Christopher Tufton | Abortion war needs dose of compassion

Our consideration of abortion in Jamaica has, for too long, been characterised by contention and an apparent lack of empathy for those directly affected.

The result has been that there are vulnerable people who have been denied the space to express themselves on the issue, leaving some of us in the dark on the precise circumstances with which they are faced.

With the recent private member's motion moved by Member of Parliament Juliet Cuthbert-Flynn, we are provided with an opportunity to, as a society, revisit the issue, which is given urgency by Jamaica's public-health objectives.

Jamaica is committed to reducing the maternal mortality ratio to less than 70 per 100,000 live births by the year 2030. In 2016, the maternal mortality ratio was 110.6/100,000 live births.

Based on available data, abortions (spontaneous and induced) are among the most common causes of maternal deaths, in addition to pregnancy-induced hypertension, obstetric haemorrhage, diseases of the cardiovascular system, ectopic pregnancy, diabetes mellitus, sickle-cell disease, obstetric infection, and cancer.

For the maternal mortality rate to be fully understood, more information is required on the circumstances in which the termination of a pregnancy occurs. Misuse of drugs available on the black market to induce abortions and the procuring of surgical services that are unsafe may result in serious complications, such as haemorrhage and infections that can result in increased mortality.

The thrust of the Ministry of Health is, therefore, to empower the population to make informed decisions with respect to their health.

In 2016, there were 1,177 admissions to the Victoria Jubilee Hospital (VJH) for complications threatening the viability (life) of the pregnancy, broadly termed abortions.

These included incomplete, inevitable, and threatened pregnancies, spontaneous abortions, as well as induced termination of pregnancy. Forty-seven, or four per cent, of these patients were admitted with complications of either a failed attempt or completed induced termination of pregnancy as disclosed by the patient.

Induced abortions may take place by the administration of drugs or by surgical means. At the point of presenting to hospital, it is difficult to say whether the abortion was spontaneous or induced. The Ministry of Health does not require that women state whether or not they have attempted to terminate a pregnancy. Documentation or reporting of induced abortions is, therefore, unreliable.

Persons exposed to unsafe abortion practices and who suffer complications or persons who have induced abortions and start to show signs of aborting such as bleeding or cramping can attend public hospitals for treatment. Access to management of complications of unsafe abortions is recommended by the World Health Organization.

 

COMPASSION

 

At the same time, one of the core issues that needs to be addressed is our compassion for women and young girls who attempt or otherwise successfully induce abortions - with or without assistance from a third party.

We must ask the question: What are some of the reasons that would cause a mother to not want to have a child, having been conceived? And there a lot of core societal issues that, I believe, require our attention that is not clinical in nature nor requires a clinical diagnosis.

It is about how we show compassion and support to our women, some of whom have been neglected. Others have been abused, and still there are those who have been misguided in terms of their life decisions.

We can function much better as a society if we understand and appreciate that for any society to work, there are those among us who have to depend on others for support and guidance - and not in the sense of requiring a clinical diagnosis or the prescribing of a drug or process to heal.

Rather, it speaks to the need for us to be each other's keeper, providing support and/or advice, as appropriate. We also need to provide people the opportunity to be heard and, therefore, put in a position to accept sound advice and/or access needed support.

 

NEEDED SERVICES

 

Meanwhile, measures to reduce the incidence of unintended pregnancies and unsafe abortions must include investments in sexual and reproductive health (SRH) services that are wide-reaching.

They include counselling, information; education; communication and clinical services in family planning; safe motherhood, including antenatal care, safe delivery care (skilled assistance for delivery with suitable referral for women with obstetric complications) and postnatal care breastfeeding; and infant and women's healthcare.

Gynaecological care, including the prevention of abortion, treatment of complications of abortion, and safe termination of pregnancy as allowed by law, are among those services.

There is, too, the need for investment in the prevention and treatment of sexually transmitted infections, including HIV, and to address diseases and malignancies of the reproductive system, including linkages with non-communicable diseases (NCDs).

The Ministry of Health is pursuing the development of an SRH Policy that will address these areas, creating a framework for identifying effective strategies to reduce maternal mortality rates. These include strengthening the linkages between obstetric and NCD programmes and reviewing our capacity within the health sector to respond effectively to cases of unsafe abortions.

The Offences Against the Person Act has long prohibited unlawful abortions, and the evolution in English law of guidelines on lawful vs unlawful termination of pregnancy has not been seen in this jurisdiction. This is an area in which publicly held values and morals have a strong impact on public policy.

 

RECENT SURVEYS

 

Through the Ministry of Health, the National Family Planning Board, in its response to Cabinet's request for broad consultations on key SRH issues, conducted surveys and consultative discussions in 2016 with community representatives on, among other things, the acceptable parameters of a national policy on the termination of pregnancy.

The more than 350 community members surveyed largely agreed that termination where the pregnancy presents a risk to the life of a baby (78%) or mother (86%) are necessary exemptions to Jamaica's prohibition against abortion, as is termination where the pregnancy occurs as a result of rape (71%).

While these public sentiments are an important guide to policymakers across all sectors, the Ministry of Health further recognises that it has a critical role to play in providing guidance on the health-specific implications of these issues.

In a bid to clarify the position in 1975, the then minister of health established a ministerial policy under which health personnel, that is, registered medical practitioners, could terminate a pregnancy.

According to the Ministry Paper titled 'Abortion: Statement of Policy', which was laid before the House of Representatives in January 1975, it was intended that the relevant sections of the Offences Against the Person Act be amended for clarity as to the circumstances in which abortion could be lawfully performed in Jamaica and to include rape, carnal abuse, and incest as lawful grounds for abortion. As the law was never amended to achieve the objectives, an Abortion Policy Review Advisory Group was established by the Ministry of Health in 2005.

The Ministry of Health, Jamaica Abortion Policy Review Advisory Group Final Report was laid on the Table of the House on January 15, 2008. On March 27 that year, on a motion by the leader of the House, a resolution was passed by the House of Representatives to appoint a special select committee to sit jointly with a similar committee appointed by the Senate to consider and report on the recommendations of the advisory group. It is imperative that the findings and recommendations of the special select committee be re-examined.

The Ministry of Health stands ready to participate in the discussions and to implement policies and procedures that will result in a healthy and stable population that is empowered to reach its fullest potential - and to do so with compassion.

Dr Christopher Tufton is the minister of health. Email feedback to columns@gleanerjm.com.