Full Text

Every day, women across Latin America are terminating their pregnancies under illegal and unsafe circumstances. The number of unsafe abortions—which represent about 95 percent of the total—grew from 3.9 million in 2003 to 4.2 million in 2008, with the annual abortion rate holding steady during that period, at about 32 abortions per 1,000 women between the ages 15 to 44. That’s more than double the rate in Western Europe (12 per 1,000)—where abortion is generally permitted without exception. The high rate of unsafe abortions, which is defined by the World Health Organization as a termination of pregnancy performed by individuals without necessary skills, or under conditions that are below minimum medical standards (or both), underlines the dismal state of reproductive rights in the region. And it has had chilling consequences for poor and rural women in particular. In Latin America and the Caribbean, 12 percent of all maternal deaths are estimated to have been the result of unsafe abortion. Annually, about 1 million women in the region are hospitalized for complications ranging from excessive blood loss and infection to septic shock arising from unsafe terminations of pregnancy. Despite these dire statistics, and their dramatic effect on women’s health, the efforts to address reproductive rights have been marked by divisive politics. While there is clear evidence that criminalizing abortion does not reduce its incidence, public opinion is resistant to change. Issues of morality, religion and tradition, combined with opposition by powerful interest groups, create a potent obstacle to expanding reproductive rights. Today, seven Latin American countries outlaw the procedure completely, and three permit unrestricted abortions. The remainder allow pregnancies to be terminated under a limited range of conditions. The stakes today could not be higher. Restricting access to reproductive health services has tragic consequences for economic growth as well as public health, ranging from lost labor and steep financial burdens on state medical services, to crippling disabilities or death among women of child-bearing age. To understand what has driven policymaking in this controversial area, it is important to examine the interactions among abortion’s opponents and proponents at the local, national and global levels. One key to untangling these interactions is to recognize that the debate over abortion is not between two absolutist points of view. Most stakeholders are neither completely “pro-choice” (i.e., advocates of abortion on demand under any circumstances); nor are they strictly “pro-life” (i.e., opposed to abortion in all cases). The majority of those involved in reproductive rights discussions fall somewhere along a spectrum that allows for the procedure under certain circumstances, but perhaps not in every case. And the region’s abortion laws clearly reflect the complexity and ambiguity surrounding the issue. Reproductive Rights Today Legislation regulating women’s access to reproductive health services in the Americas varies widely, with no clear trend in one direction. In Chile, El Salvador, the Dominican Republic, and Nicaragua, for example, abortion is criminalized in every case—even when the mother’s life is threatened, or when the pregnancy is the result of rape or incest. In contrast, in Cuba, Guyana and the Anglophone Caribbean, women tend to have broader legal access to the procedure and—as a result—a lower rate of unsafe abortions (46 percent) and ensuing morbidity and mortality. Latin American and Caribbean countries can be divided into six categories according to the extent of their abortion rights restrictions. [See Figure 1] International and local pressure Abortion—a quintessentially private matter—has become a topic of intense public debate, argued in forums ranging from municipal courtrooms to international institutions. As domestic pro-choice advocates increasingly face opposition from local or national leaders, they have sought support from international non-governmental organizations such as the New York-based Center for Reproductive Rights; Ipas, a global advocacy group based in North Carolina and working with partners in Mexico, Central America and Bolivia; and the UN Committee on the Elimination of Discrimination Against Women (CEDAW). Others work with local groups that participate in pro-choice networks, such as Catholics for Choice, which has offices throughout the region. Anti-abortion forces similarly seek out alliances beyond national borders. Local dioceses and parishes receive support from global institutions, most notably the Roman Catholic Church. Its representatives, along with increasingly influential Evangelical leaders, have come to play a key role in the hemisphere’s politics. In fact, few leaders in the region today can win elections without the support of religious authorities. While global institutions have declared that women’s rights are human rights, pro-choice advocates still face staunch opposition to change when confronting domestic actors and those who back them. In the U.S., opponents and proponents of abortion are exerting pressure at the national and state levels. Although the 1973 Supreme Court case of Roe v. Wade guaranteed U.S. women the right to abortion, in recent years there have been increasing legal challenges to the procedure. As is the case throughout the hemisphere, these struggles are compounded by battles between states and the federal government over jurisdiction—and they are not exempt from influence by global institutions. In 2011, the fight over this issue in the U.S. heated up more than at any time since legalization. Some 83 laws restricting access to abortions were passed by state legislatures, in sharp contrast to 23 laws passed in the previous year. The legislative initiatives range from requiring an ultrasound prior to the procedure, to banning all abortions after 20 weeks of pregnancy and a prohibition on private insurance plan coverage in some states. The fight over abortion has similarly escalated across Latin America. Some jurisdictions and countries have made notable legislative advances. In 2006, Colombia’s Constitutional Court decriminalized abortion in limited cases. In April 2007, Mexico City legalized abortion on demand in the first trimester. However, fears that the capital city’s law would spawn similar legislation elsewhere prompted a backlash: 17 of 31 states across Mexico rewrote their constitutions to grant embryos the “right to life.” These initiatives have been promoted by legislators from the conservative Partido Acción Nacional (National Action Party—PAN) and the Partido Revolucionario Institucional (Revolutionary Institutional Party—PRI), with strong support from the Catholic Church. Argentina seems to have reached a tipping point as well. Last November, the Commission on Penal Legislation of the Chamber of Deputies approved an initiative to decriminalize abortions in the first 12 weeks of pregnancy by a 7–5 vote. Though the bill is still being debated in Congress, it has been co-signed by more than 50 representatives from a wide cross-section of political parties and ideological persuasions. In March 2012, this legislation was given a boost by the Argentine Supreme Court, which legalized abortions in cases of rape. In other places, the status quo remains; in some cases even more restrictive legislation than what existed in the past has been passed. Countries that for many years allowed therapeutic abortion when the mother’s life was at risk or in the case of rape or incest have in recent years passed measures to outlaw the procedure in all cases. These countries include Chile (1989), El Salvador (1997) and Nicaragua (2006). El Salvador, in 1999, also passed a constitutional amendment recognizing personhood from the moment of conception. Regardless of whether reproductive rights have been expanded or curtailed, the outcome has turned on two factors: the mobilization of domestic and international actors (including churches and NGOs), and judicial and legislative action. Supporters of reproductive rights in particular have found that documentation of the detrimental effects of illegal abortions isn’t enough to sway the results in their favor. The decisive drivers of policy change are horrific individual stories—often involving minors who are victims of rape and/or incest...