By Claire Davaine
International Women's Initiative Staff Writer
In Latin America, in recent decades, women throughout the region have made tremendous strides towards securing equal rights in almost every sphere. However, a number of challenges remain: lack of access to reproductive health services, comprehensive sexuality education, and contraception... Latin American countries have some of the most restrictive reproductive health laws and policies in the world, particularly with regard to abortion.
Abortion has been a controversial subject in many societies through history on religious, moral, ethical, practical, and political grounds. It has been banned frequently and otherwise limited by law.
In Chile, Nicaragua, El Salvador and the Dominican Republic, abortion is illegal under any circumstances. Together with Vatican City and Malta, they comprise the six countries in the world that have a blanket ban on abortion, according to data from the United Nations.
In some countries such as Brazil and Panama, abortion is permitted in cases of the pregnancy threatens the woman's life, in cases of rape or fetal impairment.
However, even in these cases, women have to face legal and practical hurdles, and most of the time, abortion is not available or authorized too late.
The consequences of such criminalization are well known. Due to unsafe abortions, women - especially the poorest and the youngest - suffer high maternal mortality and morbidity rates.
Indeed, imposing legal restrictions on abortion does not reduce the likelihood that women will seek this reproductive health service. Instead, harsh laws compel women to risk their lives and health by seeking out unsafe abortions. In fact, Latin America has the highest proportional number of maternal deaths as a result of unsafe abortions in the world.
Legal Status of Abortion in Latin America
In Latin American the rules vary from extremely restrictive to legal and widely available. Uruguay and Cuba are the only nations in Latin America where abortion is legal and widely available. Other countries allow it in cases of rape, incest or when a mother’s life is in danger. In Chile, the Dominican Republic, Nicaragua and El Salvador, the procedure is banned completely.
But access to safe abortion not only depends on the law. It also results of implementation of measures of sexual and reproductive health in the countries.
Cécile Pouilly, spokesperson for the Office of the High Commissioner for Human Rights (OHCHR), says “in some countries that allow some legal abortions, abortion is still not available for many women, especially for the most vulnerable. Health services should always be available, accessible and affordable, of good quality and without discrimination.”
She adds that access to abortion should be considered in the context of public policies on sexual and reproductive rights. "Ensuring equal rights of women to decide the number of children and timing of them is a guarantee of a basic right”.
In Latin America, more than 97% of women of childbearing age live in countries where abortion is restricted or banned.
Unsafe Abortion and Its Consequences
According to a 2014 report by the UN's Department of Economic and Social Affairs, countries with restrictive abortion policies have much higher unsafe abortion rates and have much higher levels of maternal mortality.
The average unsafe abortion rate was more than four times greater in countries with restrictive abortion policies in 2011 (26.7 unsafe abortions per 1,000 women aged 15 to 44 years) than in countries with liberal abortion policies (6.1 unsafe abortions per 1,000 women aged 15 to 44 years).
In the same way, the average maternal mortality ratio was three times greater in countries with restrictive abortion policies in 2013 (223 maternal deaths per 100,000 live births) than in countries with liberal abortion policies (77 maternal deaths per 100,000 live births).
In Latin America, according to 2016 estimates of the Guttmacher Institute, at least 10% of all maternal deaths (900 in total) annually are due to unsafe abortion, while about 760 000 women in the region are treated annually for complications from unsafe abortion.
The most common complications from unsafe abortion are incomplete abortion, excessive blood loss and infection. Less common but very serious complications include septic shock, perforation of internal organs and inflammation of the peritoneum. Some women with untreated complications also experience long-term health consequences.
Because poor and rural women tend to depend on the least safe methods and on untrained providers, they are more likely than other women to experience severe complications from unsafe abortion.
Moreover, as post abortion services in the region are often of poor quality, women are likely deterred from obtaining needed treatment: delays in treatment, use of inappropriate interventions, inadequate access and judgmental attitudes.
Education and Legalization are the key
If the grounds for legal abortion in the region were broadened, and access to safe abortion services improved for women, the number of clandestine procedures could be reduced and women prevented from suffering and deaths. Thus, legalization would permit to reduce the high levels of morbidity and mortality that result from unsafe abortion.
Moreover, if access to family planning and post abortion care were made more equitable, the disproportionately high rates of morbidity and mortality from unsafe abortion among poor and rural women would decrease.
Also, access to adequate information on contraceptive methods, with the idea of enabling women to make decisions about whether and when they want to get pregnant, is fundamental.
In fact, contraceptive use is the surest way for sexually active couples to prevent unintended pregnancy. Programs and policies that improve women’s and men’s knowledge, of access to and use of contraceptive methods, are critical in reducing the need for abortion.
“Unwanted pregnancies and access to contraceptives, particularly in highly religious countries in Latin America, are an issue. It is a matter that falls on the side of ethics and human rights,” says Marcos Espinal, director of the Department of Communicable Diseases and Health Analysis of the Pan American Health Organization. “But what we say is that the decision of pregnancy is a decision of the woman, her partner and their doctor.
But most of these Latin American countries are also Catholic, so access to birth control is often poor and abortion is flat-out banned. “This kind of recommendation that women should avoid pregnancy is not realistic,” says Beatriz Galli, a Brazil-based policy advisor for the reproductive health organization Ipas.