•DIANNE HUBBARD THE LATEST discussion about abortion law reform is a welcome development, but policy and legislation should be based on accurate data. At the moment, there appears to be some confusion about what the numbers mean.
And, even more importantly, we need to focus on the question of rights, and on the best ways to reduce unwanted pregnancies and abortions in practice.
The numbers
The recently-cited statistics on abortion generated widespread alarm. But a closer look reveals that the numbers relate mostly to “spontaneous abortions” (7 197 incidents). “Spontaneous abortion” is an internationally-used medical term, which bears no relation to what laypersons understand as abortion, but refer in fact to a miscarriage.
It is possible that an attempted abortion could be presented at a hospital as a miscarriage in some cases, but it is probable that most of the miscarriages in question occurred naturally. In fact, it is estimated that half of all fertilised eggs fail to develop successfully – with miscarriages often taking place before the woman even knows that she is pregnant.
The recently-cited statistics include 138 “medical abortions”. These probably included some cases where the foetus was no longer living and needed to be expelled, or where the procedure was necessary to save the mother’s life. Again, these numbers could include some problems arising from attempted abortions in the mix, alongside other situations.
So, the recent statistics provided by the Ministry of Health and Social Services do not in fact indicate that over 7 000 women had illegal abortions.
But illegal abortion is nonetheless a serious problem. In 2006, the Ministry of Health and Social Services conducted a countrywide study on emergency obstetrics care, which assessed the situation at 34 state hospitals, seven private hospitals, 32 health centres and 27 clinics.
This study found that abortion accounted for 20,7% of direct obstetric complications and one of the 12 maternal deaths recorded at these facilities in the one-year period from November 2004 to October 2005.
We were not able to locate any more recent medical statistics on the incidence of abortion in Namibia. In any event, many illegal abortions probably take place without resulting in medical treatment.
Namibian Police statistics report 23 cases of illegal abortion in 2013, 19 in 2014 and 13 in 2015. Again, this is not indicative of the actual numbers of illegal abortions taking place since it is likely that many such cases remain unreported and undiscovered.
Since most abortions take place in the shadows, we may never know the actual extent of the problem in Namibia.
The rights
Different religions and individuals have different views about when life begins. The Namibian Constitution promises freedom of religion and freedom of conscience and belief to everyone in Namibia. This means that society as a whole cannot be forced to accept the views of any particular religion. The right to make individual decisions on matters of conscience is a fundamental part of what it means to be human.
No one knows when life begins in scientific terms. In legal terms, personhood – in the sense of the ability to have legal rights, duties and capacities – begins at birth. But the potential for personhood is an important consideration, both morally and legally, which is why countries with more liberal abortion laws generally include various restrictions and limits.
At the same time, women have a right to make their own decisions about their own bodies, including decisions about contraception and abortion. Physical autonomy is a crucial component of the right to dignity. So, the law must try to balance the competing rights and considerations at stake.
Conundrums such as these can arise in other contexts. Should the law force you to risk injury or death to save the life of another person in peril? Should you be charged with a crime if you do not offer to give your blood to someone who needs a blood transfusion? Should the law be able to force you to donate a kidney to someone who needs it? Most would agree it is inappropriate for the law to force people to perform such services, even if the life of another person is at stake.
Justice Albie Sachs, who was formerly on the South African Constitutional Court, said: “Those who are against birth control or against abortion will have the right to argue their views and work towards finding alternative approaches, but will not have the right to impose their position on others, who hold different opinions.
“Similarly, those who favour contraception and the right to terminate unwanted or dangerous pregnancies should be free to put forward their positions, but not have the right to insist on birth control and abortion for those who do not want it. What apartheid society has never done is to allow people to choose for themselves how they wish to lead their lives. What post-apartheid society must do is to guarantee to people for the first time the basic rights of personal self-determination.”
The practicalities
No one is arguing that abortion should be undertaken lightly, or as a form of family planning. Most proponents of greater freedom of choice see abortion as a last resort in a spectrum of options for dealing with unwanted pregnancies. Most people on both sides of the debate would agree that the overriding goal should be to reduce the incidence of unintended pregnancy and abortion.
But laws restricting access to abortion do not discourage women from having abortions. They simply drive abortion underground, with tragic consequences for women’s health and wellbeing.
Laws against abortion also discriminate against women with lower financial resources. Some Namibian women can afford to access safe abortions by travelling to countries where abortion is legal, while others are left with “backstreet abortions” or home remedies. Namibia’s restrictive laws have also resulted in a black market in abortion-inducing pills, allowing some to profit handsomely from the troubles of others. This situation is manifestly unfair and dangerous.
Even though I support legal change to respect women’s rights to make decisions about their own bodies, I am personally opposed to abortion. But in my view, and based on the experience of many other countries, positive measures can be more effective in reducing abortion than criminal sanctions.
Unwanted pregnancies can be discouraged by measures such as increased information about sexuality and reproduction, easier access to contraception and more effective implementation of the learner pregnancy policy so that young mothers are not tempted to terminate pregnancies so they can remain in school.
Options to abortion such as adoption and kinship care should be publicised and promoted. Much more could be done to ensure that fathers do their share to support their children emotionally and financially. Women confronted with unwanted pregnancies could be provided with counselling, and informed of support services such as state maintenance grants.
The question we should be asking ourselves is not whether abortion is right or wrong. That is a question on which society will always disagree. The real question is whether the law should decide this issue for everyone.
