As abortion rights activist we are regularly having to explain to people the issues surrounding abortion, usually with quite negative opinions. Recently, an interesting conversation was started over a comment that ABORTION PROVIDERS are ABORTION PROMOTERS. This is a common allegation made against abortion rights activists and doctors and it may be worth considering its merits if any. This term implies that we are salesmen creating a demand for abortions as a business. It may seem obvious to us that this is clearly a falacy, as we don’t need to create a demand but can see safe abortion as an unmet need.

But I think this idea needs to be taken more seriously as an anti choice argument. This accusation implies that beyond services for unwanted pregnancies, we are also encouraging unplanned pregnancies. It would mean that we are actively discouraging the use of modern contraceptives to keep us in business. Since all responsible doctors actually use our contacts with clients as an opportunity to inform them on modern contraceptive methods, this argument is clearly untenable.

Of course, there are some unethical abortion providers who just do abortions for the profit.  That happens when society creates the stigma and legal obstacles to safe abortions, whether perceived or real.  It becomes easier to carry out ‘clandestine’ abortions at exorbitant fees as a special ‘favour’ to their clients. There are providers who are known to carry out these procedures only after office hours, often late at night, which further reinforces the impression of the legal risks involved.

Abortion services should also be seen in the context of other non-controversial medical services. Take for example an orthopedic surgeon, whose clients largely comprise of victims of motor vehicle accidents. Can the surgeon be criticised for providing care needed by the accident victims? Can an excellent trauma department be blamed as the cause of so many motor vehicle accidents? Would it better if he didn’t provide the service and would people then take more care in driving their vehicles knowing that treatment for their injuries are not easily available?

In the context of abortions, the term ‘accidents’ is rather appropriate because our clients usually refer to their unplanned pregnancies as ‘accidental’. Women in a sexual relationship without wishing to get pregnant use many methods to avoid pregnancy. Unfortunately, some methods are less effective than others and thus the pregnancy is an ‘accident’ as much as when you cross a road, your intention is not to be knocked down by a car!

Most people consider pregnancy a natural physiological process which a woman is consciously willing to undergo because she wants a child. However, the 9 month gestation period is not without risks for the woman as anyone working in an obstetric service knows.

These risks of course vary depending on the quality of existing medical services. In third world countries, it is often considered a life threatening condition; there is a saying among African tribal areas that ‘to be pregnant is to have one foot in the grave’.

In Malaysia, our official maternal mortality rate is 27 per 100,000 pregnancies.  That is excluding other non-fatal and sometimes risky complications that occur during the pregnancy, at delivery and afterwards.

The mortality rate for safe abortion in the first trimester is estimated at 0.6 per 100,000 (Guttmacher Institute). Thus a woman undergoing a pregnancy taken to term is exposed to 50 times of the risk of death compared to an early termination of pregnancy. Should a woman not be given a choice to discontinue an unwanted pregnancy to term to avoid these known medical risks if she so wishes?

If in addition we take into account the psychological stress of realising her responsibility of care for the next 18 years of a child’s life and the disruption of any long-term plans made before the unplanned pregnancy, it is difficult to fathom how some conservative doctors and policy makers can glibly talk about the need for a psychiatric opinion before acknowledging that the medical risks and psychological stress cause by a denial of termination are real.

Ultimately, it is absurd for laws to dictate that the moment a woman’s uterus carries an embryo, that part of her body is suddenly the property of the state and anything the woman wants done is regulated by outside parties – she can’t even request for treatment to save her life if the laws don’t permit it.