Wikipedia

Abortion in Madagascar

In Madagascar, abortion is illegal in all circumstances. The abortion law punishes receiving or assisting in an abortion with imprisonment or fines. It is one of the only countries with a total abortion ban.

Abortion has been illegal since the French colonial era, influenced by attitudes favoring increased births. In 2017, the government rejected a proposal to legalize therapeutic abortion. In November 2021, Member of Parliament Masy Goulamaly introduced a bill allowing abortion in the case of rape. The parliament withdrew the bill.

Most people in Madagascar oppose legalizing abortion. Churches which oppose abortion influence politicians. International organizations have called for the legalization of abortion. The abortion-rights group Nifin'Akanga leads research and protests.

Abortions in Madagascar are unsafe and are a major cause of maternal death. Some abortions are performed clandestinely by medical professionals. Some women self-induce abortions or seek traditional remedies from traditional midwives. Madagascar has low use of contraception.

Legislation

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Article 317 of the penal code of Madagascar says women who receive abortions can be punished by six months to two years of prison or a fine of 2 million ariary. It sentences people who assist in an abortion to one two five years of prison and a fine of 360 thousand to 10.8 million ariary (€80 to €2,500), or higher for repeat offenders.[1]

As of 2020, Madagascar is one of thirteen countries that completely bans abortion.[2] Post-abortion care is legal.[3]

Public opinion

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According to a 2022 survey by Afrobarometer, 96% of Malagasy oppose the legalization of on-demand abortion, and 85% in the case of rape. However, 65% approve of abortion if the pregnancy is risky.[4]

The Catholic Church in Madagascar and the Church of Jesus Christ in Madagascar completely oppose abortion.[5] Marie Fabien Raharilamboniaina, head of the Episcopal Conference of Madagascar, has argued that the life of the infant is sacred.[6] The church is influential on the electorate, and politicians fear losing its support.[7]

History

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Madagascar's law was inherited from the French Penal Code of 1810.[2] On 15 June 1898, Governor-General Joseph Gallieni issued a decree of "diverse measures aimed at favoring the growth of the population in Imerina". It criminalized abortion. The government believed the Madagascar had a high abortion rate because a lack of medical facilities caused women to fear abortion. Gallieni believed the ban would reduce deaths during childbirth.[8]

During the colonial period, Christian views, such as sexual morals, were associated with social mobility. In 1920, a French law banned contraception and abortion, with the intent of increase birth rates. Madagascar retained this law until amending it in December 2017.[9]

21st century

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In 2003, Madagascar signed the Maputo Protocol, which guarantees a right to abortion, but did not ratify it.[1] In late 2007, multiple United Nations agencies suggested decriminalizing abortion. The Catholic Church and President Marc Ravalomanana appeared to state their disapproval.[3][10]

Since 1984, Republican presidents of the United States implemented the Mexico City policy, which prohibited U.S. federal funding for foreign organizations that advocate for abortion. On 23 January 2017, Donald Trump reinstated and expanded it.[11] Madagascar was strongly impacted by the policy as it had few foreign donors.[12] The United States Agency for International Development (USAID) funded non-governmental organizations that supported the Ministry of Health (MOH) and supplied contraceptives to health facilities. In 2014, 85% of the country's sexual and reproductive healthcare funding came from USAID, followed by 11% from the United Nations Population Fund.[3] Without training from NGOs, public-sector providers were unable to provide long-acting or permanent contraceptive methods.[11] Women in Madagascar faced higher fees, stock-outs, and further distances to access contraceptives.[13] Some had unintended pregnancies. Madagascar's government listed the loss of USAID funding as an obstacle to its family planning commitments.[3]

Two international NGOs, including MSI Reproductive Choices were major contraception partners of the MOH. Both refused to sign the Mexico City policy because they advocate for the legalization of abortion, though they do not provide illegal abortions.[3][12] Its Madagascar funding was redistributed to organizations such as Population Services International.[12] It stopped receiving $3.5 million of USAID funding, which had been nearly half of its funding in Madagascar. In 2018, it recovered $1 million.[3] It scaled back on 21 of its 22 contraception clinics and shut down its voucher program that provided free contraceptives.[14][15] It ended support to 100 public and 90 private health facilities. It returned twelve vehicles, which it partly replaced through a donation, which were transferred to a U.S. organization.[3] In 2021, Joe Biden reversed the policy.[13]

In December 2017, the parliament rejected a proposal to decriminalize therapeutic abortion. It was opposed by politicians and the public.[16] Nifin'Akanga led a debate in protest. Participants argued that abortion was a public health issue and chanted "Keep your rosaries off our ovaries!"[7] In 2022, a committee continued to look into the draft law.[17]

The University of Antananarivo hosted the country's first event for International Safe Abortion Day in 2019.[18] In December 2019, a visiting delegation from the African Union advocated for Madagascar to ratify the Maputo Protocol.[3]

During the COVID-19 pandemic, use of family planning in health centers went down by 40%. This led to an increase in unwanted pregnancies and abortions.[2] MSI received government permission to use its buses to deliver services to women's homes and take women to health facilities.[19]

Nifin'Akanga is an abortion-rights group. It is named after an herb used intravaginally in illegal abortions.[16] In 2021, a documentary about the group's research was shown at the Institut français de Madagascar [fr] and broadcast on the radio.[20] In May 2022, the group led a protest with founding member Mbolatiana Raveloarimisa outside of the National Assembly.[1] When France declared a constitutional right to abortion, Raveloarimisa spoke at the ceremony.[21]

2021 proposal

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On 2 November 2021, independent MP Masy Goulamaly introduced a bill allowing abortion in the case of rape or incest.[1] She emphasized that her proposal would provide for abortions when medically necessary, not on-demand.[22] The president of the National Order of Physicians, Eric Andrianasolo, supported legalizing abortions performed to protect health. The deputy of the ruling MAPAR [fr] coalition, Aina Rafenomanantsoa [fr], opposed the bill on the grounds of fetal rights.[23] Catholic Church lobbied against the bill.[24]

The government did not comment on the bill. On 17 May 2022, it was withdrawn without deliberation.[25] Rapporteurs said the bill was "incompatible with Malagasy values". Supporters of the bill on social media said the decision was hypocritical and criticized President of the National Assembly Christine Razanamahasoa for opposing the bill. Women's rights activist Marie Christina Kolo said the decision was "insupportable".[24] Goulamaly proposed an abortion law every year.[26]

In March 2024, Razanamahasoa said she supported wider debate and awareness about abortion. She said the situation in Madagascar was "kind of special" due to the role of Christianity.[27] In 2024, the regional director of the United Nations Population Fund, Lydia Zigomo, urged Madgascar to reform its law.[28]

Prevalence

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Between 1990–1994 and 2015–2019, the unintended pregnancy rate in Madagascar decreased 27%, and the share of unintended pregnancies resulting in abortion rose from 43% to 63%.[29] Nearly 75,000 illegal abortions are performed per year, according to the Center for Reproductive Rights.[30] A 2016 survey in ten districts of Madagascar found that 11.0% of sexually active women had had an abortion in the past ten years.[31] In Madagascar, abortion providers are known as "angel makers".[16]

In 2015, the Ministry of Health estimated that abortion caused 11.8% of maternal deaths.[3] Unsafe abortions are the second-leading cause of maternal mortality in Madagascar, behind postpartum hemorrhage.[32] Three women per day die of induced or spontaneous abortion, according to MSI Reproductive Choices in 2019.[33]

Methods

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According to a 2021 study, 52% of abortions are performed outside of medical facilities, and 31% are by people without medical training.[32] Private abortion providers are common, especially in Antananarivo. The cost of the procedure and transportation make it difficult for women to access these.[9]

An abortion from a doctor costs about 50,000 ariary (€10), as of 2020.[2] Common methods performed by trained providers include curettage, insertion of a catheter, and use of misoprostol alone.[31] Manual vacuum aspiration is preferred by many women, who believe it "cleans" the womb similarly to menstruation.[9] La Gazette de la Grande Ile has written that, despite the ban, finding an abortion provider is easier than finding a safe childbirth facility.[33] The National Order of Physicians does not perform abortions but offers alternatives.[7]

Misoprostol is widely available but not regulated for abortions. Use of misoprostol is not correlated with lower risk of infection.[31] Doctor's instructions are varied and do not match WHO guidelines and can result in side effects.[34] Black market vendors sell adulterated misoprostol pills.[9]

Abortions are often self-induced with abortifacent herbs, tambavy.[9] Some women induce abortions by taking pills or inserting objects into their uteri. Many women receive abortions from traditional midwives, reninjaza, who are not medically qualified. Traditional providers charge much lower fees than medical providers.[34] Most women in villages consult traditional reproductive health providers, matrones. They commonly provide clients with tambavy teas, which may be uterotonic. Matrones often deny knowledge of tambavy that are abortifacent. Abortifacent plants include nifin'akanga and ahilava.[35]

Post-abortion care

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In 2016, an estimated 27.7% of abortions resulted in post-abortion care (PAC).[31] MSI provides PAC in public hospitals to 200,000 women per year. The most common complication is organ perforation.[16]

Misoprostol was approved for PAC in 2017. It is not approved for use by private-sector health facilities.[9] Approval of the drug was contoversial as it can be used to induce abortions. As of 2016, misoprostol was available only at MSI clinics under the name Misoclear.[35]

Societal factors

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Abortion is a taboo subject in Madagascar. It is considered to violate the concept of life force, or aïna.[2] Pregnancies, including unwanted ones, are considered positive signs of a woman's fertility.[9]

Contraception is rare. One-fifth of women do not have access to Madagascar. Most cannot afford it. Other reasons include rumors about negative health effects and pressure from abusive husbands.[16] Although Malagasy families historically preferred having many children, many are now having fewer children to focus on finances and completing school. Mobile contraceptive clinics from MSI have been popular in many villages.[15] Many students have premarital sex, but contraceptive use is low. Many believe the side effects of contraception are more problematic than abortion. Some are discouraged from using birth control by their families.[9]

Women who are more likely to have had abortions are those who are young, have more education, or have ever had transactional sex.[31] Abortion is more common in urban than rural areas.[9]

References

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  1. ^ a b c d Caramel, Laurence (12 May 2022). "A Madagascar, « dans chaque famille, on connaît au moins une femme qui a dû avorter »" [In Madagascar, "In every family, we know at least one woman who has had an abortion"]. Le Monde (in French). Retrieved 2 August 2024.
  2. ^ a b c d e Verneau, Laure (7 October 2020). "A Madagascar, les avortements clandestins se multiplient depuis le confinement" [In Madagascar, clandestine abortions are multiplying during lockdown]. Le Monde (in French). Retrieved 2 August 2024.
  3. ^ a b c d e f g h i Ravaoarisoa, Lantonirina; Razafimahatratra, Mamy Jean Jacques; Rakotondratsara, Mamy Andrianina; Gaspard, Naomi; Ratsimbazafy, Marie Rolland; Rafamantanantsoa, Jean Florent; Ramanantsoa, Voahanginirina; Schaaf, Marta; Midy, Anne-Caroline; Casey, Sara E. (13 November 2020). "Slowing progress: the US Global Gag Rule undermines access to contraception in Madagascar". Sexual and Reproductive Health Matters. 28 (3): 39–53. doi:10.1080/26410397.2020.1838053.
  4. ^ Rakotobe, Narindra (28 October 2022). "Grossesse non désirée : 96% des Malgaches contre la légalisation de l'avortement" [Unwanted pregnancy: 96% of Malagasy people against legalization of abortion]. Midi Madagasikara (in French). Retrieved 2 August 2024.
  5. ^ Rakotobe, Narindra (1 February 2024). "Santé de la reproduction : Plus de 81% des femmes qui avortent affirment leur chrétienneté" [Reproductive health: More than 81% of women who have abortions affirm their Christianity]. Midi Madagasikara (in French). Retrieved 2 August 2024.
  6. ^ "Madagascar - IVG : l'Eglise catholique réaffirme le rejet de sa dépénalisation" [Madagascar - Abortion: the Catholic Church reaffirms its rejection of decriminalization]. LINFO.re (in French). 2 August 2023. Retrieved 2 August 2024.
  7. ^ a b c "Madagascar: la légalisation de l'avortement fait l'objet d'un débat" [Madagascar: legalization of abortion is the subject of a debate]. Radio France Internationale (in French). 1 July 2018. Retrieved 2 August 2024.
  8. ^ Cook Andersen, Margaret (1 June 2010). "Creating French Settlements Overseas: Pronatalism and Colonial Medicine in Madagascar". French Historical Studies. 33 (3): 436. doi:10.1215/00161071-2010-004.
  9. ^ a b c d e f g h i Aasgaard Jansen, Karine (9 July 2020). "'Cleaning the womb': perspectives on fertility control and menstruation among students in Antananarivo, Madagascar". Culture, Health, and Sexuality. 23 (9): 1227–1240. doi:10.1080/13691058.2020.1773539.
  10. ^ Gastineau, Bénédicte; Rajaonarisoa, Stellina (September 2010). "Sante De la reproduction et avortement a Antananarivo (Madagascar) Resultats d 'une recherche originale" [Reproductive Health and Abortion in Antananarivo (Madagascar): Results of an Original Research]. African Journal of Reproductive Health. 14 (3): 223–232.
  11. ^ a b Maistrellis, Emily; Juma, Kenneth; Khanal, Aagya; Kimemia, Grace; McGovern, Terry; Midy, Anne-Caroline; Rakotondratsara, Mamy Andrianina; Ratsimbazafy, Marie Rolland; Ravaoarisoa, Lantonirina; Razafimahatratra, Mamy Jean Jacques; Tamang, Anand; Tamang, Jyotsna; Ushie, Boniface Ayanbekongshie; Casey, Sara (19 July 2022). "Beyond abortion: impacts of the expanded global gag rule in Kenya, Madagascar and Nepal". BMJ Global Health. 7: e008752.
  12. ^ a b c Bearak, Max; Morello, Carol (10 October 2018). "How a change in U.S. abortion policy reverberated around the globe". The Washington Post. Retrieved 16 July 2024.
  13. ^ a b Casey, Sara E.; Maistrellis, Emily A.; McGovern, Terry (4 February 2021). "US anti-abortion "gag rule" hits women hard: what we found in Kenya and Madagascar". The Conversation. Retrieved 16 July 2024.
  14. ^ Burns-Pieper, Annie (16 September 2017). "Trump changes to foreign aid restricting access to family planning services in poorest countries". CBC News. Retrieved 16 July 2024.
  15. ^ a b Beaubien, Jason (14 October 2017). "U.S. Slashes Funds For Family Planning In Madagascar". NPR. Retrieved 16 July 2024.
  16. ^ a b c d e "Madagascar's 'angel makers' flourish in ban on abortion". France 24. Agence France-Presse. 9 January 2019. Retrieved 16 July 2024.
  17. ^ Tétaud, Sarah (30 September 2022). "À Madagascar, l'avortement reste un crime, même pour raisons médicales" [In Madagascar, abortion remains a crime, even for medical reasons] (in French). Retrieved 2 August 2024.
  18. ^ "Pour la première fois, Madagascar célèbre la journée de «l'avortement sécurisé»" [For the first time, Madagascar celebrates the day of "safe abortion"]. Radio France Internationale (in French). 1 October 2019. Retrieved 2 August 2024.
  19. ^ Banke-Thomas, Aduragbemi; Yaya, Sanni (14 December 2021). "Looking ahead in the COVID-19 pandemic: emerging lessons learned for sexual and reproductive health services in low- and middle-income countries". Reproductive Health. 18: 248. doi:10.1186/s12978-021-01307-4 – via BioMed Central.
  20. ^ Bezain, Laetitia. "Madagascar: des femmes témoignent des risques de l'avortement clandestin" [Madagascar: women testify on the risks of clandestine abortion]. Radio France Internationale (in French). Retrieved 2 August 2024.
  21. ^ Rakotobe, Narindra. "Constitutionnalisation de l'IVG en France : Nifin'Akanga fait entendre la voix des femmes malgaches" [Constitutionalization of abortion in France: Nifin'Akanga makes the voice of Malagasy women heard]. Midi Madagasikara (in French). Retrieved 2 August 2024.
  22. ^ R., Mandimbisoa (22 October 2021). "Masy Goulamaly défend la propostion de loi sur l'ITG" [Masy Goulamaly defends proposed law on therapeutic abortion]. Madagascar Tribune. Retrieved 2 August 2024.
  23. ^ "Madagascar - Interruption de grossesse : la députée Mapar Aina R. contre le projet de loi" [Madagascar - Termination of pregnancy: MAPAR deputy Aina R. against the measure]. LINFO.re (in French). 21 October 2021. Retrieved 2 August 2024.
  24. ^ a b Tétaud, Sarah (4 June 2022). "Madagascar: la loi sur l'interruption thérapeutique de grossesse à nouveau écartée de l'Assemblée". Radio France Internationale (in French). Retrieved 2 August 2024.
  25. ^ Verneau, Laure (18 May 2022). "Madagascar: l'examen de la loi sur l'interruption de grossesse s'éloigne encore" [Madagascar: review of the law on termination of pregnancy moves further away again]. Radio France Internationale (in French). Retrieved 2 August 2024.
  26. ^ Minas, Bruno (6 April 2023). "Madagascar : l'avortement est toujours interdit dans tous les cas" [Madagascar: abortion is always banned under any grounds]. La Première (in French). Retrieved 2 August 2024.
  27. ^ Belalahy, José (9 March 2024). "Interruption volontaire de grossesse : Christine Razanamahasoa plaide pour un débat élargi" [Voluntary termination of pregnancy: Christine Razanamahasoa calles for a wider debate]. Midi Madagasikara (in French). Retrieved 2 August 2024.
  28. ^ Tétaud, Sarah (17 March 2024). "Santé: à Madagascar, la question de l'interruption volontaire de grossesse avance peu" [Health: In Madagascar, the question of voluntary termination of pregnancy makes little progress]. Radio France Internationale (in French). Retrieved 2 August 2024.
  29. ^ "Madagascar country profile". Guttmacher Institute. 2022. Retrieved 16 July 2024.
  30. ^ Cascais, Antonio (16 July 2022). Walker, Keith (ed.). "Abortion: Is Africa becoming more liberal?". Deutsche Welle. Retrieved 16 July 2024.
  31. ^ a b c d e Ratovoson, Rila; Kunkel, Amber; Rakotovao, Jean Pierre; Pourette, Dolores; Mattern, Chiarella; Andriamiadana, Jocylene; Harimanana, Aina; Piola, Patrice (6 May 2020). "Frequency, risk factors, and complications of induced abortion in ten districts of Madagascar: results from a cross-sectional household survey". BMC Women's Health. 20: 96. doi:10.1186/s12905-020-00962-2 – via BioMed Central.
  32. ^ a b Bezain, Laetitia (1 October 2021). "À Madagascar, les avortements clandestins sont la deuxième cause de décès maternels" [In Madagascar, clandestine abortions are the second cause of maternal deaths]. Radio France Internationale (in French). Retrieved 2 August 2024.
  33. ^ a b Mateso, Martin (9 February 2019). "A Madagascar, "trois femmes meurent chaque jour des suites d'un avortement"" [In Madagascar, "Three women die every day from the effects of an abortion"]. France Info (in French). Retrieved 2 August 2024.
  34. ^ a b Pourette, Dolorès; Mattern, Chiarella; Ratovoson, Rila; Raharimalala, Patricia (11 December 2017). "Complications with use of misoprostol for abortion in Madagascar: between ease of access and lack of information". Contraception. 97 (2): 116–121. doi:10.1016/j.contraception.2017.12.005.
  35. ^ a b Collins, Lillian; Mmari, Kristin; Mullany, Luke C.; Gruber, Christian W.; Favero, Rachel (1 April 2016). "An exploration of village-level uterotonic practices in Fenerive-Est, Madagascar". BMC Pregnancy and Childbirth. 16: 69. doi:10.1186/s12884-016-0858-3 – via BioMed Central.
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