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Prevalence of Unsafe Abortion

Aditi Aryal

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Every day in India, 13 women die of unsafe abortions. It accounts for 10 to 12 per cent of total maternal deaths in Pakistan, and 7 per cent in Nepal. Unsafe abortions have increased three folds in the last decade in South Asia and this has become a pressing problem. These abortions are done without medical supervision, and include activities like inserting surgical devices or inapt herbs and spices or poison through the vaginal canal, consumption of non-OTC abortion pills without medical consultation, and perforation of the uterus. These methods are hazardous to the health of women as such abortions are performed by medically unqualified personnel and sometimes induced by the pregnant women on themselves and more often than not causes disability or worse, death.

This deliberate termination of pregnancy, abortion, is perhaps why today it is one of the most widely debated topics worldwide. The convictions on whether or not abortion should be conferred on a woman is powerfully held by groups on either side of the debate. Proponents and opponents argue for and against a worldview that focuses on rights of the people to undergo an abortion and that it cannot be curbed by the government or other violators of rights, contrasting with sanctity of the life of the foetus and that nobody should hold the rights to end a life especially when some other people fail to conceive.

The important question that should be addressed is whether rights to a safe abortion should be bestowed on a woman by formal and informal mechanisms of control or should she have the sole autonomy of her bodily rights.

Actually, there are several complex reasons for why some are against abortion but the underlying generalisation is that women, by choosing abortion, are opting an easy way out. The battle between the pro-choice and the pro-life schools of thought exists on a much larger scale than ideological. The spillovers are reflected in inconsistencies in policy making, ease of availing rights or medicinal facilities, and attitudes, knowledge and practice among various groups on a much larger scale than possibly imagined. This goes on to be reflected in inflexible abortion laws in countries like Pakistan and Bangladesh, non-application of seemingly liberal laws in India, and difficulties to implement very liberal abortion laws in Nepal. However, that perception may be unfair because abortion is nota cinch and women who do consider it weigh all their costs and decide to go for one atrocious procedure that changes their bodies and lives forever.

Whatever may be the underlying reason for why an abortion is sought, to address the legal complexities is not even the most difficult challenge surrounding abortion, albeit the cumbersome nature of making and amending laws. What happens actually is that existence of rigid laws only curb abortions to an extent and in turn create situations where people still find their ways around getting illegal abortions- clandestine and precarious. Thus, the most difficult challenge that exists is of unsafe abortions that take place whatever the law may be on paper. For instance, in Bangladesh, despite abortion being illegal an estimated 1,194,000 induced abortions were performed in 2014 and most of these were unsafely carried out. Abortion under any circumstances has been legal in Nepal since 2002. Yet, about 58% of the total abortions that are induced even today are unsafe.

This convenience is hampered by hindrances that make unavailable even the legally permitted abortion to women. Religious ordinances and diktats render abortion an impermissible activity. Apart from this, situations arise where women are not able to avail an abortion because of unwanted pressure exerted on them by the family. Non-awareness of the laws and medical procedures, limited reach and accessibility, societal, financial, religious, and cultural hindrances are some obstructions that need to be overcome to get a safe abortion.

Unsafe abortions put at risk the health of a woman. Abortion without the involvement of a trained medical expert will definitely lead to a difficult and unsanitary situation. Meanwhile, trained medical experts are also rare in rural areas as is the information on how to obtain abortions legally. Weak financial conditions clubbed with the absence of reach and accessibility is the biggest hindrance to getting an abortion and reasons behind posing a problem despite lax laws.

Sex selection abortion is highly prevalent in India as parents continue to long for male children over female children. Because this is a criminalised activity, women continue to choose unsafe abortions with the help of their family members. This was actually a family planning method to ensure the one-child policy in China and people preferred male children over female. In fact, 336 million abortions have been performed in China between 1971 and 2013. Only recently in 2018 have new rules sprung up where women need to get a signed approval from a medical practitioner.

In India, abortion is not readily available to women except in cases where the pregnancy results out of a rape, where the foetus is unsafe for the woman to carry, where the baby would be born with severe disabilities or deformities, and in case of married women upon the failure of contraception. A burdensome consultation permission from a doctor is required before 12 weeks, and permission from two doctors are required after 12 before 18 weeks and additionally, the court needs to permit abortions and due to legislative delays so the woman is far outside the safe abortion bracket causing health risks to herself.Similarly, so many survivors of rape, even minors, have been denied abortion in India and instead have had to marry their rapists because the best interests of the child were taken into consideration and not of the mother. The onus of proof lies on the woman where she has to prove it to the court that she deserves to be granted an abortion because she needs it.

Abortion delayed is abortion denied and state mechanisms should have no say on when or not to grant an abortion. Every person should have the right to avail healthcare as they will and abortion should be covered and talked about openly. Women should have full decisions over abortion and the choice to consult with a partner should be solely theirs because bodily rights cannot be conferred to the state by another person, even a sexual partner.

Aryal is a student of Social Science and writes about social and developmental issues pertaining to exclusion, inequalities, and gender disparities in the South Asian context.

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New Social Compact

Will COVID 19 further exacerbate xenophobia and populism?

Gary Rynhart

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Refugees and migrants gather at the Pazarkule border crossing near Edirne, Turkey, hoping to travel into Greece. © UNICEF

The onset of COVID 19 saw a significant rise in racism and xenophobia.  From racist incidents against Africans in Guangzhou to anti-Asian racism to just about everywhere. 

This comes after a decade of rising xenophobia driven by the fallout from the global financial crisis of 2008. Duarte, Trump, Erdogan, Bolsonoro, Johnson, Xi Jinping and Putin all traded successfully in these waters.  Last year the United Nation’s Secretary-General António Gutiérrez formed a special UN team to combat hate speech. As an example of the growing hate discourse he cited ‘how the debate on human mobility, for example, has been poisoned with false narratives linking refugees and migrants to terrorism and scapegoating them for many of society’s ills.’ The fear now is that as the global economy enters a prolonged period of economic recession this will create a fertile environment to extenuate further xenophobia along with its populist political cheerleaders.

2020 also saw the Black Lives Matters movement emerge into the political and social discourse in what seems like an epoch defining way. Add it all together and it seems that we have reached a tipping point of global racial discord and distrust of the ‘other’.

History can be instructive here. The onset of the Spanish Flu of 1918-1920 was bookended eleven years later by a global financial crash in 1929. The exact opposite sequence has now happened. The global financial crisis of 2008 has been bookended by COVID 19, also eleven years later in 2019.

This disrupted sequence may actually prove significant. The first (financial) crisis in 2008 ushered in many populist politicians; the second crisis (health) exposed them. Many of the most badly affected countries, as a consequence of poor crisis management, come from this pool of populist administrations.

The economic consequences of the shutdowns are already playing out and more pain will follow through into 2021, but electorates and populations do have the near history hindsight of populist promises post the 2008 financial crisis to consider. This may well in time steer populations away from the same fiery promises of nationalist exceptionalism and sunlit uplands.

Some commentators think the advent of vaccine nationalism will provide political deliverance for these same populist leaders. Yet if countries with a large number of cases lag in obtaining the vaccine and other medicines, the disease will continue to disrupt global supply chains and, as a result, economies around the world. That is in nobody’s interest.

Additionally, the assertion that xenophobia and discrimination are all on an upward trajectory can be contested. For example, according to a 2019 Pew Research Centre survey of 18 countries, in 1994 63 per cent of US citizens felt immigrants were a burden on the country. Fast forward 25 years and the figures are reversed. By a ratio of two to one, US citizens are pro-migration.  According to the same Pew survey, majorities in top migrant destination countries, which host half of the world’s migrants, say immigrants strengthen their countries. Majorities in the UK, France, Spain, Australia, Canada, Sweden and Germany all agree with the statement ‘migrants make my country stronger’.

There is also a generational shift in play. According to the results from the 2017 ‘Global Shapers Survey’ by the World Economic Forum, for a large majority of young people, identity is not about region, geography, religion or ethnicity; they simply see themselves as ‘human’. This is also the most popular answer choice across all regions. Majorities in the US among Generation Z (born after 2000) and Generation Y (born after 1981) say increasing racial and ethnic diversity in the US is a good thing for society. In 1958, only four per cent of Americans approved of inter-racial marriage, according to Gallup polling. Support only crossed the 50-per-cent threshold in 1997. It has now reached 87 per cent.

All this is has been feeding into the calculus of global companies who are becoming unlikely champions in the fight against xenophobia.

According to a 2018 Deloitte Millennial Survey, 69 per cent of employees who believe their senior-management teams are diverse see their working environments as motivating and stimulating. And 78 per cent of Millennials who say their top teams are diverse report that their organizations perform strongly in generating profits. Firms seen as diverse and perceived to have a diverse workforce are rated highly by Gen Y and Z. They want to work for them and buy their stuff.

In many ways, COVID 19 will probably push the private sector further in the diversity and inclusion direction, although the need to do this is in a more structured way (a recent global survey found only 35% of companies gathered data on company diversity).

Diversity particularly in decision-making brings multiple perspectives to bear on problems. This is not just corporate guff – this stuff really matters.   There is plenty of empirical evidence to back all this up. In the 2008–09 global financial crisis, banks with a higher share of women on their boards were more stable than their peers and the evidence suggest that banks run by women might be less vulnerable in a crisis.

This is not to downplay the pervasive threat that xenophobia presents. It continues to impact on millions of people’s daily lives, often in most distressing ways. Migrants are still being washed up on Greek beaches while the well-heeled look the other way.

Yet, there is plenty of counter evidence for optimism.  Populist leaders have been found out. Greater global connectivity is helping create greater awareness of different perspectives, views, cultures and ways of doing things. Many Front line workers in hospitals treating the victims of COVID 19 (along with supermarket workers and cleaners) are migrants leading to a greater appreciation of their role in societies.

The philosopher Bertrand Russell remarked that collective fear stimulates herd instinct, and tends to produce ferocity toward those who are not regarded as members of the herd.

With so much talk of ‘herd immunity’ COVID 19 has clearly demonstrated  that we are all in fact part of the same herd.

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Euthanasia, Living Will and The Analysis In India

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Euthanasia, i.e. mercy killing, refers to the act of painlessly putting to death a person who is either very old or very ill to prevent further pain and suffering. It is basically a practice that is done on people suffering from incurable diseases or incapacitating physical disorder wherein they are allowed to die by the withdrawal of artificial life support system or withholding of medical treatment. On 9th March 2018, the Supreme Court of India, in a historical decision, legalised passive euthanasia and the right of terminally ill persons to give advance directives for refusal of medical treatment. Therefore, the concept of ‘living will’ was recognised which essentially refers to the document that the person writes in a normal state of mind seeking passive euthanasia when he reaches an irreversible vegetative state or when he gets terminally ill. For a comprehensive understanding of this whole topic, we have demarcated between different types of ‘mercy killing’ in the next section. Also, we will discuss the concerned judgement in detail not forgetting to mention the backdrop that led to the much-anticipated move. Additionally, we will try to summarise the arguments of both the supporters as well as the dissenters of the move before finally moving to the conclusion.

Active Euthanasia, Passive Euthanasia, Indirect Euthanasia and Assisted Suicide

Active Euthanasia refers to the deliberate act of ending the life of a terminally ill or incurable patient through the administration of a legal drug or injection by the physician. Passive Euthanasia is the withdrawal or withholding of artificial life support system when the patient requests to do so or when prolonging of his life is termed futile. Indirect Euthanasia means the provision of treatment with an aim to reduce pain and suffering, but which eventually speeds up the process of death. And, assisted suicide (also called physician-assisted suicide) refers to the situation when the doctor intentionally and knowingly provides the patient with the knowledge and/or means to commit suicide. The laws regarding euthanasia differ throughout the world. In countries like Belgium and the Netherlands, euthanasia has been legal since 2002. The practice of ‘Assisted Suicide’ is legal in European countries of Switzerland and Germany. In England, both euthanasia, as well as assisted suicide, are illegal. In most of the U.S., euthanasia is illegal but physician-assisted suicide has been legalised in ten of its states. In India, passive euthanasia was legalised two years back. The next section discusses the same in detail.

Euthanasia in India: The Aruna Shanbaug Case and the Common Cause Judgement

The case of Aruna Shanbaug has been quite instrumental in changing the euthanasia laws in India. Ms. Aruna Ramchandra Shanbaug was an Indian nurse who in 1973, was sexually assaulted by a ward boy in the hospital as a result of which she went into a vegetative state. In 2010, a plea was filed by activist Ms. Pinki Virani before the Supreme Court seeking euthanasia for Ms. Aruna Shanbaug. The Court took up the plea and finally, on March 7, 2011, delivered the historical judgement. Ms. Virani’s plea got rejected but at the same time, broad guidelines were issued legalising passive euthanasia in India. It was held that the decision to withdraw life support must be taken by parents, spouse or other close relatives in the absence of all of whom, the ‘next’ friend would be entrusted with the responsibility. In this particular case, the hospital staff that had been taking care of Ms. Aruna for years was called the ‘next friend’ and not Ms. Virani. In 2015, Ms. Aruna Shanbaug, after 42 years of constant suffering died of pneumonia at the age of 66 but not before playing a vital role in influencing upcoming euthanasia-related laws in India.

In a separate move, ‘Common Cause’, an NGO working for people’s rights, approached the Supreme Court under Art. 32[1] of the Constitution in the year 2005, wherein they prayed for the declaration that ‘Right to Die with Dignity’ be made a fundamental right under Art. 21 [2] i.e. Right to Life. Additionally, they requested the court to give directions to the government with regards to the execution of living wills in case a person gets terminally ill. The argument was that subjecting terminally ill people or the people suffering from chronic diseases to cruel treatments denied them the right to live with dignity. On February 25, 2014, a 3-judge bench of the Supreme Court led by the then CJI P. Sathasivam started final hearing in the case wherein it came out that the previous judgements given in the case of Aruna Shanbaug v. Union of India (2011)[3], as well as the case of Gian Kaur v. State of Punjab (1996)[4], were inconsistent. The matter was then referred to a 5 Judge Constitutional Bench. And finally, on March 9, 2018, in a historical decision, CJI Deepak Mishra led bench recognised the concept of ‘living will’ that was to be drawn by terminally ill patients for passive euthanasia and also laid down comprehensive guidelines for the same. Hence, the ‘Right to Die with Dignity’ was held to be a fundamental right.[5]

Euthanasia- a good or a bad thing?

The proponents of Euthanasia argue that allowing an incurable patient to die will alleviate the constant pain and suffering that one has to go through when in the vegetative state. The other point which they talk about is that ‘right to die with dignity’ is a matter of personal choice and no-one else should be allowed to interfere in the patient’s decision. It has also been said time and again that timely executed euthanasia could also relieve the financial burden on the family of the patient which in case of absence of the law, could exert a lot of financial burden on poor households.

Moreover, coming to the major points that the opponents say, the fact that the law on euthanasia could be misused is always talked about. It is argued that children of old and ill parents would certainly want to neglect their parents when they are needed the most. This does not fit with the kind of social and cultural environment that we have in India, where parents are supposed to be provided with care when they get too old. Also, the opponents lay emphasis on the sanctity of life and reckon that accepting euthanasia would lead to a reduction in society’s respect for life.

Benefits of recognising Living Will

Recognition of Living will indeed have some good impact. The concept essentially requiresa person to write the will as an advance directive when he is capable of making a sensible decision. And, thus, this rules out the possibility of the situation when the patient, being too ill, is not able to make an informed and competitive decision especially so in the case of Mentally Challenged patients and the patients who are incoma. Also, the living will, to much extent, would relieve the moral burden from the family member who actually takes steps for euthanasia, for ultimately, he would be fulfilling the informed wish of the patient only. Passive Euthanasia could sometimes, in exceptional circumstances, lead to the allegations of murder so the existence of a living will have a role to play in preventing such situations. In and all, the legalisation of ‘living will’goes a long way in effective implementation of the laws of euthanasia in India.

Concluding Remarks

In the course of this article, we tried to explain with clarity the concepts of euthanasia as well as ‘living will’. We listed out the arguments of both the proponents as well as the opponents of euthanasia and also mentioned how the ‘living will’ is going to have a positive impact. Giving due importance to the judgement of the Supreme Court in the Common Cause Case, the long-anticipated Fundamental Right to Die with Dignity has finally been accepted. The legalisation of Passive Euthanasia, along with the recognition of ‘living will’ would make a lot of difference in how the severely ill patients meet their death. Having a dignified death is equally important as having a dignified life, so in that respect, the laws on euthanasia would come out to be of vital importance. As far as the living will is concerned, it is definitely going to simplify the entire process of euthanasia. In the end, we could just hope that the laws are able to achieve the desired objectives.


[1]The Constitution of India, 1950, Art. 32.

[2]The Constitution of India, 1950, Art. 21.

[3] Aruna Ramachandra Shanbaug v. Union of India, (2011) 4 SCC 454.

[4]Gian Kaur v. State of Punjab, (1996) 2 SCC 648.

[5] Common Cause (A Regd. Society) v Union of India and Anr, 2018 5 SCC 1.

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New Social Compact

Reimagining Governance after Covid-19

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What will it take to rescue the global economy in the wake of COVID-19? Are adjustments, improvements or amendments enough? Haven’t we done this before? Maybe it’s time to rethink this with a mindset, not of ‘starting again’ which would tend to invite ‘again’ thinking, but instead to begin with a completely blank slate – no preconceptions – just goals.

 I suggested a new paradigm, a total reset.

Change most often happens incrementally, over decades, if not centuries and many historical truths define the present long past their relevance. For one, the fundamental principles of our global economy still rest on the agrarian and industrial revolutions. Tilling the soil and staffing factories remain the foundations of today’s economic planning – despite the fact that we have well entered the digital, automated world.

Another of these historical, yet increasingly outdated conventionsis the pervasiveness of male leadership.

The position of women has evolved incrementally and at best- unevenly – throughout the world. Although women comprise half the population, the world’s political, economic and social systems continue to be based on designs stemming from and reflecting men’s nature. 

All things being equal, it is very costly to knock down the entirety of something and start from scratch. Perhaps fortunately, the devastation caused by COVID-19 is happening at a time of acute and increasing awareness of the imbalance in society. This offers a rare, first-ever opportunity to revisit the definition of effective.

That is whyit make sense to re-architect these systems now, imbuing governance with a mix of qualities of success that are peculiar to women as well as those of men.An op-ed in the British Medical Journal recently noted that to avoid ‘groupthink’ and blind spots, policy decisions must include representatives with diverse backgrounds.  But during the outbreak of covid-19 the male-led governments of the UK and Sweden relied mainly on epidemiological modeling by internal advisors. Few channels were open for dissenting views. By contrast, Merkel looked to outside sources, beyond epidemiology to medical providers, and as far as South Korea’s successful testing and isolation procedures.

Two notable characteristics of leadership of women leaders during Covid-19 were inclusiveness and compassion: embracing diversity in political institutions and empowering society. In the battle against corona this meant transparency, clarity of responsibility with everything visible – not behind the scenes. It meant swiftly finding ways to allow the populace to become stakeholders in the solution. It included appealing to the citizenry with an executive demeanor that conveyed commitment and a sense that there was a consistent plan of action that demanded civic responsibility while at the same time, leaving the people with a great deal of discretion and personal influence over their own experience. 

Compassion informed a compelling vision presented with warmth. 

Some like Peter Huang of the University of Colorado Law School, have already noted the most important leadership lesson of COVID-19:put more women in charge. But is that enough when the system itself is informed by and imbued with male characteristics, language, energy?

Societal norms are defined and shaped by millennia of men at the helm.  Thus most women remain compelled to conform to the existing framework, created by and for men, to attain and hold their positions. In most cases, that means; act like a man. Adapt to systems where leaders are expected to be aggressive, domineering and cut-throat.

The devastation wreaked by COVID-19 shows that the existing framework is no longer relevant, opening an opportunity to invent something totally new. The virus has created a moment where we can begin to see the possibilities devoid of the limitations of our old ways. The time has come to expand the definition of what is effective and reimagine measures for governance based on entirely new systems that emerge from a cooperative process of creation. For the first time in the history of humanity, society can be built on foundations rising from a fully cooperative process between men and women.  With a clean slate and a balanced – male and female, yin and yang -defined approach, we have the opportunity to do it right.

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