Photo courtesy of resurj

Sri Lanka enshrines a right to universal healthcare but critically neglects women in this universal promise. Acknowledging that abortion is politicized through its economic and colonial history is crucial for recognizing how women’s bodies are turned into political playgrounds, and thus women are deprived of their right to a full range of reproductive services. A pro-choice future will ensure that women repossess their bodily autonomy, prevent the number of unsafe abortions that are carried out every day and work to remedy the longstanding domination of women under bigoted state policies.

The pipedream of free and universal healthcare

Sri Lanka guarantees free and universal healthcare to all citizens. Article 11 of the Constitution requires the establishment and maintenance of public hospitals, rural hospitals, maternity homes and dispensaries, as well as public health services including family health maternity and childcare. The Constitution also makes provisions for the continual development of healthcare and health teaching. Furthermore, Article 9 stipulates the state’s responsibility for supervision of private healthcare and commitment to population control and family planning. While reproductive healthcare is never specifically mentioned, it does fall under the purview of Articles 9 and 11. Sri Lanka has signed and ratified all of the main UN Conventions pertaining to women’s health including the Convention on the Elimination of Discrimination Against Women (CEDAW) and the International Covenant on Economic, Social and Cultural Rights (ICESCR) with no reservations. Based on Sri Lanka’s national and international commitments, there is major scope – indeed, a major necessitation – for all-encompassing reproductive healthcare.

And yet abortion remains illegal in Sri Lanka. Exceptions are made only in the instance that the mother’s life is at risk, and abortions are limited to the private sector where women must pay a premium price for the service. The Penal Code Amendment Bill of 1995 proposed the legalization of abortion in the instance of rape, incest, or birth defects but the proposal was never sanctioned. As a result, Sri Lanka has a high rate of criminal and unsafe abortions. In 2019, the mortality rate for undocumented abortion stood at roughly 15%.

As it is well known, a movement to criminalize and limit abortions simply lowers the rate of safe and legal abortions but not abortions themselves, which have been practiced since the beginning of humankind and will continue to be practiced regardless of legislation. Paradoxically, the Family Planning Unit under the Ministry of Health expresses an explicit desire to reduce abortions in the country. This appears to run contradictory to Constitutional commitments to family planning and population control since abortion is a key tool in free choice elements of family planning and can directly contribute towards population control in Sri Lanka.

Ensuring that contraception is available to the public also remains a challenge in Sri Lanka. Despite the ready availability of birth control at any pharmacy and the accessibility of contraception via family planning clinics, it remains a clandestine exchange due to a lack of public discourse on matters of sex and contraception. Sex, unless practiced within marriage, remains taboo. Despite universal state-sponsored delivery of contraceptive methods, contraception falls under the purview of the “Family Planning Unit”, which appears to alienate and deter unmarried women, LGBTQ women, women choosing to have sex outside of family-building purposes, or women seeking contraception for purposes unrelated to sex. Indeed contraception, testing for sexually transmitted diseases and wider access to reproductive information are all premised on marital status. Hence reproductive health options remain limited or unacceptable for women falling beyond the conventional marital and nuclear family unit.

In short, the true promise of universal healthcare and non-discrimination on the basis of sex is hardly realized in Sri Lanka.

An insidious history of appropriating reproductive labor

In a modern, capitalist state, the division of labor is necessary. We typically understand labor as labor of the wage: a commodity production and masculinized workforce, absolutely crucial for the survival of mankind. However, wage labor refers to paid public labor for commodity production. Reproductive labor, on the other hand, refers to the private, unpaid women’s labor that is necessary for social reproduction. This involves a plethora of activities including child bearing, child rearing, and household work, all of which are mystified, concealed and deemed as a woman’s “natural” duty, so as to emphasize why reproductive labor is undeserving of a wage. Capitalism – indeed, modern society – relies on unpaid reproductive labor for the functioning of commodity production. There is no society, no workforce and no functioning state without appropriated reproductive labor.

It then begs the question: when did we decide that only public labor was deserving of a wage? Why does reproductive labor remain concealed and mystified as a woman’s natural duty?

The answer is that society profits off of unpaid reproductive labor. The idea that women’s work is not “real work” is not simply a product of gender and cultural norms, but a calculated foundation of the modern state which benefits from women’s free labor. The reproduction of humankind is the essential, free commodity for sustaining an economy – and it is achieved via the policing of women’s reproductive rights and the criminalization of abortion.

Tracing the first legal restrictions on abortion to Europe in the 15th and 16th century, it is clear that wresting reproductive power away from women became a necessary means of state control. The earliest forms of abortion laws, for instance, were created as a result of mass population decline following the Black Plague. With a decline in population came the weakening of the workforce and a real fear among European elites that population decline would slow the production of capital and necessitate a higher paid wage for laborers. Mercantilism, an ideology born concurrent to capitalism, stipulated that the size of the labor force is crucial for a nation’s wealth, and the development of the modern state as a political power. Thus, ensuring that a woman would reproduce so as to spur population growth and the production of capital became a primary objective of the state.

New forms of surveillance were undertaken to ensure that women would not terminate their pregnancies. Midwives were subject to hyper-suspicion of encouraging contraceptive use and abortion practices, which were designated as “witchcraft” and therefore “female crimes”. This resulted in the masculinization of reproductive medical fields, which in the Middle Ages had been a depository of reproductive knowledge amongst the midwives. As women were stripped of their roles in the birthing process, midwives became a primary target of the brutal “Witch Hunts” that would take place in Europe and soon be exported to the colonies. This revealed a bloody war against women, deemed witches, for their exercise of reproductive autonomy. By dispossessing women of their historic knowledge and practices regarding reproduction, women were reduced to a passive role in child delivery, whereby “wombs became public territory, controlled by men and the state, and procreation was directly placed at the service of capitalist accumulation”. Silvia Federici’s “Caliban and the Witch” remains a seminal text that explores the rise of patriarchal order during the era of European witch hunts.

The origins of reproductive control as a European project is essential for road mapping its export to the colonies, and its arrival on Sri Lankan shores. Quite literally, reproductive control became a capitalist project for colonizers, who were concerned with extracting labor and wealth from their colonies. Given the economic motives behind criminalizing abortion, it is unsurprising that the first law on marriage established by the British in Sri Lanka was the criminalization of infanticide in 1823. Criminalization of infanticide was not defined in our modern understanding of the act but rather constituted a broad category used to focus on abortions and, sometimes, failure of mothers to carry their pregnancy to full term. The wide scope of the law allowed women to be criminalized for abortion as a murderous charge. It also became required that every birth was state registered, so that the state could surveil any instances of abortion, births out of wedlock, and criminalize female “offenders” accordingly.

Regulations against abortion and contraception comprised a massive missionary project, premised upon the pursuit of Christian morality. For sexually liberal societies such as pre-colonial Sri Lanka, marriage for the lay individual was a private affair, polygamy and polyandry were not criminalized, and control of reproduction was a woman’s right. The overturn of reproductive rights as a state-regulated matter was met with passive and overt resistance; yet the British rule of law prevailed and remains the law of the day.

Hardly pro-life but anti-choice

“Pro-life” versus “Pro-Choice” remain catchall phrases of the abortion cause in the US, but nonetheless encompass much of the moralistic prerogatives behind abortion laws in Sri Lanka as well. The notion that one is “pro-life” by supporting the criminalization of abortion totally neglects the life of the mother and the life of the fetus beyond the embryo. More accurately, this stance is anti-choice and supportive of an insidious history that appropriates and dominates women’s reproductive choices.

The illegality of abortion is the continued subordination of women’s bodies to the state. It is a continuation of bloody capitalist practice that appropriates a woman’s reproductive labor, turns her into a machine of reproduction and discards her choice and autonomy. There is nothing “natural” or “mystic” about relegating women to the private sphere and then proceeding to subject her body to state policing through draconian abortions laws. In fact, it is a calculated and precise political and economic move, stripping a woman of her body and autonomous choice and reaping the benefits of her appropriated reproductive labor.

The idea that women were naturalized into the household sphere is also false – it took centuries of bloody terror campaigns, what we now know as the European “Witch Hunts” – to bring a woman’s body under the purview of the nuclear family and the state. A new patriarchal order was exported to the colonies, imposed upon nations such as Sri Lanka and a patriarchal order remains today. Colonial ideals of a nuclear family unit, the confinement of women to the home and the devaluing of women’s lives beyond their reproductive function are all consequences of this strategic, constructed patriarchal order.

If Sri Lanka is to fully realize its objectives of delivering universal healthcare services, then the country must shift towards a rights-based approach to healthcare that actively ensures and monitors a full range of reproductive healthcare and health choices for citizens. By emphasizing a rights-based approach to reproductive healthcare through provisions already outlined in the Constitution, such as the right to free and universal healthcare, family planning services and the right to non-discrimination, Sri Lanka can strengthen its reproductive healthcare system and ensure that universal reproductive healthcare – including safe abortion services – is actually being delivered to all citizens.

Until then, the pipedream of universal healthcare plays on.