Abortion in the Maldives: the untold story

When the strip on the pregnancy test turned pink, 23-year-old Mustafa asked his girlfriend to marry him. Not because he wanted to, but because he believed it was the right thing to do.

She said no.

Aminath, who was 19, replied she was too young to have a child. And so, he told her he would “fix it”.

A few days later, Mustafa learned of a man who charged Rf2,000 (US$155) to perform an abortion. Reassured by two friends who had used him, he set up an appointment in Male’.

“The man gave her three injections and said that within one to four hours, she would start to bleed and it would be very painful and it would be like giving birth,” says Mustafa, his frail voice quivering.

“At this point I was having serious doubts about this guy. He wasn’t a doctor… he was boasting about his abortion activities and the number of girls he had done this to. He said at one point it was almost one every night. The way he said it was without a trace of compassion.”

Mustafa’s description of what followed is harrowing: Aminath was carried back and forth to the toilet, she threw up twice and was writhing in agony. Four hours later, she began to bleed.

As a Muslim country, abortion is illegal in the Maldives except to save a mother’s life, or if a child suffers from a congenital defect such as thalassemia. But anecdotal evidence points overwhelmingly to a high rate of abortion.

“I can count seven of my friends, three girls and four boys. The story was the same,” says Mustafa.

Statistical vacuum

There is scant information available on abortion in the Maldives. No research on the subject has ever been commissioned. But, says Fathimath, 40, a social researcher on youth and women, other statistics indicated that abortion was prevalent.

She points to the discrepancy between the decline in the fertility rate and the low rate of contraceptive use – an estimated 39 per cent – which raised important questions that remained unanswered.

Halfway through the conversation, Fathimath says she herself has terminated two pregnancies. The first time she was 20 and a newlywed. She had been given the opportunity to study in the UK and felt her pregnancy was ill-timed. Her second abortion was more recent: her husband had been cheating on her when she found out she was pregnant.

“At that time, I wasn’t emotionally capable of having a child,” says Fathimath, who had both of her abortions abroad.

The only tidbit of official information that exists comes from the Reproductive Health Survey conducted in 2004. The survey found that despite the absence of reliable data, it was likely that unsafe abortions could be a cause for concern. Three years later, an unofficial report by the International Planned Parenthood Federation (IPPF) reached a similar conclusion.

Interviews with four demographically-diverse focus groups revealed that induced abortions were common among women and girls in Male’ with most ostensibly taking place in unsafe circumstances.

But, the IPPF never obtained government permission to carry out the study and because of the qualitative nature of its research, its findings were never acknowledged or made public, says Fathimath.

The report found that the stigma of having a child out of wedlock compels women and girls to opt for abortions. Two focus groups of unmarried boys and girls asserted that abortion was widespread. Some said they knew of girls as young as 12 who had undergone abortions and each knew at least one person who had terminated a pregnancy.

The discussions further revealed that while abortion was more common among unmarried youth, it was still widespread among married couples. Even within marriage, an optimal family size, economic hardship, infidelity, domestic violence, contraceptive failures and unexpected pregnancy in older women were factors that contributed to the decision.

In one interview, the IPPF spoke to a 37-year-old woman from a poor socio-economic background whose husband suggested she have an abortion. He procured and administered the injections but soon after, the woman fell sick and began to bleed profusely. She consulted a doctor and discovered the baby was still alive; she had to travel to India for a safe abortion.

Honour killings

For those who can afford it, travelling to India or Sri Lanka is an option. But in neighbouring Sri Lanka, where abortion is illegal, the operation is performed by unskilled individuals in unhygienic settings.

One unmarried woman interviewed by the IPPF travelled to an abortion clinic in Sri Lanka when she was 31.

She said she remembered hearing the sound of women crying and the stench of blood. The abortion was carried out on a soiled bed and she was not anaesthetised.

“I felt like a piece of meat; I couldn’t help crying throughout [the process],” she said. Once the abortion was over, she was ordered out of the room despite not being able to physically move.

For those like Mustafa who cannot pay to go abroad, the alternatives are bleak. Abortion-inducing pills and injections administered by amateur abortionists are one recourse while others turn to harmful vaginal preparations, containing chemicals such as bleach or kerosene. Although infrequent, some insert objects into their uterus or induce abdominal trauma.

“It’s difficult to name names but I know prominent women who have had multiple abortions,” says Aishath Velazinee, a well-known campaigner for human rights.

“If a daughter gets pregnant, parents would rather have an abortion,” she says, referring to the shame of pregnancy outside of marriage. “I think it’s appropriate to call these abortions honour killings.”

Taboo

Using the information gleaned from the focus groups, IPPF concluded that widespread premarital and extramarital sex, high rates of divorce and remarriage (including sex between marriages), and poor access and practice of contraception could lead to a high number of unwanted pregnancies.

All four groups said that despite being illegal, sex outside of marriage was commonplace, especially among young people. Nor was it uncommon for married men to have affairs with unmarried girls.

But disturbingly, the focus groups said that couples preferred not to use contraception. Among the reasons offered included a reluctance to use condoms.

For some, the IPPF discovered, having an abortion was itself a form of contraception. One girl said: “When abortions can be obtained without much difficulty, young people do not want to use contraceptives as those take away the pleasure.”

Under the form of sharia law practiced in the Maldives, both sex before marriage and adultery are offences punishable by flogging. But attitudes towards sex reveal a discrepancy. While it is acknowledged in private that both take place, social norms and cultural attitudes restrict public discussions on the subject. As a result, students are not taught about contraception at school as for many this would be tantamount to condoning sex outside of marriage.

Government policy

Nazeera Najeeb, head of the population division in the health ministry, stressed that it was difficult to grasp the extent of the problem in the absence of official statistics.

“Without that it’s difficult to say exactly what’s happening,” she says.

The health ministry has plans to conduct research into abortion in the Maldives and educate the public about the health risks involved, she says.

“We are trying to create awareness on the disadvantages. At present we are trying to develop some mass media programmes.”

The list of potential health complications associated with unsafe abortion rolled off by Nazeera makes for grim reading: reproductive health infections, infertility, septicaemia, shock and even death.

While students could not be taught about contraception at school, they could be alerted to the dangers of unsafe abortion, she said. In addition, the health ministry could redouble its efforts to promote contraception among married couples.

For Velazinee, however, as long as the government continues to shy away from the sensitive issues that surround abortion, couples will continue to find themselves in the same quandary.

As with the drug epidemic, only government policies that addressed the real picture would help break the taboo, and thus, move the country towards finding a solution, she says. Until a shift in policy-making occurred, she adds, society will continue to be marked by a dualism: a public facade that does not reflect the private sphere.

“We gear policy to the normative standards of being a 100 per cent Muslim country rather than the reality. The government doesn’t want to publicise the availability of contraception for fear the move will be misinterpreted. They don’t want to acknowledge these issues, but the reality is that these things happen.”

The names of all those who have spoken about their personal experiences involving abortion have been changed.