Abortion and Cesarean Sections: Acts of Crime?

Prime Minister Recep Tayyip Erdogan has recently declared that abortion is an act of murder and called on legislators to restrict this procedure. Another subject that he emphasized was the high proportion of Cesarean births in Turkey, declaring that Cesarean sections were crimes that restricted the growth of the Turkish population. He had previously asked couples to have at least three children in order to keep the Turkish population young and energetic.

Erdogan’s remarks were generally interpreted as an indication of the increased radicalization of his well-known Islamic orientation. A number of women’s rights groups and organizations issued declarations and protested the statements. The Medical Association, as well as the Speciality Associations of Turkey issued warnings about the possible outcomes of revoking the abortion law that has been valid since 1983.

Erdogan’s followers have supported the statements by reciting quotations from the Quran and other religious sources that support the idea that a fertilized ova must be accepted as a human being and not be sacrificed.

To correctly predict the outcome of these impending changes, it may help to examine Pakistan, a country where abortion is legal only in very limited situations. The population of Pakistan is 174 million and, like Turkey, the prevailing religion is Islam. It is estimated that around 200,000 women were hospitalized because of complications following clandestine abortions performed in 2002, (Population Council, “Unwanted Pregnancy and Post-abortion Complications in Pakistan: Findings from a national Study,” Islamabad, 2004).

A number of studies indicate that about 10 percent of the women seeking medical care after having illegal abortions could not be saved, (Bhutta S. et al, “Surgical complications after unsafe abortions,” Journal of the Pakistan Medical Association, 53:286, 2003)

Turkey’s population is about 76 million, which is slightly less than half of that of Pakistan. Hence, if the availability of abortion in properly-equipped hospitals was to be denied to women, we should expect that about 100,000 beds would be occupied by cases of complication following illicit interventions and that about 10,000 of these women would die.
In Turkey, when the law effectively prohibiting abortions was in force before 1983, the specialists of gynecological departments spent long periods of their time battling post-abortion complications and carrying out peritoneal dialysis for those women whose kidneys had ceased functioning. A large number of these young patients died. In 2013, Turkey can now realistically expect to return to this condition.

It is clear that whenever an unwanted pregnancy happens, religious principles and restrictive laws do not hinder its elimination. There can only be one humane and logical reaction to this well established fact: women bearing unwanted babies should be offered proper sterile hospital conditions for their termination.

The absence of a logical approach in confronting contemporary reproductive problems reminds one of similar mistakes that were made during the period when housing problems for internal migrants to towns had to be dealt with. In the past, thousands of people from Turkey’s rural areas flooded the cities and started building their own homes. These local immigrants were compelled to build their houses over the course of one night in order to avoid the possibility of being caught while transporting the building material to the site, and the subsequent demolition of their new house. These huts are thus referred to as “gecekondu” in Turkey, which translates something like, “made during the night.” The qualities of these shanty huts were abominable, mainly because repeated governments ignored the fact that the immigrants simply had to build something in which to take shelter and that they would build it even if the laws were merciless and police measures were harsh.

A different approach was displayed in Taiwan. People migrating to towns there were not compelled to build their houses overnight, they were allowed to build their houses in allocated areas and they were only responsible for taking a minimal number of health measures. Consequently, the huts built by the Taiwanese villagers were significantly healthier places to live in.

Following Erdogan’s remarks about the ideal number of children per couple, women’s rights groups and associations declared that it was not up to the prime minister or the government to decide the number of children each couple would eventually have. In demonstrations protesting the prime minister’s statements, speakers pointed out that it was up to the people to decide and that governments were obliged to offer the means to limit and time the births of their children who had not yet been given birth to.

Many columnists have also pointed out that the driving factor in deciding the number of children is economic. Thus, the government should, before anything else, ameliorate the economy if it is really interested in population figures.
The prime minister’s argument about Cesarean section births was equally erroneous: The most logical rationale for the recent increasing rate of C-sections is that the government has recently limited the expenditure from procedures. Let me explain why and how:

Before making statements such as those Erdogan has made, the authorities should first study the reasons why the proportion of these operations is on the rise everywhere. Statistics from the countries where social studies are dependable indicate that most of the indemnities paid in malpractice are attributed to obstetrics patients; that birth is a biological process during which a great number of parameters related to the baby and the mother are perpetually changing is one of the factors that causes mishaps.
With this very important piece of information, consider that a Turkish obstetrician following a birth – which normally lasts about 8 to 12 hours – will be extremely cautious upon confronting a phenomenon that has the potentiality of evolving ominously. A few changes in the fetal heart tones, accompanied by some changes in the tracings of the fetal heart beats, may simply indicate the necessity for extra attention. It is true that in such cases, the heart beat may eventually be normalized when the narrow part of the birth channel is negotiated by the fetal head.

Suppose you are a Turkish (or an American, Afghan or Albanian) obstetrician working at a hospital where the operating rooms cannot instantly be available in the event that an urgent C-section has to be performed. Also, bear in mind that it usually takes hours for such a preparation. Under these circumstances, whenever you confront a potentially threatening finding, you will most probably prefer to perform an immediate C-section, rather than opting for observation for a longer period of time and thus risking the infant. It is this that contributes to the proportional rise of C-sections in statistics.

Another factor significantly contributing to the increase of abdominal deliveries is whether, as a principle, you allow women who insist on having a C-section despite the fact that they are informed about the suitable dimensions of their pelvises and the relatively small size of their fetus, rendering a natural birth exceedingly likely. A humanistic way of thinking dictates that you must comply and perform a C-section in these cases and thus increase the proportion of abdominal deliveries.

The fallibility of Erdogan’s statements are noteworthy not only for their repudiation, but also because they cause us to question the objective of his party in modifying the constitution and the electoral laws. AKP is striving to create a presidential system in which the president will be omnipotent. If Erdogan, the strongest candidate for such a position, with an authority approaching that of Vladimir Putin in Russia, displays more errors like his statements on abortion and C-sections – which could have easily been avoided with merely an open mind and proper consultation – the prospect is not encouraging. The possibility of Erdogan committing such grave errors subsequent to his empowerment to the omnipotent presidency is an exceedingly
dangerous notion.