Abstract
In Sri Lanka, abortion continues to be a criminal offence under the Penal Code of 1883. Several attempts have been made to challenge the colonial-era law since the 1990s with no success thus far. This study documents and centres the knowledge of women and transpersons in accessing abortion and sexual health and reproductive health services in Sri Lanka in order to contribute to the conversation on abortion law reform as well as research and advocacy. Our data suggest that the existing legal reforms proposed to the abortion law would be unresponsive to the needs of women and transpersons in Sri Lanka, and that in additional to legal changes, we would need significant social and cultural changes. This study uses feminist research methodologies, building towards a feminist ethics in abortion research.
Introduction
This study explores the experiences of women and transpersons in accessing abortion and sexual health and reproductive health services in Sri Lanka. This work was driven by a desire to weave feminist methodologies into the documentation of these experiences and to represent these voices and stories using an intersectional feminist approach. This was in order to create and contribute to a conversation surrounding abortion reform as well as to explore how abortion research and advocacy could be done through a lens of feminist ethics in Sri Lanka.
History of Abortion Law Reform in Sri Lanka
Abortion in Sri Lanka continues to be a criminal offence under the Penal Code of 1883. The current law criminalises all attempts to abort a foetus, including assisting in an abortion, except under life-saving circumstances, and the current punishment for ‘causing’ a miscarriage is a fine and/or up to three years imprisonment (Law Commission of Sri Lanka, 2013). This law is one of several laws from the legacy of colonial rule (Kumar, 2013) that remains un-amended.
In comparison with the rest of the South Asian region, Sri Lanka’s abortion law is relatively restrictive (Kumar, 2013). In India, abortion is permitted on the grounds of social and economic reasons, in cases of rape and foetal impairment. It is allowed in Pakistan to preserve health (Center for Reproductive Rights [CRR], 2020). Nepal, carrying the most progressive abortion law in the region, permits abortion within gestational limits of 12 weeks but prohibits sex-selective abortion (CRR, 2020).
Several attempts to challenge Sri Lanka’s colonial-era abortion law have been made since the 1990s. The first significant address of abortion in Parliament was made in 1995, when the then Sri Lankan Minister of Justice, Professor G.L. Peiris presented an amendment bill to the Penal Code in Parliament, which proposed several amendments. Clause 3 of the amendment proposed the relaxation of the strict prohibition on the termination of a pregnancy and sought to decriminalise termination in the case of rape, incest and congenital abnormalities (Law Commission of Sri Lanka, 2013). However, the minister chose to omit Clause 3, and therefore it was not voted on (Law Commission of Sri Lanka, 2013). The minister’s decision to delete the section on abortion was brought about by his own concern over the ‘controversiality’ of the topic (Abeysekera, 1997).
While the amendment relating to abortion, in cases resulting from rape or incest or foetal abnormality, had been withdrawn, the topic was addressed by several member of Parliament (MPs) during the parliamentary debate (Abeysekera, 1997) with very limited support for abortion as a woman’s right.
During the debate, different MPs presented their positions on the issues. Their arguments seemed to reflect common perceptions and misperceptions about abortion and women’s reproductive and sexual rights (Abeysekera, 1997). There were arguments that showed concern about women’s ‘natural tendency to be promiscuous’ (Abeysekera, 1997, p. 88), the possibility that this reform could ‘open the floodgates’ (Abeysekera, 1997, p. 88), the possibility of women making false claims of rape, and the need to respect cultural, religious and traditional ideals (Abeysekera, 1997). Those who spoke in favour of the reforms often took a paternalistic attitude towards the protection of ‘weak’ and ‘vulnerable’ women (Abeysekera, 1997). A few voices called for rights-related approaches. MP Tiruchelvam (Tamil United Liberation Front) argued for a more humane and realistic regulatory framework with an acknowledgement of the importance of women’s equality, and MP Perera (Sri Lanka Muslim Congress), quoting Hillary Clinton, argued that ‘The rights that women are fighting for are none other than the rights that are enjoyed by other human beings’ (Abeysekera, 1997, p. 89). After hearing several different points of view citing cultural, moral and religious arguments, it was clear, as Abeysekera (1997) writes, that cultural and religious values would obstruct the challenge to legal norms.
The abortion debate was once again revisited in 2011, when the Minister of Child Development and Women’s Affairs, Tissa Karaliyadda, raised the topic of abortion law reform in Parliament (Kumar, 2013). That year, a goal to decriminalise abortion for rape and major congenital abnormalities was included in the National Action Plan for Human Rights (National Legislative Bodies/National Authorities, 2011). In 2013, a draft bill was prepared by the Law Commission in consultation with the Ministry of Child Development and Women’s Affairs, the Ministries of Health and Justice and Sri Lankan medical professionals. The proposed bill would permit abortion in instances of rape, incest, and foetal abnormalities and based on the recommendations of a panel of medical experts based at a government hospital (Kumar, 2013). The proposed bill was not approved.
The push for reform from 2011 to 2013 received significant opposition from the Catholic Church of Sri Lanka (Kumar, 2013) and Catholic professionals including physicians. The Archbishop Cardinal Malcolm Ranjith linked the move to ‘Western conspiracies’ (Kumar, 2013). A number of Buddhist clergymen also expressed their opposition in media interviews (Kumar, 2013). The government maintained its silence on legal reform.
Most recently, in August 2017, recommendations were made by Justice Aluvihare of the Special Committee to allow abortions in the cases of rape and incest, pregnancy in women below the age of 16 years and pregnancies with serious foetal impairments (Meyler, 2018). The cabinet approved a draft bill allowing abortion in the cases of lethal congenital impairments of the foetus and in cases of rape (Srinivasan, 2017). This move was met with formidable opposition from religious lobbyists and institutions. As opposition to the draft bill grew, doctors from the Health Ministry briefed a group of male religious leaders from different faiths, following which the proposed bill was put on hold (Srinivasan, 2017). It has not been revisited since.
The reforms proposed in 2017 were deemed problematic by some feminists in Sri Lanka. Perera (2017) noted that the proposed reforms did not centre women’s rights to autonomy and instead handed over that power to doctors, and Wijesiriwardena (2017) noted that the proposed reforms, if successful, could exacerbate inequalities among women and reinforce harmful normative ideas about women. Samararatne (2017) wrote that implementing the reforms could be complicated and impractical within the context of Sri Lanka’s criminal justice system.
Background to the Framework
We find that the abortion law reform project in Sri Lanka has often been framed in medical terms by medical professionals, rather than by feminists or the women’s rights movement(s). Medical paternalism 1 within the abortion law reform project has been both at the level of discourse and at a very practical level: women’s rights advocates were not included at the earliest discussions on drafting a reform bill in 2017, and women were altogether absent from an important briefing between the medical practitioners who were leading the reform advocacy and religious leaders (Perera, 2017).
In 2017, we saw a considerable amount of writing by women 2 (lawyers, researchers and advocates) in the non-mainstream media (particularly online, such as on the civic journalism platform Groundviews 3 ) and, to a lesser degree, in the mainstream English press. 4 However, at the political and decision-making level, the conversation was still largely dominated by medical professionals and politicians with a concerning lack of women at the centre of the conversation.
The Framework: Feminist Knowledge Production
We are aware that domains of ‘knowledge’ have been heavily shaped by experiences of colonialism and patriarchy in Sri Lanka, as in other places. ‘Objectivity’ is valued as ‘knowledge’ and the ‘subjective’ or ‘experiential’ has historically been dismissed, in the case of women, especially as ‘superstition’ and ‘old wives tales’ (Alcoff & Dalmiya, 1993).
Knowledge, which women would traditionally have been the custodians of (e.g. relating to abortion, pregnancy and childbirth), and other traditional knowledge systems were systematically erased, and the ‘cognisers’ were deliberately discredited by colonial projects, the advancing (male-led) medical establishment and other institutions such as the Church in the past (Alcoff & Dalmiya, 1993; Ehrenreich & English, 1988).
This paper seeks to, in part, address this ‘epistemic discrimination’ (Alcoff & Dalmiya, 1993). We see the absence of women’s stories, voices and perspectives in the debates and conversations about abortion in Sri Lanka 5 ; we also see the absence of women’s insights and knowledge in the decision-making process. Therefore, ‘the woman’ is almost entirely absent from both the discourse and the draft recommendations to reform abortion law, other than as narrativised by others (in this case, frequently medical professionals, some of whom are undoubtedly women, but are seemingly speaking as ‘doctors’ and not as those who also bear subjective or experiential insight about sexuality, pregnancy, abortion and so on).
We set out to expand the boundaries of what is considered ‘knowledge’ in the realm of the abortion debate and the reform process by deliberately seeking out and recording the subjective and experiential. 6
We also wish to add to what could be considered ‘indigenous’ knowledge 7 in Sri Lanka on sexual and reproductive health and rights and abortion, aware of the imbalance in the global knowledge economy skewed to ‘the West’ (Wickramasinghe, 2010).
Feminist Research Methodology: The Ethics of Talking About Abortion
In this work, from the stage of conceptualisation, 8 we have attempted to use and centralise certain modes and principles underpinned by what we believe to be core ‘feminist’ ideas such as value for the subjective and the experiential, collective decision-making, interdisciplinary and community-based approaches. We designed this process while standing at the intersection of politics, ethics and practice.
We developed and adopted a feminist ethics for research, and so a significant area of concern was sensitivity to our respondents (Wickramasinghe, 2010), especially since it could be expected that the issue of abortion, sex or sexuality could be challenging topics to address (due to the cultural context of Sri Lanka, combined with the fact that abortion is criminalised and punishable by law). We ensured, to the best of our abilities, that our respondents were safe and their privacy was protected.
‘Choice’ becomes crucial in the process; one has to make choices and acknowledge them; one has to balance and prioritise the ethical implications of each issue and each action with the desire to represent respondents’ and their voices accurately and authentically (Wickramasinghe, 2010). Therefore, at times, ethical concerns about confidentiality and the safety of the respondents meant ‘exclusion’ from the research altogether or from research outputs in the interest of safety. For example, this meant that we did not badger or pursue doctors, midwives or other medical practitioners who we knew were abortionists as well, to speak specifically about abortion service provision. We did not record those stories.
We did our best not to allow our interpretations to shape the interviews (merely speaking as little as possible during the interviews helped). We wished to be conscious and transparent about our own subjectivities, positionalities and privileges (Wickramasinghe, 2010)—different researchers embodied diverse privileges such as class and ethnicity in relation to some respondents—and we did our best not to socially or culturally alienate our respondents from us, or ourselves from them.
The Ethics of Broadening Our Framework
Through the adoption of what we believe is a feminist research methodology, we allowed the interviewees themselves to guide the research process. We tried to approach the collection of stories from interviewees without having a sense of certainty about where the path would eventually lead.
We began by saying we wanted to talk about abortion (see the appendix). However, as the interviews progressed, it was clear to us that our respondents wanted to speak about a range of issues and challenges, in relation to sexual and reproductive health and rights (SRHR), and at times, more deeply, about sexuality. We recorded these interviews as they were. These insights broadened our own understanding about our search.
The interviews broadened our own understanding of what the underlying causes were of the challenges in accessing SRHR in Sri Lanka, as well what the remedies could be.
Finally, we made a deliberate effort in 2019 to interview sex workers and trans, intersex and queer-identifying persons, since they are historically missing from the abortion debate (Chastine, 2015).
We did this because we posit that gender-based discrimination is not just limited to those assigned ‘female’ at birth, but also happens on the basis of sexual orientation, gender identity and gender expression, to those who fail or refuse to conform to the (unspoken) normative requirements set by dominant groups in society (Butler 1990).
The Method
The research team spoke to women and persons of ages 28–50 years who were married, single, widowed, migrant workers, sex workers and others. The team spoke with women’s groups and health service providers such as doctors, counsellors and midwives across the districts of Colombo, Kurunegala, Batticaloa, Jaffna, Mannar and Trincomalee. The participants comprised of 52 women, 7 transpersons and 3 men, and overall the research team carried out 29 in-person (1–1) interviews, one focused group discussion with 15 participants in Batticaloa and one focused group discussion with 18 people in Kurunegala.
Our respondents were Sinhalese, Tamils and Muslims and from diverse class and caste backgrounds. We conducted group discussions within the confines of offices of local women’s organisations. We also conducted several one-on-one interviews.
The interviews were conducted in Sinhala, English and Tamil (depending on what the respondents were most comfortable with). When the need arose, researchers had the support of language interpretation.
The interviews were sometimes recorded through voice recording devices (when there was consent) and, at other times, captured with notes only. Full interview transcripts were never shared across the group to protect the privacy of the interviewees; instead, researchers shared their own notes.
The group collaboratively thought about what some of the key insights were, which emerged from the interviews and the discussions, which eventually fed into two trilingual campaigns for the 16 Days of Activism Against Gender-Based Violence in 2018 and 2019.
On some occasions, such as in Batticaloa and Kurunegala, the interviews were preceded by or wedged within larger, collective discussions and workshops around abortion and SRHR.
Our Findings
(All names, when names are used, have been changed henceforth.)
The Circumstances in Which People Choose Abortions
In our research, we found that people reported a wide range of diverse reasons for wanting an abortion, though in our line of questioning we never asked them to tell us why. We recognise that there is a politics to the question ‘why?’, as it assumes there is an inherent unjustifiability to the act of abortion.
Warren (1973) argues that while to the pro-abortion lobby, ‘the moral permissibility of abortion appears to them to be too obvious to require proof’ (p. 1), it is still important for the pro-abortion lobby to grapple with the fundamental moral debates about abortion, or else ‘the arguments which they advance in opposition to laws restricting access to abortion fail to refute or even weaken the traditional anti-abortion argument’ (Warren, 1973, p. 1).
The Guttmacher Institute, in as early as 1998, published a report with evidence from 27 countries in which it clearly states the broad categories of ‘reasons’ women give when they seek abortions: (a) to postpone or stop childbearing (reported mostly among older and/or married women), (b) socio-economic reasons, which included disruption of education or employment; lack of support from the father; desire to provide schooling for existing children; and poverty, unemployment or inability to afford additional children (Bankole et al., 1998).
The report categorically states:
Reasons women give for why they seek abortion are often far more complex (and are) usually motivated by more than one factor… some abortions will remain difficult to prevent, because of limits to women’s ability to determine and control all circumstances of their lives. (Bankole et al., 1998)
A respondent in the Eastern Province told researchers, ‘The conversation needs to go beyond looking for a reason that someone might want an abortion, like rape. A 40-year-old married woman or an unmarried woman should be able to say, “this is what I need”.’
Safeguarding Ourselves, Our Jobs, Our Families
The fact that many women who seek abortions are already married and are doing so for not wanting to bear more children was highlighted in our findings. The interviews we conducted with doctors, counsellors and midwives anecdotally confirmed that women who seek abortion are often married women with children.
Mumtaj, a 38-year-old married woman with five children, terminated her fourth pregnancy. A male Muslim travel agent who was helping Mumtaj to get herself a passport helped her to get an abortion. The pregnancy was perceived as a threat to her becoming a migrant worker, which was her preference at that time. In her words:
I cried in pain. Doctor said, ‘do not scream, you should have thought about it before committing the sin’… I said, ‘do not say like this doctor. This is a child from my husband. I am doing this because of my poverty.’
This is supported by evidence gathered in the only conclusive study done in clinics in Sri Lanka where abortions were being provided: this study, done in the late 1990s in a project sponsored by the United Nations Population Fund, stated that a majority of abortion-seekers reported being married (Kumar, 2013; Samararatne, 2017).
One of our trans respondents in the Northern Province, a pharmacist, recounted:
As a pharmacist, I have given many abortion pills to people. Out of those, seldom did I give them to young women, unmarried women, and couples. I would say about 80% of people who need the abortion facilities are the married ones.
In some cases, women reported failure of the methods of contraception chosen by them. For example, Reka, a 39-year-old single woman, who was pursuing her higher studies, had accidentally conceived even after taking the morning-after pill.
The aim of safeguarding one’s own well-being (to the best of one’s ability) was another ‘reason’ we saw in many of our respondents’ stories. Rupika (who identifies as queer) said:
I was going through a difficult period in my life. I had depression, I was taking medication for depression. I got pregnant at this time. I went to a doctor and told the doctor that I wasn’t going to marry the father, is there any way to get rid of this? I knew I couldn’t have that baby at that time.
Challenges in Exercising Autonomy
As noted by Bankole et al. (1998), ‘limits to women’s ability to determine and control all circumstances of their lives’ (n.p.) must be taken into account.
Our respondents spoke about circumstances which complicated their ability to exercise autonomy. Sumana in the North Western Province said, ‘we do not always have autonomy over our own bodies. Sometimes we cannot choose how many children we have or how long we wait between children.’
Importantly, both doctors and midwives in our interviews also raised the issue of coercive behaviours which women are subjected to, within the institutions of marriage and family, which challenge women’s ability to exercise bodily autonomy. One midwife’s account was this: ‘Sometimes husbands come in here demanding that we take the IUD out (of the wife). So we have to do it, because we fear that otherwise, he will harm the woman. Men mistrust the woman when she has had an IUD implant.’
Two military widows in the North Western Province spoke about how they had been forced to have abortions by their in-laws, as they conceived after the deaths of their husbands due to the social stigma faced by women who engage in sex outside of the institution of marriage. On the other hand, another woman said:
Working women face a lot of problems. A lot of the time, women are forced into having more children than they want. Women are overburdened with housework and care work, as well as their jobs, as well as rearing more children. But the families are forcing women to bear more children.
Abortion Is Critical Trans Healthcare
We also learned about the challenges transmasculine persons
9
faced. Sahan, a transmasculine respondent in the Western Province, said:
Transpeople live more or less permanently in a state of danger. Sexual violence, forced marriage, ‘corrective rape’10, 11 is commonplace. When considering that, the ability to access safe and legal abortion is a must for transmasculine persons.
But we should not assume that rape is the only cause for unwanted pregnancies for transmasculine persons. Another trans-activist respondent in the Northern Province said:
A transman that I know got pregnant accidentally. He did not want to keep it. He took the tablets and aborted it. He knew that he did not want a child and the decision to abort it was a clear decision for him.
In January of 2020, media reports in mainstream Sinhala and English press in Sri Lanka reported: ‘Man gives birth to baby.’
12
Sahan, who is also a trans rights activist, went on-site to the hospital during this incident, with another lesbian, gay, bisexual, trans, intersex and queer (LGBTIQ) activist, to ensure the safety of the transmasculine person involved. Sahan told us:
This person did not want this baby. But we can’t assume that this was the result of rape, we don’t know. Many people assume that all trans people adopt a ‘straight’ sexual orientation, so I think many people are shocked by the idea that a transman can end up [being] pregnant.
What’s Really Blocking Our Access to Services?
Sexuality and Stigma
One of our most important findings across the board was the significant experience of stigma 13 reported by all those we spoke with, posing a major block when women attempted to access sexual and reproductive health services.
A women’s rights activist from the Eastern Province said, ‘There is a lot of stigma around women’s sexuality. This is one of the biggest problems for us.’
Since persons, especially women and girls, are often told of the ‘dangers’ of sex (such as ‘falling prey’ to sexual abuse or rape or becoming pregnant outside of marriage), many have come to fear their own sexuality (Abeysekera, 1999, n. p). People’s bodies and sexual drives elude even their own understanding and remain mysterious; their sexual desires are well hidden and become well masked by socially ‘acceptable’ behaviours (Abeysekera, 1999, n. p). Vance (1984) and Abeysekera (1999, n. p) both address the tropes of ‘good’ and ‘bad’ women, constructed in relation to women’s sexual behaviours. Vance (1984) proposes that women are ‘vulnerable to being shamed about sex’ (p. 6).
A midwife spoke to the researchers about her experiences with women’s reluctance around their own bodies, ‘As a midwife, I have to really push women to even submit themselves to a full vaginal examination. Something like a pap-smear is a big challenge.’
The issue of sexuality was raised by young respondents in the North Western Province as well. A young military widow said:
As widows of military servicemen, sometimes we are very young. Society believes that we are asexual beings after our husbands have died, even though this is not the case. We are also vulnerable to non-consensual advances, because men think since we are widows, we must be ‘available’.
Most of the military widows we spoke to were under the age of 25. They fear they would risk losing their compensation from the state to the families of their deceased husbands, and furthermore, risk social marginalisation (Chenoy, 2004).
One woman said:
In our society, if you are an unmarried woman, there is no structure of support. If you wish to have a child or raise a child, as a single woman, it won’t be accepted—similarly if you want to have an abortion, it is not accepted. There is a double bind for unmarried women of any age.
The notion of who society perceives as being sexually active played out very strongly in the lives of our respondents. Some in the North Western Province said, ‘People in our village think that only married women need to visit a gynaecologist. If you are unmarried and you go to the doctor, there is a lot of shame.’
One respondent said:
There is a lack of access for older women to SRHR information and services. Military widows and many single women and single mothers have a lot of cultural blocks in accessing SRHR information and services—these groups of women considered to not have any sexual and reproductive health needs.
Many of the respondents raised the issue of social expectations of women (and those assigned female at birth) and traditional gender roles, which shape the ability of women and transpersons to access health services. One respondent (Northern Province) categorically said, ‘There are many social and cultural barriers for women who want to terminate an unwanted pregnancy.’
Sakuntala, a respondent in the Eastern Province, also addressed the way in which society ‘blames’ women: ‘Everybody blames the woman. Nobody ever thinks, it takes two people, nobody ever thinks the man is also responsible for this.’
The interviewees in the North Western Province told us about the intense stigma associated with visiting the SRH clinics. One of them said, ‘Sometimes I take the bus and go to another village if I need to see (that kind of) a doctor! It’s better than being seen by someone I know.’
One woman spoke of her experience of going to get an abortion to a clinic, where she bumped into someone who goes to the same temple as her:
At the clinic, there was a woman… She comes to perform rituals at the same temple that I go to. This was something I did in hiding from the rest of the society. It is still a taboo in our societies. I was very worried that my secret will be (brought) out by her. Then the whole village will get to know. I felt so shy and ashamed.
Rupika said, ‘When I got an abortion, I couldn’t tell anyone. Even myself, we have all internalised this stigma. It was a very isolating experience.’ Rupika is an urban woman with several higher professional degrees from foreign educational institutions. This pointed to the possibility that experiences of stigma (internalised and otherwise) and shame are not necessarily contained within class, determined by education-level or whether one is rural or urban.
Rupika also told us in detail about her experience with a gynaecologist’s office in a leading hospital in the city and the pharmacy:
The whole thing was strange. First, the doctor asked the nurse to leave the room before telling me I was pregnant. He knew I was unmarried, so he asked the nurse to leave the room first. Later, at the pharmacy, when I handed over the prescription for the pills the doctor had given me (to begin the process of termination), the pharmacists acted very shocked. They whispered among each other and stared at me.
Social and Cultural Norms
The perceived role of women as ‘mothers’ was another strongly recurring theme in our conversations. Sriya in the North Western Province said, ‘There is a strong cultural sense that the mother has to be virtuous, is responsible for the whole family, etc. If there is anything wrong with the kids or with the home, the mother is always blamed.’
Similarly, some of our interviews revealed that medical professionals also show concern toward the concept of ‘virginity’ in women as a part of their practice. For example, Rupika said, ‘Before a pelvic exam, they always ask ‘are you married?’ This thing, ‘virginity’, controls everything. If I say I want to keep my virginity ‘intact’, they probably wouldn’t perform the exam, which can be dangerous.’
Sachee in the Eastern Province spoke about the way in which a doctor strongly influenced her decision, persuading her to forego an abortion, ‘When I got pregnant, the doctor pressured me to get married to my boyfriend even though I wanted to study. So I married very young, had a baby and gave up on my future. He (husband) has now left me.’
Dr Munza in the Eastern Province said, ‘I think a lot of women and families come to me because they know I won’t scold them or ask unnecessary questions. As a doctor, my job is to take good care of the patient.’
Lack of Information on SRHR
We found that the lack of information about sexual and reproductive health was a major block to our respondents’ ability to access health services, or even in knowing what kind of services to seek.
In Sri Lanka, 50 percent of young people are unaware about most aspects of basic sexual and reproductive issues (Family Health Bureau, 2015) and 66 percent of girls in Sri Lanka are not aware of menstruation until their first occurrence (UNICEF, 2018).
Issues related to sexuality are widely considered ‘taboo’ (in the words of one of our respondents) at the family, community and social level, and we believe this contributes to and is in exchange with the lack of meaningful education on sexual and reproductive health in schools and other spaces for formal education. 14
One woman said, ‘I had a boyfriend and I was 18 when I got pregnant. I didn’t even know that I was pregnant. My stomach started to grow bigger after 6 months. My family thought it was shameful and hid me.’ She said that at that time she did not know that sexual intercourse could lead to conception.
During one group discussion in the Eastern Province, a story was told to us by the discussants within this group about a major international organisation coming to their town to hold a discussion with school principals, teachers and advocates, about menstruation. One respondent said:
Even for this meeting, neither the female nor male teachers from the schools had agreed to attend. They refused to attend. This is with a program where they’re doing sanitation—like periods and pads, and sanitation projects in the school. Teachers are not even willing to come to this meeting.
During this group discussion, another respondent said:
Here, according to our culture, how can you talk about these issues? You are not going to tell your child about safe sex and to go and have sex. I’m not going to tell my child that. Even if I do, all the other parents aren’t going to tell their children to have safe sex or take a condom to school. So how are you going to have these conversations about putting safe sex, abortion, and sex education in the syllabus? There’s no point saying it’s children’s rights.
A trans sex worker and activist we interviewed in the Western Province also told us about the reluctance of teachers to teach this subject:
No one taught me how to take care of issues related to my sexual health. I wish they taught us that in schools. We experience bodily changes when we are still schooling. However, our teachers do not teach us anything about it. They do not even teach the chapter on reproductive health. This must change.
In the North Western Province, a respondent said:
There’s a big gap in knowledge on maternal health, and also early pregnancy in our areas. There’s a lot of suicide prevalent because of these issues. Reproductive rights especially for rural women need to be worked on. There’s a lack of information and there’s negligence of rural women in these areas.
But our interviews also highlighted that this lack of information is not confined to non-urban communities. For example, Rupika said, ‘It was not easy at all. It was only peer networks, we could ask a friend, but that was it’, when asked about how easily she was able to access sexual health and abortion-related information at the time she was seeking an abortion in 2016. She also said, ‘You know, we don’t really know anything about our ovaries, our anatomies.’ She said she was suffering, unknowingly, from severe symptoms related to fibroids for about a year before even understanding she should see a doctor.
Socio-economic Status and Safe Abortions
Socio-economic status and income level (of the person, their family and indeed the country) play a key role in shaping what kind of experience one might have if seeking out abortion services or sexual and reproductive healthcare services, especially in a country where abortion is criminalised.
The issue of ‘safety’ 15 of abortions has been correlated to ‘legality’ (to show that in countries where the laws around abortions are not restrictive, abortions tend to be ‘safer’). A study published in 2017 in the Lancet 16 states that when the distribution of abortion safety was considered by the legal status of abortion, 87.4 percent of all abortions in the 57 countries in which abortion was available on request were safe compared with 25.2 percent in the 62 countries where abortion was completely banned or allowed only to save the woman’s life or to preserve her physical health. In legally restrictive settings, nearly a third of abortions were categorised as least safe (Ganatra et al., 2017).
The study also notes that the income level of the country seems to have a bearing on the availability of safe abortions, along with the legal status of abortion. 17 This puts people seeking abortions in Sri Lanka in a vulnerable position.
One activist in the Eastern Province said, ‘This (unsafe abortion) is only an issue for poor women. For women who can afford it, there are safer options.’
Andrew, a trans respondent from the Eastern Province (interviewed in the Western Province), said: ‘According to my experience, it’s very unfortunate, but money talks. If you can’t afford private healthcare, I don’t know what your options will be.’
Some women in our study did report having gone to private clinics or hospitals where they had to pay significant sums of money to have abortions performed by doctors (or to have abortion pill/s prescribed by doctors after consultation). Rupika said she went to her doctor in a private hospital for a check-up, when she was told she was actually pregnant (in the Western Province):
I went to a doctor who I had seen before at (a major private hospital in the city). He had performed a surgery on me before. He told me I was pregnant. I had no idea. He said I was about two months along. He had to perform another surgery on me in a few days’ time anyway, so he suggested we do the termination of pregnancy at the same time.
Another respondent in the Northern Province said, ‘Our family doctor performed the abortion. Since the law does not permit abortion, it had to be done in a private clinic.’
On the other hand, we heard many stories about community-level abortionists. In our group discussion in the Eastern Province, we heard this story:
We know this woman – she’s a very poor woman. She was pregnant. She went to some place to have an abortion. She didn’t have any money but she had some jewellery. So this ‘doctor’ said ‘give me what you have’. So, she gave whatever money and jewellery she had. He did something to her. After that, she was bleeding, so she went home. When she went home, she stopped bleeding but later she discovered that she was still pregnant. When she went back to this ‘doctor’ he said, ‘whatever money you gave me, I did something. I didn’t ‘fully’ do it because that would have cost more, so I did it ‘half’ – since you only gave me half the money.’
Challenges for Queer and/or Transpersons, and Those Who Are Sex Workers
Additional challenges for our respondents, especially our queer and trans respondents, also arose from the fact that sexual and reproductive healthcare service provision, when accessible, is often underpinned by heteronormative 18 and cisnormative 19 assumptions.
Rupika said, ‘The questions you get asked at the doctor’s office, everything operates on the assumption that you are heterosexual of course.’
It was clear that the scope of the conversation needed to go well beyond abortion. Much of what we learned during these interviews pointed to the fact that sexual and reproductive health services, broadly speaking, were still elusive to many transpersons.
Sahan, a transmasculine respondent (Western Province), told this story:
Once I got an infection (in the genital area), related to the prosthetic that many of us wear (as transmen). I had no one to go to, not even anyone to ask a question from. I had to do some research on the internet and treat myself.
Andrew, who is a Tamil, trans and from the Eastern Province, talked about his experiences with transitioning, language inequality in Sri Lanka
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and more:
Finding trans-friendly psychiatrists or doctors who are Tamil-speaking has been a big challenge. Finding healthcare professionals who understand trans issues, and who speak my language has been almost impossible. Honestly, I have no idea where someone like me would even go if I had a question about my sexual and reproductive health. Where could I go where they would even listen to me?
Andrew also highlighted that a conversation about fertility options should be a part of providing SR healthcare to transpersons:
As a transperson transitioning medically, it is my experience that not a single doctor will ever ask you, ‘Do you want to preserve your eggs?’ The idea is, ‘Oh, now you’re a man.’ No one talks you through the options. We are left with no avenues to produce offspring.
Trans-rights advocacy has paved the way for the availability of gender-affirming surgery in Sri Lanka, but there is a need to go beyond, in providing healthcare to transpersons. As Sahan clarified:
Things are better (now) for transpersons. There’s been some progress. Now in Colombo, Galle or Jaffna, you can have the surgeries you want. But there is still a long way to go in providing every-day sexual and reproductive healthcare for transpersons.
A sex worker (who identifies as a transwoman) from the Western Province, further highlighted the fear and anxiety experienced by transpersons and sex workers when interacting with the healthcare system:
Once I had to be admitted to the hospital to treat a head injury. It was a female ward. I was tense. I was in a state of fear until they discharged me the following day. Trans people often get bullied and ill-treated. Some doctors, nurses and attendants also bully us.
In the North Western Province, Kumari said:
We also work with sex workers, and they have a big barrier in accessing SRHR services. Many who work in this area have to go far away to go to a clinic because they’re ashamed to meet someone they may know.
Political Will and Intervention
Several of our respondents flagged the issue of political intervention and intimidation. According to our interviewees’ analyses, social stigma is deployed tactically against women, and is put to work to uphold normative and dominant structures of power.
In the North Western Province, one of the military widows we interviewed talked about the political forces they had to face:
There is also a lot of political influence blocking some of these issues. Especially on our work with the SRHR of military widows, there is huge political power play to be considered. We also raise concerns about sexual harassment that military widows face from within the system once their husbands are dead. We are challenging ‘the military’. There is huge intimidation.
What Is the Impact of Criminalisation and Stigma?
Several doctors we spoke to felt that the law and surrounding social circumstances prevented them from serving what they believe to be their purpose, which was to do what was best for their patients.
Dr Munza in the Eastern Province told the following story:
During the war, a young girl came into my ward. She was pregnant. I believe she was a cadre.
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I think it would have been punishable by death (by LTTE), that she was pregnant. She wanted it taken care of. But there was nothing I could do. I took care of her. I did my best. She was in my ward for some weeks, I kept a close eye, but one day I came in and she was gone. Some people said ‘they’ had come and taken her away. I never saw her again. I still think of her. Sometimes it is like our hands are tied. Maybe if I had the option, I could do what was needed. After all, we want to serve our patients. That is our job.
In the Eastern Province, we heard this story from a respondent:
During the war years, I was working and the place where I worked said if you’re married, you’re going to lose your job. I got pregnant and went for an abortion because I really needed the job. They didn’t do it (abortion) properly so I was transferred to the government hospital, at which they reported me and I was arrested. I lost my job. My whole family and village got involved, which made my life much worse.
In the North Western Province region, Thayalini, a community activist, said:
The impacts of criminalising abortion are very severe. One woman didn’t want to have a child and tied her stomach with a piece of cloth and another woman took some pills and they have had children with disabilities.
In the Eastern Province, some women’s rights activists told this story:
Thanushka came to us when she was 18. She came to us because she has been a part of the system. She is an orphan; she doesn’t have parents; her grandmother is looking after her. Her whole family died during the tsunami. She has been in and out of institutions. When she was 18 and pregnant, probation officer said ‘not our responsibility’. There was nowhere to keep her. Once you’re 18, the system drops you. They don’t care. The thing is, she has to carry this pregnancy for 9 months. She’s also not been in school. Mentally, she is okay but she may not be able to look after the child. Later, the child was given up for adoption. Her education was lost. We tried to make sure she had family planning.
Counsellors said they had been in conflicting situations. A counsellor working in an organisation which supports women who are survivors of domestic violence (in an interview recorded in the Eastern Province) said, ‘As counselors we want to help women. If it (abortion) wasn’t illegal, we could offer women the choice. Sometimes we know it’s the best solution.’
In our group discussion in the North Western Province, this story was told by Daya, a migrant worker:
I was a migrant worker for many years. I worked as a domestic maid (in central Asian country) for 12 years. I know of many stories where migrant worker women are taken for abortions by quacks who use many dangerous methods, and sometimes the termination is not even successful. This is a business. Some of these men work together. The men who sent the women abroad here are working with the men there, who then have relations with women against their will and then the women get pregnant; they also work together with the quacks who perform the terminations back home here.
The trans pharmacist had this story to tell:
Once an unmarried couple got the tablets from us. They did not pay attention to the instructions given. She got an infection. She had a terrible reaction like high fever and continuous vomiting. Later, she had to be taken to a doctor.
We heard countless stories about botched procedures and unsafe conditions. In the North Western Province, Sulochana said: ‘There are so many fake ‘doctors’ in our village, who perform procedures to terminate pregnancies. These are often very dangerous and risky for women.’ The trans pharmacist said: ‘Unsafe abortion can cause over-bleeding, nausea, lethargy, weight-loss… it is highly risky.’
A trans sex worker from the Western Province also highlighted how she faces an added layer of stigma and prejudice (as well as criminalisation 22 ) as a sex worker.
She insists:
All kinds of people do sex-work, like women, men, trans, gay, lesbian, etc. It is their wish. It is the responsibility of the government to make sexual and reproductive health facilities accessible to all without any preconceived ideas and/or taboos.
Similarly, a gay respondent from the Northern Province said that queer-identifying persons also felt the added anxiety of being criminalised as queer.
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He said:
As a man, I cannot say that I have sex with men when they (medical professionals) ask about my sexual activities. I could be arrested for that.
Learnings and Reflections
Our findings support the fact that the reforms proposed to the abortion law in Sri Lanka by physicians would be unresponsive to existing data and to the legitimate needs of women and transpersons. Furthermore, supporting these reforms pose problems to those working with a feminist political framework. The reforms would not necessarily support or protect the rights of women and transpersons or strengthen their ability to exercise autonomy. Instead it could expose them further to the criminal justice system which is already biased against them (especially in the case of queer and transpersons and sex workers), or further limit their autonomy within existing power structures such as the family and community.
Across our interviews in a range of districts, with women and transpersons of different ethnicities and socio-economic backgrounds, we found our respondents to be quite self-aware in terms of their needs, in relation to sexual and reproductive health, and they framed these needs in terms of ‘rights’. An intersex respondent (Northern Province) said, ‘Abortion should be the right of the woman. It is her body. It should be her right.’
Another respondent in the Eastern Province said, ‘Why is it compulsory to bear the child? Because I have a womb, I should bear a child?’ Another respondent in the same region said, ‘Why is women’s right to choose, women’s right to work and to an education always secondary to women and girls’ role as bearers of children?’
Entrenched heteronormativity, cisnormativity and stigma against sex work reduce the chances of trans, queer and intersex people and sex workers receiving sensitive and meaningful health care. It is essential that sexual and reproductive health care be accessible and equitable to everyone.
Our findings show that there are many political, social and cultural gains that would need to be made for legal gains to have meaning. Our respondents were able to clearly articulate these diverse and intersecting needs.
We found that the clarity in their articulations and the complexities of their lives are not reflected in the discourse around abortion when it is framed purely as a health/medical issue. Nor is it entirely captured when there is an overemphasis on ‘choice’ (as is sometimes the case, when feminists determine abortion discourse in some contexts).
We found that our respondents, in their choices and their own understanding of these choices, defy the normative binary between force/choice (Shah, 2014). Our respondents are not making choices because they are forced to do so, neither are they making choices purely as an exercise of their own free will—with their reproductive decisions often being shaped simultaneously by their own desires, as well as families, communities, healthcare service providers, social and cultural norms and political forces, all of which are closely and inextricably linked. When we force all abortion-seekers into a singular narrative, we erase complexity in important acts of agency.
Finally, we believe that it is through employing a feminist research methodology and centring a framework of feminist ethics in talking about abortion that we arrived at these stories which yielded these findings.
Despite the fact that ‘the woman’ has been repeatedly (and continues to be) narrativised either as victimised and dispossessed or as ‘wantonly promiscuous’ in the abortion debate in Sri Lanka, our interviews revealed that sexual and reproductive health and abortion are important domains in which women and transpersons are actively exercising their agency and articulating their needs. And quite often, they are doing so in the explicit search for their ‘rights’.
Footnotes
Acknowledgements and Attributions
Originally, the research project was proposed as a part of a broader advocacy strategy towards decriminalisation of abortion in Sri Lanka. An informal collective (we called ourselves ‘The Feminist Coalition for SRHR’) was formed to conduct and support the research: it included independent activist researchers, an informal young feminist collective (A Collective for Feminist Conversations) and women’s rights organisations Women and Media Collective (WMC), Suriya Women’s Development Centre (SWDC) and Women’s Coalition for Disaster Management. Subha Wijesiriwardena, Hasanah Cegu Issadeen and Cayathri Divakalala conducted the research. Divakalala and Cegu Issadeen led research and documentation in Batticaloa, Jaffna, Mannar and Trincomalee. Wijesiriwardena did additional research and documentation in Batticaloa (with the support of SWDC) and led research and documentation in Kurunegala (with the support of the Women’s Resource Centre) and Colombo. Thilini Perera was the designer behind the two campaigns we produced based on these findings. All the writers and researchers involved in this work are indebted to the interviewees and key informants, who gave of their time freely to discuss deeply intimate and sometimes difficult matters and those who played a vital role in connecting us to women from various locations. This paper is written by Subha Wijesiriwardena, and Kimaya de Silva, with input from Cayathri Divakalala and Hasanah Cegu Issadeen.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support for the research, authorship and/or publication of this article: The research process was funded by a portion of a grant received from Urgent Action Fund, through WMC; a collective including independent activists and WMC applied for and received emergency funding in 2017 to capitalise on an opportunity to do advocacy around decriminalisation of abortion. Tehani Ariyaratne took the lead in writing that proposal. At WMC, Kumudini Samuel, Dr Sepali Kottegoda and Tharanga de Silva were instrumental in supporting this research and administering the UAF grant. In addition, we enjoyed the support of Sumika Perera, Sarala Emmanuel, Setheeswary Yogathas and many others who cannot be named. We are thankful to them for setting up focus group discussions and interviews, providing organisational space and letting us into their networks of trust.
Notes
Appendix
Below are some guidelines all the researchers agreed on, and used:
All interviews with women should be conducted in private, unless when an interpreter is needed.
If an interpreter is needed, ensure it is someone that both the interviewer and the interviewee know (at least broadly).
The interviews should be organised covertly, through word of mouth only, and can be hosted in the offices of the partner organisations.
Names of interviewees should be changed.
Interviewers should be non-judgemental and ask questions gently, but allow the stories to flow themselves.
Interviewers should not only document the abortion-related experience, but other things such as the interviewee’s access to information, medical services, contraception (or lack thereof).
The interviewee should not be asked to disclose anything they do not wish to disclose.
The interview should be preceded by informed consent (does not have to be written/signed, but recorded in whatever way is comfortable).
Some guidelines for questions (these are just some things which could be documented, none are mandatory):
Age, location Age at time of experience, and location Level of education and occupation if any Ethnicity Married/unmarried at the time of the experience Did you undergo a pregnancy test first; did the person performing the termination perform such a test? Were you informed what the procedure would be—for example, suction with or without anaesthesia; with an anaesthetic? Who performed the procedure? Did you try to terminate the pregnancy yourself first in any way? Did you have any infection post the procedure, were you tested for this? Were you asked to take a pregnancy test post the procedure—some of the women I met said they had to repeat the procedure because a post procedure test showed they were still pregnant. Both pre- and post-abortion SRHR-related care/lack thereof and information on post-abortion care. Any complications during or after procedure? Did you visit a hospital after the procedure? Did you seek advice to help you make the decision? Support from friends, family, partner/lack thereof Did you do it alone or with someone? What kind of information did you have about the procedure? What kind of information did you have about what your options were? What kind of information did you have about contraception and contraceptive options at this time? How did you find someone to perform the procedure? How much did you pay? Health status at present, reproductive health status/issues if any?
