Abortion and Class: Why the Link Matters (The F Word: Let's Talk Feminism and Gender and bakamoono.lk)

(This piece first appeared as part of a weekly column for The Sunday Morning and then subsequently on bakamoono.lk)

In 1973, a ruling was passed in the US Supreme Court that changed the face of abortion access. In the now famous Roe vs. Wade case, the court ruled that Due Process Clause of the 14th Amendment to the US Constitution provides a fundamental “right to privacy” that protects a pregnant woman’s liberty to choose whether or not to have an abortion.

Last week, the abortion debate in the US came once again to the forefront with some states passing incredibly restrictive laws – states including Alabama, Arkansas, Georgia, Kentucky, Mississippi, North Dakota, and Ohio.

In Ohio, for example, the Governor also signed a heartbeat bill this year, banning abortions once a foetal heartbeat is detected. Louisiana, South Carolina, and Missouri are halfway towards passing a foetal heartbeat law. Other states, including Maryland, Minnesota, Texas, and West Virginia are also considering abortion restrictions.

In almost all of these states, if the bills are signed into law, it would restrict the procedure in nearly all circumstances, including rape and incest. The only exception to the ban is where a woman’s health is at serious risk. This brings their law in line with countries like Sri Lanka, with an even greater punishment in some cases. Alabama’s Bill for example, would make performing an abortion at any stage of pregnancy a felony punishable by up to 99 years or life in prison for an abortion provider.

This is even greater than Sri Lanka where the punishment (under Section 303 of the Penal Code) is up to seven years and/or a fine. Politicians behind the bans across the country have made it clear that their goal is to prompt court challenges in hopes of ultimately overturning the 1973 Roe vs. Wade decision – legalising termination for up to three months. It is unclear right now what the outcome will be, but the concerns are very real. Even in a best-case scenario, there is a chance the High Court could agree to hear any of several less-sweeping, anti-abortion rights measures. Some would tighten restrictions on clinics; others seek to ban certain categories of abortions.

Sri Lanka, as mentioned previously, has some of the most restrictive national abortion laws in the world. Despite this, however, the Ministry of Health reported in 2016 that 658 abortions are carried out daily. Research carried out in two abortion clinics in Colombo in 1997 showed that more than 90% of patients were married women, and more than half of them already had one or two children. Among the reasons given by married women for needing an abortion were those of poverty and foreign employment.

The debate around access and the right to choose to terminate an unwanted pregnancy has many faces and facets – from the very basic tenants of a woman’s right over her body to what it means for rape victims, victims of incest, and how we value the lives of women and girls in painful circumstances.

However, one aspect that remains woefully undiscussed is the class and socio-economic aspect of this conversation. In the limited work that has been done by academics, the link between ease of access to termination and reasons women (often taking desperate measures) terminate against the law can be linked to broader health and socio-economic inequalities. Class inequalities do not exist in a vacuum and while the moral aspect of this debate is the loudest, it more often than not completely dismisses these very real structural inequalities that impact this decision.

Fatal laws

In Sri Lanka, as mentioned before, studies show that women (married women) cite poverty as a major reason for seeking a termination. Imagine you are a 35-year-old mother living as one of our urban poor in low-cost housing. You already have two children and are struggling to make ends meet. Another child means that you would need to stay home for a minimum of six to eight months without an income to care for a newborn. This is not an option for many women whose families cannot survive without the additional income and for who childcare is not an affordable option. This is where it begins.

The decision may also be further complicated later in the pregnancy if it is found the child will be born with significant foetal abnormalities or disabilities. These children will require sustained, full-time care which the families cannot afford to give.

Even the issue of seeking termination disproportionately affects those who are poorer. Those with a substantial income can afford to travel outside the country for termination in places where it is legal and thus infinitely safer. Those who are residents in cities like Colombo and have access to circles of influence can find under-the-radar providers who will perform the procedure for a substantial fee. None of these are options for women living in poverty – they simply cannot afford it.

This is what pushes them to unsafe clinics which result in complications (abortion is the third highest reason for maternal mortality in Sri Lanka) or resort to dangerous home remedies that include papaya leaves and bicycle spokes. These situations become all the more infuriating when you are reminded that when done following proper medical procedure, surgical abortions are one of the safest medical procedures. What makes them unsafe is that they are illegal and therefore unregulated. The illegality of abortion is not saving lives – it is taking them. It is killing women.

Image Credit: World Health Organization
The women who find the risks (all of which should not be there) are too great, find that they once again have the choice taken away from them. They go ahead with the pregnancy and this system creates a vicious cycle of poverty.

We have endless evidence to show that a woman’s socio-economic success is intrinsically tied to their reproductive lives – even among more privileged women who see their career trajectories tied to their child-bearing. Studies show that forcing women to carry an unwanted pregnancy to term quadruples their odds of living below the poverty line, and laws that restrict abortion access have proven to deteriorate economic outcomes for women.

We know that family planning can make all the difference in achieving life goals and the situation is further exacerbated for these women who work in the informal economy, thus limiting their access to paid maternity leave and flexible work hours.

For many of them – you don’t work, you don’t eat. And this has the potential to push them into debt. This is to say nothing of the negative impact on the health, opportunities, and emotional wellbeing of the children born into these situations.

Emeritus Professor of Obstetrics and Gynaecology John J. Sciarra’s words in 2013 come to mind. He said: “No law that has ever been passed and no law that will ever be passed can prevent a determined woman from trying to end an unwanted pregnancy. Society and hospitals must accept their role in keeping women safe in that process.”

We need to ask ourselves if we are having the right conversation – the one that places the realities of women and their children in Sri Lanka at its forefront – or are we being clouded by concerns over debatable and impractical morality?