BY Ruwan Laknath Jayakody
Until the laws for the legalisation of abortion for more conditions are enacted in Sri Lanka, family planning services and counselling should be offered especially in pre-marital, pre-pregnancy and post-pregnancy periods in order to reduce the number of unsafe abortions.
This recommendation was made in an original article on “Abortion and its legalisation: An overview of the opinion of doctors in the Colombo South Teaching Hospital, Kalubowila” which was authored by R.P.A. Dinethri, N. Roshanthan, M.A.P.A. Perera, W.D.O. Wasana and A.A.B.S. Perera (undergraduates), Prof. M. Vidanapathirana (attached to the Sri Jayewardenepura University’s Medical Sciences Faculty’s Forensic Medicine Department), Senior Prof. K. Wijewardena (attached to the same latter Faculty) and the Colombo University’s Demography Department’s Professor Emeritus K.A.P. Siddhisena and published in the Medico-Legal Journal of Sri Lanka 4 (1) in December 2016.
Abortion is defined in the “Mosby medical dictionary's eighth edition” as the spontaneous or induced termination of pregnancy before viability. According to Section 303 of the Penal Code, miscarriage is the termination of pregnancy before its natural expulsion, and therapeutic abortion can only be performed when the mother’s life is in danger. Per Section 303, anyone voluntarily causing a woman with a child to miscarry (terminate pregnancy) is subject up to three years of imprisonment and/or the payment of a fine, unless (and only when) the miscarriage was caused in good faith (and required) in order to save the life of the mother.
However, safe abortions, as noted in P.A. Lohr, M. Fjerstad, U. de Silva and R. Lyus’s “Abortion”, do not cause either long-term mental or physical problems. The World Health Organisation’s (WHO) “Safe abortion: Technical and policy guidance for health systems. Second edition” recommends that this same level of safe and legal abortions be made available to all women globally.
Morbidity and mortality due to unsafe abortions are, Dinethri et al. observed, a global issue. Unsafe abortion is defined in the WHO’s “Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008. Sixth edition” as a procedure for terminating an unintended pregnancy which is carried out by persons lacking the necessary skills and/or in an environment that does not conform to the minimal medical standards. According to S. Sedgh, S. Singh, I.H. Shah, E. Ahman, S.K. Henshaw and A. Bankole’s “Induced abortion: Incidence and trends worldwide from 1995 to 2008”, 50% of the estimated 44 million abortions performed globally each year are performed unsafely, and they, per I. Shah and E. Ahman’s “Unsafe abortion: Global and regional incidence, trends, consequences and challenges”, result in approximately five million hospital admissions and 47,000 maternal deaths per year globally, with 13% of them, as per D.A. Grimes, J. Benson, S. Singh, M. Romero, B. Ganatra, F.E. Okonofua and I.H. Shah’s “Unsafe abortion: The preventable pandemic”, being due to unsafe abortions.
In many parts of the world, as Dinethri et al. mentioned, there is controversy over the moral, ethical, and legal issues of abortion with those who are against abortion generally stating that an embryo or foetus is a human with the right to life and therefore compare abortion to murder while those who support abortion rights emphasise a woman’s right to decide on matters concerning her own body.
Abortion is legalised in many countries for many indications other than when the mother’s life is in danger, such as when the mother’s health is in danger, pregnancy following rape or incest, foetal anomalies and contraceptive failure (in India, it is legal up to 28 weeks of pregnancy under the Medical Termination of Pregnancy Act). It is estimated that of the 210 million pregnancies that occur globally each year, 10%, according to the United Nations “Sri Lanka: Abortion policy”, are due to the ineffective use of a contraceptive method.
Rape, per Section 363 of the Penal Code is defined as “committing sexual intercourse without consent under the listed circumstances”. Incest, per Section 364A of the Penal Code, means “whoever has sexual intercourse with another who stands towards him in any of the enumerated degrees of relationships as described”.
In 1973, the Medico-Legal Society of Sri Lanka recommended that the law should be liberalised to allow abortions to be performed to prevent grave injury to the physical and mental health of the mother, in cases where the pregnancy resulted from rape or incest, and in cases where there was substantial risk that the child, if born, would suffer from severe physical or mental abnormalities. In 2011, the Sri Lanka College of Obstetricians and Gynaecologists presented a draft petition to the relevant authorities appealing to liberalise the abortion law in cases of pregnancy following incest, rape or lethal congenital anomalies.
“Despite rigid Statutory Provisions, Sri Lankan women of higher socio economic status who desire to terminate their pregnancies, find little or no difficulty in getting it done. Women from the middle and lower socio income layer, however, often resort to abortions performed by back door abortionists, under primitive and unhygienic conditions,” Dinethri et al. claimed.
- Jayaratne’s “Maternal death surveillance and response” estimated that the 2014 maternal mortality rate was 32.03 deaths per 100,000 live births, and that of them, 12.5% related to unsafe abortions, and that today, abortion is the third commonest cause for maternal death in Sri Lanka, while the Family Planning Association of Sri Lanka estimates that there are around 1,000 abortions performed daily.