POLICY LANDSCAPE

1 United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Prospects 2019, Online Edition. Rev. 1 https://population.un.org/wpp/Download/Standard/Population/

2 Maternal mortality in 1990-2015 WHO, UNICEF, UNFPA, World Bank Group, and United Nations Population Division Maternal Mortality Estimation Inter-Agency Group http://origin.who.int/gho/maternal_health/countries/mdv.pdf 3 Maldives Demographic and Health Survey 2016-17 https://dhsprogram.com/pubs/pdf/FR349/FR349.pdf 4 Trends in Maternal Mortality: 1990 to 2015

https://apps.who.int/iris/bitstream/handle/10665/194254/9789241565141_eng.pdf?sequence=1

5 Maldives Health Statistics 2015-16 http://www.health.gov.mv/Uploads/Downloads//Publications/Publication(73).pdf 6 Section 416, The Penal Code, 2014 (Maldives) https://www.law.upenn.edu/live/files/4203-maldives-penal-code-2014 7 National Reproductive Health Strategy (2014-2018). Ministry of Health.

http://www.health.gov.mv/Uploads/Downloads//Informations/Informations(47).pdf 8 Abortion permissible in five circumstances, rules Fiqh Academy https://en.sun.mv/18588

9 Approved Drug List.2019 http://www.health.gov.mv/Uploads/Downloads/Informations/Informations(210).pdf

REFERENCES

ABORTION

POLICY LANDSCAPE

Maldives

The National Reproductive Health Strategy (2014 – 2018) by the Ministry of Health⁷ says that recog- nizing the magnitude and impact of unsafe abortions, the Ministry of Health and Gender approached the Ministry of Islamic Affairs to update the ruling for abortion. In response, the Fiqh Academy of Maldives (Government’s Council of Religious Scholars) released a Fatwa⁸ in 2013, allowing abortion in case of five conditions (Figure 1). This has been implemented in the country

Maternal mortality ratio

68/100 000 live births

²

20.9 years

³

23.2 years

³

2.1

³

19%

³

31%

³

Median age at first marriage

Median age at first birth

Total fertility rate

Contraceptive prevalence rate (all methods)

Unmet need for family planning

BACKGROUND

Located in the Indian Ocean, Maldives, the smallest Asian country, is an archipelago of 1 190 coral islands. It has a total population of 531 000, of which 195 000 are females¹. The sex ratio is 148 males per 100 females¹.

ABORTION-RELATED INDICATORS

Data on the total number of abortions or the abortion rate for Maldives is not available. As per Maldives Health Statistics 2015 – 2016⁵, 387 inpatients were admitted in tertiary hospitals for abortion in 2016, of which 82 were 15 – 24 years of age.

CONSENT FOR ABORTION

Consent for abortion is required from the woman undergoing the procedure but abortion can only be provided with spousal authorization; if the spouse is not available, consent is required from the paternal father or guardian.

PROVISION OF CAC AND POST-ABORTION CARE

 Abortions are highly restrictive and can be provided only by registered obstetricians/

gynecologists.

 Abortion can be performed only in higher-level health facilities and the procedure is covered under the national health insurance scheme .

 In the Approved Drug List of the Ministry of Health:

 Mifepristone appears in the pre-authorization list implying that pre-authorization (approval) must be taken prior to import. The approval is valid for one year. It is restricted for hospital use only and was last approved in 2014 based on a special request from a clinician.

 Misoprostol appears in both the pre-authorization list (25 mcg restricted to hospital use with valid approval till 2020) and exemption approval list (200 mcg) which implies that it can be imported based on special approvals that are also valid for one year⁹.

ABORTION LAWS AND POLICIES

According to Section 416 of the Maldives Penal Code, 2014⁶, abortion is permitted to save a woman’s life and if the pregnancy is a result of rape or incest.

The country’s MMR showed improvement over the years – it reduced from 677 in 1990 to 68 in 2015². This amounts to a 9.2″ % decline in MMR annually compared with the global rate of 2.3″ % annual decline⁴.

Unsafe abortion continues to be a major contributor to maternal mortality and morbidity. In 2010, among the eight maternal death cases, three cases were related to abortion⁷.

POLICY PROGRESS AND GAPS

3

Abortion-related drugs and supplies are not part of the registered products list, and approval status is ambiguous.

1

Advocacy efforts, particularly with the religious groups, led to amendment in the country’s penal code resulting in expansion of conditions in which abortion can be provided.

2

Even though abortion is permitted for a number of indications, there is no legal clarity and no national standards and guidelines for induced abortion and post-abortion care are available.

Figure 1: Conditions and gestation limit for which abortion is permitted in Maldives (as per the Fathwa released by the Fiqh Academy of Maldives)

* If a licensed medical practitioner declares a woman’s life to be in danger.

** Includes rape within marriage.

*** Doctor to confirm if fetus is thalassemia major or a sickle cell major or carries a disease that might result in a major permanent deformity to its body or brain and cannot be cured through medical treatment or medication

Save woman’s life*

Physical health

Mental health

Rape/

Incest**

Fetal

impairment

***

Economic/

social reasons

On request

Conditions

permitted (no limit)

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