Abortion laws and their consequences in Sri Lanka Essay Assignment Paper

Instructions – major essay

Your essay should be 3000 words, is worth 60% of the total marks for this subject.

Please ensure that you critically review the available evidence about the topic that you have chosen (i.e. Don’t just summarise the literature!). I highly recommend you choose a particular setting to focus your essay. The geographical scope should be commensurate with, and appropriate to, the issue you are writing about. For example, focusing on ‘Africa’ is inappropriate for an essay on HIV – you will drown in literature and be unable to critically discuss social or cultural factors across the very diverse continent. Rather, choose a specific country. For other issues where the literature is sparse, a region may be an appropriate setting.

ORDER A PLAGIARISM-FREE PAPER HERE

Do try to write with a ‘gender lens’ – you do not need to strictly apply one of the gender analysis frameworks that we have discussed in class, but do discuss how gender roles and responsibilities impact upon the health issue that you are writing about, in the particular setting you have chosen Abortion laws and their consequences in Sri Lanka Essay Assignment Paper.

INSTRUCTIONS:

The task is to critically review the available evidence – don’t just summarise the literature. For example, focusing on ‘Africa’ is inappropriate for an essay on HIV – you will drown in literature and be unable to critically discuss social or cultural factors across the very diverse continent. Rather, choose a specific country. For other issues where the literature is sparse, a region may be an appropriate setting.

o The paper has to be ‘critic’ the evidence enough. This means, what was ‘wrong’ or ‘missing’ or ‘contradicted’ about the evidence. At the same time, what was ‘insightful’, ‘valid’ or ‘true’ about the evidence?

State the findings from the literature in a clear way (stating only what is relevant to your topic).
Say what was missing/wrong/incorrect/incomplete about the evidence.
Say what was good about the evidence; did it have a high sample that represented all social classes? was it conducted independently from a group of both women and men fairly? Abortion laws and their consequences in Sri Lanka Essay Assignment Paper

o The paper has to cover strongly how gender roles and responsibilities impact upon the health issue. Look at the literature on cultural gender roles in India society.

o The paper has to present following an outstanding logical sequence.

o The paper has to demonstrate critical thinking/questioning/critique with regard to the material presented.

o The arguments in the paper have to be clearly and logically.

o The paper has to present alternative viewpoints

o The paper has to draw on material beyond what was uploaded in the attachments. ”

o The time frame of references has to be no more than 10 years, also to being of academic and reliable sources and citations correctly and consistently.

o The required FORMAT is the Harvard style

Format of written assessments

Assignments should be typed, using 11-point font and 1.5 spaced format and submitted as a Microsoft Word file or pdf.

Your arguments should be evidence based and all assertions should be appropriately referenced.

Referencing for written assessments

The Harvard referencing system should be used

Women and Global Health

Abortion laws and their consequences in Sri Lanka

Every year 22 million women undergo unsafe abortions worldwide- the vast majority of these occur in developing countries and they account for 13% of all maternal deaths in these regions (Ipas, 2014, Okonofua, 2006). Unsafe abortions are procedures performed “without the necessary skills or in an environment that does not conform to minimum medical standards, or both” (Grimes et al., 2006). These occur more commonly in countries where abortion is restricted by law and thus, can be considered as a largely preventable public health and human-rights issue (Ipas, 2014, Grimes et al., 2006). Sri Lanka presents a case-study with prohibitive legislation that is worth consideration; here, abortion is illegal except when a mother’s life is under threat (Kumar, 2013). By all accounts, Sri Lanka is a South Asian country to which others can aspire- enormous efforts have been made to improve health and education for all citizens (Arambepola and Rajapaksa, 2014, Gill and Stewart, 2011). Consequently, one might assume that gender equality is advancing in strides, irrespective of current abortion laws. Indeed it appears this assumption has been adopted by the Government, undermining any impetus for change. In this essay we will examine the current approaches to abortion laws in Sri Lanka, their validity within a national and international context and consequences of unsafe abortions for the health and well-being of Sri Lankan women. It will become apparent that despite superficial appearances, abortion laws- rather than being irrelevant to current progress in gender equality- are a symptom of a disconcerting double standard; where the rights of women are respected only within the limits of culture, religion and a predominantly patriarchal power structure. Ultimately, allowing women to have control over their own bodies “is a fundamental prerequisite to the achievement of sexual and reproductive health and rights” (Sri and Ravindran, 2015), and the Sri Lankan Government must recognise this critical issue if they are to continue to improve gender equality now and into the future Abortion laws and their consequences in Sri Lanka Essay Assignment Paper.

Gender inequality in Sri Lanka

Gender inequality is comparatively more pronounced within Sri Lanka than in 71 other countries in the world, according to the gender inequality index; this score is based on reproductive health, empowerment (political participation and education) and labour market participation (Social Institutions & Gender Index, 2016). Whilst an improvement upon previous years- particularly in light of two decades of conflict and a tsunami disaster (Gill and Stewart, 2011)- this intermediary rank also indicates that substantial barriers to equality remain. Progress has largely been attributable to an improving economy, the provision of “free health for all” and universal education (Asian Development Bank, 2015, Gill and Stewart, 2011). Maternal mortality rates have declined significantly, health service utilisation- such as antenatal care- is enviably high and girls have higher enrolment and retention in secondary and higher education compared with boys (Asian Development Bank, 2015). Despite this, women are still perceived as natural reproducers and nurturers who must “obey and respect” their husbands (Jayatilleke et al., 2011). Controlling a wife’s behaviour is commonplace and acceptable (Bourke-Martignon, 2002) and for those women who transgress cultural norms, they are at significant risk of intimate partner violence (Jayatilleke et al., 2011). Indeed, lifetime prevalence of such violence is estimated at around 40% (Kuruppuarachchi and Wijeratne, 2005). Outside of the home, unemployment gaps between men and women have been narrowing, yet averages conceal the “unconscionably high” rates among younger or well-educated women relative to their male counterparts (Jayaweera et al., 2007). There are also horizontal and vertical gender divisions- women are excluded from higher income positions and of those that are employed, this largely occurs in the informal sector with low-skill jobs or even unpaid family labour (Asian Development Bank, 2015, Gill and Stewart, 2011). Female representation in parliament has failed to exceed 6% (Asian Development Bank, 2015) and legally the elimination of gender-based discrimination in inheritance rights has not occurred (Social Institutions & Gender Index, 2016). Thus, despite the relatively satisfactory position of Sri Lanka compared to other South Asian countries, there are clearly lingering barriers to equality that permeate everyday life, let alone controversial issues such as abortion Abortion laws and their consequences in Sri Lanka Essay Assignment Paper.

Current approaches to abortion in Sri Lanka

The primary means by which the Sri Lankan Government impedes access to abortion services is through legal restriction, however this essentially amounts to sexual discrimination- given that these services are only required by women- and ultimately does little in the way of actually preventing terminations. Sri Lankan abortion laws are based on arachic colonial legislation from 1883 and state that abortion is legal only to save a woman’s life, and those who do not obey this law will be “punished with imprisonment” (Walatara, 1998, Government of the Democratic Socialist Republic of Sri Lanka). Simultaneously, the 1978 Constitution guarantees women fundamental rights as well as protecting against discrimination on the grounds of gender (Asian Development Bank, 2015). Sri Lanka has further ratified the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), a document that considers access to safe abortion services as a necessity for gender equality (Gomez, 2004). Thus clearly current legislation is antithetical to sentiments in both the national constitution and international treaties, and infringes upon basic human rights. Nor is this transgression founded on inaction, but rather active opposition; recent attempts to amend the law in instances of rape, incest, and fetal abnormalities were unsuccessful (Kumar, 2013). Resolving this conflict, one is left to assume that the Ministry of Health places enormous significance on the imperative to save lives by criminalising abortion, above and beyond any ramifications on human rights or the law. Ironically however, this hard-line stance does little in the way of actually preventing terminations and instead, promotes unsafe practices and places women’s lives at risk. Clandestine services and abortive medications (although unregistered) are widely available and whilst there are no national level statistics, it is estimated that over 500 abortions occur per day (Ban et al., 2002). Therefore Sri Lankan women are not only facing unlawful discrimination- despite national sentiment supporting gender equality- the Government is also compromising their health and wellbeing through the consequences of inevitable unsafe practices.

Remaining defiant on the issue of legalisation, the Sri Lankan Government instead favours primary prevention and tertiary management of the consequences of unsafe abortions (Family Health Bureau, 2009); however even these services are implemented through a gender lens that emphasises traditional roles and responsibilities for women. Primary prevention is the provision of health services to minimise the risk of unwanted pregnancies. This largely encompasses family planning programs- accepted into national policy in the 1960s (Asian Development Bank, 2015)- as well as sexual and reproductive health education. These programs are well-established and expansive, increasing contraceptive use to 70% and causing a decline in the national fertility rate to 2.3 (Asian Development Bank, 2015). National averages such as these however, overlook district variations as well as the inconsistent impact on vulnerable and marginalised women. Barriers to contraceptive use include inaccessibility, privacy concerns, social barriers and financial costs, and for some women abortion becomes the predominant method of family planning (Perera et al., 2004). It is also worth noting that contraceptives are largely targeted to married women, whom historically have constituted the majority of individuals seeking terminations (Abeyasinghe et al., 2009). Even so, this underestimates changing societal norms within Sri Lanka; premarital sex appears to be increasing along with urbanisation, internal and external migration, increased marital age and a shift from arranged marriages towards “love marriages” (Jordal et al., 2013). Persisting cultural barriers- see above- and a lack of sexual education for adolescents has led to notably poor contraceptive use among unmarried couples (Kumar, 2012). This highlights how the current system is failing women- failing to afford them with equal sexual and reproductive health services in the first place and then failing to give them control over choices to manage the ensuing consequences. The reason why this occurs is likely the same mechanism as for discrepancies in the employment and political sectors. Were the Sri Lankan Government truly committed to gender equality and simultaneously opposed to abortion, one would anticipate efficient and effective primary preventative services for all women, not the deficiencies described here. Thus abortion laws are merely a symptom of an ongoing disease of discrimination.

Tertiary management of unsafe abortions, involving the “integration and institutionalization” of post-abortion care into the Sri Lankan health care system, also fails to adequately meet the needs of women (Okonofua, 2006)Abortion laws and their consequences in Sri Lanka Essay Assignment Paper. For the most part, tertiary management has been achieved through “free health for all,” rather than specific directives. Indeed, the most recent Reproductive Health Policy of 1998 and the National Strategic Plan on Maternal and Newborn Health (2012-2016), both failed to include provisions for post-abortion care (Kumar, 2012). This passive stance endangers the health and well-being of women, particularly given the ongoing rate with which abortions occur. This is compounded by fear and stigma. In one small study, many women delayed seeking help from a Government hospital following an abortion because they were concerned about legal ramifications, as well as discrimination from health care providers (Thalagala, 2010). These women claimed that they had few opportunities to ask questions regarding their health upon admission and more than 10% experienced verbal abuse from staff (Thalagala, 2010)- women who have had abortions are often subject to “social ridicule, reprimand and exclusion from both family and society” (Jordal et al., 2013). This is particularly true for unmarried women, who are seen to be violating sexual norms and proper behaviour, with a woman’s virginity closely linked to the dignity of a family (Jordal et al., 2013). Thus clearly a more direct approach to managing the consequences of unsafe abortion is required, and one that adequately addresses privacy and legal concerns. The situation described above reflects not only a failure to manage medical consequences of terminations, but a disregard for the wide-reaching ramifications of abortion laws; it appears that “free health for all” has a caveat- so long as women conform to rules and regulations placed upon their behaviour (Gill and Stewart, 2011).

Consequences of abortion laws and unsafe practices

Liberalisation of abortion laws within other South Asian countries has largely been driven by a desire to reduce maternal mortality (Shakya et al., 2004, Klugman and Budlender, 2000)- whilst this impetus is absent from Sri Lanka, by no means are preventable deaths due to unsafe abortions “acceptable”. Maternal mortality rates have received international commendation, steadily declining since the 1950s to reach 35 deaths per 100,000 live births (Kumar, 2013). It is estimated that more than 98% of births are attended by skilled personnel or take place in hospitals (Kumar, 2012). Therefore maternal mortality is not a “campaign-turner” for abortion reform, but the impact of these laws on health and wellbeing cannot be overlooked (Kumar, 2012). Whilst reliable statistics on abortion morbidity and mortality are unavailable- women accessing care often do not disclose their medical history- it has been estimated that 7-16% of hospital admissions for women are related to the complications of these procedures (Kumar, 2013). Given the widespread success of health care reform in Sri Lanka, other preventable causes of maternal mortality have generally declined such that the proportion of deaths attributable to unsafe abortions has steadily increased (Kumar, 2013). For example, in 2008 it is estimated that mortality from unsafe abortions was equivalent to those caused by postpartum haemorrhage (Family Health Bureau, 2011), the predominant cause of maternal deaths in most developing countries (Kumar, 2013). More important however, is the fact this morbidity and mortality is preventable. Continuing to deny women access to safe abortions is a denial of women’s rights- women are dying “because societies have yet to make the decision that their lives are worth saving” (Fathalla, 2006). Sri Lanka has shown some commitment to gender equality, however it appears this is only superficial, with little concern for the lives of individuals who fail to meet expectations according to traditional social and cultural norms.

Illegal abortion- and false pretences of gender equality- not only endanger the psychological and physical well-being of women, but also broaden the social inequality gap. This has significant consequences for both individual women and for the ongoing socioeconomic development of Sri Lanka. Terminations continue to occur illegally within an unregulated market, where access to safe services are dictated by the ability to pay a “substantial fee” (Arambepola and Rajapaksa, 2014). A decision to undergo an unsafe procedure is based on economic instability (Arambepola and Rajapaksa, 2014) and thus women of low socio-economic status (SES) will more often than not, find safe abortion services to be too expensive (Okonofua, 2006). Moreover, poverty is one of the most common reasons for seeking out an abortion within Sri Lanka in the first place (Perera et al., 2004). Thus poorer women are more likely to require an abortion but less capable of accessing quality services; this places them at increased risk of physical complications as well as social stigmatisation. The alternative choice, to continue the pregnancy in unfavourable conditions, has its own ramifications. Lacking the ability to control the timing of motherhood, these women often sacrifice educational or economic independence, perpetuated by the predominant role of Sri Lankan women in childrearing (Siegel and Siegel, 2013). In this way, the cycle of illegal abortions and poverty becomes self-perpetuating and women of lower SES have fewer opportunities to control her own health, well-being and future direction in life. Given these laws apply only to women, clearly this also further entrenches gender inequality in Sri Lanka and highlights a double standard for a Government committed to improving the health of all of it’s citizens (Arambepola and Rajapaksa, 2014)Abortion laws and their consequences in Sri Lanka Essay Assignment Paper.

Proponents of anti-abortion laws state the necessity to protect the sanctity of human life, however within Sri Lanka these decisions are dictated by a patriarchal power structure that appears to be more concerned with controlling women (Jordal et al., 2013). Potential amendments to the law were recently put forward in Parliament, however it was thought this would “affect the fundamentals of social and cultural life” and result in an increase in promiscuity among women (Kumar, 2012). Clearly this sentiment reflects underlying intentions- to control thought and behaviour. Furthermore, if the sanctity of human life really were central to this law, it is expected that the Government would “bend over backwards” to provide support to women who are “ required to bear- too often alone- the awesome physical, emotional, and financial costs of pregnancy, childbirth, and childrearing” (Siegel and Siegel, 2013). In reality however, vulnerable women must face compelled motherhood with veritable indifference from the Government (Siegel and Siegel, 2013). Single mothers represent the extreme- despite not being allowed to undergo an abortion, should they continue with the pregnancy they receive no state support, face social stigma and are often forced to work in low paid positions or even migrate (Jordal et al., 2013). Thus abortion laws in Sri Lanka reflect a perception of what is “natural” and appropriate for a woman within society. Indeed as was seen above, this law is not only failing to protect human life- since abortions continue to occur- it is actually placing lives in extreme danger. As described by Gill and Stewart (2011), Sri Lanka and other similar South Asian countries must “develop a critical consciousness of their common patriarchal cultural ideology, which exacerbates gender inequities” and only by doing this will progress truly be made for women’s rights.

Conclusion

Overall, recent socioeconomic development within Sri Lanka stands to disguise the ongoing inequality faced by women and that is reflected in current abortion laws. There is a double standard whereby the Government legally, politically and publically has committed itself to protecting the rights of women, whilst simultaneously undermining them and perpetuating discriminatory behaviour. Moreover, a failure to provide adequate services to prevent and manage the consequences of this approach underscores a general disregard for the health and wellbeing of women, particularly those who do not conform to societal norms. Clearly legislation surrounding abortion has less to do with safeguarding and cherishing life, and more to do with power and control over women. In reality what is required for this controversial issue, is the same dispassionate and scientific approach as other public health concerns (Grimes et al., 2006). Whilst this is unlikely to occur in the foreseeable future given current active opposition, it is imperative that the Sri Lankan Government make steps to recognise this issue in order to move towards true- rather than superficial- gender equality. Admittedly legalisation on abortion is not the complete picture either, and a shift in societal and cultural norms is also required to provide free access to sexual and reproductive services, but certainly this will act as a precedent for such change (Grimes et al., 2006). The facts are that abortions occur regardless of legislation and access to safe services improves health and equality for women (Grimes et al., 2006)- it’s hard to argue with that.

References

ABEYASINGHE, N. L., WEERASUNDERA, B. J., JAYAWARDENE, P. A. & SOMARATHNA, S. D. 2009. Awareness and views of the law on termination of pregnancy and reasons for resorting to an abortion among a group of women attending a clinic in Colombo, Sri Lanka. J Forensic Leg Med, 16, 134-7.

ARAMBEPOLA, C. & RAJAPAKSA, L. C. 2014. Decision making on unsafe abortions in Sri Lanka: a case-control study. Reprod Health, 11, 91.

ASIAN DEVELOPMENT BANK. 2015. Country Gender Assessment: Sri Lanka. An Update. Philippines: Asian Development Bank.

BAN, D. J., KIM, J. & DE SILVA, W. I. 2002. Induced abortion in Sri Lanka: who goes to providers for pregnancy termination? J Biosoc Sci, 34, 303-15.

BOURKE-MARTIGNON, J. 2002. Violence against women in Sri Lanka: Implementation of the convention on the elimination of all forms of discrimination against women by Sri Lanka Committee on the Elimination of Discrimination Against Women, Twenty-sixth Session. Geneva, Switzerland: World Organisation Against Torture.

FAMILY HEALTH BUREAU. 2009. Overview of maternal mortality in Sri Lanka 2001–2005. In: MINISTRY OF HEALTHCARE AND NUTRITION. Colombo, Sri Lanka: Ministry of Healthcare and Nutrition.

FAMILY HEALTH BUREAU. 2011. National Strategic Plan on Maternal and Newborn Health (2012-2016). Colombo, Sri Lanka: Ministry of Health Sri Lanka.

FATHALLA, M. F. 2006. Human rights aspects of safe motherhood. Best Pract Res Clin Obstet Gynaecol, 20, 409-19.

GILL, R. & STEWART, D. E. 2011. Relevance of gender-sensitive policies and general health indicators to compare the status of South Asian women’s health. Womens Health Issues, 21, 12-8.

GOMEZ, S. 2004. Women of the World: Laws and Policies Affecting Their Reproductive Lives: Sri Lanka. Women of the World: Laws and Policies Affecting Their Reproductive Lives: South Asia. New York, USA: Center for Reproductive Rights.

GOVERNMENT OF THE DEMOCRATIC SOCIALIST REPUBLIC OF SRI LANKA. Penal Code, Section 303 [Online]. Available: http://hrlibrary.umn.edu/research/srilanka/statutes/Penal_Code.pdf [Accessed 08/11/2016]Abortion laws and their consequences in Sri Lanka Essay Assignment Paper.

GRIMES, D. A., BENSON, J., SINGH, S., ROMERO, M., GANATRA, B., OKONOFUA, F. E. & SHAH, I. H. 2006. Unsafe abortion: the preventable pandemic. Lancet, 368, 1908-19.

IPAS. 2014. Ensuring women’s right to safe legal abortion and gender equality in the post-2015 development goals [Online]. USA: International Pregnancy Advisory Services. Available: https://www.ipas.org/en/Resources/Ipas%20Publications/Ensuring-womens-right-to-safe-legal-abortion-and-gender-equality-in-the-post-2015-developm.aspx [Accessed 08/11/2016].

JAYATILLEKE, A., POUDEL, K. C., SAKISAKA, K., YASUOKA, J., JAYATILLEKE, A. U. & JIMBA, M. 2011. Wives’ attitudes toward gender roles and their experience of intimate partner violence by husbands in Central Province, Sri Lanka. J Interpers Violence, 26, 414-32.

JAYAWEERA, S., WIJEMANNE, H., WANASUNDERA, L. & VITARANA, K. 2007. Gender Dimensions of the Millennium Development Goals in Sri Lanka. Colombo, Sri Lanka: United Nations Development Programme.

JORDAL, M., WIJEWARDENA, K. & OLSSON, P. 2013. Unmarried women’s ways of facing single motherhood in Sri Lanka – a qualitative interview study. BMC Womens Health, 13, 5.

KLUGMAN, B. & BUDLENDER, D. 2000. Advocating for abortion access: eleven country studies. Johannesburg, South Africa: University of Witwatersrand.

KUMAR, R. 2012. Misoprostol and the politics of abortion in Sri Lanka. Reprod Health Matters, 20, 166-74.

KUMAR, R. 2013. Abortion in Sri Lanka: the double standard. Am J Public Health, 103, 400-4.

KURUPPUARACHCHI, K. A. & WIJERATNE, L. T. 2005. Domestic violence and female mental health in developing countries. Br J Psychiatry, 187, 587-8.

OKONOFUA, F. 2006. Abortion and maternal mortality in the developing world. J Obstet Gynaecol Can, 28, 974-9.

PERERA, J., DE SILVA, T. & GANGE, H. 2004. Knowledge, behaviour and attitudes on induced abortion and family planning among Sri Lankan women seeking termination of pregnancy. Ceylon Med J, 49, 14-7.

SHAKYA, G., KISHORE, S., BIRD, C. & BARAK, J. 2004. Abortion law reform in Nepal: women’s right to life and health. Reprod Health Matters, 12, 75-84.

SIEGEL, N. S. & SIEGEL, R. B. 2013. Equality Arguments for Abortion Rights [Online]. USA. Available: http://www.uclalawreview.org/pdf/discourse/60-11.pdf [Accessed 04/11/2016].

SOCIAL INSTITUTIONS & GENDER INDEX. 2016. Sri Lanka [Online]. Available: http://www.genderindex.org/country/sri-lanka [Accessed 01/11/2016].

SRI, S. B. & RAVINDRAN, T. K. 2015. Safe, accessible medical abortion in a rural Tamil Nadu clinic, India, but what about sexual and reproductive rights? Reprod Health Matters, 22, 134-43.

THALAGALA, N. 2010. Economic Perspectives on Unsafe Abortions in Sri Lanka. Sri Lanka: Family Planning Association of Sri Lanka.

WALATARA, S. 1998. Abortion: the right to choose. Moot Point, 2, 24-

Assessment criteria – Major Essays (60% of total mark)

Criteria	Marks allocated
*Logical organisation and presentation of ideas*(Does the material presented follow a logical sequence? Are you able to build a convincing argument or clearly and logically make your point? Does the paper follow written conventions ie. have an introduction and conclusion?)	10%
*Inclusion of required material*(Does the paper include material that addresses the question outlined in the subject guide? i.e. have you written the paper you were asked to write?)	5%
*Clear definition of terms*(Does the paper clearly define the terms that are drawn upon? – in relation to the condition discussed, determinants of that condition, and gender frameworks discussed)	5%
*Comprehensive response*(Does the paper demonstrate independent research in the area? i.e. Draw on material beyond what was given to students in the readings. Does the paper comprehensively respond to the question? Is there sufficient depth and breadth to the essay, within the limitations of the word count?)	14%
*Critical analysis of information presented*(Does the paper demonstrate critical thinking/questioning/critique with regard to the material presented? Are alternative viewpoints presented? Does the paper demonstrate that you can critically engage with concepts from the course and with the literature?)	14%
*Coherent written expression*(Is it clear that the paper has been proof read before submission? – particularly with regard to grammar, spelling, sentence structure, and English expression. Does the paper follow academic conventions with regard to language?)	6%
*Presentation, referencing and citations*(Is the presentation of the paper appropriate to postgraduate level? Are references and citations correctly and consistently used? Please use the Harvard (author-date) referencing format) Abortion laws and their consequences in Sri Lanka Essay Assignment Paper