Development & Aid, Headlines, Health, Human Rights, Latin America & the Caribbean, Population

HEALTH-LATIN AMERICA: Contrasts in Sexual and Reproductive Health Policies

Diana Cariboni

LONDON, Sep 2 2004 (IPS) - Colombia, caught up in an armed conflict and with a hard-right government that tends to clash with rights groups and other civil society organisations, nevertheless has fairly advanced sexual and reproductive rights policies.

Bolivia, on the other hand, seems to be moving backwards in that area, despite its active social movement.

“Colombia is a country of extremes, almost schizophrenic,” the executive director of the Association for the Welfare of the Colombian Family (Profamilia), Maria Isabel Plata, told IPS in London.

“We have a violent conflict whose effects are felt in rural areas and small cities. But we also have a very advanced constitutional, judicial and legal framework, which is a model for many countries,” said Plata.

The Colombian constitution, rewritten in 1991, establishes that family planning is a human right. “Public and private entities are obligated to provide (reproductive health) services of treatment, information and access to contraceptives,” she explained.

In addition, the 1993 reform of the health system “is seen in a very positive light by those of us who work in the field of sexual health, because it created more equitable mechanisms for the assignation of resources,” she added.

In 1995, Profamilia’s National Survey on Demographics and Health found that 72 percent of women in stable relationships used some method of birth control – a proportion that rose to 77 percent in 2000.

Colombia has made moderate progress in following the action plan adopted by the 1994 International Conference on Population and Development (ICPD) in Cairo, which put an end to the population control paradigm and set forth a rights-based model, according to a report distributed in the “Countdown 2015: Sexual and Reproductive Health and Rights for All” conference this week in the British capital.

Defying the negative image that it has earned among local and international human rights organisations, the government of President Alvaro Uribe follows “progressive policies in sexual and reproductive health,” said Plata.

The current government, the same one that accuses social and human rights activists of instigating “terrorism”, has implemented a plan to ensure respect for the sexual and reproductive health rights consecrated in the constitution.

In late August, the country’s health authorities launched an all-out offensive to cut in half the number of women who die of childbirth-related causes, who number around 700 a year.

As part of the plan, “the state itself proposes working together with civil society,” said the activist.

But Colombia is in the midst of a bloody civil war fuelled by drug trafficking, that pits right-wing paramilitaries and government forces advised and financed by the United States against leftist insurgent groups that have been in arms for four decades.

“The war absorbs a large part of the budget. When the money is going to bullets and helicopters, no sustainable health policy is possible,” said Plata.

In addition, “corruption takes its share,” and the lack of enforcement of the country’s laws leads to impunity. “In Colombia, no one goes to prison, and the impunity generates indifference, loneliness and personal anguish,” she added.

As in the rest of Latin America, the influence of the Roman Catholic Church is strong. Since 2000, Profamilia has faced legal action three times for distributing emergency contraception (the morning-after pill) in an attempt to reduce the number of unsafe, illegal abortions, estimated at between 320,000 and 400,000 a year in Colombia, a country of 42 million.

Colombia’s laws do not even allow therapeutic abortions, in case of a threat to maternal health, for example.

Meanwhile, to the south, in the impoverished Andean nation of Bolivia, abortion is only legal in cases of rape or when the expectant mother’s life is at risk.

But no woman has been given legal authorisation for an abortion under those circumstances, according to a study by the U.S.-based IPAS, an international organisation dedicated to preventing deaths and injuries to women from unsafe abortion.

And although last May, parliament did not hesitate to approve a law on access to family planning methods, birth control and confidential information services for adolescents, based on an agreement among all parties, President Carlos Mesa sent it back to Congress.

“This is unusual in Bolivia. Mesa did not object to the content of the bill, but recommended that it be submitted to a deeper debate,” Bolivian Deputy Erika Brockmann, a member of the Movement of the Revolutionary Left (MIR) party, chair of the parliamentary Ethics Commission, and founder of the Women’s Political Forum, said in an interview with IPS.

But Brockmann thinks she knows why: “In the current context of instability and conflict in Bolivia, the Catholic Church has become the government’s main backer.”

(Nationwide protests and rioting forced then-president Gonzalo Sánchez de Lozada to step down in October 2003, and he was succeeded by Mesa.)

No other institution enjoys such a high level of public credibility in Bolivia as the Catholic Church, due to its contribution to fighting poverty, the social assistance it provides, and its defence of democracy.

“Parliament and the political parties, on the other hand, have been severely discredited,” Brockmann pointed out.

The bill on reproductive health that was approved by parliament and vetoed by the president has drawn fire, even from within the social and indigenous movements.

The Central Obrera Boliviana (COB), the main labour federation, and the combative trade union confederation of the city of El Alto, a mainly slum district located next to La Paz, joined marches held to protest the draft law.

Many lawmakers who voted in favour of the bill have since had a change of heart. “This tells us a lot about the level of comprehension among the legislators with respect to sexual and reproductive health,” said Brockmann.

“There has been enormous distortion of the bill’s content. The Church has stated that providing confidential information to adolescents is an attack on paternal authority,” she added.

In Brockmann’s view, it is better to encourage a lengthy debate than to force a new vote in parliament.

“The healthy thing about this is that for the first time, we’re talking out loud about issues that used to be confined to the private sphere,” said the lawmaker.

Memories of population control policies imposed from abroad are still alive in Bolivia, a country of 8.5 million.

In the 1960s, frequent reports of forced sterilisation of campesino (peasant) and indigenous women, practised by volunteers working with the U.S. Peace Corps, gave rise to an alliance between the Church and the labour unions, based on “anti-imperialist” sentiments.

The Peace Corps was kicked out by the government, which was also forced to suspend family planning programmes, that did not get under way again until 1986.

Nevertheless, Bolivia’s birth rate fell, from an average of 6.5 children per woman in the 1970s to 3.8 today, according to the United Nations Development Programme (UNDP).

The bill vetoed by Mesa does not even mention abortion. “The climate does not exist to start discussing abortion,” said Brockmann.

However, the Mesa administration has put into effect a National Plan on Sexual and Reproductive Health, which is being implemented around the country and includes access to birth control services. The biggest obstacle is the state’s lack of funding.

Bolivia’s maternal mortality rate is among the highest in the region: 550 deaths per 100,000 births, according to UNDP figures.

Bolivia and Colombia are just two examples of advances and setbacks in Latin America in terms of implementation of the ICPD action plan, discussed by the roughly 700 delegates meeting Tuesday through Thursday in the Countdown 2015 conference in London.