Between 2015 and 2019, on average, 73.3 million induced (safe and unsafe) abortions occurred worldwide each year. Over half of all estimated unsafe abortions globally were in Asia, most of them in south and central Asia. Though the two most populous countries, China and India, are deemed to have “liberal” abortion laws; the statistics point to a hugely neglected problem. Even though abortion is broadly legal in India, only two–fifths of abortions there are considered safe. The World Health Organization estimates that in Asia in 2008, 12% of all maternal deaths (17,000) were due to unsafe abortion. Considering that this large percentage of deaths can be attributed to social, legal, and economic barriers alone, and can be easily prevented, makes it even more important to address the issue.
Establishing a liberal abortion law is the first step, but it does not in itself ensure that women are able to obtain safe procedures. Health providers, legal bodies and the general public need to be made aware of the circumstances under which abortion is allowed, providers need to be trained and sensitized, and facilities equipped. This scenario is observable in countries like India, Nepal and Cambodia, where abortion laws are relatively liberal, but procedures are performed in substandard conditions. People with a low socio-economic background bear the brunt owing to the lack of healthcare facilities, social stigma, and costs.
Seventeen countries in Asia allow abortion but impose gestational limits. Gestational limits prescribe the point within pregnancy when a termination is permissible. Such limits often vary depending on the legal framework, including the circumstances under which abortion is allowed. The most common gestational limit is 12 weeks, and the shortest is 8 weeks. It is important to note here that these limits do not imply that the pregnant person will not seek an abortion anymore. It simply means that they will now be forced to turn towards illegal methods, which may be unsafe. In China, North Korea and Vietnam, gestational limits are not specified, and have different regulatory mechanisms.
Out of those countries which allow abortion to preserve health, most of them allow them on the pretext of preserving only physical health, and fewer include mental health as a valid condition too. Including mental health makes a huge impact on the accessibility and legality of abortion care, as it ackwoledges the mental health issues that can arise by continuing an unwanted pregnancy, as well as any pre-existing conditions. A common myth that anti-choice groups try to spread is that having an abortion increases risk to mental health problems. Studies have squashed this argument, showing that post-abortion responses are varied, and abortion is not responsible for mental health problems, if any. What may have a direct relation to depression, anxiety and emotional distress, is in fact, not having the rights or means to seek abortions and the shame thrust upon the seeker.
In some parts of Asia, postabortion services are of poor quality, largely because government spending on all health care is low. To reduce the high levels of morbidity and mortality that result from unsafe abortion, the provision of high-quality postabortion care should be improved and expanded.
Bangladesh has an interesting scenario. Though abortion is illegal, it is still carried out under "Menstrual Regulation", as a post-contraceptive method of birth control which does not come under the section 312 of the penal code. Under stativity scheme, pregnancy is an essential element of the crime of abortion, but the use of MR makes it virtually impossible for the prosecutor to meet the required proof. The use of MR is allowed up to 10 weeks after a missed period, and cases with longer duration are referred to as abortion cases. However, most of these procedures are unsafe. The common practice is to induce abortion by inserting objects in the uterus or by performing vigorous physical exercise which can lead to serious complications.
Abortion is not permitted for any reason in three Asian countries: Iraq, Laos, and the Philippines. It is a well-established fact that countries with restrictive abortion policies also have the highest number of unsafe abortions and related deaths. While Iraq is an Islamic country, Laos is Buddhist, and the Philippines is the only Christian country in Asia. Thus restrictive laws cannot be attributed to a particular religion or cultural belief.
Abortion is criminalized by the Philippine law. Articles 256, 258 and 259 of the Revised Penal Code of the Philippines mandate imprisonment for women who undergo abortion, as well as for any person who assists in the procedure. Article 258 further imposes a higher prison term on the woman or her parents if the abortion is undertaken "in order to conceal [the woman's] dishonor". The law justifies it with its (noble) intention to protect the “sanctity” of family life. Some hospitals refuse to treat complications of unsafe abortion, or operate without anesthesia, as suffering these complications will serve as punishment for the patients. Iraq and Laos make exceptions for abortion only on grounds of saving the woman’s life. Unlawful abortions in Lao PDR performed without a woman’s consent are punished by 2-5 years’ imprisonment and a fine of 200 000 – 5 million Kip, and up to 10 years’ imprisonment if the act results in the degradation of the woman’s health or her death. Lesser penalties are provided for women who perform the abortion themselves or recruit someone else to do so.
Perceived sex-selective abortion is banned in China and Nepal, while India bans it as part of a separate fetal imaging law. In addition to the difficulty of determining which patients are seeking abortion for perceived sex selection, health workers need to be aware of the pressures women face to bear sons and understand that they may seek unsafe services elsewhere when unable to obtain abortions in hospitals. It has nothing to do with abortion except for the simple fact that abortion is the process used to terminate a pregnancy where the foetus isn’t of the desired sex. This is an essential distinction to make. While these laws may have tightened the shackles of the system that would prevent one from finding out the sex of a foetus, and in the process may have even reduced instances of termination of female foetuses – but since no one questioned and challenged people’s opinions about why male children were prioritized over female ones – there has been a counter increase in the number of acts against female infants where they are - denied education, nutrition, and an adequate childhood; where they are quickly married off and not given a dignified life and in some cases - even killed. Legislative, advocacy, and social efforts aimed at promoting gender equality are necessary to reduce the cultural and economic pressures for producing male children.
Use of contraceptives can obviously decrease the number of abortions, thus also preventing unsafe abortions, but it is imperative to understand that the contraception access will not eliminate the need for seeking abortions. While improving access to and awareness about contraception is essential, what is also required is to state the gender politics surrounding contraception itself. The burden of contraception unevenly lies on the female partner’s shoulders, proven by the huge gap between the variety as well as use of female and male contraceptives. In India, for instance, out of all sterilisation procedures, roughly 93% were tubectomies, and only a mere 7% were vasectomies. Contraception is promoted by governments under the banner of “family planning”, as a means of population control alone, thus shifting the narrative away from reproductive rights and bodily autonomy. As such, there is a lack of awareness among adolescents about contraception, as expected with the lack of comprehensive sex education in most countries. Where there are recognized CSE programs in school syllabi, it talks only about STIs and gender-based violence, omitting important topics like consent, pleasure, diverse sexual orientations and gender identities.
Here are four categories of countries grouped according to the legal status of abortions.
Illegal with exceptions
Countries which allow abortion on the pretext of saving the woman’s life are : Afghanistan, Bangladesh, Bhutan, Brunei Darussalam, Indonesia, Iran, Lebanon, Myanmar, Oman, Sri Lanka, Syria, TimorLeste, United Arab Emirates, West Bank and Gaza, Yemen
Bhutan and Indonesia also allow abortion in cases of rape.
Indonesia and Iran allow abortion if fetal anomalies are found.
Syria and UAE require parental/spousal authorization, while TimorLeste requires parental authorization only.
Iraq, the Philippines and Lao PDR have criminalized abortions altogether.
Legal- to preserve health
The following countries allow abortions to preserve health of the woman:
Physical/mental health: Israel, Malaysia, Thailand
Only physical health: Jordan, Kuwait, Maldives, Pakistan, Qatar, Saudi Arabia, South Korea
Parental/spousal authorization is required in Kuwait and Saudi Arabia.
Spousal authorization required in Maldives and South Korea.
Legal- on broad socioeconomic concerns
Countries that may provide abortion on the basis of socioeconomic or health concerns: Cyprus, Hong Kong (China), India, Japan, Taiwan
Spousal authorization required in Japan, parental/spousal authorization in Taiwan.
Hong Kong and India ban sex-selective abortion.
Legal-on request
Countries that provide abortion on request: Armenia, Azerbaijan, Bahrain, Cambodia, China, Georgia, Kazakhstan, Kyrgyzstan, Mongolia, Nepal, North Korea, Singapore, Tajikistan, Turkey, Turkmenistan, Uzbekistan, Vietnam
Parental authorization required in Armenia, Cambodia, Georgia, Turkey.
China and Nepal prohibit sex-selective abortion.
China, North Korea and Vietnam do not specify gestational limits.
Resources:
https://www.isayadvocates.com/training-toolkit/
https://asap-asia.org/country-profiles
/https://apps.who.int/iris/rest/bitstreams/912275/retrieve
https://reproductiverights.org/our-regions/asia/
https://www.who.int/news-room/fact-sheets/detail/preventing-unsafe-abortion
https://www.guttmacher.org/news-release/2021/guttmacher-institute-releases-sexual-and-reproductive-health-profiles-more-130
https://maps.reproductiverights.org/worldabortionlaws?country=IND
https://www.guttmacher.org/sites/default/files/factsheet/ib_aww-asia.pdf
https://www.sciencedirect.com/science/article/abs/pii/S104938671100132