A Critique of the Abortion Policy Review Advisory Group’s (APRAG) Report
and the Draft Bill “Termination of Pregnancy Act of 2007”
By: Dr. Charles A. Royes MB, BS (Hons.), DM(Surgery), FRCS, FACS
Consultant General Surgeon
1. The terms of reference provided to the APRAG
The stated terms of reference include “the need to develop systems and guidelines toensure that abortion is safe and accessible for all”.Now obviously this would not be possible in a system where abortion is illegal.
So it appears that the Group was not being mandated to study and make recommendations on
the controversial issue as to whether the law in Jamaica should be changed to make abortionslegal; but rather to advise on how legalized abortions could be made safe and accessiblefor all
. These terms of reference seem to be based on a predetermination that abortion shouldand would be legalized.
Thus, the crucial first step in the research process has been neglected – i.e. a careful andthorough study of the pros and cons of legalizing abortion based on the wealth of
available data worldwide.
Based on imposed tunnel vision, this report is proposing the use of a medical procedure,
induced abortion, to help solve what is essentially a social problem – unwanted pregnancy.
The wider landscape of interpersonal attitudes and conduct, sexual education and behavior,
family life, moral, ethical, religious and social issues has not been carefully surveyed and
included for deliberation.
2. The data utilized in the APRAG report was totally inadequate and the analysis severely
flawed.The Advisory Group acknowledged as much in their report : “The Ministry’s ‘Abortion PolicyReview Advisory Group’ has to the best of its ability, given the paucity of statistical data
on the practice of abortion in Jamaica, worked assiduously to respond to its terms of
reference” - terms of reference so biased and predetermined in their formulation as to pressthe group into using obviously inadequate data to make a case and support their
recommendations.
2.
The data presented from the Victoria Jubilee Hospital of some 641 admissions to Ward 5 over a
six month period in 2005 give the impression that these were all cases of induced abortion but
that only 7% of these patients confessed to deliberate interference. This is extremely misleading
as cases admitted to this ward include all cases of bleeding in pregnancy – i.e. spontaneous
abortions (miscarriages), or where bleeding in pregnancy indicates that the pregnancy is in
danger of being lost (threatened abortion), as well as cases of deliberate (induced) abortion.
The report was that during this period no patient died (i.e. zero mortality) but that morbidity (i.e.
the complication rate) was “high”; however no morbidity data were provided to support this.
The report then sees it appropriate to emphasise that many of these women were “young,poor, unemployed and lived in economically and socially deprived communities”.That observation was no doubt factual. But the same demographics would likely be true of
patients in other wards of the same hospital being treated for fibroids or cervical cancer; or in the
KPH suffering from diabetes, or heart disease, or appendicitis.
The fact is that the complications of abortion are found among patients of all social and
economic strata in both public and private hospitals.
Complications related to abortion are not limited to the home-style methods or the “back street
practioner”, but occur also, and not infrequently, in cases performed by trained medical
personnel.
In Canada, where abortions are performed by trained persons in proper facilities, early physical
complications are reported at 10% - and this does not include later physical complications or
psycho-emotional problems which are alarmingly prevalent.
The point must be made and stressed that legal abortion does not equate to safe abortion!
Qualitatively similar criticisms can be made of the data offered from Cornwall Regional Hospital.
The idea that there is a necessary correlation between abortion’s illegality and higher
maternal mortality rates is challenged by the data reported from several countries:
Poland banned abortion in 1993 after decades of abortion on demand as a Soviet satellite.Since then, not only has the number of legal abortions dropped considerably,
from 59,417 in 1990 to 151 in 1999 (these were for rape, problems with the
fetus, or threats to the mother's life or health), but so has maternal and
infant mortality. Maternal mortality, recorded at 15.2 per 100,000 live
births in 1990, dropped to 7.3 per 100,000 by 1999. Infant mortality also
showed a steady decline, from 18.1 in 1991 to just 8.9 in 1999 (and dropped
again to 8.1 in 2000).
3.
According to the 1990 UN Demographic Handbook, it was Ireland, not the UK,that reported the lowest maternal mortality rates for 1988 - - some three
and a half times lower than that reported for the British.
At least in these two countries, mothers appear to be safer in the country where abortion
Is not legal.
While the number of abortion-related maternal deaths did decline in the time
frame of abortion's legalization in the United States, it was just the continuationof a larger, longer downward trend in maternal mortality. This decline began
in the 1940s with the introduction of sulfa drugs and penicillin and
continued through the 1950s and 1960s with the advent of better surgical and
anesthetic techniques and instruments. Overall maternal mortality declined
during the same time frame by roughly the same margin, a further indication
that these innovations, not abortion's legalization, were driving the
mortality figures down.
Legalising abortion is neither a necessary nor a sufficient measure to achieve a reduction
in maternal mortality.
On the other hand, it is well known that improving quality of health care including ante-natal care
does make a significant impact on maternal morbidity and mortality - properly equipped
hospitals, clinics and health centres, adequate numbers of trained medical staff, availability of
drugs, blood and blood products, etc.
3. The Recommendations of the APRAG and the Draft Bill
Within the terms of reference with which it was provided, the APRAG probably saw no
alternative but to advise that the law be amended to make abortion legal in Jamaica.
The unacceptability of this approach has already been stressed.
a) Circumstances and Indications:
The report then proceeds to define the circumstances under which abortions should be legally
performed. These are outlined on what on my copy is page 6 of the APRAG report.
Based on these recommendations, the draft bill “Termination of Pregnancy Act of 2007” states
the locations where and the personnel by whom abortions may be performed in the different
stages of pregnancy.
4.
The stated indications for abortion include :
(a) Cases of rape, incest, carnal abuse. In every such case counselling as provided under
Section3 shall take place before a decision is made to terminate a pregnancy and to continue
after the termination.
(b) When continuation of the pregnancy would involve risk to the life of the patient or risk of
great injury to her physical or mental health.
In determining whether continuation of a pregnancy would involve risk of grave injury
to a pregnant woman, an authorized medical practitioner shall take into account the
interests of other children in the pregnant woman's family as well as her entire social and
economic circumstances, whether actual or foreseeable.
Under these indications, any woman with a pregnancy which is causing her distress – physical,
mental, emotional, financial, or social – qualifies for an abortion; and this applies whether the
stress factors are actual or foreseeable!
Even after 22 weeks, at a stage of potential fetal viability, it is proposed that abortion be allowed
if an authorized medical practitioner (i.e. one doctor) deems some “special” but undefined
indication to be present.
Now a woman does not request an abortion unless it is causing her some sort of significant
distress. She requests an abortion when the pregnancy is causing her distress; and the draft bill
proposes in effect that if she is distressed she should be allowed to have an abortion.
How this translates in practice is that no lady with an unwanted pregnancy will be denied
an abortion.
In other words these indications amount to abortion on request.
What is the message here to our people : “If you get pregnant and you don’t want it, you may
have an abortion”.
In our local parlance : “Dash it wey!”
5.
b) Counselling:
Both the report and the draft bill speak to the need for counseling before and after abortion.
The reported experience from countries which have implemented this approach is that in many
cases this either does not happen at all or is offered in a perfunctory, cold or routine manner to
fulfill the letter of the law. Very often, what is called counseling is in reality the application of
pressure to have an abortion.
Let us accept the uncomfortable fact that those involved in the medical assessment of the
patient and in offering advice and counsel are often those who themselves stand to gain
financially from a decision to abort the pregnancy.
The inclusion of a recommendation for counseling in no way guarantees the caring assistance
needed by a woman with an unwanted pregnancy.
c) Minors:
The draft bill also proposes that a mentally competent minor would not be required to obtain
consent for an abortion from parent or guardian or to notify them. This would seem to contradict
the existing law regarding parental consent for a medical procedure.
d) Penalties:
The draft bill proposes that
“ Where any midwife or medical practitioner or other health service provider who objects to
termination of pregnancy on the grounds of conscience , refuses or deliberately fails to inform
any woman seeking an abortion of a practitioner who provides the service under sections 4 and
15 he shall be liable on summary conviction to a fine of up to $250,000 and/or imprisonment for
a period not exceeding three months.”
How does this square with
i) my duty as a doctor to provide my patient with what in my opinion is the best medical advice,
and
ii) my right to conscientious disagreement and objection
6.
The APRAG report and the draft bill propose the provision of legal abortion on request as a tool
designed primarily to reduce maternal morbidity and mortality and help achieve compliance with
Millennium Development Goals.
Little or no attention is paid to other means by which these objectives could be achieved.
And little or no consideration is paid to the facts that:
Abortion involves the taking of a human life
Abortion carries real dangers to the woman, whether done legally or illegally – potential
serious threats to her physical, mental and emotional well-being, both in the short term and the
long term.
Abortion carries dangers for the society.
Already our society is struggling with problems like disrespect for each other, violence,
exploitation and abuse of women and minors, and disregard for life and property.
Do we think that legalizing abortion, which to be accurate is the killing of unborn babies, will help
to lift us up as a people?
Is it congruous with our desire for wisdom, justice and truth?
Is it the enactment of a nation’s prayer learn true respect for all?
Maternal health is precious and must be fought for and guarded.
So too must the soul of our nation – the things we believe are right and wrong, the principles we
hold and the way we live.
Surely we can find a better way than what is mapped out for us in this report and the proposed
bill.
The Coalition for the defence of life
Abortion – What is the real cost?
Christina Milford (Director)
Pregnancy Resource Centre of Jamaica (PRCJ)
Montego Bay, St James
According to your article “Rethink abortion” [1], the Ministry of Health-commissioned report has recommended that current laws prohibiting the practice [of abortion] be repealed and replaced with legislation outlining conditions under which medical termination of pregnancy would be lawful (Italics mine). The indication is that this is largely due “to an alarming number of botched abortions taking place in the island”, and that this phenomenon has resulted in the burdening of the public health sector:
Please note that termination of pregnancy is really the termination of a pre-born baby’s life. In 1975, the Glen Vincent Clinic was sanctioned by the then Minister of Health, the Hon. Kenneth McNeil for the purpose of killing babies. Abortions were done there under the watchful eyes of the Medical Association of Jamaica and the practitioners paid by the Government of Jamaica. Abortion was/is just another form of “contraceptive” for teenage girls (after their failed experiments with the oral contraceptive Perle and the condom, Panther) [ .] This has since then closed. Where are abortions performed in Jamaica, today? Daily they are self-induced at home, done in public hospitals, in doctors’ offices and in private clinics. From personal conversations, even with persons in the medical field, it seems that, before the 2005 highlights calling for legalization of abortion, most Jamaicans had no idea that abortion is not legal, and most women do not know they are killing a baby… Shame associated with abortion is the primary reason our women do not speak of it openly, not fear of being charged for a crime.
Was this commissioned report a little skewed? There seems
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