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The Politics of Abortion in Latin America

12:29 pm in Uncategorized by RH Reality Check

Written by Cora Fernandez Anderson for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

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In light of the recent case of Beatriz, a 22-year-old Salvadoran woman and mother of a toddler, who, while suffering from lupus and kidney failure and carrying an anencephalic fetus, was denied the right to an abortion, it is relevant to discuss the restrictive abortion laws in Latin America and some of the reasons behind them.

Latin America is home to five of the seven countries in the world in which abortion is banned in all instances, even when the life of the woman is at risk: Chile, Nicaragua, El Salvador, Honduras, and the Dominican Republic, with the Vatican City and Malta outside the region. Legal abortion upon request during the first trimester is only available in Cuba (as of 1965), Mexico City (as of 2007), and Uruguay (as of 2012). In the rest of the continent, abortion is criminalized in most circumstances, with few exceptions, the most common of which are when the life or health of the woman is at risk, rape, incest and/or fetus malformations. However, even in these cases the legal and practical hurdles a woman has to face to have an abortion are such that many times these exceptions are not available, or by the time they are authorized it is too late. The consequences of such criminalization are well known: high maternal mortality and morbidity rates due to unsafe back alley abortions that affect poor and young women disproportionately.

The current laws ruling abortion in the region have been inherited from colonial powers. They are a legacy of the Spanish and Portuguese empires. While European women have already gotten rid of these laws many decades ago, Latin American women still have to deal with them. Why is this so?

As both scholars and activists know by now, women’s rights, like other human rights, are only respected if a movement organizes around them and puts pressure on the state to change unfair laws and policies. While feminist movements swept Europe and North America during the 1960s and 70s, Latin American countries were busy fighting dictatorships and civil wars. It is not that women did not organize, but rather they did so to oppose the brutal regimes and to address the needs of poor populations hit by the recurrent economic crises. Reproductive rights just had to wait. When democracy finally arrived in the region—in the 1980s in South American and the 1990s in Central America—feminist movements gradually began to push for reproductive rights. For example, the September 28th Day of Action for Access to Safe and Legal Abortion was launched in 1990 in the context of the Fifth Latin American and Caribbean Feminist meeting held in San Bernardo, Argentina. Since then, most countries in the region have seen mobilizations and protests around this date. However, by the time the movements began to focus on reproductive rights, the global context had changed and the conservative right had also set up a strong opposition to any change to the status quo.

The strongholds of the opposition to decriminalization lie in two places: first, the Catholic Church, and second, the ascendance of the religious right in the United States. The Catholic Church has historically been a strong political actor in Latin America, ever since its large role in the conquest and colonization of the continent by the Spanish and Portuguese crowns in the 16th and 17th centuries. The church’s influence among both political and economic elites is still a reality in the whole region with only a variation of degree among the different countries. However, the church’s strong opposition to abortion has not been constant. While the church has always condemned abortion, it used to be considered a misdemeanor and not a murder of an innocent human life, as in the current discourse. In addition, it was not until the late 1800s that the church considered that life started at conception. Until 1869, a fetus was thought to receive its soul from 40 to 80 days after conception, abortion being a sin only after the ensoulment had taken place.

Even in the beginning of the 20th century, when many Latin American countries passed their current legislation that allowed legal abortion under certain circumstances, the Catholic Church did not pose a strong opposition to these reforms. As Mala Htun explains in her research on South American abortion laws, at the time abortion reforms were passed by a nucleus of male politicians, doctors, and jurists. In addition, these reforms legalized abortion only in very limited circumstances and required the authorization of a doctor and/or a judge, and therefore represented no real threat to the dominant discourse of abortion being morally wrong. The church only began organizing against abortion decriminalization when feminist movements came together to claim the autonomy of women’s bodies threatening this consensus.

When John Paul II became Pope in 1978, moral issues such as abortion were given a priority in the church’s mission as never before. Having lived through the Soviet conquest of his home country, Poland, and experienced the repression of Catholicism and the legalization of abortion there, the Pope felt very strongly about these issues. Once many of the European Catholic countries achieved the legalization of abortion in the 1970s and 80s, Latin America, being the largest Catholic region in the world, became the battleground in which abortion policy would be fought and decided.
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You Can’t Have it Both Ways: The Interpretation of Catholic Health Policy and the Consequences for Pregnant Women

12:46 pm in Uncategorized by RH Reality Check

Written by Marge Berer for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Republished with permission from Reproductive Health Matters.

“There is only one way to be sure a woman’s life is at risk, that is, after she dies.” — Christian Fiala, 2012

 

A view of Galway Hospital and parking lot

Savita Halappanavar died at Galway University Hospital.

In 1987, the year the first Safe Motherhood Initiative was launched by the World Health Organization (WHO), there were more than half a million maternal deaths annually. The women who were dying were often anonymous and their deaths never recorded or studied. They were mainly from poor and often rural backgrounds in developing countries, such as India. A study in India published in 1999 comparing 100 maternal deaths in a Rajasthan hospital in 1983-85 to 100 in 1994-96 found that: “Most of the women who died in hospital in 1994-96 would have died at home in the earlier decade.”1 What had changed was that they had reached a hospital and were therefore no longer anonymous, but they were still overwhelmingly women living in poverty with little or no access to skilled pregnancy and delivery care. 

Contrast this with the death of Savita Halappanavar on 28 October 2012, a dentist from a privileged background in India, who miscarried 17 weeks into a very wanted pregnancy and died in the maternity ward of a hospital in Ireland, a country with a very low maternal death ratio.2 Savita’s death was anything but anonymous; her name and photograph circled the globe within days of her death and sparked street demonstrations and protests, not only across Ireland but also in many other parts of Europe and in India. Six weeks later, articles and blogs about her death continued to be published in many countries, demands by her husband for a maternal death audit were headline news, and the Irish government has been forced to consider the effects of her death for the law, health policy and the Constitution of Ireland. 

Savita’s death became iconic for a number of reasons. First, preventing maternal deaths has been a global priority since 1987 when the first WHO Safe Motherhood Initiative was launched. Since 2000, reducing maternal deaths by 75 percent by 2014 has been the main target of Millennium Development Goal No.5, and since 2010 it has been one of five main goals of the UN Secretary-General Ban Ki-Moon’s Global Strategy on Women’s and Children’s Health. Hence, maternal deaths have started to be a news item globally, with journals like Reproductive Health Matters carrying studies and the media in many countries where deaths remain frequent, reporting successes and failures to reduce deaths, and individual stories regularly.

Secondly, holding governments accountable for their failure to provide the required services, both antenatal and delivery care and emergency obstetric care, to prevent avoidable maternal deaths has become the subject of public protests by women’s rights advocates, of court cases, including in India, and of hearings by human rights bodies, particularly CEDAW, examining individual cases and making policy recommendations to governments.3

What was different about Savita’s death, however, was the fact that it was also about whether and when to terminate a pregnancy when it is not viable and the woman’s health and life are at risk, and how that intersected in Savita’s case with individual health professionals’ interpretation of Catholic health policy and the law on abortion in Ireland. 

As a committee of the Irish Parliament considers proposals to offer limited legal abortion in Ireland, this paper explores how these issues came together around Savita’s death, the interpretation of Catholic health policy and the consequences for pregnant women.

Preventing maternal deaths as global policy

Maternal deaths, especially in countries where they remain frequent, are getting more and more media coverage. The Millennium Development Goals have made countries with continuing high maternal mortality ratios4 conscious of their shortcomings, and civil society organizations are beginning to pursue justice and even compensation in individual cases. 

In India, for example, a petition for legal redress was filed in the Delhi High Court in the case of Shanti Devi, who died in childbirth in January 2010 after two high-risk pregnancies in which she received delayed and insufficient care. With the first of these two pregnancies, she fell down the stairs and afterwards could no longer feel the baby moving. Induction of the pregnancy was delayed until she required intensive care which, when she finally received it, was inadequate. With her health still very precarious, she became pregnant again six months later, went into labor prematurely at seven months, delivered the baby at home without a skilled birth attendant or any medical assistance, and within an hour after delivery, began hemorrhaging and died. This case ensured that the Court took into account not just the individual death but also the constitutional and human rights obligations of the central government of India.5

Some communities where women are at high risk because of the lack of routine and emergency obstetric care are also beginning to protest against maternal deaths. One such event took place in Uganda where, in May 2011, hundreds of concerned citizens and health professionals stormed the Constitutional Court in Kampala, Uganda, protesting the deaths of women in childbirth, in support of a coalition of activists who took out a landmark lawsuit against the government over two women who bled to death giving birth unattended in hospital.6

Another example from India comes from Barwani district, Madhya Pradesh, India, where there were local protests against 27 maternal deaths in the period from April to November 2010. In January 2011, an NGO fact-finding team found an absence of antenatal care despite high levels of anemia, absence of skilled birth attendants, failure to carry out emergency obstetric care in obvious cases of need, and referrals that never resulted in treatment.7

Events like these are making the governments concerned highly sensitive to criticism. As an upper middle-class woman, Savita Halappanavar would have been highly unlikely to die in India from the appalling treatment experienced by Shanti Devi or the tribal women in Barwani. Yet, ironically, the Indian government was among the first to criticism those in Ireland who failed to prevent Savita from dying. For example, India’s ambassador to Ireland said that Mrs Halappanavar may be alive if she had been treated in India.

Emergency obstetric care, termination of non-viable pregnancies and Savita’s death

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