Women have abortions, whether it is legal or not. The question, then, is not whether we agree or disagree with abortion, but whether we choose life or death for women. Maintaining the punitive laws currently in effect means choosing death. One afternoon during my high school years in Mexico City, my best friend confessed to me in a panicky voice that she had not had her period for a couple of months. We got the name of an abortion practitioner, a doctor, and drove to his office. It was a somber place. The doctor said he would do the proce- dure, but only after lecturing my friend about her irre- sponsibility and lack of self-respect. He also made it clear that he was putting himself on the line for her, and that it would cost her. "Come back tomorrow," he said, "and bring the money." The struggle to get what at the time seemed like an impossible amount of money, plus the anxiety caused by our absolute ignorance about the procedure, kept us up all night until the morning appointment. An hour after she went into the consultation room, the doctor came out, furiously shouting that her pregnancy was too advanced and that he could do nothing more. We were to leave immediately and never come back. My friend went home. I didn't hear from her for months, after all communication between us was for- bidden by her outraged parents. They pulled her out of school and sent her to live with relatives in New Jersey, where she was able to have the procedure. She lost her uterus in the process. She was seventeen years old. Even for the most liberal Latin Americans, abortion brings up feelings of guilt, a certain sense of indecency, and deep sorrow. As I mulled over the episode many times afterward, I often found myself asking why. Lucia Rayas is a sociologist and the Information Coordinator of the Information Group for Reproductive Choice (GIRE), an NGO based in Mexico City She would like to thank Rosario Taracena, Angeles Garcia, Martha Judrez, Renate and George Gugelberger Jeff House and Sharon Bissel for their for help with this article. Now, years later, many women have come to under- stand that the right to have an abortion is a necessary condition for women's sexual freedom. The feelings of guilt and indecency that surround abortion arise because the very fact of pregnancy attests to having exercised sexuality-a tremendous affront to institutions like the state, law and religion which seek to control women's sexual lives. In Latin America, the Catholic Church has played a particularly insidious role in defining and enforcing ideologies of womanhood.' Wherever these ideologies exist, women-and men-are bound to feel the restrictions that these invisible chains place on us all. Most Latin American and Caribbean countries are Catholic, almost by definition. We share a history of conquest by conversion. Minds and hearts were won, however forcibly, and made to abide by a stringent set of values that equate woman with mother-a saintly, devoted mother whose sexuality is forever linked to reproduction. Women who seek pleasure are seen as evil, and those who do not opt for motherhood are self- ish and unworthy. Several centuries later these basic tenets still prevail. They are reflected in most of our leg- islation and are protected by a patriarchal state. Women are men's property and the bearers of their future heirs-women as the wombs of the nation, for better or for worse. Most Latin American and Caribbean countries penalize abortion, punishing both the woman and the person who performs the procedure. Yet in practice, anti-abortion laws are not enforced in many countries in the region. Legislation is in place to appease the "good con- sciences" of those who need to feel they live in a con- servative, Church-abiding country. Yet those of "good conscience" remain blind to the underlying problems surrounding ille- gal abortion: high rates of maternal mortality, pov- erty, tIu e absenIce of sexual education, and insufficient information about and availability of contraception. With or without fundamentalist ideologies or restrictive laws, millions of Latin American women undergo back-alley abortions, per- formed under the worst circumstances by people who benefit financially by trading in the abortion black mar- ket. In 1990, four million abortions were performed in Latin America, according to the New York-based Alan Guttmacher Institute. 2 Health professionals, public offi- cials and the women's movement have long pointed out the adverse consequences of illegal abortion. When reg- ulated and performed by trained physicians, abortion is a very safe procedure. Criminalizing abortion, on the other hand, forces women to undergo unregulated and risky procedures that put their lives and their future reproductive health at risk. This is especially the case for poor women, who often lack access to family-planning services. In cases of unwanted pregnancies, such women can rarely afford to pay the private physicians who could ensure a safe pro- cedure, and so expose themselves to potentially unhy- gienic, risky abortions. A safe first trimester abortion in Mexico, for example, ranges from the equivalent of $238 to $714-an amount payable only by a few privi- leged women. Between 50 and 60% of women who try to induce abortion themselves or with the assistance of non-medical personnel experience complications. 3 The A pregnant woman in Havana, Cuba looks at a family-planning poster Graffiti on a wall in Chiapas, Mexico reads, "freely chosen motherhood." interruption of unwanted or unplanned pregnancies is among the first causes of maternal mortality and mor- bidity in the region. Maternal morbidity, caused by abortion complications such as perforated uteruses or infection of the reproduc- tive tract, forces women to seek emergency medical attention at public health facilities. Approximately 800,000 Latin American women are admitted to hospi- tals every year due to such complications. 4 Keeping abortion illegal is an extremely costly way of allocating scarce medical resources. A survey of several hospitals in Buenos Aires revealed that women facing abortion complications remain hospitalized an average of 7.4 days, making the cost of a botched abortion nine times that of a normal birth and 4.5 times that of a cesarean section. 5 The same survey showed that 37% of the total budget for gynecological services is spent on treating abortion complications, representing 4.5% of the global budget of these hospitals. 6 Abortion, therefore, is not only an issue of women's reproductive rights. It also involves problems of public health, social justice and ethics. Whenever the topic of abortion is discussed openly, the Catholic Church hierarchy and groups similar to the U.S. Pro-Life Movement jump into the fray with argu- ments that exclude women and their rights. No woman has an abortion because it is fun or pleasant. Behind every decision to interrupt a pregnancy, there is pain, anguish and serious considerations. No one wants abor- tions to continue to exist, but prohibiting them does not resolve the situation. Rather, it creates larger problems of public health and needlessly puts at risk the lives and health of women-especially poor women-who feel the need to end an unwanted or unplanned pregnancy. VOL XXXI, No 4 JAN/FEB 1998 0 23REPORT ON SEXUAL POLITICS Abortion Legislation in Latin America Countries in which abortion is available on demand Cuba' Guyana Puerto Rico Countries in which abortion is illegal except in the following circumstances For social and socio-economic reasons Barbados Belize To preserve woman's health and in case of fetal deformation Argentina 2 Bahamas Bolivia 2 Costa Rica 2 Grenada 2 Jamaica Panama Peru Trinidad and Tobago Uruguay 2 To save woman's life Brazil Dominican Republic Ecuador Guatemala Haiti Honduras Mexico Nicaragua Paraguay Surinam Venezuela In case of rape and incest Bolivia Brazil Ecuador Mexico Countries in which abortion is totally forbidden Chile Colombia El Salvador 1. During the first ten weeks of pregnancy. 2. Designates countries in which abortion is allowed only to preserve a woman's health. Source: Elaborated by author based on the penal codes of corresponding Latin American and Caribbean countries. And there will, of course, continue to be unwanted or planned pregnancies as long as there is lack of access to information and sex education, insufficient or complete absence of contraceptive methods, and contraceptive methods that are not 100% reliable. In Latin America, full compliance with reproductive rights and with the rights of women would require access to safe and vol- untary abortion so that all women may choose what they do with their own bodies. Legalizing abortion does not mean, of course, that women will be forced to have abortions, as some conservatives have argued. It only means that the opinions of a few will not be imposed upon others, as is presently the case. With the exception of Cuba, Guyana and Puerto Rico, where abortion is available on demand, abortion is legally penalized in Latin America and the Caribbean. In most of these countries, however, there are certain extenuating circumstances under which a woman may be legally permitted an abortion. [See Table 1.] In most countries, for example, an abortion may be obtained when a woman's life or health are in danger. Some countries allow for abortion if the fetus is deformed, and a few countries allow it in cases of extreme economic hardship. Until recently, only Chile prohibited abortion completely, even when the life of the woman is at risk. In 1997, however, both Colombia and El Salvador changed their penal codes in order to prohibit abortion under any circumstance. This marks a dramatic reversal in the move toward liberalization marked by Guyana's 1995 decision to make abortion available on demand, and by growing debate on abor- tion elsewhere in Latin America. In Uruguay, for exam- ple, the Broad Front, a coalition of left-wing parties, recently revived a project to decriminalize abortion, while in Peru, the newly created National Reproductive Health Program has recognized abortion as a public health problem. In Chile, the law that criminalized therapeutic abor- tion was passed in 1989, in the last weeks of the Pinochet dictatorship. Jaime Guzmin, a lawyer and Opus Dei affiliate who authored the 1980 Constitution, spearheaded the campaign to make abortion completely illegal before the return to democracy. He also champi- oned a constitutional amendment establishing the right to life, including the protection of the life of the unborn, which effectively blocks all future attempts to decrimi- nalize abortion or pass any other legislation that may provide access to this reproductive right. Guzmin, who was killed in 1991, allegedly by the Manuel Rodrfguez 24 NACIA REPORT ON THE AMERICAS Table 1REPORT ON SEXUAL POLITICS Patriotic Front (FPMR), reportedly said that individuals faced with martyrdom or moral fault should choose the former.' Of course, under the rulings Guzmdn helped pass, all possible "martyrs" are women. Despite its illegality, an estimated 160,000 to 300,000 Chilean women undergo abortions each year. According to one comparative study, Chile had the highest abortion rates in Latin America, with six abortions for every ten live births. The other countries included in the survey- Brazil, Colombia, Peru and the Dominican Republic- had an average of four abortions every ten live births, with the exception of Mexico, which averaged two abortions every ten live births. 8 [See Table 2.] According to Ministry of Health statistics, in 1990, 44,500 women obtained abortion-related medical care. In two out of three cases, treatment involved abortion complications. 9 In Chile, 36% of maternal deaths are due to illegal or clandestine abortions, making this the In C first cause of maternal death in this country.'o where During the Pinochet regime, med- ical personnel were encouraged to denounce women who sought treat- on dem ment after botched abortions as well as those who performed the proce- materna dure. Although today there are fewer legal cases against women who rate is 39 undergo abortions and against abor- 100,000 li tion practitioners, the fear of accusa- tion often discourages women from compared seeking medical care even when they 220 per suffer severe complications. Needless to say, this mostly affects the poorest in Cen Chilean women, who cannot afford the high costs of a safe procedure that South poses no risk to their health. respe Unlike Chile, most Latin American respe countries criminalize abortion but per- mit it under extenuating circum- stances. The legislation that on paper permits abortion under specific circumstances, however, does not neces- sarily provide a real framework for it to take place. In most countries, women seeking abortion under such pro- visions have to take their cases to medical committees which may take so long reviewing each case that by the time they reach a conclusion, the pregnancy may be too advanced. Or, the answer may be negative. Another ele- ment that makes abortion law inadequate is that very few people-the general public as well as medical person- nel-know that there are extenuating circumstances that permit the interruption of pregnancy. This is clearly the case in Mexico, where abortion is permitted in certain states under specific conditions. Abortion is legal in all 32 Mexican states in the case of rape, and in 29 states to save the life of the mother. A handful of states allow abortion if fetal deformation is detected or after a woman is forcibly subjected to artifi- cial insemination, and one state allows it for economic reasons if the woman has at least three children. In prac- tice, however, these written regulations add up to no regulations, since they do not outline the procedures women in these circumstances can follow to obtain legal abortions. Nor is there any attempt to provide pub- lic information to make people aware of their right to legal abortion under certain circumstances. Forty per- cent of all pregnancies in Mexico are unwanted, and 17% of these are terminated. There are an estimated half a million abortions in Mexico every year, and one in every four results in medical complications.12 Official :uba, abortion ailable rand, the I mortality deaths per ve births- to 160 and 100,000 tral and America, ctively. figures report abortion as the fourth cause of maternal mortality in the country. In three national surveys carried out by the Information Group for Repro- ductive Choice (GIRE), a nongovern- mental organization based in Mexico City, over 80% of Mexicans said that they believed the decision to termi- nate a pregnancy or to carry it to term is exclusively that of the pregnant woman or of the woman and her part- ner, and that neither the Church nor the state should have a say in the matter.' 3 Cultural critic Carlos Monsivdis once said that abortion was so widely accepted in Mexico that in effect, it was morally decriminalized. Despite this liberal attitude toward abortion among the population, the debate on reproductive rights in Mexico has been consistently stymied by conserv- ative groups and sectors of the Catholic Church. This was the case in the state of Chiapas in 1990, when the legislature pro- posed to reform the state's penal code to legalize abor- tion. The Church hierarchy and its conservative allies attacked the initiative with such vehemence that the reforms were repealed. n sharp contrast to Chile and Mexico stand Puerto Rico and Cuba, two of the three countries in the region where abortion is legally available to women on demand. But the differences in the origin of the laws legalizing abortion in both countries mean that abortion takes on very different meanings in each society. Given that Puerto Rico is a U.S. colony, all the rules and regulations regarding abortion on the island come VOL XXXI, No 4 JAN/FEB 1998 25REPORT ON SEXUAL POLITICS from the United States. After the 1973 Roe v. Wade decision by the U.S. Supreme Court, abortion became legal in Puerto Rico via jure ex colonia (legislation due to colonial status).14 Yet this seems to have created a situation in which abortion is not widely accepted as a right, since it was not the result of local demands but was imposed from above." 5 Many obstacles remain, moreover, to women's access to safe abortions in Puerto Rico. For example, official rules restrict the public advertisement of abortion services. Yamila Azize-Vargas and Luis Avilds calls this "legal clandes- tinity," and argue that this plays a powerful role in inhibiting women who desire to end pregnancies from seeking abortion services because it shrouds the process with feelings of guilt and illegality."6 At the same time, however, there is a markedly low incidence of abortion in Puerto Rico. Again, the island's colonial history can probably best explain this. Population-control programs have been implemented in Puerto Rico since 1937, long before they existed in any other Latin American or Caribbean country. As a result, the rate of contraceptive knowledge and use among Puerto Rican women has been higher than their Latin American and Caribbean counterparts. In 1982, 69% of women living with their partners used some form of contraception. More astonishing is the fact that 49% of Puerto Rican women of childbearing age (15- 49) have been sterilized-the legacy of U.S.-funded sterilization campaigns. 17 Table 2 Case Studies: Abortion Rates and Ratios Abortion rate' Ab Countries in which abortion is available on demand Puerto Rico 22 Cuba 58 Countries in which abortion is restricted by law Mexico 23 Chile 45 1. The abortion rate is the number of legal abortions per 1 of childbearing age (15-44 years). 2. The abortion ratio is the number of abortions per 100 (excluding involuntary miscarriages and stillbirths). Source: Adapted from Yamila Azize-Vargas and Luis A. Avilc in Puerto Rico: The Limits of Colonial Legality " in Abortion Business, Reproductive Health Matters Series, No, 9 (May 1. The situation is quite different in Cuba, where abor- tion was legalized in 1979 after a study demonstrated that illegal abortion was the primary cause of death of women between the ages of 15 and 44.18 For nearly 20 years, the legal, religious and political restrictions that surround abortion in other Latin American countries have not existed in Cuba. In fact, Cuban abortion law has sought to protect women, especially by assuring them equal access to a safe and affordable procedure. Abortion during the first-trimester is illegal, for exam- ple, if the abortion is performed against the will of the woman, when it is performed by untrained personnel who cannot guarantee the safety of the procedure, when it is done for profit, and when it is done outside official health institutions. The result is that Cuba has a very low rate of mater- nal mortality compared to its Latin American and Caribbean neighbors. In 1988, there were 39 maternal deaths per every 100,000 live births in Cuba, compared with averages of 160 and 220 per 100,000 in Central and South America, respectively. 1 9 But abortion rates are markedly high, at 58 abortions per 1,000 women. Abortion, in effect, has become a de facto means of birth control, largely because contraceptive devices are in short supply due to the U.S. economic blockade. 2 0 The contrasting cases of Puerto Rico and Cuba sug- gest that women's autonomy and sexual freedom require changes in society that go beyond legal norms. Such changes will come about only as a result of greater awareness about the real public health problems that result from criminal- izing abortion and an understanding that a ion raio key aspect of women's emancipation is equal access to safe contraceptive meth- ods as well as abortion when necessary.21 To be denied control over reproduction or sexuality is to be denied full personhood. 20 "It is essential to recognize the inextrica- 45 ble interrelationship between reproduc- tive and sexual decision making," says feminist scholar Rhonda Copelon, "and the broader demand for equality." 2 2 Making abortion safe and legal is an inte- 16 gral part of this process. As Luis de la 35 Barreda, president of Mexico's Human Rights Commission says: "The question ,000 women is not whether we agree or disagree with abortion, because whether or not it is pregnancies legal, women have abortions, as statistics everywhere demonstrate. Rather, the s, "Abortion option is choosing life or death for : Unfinished women. Maintaining the punitive laws 997). currently in effect means choosing death." 23 Criminalizing Abortion: A Crime Against Women 1. Jacqui Alexander, "Mobilizing against the State and International 'Aid' Agencies: 'Third World' Women Define Reproductive Freedom," in Marlene Gerber Fried, ed., From Abortion to Reproductive Freedom: Transforming a Movement (Boston: South End Press, 1990). 2. The Alan Guttmacher Institute, Aborto clandestino: Una realidad latinoamericana (New York: The Alan Guttmacher Institute, 1994). VOL XXXI, No 4 JANIFEB 1998 3. The Alan Guttmacher Institute, Aborto clandestino, p. 17. 4. Childbirth by Choice Trust, Abortion in Law, History and Religion (Toronto: Childbirth by Choice Trust, 1995), p. 39. 5. See the Alan Guttmacher Institute, Aborto clandestino. Statistics from Susana Checa and Marta Rosenberg, Aborto Hospitalizado. Una cuestibn de derechos reproductivos, un problema de salud pOblica (Buenos Aires: Ediciones El cielo por asalto, 1996). 6. Susana Checa and Marta Rosenberg, Aborto Hospitalizado. 7. Lidia Casas-Becerra, "Women Prosecuted and Imprisoned for Abortion in Chile," in Abortion: Unfinished Business, Reproductive Health Matters Series, No. 9 (May 1997), p. 29. 8. Lidia Casas-Becerra, "Women Prosecuted and Imprisoned for Abortion in Chile," p. 30. 9. Lidia Casas-Becerra, "Women Prosecuted and Imprisoned for Abortion in Chile," p. 30. 10. Childbirth by Choice Trust, Abortion in Law History and Religion. 11. Lidia Casas-Becerra, Mujeres procesadas por aborto (Santiago de Chile: Foro Abierto de Salud y Derechos Reproductivos, 1996). 12. The Alan Guttmacher Institute, Aborto clandestino. 13. Information Group for Reproductive Choice (GIRE), Encuesta de opinion sobre el aborto (Mexico City, 1994). 14. Yamila Azize-Vargas and Luis A. Avilfs, "Abortion in Puerto Rico: The Limits of Colonial Leglislation," in Abortion: Unfinished Business, Reprodutive Health Matters Series, No. 9 (May 1997), p. 56. 15. Yamila Azize-Vargas and Luis A. Aviles, "Abortion in Puerto Rico." 16. Yamila Azize-Vargas, "La realidad del aborto en Puerto Rico: Investigar para educar," Paper presented at the Meeting of Researchers on Induced Abortion in Latin America and the Caribbean at the External University of Colombia (Santaf6 de Bogota, 1994), p. 97. 17. Yamila Azize-Vargas and Luis A. Aviles, "Abortion in Puerto Rico," p. 59. 18. B. Viel, "The Risk of Unwanted Pregnancy: A Latin American Perspective," IPPF Medical Bulletin (February 1989). 19. Lisa C. Remez, "Confronting the reality of abortion in Latin America," International Family Planning Perspectives, Vol. 21, No. 1 (March 1995), p. 33. 20. Lisa C. Remez, "Confronting the reality of abortion in Latin America." 21. Angela Davis, "Racism, Birth Control and Reproductive Rights," in Gerber Fried, ed., From Abortion to Reproductive Freedom. 22. Rhonda Copelon, "From Privacy to Autonomy: The Conditions for Sexual and Reproductive Freeedom," in Gerber Fried, ed., From Abortion to Reproductive Freedom. 23. Luis de la Barreda Sol6rzano, El delito de aborto, una careta de buena conciencia (Mexico City: National Institute of Criminal Studies, 1991).
