Latin American abortion laws hurt health care and economy – a lesson for post-Roe United States

As the United States braces for a possible decline in abortion rights later this year, seismic changes are occurring south of the border. A series of recent legal and legislative decisions have started to ease restrictions in Latin America, a region with some of the toughest anti-abortion laws in the world. And they could chart a path to reform for governments that still advocate that the procedure remain illegal. The health and economic consequences of maintaining long-standing bans may provide lessons for caution in the United States as Supreme Court decision to remove Roe vs. Wade seems imminent.

El Salvador has been distinguished by its aggressive pursuit of pregnant women who request an abortion or have a miscarriage. Since 1998, the country has maintained a total ban on abortion, even in cases of rape, incest and high-risk pregnancy. As a result, around 181 women were prosecuted between 2000 and 2019 for having aborted or suffered an obstetric emergency, according to data compiled by a human rights group.

A woman known only as Manuela was one of them. In 2008, she miscarried and went to the hospital for treatment for severe blood loss and preeclampsia. Her doctor suspected Manuela of taking steps to voluntarily terminate her pregnancy and called the police. Manuela said she lost the fetus after falling into a river while washing clothes. But she was almost immediately arrested. A few months later, she was sentenced to 30 years in prison for “aggravated homicide”. She died in 2010, after receiving erratic treatment for Hodgkin lymphoma.

On November 30, the Inter-American Court of Human Rights ruled that El Salvador had violated Manuela’s rights and was responsible for her death. The court ordered the government to compensate Manuela’s family and create a number of protocols, including one that protects patient-doctor confidentiality. Morena Herrera, head of the Citizen’s Group for the Decriminalization of Abortion in El Salvador, says the move is unprecedented in the region and could trigger much-needed changes. “It will not be automatic, I think, but recognize that the total ban [of abortion] cause of such injustices is an important step, ”she said. “It erodes the crime to which some conservative sectors are so attached.”

Pressure on the government of El Salvador continued following the decision of the human rights tribunal. Three women jailed for obstetric complications, such as miscarriage, were released by the government on December 23, bringing the number of women released since 2009 to 60, a direct result of activism by human rights groups.

The court ruling may contribute to a larger but by no means monolithic trend in which Latin America has begun to decriminalize abortion. This regional shift comes just as the U.S. Supreme Court signals it may be ready to end Roe deer v. Wade, the 1973 case which guarantees a constitutional right to procedure.

If that decision is overturned, at least 26 states are set to immediately ban or severely restrict access to abortion, according to analysis by the Guttmacher Institute, a research group based in New York and Washington, DC. which supports abortion rights. “A publication-Roe deer The United States is one with dramatically widened inequalities in access to abortion, ”says Caitlin Knowles Myers, economist at Middlebury College. “The result will be that approximately 40% of American women who reside in large parts of the South and Midwest will experience shutdowns from nearby abortion providers. “

To understand what has reduced access to abortion in aRoe deer the future might mean, some experts suggest examining Latin America’s past experiences and its current move towards easing bans. Many countries in the region have used abortion restrictions as a way to undermine the agency that women and others, like transgender men and non-binary people, keep on their bodies, says researcher Mariana Romero in Reproductive Health who runs the Center for the Study. of state and society in Buenos Aires. “What these laws seek is control,” says Romero. “And [shaping] the perception of this autonomy [to abort] as a selfish and deviant act.

The legal status of abortion across Latin America confirms her point of view. Until recently, only a handful of small countries – Cuba, Guyana and Uruguay – had decriminalized abortion. A Guttmacher report showed that more than 97 percent of women in the region lived in restricted countries in 2017. And it found that around 760,000 of them were treated each year for complications of a unsafe abortion, although the use of self-administered abortion drugs, such as misoprostol, has increased the safety of clandestine procedures.

Decades of prohibitions “have allowed us to see the most dire consequences of the disproportionate and arbitrary application of criminal law” on abortion, says Carmen Martínez López, regional manager for Latin America and the Caribbean at the Center for Reproductive Rights, a New York-based legal rights advocacy organization.

But the situation is changing. In the past year alone, Argentina has become the largest country in Latin America to legalize abortion for anyone who is pregnant who requests the procedure within 14 weeks of gestation, the culmination of a multi-year movement to expand abortion rights in the country. And last year, the Mexican Supreme Court ruled that imposing criminal penalties on those seeking an abortion is unconstitutional. Chile, which categorically banned abortions until 2017, debated a bill to ease restrictions on the procedure. And Colombians are now awaiting a potential decision to remove barriers to legal abortion and end legal proceedings against people who have had an abortion. The abortion debate intensified during the Zika epidemics in the Americas in 2015 and 2016.

Romero is the lead author of a study in six countries, ranging from Argentina to El Salvador, which revealed how access is still disparate and how abortion persists as a major public health problem. After interviewing nearly 8,000 women, her results show that nearly 50% of them experienced moderate pregnancy-related complications and over 46% mild complications. The rest performed poorly, with more than 3% who faced life-threatening consequences and 0.2% who died. The study noted that restrictive policies, as well as the stigma surrounding abortion, can make the procedure unsafe.

Complications from abortion can decrease quickly when policies are relaxed. In 2007, when Mexico City legalized abortion for the first trimester of pregnancy, women’s health improved dramatically. There was an immediate drop in hospitalizations due to blood loss, a common complication after unsafe abortion. “The magnitude of the effect is so large,” says Damian Clarke, a health economist at the University of Chile, co-author of the research. “There have been very few public health implementations where you just see it cut morbidity in half with just one law change. “

The benefits of legalizing abortion are not just related to health. In a 2021 analysis, Yana van der Meulen Rodgers, a health economist at Rutgers University, and her colleagues read hundreds of studies assessing the impact of abortion care and policies on the world’s economies, including in Latin America. “Overall, we’ve seen significant financial costs to individual women, as well as to national governments, when there are restrictive abortion laws,” Rodgers said. Women, she found, faced higher medical costs as they tended to delay abortions and seek unsafe procedures. In Latin America, medical assistance following unsafe abortion accounted for more than half of countries’ budgets for obstetric care.

For Clarke, the breadth of evidence holds a message to the United States “At the moment, however precarious it is, abortion is available,” he says. “If this is removed, we should expect a very big spike in [abortion-related] complications.”

A nascent movement has started among activist groups in Mexico to help American women access abortion pills. Several organizations are meeting in January to outline a plan to distribute abortion drugs in Texas, which enacted a new ban on the procedure in September. The goal is to create “a cross-border safe abortion support network for Texan women,” says Verónica Cruz, director of the Guanajuato-based feminist organization Las Libres, which leads the initiative. Should Roe deer v Wade being reversed, the idea is to extend this network of support to other states, she adds.

Roe deerThe potential disappearance of abortion could also have a ripple effect in countries where there is a tradition of severe criminalization of abortion. Previous US legislation had a similar effect. In 1984, the nation adopted the so-called global gag rule. Indeed, the policy, which has been repealed and reinstated several times, prohibits foreign organizations that receive U.S. funds from providing abortion counseling or advocating for the decriminalization of the procedure or the expansion of abortion services. ‘abortion.

In a 2018 book on the gag rule, Rodgers looked at data from over 50 countries and found that when the United States limited them financial aid based on whether or not they provided services to abortion or referrals, abortion rates were increasing in Latin America and the Caribbean. , as well as in sub-Saharan Africa. “There was less financial support for reproductive health services, so clinics either closed or their staff were downsized. They had fewer supplies, ”Rodgers says. This resulted in less access to contraception, more unplanned pregnancies and more abortions, many of which were dangerous due to restrictive laws.

It is not yet clear whether Roe deerthe reversal of the situation would again provoke such dramatic disturbances. But the decision would likely strengthen the ideological position of regional conservative movements in Latin America and influence legislative changes. “You cannot be naive”, says Martínez López, “even if you are optimistic”.

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