Overview of abortion in the Caribbean. Looking at laws, restrictive provisions, safety, accessibility and state regulation of womens's bodies

1. THE JOURNEY
TO SAFE,
LEGAL AND
ACCESSIBLE
ABORTION
IN THE
CARIBBEAN
Taitu Heron, Head/Development Specialist
Women and Development Unit (WAND)
University of the West Indies, Open Campus
taitu.heron@open.uwi.edu

2. The Focus of the Presentation
1. The regional legislative landscape; including
examples of reform; its limitations and impact
2. Impact of criminalising abortion on women in the
Caribbean (unsafe abortions)
3. Response: What would a legislative & policy
framework look like for safe, legal and accessible
abortion look like?
4. Recommendations for abortion law reform

3. The Offences Against the Persons Act
of 1861 (2 Sections regarding abortion)
• One section: Any person who (a) being a woman with child with
intent to procure her own miscarriage, unlawfully administers to
herself any poison or any other noxious thing or unlawfully uses
any instrument or other means whatsoever; or (b) with the intent
to procure the miscarriage of any woman, whether she is or is
not with child, unlawfully administers to her or causes to be
taken by her any poison or other noxious thing, or unlawfully
uses any instrument or other means whatsoever, shall be guilty
of felony and being convicted thereof shall be liable to
imprisonment for life.”
• The other section addresses the matter of persons who aid
and abet an abortion. Such persons are also liable under the
1861 Act and if convicted subject to imprisonment.

4. Barbados (Medical Termination Act 1983)
• The act allows the termination of a pregnancy to
protect a woman’s life or physical and mental
health, for economic and social reasons, in
pregnancies resulting from rape, and in cases
where the foetus suffers severe abnormalities;
but not at the woman’s request.
• Over the next 25 years, Barbados’s maternal
mortality ratio plummeted by 53%. Maternal mortality
ratio of Barbados fell gradually from 44 deaths per 100,000 live births in
1996 to 27 deaths per 100,000 live births in 2015.

5. Barbados cont’d
The authorization of one doctor is required by law if gestation is
12 weeks or less. If the pregnancy has reached 12 weeks but is
less than 20 weeks, the law requires the authorization of two
doctors. If the pregnancy is more than 20 weeks on, an abortion
requires the consent of three doctors. Before an abortion can be
performed, the woman has to receive counseling and provide
written consent when the cause of pregnancy is rape or incest.
Only doctors are authorized to perform abortions and if the
pregnancy is more than two weeks on, the abortion must be
carried out at a government authorized hospital.
Limitations: Hoops to get one. Plus, the law needs reform to
21st medical options. Underground market in misoprostol that is
not regulated & private doctors still can’t legally perform an
abortion.

6. Guyana (Medical Termination of Pregnancy Act 1995)
• To save the pregnant woman’s life, to
protect the woman’s health during high
risk pregnancy, to protect the mental and
physical health of the pregnant woman, to
protect the woman in case of a pregnancy
caused by incest or rape, to protect the
woman in the case of poor fetal
development, in case of woman’s
socioeconomic limitations.

7. Guyana cont’d
• Does not yet uniformly offer the provision of
abortion services in its Public Hospitals and
Medical Facilities across the length and breath of
the country.
• Medical personnel are still scarce in comparison
with the country’s population and size.
• Access for rural women is a serious challenge.
• Has not dented MMR. Estimated at maternal
mortality rate estimated at 229 per 1,000 live
births.
• 2016: The Guyana Responsible Parenthood Association
started to offer medical abortions as part of their
programme.

8. The restrictions & allowances under the
law in other CBN countries
Some countries in the Caribbean region allow
abortion in cases of (a) rape, (b) incest or (c) foetal
anomaly. Some countries restrict abortion by
requiring (d) parental authorization. Countries that
allow abortion without restriction as to reason have
gestational age limits (generally the first trimester).
*Includes countries with laws that refer simply to
“health” or “therapeutic” indications, which may be
interpreted more broadly than physical health.

9. Abortion & the regional landscape
Reasons for which abortion is
legally permitted
Country (CARICOM/CARIFORUM/CW)
Prohibited altogether Dominican Republic, Haiti, Suriname
To save the life of the woman Antigua & Barbuda, Dominica
To save the life of the
woman/preserve her physical
health
Bahamas, Grenada
To save the life of the woman/
preserve her physical and mental
health*
Jamaica, St Kitts & Nevis, St Lucia (a,
b), Trinidad & Tobago
To save the life of the woman/
preserve physical or mental
health/ socioeconomic reasons
Barbados (a,b,c), Belize, St Vincent
and the Grenadines (a,b,c)
Without restriction as to reason Cuba (d), Guyana, Puerto Rico
Singh S et al., Abortion Worldwide 2017: Uneven Progress and Unequal Access, New York: Guttmacher Institute, 2018

10. Impact: Incidence and Trends
• The LAC regional abortion rate is roughly 48 per 1,000 for
married women and 29 per 1,000 for unmarried women.
• Data for 2010–2014, abortion rates range across
subregions, from 33 per 1,000 women in Central America to
48 per 1,000 in South America to 59 per 1,000 in the
Caribbean.
• The proportion of all pregnancies in Latin America and the
Caribbean ending in abortion increased between 1990–
1994 and 2010–2014, from 23% to 32%.
• Data 2010–2014, Latin America and the Caribbean has the
highest rate of unintended pregnancy of any world region—
96 per 1,000 women aged 15–44. In the subregion of the
Caribbean, the rate was 116 unintended pregnancies
per 1,000 women.

11. Unsafe abortion and its consequences
• Induced abortion is medically safe when
WHO-recommended methods are used by
trained persons, less safe when only one
of those two criteria is met, and least safe
when neither is met.
• Many women undergo unsafe (i.e., less
safe or least safe) procedures that put
their well-being at risk.

12. Consequences cont’d
• During 2010–2014, about one in four abortions
in Latin America and the Caribbean were safe.
The majority (60%) of procedures fell into the
less-safe category.
• In 2014, at least 10% of all maternal deaths (or
900 deaths) in Latin America and the Caribbean
were from unsafe abortion.
• The most common complications from unsafe
abortion are incomplete abortion, excessive
blood loss and infection.

13. Consequences cont’d
• Poor and rural women are the most likely to
experience an unsafe abortion and severe
complications thereof.
• Postabortion services in the region are often of
poor quality. Common shortcomings include
delays in treatment, use of inappropriate
interventions, inadequate access, and
judgmental attitudes among clinic and hospital
staff. These factors likely deter some women
from obtaining needed treatment

14. Consequences cont’d
• The use of misoprostol to induce abortions
is growing more common throughout the
region and seems to have increased the
‘safety’ of clandestine procedures.
• It remains unregulated.
• Unreliable statistics on maternal mortality
in the Caribbean because of restrictive law
drives the procedure underground.

15. Reform vs Implementation of services
Guyana has legal abortion yet limited
access and proper services. The law has not
positively impacted the lives of women.
Jamaica – with restrictive legislation, has a
lower MMR than Guyana at 89
deaths/100,000 live births.

16. Impact and Response (Fred Nunes)
• Do restrictive abortion laws secure a reduction in abortions?
• How well do criminal abortion laws protect the sanctity of life?
• Are restrictive laws equitable across all classes of women?
• Do liberal abortion laws result in a weakening of the moral fabric
of society?
• Do liberal abortion laws result in an explosion of abortions?
• How does either approach affect the physical and emotional
health of women?

17. Social
Values
& Attitudes
Sexual
Activity
Unplanned
pregnancy
Non-use of
contraceptives
Unwanted
pregnancy
•Families
•Churches
•Temples
•Mosques
•Synagogues
•Friends
•Schools
•Communities
•Parents
•Teachers
•Peers
•Health clinics
•Private doctors
•Family planning services
•Religious leaders
Abstention
Abstention
Use of
contraceptives Planned
pregnancy Wanted
pregnancy
5
4
3
2
1
The Social Problem
Faithful partnership

18. The Current Legal Response
Involuntary
pregnancy
Decide to
Terminate
pregnancy
Motherless children
Fractured families
High, unnecessary
human suffering
and public cost
No behaviour
change
Haemorrhage
Sepsis
Incomplete abortion
Sub-fertility
Pelvic inflammatory disease
Chronic pelvic pain
Fistula
Death
No emotional support or
moral guidance
No contraceptive information
Compassionate care
Almost no complications
Thorough guidance
Contraceptive information
Voluntary
pregnancy
Unsafe
abortion
Keep & care
Keep & struggle
Adoption
Foster
Safe
abortion
Abandonment
Infanticide
Suicide
F
D
6
E
BA
C

19. Involuntary
pregnancy
Social Values
& Attitudes
Sexual
Activity
Unplanned
pregnancy
Non-use of
contraceptives
Unwanted
pregnancy
• Families
• Churches
• Temples
• Mosques
• Synagogues
• Friends
• Schools
• Communities
• Parents
• Teachers
• Peers
• Health clinics
• Private doctors
• Family planning services
• Religious leaders
Abstention
Abstention
Use of
contraceptives
Planned
pregnancy Wanted
pregnancy
5
4
3
2
1
The Present Criminal Law Makes the Problem Worse
The Social Problem and Current Legal Response
Motherless children
Fractured families
Decide to
Terminate
pregnancy
No behaviour
change
High, unnecessary
human suffering
and public cost
Compassionate care
Almost no complications
Thorough guidance
Contraceptive information
F
D
6
The Consequences of Restrictive, Criminal Law
Likely pattern of repeat abortions
E
Fred Nunes
Faithful partnership
Haemorrhage
Sepsis
Incomplete abortion
Sub-fertility
Pelvic inflammatory disease
Chronic pelvic pain
Fistula
Death
No emotional support or
moral guidance
No contraceptive information
Abandonment
Infanticide
Suicide
Likely use of contraceptives
Voluntary
pregnancy
Unsafe
abortion
B
Keep & care
Keep & struggle
Adoption
Foster
Safe
abortion
A
Morality Knowledge
C

20. The Proposed Legal Response
Request a
termination
Safe abortion
Voluntary
pregnancy
Pre-decision
counselling
Voluntary
pregnancy
Post-abortion
counselling
Keep & care
Adoption
Foster
Keep & struggle
Keep & care
Keep & struggle
Adoption
Foster
6 7
8 9
©

21. Social Values
& Attitudes
Sexual
Activity
Unplanned
pregnancy
Non-use of
contraceptives
Unwanted
pregnancy
• Families
• Churches
• Temples
• Mosques
• Synagogues
• Friends
• Schools
• Communities
• Parents
• Teachers
• Peers
• Health clinics
• Private doctors
• Family planning services
• Religious leaders
Abstention
Abstention
Use of
contraceptives
Planned
pregnancy Wanted
pregnancy
5
4
3
2
1
The Proposed Civil Law Helps to Correct the Problem
The Social Problem and Proposed Legal Response
The Potential of Regulatory, Civil Law
Fred Nunes
Faithful partnership
Request a
termination
Pre-abortion
counselling
Safe abortion
Post-abortion
counselling
Voluntary
pregnancy
6 7
Voluntary
pregnancy
Keep & care
Keep & struggle
Adoption
Foster
8 9
Emotional Comfort Medical Safety
Keep & care
Adoption
Foster
Keep & struggle
Increased use of contraceptives
Fewer repeat abortions
Contraceptive
Knowledge
Emotional Comfort Medical SafetyMorality Knowledge

23. Recommendations
a) Undergo a legislative overview of Caribbean countries
with the restrictive legislation
b) Develop model legislation
c) Identify a core team of actors/stakeholders across the
regional that are willing to adopt a regional approach for
advocacy and law reform.
d) Identify legal technical assistance /regional consultants
that may be required for (a) and (b)
e) Consultation with technocrats, regional and local, re
entry points in CARICOM & Commonwealth Foundation
or the Commonwealth committees? ?
f) Other recommendations from broader discussions.

24. Sources cited
• Singh S et al., Abortion Worldwide 2017: Uneven Progress and Unequal
Access, New York: Guttmacher Institute, 2018; special tabulations of
updated data from Sedgh G et al.,
• Abortion incidence between 1990 and 2014: global, regional, and
subregional levels and trends, Lancet, 2016, 388(10041):258–267.
• Fred Nunes, Abortion: Thinking Clearly about controversial public policy.
• UNFPA, 2017. Overview of the Situation of Maternal Morbidity and
Mortality: Latin America and the Caribbean.
https://lac.unfpa.org/sites/default/files/pub-pdf/MSH-GTR-Report-Eng.pdf
• Miller, Billie and Parris, Nicole, Capturing the Moment: The Barbados
Experience of Abortion Law Reform - An Interview with Dame Billie Miller.
Social and Economic Studies Vol. 61, No. 3, September 2012, Special
Issue on Women’s Reproductive Health and Rights in Select Caribbean
Countries (Guest Editors: Taitu Heron and Shakira Maxwell) . Available at
SSRN: https://ssrn.com/abstract=2233882