An unexpected turn of events saw a woman referred to as Beatriz get a life saving caesarean section, thanks to doctors in El Salvador who supported her cause, and a rousing international movement. She was earlier denied an abortion, it being criminalised in predominantly Catholic El Salvador, with the ensuing imprisonment of women and doctors (doi:10.1136/bmj.f3612). Timely intervention prevented Beatriz going the same way as Savita Halappanavar did a few months back in Ireland. Savita died after being denied an abortion on the grounds that “it [Ireland] is a Catholic country” (doi:10.1136/bmj.f2208). Her death and Beatriz’s struggle for life raise the question: Why does religion interfere?
A parallel conflict between religion and governance is taking place in the Philippines. At the Women Deliver conference I attended last week, it pained me to hear Filipino women with 16 and 22 children talk of how they were tired of having children, of having to provide for them under conditions of extreme poverty, and fearful of dying in the process of childbirth. Senator Pia Cayetano provided an inspirational narrative of having the reproductive health bill passed last year after five congresses and nearly 15 years. Recognised by President Aquino as a “matter of urgency,” the law marks a momentous achievement to make available free contraceptives, sex education, and comprehensive obstetric services (doi:10.1136/bmj.e8535). The struggle is not over however. With a largely Catholic, conservative, and patriarchal hierarchy, the constitutionality of this law has been challenged in the Supreme Court.
In a review of abortion policies worldwide, Sophie Arie reports a threat that countries may be headed towards being more restrictive (doi:10.1136/bmj.e8161). Closer to home, India may laud itself for a progressive abortion law but it continues to have one of the highest rates of unsafe abortions. Suchitra Dalvie, coordinator of the Asia Safe Abortion Partnership, shares grim statistics whereby, “every year about 11 million abortions take place [about 700 000 are reported] and around 20 000 women die due to abortion related complications.” Clearly the law has not translated into enabling physical, social, or financial access to these essential reproductive health services (doi:10.1136/bmj.f3159). Contrary to what may be expected, states are further imposing severe curbs on medical abortion pills (doi:10.1136/bmj.f1957). In the latest BMJ poll we look forward to hearing what you think of this.
Signifying a commitment to make comprehensive family planning services a reality globally, the London Summit on Family Planning (FP 2020) laid the ground for collaboration among donors and governments (doi:10.1136/bmj.e4160). At Women Deliver, Kavita Ramdas from the Ford Foundation emphasised, however, that “access to contraceptives” needs to be the message, and not just family planning. The importance of this is immediately evident in a similar conflict between the state and religion in Muslim dominated Indonesia where unmarried women are denied reproductive health services including contraception. Shereen El Feki, author of Sex and the Citadel, shared voices of young unmarried men and women from the Arab region who are “sexually active, but not sexually informed” as “marriage remains the only the only socially accepted context for sex—state-registered, family-approved, religiously-sanctioned.” The needs of this large and growing community of single men and women often tend to be neglected in the discourse on family planning.
Nozer Sheriar, secretary general of the Federation of Obstetric and Gynaecological Societies of India (FOGSI), shared that, with an estimated 21.6 million women worldwide experiencing an unsafe abortion each year and with about 70 000 deaths, it is a silent tsunami knocking door to door. As symbolised by Salvadoran doctors who stood strongly behind Beatriz so she would not die giving birth, there is a role for healthcare providers to support women’s choice on this reproductive right that society is so reluctant to give.
Cite this as: BMJ 2013;346:f3715