Doctor at Fuvahmulah Hospital refuses to deliver stillborn baby

A doctor at Fuvahmulah Hospital has refused to do C-section surgery on a nine-months pregnant woman whose baby had died in the womb.

The gynecologist refused to do a cesarean, saying she was not ready to take the risk as there was no surgeon or a pediatrician present, local media has reported.

A relative of the patient told Haveeru that they were now waiting for her to give birth naturally as the hospital does not have obstetric gel which is required to ease birth in such situations.

The Ministry of Health and Gender is currently investigating both incidents, telling the press that it would not comment before it had finished.

Citing the family member, Haveeru reported that the patient was first taken to the hospital after she started having labour pains and was immediately taken into the labour room around 10:45pm on May 31.

The hospital reported the next day that both the baby and the mother were in good health, said the relative.

“And this evening (June 1) around 5:30pm, the doctor came out of the labour room and suddenly said the baby has died. According to the doctor the baby’s heart beat went too low. They didn’t provide any further information,” they added.

According to local media reports the female doctor, a Pakistani national who joined the hospital four months ago, is the only gynecologist working at the hospital and had been involved in a similar incident the previous evening.

Media reported that the doctor had refused to do cesarean surgery on a 25-year-old woman brought into the hospital, stating that she was scared to go ahead with it.

Reports say that after making an incision into the patient,  the doctor then sewed it up before the woman was transferred to Hithadhoo regional hospital in the neighbouring atoll for delivery.

Meanwhile, opposition Maldivian Democratic Party MP Rozaina Adam has today submitted a medical negligence bill to the parliament stating it to be “very important in light of the current medical situation in the Maldives”.

Rozaina told Minivan News that the bill, drafted in 2011, was delayed as she was awaiting both comments and two other bills from the Health Ministry, which medical professionals had told her would complement her proposed legislation.

Following the transfusion of HIV positive blood to a patient due to a technical error at IGMH earlier this year, Rozaina opted to submit the bill without the ministry’s comments.

“We didnt receive any comment from the gender ministry, earlier they said this bill has to come with legislation concerning health professionals and with health services,” explained the Addu Meedhoo MP.

“But three years has passed waiting for their comments, so I decided to submit it – especially considering that such incidents are taking place. From the perspective of patients this cannot be delayed, and I think the government will speed up the other bills once this bill is in the Majlis,” said Rozaina.


Discovery of dead baby in outdoor shower a distressing reminder of the Maldives’ failure to address unwanted pregnancies

The police have recovered the body of a newborn infant buried in the outdoor shower of a house on Shaviyani Feydhoo island. The baby’s mother was identified as a 15 year-old school student.

This incident is a reminder of the pervasiveness of underage and out of marriage pregnancies in Maldives, and the subsequent acts of infanticide and abortions – a distressing flaw in the social fabric of the island nation which continues to be unacknowledged and under-addressed by authorities.

According to local news outlet Sun, Feydhoo island girl was allegedly sexually abused and impregnated by her own stepfather. The allegation has not been confirmed by the police.

Media official Sub-Inspector Hassan Haneef said “the case is sensitive” as the girl is a minor, was being investigated in collaboration with the Gender Ministry. He also refrained from confirming local media reports that the girl is now under arrest.

However, he noted that four people, including the girl’s legal guardians, mother and step father, were now under police custody in relation to the case. He added that the suspects resisted arrest, causing a scene on the island of approximately 700 inhabitants.

“We are investigating allegations of  giving birth outside wedlock, killing and burying the baby,” Haneef explained.

Doctors confirm the baby was already dead when found by the police at around 6:30pm, he observed, adding that the police are investigating the cause of death as well.

However, without post-mortem services and an absence of visible wounds on the infant’s body, proving infanticide in the Maldives is almost impossible without a confession from the suspects.

In 2006, the Juvenile Court acquitted a woman from Dhabidhoo island, who police alleged killed her newborn and threw into the lagoon, ruling that her three confessions contradicted each other. The woman gave birth out of wedlock in 2008.

Tale of illegal pregnancies and throwaways

Due to the conservative exterior of the Maldives  and the deep-rooted culture of blaming the victim, the stigma of having a child out of wedlock drives women to desperate measures.

Mothers helplessly hide the growing bump for nine months and endure the pain and struggle in silence until an abortion is possible, or else abandon the newborns after birth – dead or alive.

Abortion is illegal and unavailable to most mothers, unless it is proved that the conception is the result of rape or that the pregnancy is a threat to the mother’s health.

In last two years, three babies have been discovered dead and two alive. The dead infants included two fetuses, one hidden in a milk tin and the other at the bottom of Male’s municipal swimming pool, while another fully-developed baby was thrown into a park having apparently been strangled by the underwear tied around its neck. Two babies were found abandoned and alive, and have now been placed under state care.

Anecdotal evidence suggests some mothers, both young and adults alike, use abortion-inducing pills or receive injections from amateur abortionists; others turn to harmful vaginal preparations, containing chemicals such as bleach or kerosene. Although infrequent, some women insert objects into their uterus or induce abdominal trauma.

Though these alarming throwaways have grabbed headlines and attracted public attention momentarily, it came short from prompting concrete action from authorities and public to address the underlying issue. Instead it merely provoked widespread condemnation and vehement calls for the mothers to be put to death.

Meanwhile, in the recent case of the 15 year-old, police have not revealed any information surrounding the circumstances of the pregnancy.

Unless it is proved that the pregnancy is the result of rape, Maldivian law provides for her to be publicly lashed and placed under house arrest.

Although the current judicial system restricts adult punishments to children until they reach the legal age of 18, there are currently three exceptions to the provision. One of these is that if she has had a child, a girl will be tried as an adult, according to a 2004 study on gender issues in the criminal justice system.

Out of fear of potentially being stigmatised, fathers seldom take responsibility for their actions, while pregnancy leaves girls guilty by default, leaving mothers to be flogged, publicly humiliated for fornication or incarcerated for infanticide – a disturbing trend of gender-bias observed in the criminal justice system.

All talks, little commitment or action

The issue has been raised at various gender related forums – with many words, but little action.

In 2010, the Deputy Minister of Health and Family at the time, Fathimath Afiya told Minivan News that a meeting was held to discuss reproductive services in the Maldives. While Maldivian and Shariah law criminalise abortion and intercourse outside of wedlock, Afiya said communication between relevant services and the judiciary made it difficult to fully address each case.

“There needs to be an appropriate legal framework for reporting these cases to the services that could help unmarried and teenage women in compromised positions,” said Afiya. “We are very concerned about the rising number of unwanted pregnancies and abortions by married and unmarried women. Today, we began formulating an action plan for short- and long-term improvements,” she added at the time.

However, at the national stakeholders meeting held by UN Women yesterday on the UN Secretary General’s Unite campaign to end violence against women and girls, officials confirmed that “no concrete action plan” has been finalised.

During yesterday’s meeting, as a Unite Youth Network Member, I gave a presentation on violence and problems faced by youth, highlighting sexual health illnesses such as STIs, early pregnancies, abortions among youth and emphasised the need for immediate sexual and reproductive health education.

All participants, including government officials, councilors, police, and gender advocates unanimously agreed on the importance of tackling the problems.

But as participants pointed out at the workshop, most of the time “it is all talk, with little commitment or action”.

“Raising public awareness and educating the girls and boys about their bodies, the ramifications of being sexually active and how to protect themselves from harm is very important,” said a public health official from the Centre for Community Health and Development.

The official noted the magnitude of the sexual health problem and its consequence as a “great national concern”.

“Discussions are underway,” the official said.


Police investigate “suspicious” death of a newborn

Police are investigating the suspicious death of a two-day old healthy newborn at the ADK hospital on Tuesday, Sub-Inspector Hassan Haneef has confirmed.

According to the Haneef, the investigation commenced after police discovered the baby boy’s mother had been married three months before the delivery, suggesting that the baby was conceived before the marriage.

“There are some suspicious circumstances surrounding the death of the baby. We have found out the mother was married just three months before the baby was born,” Haneef noted.

Speaking to Minivan News, Managing Director of ADK hospital, Ahmed Afaal, said doctors who examined the boy has declared it was “sudden death” as the boy was born perfectly healthy and had no complications.

Afaal said the real cause of death cannot be identified without an autopsy in sudden death cases.

He noted that the boy had died while under the care of mother, who is reportedly from Nilandhoo in Gaaf Alif Atoll.

Newborns are not admitted to the nursery and transferred under family care if no complications are found, he added.

“The hospital staff were alerted by the family on Tuesday morning after the boy was found not breathing. The staff examined the body and declared the boy was dead,” according Afaal.

Meanwhile, local media Haveeru has quoted an unidentified official from ADK saying that the “doctors assume the baby had died of choking but that they couldn’t pinpoint the exact cause of death without carrying out an autopsy”.

Haveeru quoted another police media official saying “the boy had an identical bruise to the sides of his nose” and had claimed their journalists had observed the bruise.

However, both Afaal and Sub-Inspector Haneef did not confirm any physical injuries and added they cannot comment further as the investigation is pending.

However Haneef added that the police so far believe that the death was “normal”.


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.

While premarital and extramarital sex is widespread, high rates of divorce and remarriage (including sex between marriages), and poor access and practice of contraception lead to a high number of unwanted pregnancies. The stigma of having a child out of wedlock compels women and girls to opt for abortions – which is illegal in the Maldives except to save a mother’s life, or if a child suffers from a congenital defect such as thalassemia.

Subsequently, anecdotal evidence suggests some women have resorted to abortion-inducing pills and injections administered by amateur abortionists, 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.

The severity of the situation was signalled last year following the discovery of several dead premature babies and abandoned alive on Male’ and across islands.

The Criminal Court last year sentenced the mother of a prematurely born baby found inside a milk can in ViliMale’ on 19 May 2011 to one year imprisonment.

Aminath Shaira, 30 of Manadhoo in Noonu Atoll, was charged with disobedience to an order under article 88(a) of the 1968 penal code as well as violations under the Child Protection Act.

Her accomplice in the crime, Mariyam Rizna, 18, of Guraidhoo in Kaafu Atoll, was sentenced to six months for assisting Shaira in delivering the baby. Rizna’s fingerprints were found on the Coast Milk can.

In the same month, a dead infant was found in a plastic bag in the swimming track area of Male’. A medical examination later concluded that the baby’s had sustained cuts, bruises and other wounds. No one was arrested or charged.

Meanwhile, in June 2011 an abandoned newborn was discovered alive inside a garage on Gaafu Dhaalu Thinadhoo island while in a similar case, a newborn was found abanded alive in bushes near the Wataniya telecommunications tower in Hulhumale’ during Novermber 2010.


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.”


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.