“I have had three abortions. The first time, I was 15 years old. I was still in school. I would have brought shame on my family if I had had the child. I hid my pregnancy from my parents and then had a procedure. For the other two times, I already had children… I decided to abort rather than put the future of my children in jeopardy,” a 24-year-old mother of two explained to Haiti Grassroots Watch (HGW).
“I got pregnant when I was 19 years old because my boyfriend didn’t know how to correctly use the condom. I could not punish my parents like that. I was still in school, and I couldn’t take on the responsibility of a child, so I had an abortion, with my parents’ connect,” a 21-year-old woman explained.
Port-au-Prince, HAITI, 12 December 2013 – Despite the fact that it is illegal, abortion is common in Haiti.
Haitian women have the procedure in secret. Women from the lower classes are the ones most at risk, because unlike wealthy women, they cannot travel to specialized clinics in places like Florida. Poorer women have to use various medicines from pharmacists or traditional healers, or they have operations performed by doctors working without any oversight from health authorities.
Since last May, when he topic of abortion was brought to the fore, the debate has often focused on proclamations about motherhood and women’s duties. HGW decided to undertake an investigation into the reality of abortion in Haiti, in the hopes that in the future, the debate might be based on fact rather than mythology.
Olga Benoit, of the Solidarite Fanm Ayisyèn (SOFA or Solidarity for Haitian Women) organization, recognizes that abortion is part of Haitian society, despite being illegal. For her, fake doctors (called “charlatans” in Haitian Creole) pose the greatest risk.
There is a big difference between what the law says and what is really happening on the ground,” she said. “Ever since 1987, SOFA has noted that girls, adolescents and young women are exposed to enormous risks – risking their health and even their lives – because they have to go to charlatan to get an abortion.”
“As the years go by, more and more doctors have complained about the cases of women in critical condition who end up in the hospital after an abortion,” she added.
It is difficult to know how many women have died following abortions in Haiti. During a recent workshop, Minister of Public Health Dr. Florence Duperval Guillaume said that “of every 100,000 live births, we have recorded 630 maternal deaths,” due to complications. The ministry speculates that 20 to 30 percent of maternal deaths are due to botched abortions.
Studies estimate that there are about 40 million abortions per year worldwide, with more than four million in the Americas. Globally, half of all abortions take place under unsafe conditions and each year, 70,000 women die and over eight million suffer medical complications following abortions due to improper conditions or follow-up.
According to the recent report Abortion World Wide: A Decade of Uneven Progress, 98 percent of abortions in poor countries take place in dangerous conditions. Vulnerable women in poor countries where abortion is illegal run the most risk. In Guatemala, Mexico, Pakistan and Uganda, for example, 45 to 75 percent of women living below the poverty line have complications after clandestine abortions.
According to the Haitian government study EMMUS-V HAITI 2012 overseen by the MSPP, of 352 women who admitted to having an abortion since 2007, “40 percent said they had complications afterwards.”
Obstetrician and gynecologist Nicole Magloire, who is also executive secretary of the National Consultancy Against Violence Against Women, said that Haiti has doctors capable of performing surgical abortions safely, but, “because it is illegal, good doctors who are capable of doing the procedure in safe sanitary conditions have to operate clandestinely, and this makes it more expensive, and thus largely inaccessible.”
Seated in a pharmacy full of medicines, cosmetics and baby items on Monseigneur Guilloux Street downtown, a pharmacist in her fifties explains the choices in familiar terms.
“If the woman hasn’t yet reached three months, she can take Cytotec pills by the mouth and another in the vagina, with a little beer,” she noted. “If she is already at three months, she needs to do a curettage, which will cost 3,500 gourdes (US$ 81.40) in our laboratory.”
A packet of Cytotec pills. Each one costs US$2.32. Photo: HGW/Marc Schindler St-Val
“Cytotec” is the commercial name for misoprostol, an anti-ulcer medicine frequently used for medical abortions in Haiti. Misoprostol is the most common abortion method due to its low price, the fact that it is easy to find, and because no doctor is needed.
Women need curettage if their pregnancy is advanced beyond three months. Curettage is a procedure involving an aspirator device.
On another street, Joseph Janvier, used clothing is displayed on hangers along the wall of a building with no sign. Behind the shirts and pants, the walls are painted green and white, the traditional colors for pharmacies. Inside, a young woman sits in the hallway to answer questions and to explain the medical “menu,” which is not posted. Among other services, she sells abortion via injection.
A row of pharmacies on Monsignor Guilloux Street in downtown
Port-au-Prince. Photo: HGW/Marc Schindler St-Val
“If Cytotec does not work, we can do an injection. That costs 1,000 gourdes (US$ 23.25). It’s not risky. We are open Monday through Friday,” she said.
The woman is selling “Pitocin” or oxytocin, a medicine based on a hormone that causes the contraction of the uterus. Some women use it to cause an abortion.
“I frequently see women who have taken a Pitocin injection,” a nurse told HGW. “It’s easy to get at pharmacies.”
“Leaf doctors” or traditional healers offer a less expensive method. They prepare a medicine with plants, pills and alcohol, with all the risks one might imagine. It could be considered the “Haitian medical method.”
“I mix a ‘dose’ leaves from pwason dan nwa (“Black Fish Teeth” plant) and the roots of verbena, logwood (Campeche) and mahogany, mixed with chloroquine and Saridon (acetaminophen, propyphenazone and caffeine), with six to ten antibiotic pills, and then wine or clairin (a strong Haitian alcohol dink made from sugarcane). If the dose doesn’t work, then I give the woman a purgative,” a woman with 50 years of experience explained to HGW. “In some cases, you have to wait about 22 days to get the hoped-for result.”
Punish women or legalize abortion?
The discussion of sex is a taboo in Haitian society. But the discussion of abortion is even more so. Haitian law outlaws the practice in all its forms. Article 262 of the Penal Code punishes both the woman who has sought an abortion, as well as those who assist her.
A pharmacy on Monsignor Guilloux Street in downtown Port-au-Prince.
Photo: HGW/ Marc Schindler St-Val
The debate on the possible legalization of abortion is very contentious. Statements of all sorts have been made in the press since last May, when the MSPP launched the debate over possible legalization. But the controversy is inevitable and necessary, according to Minister Dr. Guillaume.
“All over the world, abortion is one of the great controversies,” the minister said in an article in Le Nouvelliste. “Haitian law goes as far as to condemn those involved in abortion to live in prison. This is why many of the women who die following a procedure are registered as having died of another cause.”
Various religious leaders have taken stands opposing the legalization in Haiti.
SOFA believes legalization is urgent.
“So long as the state continues to consider it a crime, it will do nothing to assure that women who are obliged to have an abortion can do so under conditions that do not put their lives in danger. At the moment, people can take advantage of women,” Benoit noted. “There are women who have been butchered by doctors but who have nowhere to turn.”
A 43-year-old woman with two children knew that abortion was risky. She did it anyway: “My husband was brutal. I knew that sooner or later, I would leave him, so I had an abortion so that he wouldn’t be leaving me with one more child. I already had two.
Haiti Grassroots Watch decided to withhold the names of the women and of the various abortion providers interviewed for this story due to the several penalties to which both would be subject, according to Haitian Law.