What is Abortion Worth?

Seed of the peacock flower, also known as Caesalpinia Pulcherrima, was commonly used as a contraceptive and abortifacient (Under large dosages) in the early colonial period by enslaved and indigenous people of America. The pertaining use amongst the enslaved was observed as women didn’t want to raise their children in an environment subjected to such atrocities. Although, from very early on the means of abortion has always been there, from the beautiful red peacock flower to readily available spice in the subcontinent called cinnamon, the perpetuated use of abortifacients originates not from the ever-existing technologies that allow for abortion, but stem from deep-rooted social structures that have long hoisted the gap between women and their freedom to make informed decisions.

The research IDEATE initiated unraveled such structures merely by an observation that all the women we talked to during our research verbally agreed that abortion is wrong but still ended up consorting to it when they felt that their family, health, or social image cannot afford this pregnancy. Furthermore, their trust to disclose their intent to abort remains amongst a closed network of women, an ecosystem within an ecology, that is perceived by them as much more accepting when it comes to abortion. This closed-off circle, bounded by the inability of the majority to empathize with a woman, includes their close family and friends along with an untrained provider commonly known as ‘Dayi’. What this circle hardly ever consists of are credible and professional resources that can guide the women out of the devastating and painful cycle of unintentional pregnancy and abortion.

‘I am too old to bear a child now! What will society think?’ — A 40 year old women from rural ICT

The act of abortion has always been considered immoral amongst many people including health professionals. From the early colonial period, health professionals have avoided assisting any women in abortion and have actively reprimanded their intentions and attempts either because of their beliefs or the legalities around abortion. This gives a rise to a phenomenon that IDEATE specifically studied into known as ‘Self-use’ where the motivated women remedy their state of pregnancy by ingesting items known to provoke abortion. Hence, the origin of the peacock flower and now the use of a pill known as Misoprostol which can be used within 3 months of pregnancy. If and when it was not self-use, then it was days and nights of traveling across the seas and crossing borders to countries or regions that do allow and practice abortion like the UK. The foundation of this relentless commitment is an unwanted/unplanned pregnancy, from rape or otherwise, that seems to threaten the economic social or physical situation of the woman or her family. The same steadfast behavior is seen in many women during our research in Rural Islamabad, who although unwilling to risk their social standing, still went against their religious beliefs and opted for termination of pregnancy. Where many of us might not agree with this practice, one thing was for certain that it was the motherhood that evoked such power in a woman to make a difficult decision so composedly

My kids require my attention. I cannot have another kid right now!, said a woman during an interview on IDEATE conducted on Post MA FP use.

Falling into a problem like unplanned pregnancy and then deciding to terminate for a woman is like frolicking into an upside-down realm where the health providers/professionals suddenly become biased, judgmental, and uncooperative while the untrained informal providers at the backstreet clinics start holding ‘the beacon of hope’ for the women to get themselves out of this tough situation under the guarantee of full privacy. This beacon of hope i.e services for termination of pregnancy will cost them up to 50,000 Rs and risk to life which in the grand scheme of things, seems to them like a small price to pay. Husbands under normal conditions do not only take pride in remaining distant from women’s SRH issues but also fail to play their part effectively in practicing safe sex through the use of contraceptives. However, during the journey of abortion, they play an instrumental role of an enabler and provides access to pills by seeking help from a pharmacist/drug seller they know and that is located within the community. Although pharmacists are observed to assist the men and provide them with abortion pills along with dosage information, they otherwise, have proven to be a partial membrane for a woman as they inhibit easy access to pills. They claim that it’s their social responsibility that no one conforms to ‘unIslamic’ ways by inducing abortions or even practicing unlawful intercourse. Many of them during our research has also denied access to contraceptives to ‘young looking’ individuals who do not seem to be married.

IDEATE had to be immensely scrupulous to get to the bottom of the abortion journeys and it had been rather tenuous because the matter is not often spoken about openly. Many women unveiled their abortion journeys under the pretense of miscarriage to avoid any judgments from us. The information on miscarriage, abortion, and delivering a baby is interchanged by many women who refer to their experiences of post-delivery, known in our native language as 40 day Chilla period, to define for themselves the steps necessary after the abortion. Where both, delivering a baby and abortion, mark an end to a pregnancy, the next steps for women are far from being the same. If a woman indulges in intercourse after 20 days of having the abortion pill, she is likely to get pregnant again and therefore, should be using contraceptives. Since women rarely are taking help from health professionals, they rely on the assumption that their body needs a 40-day healing period and thus, only consider using a contraceptive after it. This puts them at risk of falling into another unwanted pregnancy.

Regardless of the taboo, the world has shown many times the consequence of breaking the silence on such ‘unspeakable topics’. One such example is that of ‘Women On Waves ’. Noticing a pattern between laws rendering abortion illegal and women often becoming victims of unsafe abortion practices, Rebecca Gombarts, a physician and an activist, started an initiative in 1997 that exploited a major loophole in international law. A ship was loaded with a container equipped to conduct abortions through pills and set out to sail initially from the Netherlands, a country that allowed for abortion if authorized by a doctor, to Ireland, a country that opposed abortion completely. According to international laws, if the ship is 15 miles (Or more) offshore, it is governed by the laws of the flagship country. In this specific case, if the ship was 15 miles offshore of Ireland but was made in the Netherlands, it would have to conform to the laws of the Netherlands. This meant, at a specified distance from their country, Irish women could get abortions that are legalized by Law. Initially, 80 women signed up for it which within 5 days reached 300. Due to the major religious and political backlashes, the activist had to announce that it was too risky to perform abortions. Yet they kept on receiving requests from women. However, as time changed, the initiative evolved into ‘Women on Web’ which, as the name suggests, is an online platform that provides information on the Self-use of Misoprostol.

“Husband told not to go to anyone so I searched online for abortion pills” — A woman using online channels to explore methods of abortion.

Another example exists within Pakistan. Before the use of pills, women were subjected to surgical methods of abortion at illegal clinics that proved fatal to their lives. In 2011 it was known that almost 32 percent (700,000) of the 2.2 million induced abortions resulted in medical treatment for complications at healthcare facilities Complications stemmed mostly from clandestine procedures being performed by TBAs (Dayis) or untrained mid-level providers. Concerned by the increased mortality and morbidity rate, a decision was made to include the MA (Medical abortion or Abortion through pill) and MVA methods in the Essential Drug and Equipment Lists. (18 Feb 2013). It was included under the conditions that all mid-level providers and Traditional Birth assistants ‘Dayi’ will be trained to use it. Now Misoprostol (MA pills) are sold at the pharmacies ideally with a prescription but in practice, pharmacists/ drug sellers are also providing it to many without it.

Brazil in the late 1900s went through a ruling by the supreme court that opened doors for the country to start discussing the possibility of legalizing abortion. In response, images and illustrations of fetuses inside a womb were explicitly shared on Facebook by the religious parties aiming to avert the people and fight against this ruling. On a social level, these images have a very powerful effect as they projected abortions at all gestational ages as interruption of life. Where one can always see the vividly shown fetus in the illustrations, the woman carrying that fetus is conveniently silhouetted to hide the details of expression and by extension any human association that comes with it. This phenomenon is called ‘attaching personhood’ to the fetus. Personhood or when a fetus classifies as a human is a scientific debate that has been occurring for decades now and has affected the way people perceived abortions. The reason this is an important debate is that once conclusive evidence emerges, it will define at what point will abortion be considered a ‘murder’ and thus will become illegal. Right now, there are varied beliefs around this topic. In some countries, the moment the embryo (Sperm and egg combine) is formed, life is associated with it and thus the use of the morning-after pill also becomes illegal. However, there are beliefs that the fetus will be considered a human at the development of the brain or the beating of the heart. Many in Pakistan believe a fetus will be considered a human when the soul is entered into it. As long as the topic remains in the grey area many can perceive it in any direction.

Pakistan’s law clearly states that abortion is allowed when and if the mother’s life is in danger. IDEATE during the study into post-MA journeys of women, stumbled upon another common behavior and practice. Many untrained providers at their clinics prescribed women wrong dosages of abortion pills, which was enough to provoke abortion but not enough to complete it. Whether it was intentional or not, we are not sure. What we did find out was, after the abortion process started, the women either had to go to the same clinics to complete their abortion via a surgical method that is known to be a costly process or just go to any health facility that legally is bound to provide the treatment to complete the abortion as now, the mother’s life is in danger. Women themselves have been trying to provoke abortion by eating thermogenic food items like dates or running up and down the stairs, lifting heavy weights so that once the abortion is provoked, no health professional can deny them help.

Why go to the lengths of putting their lives in danger, go against their beliefs and morals, risk their reputation in society and spend enormous amounts of money but not use contraceptives that are significantly safer and cheaper to use? With low literacy levels, along with long-established myths, misconceptions and cultural conforms around the use of contraceptives, these rural communities call for a major behavior change before women start adopting contraceptives without a degree of doubt and question. The problem is not only prevalent in rural areas but quite deep-rooted in higher literate areas of Pakistan, where long set traditions of women bearing children to prove their fertility actively inhibit women from seeking any information on the use of contraceptives from a credible channel at a younger age. The providers will ask if a woman is married before providing them with any information on the topic. Therefore, the problem at hand can be classified as a wicked problem because there is no one right answer or solution to it. Increasing information and supplies of contraceptives have improved on the situation but can never completely solve it without an array of interconnected interventions that can address social, cultural, political, technical, and ethical issues that are embedded in our country.

Our project aimed at breaking the vicious cycle of unwanted pregnancy and abortion by providing immediate and timely access to contraceptive-based information to the women who have gone through an abortion and had no health professional to guide them on the next steps. In our research, we found out that the use of contraceptives before and after the experience of abortion remains the same for many women. Other than the prevailing myths and misconceptions around the side effects of the contraceptives it seemed as if women themselves have avoided using the methods because to them the use of contraceptives was associated with a day to day slow suffering from minor side-effects they had to go through which is worse than going through one painful but quick process of abortion. ‘What is abortion worth?’ is a series of articles that will walk you through the heart-gripping stories of women who had to consort to abortions amidst a medically ill-equipped community and will delve deeper into the issues addressed here in this article. It will explore what the infamous slogan ‘My body, My rights’ mean for the women of rural ICT and will explain the importance of certain interventions that IDEATE deemed necessary to solve the problem at hand.

References

• Techno ecologies of Birth Control: Biopolitics by Design
• https://www.ipas.org/wp-content/uploads/2020/07/PAKSHABE15-CoordinatedApproachtoPolicyChangeProgrammaticIntegrationSafeUEPACPunjabProvincePakistan.pdf