Health

A thriving industry behind the curtains

Foetus-killing or illegal abortion in Sri Lanka :

by Indeewara Thilakarathne

It was in one of the so-called Family Planning Clinic situated in the heart of the city of Colombo, in close proximity to leading schools. In the garden a group of youngsters were walking about impatiently waiting for their girl-friends and mistresses to descend from the fleet of steps that led to the no-go-zone for men. On the top floor, women ranging from teenagers to the middle aged were put in a row on number of hospital-styled beds waiting to be operated.

It was this clinic, an illegal abortion centre which was raided on July 27 by a Decoy Women Police constable. Fourteen young women were being operated on at the time of the raid.

Often the methods employed in killing the baby or the foetus is high risk given the primitive equipments used in the operation which is performed in the similar manner of slaughtering animals in butchery.

Although abortion is illegal in Sri Lanka, it is believed that about thousand abortions are performed on a single day in different parts of the country, primarily in the cities. The annual figure stands at a staggering 300,000 amounting to a silent genocide. Well-qualified doctors are also into the thriving business charging an average fee of Rs.10, 000 per abortion

According to POLICY a study by team of researches including W. Indralal De Silva, Aparnaa Somanathan, Vindya Eriyagama of Health Policy Programme, Institute of Policy Studies of Sri Lanka, though the unwanted pregnancies among the adolescent are very law compared to international studies, it has been noted that the unwanted pregnancies that occur among the unmarried adolescents ended up in abortions often performed by alleged quacks charging a fee ranging from sum of Rs.10,000 to Rs.3000.

The study further pointed out that approximately 19 percent of abortion seekers were identified as adolescents ages 15 to 24, the majority of whom were married 23 percent and most of the abortions have been performed at private clinics and nursing homes.

One of the cardinal reasons for unwanted pregnancies and resulting illegal abortions is a low prevalence of use of condoms and other contraceptive methods in Sri Lanka.

Kanchana is a one of the abortion seekers at the clinic. She is in her teens and had an affair with her boy-friend for more than two years. It was an accidental pregnancy and was clear that no contraceptive method was used during sex, resulting in the unwanted pregnancy.

After I discovered symptoms, my boy-friend and I realised the gravity of the problem as I am preparing to sit for the A/L examination for the second time and as we are not prepared to be parents, I decided to kill the foetus here. If not I could not face my family, relatives and friends, said Kanchana with a sad voice.

However, another abortion seeker Mala's case is entirely different from Kanchana's as she is a mother of four grown-up children and is also from a well-to-do upper middle class family. Her paramour aged enough to be one of her sons, stands confidently by her asserting his male superiority.

The affair was blind love and in a way a fatal attraction which knows no bounds. The paramour had met his sweet heart in her 40's at the Dehiwal Pola which is usually crowded with men and women of all ages. Since the first salacious glance at her, she was enticed to this youth forgetting all the barriers and the passionate love affair went on for over two years. Although they occasionally used condoms, they did not stick to it resulting in unwanted pregnancy.

I have no option but to seek the service of a doctor or anybody who is willing to perform an abortion. It is a private affair and a child at this stage will be disastrous to me and I have no way of facing my husband who is faithful and we have grown up sons, some of them have settled down.

Though it is illegal, I have absolutely no option. God help us. It is a do-or-die operation. I came here on my own with my boy friend. Even after the abortion, I will continue the affair as he has already become a part of my life, said Mala with a shy countenance.

It is clear that illegal abortion in Sri Lanka has become a thriving industry producing large number of alleged quacks. The debate has come to the fore again whether it is appropriate to legalise abortions in Sri Lanka or to introduce an effective mechanism to curb large number of deaths resulting from unhygienic methods used in illegal abortions in Sri Lanka.

According to the WHO, about one third of the 150,000 daily abortions world-wide are high risk and a woman dies every seven minutes as a consequence. It has been estimated that 36-56 million induced abortions are performed each year.

Some of the ethical issues involved in the birth process include: the choice of women for surrogate motherhood and donor insemination, selection of the sex of children, the use of organs from anencephalics for transplantation, sterilisation and contraception for the young, sex offenders and the mentally abnormal, embryo research - storage, experimentation, and destruction, prenatal diagnosis of sex and abnormalities in the light of present abortion laws, selective care for new-born with different risk assessments, use of foetal or embryonic tissue for therapeutic application e.g. in the treatment of Parkinson's disease, donation of genetic material for human reproduction, the use of antiprogestins for contraception, identification of partners with HIV, regulation of parturition for the convenience of health care workers or parental wishes e.g. to fit 'auspicious times' and mental disorder and the right of the individual to experience sex and reproduction.

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Grounds on which abortion is permitted: Sri Lanka

To save the life of the woman Yes
To preserve physical health No
To preserve mental health No
Rape or incest No
Foetal impairment No
Economic or social reasons No
Available on request No

Additional requirements:

The Penal Code contains no procedural requirements for the legal termination of pregnancy, except that the pregnant woman's consent is necessary. There are no provisions specifying the qualifications of those authorised to perform abortions nor the type of facilities in which the procedures are to be performed. Government view on fertility level:Satisfactory

Government intervention concerning fertility level: To lower

Government policy on contraceptive use: Direct support provided

Percentage of currently married women using modern contraception (aged 15-49,* 1993): 44

Total fertility rate (1995-2000): 2.1

Age-specific fertility rate (per 1,000 women aged 15-19, 1990-1995): 20

Government has expressed particular concern about:
Morbidity and mortality resulting from induced abortion No
Complications of childbearing and childbirth Yes
Maternal mortality ratio (per 100,000 live births, 1990):
National 140
South-central Asia 560

Female life expectancy at birth (1995-2000): 75.4

* Excluding areas containing roughly 15 per cent of the population. Source: Population Policy Data Bank maintained by the Population Division of the Department of Economics and Affairs of the United Nations’ Secrerariat.

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The silent cry

by Rosanne Koelmeyer Anderson

What is life? How much do we value life? In a world that is fast dissipating and a throw-away culture emerging, we too are not so far behind. Disposals are the order of the day.

It’s more easily said than done. The immense trauma, mental and physical that an abortion could cause could be irrevocable. The recent raid on this clinic is an eye-opener for the relevant authorities to take necessary action. It also raises awareness among the general public of the consequences of abortions.

The scenario at this place was highlighted by the Sunday Observer investigative team in an article which appeared in 2004. The clientele of this clinic were the very young unmarried school going girls, married women while some of them were repeat clients and the after effects were significant. The responsibility and burden on society is great. Is there an answer to this pressing issue?

The psychological and physical effects of abortion could be a more difficult situation to deal with rather than the abortion itself. A doctor must be sensitive to this fact explained Dr. Rohan L. Perera, Consultant Gynaecologist explained in answer to the question of abortions and its side effects.

Abortion was created to aid certain situations in which a woman could not or did not want to give birth to a child and care for the child. Abortion is a method in which the baby still in the mother’s womb or the living embryo/foetus is killed and is performed for many reasons such as the case of unwanted pregnancy for social and/or financial reasons, or if there are medical circumstances relating to the child and/or the mother. However, there are many repercussions that sometimes could be detrimental?.

If a woman may be unable to carry the child or there may be congenital defects and the child is unable to live afterbirth or if the child may have genetic irregularities, such as Down syndrome and the parents feel that they would be incapable of caring for the child then performing an abortion is possible.

However, whatever the reason be, there are many negative effects as well, both psychological and physical doctors should be sensitive to and the results may actually be worse than the problem itself which was solved.

The psychological and physical side effects of abortion should be discussed more openly within educational institutions and through the media so that women may become more aware of the potential risks they are taking. This would lead to an increase of knowledge on the subject especially among women who are making decisions related to an unwanted pregnancy.

Intense bleeding is one of the most probable side effects, which usually occurs directly after the abortion procedure. Infection can set in within twenty-four hours of the abortion and can cause severe illness. Cervical laceration can occur at the time of abortion and may contribute to bleeding after the abortion. Severe haemorrhage can happen at the time or directly after the abortion. Seizures are another risk that can occur at the time of the abortion or soon after.

Some of the long-term effects directly attributed to abortion are reduced fertility, which can happen years later, and an increase in breast cancer risk. Uncontrollable blood clotting can occur at the time of abortion and women have died. If an abortion is not handled correctly and the attempt to fix the mistake fails, a hysterectomy may be performed in which the woman’s uterus is taken out completely.

Studies by researchers also conclude that women often have difficulty coping with life after an abortion. Women experienced a sense of guilt and even regret the abortion, while in cases of selective abortion, there was grief for a wanted child. Questions about the characteristics of the baby, worries about future pregnancies, ambivalence about abortion itself, and guilt, terrible guilt when a pregnancy fails.

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The first LDLT done on Lankan a success

A new lease of life for Dr. Sarath Kappuwatte:

by Rosanne Koelmeyer Anderson

Delivering the key note address at the Annual Medical Sessions of the College of Surgeons Sri Lanka at the Galadari Hotel, Colombo, Dr. K. C. Tan, Consultant Surgeon/Director, Liver Transplant Programme, Asian Centre for Liver Diseases and Transplantation, Gleneagles Hospital, Singapore said the living liver donor transplant gives a patient a new lease of life.

The increasing incidence of liver disease in Asia today has become a pressing problem. But Gleneagles Hospital Singapore has launched a Living Donor Liver Transplant (LDLT) to cure liver diseases and other countries like Sri Lanka could follow suit if and when they are ready. .

Together with Dr. Tan was our very own Dr. Sarath Kappuwatte from Kandy who was Dr. Tan’s first Sri Lankan patient to do the LDLT three years ago in Singapore.

Dr. Kappuwatte who has certainly been blessed with a new lease of life, looked good, and in an interview with Sunday Observer said he was doing fine and was working at his clinic full day since then, but he wears a mask while working in order to avoid unnecessary complications and does a forty minute work-out on the treadmill daily.

Dr. Kappuwatte is apparently the President of a champion Rugby Club in Kandy too, he revealed with a modest smile while his donor married six months after the transplant.

The wedding was postponed in fact because of the transplant. Dr. Kappuwatte was at the head table to relate his success story.

Dr. Tan went on to explain Hepatobiliary that the exercise involves a huge gamut of doctors, Transplant and Hepatobiliary Surgeons, Anesthesiologists, Gastroenterologists/Hepatologists, Radiologists, Pathologists, Infectious Disease/Microbiologists and Haematologists and in addition nephologists, pulmonologists, neurologists, psychiatrists, dieticians and transplant coordinators which is a huge team of doctors.

So, if you are not ready with all the expertise do not start, because if you fail it will set you back by three to five years. The first case is the most important and most difficult one.

Singapore is the only country in the world that permits emotionally related transplants. So far only genetically related transplants have been done and Dr. Tan is the pioneer in the LDLT procedure.

The LDLT is a procedure in which a diseased liver is replaced with a segment of liver from a healthy human donor usually a sibling or a close family member, Dr. Tan further explained.

During LDLT, two teams of doctors will perform the donor and recipient operations almost simultaneously, about half the donor liver will be retrieved from the living donor. Once the diseased liver is removed from the recipient, the liver graft that was retrieved earlier is implanted. Both halves of the liver will regenerate and grow to full size in four to six weeks.

The donor and recipient operation takes six to eight hours and eight to ten hours respectively.

After the operation, the donor is nursed in the intensive care unit for 24 hours, hospitalised for six to eight days and closely monitored by surgeons over several weeks, initially in the intensive care unit and later in the surgical ward during which period the recipient will be closely checked for infection, rejection and regeneration of the transplanted liver, Dr. Tan added.