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COLOMBIA: Therapeutic Abortion – A Right in Name Only?

Constanza Vieira

BOGOTA, May 9 2008 (IPS) - A woman in Pasto, the capital of the western Colombian province of Nariño, found out that the baby she was expecting was severely deformed. But when she went to the provincial university hospital for an abortion, the chief obstetrician gynaecologist told her that “If your son is born deformed, take him to a circus.”

Cases like this one gave rise to LAICIA (High Impact Litigation, the Unconstitutionality of Abortion Law in Colombia). The group is headed by Mónica Roa, a young lawyer with Women’s Link Worldwide (WLW), which works for gender equality through legal action and “the development and strategic implementation of human rights laws” around the world.

Since 2005, Roa has been fighting to get the Constitutional Court in Colombia – where abortion on demand is illegal, as in the rest of Latin America, with the exception of Cuba and Mexico City – to take a stance on the issue.

Her group is backed by the Mesa por la Vida y la Salud de las Mujeres (Committee for the Life and Health of Women), which has been working for several years to make sexual and reproductive rights a reality in Colombia.

In May 2006, the Constitutional Court handed down a verdict that decriminalised therapeutic abortion in cases where pregnancy is the result of rape or incest, the foetus has a deformity that would prevent survival outside the womb, or the expectant mother’s health or life is in danger.

Since then, abortion in such cases has become a legal right, and Roa has worked at making sure that the court’s decision does not remain a paper promise.

The powerful Roman Catholic Church excommunicated the five Constitutional Court magistrates who voted in favour of the verdict, and threatened to do the same for doctors who perform therapeutic abortions.

Of all pregnancies in Colombia, 24 percent end in abortion and 26 percent in unwanted births, says a Ministry of Social Protection report made available to IPS by Deputy Minister Carlos Ignacio Cuervo.

More than half of all pregnancies are unplanned, and in one out of four illegal abortions, the patient ends up in a hospital or clinic because of complications. Between 1990 and 1995, more than 80,000 women were hospitalised as a result of abortion-related complications.

This figure “suggests that for every 10 live births, there are nearly four abortions, and for every 100 women between the ages of 15 and 49, three have had an abortion,” says the report. The Ministry of Social Protection estimates that around 300,000 illegal abortions a year are practiced in Colombia.

According to the ministry, abortion is the third cause of maternal mortality in this country, a rate that Colombia must reduce by 75 percent by 2015, from 1990 levels, to meet the fifth of eight Millennium Development Goals (MDGs) adopted by the international community in 2000.

But Beatriz Quintero, general coordinator of the Mesa por la Vida y la Salud de las Mujeres, does not believe the decriminalisation of therapeutic abortion has had an impact on maternal mortality.

According to the Ministry of Social Protection regulations drawn up in late 2006 and 2007, based on the Constitutional Court ruling, therapeutic abortion must be performed under the specified conditions by all public or private health services.

Health clinics and hospitals are also required to submit quarterly reports on abortions practiced in their institutions. But instead of statistics, there is merely “a black hole,” Quintero told IPS. “There is no data. An information system does not yet exist,” she added.

In eight cities where the Mesa is active, and where 60 percent of the coalition’s right to information petitions received a response, the women’s rights group obtained more nationwide data, and covering a longer time period, than the Ministry of Social Protection did: on 40 cases in 22 months, compared to 21 cases in just the year 2007.

And while the ministry’s report does not specify the ages of the 21 women nor the reasons for the abortions, the information compiled by the Mesa indicates that of the 40 cases, 67 percent involved rape, 20 percent foetal malformations, and 13 percent risks to the expectant mother’s health.

“The Colombian Family Welfare Institute (ICBF) reported 12 adolescents under the age of 18 who sought an abortion because of sexual abuse,” Inspector General Edgardo Maya said in a press conference Wednesday.

But Quintero said “there are many administrative barriers standing in the way of women gaining access to this right, because of a lack of information on the part of women themselves, among health service providers, and among the authorities.”

Many hurdles not established by the new regulations are thrown up, said the activist. For example, in some cases the patient is told that she needs permission from a team of doctors specifically convened for that purpose, and in others, the women are told that a judge has to authorise the procedure, she said.

“The Ministry of Social Protection should carry out a much more aggressive campaign…and begin to train public employees and health professionals, because they try to implement the new regulations in accordance with their own moral decisions on abortion,” she added.

“They treat women like invalids, incapable of making their own decisions. The training would be aimed at getting health practitioners to act according to the new regulations,” said Quintero.

In many cases, the obstacles lead to the birth of severely deformed babies, or force women or girls who have been raped or are ill to suffer severe trauma and damages to their health.

“When a woman is unable to gain access to an abortion to which she has a right, it is not just something that happened, but a violation of the woman’s rights,” said Constitutional Court magistrate Fernando José Cepeda.

He mentioned a Constitutional Court verdict that refers to an abortion denied a 14-year-old rape victim, which establishes sanctions and instructions aimed at ensuring that the right to therapeutic abortion is respected and enforced.

The office of the inspector-general (Procuraduría General de la Nación) and Women’s Link Worldwide announced an inter-institutional cooperation agreement for jointly monitoring implementation of the new regulations.

After the Constitutional Court handed down its landmark ruling in 2006, health clinics run by religious groups and Catholic doctors announced that they would refuse to perform abortions on any grounds.

But only individuals, and not institutions, can raise objections of conscience to refuse to practice therapeutic abortions in the circumstances in which they are now allowed.

All clinics are either required to have doctors on their staff who are not conscientious objectors or must refer patients to institutions that will perform the necessary procedures, according to the Ministry of Social Protection regulations drawn up in late 2006 and 2007, based on the Constitutional Court ruling.

If the pregnancy is the result of rape or incest, all that is needed is a copy of the complaint to the police, and no time limit is set for making the complaint or requesting an abortion.

The regulations do not establish a specific list of illnesses that can be used to justify an abortion in case of risk to a pregnant woman’s health or life. Only medical certification is needed.

For example, a woman has a right to an abortion if her pregnancy could aggravate serious cardiac problems, or if it stands in the way of treatment of chronic or terminal diseases, like cancer.

The same doctor who diagnoses the woman’s health problem can practice the procedure, under a confidentiality agreement.

Even if she is a minor, the woman does not need permission from any family member or guardian to undergo a therapeutic abortion, which must be performed within five days after the request is made.

However, the World Health Organisation (WHO) defines health as “a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity,” which opens a path to expanding the arguments that could be used to invoke the right to therapeutic abortion.

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