HEALTH-CUBA:
Abortion Competes With Contraceptives
Dalia Acosta

HAVANA,  (IPS) - Many women in Cuba resort to abortion, 40 years after it was decriminalised, as though it were just another contraceptive method. Some even prefer it to condoms, the pill or intrauterine devices (IUDs), without giving a thought to the risks involved or the ethical aspects.

"It's a safe method," "it's not a big deal," "it's a quick fix," whereas "contraceptive methods cause discomfort and are neither effective nor pleasant," were some of the explanations given by 132 women who claimed to prefer abortion in a nationwide survey.

More than 4,000 women all over the country were interviewed by biostatistics expert Miriam Gran for her research study entitled "Voluntary termination of pregnancy and contraception: two methods of fertility control," published with the support of the United Nations Population Fund (UNFPA).

Although the abortion rate is falling, the trend is not so marked "as to be able to speak of major changes" in the last two years, Gran told IPS.

"Over decades, the rate has indeed declined, which reflects well on family planning, health education and sex education. It has to be taken into account that whenever the birth rate falls, as has been happening in Cuba, abortions nearly always decline as well," she said.

The study, which was published this year and is being circulated among government officials and specialists, included 1,806 women who decided to terminate their pregnancies, and 2,442 who did not.

Among the women who had abortions, 52.2 percent said that they had taken this measure because they had "given up" some birth control method, 30.1 percent because of "lack of knowledge," 7.3 percent because they "preferred it," and the remaining women said they aborted due to health problems, because they got pregnant by accident, or for other reasons.

Abortion has been legal in Cuba since 1965, as a woman's right. The law stipulates that abortions should be carried out before the tenth week of pregnancy, and afterwards only for medical reasons. Terminations carried out outside the public health system are punishable by law.

Abortions carried out "in safe conditions contribute to women's perception of the low risk of the procedure, and to similar views even among service providers," and encourage "a more favourable psychological outlook among women towards abortion," Gran's study concludes.

"Not that I like it, but it is a solution," said Patricia García, a 21-year-old university student who has had two abortions since she became sexually active at 17. "Something always goes wrong, you either forget to take one of your pills or the condom breaks," she told IPS.

García is awaiting confirmation of her third pregnancy, and has again decided to terminate it. She admitted being afraid of the "disagreeable process," the pain of the injections, the feelings of sickness afterwards, but she does not think about the possible consequences that general anaesthesia or the abortion itself could cause, let alone about her chances of dying.

The latest edition of the Public Health Ministry's Health Statistics Yearbook indicates that 58 women died in this Caribbean island nation in 2004 of causes related to pregnancy and childbirth, leading to a maternal mortality rate of 38.5 per 100,000 live births. Eleven of the deaths were due to abortion.

The number of deaths is insignificant compared with the high abortion rates in the country. A total of 67,277 pregnancies were terminated in 2004 in the health system's hospitals, 93,649 fewer than in 1986, but still considered a high figure by experts.

The decline in the number of abortions is partly attributed to the increasing use of "menstrual regulation", a method which can be used if a woman sees a gynaecologist immediately after detecting a delay in her menstrual cycle.

Menstrual regulation - also known as menstrual aspiration or extraction - is a simple procedure similar to the one used for inserting IUDs.

The menstrual regulation rate in 2004 was 36 per 1,000 women of fertile age, according to the Public Health Ministry.

Experts consider that the case of Cuba shows that decriminalising abortion has a significant impact on reducing maternal mortality, but that it should be accompanied by sustained efforts in sex education and family planning, in order to limit its use to emergencies only.

As of late 2004, Cuba had a population of 11.2 million, with 1,003 men for every 1,000 women. The fertility rate is below the population replacement level, at 0.75 daughters per woman. There are 20.9 abortions per 1,000 women of reproductive age, and 52.5 for every 100 births.

In most Latin American countries, abortion is only legal in cases of rape or when the mother's life is in danger. Cuba and Guyana are among the few countries in the world in which abortion has been fully legalised and is carried out at the woman's request..

UNFPA sources have estimated that every year, around 19 million abortions are carried out worldwide in unhygienic or other medically unacceptable conditions. Out of that total, some four million are carried out in Latin America, many of them resulting in serious injury or death for the pregnant woman.

Throughout the world, some 68,000 women die from unsafe and illegal abortions every year. Research quoted by the UNFPA concluded that one out of every 10 pregnancies end in terminations in unacceptable conditions, and most of those abortions are performed in Asia, Africa and Latin America.

"The UNFPA supports Cuba's efforts to maintain its achievements in sexual and reproductive health, including its actions in the field of sex education and access to family planning methods," Alfonso Farnós, assistant representative of the U.N. agency in Havana, told IPS.

The UNFPA programme for cooperation with Cuba for the period 2004-2007 includes 3.3 million dollars to be spent on reproductive health projects.

In contrast to what happens in many countries, Patricia García did not have to be a rape victim, have a serious health condition or get her partner's permission to have an abortion at a public hospital. For her, this service is an undisputed right.

The high abortion rate has historical precedents in the country, going back to the mid-20th century. "In Cuba, terminating a pregnancy is not charged with negative symbolism, it isn't seen as a crime," Dr. Leticia Artiles, coordinator of the Cuban Gender and Collective Health Network, commented to IPS.

That, together with the absence of "social taboos against single women seeking contraceptive methods," enables women to exercise their "reproductive rights of deciding how many children they will have, when, and how they will be spaced, so that when they do have a child, it is wanted," she said.

But according to Artiles, as well as showing "absolute confidence in the health services," the high number of abortion requests reflects "a lack of perception of the risk that any operation, however simple, can pose to a woman's life, to a subsequent pregnancy, or to her all-round health."

Experts believe that more than 70 percent of Cuban women who consult for infertility problems have a history of one or more abortions in adolescence or young adulthood.