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Sri Lankan Women Too Scared to Seek Legal Post-Abortion Care

Abortion is illegal in almost all cases in Sri Lanka, but it’s perfectly legal for women to seek help after complications from backstreet abortions. Still, the fear of stigma and discrimination prevents many from coming forward.

Written by Sophie Cousins Published on Read time Approx. 4 minutes
The availability of mifepristone has caused abortion-related deaths to drop in Sri Lanka, but, lacking information about how to use the drug, many women still suffer complications. Phil Walter/Getty Images

COLOMBO, Sri Lanka – When Pabita* met her boyfriend, she thought he was the one. He told her he loved her and she dreamed of their marriage, one where her parents, who no longer live in Sri Lanka, would come home for the celebration.

She thought nothing of it when he jokingly pulled her into the water at the beach on the outskirts of Colombo last August, and told her she could get changed into fresh dry clothes at a nearby hotel.

Through her tears, Pabita told News Deeply that her boyfriend raped her at the hotel. She said she didn’t know what was happening. She believes he had planned it all in advance.

Three months later, Pabita realized she was pregnant. Seven months into the pregnancy, she took misoprostol and mifepristone – medical abortion tablets that she bought illegally from a pharmacy. But the tablets didn’t work – they are only effective for pregnancies up to 10 weeks – and it was too late for a surgical abortion.

Pabita had run out of options, but knew she didn’t want to keep the baby. So she started looking for a backstreet doctor who could help. She found one who, after charging 35,000 rupees (US$225), induced labor and delivered the baby two months premature.

“He gave me pills and then a little while later I was holding the baby in my arms. I kept the baby on my heart, in my hands, for 20 minutes, before he passed away,” Pabita said.

“In my arms, my baby passed away. He’s my first baby. I can’t ever forget him. If I was in a good situation, I would have kept the baby.”

Pabita suffered light bleeding and cramps for days after the procedure. But she, like many other Sri Lankan women, didn’t know that she could seek care at a government hospital without fear of reprisal.

Post-Abortion Care

In 2015, the Sri Lankan Ministry of Health issued new guidelines on comprehensive post-abortion care for healthcare workers. The guidelines stipulate that any woman who undergoes an illegal abortion can seek medical care for complications, if needed, at any government facility without fearing prosecution. The guidelines also allow selected government hospitals to use misoprostol for incomplete abortions.

“When women used to come to the hospital after an abortion, we used to have to inform the police, and then the police would come and threaten patients and demand bribes,” a gynecologist in Jaffna, who wanted to remain anonymous, told News Deeply.

“We never report cases to the police [now] but women don’t know they can come [here] without fear.”

In addition to providing medical services, post-abortion care covers the provision of counseling, education and family planning services to help women prevent future unwanted pregnancies.

There are no official figures on the number of illegal abortions that take place every year in Sri Lanka, but estimates suggest that up to 650 are carried out every day.

Dr Kapila Jayaratne, national program manager for maternal and child morbidity and mortality surveillance at the Family Health Bureau, said deaths from unsafe abortions had significantly declined since the introduction of abortion drugs, which began to be smuggled into Sri Lanka from India and Bangladesh in 2008.

Previously, coat hangers, bicycle parts or papaya leaves were the most common methods of unsafe abortions, which can often lead to sepsis and death.

Yet, while the tablets are available on the black market, many women aren’t given accurate information about how to take them, which can lead to complications.

Liberalizing Abortion Laws in Sri Lanka

Sri Lanka has one of South Asia’s strictest abortion laws: The procedure is only allowed to save the woman’s life. However, in August this year, the cabinet approved a draft bill allowing abortion under two circumstances: When the fetus is diagnosed with a lethal congenital malformation or when the pregnancy is the result of rape.

The bill still needs to be approved by parliament, and experts don’t know when – or if – that will happen.

Public health experts, doctors and activists have welcomed the proposed amendment that has been a long time in the making. However, it has been met with fierce opposition, primarily from religious bodies.

“The proposal to amend the law dates back to 2010 when we were lobbying the government to reduce deaths from unsafe abortion and legalize full abortion, but nothing happened,” said Dr. Sanath Lanerolle, consultant obstetrician and gynecologist at Castle St Hospital for Women in Colombo.

“The Catholic Church controls politics. This is in the hands of politicians, not doctors. I see a lot of pregnancies from rape. The amendment would change the quality of women’s lives drastically.”

If the amendment is approved, it means that women like Pabita could legally seek an abortion.

The gynecologist in Jaffna said he was so disillusioned by Sri Lanka’s strict abortion laws that he was performing surgical abortions and giving out medical abortion tablets to those in need.

“I’m taking justice into my hands,” he said

He said that one out of four pregnant women who come to see him ask for an abortion. He doesn’t perform them in every case; he tries to counsel some women to keep the baby. But in cases of rape, incest, pregnant teenagers, women who have numerous children or those can’t afford to raise another child, he will often agree to their requests.

“I consider termination for the benefit of the patient. We need to let women have the right to decide what they want to do,” he said.

*Name changed to preserve anonymity.

Reporting for this story was supported by a grant from the South Asian Journalists Association.

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