SANTIAGO (WOMENSENEWS)--Monica Maureira remembers how--as the nurses interrogated her and the doctors lectured her--she watched her hands going transparent from the blood loss.
She was 16 years old and was hemorrhaging after having had a clandestine abortion in Chile, a country where abortion is illegal and considered immoral.
"I remember the nurses telling me that if I didn't give them the name of the doctor who gave me the abortion, they would let me bleed to death," Maureira says.
She lived to tell her story, but many women don't.
Across Latin America, an estimated 5,000 women die every year as a result of clandestine abortions, according International Planned Parenthood Federation. An estimated 800,000 are hospitalized due to complications, according to the Alan Guttmacher Institute, based in New York and Washington.
Abortion is prohibited across most of Latin America. Cuba and Puerto Rico are the exceptions. While some countries allow abortion in cases of rape or danger to the mother's life, there are no exceptions in Chile, Colombia and El Salvador. These countries prosecute hundreds of women for having abortions.
Policy of Prosecuting Women
Lidia Casas, a lawyer and professor at Chile's Diego Portales University, in Santiago, says during the 1980s, Chile began a policy of prosecuting women. Between 250 and 300 cases go into the justice system per year, she says, and in 2001, around 50 people were convicted for having an abortion.
"It's mostly poor women who end up going to the hospitals for their complications of an illegal backstreet abortion and some of the doctors or the midwives working in the maternity wards used to report the women to the police right there," says Casas. The maximum penalty is five years in prison.
But despite such legal risks, Latin America continues to experience abortion rates that are much higher than most countries where it is legal.
There are an estimated 4 million abortions every year across the region. Up to 200,000 clandestine abortions take place in Chile every year--twice as many as in Canada, which has 100,000 a year--and Chile has half the population.
Rates Highest in Chile and Peru
The abortion rates are highest in Chile and Peru (where one woman in 20 has an induced abortion). In Brazil, Colombia and the Dominican Republic, it's about one woman in 30, and in Mexico approximately one in 40. (In the United States, the rate is 21.3 per 1,000 women.)
Cristina Alonso works at the Luna Maya birthing clinic in San Cristobal de las Casas, Mexico. She says there are between half a million and a million abortions a year in Mexico. And while abortion is legal in cases of rape or a threat to life, the actual mechanism to get permission to have a legal abortion is so complex that it discourages women. Alonso points out that last year in Mexico City, only 17 legal abortions were approved, yet there are 30 rapes reported to police per day there.
Ramiro Molina, a doctor and the director of the Centre for Reproductive Medicine and Public Health at the University of Chile, led a 10-year study in three impoverished communities on the outskirts of Santiago. Clinicians provided direct medical attention for women at high risk of pregnancy. A social worker also called them regularly and worked around their schedules. They had access to all birth control methods, education, counseling and follow-up visits. The abortion rate dropped 82 percent in some communities after this intense grassroots intervention.
Public health advocates cite the study as proof that abortion rates can be lowered through improved availability, delivery and quality of contraception and the establishment of post-abortion contraceptive counseling in hospitals.
In analyzing why--despite tough legal penalties, health risks and the predominant influence of the Catholic Church-- Latin America's abortion rates so high, some people put the blame on gender inequality.
Anibal Faundes, a doctor and researcher at the Universidad Estadual de Campinas in Sao Paulo, Brazil, singles out gender inequality as the No. 1 reason for the high abortion rate. He says religion isn't a deterrent, because there is an inherent hypocrisy in the region's Catholics and conservative defenders of family values, who don't always practice what they preach.
"There is a culture that is said and a culture that is done," Faundes says.
'Concrete Gender Frameworks'
Alonso agrees: "In Latin America, we still have very concrete gender frameworks in terms of male sexual behavior. Men are not supposed to be responsible for the consequences of sexual behavior, but they are supposed to be active sexually . . . Women, on the other hand, still maintain fairly strong gender notions of passivity, of wanting to trust the man. You know there's this whole idea in Latin America of romance and 'maybe if I do get pregnant he'll stay with me forever.'"
When the man doesn't stay, many jilted women turn to an abortion.
Alonso says another problem is that most of the family planning has been geared towards women and attitudes toward sexual behavior can't change without including men, who often impose sex on women.
"Much of the education is expecting women to take control of their bodies," says Alonso. "But this is a country where women don't have cultural control over their bodies. So how are they expected to make a decision over whether or not they get pregnant?"
That lack of control over when to have sex often leads to unwanted pregnancies, which often end in abortions.
Contraception Access Blocked
In Andean countries, the story is the same, says Jeanine Anderson, an anthropologist with the Catholic University of Peru in Lima. Men often resist giving their wife access to contraception because they fear losing control over her and how many children she will have, says Anderson.
"I think that in their heart of hearts, they really want to control family size," says Anderson. "That shows in their behavior. You know, they aren't having ten kids like their grandfathers did. But there is an issue of who controls her sexuality . . . Is it me, the obstetrician, or the health post, or is it me, the husband or the father, or the brother?"
A sign of women's lack of control over their fertility, says Carmen Barroso, director of International Planned Parenthood Federation for the Western Hemisphere, is the fact that at least half Latin America's pregnancies are undesired.
Reducing unwanted pregnancies requires cultural changes, says Mariana Schkolnik, a consultant, with the social development division of the U.N.'s Economic Commission for Latin America and the Caribbean. This includes adjusting traditional gender roles, erasing the social stigma attached to abortion and changing outdated family laws.
But legalizing abortion is also key, says Schkolnik, to prevent so many women from dying. She points out that where abortion is legal--such Europe and North America--the percentage of abortions performed has actually gone down. She says that's because legalization is usually accompanied by informed access to public health, education and family planning.
Claudia Lagos, journalist and author of the 2001 book "Aborto en Chile," says the topic has been avoided in Chile because it has high political costs for any politician who dares weigh in on this controversial topic. Plus, without statistics, it isn't clear who's affected, so there are no clear electoral benefits. Lagos says the Catholic Church has also been influential and not only on conservative sectors of the population.
"The Church played an important role in protecting leftists and defending human rights during the dictatorship of General Augusto Pinochet," she explains. "So when democracy was restored in 1990, a new political class that had been protected by the Church assumed power and in many ways they had to pay their dues. And that has meant avoiding some leftist issues the Church opposed, such as abortion."
Casas says she doubts abortion will become a priority for the political classes in Chile because it doesn't touch their lives.
"The political elite, or the people who have money, happen to have access to abortions under optimal conditions, a doctor, a clinic, anesthesia . . . or they can even go to Miami to a clinic, so it's not an issue for them. Poor women risk their lives."
Jen Ross is a Chilean-Canadian freelance journalist who returned to her mother's homeland a year ago to tell its untold, or under-told, stories.
For more information:
Alan Guttmacher Institute--An Overview of
Clandestine Abortion in Latin America:
International Planned Parenthood Federation--
Documents and reports:
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