Unsafe, Illegal Abortion:
Personal Experiences ************************ 18 April 2016
Dying for an abortion in Sierra Leone
by Nina Devries
13 April 2016
A 20-year-old student called MK fell pregnant. She did not want to be pregnant, because she wanted to concentrate on her education. She did not know what to do. So she went to see a traditional practitioner who she believed could help her end the pregnancy.
She was instructed to drink a sour green concoction and shortly afterwards, bleeding began. "I was so scared and was afraid to tell anyone," she remembers. "I felt so so sick ... so bad." Her older sister found her crawling around on the floor in unbearable pain, and took her straight to hospital. They arrived just in time and a safe post-abortion procedure was performed.
MK is described in this article as one of the lucky ones because so many others who visit traditional practitioners are even more unfortunate.
Unsafe abortion accounts for an estimated 10% of maternal deaths in the public hospitals in Sierra Leone, according to Ipas, among women who got there too late for their lives to be saved. Many more women do not manage to receive care in health facilities at all, but die in their communities or suffer short or long-term morbidity.
Another young woman's boyfriend of several months had refused to wear a condom, and she hadn't known about birth control pills, but many others her age end up pregnant as a result of rape. Another recalls that she was raped several decades ago, when she was 16. When she discovered she was pregnant, she found a nurse who gave her an injection that was supposed to help her abort. The pain lasted a month, along with heavy bleeding, until the dead fetus was expelled, and she thought she was going to die. She still experiences irregular periods.
Arlene Omo-Liska, who works for Ipas in Sierra Leone, says some women and girls try to abort themselves, sometimes by inserting the straightened top of a coat hanger into their cervix, sometimes by falling from a high point onto their bellies, or they will lie on the floor and invite someone to jump on their stomach, she explains. Only safe services will prevent these young women from dying from unsafe abortions.
President Ernest Bai Koroma, has so far refused to sign off on the Safe Abortion Act, passed by the country's parliament almost unanimously, not once but twice. The new law allows abortion on request up to 12 weeks, and up to 24 weeks in cases of incest, rape, fetal impairment or when the woman's health is at risk.
'She died in front of my office door'
Sierra Leone has one of the highest maternal mortality rates in the world, with 1,360 deaths per 100,000 live births in 2015.
Dr Rowland Taylor is an obstetrician-gynaecologist at the Princess Christian Maternity Hospital, in Freetown. He says that, on average, two women a week come to see him with complications resulting from an unsafe abortion, in some cases severe. It is, he stresses, a public health issue that has nothing to do with religion or ethics.
He recalled one nursing student who came in after an unsafe abortion. "She was bleeding from her vagina and the blood was black," the doctor recalls. "That's the first time I've ever seen someone bleeding with the blood black. She died in front of my office door. Her head just slumped back in her wheelchair. She was 24 years old."
Tags: Sierra Leone, unsafe abortion, abortion law and policy, personal experience
Unsafe abortions in spite of a liberal law
by Violet Mengo
MM from a village in Nchelenge district was the only girl in a large family. She wanted to become a lawyer and was always a top student. However, one fateful day on her way from school, she was attacked and raped by a stranger. With little or no knowledge of where to go, she decided not to tell anyone about what had happened. By the time she decided to go to the health centre, she was two months pregnant. This news was shocking and disappointing. She saw her dream of becoming a lawyer shattered.
Later, she went back to the health centre to get advice on how to get an abortion, but she was instead rebuked by the health personnel for being promiscuous. So, with the help of a friend, she used some cassava stems to terminate the pregnancy. No sooner had she inserted the cassava stems in her cervix than she started bleeding profusely. MM was later referred to the General Hospital where her uterus had to be removed.
According to WHO guidelines, if a termination is to be done, it should be done by somebody who is trained and in an environment that is considered to be medically-acceptable. In Zambia, that means in a medical facility that has been certified by the Health Professions Council.
In Zambia, safe, legal abortion is inaccessible for many women, in spite of the 1972 Abortion Act, which is considered by many to be among the most liberal in the world. University of Zambia Teaching Hospital (UTH) head of obstetrics and gynaecology Bellington Vwalika explains that the law to a great extent allows provision of safe abortion in a hospital if the medical personnel certify in good faith that the pregnancy should be terminated on grounds of risk to the health of the woman, risk of social, mental or physical injury to the woman, including on socio-economic grounds, risk of mental or physical injury to her children, or risk of fetus abnormality incompatible with life. Moreover, when the Government noticed that there was an increase in the number of rape, defilement and incest cases, the Act was amended via the Penal Code in 2005 to allow abortions on these grounds.
Dr Vwalika describes the second clause as very broad in intent. “For example, if a woman has many children or has contraceptive failure, she has a pregnancy that she did not plan for, so this can lead to a mental injury of the woman. However, it is believed that very few women who need an abortion meet the requirements.
Unfortunately, the law also requires three doctors in good faith to determine that the pregnancy should be terminated, one of whom should be a specialist in obstetrics and gynaecology. Yet the country has fewer than 60 ob-gynae specialists, most of whom are located along the line of rail that links the main cities.
If a woman or adolescent like MM in a rural area needs an abortion, where would she find a specialist to certify that she meets the requirements? This is a major impediment.
In 2009, Government issued standard guidelines which have further spelled out how to harmonise the provision of the service on abortion. Yet women do not necessarily access services for several reasons. First, according to Dr Vwalika, neither health workers nor the community are aware of the law and that safe abortion can be provided.
Secondly, clandestine provision by health workers is taking place, in which they ask for a fee before they carry out an abortion, which is an impediment for the many women who are poor cannot and afford the fee, and who therefore go to someone in their community who charges little or no fee.
The Ministry of Health estimates that up to 30% of maternal deaths are a result of complications of unsafe abortions, mainly in young girls like MM and vulnerable or poor women who cannot afford safe services. Some studies suggest that if Government invested in the provision of safe abortion services, the treasury would save about US$13 per unsafe abortion treated.
SOURCE: Zambia Daily Mail
Tags: Zambia, unsafe abortion, abortion law and policy, personal experience
Let's make the provisions in the Addis Ababa Declaration real
by Zane Dangor, Special Advisor to the Minister of Social Development, South Africa, from Notes for a speech at a side event addressing the needs of young people in Africa, 49th Commission on Population & Development, New York
12 April 2016
Let’s meet Rosa. She is a 24-year-old living in Senegal where access to safe abortion is restricted. She fell pregnant at the age of 16, but because she is from a relatively wealthy family she was able to secure a safe abortion in a private clinic. The fact that she got pregnant and had to get an abortion strained her relationship with her family. She did, however, fall pregnant, again when she was 21 years old. She knew immediately that she would be getting an abortion as her circumstances were not conducive to having a child. Afraid of approaching her family she followed the advice of her friends and went to a backstreet abortion provider. The man inserted a tube and gave her some antibiotics. Two days later she bled profusely and was rushed to hospital where the doctors refused to provide her with post-abortion care. She would have been dead if her uncle, an influential army colonel, had not intervened. She was admitted and her life was saved.
In March this year, Noziziwe a 19-year-old student in South Africa died from complications due to an unsafe abortion. Noziziwe should not have died as the South African constitution and law provides for all women, the right to access quality, affordable, even free, acceptable sexual and reproductive health services, including abortion. Noziziwe died as she was a poor student, who could not access private health care. There was insufficient information available of the services that she could access at public health institutions, and there is also some speculation that she may have been afraid of the attitudes of the public health care workers based on the experiences of some of her friends.
Rosa and Noziziwe had two paradoxically different experiences. Rosa was able to acquire her first abortion safely in a country where abortion is illegal. Due to stigma her second abortion at the hands of a quack nearly killed her. Noziziwe died from an unsafe abortion in a country where abortions are legal, but she could not access these services, which was her right, because she was not informed of those rights or what services were available, she was poor and had no access to private providers, and the people who were supposed to help her and treat her with dignity scared her to the clutches of backstreet abortionists because of their discriminatory attitudes.
These two similar and yet different stories tell us that in countries where abortion is illegal, those with the means can access safe abortions and even in countries where abortion is legal, the poor can die due to a lack of access. In the end, Noziziwe died due to health systems deficiencies, stigma and discrimination, and Rosa only survived because of her status.
“One of my friends is five weeks pregnant. She is uneducated and poor. Her boyfriend ran away when she told him that she was pregnant. She’s crying and helpless. She’s thinking about abortion with an unlicensed nurse. It’s too dangerous for her… It’s been five weeks.”
This is an email that Women on Web received last year from a distressed woman in Burma, a country where abortion is only permissible where the woman’s life is at risk and otherwise punishable by three years in prison. Women on Web advised her that misoprostol is available legally over the counter at a pharmacy in her town in Burma and gave her information on how to use it safely. Most women in Burma don't receive this information, however.
According to Ipas, more than 246,000 Burmese women attempt unsafe abortions annually. As a result, 10% of maternal deaths result from unsafe abortion, the third leading cause of maternal mortality. Along with the harsh realities of sexual assault, limited sexuality education and widespread poverty, many Burmese women are inserting something in their cervix, or pummeling their abdomen to try to bring on a miscarriage.
The Mae Tao Clinic is famous for its care for Burmese migrants who cross the border into Thailand searching for help. The clinic treated 49 women suffering complications of incomplete abortion in February alone. “Incomplete” is a benign way of describing the very real consequences of a botched abortion attempt. Most of the women seeking a termination at Mae Tao cite financial problems, an unfaithful partner or the stress of having too many mouths to feed already.
AT, a 25-year-old woman from Myawaddy, is curled up on a makeshift hospital bed in one of the Mae Tao Clinic’s wards. She says she paid a village midwife 100,000 kyat (US $82) to end her 11-week pregnancy. The woman gave her a combination of unidentified vaginal and oral drugs and inserted a stick into her uterus through her vagina. This resulted in septicemia and internal injuries. The midwife had intended to do a manual extraction, but when AT developed a fever it could not be done. Her partner took her across the border in search of help.
Through a translator, she spoke of crippling poverty and the stigma attached to living with her partner out of wedlock. “[The midwife] tried to dilate my cervix and used scissors to remove the fetus… She told me to come to the Mae Tao Clinic, but said I should not tell them about the instruments she used… It hurt very badly.”
MH was born in a refugee camp, but these days you can find her pacing the floor of the reproductive health inpatient ward at the Mae Tao Clinic. Some days she’s delivering babies and comforting expectant parents, other days she treats women who turn up with the consequences of backyard abortions. She says women come across the border suffering fevers and injuries from failed abortions. Many recover, but many others succumb to their injuries. The needless loss of life is a symptom of Burma’s crumbling health care system and conservative views on women and sexuality.
MH says many of the women she treats weren’t using any form of contraception. Before they are discharged, staff at the Mae Tao Clinic discuss contraception and commonly offer oral contraception or Depo-Provera to the women.
Little chance of coming change
The women who are seen at the Mae Tao Clinic were able to travel across the Thai border to get help. But in desperately poor and isolated parts of Burma such as Arakan and Chin states, no alternative exists to "traditional" medicine.
The persecuted Rohingya minority, predominantly sequestered in Arakan State, are said to face denial of health care so bad that it has been deemed genocidal. A 2011 study seen by human rights watchdog Fortify Rights found that over one third of Rohingya women in the state had undergone at least one abortion, and one quarter had suffered multiple clandestine terminations.
Fortify Rights fears that Burma’s recently passedPopulation Control Healthcare Bill, which mandates 36 months between pregnancies, will only increase the strain on women and families. Critics have questioned how this law will be enforced. Burma’s legal and health framework has a long way to go before it catches up with the realities of life for many women in Burma. That means health care workers like MH will continue to deal with the consequences of dangerous abortion methods, and women like AT will continue to suffer from them.
SOURCE: DVB Tags: Burma, Thailand, unsafe abortion, poverty, post-abortion care, personal experience
Foto: Gloria Marisela Morán / http://agrupacionciudadana.org/ People's Tribunal to examine cases of three women imprisoned after losing babies and call for redress
by Nina Lakhani
14 April 2016
Guadalupe Vásquez was imprisoned for more than seven years after losing the baby she conceived when she was raped at the age of 17. Vásquez, who was sentenced to 30 years for murder in 2008, was pardoned and freedlast year after the Supreme Court ruled her conviction was unsafe. Her case is one of three that will come under renewed scrutiny this weekend following a determined campaign by reproductive rights campaigners and relatives of women unfairly convicted under anti-abortion legislation.
As the tribunal was being prepared yet another Salvadorean woman was jailed in March 2016 for an abortion she did not commit. For the past eight months, a police cell in Sonsonate has detained Flor Sanchez, a woman who after three days of fever suffered a premature birth, fell unconscious, was taken to hospital and from the hospital to jail. She, her children and their lawyers all say she is innocent.
The campaigners aim to keep the women’s plight in the public consciousness and put pressure on the authorities to decriminalise abortion, ending the imprisonments that have blighted the lives of Vásquez and many other Salvadoran women.
According to research by the Salvadoran Citizens’ Group for the Decriminalisation of Abortion, more than 250 women were reported to the police between 2000 and 2014, of whom 147 were prosecuted and 49 convicted – 26 for murder and 23 for abortion. The vast majority were like Vásquez: young, poor single women who lost their babies after an obstetric complication.
“The tribunal is a way to access alternative justice for the women. It will provide a space to make visible the systematic human rights violations suffered by these women, and advocate for justice in each particular case,” said Sara García, an advocacy worker with the Citizens’ Group.
The eldest of nine children from a rural family in La Paz in the south of the country, Vásquez started work at the age of nine. By 14, she was a live-in domestic worker and nanny in the capital, San Salvador. Three years later, Vásquez was raped. She was subsequently unable to attend antenatal appointments due to her relentless work schedule. Refused permission to go home to give birth, she delivered her daughter at full term in her tiny bedroom, alone. The baby cried once before dying, says Vásquez. Three months later she was imprisoned for murder, without ever hearing the evidence against her. She was 18. “The doctor in the hospital was angry at me. A policeman told me that if I’d been his woman he would have cut off my head. The judge treated me hatefully,” she says.
The tribunal will consider whether the state should make reparations to Vásquez for the years she spent in jail, and also address her social, psychological and medical needs. None of the women freed in recent years have received any compensation.
The tribunal is supported by Barcelona’s College of Lawyers. It will also consider the case of Maria Teresa Rivera, 33, who is serving a 40-year prison sentence for aggravated homicide. Rivera, who did not realise she was pregnant, had a miscarriage in November 2011. She was convicted on the basis of her employer’s claim that shehad known she was pregnant in January 2011 – which would have made her 11 months pregnant at the time of the miscarriage.
The third case isTeodora del Carmen Vásquez, 32, who was sentenced to 30 years in 2007 after experiencing a stillbirth days before her due date. The judge accused her of failing to do enough to save the baby, even though she became unconscious after calling emergency services.
The tribunal will take place at the Jesuit-run Central American University in San Salvador, which has an illustrious history of human rights work. The university has hosted several People’s Tribunals to examine civil war cases of murder, torture and forced disappearance that have escaped justice because of the country’s amnesty law. Abortion and reproductive rights are on the university’s agenda for the first time – significant, considering the Catholic Church’s pivotal role in promoting the abortion ban.
The panel will make symbolic rulings and recommendations that will be sent to the relevant authorities. Despite her ordeal, Vásquez is optimistic. She gave birth to a healthy daughter this year, and is very happy to be a mother.
Unprecedented violence and threats against abortion providers in 2015
6 April 2016
The National Abortion Federation (NAF) has compiled statistics on incidents of violence and disruption against abortion providers in the USA for almost 40 years,according to a press release they issued this month. The statistics for 2015 “reflect a dramatic increase in hate speech and internet harassment, death threats, attempted murder, and murder, which coincided with the release of heavily-edited, misleading, and inflammatory videos beginning in July.”
Since 1977, there have been 11 murders, 26 attempted murders, 42 bombings, 185 arsons, and thousands more incidents of criminal behaviour directed at abortion providers, according to their data.
Three of the 11 killings happened in November 2015, when Robert Lewis Dear Jr. allegedly laid siege on a Planned Parenthood clinic in Colorado Springs.
There were 94 threats of direct harm in 2015 as compared to only one such threat in 2014. After the videos maligning Planned Parenthood (which have been completely discredited) were released, one NAF member received a voicemail that said someone planned to “…wipe everyone out”. An unknown male called a hospital switchboard in North Carolina and said: “We will kill all [hospital] abortion doctors.”
The threats of violence were so overwhelming that NAF hired a security firm to monitor online threats. The security firm began its work in mid-November, four months after the smear videos were first released. The security firm identified more than 25,000 incidents of online threats in six weeks.
There has also been a sharp rise in clinic violence. NAF, through its online monitoring work, identified an anti-choice radical who advocated online setting clinics on fire en masse. Within three months of that post, according to NAF’s report, clinics in Washington,Louisiana,California, andIllinoiswere victims of arson. A clinic in New Hampshire was damaged when someone broke into the clinic and used a hatchet to destroy equipment, exam rooms, computers, phones, and plumbing fixtures, which flooded the clinic.