By Celeste Kauffman*
Worldwide, an average of 43.8 million abortions are performed each year, with a rate of 28 per 1000 women between the ages of 15 and 44. Abortions in Latin America represent more than 10 percent of these, with a rate of 32 abortions per 1,000 women aged 15-44. According to the Guttmacher Institute, worldwide, nearly half of all abortions are unsafe (self-induced abortions, those provided by those lacking necessary skills, or in an unsafe environment). Latin America is an unfortunate example of this trend, as 95 percent of all abortions performed in 2008 were unsafe, granting it the dubious distinction of the region with the highest unsafe abortion rate in the world, with 31 unsafe abortions per 1000 women.
The health consequences of unsafe abortions are dire. The World Health Organization estimates that in Latin America and the Caribbean in 2008, 12 percent of all maternal deaths were the result of unsafe abortion. Each year, around 1 million women are hospitalized in the region as a result of complications from unsafe abortions. Such complications include hemorrhaging, infection, septic shock, and perforation of organs, among others. Many suffer long-term health consequences, including infertility.
Trends in Unsafe Abortion Incidence 1990-2008
But why are so many abortions in Latin America unsafe? The answer is complicated, and involves a combination of legal, administrative, moral, and religious reasons, as well as growing influence from the U.S. anti-abortion movement.
The criminalization of abortion
Although abortion restrictions have been slowly loosening over the past decade, Latin American countries still have some of the most restrictive abortion laws in the world. Four of the six countries in the world that prohibit abortion in all circumstances, without exception, are found in Latin America: Nicaragua, El Salvador, Honduras, and the Dominican Republic. Additionally, abortion is legal for any reason, during the first trimester in only three countries in the region (Cuba, Uruguay, and Mexico City). In the remaining 28 countries, abortion is criminalized in most circumstances, with a few exceptions, generally in the case of rape or incest, when the life or health of the woman is at risk, or serious fetal abnormalities. This means that 95 percent of Latin American women of childbearing age live in countries where abortion is generally criminalized and access to legal abortion is highly restrictive.
Abortion restrictions in Latin America
Regardless of one’s beliefs regarding abortion, such laws are problematic for the simple fact that they don’t work. Restrictive abortion laws do not lead to fewer abortions, they lead to more dangerous ones, as explained in a previous blog, and punish women for exercising their reproductive rights. According to International Pregnancy Advisory Services, in countries where abortion is illegal, the risk of death and injury from abortion is 30 times higher than in those where it is legal. This makes sense when one considers that many women have been criminally prosecuted after seeking medical care for complications for unsafe abortions. Earlier this year, El Salvador made international headlinesafter a woman was released from prison after serving 7 years of a 30-year murder conviction. She had become pregnant after being raped at age 17, and was convicted of murder after giving birth to a stillborn baby. According to the Citizens’ Coalition for the Legalisation of Abortion, 129 women were convicted of abortion-related crimes (often for murder) between 2000 and 2011 in El Salvador, many after suffering miscarriages.
Influence of the Catholic Church
Another factor that leads to the criminalization of abortion and to unsafe, clandestine abortions is the strong role of the Catholic Church in Latin America as a moral and political force. In the region, the Church has led a moral crusade against abortion, which led to the tightening of abortion restrictions and greater societal disapproval of abortion on moral grounds. Thus, on moral grounds, an 11 year-old Paraguayan rape victim was forced to give birth earlier this year.
The Church also encourages catholic doctors to refuse to provide legal abortions in public and private hospitals. Such cases have been documented in Peru and Colombia, where the Constitutional Court has wrestled with the tension between permitting doctors to exercise their right to conscientious objection and women’s access to safe abortion. According to conservative factions, conscientious objection means that a woman may approach a public hospital requesting a legal abortion, and her doctor can refuse to perform it, denying her right to reproductive care. While this may not seem like a serious problem in large urban centers, where a large number of doctors are available, in many rural areas, the doctor refusing to perform an abortion for religious reasons may be the only doctor available. This pushes women to seek clandestine, unsafe abortions.
Additionally, societal and family disapproval of abortion based on religious reasons means that many women are too ashamed or fearful of going through legal channels to obtain an abortion. Thus, they resort to unsafe abortions to avoid the judgment of their families and public hospitals.
Excessive administrative obstacles
Even when a woman’s request for an abortion fits within the legal exceptions to criminalization, health-care sector bureaucracy may place so many administrative and practical obstacles in her path that she is forced to obtain an unsafe abortion outside the healthcare system. This is evident in Colombia, where less than 1 percent of all abortions are performed legally. In 2011, the Constitutional Court ruled on a case where a 12 year-old rape victims’ insurance company created so many delays and obstacles that the girl had given birth by the time the Court was able to demand the company to provide the abortion. This burden is especially heavy on poor women, who often cannot afford reputable private clinics, whose costs, even with reduced prices, can exceed a woman’s monthly income.
Growing influence of the U.S. anti-abortion movement
As the anti-abortion movement in the U.S. grew in strength, it began to forge partnerships with like-minded religious groups in other parts of the globe. Latin America has been particularly affected by this exportation of anti-abortion activism. For example, the anti-abortion group Heartbeat Services has partnered with the Centro de Ayuda para la Mujer (CAM) to set up 98 anti-abortion “ministries” in 15 Latin American countries. These ministries train Latin American partners in U.S. tactics, which, among others, include “pregnancy crisis clinics,” modeled after those in the U.S. that deceive women seeking an abortion into thinking their clinic provides abortions. Once at the “clinic,” women are lectured on the evils of abortion, forced to look at (often fake) ultrasounds of their fetuses, given false information about the risks of abortion, and badgered into keeping their pregnancies.
Additionally, outside the most well-known legal, private abortion provider in Bogota, Colombia, anti-abortion activists pray, chant, and harass womenentering the clinic with pictures of dismembered fetuses and pamphlets (published in the U.S.) about the sin of abortion. These protesters are not outside the many less-reputable clinics in the area, where women are more likely to receive illegal and dangerous abortions.
Latin American women’s rights advocates have fought an uphill battle to loosen abortion restrictions in the region. However, we have a long way to go before women’s right to choose is actually guaranteed in the region, and will need tactics that combat the many barriers to access to safe abortion. In the meantime, it would do well for politicians and moralists to realize that their “pro-life” policies are endangering the lives of 4.4 million of their citizens each year, while doing very little to reduce the number of abortions.
* Celeste Kauffman is a researcher at the Center for the Study of Law, Justice, and Society (Dejusticia)