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Matters of life and death
published: Sunday | February 17, 2008
Colin Steer, Associate Editor - Opinion
Robinson ... advisory group has not proposed law allowing abortion on demand. and Reece ... assists pregnant women with adoption facilities. - file
The first casualty of any battle, it is said, is the truth, and in the declaration of war by a coalition of Christian groups against proposals to amend the country's abortion laws, fairness and accuracy have taken a severe battering.
This resurgent controversy is anchored in two broad sets of concerns: the morality and ethics of terminating pregnancies (at any stage), and [COLOR=orange! important][COLOR=orange! important]public-health[/COLOR][/COLOR] issues.
Various spokespersons of the Christian coalition have stated their strong moral conviction against the legalising of what they termed "abortion on demand", reflecting the widely held view of a majority of Jamaicans. They are also upset over what some deemed a rush to pass legislation without public discussion. But this is neither a fair nor accurate representation of the recommendations of the Abortion Policy Review Advisory Group as outlined in the report submitted to the Ministry of Health, and subsequently to Parliament.
A bit of background provides the context in which this issue has resurfaced.
In January 1975, then Minister of Health Dr Kenneth McNeill tabled a ministry paper outlining the government of the day's policy position on abortion and the context in which it was felt that the law relating to the termination of pregnancies needed to be clarified and amended.
maximum penalty
Under Jamaican statute (then and now), it is a criminal offence for anyone to procure an unlawful abortion. Sections 65 and 66 of the Offences Against the Person Act lay down a maximum penalty of life imprisonment for the offence. The statute also provides a maximum penalty of three years' imprisonment for anyone who assists in the procuring of an unlawful abortion.
Dr McNeill noted, however, that the common law position (that is one which derives its force and authority from 'universal consent' based on precedent instead of statute) was that it was lawful for a registered medical practitioner, acting in good faith, to take steps to terminate the pregnancy of any woman, if the doctor formed the opinion that the continuation of the pregnancy was likely to constitute a threat to the life of the woman or have an adverse effect on her mental and physical health.
The government at the time said that after careful consideration, it would take steps to amend the relevant sections of the Offences Against the Person Act to make it clear when an abortion would be lawful in Jamaica - that is, to have spelt out in statute what the common law position is. It also proposed that steps be taken to make rape, carnal abuse and incest lawful grounds for abortion. Strong opposition resulted in no legislative change flowing from that ministry paper.
Significantly, however, despite Jamaica's legal framework, and given the public-health concerns about the number of 'unsafe abortions', the government in 1976 established the Fertility Management Unit at the Glen Vincent Health Centre on Eureka Road, St Andrew, where termination of pregnancies took place - apparently without much opposition. This unit was closed in the mid-1990s for want of funding and adequate staffing.
Over the next 30 or so years later, amid much concern by public-health officials over what was termed "the disturbing rates of unsafe abortions" and complications, especially among adolescents, there have been calls for a revisiting of the country's laws relating to the termination of prenancies. Those pushing for amendment wanted government-approved and certified and trained personnel to be able to perform such surgeries without the fear of criminal prosecution.
However, despite repeated attempts to put the issue on the public agenda, and given the strong cultural and religious opposition to any such move, governments have been reluctant to address the issue.
In the meantime, medical personnel in public-health facilities continue report a high incidence of botched abortions and complications, prompting a renewal of the call to re-examine the entire legal framework within which doctors are expected to operate. Also, medical personnel from the Victoria Jubilee (VJH) and Cornwall Regional hospitals have tabulated data of women - many of them teenagers - turning up at the facilities with complications arising from "incomplete abortions" each year. According to the advisory group, as many as 641 patients were admitted to the VJH, which deals with abortions and their complications, between March 1 and August 31, 2005
Against the background of these concerns, the Abortion Policy Review Advisory Group was established by former health minister John Junor and had its first meeting in September 2005. The group was also set up against the background of the Ministry of Health's stated objective of reducing maternal deaths in Jamaica by 75 per cent by the year 2015. This would be in keeping with the Millennium Development Goal for improving maternal health.
objectives
Among the objectives of the advisory group cited were :
(1)To articulate a policy for the provision of safe reproductive health services in Jamaica with special emphasis on safe abortions; (2)To draft recommended amendments to the existing Offences Against the Person Act in support of termination of pregnancy for medical and humanitarian reasons, e.g. statutory rape.
The advisory group comprised Dr Wynante Patterson (chairman), Dr Joseph Hall, Rev Phillip Robinson, Dr G. Wesley Bernard, Dr Olivia McDonald, Dr Glenda Simms, Mrs Beryl Weir, Dr Karen Lewis-Bell, Mrs Magarette Macaulay, Dr Douglas McDonald, Dr Errol Daley, Mr Easton Williams and Mrs Sheila Jones.
In a cover letter accompanying the draft report dated February 10, 2007, addressed to then Minister of Health, Horace Dalley, chairperson of the advisory group, Dr Wynante Patterson, referred to the Government's commitment to public consultation and of her group's taking steps to help in that process.
"In 2006, we were advised by the ministry that the Government required that matters such as the one that we were reviewing should be presented to the public for consultation before a final decision would be made. The group, therefore, though not part of our terms of reference, prepared the necessary documents to give effect to this requirement. These documents did not form part of our report. They have been submitted to the relevant officers in the ministry through whom an application for funding has been made to the Cabinet Office. We have recently been advised that funding for the exercise has been identified and that the report with its attachment we are submitting to you today (February 19, 2007) contains the information necessary to move the process forward."
Among the group's recommendations were the repeal of the relevant sections of the Offences Against the Person Act to be replaced with a termination of pregnancy act stating conditions under which medical termination of pregnancy would be lawful.
therapeutic abortions
They also said that the Government should develop, maintain and staff specified centres in each health region for the provision of therapeutic abortions. Pregnancies over 12 weeks' gestation should be performed only by authorised medical practitioners and in registered facilities; pregnancies over 22 weeks' gestation were not recommended except under exceptional circumstances agreed by the woman and two authorised medical practitioners.
Subsequent to the submission of the report, which also had references to the legal position in other Caribbean countries, the Ministry of Health has since advertised for a consultant to help guide the public discussions.
In her letter, Dr Patterson noted that not all members of the advisory group signed off on the draft report.
Among those who did not sign the draft report were the Rev Phillip Robinson, who sat on the committee in his capacity as president of the Jamaica Council of Churches at the time, and Mrs Sheila Jones, representing the Nursing Council of Jamaica. The Nursing Council representative did not sign the draft report, reiterating its position of supporting abortion only in instances of a threat to the life of the mother, incest and rape. This was attached to the advisory group's report.
Rev Robinson told The Sunday Gleaner that he had not been able to have sufficient consultation with the wider church community - apart from a meeting called at short notice and attended by representatives of the Roman Catholics and Ethiopian Orthodox Church, and so did not consider it appropriate to sign the document at the time of its drafting.
He said, however, that during the meetings there was a high percentage of medical personnel, the perspective of the Church was sought and it was always understood and stated that there would be wider public consultation. He noted, too, that the position of the Jamaica Council of Churches is that the laws need to be revisited and if necessary, revised not only to protect medical personnel, but also the life of the unborn.
ethical perspectives
"The medical personnel were largely guided in the deliberations by the reports they were getting from within their profession about the number of botched abortions. But they did give consideration to wider ethical perspectives and concerns," Rev Robinson said. He added that he was not of the opinion that the advisory group was recommending "abortion on demand", meaning that persons could just walk into a facility and obtain an abortion as a matter of course.
Beryl Weir, a member the advisory group and director of the Women's Centre Foundation of Jamaica, also told The Sunday Gleaner that there was vigorous discussion among members of the group taking into account the law as it existed in Jamaica and elsewhere, considerations of ethics, and conscience, as well as social realities that obtained in Jamaica.
She stressed that the matter of counselling was highly recommended for persons who might be seeking an abortion, given the experience of professionals working with women who may have been traumatised by the circumstances of their getting pregnant.
"It is inaccurate to suggest that we were recommending abortion on demand," she said. "In fact, in my experience at the Women's Centre, often after the girls are counselled, they indicate that they do not want to have an abortion. And the counselling aspect is strongly advocated in the draft report. The next step is to get them into a programme that will allow them to have their babies while continuing their education. However, it is also a fact that many women are very clear that they do not want to carry the pregnancy to full term and will have an abortion by whatever means."
She said the challenge for the public-health system is that in the absence of proper facilities, women resort to various risky back-door methods which often later end up as serious public-health issues.
Now, whatever, the context and contents of the advisory group's report, the position of many Christians is unambiguous. Neither rape (including statutory abuse of a minor) nor incest is good enough grounds for the termination of a pregnancy. The argument goes that just because a man has committed a crime against a woman, that is no good reason for her to commit one herself by taking a life. Activists for women's rights have rejected this position saying that essentially the woman is being forced to be a container for a foetus even in cases where she herself was an unwilling victim in the process.
While the Christian coalition has argued that its primary concern is the sanctity of life, there is also the view that a more liberal legislative framework effectively sanctions indiscriminate sexual behaviour and makes it far too easy for people to opt out of the consequences of their actions.
An he was not a member of the coalition, Roman Catholic deacon and Gleaner columnist Peter Espeut captured this view well when he wrote in his column last Wednesday: "Both the man and the woman made the earlier choice to have sexual intercourse. When they made that choice, they would have known the consequences. We are skirting the real issue: All this talk of abortion is about trying to avoid the consequences of irresponsible sexual intercourse." That position of course, is a distortion of the various levels of concerns that people have about the issue.
delineation
While the Christian coalition was very clear at its February 7 press conference that it would oppose the proposals that would allow "safe abortions", media reports suggest that they did not address the question of whether there should be any delineation regarding incest or rape and if so, what the law should say about those circumstances.
Roman Catholic Archbishop of Kingston Donald Reece told the press conference that some church-related groups were "seriously engaged in setting up facilities that would assist pregnant women to term their pregnancies with the possibility of adoption".
In the meantime, however, the Women's Centre Foundation of Jamaica, now in its 30th year, has one of the more visible places of refuge for teen mothers. It continues to limp along in the service it provides to hundreds of girls under the age of 15.
Weir noted that some churches and agencies, for example Jones Town Baptist, Braeton Methodist and St Patrick's Foundation, have allowed their facilities to be used as satellite centres for the training of the teen mothers.
Hundreds of children given up for adoption remain as wards of the State for many years and the centres caring for teen mothers languish for lack of financial support.
published: Sunday | February 17, 2008
Colin Steer, Associate Editor - Opinion
Robinson ... advisory group has not proposed law allowing abortion on demand. and Reece ... assists pregnant women with adoption facilities. - file
The first casualty of any battle, it is said, is the truth, and in the declaration of war by a coalition of Christian groups against proposals to amend the country's abortion laws, fairness and accuracy have taken a severe battering.
This resurgent controversy is anchored in two broad sets of concerns: the morality and ethics of terminating pregnancies (at any stage), and [COLOR=orange! important][COLOR=orange! important]public-health[/COLOR][/COLOR] issues.
Various spokespersons of the Christian coalition have stated their strong moral conviction against the legalising of what they termed "abortion on demand", reflecting the widely held view of a majority of Jamaicans. They are also upset over what some deemed a rush to pass legislation without public discussion. But this is neither a fair nor accurate representation of the recommendations of the Abortion Policy Review Advisory Group as outlined in the report submitted to the Ministry of Health, and subsequently to Parliament.
A bit of background provides the context in which this issue has resurfaced.
In January 1975, then Minister of Health Dr Kenneth McNeill tabled a ministry paper outlining the government of the day's policy position on abortion and the context in which it was felt that the law relating to the termination of pregnancies needed to be clarified and amended.
maximum penalty
Under Jamaican statute (then and now), it is a criminal offence for anyone to procure an unlawful abortion. Sections 65 and 66 of the Offences Against the Person Act lay down a maximum penalty of life imprisonment for the offence. The statute also provides a maximum penalty of three years' imprisonment for anyone who assists in the procuring of an unlawful abortion.
Dr McNeill noted, however, that the common law position (that is one which derives its force and authority from 'universal consent' based on precedent instead of statute) was that it was lawful for a registered medical practitioner, acting in good faith, to take steps to terminate the pregnancy of any woman, if the doctor formed the opinion that the continuation of the pregnancy was likely to constitute a threat to the life of the woman or have an adverse effect on her mental and physical health.
The government at the time said that after careful consideration, it would take steps to amend the relevant sections of the Offences Against the Person Act to make it clear when an abortion would be lawful in Jamaica - that is, to have spelt out in statute what the common law position is. It also proposed that steps be taken to make rape, carnal abuse and incest lawful grounds for abortion. Strong opposition resulted in no legislative change flowing from that ministry paper.
Significantly, however, despite Jamaica's legal framework, and given the public-health concerns about the number of 'unsafe abortions', the government in 1976 established the Fertility Management Unit at the Glen Vincent Health Centre on Eureka Road, St Andrew, where termination of pregnancies took place - apparently without much opposition. This unit was closed in the mid-1990s for want of funding and adequate staffing.
Over the next 30 or so years later, amid much concern by public-health officials over what was termed "the disturbing rates of unsafe abortions" and complications, especially among adolescents, there have been calls for a revisiting of the country's laws relating to the termination of prenancies. Those pushing for amendment wanted government-approved and certified and trained personnel to be able to perform such surgeries without the fear of criminal prosecution.
However, despite repeated attempts to put the issue on the public agenda, and given the strong cultural and religious opposition to any such move, governments have been reluctant to address the issue.
In the meantime, medical personnel in public-health facilities continue report a high incidence of botched abortions and complications, prompting a renewal of the call to re-examine the entire legal framework within which doctors are expected to operate. Also, medical personnel from the Victoria Jubilee (VJH) and Cornwall Regional hospitals have tabulated data of women - many of them teenagers - turning up at the facilities with complications arising from "incomplete abortions" each year. According to the advisory group, as many as 641 patients were admitted to the VJH, which deals with abortions and their complications, between March 1 and August 31, 2005
Against the background of these concerns, the Abortion Policy Review Advisory Group was established by former health minister John Junor and had its first meeting in September 2005. The group was also set up against the background of the Ministry of Health's stated objective of reducing maternal deaths in Jamaica by 75 per cent by the year 2015. This would be in keeping with the Millennium Development Goal for improving maternal health.
objectives
Among the objectives of the advisory group cited were :
(1)To articulate a policy for the provision of safe reproductive health services in Jamaica with special emphasis on safe abortions; (2)To draft recommended amendments to the existing Offences Against the Person Act in support of termination of pregnancy for medical and humanitarian reasons, e.g. statutory rape.
The advisory group comprised Dr Wynante Patterson (chairman), Dr Joseph Hall, Rev Phillip Robinson, Dr G. Wesley Bernard, Dr Olivia McDonald, Dr Glenda Simms, Mrs Beryl Weir, Dr Karen Lewis-Bell, Mrs Magarette Macaulay, Dr Douglas McDonald, Dr Errol Daley, Mr Easton Williams and Mrs Sheila Jones.
In a cover letter accompanying the draft report dated February 10, 2007, addressed to then Minister of Health, Horace Dalley, chairperson of the advisory group, Dr Wynante Patterson, referred to the Government's commitment to public consultation and of her group's taking steps to help in that process.
"In 2006, we were advised by the ministry that the Government required that matters such as the one that we were reviewing should be presented to the public for consultation before a final decision would be made. The group, therefore, though not part of our terms of reference, prepared the necessary documents to give effect to this requirement. These documents did not form part of our report. They have been submitted to the relevant officers in the ministry through whom an application for funding has been made to the Cabinet Office. We have recently been advised that funding for the exercise has been identified and that the report with its attachment we are submitting to you today (February 19, 2007) contains the information necessary to move the process forward."
Among the group's recommendations were the repeal of the relevant sections of the Offences Against the Person Act to be replaced with a termination of pregnancy act stating conditions under which medical termination of pregnancy would be lawful.
therapeutic abortions
They also said that the Government should develop, maintain and staff specified centres in each health region for the provision of therapeutic abortions. Pregnancies over 12 weeks' gestation should be performed only by authorised medical practitioners and in registered facilities; pregnancies over 22 weeks' gestation were not recommended except under exceptional circumstances agreed by the woman and two authorised medical practitioners.
Subsequent to the submission of the report, which also had references to the legal position in other Caribbean countries, the Ministry of Health has since advertised for a consultant to help guide the public discussions.
In her letter, Dr Patterson noted that not all members of the advisory group signed off on the draft report.
Among those who did not sign the draft report were the Rev Phillip Robinson, who sat on the committee in his capacity as president of the Jamaica Council of Churches at the time, and Mrs Sheila Jones, representing the Nursing Council of Jamaica. The Nursing Council representative did not sign the draft report, reiterating its position of supporting abortion only in instances of a threat to the life of the mother, incest and rape. This was attached to the advisory group's report.
Rev Robinson told The Sunday Gleaner that he had not been able to have sufficient consultation with the wider church community - apart from a meeting called at short notice and attended by representatives of the Roman Catholics and Ethiopian Orthodox Church, and so did not consider it appropriate to sign the document at the time of its drafting.
He said, however, that during the meetings there was a high percentage of medical personnel, the perspective of the Church was sought and it was always understood and stated that there would be wider public consultation. He noted, too, that the position of the Jamaica Council of Churches is that the laws need to be revisited and if necessary, revised not only to protect medical personnel, but also the life of the unborn.
ethical perspectives
"The medical personnel were largely guided in the deliberations by the reports they were getting from within their profession about the number of botched abortions. But they did give consideration to wider ethical perspectives and concerns," Rev Robinson said. He added that he was not of the opinion that the advisory group was recommending "abortion on demand", meaning that persons could just walk into a facility and obtain an abortion as a matter of course.
Beryl Weir, a member the advisory group and director of the Women's Centre Foundation of Jamaica, also told The Sunday Gleaner that there was vigorous discussion among members of the group taking into account the law as it existed in Jamaica and elsewhere, considerations of ethics, and conscience, as well as social realities that obtained in Jamaica.
She stressed that the matter of counselling was highly recommended for persons who might be seeking an abortion, given the experience of professionals working with women who may have been traumatised by the circumstances of their getting pregnant.
"It is inaccurate to suggest that we were recommending abortion on demand," she said. "In fact, in my experience at the Women's Centre, often after the girls are counselled, they indicate that they do not want to have an abortion. And the counselling aspect is strongly advocated in the draft report. The next step is to get them into a programme that will allow them to have their babies while continuing their education. However, it is also a fact that many women are very clear that they do not want to carry the pregnancy to full term and will have an abortion by whatever means."
She said the challenge for the public-health system is that in the absence of proper facilities, women resort to various risky back-door methods which often later end up as serious public-health issues.
Now, whatever, the context and contents of the advisory group's report, the position of many Christians is unambiguous. Neither rape (including statutory abuse of a minor) nor incest is good enough grounds for the termination of a pregnancy. The argument goes that just because a man has committed a crime against a woman, that is no good reason for her to commit one herself by taking a life. Activists for women's rights have rejected this position saying that essentially the woman is being forced to be a container for a foetus even in cases where she herself was an unwilling victim in the process.
While the Christian coalition has argued that its primary concern is the sanctity of life, there is also the view that a more liberal legislative framework effectively sanctions indiscriminate sexual behaviour and makes it far too easy for people to opt out of the consequences of their actions.
An he was not a member of the coalition, Roman Catholic deacon and Gleaner columnist Peter Espeut captured this view well when he wrote in his column last Wednesday: "Both the man and the woman made the earlier choice to have sexual intercourse. When they made that choice, they would have known the consequences. We are skirting the real issue: All this talk of abortion is about trying to avoid the consequences of irresponsible sexual intercourse." That position of course, is a distortion of the various levels of concerns that people have about the issue.
delineation
While the Christian coalition was very clear at its February 7 press conference that it would oppose the proposals that would allow "safe abortions", media reports suggest that they did not address the question of whether there should be any delineation regarding incest or rape and if so, what the law should say about those circumstances.
Roman Catholic Archbishop of Kingston Donald Reece told the press conference that some church-related groups were "seriously engaged in setting up facilities that would assist pregnant women to term their pregnancies with the possibility of adoption".
In the meantime, however, the Women's Centre Foundation of Jamaica, now in its 30th year, has one of the more visible places of refuge for teen mothers. It continues to limp along in the service it provides to hundreds of girls under the age of 15.
Weir noted that some churches and agencies, for example Jones Town Baptist, Braeton Methodist and St Patrick's Foundation, have allowed their facilities to be used as satellite centres for the training of the teen mothers.
Hundreds of children given up for adoption remain as wards of the State for many years and the centres caring for teen mothers languish for lack of financial support.