When the tide begins to turn for women in Latin America, the right wakes up. An article in the New York Times this week reports on the growing list of abortion restrictions being passed in states in Mexico since the country’s capital legalized elective abortion some three years ago.
Archive for unwanted pregnancy
I would like to bring to my readers’ attention a few articles that have emerged in the last couple of weeks highlighting the particularly vulnerable situation of immigrant women seeking access to reproductive health care, especially abortion. In light of recent debates in the U.S. on immigration reform, including the anti-immigration legislation passed in Arizona and other states, it seems particularly important to consider how these policies affect the reproductive rights of women immigrants. In general, the forecast is not good–while ABC News notes that immigrant women are frequently customers of “cheap, do-it-yourself abortion,” guest writer Marcy Bloom of the blog “Trust Women” points to the dual attacks of the right on immigration and reproductive rights. I encourage you all to read these pieces, and join in on the debates.
This week, a variety of news bits on Bolivia and reproductive rights around the world.
First, a story of social and political conflict in Bolivia’s Potosí department, where for the past 18 days, strikers have blocked roads and led social protests in the area. Protestors are attempting to hold the Evo Morales government responsible for a number of projects that, although promised some time ago, have scarcely advanced. The projects include an the construction of an international airport in the city of Potosí, the establishment of a new cement factory in the region, and government preservation of the historic Cerro Rico–the mountain pictured below whose silver deposits essentially financed the Spanish conquest of Latin America over 500 years ago.
The Andean Information Network (AIN) interprets recent protests in Potosí as evidence that Evo Morales’ traditional bases of support are disappointed with the administration’s failure to keep its promises. While the Morales government often describes protests as led by the right wing, the AIN notes that, “seventy-eight percent of Potosí voters chose Morales in the 2009 presidential elections, second only to voters in the La Paz department.” La Paz’s paper La Razón reports today that a variety of officials of the Morales government have been in negotiations with the Potosí protestors, and that some progress has been made on at least one point of contention, the plan to construct an airport. However, hunger strikes and street blockades have continued, since five other major grievances have not yet been addressed. Meanwhile, in the city of Potosí, families have been subsisting largely on noodles and rice, since blockades have prevented meat from reaching local markets.
None of the coverage of the Potosí protests that I have encountered thus far has discussed women’s particular participation in the protests or how women and girls are being affected by the conflicts. In similar mobilizations in Bolivia, however, women have taken an active role.
As political conflict rages in Bolivia, Argentina received an embarrassingly poor report card last week on women’s reproductive and sexual rights. Last Tuesday, Human Rights Watch released a 52-page report chronicling, “the many obstacles women and girls face in getting the reproductive health care services to which they are entitled, such as contraception, voluntary sterilization procedures, and abortion after rape.” Regular readers will remember that these are also common problems in Bolivia. Their prevalence in Argentina, however, is even more appalling considering that this country’s socioeconomic indicators tower above those of Bolivia, even after the economic crisis of 2000-2001.
Similar to conditions in Bolivia, the report, entitled, “Illusions of Care: Lack of Accountability for Reproductive Rights in Argentina,” notes the high prevalence of illegal abortion, high rates of maternal mortality due to abortion, and the failure of judges and doctors to authorize and perform those abortions that are legal (ie., in cases of rape). Access to contraceptives is also restricted due to a variety of issues, such as long waits at clinics, the (unauthorized) demand that a husband sign for a woman’s sterilization procedure, and financial costs. These issues–and other, similar ones around the world–prompted one Guardian blogger to call for a UN agency specifically devoted to women. That’s an idea that’s easy to get behind.
The Human Rights Watch report on Argentina can be downloaded here.
Finally, good news from the U.S.A.: the Food and Drug Administration (FDA) in that country approved a new pill to be used to prevent pregnancy after intercourse. The medication, called “Ella,” is considerably more effective than the morning-after pill that is currently on the market, Plan B. While Ella will prevent pregnancy for up to 5 days following sex, Plan B is only effective for 3 days, and becomes less effective the later it is taken after the event.
This move by the FDA has been interpreted as “evidence of a shift in the influence of political ideology at the FDA,” since its approval moved more quickly than that of Plan B, and, as one activist mentioned, was “‘based on scientific evidence, not politics.’” This does not mean that the battle has been won, however–anti-abortion activists have been quick to describe Ella as an abortifacent, and some are planning campaigns against the drug. At the moment, women can obtain Ella with a prescription from their health care provider at any time, so they can keep a supply at home. Go get yours today!
This week, New York Times blogger Nicholas Kristof opines, “my sense is that the illegality of abortion isn’t as large an element in maternal mortality as some people believe it is.” On the one hand, Kristof points to a certain truth–just because abortion is illegal does not mean that it is not available. Thousands of women undergo relatively safe abortions every day in countries where the procedure is illegal. However, in these same countries, many more thousands of women end up getting unsafe abortions, since the key to accessing a safe pregnancy termination is usually money. And most women worldwide–let’s face it–are poor.
The problem with abortion’s illegality is that it creates a class-based abortion industry, where women with money can access safe procedures, but women without, cannot. Since where it is illegal abortion officially does not occur, government and public health officials can ignore the glaring class disparities in abortion care and in the resulting maternal deaths. Since it is difficult to regulate an industry that officially does not exist, unscrupulous, unsafe abortion clinics exist alongside relatively safe medical centers, and most women do not have the information they need to make careful decisions about which to visit.
Reflecting on Kristof’s comments, I am further struck by how many aspects of unwanted pregnancy operate on the margin of the law in Bolivia. The illegality of abortion–just one strategy for confronting unwanted pregnancy–is by far the most glaring. Womankind estimates that 30,000 illegal abortions occur per year in Bolivia. According to the country’s penal code, the individuals who perform abortions and the women who have them are subject to incarceration for three to six years. However, as of 2004 only two judicial cases were ever brought against abortion practitioners, and both cases were later dismissed by the Supreme Court. As far as I know, no woman has ever been incarcerated in Bolivia for having had an abortion. In other words, the law criminalizing abortion doesn’t work on two fronts–it doesn’t prevent illegal abortions, and it doesn’t penalize abortion practitioners or the woman who undergo the procedures. Finally, as I have mentioned before, laws allowing for legal abortions in Bolivia–in cases of rape, incest, or to protect the woman’s health–are equally ineffective. Since 1973, when a stipulation was made in Bolivia’s penal code to allow abortion in the above cases, only a handful of legal abortions have ever been performed.
Other women, when met with unwanted pregnancy, end up abandoning their children rather than having abortions. This may be because they are so traumatized by the pregnancy, or too poor to afford an abortion, that they are unable or unwilling to terminate the pregnancy before the child is born. In other cases, women may abandon children that were and are “wanted” due to crushing economic circumstances or domestic abuse. While some women will abandon infants in orphanages like the one pictured in this post, others will leave their children with neighbors, on street corners, or, notoriously, in garbage bins. Like laws penalizing women who get abortions, laws targeting parents who abandon their children seem to be equally ineffective–in 2003, the national police registered two cases of child abandonment in the La Paz department, while local anti-abandonment activists argue that 17,000 children are abandoned in the country yearly.
Regardless of where they are left, most abandoned children will end up in orphanages. Orphanages in Bolivia come in several varieties; some depend on the state, some on private institutions and donors, and still others are illegal and even clandestine, with no relationship to local authorities. One association of young people who grew up in orphanages recently told me that children residing in illegal orphanages have little chance to be adopted–at least not through legal channels. (Even worse, sexual abuse in all types of orphanages is apparently the pan de cada día, or an everyday occurrence.) While adoptions do take place, most Bolivian parents hope to adopt children under the age of one, who they can pass off to neighbors as a natural child. The bureaucratic processes required to adopt children are so lengthy, however, that few children are adopted before they reach their first birthday, and once s/he turns one year old, a child’s chance of being adopted plummets.
Although it is difficult to find trustworthy data, activists in the fields of child abandonment and adoption insist that illegal adoptions are likely more numerous in Bolivia than legal ones. While some of these adoptive parents have discovered children on their doorsteps or taken in kids from neighbors and friends, others, desperate to adopt, resort to illegal channels to bring kids home from orphanages. Even adoptive parents who have completed the adoption process legally admit that they were tempted to go the illegal route to avoid the costly and lengthy processes associated with adopting a child. Because of the increased legal and ethical issues involved with international adoptions, most of these are subject to rigorous scrutiny to ensure their legality. Since the rise of President Evo Morales, however, international adoptions face new restrictions and are on the decline. In the meantime, nearly all of the orphanages in La Paz and El Alto are facing serious over-crowding–even the illegal ones, to which the state, when in a pinch, occasionally sends children.
In sum, abortion is not the only consequence of unwanted pregnancy that is illegal in Bolivia–child abandonment, the housing of abandoned children, and even adoption often operate under the table. On the one hand, these institutions, even illegal, function–women get abortions, and children are adopted. But how well do these institutions function? I must say that I have to disagree with Kristof. Illegal abortion does lead to devastating rates of maternal death. Illegal child abandonment, and the housing of these children in clandestine orphanages, leads to children who lack the possibility of legal identities and families. When the state allows problems of this magnitude to languish in dubious legal territory, it reserves the right to ignore their consequences. But avoidance will not work forever. Eventually, something has got to change.
A couple of recent events have revealed the fragility of women’s right to choose in Latin America and in the United States, despite laws guaranteeing abortion access in those countries (or at least, under certain circumstances).
A few weeks ago, in a piece for Womanist Musings, I commented on the case of a nine-year-old-girl in Brazil who, after much difficulty, succeeded in securing a legal abortion when a rape left her pregnant with twins. In that case, the Brazilian Archbishop ex-communicated the entire medical team that performed the procedure, along with the girl’s mother. Now, RH Reality Check brings us the story of another young girl, raped and impregnated by her step-father in Quintana Roo, Mexico. According to the local reproductive rights group, GIRE (Grupo de Información en Reproducción Elegida), the pregnant girl and her mother “received biased information from authorities about their rights and access to abortion.”
As in Bolivia and in many other areas of Latin America, women in Mexico who become pregnant as a result of rape are legally permitted to have an abortion. However, in practice, the bureaucratic processes necessary to secure a legal abortion, as well as the tendency of anti-abortion authorities to pressure women against the procedure, make cases of legal abortion fairly rare. This is not, as many have pointed out, because rape is rare: Marcy Bloom, of GIRE, notes that in 2009 alone, 881 women in the Mexican state of Quintana Roo “became pregnant as a result of rape.”
After some deliberation, this young Mexican girl and her family have decided to continue the pregnancy and keep the child. Still, anti-choice activists in the country have used the case as an opportunity to attack pro-choice groups like GIRE, arguing that the organization attempted to pressure the girl to get an abortion. In fact, women who become pregnant as a result of rape in Mexico are much more likely to be pressured by anti-choice elements to give up their legal right to abortion (see the RH article for a number of examples).
In case you are tempted to believe that legal abortion is so difficult to secure in Latin America because of the restrictions surrounding the procedure, think again: this week, abortion access suffered a major blow in the U.S. state of Oklahoma, where Roe v. Wade ostensibly extended abortion rights to women over 30 years ago. Thanks to the Oklahoma Legislature, women seeking abortion in that state will now have to view ultrasound images and “listen to a detailed description of the fetus.” Like the 24-hour wait law and other obstacles to abortion access, the Oklahoma measures display the profoundly condescending notion that unless forced, women will not think deeply about their decisions to have an abortion. That, unless the state imposes its own definitions of “thoughtfulness” and “consideration” onto women’s abortion decisions, then women will approach these decisions with frivolity and disdain.
The photographs in today’s posting were provided by a guest photographer.
When women were granted the vote, we were supposedly recognized by the state as “adults” capable of making independent decisions and of running for office. Restrictions to abortion access, however, return women to the realm of childhood, where we are deemed wards of the state who cannot be trusted with decisions impacting our own bodies and reproductive lives. These three stories reveal a painful truth–that we cannot trust the law. Laws alone will not protect us. Access to legal abortion–and “permission” to act as capable adults–are still a long way off.
Last week, The Lancet published an online study on worldwide maternal mortality that showed significant improvements in maternal death rates since 1980. Although it continues to sport the highest maternal mortality rate in Latin America, Bolivia emerged of the few countries that is demonstrating “accelerated progress” in this area. The full article may be accessed here:
According to the study, the major factors that have contributed to reducing maternal mortality rates in the last 30 years include dropping total fertility rates, increased income and educational levels among women, and an increase in skilled birth attendants.
Although it is somewhat difficult to measure, I would imagine that in the Bolivian case another factor has contributed to reducing maternal mortality: the Ministry of Health’s program for the treatment of hemorrhages in the first half of pregnancy. Facing high rates of maternal death in part due to complications from abortion, in 1998 the Ministry instituted a program to deal with the public health implications of illegal abortion without touching the legal issue of abortion itself. The program trains medical providers in the use of the cheap, effective, and safe manual vacuum aspirator (MVA) technology for the solution of incomplete abortion and miscarriage, and in extending non-judgmental care to women who may have attempted to provoke their own miscarriages.
Under the current provisions of the program, a woman experiencing vaginal bleeding in the first twenty weeks of her pregnancy can visit any public health facility to receive an MVA treatment for free under the Seguro Universal Materno Infantil (the universal maternal-child health insurance). Unlike in the early 1990s–when doctors would sometimes refuse women treatment until they provided the name of the person who had provoked their abortion–medical providers are now prohibited from questioning women about the circumstances of their bleeding. Prior to the introduction of this program, women experiencing bleeding in pregnancy were often too scared to go to a hospital for treatment, which often led to severe infection and even death. Although it is difficult to measure with precision the effects of the hemorrhage treatment program, the Ministry of Health believes that it has greatly reduced maternal deaths due to abortion.
Although legalizing abortion and regulating the facilities that provide it is likely the most effective (and most just) means of reducing abortion-related death, the Ministry’s hemorrhage treatment program is perhaps a good stepping stone toward that end. With the program for the treatment of hemorrhages in the first half of pregnancy, the Ministry is recognizing and elevating the public health aspects of abortion over questions of politics and the supposed protection of (fetal) “life.” Thanks to the dedicated work of individuals of conscience, this program provides an opportunity to keep Bolivia on the right track toward the reduction of maternal deaths. Hopefully, the next step will be the provision of legal and safe abortion to any woman who decides that she needs it.
This week, the La Paz daily, La Razón, reported on an upcoming campaign to vaccinate 30,000 Bolivian girls between the ages of 9-13 against the Human Papillomavirus (HPV), one of the leading causes of cervical cancer. The campaign, which will vaccinate girls in five cities and one rural community in Bolivia between April 6-10, is being carried out by the Centro de Información, Educación, y Servicios en Salud Sexual y Reproductiva (CIES) in cooperation with the Ministry of Health. The vaccinations will be provided without cost, and will be distributed at schools and in public health centers in the areas of highest cervical cancer incidence in the country–El Alto, Oruro, Potosí, Trinidad, Sucre, and in rural areas outside of the city of Sucre. According to Wilma Pérez, the author of the article, “Bolivia has one of the highest rates of mortality due to uterine cancer in the world,” with “five women dying daily from the disease.” The World Health Organization reports that cervical cancer is the leading cancer affecting women in Bolivia.
According to EhealthMD, poverty and failing to get regular pap test screenings are among the leading risk factors for cervical cancer. Since women who suffer from cervical cancer generally show few symptoms until the disease is quite advanced, a yearly pap test–which detects changes in the cells of the cervix that can be related to cervical cancer–is the best way to catch the disease early on. Women who are poor generally know less about the causes of cervical cancer and the importance of yearly screenings, have less access to sexual and reproductive health services, and are frequently malnourished–a condition which also increases the risk of cervical cancer. Since Bolivia is the poorest country in Latin America apart from Haiti, it is not surprising that it also displays one of the highest rates of death from uterine cancer in the world–according to the WHO study cited above, only 28% of women in Bolivia report ever having had a pap exam.
Although I am as yet unable to provide concrete statistical data on these themes, my own research seems to support the conclusions of the articles cited above. Since beginning research in Bolivia, I have examined thousands of gynecological and obstetrical records from prominent La Paz and El Alto hospitals stretching from the mid-1950s to 2009. Anecdotally, I can attest to the fact that the majority of women seen at these facilities across these years report never having had a pap test. A smaller majority report having had perhaps one or two pap tests across their entire reproductive lives, rather than the yearly test that is recommended. The number of patients that report to hospitals with advanced cervical cancer seems astounding; many of these women die during their hospital stays.
Another fact that I have noticed in these records, which you can interpret how you like, is this: those women who report having had more than three pap smears in their lives are also more likely to report having used some method of birth control (including the rhythm method), and are more likely to report having had an abortion.
It seems very unlikely that any one of these factors–birth control use, pap tests, or abortions–causes in any direct way any of the other two factors. Instead, it seems to me that each one of these factors corresponds to a degree of control that women are exercising over their own sexual and reproductive lives. Women who get yearly pap tests or who use birth control to limit or to space their births are, through these actions, declaring a sense of autonomy over their bodies, sex lives, and reproductive choices. And women who have abortions, I would argue, are also exercising this autonomy. Although few women actually want to experience an unwanted pregnancy or to have an abortion, many women who do choose abortion–particularly young women–report that the experience made them more mature, responsible adults, since for many, it was the first time they were forced to make a truly autonomous decision about their lives. So, perhaps it should not surprise us that women who have had abortions in Bolivia also get pap tests and use birth control. The conditions of these women’s lives have allowed them access to information and services in sexual and reproductive health, which have given them the tools to exercise control over their own bodies–something that many Bolivian women lack.
A final note: it seems sort of ironic to me that the HPV vaccination campaign has been timed so close to Easter, a holiday that is widely celebrated in the largely Catholic country of Bolivia. The HPV vaccine has drawn criticism from right-wing and religious elements in other countries due to the belief that girls who are vaccinated–like girls who have access to birth control–will have sex earlier than girls who are not (or do not). Instead, opponents of the vaccine believe that young people should not be taught about sex, have access to birth control, or be protected from HPV, and that this will simply prevent adolescents from having sex. This profoundly sex-negative message–which was institutionalized in the U.S. through abstinence-only education in many schools during the Bush years–has proven to only increase rates of adolescent pregnancy and STI infection. Fortunately, right-wing forces have not derailed the HPV vaccination campaign in Bolivia. So, during the week following Easter, 30,000 Bolivian girls will receive something much more valuable, though perhaps less tasty, than chocolate eggs.