World View : Faith & Practice : A Changing World Puts Abortion in the Spotlight

NEW DELHI —  In the street below, vendors hawked incense, guavas and sugar-cane juice while a Hindu priest intoned mantras to Lal Sain, a water god. On the top floor of a dirty-yellow, two-story house the doctors and nurses were ready for the next patient.

The gynecological table with its steel stirrups had been covered with a worn but clean green sheet. The room reeked of disinfectant. If all went well, the surgery, performed 10 times a day on average, would take five minutes.

A client, probably a married woman who did not want a third or fourth child, would climb onto the short metal table and be given a numbing shot of Xylocaine. Ignoring the clamor of the market and temple outside, Dr. Renu Gupta or a colleague at the clinic in Delhi’s Lajpat Nagar neighborhood would gently insert a thin plastic tube into the pregnant woman’s uterus.

A vacuum pump, sucking with 250 millimeters of mercury pressure, would inhale the embryo growing in her womb. In minutes, the nucleus of life would be reduced to a small mass of tissue and fluids at the bottom of the pump’s intake jar. An orderly would dispose of it.

Abortion.

It arouses such passion in the United States that a few of its opponents have been spurred to commit murder, but the procedure has never been more prevalent worldwide.

According to a study conducted by several specialists on behalf of the World Health Organization, an estimated 30 million legal abortions are performed annually, as well as another 20 million “unsafe”--a euphemism for illegal--abortions.

Fifty million artificially terminated pregnancies each year--the equivalent of the population of a country such as France.

In the United States, the legal right to an abortion, laid down by the Supreme Court in the 1973 Roe vs. Wade case, was a landmark victory for the women’s rights movement. (The anniversary of that decision was Monday.) But taking a Western perspective to generalize about the social effects of the wider availability of abortion can be misleading.

Take India, for instance. Many activists fear that the liberal 1971 Medical Termination of Pregnancy Act, which allows any woman to end an unwanted pregnancy during its first 20 weeks, may in fact end up diminishing the standing of women, since many couples, to avoid having daughters and the eventual cost of their marriages, get sex-determination tests and abort female fetuses.

By 1991, the sex ratio in the Indian population had tilted to 927 females per 1,000 males. Parliament last July made it a crime, punishable by three years inprison, for operators of ultrasound clinics to divulge the sex of a fetus to an expectant mother. But the economic stakes are so enormous--a daughter’s marriage dowry can ruin a family--that the law is not expected to be effective.

In China, abortion has become a chilling tool in the hands of the Communist Party leadership to enforce its one-child per couple demographic policy. In the last decade, an estimated 100 million pregnancies have ended in abortion as the rate climbed to one termination for every two live births. In the world’s most populous country, abortion now is often not a matter of choice, but a duty imposed by a salaried state functionary.

“Family planning cadres in the countryside often force abortions as late as the sixth month of pregnancy,” a female Chinese physician said. “Sometimes women in the countryside try to hide, but they can’t hide forever.”

Perhaps controversy is inevitable, for few contemporary issues pose more difficult questions than abortion: about individual rights, religious teaching, the state’s interest in protecting citizens yet to be born, a woman’s place in society, whether sex need result in procreation. Often, a country’s stated policy cloaks a shockingly different reality.

Emotion-charged wrangling about abortion nearly wrecked the International Conference on Population and Development last September in Cairo. The Vatican, the world’s most influential opponent of abortion, joined with some Muslim countries to stymie plans by Western activists to get abortion declared a woman’s right. Some conference participants accused anti-abortion forces of pious deceit.

“Morality becomes hypocrisy if it means accepting mothers suffering or dying in connection with unwanted pregnancies and illegal abortions, and unwanted children living in misery,” Prime Minister Gro Harlem Brundtland of Norway said.

Of course, how one defines morality often depends on one’s religious upbringing. Though the world’s great faiths all preach the sanctity of life, they are far from unanimous when it comes to abortion. The Roman Catholic Church considers it “an abominable crime.” But at the Marie Stopes Clinic, Dr. Gupta experiences no ethical qualms about her work.

“Hindus,” the 30-year-old physician explained, “feel that a person has a soul only after it’s been born, after nine months.”

Whatever one’s judgment on abortion, the worldwide estimate drawn up for WHO includes one number that can please nobody. According to sociologist Stanley K. Henshaw of the Alan Guttmacher Institute, a U.S.-based research institute and lobby that promotes individuals’ “reproductive rights,” each year 50,000 to 100,000 women die after receiving an abortion in unsafe or unsanitary conditions.

In many cases, these are women desperately attempting to circumvent laws making abortion a crime or, in a cruel paradox, deliberately incurring risks to their own health because abortions are legal only when pregnancy is deemed a threat to a woman’s life.

In Brazil, Colombia, Chile, Mexico, Peru and the Dominican Republic, abortion is banned except for the strictest medical reasons. In these countries, a 1992 study by the Guttmacher Institute found, women may be penetrated with pencils, jump from a tree, have their husbands punch them in the stomach, gulp down laxatives or introduce bleach, cheap hair dye, laundry bluing, geranium stalks or tea made from boiled coins into their vaginas in the hope of bypassing the law.

In those Latin American countries alone, the institute estimated, 4 million clandestine abortions occur each year. If their laws are meant to stop abortions, they are not working.

Asked why she had chosen this month to have a doctor terminate her pregnancy, Poonam, 23, a Delhi housewife, answered: “I decided to have an abortion because of problems in the family.” Married to a factory worker and already the mother of a 1 1/2-year-old son, the shy young woman did not want to say more.

“I decided.” For more women than ever, it is that simple, and that sums up the most important trend governing access to abortion throughout the world. Despite what Henshaw terms “eddies” of resistance--he mentions the United States, Iran and Poland, where abortion laws have been tightened or anti-abortion movements have gained strength--he believes that the overall trend will continue.

In many instances, he says, a Malthusian logic seems to be at work. As societies become more prosperous and lifestyles change, “people are beginning to want fewer children. As long as that happens, people are going to be turning to abortion and contraception,” Henshaw said in a telephone interview.

Temporarily legalized for the first time in the Soviet Union in 1920 as a badge of proletarian sexual freedom and equality, abortion in some form is now widely permitted in every country of Western Europe save for Ireland and Malta, where it is banned except to save the mother’s life.

But just as forbidding the practice does not stop it, legalization does not silence those who oppose it. And opponents include some of the world’s top leaders. Pakistani Prime Minister Benazir Bhutto, an American-educated Muslim and a mother of three, says: “The Holy Book tells us: “Kill not your children on a plea of want. We provide sustenance for them and for you.’ ”

There remains no worldwide consensus on this deeply moral issue.

Abortion was one of the thorniest issues that had to be resolved before German reunification, and following a May, 1993, ruling by the Constitutional Court that abortion was technically illegal in most cases, the question remains so divisive that German lawmakers were unable to come up with new legislation last year.

In Chile, abortion is illegal and can lead to a 15-year sentence. But Chile has Latin America’s highest abortion rate, said Dr. Rene Castro, head of the Health Ministry’s maternal perinatal health program.

The Guttmacher study estimated that 35% of Chile’s 450,000 annual pregnancies are terminated artificially. Many Chilean women who do not want children must resort to a “scraping” by an uneducated midwife working secretly in her home. These amateur abortions, costing $175 to $350, often result in hemorrhaging and land the patient in an emergency room.

In Ireland, a predominantly Catholic country where abortion is outlawed, the per capita abortion rate is now believed to be higher than in the Netherlands, where there is no legal prohibition. Each year, at least 4,000 Irish women cross the Irish Sea to Britain, where a 1967 law allows doctors to terminate pregnancies up to their 24th week.

A 1992 uproar over constitutional laws that barred a 14-year-old rape victim from leaving Ireland for an abortion led voters to pass a referendum endorsing the liberalizing of information about abortion and overseas travel for the operation. But the government in Dublin has balked at passing enabling legislation.

“The church is against it and is fighting a delaying action,” one government official said. “Politicians realize it is a hot potato, and aren’t pushing.”

To date, there are only scattered, pale parallels abroad to the high-decibel and sometimes lethal abortion debate in the United States. (In the last 22 months, according to one press account, two American doctors, two clinic staff members and a voluntary escort have been slain. In the last 12 years, these accounts say, here have been 123 cases of arson and 37 bombings in 33 states, and more than 1,500 cases of stalking, assault, sabotage and burglary linked to abortion.)

In Asia and Europe, people are bewildered by that level of anger and violence.

“When someone opposes abortion on the grounds that they value life, how can they turn around and murder someone?” asked Kazunari Yamada, 40, an aide to a member of the Japanese Parliament.

Foreign opposition to abortion is sparse and generally low-key. The most militant anti-abortion movement is in France, where in the 18th Century anyone helping to perform an abortion could be clapped in irons for 20 years.

Two years ago, France’s legislature outlawed interference with abortions--they have been legal since 1974--but bands of protesters have been invading hospitals and clinics, chaining themselves to operating tables. Members of the prominent Truce of God group, founded by a Catholic mother of eight, Claire Fontana, are suspected of harassing doctors, but no incidents of violence have been reported. Last week, Fontana and six fellow activists were given fines and suspended sentences for occupying a surgery wing at a Grenoble hospital.

“I promise you that it’s not over, that the rescue can’t be stopped,” Fontana vowed.

In Norway, opposition to the 1978 law allowing unconditional abortion during the first 12 weeks of pregnancy is led by a former minister fired by the state Lutheran Church. He displays model fetuses smeared with ketchup, but disavows violence as a tactic.

Heavily Catholic Poland, where presidential elections are scheduled this autumn, may be the only other country where, like in the United States and France, abortion has become a divisive, hot-button national political issue. President Lech Walesa, a devout Catholic and father of eight, is an ardent foe of abortion rights. He will likely face a strong opponent from one of several left-wing parties, which have been pushing unsuccessfully over the last year for an easing of abortion restrictions.

Under communism, abortion was available to Polish women virtually on demand, but with church backing, Parliament in 1993 voted to allow abortion in just three cases: when a woman’s health is threatened, when a prosecutor determines the pregnancy resulted from a crime, or if the fetus is badly deformed.

In African countries such as Kenya, restrictive abortion laws have led to some horrifying consequences. Every day on a hilltop overlooking Nairobi, injured girls and young women limp or are carried through towering groves of eucalyptus to the door of Kenyatta Hospital, one of sub-Saharan Africa’s largest.

Their bellies are swollen with infection, their faces feverish. Some are bleeding freely from internal puncture wounds. Nearly all are young, in their teens and 20s.

Some days there are three, some days many more--1,600 last year at Kenyatta hospital alone.

“They say they were pregnant and everything was fine, then they got sick like this,” Dr. Augustin Muita said.

What they do not say is that in a tin-roofed shack in one of Nairobi’s sprawling shantytowns, or in a mud hut in a village, they could not endure the thought of providing for another child. Often, they end up mutilating themselves with a knitting needle.

Public health tragedies such as Kenya’s, where fully half of all maternal deaths are linked to abortion complications, are cited by proponents as the most telling argument for legalizing abortion. On Africa’s plains or in industrialized Europe, they say, the only realistic alternative is back-alley operations, fear, injury and death.

The issue is nearly the same in the developed world.

“I don’t favor abortion, nor would I ever have recourse to it myself,” said Marilena Longhi, an Italian Catholic and a mother. “But I realize the need for some kind of legislation in this day and age, if only to prevent the practice of dangerous, life-threatening clandestine abortions.”

Italy took that step in 1978, when in the face of strong Vatican opposition, Law No. 194 was adopted by Parliament in a bitter legislative fight.

But in many highly religious countries, tradition, religious orthodoxy or simple modesty make it impossible to speak of abortion as a right or alternative.

Aziza Hussein, leader of Egypt’s non-governmental National Committee for Population and Development, believes that it is smarter to work behind the scenes to make safe abortion available to women who need it. Try to put the item on the political agenda, and you arouse hostile public debate, she said--as the Americans have done.

“We need education, slowly and in a credible way,” Hussein said. “Start with politics, and you go to war.”

Contributing to this article were Times staff writers Tyler Marshall in Brussels, Rone Tempest in Beijing, David Holley in Tokyo, William Tuohy in London, Marjorie Miller in Bonn, Dean E. Murphy in Warsaw, John Balzar in Nairobi, Kim Murphy in Cairo and Mary Curtius in Jerusalem. Researchers Eva Vergara, Susan Drummet, Chiaki Kitada, Megumi Shimizu and Janet Stobart also contributed.