This is a remarkably well thought out Myanmar Times article on an important issue in reproductive health in Myanmar.
Jamie
++++++++++++++++++
How the abortion taboo is killing women
Cherry Thein
Myanmar Times
Monday, 22 June 2015
Legally banned in the public health sector, including hospitals and clinics, any doctor caught performing an abortion can lose his or her licence to practice, and even be sent to prison. More than this, they are seen as having defamed the prestige of the entire profession of medicine.
Not to say that abortions aren’t performed in Myanmar. They’re just not performed legally; they’re not performed not safely; and – most often – they’re not performed by anyone with proper medical training.
As is the case worldwide, two schools of thought on abortion exist here : the so-called “pro-choice” camp, who believe a woman has, or should have, the right to choose to terminate her own pregnancy; and the so-called “pro-life” camp, who believe that terminating a pregnancy is murder in any circumstance, which a woman must not be allowed to do.
In all countries, of course, each camp argues from a position of public policy as well as social, cultural and religious norms. In Myanmar, as in other countries with strong traditional beliefs, abortion is generally construed as not just illegal but immoral as well, due to Buddhist beliefs which feel the taking of life is a sin.
What else traditional societies have in common, however, is a lack of easily available contraception and a lack of public discourse about its proper use, which means that unplanned pregnancies do happen, and, as a consequence, so do abortions, as women are left feeling they have no other choice to make. Myanmar culture frowns upon women pursuing greater knowledge of sex because it goes against traditional teachings which say sex – even knowledge about sex – damages her dignity. However, if she ends up pregnant, it is she, not her male partner, who will be left to deal with the burden. And the stigmas are heavy.
Death threats can result from surprise pregnancies, even from one’s own family. As a result, some women try to hide the growing evidence and give birth anonymously, then either raise or giving away the newborn. Others seek more drastic measures.
Tools of the trade
Abortions are mostly carried out by mid-wives or even the pregnant women themselves. As the practice is illegal, the tools are necessarily improvised – and therefore radically unsafe.
The most common technique to end a pregnancy is by breaking open the amniotic sac. To do so, a stick is rammed inside the vagina. Materials range from bamboo to steel or iron; implements range from branches broken off trees to the ends of umbrellas. Sometimes, as an alternative, acid is poured inside.
Whatever the method, the attempt is to end the pregnancy – the health and welfare of the mother comes a distant second.
Some use ma yawe yo, a branch of a ma yawe tree which has the characteristic of expanding when wet. It is inserted into the vagina, it absorbs moisture and swells. The possible consequences range from bacterial infection to physical damage to internal organs.
Hiring such services cost between K150,000 to K300,000 in Yangon, depending on the experience and expertise of the individual. While there are no official statistics on abortion rates, East and South Dagon and South Okkalapa township are said to be common places to procure one in Yangon, with services easily available in neighbouring Bago and Ayeyarwady regions as well.
Unplanned results
Dr Aye Thida, consultant and obstetrician/gynecologist at Thingyan Kyaung Hospital, told The Myanmar Times that the general public needs more awareness and knowledge about family planning and reproductive health to prevent women resorting to such desperate methods to end an unwanted pregnancy.
“There are many cases of women determining to get an abortion because information and health services are hard to access,” Dr Aye Thida said.
The stigma of an unwanted pregnancy, however, could only be outweighed by the stigma of an attempted abortion. Those suffering complications are reluctant to seek assistance, even when the aftermath proves life-threatening.
“When they have induced abortion, septicaemia [blood poisoning] is likely. But they dare not to see the doctor or go to a clinic or hospital because they afraid of being scolded. Some are afraid of being arrested.”
In desperate situations, a woman may come to the hospital only when septicemia has already infected the kidney, affecting her ability to release urine. Most induced abortions, Dr Aye Thida said, lead to damaged kidneys.
Unsure about how to best take care of themselves generally, many women are particularly uninformed about treatment options for the many gynecological problems they will face throughout their lives. Without safe space to ask questions and trusted medical experts to ask them too, they resort to whatever means they can think up themselves.
Dr Aye Thida recalled a woman who, wishing to end a pregnancy, asked her three children to jump on her belly 100 times. Sadly, she later died from the internal injuries that resulted, the pressure having damaged her uterus and intestines.
“I was surprised at how she dared take the risk. But there are many implausible induced-abortion-related cases,” Dr Aye Thida said.
She recalled another case in which healthcare workers spoke to a practitioner of traditional medicine whose method of ending pregnancies involved inserting a chicken feather into the vagina. The man confessed surprise at the fact that woman got infections as a result of this procedure. “‘I have no idea how women got infected. I know hygienic practice – I use one feather for one client. And I only snatch a feather when they come and ask me to,’” she recalled him saying.
“We were struck dumb with disbelief,” Dr Aye Thida said, “not knowing whether to blame him or burst out laughing.”
Of course, she and other experts know such rudimentary techniques are all too common, and are no laughing matter. According to a 2015 United Nations Population Fund (UNFPA) report, 200 mothers die per 100,000 live births in Myanmar. Of these deaths, 20 follow induced abortions.
The “abortion booms”
Some women cross the border to neighbouring countries, where clinics display signboards advertising, in Myanmar language, artificial insemination and abortion services – described, respectively, as “putting babies in” and “taking babies out”.
As evidenced by the number of patients seen at Yangon hospitals in the aftermath of botched procedures, however, many seek abortion procedures right at home.
While many have heard of “baby booms” – spikes in birth happening nine months after a period in which more couples than average have sex, usually due to some period of unusual social upheaval like a holiday, a weather event that keeps everyone indoors or the end of a war – less commonly discussed are “abortion booms”.
Hospitals in Myanmar consistently see two annual waves of patients arriving with complications due to botched abortions: two months after Valentine’s Day in mid-February, and two months after Water Festival in mid-April.
That means that, in mid-April and mid-June, Dr Aye Thida deals with the fallout two induced abortions and one septic shot per day.
Such holiday periods warrant particular targeting by campaigns to promote contraception use, she said. A recent targeting of pharmacies by police during Thingyan, in which a round-up of date-rape drugs saw legitimate contraception being swept from the shelves as well, was particularly wrong-headed, she said.
“Using condoms is one of the options for contraceptive practice. I wonder why the authorities withdrew condoms during this past water festival,” she said.
Knowledge is power
Daw Nang Phyu Phyu Lin, co-chair of Gender and Equality Network, said another factor that needs to be addressed head-on, particularly in rural or ethnic areas, is male chauvinism, which keeps women from gaining knowledge and making decisions about their own best interests.
“There are still many women kept ignorant and uninformed, who do not even know their own bodily functions and periodic cycles,” Daw Nang Phyu Phyu Lin said.
Traditional culture and social norms, she said, make advocating family planning and open discussion of reproductive health difficult. Such topics remain taboo to discuss with women, in spite of the fact that women, as potential child-bearers, are put at far greater risk than men when undergoing sexual activity. Most advice for women, when it comes at all, can be reduced to a simple word – “don’t” – with girls being taught that boys are thirsty for sex and that it’s best to keep one’s distance. What to do if that’s not possible – if one is in love, or, worse, coerced or forced into sex, by a trusted partner or an attacker – isn’t made clear.
Even for married women, misinformation and peer pressure affects childbearing and childrearing decisions. Daw Nang Phyu Phyu Lin said rural areas especially see pressure to keep getting pregnant until one brings up a boy, with female children less desirable and therefore seen as easier to terminate.
“We heard a lot about this in the fields – ‘God wants you to have child, so don’t stop.’ … If the ultrasound result said ‘girl’, okay, you can do an abortion. But in some occasion no matter boy or girl you must give birth until you get a boy,” Daw Nang Phyu Phyu Lin said.
“Women are not robots, and the uterus is not a child-making machine. But many women are considered like birthing robots,” she said.
Dr Sid Naing, a public health practitioner, told The Myanmar Times it is essential to give contraceptive technique and health service effectively. He said society’s attempts to protect women from sexual knowledge is done, in most cases, “with good will, but in practicality it bring more problems”. So-called “protectors”, namely policy makers, religious leaders and society, need to know more about the lives and struggles of those they seek to protect, he said.
“The protectors are not always next to the protected ones. It is essential to give awareness, knowledge and capacity to them so that they can protect themselves, and create easy access to get safer ways,” he said, identifying the poor, the uneducated and rural residents as being among the most vulnerable.
An ounce of prevention...
Health sector workers contacted for this article suggested offering sex education as part of the mainstream education curriculum, as well as opening youth clinics which could offer confidential counseling, as two of many ways to keep women from needing, or undergoing, such induced abortions. Combined, these factors could help reduce the rates of teenage pregnancy especially – particularly frightening for women, given the stigma against pre-marital sex and intimate relationships at a young age.
Workers also advocate awareness programs covering contraceptives and family planning through government information bodies. Even television programs which are up-to-date and appropriate for today’s lifestyle could do valuable service in spreading valuable, life-changing information, they say.
For instance, one traditional sort of birth control often relied upon in the months after having a child is the fact that, in a process called lactation amenorrhea, women who are breastfeeding infants do not menstruate for six months, and therefore will not conceive during this time. However, with busy schedules, many women are turning to bottles to fill in the gaps, which can affect the body’s natural processes and renew in some instances renew fertility. As many women rely on the traditional belief in breastfeeding as a way to control pregnancy, they may put themselves at risk of conceiving another child unexpectedly. Doctors therefore urge women to get a birth-control injection 45 days after childbirth, whether or not their period has returned. Spreading the word about these issues would do much to prevent unwanted pregnancies.
Lastly, health workers say, it is a must to practise a holistic approach to preventing unwanted pregnancies before they happen, by increasing health services and supporting contraceptive tools and services across the board, in every corner of the country. A higher budget and more qualified personal, they say, is urgently needed in the health sector.
In 2011, the government spent 1.74 percent of its budget on health. For the 2015-16 year, the budget stands at K757 billion (US$757 million), still only 3.3pc of the overall budget. As a comparison, defence was allotted 11.1pc.
Most government hospitals, including Thingyan Kyaung where Dr Aye Thida practises, offer information, counseling and free contraceptive techniques. But while they offer intrauterine devices or birth control pills, they can’t afford the Depo-Provera birth-control injection, which is too costly for government hospital. Morning-after pills are not licenced here either, meaning that only the ones smuggled in from India, China or Thailand and sold under-the-counter are available.
The cost of keeping quiet
While Myanmar society generally finds it impolite to talk about sex, sexual organs and sexual practices, the desire for decorum ultimately brings far more unpleasant realities. Demand for better options increases daily, yet information, support and services remain hard to access. Whatever one’s opinion on abortion, it is clear the laws against it are not enough to prevent women from having them – nor to keep them from being in a position where they feel the need to seek one.
http://www.mmtimes.com/index.php/special-features/208-health-2015/15156-how-the-abortion-taboo-is-killing-women.html
