Abortion Services - Safe or Dangerous - Restricted
Hong Kong, Myanmar, Turkey, Pakistan, Canada, and USA


18 November 2016


Hong Kong Mong Kok district – home to many unlicensed abortion clinics
In Hong Kong, accessing abortion is difficult, expensive, and dangerous
While a public hospital in Hong Kong will perform an abortion up to 24 weeks of pregnancy, it may be impossible to get an appointment. But there are also basic legal barriers: Hong Kong's abortion law states that "a pregnancy may be terminated if two registered medical practitioners are of the opinion, formed in good faith, that:

  • Continuing the pregnancy would involve risk to the life of the pregnant woman or of injury to her physical or mental health, greater than if the pregnancy were terminated; or
  • There is a substantial risk that if the child were born, it would suffer from such physical or mental abnormalities as to be seriously handicapped.

"The government doesn't have an official reason to oppose abortion. But they don't support it, so what they do is ignore it," said Bowie Lam, who runs Teen's Key, an organization dedicated to supporting young women in vulnerable situations. "If four out of eight doctors oppose abortion at a hospital, for example, the hospital will just shut down services, and the government leaves it."

A group called Teen's Key has a new program supporting girls with unwanted pregnancies and new young mothers in a tiny office in Kowloon. They describe how young women have to search the black market by looking for flyers on office buildings that read "GYN", for clinics that open, close and constantly move, many in Kowloon's Mong Kok neighborhood.  Many other girls cross the border by train into mainland China, where there are many unlicensed clinics that offer cheap abortions, which may be easy to get but are not necessarily safe. According to data from China's National Health and Family Planning Commission in 2015, about 13 million abortions take place in the country annually, 62% for women aged 20 to 29, most of whom are single. But that number does not include abortions at unlicensed clinics...




Yangon Central Women's Hospital
Six in ten maternal deaths from botched abortions in Yangon Central Women's Hospital
Women denied the right to an abortion are injuring and killing themselves in an attempt to end their pregnancies, doctors and specialists say. These botched abortions are often carried out by the women themselves.
The two main causes of maternal mortality are heavy blood loss and sepsis. Many of the women brought to hospital with one or both these complications arrive too late to be saved, says obstetrics and gynaecology specialist Dr Soe Lwin, an associate professor at Yangon Central Women's Hospital. “Of every 10 pregnant women who die in our hospital, six have had unsafe abortions,” he said. “A patient suffering from menorrhagia can die within the hour. A woman who becomes infected after an unsafe abortion can suffer for a long time. And, if she is not brought to hospital in time, she will die.”

Abortion is
illegal in Myanmar and a doctor providing abortion can lose their licence, be fined or sent to prison for up to five years. Data on abortions in Yangon are hard to obtain, and data from outside Yangon are even more unreliable. Estimates of the proportion of maternal deaths due to unsafe abortions by different sources in the country range from the government figure of 10%, to 35% according to Dr Naing, and as high as 60% in Yangon Central Women's Hospital...




Hotline launch – Dhaka, 24th October and Rajbara, 25th October – 2013

Misoprostol Hotline Pakistan
In Pakistan, an estimated 890,000 induced abortions take place every year. The current restrictive law, which came into effect in 1997, permits abortion only to save the woman’s life or to provide “necessary treatment”. With support from the Asia Safe Abortion Partnership (ASAP), three groups in Pakistan launched the Misoprostol Hotline in 2010:

  • Wake Up Call International 0307 - 494 07 07 (information in Urdu & Punjabi languages)
  • Peace Foundation 0315 - 947 33 99 (information in Urdu & Sindhi languages)
  • Aware Girls 0315 - 917 04 08 (information in Urdu & Pashto languages)

Training for representatives of the three NGOs and for Hotline staff was conducted by a Women on Web team. Women’s rights activists, youth leaders, women’s health counsellors and doctors participated in this training. The Hotline was launched at a press conference and began receiving calls from Pakistani women and women outside the country too, and from young girl’s asking about self-management of abortion and post-partum haemorrhage. The Hotline campaign was acknowledged and awarded membership of the Pakistan Alliance for Post-Abortion Care in Pakistan...



"Don't touch our abortion rights", demonstration, Istanbul 2012 CREDIT: Bulent Kilic
Restricting access to abortion services: government policy since 2012

During the pro-natalist period, the Turkish Penal Code, ratified in 1926, considered induced abortion to be a crime. In 1965 a “population” law was enacted, allowing the sale and use of contraceptive methods. Abortion was permitted only to save the life or preserve the health of the pregnant woman and in cases of fetal impairment. Abortion was then legalised in Turkey in 1983 up to 10 weeks of pregnancy on the decision of women. The decision has to be confirmed by the husband, however, if the woman is married, or by the parents/legal guardian if the woman is aged under 18. Pregnancies over ten weeks can be terminated only on medical grounds.
After 1983, the numbers of unsafe abortions and their adverse effects decreased sharply. The prevalence of induced abortions rose initially, but started to decline in the 1990s and continues to do so today. According to Turkey Demographic & Health Survey data, the number of abortions per 100 pregnancies dropped from 19.0 in 1983 to 4.7 in 2013. 
Since 2012, there has been political opposition to the provision of abortion services. Some hospital clinics that provided both family planning and abortion services had to stop providing abortions. Thus, the availability of safe abortions depends not only on permissive legislation but also on political support and the ability of health professionals to provide it. If restrictions on accessing abortion services continue, the country will again be faced with an increase in women seeking abortions in unsafe conditions, resulting in increases in maternal morbidity and mortality...



Canada - La pilule abortive devrait être distribuée par des pharmaciens, selon des spécialistes
(The abortion pill must be available from pharmacies, according to specialists)
In an article entitled "Requiring physicians to dispense mifepristone: an unnecessary limit on safety and access to medical abortion" in the Canadian Medical Association Journal, published in October 2016, Dr Wendy Thomas, a family doctor, and Prof Judith A Soon, Faculty of Pharmaceutical Sciences, University of British Colombia, said the federal government must allow pharmacists to prescribe the abortion pill to ensure safe and equitable access for women across Canada.
In Canada, currently, 96% of abortions are surgical, provided mainly in clinics in the large cities. The current system for physicians in rural areas especially to have to prescribe the pills is too complicated and unnecessary, the article shows.
Access to medical abortion on prescription through pharmacies would help to reduce the inequalities experienced by women living in the vast rural areas of the country...




Donations to US abortion providers have surged since the election disaster

It all began in 2011, when as an Indiana congressman Donald Trump's running mate introduced several anti-abortion measures, including the first bill to strip Planned Parenthood of all federal funding. Donations to Planned Parenthood have soared since the election earlier this month. Mike Pence, now Vice-President elect will be sent a gift certificate for every donation they receive.

The National Abortion Federation (NAF), the national network of US abortion providers, also receiving donations, has taken up the same practice. On 14 November they published the following message on Facebook:
"Thank you, Vice President-elect Mike Pence, for inspiring so many to fight for abortion access and donate in your honor. You can join them here:

(Our Hotline staff will continue to provide direct assistance to women seeking abortion care. Our medical team will continue to help ensure the high quality of abortion care. Our security team will continue to protect the safety and security of our members. Our public policy team will continue to advocate against further abortion restrictions and for proactive measures to expand women’s access to abortion care. With your help. #WeSeeYou #WeFightOn #WeWontGoBack"...



One woman (who used a coat hanger) has already spent a year in jail and now faces new charges in Tennessee
Anna was first jailed in December 2015. The initial charge was attempted first-degree murder, which was downgraded last spring to aggravated assault. Now, on 12 November this year, three new charges were filed by the local County grand jury: aggravated assault with a weapon, attempted procurement of a miscarriage, and attempted criminal abortion. The new charges will replace the aggravated assault charge brought last year. Last month, her attorney filed a motion to dismiss the case, arguing that bringing her to trial "makes every pregnant woman vulnerable to arrest and prosecution if she is perceived to have caused or even risked harm to a human embryo or fetus…The prosecution is absurd, illogical, and unconstitutional." The court date is 28 November.


On 30 September, Daniel Grossman wrote: "Give women their reproductive revolution"
"…In March of this year, the FDA approved an updated label for mifepristone, which has allowed physicians in Ohio and Texas, as well as North Dakota, to once again offer medication abortion according to evidence-based protocols. The fact that the FDA process of updating the label occurred without political interference is also cause for celebration.
But beyond state-imposed roadblocks, though, there are restrictions on how mifepristone can be dispensed. When the drug was approved back in 2000, there were concerns about its safety profile that led to certain restrictions in how it could be distributed. For example, mifepristone can only be dispensed at a clinic, doctor's office or hospital, and it cannot be obtained at a pharmacy with a prescription. A doctor who wants to provide mifepristone must enter into a relationship with the drug's distributor and self-certify that she or he is competent to do certain things such as determine how far along the pregnancy is, which most physicians who treat reproductive-aged women do on a weekly basis.

It is time for these dispensing restrictions on mifepristone to be removed. After 16 years of experience with medical abortion, it is clear that this option is very safe. A well-designed
study of over 11,000 medical abortions in California found that less than one-third of one percent of patients had a complication requiring treatment in a hospital… and death after medical abortion is exceedingly rare.


On 8 November 2016, Elisa Wells and Francine Coeytaux wrote: "Mail order abortion: the future is now"
With the devastating election result and talk of abortion regulation reverting back to state control, it is time to generate outrage about the lack of access to abortion pills in the US compared to other countries. The time is ripe for creative strategies that put pills directly in women's hands.


Study tests the safety of using abortion pills sent by mail
When the abortion pills arrived in her mailbox this summer, she felt anxious but also in control, knowing she could end her pregnancy entirely in the privacy of her own home. “I was happy that I was going to be able to do it myself and I did not have a nurse there or doctors there staring at me and judging me,” she said, asking to be identified only by her middle name, Marie, because she did not want people outside her immediate family to know about her abortion.
At a time when access to abortion is being restricted on many fronts, advocates say being able to terminate a pregnancy through telemedicine and mail-order drugs would provide a welcome new option for women...



Editor: Marge Berer

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