Asia's 'progressive' abortion laws safe, but accessibility still an issue in Singapore, Malaysia, South Korea

Asia is often painted as restrictive and less liberal than the West, but when it comes to abortion, many Asian societies have legalised the medical procedure.

In much of the region, there is close to no debate about banning abortions, despite the United States now attempting to overturn abortion rights.

From metropolitan societies like Singapore and South Korea, to Muslim-majority countries like Indonesia and Malaysia, abortions are legal - albeit tied to varying conditions.

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Dr Subatra Jayaraj, a sexual and reproductive health expert and president of the Reproductive Rights Advocacy Alliance Malaysia, said Malaysian laws were "quite progressive" compared to those in the US, and the debate in the US was "not relevant" to Malaysia's context.

In Singapore, Shailey Hingorani, head of research and advocacy at women's rights group Aware, said she had not noticed any immediate impact from the US debate on the city state.

Earlier this month, it emerged in a leaked draft paper that the US Supreme Court had voted to strike down the landmark 1973 Roe v. Wade decision, one that guaranteed federal constitutional protections of abortion rights.

"Roe was egregiously wrong from the start," wrote Justice Samuel Alito, referring to Jane Roe, the legal pseudonym for Norma McCorvey, who fought for the right to abort her third child in the state of Texas. Abortions were then illegal in Texas except when necessary to save the mother's life.

If Roe v. Wade is stuck down or scaled back, abortions could again become illegal in many US states.

Abinaya Mohan, head of campaigning at the Women's Aid Organisation in Malaysia, called the US debacle a regression of women's rights to bodily autonomy.

"As a whole, the abstinence-first policy is detrimental and does not take into account the realities of women's lives," Abinaya said. "And when paired with strict laws on abortion, we have disastrous consequences for so many in our country."

Abortions have been legal in Singapore since 1969, making it one of the first countries in Asia to allow the procedure for a number of reasons, from family and financial conditions, to pregnancy via rape or incest. Before that, abortion was only allowed if the mother's life was in danger. It is "relatively progressive", Hingorani said.

Sociologist Tan Ern Ser said the procedure was likely legalised to help with population control. Back then, Singapore was trying to reduce the nation's birth rate, and in the 1970s, it had embarked on a campaign encouraging people to have just two children. In 1966, a Singaporean woman had 4.42 children on average. (The average now is a worryingly low 1.12 children born per woman.)

South Korea made a similar attempt at population control decades ago. Although abortions were illegal from 1953, officials had in the 1960s and 1970s encouraged women to go for the procedure. In addition to propaganda posters that read, "Two is enough", the government also paid for abortions and sent out "abortion buses" that performed the procedure on the road.

The messaging was so prevalent that Jay Kim, a team leader specialising in women's health and reproduction issues at Korea Womenlink Centre, said women had no idea that abortions were illegal. That only became clear later when falling birth rates prompted the government to crack down on clinics performing abortions.

It was only in 2019 that South Korea ruled that criminalising abortion was unconstitutional, paving the way for legal abortions starting last year.

As birth rates fell in Singapore and South Korea, so did the number of abortions. There were just 4,029 abortions in Singapore in 2020, compared to 175,929 from 1970 to 1983 - an average of some 12,000 a year. In South Korea, the The Korea Institute for Health and Social Affairs estimates that abortions fell 241,411 in 2008 to just under 50,000 in 2017.

Asked if decades of abortion rights in Singapore had benefited the country, sociologist Tan said the matter was not straightforward. If it contributed to declining birth rates, then it was a bad given current low fertility rates, he said.

He said it was also bad if women had relied on abortion as a form of birth control instead of using contraceptives. But if it led to fewer unwanted children being born, "I think the answer is mixed, depending on one's attitude towards abortion".

While abortion is legal, varying rules and differing prices mean it's not always accessible to all women.

In Malaysia, medical practitioners can make decisions "in good faith" to proceed with a termination of pregnancy up to the second trimester.

But the penal code also states that those who induce an abortion with a woman's consent can be imprisoned for a term of three years or a fine, or both.

Should the woman be "quick with child", defined as beyond the fourth month of pregnancy, then both she and her abortion provider can be sentenced up to seven years in jail or fined.

Subatra, the sexual and reproductive health expert, said this meant abortions could be carried out if "it involves risk to the life of the pregnant woman or injury to the mental and physical health of the pregnant woman".

Abinaya from Women's Aid Organisation said this meant doctors were wary of carrying out abortions, leading to some women being denied the procedure or having to turn to illegal clinics. The consequences can be disastrous, she said.

In February, a 15-year-old Malaysian girl was charged with murdering her own baby. She gave birth at home with help from a friend, who left to inform a clinic about the delivery. When clinic staff arrived, they found the baby bleeding from stab wounds. It later emerged that the teenager had been a rape victim.

"The outcome of the case is extremely upsetting and points to a systemic failure to protect girls and women in Malaysia on so many fronts," Abinaya said. "The state failed to implement safeguards for survivors of sexual violence in the country - including the right to terminate unwanted pregnancies, as well as education and awareness of this."

In a less extreme scenario, 33-year-old Anna - who declined to use her real name, outlining the stigma surrounding abortions - terminated a pregnancy five years ago. She had just started work and was unmarried, and was not ready to become a mother. But because her pregnancy did not present a risk to her life, physical health or mental health, Anna had to spend 1,200 ringgit (US$273) on an illegal abortion.

In Singapore, while a woman can have an abortion for any reason up to 24 weeks into her pregnancy, she is made to undergo counselling and only have the procedure 48 hours later.

Aware's Hingorani said this "may inadvertently imply that seeking abortion is morally wrong, inducing artificial guilt and regret", while also increasing overall costs by forcing multiple trips to the doctor.

Low-income women also struggled to pay the fees that could range from S$300 to S$3,000 (US$215-US$2,150), depending on how far along the pregnancy is, how much anaesthesia is used and if it is carried out at a public hospital or a private clinic, she said.

"This indicates that abortion is not equally accessible to all individuals in Singapore," she said.

Hingorani said some women had also reached out to Aware, saying social services "use language that clearly suggests their disavowal of abortion and push adoption as the more morally sound option".

In South Korea, Kim said there were still no clear standards for abortions.

There are clinics that will only perform the procedure before 10 weeks of pregnancy, while others are willing to perform surgery after 20 weeks at a price that is four times higher than the average cost for abortions in the country - which is around 1 million won (US$780).

"There hasn't been new measures to make it more accessible to women, such as providing medical insurance for operations, providing consultation services or allowing medication abortions," Kim said.

Stigma surrounding abortion also persists in South Korea. Kim recalled speaking to a woman who had called a clinic and was advised to "save" her baby, while another found anti-abortion posters hanging on the hallways of the clinic she visited.

What worries the experts - even though there is still no chatter in Asia about banning abortions - is that tides of opinion can turn overnight.

Kim said the US' example "just shows that even our laws have the possibility of going into regression".

Hingorani added: "They tell us how easily rights can be yanked away, despite being widely accepted for decades as a part of a minimum basket of rights for women."

This article originally appeared on the South China Morning Post (SCMP).

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