Abortions - uncertainty about 'bleeding statistics'

by Chandani Jayatilleke

While scores of women lament over their inability to conceive a child and enjoy motherhood, many others decide to terminate the lives of their unborn babies, also risking their own lives. Many women die during illegal abortions and often mishaps occur as most of the persons who carry out the abortions are not properly trained or educated.

But in many other cases the person who undergoes the abortion goes back alive but with some severe damage to her reproductive system.

Abortion is illegal in Sri Lanka. According to the law, abortion can be allowed only to save the life of the mother.

In Sri Lanka where there are social and legal restrictions, an assessment of the incidence of induced abortion is difficult. From time to time numerous figures are quoted in the press as well as in medical circles, according to a WHO country report.

Although people say it is young and unmarried women who resort to abortion in large numbers, the incidence of induced abortion is very low among unmarried women compared to married women, the report says.

"The rate is higher for the rural sector compared to the urban sector. The abortion rate is seen to increase with the number of living children," the report said.

The high rates of abortion are in keeping with reports on unwanted pregnancies. In a sample of women admitted to an antenatal ward in a tertiary care hospital 32 per cent indicated that the pregnancy they carried to term was unintended.

Similarly in a field study in a Medical Officer of Health (MOH) area in the North Western Province, in 33 per cent of women attending field antenatal clinics the pregnancies were unplanned, in 23 per cent the pregnancy was mistimed and 10 per cent, it was unwanted, explains the report.

The reasons for this situation could be varied. Some women already have a complete family, or the required number of children. They may not be able to raise another child within the same income level.

Some women do not have support from their extended families. Some others want to postpone their pregnancy. Some women already have grown up children, so that another pregnancy at that stage would be an embarrassing situation for the mother.

Medical professionals working in the family planning sector say that there are women who had undergone abortions more than once in their lives. Of course, there is a small proportion of young and unmarried women who seek abortions as the last resort. But the crucial issue is still with the married women, according to a medical officer at the Family Planning Association of Sri Lanka (FPASL). Why are abortions common among married women?

WHO report says: "An analysis of abortion trends found that induced abortion rates often increase in early fertility transition, at a time when contraceptive practice is also increasing.

In Sri Lanka the contraceptive prevalence rates are high; 66 per cent in 1993 and 71per cent in 2000, but abortion rates have remained high late into the fertility transition. A decline in desired family size and women completing their child bearing over a relatively early and short period of time leads to an increase in the proportion of women at risk of an unwanted pregnancy.

If one considers the mean age at marriage to be 25 years and the desired family size to be two, a woman would need protection from pregnancy at least for a period of 19-20 years. If premarital sexual activity starts early, the period when she needs protection would increase further.

Cross sectional prevalence surveys do not always reflect the number of women years of protection provided."

Today, men and women have enough, reliable contraceptive methods which prevent pregnancy or would help postpone pregnancy. An abortion can be a trauma for anyone. Even in a country where abortion is legal, women experience much trauma and depression after the abortion.

The medical officer of the FPASL said the number of persons who seek assistance in connection with various family planning issues, have decreased in the recent past.

"The number has reduced from 20,000 in 2002, 17,000 in 2003 to 14,000 in 2004," she said.

Although there is no particular reason for this decrease, the FPASL feels that this could be due to the introduction of a fee for consultation, whereas the services earlier were free. However, the charges now in place are ranging from as low as Rs. 30 to Rs. 300 - for consultation and offering different contraceptive methods.

"Lots of people visit us seeking the termination of the life of the foetus. But we clearly tell them that we offer only consultation services and family planning methods and we do not encourage abortions," she asserted.

"We also explain to them the pros and cons involved in an abortion and also about the post-abortion care which is not happening in many cases. Following our advice, certain people change their mind not to have an abortion, but learn to accept the child," the medical officer added.

According to research, maternal deaths attributed to abortion have steadily increased over the years. Abortions accounted for about 8 per cent of all maternal deaths in 1996 and they were the third leading cause of direct maternal deaths, totalling 11.3 per cent of such deaths.

The FPASL offer different services to those who need assistance in family planning and contraceptive methods.

Although contraceptive prevalence in Sri Lanka is around 72 per cent, many people think that contraceptive methods have side effects. This is mainly because they listen to the opinion of their neighbour or that of the community.

They also do not want to follow a proper method to avoid getting pregnant. Instead they practise the 'safe period' method which is not 100 per cent sound, she said.

"We need to educate people on this issue and convince them that there are no health hazards involved in a contraceptive method, and it's the safest way for proper family planning."

She added that assistance on contraceptive methods is widely available through Government and private sector organisations.

The other sad factor about family planning in Sri Lanka is that it is the women who practise a contraceptive method most of the time. Men's rate, seeking contraception is significantly low, according to medical professionals, she said.

Meanwhile, women's rights groups and advocates say that access to legal abortion is the right of a woman and such access is needed for the mental and physical health of women.

Women's groups have also tried to push legislation through Parliament, but have not been successful so far, as there are other groups lobbying against illegal abortions.