TT — One of the highest rates of abortions in the world

TT is one of the countries with the highest incidence of abortions, according to Dr Fred Nunes, a Jamaican Social Scientist. In his presentation during a conference held jointly by the Gynaecological and Obstetrical Society of TT (GOSTT) and the General Practitioners Association of TT (GPATT) last weekend at Crowne Plaza, Port-of-Spain, Dr Nunes showed figures for nations with the highest incidence of abortions, pointing out that while TT was not among the list which he presented, this country was among those with the highest rate. Comparing statistics, he said that the countries which had liberal laws in relation to abortions were the Netherlands (5.3), Canada (12), the UK (14.2), USA (27.3) and Cuba, also showing the lowest rate. The figures represent the abortion rate per 1000 women in the 15-44 age group, which means, for example, 5.3 would represent approximately five to six in every 1,000 women who would have an abortion in the Netherlands.

In countries where there were restrictive laws regarding abortion, the figures were much higher — in Mexico (23.3), Brazil (36.5), Dominican Republic (43.7), Chile (45.4) and Peru (51.9). Speaking with Sunday Newsday last week, Dr Nunes estimated that TT would be within the restrictive laws category, which showed some of the highest figures in the abortion rate, hovering around 45. This means that approximately 45 in every 1,000 women in the 15-44 age group in TT have abortions. He estimated that approximately 20,000 women in TT have “backyard” procedures every year, and close to $1 million a month is spent in local hospitals dealing with the incidence of unsafe abortions. Referring to the previous statistics, Dr Nunes asked: “What do we do then? Do we make abortions legal and lower the abortion rate or do we make it illegal and increase the abortion rate?” He referred to the situation in Romania in which maternal deaths shot up when abortion was banned and fell sharply when it was legalised.

The debate has been sparked by Advocates for Safe Parenthood Improving Reproductive Equity (ASPIRE), following a Draft Bill “Women’s Choice on Pregnancy Bill”, which seeks to legalise the termination of pregnancy during the first 14 weeks and termination of a pregnancy of more that 24 weeks duration. The Draft legislation was formulated by ASPIRE after looking at legislations from a number of other countries and an in-depth research study on abortions in TT undertaken by the organisation. ASPIRE Executive Director, Glennis Hyacenth, said based on studies, countries which had abortion law reforms, changing it to a civilised law, showed reduced abortion rates. She said, however, while changing the law is important, it is not sufficient, since other components must be established in order to reduce the abortion rate. However, obstetrician/gynaecologist Dr Godfrey Rajkumar, argues whether or not the local figures representing the number of abortions in TT are correct, pointing out that almost all abortions, whether voluntary or spontaneous (such as miscarriages), are listed in the public hospitals as abortions.

Types of abortions

Abortions have been around since early centuries, said health officials, but over the years have been scientifically developed and can be procured orally, by insertion through the woman’s genital area, surgical procedures and injections. Some abortions can be procured easily with the safest methods if detected early, but once the foetus has grown and enters the second trimester, it is a lot more difficult since it usually results in partial abortions. In this case, the foetus may be expelled partially with the use of drugs and/or injection, and the woman may later need surgery in order to complete the abortion.

Evacuation of the uterus by suction can be done before the pregnancy is proven, as well as menstrual regulation can be done if the person is pregnant 14 days or less. A hollow plastic tube with an opening in one side of the tip inserted into the uterus is called vacuum aspiration.
Dilation and evacuation is used in the second trimester of pregnancy (15-24 weeks) and requires a woman be at a clinic several hours to two consecutive days. Dilation and Extraction is a procedure referred to as “partial birth” and can be used in the second trimester. D&C (Dilation and Curettage), or scraping of the uterine wall, is used for a variety of reasons, but rarely for abortion.

Gynaecologist warns about over-counter drugs

Obstetrician/gynaecologist, Dr Godfrey Rajkumar, attached to the Lukini Clinic, Valsayn, has appealed to women to avoid purchasing “over the counter” drugs to induce abortions without a doctor’s prescription. He also condemned the pharmacies, who, knowing that certain drugs should not be sold without a prescription, continue to do so, at the risk of women’s lives. Over the years, there have been local concoctions and imported drugs available at pharmacies for the procurement of abortions. One particular drug, which has become quite popular, is available over the counter at some pharmacies, even though it is a precribed drug, used mainly for the curing of stomach ulcers.

If abused the drug can cause severe haemorrhage and phocomelia or amelia, which is the absence of limbs and skull bones or abnormal babies.  “There are many drugs which one can get at pharmacies which are not supposed to be sold over the counter. But if they are selling the drug to people without precriptions, they are putting people at risk unnecessarily because of the general abuse of this drug,” he said. Pointing out that a lot of women use the popular drug in their desperation to terminate a pregnancy, Dr Rajkumar reminded them that they are also entitled to change their minds and keep their babies. He appealed to them to go for pre-abortion counselling before making a decision.

Women’s Choice on Pregnancy Bill

The following are excerpts from the Draft Legislation of the “Women’s Choice on Pregnancy Bill” proposed by ASPIRE: “A Bill to enhance women’s reproductive health, to secure access to voluntary, lawful, safe abortion for all women and to provide for matters connected therewith. “Sections of the Preamble— “Recognising that women have a right to appropriate health care services to ensure safe pregnancy and childbirth and a right to be informed about having access to safe, legal termination of pregnancy free from physical and emotion harm and discrimination.

“Recognising that the provisions of the Offences Against the Person Act severely restrict access to safe, legal termination of pregnancy and counselling in respect thereof, this Act therefore modifies those provisions and provides for the exercise of reproductive choice by providing every woman the right to choose safe, legal termination of pregnancy and counselling thereof. “Recognising that this law aims to enhance the dignity and sanctity of life, to reduce the incidence of induced abortions, to reduce the practice of repeat abortions, to encourage non-directive counselling, to advance the attainment of women’s health and future safe motherhood by reducing the deaths and the complications that result from unsafe abortion.”

ASPIRE—

Current TT law encouraging hundreds of ‘unsafe’ abortions

“We believe that because abortion is seen as a criminal law, this is the reason why many women seek abortions in unsafe settings” — Glennis Hyacenth, Executive Director, Advocates for Safe Parenthood: Improving Reproductive Equity (ASPIRE). GLENNIS Hyacenth believes that the current law (described as a criminalised law against women) has turned the abortion scenario into a serious public health problem, as hundreds of women in TT are having “unsafe” procedures, several of whom have died as a result.

The 1861 law of abortion in TT is a criminal offence and under the Offences Against the Person Act, Chap, 11:08 at 56-57 the law states — “56. Every woman, being with child, who, with intent to procure her own miscarriage, unlawfully administers to herself any poison or other noxious thing, or unlawfully uses any instrument or other means whatsoever with the like intent, and any person who, with intent to procure the miscarriage of any woman, whether she is or is not with child, unlawfully administers to her or causes to be taken by her any poison or other noxious thing, or unlawfully uses any instrument or other means whatsoever with the like intent, is liable to imprisonment for four years. “57. Any person who unlawfully supplies or procures any poison or supplies any poison or other noxious thing, or any instrument or thing whatsoever, knowing that the same is intended to be unlawfully used or employed with intent to procure the miscarriage of any woman, whether she is or is not with child, is liable to imprisonment for two years.”

Hyacenth said this law is especially susceptible to poor women who are not able to afford it legally. She said based on the statistics, it was discovered that approximately three to four thousand women ended up in public hospitals as a result of complications from “unsafe” abortions. These complications include sepsis, perforation, haemorrhage and death. Hyacenth said that the Health Ministry’s annual report disclosed that government spends about $900,000 to $1 million per year to treat women who end up in the hospital wards, dubbed “slip and slide” wards. These include women ranging from all ethnicities, religions and different ages, she said. However, they all have one thing in common — they were women from the lower socio-economic background, since many of them cannot afford treatment at private, health institutions. Based on the research, it was also shown that at least two out of every three women throughout the Caribbean, including TT, would have had an abortion by the age of 45. From the studies, the team from ASPIRE realised that it was because of the law, women who had “unsafe” abortions ended up in the hospital.

“In TT, the law states that it is unlawful to procure a termination or assists in procuring an abortion, therefore, to many people, it is illegal. But that is not the case, because it is legal in certain circumstances,” Hyacenth pointed out. “We believe that because abortion is seen as a criminal law, this is the reason why many women seek abortions in unsafe settings.” She pointed out that many women in TT have used “unsafe” methods including unsterilised instruments such as crochet needles, cassava sticks and clothes hangers. She noted that the majority of the public may view these methods as farfetched but said it is a “stark reality”. Hyacenth recalled that in 2001, a young woman died after she haemorrhaged because of a “backyard” abortion. Are there “safe” abortions? Hyacenth said, according to the World Health Organisation (WHO), the  termination of a pregnancy in its early stages, (the first trimester), if done under correct conditions by a well-trained health provider, is one of the safest procedures. She said she was aware that a certain section of the population felt that ASPIRE was promoting abortions or promoting the “murdering of babies” and sought to clarify this perception.

“If a woman allows someone to do that to her, it suggests that she is desperate to terminate a pregnancy. Therefore, ASPIRE is not promoting abortions, we are not telling people to go out there and have abortions. Abortions have been happening long before ASPIRE came on the scene and the current law is not preventing it from happening,” she said. Hyacenth said since ASPIRE has seen the problem as a public health situation, it has recommended an in-depth information and education programme which needs to start within the schools and among families and couples, a comprehensive and accessible contraceptive delivery service and the changing of the current “criminal” law on abortion, to a “civilised” law with regulations. “A civilised law would mean that abortions would be legal in TT. ASPIRE is not promoting the killing of babies. A civil law would allow certain things to happen, such as, pre-decision counselling,” she said.

With the availability of pre-decision counselling, the woman would be able to be informed about her decision and her options and how to avoid it in the future, thereby decreasing the number of repeated abortions, Hyacenth noted. She said with the abortion law reform, government can also employ training of health-care providers to perform the procedure in a safe and proper setting, noting that there were several doctors who performed “unsafe” abortions, leading to serious health complications and subsequently, death. As for the woman’s decision to have an abortion, Hyacenth believes that it should be respected because she would have thought about it “long and hard” before going through with the procedure. She reminded the national community that there were deep-set, psychological issues for having abortions, such as, a baby conceived out of rape and an incestuous relationship, or severe foetal abnormality, or a mother who has too many children and cannot afford to bring another child into the world.

She said while there are women who may use abortion as a contraceptive measure, these may be in the minority. “The whole issue of life and conception is a valid argument and we are not saying that foetus is of no value. We are aware that the foetus is the continuation of life, therefore, that is why we need a law that is effective,” she said. “The present law is not working, it shows no respect to a woman, nor the foetal life. With law reform, if well-managed, we can see a reduction in the number of abortions altogether and eliminate the number of unsafe abortions.”

IRO condemns proposed abortion law

The Inter-Religious Organisation (IRO) has strongly condemned any action for the legalising of abortion in this country. In a statement, the IRO, which comprise representatives of the Christian, Orisha, Islam, Hindu and Bahai faiths, said it declares its opposition to the active lobby to the TT government pressing for an amendment to the laws of TT to enable the legalising of abortion on demand. The IRO noted that at present, by virtue of Sections 56 and 57 of the Offences Against the Person Act, it is unlawful to procure, or to aid in procuring an abortion and it is a criminal offence. “One of the principles which unite us, as faith-based organisations, is our profoundly held belief that human life is sacred. Grounded in that belief, respect for human life is recognised as an imperative from conception to natural death,” the IRO said.

It added that it has derived assurance from the fact that the Preamble to the Constitution of TT acknowledges, inter alia, the supremacy of God, the dignity of the human person and the position of the family in a society of free persons and free institutions. The IRO pointed out that the Constitution further enshrines the right of the individual to life, liberty, security of the person, enjoyment of property and the right not to be deprived except by due process of law. “The Constitution further recognises the family and the family is acknowledged as the initial building block of society, upon which all civilisation rests. Society regenerates itself through births and hence the sanctity of our coming generations must be protected,” the IRO said. Referring to the “right to choose”, the IRO noted that scientific knowledge of the foetal development has confirmed that the beginning of any one human individual’s life, biologically speaking, begins at the completion of the union of the father’s sperm with the mother’s ovum. “That is the process of ‘conception’ or ‘fertilisation’. Human life is a continuum from that time until natural death,” the organisation said.

“In a pregnancy, there are two living humans involved: the unborn child and the mother. The right to life of the unborn cannot and should not be determined at anyone’s pleasure. The right to life of the unborn is as scared as the right to life of any other person, including the mother. We subscribe to the belief that a pregnant woman facing problems must be offered aid in solving her problems.” The IRO said it is aware that in extreme medical health circumstances, a threat to her life by virtue of the pregnancy itself may be diagnosed. It stated that in such an event, the duty of the medical specialists is to make every effort to save both lives, even though, despite all endeavours, the baby may die. The IRO pointed out that a full explanation of the possible treatments available must be discussed with the mother. “Where there is no threat to the mother’s life, we distinguish between two sets of circumstances relating to pregnancy, namely a single parent and the parents within a family. In the latter case the pregnancy must be acknowledged as ‘gift from God’, irrespective of the hardships of the family,” the IRO said.