PLACING a red-hot brick on your stomach, having your abdomen grabbed and wrenched
till you feel excruciating pain, or having your midsection cut open with scissors
- these may sound like medieval tortures, but in fact they are some of the common
methods used by Cambodian women in illegal attempts to abort unwanted fetuses.
However, a new Ministry of Health project, along with the passage last month of Cambodia's
first abortion law, leads many experts to feel optimistic that women can be spared
the dangers of illegal abortions. Yet qualms about abortion's morality remain in
this strongly Buddhist country.
"I was very, very afraid ... there was a lot of blood and very bad pain,"
said a 33-year-old ex-prostitute of her recent illegal abortion. Sold into a brothel
where only about half the clients used condoms, she was soon pregnant. The brothel
owner took her to a back-alley midwife.
"I don't know where it was, it was just someone's house. I was too afraid to
say anything," she said. The midwife gave her a "massage" abortion,
which consists of pinching and twisting the womb from the outside in order to break
the body of the fetus.
Now, she said, she suffers from a painful infection of the uterus and has not been
able to get pregnant again.
Safer abortion methods, such as aspiration (suction) or a dilation and curettage
(D and C), both of which are used in Western countries, are available in Cambodia.
However, many women use (or are forced to use) the more brutal methods because they
are cheaper, said Chanthol Oung, executive director of the Cambodian Women's Crisis
Private clinics offer safer abortions performed by doctors, but at a cost. Charges
at a well-known maternity clinic in Phnom Penh start at $60 and get higher the more
advanced the pregnancy is, according to a medical assistant.
Chanthol Oung said a midwife will typically charge 90,000 riels (about $30) for a
suction or D and C procedure, as opposed to a 20,000-riel ($6) massage. "Some
women just beat themselves," Oung added.
According to a 1995 survey by the National Maternal and Child Health Center, 5.4%
of women admitted to having an abortion, and 25% said they knew someone who had.
The second figure hints that the first may be a product of under-reporting, according
The Ministry of Health embarked in July on a new phase of the National Maternal and
Child Health project, aimed at improving reproductive health conditions nationwide.
The United Nations Population Fund and the British Overseas Development Association
are providing $7 million for the four-year project. The program concentrates on birth
spacing, maternal and child health, and management of sexually transmitted diseases,
according to Dr Chhun Long, project coordinator.
While stressing that the project emphasizes contraceptive methods - not abortion
- in its counseling and campaigning, Dr. Chhun Long acknowledged that there is a
need to provide abortions nonetheless.
"We want to provide contraception first. But we know that we cannot get all
women to use birth spacing methods, so, for the rest of them, we want to save their
lives too," he said.
The project will train doctors and midwives to be "authorized providers"
of safe abortion services and to deal with the complications from botched back-alley
jobs. Although statistics on abortion dangers are hard to estimate, Chhun Long said,
a 1994 hospital survey showed that abortions caused about one-third of all maternal
deaths. Late abortions were particularly dangerous, he noted.
"Sometimes women we see in late stages of pregnancy waited and waited [to go
for an abortion] because they had no safe place to go. We hope there won't be many
now," said Chhun Long of the new abortion law.
Kann Man, chairman of the National Assembly commission on public health, agreed that
legal abortions would help save lives. "We created and adopted this law with
the aim of protecting women's lives and social order," he said of the Assembly's
unanimous passage of legislation legalizing abortions Oct 6.
The new law allows women to abort unconditionally in the first 12 weeks of pregnancy
and, if there are health dangers, in later stages as well. Women who have been raped
may abort at any time. The law also sets out requirements for legal abortion providers
and penalties for violators.
"You don't have to avail yourself of the law but you can choose - at least have
it done safely," said Eve Tamela of Marie Stopes International, a UK-based reproductive-health
organization providing technical support to the Ministry of Health project.
However, the new law is not without its critics. Dr. Lao Mong Hay, executive director
of the Khmer Institute for Democracy, said that his group had appealed to MPs to
derail the law during the parliamentary debate, on the grounds that abortion is contrary
to Buddhist beliefs and a violation of human rights.
"Buddhism's first precept is that we must not terminate life," Mong Hay
said. "It's a state religion in our Constitution...we need to restore moral
and ethical values in this country."
A medical assistant at a clinic where abortions are performed agreed. "The doctors
here are all Buddhists. Sometimes they feel guilty, like they are committing sins.
But because they are state employees and don't have enough salary, they must [perform
abortions on the side] to feed their families."
"We don't have a word for 'fetus' in our language," continued Mong Hay.
"'Human infant' is the word we use. Based on this Cambodian conception, this
is a term of life. So [abortion] is a violation of human rights - the right to life
as guaranteed by the Constitution."
Sam Kanitha, one of the few female National Assembly members, dismissed such criticism.
"It is not to kill people, but to prevent illegal killing. And we also prohibit
private clinics from conducting illegal abortion, as they were not responsible for
any dangers. I supported this law because as long as we have it, we are able to decrease
these illegal activities."
Dr Chhun Long said: "I don't think anyone will be opposed to this law ... if
they think a little bit, they will support us."