Women’s bodies and the control of them in the medical space has always been one of the issues driving me to womanist lobbying. The issue of abortion is again at the forefront of regional attention and I have, up to now, not weighed in in this space.
I wholly support a woman’s right to abortion up to the 12th week of pregnancy. I believe that until a foetus is viable outside of its mother it is simply an extension of her body and she is free to make decisions about it in the same way that she would be entitled to any other part of her body. I believe in late term abortions only in extreme circumstances or in cases where the mother has to make a lifesaving decision.
A conversation that I had with social commentator Peter Wickham a few days ago helped me to further crystallize issues in my mind about abortion. The conversation also helped me to realize that there are elements of confusion about the points I am trying to make. I’ll try to be clearer here.
Peter’s view on abortion with respect to Barbados is that abortions are legal and that we are far more progressive in our legislation than much of the Commonwealth Caribbean. That is a very typical Barbadian approach to our social condition. Instead of asking what more we have to do to be better, we count gains we have already made that make us ‘better than’ others to our minds.
Peter and I agree and disagree, as we are prone to do. I agree that legalizing abortion in Barbados was progressive. I disagree that because we took the step in 1983 that we can rest on our laurels and believe that a bill drafted in 1983 could be seen as progressive in the same way in 2019. I also maintain that the problem with abortion in Barbados is not just one of the legality and still very much one of practice and perception.
Let me deal with the medical issues that I see first and then I’ll return to the practices. The 1983 Act is silent on medical abortions. This is simply because at that time, medical abortion was not common practice. Medical abortions are non-invasive, they offer more privacy and power for women to negotiate the process of abortion in a comfortable space.
Up to ten weeks of gestation, medical abortions are thought to be relatively risk free and if there are complications, these are generally manageable. I think that our 1983 legislation can be significantly modernized by speaking to the issue of medical abortion. The physician is no longer so necessary for a woman to negotiate an abortion before 12 weeks safely. When I speak about ‘freeing up’ abortions, this is what I refer to.
I think that we have to decide if there is a value to allowing pharmacists to legally dispense the medical abortion drug over the counter. Although I know that suggestion is not a simplistic one, I am open to the national discussion that should be had to determine if it is a viable option for Barbados as it is for some other countries.
Another issue that I think needs to be revisited within the Medical Termination of Pregnancy Act is the question of who counsels and what counselling entails. The Act obviously had all good intentions when it spoke to counselling but that process has become one of discomfort for many women. It is the point at which some people take the opportunity to instil doubt in women or otherwise seek to alter their decision or prescribe on what God would want.
I honestly am leaning toward the requirement for counselling being relaxed in our law. I think the requirement has done more harm than good over the years, although I appreciate that it may have been written in with good intentions. We have many more educated women in Barbados who fully understand abortion both as a choice and a process. Counselling, in this context, seems an unnecessary restriction and a redundancy.
The final concern that I have with our current legislation is the laxness around ‘the physician’ that can perform an abortion before 12 weeks. Again, in 1983 when the legislation was developed, we were in a medical environment where specialization was not as rigid as it now is. I do not agree with general practitioners doing vacuum aspirations at any stage of a pregnancy. I believe that that aspect of the legislation needs to be streamlined to ensure that where vacuum aspirations are done, they are only done by gynaecologists.
We now return to the issues of practice in relation to abortion in Barbados. The issue is still a taboo one and women seeking the services report feelings of judgement and discomfort in spaces where the services are provided. There is also a view that enough attention is not paid to ensuring privacy. These things may not be concerns that can be enshrined in law, but they certainly can be encouraged through policy and staff training.
Perhaps we can strengthen a woman’s ability to access abortions by paying attention to a payment schedule for the services. In addition to the points made above in favour of medical abortions under ten weeks, let me add that they are also the most cost effective way to negotiate an abortion. I am concerned that some doctors are currently extorting women with respect to abortion services, when they opt for vacuum aspirations. This is another prohibitive factor in accessing the services.
There is also a need to educate women about their options regarding abortion. Some of the practices that they are encountering when negotiating abortion are practice and not law. The only way that women can ensure they get the services enshrined in our law is to know what they should get. Knowledge is always power and public discourse is the bedrock of forward movement and continued progressiveness.
Marsha Hinds is the President of the National Organisation of Women.