest, rape, and pregnancy of minors under age 16. A Cabinet paper was submitted with a view to amend the legislation based on this proposal but due to concerns raised by religious groups, this process was stalled and eventually tossed aside.
All aspects of a woman’s body are either regulated by the State or the society. Women are deprived of bodily autonomy, which is essentially about the right to make decisions over one’s own life and future. It is about being empowered to make informed choices and to do what’s best for oneself. In addition to the stringent laws that are prevalent in Sri Lanka criminalising abortion, society too plays a major part in demarcating the boundaries of what a woman can or cannot do. Many incidents are recorded where young girls are married off to the man who raped and impregnated them, just so that the child will have a father, conveniently forgetting that the to-be mother, too, is a child. Getting an abortion continues to be a hush-hush topic where women are humiliated, ridiculed, and cast aside even for exploring the option.
Giving birth to a child completely changes a woman’s life regardless of what society makes us believe. Unless the woman is physically, mentally, psychologically, and economically ready to go through pregnancy and raise a child, unwanted, unplanned, and forced pregnancies will affect the quality of life of the woman and also of the child/children she may already have. To protect the vulnerable, who cannot afford decent and safe healthcare from any other place but the public health sector, the option of abortion should be made available for all women – so women do not have to insert scissors, blades, or cleaning liquids by themselves at home to terminate a pregnancy.
It is important that stringent steps are taken to protect the lives of young girls and women, like this little girl who had to pay the ultimate price because abortion continues to be a taboo and a crime in Sri Lanka. The purpose of enacting a law is to make life better through the legislative process. It is a no-brainer that laws must evolve in tandem with society if they are not to become an obstacle for society’s progress. Many laws that belonged to the British era have clearly become redundant. Unfortunately, no Government thus far has had the will to repeal the penal code and decriminalise abortion which would have ensured the safety and bodily autonomy of generations of women.
(The writer is an Attorney-at-Law and a member of the Progressive Women’s Collective)