A "witch hunt against poor women": Across the Americas, abortion laws are harming health and securityRestrictive reproductive policies in El Salvador, Colombia, the U.S., and elsewhere are pushing women toward unsafe procedures. Journalist Angelika Albaladejo argues that countries need to ensure that reproductive care is recognized as a human right. Current legislation only exacerbates the inequality, shame, and discrimination that women face across the Americas.
In 2011, Maria Teresa Rivera woke up handcuffed to a hospital bed. Earlier that day, suffering stomach cramps, she had gone to the latrine in her backyard and collapsed. Her mother-in-law had found her, lying in a pool of blood, and rushed her to the hospital.
The 27-year-old Salvadoran garment worker and single mother had miscarried without ever knowing she was pregnant. But when she regained consciousness, she learned that hospital staff had suspected her of inducing an abortion and reported her to the police. The next day, still nauseated and feverish, she was moved to a jail cell. A few months later, a judge sentenced her to the maximum punishment for murder: 40 years in prison.
Maria Teresa is not alone. Across the Americas, restrictive reproductive rights laws are harming women’s health and security, offering a picture of what the United States could look like if Donald Trump’s administration has its way. Strict statutes paired with inequality and generalized violence strip women of control over their bodies and impede access to health care, especially for those in the poorest communities. “The women who are already in vulnerable situations are always going to suffer the most,” said Paula Avila-Guillen, an attorney and programs specialist for the Center for Reproductive Rights, a global advocacy group based in New York City. “The discrepancies in the level of access are really just outrageous, and it becomes even more worrisome when it comes to access to reproductive health services.”
Seven countries in Latin America and the Caribbean have complete bans on abortion, including the Dominican Republic, Haiti, Honduras, Nicaragua, Chile, and Suriname. But nowhere in the region is the criminalization of women’s bodies more visible than in El Salvador. The smallest and most densely populated country in Central America used to have a three-exception rule common in other Latin American countries. Women could seek out an abortion in cases of rape, if the fetus had severe defects, or when the pregnancy posed a risk to the mother’s life. But, fueled by a pro-life lobby backed by socially conservative politicians and the Catholic Church, “all of those exceptions were stricken from the books in 1998,” explained Charles Abbott, senior legal adviser for Latin America and the Caribbean for the Center for Reproductive Rights.
Since 2000, at least 129 women have been prosecuted for abortion-related crimes in El Salvador. The most notorious cases are those of Las 17—a group of women, which includes Maria Teresa, who were sentenced to more than 30 years for having a miscarriage or stillbirth. While still known as Las 17, the group has grown to include at least 25 women, most of whom worked low-income jobs, lived in poor or rural areas, and had little education or were illiterate. Dennis Muñoz, a lawyer who has represented several of Las 17, has described the abortion policy as a “witch hunt against poor women.”
A decade-long international campaign by women’s rights groups and human rights lawyers—including the Center for Reproductive Rights and the San Salvador-based Citizens’ Association for the Decriminalization of Abortion—has kept a spotlight on cases like Maria Teresa’s while pushing for the release of Las 17 and reforms to the total ban on abortion. After four years of domestic and international pressure, Maria Teresa was set free in May 2016.
A new judge reviewed her case and determined that serious “judicial error” in her trial had resulted in a conviction without a motive or evidence of wrongdoing. “The general picture is one of a complete lack of due process starting with the beginning of the investigation, [followed by] a very serious combination of human rights violations that can lead to up to 40 years in prison,” Abbott said.
“When they told me I was free, I did not have words. I felt happy, because I was going to see my son,” Maria Teresa said in a letter to supporters. “In El Salvador, justice has been served and this needs to happen again with my compañeras, [the other women imprisoned on similar charges].”
Maria Teresa’s release followed that of Carmen “Guadalupe” Vásquez Aldana in 2015. At 18 years old, Guadalupe was raped and became pregnant. She miscarried while at work as a housekeeper. Her employers rushed her to a hospital, but the staff called the police. She was arrested and charged with aggravated homicide. A judge gave her a 30-year sentence, despite a lack of evidence that she intentionally ended her pregnancy. After serving seven years, she was granted an unprecedented pardon by the Salvadoran legislative assembly. Morena Herrera, president of the Citizens’ Association, attributed the pardon to “significant social pressure, nationally and internationally” and the Supreme Court’s recognition that due process violations were evident in Guadalupe’s case.
Still, at least 25 women remain behind bars in El Salvador with stories similar to those of Maria Teresa and Guadalupe. Dr. Eduardo Espinoza, El Salvador’s vice-minister of health, has called the abortion ban “archaic” and “not fair.” But, as Herrera explained, no more pardons have been granted due to the “economic and media power” of right-wing religious groups and the country’s conservative Nationalist Republican Alliance party, known by the Spanish acronym ARENA.
In July, ARENA members proposed a change to the law that would increase the maximum jail sentence for women accused of having abortions to up to 50 years—making the country’s already severe anti-abortion laws even more punitive. “This would equate abortion in terms of criminal penalties with the maximum punishment for any crime in El Salvador,” Abbott said.
This means if a woman or girl gets an abortion after becoming pregnant as the result of rape, she could face up to 50 years in prison, while the maximum sentence her rapist could receive is eight years.
Salvadoran women’s rights groups have rallied together to advocate against the proposed change, and internal disagreement within the ARENA party makes it unlikely that the legislation will pass. In October, members of El Salvador’s ruling party, the leftist Farabundo Martí Liberation Front (FMLN), introduced legislation that would revert the country’s abortion laws back to a three-exception rule. But given the current political climate, proposals to ease restrictions on abortion are even less likely to succeed.
“We’re facing an uphill battle,” Herrera said. “I’m not sure things will get any easier in my lifetime.”
COLOMBIA’S PARTIAL DECRIMINALIZATION
While El Salvador’s laws are among the most extreme, they are hardly the only prohibitions in the region. From Colombia to the United States, laws restricting access to abortion are pushing women toward unsafe procedures and stigmatizing those who seek reproductive health care. Alarming rates of sexual violence further exacerbate the situation. Survivors of sexual violence are often discouraged from reporting the crimes due to widespread impunity, fear of reprisal, and discrimination. In countries where abortion is legal or partially decriminalized, access to abortion services and other forms of reproductive care are becoming more limited—and the impacts are devastating.
More than half of the countries in the Americas—29 in total—criminalize abortion in all but a few specific cases, usually some form of the three-exception rule. Even when abortion laws are slightly less restrictive on paper, women—especially the region’s poorest women and those in rural areas—are often blocked from accessing these procedures due to social and institutional barriers.
Ten years ago, Colombia’s constitutional court made a landmark decision brought on by years of advocacy by women’s rights groups; it decriminalized abortion in cases of rape or incest, when the mother’s life or health is at risk, or when the fetus can’t survive outside of the womb. These exceptions, however, have not been consistently applied. “One of the issues with partial decriminalization is that the implementation of those laws becomes very difficult,” Avila-Guillen said. “There is not 100 percent clarity. . . . Even hospitals, doctors, and judges don’t know how to apply the law.”
In many Latin American countries, including Colombia, doctors can refuse to provide abortion services by claiming a “conscientious objection” based on their religious or moral beliefs. When denied care on these grounds, women in urban areas can often seek help elsewhere. But, when the objecting doctor is the only one available, women may have nowhere to turn. Overall, “the service continues to be very limited in rural areas and for women who just don’t have the economic means or the power to fight a hospital,” Avila-Guillen said.
But the main obstacle to implementation of the law continues to be the state itself, and the institutional hurdles are most visible in cases of rape. In Colombia, survivors of sexual violence must immediately file a report with the attorney general’s office to receive the documentation needed to get a legal abortion. However, women will often avoid filing reports out of fear of being humiliated by officials or concern their families and communities might find out. “The attorney general’s office is where victims of sexual abuse face the most discrimination,” Millena Zapata Muñoz, a Colombian survivor of sexual violence, told the women’s rights group Corporación Sisma Mujer. “You go to file a report and they say, ‘Are you even pretty enough for [them] to want to rape you?’ . . . When you suffer a case of sexual abuse, you tend to stay quiet because of the discrimination and the criticisms.”
Ensuring that doctors make these abortion exceptions is most difficult in Colombia’s countryside, which has been ravaged by the longest-running armed conflict in the Western Hemisphere. Since the 1950s, leftist guerrilla groups, right-wing paramilitaries, and the Colombian military have fought over political representation and land rights, primarily in rural areas that have historically lacked a strong state presence or infrastructure for health, education, and transportation. These factors place women at high risk of sexual violence and unplanned pregnancies without access to adequate reproductive health care or the autonomy to make decisions about whether or not to carry a pregnancy to term.
Julia, whose name was changed to protect her identity, recounted in a 2014 interview with the Ministry of Justice how she was raped for several days by paramilitary soldiers who came to her village 10 years earlier in Chocó, a predominantly indigenous and Afro-Colombian area on the northwest Pacific coast. “When they stopped raping me, I went to a health provider who gave me a powder . . . to avoid any infection,” she said. “However, I never denounced the rape, because I did not trust [the officials]. I also did not get any kind of psychosocial support or go forward to enroll myself in the [government’s official] register of victims.”
After five decades of conflict, the war appeared to be ending with the signing of a peace agreement in September between the Colombian government and the country’s main guerrilla group, the Revolutionary Armed Forces of Colombia (FARC). International bodies lauded the pact for its inclusion of victims’ proposals. A gender subcommittee, the first of its kind in any peace process, pushed to include women’s and LGBT rights in every section of the accord. Significantly, a special unit would have been established to investigate sexual violence against women during the conflict, and perpetrators of these crimes would not be eligible for amnesty. However, a public referendum vote in October narrowly rejected the deal, creating uncertainty over what will come next.
Peace would create opportunities to expand reproductive health services in the countryside. But even if a peace agreement that includes women’s rights can be passed, the difficulties ensuring adequate reproductive care in Colombia’s cities suggest improving access in rural areas will remain a challenge.
LACK OF ACCESS
More than 97 percent of women in Latin America and the Caribbean live in countries where abortion is heavily restricted or completely banned, according to the Guttmacher Institute, the foremost global research and policy organization on sexual and reproductive health. Yet, the region still has the highest rates of abortion in the world.
Restricted access to reproductive health care and the inability to prevent unwanted pregnancies almost always lead to higher rates of abortion, legal or otherwise, according to a study by the World Health Organization and the Guttmacher Institute. This link between lack of access and high abortion rates is apparent in Latin America and the Caribbean where more than 23 million women have an unmet need for effective contraceptive methods and more than half of all pregnancies are unintended, according to the Guttmacher Institute.
The absence of reproductive care has been especially significant as the mosquito-borne Zika virus sweeps across the region. Zika has been linked to severe birth defects and can be sexually transmitted. Many of the affected countries, however, have focused their response on advising women not to get pregnant, and not on increasing access to prevention methods or abortions when needed.
Throughout the Americas, poor women who seek out abortions tend to rely on untrained providers and the least safe methods. According to the Guttmacher Institute, illegal abortions cause at least 10 percent of maternal deaths, and every year, at least 760,000 women are treated for complications from these procedures across Latin America. In El Salvador alone, over 35,000 potentially unsafe secret abortions take place annually since the total ban on abortion was passed in 1998, according to estimates from the Citizens’ Association. In Colombia, clandestine abortions still far outnumber legal ones, more than 10 years after partial decriminalization.
OUT OF REACH
Even in countries where abortion is legal, access to reproductive health care is becoming increasingly limited. In the United States, laws at the state and federal level that withhold funds and decrease access to abortion providers have hurt women both inside the country and abroad.
In addition to setting an example domestically that helps keep restrictive policies firmly in place throughout the Americas, the U.S. Congress has consistently prevented foreign assistance from reaching clinics that provide abortion services.
Following Supreme Court hearings in the 1970s that recognized women’s rights to abortion at the federal level, U.S. states began passing hundreds of laws aimed at restricting access. These measures have included everything from expanded mandatory waiting periods to health regulations intended to shut down clinics, which the Center for Reproductive Rights argues, “willfully disregard scientific accuracy and patients’ health and rights.” In the first half of 2016, states proposed 360 restrictions on reproductive services, more than 60 of which have been signed into law.
Conservative states like Texas have relied on targeted regulation of abortion providers laws, commonly known as TRAP laws, to shut down clinics that provide abortion services by requiring hospital-like standards and admitting privileges at a nearby hospital. The Supreme Court has since ruled these laws unconstitutional, because they failed to advance women’s health and placed an undue burden on those seeking to access abortion care. The ruling sets a precedent for other states, but does not automatically invalidate all TRAP laws. Conservative lawmakers are already testing new tactics to curb abortion access, such as Oklahoma’s recently failed attempt to criminalize physicians who provide the procedure.
In Texas, these laws, paired with Republican-led budget cuts to women’s health programs, have endangered those seeking reproductive care. Between 2010 and 2014, the number of women who died from pregnancy-related complications doubled, giving the state the highest maternal mortality rate of anywhere in the developed world.
These state restrictions are compounded at the federal level by laws that further restrict access for poor women. Since the 1970s, the U.S. Congress has used an appropriations rider known as the Hyde Amendment to bar the use of Medicaid health insurance funds for abortion services in all but a handful of circumstances. “The impact . . . is clear: preventing low-income women, especially women of color, from making their own decisions about what is best for their families and their lives,” explained Angel Ricker, a certified nurse practitioner who provides sexual health services. “For 40 years, politicians have used the Hyde Amendment to take away low-income women’s ability to make meaningful decisions about pregnancy.”
And the federal restrictions on funds do not stop there. For decades, the U.S. Congress has prohibited the use of U.S. foreign assistance to perform abortions or to “motivate or coerce individuals to practice abortions.”
In practice, the restriction has been used to block U.S. aid from reaching clinics or organizations in foreign countries that provide family planning services or support reproductive rights. Even supplying information or counseling on abortion is not allowed in U.S.-funded facilities. “Some of the most vulnerable women overseas, including, for instance, those who have been raped in situations of armed conflict, or who face a life-threatening pregnancy, are less likely to be able to access care as a result of this U.S. policy, undermining our foreign-policy goals of promoting gender equality and global health,” Aram Schvey of the Center for Reproductive Rights told Foreign Policy in Focus in 2015.
While U.S. aid and diplomacy on abortion rights are highly restricted, U.S.-based organizations like the Center for Reproductive Rights, Amnesty International, and Planned Parenthood Global have spearheaded advocacy campaigns, provided legal representation, and attempted to fill gaps in reproductive health coverage in Latin America.
At the same time, some U.S. church ministries and anti-abortion groups are using private money to export opposition to expanded abortion access to other parts of the Americas, Abbott said. One strategy used by anti-abortion groups in the United States that is popping up in cities like Bogotá and Mexico City is the tactic of placing protesters outside of abortion clinics to physically block access and shame women from seeking the services. In Mexican “crisis pregnancy centers,” women are often legally obligated to watch graphic videos, a tactic imported into the country by religious pro-life groups like Heartbeat International, which manages similar antiabortion facilities in the United States.
This year, the Democratic Party’s platform called for the repeal of restrictions on domestic and foreign funding for abortion providers, marking the most significant shift in the party’s stance on abortion in nearly three decades. But these limits on aid continue to have wide bipartisan support, making it unlikely that a policy shift will occur.
With a Republican-held Congress and Trump in the White House, the future of reproductive rights in the United States looks bleak. In his first prime-time television interview after winning the election, Trump said he would appoint Supreme Court justices who would vote to overturn the 1973 Roe v. Wade ruling, which affirms abortion rights.
“Having to do with abortion,” he said, “if it ever were overturned, it would go back to the states.”
“But then some women won’t be able to get an abortion,” CBS’ Leslie Stahl replied.
“Yeah, well,” Trump said, “they’ll perhaps have to go—they’ll have to go to another state.”
“And that’s OK?” she asked.
“Well, we’ll see what happens,” Trump said. “It’s got a long way to go.”
REPRODUCTIVE RIGHTS ARE HUMAN RIGHTS
Reproductive rights have long been considered a basic human right by a number of regional and international committees, charters, and treaties. But across the Americas, countries enforce highly restrictive abortion laws in violation of these obligations.
Latin American women have long led the struggle for recognition of women’s rights. In 1945, Brazilian delegate Bertha Lutz pushed for the United Nations Charter to become the first international document to acknowledge equal rights for men and women.
In the decades since, women’s reproductive rights have been further defined in the international arena through a wide range of agreements. Most significantly, member states of the United Nations have affirmed sexual and reproductive health as a fundamental human right and agreed to take steps toward eliminating discrimination against women by ensuring access to health services, including family planning. These international obligations also assert the right to reproductive choice.
When it comes to abortion, international standards set by the United Nations require states to at least provide access to safe and legal abortion in cases of rape, incest, or a threat to the life or health of the mother. U.N. human rights advocates have also stated that laws that fully criminalize abortion, like those in El Salvador, are discriminatory. As such, the U.N. experts have called on all states to repeal punitive abortion statutes, writing in September, “legislation which denies access to safe abortion is one of most damaging ways of instrumentalizing women’s bodies and a grave violation of women’s human rights.”
Regionally, the Organization of American States (OAS) has adopted a convention to prevent, punish, and eradicate violence against women, including sexual violence and discrimination. Colombia’s constitutional court complied with this inter-American human rights law by lifting that country’s absolute ban on abortion in the 1990s. Few other countries have followed suit.
The Inter-American Commission on Human Rights (IACHR) has held several hearings on women’s sexual and reproductive rights. In a 2016 hearing, IACHR Commissioner Margarette May Macaulay acknowledged that many governments in the region do not “comprehend or appreciate women’s rights” and that a “passionate backlash” against expanded reproductive rights has been drummed up in the region by fundamentalists and male politicians who seek to “control [women’s] bodies.”
This opposition has made it difficult to enforce existing human rights laws. Organizations like the U.N. and the OAS have repeatedly called on countries to comply with international law, but have no recourse when governments refuse to abide by their agreements.
In spite of this, social movements and shocking cases—like that of an 11-year-old Chilean girl denied an abortion after being raped and impregnated by her mother’s boyfriend—have pushed some policymakers to change their stances. This year, Chile, one of seven Latin American countries with a total ban on abortion, has taken steps to partially decriminalize the procedure. In the face of a fierce debate over the issue, the country’s first female president has supported relaxing the law based on her background as a physician and health minister.
To ensure that access to reproductive care is recognized as a human right, many other states need to change their legislation, on paper and in implementation. Current laws only exacerbate the inequality, shame, and discrimination that women face across the Americas.
“Changing the law creates a social change,” Avila-Guillen said. “When you talk about [abortion] as a right, you don’t feel stigmatized in the same way. By changing the law, we would be creating a destigmatization of basic reproductive health services and that eventually would help guarantee access.”