Let’s talk about Abortion!

Neelam Saleem Punjani, Youth Champion, Pakistan


On #InternationalWomensDay, our #YouthChampion reflects on her work and the need to #PressforProgress in order to ensure that every woman, everywhere has access to #safe and #legal #abortions. 

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Working with women on some of the most stigmatized topics like women’s right to safe abortion is not a challenge that many people would welcome. It is sometimes difficult, often frustrating and at times confrontational. But for me advocating for women’s right to safe abortion is simply the best job in the world!

I was motivated to work with women by my own experience of growing up in a patriarchal society where speaking about women’s right is always considered a taboo.

Young girls and women around the world face abortion stigma every day due to restrictive laws and policies. The young girls and women are humiliated for seeking abortion services regardless of the country laws on abortion.  This prevents them to look for timely help which results in 46% of unsafe abortion worldwide. Not only this, every year 47,000 women die due to unsafe abortion which increases the burden of maternal mortality.

I strongly believe that abortion should be legal and safe for every woman.

Based on the human rights to equality and dignity, women should never be forced to continue the unwanted pregnancy against their wishes. The consequences of stigma, silence, and shame around abortion end up in life-threatening consequences for the women. It is high time that all governments should acknowledge women’s reproductive rights to safe abortion and create a conducive environment for women to fulfill their rights.

As an abortion advocate, my motivation is always to give young girls and women the opportunity to access their sexual and reproductive health rights and providing them awareness, support, and opportunities which they may never have had before due to the taboo attached to such topics.

We need to start challenging the prevailing stereotypes about abortion for young girls and women in our societies.

I have noticed that people around me are extremely uncomfortable to even say the word “abortion”. Just the sound of it is shameful to them. However, after I have spoken up publicly at various forums about women’s rights to safe abortion, many people around me feel less awkward discussing the topic. I believe that the young generation does have the power and rights to speak up and be well-informed about decisions that determine their health and well-being, in order to protect themselves from harmful consequences.

In order to make women empowered, governmental organizations along with private sectors should prioritize women’s sexual and reproductive health through scaling up the existing programs. This will ensure the protection of fundamental human right which is a key to achieve sustainable development.

My message to young people is –if I can talk openly about abortion, so can you!

So let’s stand up, together, and speak out to ensure women’s right to safe and legal abortion!

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The pro-choice movement in Asia: A retrospective

Dr. S. P. Choong. Founding Member, Asia Safe Abortion Partnership


As a founding member of ASAP,  I  am taken aback to suddenly realize that it’s been 10 years since we adopted the idea of a regional alliance for abortion rights. I guess it has been such an enjoyable and fulfilling ride for me to witness the growth of the pro-choice movement – in different countries, involving different professions and especially different generations.

Starting out as an individual abortion rights activist 50 years was a lonely business – facing stigma from friends and professional colleagues. No matter how strong our own internal convictions, it can still be stressful

Fortunately in Asia, unlike in the US, the anti-choice groups have not begun demonstrate and harass abortion clients right up to the doorsteps of abortion clinics. But there are now groups of pro-choice doctors there formed to meet up regularly for mutual psychological support.
I must confess that for a long time my self-introduction to strangers was as a director of a ‘family planning clinic’. Since building up advocacy networks through RRAAM in Malaysia and ASAP, I am now an up-front abortion rights activist. My view now is if we have self-censor our role as abortion rights activists, how can we possibly convince others of our cause. I hope all our younger activists can adopt that position.

The anti-choice movement has become so vocal and aggressive, it is important that everyone of us must as it were,  come out of the closet. Meeting colleagues in the pro-choice movement should make this shift in outlook move a lot easier for us..

Coming out as a pro-choice activist when meeting new people can be an interesting experience.  A good starting point in assessing the prejudices of the listener. And perhaps to initiate an interesting conversation!   And you may get some surprises on the way. People are not so bigoted on the abortion issue you may think.

A story told to me by Dr Susan Yanow made a point. When she casually mentioned her work on abortion to an air stewardess,  she was promptly upgraded to business class! So you never know your luck!  So try this out on new friends and colleagues at work and see their reactions.  Make it like a game!

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Freedom which is Restricted and Violated from Us.

Lakmini Prabani Perera, Youth Champion, Sri Lanka


On the occasion of Independence Day in Sri Lanka, our Youth Champion reflects on what it means to be free, and the need to build partnerships across anti-colonial and feminist movements to achieve true freedom.  


To what extent are we independent as a nation or as people? I believe, as a citizen of Sri Lanka, that you might have asked this question more than once to yourself.

Sri Lanka annually celebrates its Independence Day on the 4th of February. This celebration is to remember the struggles of history and to celebrate our independence from the colonial rule of the Portuguese, Dutch and especially over the British, in the year 1948. Today we celebrate Independence Day by hoisting the national flag, with speeches by people in power, and with a parade of the military.

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The Lankan political system and laws were made and shaped by the British colonial rule from 1801. In 1931, the Constitution gave some sort of authority to the native citizens who were elected. It was on 16th of May, 1972 when the country was officially declared as an independent republic. The Constitution which is currently in force gave more authority and equality for native ethnic groups. For these past years, the Constitution has been amended several times and yet bears the shape and signs of colonialism and oppression.

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Whenever Sri Lanka tried to progress there have been barriers, where we are still fighting to find our own identity, respect, equality and justice for all citizens. National unity, rights of minorities, women’s rights, the centralization of political power, and judicial dependence and politicization, are some of the issues and challenges that we are facing as a nation and where we cannot say we are experiencing the true meaning of freedom.

Looking at a normal day in Sri Lanka, just only from reported cases in newspapers, we see that many civilians in our country are suffering, are vulnerable, and are not free from violence. That means every individual in this land isn’t living a life which is free. Especially women and girls have become more vulnerable in this situation. Simply being at home, in schools, workplaces, police stations, government offices, schools, courts, buses, trains, streets make them open for discrimination, exploitation and violence. As the Women’s U.N. Report Network, 2015 mentions 30% – 40% of women in Sri Lanka suffer from some kind of violence while 60% of women across Sri Lanka are victims of domestic violence.

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According to UNFPA female participation for foreign employment was 51.73%, total of 247,119 in 2009. The violence and discrimination they have to go through has increased with the numbers and women and girls who are working in Sri Lanka.

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Recently a woman candidate in Wellawaye area in Monaragala District was attacked while she was involved in the election campaign. This shows that the country doesn’t have a free environment for individuals to engage in politics freely. According to UNFPA, women’s representation in parliament was 5.8% in 2010, 4.1% in provincial councils in 2009 and 1.8% in local councils in 2006. Could this be any better when there is no assurance for free and just political and civil rights in the country?

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Women were entitled to purchase liquor under Sri Lankan law from 08th of Jan, 2018 where President rejected this decision and the Cabinet banned women from purchasing liquor from 16th of Jan, 2018. Are women in Sri Lanka enjoying equal rights or the nondiscrimination on the grounds of sex as guaranteed by the constitution?

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Even the amendments on abortion laws are on hold to please men in this country. According to Family Planning Association of Sri Lanka, 700 plus abortions take place daily in Sri Lanka which takes place in unsafe and unhygienic conditions. This risks women’s lives because of health complications, septic abortions, infertility and even by death. As the Family Health Bureau emphasises maternal deaths due to septic abortion are the third highest reason (13%) for maternal deaths. Women are not in a position to decide when to be pregnant and to decide and terminate an unwanted pregnancy. Whether the women get access to medical information and services to terminate an unwanted pregnancy is highly doubtable in a country where purchasing liquor was ban for women by the President.

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Women are most vulnerable in every genre of the society, every institute and where they are treated without respect and dignity. The years of violence and oppression has not let them achieve their fullest potentials and real essence of freedom. Here is a promised land where women has to risk almost everything to decide for themselves.

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I hope this is the right time for us to go forward courageously to the Day of Freedom for all Sri Lankans. I will with all of you dream for that day!

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Abortion in India: Changing Legal Contexts and Challenges

Four decades after legalization of abortion, poor women in India still do not have access to safe abortion services. Part of addressing this challenge requires an understanding of the legal framework for liberalizing abortion, starting with the MTP Act of 1971, the subsequent shifts in context. We attempt to do this through our two part blog series that focuses first on the Act itself and its shortcomings, and calls attention to other challenges to the regulatory framework in the second blog. The first blog in the two-part series can be read here

 This is excerpted from the speech given by Dr Saroj Pachauri on the occasion of the Global Health Strategies meeting held on the 24th of November, 2017 in New Delhi, India.


As we set out in the previous blog, despite the MTP Act, unsafe abortions far outnumber safe, legal procedures. Part of these concerns were sought to be addressed through the amendment of the MTP Act towards which considerable research and advocacy was dedicated.

The MTP Amendment Act of 2002 decentralized the regulation of abortion facilities from the State to District Level Committees. It also allowed Registered Medical Practitioners to provide medical pill abortions up to 7 weeks of pregnancy in a facility approved for providing abortion services.

A second round of amendments was proposed under the MTP Bill of 2014, which attempted to further liberalize the Act. It proposed an extension of permissible abortions from 20 to 24 weeks, and an exception to the time limit for termination in case of fetal abnormalities. It also proposed approval for Ayurvedic, Homeopathic, Yunani, and Siddha practitioners to carryout Medical Abortion.

However, in May 2017 the Prime Minister’s Office sent the Bill back to the Ministry of Health and Family Welfare with the recommendation to strengthen the draft, and the recommendations remain un-tabled.

While these efforts to amend the MTP Act were underway, simultaneously, other abortion-related processes complicated the picture, creating new barriers to safe abortion care.

The first of these was the furore around the issue of sex-selective abortions, which also captured a large media following. A result of this agitation was the Pre-Conception and Prenatal Diagnostic Techniques (PCPNDT) Act, passed in 1994.

Second, stemming from concern for child sexual abuse the more recent Protection of Children from Sexual Offences (POCSO) Act was passed in 2012.

There are serious conflicts in the framing of the MTP Act, the PCPNDT Act, and the POCSO Act. This is made worse by the fact that there is a lack of clear understanding of these Acts, not only among the users of services, but also among government officials (gatekeepers), and the providers of services.

For instance, officials carrying out stringent inspections to curb sex determination, end up clamping down on MTP Centers and gynaecologists legally qualified to provide abortion services. This has led to many qualified practitioners now being guarded in providing abortion services, especially during the second trimester, posing a major challenge to women trying to access services.

Similarly, the POCSO Act was passed to strengthen legal provisions for the protection of children below 18 years of age from sexual abuse and exploitation. Under this Act, if any girl under 18 is seeking abortion the service provider is compelled to register a complaint of sexual assault with the police. Consequently, service providers are hesitant to provide abortion services to girls under 18. Given that in this country some 45%-47% of girls get married under 18 years of age, this presents a huge problem. Thus, it is evident that the implementation of these Acts has unfortunately become major barriers to the effective implementation of the MTP Act resulting in further limiting access to safe abortion services in India.

Clearly, there is an urgent need to strengthen the MTP Act, and review and amend the conflation among the three Acts. And most importantly, to improve the understanding of the users, providers, gatekeepers, and all stakeholders of these three Acts.

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Abortion in India: The Medical Termination of Pregnancy Act.

Four decades after legalization of abortion, poor women in India still do not have access to safe abortion services. Part of addressing this challenge requires an understanding of the legal framework for liberalizing abortion, starting with the MTP Act of 1971, the subsequent shifts in context. We attempt to do this through our two part blog series that focuses first on the Act itself and its shortcomings, and calls attention to other challenges to the regulatory framework in the second blog.

This is excerpted from the speech given by Dr Saroj Pachauri on the occasion of the Global Health Strategies meeting held on the 24th of November, 2017 in New Delhi, India. Dr. Pachauri is a Population Council Distinguished Scholar.


The passing of the Medical Termination of Pregnancy Act in 1971, was a landmark in the legalization of abortion in India. The act was the culmination of a decade’s worth of public debate that started in the early 1960’s and led to the setting up of the Shanti Lal Shah Committee. The Committee submitted a positive report on the need to liberalize and legalize abortion, and resulted in discussions of appropriate regulatory frameworks and laws. The unanimously adopted MTP Act of 1971 is a result of that debate.

The MTP Act of 1971 permits the termination of pregnancy in the following two cases:

  • Where continuation of the pregnancy would involve a risk to the life of the pregnant woman or grave injury to her physical or mental health; and
  • Where substantial risk exists of the child being born with serious physical or mental abnormality.

 Further, pregnancy caused due to rape or due to the failure of contraceptive methods also falls under the ambit of the Act, as the “anguish caused by such unwanted pregnancy may be presumed to contribute a grave injury to the mental health of the pregnant woman”.

Since the Indian Penal Code criminalizes abortion, this Act served to allow exceptions under certain conditions.

The origin of the MTP Act and the changes in regulatory controls on abortion stemmed initially from concerns about high maternal mortality in India, and the process was led by the medical community. Thus, the MTP Act is a highly medicalized Act.

Its twin objectives were:

  • The liberalization of the grounds on which abortions were possible, and
  • Strict controls for the conduct of the procedure, which would ensure that only legally recognized, skilled medical practitioners could provide it.

However, despite the presence of such a liberal law, at least 60% of all abortions seem to be conducted outside the legal system. The question remains, why?

Part of the explanation lies in the fact that although the law was conceptualized in the interest of women, and with the full support of the medical community, it relied on a vision of a far too idealistic healthcare system, rather than what was available in reality. On the ground, healthcare service provision was far less organized and regulated than what was assumed.

Moreover, the Act while liberal in its mandate, has several restrictions that relate to who can provide abortion services and where; abortion services can be provided by a Registered Medical Practitioner, at a registered facility, within 20 weeks of pregnancy. Consequently, one of the impacts of the rules and regulations drawn up under the MTP to safeguard women strangled the growth of services.

Furthermore, the context for the delivery of reproductive health services for women has changed significantly over the past decades. When the MTP Act was passed, the legal context was NOT the Government’s recognition of women’s rights to control their own sexuality, fertility, and reproduction, which, arguably, it is today.

Thus, the ideological underpinnings of the concept then and now are radically different.

Therefore, despite being a landmark in social legislation in 1971, the MTP Act has failed to translate into reality for the majority of Indian women, particularly the rural poor.


In the next part we call attention to how subsequent changes in the larger legal framework and attempts to amend the MTP Act itself, further complicate the situation.

 

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