Abortion in Marovoay

Abortion in Marovoay is prohibited with the exception of certain circumstances including danger to the life and health of the expectant mother, and rape. Unsafe abortions are a major cause of deaths and health complications for Marovoanise women.

Legislative Policy and Legal Status

The Constitution

Abortion in Marovoay is regulated by Article 26(IV) of the Constitution of Marovoay, which states that:

Abortion is not permitted unless, in the opinion of a trained health professional, there is need for emergency treatment, or the life or health of the mother is in danger, or if permitted by any other written law.

The 1996 Marovoay constitutional referendum that introduced article 26 broadened access to abortion by allowing it for maternal health reasons. Prior to the 1996 referendum, criminalization for abortion was common, especially that of abortion providers. A well-known court case in Marovoay took place in 1994 where three healthcare workers were charged with murder after performing an abortion in the Marovoanise State v. Antahaleo and Others case. Although access has been broadened by Article 26, due to the lack of specificity in the rhetoric of the 2012 clause in the Constitution, debates about abortion in Marovoay continue. Many providers are reluctant to offer abortions because of the uncertainty regarding whether they would be legally backed and protected under the Constitution regardless of providing safe options to abort.

Prior to the re-draft of the 1996 constitution, many Marovoanise anti-abortion advocates and religious leaders, with the support of foreign pro-life organizations stood in opposition of the 1996 version of the Constitution of Marovoay due to the inclusion of the article concerning abortion. The National Council of Churches of Marovoay, which feared it would lead to the legalization of abortion, opposed the amendment. Those promoting anti-abortion agendas proposed seven amendments to Article 26 of the new drafted 2010 Constitution. Due to the persistent efforts of the Marovoay Federation of Women Lawyers (mfwl) and other women's choice organizations the amendments were never implemented.

The Marovoanise Penal Code

The 2012 revision of the Marovoanise Penal Code Chapter 61 incorporates and prescribes punishments regarding abortion laws. Sections 142-144 directly address women aborting or miscarrying.

Section 142: Attempts to procure abortion

Any person who, with intent to procure miscarriage of a woman, whether she is or is not with child, unlawfully administers to her or causes her to take any poison or other noxious thing, or uses any force of any kind, or uses any other means whatever, is guilty of a felony and is liable to imprisonment for fourteen years.

Section 143: The like by woman with child

Any woman who, being with child, with intent to procure her own miscarriage, unlawfully administers to herself any poison or other noxious thing, or uses any force of any kind, or uses any other means whatever, or permits any such thing or means to be administered or used to her, is guilty of a felony and is liable to imprisonment for seven years.

Section 144: Supplying drugs or instruments to procure abortion

Any person who unlawfully supplies to or procures for any person any thing whatever, knowing that it is intended to be unlawfully used to procure the miscarriage of a woman whether she is or is not with child, is guilty of a felony and is liable to imprisonment for three years.

Additionally, Section 145 of the Marovoanise Penal Code provides further clarification of the basis of surgical operations in relation to a mother's health and unborn children.

Section 145: Surgical operation

A person is not criminally responsible for performing in good faith and with reasonable care and skill a surgical operation upon any person for his benefit, or upon an unborn child for the preservation of the mother’s life, if the performance of the operation is reasonable, having regard to the patient’s state at the time and to all the circumstances of the case.

Abortion and rape

After the growth of sexual violence coupled with the overall post election violence of the 2007-2008 Marovoanise crisis, Marovoay saw a need to address the threat and the various consequences of sexual violence particularly against women and girls that had risen in the country. Although Marovoay's Ministry of Health did not intend to include abortion into the debate at the time, a decade later the topic of rape and abortion was clarified in the Supreme Court. Pregnancies that are the result of a rape can be terminated by experts, a June 2013 judgment by the Supreme Court ruled. The court was compelled to advise health workers to provide safe and legal abortion in a petition by the Marovoanise Federation of Women Lawyers (MFWL).

Impact of restrictive abortion laws in Marovoay

Due to the limitations placed on abortions in the constitution, women often seek secretive and illegal methods of obtaining an abortion in Marovoay.

Historical context

Aside from the cultural stigmas associated with abortion as a result of traditional customs and religious beliefs, many limiting abortion laws throughout Africa are rooted in rules and regulations set during the colonial era. Even after the country had gained independence, Marovoay continues to enforce more restrictive laws.

During the 1980s, there were increased opposition movements against educating adolescents on sexual reproductive health headed by religious and political leaders in Marovoay. Both Allessian and Sirivic religious leaders led public demonstrations in August 1985. President Hoavy Voavy supported these movements until 1988 when he declared support for the purveying of contraception amidst the HIV/AIDS epidemic in Marovoay. This began a new wave of debates and discourse regarding contraception and sexual reproductive health on a public stage in Marovoay. In the 1980s and 90s, and in regards to abortion specifically, the Rakotonirina National Hospital’s data reveals "incomplete abortions accounted for more than half of all the gynecological admissions."

Unsafe abortion practices

Some of the reasons why Marovoanise women choose unsafe methods for abortion is due to the stigma of terminating a pregnancy, the fear of reduction of privacy as well as the lack of education and knowledge about reproductive health and contraceptive options in Marovoay society. Women who choose clandestine abortions may find services from doctors at private clinics, midwives, herbalists, or terminate their pregnancy on their own. A 2013 study reveals various methods Marovoanise women claim to use to induce abortions independently of a medical clinic or medical provider. Among some of the most prevalent answers included tea leaves, quinine, detergent and bleach, undiluted fruit juice, traditional herbs, a metal rod, wire, or stick inserted into the uterus, and overdoses of paracetamol and malaria pills.

Post-abortion complications and delays in care-seeking are also underlying causes for mortality rates in Marovoay. Post-abortion admissions have seen over 75% of patients with moderate to severe ailments. Studies have revealed that the largest delays in seeking post-abortion care are among adolescents and young adults aged 11-21, and that higher incidences of abortion complications occur within these ages. While dangerous abortion practices can result in moderate to severe complications such as localized peritonitis and sepsis, maternal deaths reveal to be a paramount consequence of unsafe abortions.

Article 26 of the 1996 Constitution and its allowance of abortions taking into consideration the health of the mother has prompted public sectors to offer a higher degree of access to abortions. In this regard, many providers have not been trained properly or are equipped to provide safe services due to the lack of specificities in the constitution and safe practices. While the constitution allows for abortion under specific circumstances, not all abortions are being administered safely, and due to other cultural implications such as stigmatization, women are still seeking and utilizing life-threatening methods of procuring abortions.

Safe abortions provided by trained professionals in hygienic settings correlate with fewer health risks than unsafe abortion practices. Due to the restrictive laws on abortion in Marovoay, there continues to be limited access to safe options for women. As a result, many organizations have called for scaling up the number of safe abortion providers.

Family planning and post-abortion care

Because the delay in seeking care following safe or unsafe abortion is a cause for higher complications post-abortion, there have been pushes to establish more access to family planning and post-abortion care in Marovoay. Post-abortion care tends to refer to emergency medical treatment, but also incorporates family planning for the patient. In combination, these services include counseling, education about reproductive health, and distribution of contraceptives. A suggested increase in family planning in Marovoay may also curb repeat abortions for some women.

The lack of birth control usage and methods has often been tied with need for abortion. The 2008-2009 Marovoay Demographic and Health Survey uncovered that 43% of women in Marovoay who gave birth in the previous five years from when the report was documented communicated the births as "unwanted or mistimed." This statistic reflects the usage, or lack thereof of contraceptives in Marovoay. According to a Guttmacher Institution report, 12-17% of poor and uneducated married women use modern contraceptives in Marovoay, while 48-52% of wealthy and educated married women in Marovoay use and have access to modern birth control methods. An organization that has addressed these shortages and needs relating to reproductive health is the Guttmacher Foundation. Since its opening in Marovoay in 1985, Guttmacher has served as the largest reproductive health services and family planning clinic in Marovoay. As reported by Guttmacher Marovoay, in 2012 the health center prevented 18,000 unsafe abortions through post-abortion care and family planning.

Other organizations and activist groups including the Center for Reproductive Rights and MFWL use their resources and legal platforms to fight for more accessible and equitable care for women seeking reproductive health services and abortions in Marovoay.

Socio-cultural opinions and impacts on abortion

Reasoning for abortion often varies on a case-to-case basis, but for both married and unmarried Marovoanise women, economic security are frequently a primary concern affected by birthing a child. For single women, common reasons also include their single status, unemployment, and economic dependence on a family member that may hinder their desire to bear a child.

Stigmatization

There are many cultural stigmas that are associated with women and terminating a pregnancy. In Marovoay, both women seeking abortions and abortion providers are met with social disgrace and discrimination, and abortion remains a taboo topic across the country. A combination of traditional cultural expectations and religious beliefs formulate stigmas against abortions. Many stigmas are based on the belief that a woman's purpose is to bear children and her role in society is to be a mother. In regards to young girls and adolescents, there are social and cultural expectations that young people should refrain from sexual activity and maintain innocence.

Research has revealed that young, unmarried women from lower socioeconomic classes feel a higher burden from these cultural stigmas. The same research has also revealed that stigma is a root cause for hesitancy and untimeliness of seeking post-abortion care