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The right to health and safe abortion in Latin America: still a long way to go

By Verónica Osorio Calderón
on September 29, 2017

In Latin America, an estimated 6.5 million abortions occurred every year between 2010 and 2014, with 95% of them performed clandestinely in unsafe and unsanitary conditions, representing 10% of maternal mortality in the region. As of today, only four countries in Latin America allow assisted abortion in all circumstances; in six countries it is not permitted for any reason, while the rest of the countries accept assisted abortion under certain circumstances. Despite the risks, Latin American women continue to undergo unsafe abortions and the region remains with the strictest and most restrictive laws and norms in the world on this issue. The right to safe abortion to avoid deaths, as well as sexual education and family planning to avoid abortions have become very polarized debates in Latin America, with endless discussion in social and political spheres.

Although the UN Human Rights Commission declared safe abortion a human right, in most Latin American countries it remains a decision of the State. Legalization does not lead to an increase in abortions, but neither does it lead to a decrease.  The only way to reduce abortion is through family planning, and thus sexual education is more than necessary, but this does not prevent women from looking for abortion if needed. This is why it is vital to legalize abortion and recognize it as a women’s human right.  Various UN special rapporteurs have called for decriminalization of and access to safe abortion services.  In Latin America, in the absence of this, hundreds of women still die every year under painful and dishonourable situations due to  clandestine abortions, even if in recent years the region has seen fewer deaths and severe complications from unsafe abortions as it is increasingly common for (at least some) Latin American women to obtain and self-administer medicines like misoprostol outside of formal health systems.

Death and disabilities in women due to abortion are preventable. The main causes of death because of unsafe abortion are related to haemorrhage, infection, and poisoning; morbidity results from complications related to haemorrhage, sepsis, peritonitis, and trauma to the cervix, vagina, uterus, and abdominal organs. In addition, symptoms of mental health problems related to the unsafe abortion often also occur such as anxiety, depression, impulse-control problems, … and other mental disorders. If abortion were legalized, women would have timely access to healthcare and an adequate and safe abortion, if needed. They could also receive counselling from professional staff.

Despite the costs and impact on women’s health, laws and norms in the region are extremely strict for women who have an abortion. Latin American countries are failing to support women facing these difficulties but they punish them without considering their reasons to abort. For example, in El Salvador, jail sentences are as high as 40 years when a woman aborts and 50 years in Mexico, even if these abortions were not voluntary; in Paraguay, an 11-year old sexually abused child delivered a baby after she was denied abortion in 2015; in Brazil, 33 women were arrested, accused of abortion, during 2014. Seven of them were denounced by healthcare staff who provided them services; in Argentina, abortion is the main cause of maternal death. There are many similar cases in other countries in the region.

Strong cultural beliefs and traditions still influence health policy making, especially in sensitive areas such as abortion. The role of women as mothers in the society forces women to continue pregnancies despite the many reasons they could have to stop their pregnancy. From the point of view of gender equality, women and men should be given the same opportunities and chances “to access and control social, economic and political resources, including protection under the law (such as health services, education and voting rights)”. However, when men cause an abortion by abandoning or denying a pregnant woman there is no equal punishment (nor the same stigmatization); needless to say, men also do not get pregnant after sexual assault. Society expects women to take responsibility and punishes her if she does not.

This Latin American idiosyncrasy was also on full display during the Zika epidemic. Pregnant women infected with the Zika virus had an increased risk of microcephaly in newborns, hence pregnant women were the target population. Governments recommended women to avoid pregnancy during the next two years, and after acknowledging the link between the virus and sexual transmission, they also provided information on the use of contraception. However, this information did not include comprehensive sexual education that could have led to conscious family planning as it was focused on the epidemic only. It was not considered that women are typically in charge of the caring tasks and that microcephaly requires full time care and financing, affecting mostly women who are mothers of the affected children. No country in the region legalized abortion during that time.

So it’s a fact: far too many women still die and have disabilities due to unsafe abortions and this harm can only be prevented by providing timely health services and family planning. So, instead of penalizing it, governments should guarantee access to safe abortion to all women without discrimination, and provide comprehensive sexual education to decrease the number of abortions. There has been little progress so far on this matter in the region. Still, Uruguay made safe abortion accessible in 2012, and Chile just passed a bill that allows women to abort for medical reasons or when pregnancy is a consequence of rape. On the downside, we are yet to see the full extent of the negative impact of the reinstatement of the Global Gag Rule in Latin American countries. Trump’s policy will affect Central America more than South America, it is predicted.

In short, there is still a long way to go. Latin America society and governments need to understand that besides a public health problem, safe abortion is a human right. Hence, the first step to take is to legalize abortion in order to provide it as a health service and avoid deaths. As the 29th Pan- American Sanitary Conference is wrapping up, we are crossing fingers that someone will have dared to bring this issue up in the discussions. In the meantime, what we can do is to stand up for ourselves and join one of the actions and events happening globally to demand the right to safe abortion.

About Verónica Osorio Calderón

Veronica Osorio is an EV 2018 & health economist with experience in health systems research. Currently, she’s a PhD Candidate at UCL, London (Social Research Institute), studying knowledge translation for evidence informed policymaking in Latin America.
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