Abortion:A Battle between Mother and Child

Abortion is an old debate. Although thanks to medical advances the procedure has become less and less dangerous, the debate surrounding it is becoming ever more heated. Because it involves issues of human rights, human life, demography, morality, and economics, abortion raises as many questions as it answers.

Taiwan has a high rate of abortion.

The Department of Health estimates that between 280,000 and 300,000 non-therapeutic abortions are carried out in Taiwan every year-a figure that approaches the number of births. Although some people think that this figure is a serious underestimate, it is nonetheless 10,000 times higher than in Sweden.

How many abortions are performed in Taiwan every year? Reliable statistics are hard to come by. In addition to an average 40,000 therapeutic abortions a year for which there are reliable statistics, there is an unknown number of non-therapeutic abortions that are not covered by the national health insurance program.

The reason the number of non-therapeutic abortions is not known is that many clinics are reluctant to disclose their revenues. Moreover, because many abortions are legally questionable and clinics want to avoid trouble with the law, they do not report the number of abortions they perform.

After the abortion pill RU-486, seen by women as a godsend, was approved in Taiwan at the end of 2000, online and brick-and-mortar retailers flooded the market with contraband pills. Untold numbers of women began to buy RU-486 directly from retailers, without a prescription from their gynecologist. In these circumstances, statistics are impossible to come by.

Should I have the baby? Or should I abort? To many women this is a very difficult decision. One can only hope that the day will come when all babies will be wanted by their parents. (photo by Chuang Kung-ju)

To abort or not to abort?

For much of human history, abortion was an accepted method of birth control. It was only in the 19th century-when it was first argued that "abortion violates the father's right to have children" and "the fetus is an individual and abortion is murder"-that many countries began to outlaw and penalize abortion. But with the growing awareness of women's rights during the 20th century, people came to accept that women have the right to make decisions regarding their own bodies, and countries around the world gradually legalized abortion.

Although in recent decades there has been a clear global trend toward legalization, the process has differed from country to country, in line with national conditions and cultural sensibilities. For example, legal provisions stipulating up to which week of gestation an abortion may be carried out differ from one country to the next.

The United Kingdom was the first Western democracy to legalize abortion. It passed an Abortion Act as early as 1967.

Since the 1960s, the abortion debate has divided public opinion in the United States into two opposing camps. On one side are the supporters of the right to abortion, known as "pro-choice," and on the other side are the opponents of abortion, known as "pro-life." The two camps have long been engaged in an endless and unwinnable debate over women's right to choose and a fetus's right to life. During every presidential election campaign, candidates have to declare where they stand on this issue.

In Ireland, a predominantly Catholic country, the constitution bans abortion. But following a referendum held in 1992, a "don't ask and don't tell" policy was adopted, which has enabled Irish women to go abroad to have abortions and allowed information regarding abortion to be disseminated within Ireland.

In some Asian countries, such as mainland China, Vietnam, and Singapore, abortion is legal without restrictions. Singapore passed an abortion law in 1969, and in Vietnam abortion was made completely legal in 1975 following the country's unification. Under China's one-child family policy, the authorities have even forced women to have abortions. This policy, which takes no account of the mother's wishes and puts no value on the life of a fetus, has provoked considerable debate, with continual calls for its relaxation.

Escape clause

Under the Genetic Health Law (GHL), abortion is now legal in Taiwan under certain conditions. But long before abortion was legalized, Taiwanese women resorted to this procedure to put an end to an unwanted pregnancy.

According to a "family and fertility" survey conducted by the then Taiwan Provincial Institute of Family Planning before the GHL was enacted in 1984, at that time some 32% of Taiwanese women-one in three-had had at least one abortion.

After the GHL was enacted in 1985, the number of women who had abortions rose sharply. A survey conducted by the Taipei City Department of Health in 1999 showed that almost 50% of adult women and 40% of unwed women had had an abortion.

Given how widespread abortion is in Taiwan, many people are shocked to learn that it is a crime under ROC law. Article 24 of the Penal Code explicitly declares that abortion is a criminal offense. Articles 288 to 292 concerning abortion make it a crime for a pregnant woman to perform an abortion herself or to seek an abortion, for a physician to perform or to profit from an abortion, and for a husband or boyfriend to instigate or abet an abortion.

However, because it was rare for anyone to be convicted on an abortion-related charge, 20 years ago a special law-the Genetic Health Law-was enacted.

The law permits abortion in the event of hereditary or infectious disease, mental illness, a risk that childbirth will cause physical or mental harm, a deformed fetus, or rape. Article 9 Subparagraph 6 states that women for whom pregnancy or childbirth are likely to cause psychological harm or whose family life may be adversely affected, are entitled to have an induced abortion. This provision is popularly seen as an "escape clause," because it is so broad that it allows almost every woman to have a legal abortion.

Do but don't tell!

The GHL has enabled Taiwanese women to have an abortion without resorting to illegal channels, and has therefore made the procedure much safer. Jeng Cherng-jye, obstetric gynecologist at the Cathay General Hospital, feels very strongly about this. He recalls that before 1985 he would often see women who had been subjected to a botched abortion come to the hospital with massive hemorrhaging, peritonitis, and other serious aftereffects. Some unlicensed quack doctors had even cut their patients' intestines. After the GHL was passed, women were able to get legal abortions in proper clinics. As a result, life-threatening aftereffects became very rare.

It is a keenly felt fact that when the GHL was enacted, its aim was not to give women the right to choose but rather to contribute to population control. In the mid-1980s, family planning was promoted to lower the birth rate. Government and healthcare organizations promoted the pill and other contraceptive methods, as well as legalized abortion, with a view to preventing unplanned births.

The origin of human life

The fetus's right to life and a woman's right to choose are two irreconcilable desiderata. It's a zero-sum game. People disagree about when human life actually begins. Some believe that human life begins at the precise moment when the ovum is fertilized. Some believe that life begins when the ovum implants into the womb lining and becomes an embryo (about seven days after ovulation) or when the heart begins to beat (at 24 days). Others believe that human life begins when the embryo is viable outside the mother's womb (at about 24 weeks). Still others think that only once the baby has been born can one speak of an individual human life.

No matter when life starts, performing an abortion is always an emotionally complex decision for a physician.

Although most people think that physicians who perform abortions encourage abortions or benefit from them, according to Jeng Cherng-jye most obstetric gynecologists do not urge their patients to get an abortion. On the contrary, most physicians urge pregnant underage women, be they married or not, to give serious consideration to carrying their pregnancy to term. Sometimes, a doctor will actually succeed in getting through to his patient on an emotional level and persuading her to keep the child.

Jeng Cherng-jye explains that the GHL stipulates that RU-486 may only be taken within the first seven weeks of pregnancy and that abortion may only be performed within the first 24 weeks. Still, because by the sixth week of gestation an embryo already has a heartbeat, by the eighth week it takes on a human shape, and by the tenth week it begins to grow hands and feet, performing an abortion on a fully formed embryo feels like "taking a life." That is why the regulations of the department of gynecology and obstetrics of Cathay General Hospital bar its physicians from performing abortions after the 18th week, other than in very exceptional and serious cases.

When it's the only choice

But the medical profession feels differently about underage pregnant women. Some argue that because the reproductive system of underage women is not fully matured, they are likely to require medical treatment whether they choose to abort or to carry the pregnancy to term, but if an abortion is done properly it will not adversely affect a woman's ability to have children in future. The student health insurance scheme, which has been in operation for 40 years, this year bowed to opinion trends and began providing cover for abortion or birth costs for senior high school and vocational school students.

Obstetric gynecologist Kao Tien-fu asks, "Put yourself in someone else's shoes. Would you want your teenage daughter to carry a pregnancy to term?" Kao knows that no matter what the answer, a decision of this sort always entails remorse and conflict.

How can remorse and conflict be reduced? What can be done to prevent the battle between mother and unborn child from being reenacted time and again? What needs to be done to make every child a wanted child? These questions cannot be avoided, no matter how difficult they may be.