Saturday, 15 September 2012

Taking the Taboo out of Abortion and Contracceptives

‘Abortion’ is a bit of a dirty word across the world. Even the majority of those who take a pro-choice stance do not see it as a valid reproductive choice alongside birth and adoption. While a growing number of people who are religious have begun to support a woman’s right to choose, religious organisations continue to equate the practice of abortion with crimes like genocide and infanticide. In addition to this, many countries where contraceptives are legally available do not have a high uptake. It therefore stands to reason that better access to contraceptives, as well as abortions, could reduce the maternal mortality rate significantly.

To examine abortion around the world, I have chosen to compare three fairly strict countries, with a country that has become more liberal. My chosen strict countries are Somalia, Nigeria, and Ghana. In the order I just listed them, they each go from being extremely pro-life, to slowly shifting towards a pro-choice stance. My liberal country is India; a place where abortion has been legal since 1971.

My first case study is Somalia, a country that has recently witnessed some excellent constitutional developments in the battle against female genital mutilation. In Somalia, the average number of children born to each woman is 7.3 and around 1,600/100,000 die as a result of childbirth. Due to the breakdown of central government in Somalia, it is hard to determine what the exact penalty against abortion is. However, articles 418-422 and 424 of the 16th of December 1962 Penal Code make it clear that abortion is only acceptable in order to save a woman’s life. Anyone performing an abortion can expect to face 1-5 years in prison, as can the woman--if she gave consent. In addition to this, medical professionals who perform abortions in Somalia can expect increased jail terms. There is no direct support for contraceptive use in the country; when coupled with the jail terms faced by women and medical professionals who perform abortions, it is easy to see why the maternal mortality rate there is so high.

My second case study is Nigeria. Nigeria has two abortion laws; one from the southern states, and the other for the northern states. However, between the two states the current position on the following situations are a no: rape, incest, foetal impairment, and economic or social reasons. While the government in Nigeria do make maternal mortality their concern and support the use of contraceptives, the 4-5% uptake of contraceptives suggests that not enough is being done to prevent unwanted pregnancies. Women in Nigeria will have 5.2 children in their lifetime--on average--and the maternal mortality rate is around 1000/100,000. A woman who consents to an abortion can expect to face a seven year jail term, while someone who performs one can face up to 14 years in prison; this is extended if the woman is injured, or dies. Again, these barriers contribute to the high maternal mortality rate.

Case study number three is Ghana. In Ghana, the maternal mortality rate is around 740/100,000. Each woman has around 6.4 children, and only 10% of women use contraceptives. When compared with many other countries in Africa, Ghana is bordering on being liberal. While women are not permitted to seek an abortion for economic and social reasons, recent UN data suggests that around 20% of women who have given birth in Accra have also had an induced abortion for other reasons. However, abortion is still criminalised in Ghana, and women who induce one illegally--which includes without the use of a medical practitioner, even when the reason is valid-- can expect to spend up to five years in prison. As the medications and facilities needed to perform abortions in Ghana are lacking, many women use illegal means. When you consider that any woman seeking medical assistance in the face of an illegal abortion induced infection could face prison, it is no surprise the maternal mortality rate is so high.

While illegal abortions alone do not cause maternal mortality rates to be so high, they do contribute to 15% of cases worldwide--according to WHO statistics. Legalising abortion would lower that statistic. Abortion continuing to be illegal does nothing to prevent it, which can be seen from the number of women who die after seeking one illegally each year. In addition to this, more needs to be done to prevent unwanted pregnancies. Not only does ‘abortion’ need to stop being a dirty word, so does ‘condoms’ and ‘contraceptives’.

India, a country that has been fairly liberal in terms of abortions since 1971, has a maternal mortality rate of around 571/100,000. While this is significantly lower than Somalia, a country with relatively no access to abortions or contraceptives, it is still too high. Abortions are only available in hospitals, and must be provided by a registered medical practitioner. While the second condition makes sense, the first does not. Not every woman in India will live near a hospital, which means between 3 and 4 million still seek illegal abortions each year. In addition to this, women under the age of 18 require the written consent of a guardian. Contraceptive uptake stands at 36%, with access continuing to be an issue.

All four of these countries demonstrate how abortion needs to be less of a taboo issue, rather than just something that is gradually made legal. While Somalia and Nigeria show how extreme laws contribute to high maternal mortality rates, Ghana and India demonstrate how a lack of access to facilities continue to perpetuate the use of illegal abortions. Until laws are changed and resources are improved, illegal abortions will continue to cause 15% of maternal mortality related deaths worldwide.

All statistics were taken from the United Nations website.

By Laura McKeever

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