Archive for July 25th, 2008

More emphasis is needed on family planning issues in poor countries, the World Bank said on Thursday, citing new data that it said showed 51 million unplanned pregnancies occur because women lack access to contraceptives.

In a report released ahead of World Population Day, the World Bank said another 25 million pregnancies in developing countries occur because contraceptives are incorrectly used or because birth control measures fail.

“It’s simply tragic that so many leaders in poor countries and their aid donors have allowed reproductive health programs to fall off the radar,” said Joy Phumaphi, World Bank vice president for Human Development and a former health minister in Botswana.

She said the issue was especially important now with countries worried about climate change and how they will be able to feed people if energy and fuel costs keep rising.

“Giving women access to modern contraception and family planning also helps to boost economic growth while reducing high birth rates so strongly linked with endemic poverty, poor education, and high numbers of maternal and infant deaths,” Phumaphi added.

The World Bank said birth rates have fallen fastest in Asia but at a slower pace in Sub-Saharan Africa, where the population is growing at a rate of 2.5 percent a year, which would double the number of people in Africa within 28 years.

By comparison, populations are growing by 1.2 percent a year in Latin America and Asia, the Bank said.

The report, “Fertility Regulation Behaviors and Their Costs: Contraception and Unintended Pregnancies in Africa and Eastern Europe and Central Asia“, said 35 countries in Africa and in Timor-Leste, Afghanistan, Djibouti and Yemen have the world’s highest birth rates with more than five children per mother.

It said some 68,000 women die every year due to unsafe abortions, while another 5.3 million suffer temporary or permanent disability as a result.

The World Bank said poor women are less likely to use contraceptives than women who are better off. Wealthier women are more than three times likelier than poorer ones to have a doctor or mid-wife to help with the births of their babies.

Sadia Chowdhury, a senior reproductive and child health specialist at the World Bank, said it was crucial that information about contraceptives be made more widely available not only to women but also to men, local leaders and youths.

“Promoting girls’ and women’s education is just as important in reducing birth rates in the long run as promoting contraception and family planning,” she said. “Education becomes a form of social contraception for women,” she added.

For thousands of Pakistani women, the World Population Day message of ‘Family planning is a right, let’s make it real’’ must sound hollow when they must resort to unsafe, illegal abortions while a debate on whether termination of pregnancy is Islamic or not rages on.

A 2004 study ‘Unwanted pregnancy and post-abortion complications in Pakistan,’ carried out over a two-year period by the Population Council of Pakistan, was an eye-opener. It said some 29 of every 1,000 Pakistani women of reproductive age seek to terminate their pregnancies and that an estimated 890,000 abortions were occurring in Pakistan annually.

But whenever activists and health practitioners, who regularly witness women dying from pregnancy-related complications, bring up the issue it only gets more entangled in an irrelevant debate over whether or not terminating a pregnancy (matured beyond 120 days) is un-Islamic and, therefore, illegal.

It does not help the pro-abortion or pro-choice advocates that even liberal Islamic scholars such as Khalid Zaheer reiterate that terminating a pregnancy after 120 days of conception is the “gravest of sins” committed unless the mother’s life was in question.

Islamic scholars in Pakistan and in neighbouring India have interpreted the ‘hadith’ (sayings of the Prophet) to say that pregnancies that have not advanced beyond 120 days is permissible, indicating that the idea of abortions in not completely forbidden in the religion.

But Zaheer says that he does not have a “simple and straightforward” answer to abortion except that it “should not be for trivial or flimsy reasons’’ such as limiting family size.

And so a dilemma that many women and their doctors face constantly remains unresolved. “What should we do when a woman comes to us requesting termination (of pregnancy) and we turn her away because it is illegal, knowing full well that she will go to some backstreet clinic and get an unsafe abortion?’’ asks a young doctor at government-run hospital. ‘’The same woman then returns either half dead or with serious complications.”

With a dismal maternal mortality ratio of 500 deaths per 100,000 live births and official acknowledgement that everyday 68 women die from pregnancy-related problems Pakistan must take quantum leaps just to meet the fifth Millennium Development Goal of reducing maternal mortality by three-quarters by 2015.

According to Dr Shahida Zaidi, vice-president of the International Federation of Gynecology and Obstetrics (FIGO), of the 46 million induced abortions each year globally, nearly 19 million are performed in unsafe conditions or by unskilled attendants resulting in an estimated 68,000 or a whopping 13 percent of preventable deaths. Of these 99 percent occur in developing countries.

FIGO is currently working in parts of the backward province of Sindh to reduce unintended pregnancies and induced abortions by improving access to safe abortion and post-abortion care in Pakistan.

A smaller scale study conducted by the National Commission for Maternal and Neonatal Health in collaboration with the Society of Obstetricians and Gynecologists of Pakistan, in 2007, found the situation no different from the 2004 Population Council report.

“Abortion in Pakistan is used primarily as a family planning method,” says Dr Azra Ahsan, research leader. “Most women interviewed wanted to terminate because of birth spacing or because their family was complete.”

“According to our research, 36.81 percent of abortions were conducted by unskilled traditional birth attendants (TBAs). The paradox here is that all the training is provided to doctors, nurses and lady health volunteers but never the TBAs,” she said. Traditional methods used are either dilatation and curettage (DNC) or laminaria stents (sticks of seaweed which absorb fluid and swell), neither of which are recommended by the World Health Organisation. “It seemed relevant to start a debate after the Population Council came out with its study, to thrash out a consensus on the contentious issue of abortion,” says Dr Yasmeen Sabeeh Qazi, senior country advisor with the David and Lucile Packard Foundation. “But it seems to have been dragged on for far too long,” she told IPS.

Her foundation supports safe abortion practices, and, to give it a more digestible cover, uses the terminology ‘post-abortion care,’ often used by the government itself so as not to pique people unduly.

She feels that the biggest stumbling block towards making abortion legal in Pakistan is “doctors and healthcare providers who are convinced by outdated, conventional medical education that this is unethical and thus totally illegal”.

She, however, is not in favour of initiating another round of debate on legalizing abortion. “I personally feel that we should let sleeping dogs lie. No one has ever been prosecuted in Pakistan for inducing an abortion but the moment we take the issue up for legislative changes, there is a risk of ruffling many feathers.”

According to Qazi, existing law has ‘’sufficient room for manoeuvre by doctors and providers for practicing safe abortion’’.

With abortion illegal, safe abortion services naturally remain elusive, forcing women to turn to backstreet clinics run by untrained TBAs, despite the risk of complications. According to Dr Shershah Syed, a practicing gynaecologist at the government-owned Qatar General Hospital, complications include “bleeding, infections, septic shock, perforated uterus, perforated bowels and, if they have survived these, infertility and chronic pain syndrome”.

While legalising abortion may result in safer abortion practices, examples of other countries where laws are more liberal (like Nepal and India) have shown that clearly it will not stop women from terminating their pregnancy through unsafe means.

“It points towards a high level of unmet need for family planning (FP) services,” explained Syed. “They want to either space or limit family size’’. He put the blame squarely on the shoulders of the government for its failure in improving access to family planning services.

Most abortions are carried out as a means of preventing unwanted births, according to studies. Reasons cited for not using contraception include inaccessibility of FP services, financial constraints and in some cases differences between husband and wife over the size of the family.

“One major obstacle to the use of contraception is the fear of health side effects and misperceptions: it appears that many Pakistani women and men regard continuing contraceptive practices more threatening to their health than an occasional induced abortion,” states the government’s report.

Plans to relax strict abortion and euthanasia laws and a proposed ban on Catholic symbols at state events have put Spain’s Socialist Government on course for a showdown with the Roman Catholic Church.

Against expectations the country’s ruling party has adopted a slate of proposals from rank-and-file members at its annual conference that are likely to enrage the Vatican.

“We are going to do these things, and we’ll start soon,” the Prime Minister, José Luis Rodríguez Zapatero, said. “We won’t take a step backwards.”

The country’s Left-leaning Prime Minister, a self-declared agnostic, became a bête noire of the Catholic Church during his first term in office by legalising same-sex marriage, introducing fast-track divorce and allowing embryonic stem-cell research.

Spanish bishops were also outraged by his decision to pull religious instruction from the school curriculum, replacing it with “citizenship” classes that opponents say are an attempt to inculcate children with leftist ideals. However, the Government’s latest batch of measures are arguably the most controversial, touching on issues — such as abortion and euthanasia — that are anathema to the Holy See. Pope Benedict XVI has made the fight against secularisation in Europe a chief concern of his papacy. Spain, a former Catholic bastion that has become one of the most socially liberal countries in Europe, has emerged as a key battleground. “The Government is sending Spanish society on a macabre journey into a culture of death,” said Leopoldo Vives of the Spanish Episcopal Conference. “I dare say the next thing they will propose is infanticide for children suffering from serious diseases.” Spain’s combative bishops are unlikely to take the latest measures lying down.

In December they led a 150,000-strong march in support of the traditional family, which quickly turned into an anti-Government tirade. Relations between the Church and the Government reached a nadir before the March general election, when Spanish bishops called on the faithful to vote against Mr Zapatero. In return, the Prime Minister threatened to review state funding for the Church, which receives some € 5 billion (£4 billion) a year from the Spanish taxpayer.

This time round, the Government says that it hopes the bishops will not take to the streets again. “It would be better if those acts were not repeated,” the Government’s director of church relations, José María Contreras, told El País. If they do, “it won’t stop the Government from adopting measures or decisions set out in its electoral programme, which were backed by the majority of Spaniards at the polls”.

Under current Spanish law pregnancies can be terminated only until the 12th week in cases of rape or until the 22nd week in cases of severe foetal malformation. But there is no time limit on abortions if there is a risk to the mother’s physical or mental health. The majority of abortions are carried out alleging a risk to the mother’s mental health, something that opponents say is a flagrant abuse of the law. Catholic groups also say the 22-week limit is widely flouted.

The Government vowed yesterday to revise the abortion law, saying that it favoured the system used by Britain under which abortions are freely available until the 24th week of pregnancy.

Spain’s ruling party also vowed to launch a consultation for a new law allowing doctors “a more active intervention in the right to a dignified death”. And it promised to do away with Christian symbols at state events.

The Peruvian government’s deliberate refusal to streamline procedures and approve guidelines for legal abortion is endangering the lives and health of women and girls who are often forced to use unsafe solutions for risky pregnancies, Human Rights Watch said in a new report released today.

The 52-page report, “My Rights, and My Right to Know: Lack of Access to Therapeutic Abortion in Peru,” documents the difficulties women face in accessing therapeutic abortion � those needed to save the life of the woman or avoid serious health risks � in Peru’s public health system. While no reliable statistics are available on how many women have been turned away from a legal abortion, in interviews with women, healthcare providers, rights activists and government officials, Human Rights Watch found that women in general lack accurate information about their right to a legal abortion, and public health care professionals are often unclear about the intent of laws guaranteeing women access to legal abortions.

“Women and girls confronting pregnancies that could kill or permanently harm them are refused legal abortions, or don’t even know they have a right to get one,” said Angela Heimburger, a women’s rights researcher at Human Rights Watch and author of the report. “The government not only has an obligation to raise awareness about the right to safe, dignified and affordable legal abortions, but it should make getting the procedure as painless as possible.”

Abortion is legal in Peru when a pregnancy endangers a woman’s life and when it is necessary to protect a woman’s health. But because a legal abortion is rarely available in a public hospital, many women seek unsafe and clandestine procedures to deal with a risky pregnancy. Human Rights Watch found several obstacles to making legal abortion accessible. Ambiguities about abortion in Peru’s legal system raise fears of prosecution among health care professionals and women. The absence of a national protocol provides no standardized outline for when a therapeutic abortion can be performed. The public health care system is ill-equipped to deal with referral procedures, and circumstances under which a therapeutic abortion can be approved are unclear. Peru has legal abortions, but in practice it is nearly impossible for a woman to have one.

Peru’s failure to ensure access to legal therapeutic abortion constitutes a violation of fundamental human rights. Women are entitled to the highest attainable standard of health, life, nondiscrimination, physical integrity and freedom from cruel, inhuman or degrading treatment. United Nations human rights officials and experts have repeatedly and forcefully called on Peru to eliminate barriers to therapeutic abortion to ensure compliance with its human rights obligations.

In the case of K.L. v. Peru, in which a 17-year-old girl was forced to carry a non-viable pregnancy to full term, the United Nations Human Rights Committee in 2005 found that the Peruvian government had violated a series of K.L.’s rights and “has an obligation to take steps to ensure that similar violations do not occur in the future” ( To date, the Peruvian government has taken no action, failing to abide by the Human Rights Committee’s recommendations.

Denying access to legal abortion can compound a risky pregnancy with severe emotional distress. For example, M.L., a married woman and mother of one, told Human Rights Watch that at 30 weeks of pregnancy, doctors told her the fetus would not survive. She asked for a legal abortion, but was refused by those same doctors at a public hospital in Lima. “They told me that the law did not permit it, that it couldn’t be done,” she told Human Rights Watch. An emergency Cesarean section was performed to remove the dead fetus several weeks later when she was at full term. She suffered from depression as a result and, four years later, is still trying to recover emotionally. “I wouldn’t want this to happen to any other woman. It’s something horrible that happened to me.”

The Peruvian government has actively obstructed some local initiatives intended to improve access to therapeutic abortion. In the absence of a national protocol to regulate and standardize this medical procedure, several hospitals and a regional government have attempted to establish their own. But national health authorities have rescinded most of these local and regional initiatives, and in one case removed a hospital director for “exceeding his authority.”

In Peru, as is the case around the world, restricting access to legal abortions does not reduce the number performed. Abortion care simply goes underground. For those with enough money and information, clandestine abortions may be performed in relatively safe circumstances. For the many poor women and girls in Peru, however, abortions are often induced by unqualified, unregulated practitioners or even by themselves through risky home remedies.

“Peruvian women and girls entitled to therapeutic abortions should never have to be driven underground or forced to pay exorbitant fees at private clinics. Such abortions should be readily available in the public health system, as required by law,” said Heimburger. “Forcing poor, often illiterate women and girls into the hands of untrained providers carries grave risks for them and their families left behind.”

Human Rights Watch calls on Peru to act immediately to:
* adopt a nationwide protocol on therapeutic abortion;
* work toward abortion law reform to ensure that all women are able to decide freely on matters relating to reproduction;
* inform the general public and health practitioners that therapeutic abortions are in fact authorized by law; and
* investigate instances in which healthcare providers deny therapeutic abortion to eligible women and girls, and take appropriate disciplinary measures.

A committee in Brazil’s lower house of Congress voted down a bill that would have legalized abortion in the world’s most populous Roman Catholic nation.

The Justice and Constitution Committee in the Chamber of Deputies voted 57-4 against a bill that had been stuck in Congress for 17 years, steeped in controversy. It is now likely to be shelved.

“This bill won’t prosper in the Chamber,” said Deputy Eduardo Cunha, committee leader.

Several ruling party legislators pushed the bill after Health Minister Jose Temporao last year all but endorsed legalizing abortion.

Church groups, which lobbied against the legislative proposal and witnessed the hearing, cheered and prayed in celebration after the vote.

Some deputies had placards hanging from their necks, showing pictures of aborted fetuses.

A few legislators supported the bill.

“You can’t treat this issue on the basis of religion or belief. It’s a public health issue,” said Deputy Jose Genoino, who voted in favor of the proposal.

Temporao angered church groups by proposing a referendum on the legalization of abortion and backing increased use of contraceptives.

The government has begun distributing condoms in public high schools and in April launched its own factory to produce condoms made of rubber from Amazon trees.

Temporao has warned that the large number of women having illegal abortions was a serious public health issue because of often dangerous complications when they went awry.

Annually more than 200,000 women are hospitalized because of botched abortions, government statistics show. Based on those figures some experts estimate the number of abortions could be as high as around 1 million per year.

Many Brazilians believe it is mostly poor teenagers who abort. But a study co-sponsored by the University of Brasilia showed that most abortions were practiced by Catholic mothers, aged 20-29, with jobs, who used contraceptive devices and had steady sexual partners.