Sunday, November 19, 2006

Why I'm glad I don't live in Guatemala

This report by the Guttmacher Institute on Abortion and Postabortion Care in Guatemala: A Report from Health Care Professionals and Health Facilities covers the unsafe abortion procedures currently occuring in Guatemala.

Guatemalan women have an average of 4 to 6 children each, and the average Guatemalan woman has one more child than she would like. Only 1 in 3 uses any form of modern, reliable contraception, and 1 in 3 children born were unplanned pregnancies. Abortion in Guatemala is illegal except in very rare circumstances to save a mother's life (and even then, it is hard to find). Wealthier urban women tend to receive their abortions from legitimate doctors. Poorer and rural women induce their own abortions, have a friend or relative do it, or go to a witch doctor or pharmacist. Overall, between 40% and 75% of women who have a clandestine abortion in Guatemala are hospitalized for complications following the procedure. Even when an actual gynecologist performs the procedure, 17% of rural women are hospitalized following the procedure for a variety of reasons (including language barriers and poorer overall health and well-being). Even hospital care for post-abortion complications is poor, and approximately 17% of maternal deaths are due to abortion complications. The burden of these complications on the already-strained health care system is significant.

Why? There is a lack of education about birth control/family planning and lack of access to quality family planning services. Access is difficult for women who are too poor to travel across town or to another village for care/services.
Why? Overall, there is poverty and a lack of money to spend supplying birth control pills and condoms to the population, and there are cultural issues as well.
Why? There are two kinds of people in Guatemala. There are the indigenous peoples (like Native Americans) and people of Spanish descent. The indigenous peoples do not speak Spanish as most of the doctors do, they tend to be very poor, and there are cultural issues with women seeking care from male doctors and pharmacists. The Spanish portion of the population is overwhelmingly Catholic and so they do not actively seek birth control services. However, a poor woman with two or three children already who finds herself pregnant again must have some sort of emotional and religious crisis when she decides to seek a clandestine abortion.

Note: the advent of the RU-486 abortion pill has made abortion much safer in Guatemala as hemmorhage and infection rates are much lower with the use of the drug. This makes sense since two of the major complications of abortion in Guatemala are bleeding due to puncturing the uterus after introducing a foreign body to the uterus to cause the abortion and infection caused by unsterile conditions and the introduction of a foregin body to the uterus. The abortion pill (not to be confused with Plan B, the morning after pill, which does not cause abortion) basically interrupts all the hormonal signals sent by the embryo and then induces contractions to expel the embryo. No foreign bodies need to be introduced anywhere and no tools have to scrape anything. No tools = lower infection rates.

Why am I telling you this? Because I want you to know that I am glad I do not live in Guatemala. I am thinking about a possible, theoretical baby #2 someday. If I develop HELLP or pre-eclampsia and need to end a pregnancy, I can. If I discover that my fetus carries a fatal, painful genetic condition, I can end the pregnancy and prevent the futile pain my baby would suffer. I have access to high-quality birth control and can (to some degree, infetility notwithstanding) control how many children I have and when. I live in a country where men and women are mostly equal and no man can force me to have sex with him if I don't want it. He cannot refuse to use a condom and get me pregnant against my will.

I am not pro-abortion. I don't think anyone really is. I think we are all pro-life, and some of us are also pro-choice at the same time. I'm really pro-empowerment and pro-education. Having a baby, though, has taught me a lot of things, and since his birth, I have become a lot more pro-choice for the following reasons:
  • I loved and wanted him so much, I cannot imagine being pregnant and not feeling that or resenting my baby. It must be just horrible.
  • I loved and wanted him so much, if anything were wrong with him or if he was doomed to die at birth or suffer at all from some medical condition, I almost feel I would be obligated to prevent that pain.
  • I now know just how much work a healthy, full-term baby is under ideal circumstances.
  • I have learned a lot about HELLP and pre-eclampsia, prematurity, and other conditions that often necessitate that a pregnancy be ended (usually rather late) to save the life and health of the mother. Women who do this are often heart-broken as they were sick and their bodies made their babies sick and they wanted their babies, but if they did not end the pregnancy not only would the baby not live anyway, the mother would die too.
Even as a teenager, I had access to effective, high-quality birth control. Right now, I could get probably eleven kinds of birth control if I wantd them (let's count: birth control pills, IUD, diaphragm, cervical cap, sponge, condom, female condom, NuvaRing, Ortho Evra patch, Depo injections, NorPlant and that other new implant, foam, spermicidal gels/creams, tubal ligation, vasectomy, and natural family planning methods...that's 17). All this is to say, I am really glad I don't live in Guatemala.

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