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| Sunday, 11 July 2004 |
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Features |  |
| News Business Features Editorial
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Abortion : Illegal yet happening A pregnancy is not always the happy event it is perceived to be. To most unmarried women and some married women, it is an unhappy burden, that needs to be dealt with, before things become visible. But how do you deal with it? Abortion seems to be an easy answer. But abortions are illegal in Sri Lanka... or are they! A four-member Sunday Observer team set off to investigate the abortion scenario in Colombo, and surprisingly, or should one say, not so surprisingly, discovered there were many abortion centres masquerading as family planning clinics in the city. Some were run by reputed and qualified medical personnel, others were run by men and women in white coats pretending to have the 'qualifications'! But going by the existing laws what both were doing was illegal. A 10-minute job The Sunday Observer investigating team visited two such clinics in Colombo. At one of the better known clinics down Duplication road, in close proximity to several schools, the receptionist in a Kandyan saree, looked them over, enquired about their problem and remarked in a somewhat acid tone. "All the doctors have gone for lunch." However she enquired about the marital status of the patient and upon being told she was unmarried said rudely, "Unmarried women are seen only in the morning. Come tomorrow at 8.30 a.m.," and resumed her perusal of the newspaper. Fifteen to twenty men and women were at the entrance and at the reception of the so called clinic. They were waiting for their girl friends, wives or daughters to return from the so called 'operations' which were being performed upstairs. A girl of 15 or 16 (a client) came down to the receptionist to clarify her bill, but was ordered by the receptionist to get back to the 'theatre' immediately. Maintaining the pretence of needing an abortion, the team returned to the clinic the next day and in order to maintain a degree of credibility, took a urine report of a pregnant colleague. The team again approached the receptionist, introduced themselves with the aliases they had been using the day before and reminded her of the previous day's visit. Displaying a more settled temperament she said, "You should have come early. Anyway come and talk to Dr. K." and proceeded to lead them towards the doctor's room. There were two rooms, each occupied by a sober looking middle-aged 'doctor'. The light blue walls gave a real clinical feeling. As the first room was already occupied, the receptionist directed the team to the second room. "What's the problem with you?" asked the doctor when the team made themselves comfortable in the room with the 'pregnant' member seated next to him. When the situation was explained, the doctor enquired when the 'patient' had last had her menses. A few health related questions later, the team forwarded the pregnancy test report, which seemed to convince the 'doctor' who after a pause asked for some personal details about the male partner. Later, he asked the female member of the team (not the one pretending to be pregnant) whether she was in a position to bear the responsibility of the girl after 'help' an euphemism for abortion was given to her. "Normally we 'do' that to the girls who come with their mothers or anybody who is responsible for them. This is because if the 'patient' starts to bleed, the guardian should be able to rush her back to this place," the doctor explained. When questioned whether the 'help' was painful and whether it carried any risk, the doctor said, "Everything is a risk. Even if you take a panadol, that's also a risk. Also it can be little painful as well. The patient should cooperate with the doctor. The whole foetus and the rest of the flesh along with it should come out properly. If the pieces of the body remain in the womb, the patient would later develop severe pain and start bleeding." The procedure, he said takes just 10 minutes. When questioned how they performed the task, he said "We use a vacuum suctioner to get the foetus out." When questioned whether it was something that was used at child birth, he said that it was something far smaller. When questioned whether the patients were given any anaesthesia he wryly said, "No. That is because if we give anaesthesia we have to keep a patient for about eight hours here. We don't have room to do so." "However you have to take a decision after talking with our chief doctor. At present he is at the theatre. He will decide whether you should go ahead with it or not. We don't charge for channelling. If he agrees to 'help' you, then you will have to pay Rs. 2,300," he said concluding what turned out to be the channelling session. When leaving the consultancy room, the team saw huge stacks of sanitary pads, and ironically on the receptionist desk, a poster of a beautiful baby. Thirty odd people from all walks of society were at the reception on day two as well. At the entrance the team managed to speak to a woman who had come to the clinic with her husband. She was returning home after aborting a three-month foetus. Though in pain, she agreed to talk. When asked whether the abortion was painful and whether she was given anaesthesia, she admitted it was painful, but said the patients were asked to pay Rs. 500 extra, if they needed anaesthesia. The woman further said that more than forty girls were waiting upstairs for their turn. "The nurses are very co-operative," she said. The team visited the second clinic also at Duplication Road, where a red and white board with the lettering 'Medical Clinic' was hanging outside a tall building. Investigations revealed this to be a clinic run by a gynaecologist who is a government health sector employee. The 'doctor' was not there. However his father said that the doctor had gone abroad, and would be returning on July 14. When explained of the situation, the father of the gynaecologist said, "Oh! don't worry. My son is well qualified. He is Dr. S. He is a gynaecologist. Those things, (abortions) are very simple for him." When the team pointed out that the doctor's qualifications were not written on the name board here," the father said "All that is not necessary, no?" ***** A crime Abortion is illegal in Sri Lanka. Yet over 1500 less than five months old foetuses are aborted daily in so called 'medical centres' that have mushroomed in every nook and corner of the country. The daily 'kill' quota is an eye-opener, that begs for remedial action. But what's equally tragic and perhaps of far more concern is the danger illegal abortions carried out by unqualified people in unhygienic conditions pose to young women seeking a way out of their predicament. The increasing maternal deaths rate has compelled the Association of Obstetrician and Gynaecologist to request the government to implement the draft laws permitting abortion under certain circumstances. They argue that the existing law introduced during the British era are outdated and do not suit the present situation of the country. However, strong opposition by religious dignitaries had led the proposed new laws being put on hold permanently. According to statistics, 25 per cent of the 250 annual maternal deaths are due to fatal after effects of unsafe abortions. According to prevailing laws 'abortion' is a crime and no doctor can perform or help to terminate a pregnancy. There are however, over 20 'abortion centres' masquerading as medical clinics in Colombo. Most run their unsavoury business with the blessings of the law enforcement authorities, informed sources told the Sunday Observer. According to Director Castle Street Hospital for Women (CSHW) there are three to eight daily admissions on 'natural abortions'. " But we do not know whether these patients, with a history of pregnancy and with bleeding from the vagina, have had or attempted illegal abortions", he said. He confirmed that there were no maternal deaths recorded during the last two years due to criminal abortion, but said that best way to avoid abortion was to follow the family planing methods, which were available free of charge. "If there is a failure in the family planning method consult a consultant gynaecologist or obstetrician immediately", he added. Consequences The Director cautioned those who seek 'treatment' from illegal abortion centres were bound to face the dire consequences due to unsafe practices of the unqualified 'gynaecologists'. "The unsafe methods will cause sever damage to the womb and according to reports various infections are the leading cause of death", he said. "There are some cases where quacks inject highly toxic material into the womb to get the foetus out. This had burnt the womb completely and the victims succumbed to death due to sever burning of the womb", he said. Dr. Lakshman Senanayake, Consultant Gynaecologist of the CSHW said that eight to ten per cent of maternal deaths were due to abortions and of these most of the deaths were due to illegal abortions. He said that it was not only unmarried women who sought to terminate their pregnancies at the hand of these quacks but also married women with children. "There is a demand for abortion from married women from respectable families due to financial burden to raise another child", he added. According to Dr. Senanayake, the present law does not permit abortions even though the latest technology like scans prove that the foetus is abnormal. "When the mother's life is in danger due to pregnancy an abortion can be performed but it should be recommended by two specialists", he pointed out. "Abortion laws are threefold. One is under medical advice when a mother's life is in danger due to pregnancy. The second is due to abnormalities of the unborn and the third is after a result of rape or incest. In some developed countries abortions are available on demand", he said. Rubella is a highly infectious disease and a woman who develops the infection, before the 18th week of pregnancy, is most likely to have a child with congenital abnormalities. " Even for a rubella victim the law does not permit an abortion", Dr. Senanayake said. Long term effects According to Dr. Senanayake, an abortion can cause long term effects and serious infections. "Women who do abortion run the risk of getting septicemia due to germs entering the womb. The chances of becoming childless are high among those women who did abortions. The most serious harm than unqualified persons do is the damage the womb to get the foetus out. In certain places, especially in remote areas they use instruments to 'kill' the unborn which ultimately damage the womb severely.", he pointed out. "Free availability of contraceptive methods and family planning services are the only solution to prevent women seeking help from illegal abortion centres", he said adding that most of people go to these places when they are faced with unexpected pregnancies under unexpected circumstances. "These women deserved family planning methods", he pointed out. Though the estimated number shows that there are over 1,500 illegal abortions taking place daily, the Ministry of Health does not have a proper data base to confirm this figure and according to gynaecologists the figure may be high compared to present demand for abortions and the centres which have mushroomed in the country. Every medical student taking the Hippocratic Oath vowes not to carry an abortion unless it is inevitable. But, despite this oath, according to informed sources, some qualified gynaecologists are also involved in this thriving business, which gives them nearly Rs. 7,000 to 10,000 per abortion.' some do this as a part time business", said the sources. According to a recent research carried out by the World Health Organisation (WHO) over 585,000 maternal deaths were recorded worldwide, last year. Out of this, a higher percentage was recorded from the developing countries. And over 75 million women become pregnant unexpectedly and out of those 45 million women resort to illegal abortions. Under sections 303 and 304 of the Penal Code an abortion can be performed only if the mother's life is in danger due to the pregnancy. ***** Whose baby is it? The existence of 'abortion clinics' in Colombo and elsewhere appears to be a contentious issue, with the Health Ministry seeking refuge in the 'no powers' claim and passing on the buck to the Municipal Councils in turn say it should be the responsibility of the Private Health Sector Development Authority. According to Dr. Nihal Jayatilake, Additional Secretary, Ministry of Health the Ministry does not have any powers to act against illegal abortion clinics as the powers lie with the Medical Officers of Health in Municipal Councils. When inquired about the clinic visited by the Sunday Observerteam, which does a significant number of abortions daily, he said that the Ministry was unaware of its activities. " The Ministry does not have a separate unit to raid these places', he said. Dr. Pradeep Kariyawasam, Chief Medical Officer of Health, Colombo Municipality (CMC) when contacted by the Sunday Observer said he does not have any authority to raid or take action against illegal medical centres or clinics within the Colombo city limits. "I can look after only the sanitation and environment of the city. I cannot do anything against illegal abortion centres. The Ministry is trying to pass the ball on to CMC's court. This is the first time I heard that these places come under my review", he said. Dr. Harsha Amal Silva, Director, Private Health Sector Development, said that he could raid medical centres that are a front for abortion clinics and take legal action against these places. But clarified the department needed written complaints supported by affidavits. "He admitted there were some rumours about the family planning clinic visited the Sunday Observer doing illegal abortions, but he said there had been no written complaints against them". However he said he was willing to raid the place if there was a written complaint. According to Dr. Silva complaints on criminal abortion cases can be lodged with the police. "Those who want such places to be raided or inspected can call 2674680 and give the information. Immediate action will be taken", he said. Dr. H.R.R. Samarasinghe, Chairman Sri Lanka Medical council (SLMC) said that complaints about gynaecologists who perform illegal abortions can be directed to the SLMC. "It should be a written complaint supported with an affidavit", he said. According to Dr. Samarasinghe, a gynaecologist found guilty of performing illegal abortion, will lose their registration. " But so far we have not received any complaints about gynaecologists who are engaged in this business. Complaints to the SLMC can be made to the SLMC, 31, Norris Canal Road, Colombo 7 or by phone 2691848. |
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