2007 06: ABORTIONS: Fear, secrecy causes of problems

NST online. Letters. 12/06/07

By : DR S.P. CHOONG, Penang

I REFER to your report ("Abortion open secret" — NST June 1) on the distress caused by medical complications suffered by a woman as a result of an abortion at an ill-equipped "clinic" in Yong Peng.

I sympathise with the woman’s plight but within the circle of professionals dealing with reproductive health, it is generally known that such cases are not uncommon and hers is only one of many which mostly remain unreported. This is a problem that is a consequence of the culture of silence that prevails in our society over the subject of abortion. Unfortunately, your report creates the false impression that abortions are an uncommon clandestine activity practised either by quacks or by a few criminal elements in the medical profession. In fact, as explained by Dr Ravindran Jegasothy, the chairman of the Malaysian Medical Association’s Ethics Committee ("Illegal abortion probe under way" — NST, June 2), abortions are permitted under certain conditions under Malaysian laws.

To be more specific, adverse effects of an unplanned pregnancy on the woman’s physical or mental health are included as factors that a doctor would consider in deciding whether a termination of pregnancy is justified.

Most abortion procedures are done safely under hygienic conditions by qualified and competent doctors. While there is no direct data available, retrospective surveys on women’s reproductive histories show a high incidence of abortions. But hospital data show a low admission rate for complications from abortions. This clearly indicates a trend away from unqualified practitioners.

They also indicate that these "minor surgical procedures" are far from uncommon.

Why then do some women resort to clandestine abortion centres? The situation has been created by several factors:
• Abortions are not readily provided in government hospitals and clinics purportedly because it is not considered an essential clinical service.
• Private clinics that provide this service usually keep a low profile because of the ambiguous status of abortions created by media reports and government statements.
• Religious conservatives constantly lobby in the media to legislate on "moral issues" relating to sexual behaviour.

Accidental or unintended pregnancies are a common occurrence worldwide. Nevertheless, it is the women who eventually carry the responsibility and "stigma" of the unwanted pregnancy and how to deal with it. Even worse, when facing social pressure, they are automatically judged the "guilty" party rather than their partner. When it comes to getting advice or information on abortions, the women’s unofficial network is often the most reliable source of information; there is no official source for such information elsewhere. However, the availability of such services varies from area to area and so it is a matter of chance whether one is referred to a reliable clinic without too much delay. Cost is another factor. Where such services are scarce, some doctors exploit the situation by charging exorbitant fees. Thus, to save costs, they may be forced to seek affordable treatment elsewhere, often ending up in dubious "clinics" and unwittingly endangering their own lives. All these factors, taken together, have created a climate of fear and secrecy surrounding abortions, strengthening the prevailing impression that it is an "underground" criminal activity. A woman faced with this problem, therefore, has to traverse a minefield of obstacles just to find a sympathetic professional before deciding whether or not to seek an abortion.

Many women’s groups and health professionals have privately expressed grave concern over this serious weakness in our women’s healthcare system which is creating an unacceptable dilemma for women with unintended pregnancies. We are in the process of forming a coalition of public interest groups to address this problem through education, dialogue and research.