Reprinted from T&T Review, March 3, 2008
By Sanka Price
As a politician there are some issues that no matter what decision you make, you are certain to anger a significant segment of the population.
One such issue is the legalisation of abortion.
You’re damned if you support it, and you damn others to suffering if you don’t.
Abortion is an issue that has strong religious, medical, and social arguments for and against it. And each side thinks they are correct.
Those who favour the right of a woman to decide if she should have an abortion are “pro-choice”. They see their goal as the empowerment of women, and the need to stop the death, disability, disfigurement and debilitating conditions scores of women endure from botched, ‘back street’ abortions.
Equally strong views are presented by those who maintain that once there is conception the emphasis must be on preserving the life of the foetus. They argue that although a woman has a right over her own body, she has no medical or legal right over the foetus because it is a separate individual with its own DNA, blood supply, and maybe, even a different blood type.
In other words, it is a person which just uses the woman’s body for nourishment for a few months. To terminate this life would therefore be a criminal act.
Some of these supporters do concede that this stance should be changed only if the life of the woman is endangered by the pregnancy. These individuals are regarded as “pro-life.”
With such irreconcilable views on either side, abortion is a political minefield.
It is such a hot potato that politicians usu¬ally leave it alone if they can.
From this perspective, the tip toeing around legalising abortion in Trinidad and Tobago and Jamaica by their Prime Ministers, Patrick Manning and Bruce Golding, is understandable – after all, no leader wants to alienate core constituencies.
That said, the fact remains that abortion law or no law, women all over the Caribbean- indeed all over the world- are finding ways to terminate undesired pregnancies.
THE CASE OF JAMAICA AND TRINIDAD AND TOBAGO
Unofficial estimates suggest that 45 out of every l,000 women in Trinidad and Tobago between the ages of 15 and 44 have had an abortion. This in a country where abortions are legally available only if they would preserve the physical or mental health of the mother; and where the procedure requires the agreement of two doctors.
This moved social scientist Dr. Fred Nunes to suggest a few years ago that approximately 20,000 women in Trinidad and Tobago have illicit terminations done annually – one of the highest abortion rates in the region.
Dr. Nunes, who was speaking at a conference organised by the Gynaecological and Obstetrical Society of Trinidad and Tobago and the General Practitioners Association of Trinidad and Tobago, said countries with more liberal abortion laws showed lower figures.
As for Jamaica, last month (February 19) a retired gynaecologist and former chairman of the National Family Planning Board, admitted that he had conducted at least 1,000 abortions. He claimed that though abortion-on-demand is still illegal in Jamaica, he does not fear prosecution since doctors employed by the Government have been conducting abortions at a clinic in Kingston for almost 30 years.
Dr R.E. David Thwaites, a 75-year-old retiree who chaired the Board from 1981 to 1989, further argued that a 14-year-old girl in secondary school, who has had her first sexual experience and got pregnant, should not be forced to suffer for life for that one mistake.
“Let’s face it, in Jamaica the girls are much brighter than the boys so, therefore, we are abusing our whole reservoir of people who are educated when you allow them to have a child at 14 or even 15,” he reasoned.
“It interrupts their life forever. They can never reach that position that they were going for before they got pregnant,” he added.
Thwaites reportedly stated, too, that during his 40 year practice he had done several abortions for the children of members of the clergy, and rhetorically asked: “The church hasn’t even been able to stop their own members from getting pregnant, so how do they want to interfere in other people’s personal decisions?”
He concluded that the church in Jamaica should stop interfering in the Government’s consideration of whether abortion should be made legal.
Been there, done that
For Barbadians looking on at this moral versus human rights tug-of-war, the arguments for and against the legalisation of abortion seem woefully familiar. After all, this year is the 25th anniversary of the passage in Parliament of the Medical Termination of Pregnancy Act (MTP).
And maybe an examination of how the law has worked here could be used as a barometer for determining an approach in both Trinidad and Tobago and Jamaica.
BARBADOS—25 YEARS OF LEGAL ABORTIONS
The 1983 MTP Act, the first liberal abortion legislation in the English-speaking Caribbean, permits legal abortion to save the life of the woman if the child is likely to suffer severe abnormalities; for rape and incest; to protect the physical health and mental health of the woman; and for social and economic considerations.
The law states that up to 12 weeks’ gestation, one doctor may determine termination. Between 12 and 20 weeks, two physicians must agree, and beyond 20 weeks, three of them must agree that termination is necessary to save the woman’s life or prevent grave injury to the woman or the foetus. Termination after 12 weeks must be done in hospitals.
The Act was passed because of the recognition that prior to 1983 not only were a lot of abortions being done in Barbados, but the unsanitary and unprofessional people who carried them out killed or left scores of women badly injured.
As one doctor recalled: “People used to do a lot more abortions at home and then have to come to the hospital, bleeding. Women used to push wire [clothes] hangers inside of them, sometimes they would pour in a disinfectant inside of them, jump off walls, all sorts of things.
“I remember as an intern in those days that . every weekend you would have five or six botched abortions coming through. Now that abortions are legal, women can get them done in safety.”
So what has been the social impact of this law?
The only publicly disseminated report which looks at this was completed 12 years ago by researchers Dr Frederick Nunes and Dr Yvette Delph, in their study on Contraceptive Knowledge And Practice Among Women Seeking Legal Abortions in Barbados.
That four-week study sought to establish some . basic estimates of abortion in Barbados, and to explore the Phenomenon of the co-existence of great contraceptive knowledge and practice, alongside a high abortion late.
According o the report: “Given me lack of reporting by medical practitioners under the 1983 MTP Act (Mcdical Termination of Pregnancy Act), and the ausence of monitoring by the Ministry of Health, there arc little or no objective criteria on which to assess the broad social impact of the law.”
Nunes and Delph concluded, however, that based on statistics from the Queen Elizabeth Hospital (QEH) on cases for admission due to septic abortions and complications of abortions between 1982 (the year before the law was enacted) and 1992, its tenth anniversary, “the law has radically improved women’s reproductive health”. Their conclusion was based on the 70 per cent decline in QEH admissions for septic abortions, and a 53 per cent decrease in complications from abortions.
“In so far as botched abortions were a leading factor impelling law reform, a substantial measure of success has been realised,” they said.
That was the good news.
The bad news was that women were having abortions done on demand. The researchers noted: “The very high value placed on small families, and the questionable effectiveness of contraceptive practices are main factors driving the demand for abortions.”
And as the Act left it to doctors’ voluntary compliance to report the number of abortions they did, there was little information available then, and now, on the actual number of abortions done here by doctors or private practice since the introduction of the law.
What is widely believed however is that many abortions are done on demand here annually.
Consultant obstetrician and gynaecologist, Dr Carlos Chase, who is president of the Barbados Association of Medical Practitioners (BAMP), agreed with this observation in an interview late last year saying not only are a lot of terminations done here, but “a fair amount are teenagers”.
Dr. Chase said the two top reasons Barbadian women have abortions are because of the age of the female involved, and the souring of the relationship between the couple, which often leads the woman to decide not to deliver the child and have to raise it on her own.
The study by Nunes and Delph in which 19 doctors participated, completed a total of 244 abortions between late May and early June 1996. However, the doctors involved said the number seen was substantially lower than what they generally per formed on a monthly basis. The sum of their low estimates was 417 and the high was 517.
Interestingly, up to 2006, an average 608 abortions were done each year for the last 19 years at the QEH – a total of 11 554. Of that number 2 306. or an average 121 each year, were performed on teenagers between 11 and 19 years old.
They would have been done free or at minimal cost under the strict regulations of the MTP Act which governs the manner in which such procedures are done here.
However, doctors quizzed said this number was just the tip of the iceberg, as the majority of terminations here were done in doctors offices where women can be assured of privacy. For this service they pay from BDS$450 (TT$1,350) to as much as BDS$800 (TT$2,400).
If there are any lessons to be learnt from the Barbados situation, one is that some level of policing of the law must be done bv the Ministry of Health to ensure that doctors keep adequate records and report on the number of terminations they perform.
The other is that family planning education and information is consistent, and quality contraceptives are inexpensive and readily available, to provide knowiedge and the wherewithal to prevent unwanted pregnancies.
The third is that the law only makes getting an abortion easier, but it does not stop women from having unprotected intercourse without thinking about the consequence of their actions, until they have an unwanted pregnancy and want to get rid of that child.
