Every day women die of unsafe, illegal abortions. Two recent deaths provoked uproar in Brazil.Elisângela Barbosa, a 32-year old mother of three, died of hemorrhage after a failed clandestine abortion. Days before, 27 year-old Jandira dos Santos Cruz was disappeared after an abortion turned deadly in an illegal clinic. Her body was found burned and dismembered in the outskirts of Rio de Janeiro. Both women had fallen prey to criminal gangs that spur when abortion is illegal.
These two women are no exceptions. Close to 50 thousand women die each year from complications of unsafe abortions. Millions more are injured physically, emotionally, and economically.
Ironically, much of this drama takes place in Latin America, where leftist governments are concerned with social justice and women are heads of state.
The recent deaths in Brazil generated uproar. Media covered the crimes; women’s groups launched acampaign asking Congress, the Ministries of Health and Justice, and the Supreme Court to decriminalize abortion. Yet women’s vulnerability to unsafe abortion seems to worsen rather than improve. This is one of the challenges that recently elected President Dilma Rousseff must face in her second term in office.
It is urgent that governments treat abortion as a major health crisis, instead of a criminal issue. It is also time to recognize that if keeping abortion illegal kills millions of women, it constitutes a form of femicide.
The costs of clandestine abortion
Research estimates that one in five pregnancies worldwide ended in abortion in 2008, half of them unsafe. The highest rate of unsafe abortion is in Latin America. According to the Guttmacher Institute, the region has 32 abortions per thousand women aged 15-44 compared to 29 in Africa. There are at least a million abortions practiced each year in Brazil; four per day in Ecuador. The World Health Organization (WHO) estimates that 98% of unsafe abortions take place in the developing world (90% are safe in Europe).
Unsafe abortions kills. It is the second cause of maternal death in Ecuador, the fifth in Brazil. Survivors often end up in hospitals. Dr. Susheela Singh estimates that five million women are admitted to hospital for treatment of complications from induced abortions each year in the developing world.
Keeping abortion illegal costs money. In Brazil, twelve women were hospitalized per hour from complications from unsafe abortion in 2010 – more than breast cancer. The health complications cost at least US$ 60 million annually to the national public health system. Contraception is an insufficient remedy. An estimated 222 million women in the developing world have an unmet need for efficient contraception. In Latin America, one in ten women do not meet their contraceptive needs.
What is needed is legislation securing safe access to abortion and post-abortion care. Abortion must be addressed as a public health crisis instead of being used to criminalize women.
Criminalizing poor women
Abortion remains illegal in most of Latin America. When it is not a total ban (Chile, Honduras, El Salvador, Nicaragua, Haiti, Surinam and the Dominican Republic), it is authorized only in extreme cases like a risk of maternal death (Brazil), rape (Colombia)or rape of women with dementia (Ecuador).
Women are criminalized in multiple ways. In addition to being forced into clandestine clinics, where many lose their lives, survivors are persecuted. In El Salvador, which has a total abortion ban, 17 women are unjustly incarcerated on abortion-related charges. Six of them were under 17 years old at the time of the alleged offences.
In many of these cases, abortions are the result of sexual violence. UN agencies estimate that up to 50% of sexual aggressions worldwide are committed against girls under 16 years old. In Ecuador, one in four women are victims of sexual violence; 30% of them end up pregnant. In Peru, the country with most reported cases of rape in South America, 80 % of rape victims are minors. Where abortion is illegal, minors try to induce abortion themselves jumping from roofs or drinking toxic liquids.
There are exceptions, though achievements are uneven. Abortion is legal in Cuba, Guyana, and French Guyana. Uruguay legalized it a year ago but access is mostly urban. Mexico City decriminalized it in 2007, but the procedure is still banned in the rest of the country. Peru’s government recently issuednational guidelines recognizing its responsibility to secure women’s access to therapeutic abortion, but laws still oblige medical providers to report women for the alleged crime of abortion.
In practice, abortion remains inaccessible to most Latin American women.
Part of the problem is inequality of access. Elite and middle class women can generally afford their way to safe abortion. Poor women cannot. They are the ones most vulnerable to dangerous forms of induced abortion, untrained providers in underground establishments. Unsafe abortion is largely the fate of poor women, accentuating Latin America’s social inequality even further.
The core of the problem, however, is the growing criminalization of abortion. As governments shut down private clinics that provided illegal but safe abortions and prosecute doctors, militias are taking over the business. This criminalization fuels clandestine clinics run by mafias, where impunity and lack of medical support lead to deadly outcomes. The rate of unsafe abortion is soaring.
Only paradoxes to offer
It is quite a paradox that regional processes of democratization over the last decade did not diminish the structural violence against women’s health. Leftist governments committed to social justice have steadily turned a blind eye or restricted reproductive rights. In Nicaragua, President Daniel Ortega passed an extreme anti-abortion law to gain the electoral support of the Catholic Church. This setback forced a 12-year old girl who had been raped by her stepfather to remain under “state protection” in a Managua hospital until she gave birth in 2012.
The arrival of women as heads of state was equally useless to reform abortion laws. Presidents Michele Bachelet, Dilma Rousseff, and Cristina Kirschner have yet to secure women’s rights to safe abortion.
Perhaps the political paradox would be resolved if governments understood the abortion paradox. To ban abortion does not stop it from happening. It only pushes it underground, putting women lives at risk and expanding the costs to society. Over 80% of abortions globally take place in developing countries where laws criminalize it. Abortion rates drop significantly where it is legal, such as Romania and the United States. In Eastern Europe, where the procedure is legal, safe and often free, abortion rates are much lower than in Latin America.
Amnesty International says bans on safe abortion are akin to torture. Unsafe abortion is an extreme form of gender-based violence linked to discrimination and economic disempowerment that results in the murder of women and may include mutilation, cruelty, and sexual violence.The killing of women and girls because of their gender is accepted with daily impunity and facilitated by states.
Unsafe abortion constitutes a systematic disregard for women’s inalienable human rights. Such crime has a name: femicide.
* Manuela Picq is a Professor at Universidad San Francisco de Quito, Ecuador.