Activists in Latin America battle to guarantee access to safe abortion in COVID-19 world
By Josefina Salomón & Christopher Alford
For decades, women human rights defenders across Latin America have been fighting an uphill battle to ensure sexual and reproductive rights, including access to safe abortion, are a reality for all. Over the last five months that battle has turned into a war.
The figures have been shocking for a long time. The COVID-19 pandemic has turned them into a catastrophe, with a potential bleak future.
Over the last five months, already high rates of violence against women have risen exponentially across the world. Countries such as Chile and Mexico have reported increases of more than 50 percent in calls to emergency helplines for women who are victims and survivors of violence.
Experts worry about the many women who are trapped at home with their abusers without access to a phone, a computer or anyone they can contact for help or support.
Enforced lockdowns and other barriers to mobility have also prevented many women from accessing essential health services, including sexual and reproductive health care, contraceptives and safe abortions.
The UN has painted a bleak picture of what is to come. Their latest estimates say that lockdowns over a six-month period could leave 47 million women across the world unable to access contraceptives. This could lead to an estimated seven million additional unintended pregnancies. Many could take place in Latin America, where access to safe abortions has been limited by draconian laws and a lack of information.
Experts and frontline workers worry that many of those women, trapped in vicious cycles of marginalization and violence, will turn to unsafe and life-threatening procedures. The consequences are too frightening to contemplate. But activists across Latin America have been stepping up to the challenge and designing strategies to help those in need.
'Things have changed a lot'
Johana Cepeda, a nurse and human rights activist from Colombia, says the pandemic has added additional hurdles to those that many women already faced when trying to access a safe abortion.
Voluntary termination of a pregnancy is only legal in Colombia under three specific circumstances that the country’s Constitutional Court approved in 2006: when the life or health of the woman is at risk, when the pregnancy is the result of rape, or in cases of fatal foetal impairment.
“The barriers to access range from lack of information to incorrect interpretations of the health clause of the ruling. Many consider the concept of ‘health’ as limited to having an illness but lack a wider understanding of it as including physical, mental and social wellbeing,” Cepeda explains.
Most clinics offering abortion services in Colombia are located in urban centres. With a significant proportion of the population living in rural areas, geography is often a factor that prevents women from accessing health care.
Appointment with doctors are usually booked over the phone or the internet. But since the start of the pandemic and the lockdowns that followed, many women have found themselves living in abusive situations or lacking the privacy needed to seek help confidentially.
“For women who have been in isolation with violent partners who abuse them or control their decisions, even calling for information has been extremely difficult,” Cepeda says. “Strict quarantines make it difficult for women to travel. For many, if a police officer stops them and asks where they’re going, it’s not easy to say they’re going to get an abortion.”
The Collective for the Life and Health of Women, a feminist organization that provides support for women to access legal abortions in Colombia, has documented 30 cases of women who have faced barriers when trying to access abortions between March and the end of May 2020. The unreported number is likely to be much higher. They found that private and public health services are deprioritizing any health issues not related to the COVID-19 pandemic, despite the fact that some, such as unwanted pregnancies, are particularly time sensitive.
The situation is similar in other countries across the region. In Chile, abortion has also been permitted since 2017 in just three circumstances: when the pregnancy is a result of rape, when the life of the pregnant woman is at risk, and in cases of fatal foetal impairment. Even then, a woman seeking an abortion must secure approval from two specialist doctors. Activists say these requirements amount to life-threatening hurdles.
Gloria Maira, a human rights activist and coordinator of the Action for Abortion in Chile, a network of organizations and activists working for women’s right to access safe abortions, says that, despite the recent legislation, abortion remains extremely hard to access in the country.
“There are many obstacles that limit women’s ability to make their own decisions,” Maira says. “The lack of information about the law, problems with its implementation and the difficulties when it comes to the accreditation of the reasons for the abortion are some of them. The implementation of the law has been minimal.”
Half of obstetricians in Chile are believed to refuse to provide abortions, even under the circumstances permitted under the law, due to objections on the grounds of their religious beliefs, according to a poll by the Ministry of Health. Feminist organizations say many others lack information about the law, a subject that is yet to be included in most medical schools’ curriculums.
This leaves many women with no option but to resort to life threatening back-street abortions.
Javiera Canales, a lawyer and human rights activist with Miles Chile, an organization that promotes sexual and reproductive rights, says that the figures tell a very concerning picture.
“In the last three years, we’ve documented 128 cases of access to lawful abortion by children under 14 years of age. However, in 2019 alone, there were 647 children aged 10 and 13 that were admitted to programmes for prenatal care. This tells us their lawful access [to abortions] is being blocked,” Canales says.
“The question is: why wasn’t the law applied in those rape cases? Nobody has explained this because no one has been looking at it.”
A bleak future
The difficulties in accessing health care services paint a bleak picture of the future for women in Latin America.
“Women will continue to abort,” Canales says. “Our concern is that they will turn to unsafe back-street abortions again.”
Local activists are extremely worried that a lack of access to safe abortion will lead to a rise in preventable deaths.
The organization Marie Stopes International estimates that around 1.9 million women that were served by their programmes around the world were not able to access their services between January and June 2020. They estimate that the disruption could lead to an additional 1.5 millon unsafe abortions and 3,100 additional maternal deaths.
Maira says that, in Chile, human rights organizations have been filling in the gap left by authorities when it comes to prioritizing the provision of sexual and reproductive health services for women, particularly for those living in rural areas who have less access.
“The networks are reporting an increase in the demand of safe abortions, which would not be surprising as sexual violence has also increased but the lack of abortion medication is making any response very challenging,” Maira explains.
Fernanda Doz Costa, deputy director for the Americas at Amnesty International, says that by denying turning a blind eye to women’s sexual and reproductive rights, world leaders are risking a new pandemic.
“For decades, activists across Latin America have warned of the wave of preventable deaths and health complications caused by the lack of adequate health care for women. Health authorities, the UN and the IACHR are already calling on governments to guarantee access to sexual and reproductive health services, which are essential health care and, as such, should not be suspended under the pandemic.”
Faced with a shortage of contraceptives and medicines used during abortion procedures since Chile closed its borders and the reprioritization of non-COVID-19 related health services, local activists are taking a proactive approach to helping women.
Almost as soon as the World Health Organization declared COVID-19 a pandemic, local organizations found ways to continue to provide free legal, health, social and psychological assistance online.
Miles, for example, is organizing transport for women living in cities where no doctor would approve a legal abortion so that they can reach other health centres. Other networks of activists have been expanding to reach the whole country.
Maira says part of the problem is that President Sebastián Piñera, who is a vocal opponent of the law allowing safe abortions, has kept the issue off the table.
“The pandemic is providing an excuse to the government who, since before, did not want to guarantee access to abortion,” she explains.
Things have also changed a lot in Colombia since the eruption of the pandemic as activists say reproductive health services have been deprioritized.
“We had to rethink our strategies and the way we support women, but what unites us is the need women have to access these essential services and the responsibility we feel for other women who need us,” Cepeda says.
One of the strategies they have been pushing for in Colombia is the use of telehealth in the public sector, so women can have access to the medication they need and take it at home, without the need to go to a clinic. This is a service that is already in use in the private sector, Cepeda explains.
“The situation is very frustrating,” Canales adds. “But the small battles that we win, such as seeing a woman able to access the care she needs or free herself from her aggressor are the little victories that fuel our fight.
Josefina Salomón is an independent journalist. Christopher Alford is Amnesty International’s campaigner for economic, social and cultural rights in the Americas.