The persistence of unsafe abortion in Africa is, ultimately, perpetuated by two key factors: (a) the restrictive laws against termination of pregnancy; and (b) the limited or lack of access to adequate abortion services. Criminalisation of abortion in majority of African countries is something inherited from the colonial laws, despite the fact that the law has since decriminalised the procedure in the colonial “mother countries” (United Kingdom 1967; France 1975; Italy 1978; Spain 1985; Belgium 1990). On the other hand, it can be observed that passing of laws for or against abortion has little effect on the numbers of abortions that take place; in fact, the only difference is that the patterns of morbidity and mortality associated with abortion change. Stringent laws against abortion will not deter women in need from going through with an abortion, the only thing such laws achieve is to push many of them to undergo unsafe procedures with consequent high rates of morbidity and mortality. The procedure of medical termination of pregnancy is simple, short and safe when undertaken in the open, by trained persons; however, carried out in secrecy, usually by unskilled operators, it is expensive, unsafe and life threatening.

Obviously, like many other freedoms- legalisation of abortion may be abused, when abortion becomes a primary method of birth control, as happened in the former USSR. Increased access to contraception since the collapse of the Soviet Union, has led to a reduction in the numbers of abortions in Russia. However, it should be realised that induced abortion may still be the only means of birth control for many women in some parts of Africa, i.e. women who have very limited access to contraception, including adolescents and youths who are denied not only the services but also information on sexuality, on moralistic grounds. For such women, the desire to do away with an unwanted pregnancy can be so intense that they will avail themselves of this last resort despite the law, or the attendant risk to their lives. Sadly, many of these women live in countries where penal codes do sanction abortion under certain conditions but they are unaware of this provision; or, for various reasons, they cannot access safe abortion services in their countries.

Evidence from the Demographic and Health Surveys, over the last three decades, shows that women (and men) in most parts of Africa have increasingly taken to contraceptive practice. For anyone who chooses to practice contraception the hope is that it would not fail her or him. The shock of the discovery that this is not so, though infrequent, can drive the hapless individual seeking termination of the pregnancy. For most people it follows logic that if contraception is acceptable, then consideration for abortion should follow where there is failure- this is why in many countries medical termination of pregnancy is an accepted second line of defence against unwanted pregnancy.

Finally, in addressing the issue of unsafe abortion particular focus is needed on ensuring equity in access to health care, especially for the poor and marginalised communities, who are the main victims of quacks in backstreet clinics. Despite the absence of supportive data at this moment, it is highly possible that in many African countries, considerably more induced abortions occur among the wealthier and more mature women than among the poor young single women, that are often reported from public institutions. It is the latter that sustain Africa’s high abortion-related maternal mortality rates, and who will make it impossible to attain national and international goals, if they are left ‘out of the loop’.

Related Link

On The Abortion Question

As if my workload was not enough, i was recently informed that i had been selected for the South African Team to represent SA in the 7th International Junior Science Olympiad- to be held in Abuja, Nigeria. Honestly, I am really excited and seriously keen for the international experience. the only problem is the immense preparation that I have to do. It’s a lot of work- but ill get through it and will, hopefully, prosper. I am even getting a private tutor to help me through the IJSO syllabus- it’s intense- like seriously yaar.

I have 3 weeks until my year end examinations. I am secretly nervous at the moment, but as I get into my revision, I should ease up and get “stuck in”. What makes my experience even more chaotic is the fact that I leave for Nigeria on teh day that I write my last exam- hows that for timing, eh?

But hey, as Sri Sathya Sai Baba said: “We are not here to do what we like, but to like what we have to do”

On that note, until my next post:
“Hum hain raahi pyaar ke, phir milenge, chalte chalte…”

Avatar out…

Date : 2010 – 2011
Format : Various Formats
Eligibility : All ages
Website : http://www.bickelbrewer.com/ippf
Email : ippf@bickelbrewer.com

From the organizers

Registration for the 10th Annual Bickel & Brewer/New York University International Public Policy Forum (IPPF) is now underway!

What’s the IPPF? Founded in 2001, the IPPF remains the only international contest that gives high school students the opportunity to participate in written and oral debates on issues of public policy. The contest is open to all schools – public and private – for free. Teams compete for NFL points and more than $50,000 in awards and scholarships! In addition, the top eight schools win-all-expense-paid trips to the finals in New York City, where the champion takes home a $10,000 grand prize!

This year, the competition topic is: “Resolved: NATO military operations in Afghanistan are not justified.” The resolution requires affirmative and negative teams to focus attention exclusively on the justification of NATO military involvement in Afghanistan.

So how do I participate? Just visit www.bickelbrewer.com/ippf to register. The deadline for signing up is October 13.

Your team must then submit a qualifying round essay to ippf@bickelbrewer.com by October 27. Contest rules and a topic primer can be found on the competition website.

Also, check out the competition flyer by visiting: http://www.bickelbrewer.tv/pdf/IPPF2010_11.pdf

That’s when my 18 year old sis came into my room to give me a banana. Peeping at my lap top screen she asked what I was doing. (She just wanted to annoy me or to get my attention I am sure). I explained what I was doing. Then she wanted to know more. She seemed to be suddenly, and rather strangely, interested in sexual rights. I explained her that women should have the right to decide whether or not to have children, when to have children, and how to have children.

“You mean women should be able to decided whether they need children or not. Ok then what in case of rape? Do they have a right whether or not have children when they event don’t have the right to decide with whom to have sex?  ” She said mockingly. “I get it… the declaration says that in a case of rape women have the right to have an abortion? But it is illegal isn’t it?” Now she seemed confused. 

I knew I had to explain. “The declaration doesn’t exactly say that women have a right to get an abortion. But if we look at it closely we understand that women have the right for a safe abortion. And yes; in Sri Lanka, abortion is illegal unless the mother’s life in danger.”

Sis: “In danger means?”

Me: “Medically, if having the baby puts a mother’s life in danger it is possible to get a safe abortion.”

Sis: “If the woman kills her self not being able to have an abortion, isn’t then her life in danger?”

Me: “Well, our constitution doesn’t say so.”

Sis: “But it is!!!  How many women commit suicide after being raped or as result of unexpected pregnancies? I think it is absurd to ban abortions. And say it is illegal, abortions have not stopped. Even _____ went for an abortion.” 

Me: “Darling, in 1995 they tried to bring an amendment to the section 303 of the penal code which says that abortion is illegal. The amendment was to be made so that it becomes possible to get a safe abortion in cases of rape, incest and if the fetus is malformed. But it couldn’t be passed, mainly because of the protests of religious groups in the parliament. And you are right sis, it is estimated that there are 1100 abortion happening every day in Sri Lanka. And most of them face post abortion complications.”

Sis: “WE SHOULD MAKE ABORTIONS LEGAL!” (She was arguing with me now).

Me: “Women’s organizations have been trying to make abortions legal for about 20- 30 years. But you see, since it’s clearly mentioned in the penal code that abortions are illegal we can’t just do it.”

Nangi wouldn’t accept this.

She argued coming up with various suggestions: Waiting for a politician’s daughter gets pregnant and making her file a court case requesting a safe abortion; Looking for a parent whose daughter died of post abortion complications and making them go to court; Publishing a book of life stories of women who faced complication after unsafe abortions and about the mental and physical hardships they faced.

She is young and very, very stubborn. She wanted to change the law at that very moment, right there in my bed room.

“What are the women’s organizations for, if they can’t even change this small sentence for the sake of women?!?”   

She was so loud that Amma came in. Having heard Nangi’s remark on women’s organisations Amma seemed annoyed. (She has been a feminist activist for more that 20 years.) Amma sat with us and joined the discussion. She explained how they have been fighting for safe abortions since they formed the first women’s organisation in Sri Lanka in the 1980s.

Nangi was flabbergasted!! “Nearly 30 years and there hasn’t been any change???”

Yes, for 30 years women in Sri Lanka have wanted safe abortions. Women’s organisations have tried their best. Although abortions were made illegal, abortions have not reduced. But complications women face have increased.

My mother fought for safe abortions. Now I am writing this article to start a discussion about abortions and I am sure somewhere in the house Nangi is also thinking her head off about how to legalize abortions.

Are we passing this issue to our children?

Should more women embrace the fate of ______ or ruin their dreams, their lives due to unexpected pregnancies?

 We need to seriously think about this now, keeping in mind that People should be able to enjoy their sexuality and be free to choose whether or not they want to reproduce. (Principle 4, IPPF Declaration on Sexual Rights.)

And, it is her fundamental right.

So can a person living with HIV have a child?

Some Sri Lankan doctors will call you mad for suggesting it. Other doctors, more politely say irresponsible, thinking the same thing. Mad.

About a year ago just after returning to Sri Lanka I had lunch with friends from school. Doc, who entered medical school in the mid 90′s, called me irresponsible for discussing the reproductive options of HIV positive people. (This is our new approach to saying PLHIV. HIV positive people is not new. It’s well worn. Normal almost. And not an acronym.) Gayatri was wearing an ’I am HIV Positive’ pin. Part of a Sri Lankan campaign based on the HIV Positive campaign in Pune. Under the impression she was HIV positive during our discussion on reproductive options Doc asked her, “Why would you want to pass on the curse?” Needless to say things got a little warm.  

Doc held his ground. He had been to medical school and learnt about the science of having babies. We non-docs had to be wrong.

His stubborn incredulity was not new. I had seen it before in Pune’s slums. Homeopathic trained docs explaining how the ‘AIDS Inflicted’ must necessarily die within 6 months. How dare people heed the word of social workers that life is still possible after HIV. A rights approach fails with these bigoted docs. It maybe her right to have a child. But if she willfully infects another with “the curse”… 

Saying viral load, Nevirapine and caesarean over and over again to Doc didnt help either. Viral Load, Nevirapine and Caesarean were just three old Roman generals at the battle of Pull-o-penis on Mount Vulva.

I should have just said, “google it.”

Antiretroviral Therapy changed the world Doc. At least for HIV positive people.

“Not everything is possible in 5 years at medical school Hans. HIV is not a focus in Sri Lanka. We are a low prevalent country.”  – A different Doc. A different day. 

But HIV is still HIV. People live with HIV even in low prevalent Sri Lanka. But who cares about 3000 people? Who cares if they want to have children? Who cares if they want to have sex? They should have thought about all that before they went out and got infected!        

We need something for Docs to read in this country. Something for HIV positive people to read and challenge the Docs with. We need a really accessible publication on living and reproducing with HIV.  Finding that publication won’t be easy.

We looked at this very pleasingly-coloured-lots-of-oranges-and-reds-and-muddy inbetweens cover. Leaping and dancing people - ‘Healthy Happy and Hot’

This little book is about how HIV positive people have the right to have sex, make love, and if they really want to, have children.  A little book published by the International Planned Parenthood Federation. A book we may want to see in Sinhalese and Tamil.  

But it needs work. It needs to do more than speak about rights. It needs to tell HIV positive people what they need to do to have children. So that in turn they have the knowledge to challenge docs with, and begin a discussion on more equal terms as potential positive parents, not ’AIDS patients.’  We also need to do more than just talk about right to have sex. Using terms like licking, sucking, kissing, and cuddling is a start, but as a young woman said after she read the book, “My boyfriend won’t go down on me. It doesn’t tell him that its ok to put his tongue in my vagina. He needs to know its really ok. He needs to know how to do it safely.”

Obviously we are not advocating that we have a section that reads ’10 tips on how to stimulate a HIV positive vagina.’ What we would like however is a discussion on body fluids. How they  need to get into the blood stream to infect. Dental dams and condoms and how they come in green tea flavour now. What would happen if HIV positive semen or vaginal fluids is swallowed by accident… tell them the truth. The risk of contracting HIV from oral sex is minimal. Give them a number. Let them understand the process of infection. Accurate and comprehensive information man! That’s what they need to make a choice. Not just – DON’T-have-sex! or wear-CONDOM-every-time!        

So HIV positive people can have a healthy sex life and can also have children.

Too much for Sri Lanka? 

A recent discussion with some non-docs on sharing a sauna with a HIV positive person – “Machang, standing in the same queue maybe… but a sauna! Come on, be real Billy.”     

So while Healthy Happy and Hot needs work to address possible issues around Cunnilingus and Fellatio (two more Roman generals at the battle of Pull-o-Penis on Mount Vulva) even in its current format the book begins a discussion. A discussion that may help some people believe the madness we spew forth on how normal life can be with HIV.  Help others get into that sauna with the confidence that even if there was a HIV positive person in there – and its a bit difficult to tell boys in the current absence of red ribbons tattooed onto foreheads  – they can still enjoy the sweating together.

Don’t wait to be HIV positive to read the book. Read the book to be HIV positive.

Read the full report on the PAI website.