How to Use Protection: The Asian Way
Dr. Taj Prabhugaunker
Goa Medical College
Key words: Abortion Laws, Contraception across Asia, Reproductive Health, Safe motherhood
In the bustling city of Manila- Maricel, a young breastfeeding mother of one, found herself in a dreadful fix. Here she was, pregnant, fearing the loss of a potential overseas work opportunity. Too desperate, she attempted to self-induce an abortion using misoprostol. It failed. Then resorted to an abdominal massage (hilot) and finally sought help from someone who performed dangerous “catheterizations” ( inserting catheters into the uterus). Fearing the legal repercussions, she delayed seeking medical attention for the ensuing complications. And by the time she approached the appropriate medical assistance, it was TOO LATE and she succumbed to sepsis- a sequel of the unsafe abortion.
Maricel’s experience highlights the complexities of abortion laws in Philippines wherein catholic teachings shape reproductive health policies despite rising alarms for more liberalisation. Due to staunch Catholic influence -Abortion being labelled as illegal / constitutionally prohibited under most circumstances in the Philippines, Maricel’s choices were forced to be limited and dangerous.
She is just one of the many across Asia, posing as the scapegoats of the intersection of culture, religion and policies that determine access to family planning services, reproductive health, abortion and contraception.
Following the above footsteps, the Srilankan lawmakers have also labelled abortion as illegal criminal practices liable to imprisonment- the only exception being to “Save life of the pregnant woman”, despite rampant practice of unsafe clandestine abortions, leading to health risks for women.
Bhutan, is yet another country, where reproductive healthcare laws are strongly driven by cultural influence. The Buddhist ideologies have a significant impact over the monarch in shaping the abortion laws.
Abortion is not a legal right, but rather a procedure permitted under specific circumstances such as:
- Result of Rape / Incest
- Mother’s life / mental health being endangered.
While the Philippines, Bhutan and Sri Lanka strongly opposed the practice of abortion, the Japanese offered a diplomatic approach.
In Japan, abortion is technically illegal under the Japanese Penal Code ( Article 212-216). However, the Maternal Health Protection Law (MBPL) allows for abortions under specific circumstances, which include:
- Endangerment to the woman’s physical or mental health.
- Economic Hardship
- Rape
with an upper limit of 22 weeks of gestation.
But there was a drawback: Japan’s abortion laws were enacted before widespread prenatal screening, and abortions were often performed based on “economic cause”.
Also, Spouse’s consent is generally required for married women, although exceptions do exist such as:
- If the spouse is not known
- If the spouse cannot express an intention.
- if the spouse no longer exists after the pregnancy
And some doctors still seek the spouse’s consent even when it is not legally necessary in Japan.
In 2023, Japan approved its first abortion pill, Mefeego. The pill, a combination of mifepristone and misoprostol, was approved for use in pregnancies up to nine weeks, which marked a significant step in providing women in Japan with a medication option for abortion care.
On the other side of the coin, countries like Nepal, China, Vietnam and the Best- India,
have transformed from the uncertain irrelevant diplomacy to provide more comprehensive, liberalised abortion laws to it’s people.
Nepal– The country usually flagged as ‘backward’ has surprisingly come up with broad minded abortion laws. In 2002, certain criteria were determined.
- Up to 12 weeks, permitted with the pregnant woman’s consent.
- Up to 18 weeks in cases of rape or incest.
- At any point during pregnancy if a woman’s life or health is at risk, or if fetal abnormalities are detected.
The Safe Motherhood and Reproductive Health Act, 2018, further clarifies and expands these rights.
For women under 16 or those lacking mental competence, consent from the woman’s nearest relative or guardian is mandatory. For easy and affordable access, services are available at approved facilities, including public, NGO, and private sector facilities and healthcare providers, including nurses and midwives, are trained to provide safe abortion services, to expand access in rural and remote areas.
Decades before the rest of the Asian countries, China’s National family planning program has declared abortion to be legal since 1953, easily accessed through public + private hospitals, and clinics nationwide.
While China has historically shifted between more restrictive and liberal abortion policies, it’s currently legal at all stages of pregnancy. A key component of China’s family planning program, abortions have no legal upper limit of gestational age, although some provinces may have restrictions on non-medically necessary abortions after 14 weeks.
Taking it a step further, Vietnam’s abortion services are legal on request up to 22 weeks of pregnancy and are provided free of charge by the state, made accessible through public clinics from primary health centres up to hospitals, with trained physicians and midwives providing care.
As for India, brings to the table, one of the finest abortion laws in practice till date.
The Medical Termination of Pregnancy (MTP) Act, 1971 & it’s recent 2021 amendment allows for termination of pregnancies up to 24 weeks, with exceptions for some categories: like survivors of rape or incest, and women with specific medical conditions.
For pregnancies up to 20 weeks, the opinion of one registered medical practitioner is required. For pregnancies between 20 and 24 weeks, the opinion of two registered medical practitioners is needed & all procedures of abortion are done only in approved healthcare facilities.
The MTP act protects the privacy of women availing abortions & women regardless of marital status, and are entitled to safe and legal abortion up to 24 weeks.
While comprehensive abortion laws are pivotal in family planning policies of a nation, it is imperative to address the core of population control- Contraception practices. Across Asia, these are influenced by a blend of socio-cultural norms, government policies, economic factors, and access to healthcare services.
Each country having their variable preferences of methods by it’s majority- have shown significant upgrade in the trend of their use and awareness. In countries like China, Vietnam and India, the government is actively promoting contraception through their policies and incentives to those who utilize them. The Chinese government’s approach to contraception has drastically changed over time, transitioning from promoting birth control in the 1950s to enforcing a one-child policy from 1979 to 2015, to a two-child policy from 2016-2020 shifting to a three-child policy (2021-till date) ,the government has used incentives like tax cuts, subsidies, and cash rewards to encourage larger families, alongside propaganda promoting the “virtue” of having more children.
Likewise, the Vietnam government has adopted a Total Market Approach (TMA) for contraceptives which involves a collaborative effort between the public and private sectors to ensure that free or subsidized contraceptives remain available for vulnerable groups, through commune centres while commercial markets cater to those who can afford to pay.
The Indian government has been a pioneer of the national family planning programme, apart from “cafeteria approach” with a variety of options, the slogan of “hum do, humare do” also promotes the idea of small families, to curb the economic liability.
Over years, the family planning and contraception services have undergone mammoth reforms battling the generational plague of taboos and patchy access to the existing contraceptive procedures resulting in a slower rate of adaptation of the same- having to face higher incidence of abortions than anticipated. Nonetheless, this conversation has eased with every upcoming generation, especially with the young urban population pushing boundaries and a quiet rise of sex-positive education across digital spaces, creating safe and trusted sources of information and assistance to choose for oneself with freedom and respect.
Afterall, THIS was the whole point!
References:
- Philippines Safe Abortion Advocacy Project. Public facilities in the Philippines. Manila: PSAAP; 2021.
- United Nations Population Fund. Bhutan country fact sheet. Thimphu: UNFPA; 2022.
Ministry of Health, Labour and Welfare (Japan). Enforcement of the Maternal Health Act. Act No. 122 of 25 September 1996. Tokyo: MHLW; 1996. - United Nations, Department of Economic and Social Affairs, Population Division. World population policies. New York: UN DESA; 2023.
- Ministry of Health and Family Welfare (India). The Medical Termination of Pregnancy (Amendment) Act, 2021. New Delhi: MoHFW; 2021.
- Guttmacher Institute. Abortion policies in Vietnam: country summary. New York: Guttmacher Institute; 2020.
Image References: - https://asia.nikkei.com/Spotlight/The-Big-Story/Abortion-in-Asia-The-limits-of-choice
- https://www.malecontraceptive.org/memes.html
- https://fivethirtyeight.com/features/better-birth-control-hasnt-made-abortion-obsolete/
