Lisa Allen-Agos­ti­ni

"End­ing the silent pan­dem­ic of un­safe abor­tion is an ur­gent pub­lic-health and hu­man-rights im­per­a­tive. As with oth­er more vis­i­ble glob­al-health is­sues, this scourge threat­ens women through­out the de­vel­op­ing world. Every year, about 19�20 mil­lion abor­tions are done by in­di­vid­u­als with­out the req­ui­site skills, or in en­vi­ron­ments be­low min­i­mum med­ical stan­dards, or both. Near­ly all un­safe abor­tions (97 per cent) are in de­vel­op­ing coun­tries. An es­ti­mat­ed 68,000 women die as a re­sult, and mil­lions more have com­pli­ca­tions, many per­ma­nent.

Im­por­tant caus­es of death in­clude haem­or­rhage, in­fec­tion, and poi­son­ing. Le­gal­i­sa­tion of abor­tion on re­quest is a nec­es­sary but in­suf­fi­cient step to­ward im­prov­ing women's health; in some coun­tries, such as In­dia, where abor­tion has been le­gal for decades, ac­cess to com­pe­tent care re­mains re­strict­ed be­cause of oth­er bar­ri­ers. Ac­cess to safe abor­tion im­proves women's health, and vice ver­sa, as doc­u­ment­ed in Ro­ma­nia dur­ing the regime of Pres­i­dent Nico­lae Ceaus­es­cu." –Un­safe abor­tion: the pre­ventable pan­dem­ic, a WHO Jour­nal pa­per by David A Grimes, Janie Ben­son, Susheela Singh, Mar­i­ana Romero, Bela Gana­tra, Fri­day E Okono­fua, Iqbal H Shah

Hypocrisy is not a crime. In this coun­try it's not even a shame. We are bold­faced cham­pi­ons of hypocrisy, con­demn­ing with our mouths what we live with our hearts. While in­cum­bent Min­is­ter of Works and Trans­port Colm Im­bert shouts from the hus­tings for his po­lit­i­cal op­po­nent Kam­la Per­sad-Bisses­sar to de­clare her po­si­tion on abor­tion, women con­tin­ue to suf­fer un­nec­es­sar­i­ly be­cause of the coun­try's bar­bar­ic po­si­tion on that is­sue.

No­body said abor­tion was a sim­ple top­ic. There are many lev­els of dis­cus­sion we could en­gage in re­gard­ing this: med­ical con­cerns are para­mount but hard­ly soli­tary. As Min­is­ter Im­bert im­plied in his ad­dress on Mon­day in Princes Town, there is a moral and re­li­gious per­spec­tive that is a huge part of how many peo­ple view the top­ic. By his re­marks one can in­fer that he sees it as a moral­ly and re­li­gious­ly rep­re­hen­si­ble act to ter­mi­nate a preg­nan­cy.

I say it is moral­ly and eth­i­cal­ly rep­re­hen­si­ble to al­low un­safe abor­tion to con­tin­ue in this coun­try. Both anec­do­tal and sta­tis­ti­cal ev­i­dence in the pub­lic do­main point to a dra­mat­ic re­la­tion­ship be­tween il­le­gal­ly pro­cured abor­tions and the rate of ma­ter­nal mor­bid­i­ty and mor­tal­i­ty. Our women, re­gard­less of the law, con­tin­ue to seek and have abor­tions by any means, and they con­tin­ue to suf­fer ill ef­fects af­ter­wards. These ill ef­fects are not be­cause of the dan­ger of the pro­ce­dure it­self. A ter­mi­na­tion by a prac­tised doc­tor in a med­ical­ly safe en­vi­ron­ment is not es­pe­cial­ly dan­ger­ous. On the oth­er hand, a par­tial abor­tion in­duced by a drug tak­en out­side of med­ical su­per­vi­sion could be fa­tal. As­pire con­tin­ues to trum­pet that abor­tion is le­gal in T&T to pre­serve the life and health of the moth­er. Yet, how­ev­er loud­ly it shouts, voic­es such as the min­is­ter's drown out its words. Safe abor­tion to all in­tents and pur­pos­es re­mains il­le­gal and out of the reach of the many, many women who seek them.

The con­se­quence is women suf­fer­ing in­fec­tions and haem­or­rhag­ing, some­times with last­ing con­se­quences for their health and fer­til­i­ty, and an al­ways-high num­ber of women seek­ing hos­pi­tal­i­sa­tion and oth­er treat­ment for pro­ce­dures that were im­prop­er­ly or in­com­plete­ly done by chem­i­cal or phys­i­cal means. The WHO states in the above-men­tioned doc­u­ment that a fifth to half of women who seek un­safe abor­tion will be hos­pi­talised. Un­safe abor­tion, the doc­u­ment says, ac­counts for 17 per cent of ma­ter­nal deaths in Latin Amer­i­ca and the Caribbean. Un­safe abor­tion, in oth­er words, kills women. "In­creas­ing le­gal ac­cess to abor­tion is as­so­ci­at­ed with im­prove­ment in sex­u­al and re­pro­duc­tive health. Con­verse­ly, un­safe abor­tion and re­lat­ed mor­tal­i­ty are both high­est in coun­tries with nar­row grounds for le­gal abor­tion."

Mr Im­bert will nev­er have to choose be­tween keep­ing a ba­by and keep­ing a hus­band. He will nev­er have to choose be­tween a preg­nan­cy and his men­tal sta­bil­i­ty. He will nev­er have to face the idea of one more child in a home al­ready crowd­ed with hun­gry mouths. Even in the most ide­al sit­u­a­tion, where a woman is hap­pi­ly mar­ried, healthy and well pro­vi­sioned, some­times a preg­nan­cy is not want­ed. Women should have the right to end those preg­nan­cies. This might not be a pop­u­lar opin­ion, stat­ed so bald­ly. Even As­pire hes­i­tates to couch its ad­vo­ca­cy in such terms. But the ba­sis of that ad­vo­ca­cy is that it is the right of a woman to chose whether or not she will car­ry a preg­nan­cy to term. Moral­ists like to think of le­gal­is­ing abor­tion as some kind of flood­gates, which, if opened, would drown the coun­try in a foetal blood­bath. The truth is the op­po­site.

Le­gal­is­ing and mak­ing abor­tion avail­able in the pub­lic health sys­tem does not typ­i­cal­ly lead to a high­er rate of abor­tion, it seems. Mak­ing abor­tion le­gal, safe, and ac­ces­si­ble does not ap­pre­cia­bly in­crease de­mand. In­stead, the prin­ci­pal ef­fect is shift­ing pre­vi­ous­ly clan­des­tine, un­safe pro­ce­dures to le­gal and safe ones. Hence, gov­ern­ments need not wor­ry that the costs of mak­ing abor­tion safe will over­bur­den the health­care in­fra­struc­ture.

Coun­tries that lib­er­alised their abor­tion laws such as Bar­ba­dos, Cana­da, South Africa, Tunisia, and Turkey did not have an in­crease in abor­tion. By com­par­i­son, the Nether­lands, which has un­re­strict­ed ac­cess to free abor­tion and con­tra­cep­tion, has one of the low­est abor­tion rates in the world.

(Un­safe abor­tion: the pre­ventable pan­dem­ic)

The doc­u­ment from which I've quot­ed is not the on­ly one that ex­ists. As­pire has writ­ten some of its own, us­ing lo­cal in­for­ma­tion. I've used this one be­cause of a sen­tence in it that caught me: "The un­der­ly­ing caus­es of this glob­al pan­dem­ic are ap­a­thy and dis­dain for women; they suf­fer and die be­cause they are not val­ued." It rings a bell. Fri­day night the Prime Min­is­ter, from the hus­tings too, dis­missed "women's is­sues" and quick­ly moved on to talk­ing oil and gas. Women are not men. Oil and gas might pay the bills for now, but un­til and un­less we ad­dress the is­sue of un­safe abor­tion half our pop­u­la­tion will face an un­equal share of ne­glect.