Repro-Briefs: Family Planning in Nepal and Other International News

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Repro-Briefs: Family Planning in Nepal and Other International News

Robin Marty

Iran slowly reduces its maternal mortality rate, Pakistan tries to provide access to RU 486 to a firestorm of protest, teens in Wales have problems accessing abortion, and Australia has an unprecedented abortion trial.

Repro-Briefs has taken a trip across the globe to bring the latest international news in reproductive health.

Iran has begun to make some advances in maternal mortality, but is still averaging one death per day due to pregnancy-related causes.  The Tehran Times reports:

In 1990 the rate of maternal mortality was considered 91 for every one hundred thousand pregnant women while in 2009 the rate reduced to 34, the Millennium Development Goals (MDG) officials reported on Sunday.

During a press conference, the officials noted that Iran has made a remarkable achievement in some areas, one is maternal health, but unfortunately still according to national data available, every day one Iranian woman dies because of pregnancy or birth-related complications. So, this is not acceptable not only for Iran but also for the world that in the 21st century a woman dies each day.

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MDG officials stated that concerning the maternal mortality there is a clear improvement in the country and this is due to the health care policy during the last thirty years.

It is a very significant improvement. However it is not exactly the improvement that is mentioned in the Millennium Development Goals, because the objective is to reduce the rate by three quarters from 1990 to 2015.

In Nepal, family planning is saving lives with reproductive health screenings, safe abortions and contraceptive options.  My Republica reminds us of how valuable family planning services can be in poor communities throughout the world.

Nepal Family Planning Association, Jadibuti branch, has provided free family planning service to 20,495 people from the poor, backward, indigenous and Dalit communities through its 35 clinics this year.

The branch has provided Depo-Provera to 14,462 persons, pills to 3,636 persons, condoms to 2,140 persons, Norplant service to 69 women and recannalization of vas deferens fo 39 males who had undergone vasectomy surgery, according to Managing Director of the branch Sarad Kumar Aryal.

The branch has started male vasectomy service from this year and nine persons have already received the service within a month. Within a year, 648 women took safe abortion facility at the clinics.

Similarly, 8,430 women availed pregnancy test service, 5,650 got treatment for sexual diseases and 1,607 received other facilities.

The center provided reproductive health education to 14,842 persons, sexual rights and reproductive health education to 900 Dalits and counseling to 64,005 persons.

Likewise, the branch also organized free HIV test programme for labours and transport entrepreneurs. Over 25,100 benefited from the service.

Access to safe abortion is a critical component in both reproductive health and family planning. In Pakistan, this knowledge that is opening up access for women to obtaining RU486.  Radio Netherlands Worldwide reports:

The helpline has been set up by Pakistani women’s organisations with support from Dutch activist group Women on Waves. The project is controversial because abortion is illegal in Pakistan. Rebecca Gomperts of Women on Waves says the most important thing is that “you can save a woman’s life here for less that 30 rupees [28 eurocents]”.

About 12 trained Pakistani staff on the helpline will provide information on how to use the abortion pill. Misoprostol costs less than 10 eurocents per pill, according to Ms Gomperts. Using the pill within nine weeks of conception causes an abortion in 85 to 90 percent of women and cannot be distinguished from a miscarriage. Most women though are unaware of this.

Nearly 900,000 women undergo illegal and often unsafe abortions every year in Pakistan. They are usually married and already have children. Contraceptives are not easy to come by in Pakistan and are often contrary to religion and culture.

Between 10 and 15 percent of women who undergo unsafe abortions die and each year 200,000 women end up in hospital. Tahira Abdullah, a Pakistani human rights activist with over 30 years’ experience, says most abortions are carried out by untrained quacks. “They use equipment that hasn’t been sterilised, boiling hot oil, coat hangers, sticks. It’s appalling.”

Unfortunately, having access to safer abortion still doesn’t make it legal in the country.  Despite the number of unsafe abortions being carried out in Pakistan, many leaders are fighting the new hotline as “anti-Islamic.” According to the Independent:

An abortion hotline which has been set up in Pakistan is facing violent opposition. Islamic groups and political parties have condemned the hotline, which was launched yesterday, as “anti-Islamic” and “colonial”, even though it will save the lives of thousands of women who die each year in backstreet abortion clinics. They have warned the organisers that they are at risk of reprisals.

The hotline, set up by a collection of women’s groups in Pakistan and the Dutch pro-choice group Women on Waves, advises women how to use a drug to induce miscarriage safely and aims to reduce the estimated 890,000 unsafe illegal abortions performed in Pakistan every year.

“There will be very strong opposition,” said Ahsan Iqbal, of the Pakistan Muslim League. “This could create misuse. It cannot be done as free choice under our law and our religion.”

Access to abortion in Pakistan is very limited. Forbidden under Islamic law unless the mother’s life is in danger, terminating a pregnancy carries a massive social stigma in the country, which is 97 per cent Muslim. As a result, a flourishing trade in backstreet abortion clinics has developed.

Figures from the Population Council of Pakistan show that the country has one of the highest rates of maternal mortality in the world, with 320 women dying for every 100,000 live births – compared to 13 per 100,000 in the UK. The Guttmacher Institute, which researches sexual and reproductive health, estimates that as many as one in six deaths are a result of illegal abortions.

The use of RU 486 isn’t causing scandal and unrest in only Pakistan.  In Queensland, Australia, a woman is being prosecuted for procuring an illegal abortion via RU486, and everyone is watching what is being hailed as an unprecedented trial.  From The Australian:

The finding by prominent obstetrician and abortion law reform campaigner Caroline de Costa reinforces how intensely the prosecution of Tegan Leach and her partner, Sergie Brennan, both of Cairns, will be watched.

The case is due to return to the District Court next month, with Ms Leach charged with attempting to procure an abortion under a 111-year-old provision of the Queensland criminal code, carrying a maximum of seven years’ jail. Mr Brennan is charged with supplying drugs to procure an abortion.

Both have been committed to stand trial.

“Over the past five years, I have been researching the history of abortion in Australia, particularly in Queensland, through medical, legal and police records,” Professor de Costa writes in a new book, Never, Ever, Again.

“My research has not produced a single previous case of a woman being charged with procuring her own abortion since the 1899 (criminal) code was first promulgated (in Queensland).

“What’s more, I have found no evidence that any woman anywhere in Australia has ever been so charged.” Ms Leach is alleged to have terminated her pregnancy in December 2008 with RU486, the abortion drug that could not be brought into the country legally until 2006.

…Professor de Costa could find no record of a Section 225 charge, under which Ms Tegan is being prosecuted for allegedly procuring her own miscarriage.

“That is why I have written this book,” she says.

“I believe that punishing a woman for making the decision . . . was inappropriate in the 19th century. It is entirely so in the 21st century.”

Teens in Wales are finding it increasingly difficult to obtain abortions quickly in the country, forcing many to either look for new places to have the procedure done early or have a later abortion.  Wales Online reports:

With new statistics showing one in 36 16 to 19-year-olds in Wales having had a pregnancy terminated, teenagers are being forced to wait for up to a month.

And experts warn a lack of provision is forcing girls to look for services other than their local GP.

The number of abortions carried out in Wales is actually in decline.

But, with only one specialist clinic in the country – in Cardiff – many young women are having to wait until much later in their pregnancy to get an abortion.

“Girls are staying pregnant for much longer than they want to. If they go to their GP at nine or 10 weeks, the doctor has to then refer them for a consultation with the NHS, which may take another three or four weeks before an appointment is available.

“And then they won’t get the treatment immediately.”

Later terminations can sometimes increase the chance for complications, but of course, those who are against abortion think forcing teens to wait is just fine.  GP David Bailey, chairman of the Welsh GP’s Committee said things are moving just fast enough.  “I think you should have at least a week’s cooling off period between one part of the process and the next.”

Finally, in Ireland the recession is being blamed for 20 percent of the abortions being sought, according to Irish Central.

The Well Women Center in Dublin has said that one in five, of the 2,000 who contacted the center last year, said financial concerns were their reason for considering abortion.

Chief executive Alison Begas said that many of the women who contacted them in 2009 were married with other children. Many were also professionals who had their salary or hours cut or their partners had lost their jobs.

“We would see probably a couple of thousand women a year of all ages. What we have found in the last year in about 15 to 20 percent of the pregnancy counseling services is that the woman was specifically citing income worries and issues around financial security as reasons for attending.

“When counselors delved deeper into that, it was either she might have lost her job recently or had her hours or salary reduced or there was a fear that was on the horizon. Or similarly that may have happened to her husband or partner.

“Sometimes these were married couples with one or two children and everything was very, very tight [financially] and considering continuing with the pregnancy was something they felt unable to do…What we have also heard from younger women, maybe in university facing a crisis pregnancy, is they were not confident they would immediately get a job on graduation or secure a job with an income that would allow them cover crèche fees.”

Even worse, women who are aborting for financial reasons are also finding it difficult to find the money to obtain an abortion in the first place.  From the Irish Times:

MORE WOMEN are reporting difficulties in coming up with the money necessary to access abortion services, according to the Irish Family Planning Association (IFPA).

The association’s chief executive, Niall Behan, said yesterday that the association counsellors were seeing more women reporting this difficulty in the current economic climate.

The association offers counselling at centres in Cork, Dublin, Dundalk, Galway, Gorey, Letterkenny, Limerick, Monaghan, Sligo and Waterford.

Mr Behan said, however, that “finances are only one of a range of factors women take into account in their decision-making process”.

His comments came a day after Dublin’s Well Woman Centre said increasing numbers of women attending its three pregnancy counselling services in the capital were considering terminating pregnancies as a consequence of the recession.