“My body my decision,” reads a slogan written on the back of an activist during a march in Lima in 2019. Credit: Walter Hupiú / IPS

By Mariela Jara
LIMA, Sep 27 2024 (IPS)

The struggle for women’s right to decide in Latin America and the Caribbean, for their access to legal, safe and free abortion continues in the region, with some countries fully criminalising it, others with severe regulations, and a few guaranteeing better conditions, while threats of regression persist.

This Saturday 28 September marks, as every year, the Global Day of Action for Access to Safe and Legal Abortion, launched in 1990, at the 5th Latin American and Caribbean Feminist Meeting, held in Argentina.

Since then, the international day of action for safe abortion has been nurtured by the agreements reached at the Cairo Conference on Population and Development in 1994, which recognised sexual and reproductive rights as part of human rights, and by the mandates of Human Rights Committees demanding that countries decriminalise abortion and protect the rights of girls, adolescents and women.

“This is a historic struggle of the feminist movement. We have made progress in the recognition of women’s human rights in the region, but those related to sexual and reproductive rights and abortion continue to be polarising; however, we have no doubt that they must be integrated into our rights as a whole”.“We have seen the great influence of right-wing fundamentalist religious groups in countries where abortion is criminalised and in others where it is barely advancing on the grounds of risk to the woman's life, malformations and danger to health”: Aidé García.

So said Aidé García, director of the non-governmental organisation Catholic Women for the Right to Decide in Mexico and former director of the organisation’s Latin American network, present in 10 countries.

The activist spoke to IPS from New York, where this September she takes part in several meetings in the framework of the High-Level Segment of the 79th General Assembly of the United Nations and the Summit of the Future.

About 51% of the more than 660 million people in Latin America and the Caribbean are women. This population faces diverse gender inequalities, according to a joint report by the Economic Commission for Latin America and the Caribbean (ECLAC) and UN Women in 2023.

The report claims that three out of every 10 women in the region live in poverty; one out of every 10 has experienced violence and, in addition, the maternal mortality rate is 87.6 per 100,000 live births.

In this context, preventing women who freely decide from terminating a pregnancy or persecuting and criminalising them for doing so, aggravates the violation of their human rights, with the connivance between the prevailing patriarchy, the Catholic Church and now even more of evangelical denominations.

A study by the Guttmacher Institute revealed that in 2010-2014 there were 6.5 million induced abortions in the region. When these are performed in unsafe conditions due to legal barriers or lack of economic resources, they cause many deaths and harm women’s overall health.

The other side of the coin is forced maternity.

Aidé García, Mexican social worker and women’s and human rights activist, former coordinator of the Latin American and Caribbean network Catholics for the Right to Decide. Credit: Courtesy of Aidé García

A scenario with gaps

“There is great inequality in Latin America and the Caribbean on the issue of abortion,” said García, who is a social worker and feminist with vast experience in contributing to debates on this issue in Mexico and in international forums.

“We have seen the great influence of right-wing fundamentalist religious groups in countries where abortion is criminalised and in others where it is barely advancing on the grounds of risk to the woman’s life, malformations and danger to health,” she said.

Among the 10 countries or territories where abortion is fully criminalised are Belize, El Salvador, Haiti, Jamaica, Honduras, Nicaragua, Dominican Republic and Suriname.

Cuba was the first to fully decriminalise voluntary termination of pregnancy in the region, in 1965, followed by Guyana in 1995. Then, in this century, Uruguay, Argentina, Colombia and Mexico, first in 13 states and then at the federal level.

In most, legislation regulates it only under the restricted grounds – and in many cases full of obstacles to its implementation – of rape, health and risk to the pregnant woman’s life, non-consensual artificial insemination, and foetal malformations incompatible with life.

The most favourable frameworks are in Colombia, where abortion is legalised during the first 24 weeks of gestation, Argentina and Guyana, where it is legal up to 14 weeks, Uruguay and Mexico, with up to 12 weeks, and Cuba during the first quarter.

The color green has spread from Argentina to other Latin American countries, to demand the right of women and feminist movements to legal and safe abortion. Credit: Walter Hupiú / IPS

These legal loopholes for access to abortion also reflect the resistance to recognising women’s right to voluntarily terminate a pregnancy.

“We are fighting for respect for the autonomy and the possibility that women and people with gestational capacity have to decide about our reproduction. We demand the recognition of the moral authority that is ours, because from a Judeo-Christian culture where the religious sphere often intervenes, women who make decisions about sexuality are blamed”, said García.

She drew attention to political, religious and economic interest groups in the region that seek to preserve a fundamentalist tradition that denies women decision-making and public and political participation.

“It has to do with a patriarchal and misogynist sense of the role that we are assigned in society, and that is a great struggle that we have in feminism because at the end of the day, it is about the control of our bodies”, she stressed.

Women and feminist movements in Latin America are fighting to spread throughout the region the tide of green scarves, which emerged in Argentina, with which they fill the streets in several demonstrations a year and which symbolise the struggle for the right to legal and safe abortion.

Brenda Álvarez, a feminist lawyer from Peru, director of the organization Proyecta Igualdad, which follows cases of women criminalized for the crime of abortion. Image: Courtesy of Brenda Álvarez

Criminalised and persecuted

Brenda Álvarez is a lawyer and president of Proyecta Igualdad, a non-governmental organisation in Peru, which through its Green Justice line provides legal counsel to prevent criminalisation in the care of obstetric emergencies related to abortion, a dramatic and little known reality in the country.

With 33 million people, the South American country is one of the most restrictive in the recognition of women’s reproductive rights. Since 1924, abortion has been criminalised, except for therapeutic reasons, when the life of the pregnant woman is in danger or there is a risk of serious and permanent damage to her health.

The struggles of feminists and women’s movements in recent decades to decriminalise abortion have come up against the opposition of conservatives linked to Catholic and evangelical religious groups, to the point that, although therapeutic abortion celebrated its 100th anniversary in 2024, the protocol for its implementation is barely 10 years old, and with limitations.

“In the midst of the pandemic, we learned of the case of Diana Aleman, a Venezuelan irregular migrant who died in a public hospital due to the criminalisation of abortion and the harassment she experienced. As we followed the case, we realised it was not the only one, that more people were experiencing this situation and were being prosecuted,” Álvarez told IPS at her office in Lima.

She said that women who go to health facilities for an obstetric emergency related to abortion are poor and vulnerable, uninformed of their rights, and in these circumstances face state violence.

“It is not only poor medical care or harassment at the time of service, but also dealing in the emergency room with interrogations by the police, the prosecutor’s office, even with samples taken by representatives of the Institute of Forensic Medicine, as was the case of a teenager a few weeks ago who arrived unconscious with pneumonia and septic shock. That’s how they wanted to take her statement,” she revealed.

In 2020-2021 they carried out the Being Born with Uterus study, which states that each year more than 184 police reports for abortion and more than 633 of prosecutorial investigations are filed in Peru. “It was alarming, even cases of therapeutic abortion that are not punishable were prosecuted, we found 55; and we found sentences including adolescents,” she explained.

Health personnel report obstetric emergencies if they suspect abortions under the questionable article 30 of the General Health Law No. 26842, and “the authorities are ready to respond as if there were no serious crimes to prosecute in the country”. Álvarez explained that the guarantee of due process is not fulfilled and that these are illegal processes.

“This is problematic because often the only evidence that ends in a conviction for abortion is the statement taken from women, girls and adolescents in health services in a context of coercion and absolute lack of legal protection,” she denounced.

Among the impacts of the criminalisation of abortion on women’s lives, she mentioned the loss of employment and mental health opportunities, the uncertainty that having a criminal record entails for the possibility of finding a job, the cost of going to the justice system “even when the legal defence is ex officio, which, we have seen, is not effective and part of the conviction system”.

In addition to the urgency of decriminalising abortion, she said there is a need to promote citizen empowerment by creating tools so that women can know and exercise their rights when they go to a hospital with an obstetric emergency. In this regard, her organisation has developed outreach and awareness-raising materials.

A feminist activist with the sign “I want my uterus free” during the 13th Latin American and Caribbean Feminist Meeting held in Lima. Credit: Mariela Jara / IPS

Improving the law and risks in the region

Twelve years ago, Uruguay passed the law on the Voluntary Interruption of Pregnancy up to 12 weeks of gestation, an important step forward in the region and the result of a long struggle by women and feminists for the legalisation of abortion. The law also established grounds for abortion in cases of serious health risk to the woman, rape and malformations incompatible with life outside the womb.

Soledad Gonzales, a political scientist specialising in gender issues, told IPS from Montevideo that there is a need to work for a new law that would remove the persistent restrictions.

In practice, this means barriers to the exercise of the right, such as the interdisciplinary board that evaluates the woman’s request, the appointment she must undergo to inform her of alternatives, and the five-day waiting period after which she either ratifies her will to end the pregnancy or not, in order to proceed according to her decision.

“A new law is in order. For example, women do not always realise they are pregnant after three months. They end up having abortions clandestinely, having started the abortion legally,” she said.

Gonzales said that the chances for this proposal, on which women’s and feminist organisations agree, will depend on the results of the Uruguayan general elections on 30 October.

García, from Catholic Women for the Right to Decide, also said that the risks of setbacks in women’s reproductive rights, such as the freedom to decide about their bodies and access to abortion in safe and free conditions, depends on the positions of governments, whether they are conservative or progressive.

“This is part of the historical struggle that leads us to never lower our guard,” she said.

Brazilian women demonstrated in São Paulo on Sept. 28, International Safe Abortion Day, which began to be celebrated in Latin America. The activists are promoting the campaign "Neither imprisoned, nor dead" against the repression of women's right to abortion, which affects even young girls who are entitled to this right by law. CREDIT: Rovena Rosa / Agência Brasil

By Mario Osava
RIO DE JANEIRO, Oct 31 2023 (IPS)

A total of 17,456 babies were born to girls aged 10 to 14 in Brazil in 2021. The annual figures are falling, but still reflect the plight of ruined childhoods and the failures of judges and doctors when it comes to the issue of abortion rights.

Data from the Information System on Live Births (Sinasc) of the Ministry of Health put the number of births to girls in this age group at 252,786 in the decade 2010-2019, compiled by the Feminist Health Network. That is an annual average of 25,278."This country does not take care of women. While cardiology has advanced a lot in Brazil, medicine dedicated to women, such as obstetrics and gynecology, remains stuck in the last century and resists updating. An example is the persistence of curettage, a practice abolished by the World Health Organization (WHO) more than 20 years ago." -- Helena Paro

This phenomenon has ceased to be invisible since 2020, when a string of scandals erupted involving girls prevented from having abortions by judges, hospitals and even authorities such as the then Minister of Women, Family and Human Rights, Damares Alves, during the government of far-right President Jair Bolsonaro (2019-2022).

In Brazil, abortion is legal in cases of rape, risk of death of the pregnant woman and anencephalic fetuses. It is also an unquestionable right of girls up to 14 years of age, since all of them are legally victims of rape and their abusers face sentences of eight to 15 years in prison.

But there were judges, even in the appeals courts, who ruled against the termination of pregnancy in girls as young as 10 or 11 years old.

At the base of this iniquity is the social criminalization of abortion, to which many religious people who identify “abortion as murder, as a repulsive crime” contribute, lamented Clara Wardi, technical advisor of the Feminist Studies and Advisory Center (Cfemea), based in Brasilia.

Religious morality infiltrates the State

“The stigma is strong, in the culture, in the family, even in schools. That is why girls are reluctant to choose abortion, even if it is legal. And to do it clandestinely is expensive and risky,” she told IPS from Petrópolis, the city near Rio de Janeiro where she lives.

Many doctors argue that they are “conscientious objectors” and refuse to carry out abortions, which forces the girls to go on a “pilgrimage” in search of respect for their rights in other hospitals and even in the courts.

In spite of everything, a Cfemea survey conducted since 2018 found a growing public opinion against the criminalization of abortion. To the question “Are you for or against the imprisonment of women who terminate their pregnancy?”, 59.3 percent said “against” in 2023, up from 51.8 percent in 2018.

Those in favor of imprisonment also increased, but less, from 26.7 percent to 28.1 percent, reflecting the ideological polarization during Bolsonaro’s administration, which caused the proportion of “undecideds”, those who answered “it depends on the circumstances”, to fall from 16.1 percent to 7.6 percent.

There are “institutional barriers” to legal abortion, an issue in which the State ceases to be secular by subordinating its services to religious morality. The most emblematic case is that of an 11-year-old girl pregnant for the second time in the northeastern state of Piauí, who in late 2022 was denied an abortion by a public hospital and by the justice system.

Taken to a public shelter, she gave birth to her second child in March 2023. In other words, the State acted to remove her from her family, deny her the legal abortion she demanded and force her to give birth, Wardi said.

Damares Alves, a radical evangelical Christian who was Minister of Women, Family and Human Rights (2019-2022) during the far-right government of Jair Bolsonaro, mobilized her officials to pressure young pregnant girls to desist from getting an abortion, which was legal in their case because they are recognized as victims of rape. CREDIT: Fabio Rodrigues-Pozzebom / Agência Brasil

Ignorance

All this occurs in the midst of “collective failures” of society itself, such as insufficient information on reproductive rights and the possibility of choice for women, especially girls. There is no choice without access to health services, she argued.

“The criminalization of abortion invalidates the legality of the three situations. It is necessary to get out the information that abortion is legal in Brazil and to train qualified personnel to offer the service, without the need for legal action to obtain access,” said Denise Mascarenha, executive coordinator of the group Catholics for Choice in Brazil.

The basic flaw is in the training of health workers, whether doctors, nurses or psychologists, who “do not recognize the violence involved in a pregnancy in girls under 14 years of age,” which has been present in the Penal Code all the way back to 1940, said Helena Paro, professor of gynecology and obstetrics at the Faculty of Medicine of the Federal University of Uberlândia.

Universities, she said, do not train doctors to take care of rape victims, but good teaching would not be enough, anyway, she added. There is a lack of experience in practical assistance to patients, with a focus on women’s human rights, said the physician specialized in gynecology and obstetrics.

In Brazil there are just over 60 medical centers offering legal abortion services – virtually nothing for a population of 203 million inhabitants in which women constitute a majority of 51.7 percent, she told IPS from Uberlândia, a city in the southern state of Minas Gerais.

Only about 2,000 legal abortions are performed each year in Brazil, where it is estimated that more than 400,000 illegal abortions are performed annually, resulting in many deaths as well as complications that overload hospitals.

Judge Rosa Weber seen passing her vote in defense of the decriminalization of abortion up to 12 weeks of gestation, in her last sessions as president of the Supreme Federal Court, before retiring on Oct. 2. CREDIT: Antonio Cruz / Agência Brasil

Medical care that discriminates against women

“This country does not take care of women. While cardiology has advanced a lot in Brazil, medicine dedicated to women, such as obstetrics and gynecology, remains stuck in the last century and resists updating. An example is the persistence of curettage, a practice abolished by the World Health Organization (WHO) more than 20 years ago,” Paro commented.

She coordinates the Uberlândia Comprehensive Care Center for Victims of Sexual Assault (Nuavidas), opened in 2017 at her university hospital. Since 2021, the center has been offering abortion-related services via telemedicine, following an initial face-to-face consultation.

The COVID-19 pandemic prompted the online assistance, also facilitated by the efficacy of the abortion drug misoprostol, approved by the WHO and Brazilian health authorities.

Paro’s activities led to an attempt to disqualify her by the Regional Council of Medicine of Minas Gerais, which accuses her of using her knowledge “to commit crimes” and not for the well-being of patients.

“It’s all upside down,” the physician replied, arguing that she cares for the health of patients “based on scientific evidence” that the Council denies.

The councils, one national and 27 regional (in each of the states), regulate medical practice in the country and several of them acted unscientifically during the COVID-19 pandemic, by approving, for example, the use of ineffective drugs such as chloroquine.

A conservative offensive in Congress threatens to further restrict the right to abortion in Brazil, contrary to what is happening in Argentina, Colombia, Mexico and Uruguay, which have decriminalized abortion up to 12 weeks of pregnancy.

A 2007 bill, called the Statute of the Fetus, gained renewed momentum last year in the lower house of Congress, at the initiative of ultra-conservative lawmakers. Its approval would prohibit any abortion, guaranteeing the fetus all the rights of a human being, especially the right to life, from the moment of conception.

Other measures to criminalize abortions even in the restricted circumstances currently permitted are under parliamentary discussion.

To counteract this conservative offensive, Brazilian women’s rights movements launched the campaigns for decriminalization “Neither imprisoned nor dead” and “Girls, not mothers”, the latter of which is being carried out throughout Latin America.

Feminists are also celebrating the ruling of Judge Rosa Weber, who recorded her vote in favor of decriminalizing abortion up to the 12th week of pregnancy on Sept. 22, before leaving the presidency of the Supreme Federal Court and retiring 10 days later.

The highest court in the country, which has acted as a counterweight to the ultraconservative initiatives of the legislature and of the Bolsonaro administration, will ultimately decide whether to rule in favor of or against the legalization of abortion on any grounds up to 12 weeks.

Weber’s vote is in line with the demands of the feminist movement, especially with the strong, early contribution of black women, in advocating “reproductive justice as a tool for social transformations,” Wardi said.

“It is an important milestone in the fight for abortion rights in Brazil” and affirms “the legitimacy of the judiciary in ensuring women’s human rights,” Mascarenha said from São Paulo.

But the current circumstances are not very favorable to her argument, with a Congress dominated by conservative and ultra-conservative groups.

Also because the process within the Supreme Federal Court on the right to abortion is facing indefinite postponement since its new president, Luis Roberto Barroso, replaced Weber.

Two pregnant girls walk through the center of the capital of El Salvador, a country with one of the highest rates of pregnancies among girls aged 10 to 14, and where, as in the rest of Central America, what prevails are conservative views opposed to the teaching of sex education in schools, which is essential to reducing the phenomenon. CREDIT: Francisco Campos / IPS

By Edgardo Ayala
SAN SALVADOR , Aug 3 2023 (IPS)

Pregnancies among girls and adolescents continue unabated in Central America, where legislation to prevent them, when it exists, is a dead letter, and governments are influenced by conservative sectors opposed to sex education in schools.

The most recent incident reflecting this situation was the Jul. 29 veto by Honduran President Xiomara Castro of an Integral Law for the Prevention of Adolescent Pregnancy, approved by the single-chamber Congress on Mar. 8 and criticized by conservative groups and the country’s political right wing."When I became pregnant I didn't even know what a condom was, I'm not ashamed to say it." -- Zuleyma Beltrán

“We don’t know the arguments behind the veto, but we could surmise that the law is still being held up by pressure from these anti-rights groups,” lawyer Erika García, of the Women’s Rights Center, told IPS from Tegucigalpa.

The influence of lobbying groups

Conservative sectors, united in “Por nuestros hijos” (“for our children”), a Honduran version of the regional movement “Con mis Hijos no te Metas” (roughly “don’t mess with my children”), have opposed the law because in their view it pushes “gender ideology”, as international conservative populist groups call the current movement for the dissemination of women’s and LGBTI rights.

In June, the United Nations expressed concern about “disinformation campaigns” surrounding the Honduran law.

The last of the marches in favor of “family and children” took place in Tegucigalpa, the country’s capital, on Jul. 22.

These groups “appeal to people’s ignorance, to fear, to religion, with arguments that have nothing to do with reality,” said García. “They say, for example, that people will put skirts on boys and pants on girls.”

According to the United Nations Population Fund (UNFPA), one in four births is to a girl under 19 years of age in Honduras, giving the country the second-highest teenage pregnancy rate in Latin America.

According to the Honduran Penal Code having sexual relations with minors under 14 years of age is statutory rape, whether or not the girl consented.

In 2022, 1039 girls under 14 gave birth.

“The problem is quite serious, and it is aggravated by the lack of public policies to prevent pregnancies among girls and adolescents,” García said.

In the countries of Central America, which have a combined total of some 50 million inhabitants, ultra-conservative views prevail when it comes to sexual and reproductive health and education.

In El Salvador, Honduras and Nicaragua – as well as the Dominican Republic in the Caribbean – abortion is banned under all circumstances, including rape, incest or a threat to the mother’s life.

In the rest of Central America, abortion is only permitted in certain circumstances.

The Honduran president vetoed the law under the formula “return to Congress”, so that it can be studied again and eventually ratified if two thirds of the 128 lawmakers approve it.

Zuleyma Beltrán, 41, talked about becoming pregnant at the age of 15 because there is no proper sex education in El Salvador. A second pregnancy led to a miscarriage that landed her in jail in 1999, where many Salvadoran women who miscarry or have abortions end up due to a draconian anti-abortion law. CREDIT: Edgardo Ayala / IPS

“I didn’t even know what a condom was”

However, having laws of this nature does not ensure that the phenomenon will be reduced, since legislation is not always enforced.

Since 2017 El Salvador has had a National Intersectoral Strategy for the Prevention of Pregnancy in Girls and Adolescents, and although the numbers have declined in recent years, they are still high.

An UNFPA report noted that in this country the pregnancy rate among girls and adolescents dropped by more than 50 percent between 2015 and 2022.

However, “it is worrisome to see that El Salvador is one of the 50 countries in the world with the highest fertility rates in girls aged 10-14 years,” the UN agency said in its latest report, released in July.

Among girls aged 10-14, the study noted, the pregnancy rate dropped by 59.6 percent, from 4.7 girls registered for prenatal care per 1000 girls in 2015 to 1.9 in 2022.

The map of pregnancies in girls and adolescents in El Salvador added that the country “needs to further accelerate the pace of reduction, adopting policies and strategies adapted to the different realities of girls aged 10-14 years and adolescents aged 15-19 years.”

Such actions must be “evidence-based,” the report stressed.

The reference appears to be an allusion to the prevalence of conservative attitudes of groups that, in Honduras for example, reject sexual and reproductive education in schools.

This lack of basic knowledge about sexuality, in a context of structural poverty, led Zuleyma Beltrán to fall pregnant at the age of 15.

“When I became pregnant I didn’t even know what a condom was, I’m not ashamed to say it,” Beltrán, now 41, told IPS.

She added: “I suffered a lot because I didn’t know many things, because I lived in ignorance.”

Two years later, Beltrán became pregnant again but she miscarried, which landed her in jail in August 1999, accused of having an abortion – a plight faced by hundreds of women in El Salvador.

El Salvador not only bans abortion under any circumstances, even in cases of rape. It also imposes penalties of up to 30 years in prison for women who have undergone abortions, and women who end up in the hospital after suffering a miscarriage are often prosecuted under the law as well.

“The State should be ashamed of forcing these girls to give birth and not giving them options,” said Anabel Recinos, of the Citizens’ Association for the Decriminalization of Abortion.

“The State does not provide girls with sex education or sexual and reproductive health, and when pregnancies or obstetric emergencies occur as a result, it is too cruel to them, it only offers them jail,” she added.

Recinos said that, due to pressure from conservative groups, the State has backed down on the strategy of providing sexual and reproductive information in schools.

“Now they are more rigorous in not allowing organizations working in that area to go and give talks on comprehensive sex education in schools,” she noted.

Not even baby formula

In Guatemala, initiatives by civil society organizations that since 2017 have proposed, among other things, that the State should offer reparations to pregnant girls and adolescents, to alleviate their heavy burden, have made no progress either.

These proposals included the creation of scholarships, making it possible for girls to continue going to school while their babies were cared for and received formula.

“But unfortunately we have not been able to take the next step, to get these measures in place,” said Paula Barrios, general coordinator of Women Transforming the World, in a telephone conversation with IPS from the capital, Guatemala City.

Barrios said that most of the users of the services offered by this organization, such as legal and psychological support, “are girls and adolescents who are pregnant because of sexual violence and are forced to have their babies.”

She said that in the last five years some 500,000 girls under 14 years of age have become pregnant, and the number is much higher when teenagers up to 19 years of age are included.

“Today we have half a million girls who we don’t know what they and the children who are the products of rape are eating,” Barrios stressed, adding that as in El Salvador and Honduras, in Guatemala, having sex with a girl under 14 years of age is considered statutory rape.

“Society sees it as normal that women are born to be mothers, and so it doesn’t matter if a girl gets pregnant at the age of 10 or 12 years, they just think she has done it a little bit earlier,” she said.

Patriarchy and capitalism

The experts from Guatemala, Honduras and El Salvador consulted by IPS said the root of the phenomenon is multi-causal, with facets of patriarchy, especially gender stereotypes and sexual violence.

“The patriarchy has an interest in stopping women from going out into the public sphere,” said Barrios.

She said the life of a 10-year-old girl is cut short when she becomes pregnant. She will no longer go to school and will remain in the domestic sphere, “to raise children and stay at home.”

For her part, Garcia, the lawyer from Honduras, pointed out that there is also an underlying “system of oppression” that is intertwined with patriarchy and colonialism, which is the influence of a hegemonic country or region.

“We have girls giving birth to cheap labor to feed the (capitalist) system, and there is a greater feminization of poverty, girls giving birth to girls whose future prospects are ruined,” she said.

In the meantime, to avoid a repeat of her ordeal, Beltrán said she talks to and teaches her nine-year-old daughter about sexuality.

“In order to keep her from repeating my story, I talk to her about condoms, how a woman has to take care of herself and how she can get pregnant,” she said.

“I don’t want her to go through what I did,” she said.

A demonstration in the city of Córdoba, capital of the province of the same name in central Argentina, in favor of legal, safe and free abortion and women's rights. The color green has identified the movement in favor of the legalization of abortion, which was passed by Congress in late 2020. CREDIT: Catholics for Choice

By Daniel Gutman
BUENOS AIRES, Jun 23 2023 (IPS)

Viviana Mazur is a doctor at the Santojanni Hospital in Mataderos, a working-class neighborhood in Buenos Aires. She has witnessed the advances in women’s rights in Argentina, where until 2020 abortion was only allowed on two grounds, while it is now available on demand up to 14 weeks of pregnancy.

“Today what we see at the hospital is that most women come in for a consultation very early; in many cases they do so as soon as their period is late. This makes it possible to resolve almost all abortions with medication, in the woman’s own home, with medical advice and monitoring,” she said."(Medical abortion) is less traumatic and less risky for the woman and it's less costly for the public health system." -- Viviana Mazur

Mazur, who is also coordinator of Sexual Health in the Buenos Aires city government, said there are many advantages of medication abortion over the traditional surgical procedures.

“It’s less traumatic and less risky for the woman and it’s less costly for the public health system,” she told IPS.

In Argentina, as a result of years of struggle by the women’s rights movement, since January 2021 abortion has been decriminalized. In the last stage of the fight, mass demonstrations by women – and also men – wearing green headscarves, which has become a pro-choice symbol in Latin America, filled the streets.

Since then, Law 27,610 on Access to Voluntary Interruption of Pregnancy allows any woman to have an abortion up to the 14th week of pregnancy free of charge and without having to explain the reasons for her decision.

Until the law came into force, access was severely restricted: a Supreme Court ruling in effect since 2012 authorized what was called Legal Termination of Pregnancy, only in the case of rape or if the pregnancy endangered the woman’s life or health.

Argentina’s Minister of Health Carla Vizzotti (C) holds the green headscarf that is the symbol for the feminist movement that fought for the successful legalization of abortion in Argentina. CREDIT: Ministry of Health

More abortions recorded in 2022

In 2022, the first full year in which the law allowing abortion on demand was in force, 96,664 abortions were performed in the public health system of this South American country of 46 million inhabitants, according to official data. This marked a significant increase over 2021, when the total was 73,847, partly due to the rise in abortions in the public health system.

“More than 85 percent of abortions in 2022 were performed with medication,” Valeria Isla, the national director of Sexual and Reproductive Health, told IPS.
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“The good news is that today these are safe practices taking place within the health system. In any case, since until recently most abortions were clandestine, we believe it is too early to draw conclusions with respect to the number. The figures have yet to stabilize,” she added.

Isla explained that her office provides training to health personnel from all over the country on how to perform abortions and that medications are distributed, as well as equipment for manual vacuum aspiration, which is a less risky medical procedure in a doctor’s office than dilation and curettage, which is performed in an operating room.

In this sense, since 2022 the incorporation of mifepristone into the Argentine health system, in addition to misoprostol, which has been used for years to perform medical abortions, has been a great step forward.

The combination of mifepristone and misoprostol, called “combipack”, makes abortions more efficient and less painful for women, and in fact the combination of these two drugs for pregnancy termination is one of the techniques recommended by the World Health Organization (WHO) since 2005.

Last year, the WHO ratified both as essential drugs for providing quality health services and backed their efficacy and safety for abortion.

Isla explained that since last year the national government has been distributing mifepristone in public hospitals thanks to a donation from the United Nations Population Fund (UNFPA).

Since March of this year, mifepristone has been fully available also for the Argentine private health system, since the governmental National Administration of Medicines, Food and Medical Technology (Amnat) authorized its sale in pharmacies.

This has allowed the “combipack” to be used in recent months in the private health system as well, where women now also have easier access to abortion.

“The incorporation of mifepristone has been very important on a day-to-day basis to make abortion easier for women, because it means less misoprostol is used, side effects are reduced and the whole process can be carried out at home, with prior and subsequent checkups,” Florencia Grazzini, a social worker at a primary care clinic in the municipality of Lanús, on the outskirts of Buenos Aires, told IPS.

Grazzini began providing support to women who needed access to abortion long before the legalization of voluntary termination of pregnancy. She worked for years at the Kimelú counseling center, formed by feminist activists and serving the southern area of Greater Buenos Aires.

She said that while access to abortion has now been greatly facilitated, for some women termination of pregnancy is still a stigma.

“Despite the fact that with the law there is no need to gjve a reason for abortions up to 14 weeks of pregnancy, the justification for the decision continues to appear in the record of the consultations,” Grazzini pointed out.

She added that, “We are working so that people can share how they feel about their situation, but we don’t want them to feel that they need to explain in order to access an abortion.”

She said the women are told that they do not need to explain why they wish to have an abortion, although psychological assistance is provided to those who request it.

Abortion, however, sometimes encounters resistance from health professionals themselves. This was reflected in May, when the Ministry of Health updated the Protocol of Care and urged the “elimination of all requirements that are not clinically necessary for the safe practice of abortion.”

Specifically, it called for the elimination of waiting or reflection periods and the requirement of parental or partner consent.

A rally at the Ministry of Health in Buenos Aires, where feminist activists showed their green scarves and demonstrated in favor of women’s rights. CREDIT: Ministry of Health

The need for support

More data that shows that the legalization of abortion has not eliminated all the actual barriers is provided by Socorristas en Red (roughly, “Helpers Online Network”), a women’s organization that provides nationwide support for women who need an abortion.

In 2022, the network received 13,292 calls from women who wanted to terminate their pregnancies.

Only 10 percent of them had abortions in the public health system and the rest had abortions that they arranged elsewhere. The organization provided them with psychological assistance, information, instructions, WhatsApp messages, phone calls, and virtual and face-to-face company by “socorristas” or helpers. With all this they found greater comfort than in the health system.

This picture is completed by the visible inequality in access to abortion in different areas of the country.

Although the number of public hospitals and health centers that perform abortions reached 1793 in 2022 – against less than 1000 in 2021 – in some provinces the supply is very limited. For example, in the northern provinces of Santiago del Estero and Chaco there are only eight and nine health institutions, respectively, that perform abortions.

“In some places there is resistance from officials and a lack of knowledge among fellow workers about outpatient treatment with medications,” Ana Morillo, a social worker in the province of Córdoba, in the center of the country, told IPS.

Morillo, who is an activist and member of the Network of Professionals for Choice and the organization Catholics for Choice, said the advocacy work of the women’s rights movement has made Cordoba one of the provinces with the greatest access to abortion, since there are 180 hospitals and health centers that perform the procedure.

“The greatest inequalities are between cities and rural areas, where it is much more difficult to access an abortion. These are the disparities in the country on which we still have to work the hardest,” she said.

On Mar. 22, 2023, dozens of people watched a live broadcast from San José, Costa Rica, on a large screen at the University of El Salvador, in San Salvador, of the open hearing of the Inter-American Court of Human Rights, listening to the testimony of witnesses in the Beatriz v. El Salvador case. The screenshot shows Beatriz's mother giving her testimony. CREDIT: Edgardo Ayala/IPS

By Edgardo Ayala
SAN SALVADOR , Mar 24 2023 (IPS)

An open hearing in the Inter-American Court of Human Rights in the Beatriz v. El Salvador case is raising hopes that this country and other Latin American nations might overturn or at least mitigate the severe laws that criminalize abortion.

That will happen if the Inter-American Court rules that El Salvador violated the right to health of Beatriz, as the plaintiff is known. In 2013 she sought to have her pregnancy terminated because it was high risk and her life was in danger."I hope that in the end my daughter's name will be vindicated, and that what happened to her will not happen again to any other woman.” -- Beatriz´s mother

But she was not given an abortion, only a tardy cesarean section, which affected her already deteriorated health and, according to the plaintiffs, eventually led to her death in October 2017.

The hearing on the emblematic case was held Mar. 22-23 at the Inter-American Court in San José, Costa Rica. Beatriz’s case builds on similar ones: the cases of Manuela, also from El Salvador, Esperanza from the Dominican Republic, and Amelia from Nicaragua.

The seven judges heard the arguments of the plaintiffs, the representatives of the Salvadoran State and the witnesses on both sides.

After the hearing, the parties have 30 days to deliver their written arguments and the magistrates will then take several months to debate and reach a resolution.

The open hearing held by the Inter-American Court of Human Rights on the Beatriz v. El Salvador case is the first time that the complete ban on abortion has been tried, and the verdict will have implications for Latin America, a region that is especially restrictive in terms of women’s sexual and reproductive rights. CREDIT: Inter-American Court of Human Rights

A historic case

“I hope that in the end my daughter’s name will be vindicated, and that what happened to her will not happen again to any other woman,” Beatriz’s mother said when testifying on the stand. Her name was not revealed in court.

The hearing has drawn international attention because it is considered historic for the sexual and reproductive rights of women in a region that is especially restrictive with regard to the practice of abortion.

“This will be the first case where the Court will rule on the absolute prohibition of the voluntary interruption of pregnancy, particularly regarding the risk to health and when the fetus is nonviable,” Julissa Mantilla Falcón, from the Inter-American Commission on Human Rights (IACHR), told the Inter-American Court.

Beatriz turned to the IACHR when the Constitutional Court of El Salvador denied, on Apr. 11, 2013, her request for an abortion.

On Apr. 19, the IACHR issued a precautionary measure in favor of Beatriz, and on May 27, 2013, it asked the Inter-American Court to adopt provisional measures which would be binding on the State.

In its November 2020 Merits Report, the IACHR established that the Salvadoran State was responsible for the disproportionate impact on various rights of Beatriz, by failing to provide her with timely medical treatment due to the laws that criminalize abortion.

The IACHR identified the disproportionate impact of this legislation on Salvadoran women and girls, especially the poor.

The Commission stated that it did not expect full compliance by the State with the recommendations of the report, and therefore referred the case to the Inter-American Court, which now, ten years later, is a few months away from handing down a resolution.

Anabel Recinos, from the Citizen Association for the Decriminalization of Abortion, one of the Salvadoran organizations that are co-plaintiffs in the Beatriz v. El Salvador case, hopes that the Inter-American Court sentence will set a legal precedent and pave the way for the modification of the 1998 law criminalizing abortion under any circumstances in El Salvador. CREDIT: Edgardo Ayala/IPS

For her part, Anabel Recinos, from the Citizen Association for the Decriminalization of Abortion, one of the Salvadoran organizations that are co-plaintiffs in the case, told IPS that she hopes that the Inter-American Court ruling will set a new precedent.

She said her hope is that the court will rule that laws in El Salvador and the region banning abortion under all circumstances must be modified.

In addition to El Salvador, Honduras, Nicaragua and the Dominican Republic are the countries in the region where abortion is completely prohibited in their penal codes. It is only legal in five countries in Latin America, while it is allowed only in strict circumstances in the rest.

“Or at least it should be allowed for specific reasons or exceptions, such as safeguarding health and life, or the incompatibility of the fetus’s life outside the womb,” Recinos said.

Twenty Latin American and Caribbean countries recognize the jurisdiction of the Inter-American Court: Argentina, Barbados, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname and Uruguay.

The IACHR and the Court make up the inter-American human rights system. They are independent bodies and in the case of the Court the sentences are final and binding, although they are not always enforced.

Recinos spoke to IPS at the University of El Salvador, in the country’s capital, where dozens of people gathered to watch the hearing, broadcast live from San José, on a large screen.

The activist added that it is likely that the Court will rule against the Salvadoran State, backing the IACHR’s conclusions.

The Court is made up of judges Ricardo Pérez Manrique (Uruguay), Humberto Sierra Porto (Colombia), Eduardo Ferrer Mac-Gregor (Mexico), Rodrigo Mudrovitsch (Brazil), Nancy Hernández López (Colombia) and Verónica Gómez (Argentina).

In March 2003, Beatriz requested an abortion during her second pregnancy, because she suffered from lupus, an autoimmune disease in which the body’s immune system mistakenly attacks healthy organs, and preeclampsia, a dangerous increase in blood pressure during pregnancy, as well as other health problems.

In other words, her life was at risk. In addition, the fetus had malformations and would not live long at birth.

However, the medical personnel, although they were aware that an abortion was indicated to save Beatriz’s life, did not carry it out due to the fear of prosecution.

Beatriz was forced to continue with a pregnancy that continued to harm her health as the days went by.

But after the Inter-American Court granted provisional measures, Beatriz underwent a cesarean section on Jun. 3, 2013, almost three months after requesting an abortion.

The child, who was born with anencephaly, missing parts of the brain and skull, died just five hours later.

Activists for the sexual and reproductive rights of women in El Salvador demonstrate on Mar. 22 outside the Inter-American Court of Human Rights in San José, Costa Rica, during the hearing for the emblematic case of Beatriz v. El Salvador. Many carried green balloons, whose color is a symbol of the fight for the right to abortion in Latin America. CREDIT: Collaborating Organizations

Misogyny on the part of the State

Since 1998 El Salvador, this Central American country of 6.7 million inhabitants, has been the most drastic in the region in the persecution of abortion, punishing women who terminate their pregnancies with sentences of up to 30 years, in all cases, even when the life and health of the pregnant woman is at risk or in cases of rape.

The legislation mainly affects poor women in rural areas. According to data from women’s rights organizations, 181 such cases have been prosecuted since 2019.

Guillermo Ortiz, a gynecologist and obstetrician who specializes in high-risk pregnancies, testified before the Inter-American Court: “Yes, I saw many women die because they did not have access to a safe abortion, despite my having requested it.”

In her testimony, Beatriz’s mother said that the many doctors who treated her daughter had recommended that the pregnancy be terminated, but did not dare to perform an abortion or c-section to remove the fetus, for fear of going to prison.

“They told my daughter that they couldn’t, because in El Salvador it’s a crime, and if they did, they could go to jail,” said the mother.

“The State failed Beatriz twice,” said the mother, before breaking down in tears.

She was referring to the failure to carry out an abortion promptly, despite her daughter’s serious health conditions. She also was talking about a motorcycle accident that the 22-year-old suffered later.

“She had an accident that shouldn’t have been fatal, she was in stable condition” when she was admitted to the hospital in Jiquilisco, a municipality in the eastern department of Usulután.

But a storm caused a flood in some parts of the hospital, so they transferred her to the hospital in Usulután, the capital of the department.

“The doctor who treated her there didn’t even know what lupus was,” she said. In the hospital, Beatriz caught pneumonia.

The mother’s testimony and that of the other witnesses at the hearing has been closely followed in El Salvador and other nations by feminist and human rights organizations that have been monitoring and criticizing the country’s strict anti-abortion law.

Yomira Cuadros faced motherhood at an early age, as well as the obstacles of a sexist society like Peru’s, regarding her reproductive decisions. In the apartment where she lives with her family in Lima, she expresses faith in the future, now that she has finally started attending university, after having two children as a result of unplanned pregnancies. CREDIT: Mariela Jara/IPS

By Mariela Jara
LIMA, Nov 18 2022 (IPS)

No woman in Peru should have to die, have her physical or mental health affected, be treated as a criminal or have an unwanted pregnancy because she does not have access to abortion, said Dr. Rocío Gutiérrez, an obstetrician who is the deputy director of the Manuela Ramos Movement, a non-governmental feminist center that works for gender rights in this South American country.

In this Andean nation of 33 million people, abortion is illegal even in cases of rape or fetal malformation. It is only legal for two therapeutic reasons: to save the life of the pregnant woman or to prevent a serious and permanent health problem.

Peru thus goes against the current of the advances achieved by the “green wave”. Green is the color that symbolizes the changes that the women’s rights movement has achieved in the legislation of neighboring countries such as Uruguay, Colombia, Argentina and some states in Mexico, where early abortion has been decriminalized. These countries have joined the ranks of Cuba, where it has been legal for decades."I didn't tell my parents because they are very Catholic and would have forced me to go through with the pregnancy, they always instilled in me that abortion was a bad thing. But I started to think about how pregnancy would change my life and I didn't feel capable of raising a child at that moment." -- Fatima Guevara

But Latin America remains one of the most punitive regions in terms of abortion, with several countries that do not recognize women’s right to make decisions about their pregnancies under any circumstances. In El Salvador, Honduras, Nicaragua, the Dominican Republic and Haiti it is illegal under all circumstances, and in some cases draconian penalties are handed down.

In the case of Costa Rica, Guatemala, Peru and Venezuela, meanwhile, abortion is allowed under very few conditions, while there are more circumstances under which it is legal in Bolivia, Brazil, Chile and Ecuador.

“In Peru an estimated 50,000 women a year are treated for abortion-related complications in public health facilities,” Dr. Gutiérrez told IPS. “This is not the total number of abortions in the country, but rather the number of women who reach public health services due to emergencies or complications.”

The obstetrician spoke to IPS from Buenos Aires, where she participated in the XV Regional Conference on Women, held Nov. 7-11 in the Argentine capital.

Gutiérrez explained that the cases attended are just the tip of the iceberg, because for every abortion complicated by hemorrhage or infection treated at a health center, at least seven have been performed that did not present difficulties.

Multiplying by seven the 50,000 cases treated due to complications provides the shocking figure of 350,000 unsafe clandestine abortions performed annually in Peru.

The doctor regretted the lack of official statistics about a phenomenon that affects the lives and rights of women “irreversibly, with damage to health, and death.”

Gutiérrez said that another of the major impacts is the criminalization of women who undergo abortions, due to mistreatment by health personnel who not only judge and blame them, but also report them to the police.

Obstetrician Rocío Gutiérrez (C), deputy director of the feminist Manuela Ramos Movement, stands with two fellow activists holding green scarves – representing the struggle for reproductive rights – during the XV Regional Conference on Women held this month in the city of Buenos Aires. CREDIT: Courtesy of Rocío Gutiérrez

Under article 30 of Peru’s General Health Law, No. 26842, a physician who attends a case of presumed illegal abortion is required to file a police report.

Gutiérrez also referred to the fact that unwanted pregnancies have numerous consequences for the lives of women, especially girls and adolescents, in a sexist country like Peru, where women often do not have the right to make decisions on their sexuality and reproductive health.

Healing the wounds of unwanted motherhood

By the age of 19, Yomira Cuadros was already the mother of two children. She did not plan either of the pregnancies and only went ahead with them because of pressure from her partner.

In 2020, according to official data, 8.3 percent of adolescents between the ages of 15 and 19 were already mothers or had become pregnant in Peru.

Cuadros, whose parents are both physicians and who lives in a middle-class family, said she never imagined that her life would turn out so differently than what she had planned.

“The first time was because I didn’t know about contraceptives, I was 17 years old. The second time the birth control method failed and I thought about getting an abortion, but I couldn’t do it,” Cuadros told IPS.

At the time, she was in a relationship with an older boyfriend on whom she felt very emotionally dependent. “I had made a decision (to terminate the pregnancy), but he didn’t want to, he told me not to, the pressure was like blackmail and out of fear I went ahead with the pregnancy,” she said.

Making that decision under coercion hurt her mental health. Today, at the age of 26, she reflects on the importance of women being guaranteed the conditions to freely decide whether they want to be mothers or not.

Peruvian activists go topless to demand the right to legal abortion, during a demonstration in the streets of the capital on Mar. 8, 2018. CREDIT: Mariela Jara/IPS

In her case, although she had the support of her mother to get a safe abortion, the power of her then-partner over her was stronger.

“Becoming a mother when you haven’t planned to is a shock, you feel so alone, it is very difficult. I didn’t feel that motherhood was something beautiful and I didn’t want to experience the same thing with my second pregnancy, so I considered terminating it,” she said.

Finding herself in that unwanted situation, she fell into a deep depression and was on medication, and is still in therapy today.

“I went from being a teenager to an adult with responsibilities that I never imagined. It’s as if I have never really gone through the proper mourning process because of everything I had to take on, and I know that it will continue to affect me because I will never stop being a mother,” she said.

She clarified that “it’s not that I don’t want to be a mother or that I hate my children,” and added that “as I continue to learn to cope, I will get better, it’s just that it wasn’t the right time.”

She and her two children, ages nine and seven, live with her parents and brother in an apartment in the municipality of Pueblo Libre, in the Peruvian capital. She has enrolled at university to study psychology and accepts the fact that she will only see her dreams come true little by little.

“Things are not how I thought they would be, but it’s okay,” she remarked with a newfound confidence that she is proud of.

Gutiérrez said more than 60 percent of women in Peru have an unplanned pregnancy at some point in their lives, and argued that the government’s family planning policies fall far short.

The National Institute of Statistics and Informatics reported that the total fertility rate in Peru in 2021 would have been 1.3 children on average if all unwanted births had been prevented, compared to the actual rate of 2.0 children – almost 54 percent higher than the desired fertility rate.

“There are a set of factors that lead to unwanted pregnancies, such as the lack of comprehensive sex education in schools, and the lack of birth control methods and timely family planning for women in all their diversity, which worsened during the pandemic. And of course, the correlate is access to legal and safe abortion,” said Gutiérrez.

She lamented that little or no progress has been made in Peru in relation to the exercise of sexual and reproductive rights, including access to safe and free legal abortion, despite the struggle of feminist organizations and movements in the country that have been demanding decriminalization in cases of rape, artificial insemination without consent, non-consensual egg transfer, or malformations incompatible with life.

University student Fátima Guevara decided to terminate an unwanted pregnancy when she was 19 years old. Four years later, she is sure that it was the right decision, in terms of her plans for her life. The young woman told her story at a friend’s home, where she was able to talk about it openly, in Lima, Peru. CREDIT: Mariela Jara/IPS

The obscurity of illegal abortion

The obscurity surrounding abortion led Fátima Guevara, when she faced an unwanted pregnancy at the age of 19, to decide to use Misoprostol, a safe medication that is included in the methods accepted by the World Health Organization for the termination of pregnancies.

“I didn’t tell my parents because they are very Catholic and would have forced me to go through with the pregnancy, they always instilled in me that abortion was a bad thing. But I started to think about how pregnancy would change my life and I didn’t feel capable of raising a child at that moment,” she told IPS in a meeting at a friend’s home in Lima.

She said that she and her partner lacked adequate information and obtained the medication through a third party, but that she used it incorrectly. She turned to her brother who took her to have an ultrasound first. “Hearing the fetal heartbeat shook me, it made me feel guilty, but I followed through with my decision,” she added.

After receiving proper instructions, she was able to complete the abortion. And today, at the age of 23, about to finish her psychology degree, she has no doubt that it was the right thing to do.

While abortion in Canada has been legal for decades, procuring one is difficult for many. Credit: Gayatri Malhotra/Unsplash

By Juliet Morrison
Ottawa, Jul 19 2022 (IPS)

Toronto resident Miranda Knight describes her abortion experience as relatively simple. After finding out she was pregnant on a Wednesday in 2017, she booked an appointment at an available clinic and got one for the following Monday. She had the procedure that day and left the clinic by noon.

But Knight’s experience is not the reality for all. As Canada’s most populous city, Toronto has several access points to abortion. Despite abortion being legal nationwide since 1988 and officially treated like any other medical procedure, many other parts of the country do not have access points.

The United Nations has highlighted this disparity. A 2016 report from the Committee on the Elimination of Discrimination Against Women encouraged the Canadian government to improve the accessibility of abortion services nationwide.

According to the Abortion Rights Coalition of Canada (ARCC), fewer than one in five hospitals offer the procedure.

ARCC Executive Director Joyce Arthur said access could be a real struggle for those living outside cities or far from the US border. Most access points are found within less than 150 kilometers of a town, where most Canadians live.

“As soon as you’re away from the city, or up north, you often might have to travel for services, sometimes hundreds of kilometers, and even sometimes for medication. Access is pretty good in British Columbia, Ontario, and Quebec […], but the rest of the provinces only have one or two or three or four access points. It’s just not enough,” she said.

Abortion access differs by province partly because healthcare in Canada is a provincial responsibility. According to 2019 figures, Quebec has the highest number of access points with 49 province-wide, while Newfoundland and Labrador have four and Saskatchewan has three.

Abortion in Canada by province. The data was published August 2019 with information from the 2014 Abortion Provider Survey. Credit: Action Canada for Sexual Health and Rights

Healthcare disparities among rural and urban communities are a significant issue in Canada—especially considering the country’s geography. But Arthur told IPS that unequal abortion access went beyond that.

“Canada is a really big country geographically, so other health care procedures might be hard to access, and people have to travel sometimes. But abortion is a very simple procedure. Early-first trimester abortion can be done on an outpatient basis and doesn’t really require a lot of special equipment. Why aren’t more hospitals doing it?”

Arthur believes the culprit is stigma from the anti-choice movement.

“Much of this is due to remaining abortion stigma from before it was de-criminalized. The anti-choice movement has continued to play a big role in reinforcing that stigma and instilling fear in providers. There’s still this feeling of silencing and shame, which comes from abortion stigma,” she said.

Arthur explained it was not that long ago that doctors would get shot for performing abortions in Canada. From the late 1970s until the mid-1990s, there were several instances of violence against physicians in their own homes.

“That permeates on various levels, not just at the level of the doctor or the patient, but also in government and in medical organizations who would rather just not have to deal with abortion and not have to think about it,” she said.

Disparities in access have led community organizers to step up and help those in need get care.

Shannon Hardy, a birth doula, founded Abortion Support Services Atlantic (ASSA) in 2012 after encountering issues related to abortion access across the Atlantic provinces.

“Some things came across my desk about lack of access in Prince Edward Island. And I didn’t actually know that PEI didn’t offer abortion services, like the entire island for 32 years just didn’t offer it. […] It kind of blew my mind,” she said.

People wanting to terminate their pregnancy can contact ASSA for information, peer support, transport to abortion clinics, or even financial help for travel. In these cases, Hardy told IPS that ASSA would often fundraise to pay for gas, hotels, or flights.

Support services are beneficial for those encountering stigma, Hardy said.

“When a person is facing an ill-timed or unwanted pregnancy, they can immediately feel a stigma around seeking abortion care. Who is safe to reach out to? Will people judge me? Will my doctor/medical center offer me care? My goal for creating ASSA was to have a place […] where anyone seeking abortion care could reach out and help would just be there.”

Hardy’s work has spearheaded a movement. Many other doula organizations have popped up across the country with a similar model. They also often collaborate with national abortion advocacy organizations to help people access the procedure in circumstances that require on-the-ground coordination and support.

Yet, Hardy believes that the need for organizations like ASSA point to critical access issues across the country and inaction at government levels.

“It’s been frustrating that there’s not more access. We, as a grassroots organization, are the ones responsible for getting people from one small town to access abortion instead of the healthcare system stepping in and saying, ‘you know what, we actually have the resources to offer that medical service. So, we’re just going to do that to make life easier’,” she said.

The proportion of hospitals providing abortions to the female population. Credit: Action Canada for Sexual Health and Rights

Working in Alberta, one of Canada’s most socially conservative provinces, Autumn Reinhardt-Simpson is familiar with how attitudes on abortion can impact care. She founded Alberta Abortion Access Network to help those across the province in 2015.

Reinhardt-Simpson told IPS that those in rural areas face increased access issues because their care is more dependent on the “private moral concerns” of the health care professionals in their area.

This can make trying to get an abortion more complicated, she explained. Many physicians and pharmacists are either unwilling to offer reproductive health services or unaware of their legality.

In one case, Reinhardt-Simpson had to visit ten different pharmacies to find one that stocked Mifegymiso—the abortion pill that became legal in 2017.

“They were saying things like, ‘Oh well, we can’t dispense this, or this isn’t legal yet. Or well, we can’t get the medication.’ And it’s like no, no, that’s not how this works,” she said.

Alberta has only four access points for surgical abortions, all in its cities. Along with another helper, Reinhardt-Simpson services the whole of Alberta’s 661,848 km² (411, 253 mi²) and helps people access abortion services.

In her view, the stigma around abortion care is detrimental. It can even be physically harmful—particularly for those in later trimesters desperate for solutions.

“The stigma is preventing thousands of Albertans from receiving critical and routine health care. Because there are so many hoops to jump through, some people will get tired of those hoops, and they will try to do something themselves. It doesn’t usually end well. […] the stigma is physically dangerous, it’s emotionally harmful, and culturally it does us no good,” she said.

Being familiar with reproductive justice issues as a community organizer, Knight feels compelled to share her abortion story to combat stigma and normalize the procedure.

She’s currently developing a storytelling project that will feature diverse abortion experiences. Knight told IPS the project’s proceeds would go to improving access across Canada. She hopes to help to improve access for others, considering how essential the procedure was for her.

“My prevailing feeling about the whole thing was just relief. I don’t want to live in an alternate universe where I didn’t have access to abortion. My life would be very different now,” she said.

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A half-century of reproduction rights upended by the Supreme Court. Credit: Greenpeace.

By Joseph Chamie
PORTLAND, USA, Jul 18 2022 (IPS)

The 24 June decision of United States Supreme Court to overturn the country’s nearly 50-year constitutional right of a woman to an abortion is being felt worldwide.

In addition to the objections and protests to the court’s landmark decision within the United States, governments, world leaders, and others have expressed their concerns and dissatisfaction about the overturning a woman’s constitutional right to an abortion.

The court’s decision to overturn the constitutional right to an abortion established in 1973 is at odds with the views of a broad majority of the public. No less than two-thirds of U.S. adults did not want the court to overturn the 1973 decision

The European Union’s parliament overwhelmingly condemned the decision ending the constitutional protections of women for abortion in the United States. Fearing the expansion of anti-abortion movements in Europe, the parliament also called for safeguards to abortion rights be enshrined in the EU’s fundamental rights charter and protections be adopted across the EU.

The Director General of the World Health Organization was very disappointed with the decision and the United Nations High Commissioner for Human Rights called the court’s decision a major setback. Access to safe, legal, and effective abortion, the Commissioner stressed, is firmly rooted in international human rights law.

Objections to the decision came from many government leaders worldwide. The Prime Minister of the United Kingdom, for example, saw the decision as a big step backwards. Accusing the court of diminishing the rights of U.S. women, the President of France said that abortion is a fundamental right of all women.

The German Chancellor viewed the decision as a threat to the rights of women, as did New Zealand’s Prime Minister who saw it as a loss for women everywhere. The Belgian Prime Minister expressed concerns about the signal the decision sends to the rest of the world about a woman’s right to an abortion.

Fifty years ago, various U.S. states criminalized a woman having an abortion. In 1973 in the case Roe v. Wade, the Supreme Court’s majority of seven justices established a woman’s constitutional right to an abortion in all 50 states (Table 1).

The justices concluded that state statutes criminalizing abortion in most instances violated a woman’s constitutional right of privacy, which it found to be implicit in the liberty guarantee of the due process clause of the Fourteenth Amendment in the U.S. Constitution.

Thirty years ago, the Supreme Court revisited Roe v. Wade in the 1992 case of Planned Parenthood v. Casey. A majority of five justices reaffirmed a woman’s right to an abortion but imposed a new standard to determine the validity of laws restricting abortions.

The new standard asks whether a state abortion regulation has the purpose or effect of imposing an “undue burden”, which is defined as a substantial obstacle in the path of a woman seeking an abortion before the fetus attains viability.

In June 2022, in the case of Dobbs v. Jackson Women’s Health Organization a majority of six justices concluded that the 1973 and 1992 abortion decisions of a dozen former justices were egregiously wrong in their legal reasoning that led to erroneous decisions concerning the right to an abortion.

After nearly a half century of women having a constitutional right to an abortion enshrined in the 1973 decision and reaffirmed in the 1992 decision, six justices of the current Supreme Court concluded that there is no such constitutional right. In the dissenting opinion, the court’s remaining three justices wrote that the U.S. will become an international outlier after the decision.

The court’s decision to overturn the constitutional right to an abortion established in 1973 is at odds with the views of a broad majority of the public. No less than two-thirds of U.S. adults did not want the court to overturn the 1973 decision.

In addition, a majority of Americans, approximately 60 percent, and President Biden with the backing of many Democratic leaders support Congress passing a law establishing a nationwide right to abortion. Such a law would protect a woman’s right to choose whether or not to have an abortion.

In contrast, a comparatively small minority of Americans, 13 percent in 2022, are opposed to abortion, with some, including Republican leaders, considering a federal abortion ban for all fifty states. Since 1975, the annual proportion of Americans who say abortion should be illegal in all circumstances has varied from a low of 12 percent in 1990 to a high of 22 percent in 2002 (Figure 1).

Source: Gallup Polls.

Following its decision to overturn the Roe v. Wade decision, confidence in the Supreme Court has reached historic lows. A majority of the U.S. public, 58 percent, have an unfavorable view of the Supreme Court. That level of disapproval is now on par with the public’s unfavorable view of Congress.

In addition, the United States has become a patchwork of abortion laws and given rise to a myriad of enforcement regulations, numerous court cases, and challenging legal questions. Abortion is now banned in at least nine states and more bans are expected in the near future. In some states, such as Alabama, Arkansas, Mississippi, Missouri, and South Dakota, abortion is banned with no exceptions for rape or incest.

Also, many state legislatures are considering ways of stopping or criminalizing out of state abortions. They are also proposing banning or tightly restricting the use of abortion medication, which was approved in 2000 by the U.S. Food and Drug Administration and accounted for an estimated 54 percent of the country’s abortions in 2020. In response, other states are advancing legislation and executive orders protecting patients and providers from legal risks outside their borders.

The Supreme Court’s recent decision finding no constitutional right to an abortion has raised concerns that other rights not enumerated in the U.S. Constitution are at risk of being overturned. Among those rights are same-sex marriage, same-sex relationships, and contraceptives.

In a concurring opinion to the recent abortion decision, for example, one of the court’s justices indicated that other precedents should be reconsidered. He also mentioned that future legal cases could curtail other rights not clearly addressed in the U.S. Constitution.

The court’s abortion decision may also embolden abortion opponents, influence policymakers, and affect reproductive health programs in other countries as well. The decision puts U.S. alongside several other countries, including Poland, El Salvador, and Nicaragua, that have backtracked on or restricted abortion policy in recent decades.

However, the court’s abortion decision runs counter to recent global liberalization trends on reproductive rights. During the past three decades about 60 countries have expanded laws and policies relating to reproductive rights, including legal access to abortion.

In sum, the recent decision of the U.S. Supreme Court has not only revoked the nearly 50-year constitutional right of a woman to an abortion, but it is also now out of sync with the increasing worldwide recognition of fundamental reproductive rights, including a woman’s right to an abortion.

Joseph Chamie is a consulting demographer, a former director of the United Nations Population Division and author of numerous publications on population issues, including his recent book, “Births, Deaths, Migrations and Other Important Population Matters.”

Women’s rights groups have questioned the legal provision requiring doctors to collect records on all pregnancies, saying it could be used to monitor abortions.

By Ed Holt
BRATISLAVA, Jul 5 2022 (IPS)

Women’s rights groups fear a new legal provision in Poland requiring doctors to collect records on all pregnancies could create what they have described as a ‘pregnancy register’ to monitor whether women are having abortions.

Poland has some of Europe’s strictest abortion laws with terminations allowed in only two instances – if the woman’s health or life is at risk and if the pregnancy is the result of either rape or incest.

Until last year, abortions had also been allowed in cases where the foetus had congenital defects, but this exemption was removed following a legal challenge by members of the ruling right-wing Law and Justice (PiS) party, which some critics accuse of systematically suppressing women’s rights.

Rights groups and opposition MPs say that in light of the tightened abortion legislation, they are worried that the pregnancy data could be used in an unprecedented state surveillance campaign against women.

“A pregnancy register in a country with an almost complete ban on abortion is terrifying,” Agnieszka Dziemianowicz-Bąk, an MP for The Left (Lewica) political alliance in Poland, said on Twitter. “Even today, Polish women avoid getting pregnant out of fear that they will be forced to give birth in every situation. There are even more reasons to be scared now,” she added.

The new provision was approved by Health Minister Adam Niedzielski on June 3 and will come into effect in October when medical staff will begin collecting additional information from patients, including data on pregnancies. This will then be entered into the country’s central Medical Information System (SIM).

Critics question why this data is being collected now, and who will have access to it, pointing out that information about pregnancies is already available in medical records, while some Polish lawyers have claimed that police and prosecutors will be allowed access to the data under certain circumstances.

Mara Clarke of the international group Abortion Without Borders said that while the collection of the information may not appear harmful in itself, against the background of the recent tightening of already very strict abortion laws, the move will only increase fears among women in Poland over their reproductive rights.

She told IPS: “There is a difference between information being gathered in a free, democratic country, and being gathered in a state with a regime suppressing women’s rights. Any talk of a pregnancy register cannot be construed as anything other than an attempt to again attack women’s rights. It will only promote more fear among women.”

Some doctors agree, saying patients have already expressed fears about what the data collection could mean.

Michal Gontkiewicz, a gynaecologist at a district hospital in Plonsk, central Poland, told local TV station TVN 24: “As a tool in itself this is not dangerous, but patients may fear it will be used as a tool of the regime. Women are afraid that if they experience a spontaneous miscarriage, which is already a huge trauma for them, someone will accuse them of terminating the pregnancy, multiplying their trauma.”

The Health Ministry has rejected claims that it is trying to create a ‘pregnancy register’ and said the provision is being implemented as part of requirements to meet EU health regulations on patient data.

A spokesman for the ministry told IPS: “We are not creating any register, only expanding the reporting system based on recommendations of the European Commission. Only medics will have access to the data.

“Information about pregnancy is important for medics, because, for example, pregnant women should not undergo a number of medical procedures, and certain medicinal products cannot be prescribed to them.”

Some local doctors have also sought to play down the significance of the data collection, pointing out that bodies such as state social insurance institutions can already check up on pregnancies and that law enforcement agencies can already access medical data in certain instances if approved by a court.

But with questions over the country’s judiciary – Poland has already been censured by the European Commission over a lack of judicial independence – critics of the provision worry the existence of the register will only make an already bad situation worse.

The Polish rights group, Women’s Strike, claims police are already involved in questioning women whose pregnancies have ended, often after being contacted by angry partners.

“Given the current state of the judicial system in Poland and the threat of investigation in cases of undelivered pregnancies, this raises a lot of concerns,” Wiktoria Magnuszewska, an activist with Lex Q, a Polish LGBT+ advocacy organisation, told IPS.

Before the provision comes into effect, activists are trying to reassure Polish women that the provision does not represent a change to legislation on terminations.

Under Poland’s abortion laws, it is not illegal to have an abortion, but it is illegal to help someone do so. Many women in Poland who want an abortion self-administer pills bought online from abroad, or travel to neighbouring countries with less restrictive legislation, such as Germany and the Czech Republic, for terminations.

“Our Polish helpline has already had a few calls from women concerned about what the situation would be if they wanted an abortion. The good news is that there is no danger that women will no longer be able to self-administer abortions,” said Clarke.

However, the fear of how the ‘pregnancy register’ could be used already appears to be driving Polish women away from the country’s doctors.

Eva Ptaskova of the Ciocia Czesia volunteer organisation in the Czech Republic which helps Polish women access reproductive services, including abortions in local facilities, says her group has already been contacted by clients looking not for terminations, but gynaecologists who will treat them during their pregnancy because they do not want their details recorded in Poland.

She told IPS: “The situation in Poland is beginning to look more and more like something from The Handmaid’s Tale. What we are seeing is women with concerns that this [pregnancy register] could open the door to investigations of pregnancies that are ‘no longer’.

“This could deter women from seeking medical care, for instance, post-abortion care, which could then be very dangerous to their health. I worry it will get to the point where women will be scared to go to a gynaecologist at all because the information will be recorded that could one day be used against them.”

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Sex workers in Chennai give a thumps up to India's liberalised abortion law. Many sex workers are living with HIV and face discrimination and stigma in accessing safe abortions. Credit: Stella Paul/IPS

By Stella Paul
NEW DEHLI, Apr 14 2020 (IPS)

Arti Zodpe is from the Tamasha (folk dance-drama) theatre in Sangli, in India’s Maharashtra state. After evening performances, some of the singers and dancers offer sex work services to the audience.

“We [Tamasha sex workers] live outside of the city as people feel disturbed by the sound of our ghunghroo [anklet bracelets with bells] and music. When we go to the city, especially to a sex health clinic, the staff say, ‘so you have come to spread your filth here’. If we get an abortion, they make us clean the floor afterwards,” she had said at a recent gathering of doctors and abortion rights experts.

Zodpe’s life narrates the difficulties vulnerable women like her face to get an abortion, and explains in painful detail the layers of social discrimination and stigma marginalised women face in orthodox Indian society.

Safe abortion still a dream for many

Abortion has been free in India since 1971, yet millions of women still fail to access safe abortions.

According to the Lancet Global Health report 2019, 15.6 million abortions occurred here in 2015, of which 78 percent were conducted outside of health facilities. Most of these abortions were also by women obtaining medical abortion drugs from chemists and informal vendors without prescriptions.

According to the Office of the United Nations High Commissioner for Human Rights (OHCHR), unsafe abortions are estimated to account for 9 to 20 percent of all maternal deaths in the country. 

A more recent study by Mahila Sarvangeen Utkarsh Mandal (MASUM), a Pune-based NGO, and Asia Safe Abortion Partnership (ASAP) conducted in seven of India’s 29 states revealed that 80 percent of women were unaware of the existing law and, as a result, feared seeking safe abortion services.

The study, released last month, interviewed 200 participants and found that all had had an abortion at some point, while some had as many as six. Yet none of the women had revealed this to their family or friends, primarily for fear of social stigma.

According to Hemlata Pisal, the project coordinator at MASUM, there were various gaps and discrepancies when it came to abortion services in public health centres (PHC):

• Medical abortion pills were largely unavailable, and even when they were available (through private clinics or mostly pharmacies), there was a variation in the dosages and types of pills prescribed.
• The out-dated D & C (dilation and curettage) method was still being used in many health centres across India and there was no standard protocol followed for both surgical and non-surgical methods.
• But above all there was a high level of stigma practiced by the staff.

“Women we interviewed reported that when they approached PHC for abortion they were often refused or subjected to extreme humiliation and abuse,” Pisal told IPS.

Liberalising the law

On Mar. 17, a week before the country went into a nationwide lockdown to stop the spread of the coronavirus disease or COVID-19, the Indian parliament voted for an amended version of the old abortion law, the Medical Termination of Pregnancy (MTP) Act, 1971, making it more liberal and accommodative.  

• One of the salient features of the amended MTP law was increasing the upper limit for abortion from 20 to 24 weeks. However, the new law will only favour “special categories of women”, which include rape survivors, victims of incest, those who are differently-abled and minors.
• It also gives a woman the opportunity to terminate her pregnancy if foetal abnormalities are detected within 24 weeks of her pregnancy. In recent years, several law suits were filed that demanded a raise in the upper limit for foetal abnormalities.

Speaking at parliament on the occasion, the India’s health minister Harsh Vardhan said that the new law was very progressive and it promised to ensure the safety of women. 

Medical practitioners and health exerts also welcomed the amendment.

Dr. Noor Fathima, a senior public health official and Bangalore-based gynaecologist, told IPS that it would make abortion “less cumbersome to service providers”.

“The [amended] MTP Act is particularly a boon to women who are facing emotionally draining and stigmatising pregnancy conditions,” Fathima told IPS.

Lack of accountability fuels discrimination

However, many said that continued social stigma posed a serious threat to the effectiveness of the new law, which also grants a woman the right to complete privacy.

But vulnerable groups of women rarely enjoy this right to privacy, said Kousalya Periasamy, the head of Positive Women’s Network (PWN), a Chennai-based group advocating equal rights for HIV positive women across India.

“Staff at any abortion centre would frequently ask us ‘why were you sleeping with your partner when you have HIV’?  We are also asked to submit identity documents and consent letters from male family members. Often we are denied an abortion even without a reason. And after the abortion, we must clean up the room,” Periasamy told IPS.

The reason behind such humiliation, says Mumbai-based gynaecologist and coordinator at ASAP, Dr. Suchitra Dalvie, is that presently there is no accountability for quality of abortion care or for refusals.

“Women are still dying of septic abortions and/or enduring immense pain, public-shaming and judgemental-abusive attitudes. Unless we are plugging these holes, the situation will not change dramatically because 80 percent of women are unaware on the law to begin with,” she told IPS.

Stigma – a global challenge

Katja Iversen, chief executive officer of Women Deliver — the New York-based global advocacy group — agrees that stigma is a serious obstacle to availing abortion services worldwide.

“Abortion is a basic healthcare need for millions of girls and women, and safe, legal pregnancy termination saves women’s lives every day. Unfortunately, abortion has been stigmatised to keep people from talking about it and to maintain control over women’s bodies, and that silence leads to political pushback and dangerous myths,” Iversen told IPS.

The study by MASUM also found some of these myths and unfounded beliefs which existed among women across the country. Some of these are:

• The medical termination of a pregnancy is illegal. 
• Abortion is legal only up to 12 weeks.
• Abortion is not allowed for first pregnancy.
• Abortion causes permanent infertility.
• One’s husband’s signature is mandatory for an abortion.

“These beliefs ultimately block the ways of society to view and discuss abortion as a normal health issue and discuss in a transparent manner,” says Pisal.

Safe abortion for a better life

According to Iversen, free and regular access to reproductive health, including abortion care, can lead to overall improved living conditions of women and a more gender-equal world.

“When girls and women have access to reproductive health services, including abortion, they are more likely to stay in school, join and stay in the workforce, become economically independent, and live their full potential. It is a virtuous cycle and benefits individuals, communities, and countries,” she said.

The United Nations Sustainable Development Goal (SDG) 3 to ensure healthy lives and promote the well-being of all also confirms this. Target 3.7 of SDG 3 specifically aims to ensure “universal access to sexual and reproductive health-care services”.

In India, however, achieving this target might need more than a change in the law.

Dr. Ravi Duggal, a senior health consultant based in Mumbai, suggests strengthening the public health system, which he believes will ensure cost regulation and access to services as a matter of right; timely and regular stocking of medicine; and sensitisation of service providers, including doctors and nurses.

Fathima agrees.

“A stronger public health system is a need of the hour. If the staff is non-judgemental, confidential, respecting privacy and (generate) prompt response will go a long way to shift women from seeking abortion care at unqualified facilities to approved facilities.”

But as India extended its three-week COVID-19 lockdown until May 3 with just over 10,000 cases recorded, it’s the poor who have been the hardest hit by the countrywide closures.

This includes women in need of abortions as all hospitals and clinics have closed their free, outdoor, non-coronavirus treatment services.

And in Sangli, Zodpe’s home district, the area has been declared a COVID-19 hotspot. For poor, marginalised women like herself this means a great struggle for survival as they are unable to work and earn a living and also remain unable to access sexual and reproductive health care.

A demonstrator in Buenos Aires wears a T-shirt with the slogan "my body, my rights," one of the slogans of the so-called green tide - the colour adopted by the movement for the legalisation of abortion, which is beginning to spread to other Latin American countries. Credit: Fabiana Frayssinet/IPS

By Tharanga Yakupitiyage
UNITED NATIONS, Jun 3 2019 (IPS)

Abortion has long been a contentious issue across the world, and the debate is only heating up, prompting women to stand up and speak out for their reproductive rights.

In response to increasingly restrictive policies, civil society is taking action to help protect abortion rights.

“The failure of states to guarantee reproductive rights is a clear violation of human rights,” said President and CEO of the Center for Reproductive Rights (CRR) Nancy Northup.

“The centre is committed to using the power of law to ensure that women and girls…are guaranteed access to sexual and reproductive health rights and services,” she added.

Human Rights Watch’s Senior Researcher Margaret Wurth echoed similar sentiments, stating: “No rape survivor should be forced into motherhood without the chance to consider a safe and legal abortion.”

Girls, Not Mothers

Latin American countries have some of the most restrictive abortion laws in the world. For instance, Nicaragua has a complete ban on abortion while Guatemala has an exception only when a girl or woman’s life is at risk.

Though the risk of maternal mortality increases when pregnancies occur in girls younger than 14, still many girls are forced to give birth.

According to CRR, over 2,200 girls between the age of 10 and 14 gave birth in 2018 in Guatemala.

In Nicaragua, eight of 10 sexual violence survivors are girls under 13 and the country has the highest teenage pregnancy rate in Latin America with 28 percent of women giving birth before the age of 18.

Fatima was only 12 years old when she became pregnant after being raped by a man in her community in Guatemala. Though the pregnancy was risky, health care providers never offered her a legal abortion.

After more than a year of abuse by her priest, Lucia became pregnant at the age of 13 in Nicaragua.

Fatima and Lucia are now young women and two of four women who have brought their cases to the United Nations Human Rights Committee with the support of organisations such as CRR and Planned Parenthood Global in order to seek justice and demand access to safe and legal abortion.

“Too many young girls in Latin America, and around the world, have been put in situations that threaten their rights and put their lives at risk because they are not able to access abortion care,” said head of Planned Parenthood Global Leana Wen.

“Forcing young girls to continue a pregnancy no matter their circumstances or wants, is not only cruel, but will have devastating impacts for them, their families, and their communities,” she added.

People around the world have since showed solidarity the four women, posting #NinasNoMadres—they are girls, not mothers.

U.S. regresses

Access to abortion has also become a point of contention in the United States as a total of 27 bans have been enacted across 12 states so far in 2019.

Most recently, Louisiana signed a bill banning abortions once a heartbeat is detectable, known as a “heartbeat bill.”

A foetal heartbeat can occur as early as six weeks into a pregnancy, often before many women know they’re even pregnant. The legislation does not include exceptions for rape or incest.

If the bill becomes law, any doctor who performs an abortion could face imprisonment for one to 10 years and/or a fine ranging from 10,000 to 100,000 dollars. 

Missouri has passed a similar bill with a penalty of up to 15 years in prison and the loss of a doctor’s professional license.

Missouri’s last and only abortion clinic was expected to close on Friday, but a judge granted a restraining order that temporarily allowed the clinic to continue. If the clinic had closed, Missouri would have been the first state in 45 years without access to abortion.

While abortion is still legal at the federal level, such moves threaten safe, accessible and affordable abortion care across the country.

“We are very concerned that several U.S. states have passed laws severely restricting access to safe abortion for women, including by imposing criminal penalties on the women themselves and on abortion service providers,” said UN human rights spokeswoman Ravina Shamdasani.

“We are calling on the United States and all other countries to ensure that women have access to safe abortions. At an absolute minimum, in cases of rape, incest and foetal anomaly, there needs to be safe access to abortions,” she added.

Not only does a complete ban on abortion drive women and girls to seek unsafe “back street” methods of termination, but a study found that women and girls are also more likely to experience short-term anxiety and loss of self-esteem, economic insecurity and poverty, and continued exposure to intimate partner violence.

But there is hope yet.

Organisations such as the American Civil Liberties Union and Lambda Legal have filed lawsuits to help protect abortion rights in the U.S.

And the UN can play a role globally too.

In 2001, a 17-year-old Peruvian girl know only as K.L. was denied an abortion after being diagnosed as having a foetus with anencephaly at 14 weeks.

The refusal had serious mental and physical consequences on her health as she was forced to continue her pregnancy and her baby, once born, only survived four days.

Working with human rights lawyers, K.L. filed a complaint with the UN Human Rights Committee, which concluded that Peru violated international human rights law and its actions constituted “cruel, inhuman, and degrading treatment.”

It was the first time a UN Committee held a country accountable for failing to ensure access to safe, legal abortion.

The committee also ordered financial compensation to K.L, who finally received it a decade later in 2015.

“In seeing justice delivered in K.L.’s case—watching it go from A to Z—we are part of an inspiring historic moment,” said Lilian Sepúlveda who directs CRR’s global legal programme and was one of the attorneys involved in the case.

“We are witnessing the results of advocates’ dedicated perseverance and the power of the UN and other international bodies to ensure our basic human rights to dignity, health, and freedom from ill-treatment,” she added.

Such efforts are more urgent than ever to ensure access to justice as well as safety and health for women and girls.

Credit: Curt Carnemark / World Bank. CC BY-NC-ND 2.0

By Lyndal Rowlands
UNITED NATIONS, Apr 7 2017 (IPS)

When Bimla Chandrasekharan saw that women who gave birth to baby girls were being sent out of the house by their angry husbands and mothers-in-law she realised a basic biology lesson was needed.

“We start educating them on this XY chromosome,” Chandrasekharan who is Founder and Director of Indian women’s rights organisation EKTA told IPS. “(But) we don’t say XY chromosome, we do it with tomatoes and limes. ‘Tomato tomato’ it becomes a girl, ‘tomato lime’ it becomes a boy.”

It is just a start but this lesson helps to show fathers that they in fact determine the sex of their children.

According to the UN Population Fund (UNFPA), there are now 117 million girls who are ‘missing’ worldwide because of sex selective abortion and infanticide.

The problem ballooned in India and China in the 1990s, partly due to increased access to ultrasounds. But according to the UNFPA the problem has also now spread to new regions including Eastern Europe and South-East Asia.

A new UNFPA program to address the problem in Armenia, Azerbaijan, Georgia, Viet Nam, Bangladesh and Nepal will draw on the experiences of both India and China in addressing the problem.

“Son preference is a practice that affects many societies around the world,” Luis Mora, Chief of the UN Population Fund’s Gender, Human Rights & Culture Branch told IPS.

“What we have seen over the last three decades is that the practice that initially was considered a sort of exception in China and India … has moved to other countries.”

Yet while the increase in sex selection has coincided with access to technologies like ultrasound, both Mora and Chandrasekharan agree that banning ultrasounds alone won’t fix the problem.

“In a patriarchal society there is always a preference for a male child,” says Chandrasekharan.

This is why EKTA challenges patriarchy and teaches mothers and fathers why they should want to have daughters just as much as they want sons.

Some of the reasons why sons are preferred over daughters are economic. In India parents have to pay a dowry for daughters. In many countries only sons can inherit property, daughters cannot.

But there are other reasons too.

As Chandrasekharan points out, some mothers fear bringing daughters into a world where they are likely to experience sexual harassment and abuse, a lifetime of unpaid housework, and marriage as young as 12 or 13.

Chandrasekharan, is an active member of a national campaign called Girls Count, which aims to fight sex selection in India, and receives funding from both UNFPA and UN Women.

She says that within Girls Count there are “two streams.”

“One stream of people believe in strict enforcement of the law,” says Chandrasekharan, “The other stream is challenging patriarchy, I belong to that stream,” She adds that she also believes in the law, but doesn’t think that laws alone work.

As Chandrasekharan points out India’s Preconception and Prenatal Diagnostic Technique Act was introduced in 1994, banning prenatal scanning and revealing the sex to parents, yet this law has not stopped sex-selective abortions.

Yet Chandrasekharan is also careful to say that challenging patriarchy doesn’t mean that her organisation is anti-men. Patriarchy is a system, she says that has consequences for both men and women, but mostly benefits men.

“We are not against you as an individual we are talking about a system,” she tells the men and boys she works with.

Mora also agrees that it is not possible to end sex selection without addressing gender inequality.

“The evidence we have (of what) what really works is changing social norms and gender norms that under-value girls and at the same time giving opportunities to girls and women.”

This includes giving rights, equal access to education, employment and land, says Mora. “These are the practical things that make a sustainable change.”

This is also why EKTA introduces role models to the community, to show that not all women will spend their lives doing unpaid housework.

EKTA’s most recent role model came from the local community herself. At a young age she met a family member who told her that she had flown to meet them by plane.

Even though the girl came from a marginalised Dalit family, she told her family that she wanted to be the ‘engine driver’ of a plane, since she didn’t yet know the word for pilot.

Last year, says Chandrasekharan, she became a full-fledged pilot and returned to speak to the community as part of EKTA’s role models program.

UNFPA’s new program in the six selected countries is funded by the European Union, however many other UNFPA programs are now in jeopardy, after the United States’ decision to withdraw all of its funding from the agency on Monday.

IPS spoke to Chandrasekharan during the annual UN Commission on the Status of Women.

Excerpt:

“Abortion shouldn’t be a crime” reads a sign held in one of the numerous demonstrations held in Brazil to demand the legalisation of abortion. Credit: Courtesy of Distintas Latitudes

By Mario Osava
RIO DE JANEIRO, Feb 8 2016 (IPS)

The Zika virus epidemic and a rise in the number of cases of microcephaly in newborns have revived the debate on legalising abortion in Brazil. However, the timing is difficult as conservative and religious groups are growing in strength, especially in parliament.

“We are issuing a call to society to hold a rational, generous debate towards a review of the law that criminalises abortion,” lawyer Silvia Pimentel told IPS.

Pimentel, one of the 23 independent experts who oversee compliance with the United Nations Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW), defends the right to abortion in cases of “severe and irreversible birth defects”.

In Brazil, a 1940 law makes abortion illegal with two exceptions: when it is necessary to save the mother’s life or if the pregnancy is the result of rape.

A third exception, in cases of anencephalic fetuses -which have no brain – was legalised in 2012 as the result of a Supreme Court ruling based on the fact that they cannot survive outside the womb.

“This is different – microcephaly is not like anencephaly, in terms of surviving outside the womb; for the anencephalic fetus, the uterus serves as an intensive care unit; many even die before they are born,” said Clair Castilhos, executive secretary of the National Feminist Network for Health and Sexual and Reproductive Rights.

Microcephalic children, who are born with abnormally small heads, often have some degree of mental retardation, but they can survive.

“In these cases, we should discuss a woman’s right to decide whether to continue with the pregnancy, once she and her partner have been informed that their child could be born with serious difficulties,” said Castilhos, a pharmacist and biochemist who specialises in public health.

If the Supreme Court rules in favour of the right to abortion in cases of microcephaly, as women’s rights activists are seeking, “it would be a fourth exception,” she said.

“Although it wouldn’t be what we’re working for, which is the right for all women to decide whether to continue with a pregnancy, in any circumstances, rather than have an abortion as a ‘permissible crime’ in some cases,” she said in an interview with IPS.

But the approval of this “fourth exception” is unlikely.

Those opposed to making abortion legal, led by religious groups, argue that it violates the most basic of human rights, the right to life. They even protested the decriminalisation of abortion in cases of anencephalic fetuses, arguing that life begins at conception.

In their campaign over the social networks, they are now arguing that abortion of microcephalic fetuses amounts to “eugenics” or selective breeding, and compare those who defend the right to abortion in these cases to Nazis.

But Débora Diniz, a researcher at the Anis Bioethics Institute and the University of Brasilia, has argued in interviews and opinion pieces that eugenics occurs when the state intervenes in decision-making in an authoritarian manner, exercising control over women’s pregnancies, and not when the idea is for women to be free to make their own family planning decisions.

The Bom Jardim neighbourhood in Fortaleza, one of the big cities in Northeast Brazil, the region hit hardest by the Zika virus. The lack of sanitation and huge garbage dumps on the banks of rivers and stagnant water in containers everywhere offer ideal breeding grounds for the Aedes aegypti mosquito, which transmits Zika virus, dengue fever and the chikungunya virus. Credit: Mario Osava/IPS

Diniz forms part of a group of legal experts, feminists and other activists who plan to turn to the Supreme Court for a ruling on abortion in the case of microcephaly, in a repeat of the process they followed in the case of anencephaly, which began in 2004 and finally led to a verdict in 2012.

On Feb. 5, U.N. high commissioner for human rights Zeid Ra’ad Al Hussein urged Latin American governments to boost access to “reproductive health services,” including emergency contraception and abortion, given the spread of Zika virus in several countries of the region.

Between October – when the outbreak of microcephaly was identified as possibly linked to the Zika virus – and Jan. 30, there were 404 proven cases of microcephaly in newborns in Brazil. Another 3,670 cases are still being studied.

There have also been 76 infant deaths due to small brain size or central nervous system problems since October, but only five cases were confirmed as Zika-related while 56 are still under investigation.

Seventeen children were born with brain malformations proven to be linked to a mother’s infection with the Zika virus during pregnancy.

Zika virus, like dengue fever and the chikungunya virus, are spread by the bite of an infected Aedes aegypti mosquito.

The main symptoms of Zika virus disease are a low fever, an itchy skin rash, joint pain, and red, inflamed eyes. The symptoms, which are generally mild, last from three to seven days, and most people don’t even know they have had the disease, which makes it difficult to assess the actual number of cases.

The government does not even have estimates of the number of victims of the epidemic, and only recently gave instructions for mandatory reporting of the disease.

There were 1,649,008 cases of dengue registered by the Health Ministry in 2015, with 863 deaths, 82.5 percent more than in 2014. This virus is more widespread and more lethal, but it does not seem to have caused such alarm among Brazilians as Zika virus.

Microcephaly, which is only a threat in the case of pregnant women, has had a much bigger public impact.

Its link to Zika was established by Brazilian researchers.

The World Health Organisation (WHO) said a causal relationship between the virus and microcephaly has not yet been fully established.

Nevertheless, on Feb. 1 it declared the Zika virus and its suspected link to birth defects an international public health emergency.

In Brazil, only when unborn babies began to be affected was a decision reached to combat the spread of the Aedes aegypti mosquito. In late January, the government launched a campaign that mobilised 220,000 military troops and thousands of health ministry and other public employees, as well as the public at large.

Brazil will have “a generation of people who have been impaired” if the mosquito is not eliminated, said Health Minister Marcelo Castro, who has been criticised for making contradictory statements about the epidemic.

But a leading national voice on bioethics, Volnei Garrafa, complained to IPS that the government wants to hold society responsible for fighing the Aedes aegypti mosquito, without assuming its own responsibility for the lack of adequate sanitation and the “garbage and stagnant water everywhere,” which generate perfect breeding grounds for the mosquito.

He said that in the renewed debate on the right to abortion, it would be important to have a bioethics council, such as the ones that operate in Europe and in a few countries of Latin America, where abortion remains illegal except in Cuba, Uruguay and Mexico City, or under extremely limited circumstances (fetal malformation, rape, risk to the mother’s life) in most other countries.

Garrafa said that with the current composition of the national Congress, where evangelical and Catholic groups have a strong influence, the approval of measures moving – even gradually – in the direction of the legalisation of abortion is nearly impossible.

“Congress is no longer ‘national’, it is an inquisition tribunal, where religious beliefs prevail,” said Castilhos.

Proposals in parliament, rather than being aimed at easing abortion law, seek to restrict the right to legal abortion in cases of rape, creating humiliating requirements for the victims that make it practically impossible for them to obtain an abortion.

“The Supreme Court has been forced to fill the legislative vacuum, at the risk of eroding democracy through the mixing up of the branches of the state, with the judiciary legislating instead of parliament,” said Garrafa.

In the past few decades, the Supreme Court has handed down rulings on complex issues such as biosafety and stem cell research, where experts in jointly evaluating biological and ethical questions would help overcome or mitigate controversies, said Garrafa, the founder of several Brazilian and Latin American bioethics institutions.

In the current political context, the Supreme Court represents the hope for progress on sexual and reproductive rights, Pimentel, Castilhos and Garrafa all told IPS.

Against this backdrop, the outbreak of microcephaly is traumatic, but it also represents an opportunity for debate on abortion and the need for universal access to sanitation, they added.

Edited by Estrella Gutiérrez/Translated by Stephanie Wildes

She is just 14, but Janida avoids eye contact with others, preferring to look down at the ground and nodding her head if someone tries to engage her in conversation.

Janida (not her real name) was once a sociable and playful child, but that was before she was sexually abused by her stepfather and giving birth to a baby who is now four months old.

Her days marked by trauma and depression, Janida is just one of many girl children in Kenya who have been abused and robbed of their childhood, leaving them emotionally scarred.

“The little girl [Janida] underwent both physical and mental torture,” Teresa Omondi, Deputy Executive Director and Head of Programmes at the Federation of Women Lawyers (FIDA) Kenya, told IPS. ”Her best option was to terminate the pregnancy rather than suffer the mental and physical torture, but she could not afford the cost of a safe abortion.”Many of the induced abortions taking place continue to be unsafe and complications are common” – Teresa Omondi, Federation of Women Lawyers (FIDA) Kenya

Under Article 26 (4) of the Kenyan constitution, “abortion is not permitted unless, in the opinion of a trained health professional, there is need for emergency treatment, or the life or health of the mother is in danger, or if permitted by any other written law.”

In September 2010, Kenya’s Ministry of Health released national guidelines on the medical management of rape or sexual violence – guidelines that allow for termination of pregnancy as an option in the case of conception, but require psychiatric evaluation and recommendation.

Then, in September 2012, the health ministry released standards and guidelines on the prevention and management of unsafe abortions to the extent allowed by Kenyan law, only to withdraw them three months later under unclear circumstances.

According to Omondi, “the law has not yet been fully put into operation and many providers have not been trained to provide safe abortion, meaning many of the induced abortions taking place continue to be unsafe and complications are common.”

The health ministry is responsible for doctors and nurses not being permitted to be trained on providing safe abortion, said Omondi, so “it is ridiculous that while Kenya’s Ministry of Health accepts that post-abortion care is a public health issue regarding numbers, practitioners have their hands tied.”

The issue of unsafe abortions in Kenya hit the headlines in September last year, when Jackson Namunya Tali, a 41-year-old nurse, was sentenced to death by the high court in Nairobi for murder, after the death of both Christine Atieno and her unborn baby in a botched illegal abortion.

Various inter-African meetings attended by Kenya have been held on reducing maternal mortality rates by providing safe abortions, with health ministers agreeing that statistics show that countries that do provide safe abortions have reduced their maternal mortality rates.

In a recent analysis, Saoyo Tabitha Griffith, Reproductive Health Rights Officer at FIDA and an advocate at the High Court of Kenya, said that despite Kenya having adopted a Constitution that affirms among others, women’s rights to reproductive health and access to safe abortion, Kenyan women continue to die from unsafe abortion – a preventable cause of maternal mortality.

For Dr Ong’ech John, a health specialist in Nairobi, perforated uteruses and intestines, heart and kidney failures, anaemia requiring blood transfusion as well as renal problems are just a few of the health complications arising from an abortion that goes wrong.

“Unsafe abortion complications are not just about removal of the products of conception that were not completely removed. One can evacuate but the perforated uterus has to be repaired, or you remove the uterus and it is rotten,” Dr Ong’ech told IPS.

“When the health ministry issued a directive in February this year instructing all health workers, whether from public, private or faith-based organisations, not to participate in any training on safe abortion practices and the use of the medication abortion, many questions were left unanswered,” said Omondi.

A highly respected Kenyan doctor, Dr John Nyamu, spent one year in prison in 2004 after his clinic was raided following the discovery of 15 foetuses on major roads together with planted documents from a hospital he had worked for but had since closed.

Speaking of his ordeal with Mary Fjerstand, a senior clinical advisor at Ipas, a global non-governmental organisation dedicated to ending preventable deaths and disabilities from unsafe abortion, Nyamu said that the publicity surrounding his imprisonment helped people to “realise the magnitude and consequences of unsafe abortion in Kenya; women were dying in great numbers. Before that, abortion was never spoken of in public.”

He went on to say that Kenya wants to achieve the Millennium Development Goal of a 75 percent reduction in maternal mortality, but that “it can’t be achieved if safe abortion is not available.”

A May 2014 World Health Organisation (WHO) updated fact sheet indicates that every day, approximately 800 women die worldwide from preventable causes related to pregnancy and childbirth, with 99 percent of all maternal deaths occurring in developing countries.

Edited by Phil Harris   

One of her defence lawyers hugs Carmelina Pérez when an appeals court in eastern El Salvador declares her innocent of homicide, on Apr. 23. She had been sentenced to 30 years in prison in June 2014 after suffering a miscarriage. In El Salvador women, especially the poor, suffer from the penalisation of abortion under any circumstances. Credit: Edgardo Ayala/IPS

By Edgardo Ayala
SAN SALVADOR, Apr 30 2015 (IPS)

International and local human rights groups are carrying out an intense global campaign to get El Salvador to modify its draconian law that criminalises abortion and provides for prison terms for women.

Doctors, fearing prosecution, often report poor women who end up in the public hospitals with complications from miscarriages, some of whom are sent to jail for supposedly undergoing illegal abortions.

There are currently 15 women in prison who were sentenced for alleged abortions after reported miscarriages. At least 129 women were prosecuted for abortions between 2000 and 2011, according to local organisations.

The campaign by Amnesty International and local human rights groups collected 300,000 signatures on a petition demanding a modification of El Salvador’s total ban on abortion.

This Central American country of 6.3 million people is one of the few nations in the world to ban abortion under any circumstances and penalise it with heavy jail terms.

The campaign was launched when a woman was freed by an appeals court. She had been found guilty of homicide and spent 15 months in prison.

Carmelina Pérez wept tears of joy when a judge declared her innocent on Apr. 23, after a hearing in a court in the eastern city of La Unión, the capital of the department of the same name.

“I’m happy, because I will be back with my son and with my family, free,” a still-handcuffed Pérez told IPS. She has a three-year-old son in her native Honduras.

Pérez, 21, was working as a domestic employee in the town of Concepción de Oriente, in La Unión, when she suffered a miscarriage. She ended up sentenced in June 2014 to 30 years in prison for homicide – a sentence that was overturned on appeal.

Of the 17 women imprisoned in similar cases since 1998, 15 are still in prison.

That was the year the legislature modified the penal code to make abortion illegal under all circumstances, even when the mother’s life is at risk, the fetus is deformed or unviable, or the pregnancy is the result of incest or rape.

Article 1 of the Salvadoran constitution was amended in January 1999 to protect the right to life from the moment of conception, making it even more difficult to reform the ban on abortion.

Carmen Guadalupe Vásquez, 25, was another one of the 17 women imprisoned, who are referred to by rights groups as “Las 17”. She had been sentenced to 25 years after being raped and suffering a miscarriage. She spent seven years in prison but was pardoned by the legislature in January 2015, after the Supreme Court recognised prosecutorial errors in her trial.

And in November 2014, 47-year-old Mirna Ramírez was released after serving out her 12-year sentence.

At least five other women have been accused and are in prison awaiting final sentencing.

Most of these women sought medical care in public hospitals after suffering miscarriages or stillbirths, but were reported by hospital staff fearful of being accused of practicing abortions. Many were handcuffed to the hospital bed and sent to prison directly, under police custody.

“The total ban on abortion is a violation of the human rights of girls and women in El Salvador, such as the rights to health, life and justice,” Amnesty International Americas director Erika Guevara said at an Apr. 22 forum in San Salvador.

Guevara added that El Salvador’s law on abortion “criminalises the country’s poorest women.”

Although there are no recent figures, a 2013 study carried out by the Agrupación Ciudadana por la Despenalización del Aborto (Citizens’ Coalition for the Decriminalisation of Abortion) found that 129 women were accused of abortion between 2000 and 2011.

Of this total, 49 were convicted – 23 for abortion and 26 for homicide in different degrees. In these cases, the prosecutor’s office argued that the fetuses were born alive and the mother was responsible for their death.

Of the 129 women accused, seven percent were illiterate, 40 percent had only a primary school education, 11.6 percent had a high school education and just 4.6 had made it to the university. And 51.1 percent of the accused had no income while 31.7 had small incomes.

In El Salvador, it is no secret that middle- and upper-class women have access to safe abortions in private clinics, and are neither reported by the doctors nor arrested and charged.

In its petition to modify the ban, Amnesty International demanded that El Salvador ensure access to safe and legal abortion in cases of rape or incest, where the woman’s health or life is at risk, and where the fetus is malformed or unlikely to survive.

Only the Vatican, Haiti, Nicaragua, Honduras, Surinam and Chile have total bans on abortion, although in Chile the legislature is studying a bill that would legalise therapeutic abortion (under the previously listed circumstances).

Delegates from Amnesty International, the Agrupación Ciudadana, and the Center for Reproductive Rights met on Apr. 22 with representatives of President Salvador Sánchez Cerén of the left-wing Farabundo Marti National Liberation Front, to demand a reform of the law and deliver the 300,000 signatures.

They also met with the presidents of the legislature and judiciary.

“There is at least a willingness to talk, we see a certain openness,” activist Paula Ávila with the Center for Reproductive Rights, an international organisation based in the United States, told IPS.

Ávila added that as women who have suffered these cases increasingly speak out and tell their stories, the state will have to accept the need to sit down and talk.

The Center, along with the Agrupación Ciudadana and the Feminist Collective for Local Development, demanded a response from the Salvadoran state to a communication sent on Apr. 20 by the Inter-American Human Rights Commission (IACHR) urging the state to recognise its responsibility in the death of “Manuela”.

Manuela – who never allowed her real name to be revealed – had a stillbirth, was erroneously accused of having an abortion, and was sentenced to 30 years in prison.

It was later discovered that she had lymphatic cancer, a disease that can cause miscarriages. She died in prison in 2010 without being treated for her cancer.

The IACHR has accepted the case and has given the Salvadoran state three months to respond with regard to its responsibility for her death.

The debate on the flexibilisation of the total ban on abortion is marked by the “machismo” of Salvadoran society and moralistic and religious overtones, with heavy pressure from Catholic Church leaders and evangelical churches that stands in the way of political changes.

But the release of Carmelina Pérez in La Unión has given rise to hope in similar cases.

For the first time, an appeals court judge dismissed the statement of the gynecologist who testified against the defendant. That decision was key in overturning her conviction.

Edited by Estrella Gutiérrez/Translated by Stephanie Wildes

Audible gasps echoed through the United Nations’ Trusteeship Council chamber on Tuesday, with audiences told the grim impacts of unsafe reproductive practices on women worldwide.

Hosted by the High-Level Task Force for the International Conference on Population and Development as part of the mammoth Commission on the Status of Women programme, the presentation on sexual and reproductive health described the stark reality for women who lack access to safe abortion or birthing procedures.

“There are 20 million women and girls who undergo unsafe abortion every year,” said Dr. Angela Diaz, Professor of Pediatrics and Preventative Medicine, and Director of the Adolescent Health Center at Mount Sinai Hospital.

To gasps from the packed chamber, she detailed the extreme measures women have gone to when safe abortion is not available.

“Inserting coathangers, sticks, bicycle spokes, knitting needles; ingesting toxic substances like laundry detergent or turpentine, or strong prescription drugs intended to treat diseases like malaria; throwing themselves down stairs or off roofs to induce trauma that leads to abortion; all because they have no access to safe legal options,” Diaz said.

“Unsafe abortion is one of the leading causes of death around the globe… every year 47,000 women and girls die from complications from unsafe procedures.”

Diaz also claimed 25 per cent of adolescent girls who check in to Mount Sinai have a history of childhood sexual abuse.

The panel of scholars, social workers and medical professionals emphasised the damaging effects of gender inequality and intrusion on women’s rights worldwide. Manre Chirtau, a young activist fighting for sexual health services in Nigeria and internationally, said there are 13 million births to girls between the ages of 15 and 19 each year.

Barbara Young, National Organiser at the National Domestic Workers Alliance, claimed only 27 per cent of work visas given to migrant workers are held by women, making migrant women wholly dependant on their husbands’ income for survival.

“When they have no visa, it entraps them in abusive and exploitative situations, with little or no legal recourse, a lack of knowledge of their rights, language barriers,” Young said.

“Sexual and reproductive rights violations can happen as soon as they leave home… the fear of deportation compels them to stay with their abusers.”

While the panellists’ shocking statistics were met with disbelief and anger from the audience, closing speaker Dr. Gita Sen spelt out hope for the future, and how closing the gender gap could bring about a brighter future.

Adjunct Professor of Global Health and Population at Harvard University, and General Co-Ordinator of DAWN (Development Alternatives with Women for a New Era), Sen said eliminating intimate partner violence would bring a US$4.4 trillion benefit to the globe.

“Closing the gender gap in labor force participants would raise global GDP [gross domestic product] by 12%… universal access to sexual and reproductive services would return US$120 for each $1 spent. That would yield US$400billion in annual benefits.”

Follow Josh Butler on Twitter @JoshButler 

Edited by Roger Hamilton-Martin

Survivors at a workshop in Pader, northern Uganda. Thousands of women were raped during Uganda’s civil war but there have been few government efforts to assist them. Credit: Rosebell Kagumire/IPS

By Carey L. Biron
WASHINGTON, Dec 10 2014 (IPS)

Nearly two dozen health, advocacy and faith groups are calling on President Barack Obama to take executive action clarifying that U.S. assistance can be used to fund abortion services for women and girls raped in the context of war and conflict.

The groups gathered Tuesday outside of the White House to draw attention to what they say is an ongoing misreading by politicians as well as humanitarian groups of four-decade-old legislation. That law, known as the Helms Amendment, specifies women’s health services that can be supported by U.S. overseas funding."We want to prevent these acts but also, when that violence does occur, to make sure that organisations and government agencies are providing the necessary post-rape care, including legal and social services, as well as mental and physical health services. Abortion services need to be part of that package.” -- Serra Sippel

This mis-interpretation, advocates warn, results in ongoing mental suffering, social disgrace and even additional abuse for women who have been raped.

“For over 40 years, the Helms Amendment has been applied as a complete ban on abortion care in U.S.-funded global health programmes – with no exceptions,” Purnima Mane, the president of Pathfinder International, a group that works on global sexual health issues, said in comments sent to IPS.

“The result is that Pathfinder and other U.S. government-funded agencies are unable to provide critical abortion care services to those at risk even under circumstances upheld by U.S. law and clearly allowable under the Helms Amendment. With the stroke of a pen, President Obama can change the outcome for many of these women and start to reverse more than four decades of neglect of their basic human rights and harm to their health.”

Advocates say such an executive action would be in line with both the law and broader public opinion. Indeed, on the face of it, the Helms Amendment seems to be quite clear.

The amendment bans U.S. funding from being used to “pay for the performance of abortion as a method of family planning” or to “motivate or coerce any person to practice abortions.” While the law does not specifically bar U.S. assistance being used for abortion services in the case of rape, critics have long noted that this has been the impact since the start.

“No U.S. administration has ever implemented this correctly, in terms of making exemptions in certain instances,” Serra Sippel, the president of the Center for Health and Gender Equity (CHANGE) and a key organiser of Tuesday’s demonstration, told IPS.

“This comes down to politics and the political environment in Washington. But what we need is for the president to take leadership and direct USAID” – the federal government’s main foreign assistance agency – “and the State Department to say the U.S. government is taking a stand and supporting access to abortion in these cases.”

Misinterpretation, self-censorship

Abortion has been, and remains, one of the most divisive issues in U.S. politics. By many metrics, this polarisation has only worsened with time.

This came to the cultural and political forefront in 1973, when the U.S. Supreme Court ruled in a landmark decision that a state law banning abortion (except to save the mother’s life) was unconstitutional. The ruling resulted in a lasting moral outrage among broad sections of the U.S. public, though polls suggest that a majority of those in the United States support services following rape, incest or when a mother’s life is at risk.

The Helms Amendment was among the first legislative responses to the court’s ruling, passed just months later. Since then, the amendment has resulted in a discontinuation of U.S. assistance for all abortion services in other countries.

It is important to note that these procedures remain legal in the United States, as well as in many of the countries in which U.S.-funded entities, including government departments, are operating. Humanitarian groups often feel they cannot even make abortion-related information available to women, including those raped during conflict – even if the Helms Amendment doesn’t specifically proscribe doing so.

“These restrictions, collectively, have resulted in a perception that U.S. foreign policy on abortion is more onerous than the actual law … [leading to] a pervasive atmosphere of confusion, misunderstanding and inhibition around other abortion-related activities beyond direct services,” analysis published last year by the Guttmacher Institute, a sexual health-focused think tank here, reports.

“Wittingly or unwittingly, both NGOs and U.S. officials have been transgressors and victims alike in the misinterpretation and misapplication of U.S. anti-abortion law … whether through misinterpretation or self-censorship, NGOs are needlessly refraining from providing abortion counseling or referrals.”

Global statistics on conflict-time rapes and resulting pregnancies are hard to come by. Human Rights Watch points to 2004 research carried out in Liberia, where rape was used as a weapon of war, suggesting that around 15 percent of wartime rapes led to pregnancy.

“Human rights practitioners and public health officials from Bosnia, the Democratic Republic of Congo, Colombia, and other countries at war, have collected evidence from conflict rape survivors showing both that pregnancy happens and that it has devastating consequences for women and girls,” Liesl Gerntholtz, the executive director of a Human Rights Watch’s women’s rights division, wrote Tuesday.

“They are left to continue unwanted pregnancies and bear children they often cannot care for and who are daily reminders of the brutal attacks they suffered. This, in turn, makes these children more vulnerable to stigmatization, abuse, and abandonment.”

Global acknowledgment

On Tuesday, the groups participating in the White House demonstration also called on President Obama to clarify that the Helms Amendment does not apply to pregnancies resulting from incest or if the mother’s life is at risk. Yet the focus of the calls remains on rape in the context of war and conflict.

Advocates say public consciousness on this issue has risen significantly over the past year and a half. To a great extent, this has been driven by the conflict in Syria and the rise of the Islamic State, as well as the ongoing violence in the Democratic Republic of the Congo (DRC), and the centrality of sexual violence in each of these.

“We know that rape has been used as a weapon of war throughout history. What’s new is the attention from governments and advocates over the past 18 months,” CHANGE’s Sippel says.

“The prevention of violence cannot stand alone. We want to prevent these acts but also, when that violence does occur, to make sure that organisations and government agencies are providing the necessary post-rape care, including legal and social services, as well as mental and physical health services. Abortion services need to be part of that package.”

The United States has been a strong global advocate against sexual violence in recent years, including with regard to conflict situations. President Obama has created the first U.S. action plan on women’s role in peace-building, a White House strategy on gender-based violence, among other actions.

Advocates say that clarifying the Helms Amendment would be the next logical step. Although the White House was unable to comment for this story, organisers of Tuesday’s rally say President Obama’s aides did meet with advocates working on sexual violence in Colombia, the DRC and elsewhere.

Edited by Kitty Stapp

The writer can be reached at cbiron@ips.org

Contraceptives on sale at a store in Sanaa, Yemen. Credit: Rebecca Murray/IPS

By Joseph Chamie
NEW YORK, Oct 1 2014 (IPS)

For most of human history, reproductive rights essentially meant men and women accepting the number, timing and spacing of their children, as well as possible childlessness. All this changed radically in the second half of the 20th century with the introduction of new medical technologies aimed at both preventing and assisting human reproduction.

Those technologies ushered in historic changes in reproductive rights and behaviour that continue to reverberate around the world, giving rise to increasingly complex theological, ethical and legal concerns that need to be addressed.New reproductive technologies have given rise to serious theological, ethical and legal concerns that have not been satisfactorily addressed.

Up until around the middle of the past century, reproductive rights were limited. The available birth control methods were rhythm, coitus interruptus (withdrawal), condoms and for some, the diaphragm.

Those methods in too many instances were unreliable and not considered user friendly. Also, while induced abortion has been practiced for ages, it was a drastic, dangerous and largely unlawful medical procedure.

In 1960, the oral contraceptive pill was introduced, dramatically transforming women’s reproductive rights and behaviour. In addition to the pill, modern methods of family planning, including the intra uterine device (IUD), injectables, implants, emergency contraceptive pills and sterilisation, have given women and men effective control over procreation.

Modern contraceptives have contributed to major changes in sexual behaviour and marriage. Women empowered with modern contraception can choose without the fear of pregnancy whether to have sexual relationships, enabling them to postpone childbearing or avoid it altogether.

And instead of marriage, cohabitation has become increasingly prevalent among many young couples, especially in industrialised countries.

The use of modern contraceptives also facilitated a rapid decline in family size worldwide. Between 1950 and the close of the 20th century, the world’s total fertility rate fell from five children per woman to nearly half that level.

Every major region of the world experienced fertility declines during that half century, with the greatest occurring in Asia and Latin America and the smallest in Africa.

With improved medical techniques, changing social norms and grassroots movements, induced abortion also became increasingly legalised globally. Although some remain strongly opposed to induced abortion, nearly all industrialised countries have passed laws ensuring a woman’s right to abortion.

Also at the 1994 International Conference on Population and Development (ICPD), 179 governments indicated their commitment to prevent unsafe abortion and in circumstances where abortion is not against the law, such abortion should be made safe.

Reproductive rights to terminate a pregnancy, however, have also led to excess female fetus abortions. Particularly widespread in China and India, their sex ratios at birth of 117 and 111 boys per 100 girls are blatantly higher than the typical sex ratio at birth of around 106.

Consequently, the numbers of young “surplus males” unable to find brides are more than 35 million in China and 25 million in India.

The introduction in 1970 of in vitro fertilisation (IVF) – fertilisation in a laboratory by mixing sperm with eggs surgically removed from an ovary followed by uterine implantation – radically altered the basic evolutionary process of human reproduction.

IVF provides childless couples the right and means to have biological children. It is estimated that more than five million IVF babies have followed since the birth of the first “test-tube baby” in 1978.

However, IVF has also raised ethical concerns. In addition to creating a pregnancy through “artificial” means, IVF has become a massive commercial industry prone to serious abuses and exploitation of vulnerable couples in the desire to make profits from childbearing.

IVF also permits gestational surrogacy, which extends reproductive rights to same-sex couples. In contrast to traditional surrogacy, where the surrogate is the actual mother, gestational surrogacy allows the surrogate to be unrelated to the baby with the egg coming from the intended mother or donor.

While those who are childless have a right to have biological children, gestational surrogacy raises challenging ethical questions, such as the exploitation of poor women, as well as complex legal issues, especially when transactions cross international borders.

In 1997, the cloning – or propagation by self-replication rather than through sexual reproduction – of the first mammal, Dolly the sheep, was achieved. The birth of Dolly was a major reproductive development.

Following the cloning of Dolly, scores of other animals, including fish, mice, cows, horses, dogs and monkeys, have been successfully cloned. These developments suggest that in the near future some humans may wish to assert their reproductive rights to be cloned, again raising serious theological, ethical and legal questions.

Among the transhumanist reproductive technologies imagined in the more distant future, one that stands out is ectogenesis, or the development of a fetus outside the human womb in an artificial uterus.

While ectogenesis may expand the extent of fetal viability, free women from childbearing and expand reproductive rights, it poses serious, unexplored medical, ethical and legal issues.

During the past half-century remarkable technological progress has been made in human reproduction. As a result of this medical progress, women and men have acquired wide-ranging reproductive rights and technologies to determine the number, timing and spacing of their children and to overcome childlessness with biological offspring.

The new reproductive technologies, however, have also given rise to serious theological, ethical and legal concerns that have not been satisfactorily addressed. Anticipated future medical breakthroughs in human reproduction make it even more imperative for the international community of nations to address the growing challenges and concerns regarding reproductive technologies and rights.

Edited by Kitty Stapp

Excerpt:

Alicia is one of the millions of Chilean women who have had an illegal, unsafe abortion because in their country terminating a pregnancy is punishable with up to five years in prison, regardless of the circumstances. Now the country is moving towards legalising therapeutic abortion. Credit: Marianela Jarroud/IPS

By Marianela Jarroud
SANTIAGO, Sep 24 2014 (IPS)

Chile, one of the most conservative countries in Latin America, is getting ready for an unprecedented debate on the legalisation of therapeutic abortion, which is expected to be approved this year.

In Chile, more than 300,000 illegal abortions are practiced annually – a scourge that is both cause and effect of many other social problems.

“Abortion in Chile is like the drug trade – surrounded by illegality and precariousness,” 27-year-old Alicia, who had an abortion five years ago, told IPS.

“A friend told me about a gynecologist, I went to see him and he told me the date, time and place to meet him,” Alicia said. “My mom came with me. A van picked me up on a random street corner in the city and I had no idea where we were going. I still remember my mother’s face, the anxiety of not knowing if I would come back, and in what condition.

“In a house a doctor and a woman, I don’t know if she was a midwife or a nurse, were waiting for me. They doped me up. When I woke up it was done. They put me in the van and took me back to my mother. We never talked about it again,” she said sadly.

The legalisation of abortion is one of the Chilean state’s big debts to women, Carolina Carrera, the president of Corporación Humanas, told IPS.

“Chile’s highly punitive legislation is a violation of the human rights of women because this level of penalisation means that women who abort do so in unsafe conditions, with physical and psychological risks,” she added.

In addition, smuggling has increased of Misoprostol, also known as RU486 or medication abortion. The medicine is sold at exorbitantly high prices, without clear medical indications, she added.

Claudia, 24, had to go to a house on one of the hills in the port city of Valparaíso, 140 km northwest of Santiago, to buy the drug to interrupt an unwanted pregnancy.

“It was a dangerous place,” she said. “I had to pay more than 600 dollars. I looked around and thought: and if something happens to me, who do I call? An ambulance, the police? No, I’d be put in prison!”

In Latin America, where the Catholic Church still has an enormous influence, abortion is illegal everywhere except Cuba, Uruguay and Mexico City. However, most countries allow therapeutic abortion in circumstances suggested by the United Nations: rape, risk to the mother’s life, or severe birth defects.

Chile is one of only seven countries in the world that ban abortion under any circumstance. Four others are in Latin America – the Dominican Republic, El Salvador, Honduras and Nicaragua – and two are in Europe – Malta and the Vatican.

Therapeutic abortion was legal in Chile from 1931 to 1989, when it was banned by the government of late dictator General Augusto Pinochet (1973-1990). None of the democratic administrations that have governed the country since then have touched the issue until now.

Since then, women who undergo an abortion have faced a possible prison sentence of up to five years.

“The frequency of abortion has remained steady in the last 10 years in Chile,” Dr. Ramiro Molina with the Centre on Reproductive Medicine and Integral Development of the Adolescent at the University of Chile told IPS. “The number of cases has not gone down, nor have there been major changes in the ages: the highest rates of abortion are still found among women between the ages of 25 and 34.”

He said there are only records of some 33,500 women a year who are treated for abortion-related complications – a figure he described as “very misleading” because it only takes into account those who go to a public health centre for emergency treatment.

Molina explained that the real total is estimated by multiplying that number by 10, which would indicate that 335,000 women a year undergo illegal abortions in Chile.

In the Latin American countries with the strictest legislation, abortions are practiced in conditions that pose a high risk to women, making it a public health problem as well as a reflection of inequality.

“Abortion is a socioeconomic indicator of poverty,” Molina said.

According to the World Health Organisation, an estimated 21.6 million unsafe abortions took place worldwide in 2008. The estimated annual total in Latin America is 4.4 million, 95 percent of which are clandestine. And 12 percent of maternal deaths in the region are the result of unsafe abortion.

Molina, one of the region’s leading experts in his field, said that while progress has been made in the last two decades, it has been very slow because “a religious-based philosophical vision” continues to prevail and stands in the way of further advances.

In Chile, the government of socialist President Michelle Bachelet, in office since March, is preparing to launch a debate on the legalisation of therapeutic abortion in case of rape, risk to the mother’s life, or severe birth defects.

She has stated on several occasions that abortion will be decriminalised this year in Chile.

During her first term (2006-2010), Bachelet authorised the free distribution of Levonorgestrel, better known as the morning after pill, by government health centres to all girls and women over the age of 14 who requested it. But its actual distribution still depends on the ideology of mayors, who are responsible for public health centres in their jurisdictions.

The morning after pill came too late for Francisco and Daniela. When she enrolled in the university, “we got pregnant,” she told IPS. The couple thought about it long and hard, but they lived with her parents and Francisco only worked part-time.

“I felt like it was cutting her life short, her dreams, her prospects,” said Francisco, who somehow managed to scrape together the 600 dollars for the abortion.

Now, at the age of 35, they have a little girl. But they remember it as a traumatic incident, “because it was clandestine, unsafe and unjust.”

Although the legalisation of therapeutic abortion was one of Bachelet’s campaign pledges, abortion remains a taboo subject in Chile. Many are afraid of the political consequences in this country of 17.8 million people, where more than 65 percent of the population is Catholic.

Edited by Estrella Gutiérrez/Translated by Stephanie Wildes

Polish conservatives protesting against a reading of Golgota Picnic in Warsaw. Credit: Maciej Konieczny/Courtesy of Krytyka Polityczna

By Claudia Ciobanu
WAESAW, Jul 8 2014 (IPS)

A mix of conservative Catholicism and nationalism has become the predominant view in Polish public debate, with some worrying effects.

These were the values around which the opposition to communism led by trade union Solidarity built itself up in the 1980s but, after the fall of communism, opinion makers in the media and politicians continued to depict them as part and parcel of being Polish.

Observers note that the Polish Catholic Church has also grown increasingly conservative since 1989, in apparent contrast to an opening up of the Church worldwide.Conservative Catholicism and nationalism were the values around which the opposition to communism led by trade union Solidarity built itself up in the 1980s but, after the fall of communism, opinion makers in the media and politicians continued to depict them as part and parcel of being Polish.

Last month, the director of a theatre festival in the city of Poznan decided to cancel showings of a play fearing he could not ensure the safety of viewers in the face of threats by conservative and far-right groups. The play – “Golgota Picnic” by Argentinian director Rodrigo Garcia – describes the life of Jesus using striking depictions of contemporary society, including some with a sexual meaning.

Among those asking for play to be cancelled were representatives of Poland’s main opposition party, Law and Justice, the main trade union Solidarity, and the far-right Ruch Narodowy (National Movement), all of which stand for traditional Catholic values. The Church also voiced its opposition to the play.

In itself, protesting against the play was unremarkable (it has also been met with opposition from Catholics in other countries, for example in France), but the Polish response was interesting: even if the festival was largely financed from public sources, the show was cancelled and there was hardly any resistance from public authorities to the decision. The public, however, made itself heard and readings of the play were organised in major Polish cities, with hundreds attending.

Meanwhile, the dynamics surrounding “Golgota Picnic” are being replicated over other issues in Polish society, among which the most striking is women’s reproductive rights. Poland is one of only three countries in the European Union where abortion is prohibited, unless the pregnancy is a result of rape or incest, there is a serious threat to the mother’s health or foetal malformation has been detected.

Abortion had been legal in communist Poland but was outlawed in 1993 after pressure from the Catholic Church. Ever since, attempts to make abortion legal have failed. In 2011, the Polish parliament came close to further tightening the law on abortion by prohibiting it no matter the circumstances.

At the time, it was not only the political forces explicitly standing for Catholic values that endorsed a total ban, but also many members of the governing centre-right Civic Platform, which depicts itself as Poland’s main liberal political force.

De facto, even the current restrictive law is not being implemented. In a series of high profile cases over the years, Catholic doctors in public hospitals have refused to perform abortions even if girls were pregnant as a result of rape, had serious health conditions or malformation had been detected in foetuses.

In May, in an escalation of the situation, over 3,000 Polish doctors, nurses and medical students signed a “Declaration of Faith” in which they rejected abortion, birth control, in vitro fertilisation and euthanasia as contrary to the Catholic faith. Signatories included employees of public clinics and hospitals. One of them was the director of a Warsaw maternity hospital who said he would not allow such procedures to take place in his institution.

The “Declaration of Faith”, which has been endorsed by the Polish Catholic Church, is contrary to Polish law and Prime Minister Donald Tusk has spoken out against it.

State authorities have been carrying out check-ups at those institutions in which signatories of the Declaration work to establish whether the law is being respected, and one fine has been imposed on the Warsaw maternity hospital whose director prohibits legal abortions. Yet more determined measures are still pending.

“Lack of massive resistance [to the Declaration] is not a sign of approval on the part of the general public,” comments Agnieszka Graff, writer and feminist activist. “It is rather a question of resignation: for 20 years we have seen politicians court the Church while ignoring public opinion on matters that have to do with reproductive rights. The pattern of submission has emboldened the radical anti-choice groups.”

Political power in Poland is firmly in the hands of conservatives. Law and Justice, the party with the best chance of winning next year’s parliamentary elections, is staunchly pro-Catholic and nationalist, and has in the past allied in government with far-right politicians. The governing Civic Platform, the choice of many liberals in this country, is bitterly divided between social conservatives and liberals, meaning it cannot enforce the constitutional secularity of the Polish state.

As Graff explains, in this political context, those who oppose the Catholicism-nationalism nexus find it difficult to coalesce into a strong movement. And ultra-conservatives continue to advance.

Far-right elements breeds in this environment and, in an ethnically and racially homogeneous country, their main targets are feminists, the LGBTQ community and leftists (the same groups that the Church condemns). Their strength is most visible in Poland during the annual Independence March on November 11, when tens of thousands of far-right youth take to the streets of Warsaw and other cities wreaking havoc.

According to June polls, the third strongest political force in Poland is the New Right Congress, which has a neo-liberal far-right agenda. The party, whose leader Janusz Korwin-Mikke has declared that women have lower IQs than men and that they enjoy being raped, gathered 7.5 percent of the vote in the May elections for the European Parliament.

“There is no clear demarcation between the Polish extreme right, the populist right and the mainstream right,” notes political scientist Rafal Pankovski of anti-racist group Nigdy Wiecej (Never Again). “The notion of a cordon sanitaire against the far-right does not seem to have been accepted in Polish politics and the media.”

Over recent years, civic mobilisation by progressive forces has nevertheless grown, and political parties with a strong liberal, secular and anti-nationalist message have been forming, but they still lack consolidation. Faced with the constant accusation of being “communists”, leftist forces that might counterbalance the conservative, nationalist and far-right trend are slow to grow in Poland.

A demonstration in support of abortion rights in Dublin. Credit: Irish Family Planning Association.

By Silvia Giannelli
ROME, Apr 5 2014 (IPS)

Two out of three doctors in Italy are ‘conscientious objectors’ to abortion, according to new data. The Italian Ministry of Health reveals that in 2011, 69.3 percent of doctors refused to carry out abortions, with peaks of over 85 percent in some regions.

In the face of such numbers, the ruling of the European Committee of Social Rights of the Council of Europe against Italy earlier this month over a complaint for violating the right to protection of health came as no surprise.“Many doctors object simply because they have nothing to gain from doing this extra work.”

“The Italian situation really worries us, and this is why we filed the complaint,” Irene Donadio, advocacy officer at the International Planned Parenthood Federation European Network (IPPF_EN) told IPS. “We believe that there is a problem with the functioning and application of the abortion law, which, in fact, would be a good law but is often violated.

“We acknowledge the fact that the right to conscientious objection is included in the same law, but the right of women to access a service that is legal and fundamental for their health needs to be respected as much as this right.”

IPPF_EN sees the high number of conscientious objectors in Italy as the main cause behind refusal of women’s right to termination of pregnancy.

IPPF_EN, with the help of several Italian associations, presented to the Committee a scenario of never-ending waiting lists and arbitrary suspensions of the service. It listed many instances where women were forced to travel for abortions within the country or to go abroad.

“According to data from the Ministry of Health, the number of voluntary interruptions of pregnancy per year is around 110,000,” Giuseppe Noia, president of the Italian Association of Catholic Gynaecologists Obstetricians (AIGOC) told IPS.

“If we consider that there are about 1,500 non-objecting physicians, each physician carries out around 74 abortions per year, that is an average of five or six per month. The fact that non-objectors are overloaded and cannot guarantee an efficient system is therefore absolutely false,” Noia said.

In its response to the Council, the Ministry had said that due to a decline in abortions, “the workload for non-objecting doctors was cut by half in the last 30 years” and therefore “it appears difficult…to maintain that the high number of conscientious objectors would be an obstacle for accessing the interruption of pregnancy.”

The ministry’s note does not elaborate on the geographical distribution of objectors across the country. This is what, according to the Council of Europe, creates a disparity in treatment depending on where the woman seeking an abortion resides.

In the southern region of Basilicata, according to official data, 85.2 percent of physicians are conscientious objectors, in Apulia they account for 79.4 percent of the total, and in Sicily 81.7 percent.

“The situation is generally worse in the South, but also Lombardy [in the north bordering Switzerland] has serious problems, and we know that this is because is a not very laic region,” Silvana Agatone, president of  the Free Italian Association of Gynaecologists for the Application of Law 194 (LAIGA) told IPS. Law 194 is the law that regulates abortion in Italy.

The decrease in abortions claimed is subject to different interpretations. The ministry maintains that this is due to “the promotion of a higher and more efficacious recourse to conscious procreation.” But Marilisa D’Amico, a lawyer who was involved in presenting the complaint, says that the increase of cases of spontaneous abortions, or miscarriages, “can only be explained as an increase of clandestine abortions” presented as miscarriages. There were less than 57,000 such abortions in 1990, 68,000 in 2000 and more than 76,000 in 2011, according to ISTAT.

The official figures show a constant increase in the number of miscarriages through recent years.

LAIGA provided a list of 45 hospitals that have a gynaecology unit but do not perform terminations of pregnancy, disregarding Article 9 of the Italian law on abortion. This article states that hospital establishments and authorised nursing homes shall ensure that procedures for the termination of pregnancy are guaranteed.

Clandestine abortions continue to take place, says Massimo Srebot, head of the department of obstetrics and gynaecology at the Lotti Hospital of Pontedera in Tuscany region, the first structure in Italy to introduce RU-486, a pill that blocks the action of the hormone progesterone in order to cause abortion without surgical intervention.

“Women who find obstacles in public hospitals seek alternative channels with physicians who, upon receiving a bribe, are willing to simulate a spontaneous abortion. These are conscientious objectors only when they have to work for free. They turn a blind an eye to their conscience in their private clinics.”

Srebot says “many doctors object simply because they have nothing to gain from doing this extra work.” Also, “carrying out abortions doesn’t help a doctor’s professional career because it is not a high-level specialisation operation.”

Srebot has proposed new solutions to ensure the respect of Law 194. One option would be to nominate a non-objector as a sub-head physician for every public hospital.

“I truly respect the real conscientious objectors, but there are those who speculate on women’s difficult situations, they don’t sustain them, they don’t help them preventing further incidents, they only wait for them to get pregnant again, so they once again cash in.”

Women march against the Dominican Republic's anti-abortion law in 2009. Credit: Elizabeth Eames Roebling/IPS

By Michelle Tullo
WASHINGTON, Mar 26 2014 (IPS)

Lawmakers and civil society leaders from over 30 countries are calling for universal access to safe, legal abortion.

The declaration, released in Washington on Wednesday, comes in the context of a 20-year review by the United Nations of the 1994 International Conference on Population and Development (ICPD) in Cairo. That landmark conference called for safe access to abortions in countries where the procedure was legal, while Wednesday’s declaration calls for the decriminalisation of abortion in all countries.“What we know now is that law changes social attitudes.” -- Nepali MP Arzu Rana Deuba

The declaration also anticipates the post-2015 development agenda. Advocates are calling to expand the discussion on women’s health to include abortion rights when determining the next round of global development goals, following the expiration of the Millenium Development Goals (MDGs).

“True gender equality cannot be achieved without access to safe, legal abortion,” it says. “In the last two decades, roughly 1 million women and girls have died and more than 100 million have suffered injuries – many of them lifelong – due to complications from unsafe abortion.”

One of the MDGs, number five, does aim to reduce by three-quarters the maternal mortality ratio and to achieve universal access to reproductive health. However, it does not include access to safe abortions in its definition of access to reproductive health.

Advocates are now planning to formally offer these recommendations at a 20-year anniversary summit of the original ICPD. That event will take place in Addis Ababa next month.

“Looking ahead to ICPD+20 and the review of the Millennium Development Goals, the one goal they would not take was reproductive and sexual health for all,” Nafis Sadik, the special advisor to the executive director of UNAIDS and the former executive director of the United Nations Population Fund, told IPS.

The new declaration targets not just the international development agenda but also U.S. policymakers.

Four-decade-old legislation here has restricted foreign assistance programmes from funding abortion-related procedures. Critics say the result is a disconnect between the work done by USAID, the country’s main foreign assistance arm, and the women’s health services offered.

“Regarding the problem of U.S. policy – it’s not just the financial support, but the moral leadership,” Sadik says. “It makes a big difference if the U.S. becomes restrictive in areas of support, if they restrict funding for any NGO that provides abortion.”

Cost-effective and feasible

The Airlie Declaration was composed following a two-day conference near Washington. It was written by representatives from over 30 countries, including health ministers, members of parliament, and medical leaders as well as advocates from the United Nations lawmakers and civil society.

“Our goal is to bring this message forward and build a broader coalition,” Elizabeth Maguire, the president of Ipas, an international NGO dedicated to ending preventable deaths and disabilities from unsafe abortions, told IPS. “Every participant is committed to pursuing action.”

Maguire led the recent conference as convenor.

One such participant is John Paul Bagala, president of the Federation of African Medical Students’ Associations. Bagala works in a hospital in northern Uganda that treated 480 women from cases of unsafe abortions in 2011-12 and another 500 in 2012-13.

According to Bagala, providing access to safe abortion is cost-effective. Treating injuries resulting from an illegal abortion in Uganda can cost more than 100 dollars, he says, while the cost of a safe abortion would be less than 10 dollars.

“As a medical student in Africa, we are taking a stand to disseminate the declaration in our respective institutions,” Bagala told IPS.

“To drive [out] stigma from our health workers when they are still in the training system, to ensure that the women, when they come for service, get the best service they need in terms of safety and quality. We are driving towards integrating the aspects of this declaration in terms of reproductive health rights into the curriculum of training health workers in Africa.”

Ipas’s Maguire likewise emphasises that providing universal access to reproductive health care is not just critical but “feasible.” In the case of Nepal, for instance, decriminalising abortion greatly increased women’s health and maternal mortality ratio.

“Nepal is one of the few countries that will be meeting MDG 5, and what the experts say is that it’s increased access to family planning, emergency obstetric care, and increased access to emergency abortion care,” Arzu Rana Deuba, a member of the Nepali Parliament, told IPS.

Deuba recounted the story of a young girl in Nepal who was jailed for 12 years after she was raped and unsuccessfully attempted an illegal abortion. The girl’s story gained international attention, and Nepal eventually decriminalised abortion in 2002.

“It’s a story of hope,” said Deuba. “After 2004, we had 1,500 skilled providers and 75 hospitals doing medical abortion services. As of 2014, 500,000 women have access to safe abortions, and that’s quite a lot for we are not a big country.”

She says Nepal’s success comes not just in the growth of medical services but in the country’s changing cultural attitudes toward abortion.

“What we know now is that law changes social attitudes,” Deuba said.

“I work at the community level and workers tell me there is no more stigma, that abortion is seen as part of women’s rights, that women are more vocal about abortion … it’s seen as part of the continuum of care. Now women don’t have to die anymore and there is a feeling of confidence and security among women.”

A young mother carries her baby out of Ramón González Coro maternity hospital in Havana. Credit: Jorge Luis Baños/IPS

By Ivet González
HAVANA, Sep 6 2013 (IPS)

In nearly all of Latin America, illegal abortion is a serious public health problem. But in Cuba, where abortion is legal, it is being overused by teenagers.

Three times as many teenagers terminate their pregnancies than carry them to term. Many pregnant 15 to 19 year olds have already had one or more abortions according to their medical histories, researchers find.

Having 76 percent of pregnant teenagers electing to abort “is a public health problem,” said Dr. Jorge Peláez, vice president of the Cuban Society of Obstetrics and Gynaecology.

Abortion “apparently avoids one problem, but it creates many others. It will never be the solution to teenage pregnancy,” Peláez told IPS.

The difficulty is the rising rate of underage pregnancy in this Caribbean island nation. In 2006, 45 per 1,000 young women aged 15 to 19 gave birth. By 2012 the rate had leaped to nearly 54 per 1,000. In the region, the average rate is 80 per 1,000.

“I made a mistake with my contraceptive pills. I talked to my mother about it and we decided the best thing to do was to have the baby, although other people recommended having an abortion,” Daniela Izquierdo, who had a child at the age of 16 and has just returned to secondary school, told IPS.

In this country with a very low birth rate, teenagers account for 16 percent of total fertility.

Abortion was decriminalised in Cuba in 1979, although terminations were already being carried out in medical institutions with the authorisation of the health ministry since 1961. As well as being an important victory for women’s rights, safe abortions have reduced the complications and consequences of unsafe backstreet abortions.

Free abortions are available on demand to any woman in hospitals and clinics in Cuba. Health personnel evaluate whether the operation can be carried out in each case. Girls under 16 need the consent of their parents or legal guardians and are provided with special counselling.

Over time, abortions became a means of regulating personal fertility. “This is a problem that is recognised by the authorities, and is extremely complex to solve,” Peláez said.

In July, the United Nations Committee on the Elimination of Discrimination against Women (CEDAW) expressed concern at Cuba’s “high rate of abortion, especially among girls as young as 12 years old,” and urged it to “increase access, as well as use of effective and high quality methods of contraception towards reducing the practice of abortion as a method of family planning.”

A study of 22 pregnant teenagers in the Havana municipality of Diez de Octubre, published this year by the University of Havana, found that eight of them had had one or two previous abortions. Another study this year, in the Havana municipality of Playa, found the same result in nine of the 24 teenagers studied.

It is the pregnant teenager and her family, especially her mother, who deal with the problem and have the last word on continuing or interrupting the unwanted pregnancy. The fathers of the babies, in general, do not feel they have an important participation in decision-making, and do not feel responsible for their partners’ abortions.

This is the finding of an article published last year by doctors Luisa Álvarez and Nelli Salomón in the Revista Cubana de Salud Pública (Cuban Journal of Public Health).

The authors say a gender perspective is needed to prevent early pregnancy and abortion.

“Efforts are being made to reduce the practice (of abortion) and increase contraceptive use, but it is necessary to delve in depth into the views of women and their partners in order to change attitudes, to achieve greater involvement of both members of the couple in their relationship and improve sexual and reproductive health,” they say.

Young women, for their part, are more concerned about social stigma than about the health consequences they may suffer.

Peláez, a specialist in paediatric and adolescent gynaecology, insists that abortion must be seen as a matter as serious as motherhood among teenagers. “We must find more effective ways of raising awareness among families, teachers and young people about the risks,” which remain high even when abortions are “performed by specialists in safe conditions.”

“It can cause infertility, among other risks,” he said. Society, especially the media, must show these dangers, “without demonising” the practice, he said.

Families can play a decisive role by providing guidance on contraceptive use. Although each case is different, the most suitable method for young people is a combination of condoms and hormonal contraceptives, whether pills or injections, Peláez said.

Teenagers and young women account for 40 percent of all unsafe abortions worldwide, according to the United Nations Population Fund (UNFPA).

In Latin America and the Caribbean as a whole, teenage pregnancy is a major problem: 10 percent of young women aged 15 to 19 are mothers. Abortion is only legal in Uruguay, Cuba and Mexico City. Unsafe illegal abortions and poor quality health services are the main causes of death for girls in this age range.

Indigenous women hauling water in Chiapas, Mexico. Credit: Mauricio Ramos/IPS

By Purnima Mane
WASHINGTON, Aug 6 2013 (IPS)

In the last decade, several countries in the Latin America and Caribbean (LAC) region have had the opportunity to experience economic growth and establish redistributive fiscal policies aimed at reducing poverty, reducing inequality and improving the coverage and quality of health, education and social protection services.

And yet significant gaps exist in the area of reproductive health and rights, both between countries and as a whole, when it comes to some of the key objectives of the Cairo Programme of Action.

Let us take one of the basic indicators of reproductive health, the maternal mortality ratio. The decline overall in the region is not enough to guarantee the achievement of the target set for 2015.

The average maternal mortality rate in LAC is 80 maternal deaths per 100,000 live births, according to estimates by WHO, UNFPA, UNICEF and World Bank, 2011. Moreover, there are significant inequities between countries.

For example, the estimated maternal mortality rate in Uruguay was 29 deaths per 100,000 live births in 2010, while it was 120 in Guatemala; Haiti exhibits the highest ratio in the region, with 350 maternal deaths per 100,000 live births.

A significant proportion of maternal deaths are caused by unsafe abortions, which represent a serious public health concern in the region.

In 2008, the annual rate of unsafe abortion estimated for the region was 31 abortions per 1,000 women aged 15-44. In 2008, 12 percent of all maternal deaths in Latin America and the Caribbean (1,100 in total) were due to unsafe abortions, according to the World Health Organisation.

Abortion is only legal in six countries, and together, these countries account for less than five percent of the region’s women aged 15-44. (Guttmacher Institute, 2012).

In addition to the discrepancies noted in regard to maternal mortality and access to safe abortion between countries, there are also intra-country disparities.

For example, while the total fertility rate has reduced considerably, in Bolivia (DHS, 2008), the total fertility rate of women with no education was 6.1 compared to 1.9 for women with higher education, and the urban-rural difference is 2.8 to 4.9, respectively; in Panama, maternal mortality is five times higher among indigenous women.

What is even more tragic is that Latin America and the Caribbean has the second highest rate of adolescent pregnancy in the world, with approximately 70 live births per 1,000 women aged 15-19. On an average, 38 percent of women in the region become pregnant before they reach the age of 20 and nearly 20 percent of live births in the region are by adolescent mothers.

The conclusion is clear: universal access to reproductive health is still far from being a reality in the LAC region.

Looking specifically at the seven components of the programme of action, the LAC countries have achieved much higher rates of contraceptive prevalence than Africa or Asia as a whole.

For example, in 2012, the average contraceptive prevalence rate (CPR) among married women in Africa was only 26 percent and 47 percent in Asia (excluding China); in Latin America and the Caribbean it was as high as 67 percent of married women [Population Reference Bureau].

As I said before, the LAC countries have brought down their collective maternal mortality rate to 80 deaths per 100,000 live births – a striking improvement over the Sub-Saharan African average of 500 per 100,000 live births and the South Asian average of 220 per 100,000 live births (UNICEF, 2010).

However, in other key areas of the Programme such as expression of and protection for sexual and reproductive rights including access to safe abortion, post-abortion care, and expression of gender identity or sexual orientation, the LAC region continues to be challenged.

The reasons for the progress in this region were mentioned earlier – development as a whole, higher rates of education and access to contraception have helped considerably.

Let us not forget however, that the lack of progress in ensuring reproductive rights and access to safe abortion in particular comes from the fact that a large number of LAC countries stated formal reservations to many of the rights components in the Programme of Action, including concern over abortion, a national belief and/or laws asserting a need to protect life from the moment of conception, and concern over alternate expressions of family beyond that of formal marriage between a man and a woman.

In contrast, while several other countries in other regions expressed similar reservations (notably many Islamic and Catholic countries), only one African and one Asian country (Djibouti and Philippines) presented formal reservations to this effect. These reservations have continued to hamper progress in these areas and produced the situation we see today in this region.

Purnima Mane, PhD, is President and Chief Executive Officer of Pathfinder International, a global leader in sexual and reproductive health.

Nearly a quarter century after Chile’s return to democracy, there is still a lack of political will to legalise therapeutic abortion, analysts say, even though Congress is debating several draft laws on the question.

Natalia Flores, executive secretary of the Observatory on Gender Equity, says the legislation currently in place, which bans abortion under all circumstances, restricts the fundamental rights of women.

“In Chile, the fact that abortion is illegal for any reason makes women second-class citizens, because they are not allowed to make decisions about their bodies, which is their basic territory,” she told IPS.

Therapeutic abortion refers to the termination of a pregnancy when the mother’s life is at risk, the foetus is deformed or dead, or the pregnancy is the result of incest or rape.

Chilean women had access to therapeutic abortion for over 50 years, until the 1973-1990 dictatorship of General Augusto Pinochet made it illegal in 1989, just a few months before the transition to democracy.

Several attempts to decriminalise abortion in cases where the mother’s life is at risk or the foetus has severe birth defects have failed in the legislature due to the votes of the right-wing coalition currently governing the country, along with the more conservative sectors in the centre-left Concert of Parties for Democracy.

But the case of a pregnant 11-year-old girl who had been sexually abused for two years by her stepfather triggered an unprecedented debate in Chile, which took on special importance in the midst of the campaign for the Nov. 17 elections.

The plight of 11-year-old Belén and similar cases that have come to light since she became headline news around the world prompted many political leaders and physicians to speak out in favour of making therapeutic abortion legal once again.

“This is a debt of democracy to Chilean women, because many of them have had very painful life stories and experiences, and have been exposed to unsafe abortions,” sociologist Claudia Dides, spokeswoman for Miles Chile (Thousands Chile), the country’s biggest pro-choice umbrella group, told IPS.

Chile is one of the Latin American countries where conservative Catholic sectors hold the greatest sway, and one of the few South American nations presently governed by the right, by the hand of President Sebastián Piñera.

It is also one of a small number of countries in the world where abortion is illegal under any circumstance.

Women or doctors found guilty of inducing an abortion can be sentenced to three to five years in prison.

But activists point out that only poor women actually face that risk, as they cannot afford to pay for a safe abortion in a clandestine clinic but instead undergo back-street abortions, which often lead to them ending up in the emergency room at a public hospital, where they face prosecution.

An average of 160,000 illegal abortions a year are practiced in this country of 17 million people, according to estimates by the National Institute of Statistics.

Flores pointed out that several international bodies like the United Nations Committee on the Elimination of Discrimination against Women (CEDAW) have warned the Chilean state that the law criminalising abortion under all circumstances violates the human rights of women.

“Nevertheless, after more than 20 years of democracy, the state has maintained its stance, and owes a great debt to women,” she said.

Since 1990, more than 20 draft laws have been introduced to modify the law penalising abortion, but none has prospered.

One of the frustrated initiatives was sponsored in 2010 by socialist Senator Fulvio Rossi and the current presidential candidate for the ruling right-wing alliance, Evelyn Matthei.

But Matthei has now spoken out against the decriminalisation of therapeutic abortion.

On the other side of the fence, former president Michelle Bachelet (2006-2010), the centre-left coalition’s presidential candidate, has publicly stated that she will attempt to legalise abortion in cases of rape and risks to the mother’s life if she is elected.

The Senate is currently studying four draft laws that would legalise therapeutic abortion, as well as abortion in cases of rape. Miles Chile, which brings together civil society organisations, health professionals and activists’ networks, is behind two of the bills.

Dides said “there is a political veto of abortion; today it is impossible to imagine a debate on it in parliament.”

She said Miles Chile is only pressing for the legalisation of therapeutic abortion because “there is no chance of obtaining legal abortion even in the case of rape,” due to the conservative composition of Congress.

Dides said 64 percent of respondents in a recent survey were in favour of legal abortion when the mother’s life is at risk, the foetus cannot survive outside the womb, or cases of rape.

But “as with other issues, Chile’s (political leadership) doesn’t even listen to civil society,” she complained.

Flores said surveys show that, despite the socially conservative attitudes that can be found in virtually all of the country’s political parties, the citizens hold much more progressive views.

On Jul. 25, more than 8,000 people – according to the organisers – marched in Santiago to demand “free, safe abortion”.

The only way progress towards the decriminalisation of abortion will be made is if the public continues to come out on the streets en masse, Flores said.

She complained about “hypocrisy” in Chile, where the rape of a young girl causes shock on one hand, while on the other, “there aren’t even integral policies for protecting children.”

Cuba, Mexico City, and most recently Uruguay are the only places in Latin America where abortion is legal. In other countries in the region it is allowed in specific circumstances, such as cases of rape, incest, foetal abnormality, or risk to the mother’s life.

But as in Chile, abortion is illegal under any circumstances in the Dominican Republic, El Salvador, Honduras and Nicaragua.

Official figures indicate that 2,550 legal abortions were performed in Uruguay between December – when the law legalising abortion went into effect – and May. No maternal deaths or health complications occurred as a result of the abortions.

Abortion is the leading cause of maternal mortality in Latin America. Bringing down the maternal mortality rate is one of the Millennium Development Goals adopted by the international community in 2000, with a 2015 deadline.

Dides said Latin American society generally supports therapeutic abortion, while more than 25 percent of the public is in favour of legal abortion on demand.

But in Chile, “the political leaders do not want to tackle the issue,” despite the public’s support for legal abortion, she added.

Brazilian President Dilma Rousseff signed a law guaranteeing treatment – including emergency contraception – for rape victims in public hospitals, in spite of strong opposition from religious conservatives who believe it will lead to the decriminalisation of abortion.

“In future when a victim of abuse goes to a hospital, the staff must follow the protocol,” said Health Minister Alexandre Padilha, announcing the president’s ratification of the law Thursday, which will enter into force in 90 days.

The new Law 3/2013 only introduces regulations for authorised procedures for multi-disciplinary care in the public health system for female victims of sexual violence, without actually modifying the country’s law on abortion.

In Brazil, abortion is only legal in exceptional cases: when the mother’s life is at risk; when the foetus has been confirmed by three doctors to be anencephalic (lacking a large part of its brain and skull); or when the pregnancy is the result of rape.

“The novelty is that the law establishes compulsory care in the health services for all cases of sexual violence,” said Beatriz Galli of the Brazilian chapter of Ipas, an international NGO that works for women’s health and reproductive rights, including safe abortions.

“At present, we know that some referral services for the care of victims of sexual violence are not working properly, especially when it comes to guaranteeing access to abortions in cases of sexual violence provided for by law,” she told IPS.

Galli said moral or religious objections by health professionals to practicing abortions were common.

She said there was even resistance in state public prosecutors’ offices, which sometimes request the seizure of records to make sure that the abortions carried out were within the limits of the law.

But the new federal law “will guarantee that health professionals can do their job with the requisite legal backing, putting an end to attempts to backslide on the reproductive rights of women, teenagers and girls who are victims of sexual violence,” Galli said.

Sociologist Angela Freitas of the Provincial Council on Women’s Rights, meanwhile, responded to conservative critics by saying that the law’s goal was not to legalise abortion but to guarantee the rights of women who suffered sexual violence, many of whom were teenagers.

“What bothers critics is that Brazil has begun to create public health services to provide care in cases of legal abortion, which is a victory for women’s movements,” Freitas, who also represents the Articulaçao de Mulheres Brasileiras (AMB – Brazilian Women’s Network) in the organisation’s Rio de Janeiro regional office, told IPS.

“Violence against women, especially sexual abuse, is on the rise, and this bill is important for guaranteeing victims access to healthcare and medical attention. People who are pro-life ought to support it,” said Galli, who added that one million illegal abortions a year are carried out in Brazil, often in conditions that put the mothers’ lives at risk.

Religious resistance

Thursday was the constitutional deadline for ratifying law 3/2013, which was based on a bill presented in 1999 by Iara Bernardi, who at the time was a congresswoman for Sao Paulo from Rousseff’s left-wing Workers’ Party (PT).

But doubts had arisen as to whether it would be signed into law, due to rising pressure surrounding Pope Francis’ Jul. 22-28 visit to Brazil, even though the bill had been unanimously approved in both chambers of Congress.

Three days before the pope’s arrival, representatives of the Brazilian Catholic bishops’ conference and other religious bodies visited Rousseff at the government palace to ask her to partially veto the law.

They were lobbying for the removal of an article referring to “pregnancy prevention” and another requiring “victims to be informed of their legal rights and all the health services available to them” – that is, the right to abort, or to take emergency contraception pills, in cases of rape.

Emergency contraception, also called the “morning-after pill”, delays ovulation or prevents implantation of a fertilised egg up to 72 hours after sex, but does not terminate an already established pregnancy.

But Catholic Church leaders fear these provisions will allow abortions to occur even when sexual abuse has not been proven – in other words, that women may “invent” reports of rape to obtain legal abortions.

“It is despicable to think a priori that women are dishonest liars,” Freitas complained. “And it also shows a lack of respect for the knowledge of the health professionals who talk to and examine patients.”

Freitas pointed out that legal abortions are not easy to obtain in Brazil. “A multi-disciplinary team made up of doctors, nurses, social workers and psychologists decides how to proceed in each case.”

So, “if a woman was inventing her story, she would be found out. But first she must be listened to and not condemned in advance,” she said.

Freitas highlighted that the new law compels the health services to follow regulations in force since 1999, “confronting the legal obstacles that anti-abortion sectors put in the way of rape victims when they decide to terminate a pregnancy and making it possible to penalise health professionals who fail to comply.”

She pointed out that, although emergency contraception and abortions are legal in certain cases, they are frequently not provided.

“There is a general lack of information and of referral services for this kind of care. Brazil is huge and hospitals with this kind of services only exist in the state capitals and other large cities,” Freitas said.

“There are doctors and hospital directors who refuse to talk about the issue and do not provide the service because of conscientious objections,” she said.

A woman collapses in front of a police barricade during one of the Occupy Gezi protests. Credit: Arzu Geybulla/IPS

By Ariam Frezghi
ISTANBUL, Jul 13 2013 (IPS)

Among the many issues bringing protestors together at Gezi Park, the now-iconic site of struggle in Istanbul’s Taksim Square, is the demand for women’s liberation.

Coming from many walks of life and expressing a myriad of ideals and values, the women of the Occupy Gezi Movement have nevertheless voiced a collective desire: to fight the undercurrent of deeply entrenched patriarchal values and reclaim autonomy over their own bodies and lifestyles.

These demands are now coalescing around proposed legislation from the country’s Health Ministry that will call on pharmacies to limit the sale of oral contraception known as the morning-after pill only to those with a doctor’s prescription, a practice that is uncommon for most drugs available to the public here.

Under Turkey’s conservative-leaning Justice and Development Party (AKP) government, women are encouraged to have at least three children to help maintain population growth rates.

Feminists and women’s rights groups representing almost 400 people say the new legislation is part of government attempts to impose traditional values onto their lifestyle, and will only reinforce stereotypes about the “ideal” Turkish woman, while stigmatising those who stray from this image.

“I can’t go to the family doctor (for my contraceptive needs) because it is a secretive issue for me,” said Merve Kosar, a 26-year-old Istanbulite who relies on the pharmacy to replenish her supply of the drug.

In Turkey, most non-narcotic drugs are available for purchase over the counter. Insisting on a prescription from a family doctor, who can report to other members of the family, places added pressure on women to conform to conservative mores.

Women like Kosar, who make the conscious decision to have sex before marriage, are worried about having fewer options to guard against unwanted pregnancies.

Nearly 34 percent of once-married and currently married women said they use morning-after pills as their main form of contraception, according to the 2008 Turkey Demographic and Health Survey.

Still, the possibility of parliament passing the bill under a larger package of reforms sometime this year seems likely and concerns women’s rights groups who say the announcement will hinder some from asking pharmacies for pills.

An article in the Hurriyet Daily News cited a notice from the Health Ministry, which stated that “growth hormones, antibiotics, antidepressants, and antihistamines” must be sold with a doctor’s prescription to reduce the misuse of drugs.

According to Zerrin Guker, a pharmacist in the commercial neighbourhood of Karakoy who sells 15 to 20 boxes of the morning-after pill per month, some customers have been misusing the drug by purchasing it a few times per week, which can cause hormonal side effects.

A 27-year-old protestor named Elif, who declined to give her last name for fear of retribution, said she suffered blood clots and nausea after taking the pill once; yet she still believes in a woman’s right to choose and says the government’s proposed restriction is designed to prevent unmarried women from having sexual relationships.

“Most women can’t even buy tampons or feminine products from stores because they are ashamed,” she told IPS, stressing that the culture of shame has become entrenched in society.

A long fight to overturn these attitudes is slowly showing results: ideals about abstinence until marriage, for instance, are shrinking, as women continue to speak out about their grievances with men including harassment and sexist swearing, practices that have infiltrated the Occupy Gezi Movement.

At a recent meeting in Yogurtçu Park in Istanbul’s Kadikoy district, more than 100 women gathered to discuss their experiences at Gezi Park.

One protestor said a drunken man grabbed her buttocks one night, while bystanders justified his actions saying he had been under the influence.

Another woman read out a list of complaints with the governing party, which included attempts to get rid of “dekolte” (low-cut dresses) and state attempts to ban abortions and “keep women at home.”

A year ago, Prime Minister Recep Tayyip Erdogan called for tighter restrictions on reproductive health by drafting a bill that would shorten the time period in which women can have an abortion from 10 weeks to eight weeks.

“There is no difference between killing the foetus in a mother’s womb or killing a person after birth,” Erdogan said in a speech before female politicians in the capital, Ankara, last year.

His words drew the ire of around 3,000 to 4,000 protestors, mostly women, who marched against the anti-abortion law in Kadikoy last June, waving banners proclaiming statements such as: “It is my body, so who are you?”

When abortion became legal in 1983, the Turkish Population and Health Survey found that 37 percent of once-married Turkish women had at least one abortion. As of 2008, that figure stood at 14.8 abortions per 1,000 women.

While the latest call to limit oral contraception has yet to spark demonstrations, many believe it will eventually ignite the tensions that have been simmering for years now.

Ayse Dunkan, journalist and activist, believes the outcry will pick up momentum, with more people rebelling against the “conservative concept (that) women (must) stay home and raise children.”

Such ideals, she told IPS, have resulted in Turkey having the world’s second highest population growth rate after China.

Selime Buyukgoze, a volunteer at Mor Cati, an Istanbul-based network for battered women, called the proposal “problematic” since the morning-after pill must be taken within 72 hours of having unprotected sex and few women will be able to reach their doctors that soon.

Like most others, though, her biggest fear is that doctors will break a woman’s confidence by reporting her lifestyle to the family.

Ahmet Kaya, a family doctor who sees almost 150 patients a week, rebukes that claim. “If your patient doesn’t want you to inform her family, you can’t make that call,” he told IPS.

At the moment, pharmacies are continuing to sell the pill without asking for a prescription

It remains to be seen whether or not the government will push ahead with the law, or whether it will respond to the will of more than 1.5 million female protesters.

A “virus” of restrictive abortion legislation is spreading from Eastern Europe, health experts and rights campaigners have said, amid Church pressure and misguided government attempts to stop falling birth rates.

Just weeks ago a new law was introduced in Macedonia tightening up relatively liberal abortion legislation which had been followed for more than 40 years. And last month, Lithuanian lawmakers gave initial approval to some of strictest abortion legislation in the world.

Tighter abortion laws are also being considered in Russia and the Ukraine while the Georgian parliament is expected to debate abortion laws after the country’s Orthodox Church made calls in May for it to be banned.

Critics say that some governments appear to be moving towards introducing total bans on the procedure."Its wider meaning is that it is a step towards more restrictive measures and, ultimately, a ban on abortions.” -- Bojan Jovanovski, executive director of the Health Education and Research Association

Bojan Jovanovski, executive director of the Health Education and Research Association (HERA) in Macedonia, told IPS: “What has happened here is not unique and is happening in a lot of countries, spreading like a virus from Eastern Europe westwards.

“What this law here will do in the short term is it will make it harder for women to get an abortion, because of the bureaucracy and hurdles they will face. This will possibly lead to them undergoing illegal abortions and the problems that brings with it.

“But its wider meaning is that it is a step towards more restrictive measures and, ultimately, a ban on abortions.”

In recent years Eastern Europe has witnessed a push, in many cases driven by socially dominant Churches, to reinforce or tighten abortion legislation and deter access to them.

In strongly Catholic Poland, abortion legislation is among the strictest in the world. Interruptions are legally allowed in only three kinds of cases: rape, incest or if the mother’s health is at risk. But perhaps more importantly, in practice it is virtually unobtainable as many doctors refuse to carry out the procedure.

Women’s rights groups say that virulent pro-life societal attitudes fostered by a Catholic Church whose influence is omnipresent at all levels of society, including in political parties, leads healthcare staff to refuse to help women seeking terminations, even in cases where they have a legal right to them. The doctors cite either their own religious convictions or fear of reprisals as reasons stopping them performing the procedure.

It is estimated that there are up to 200,000 illegal abortions carried out in Poland every year because women cannot access them legally and do not have the money to travel abroad to undergo the procedure in countries where it is legal.

Because of their nature, these illegal abortions are inherently risky. They are almost invariably carried out in unsterile conditions, usually in a room in a flat, by a doctor anxious to get the termination completed for constant fear of being caught and potentially jailed.

No figures of mortality rates or serious health problems resulting from these illegal abortions can be obtained because of their clandestine nature.

However, the World Health Organization (WHO) has stated that even today up to 30 percent of maternal deaths in some countries of Eastern Europe and central Asia are caused by unsafe abortions.

The new Lithuanian law, which is modelled on Poland’s legislation, will also allow terminations only in cases of rape, incest or health complications. Abortion is currently allowed on demand up until 12 weeks. The new legislation must pass further parliamentary approval before it comes into law.

The region’s declining birth rate has been another factor behind the anti-abortion trend at the political level. Many politicians believe that restricting abortion access will help push birth rates up.

But evidence from Poland and other countries around the world suggests otherwise.

Wanda Nowicka, a prominent Polish women’s rights campaigner and member of a United Nations taskforce for next year’s International Conference on Population and Development, told IPS: “Since 1993 when Poland introduced its strict abortion legislation the birth rate has fallen. But politicians still follow the populist argument (to limit access to abortion).”

Official government figures show the Polish birth rate has fallen steadily from 1993 to 2012.

Nowicka added: “What happens is that when a woman is unsure about her reproductive choices she decides not to have children.”

Poland’s abortion law served as the model for the new legislation in Lithuania, and it was originally proposed by MPs from the country’s Polish minority. The Church, as in Poland, has a strong influence in society and among politicians and it has for years actively backed a tightening of the country’s abortion legislations.

The law is also expected to have a negative impact on Polish women’s abortion options as many currently cross the northern border to Lithuania for abortions they cannot get in their homeland. This will potentially force even more into undergoing dangerous illegal terminations.

In Macedonia, under the new legislation, official requests for abortions will have to be submitted, women will have to attend counselling, and confirm their partner has been informed of their decision to have an abortion. They will also be banned from having a second abortion within a year of their first.

The government has said that the new law was brought in to strengthen women’s health. But critics contend this, pointing out that it was approved in just two weeks in accelerated parliamentary procedures – effectively preventing any debate about it – and that gynaecologists were not consulted in its drafting.

Jovanovski told IPS: “The law does not meet international human rights nor medical health standards.”

He added: “What’s happened here might be copied by other Balkan countries and in other parts of Eastern Europe and spread. Countries in the West that have long traditions of upholding human rights should be looking at this closely and doing something about it.”

LGBT activists, human rights observers and police officers wait outside a courtroom in Uganda's constitutional court. Four activists had brought a case against Minister of State for Ethics and Integrity Simon Lokodo. Credit: Will Boase/IPS

By George Gao
UNITED NATIONS, Apr 26 2013 (IPS)

Ishita Chaudhry spent the past 36 hours listening to U.N. delegates discuss population growth and development. She noticed that on “controversial” topics, such as sexual and reproductive rights, young people’s voices often get lost.

“For us as young people, it’s really not as controversial as it is for governments,” said Chaudhry, a member of the High-Level Task Force for the International Conference on Population and Development (ICPD), at a press briefing Thursday.

“We know that we need to be empowered to claim our human rights… And we understand that access to sexual, reproductive health and birth services, and comprehensive sexuality education is a key aspect of that empowerment,” she explained.

Joaquim Alberto Chissano, a former president of Mozambique and co-chair of the task force, added, “Fulfilling sexual and (reproductive) health and rights is not only a human right… it also offers solutions to many of today’s global problems.”

Chissano – often credited for ending civil war and strengthening democracy in Mozambique – cited the links between sexual and reproductive health and national progress.

He explained that by promoting sexual and reproductive health, the international community can “fully unleash human potential, energies and talents… to nurture the human capital that countries need to reduce poverty and inequality”.

If sexual and reproductive rights are not addressed, “those who will feel the pinch more are the coming generations”, he warned.

The task force’s work – entitled “Policy Recommendations for the ICPD Beyond 2014: Sexual and Reproductive Health and Rights for All” – reaffirms values established almost twenty years ago in Cairo, where 179 governments gathered to adopt a Programme of Action that placed the human rights of women at the centre of international development goals.

The task force calls on the governments to address Cairo’s “unfinished agenda” by: ensuring sexual and reproductive rights through law; working towards universal access to sexual and reproductive health services; providing sexuality education for all young people; and eliminating violence against women and girls.

It argues that governments should expand access to safe abortion and to services for victims of gender-based violence, and that the international community should adopt a definition of “comprehensive sexuality education”.

The task force’s work will inform U.N. negotiations for a new development framework, to replace the expiring Millennium Development Goals (MDGs) post-2015.

According to the task force, the sexual and reproductive health of young women and girls are particularly compromised. It cites that one in three girls in developing countries are married without their consent; 2,400 young people are infected with HIV every day; and up to 50 percent of all sexual assaults are committed against girls under the age of 16.

Asked if sexual and reproductive rights are often barred by social or cultural norms, Chaudhry – founder of The YP Foundation, a non-profit organisation in India – said, “I come from a country that has a broad representation, both in terms of religion (and) culture. It has a lot of sensitivities.”

She emphasised the importance of providing information and sexuality education to approach such sensitivities. “You’re not telling the young person that they should or shouldn’t do something, you’re giving them access to evidence-based information, which means that they are in the best place to decide (for themselves).”

She said, “Because there’s such a broad lack of understanding… the fear and stigma and discrimination around issues of sex and sexuality therefore remains very high.”

Chaudhry argued that some of the most effective cases in achieving sexual and reproductive rights are when governments invest at community levels in reducing levels of related stigma.

She explained, “One of the biggest misconceptions of sexuality education is that if you provide sexuality education to an adolescent, you’re going to decrease the age of first sex.”

She added, “Once you start breaking the stigma and the silence around issues of sex and sexuality, you find that even parents and religious leaders themselves have questions… They (just) haven’t had anybody else to ask.”

Tarja Halonen, former president of Finland and co-chair of the task force, posed a question of her own: would you want to perpetuate socially rooted injustices, “or would you like to be the founding father or mother with a new way of (doing things)”?

She explained that while it is important to respect traditional values, it is also important to abide by the Universal Declaration of Human Rights. She emphasised the need to work with experts from schools, health centres and religious communities.

Halonen noted that social stigmas on sexuality are prevalent even in Finland – ranked the second happiest country by the U.N.’s World Happiness Report. These stigmas discourage victims of sexual abuse from seeking the help they need, while providing impunity for perpetrators.

Halonen told IPS, however, that there has been some progress. She shared her experience fighting for sexual and reproductive rights, which started over four decades ago when she was a young lawyer.

“In the late 1960s, when I spoke on behalf of young Finnish students… I said that (students) need more information for these issues,” said Halonen.

“I remembered how they answered me in Parliament. They said, ‘(Students) are in the university in order to study, not to have sex’.”

Despite social stigmas and Parliament’s neglect, Halonen was able organise sexual and reproductive health services and information for the university’s health care centres.

Her national progress for sexual and reproductive rights continued from there.

“We changed the legislation in 1970s concerning minorities (and) homosexuals. Then we changed the abortion law, little by little. Now when we look at statistics, we see afterwards that it has worked well. We have less abortions, we have better birth rates, we have fewer HIVs,” she said.

“So what are we afraid of?” she added.

By Sabine Clappaert
BRUSSELS, Jan 20 2013 (IPS)

Despite staggering advances in medical science and technology over the years, women around the world continue to suffer gravely as a result of inadequate access to basic reproductive health services.

Marleen Temmerman, head of the Department of Reproductive Health and Research at the World Health Organisation (WHO). Credit: World Health Organisation.

Roughly 134 million women are “missing” worldwide as a result of sex-selective abortions and neglect of newborn girls. Complications in childbirth are responsible for the deaths of over 350,000 women annually, 99 percent of them from developing countries.

Against this backdrop, the appointment this past October of fifty-nine-year-old Marleen Temmerman – known as ‘Mama Daktari’ in Kenya, where she worked as a gynaecologist for many years – as head of the Department of Reproductive Health and Research at the World Health Organisation (WHO), is a promising move in the right direction.

IPS correspondent Sabine Clappaert spoke to Temmerman, an illustrious Belgian physician, about her plans to weave the reproductive health agenda tightly into the WHO’s mission.

Excerpts from the interview follow:

Q: Why did you decide to leave your career as head of the Obstetrics and Gynaecology Department and member of the board of directors at the Ghent University Hospital to join the WHO?

A: Throughout my career, my goal has always been to improve the reproductive and sexual health and rights of women and girls across the world. While I wasn’t actively looking for a new job I realised that this opportunity at the WHO presented a very powerful lever to help me achieve these goals.

Q: What budget are you working with and what are your goals?

A: I have a working budget of approximately 40 million dollars, which is less that what it has been in previous years. The (global financial) crisis is clearly also impacting the budgets allocated to sexual and reproductive health. At the time of my appointment, for example, I was promised a significant contribution by the Belgian government. Sadly, it never materialised.

I do fear that the difficult economic climate will mean that sexual and reproductive health are seen as less of a priority, yet nothing is further from the truth. If we want the next generations of women to be healthy and empowered, we need to give them access to facilities and programmes that keep them alive and well during pregnancy and childbirth or give them access to family planning services so they can plan their own future.

Family planning is key not only to women and children’s health, but also to slowing unsustainable population growth and sustaining the economy and ecology.

An estimated 222 million women do not have access to family planning: women who would like to delay or stop childbearing but who are not using any method of contraception. In China, for example, only married women have access to family planning clinics. If we could change policy to also give single women access to family planning, we could help make a real difference.

In my new role, I will be looking at why this problem persists and how we can reduce it from various perspectives: by looking at contraceptive solutions in the R&D (research and development) pipeline, through implementation research that aims to identify possible barriers – cultural and religious beliefs or the availability and cost of family planning, as well as what educational initiatives need to be taken to correct misconceptions at the community and individual level.

Adolescent sexual and reproductive health is also enormously important if you consider the fact that abortions and complications during childbirth remain the number one cause of death among 15 to 19 year-old girls.

Q: In 1994 you founded the International Centre for Reproductive Health (ICRH), which today is active in many countries across the world including Kenya, Mozambique, China and Guatemala. What lessons did you learn that you take with you into your new role at the WHO?

A: One of the most important lessons I’ve learnt is that collaboration is key to the success of projects in the sexual and reproductive health realm. At the moment we’re working on a project in Kenya that aims to support girls and women who are victims of sexual violence. We’re training medical staff to make sure they follow correct procedures and do all the right medical checks. We also ensure that girls are given psychological support and that they have access to legal advice.

Secondly, I’ve learnt that sexual and reproductive health remains a sensitive topic; that changing attitudes, behaviours as well as political vision and policies is a long, slow process. We have to remain committed to the importance of improving women’s sexual and reproductive rights. One of my biggest concerns is that, due to the crisis, budgets allocated to sexual and reproductive health will “disappear” into general health budgets. If this happened, it would take away the focus and attention that we must keep on this topic to help drive real change.

There is still so much to be done to end female genital mutilation (FGM), to lower mortality rates during childbirth or to make sure that every girl and woman has access to sexual and reproductive health facilities. There is a saying that says ‘If you want to go fast, go alone; if you want to go far, go together’. I think we must go fast and far. And we can only do this together.”

Q: What is the developed world’s role in assuring reproductive health and justice in the global South?

“I think the developed world has a fundamental responsibility toward developing countries. The traditional North-South view is clearly out-dated, but on the other hand, women’s rights and gender equality are much more advanced in the developed than in developing world. It is our responsibility to support women in the South, to ensure that programmes of sexual and reproductive health don’t “disappear” into global health initiatives, that we continue to commit sufficient resources and budgets to advancing women’s access to sexual and reproductive health facilities.

Q: What has been the hardest lesson for you while undertaking your work in Africa?

There is no doubt about it: the young women and new-born babies that have died in my arms simply because they were in a part of the world where I did not have access to medical technologies that I would have access to in Europe or another developed part of the world. There is nothing worse than the powerless feeling of holding a dying young woman in your arms and thinking: “If we were in another part of the world now, she would have lived.”

I am also always shocked by the ease with which our societies brush over topics such as sexual violence, as if it is normal. So often I am told “but it is part of our culture”. This has to change. The way we bring up boys and girls, and the gender roles we instil in our children, must change.

(END)

Excerpt:

Lack of family planning has led to a surge in unsafe abortions in Eastern Europe. Credit: William Murphy/CC-BY-SA-2.0

By IPS Correspondents
PRAGUE/WARSAW, Nov 14 2012 (IPS)

Pressure from the Catholic Church, social stigma, a lack of information about sexuality and reproductive health and limited access to reproductive healthcare services are putting the lives of hundreds of thousands of women across Eastern Europe at risk.

According to the World Health Organisation (WHO), “Women are over four times as likely to die in childbirth in the newly independent states of the former USSR as in the European Union.

“In some countries unsafe abortions cause over 20 percent of all registered maternal deaths, and Eastern Europe has the highest abortion rate in the world.”

In the ‘State of World Population 2012’ report, released Wednesday, the United Nations Population Fund (UNFPA) urges all developed and developing countries to “increase financial support and political commitment” to reproductive health and “promote family planning as a right” to ensure women’s health and safety.

But far from heeding the calls of the international community, Eastern Europe appears to be sliding further away from these goals.

“The reproductive health situation in Eastern Europe and Central Asia is quite dire. The contraceptive prevalence rate in some countries is as low as (the rate) in least developed countries,” Werner Haug, director of the UNFPA’s Eastern Europe and Central Asia regional office, told IPS.

While governments drag their feet on implementing national reproductive health policies, women are left at the mercy of a conservative society that offers very little space or support for family planning.

The last few years have seen a push, in many cases driven by the Church, to reinforce or tighten abortion legislation and deter access to or discussion of contraception.

This and other factors such as poverty, say women’s rights groups, have already led to a thriving underground abortion industry riddled with health risks and, in some countries, a growing practice of do-it-yourself terminations that are dangerous at best, but often fatal.

Poland: a laboratory of unsafe practices

Poland has some of Europe’s tightest restrictions on abortions, only allowing termination of pregnancy in the case of rape, incest or if the mother or baby’s health is at serious risk.

Yet even when those conditions are met, doctors in this staunchly Catholic society often refuse to carry out abortions for their own moral reasons, says Dr. Dorota Pudzinowska, a lawyer at the Helsinki Foundation for Human Rights in Poland.

“In principle, the law states that abortions should be allowed in certain circumstances,” she told IPS. “But the law also protects doctors’ rights to refuse certain procedures,” which means women are often forced to seek illegal abortions or go abroad to terminate their pregnancies.

“Approximately every third private gynaecologist provides abortion services illegally, which cost between 400 and 700 euros, but women have no control over the conditions in which these termination are provided” nor can they determine the skill level of the so-called doctors who carry out these operations, according to Aleksandra Szymczyk, an activist belonging to a prominent women’s rights group in Poland that organises an annual demonstration on Mar. 8 to demand reproductive justice.

Under the constant threat of being caught and potentially jailed for assisting women to terminate their pregnancies, doctors generally carry out these procedures hastily, in unsterile conditions, away from the gaze of the medical establishment or law enforcement officials.

Several women in Poland unable to receive any kind of operation at all have taken their cases to the European Court of Human Rights.

One was the case of a 14-year-old rape victim from the southeast Polish town of Lublin, known only as ‘P’, who was turned away from a number of clinics where she sought a termination. Church leaders would wait at the clinics to try to persuade her not to terminate the pregnancy.

The Court condemned the Polish state for the inhumane and degrading treatment of the girl, and ordered it to pay compensation.

That case, say campaigners, was just an extreme example of a climate around reproductive health in Poland that puts moral strictures laid down by the church ahead of women’s well-being.

“A major issue is that nobody knows how many abortions are conducted every year and in what conditions. Official data indicates just over 600 legal terminations annually, but it is common knowledge that many more abortions happen every year – women’s groups estimate that the number could be anything between 100,000 to 200,000 annually,” Elżbieta Korolczuk, another activist from the ‘March 8’ group, told IPS.

“Most abortions are carried out at home without any medical assistance, and judging from the content of Internet forums, many of the women do not use abortion pills but drugs that cause abortion as a side-effect,” she said.

“As a result, they expose themselves to a number of other side-effects and health problems, which they often don’t report afterwards out of fear and shame.”

Family planning is an issue that desperately needs to be discussed in Poland, said Karolina Wieckiewicz, a lawyer at the Polish Federation for Women and Family Planning.

“There is no counselling, no family planning advice available as part of primary health services,” she told IPS. “Even if a woman knows about the possibilities of avoiding pregnancy, she often does not have access to contraception.”

Contraceptives are available on prescription, but not every doctor will prescribe them. “And often pharmacists will refuse to hand over contraceptives because they say it is against their conscience,” Wieckiewicz said.

The problem is not limited to Poland, but is widespread throughout the region.

Reports in the former Soviet state of Armenia last month stated that there was evidence suggesting that the last few years have seen an upsurge in dangerous home abortions using freely available pharmaceuticals for the treatment of ulcers.

The pills have a contraindication of causing bleeding and miscarriages, and women have been using them to terminate unwanted pregnancies.

But doctors have reported that this method often results in severe bleeding and incomplete abortions, with many women being admitted to hospital needing emergency surgery.

Surgical abortions at a hospital cost up to 50 euros while these over-the-counter pills cost closer to 50 cents. The average monthly wage in Armenia is around 400 euros, effectively making professional surgical abortions cost-prohibitive.

No official record of mortality rates or serious health problems resulting from these illegal abortions can ever be obtained because of their clandestine nature.

However, the WHO has stated that even today up to 30 percent of maternal deaths are still caused by unsafe abortions in some countries of Eastern Europe and Central Asia.

*Pavol Stracancsky contributed to this report from Prague and Claudia Ciobanu and Chloe Arnold from Warsaw.

“The law has many gaps, and satisfies no one,” says activist Martha Aguñín. Credit: Hacelosvaler.org

By Raúl Pierri
MONTEVIDEO, Oct 18 2012 (IPS)

The Uruguayan Congress passed a law Wednesday decriminalising abortion, making it one of the few countries in the region where abortion is allowed in cases other than rape, incest, malformation of the fetus or danger to the mother’s life. But activists who backed the bill are not pleased with modifications introduced in the final version.

“We see this law as minimal; it is not what we were hoping for,” Martha Aguñín, spokeswoman for Mujer y Salud en Uruguay (MYSU – Women and Health in Uruguay), told IPS.

“It has many gaps, and satisfies no one,” added Aguñín, whose non-governmental organisation is leading the campaign “Legal Abortion – Uruguay; They are your rights, demand that they be respected!”

The law decriminalises abortion in the first trimester of pregnancy. But it will only be permitted in cases in which the pregnant woman complies with certain requisites.

Under the bill approved by the Senate Wednesday, which is set to be signed into law by President José Mujica, the woman seeking an abortion must first explain to a doctor the “economic, social, family or age difficulties that in her view stand in the way of continuing the pregnancy.”

The doctor will immediately refer her to an interdisciplinary panel made up of at least three professionals: a gynaecologist, psychologist and social worker.

The panel will advise her on the content of the law, the risks posed by the procedure, and the alternatives to abortion, and she will be given five days to mull it over.

If she doesn’t change her mind after the five-day waiting period, she will be allowed to have an abortion, without any further necessary steps, in one of the country’s health clinics or hospitals.

But Aguñín criticised this system, saying the panels would act in practice as a sort of “tribunal” or court.

“When women make a decision of this kind, we don’t need to be instructed to reflect on it, because we already do that in a conscious, adult, responsible manner,” she said.

“We have the right to decide when and how we will have children, and how many, without having to go in front of a tribunal that orders us to think about it for five days,” she said.

The activist explained that the new abortion law was not the one civil society groups wanted, but was the only one possible, as it was the result of negotiations and concessions made by the lawmakers of the left-wing Broad Front coalition, which has governed Uruguay since 2005, who have a majority in Congress.

A similar attempt failed in 2008, when the legislature approved a law on “the defence of sexual and reproductive health” but President Tabaré Vázquez (2005-2010), the leader of the Broad Front at the time, vetoed the articles that legalised abortion.

Vázquez, a prominent oncologist, argued at the time that abortion was “a social ill that must be avoided,” and said the bill could not deny “the reality of the existence of human life in the gestational state.”

But this time around, President Mujica has said he will not interfere and will sign the bill.

After a debate that dragged on for over 10 hours, the law was approved with the votes of 16 Broad Front senators and one senator of the centre-right National Party, in the 31-member Senate. The Chamber of Deputies had already passed the bill.

The new law, in practice

MYSU also expressed doubts about the implementation of the new law, given the shortcomings of the Uruguayan health system.

“We have found that women who live in some places in the interior, like Río Branco (a small town in the northeast of the country), do not have access to the services or the referral teams on sexual and reproductive health. They have to travel 80 km to receive attention and advice” in a larger city, said Aguñín.

“The system does not offer the conditions, under these urgent timeframes, for women to have an abortion in safe conditions,” she contended.

But Ana Labandera, president of the organisation Iniciativas Sanitarias (Health Initiatives), made up of health professionals who support the new law, was more upbeat.

“It is a law that can be perfected,” she told IPS. “It has a few problems, but it is a big stride anyway towards guaranteeing the rights of women, and allowing them to complete their decision process about having an abortion within the integrated national health system.”

With regard to the implementation of the law, Labandera said there are now trained professionals in different parts of the country, thanks to articles of the 2008 law on sexual and reproductive health that were not vetoed by Vázquez.

“These services are starting to function, or are already functioning, and this will clearly make it possible for the professionals to become qualified to deal with the entire process involved in abortion cases,” she said.

“The platform, the infrastructure, has already been put in place so that this law can be a complementary part of the services that are already provided,” she added.

The international human rights group Médicos del Mundo (Doctors of the World) celebrated the new law, describing it as a “positive precedent” for all of Latin America.

In a statement, the organisation said the law was a step forward for women’s health, from a regional perspective, and added that it would closely follow its implementation.

Abortion had been legalised in Uruguay in 1934, during a time of new liberal ideas. But that change provoked controversy, and in 1938, abortion was made a crime under the penal code. Since then there have been eight unsuccessful attempts at reforming the law, the last of them in 2008.

It is estimated that more than 30,000 abortions a year are practiced in this South American country of 3.3 million people. Of every 10 pregnancies, three or four are interrupted, Labandera said.

According to figures provided by MYSU, the highest rates of abortion are in Latin America and Africa, where the practice is highly restricted in nearly every country, and where many women have unplanned pregnancies.

In this hemisphere, abortion on request is currently only legal in Cuba, Canada, the United States, Puerto Rico, three countries of the French Antilles, French Guiana, Guyana and Barbados. And in 2007, the Mexico City government made abortion legal in the capital.

In the rest of heavily Catholic Latin America, it is only allowed under narrow circumstances, such as cases of rape, incest, a malformed fetus or danger to the mother’s life. And in Nicaragua it is illegal under any conditions.

In a survey carried out in June by Radar, a Uruguayan polling firm, 51 percent of respondents said they were in favour of decriminalising abortion, 42 percent said they were opposed, and the rest did not express an opinion.

The Public Health Ministry reported that between 2007 and 2011, there were no deaths resulting from illegal abortions, although civil society organisations express doubts over that claim.

So far this year, two women, ages 28 and 32, died in public hospitals as a result of complications caused by medical abortion brought on by misoprostol, a drug used to treat ulcers that also causes early abortion.