Hundreds of thousands of abortions take place every day around the world. Test your knowledge of this common medical procedure now – maybe you`ll learn something that will surprise you! In addition to acknowledging that unsafe abortion is a problem, the Ministry of Health offers little substantive advice on combating unsafe abortions. For example, the National Strategic Plan for Maternal and Newborn Health (2012-2016) makes reducing abortion mortality from 4.5 to 3 deaths per 100,000 live births a goal of the National Maternal and Newborn Health Program. Beyond its mantra of improving access to contraception and post-abortion follow-up, the ministry offers no new ideas to achieve this goal.26 Sonali points out that « the entire campaign should focus on women`s right to vote, up to 12 weeks, but if a compromise is to be found that abortion will be legalized according to medical demands (in case of rape, incest and severe fetal malformations), this alone will be a victory for women in Sri Lanka. « If we don`t legalize abortion, illegal abortion will be the happiest, » he continued. However, if a doctor monitors the abortion, it is not a guarantee of a healthy outcome. The annual calculation of the maternal mortality rate in Sri Lanka includes data on abortion-related deaths. Abortion accounted for five percent of cause-specific maternal deaths in 2016, up from 12.5 percent in 2014. Proposals have also been made to legalize mifepristone and misoprostol, two drugs commonly used for illegal abortions in Sri Lanka. Although currently banned, supplies in returnees` pockets are smuggled into the country from India, where they are readily available. Misoprostol is sold secretly in most pharmacies at a price of Rs 150 per tablet.
Medical abortions have advantages over surgical abortions because they are less intrusive procedures, there is no risk of general anesthesia, and there is a lower risk of secondary infertility due to scarring and intrauterine adhesions (scar tissue that forms between the inner walls of the uterus). However, due to the inability to regulate the sale of these drugs, patients do not have complete information about the correct doses, so there may be health risks from taking the wrong dosages. An attempt to legalize misoprostol in 2010 failed when the competent body could not make a decision on registration. The Irish example underscores the global relevance of the current abortion debate. Sonali Gunasekera, advocacy director at the Family Planning Association of Sri Lanka, says that for real progress to be made in Sri Lanka, the issue needs to be brought to the attention of the public through campaigns and community discussions. Young people must be motivated to take up this challenge and continue to fight for reforms. Abortion debates often overlook the context in which women seek and use abortion services. There is little discussion about the lucrative services offered by doctors and others because abortion is criminalized. There is also no concern about how women are humiliated and made vulnerable in the hands of health care providers. A survey of 665 women who had abortions found that about 70% identified their providers as doctors. In this study, the abortion procedure was explained to just over a quarter of the sample, and most providers warned their clients to keep the abortion secret. A qualitative component of this study captured the inhumane treatment that women received from their providers.
For example, three participants referred to sexual advances from health care providers, and one participant from the war-torn Eastern Province was able to obtain the service on the condition that she had sex with the provider.13 Sri Lanka has some of the strictest abortion laws in the world. according to which abortion is only allowed if the mother`s life is in danger. in accordance with article 303 of the Penal Code of 1883. As Tegal noted, the penalty for causing a miscarriage is a fine and/or up to 3 years in prison. The attempt to reform the law in 2017 was initially successful, with then-Justice Minister Dr Wijeyadasa Rajapkash saying: « I don`t think there will be many challenges. » However, drafting of the law was suspended because President Maithripala Sirisena wanted to consult religious leaders who strongly opposed the reform. It was subsequently reported that the proposals had not been submitted to either the Ministry of Health or the Government and that only one discussion had taken place. If the proposal is received, it will be discussed in cabinet. However, Christian Affairs Minister John Amaratunga reportedly said Prime Minister Ranil Wickremesinghe had assured him that abortion would not be legalized.
The high rate of unintended pregnancies has been attributed to the lack of information about contraceptives conveyed by formal health education programmes in schools and in the community.29 However, these analyses overlook the fact that contraceptives never eliminate the need for contraceptives due to their relatively high failure rates in typical use. as well as the fact that they are unlikely to be used when sexual intercourse is forced. 32 In Sri Lanka, abortion is so severely restricted that people who cannot afford quality services at home or abroad are forced to risk their lives to undergo the procedure in unsafe conditions, or are forced into a pregnancy they cannot afford. do not manage or do not want to. He also raised the issue that abortions could lead to future regrets and psychological problems for the mother. However, there is no confirmed link between abortion and psychological trauma, and the possibility of regret is not enough to criminalize abortion. But with opposition parties divided and broad public support for the government`s handling of Covid-19, the SLPP appears to be further centralizing power. And the impasse over abortions in parliament is expected to change little. Sonali: Sri Lanka has one of the strictest abortion laws in the world, which states that abortion is illegal unless the mother`s life is in danger. You must have three signatures from doctors to agree; Otherwise, abortion is not allowed.
Doctors at the Ministry of Health continue to push for legislative reforms for cases of rape, incest and severe foetal malformations. However, this reform will affect only a small percentage of women who wish to have an abortion in Sri Lanka. Admittedly, these are legal frameworks that say nothing about their implementation or effectiveness. For example, reforms could be opposed using the examples of India and Nepal, as abortion-related mortality in these contexts remains quite high despite legislative reform. However, various factors, including the lack of resources to provide primary health care, have prevented the implementation of these laws in India.28 Similarly, the provision of accessible and affordable abortion services in remote areas of Nepal has remained difficult due to poor health infrastructure and resources.41 42 Given that Sri Lanka has been successful in providing safe obstetric services throughout the country, it seems imprudent to predict the effectiveness of reforms in Sri Lanka based on the experiences of India and Nepal. In DECEMBER 2011, the abortion debate in Sri Lanka gained momentum when the Minister of Child Development and Women`s Affairs, Tissa Karaliyadda, raised in Parliament the need to reform the abortion law.1 The existing law, a legacy of colonial rule, only allows abortion to save a woman`s life. 2 This archaic law has not been revised since 1883.3 The proposed amendment will make abortion legal in cases of rape, incest and fetal abnormalities.1,4 A bill drafted by the Law Commission in consultation with the Ministry of Child Development and Women`s Affairs and the Ministries of Health and Justice has not yet been approved.4 5 This law, if passed by Parliament, allow abortion in these circumstances if recommended by a panel of medical experts in a public hospital (Anonymous, email communication, August 28, 2012). While the proposed amendment makes abortion laws less restrictive and gives Sri Lankan women some leeway, much broader legal and policy changes will be needed to combat unsafe abortions.
The country`s stance on abortion contrasts with its record on maternal health, an area in which Sri Lanka is known around the world as a success story. The country has a robust health service that provides free health care throughout the country, including in rural areas where the majority of the population lives. But despite the secrecy surrounding this issue, access to abortion-inducing drugs is relatively easy.