Vol. 8 Abortion Rights, Son Preferences and South Asia
Reproductive rights, cultural stigma, sex-selective abortions and maternal mortality
This issue includes news from the region, a look at abortion rights across South Asia and a quick take on sex-selective abortions and son-preferences by Bansari Kamdar and an article by our Pakistan Editor Anmol Irfan on cultural norms and access to abortion in Pakistan. A quick shoutout to Maneesha Kaur Khalae, our new Research Associate who worked on abortion laws for this edition.
Best,
Bansari Kamdar
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News from South Asia
Hundreds of women in Nepal are protesting a new anti-traffiking law that would ban women from traveling abroad without permission from their families. Meenakshi Ganguly, South Asia director at Human Rights Watch, said the current proposals could “force women into riskier, undocumented employment, increasing the danger of trafficking and abuse”. (The Guardian)
The United Nations (UN) and Maldives have signed a project on digitialising social services in order to better protect women and girls from poverty and violence during emergency situations. (The Edition)
Disha Ravi, a 22-year-old climate activist finally got bail after being arrested and detained in India. Ravi was arrested for sharing an online document raising awareness about the farmer’s protests in India. Police said the document aimed to “spread disaffection against the Indian state.” Other young female activists, like the 25-year-old Dalit labor activist Nodeep Kaur have been in jail for nearly 50 days without due process for participating in the protests. Even as her family alleged that Kaur had been beaten and sexually assaulted in custody, a local judge has refused her bail. (Bloomberg/Article 14)
The Women Parliamentarians Caucus of Sri Lanka has extended their support for Deputy Inspector General of Police (DIG) Bimshani Jasin Arachchi, who is the first and only female DIG of Sri Lanka. Thirty-three Senior Superintendents of Police (SSPs) petitioned the Supreme Court to overturn Bimshani’s appointment alleging that a female officer cannot be appointed as the DIG of Police given that the word ‘women’ is not mentioned in the regulations pertaining to promotions. (Sunday Observer)
In a landmark judgement, the Delhi High Court said that sexual abuse takes away the dignity and self-confidence of a woman and that the"right of reputation cannot be protected at the cost of the right of life and dignity." The statement came in response to a defamation case against Indian journalist Priya Ramani after she accused M.J. Akbar of sexually harassing her in a hotel room during India’s #MeToo. In South Asia, defamation lawsuits have had a “chilling effect” on the #MeToo movement. In Pakistan, Ali Zafar slapped defamation suits against actress and singer Meesha Shafi and eight others for accusing him of sexual harassment. (NPR/Reuters)
Unsafe Abortion and South Asia
The Center for Reproductive Rights predicts that an estimated 53.8 million unintended pregnancies occur each year in Asia. Nearly two-thirds (65%) of these end in abortion. During 2010–2014, the majority of induced abortions occurred in South and Central Asia.
Three of the ten most populous countries in the world - India, Pakistan and Bangladesh - are in South Asia. Nearly one in every four (24%) of maternal deaths around the world happen in South Asia. Maternal mortality remains high and access to safe abortion and contraceptives is limited.
Unsafe abortions are one of the major causes of the high maternal mortality in the region. The World Health Organization (WHO) finds that less than 1 in 2 abortions were safe in South and Central Asia. In Bhutan, one of top reasons obstetric morbidity occurs is abortion fatalities, with a 1.4% case fatality rate.
While all eight South Asian countries allow for legal abortion to save the woman’s life, they differ on other abortion rights to a varying degree. For instance, in Nepal, abortion is interpreted as a constitutional right due to the groundbreaking Lakshmi Dhikta v. Nepal case; in comparison, countries like Bangladesh, Afghanistan and Sri Lanka permit abortion only to save a woman’s life.
“Reproductive rights are considered to be an inseparable part of women’s human rights and within that the right to abortion is seen to hold an important place.”
- Lakshmi Dhikta v. Nepal, Supreme Court of Nepal, 2009
Despite highly restrictive legislation, Bangladesh also allows for Menstrual Regulation (MR) for up to 10 weeks of the pregnancy, a procedure that uses manual vacuum aspiration or a combination of mifepristone and misoprostol to “regulate the menstrual cycle when menstruation is absent for a short duration.”
Bhutan’s Section 146 of the Penal Code legalizes abortion on only three conditions. The pregnancy can be terminated to save the woman’s life, if the pregnancy resulted from incest and rape, and if the mother is not of sound mental condition.
In Maldives, the Government’s Council of Religious Scholars released a Fatwa in 2013 to allow abortion under certain conditions - till 120 days are for economic and social reasons, rape/incest, and with no limit is to save a woman’s life. Nonetheless, abortion access remains highly restrictive and can only be performed at higher level facilities. Spousal consent is required for any termination of pregnancy, as well as parental consent for minors. There is a lack legal clarity and national guidelines for induced abortion and post-abortion care.
Even in countries with more liberal abortion laws like Nepal and India, access to safe and legal abortion remains limited and the implementation of these laws has largely undermined their impact. Some obstacles include difficulty finding providers willing to perform abortion, substandard conditions in health facilities, lack of awareness of the legal status of abortion and fear of stigmatization.
A recent study found that in India and Nepal, less than 40% of public sector facilities that are permitted to provide abortion services do so; in Bangladesh, the situation is somewhat better, at 53%. The researchers also noted that there are disproportionately fewer facilities that offer abortion care in rural areas in comparison to the proportion of women living in these areas.
Poor and rural women may often have to depend on the least safe methods and providers, and hence be more likely than other women to experience severe complications from unsafe abortion.
This pushes many women to pursue non-licensed abortions. Despite abortion being legal in India since the 1971 passage of the Medical Termination of Pregnancy (MTP) Act, 10 women die every day due to unsafe abortion. Only two in five of the estimated 6.4 million abortions that occur in India annually are considered safe.
A recent study by Guttmacher Institute finds that in India, Nepal and Bangladesh, the proportion of all abortions that are illegal ranges from 58% to almost 90%. The same study finds that from 22% to more than half of facilities turned away some women who would otherwise be eligible for an abortion or Menstrual Regulation (MR) procedures in Nepal, India, and Bangladesh.
In Sri Lanka, which has some of the most restrictive and punitive abortion laws alongside Afghanistan, Ramya Kumar writes that illegal abortions remain easily available and accessible. The Sri Lankan government’s attempts to reform its colonial-era abortion laws in 1995, 2011 and 2013 have failed due to anti-abortion sentiment.
In countries where abortion is illegal there is also a dearth of recent national-level statistics on induced abortion. For example, the most recent data for Sri Lanka is from 1998 when a United Nations Population Fund report that estimated the abortion rate was 45 for every 1,000 women of reproductive age - close to 650 abortions daily that year.
Women are more likely to be exploited, both financially and otherwise, when they pursue clandestine abortions. These margins of exploitation widen in countries where abortion is criminalized. Women are not just traumatized by the experience of accessing abortion in a criminalized context but are also likely to encounter stigma in post-abortion care. Most importantly, women can lose their lives or develop long-term complications because they get to a hospital too late.
In many countries, risk of prosecution might also deters women from seeking care. A study of 56 women admitted for postabortion care to five government hospitals in Sri Lanka found that these women delayed seeking care because they feared being reported to the police.
Although abortion is permitted only on narrow grounds in Pakistan, a survey of health professionals found that two-thirds (68%) of women who have clandestine abortions obtain the procedure from doctors, nurses or midwives. The remaining have an elevated risk of complications, because they go to traditional providers (24%), rely on pharmacists or other commercial outlets (5%) or self-induce (4%). Urban women are twice as likely to go to professionals over rural women.
In one study in Sri Lanka, unmet needs in family planning accounted for 73% of unsafe abortions. Another study in Pakistan finds that over half (52%) of married women of reproductive age who want to avoid a pregnancy are not using a modern contraceptive methods. Lack of knowledge, health concerns, religious restrictions, son preference, opposition from husbands, lack of access, are some major barriers to contraceptive methods in South Asia.
Researchers estimate that if unmet need for modern contraception were fully satisfied while maintaining current levels of maternal and newborn care, there would be a 91% decline in unintended pregnancies among women from the poorest households and a 74% decline among women from the wealthiest households.
South Asian women have a fundamental right to their body and safe abortion. This can be done by:
Strengthening policies that improve access to contraception to prevent unintended pregnancy and the need for abortion
Broadening the grounds for legal abortion
Improving healthcare infrastructure and post-abortion care
Providing equitable access to family planning and abortion care for poor and rural women
Deep Dive: Abortion and Stigma in Pakistan
by Anmol Irfan
Pakistani web series Churails made some noise when it was released in August of last year. For many within the women’s movement in Pakistan, the show was lauded for its uncensored portrayal of the struggles and experiences of women from all walks of life. Amongst the many taboo topics it touched upon, the show explored the not-so-hidden world of illegal abortions, hidden behind the guise of a decrepit beauty salon.
Churails portrayed the clinic both as a safe haven for some women, and a hell hole for others. Used as a way out for men in a certain group who would abuse women in the entertainment industry and then rid themselves of the consequences by forcing the women they got pregnant to abort the child.
Abortion in the show highlighted the dark side of a health crisis in Pakistan that no one really talks about. The Pakistan Penal Code allows for abortion to be carried out only if the mother’s life is in danger, or if the baby’s internal organs are not formed. The legal punishment for abortions carried out otherwise is prison sentences that range from 3-10 years. However, lawyer Sarah Malkani said that there haven’t been cases of imprisonment for abortion-related offences, in an article in Soch.
Even without legal consequences to abortion, the cultural stigmas are dire. Both religious and cultural beliefs cite abortion as murder, and as a rejection of God’s blessing. In a society with low literacy rates and contraception looked down upon or just outrightly seen as a sin, abortion often remains the only resort for women who cannot afford pregnancies (for reasons that go beyond just money).
The cultural response to abortions being a sin is so strong that most gynaecologists or midwives often refuse to carry out abortions, because they don’t want to ‘partake in a sin’ and only take action in extreme cases such as when women show up with botched abortions.
Pakistan is estimated to have one of the highest rates of abortion in the world, according to a 2012 study by the Population Council, a non-profit that advocates for family planning. The annual abortion rate was estimated to be 50 per 1,000 women for women aged 15 to 44.
In addition to high rates of abortion, Pakistan also has one of the highest maternal mortality rates in South Asia. Nearly one in five women are likely to develop complications during childbirth, and roughly six per cent of all maternal deaths in Pakistan—according to statistics from 2007—stemmed from unsafe abortions
“Pakistan is a unique country,” said Dr. Xaher Gul. “Our laws around abortion are liberal and yet every six hours a woman dies because of abortion-related complications. Doctors are pushing women towards threat.”
According to him, patriarchy and paternalism within the medical fraternity impede access and endanger lives. “A woman seeking an abortion is automatically assumed to be of bad character.”
The women’s movement in Pakistan has fast been gaining ground, and has made noise on both local media outlets and social media platforms. But somewhat surprisingly, the debate around abortion rights has still largely remained under the radar. This is despite the efforts of doctors like Dr. Gul, and others who run free abortion centres and try and provide reproductive health education and resources with the little they have.
The negative associations with abortions stem from mindsets and beliefs that have been passed down intact throughout generations and yet have never been widely questioned. The lack of attention around this issue puts thousands of women at risk every day.
Quick Take: Abortion and Sex-Selection
One major drawback of liberal abortion laws in South Asia, is the high prevalence of sex-selective abortion. Amartya Sen once called the rampant female foeticide in the region a “terrible story of inequality and neglect.” An estimated 6.8 million fewer girls will be born India by 2030.
Son preference in India remains high. Despite it being illegal to reveal the sex of an unborn child except for strictly medical purposes, it is estimated that 100,000 sex-selective abortions are performed in India every year.
It has become a feminist dilemma with the right of women to be born pitted against the right of women to control their bodies.
India’s very high son preference is also partly to blame for its high rates of child marriages. Girls Not Brides estimates that 27% of girls in India are married before they turn 18. Poorer families who keep trying to have sons may marry off their daughters early to afford the sons they want. The Indian government’s latest proposal to raise the minimum legal age of marriage for women from 18 to 21, to reduce child marriages, may have the unintended consequence of increasing sex-selective abortion, argues Shruti Rajagopalan.
Studies show that denying access to prenatal technologies and abortion care has little effect on rates of sex-selective abortion. Instead, a multifaceted approach that addresses the underlying cultural, social, economic, legal and other factors that promote gender discrimination is needed.
The case of South Korea is an interesting example of how government policies can address imbalanced sex ratios and son preferences. When its sex ratio peaked in the mid-1990s to almost 117 boys for 100 girls, South Korea pursued stricter legal bans on sex-selective abortion and stronger enforcement of the pre-existing laws.
Alongside laws, South Korea also pursued legal and policy measures to support girls and women like the amendment of the Family Law was amended to eliminate gender discrimination and allow equal inheritance and the enactment of the Gender Equality Employment Act. Modernization, urbanization and increased female employment also played a key role in the altering perception.
The South Korean government also pushed for awareness campaigns alongside the NGOs to change people’s attitudes towards daughters. These included TV advertisements, posters, slogans and seminars with journalists and drama writers. According to the World Bank, South Korea is now the first Asian country to reverse the trend in rising sex ratios at birth.
Feminist Reading List
Listen to Aji’s Podcast that captures the stories and legacy of the elderly community in Nepal. It is available in Nepali, Newari, and English.
Also check out Boju Bajai. The podcast and Youtube channel is run by Itisha Giri and Bhrikuti Rai. The two women discuss and dissect news in Nepal with their biting sense of humor and well-researched analysis.
Read this beautiful (and slightly old) long-form article in the New York Times on female friendships in a Bangalore factory and what happens when female rural migrants start working in cities - from their long hours and low wages to falling in love and buying their own cellphones.
“From childhood, they have been told that it is disrespectful for a girl to laugh out loud in the presence of elders. In the event of irrepressible laughter, girls must cover their mouths with anything at hand: the corner of a dupatta, a hand, a washcloth. This lesson, too, flies out the window. In the hostel they laugh like tractors. They laugh so loud they spit their water out,” writes Ellen Barry.
Sona Mitra and Saumya Kapoor Mehta make a case for compensating women for their unpaid work, in the Indian Development Review. India’s first time use survey found that Indian women devote almost 10x more time performing unpaid domestic and caregiving work than men. Women across South Asia continue to do disproportionate amount of unpaid work.
Use this calculator that allows you to calculate the value of your unpaid labor by just entering the hours you spend on each task per week!
Postcards of Courage: Pasang Lahmu Sherpa
Pasang Lahmu Sherpa was the first Nepalese woman to climb the summit of Mount Everest. She was born into a mountaineering family and took to climbing from her teens. Pasang had attempted Everest three times before she succeeded on April 22, 1993.
In 1990, she was a part of the team with French mountaineer Christine Janin who became the first French woman to summit the peak of Mount Everest. However, Pasang Lahmu was not allowed to summit that day with Janin by Marc Batard, the Frenchman who led the expedition. He did not want the triumph of a white French heroine to be eclipsed by a brown Nepali one.
Pasang Lahmu built her own all-Nepali team and reached the summit in 1993. On her descent, however, tragedy struck when the weather suddenly turned bad causing Pasang Lahmu to lose her life. Posthumously, she became the first woman to be decorated with the "Nepal Tara (Star)" by the King of Nepal.
Today, she has become an inspiration for a new generation of Nepali women climbers. Watch “The Glass Ceiling: The Untold Story of Pasang Lhamu Sherpa” a documentary on her life by Nancy Svendson and Alison Levine.
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Bansari Kamdar is the founder and managing editor of Newspaperwali. Kamdar is an independent journalist and researcher who works at the Gastón Institute for Latino Community Development and Public Policy and Harvard University’s Center for International Development. She reports on gender, immigration, security, and political economy in South Asia. She has written for The Boston Globe, World Politics Review, The Diplomat, Huffington Post, CNN-News18, and more.
Anmol Irfan is a Muslim Pakistani feminist writer and journalist and our editor for Pakistan. She’s the founder of Perspective Magazine, an online Pakistani community platform, and writes about intersectional feminism, social equality, and South Asian society. Anmol has also written for VICE, HUCK, Harpy Mag, and more.
Maneesha Kaur Khalae is the newest member of the team who will be joining as a Research Associate. She is studying International Relations and Economics at Boston University and is from the sunny island of Penang, Malaysia. She is deeply interested in foreign policy, climate change and conflict resolution as well as development in South Asia.