THE LIMITS OF CHOICE
Abortion in Asia is seldom as black and white as the ‘pro-life’ versus ‘pro-choice’ arguments that dominate Western discourse.
‘Keeping it was never an option,” says Rara, a woman in her 20s from Jakarta. It was 2017 and Rara (not her real name) was studying communication at a private university in the Indonesian capital. After becoming pregnant by her unmarried partner, who had another girlfriend at the time, she felt she could not disappoint her devout Muslim parents.
Rara’s circumstances led her to a small clinic in Raden Saleh, a district in Jakarta well-known for providing illegal abortions. Outside, peddlers were scouting for customers, asking female passersby, “Are you late?” — a coded offer of pregnancy termination services.
Speaking to Nikkei Asia over the phone, Rara’s voice shook as she recounted her experience. She recalled feeling nervous, and the lack of any apparent compassion in the doctor and nurse who tended to her. She was conscious throughout the procedure. “It was traumatic,” she said, in tears.
Following her abortion, Rara suffered throbbing pain every month when she had her period — pain she put up with for a year before plucking up the courage to visit a doctor.
Abortion is illegal in Indonesia except in cases of rape or when the mother’s life is in danger. Women found guilty of undergoing illegal abortions can be subject to up to 10 years in prison.
Rara confessed that her view on abortion remains complicated, despite having experienced one herself. Before the procedure, she said, “I could never imagine killing a living being, including a foetus. But when I remember that it happened to me, regardless of whether my foetus was alive or not, I think that women in situations like mine must be well accommodated” with safe and legal abortions.
Rara is one of around 36 million women who have abortions in Asia each year, according to data released in 2017 by the Guttmacher Institute, a US-based sexual and reproductive health and rights research organisation. The same data shows that 6% of maternal deaths in the region in 2014 were caused by unsafe abortions.
Across the continent, the right to an abortion remains a contentious issue, located at a complicated intersection of religion, culture, law and politics.
An impending decision by the US Supreme Court to overturn the landmark Roe v Wade case of 1973, which would end the right to safe and legal abortions in many states, marks a potential turning point for women’s reproductive rights in the West.
In Asia, however, abortion is seldom as black and white as the “pro-life” versus “pro-choice” arguments that dominate Western discourse. Many countries have recently liberalised abortion laws — from Thailand to South Korea — while some formerly “liberal” countries, such as China, have begun to examine restricting abortions in response to demographic pressure.
Abortion in Asia presents a contradiction: Thousands of women die every year due to illegal and unsafe abortions, a compelling case for more liberal laws. However, every year in countries where abortion is legalised, such as India and Vietnam, thousands of female foetuses are aborted in the pursuit of a male child.
Even in countries where abortion is broadly legal, such as Japan, the issue is too far entrenched in demographics and social norms to be viewed through the lens of female autonomy.
“[Abortion policies] are not about the advancement of women’s rights here. Here, [abortion] is more about population control,” said Masako Tanaka, a professor of gender studies at Sophia University in Tokyo.
The same rings true for countries across Asia. From China to Bangladesh, abortion plays a role in limiting, expanding and altering populations.
POPULATION BOMB
The first country in Asia to legalise abortion, Japan introduced the procedure as part of the Eugenic Protection Act (now revised as the Maternal Health Act) in 1948. The population was booming following soldiers’ return from World War II, but a postwar economic downturn threatened food security.
To curb population growth, the Act was updated in 1949 to permit abortion for economic as well as medical reasons, and in cases of rape. It also allowed the voluntary and involuntary sterilisation of women with hereditary diseases, mental illnesses and intellectual disabilities. The law required married women seeking an abortion to get written consent from their spouse.
By the early 1960s, annual births in Japan had fallen from an all-time high of 2.7 million in 1949 to around 1.6 million.
“It’s impossible to say whether the legalisation of abortion directly brought about a decline in the birthrate, but state intervention in family planning after the war can certainly be seen as a success,” said Isabel Fassbender, an assistant professor at Doshisha Women’s College in Kyoto.
As long as Japan’s population was growing, attitudes towards abortion remained relatively lax. Yukako Ohashi of the reproductive rights group Soshiren recalled how, in the 1960s, doctors would often knowingly accept a fake spouse’s signature from a woman wanting an abortion. “It’s only in the last couple of decades that doctors have got strict about the spousal consent law,” Ohashi said.
It is not unusual for unmarried women to be turned away by doctors for failing to present the signature of a male partner — there are even cases of rape victims being asked to provide the signature of their abuser.
Campaigners have been calling for the requirement of spousal consent to be erased. But policymakers are making no moves towards reform.
Fassbender doubts Japan’s abortion laws will be updated so long as the population is declining.
In China, too, access to abortion is shaped by demographics. The procedure was a legal and widely available measure to curb population growth under the one-child policy, which was introduced in 1980. Parents with unauthorised pregnancies could face serious fines, compulsory sterilisation and forced abortion.
The Chinese government estimated that, by 2016, some 400 million births had been prevented by the policy, although some analysts dispute this finding.
But as China’s population growth slows, restrictions on abortion could be on the horizon. Abortion remains legal, but the State Council in 2021 laid out guidelines calling for a reduction in “non-medically necessary abortions”.
Despite China’s population growth reaching its slowest pace since 1960 last year, abortions have been increasing every year since 2017, according to the National Health Commission. The total averaged roughly 9.5 million per year for the past five years.
The National Population and Family Planning Commission in February said it plans to reduce teenage and premarital pregnancies to decrease the number of abortions, amid concerns of an ageing population.
Although these statements are seen as signals of more restrictions, activists think legal abortions are here to stay.
“The policy has not changed and will not likely change … because China believes in eugenics,” Lu Pin, a journalist and leading Chinese feminist, told Nikkei. “The Chinese government and individuals both worry about the births of unhealthy infants.”
SEX SELECTION
In India, home to 17% of the world’s population, abortion has also historically played a role in shaping the population. As a perverse result of the legalisation of the procedure in 1971, many foetuses identified as female get aborted as couples try for male children. According to India’s latest National Family Health Survey (201921), an average of 929 girls were born for every 1,000 boys over the last five years.
Especially in rural areas, traditional gender roles and the belief that a male heir is required for family businesses lead many couples to seek abortions of female foetuses. A girl is often seen as a financial burden who will be married off and sent to another house with a dowry.
Abortions for sex selection are illegal under the 1971 law, and doctors are forbidden from telling patients the sex of an unborn child. But many go abroad to find out the sex and then visit illegal clinics for an abortion, if they can afford it. Around eight women a day die in India due to unsafe abortions, according to the Guttmacher Insitute.
Another country where sex selection is rife is Vietnam, which has the world’s third-highest abortion rate. The country averaged 64 abortions per 1,000 women annually from 2015-19, lower only than Georgia and Azerbaijan.
At a sleek clinic in central Ho Chi Minh City, for example, the walls are bare but for a small sign made by the office printer and directed at the ultrasound technicians: “Do not reveal the gender of the baby.”
Traditionally, male children were favoured in Vietnam in order to continue the line of succession, whereas girls would leave the family to move in with in-laws after marriage.
But male preference is not the only reason for the high abortion rate. The US military’s use of the dioxin-laced defoliant Agent Orange during the Vietnam War, and the deformities it continues to cause, also play a role, as do the relatively large population of 99 million and the fact that women’s rights are core to the communist ideal of equality.
Among women who terminate pregnancies, some are wary of birth defects if they have been exposed to dioxin, while others fear passing on HIV and other diseases, according to research by anthropologist Tine Gammeltoft.
Abortion has been legal since the 1960s, and was key to the government’s two-child policy, which was introduced in 1988 and halved the birth rate from 4.2 to 2.1 children per woman within two decades of being implemented.
The two-child policy was reversed five years ago. Son preference is also waning, and Vietnam now treats reproductive rights as human rights, said Nguyen Thi Thuy Hanh of the population department at Hanoi Medical University.
MORAL MINORITY
Restrictions on abortion are especially strong in countries with entrenched religious beliefs, such as in Muslim Bangladesh, the Catholic Philippines, and Buddhist Thailand.
In Bangladesh, abortion remains strictly illegal. But backstreet abortions are common — the Association for Prevention of Septic Abortion, Bangladesh (Bapsa) provides post-abortion care to around 90,000 women suffering from complications caused by unsafe abortions every year, according to its director, Dr Altaf Hossain.
Religion also underpins attitudes in the Philippines, which forbids the procedure with some of the strictest laws in the world. The penal code punishes a woman who undergoes and anyone who assists an abortion with up to six years of imprisonment.*
But anecdotal evidence shows more Filipinos have started to adopt an open mind on decriminalising abortion, said lawyer Clara Rita Padilla of the Philippine Safe Abortion Advocacy Network (Pinsan). Around 30,000 people have signed a Change.org petition launched by Pinsan calling for the decriminalisation of abortion.
President-elect Ferdinand Marcos Jr has said he supports abortion in limited cases. Such a stance risks a clash with the influential Roman Catholic Church, to which more than 80% of the population belongs.
“The church’s teaching on abortion does not change and isn’t changing,” said Father Jerome Secillano, a spokesman for the Catholic Bishops’ Conference of the Philippines. “The church considers [abortion] plain murder no matter the circumstances.”
In Thailand, abortion was narrowly legalised in 2021 in a last-minute effort by lawmakers to maintain some penalties on women and abortion providers. Before the amendment, women found guilty of abortion faced up to three years in prison and abortion providers up to five years.
Abortions are now legal under any circumstances if performed no more than 12 weeks into a pregnancy. Passing the law was a stopgap measure that came after the Constitutional Court ruled the previous penalties unconstitutional. A proposal by the opposition Move Forward Party to allow abortion up to 24 weeks was rejected by the House.
In South Korea, conservative Christians, who make up 30% of the population, and demographic pressures kept abortion illegal until last year. Dubbed “a win for women’s rights” by the International Planned Parenthood Federation, South Korea decriminalised abortion in 2019, ruling punishment for women and doctors who have or perform abortions was unconstitutional.
But the country’s Christian community remains largely opposed to abortion and is lobbying legislators to reflect their beliefs in the pending revisions of the criminal law.
CHOICE AT A PRICE
Access to abortion is considered essential by feminist campaigners in the US, but in several Asian countries, access to abortion can in fact threaten women’s bodily autonomy.
In Indonesia, a case of forced abortion went viral in late 2021, graphically demonstrating how access can be misused. A woman named Novia Widyasari from Central Java was forced to take an illegally obtained abortion pill by her policeman boyfriend, Randy Bagus, after twice falling pregnant by him.
Social pressure not to have children out of wedlock, largely fuelled by Islamic beliefs, led Bagus to fear he would lose his job if Widyasari went through with the pregnancy.
Already depressed after being forced to abort her first child, Widyasari committed suicide four months after Bagus coerced her to abort her second, by poisoning herself with potassium in December 2021.
Bagus was fired from the police force and sentenced to two years in prison for his involvement in an illegal abortion.
There was an attempt to include forced abortion as a criminal act in Indonesia’s new Bill on Eradication of Sexual Violence, passed in April, but to no avail. Coercing a woman into an abortion is still not a criminal offence.
Even in countries where forced abortions are rare, legal access to abortion does not necessarily equate to more female autonomy. In Singapore, for example, although women can terminate pregnancies up to the second trimester, they are legally required to undergo counselling and must wait 48 hours before consenting to the procedure.
Women’s rights activists argue that the counselling rule prevents women from freely making decisions. “Counselling and waiting periods may give the impression that seeking an abortion is reprobate or morally unsound — something to feel guilty or regretful over,” said Shailey Hingorani, head of research at the Association of Women for Action and Research in Singapore.
[Abortion policies] are not about the advancement of women’s rights here. Here, [abortion] is more about population control
MASAKO TANAKA Sophia University, Tokyo