Samreen was 22 when she missed her period by two months. Hailing from a middle class Muslim family, being an unmarried mother was not an option. But when she went to LABAID, she was required by hospital protocol to provide her husband's name, profession and address. After completing the tests using her cousin as an alibi, she found she was seven weeks pregnant.
“When I mentioned I wanted to terminate, she flatly refused. According to hospital policies, abortion or menstrual regulation is not allowed, and neither are they allowed to refer patients elsewhere or provide any kind of assistance.”
She later opted for a smaller, local clinic. Although she was able to terminate the pregnancy, she was shaken by the experience and surprised by the stigma she faced.
Unsafe practices and unfair laws
There are many such untold stories of women who have suffered from last-minute abortions due to a lack of information and access. In the absence of any sex education policy, women in Bangladesh are completely at a loss on how to deal with unwanted pregnancies, and unable to find healthcare service providers who will advise them. Unsafe abortions are responsible for 8,000 maternal deaths and over 572,000 women suffer complications every year in Bangladesh, according to statistics provided by Women On Waves (Wow), a Dutch pro-choice non-profit created to bring reproductive health services to countries with restrictive abortion laws.
Under the penal code of 1860, induced abortion is illegal except when performed to save a woman's life. No exceptions are made to preserve a woman's physical or mental health, to deal with foetal impairment, for economic or social reasons or even for rape victims.
“In 2015, there were 666 cases of rape - what about women like them?” asks Ayesha Khanam, President of Bangladesh Mahila Parishad. “If professionals, organisations and the government have any respect for human rights, they should reconsider these laws and step forward to help such cases.”
Ambiguities in the law
“During the 70s, there was a real civil society movement around abortion, especially in relation to atrocities committed during the Liberation War,” states Advocate Sultana Kamal, lawyer and human rights activist. “That's when we started to talk about making abortion legal in the first trimester.”
Although the abortion law was temporarily waived in 1972, it is currently functioning without any changes. Instead, women are allowed to use Menstrual Regulation (MR) services as a family planning method, a procedure that uses manual vacuum aspiration (MVA) to safely terminate pregnancy within 10 weeks from the last period. However, due to lack of information, many woman risk unsafe abortions instead.
“Menstrual regulation is a huge step for Bangladesh, but what is important is to ensure quality of care, so that there are no infections or other medical problems,” says Dr Kaosar Afsana, Director of BRAC's Health, Nutrition and Population Programme. “Awareness is a big issue - we also need young people to actually know that they could get pregnant and be aware of MR services. But it is important for us to take this further and legalise abortion, so that women are able to exercise their rights and have agency over their bodies.”
What are the penalties associated with illegal abortions? According to The Population Policy Data Bank by the UN Secretariat, performing abortions can lead to up to seven years imprisonment (depending on circumstances), a fine or both, even if a woman performs it on herself.
“The idea of miscarriage is illegal according to section 312 to 316 of the penal code, and abortion is a punishable offence even if it is done with consent.” Asif Bin Kamal, Barrister-at-Law and Supreme Court Advocate, explains. “However, if it is performed between 8 to 10 weeks then it strictly does not fall in the scope of penal code sanctions because there is no way to provide clear indication that the woman is pregnant. This is where Menstrual Regulation comes in, and a few clinics here use this for family planning.”
Is menstrual regulation enough?
Many would argue that MR is not enough to ensure reproductive rights. According to the Guttmacher Institue, an estimated 646,600 induced abortions were performed in Bangladesh in 2010, the majority of which were unsafe. Nationally, the annual abortion rate was 18.2 per 1,000 women aged 15–44. The same report found that an estimated 572,000 women suffer complications from unsafe abortions annually, but only 40% receive care from a facility. Of the women who do seek help, 26% are refused services. Roughly 120 out of every 1,000 MR procedures result in complications that are treated in health facilities. In the case of clandestine abortion, three times that rate—approximately 358 per 1,000—result in complications.
For these reasons, several organisations have stepped forward to provide health care services. Leading the way is Mary Stopes (MS), a Bangladeshi NGO. Consisting of a network of 132 clinics, MS Referral Clinics provide sexual and reproductive healthcare services in all major cities and some district towns.
Naribandhob is another organisation that has a sexual and productive health hotline to provide women with information on reproductive health, safe medical MR and abortion drugs. It also provides crucial information on post MR care, since deadly bleeding is one of the leading causes of maternal death and injury. Their services are free of charge at their hotline number +8801853-892-424.
According to Advocate Anwar, “abortions should be legally provided, but one should take into account the woman's age, her matrimonial status, her psychiatric condition, etc and also her personal liberty to choose.”
While some believe the laws need to be altered to make both abortion and MR easier and reduce social stigma, others believe the laws in place are, to some extent, justified.
“If a woman is pregnant beyond 10 weeks, performing an abortion imposes major health risks.” AKM Rezaul Haque, Premier Director, Health and Training of Gonoshasthaya Kendra (GK) explained. “In that case, we try to convince the mother and her family to decide otherwise.” With around 45 centres around Bangladesh, this NGO works to implement community health care programmes amd improve access to health for the poor.
Photo credit: What could have been by Liza Hasan