The Politics of Abortion in Latin America: Public Debates, Private Lives 9781626378421

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The Politics of Abortion in Latin America

The Politics of Abortion in

Latin America PUBLIC DEBATES, P R I VAT E L I V E S

Jane Marcus-Delgado

b o u l d e r l o n d o n

Published in the United States of America in 2020 by Lynne Rienner Publishers, Inc. 1800 30th Street, Boulder, Colorado 80301 www.rienner.com

and in the United Kingdom by Lynne Rienner Publishers, Inc. Gray’s Inn House, 127 Clerkenwell Road, London EC1 5DB © 2020 by Lynne Rienner Publishers, Inc. All rights reserved Library of Congress Cataloging-in-Publication Data Names: Marcus-Delgado, Jane, 1961– author. Title: The politics of abortion in Latin America : public debates, private lives / by Jane E. Marcus-Delgado. Description: Boulder, Colorado : Lynne Rienner Publishers, Inc., 2020. | Includes bibliographical references. Identifiers: LCCN 2019014161 | ISBN 9781626378063 (hc : alk. paper) Subjects: LCSH: Abortion—Latin America. | Abortion—Government policy—Latin America. Classification: LCC HQ767.5.L37 M37 2020 | DDC 362.1988/80098—dc23 LC record available at https://lccn.loc.gov/2019014161

British Cataloguing in Publication Data A Cataloguing in Publication record for this book is available from the British Library.

Printed and bound in the United States of America

The paper used in this publication meets the requirements of the American National Standard for Permanence of Paper for Printed Library Materials Z39.48-1992. 5 4 3 2 1

I Had an Abortion

I had an abortion and I am the housekeeper in apartment 5A I had an abortion and I am the Ministry of Health official I had an abortion and I am your children’s teacher I had an abortion and I am the neighborhood activist who distributes the handouts I had an abortion and I am the taxi driver’s wife who takes you dancing I had an abortion and I am the nurse who monitors your blood pressure I had an abortion and I am the university professor who talks about “gender” I had an abortion and I am the newsstand worker who knows your brand of cigarettes I had an abortion and I am the newspaper street vendor who reserves the Sunday paper for you I had an abortion and I am the congresswoman who votes for laws against women I had an abortion and I am the teenager who studies in a private school I had an abortion and I am the artist who paints the faces of poverty I had an abortion and I am the obstetrician who delivers your births I had an abortion and I am the cell phone saleswoman who works in the street I had an abortion and I am the supermarket cashier who asks for a break I had an abortion and I am the prostitute you visit on Thursdays I had an abortion and I am the factory worker who sleeps on the bus I had an abortion and I am the judge who guarantees a secular state I had an abortion and I am the journalist who tolerates misogynistic jokes

continues

I had an abortion and I am the model you admire in magazines I had an abortion and I am the veterinarian who looks after your cats I had an abortion and I am the psychologist who listens to your problems I had an abortion and I am the lawyer who defends rapists I had an abortion and I am the disabled person who was raped by her uncle I had an abortion and I am the Catholic who beats my chest at Mass I had an abortion and I am the bisexual whose condom broke I had an abortion and I am the successful athlete that you follow fanatically I had an abortion and I am the one at the government office who receives your requests I had an abortion and I am the striker who blocks roads to fight hunger I had an abortion and I am the police officer who arrests you because you aborted I had an abortion and I am the disappeared by the genocidal military I had an abortion and I am all the women who in this country are forced into motherhood I had an abortion and I am all women who die from clandestine abortions I had an abortion and I am all women who survive a clandestine abortion I had an abortion and I am all women who shout and declare: MY BODY IS MINE! —“Fugitivos del Desierto,” Neuquén, Argentina Translated by J. Marcus-Delgado Reprinted by permission of the author

Contents

Acknowledgments 1 2 3 4 5 6 7 8

The Politics of Abortion in Latin America

ix

1

Intersections of Morality and Political Reality

27

Pressure from Below

65

From Revolution and Reform to “Right to Life” When Civil Society Meets Uncivil Opponents Private Lives on the Global Stage Outside Forces at Work

The Promise of Public Debate

List of Acronyms Bibliography Index About the Book

vii

45 85

103

123 143

155 157 169 181

Acknowledgments

Abortion is a quintessentially private act that has been thrust into the public sphere. Its politics disproportionately victimize lowerincome and marginalized women and girls, whose access to power has been circumscribed throughout Latin America’s history. Those who have spoken out—as advocates, government actors, scholars, and private citizens—have given voice to the issue. But their work is made possible only because affected individuals have had the courage to come forward and demand reproductive justice. This book would not exist if together they had not challenged the dire state of abortion politics in Latin America’s very public arena. The book emerged from conversations with Joan Caivano of the Inter-American Dialogue. Joan has spent decades facilitating encounters among the Western Hemisphere’s women leaders, with the unwavering goal of improving the lives of women and girls. We began a series of discussions that led to several articles, talks, and gatherings; Joan is the single driving force behind this book. She also collaborated on the volume through her writing and analysis and our shared conversations with representatives from the Center for Reproductive Rights, Catholics for Choice, International Planned Parenthood, Ipas, Human Rights Watch, Amnesty International, and political actors and advocates. I am grateful for her intelligence and support, as well as for the kind hospitality and friendship that she and Eileen Kessler have shown me over the years. Several other professionals supported the writing of this book, and I thank Julia Burch, Cynthia Wilcox, and especially Mary Dempsey for ix

x

Acknowledgments

their help and encouragement. Two anonymous reviewers also provided very useful critiques of the work, for which I am extremely grateful. I am also indebted to Carrie Broadwell-Tkach and Lynne Rienner for their unequivocal backing of this project. Dee Redwine and Gina Margillo of Planned Parenthood Federation of America also provided much needed information and contacts for my research. Patricia Vera, formerly with the Instituto de Estudios Peruanos, assisted with early research. And valeria flores of Neuquén, Argentina, graciously allowed me to include her group’s poem in this volume. My friends, colleagues, and students at the College of Staten Island of the City University of New York are the heart and joy of my professional life. I thank Valeria Belmonti, Joan Campione, Stephen Ferst, Richard Flanagan, Roshen Hendrickson, Giancarlo Lombardi, Florinda Mattia, Gerry Milligan, Anat Niv Solomon, Michael Paris, and especially Natalie Kimball—and many others—for their camaraderie and for providing me with such a wonderful and fulfilling work environment. I would be remiss in not acknowledging the brilliant people who inspire me every day: my friends Laura Pirott, Nancy Zlotsky, Anne Libby, Darya Geetter, Talia Schaffer, and LoriJeane Moody; my sisters, Ruthanne Marcus, Laura Marcus, and Penny Leto; and my stepmother, Dora Marcus. I cannot fail to mention my late father, Philip Marcus, who first introduced me to Latin America through its literature and whose wit and wisdom have reverberated throughout my life. This book is dedicated to three people: my late mother, Marcia Grace, whose example as a warrior for social justice permeates every fiber of my life and work; my daughter, Liz, the embodiment of love and goodness; and Carlos, my husband, best friend, unflinching supporter, and constant companion. And, finally, this book honors the work of the courageous girls and women, the righteous health-care providers, the outspoken politicians, and the countless feminists who fight tirelessly for abortion rights. May their descendants look back on their struggle with appreciation and due respect.

1 The Politics of Abortion in Latin America

pies. It is a private decision that rests in the public arena. It is a public health issue that overlaps with reproductive—and, more basically, human—rights. It can make or break political careers, arouse dormant constituencies, and spark local and global outcries. It is darkly intertwined with rape and other violence against women. It is also an economic issue that directly affects the participation of women in public life. There are few places in the world where the drama, trauma, dialogue, and, indeed, battle surrounding abortion rights is more complex than in Latin America. Every year, millions of women and girls worldwide face unintended pregnancies. Methods of contraception are not readily accessible, or, when they are, they fail. Some of these pregnancies affect women who are unaware of the need for birth control or who believe themselves to be too young or too old or unable to conceive. For others, the pregnancies result from rape or incest. There are also pregnancies—planned or not—that threaten the health of women or endanger their potential offspring. These include pregnancies in which the fetuses are seriously compromised by outside dangers, including exposure to phenomena such as the Zika virus. In many countries, whether to terminate a pregnancy—because of health, economics, family size or circumstances, sexual violence, or other reasons—is recognized as a personal decision. While the state may regulate it as a medical procedure, it does not otherwise interfere. In these countries, sanctioned procedures range from medical abortions, which are

Abortion distinguishes itself by the complex space it occu-

1

2

The Politics of Abortion in Latin America

achieved through the use of pharmaceuticals, to surgical abortions. Other countries are more restrictive, allowing certain medical options, but not all, and circumscribing when a pregnancy may be ended, often predicated on whether rape or incest is involved, whether the woman’s or fetus’s health is endangered, or how advanced the gestation period is. There are twenty-six countries around the globe where abortion is banned under all circumstances, with no exceptions. Six of them are in Latin America. Latin America is a hostile place for girls and women who seek to end their pregnancies. Only one country permits abortion on demand. In the rest, the restrictions vary, but, overall, procedures to terminate pregnancies are restricted or banned in more than 97 percent of the region. Indeed, there are women—and girls—in prisons whose only “crime” is that they ended their pregnancies. Abortion rights have been won, lost, won, and lost again throughout the region. The judiciaries in some countries have forced children— impregnated through rape—to give birth; judges have also ordered women imprisoned on murder charges after they experienced miscarriages. Doctors and other medical personnel have been forced to navigate the chilling effect of legislation that can send them to jail for ending pregnancies even in life-threatening circumstances or for failing to inform on others who do. These legal barriers have mobilized groups to rise up in protest and resistance, and they have diminished the region’s standing on the global stage. Meanwhile, legal or not, abortions continue—as they always have. Statistics Tell the Story In Latin America and the Caribbean, more than 6 million pregnancies are voluntarily terminated each year. Women with access to legal, safe, and affordable abortion services end their pregnancies under the care of trained medical professionals in a timely manner in a sanitary environment. But they are the minority. For most other women, the abortions take place illegally, in unregulated and precarious settings; some of these women die as a result. The toll taken by abortion bans is formidable. They affect the ability of women and girls to get an education, to contribute economically to their families and communities, to enjoy good health, to thrive financially. These personal setbacks in turn exact a cost on the nation. Regardless of this, the path to reform is arduous, and the current state of abortion rights in Latin America remains woeful.

3

The Politics of Abortion in Latin America

Cuba stands alone in allowing women an unrestricted right to choose. In the Dominican Republic, El Salvador, Haiti, Honduras, Nicaragua, and Suriname, the procedure is criminalized under all circumstances, even when the mother’s life is threatened or the pregnancy is the result of rape or incest. Between those two positions lay the rest of the countries, each sidled up against a range of caveats and restrictions. In Uruguay, abortion is legal up to the twelfth week of gestation, although there is a five-day waiting period before the procedure can be performed. In Mexico, abortion is legal in the national capital but not in states outside it. Colombia’s exception to its anti-abortion laws includes fetal “malformations” in addition to threats to the mother’s health or cases of rape and incest. Table 1.1 demonstrates the extent to which abortion is proscribed in the region.1 Table 1.1 Legal Access to Abortion in Latin America by Country

Country

Argentina Bolivia Brazil Chile Colombia Costa Rica Cuba Dominican Republic Ecuador El Salvador Guatemala Haiti Honduras Jamaica Mexicoa Nicaragua Panama Paraguay Peru Suriname Trinidad and Tobago Uruguay Venezuela

No X X X X X X

X X X X X X X X X X X X X

X

X

Yes

X

To Save Mother’s Life X X X X X X

To Preserve Mother’s Physical/Mental Health X X

X

X

X

X X X

X

X

X

X

X X X X

Impaired or Nonviable Fetus

X X

X

X X X

In Cases of Rape or Incest

X

X X X

X

X

Source: Singh et al., Abortion Worldwide 2017; World Bank, Teenage Pregnancy; Guttmacher, “Fact Sheet”; updates by the author. Note: a. In Mexico, the exception is Mexico City, which in 2007 decriminalized abortion.

4

The Politics of Abortion in Latin America

The situation in Latin America is as paradoxical as it is urgent. By most measures, the legalization of abortion is gaining momentum globally. At the same time, while the overall number of abortions in developed countries has declined, it has risen in Latin America and the Caribbean. Some 4.4 million abortions took place across Latin America from 1990 to 1994; that figure jumped to 6.5 million between 2010 and 2014. The latter statistic is especially significant in South America, which accounted for 4.6 million abortions in the four years ending in 2014, up from 3.1 million two decades earlier.2 Although the increase is mainly due to greater numbers of women of child-bearing age, the rate of illegal and unsafe abortions is alarming. Even in Colombia, where legislation was passed in 2006 to expand the circumstances under which abortion is permitted, more than 90 percent of all abortions are illegal. Unsafe abortions account for 31 percent of the maternal mortality rate in Argentina.3 Similar statistics pepper the rest of the continent. Despite these alarming data, the region’s leaders maintain a stubborn opposition to legalizing the procedure. They ignore study after study that shows criminalizing abortion does not reduce its incidence. In fact, the biggest consequence of keeping abortion illegal is to make the procedure unreliable and even life threatening for women and girls. Quite simply, if abortion is to be safe, it must be legal. Most legal abortions are relatively uncomplicated medical procedures. In industrialized countries, about 90 percent of legal abortions are considered safe. (In the United States, about 99 percent of legal abortions fall into the safe range.)4 In contrast, nearly half the abortions in Latin America and the rest of the “developing” world are deemed unsafe by the World Health Organization (WHO). A 2017 WHO study divided abortions into three categories: safe, less safe, and least safe. In Latin America and Africa, only 25 percent fell into the first category. Latin America fared slightly better than Africa because many women in Latin America had been gradually shifting away from the most dangerous methods for ending pregnancies and toward home-based pharmacological treatments.5 Still, while medications for ending early pregnancies can be trustworthy, women in the region often use them without oversight as to the drugs’ quality, without sufficient information, or without reliable experts to provide support in administering the drugs. Separate research concluded that among the more than 55 million abortions that took place around the world between 2010 and 2014, some 25.5 million were unsafe,6 and 97 percent of those unsafe procedures took place in Latin America, Africa, and Asia. As the WHO report noted, the countries with the highest proportions of safe abortions were also the ones with the least restrictive

The Politics of Abortion in Latin America

5

reproductive rights laws. As if to underscore this, Latin America ranks at the top of an alarming list: it has the world’s highest proportional number of maternal deaths due to unsafe abortions, with approximately 2,000 women dying annually. Furthermore, according to the Guttmacher Institute, approximately 760,000 Latin American women are hospitalized each year to treat complications from unsafe abortions.7 These include the effects of drinking toxins, such as turpentine and bleach, or swallowing concoctions mixed with livestock manure. They also include injuries that occur when items such as twigs, hangers, or chicken bones are inserted into the uterus. Untrained providers can improperly perform abortions, causing perforations and infections. Still other women are harmed when they jump from staircases or off roofs or inflict blunt trauma on their abdomens.8 The situation is dire, but political reforms could effect dramatic changes in these women’s fates. Goals and Contributions This book strives to contribute to an understanding of Latin America’s abortion politics. To do so, it examines the interactions among the primary stakeholders in the reproductive rights debate. Given the region’s heterogeneity, this is a formidable task, and a study of this scope will inevitably fall short. But each of the chapters advances this goal in a specific way, emphasizing the work’s overarching assertion: Latin America urgently needs abortion policy liberalization. This claim leads to the study’s three principal concerns: When, how, and under what circumstances do changes to abortion legislation occur? What is the nature of the abortion debate, and how do its diverse stakeholders interact to effect change? And, from a more quotidian perspective, what are the day-to-day consequences of abortion criminalization for the lives of the region’s women and girls? This book addresses the first question by comparing a limited number of cases from across the region. The chapters highlight the roles of three groups: government actors, civil society, and the international community. The approach is holistic, because the study argues that abortion rights lawmaking is the result of a convergence of factors and interactions.9 It rests on a four-pillar framework based on the following considerations: the power of actors or institutions, the political context in which they operate, the ideational frame they deploy to portray the issue, and the nature of the abortion issue itself.10 These may broadly include (but are not limited to): the level of a society’s religiosity and the influence of religious institutions, presidents’ personal religious convictions

6

The Politics of Abortion in Latin America

(or those of their opposition), left- or right-leaning leaders, public opinion, the government’s responsiveness to international pressures, and civil society’s relationships with the state. The descriptions reflect a conjunctural analysis that sheds light on the politics of unique aspects of diverse countries. At the same time, it synthesizes key elements of abortion politics that aim to explain the variations in policy outcomes. The study draws from a well-established body of scholarship on Latin American politics.11 The chapters on political actors rest on writings on the region’s history of “presidentialism” (presidencialismo)— with its associated machismo, caudillismo, personalism, and populism— and emphasis on executive power vis-à-vis other branches of government. Presidents play an outsized role in abortion politics, and the subject can be a litmus test for their political destinies. This focus is juxtaposed with examples of those who influence abortion policymaking from other governmental institutions: the judiciary, the legislature, subnational bodies, and even health ministries. Explanations for these variations include the degree to which different government actors wield power independently from the presidency, a factor that varies considerably across Latin America. Political context is critical to the abortion debate. This study presents instances in which opportunities arise for change, such as the impetus catalyzed by international events (e.g., the ripple effect of Roe v. Wade in 1973 or the International Women’s Conferences in the 1990s), elections of particularly strong candidates or parties advocating for reform, or horrific individual cases that cause public outrage. Timing plays a key role as well, whether through the strategic, unrelenting persistence of individuals and actors or through the convergence of opportune events at a particular political or social juncture. In every case, both context and effective actors must align to effect abortion rights reforms. The discussion of civil society builds on literature on social movements and issue networks,12 emphasizing women’s movements (and the reproductive rights movement, an offshoot) and their relationships with the state. Advocates and opponents form “policy communities,” networks of individuals and organizations, that share a common interest in the abortion issue.13 The communities’ composition varies from country to country, and support for abortion rights can emerge from diverse quarters. Participants may include health-care professionals, nongovernmental organizations (NGOs), political parties, union members, the media, religious organizations, and academics, among others. They can also comprise counterparts within government and across national borders—with transnational activists playing a critical role. This study

The Politics of Abortion in Latin America

7

concurs with the established literature on women’s rights that the relative strength of actors and institutions within policy communities in relation to lawmakers can determine the issue’s success or failure.14 It additionally points out that the most effective strategy for abortion rights reform is one of persistent, long-term, gradual advocacy; this notion is borne out throughout the case studies. The book further aims to shed light on relationships among domestic actors and the global community in abortion policymaking. International and transnational advocacy groups have successfully litigated cases on the global stage on behalf of Latin American girls and women and have exposed the inhumanity of abortion bans to world scrutiny. Their efforts have had mixed results, however, as the region’s governments vary in their responsiveness to international pressures—more autocratic regimes appear to yield less than their democratic counterparts. And strong domestic and global alliances are essential elements for reform. This study’s second area of focus is the nature of Latin America’s contemporary abortion debate itself. It rests on the assertion that women and girls gain abortion rights when their reproductive choices are successfully articulated in the public arena and those choices become law. This implies the visible exercise of political agency—the capacity of individuals, groups, and institutions to engage in a process of asserting power to achieve a desired outcome. The very notion of agency is critical to understanding the barriers to reform in reproductive rights. There are fundamental inequalities worldwide in asserting one’s agency based on—among other things—gender and socioeconomic status. The abortion debate is one in which its actors, many of whom would remain relatively voiceless as marginalized members of society, gain power through the discursive agency of the publicly antagonistic struggle for their rights. The argument rests on the premise that ideas and discourse “exert a causal influence in political reality and, thereby, engender institutional change (or continuity).”15 It is the articulation of the debate that gives agency to its stakeholders, who in turn exercise their power to shape the societies in which they live.16 Conceptually, the debate is a reflection of three ideational “frames”: a human rights frame, a medical frame, and a moral frame.17 Taken together, they form the paradoxical foundation for the strongest arguments for and against abortion rights. The area of human rights, for example, emphasizes individual rights for women that have been codified in decades of international jurisprudence and are reflected in most Latin American constitutions. Abortion rights arguments extend beyond pregnancy termination to the realms of physical autonomy, gender equality, and social and economic justice. At the same time, anti-abortion

8

The Politics of Abortion in Latin America

proponents make claims for a fetus’s “right to life,” assigning it individual autonomy (“personhood”) at the moment of conception. The notion of when life begins straddles all three abortion rights frames, as it is argued on legal, scientific, and religious grounds. The medical frame of the abortion debate drills down on discourse in the health-care community, overlapping with rights-based arguments in many respects. The right to quality health care is, by most definitions, one of the most basic human rights. In fact, the right to health care is enshrined in the national constitutions of over one-third of the world’s nations and has been named as one of the United Nations Sustainable Development Goals (number three). Obviously, physicians, pharmacists, midwives, and others in the health-care profession generally are best equipped to understand the complexities and complications of pregnancy and to respond medically to the need for pregnancy interruption. Political conflicts arise when the state gets involved in doctorpatient relationships, forcing medical experts to withhold or perform services that may not be in their patients’ best interests. The fear of harassment or other legal repercussions, including prosecution and incarceration, prompts some health-care workers to refuse to provide procedures to terminate pregnancies, even in life-or-death situations. Individual providers working on the front lines to provide care for women with unintended pregnancies are constantly forced to participate in the abortion controversy, whether they choose to or not. The domestic and international associations that represent these health-care personnel have frequently called for the legalization of therapeutic abortions, even in countries where such procedures are completely outlawed. One such case was the emergency resolution by the World Medical Association (WMA) in response to Nicaragua’s 2006 abortion ban. The WMA cited the danger to women’s lives and health, as well as the risk of imprisonment or suspension posed to physicians.18 Other groups—from Chile’s midwives to the International Federation of Gynecology and Obstetrics—have added their voices to the call for abortion law reforms. This has been especially true in cases involving low-income and marginalized sectors of the population, the demographics most exposed to the serious negative consequences that result from barriers to safe and reliable health-care services. The medical frame, as with the human rights argument, can also encompass the perspectives of “right-to-life” providers who refuse to perform abortions on religious or other moral grounds. They often belong to local and global organizations positioned on the other side of the debate, lobbying for restrictions on abortion. Those organizations include the Federation of Latin American Catholic Medical Associa-

The Politics of Abortion in Latin America

9

tions, which is the regional arm of the World Federation of Catholic Medical Associations. The politics of the medical argument become especially complex when physicians are elected to public office, as they often use the government as an arena to promote policies that reflect their moral perspectives on abortion rather than scientific or public health findings on the issue. It is, in fact, the moral frame of the abortion debate that may pose the greatest political challenge to reproductive rights. On the anti-abortion side is the Roman Catholic Church, which has dominated religious life in the region for centuries, along with burgeoning conservative Protestant groups that bolster the Catholics’ hard-line stance. Sectarian views on abortion permeate nearly all levels of governmental discourse on the subject. Even among less religious sectors of society, “pro-family” and pro-natalist traditions remain dominant in every social stratum. However, like the other areas of the abortion debate, the moral frame can also work to the advantage of pro-choice advocates. Most major pieces of abortion rights legislation passed in recent decades have been catalyzed or bolstered by the moral outcry of public opinion on behalf of a victim of reproductive violence. Individual cases—some of which are described in detail in this book—trigger civil society outrage that can lead to political action. The morality of abortion becomes clearer when placed in a larger social, economic, and cultural setting. Given the number of unintended pregnancies, coupled with many families’ inability—for financial or other reasons—to raise children, the decision not to give birth can be a supremely moral choice. As Katha Pollitt writes, “We need to see abortion as an urgent practical decision that is just as moral as the decision to have a child—indeed, sometimes more moral. . . . We need to talk about abortion in its full human setting: sex and sexuality, love, violence, privilege, class, race, school and work, men, the scarcity of excellent, respectful reproductive health care, and of realistic, accurate information about sex and reproduction.”19 Participants in the abortion debate engage these ideational frames in many ways, and the only constant is a high level of contestation among and within different factions. Subsequent chapters examine ways in which interconnected and overlapping groups of actors engage these constructions to influence discourse, norms, cultural perceptions, and, ultimately, legislation. It is clear that the topic has emerged as one of the most contentious and critical political issues publicly discussed today. This book asserts that the confluence of human rights, morality, and public health is a linchpin in understanding why abortion has assumed a disproportionate role in contemporary political discourse.

10

The Politics of Abortion in Latin America

Public opinion and public policy can be shaped by statistics, and the numbers are sobering. Cases that spark moral outrage in the public sphere can have a powerful political effect, especially when the accompanying socioeconomic injustices affecting their victims are starkly obvious. In northeastern Brazil, the public witnessed graphic evidence in the media of the devastating effects of the Zika virus outbreak in 2015. Not only did the mosquito-borne illness cause serious brain malformations in Zika victims’ babies, but the women’s poverty and lack of financial resources overwhelmed an already dire scenario. The epidemic and ensuing public outcry stirred up a heated debate in the Brazilian legislature, placing the abortion issue front and center in national politics. In that case, the moral, human rights, and medical (public health) frames of the abortion debate converged to bolster the ranks of pro-choice proponents and spark an equally strong backlash among conservative lawmakers. Overview of the Book The remainder of this chapter examines key factors contributing to the need for abortion rights reform. It focuses on the difficulties endemic to the region that women and girls with unintended pregnancies face. These difficulties include high levels of adolescent pregnancy and sexual violence, as well as economic, cultural, and educational barriers, and limited public health services. Concluding sections review the study’s historical context, exploring the trajectory of contemporary abortion politics. Chapters 2 and 3 discuss government actors, with the former illustrating successful cases of abortion rights reform and the latter demonstrating setbacks or reversals in progress. The chapters contrast three “leftist” presidents, Chile’s Michelle Bachelet, the Dominican Republic’s Danilo Medina, and Nicaragua’s Daniel Ortega, highlighting the broad divergence in abortion policies among them. They also compare Colombia’s successful multipronged judicial and legislative strategy with the frustrating, seemingly endless campaign in Argentina. The subsequent chapters address the critical role of civil society in abortion politics, juxtaposing progressive reforms in Chapter 4 with ongoing obstacles in Chapter 5. Two cases—those of Mexico City and Bolivia—demonstrate the complexity of abortion policy communities. The former sheds light on the interactions among a broad network of actors at the municipal and international levels, and the latter engages the role of indigenous women, challenging notions of hegemonic Western approaches to abortion politics. For its part, Chapter 5 pres-

The Politics of Abortion in Latin America

11

ents Nicaragua’s and El Salvador’s draconian abortion bans, with a glance at political obstacles in Peru, and the civil society actors fighting to challenge them. Shifting from the grass roots to the global stage, Chapters 6 and 7 continue the book’s pattern of weighing pro-choice cases against antiabortion actors. Chapter 6 also addresses Peru, highlighting the case of a Peruvian teenager who successfully sued her country’s government before the United Nations and won. It further analyzes the role of international jurisprudence and the global public health community in confronting Latin America’s anti-choice policymakers. The study’s final cases examine two powerhouses that employ religious and “moral” discourse to advance anti-abortion crusades worldwide: the US government and the Catholic Church. The concluding chapter reviews successes and failures in Latin American abortion politics, emphasizing the seemingly endless challenges to pro-choice reform. It serves as a reminder that the journey toward liberalization is arduous and complex and that the goal of reproductive self-determination remains elusive for many of the region’s women and girls. Raped at Nine, Mother at Eleven In August 2015, an eleven-year-old Paraguayan girl was forced to undergo a cesarean section to deliver an unwanted baby. She became pregnant at age ten after her stepfather had sexually abused her for at least a year. Her mother pleaded with hospital officials to terminate the pregnancy, but the only exception to Paraguay’s no-abortion law is when the pregnancy endangers the woman’s (in this case, the young girl’s) life. The state determined that this girl was “healthy enough” to give birth, which she did. Like other girls in such situations, she now faces severely circumscribed educational and economic opportunities, not to mention the psychological and physical consequences of this victimization. Her future has become fragile. The stepfather was charged with rape, but he is not likely to face harsh punishment. Prosecution rates in Paraguay and throughout Latin America are notoriously low. Shockingly, this girl was not alone: youngsters between ten and fourteen years old account for two births per day in Paraguay (and also for 2.13 percent of all maternal deaths in that country).20 In fact, Latin America has one of the highest teen pregnancy rates in the world—64 births per 1,000 girls—slightly trailing Africa.21 Not

12

The Politics of Abortion in Latin America

all teenage pregnancies are accidents, of course. There are reasons why adolescent girls may wish to have babies, ranging from the desire to be mothers to the belief that forming a family will provide elevated socioeconomic status and economic security. But the downside of teenage motherhood outweighs its benefits. Pregnant girls are more likely to face medical and health complications than adult women who are pregnant. They also face greater risk of maternal mortality. These young mothers are frequently forced to leave school, and their resulting lack of education puts them at a great disadvantage economically, limiting future job opportunities and earnings. Geographic areas with high numbers of adolescent births also tend to have greater gender inequality in wages. 22 And since lower-income and rural girls have less access to contraception and family-planning education, the cycle of young motherhood and poverty remains persistently self-perpetuating. Unfortunately, not only the health and well-being of young mothers are adversely affected. Children born to teenagers are 35 percent more likely to die before the age of one and 26 percent more likely to die before the age of five. Their mothers generally do not receive the antenatal care needed to ensure a healthy pregnancy, and low birth weights are common. After birth, these children are less likely to receive necessary immunizations, and they suffer the same lack of access to health care as their parents.23 Given other limitations, including poor nutrition and substandard educational opportunities, many offspring of teen mothers face a future wracked with unmet needs. Because of the host of problems surrounding sexual education, access to contraception, women’s rights, and teen parenthood in Latin America—not to mention sexual violence and incest—it is little wonder that 60 percent of adolescent pregnancies are unintended and many girls seek to terminate them. For the Paraguayan rape victim and other girls in countries where abortion is severely restricted or illegal, the consequences can be dire. Teenage pregnancy is one of the leading causes of suicide in El Salvador, which bans abortions under all circumstances. In 2014, the Salvadoran government reported that three of every eight maternal deaths were the result of suicide among pregnant adolescent girls. Many girls raped by relatives or gang members do not report the crime because of fear and the stigma associated with sexual assault. In cases where the rapist is the household’s principal wage earner, family members may be unwilling to seek help for the girl, since doing so would jeopardize their economic survival.24 On a regional level, the Latin American Federation of Societies of Obstetrics and Gynecology

The Politics of Abortion in Latin America

13

estimates that every five minutes, a Latin American teenager kills herself because of problems related to sexual and reproductive health. There is also a correlation between the demand for abortion and the prevalence of sexual violence, which is shockingly high in the region. The situation is especially severe in the case of young girls and teenagers. In 2016, the European Parliament’s Subcommittee on Human Rights commissioned a multicountry study on sexual violence against minors in Latin America.25 The study found a lack of data around the incidence and prevalence of sexual violence against minors. That was largely due to widespread underreporting: girls not reporting experiences to adults; children not being believed by adults; girls being blamed for “provoking” sexual experiences; and a lack of receptivity on the part of state institutions. The latter can include hospital authorities, police, public prosecutors’ offices, or ombudsman’s offices. Despite the dearth of available statistics, there is clear evidence that the sexual abuse of minors is widespread. The European Parliament study cites, for example, data from Peru indicating that 40 percent of female adolescents characterized their first sexual experience as “nonconsensual.” It also reports that one-fifth of Bolivian girls are victims of sexual violence. Even with low prosecution rates and a chronic lack of data, available evidence from throughout the region demonstrates that girls aged twelve to eighteen are most likely to be victimized by family members or intimate partners. “A Never-Ending Story” Before we turn to the political aspects of the abortion debate, it is critical to more deeply contextualize the intense abuse of women of all ages because, in many cases, this violence surrounds sexuality and pregnancy. The rates of unwanted pregnancies that result from violence— from incestuous contact within families to the near-epidemic proportion of sexual assaults at the US-Mexican border—are perhaps the most compelling argument of all for abortion rights.26 Efforts to reduce gender violence in Latin America are in danger of backsliding, the head of the Organization of American States (OAS) announced in November 2017 at a conference on gender violence. While acknowledging the passage of legislation to protect women and the recognition of femicide as a specific crime, OAS secretary-general Luis Almagro said the laws are not being implemented and enforced. “Violence against women and girls in our region continues to be one of our most alarming phenomena. Physical, sexual violence, and femicides—

14

The Politics of Abortion in Latin America

this is something that affects us every day,” said Almagro. He called violence against women in Latin America “a never-ending story.”27 More than twenty years ago—in June 1994—the region officially addressed the severity of the very same issue by creating the InterAmerican Convention on the Prevention, Punishment, and Eradication of Violence Against Women, commonly known as the Convention of Belém do Pará. The convention was the first international human rights treaty to recognize violence against women as a phenomenon spanning race, class, age, and religion. Belém do Pará has been invoked many times, along with other gender-related treaties, to adjudicate cases on behalf of women’s rights in the region. The institutionalization of protections against such abuses is extremely important, but it has not solved the problem in Latin America. For a sense of the scope of sexual violence in the region, the Mexican reproductive rights organization Grupo de Información en Reproducción Elegida reports the following statistics: In Mexico, 600,000 sex crimes are committed each year. Of those, nine out of ten victims are women; four out of ten of them are under fifteen years old. Alarmingly, the place where women could be safest is the place where half of the sex crimes take place: their homes, and 60 percent of the time their aggressors turn out to be relatives or people they know. Every day, there are 1,640 charges filed of sexually violent crimes, but the most worrisome is that this high number represents only 10 percent of what actually occurs.28

The group also reported that local and federal officials in Mexico received 70,630 reports of rape from January 2009 to June 2016, but that departments of health had carried out only sixty-two abortions in rape cases during the same period. This comes despite the fact that abortion is legal for rape victims in Mexico. Unintended pregnancy is but one of many consequences of genderbased violence, but its impact is far-reaching in women’s lives. A highly contested area of the abortion debate concerns the legality of allowing women to terminate pregnancies resulting from rape (as in the case of the Paraguayan girl) and how countries vary in their regulations in that circumstance.29 Perpetrators of sexual assault include strangers and intimate partners, with prosecution rates low in both cases. Logically, there is an increased incidence of unwanted pregnancy among rape victims. This is also true for cases of domestic violence. A multicountry survey conducted jointly by the Pan American Health Organization and the US

The Politics of Abortion in Latin America

15

Centers for Disease Control and Prevention found the percentage of women in the region who reported an unintended pregnancy was significantly higher among those who had experienced physical or sexual violence involving an intimate partner.30 In the decades since the Convention of Belém do Pará, Latin American governments have taken important steps to combat gender-based violence, although, as OAS chief Almagro noted, tremendous obstacles remain. In the area of abortion rights, inextricably linked to such sexual transgressions, there has been much less success. Public debate and political pressure are the key to social change. Pro-choice advocates are pushing toward a first step in legislative reform. This book examines how, when, where, and by whom. Although women in Latin America have positioned themselves as potential drivers of change, the results are mixed. The increasing presence and influence of women with political power—while slow to contribute to a shift in abortion rights policies—has granted feminist issues a more prominent position on the region’s political agenda. The impressive numbers of female legislators across the region (nearing 40 percent in some countries, compared with 17 percent in the United States) have coincided with important legal advances in women’s rights. Women have made greater inroads in politics and public institutions, and female legislators united in multiparty alliances have been responsible for passing laws on domestic violence, rape, electoral quotas, and the reform of discriminatory civil and criminal codes. Still, public dialogue is not the game changer. Abortion legislation ultimately ends up in the hands of government officials, many of whom oppose abortion rights. Numerous studies have shown that the mere presence of women in power does not automatically produce policy outcomes favorable to women’s interests.31 In Latin America, that has proven true. The Costs of Abortion Restrictions Access to abortion—as well as lack of access—has a profound impact on millions of women’s lives. That, in turn, affects their families, their communities, and their countries in far-reaching ways. For many women and girls, an unwanted pregnancy is a life changer, interrupting education, jeopardizing career aspirations and current and future financial security, and sometimes compromising health and safety. Access to abortion—or lack of access—carries other immediate societal costs. In recent years, the appearance of the Zika virus has

16

The Politics of Abortion in Latin America

proved a stunning example. When the Zika virus surfaced in Latin America, it quickly became an urgent public health and public education issue that carried with it extraordinary costs, both fiscal and societal. Women’s health, their economic and educational opportunities, and their legal vulnerability—not to mention their personal autonomy and self-determination—as well as societal costs are all components of the abortion rights argument. A traditional pro-choice stance, completely valid, treats unintended pregnancy as a condition in which women in all walks of life may find themselves and a condition whose outcome women in all walks of life have the right to determine. A more feminist perspective challenges the notion that sexual intercourse is coequally determined and that women significantly control their sex lives. Rather, the feminist perspective factors in the idea that nonconsent, subordination, and violence are too often part of women’s experience. It also underscores the societal expectation that women be sexually available and that their value in society may be based on their sexual desirability and accessibility in a context skewed toward male dominance. Against that backdrop, contraception is seen as continuingly stigmatized on the grounds that it acknowledges and plans for sexual intercourse, implying a desire to have sex and promiscuity on the part of women.32 The United Nations Population Fund starkly describes the situation: “Gender inequality, gender-based discrimination and other forces prevent millions of women from accessing modern methods of contraception. Husbands or partners may pressure women to bear children as soon and as frequently as possible. Judgmental service providers may deny contraception to women or adolescents who are not married or in a union. Other providers may see contraception as a decision to be made only by men.”33 If women cannot access contraception or decide if and when to bear children, they remain disadvantaged partners in sexual relations. Thus, abortion must be seen not just as an “accidental” consequence of sexual activity between two equals, but also as the outcome of intercourse under conditions of gender disparity. Sexual inequality and power imbalances permeate a broad swath of global societies, with varying degrees of impact on women’s lives. In Latin America, these conditions are most dangerously and ubiquitously manifested in two interconnected areas: adolescent pregnancy and gender-based violence. Together they provide a convincing argument for the critical need for progress in the abortion rights struggle. To understand how Latin America arrived at the contemporary iteration of that debate, a glance at the past sheds light on its trajectory.

The Politics of Abortion in Latin America

17

The Past Informs the Present Major political shifts took place in Latin America at the end of the Cold War. Many nations transitioned from decades of military dictatorships to inchoate democratic governments. It makes sense that the abortion debate, like other issues sidelined during the intense activism to combat repressive regimes, would emerge as a pressing and provocative matter with the liberalization of political discourse. The result in many places, ironically, was a broad step backward, as many pro-choice advocates witnessed a reversal in long-standing laws regulating abortion rights. Therapeutic abortions (those performed when a pregnancy threatens the health or life of a woman) were legal across large swaths of Latin America during much of the twentieth century. The region’s abortion laws generally reside in civil and criminal codes that are entrenched in long-established traditional institutions and thus not easily altered. As such, they endured through military coups, writings and rewritings of constitutions, and tumultuous economic ups and downs.34 It was not until the last century’s final decades that existing legislation began to unravel. Argentina, for example, approved a criminal code in 1922 to permit abortions for medical reasons and in some cases of rape; that legislation lasted until the anti-abortion crusades under the presidency of Carlos Menem and the 1994 constitutional reforms that recognized global antichoice perspectives. Chile, following Argentina’s lead, had legalized therapeutic abortion in 1931. That law remained in effect until it was replaced by a complete ban in 1989 and reformed again in 2017. Nicaragua’s 1891 penal code allowed for abortions to save a woman’s life, a provision that lasted until 2006. Today, Nicaragua has one of the world’s most restrictive abortion laws. El Salvador’s 1973 criminal code also permitted abortion to save a woman’s life and for rape victims who became pregnant. Those protections remained in place until 1997, when abortion was completely prohibited.35 The Catholic Church has played an outsized role in the abortion rights debate. Paradoxically, its political clout in bringing a shift toward more restrictive abortion laws held strong even as the church’s membership dropped off. The number of Latin Americans practicing that religion declined to 69 percent in 2014. (In the 1960s, at least 90 percent of all Latin Americans had identified as Catholics.) While many Catholics in recent decades switched to Protestant denominations, a large group disaffiliated with any organized religion.36 Nor does there appear to be a correlation between Catholic Church doctrine on abortion, which became increasingly strident at the century’s end, and religious piety. In other words, while church membership may fall, opposition to

18

The Politics of Abortion in Latin America

abortion can remain constant or even rise. Restricting reproductive rights clearly reflects more than a blind adherence to religious doctrine. It is also about a structural subjugation of women. It is impossible to attribute legislative changes for or against abortion rights to a single cause, although the second half of the twentieth century saw a confluence of elements that undoubtedly tipped the scales. By the 1960s, the push to legalize abortion in Europe and the United States began to steamroll. The United Kingdom legalized abortion (with some caveats) in 1967, followed by the United States in 1973 through the landmark US Supreme Court ruling in Roe v. Wade. France followed suit by legalizing abortion in 1975. At the same time, women’s rights movements were reaching unprecedented levels of visibility, public recognition, and activism, both regionally and internationally. Women’s movements burst into the public sphere in Latin America, emboldened by the return to civilian rule. International women’s conferences in the 1970s, discussed in Chapter 6, further empowered the region’s feminists and brought attention to their concerns. In a breakthrough of tremendous importance, the Fourth World Conference on Women in 1995 called on the 189 member states of the United Nations to work toward ensuring women’s access to and participation in decisionmaking and leadership. The conference resulted in the Beijing Declaration and Platform for Action, which, while not explicitly calling for abortion rights, committed to working to “enhance women’s sexual and reproductive health as well as education.”37 In the region, as in much of the world, governments created genderbased institutions to attend to concerns articulated in the Beijing Declaration and, domestically, to respond to women’s rights advocates. These governments also recognized that in order to build effective representation in their inchoate democracies, they needed to significantly increase the election of women to political office. The region’s gender quota laws, which became a model for the rest of the world, irrevocably reshaped Latin America’s political landscape and saw women making substantial gains. Among other things, women began enjoying progress in unprecedented areas, including the ownership of property, access to divorce, the outlawing of gender-based violence, and representation in public office. Women’s rights were generally viewed in a favorable light, with only one glaring exception: public opinion was divided when it came to support for or opposition to sexual and reproductive rights. So emotionally charged was the division that even small advances in sexual and reproductive rights brought swift and punishing backlash. Under the leadership of Pope Paul VI (1963–1978), the Catholic Church exerted the full force of its influence at the local, national, and global lev-

The Politics of Abortion in Latin America

19

els. The pope’s encyclical letter Humanae vitae (Of Human Life), signed on July 25, 1968, firmly reasserted the Catholic Church’s strict opposition to contraception, abortion, and any other actions taken to prevent procreation. Even as its membership dropped, the church managed to mobilize hordes of anti-abortion activists and increase its visibility in politics. That position was further bolstered by conservative Protestant congregations, some of which had members who were even more antiabortion than the Catholics. In civil society, “pro-life” advocates emerged in vocal opposition to demands of pro-choice feminists, and their activism within right-wing social movements, including women’s organizations and the political arena, took center stage. It was a combative arena, and many Latin American countries, as Table 1.2 indicates, responded by enshrining the notion of “personhood” (rights of the unborn) in their national constitutions. The twentieth century closed with a cacophonous abortion rights argument unfolding on the world stage. The forces of globalization, new technologies, transnational movements, and aggressive media outlets jumped Table 1.2 Fetal Rights in Latin American Constitutions

Country Chile

Article 19

Dominican Republic Ecuador

37

El Salvador

1

Guatemala

3

Paraguay

4

Peru

2

45

Statement

“The law protects the life of the unborn.”

“The right to life is inviolable from conception to death.” “The state shall recognize and guarantee life, including care and protection from the time of conception.” “El Salvador … recognizes as a human person every human being from the instant of conception.” “The state guarantees and protects human life from the moment of conception, as well as the integrity and security of the person.” “The right to life is inherent to human persons. Its protection is guaranteed, in general, from conception.” “The unborn child is subject to rights in cases that benefit him.”

Source: Political Database of the Americas.

Date/Law

Constitution of 1980, with reforms through 2010 Constitution of 2010 Constitution of 2008

Constitution of 1983, with reforms through 2009 (Legislative Degree 541, February 1999) Constitution of 1985; reformed in November 1993

Constitution of 1992

Constitution of 1993, with reforms through 2005

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The Politics of Abortion in Latin America

into the fray, pushing the political debate beyond national borders throughout Latin America. Suddenly, the plight of a pregnant preteen could be heard worldwide, with participants from all sides of the issue jockeying to frame the conversation and influence public policies on her behalf. Political Expediency Sets the Tone in the Abortion Debate Ultimately, government officials make laws and constantly strive to remain in office, especially in settings of electoral contestation. These government officials include elected and unelected public administrators serving at the national and subnational levels. In Latin America, presidents figure prominently, since the region’s executives tend to play an outsized role in driving the political agenda. That said, in some places, individual states or districts have broken rank with national policies and legalized abortion on their own. Mexico City is a notable example. The judiciary or the legislature has also played a decisionmaking role in several countries by affecting or stalling reforms in either the pro-choice or the anti-abortion direction. Although the region experienced a so-called pink tide—a shift to the political left—at the century’s onset, abortion rights reform was not carried with it. Interestingly, some of the biggest moves to loosen abortion laws and policies took place with center-right to right-wing administrations (as in Colombia), while “revolutionary” Nicaragua imposed a total ban on abortion under its leftist executive. The populace may have expectations that leftist politicians will support women’s issues in general, but abortion rights have a mixed record in that regard. The rise of women in politics has produced equally variegated results. Some female presidents, such as Michelle Bachelet in Chile, worked consistently for reproductive rights, from the so-called morningafter pill to legalized abortion in most cases. In Argentina, by contrast, it was women lawmakers, not the former female president, who led the rallying cry for abortion rights for decades. A prominent judge in Argentina also vocally supported abortion rights. In still other countries, female leaders and lawmakers have rejected progress, avoided the issue, or divided and planted themselves on both sides of the argument. Elected officials who embrace a pro-choice position find the political costs can be high, explaining why most female political leaders remain mute. The trajectory of Dilma Rousseff, who served as Brazil’s president from 2010 to 2016, is a stark example. In the final weeks of her presidential campaign, Rousseff’s past declarations favoring

The Politics of Abortion in Latin America

21

decriminalization of abortion nearly cost her the election. The wife of José Serra, her competitor, went so far as to call Rousseff a “baby killer,” and religious groups and leaders mobilized against the Workers’ Party candidate. In the end, Rousseff announced her opposition to abortion rights and promised not to reverse the country’s laws against the procedure—a position she apparently was forced to adopt to win the presidency. While leading the country, Rousseff made few inroads into women’s rights. When she was eventually toppled from office in a corruption scandal, she claimed that gender discrimination contributed to the push for her removal. At times, a politician’s pro-choice stance has consequences that reach beyond even the political sphere. On July 13, 2011, Argentina’s legislature held a public hearing that drew three hundred organizations to a session organized by the Campaña Nacional por el Derecho al Aborto Legal, Seguro y Gratuito (National Campaign for the Right to Legal, Safe, and Free Abortion). The meeting, which featured a bill sponsored by fifty congressional deputies, erupted in violence when abortion opponents physically attacked a member of the Chamber of Deputies, Victoria Donda of the Encuentro Social y Popular (Popular and Social Encounter).38 Although Donda sustained no serious injuries, the incident exemplified the intense divisiveness of this issue: a politician’s personal safety could be endangered by the mere act of holding a hearing on abortion rights. There is no single strategy for politically advancing a reproductive rights agenda in Latin America, but there are elements that contribute to its success or failure. These include, but are not limited to, politicians’ personal religious convictions, the strength of a religious opposition and the influence of faith-based organizations, and politicians’ membership in a political party or movement that hinders their ability to tackle controversial social issues. National administrations also vary in the extent to which they respond to international pressures, ranging from social media campaigns to urging from intergovernmental institutions, as well as to pressures from domestic advocacy groups. Civil Society: Pressure from Below The second broad collection of stakeholders is loosely grouped as “civil society.” Under this umbrella, feminist movements emerge as the driving force for reproductive rights. The movements’ interactions with the state have shifted over time, institutionalizing women’s issues in the government apparatus and bringing a burgeoning presence of women in

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elected office. Women’s movements are challenged to advance issues such as abortion rights at the national level without excluding critically important, but historically marginalized, swaths of the population. Not all women support abortion rights; anti-abortion groups are organizing and gaining strength. Thousands of activists from both sides fight tirelessly to sway policymakers to their positions. Their actions have become increasingly sophisticated and well managed. Differing strategies have met with divergent results. Feminist organizations have provided the foundation and impetus for abortion rights in Latin America, and they form coalitions and alliances to advance the debate. A less politically vocal but arguably no less influential group has been the health-care community. Physicians, pharmacists, midwives, and professional medical associations work on the front lines of abortion services. They drive discourse on the fundamental argument for reproductive justice: the basic right to equal health care for pregnant women. In every case that has gained public notoriety, a physician or a hospital administrator has taken a stand on a patient’s access to an abortion. In many instances, the refusal to perform the procedure has been based on the danger of legal repercussions against the doctor or the institution. In others, personal religious convictions have driven the decision. The health-care community includes groups that strongly advocate for “conscientious objection” loopholes that permit practitioners to opt out of providing abortions. (The influence of these groups was evident during a 2017 debate in the Bolivian legislature.) There are also physicians leading powerful anti-abortion efforts. On the other hand, there are countless health-care workers doing the work to terminate pregnancies, often to save women’s lives, at great risk to their professional or personal security. Increasingly, with advances in pharmaceutical options, these procedures are carried out not by physicians but by nurses, pharmacists, and other trained caregivers. Their roles in the abortion rights debate and their interactions with those directly influencing public policies are diverse. Other civil society groups and players have also staked out space in the abortion rights debate, among them labor unions, lawyers, journalists, and political parties. Each one has played a distinctive role. Unions advocate for abortion rights in Uruguay. Lawyers are driving the judicial argument in Colombia, while the media are publicizing emblematic cases in Chile. In Mexico, meanwhile, political parties are both helping and hindering the push for action. Coexisting with these diverse groups is the ever-present political force of public opinion, which can (although it doesn’t always) hold tremendous sway in shaping electoral politics.

The Politics of Abortion in Latin America

23

The International Community: Globalizing Choice The decision to terminate a pregnancy is highly personal; yet it has emerged as one of the most contentious public issues in politics today. In Latin America and many other regions around the world, lawmakers and other leaders argue about abortion more than any other medical issue. It is a subject that links the most vulnerable members of societies to the most powerful individuals and global institutions—as evidenced by a Central American teenager’s case being considered by the InterAmerican Commission on Human Rights. Abortion first morphed into a public discussion at the national level and has now shifted to the global stage. Latin American countries do not exist in a vacuum. They are signatories to international trade pacts and treaties. They are investment locations for multinational corporations that embrace (or are required by their home countries to embrace) global business ethics. They are recipients of assistance from international nongovernmental organizations. As such, Latin American countries have opened themselves to scrutiny on wide-ranging issues, among them women’s rights and reproductive rights. The fate of one pregnant teenager in the region can now spark a dramatic national—and sometimes international—outcry. In the 1990s, the global arena witnessed an explosion of international conferences, agreements, and declarations that forced the world to wake up and seriously consider women’s rights as basic human rights. From the 1994 UN International Conference on Population and Development in Cairo and the 1995 UN Fourth World Conference on Women in Beijing, to the protocols of the Convention on the Elimination of All Forms of Discrimination Against Women, platforms were launched that focused the international community’s attention on the consequences of unsafe abortions and the public health risks they pose. Important policies, protocols, and laws were passed in defense of women’s rights on the global stage, including the previously mentioned Convention of Belém do Pará. Many of these actions had significant influence on domestic legislation. Like a perfect storm, anti-abortion activism gained momentum during that same period in the 1980s and 1990s, encouraged by both religious and political leaders on the world stage. The Catholic Church launched a strident rejection of liberation theology, a forward-looking movement that had embraced social justice and empowerment for the poor in Latin America. The Vatican replaced hundreds of progressive bishops, and discussions of reproductive issues—including contraception, family planning, and abortion rights—were summarily repressed.39

24

The Politics of Abortion in Latin America

The Catholic Church’s anti-abortion position was bolstered by a boom in evangelical Protestantism. These born-again Christians also used their pulpits to promote an anti-choice agenda in the region’s congregations and among the political elite. Religious leaders have also found support in the global political arena, especially from the United States. Most damaging was President Ronald Reagan’s 1984 “global gag rule” (also known as the “Mexico City policy,” for its city of origin), which prohibited domestic or international organizations receiving US federal funds from performing or promoting abortion as a method of family planning.40 As a result of that legislation, the US government cut $40 million in support for international family planning and defunded the International Planned Parenthood Federation and the United Nations Population Fund. It prohibited nongovernmental organizations that received funds from the US Agency for International Development from advocating or providing abortion-related services or referrals, even when using their own, non-US financing. As might be expected, Latin American NGOs were particularly hard-hit by this policy, given their dependence on international development assistance. Since its inception, each subsequent Democratic administration has lifted the gag rule, and each Republican president has reinstated it. One of President Donald Trump’s earliest acts upon taking office was to immediately resurrect the policy—and to broaden its scope. US government policies and the influence of US-backed antiabortion organizations remain substantial, but the internationalization of the abortion rights debate is far broader and more complex. On the government side, some state agencies from western Europe have stepped in to compensate for severe US measures. On the NGO side, the level of coordination and cooperation on pro-choice activities is unprecedented. Among the notable players are Catholics for Choice and its Latin American counterpart, Católicas por el Derecho a Decidir; the US-based Ipas; and the regionally based Comité de América Latina y El Caribe para la Defensa de los Derechos de la Mujer, which is a network of NGOs. These groups and others have dramatically changed the face of reproductive rights advocacy. At the same time, in the area of human rights, organizations such as the Center for Reproductive Rights, International Planned Parenthood (despite the gag rule), Amnesty International, Human Rights Watch, and regionally based juridical associations all work with local partners to seek legal relief and legislative reforms. Finally, Latin American women and girls have appealed to the highest levels of intergovernmental judicial powers, including the Inter-

The Politics of Abortion in Latin America

25

American Commission on Human Rights and the Inter-American Human Rights Court, as well as the United Nations Human Rights Council, to bring cases against their governments for violations of abortion rights. As most Latin American nations are signatories to the principal human rights protocols and many have integrated them into their national constitutions and laws, they are required to comply with the provisions of the global documents. Notes 1. Although they are not the focus of this study, it is worth noting that women in the anglophone Caribbean tend to have broader legal access to abortion. 2. Sedgh et al., “Abortion Incidence,” 258–267. 3. Kohen, “Legal Strategies,” 93. 4. See Ganatra et al., “Global, Regional, and Subregional Classifications,” for detailed data comparing the safety of abortions worldwide. 5. The most commonly used medications to terminate early pregnancies are mifepristone (also known as RU 486, Mifegyn, Mifeprex, Zacafemyl) and misoprostol (sold under the names Cytotec, Arthotec, Oxaprost, Cyprostol, Milbetec, Prostokos, or Misotrol). See Women on Waves (https://www.womenonwaves.org). See also Emily Bazelon, “The Post-Clinic Abortion,” New York Times Magazine, August 31, 2014, 22–25 and 44–45. 6. Ganatra et al., “Global, Regional, and Subregional Classifications.” 7. Guttmacher Institute, “Fact Sheet.” 8. Haddad and Nour, “Unsafe Abortion,” 122–126. 9. On holistic approaches to qualitative case-oriented analysis, see Ragin, The Comparative Method. 10. The framework was adapted from Shiffman and Smith, “Generation of Political Priority,” in their work on maternal mortality. Cited in Sánchez Fuentes et al., “The Decriminalization of Abortion,” which applied the model to abortion legislation in Mexico City. 11. Some examples of important texts on these topics are Mainwaring and Shugart, eds., Presidentialism and Democracy; Escobar and Alvarez, The Making of Social Movements; Jaquette, Feminist Agendas; Jaquette, The Women’s Movement. The two most significant works on abortion politics in Latin America are Htun, Sex and the State, and Blofield, The Politics of Moral Sin. On US–Latin American relations, see Lowenthal, Exporting Democracy, and Smith, Talons of the Eagle. The seminal work on transnational advocacy networks is Keck and Sikkink, Activists Beyond Borders; on the church, see Hagopian, Religious Pluralism, among others. 12. Htun, Sex and the State. 13. Shiffman and Smith, “Generation of Political Priority,” 1371. 14. See, for example, Sánchez Fuentes et al., “The Decriminalisation of Abortion”; Weldon and Htun, “Feminist Mobilisation”; Htun, Sex and the State; Keck and Sikkink, Activists Beyond Borders, among others. 15. Schmidt, “Discursive Institutionalism,” 306. 16. Discourse analysis and discursive agency arguments rest on Foucault, “Order of Discourse,” 48–78, and Laclau and Mouffe, Hegemony; on discursive agency, see Leipold and Winkel, “Discursive Agency,” 510–534; on discursive institutionalism, see Schmidt, “Discursive Institutionalism,” 303–326. See also chapters

26

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by the editors in Butler and Scott, Feminists Theorize. There is also a useful chapter titled “Promoting Women’s Agency” in World Bank, World Development Report. 17. The notion of the debate’s three frames is introduced in Boyle, Kim, and Longhofer, “Abortion Liberalization,” 882–913. The authors categorize them as a women’s rights frame, a medical frame, and a religious, natural family frame. 18. Cited in Boyle, Kim, and Longhofer, “Abortion Liberalization,” 882–913. 19. Pollitt, Pro, 16–17. 20. Amnesty International submitted a petition with 150,000 signatures and issued an “Urgent Action” request on behalf of the girl, who was known as “Mainumby.” See, for example, “11-Year-Old Rape Survivor Gives Birth as Paraguay Upholds Draconian Anti-abortion Law,” Amnesty International, August 13, 2015, https://www .amnesty.org/en/latest/news/2015/08/11-year-old-rape-survivor-gives-birth-as-paraguay -upholds-draconian-anti-abortion-law. 21. See UNFPA, Worlds Apart. Includes adolescents aged fifteen to nineteen. 22. UNFPA, Worlds Apart. 23. Campbell and Jenkins, “Adolescent Pregnancy,” 465–484. 24. See Moloney, “Rape, Abortion.” 25. Boestein, “Sexual Violence.” 26. For a well-researched, chilling volume on femicide in Latin America, see Fregoso and Bejarano, Terrorizing Women. 27. Organization of American States conference held in Bogota, Colombia, November 7, 2017, https://www.voanews.com/a/violence-women-latin-america /4105894.html. 28. GIRE, Violencia sin interrupción, 5. 29. The issue of rapists’ parental rights has also been debated in the United States. In October 2017, a convicted sex offender who impregnated a twelve-yearold girl was briefly granted joint custody of the child. 30. Botts et al., Violence Against Women. 31. See, for example, Htun and Piscopo, “Presence Without Empowerment,” 1–24; Piscopo, “States as Gender Equality Activists,” 27–49; Escobar-Lemmon and TaylorRobinson, Representation; Franceschet, Krook, and Piscopo, Impact of Gender Quotas. 32. MacKinnon, Toward a Feminist Theory, 184–185. 33. UNFPA, Worlds Apart, 38. 34. Htun, Sex and the State, 3–4. 35. Gianella-Malca and Gloppen, Access Denied. 36. “Religion in Latin America: Widespread Change in a Historically Catholic Region,” Pew Research Center, November 13, 2014, http://www.pewforum.org /2014/11/13/religion-in-latin-america. The Pew surveys also found that Catholics were more likely to support abortion rights than many of their Protestant counterparts, despite the church’s stance on the issue. 37. United Nations, “Fourth World Conference.” 38. “Agreden en el Congreso a una diputada en medio del debate por el aborto,” Clarín, July 7, 2011, https://www.clarin.com/politica/aborto_0_r1gXfpkpPQg.html. 39. Hogan, “Latin America.” 40. The “global gag rule” is also known as the “Mexico City policy,” as President Ronald Reagan announced it at the United Nations Population Council meeting in that city. The legislation remained in effect until the Bill Clinton administration repealed it. It was reinstated during the George W. Bush presidency and ended again during the Barack Obama administration. A more restrictive version of the policy was introduced at the onset of the Donald Trump administration.

2 Intersections of Morality and Political Reality

cases: when a pregnancy endangers a woman’s life, when a fetus is unviable, and when pregnancy results from rape.1 For the country’s prochoice proponents—led by then president Michelle Bachelet—the law’s passage marked a milestone in a long and hard-fought battle. Chile’s notorious dictator, Augusto Pinochet, had instituted a total ban on abortion in September 1989. With one fell swoop, he imposed a restriction so draconian that it exists in only a handful of the world’s nations. It took nearly three decades for a new president to restore the most basic abortion rights provisions for Chile’s women. This chapter examines the complexity of political leadership in abortion politics. It features two cases of reforms (Chile and Colombia) that succeeded thanks to persistent, well-orchestrated, and coordinated strategies, as well as powerful combinations of institutions and individuals. The discussion explores three questions that contemporary government actors pose. First, given the recent decades’ wave of left-leaning leaders (the so-called pink tide), coupled with the broad emergence of women in government, why did so many of Latin America’s state officials fail to adopt a pro-choice stance? Second, broadly speaking, under what circumstances and types of leadership will abortion rights reforms occur? In other words, strong presidents clearly wield considerable power in abortion policymaking, but what other factors effect changes in legislation? And third, how do stakeholders from divergent quarters—judges, legislators, health ministers, and others—interact with contextual elements such as international treaties, peace processes, and historical distributions of power in reproductive rights policymaking?

On September 23, 2017, Chile legalized abortion in three

27

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At first glance, there appears to be little rhyme or reason to a politician’s position on abortion rights. Pro-choice legislation has become law under center-right presidents like Colombia’s Álvaro Uribe, while Brazil’s Dilma Rousseff, a feminist, responded to political pressure by rejecting calls for reform during her initial presidential campaign. In Mexico, one subnational government can legalize abortion, while neighboring states pass constitutional amendments stating that life begins at conception. In the Dominican Republic, an entire country can be moved by the story of a dying teenager denied chemotherapy due to strict antiabortion laws, and then have its congress reject presidential initiatives to pass potentially life-saving laws. If there is any logic to the politics of an outright anti-abortion stance or, at the least, support of the status quo, it may emerge from one or more of three attributes: a leader’s personal religious convictions, the presence of a strong right-wing opposition, and membership in a political party or movement that hinders a politician’s ability to tackle controversial social issues. Autocratic and populist presidents—and populist party machines—are less likely to be responsive to civil society pressures and, consequently, less willing to consider policy liberalization.2 Often, a confluence of these factors is at play in the suppression of abortion rights. While broad, these benchmarks help discern patterns that can affect policy decisions. In the case of personal religious convictions, which cut across political affinities, there may be degrees to which a leader is genuinely motivated to oppose abortion rights. For some, the correlation is clear and straightforward. The rejection of abortion reforms by Ecuadoran president Rafael Correa, for example, was consistent with his long-standing adherence to Catholicism. Other leaders, such as Daniel Ortega in Nicaragua, appear to adopt religious mantles for more opportunistic reasons: they cannot get elected without the support of the Catholic Church. In still other cases, politicians may be less religious, but their party affiliations preclude a more progressive stance, tying their hands even when they support pro-choice policies. Such was the case during Bachelet’s first presidency. Although she was ready to advocate for early liberalization of Chile’s abortion laws, members of her ruling coalition would not allow it. It was not until the second election, when the makeup of the political alliance shifted, that she could move forward with her pro-choice agenda. Right-wing opposition to abortion is especially strong in countries where the anti-choice movement is closely tied to conservative religious organizations. This is the case across most of Central America, especially El Salvador, where the ultraconservative Catholic organization

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Opus Dei wields considerable clout within the political arena. Even under years of progressive administrations, the Salvadoran government has remained steadfast in its anti-abortion stance. Presidents’ Paradoxical Power over Pregnancies Latin American presidents have played a weighty role in the abortion debate relative to other actors over the past two decades. They have directly eliminated a woman’s right to a therapeutic abortion, used their power to guarantee passage of anti-choice legislation or to bring antichoice changes to their countries’ constitutions, or stood aside while abortion rights were compromised during their administrations. The back-and-forth on abortion rights in Uruguay exemplifies the extent of this presidential power. In 2008, then president Tabaré Vázquez, a physician, vetoed pro-choice legislation, citing his religious convictions. His successor, José Mujica, from the same Frente Amplio (Broad Front) political party, did an about-face and supported a congressional vote to legalize abortion. (When Vázquez returned to power in 2015, he left Mujica’s reforms in place.) With each change in leadership, a woman’s access to a safe and legal abortion fell subject to the decision of a single person: the president. In Latin America, the right to choose is often subject to the vicissitudes of “personalistic” politics dominated by individual leaders rather than political parties. However, the region’s debate over abortion becomes murkier when it comes to classification within a left-versusright political dichotomy. Perhaps the most striking example of this came with Colombia’s reproductive rights reform, which occurred in 2006 during the administration of a “rightist” president, Uribe. This contrasts to “leftist” Ortega’s backing—in the same year—of a total ban on abortion in Nicaragua. Indeed, the most perplexing aspect of Latin America’s abortion policies is how pro-choice rights were affected by the region’s shift to the left in the early part of the twenty-first century. The launch pad for the new leftist leaders was the common ground that remained after a decade of neoliberal economics, the post–Cold War “triumph” of capitalism over communism, and the reconstitution of state-societal relationships in the postmilitary period. The incoming new leaders represented diverse backgrounds, from the revolutionaries of Nicaragua and El Salvador to the charismatic populists of Venezuela, Ecuador, and Argentina. Most of these leaders developed their political credibility against a backdrop of military dictatorship and virulent persecution of progressive activists. They took office on a wave of

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anti-imperialist and anti-neoliberal protests across the region, promising far-reaching alternatives to the pro-market paradigm. For feminists and other progressive activists, the recalibration of the pink tide heralded an era of social justice and human rights. The new political landscape was supported by gender-based quota laws and a rejection of the inequities associated with both military dictatorships and neoliberal policies. But as quickly as the progressives rose to power, distinctions began to surface among them. One of those differences was their willingness to tackle the most contentious social issues of the day.3 From electoral politics to social change, the results were decidedly mixed. The pink tide presidents—Venezuela’s Hugo Chávez, Ecuador’s Correa, Argentina’s Néstor Kirchner, Dominican Republic’s Danilo Medina, Bolivia’s Evo Morales, Nicaragua’s Ortega, and Brazil’s Rousseff, among others—initially did improve the lives of the masses that elected them.4 Access to basic goods, housing, education, and health care expanded, and they nationalized selected assets and pursued relatively redistributive economic strategies. But while their policies benefited the poor to some extent, they generally failed to alter the existing economic or social order in any significant way. Even more, as financial pressures increased during the century’s first decade, these leaders increasingly turned to old-style export-led policies, including the exploitation of extractive resources, which brought little substantive change to the structural status quo of neoliberalism.5 When it came to women’s rights, these presidents’ records were equally disappointing. Further complicating matters was the left’s far-from-harmonious relationship with feminist issues. In the ideological struggles against military dictatorships, as the left fought to overthrow an entrenched oligarchy through armed resistance and revolutionary movements, abortion rights had been relegated to the back burner. The political vanguard proved somewhat more inclusive of women in its leadership, but it retained the basic structures of machismo that had always existed in Latin America. Women could be combatants and activists, but they were also expected to be mothers. Inside El Salvador’s Farabundo Martí National Liberation Front (FMLN) and Nicaragua’s Sandinista Front for National Liberation, women became important participants, both in revolutionary cadres and as symbols of a more just society. But they were also subject to those revolutionary movements’ pro-natalist agendas, which did not include the option to terminate pregnancy. Motherhood was woven into the discourse of resistance, becoming an effective rhetorical weapon for women on both ends of the political spectrum.

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Writing during the 1980s, Maxine Molyneux refers to the Sandinistas’ “canonization” of the Mothers of the Heroes and Martyrs, the enduring symbol of Nicaraguan women throughout the decade.6 In Argentina, meanwhile, the Madres of the Plaza de Mayo—the women demanding information about their children and grandchildren “disappeared” by the military—became the preeminent symbol of women in opposition to dictatorship. In fact, motherhood, as it has throughout history in much of the world, served as a driving force in politicizing Latin American women. Maternalism can spur women to activism and simultaneously curtail their support for abortion rights, reflecting the lack of unanimity on the subject. Both the moral imperative and the symbolic value of motherhood echo throughout the region, and women often deploy pro-family discourse for political ends. Women’s active participation in the events of the late twentieth century blossomed as the region’s political spectrum shifted leftward.7 The pink tide rose in tandem with a tsunami of women entering leadership roles in electoral politics. By the late 1990s, Latin America had established itself as a global trailblazer when it came to gender-based quota laws and the presence of women in political office. Its largest countries elected female presidents, and most countries passed laws requiring that women hold from 20 to 50 percent of the seats in national legislatures. Women’s presence in the judiciary, as well as in subnational offices at the municipal and provincial levels, also expanded. Many hailed this dramatic upsurge, but it also provoked a complex debate about the nature and quality of women’s political leadership. This was especially true in the area of abortion rights. Expanded female participation in politics stimulated greater discussion and political action on this issue. It also sparked a conservative backlash, with female and leftist presidents presenting the most vexing challenge to pro-choice reforms. Assumptions about their political commitment to poor women’s health, feminist issues, and antiestablishment social change—indeed, the very question of whom they represented—defied facile explanation. In other words, while the presence of women’s movements and women in political office did have an impact on abortion rights policies, that influence was unpredictable and, at times, counter to pro-choice goals. The case studies of government officials in abortion rights policymaking illustrate this conundrum in this chapter and in Chapter 3. The following sections contrast two countries, one in which a progressive woman president played a leading part in the process and one in which the judiciary took on a decisive role. The critical role of health ministers, many of whom have been women, is also reviewed with an eye on

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whether and how they bridge the gap between politics and public health. Chapter 3, meanwhile, looks at the other side of the spectrum, analyzing the reproductive rights agendas of two pink tide administrations— Nicaragua’s Ortega and the Dominican Republic’s Medina—as well as the abortion debate in Argentina’s legislature and the complex interactions of civil society activists, legislators, and partisan politicians. Chile’s Uphill Pro-Choice Battle On January 31, 2015, a year into her second term, President Bachelet sent a bill to Chile’s congress that would decriminalize abortion in cases when a woman is raped, when a pregnancy endangers a woman’s life, and when a fetus is not viable.8 In doing so, she fulfilled a promise made during her election campaign and broke a decade of political paralysis on the issue. While bolstered by the determination of a prochoice leader, the abortion initiative was simultaneously lashed by the onerous political obstacles that presidents face in bringing such convictions to fruition. Bachelet, a medical doctor, former health minister, and opponent of Pinochet’s military regime, had been arrested and tortured during the sixteen-year dictatorship that ended in 1989. She began her political career as the country made its transition to civilian rule in 1990, just one year after Pinochet imposed a ban on abortion in all circumstances. Prior to entering politics, Bachelet was a pediatrician and a public health worker, witnessing firsthand the repercussions of unwanted and medically unsafe pregnancies in Chile. As a self-declared agnostic and a divorced single mother, she was an unusual candidate for the traditional Chilean electorate. Indeed, she was the first female head of state elected in Latin America on her own merits, with no connection to a prominent husband.9 One of her earliest acts as president was to create a cabinet with an equal number of men and women.10 Chile had a long history of legal therapeutic abortion prior to 1989, but official reinstatement of the procedure was not addressed until a decade after the return to civilian government. In the immediate wake of the dictatorship, the country’s main political objective was to rebuild civil society and solidify ties among parties.11 In the urgency to build consensus, it appears that pro-choice candidates sacrificed abortion rights for electoral victory. Abortion never made it onto the agenda of the center-left Coalition for Democracy (the Concertación) that ruled Chile from its transition to democracy in 1990 until the coalition’s electoral defeat in 2010.

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One reason for the unwillingness by the Concertación to reform abortion laws was the presence in the ruling coalition of the centerright Christian Democratic Party, which had close ties to the Catholic Church. The church had played an important role in protecting the human rights of Chileans persecuted by the Pinochet dictatorship, and members of the ruling coalition owed it a debt of gratitude. As a consequence, issues such as abortion and divorce were relegated to the legislative back burner. (Chile did not pass a divorce law until 2004, making it one of the last countries in the world to legalize the dissolution of marriage.) When then presidential candidate Eduardo Frei (1994–2000) issued a statement on the need to open the debate on abortion, many groups responded negatively, claiming abortion should not be turned into an election issue. In 2005, Concertación candidate Bachelet, of the Socialist Party, declared—even though she was a staunch reproductive rights advocate— that she would not seek to overturn the country’s laws banning abortion. As promised, the legalization of therapeutic abortion remained off the legislative agenda during her first term (2006–2010), and her administration remained largely silent on the issue. She did, however, fight long and hard to legalize the free distribution at public health clinics of emergency contraception, the “morning-after pill,” to females fourteen and older. Bachelet received support from her minister of health, who denounced the inequality and “hateful discrimination” of a judicial ruling that denied poor women access to the pill.12 The hard-won battle on this front survived two Supreme Court appeals. Table 2.1 details the chronology of actions by Bachelet’s administration. Although the legalization of emergency contraception did not immediately affect the push for abortion rights, it opened the door to a decades-long debate over women’s health and reproductive autonomy. By the time Bachelet ran for her second term, her political party coalition (now called New Majority, or Nueva Mayoría in Spanish) had broadened its reach to include leftist groups, among them the Communist Party. The new positioning appears to have freed the coalition from its obligations to the Catholic Church, which had hindered progressive social reforms. In her May 2014 inaugural address, the president stated her intention to put forward the more lenient abortion bill that emerged in January 2015. Bachelet’s persistence paid off. In 2017, Chile legalized abortion under the three conditions she advocated. The new law is a successful example of the gradualist strategy favored by many reproductive rights advocates (and detractors), who maintain that a step-by-step process yields better results than radical campaigns for sweeping reforms.

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Table 2.1 Bachelet, the Courts, and Emergency Contraception (EC): A Timeline

2001: As health minister, Bachelet proposes giving sex-abuse victims access to the EC pill Postinor. A flurry of lawsuits, countersuits, injunctions, and constitutional challenges follows. August 2001: The Supreme Court bans the sale of Postinor, considering it an abortifacient. November 2005: The Supreme Court rules that plaintiffs cannot represent unborn babies and determinations about when life begins are out of the court’s realm of competency. 2005: While running for president, Bachelet says she will not seek to overturn the country’s laws outlawing abortion, stating that terminating an unwanted pregnancy is a “bad solution.” March 2006: Two weeks after her presidential inauguration, Bachelet announces that the public health system will provide EC to “everyone who requires it.” September 2006: A decision by Chile’s Ministry of Health opens the way for the introduction and free distribution of EC by public health-care centers to any females aged fourteen and up. September 2006: A group of conservative lawmakers files a petition in Santiago’s Court of Appeals against Chile’s Ministry of Health, aiming to overturn access to EC. The Court of Appeals places a provisional suspension on the government’s decision to distribute free birth control and EC to females fourteen and older without parental consent. Bachelet says, “Any person with a doctor’s prescription can buy [EC] because it has been legalized for sale, but there are people with fewer resources who cannot buy it, and so we have opted to provide it at doctors’ offices as needed,” according to Salon. January 17, 2007: Chile’s Supreme Court terminates a four-month-old program that provided free birth control, including emergency contraception, to females over the age of fourteen. In a 6–4 vote, the court rules that the program is unconstitutional because it was initiated by administrative decree rather than by presidential decree or legislation. Late January 2007: Bachelet issues an executive order authorizing free distribution of emergency contraceptives to all females over the age of fourteen. April 4, 2008: The Constitutional Court of Chile bans the sale and distribution of EC in public health facilities, reversing Bachelet’s presidential decree. The court concludes that the morning-after pill sometimes acts as an abortifacient, so free distribution of emergency contraception is unconstitutional. July 2009: The Bachelet administration introduces a bill to allow the free distribution of EC in the public health system and to guarantee every person, regardless of economic situation, access to the EC pill. The bill passes the Chamber of Deputies overwhelmingly on a 73–34 vote. December 16, 2009: The bill passes the Senate. January 18, 2010: Bachelet signs the measure into law before leaving office.

Sources: Center for Reproductive Rights, “In re Access”; Feminist Majority Foundation,“Chile’s Policy”; Castellanos, “Chile: The Struggle”; Caivano and Marcus-Delgado, “Time for Change.”

Bachelet’s efforts shed light on several facets of the politics of abortion rights. In presenting the bill, she scaled two decades of barriers to reform. Following the 1989 repeal of therapeutic abortion, there had been unsuccessful efforts to liberalize the law in 1991, 2001, 2006, and 2012. These attempts were countered by the conservative right’s push for even more anti-choice initiatives, including constitutional amendments and changes to the criminal and health codes to make penalties

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harsher. When two members of the Chamber of Deputies introduced a bill to decriminalize abortion in the first twelve weeks of pregnancy, the opposition barred it as unconstitutional. The law prior to 1989 had allowed exceptions to save the life or preserve the health of a woman, but when a bill was introduced to take that further, adding a provision for abortion in the case of rape or fetal abnormality, it was tabled. Although Bachelet’s 2015 proposal faced steep resistance in the legislature, it managed to win approval in both the Health Committee and the Constitutional Committee of the Chamber of Deputies that same year. It was then sent to the full chamber, where in March 2016 it passed on a 66–44 vote. In the Senate, the initiative faced sixteen months of intense opposition until July 2017—more than two years after the bill’s introduction—when senators voted to allow the three exceptions to the abortion ban: when a mother’s life is in danger (in a 20–14 vote), when a fetus is unviable (in an 18–14 vote), and, the most contentious exception, in cases of rape (also in an 18–14 vote).13 The strength of the opposition and the machinations of party politics play critical roles in both foiling and advancing abortion rights reform. Less clear, however, is the impact of gender. As president, Bachelet brought about important progress in gender equity by using her country’s unusually strong executive branch. She pursued a strategy of legislative reform that targeted issues of concern to women. These included the introduction of gender quotas in her electoralreform package and the elevation of the National Women’s Service (Servicio Nacional de la Mujer, or SERNAM) to the rank of a ministry. In addition, she appointed Claudia Pascual Grau as minister of SERNAM. Pascual Grau is a strong feminist from the far left of the coalition and a member of the Political Commission of the Communist Party, the first Communist Party member to serve in a ministerial position since the 1973 coup that toppled Salvador Allende. The Women’s Ministry maintained a high profile and presence in the media during Pascual Grau’s tenure, helping to make issues like therapeutic abortion part of the public debate. Chile has influential women in positions of political power, but it lags behind most of Latin America when it comes to the number of elected female officials. Women occupy only 16 percent of the seats in Chile’s congress, and many of them are conservative lawmakers. Almost immediately after Bachelet introduced the therapeutic abortion bill, a group of female members of the Chamber of Deputies and female party activists from the right-wing Independent Democratic Union (Unión Demócrata Independiente) held a news conference to oppose the bill. The small number of women in Chile’s congress and

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their divided positions on reproductive rights left Bachelet with an uphill battle on the legislative side. Chile’s Supreme Court and Constitutional Court are both composed mainly of men. In 2010, only 25 percent of the Supreme Court justices were women. In 2015, only one woman sat on the Constitutional Court. In both courts, the few women on the bench are conservative, ruling out a judicial strategy to overturn Chile’s total ban, as was accomplished in Colombia. With strong opposition in the legislature and a conservative court, Bachelet bargained—correctly—that Chile’s path to reform depended primarily upon the strength of the executive branch. Colombia: A Victory in the Courts and Congress In a 2014 interview, attorney Monica Roa spoke about pro-choice activists’ need to shift the power dynamic if they were to empower women, including those whose presence was often weak or absent from the public sphere.14 As the person responsible for successfully litigating abortion rights in Colombia, Roa explained her team’s winning strategy. A key element of their victory was a keen understanding of the country’s political situation. They recognized that the only way to achieve reforms would be to move the debate gradually toward the prochoice camp, allowing neither absolute-legalization or anti-abortion forces to derail the process. They also were knowledgeable about how the courts worked, including how judges were chosen, who the judges were, and how public opinion could influence them. They saw leverage in the legal system, which allowed action to be brought before the courts on behalf of individuals whose rights had been violated. Their goal was to represent women whose voices had been traditionally excluded from the political debate on abortion but whose lives had been directly affected by restrictions on reproductive rights. In March 2005, Roa (then working for Women’s Link Worldwide) filed a lawsuit in alliance with Advocates for Women’s Life and Health (Mesa por la Vida y la Salud de las Mujeres, or “La Mesa”). The lawsuit argued that the abortion prohibition violated women’s fundamental right to health. Roa based the argument on the government’s ratification of international treaties, including the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), and claimed that the ban was discriminatory and unconstitutional. Roa’s legal action culminated a Women’s Link project known as High Impact Litigation in Colombia for the Unconstitutionality of Abor-

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tion. Launched in 2004, it had a three-legged strategy with legal, alliance, and communications components.15 Although the ultimate focus was on the court, advocates mobilized simultaneously on a number of other fronts, forming a network of experts and nongovernmental organizations to work on the case. On May 10, 2006, Colombia’s Constitutional Court issued a landmark decision (C-355/06) declaring that the nation’s total ban on abortion violated women’s constitutionally protected rights as well as international human rights law. The ruling legalized abortion in three instances: when a woman’s life or physical or mental health is at risk, in cases of serious fetal impairment, or when a pregnancy results from incest, rape, or forced insemination or egg implantation. Certain restrictions were maintained. Women still could not elect to terminate a pregnancy by choice, and the first two conditions still required a doctor’s approval. In the third case, victims were required to report the crime, but it did not need to be irrefutably proven for the procedure to take place.16 Despite these limitations, the ruling was a watershed in Latin America’s abortion rights debate. It upheld the procedure’s legality within a comprehensive equality and human rights framework and, in doing so, acknowledged the link between access to abortion and the many forms of discrimination faced by women, including prejudice in the areas of race, age, ethnicity, geographic location, and income. It also acknowledged special considerations due to victims of internal conflicts.17 In addition, its reliance on the 1991 constitution positioned it on firm legal ground, as did its explicit recognition of international law and human rights treaties. In fact, while legislative efforts directed at abortion reform in Colombia predate it by several decades, it is the constitution that provided the foundation for the process to move forward. The Constitutional Assembly that led to the charter’s rewriting emerged from a lengthy and intense period of military conflict, peace negotiations, and civic activism, especially on the part of women’s organizations. Only four of the assembly’s seventy-four members were women, but activists and women’s organizations played a critical role in shaping the document’s final form.18 Women’s rights advocates demanded that the new constitution include provisions from CEDAW, pointing out that the government had done little to implement the antidiscrimination convention since ratifying it a decade earlier. The new charter rectified that omission, explicitly embedding CEDAW’s two-pronged strategy that prohibited discrimination against women while also ensuring that the state provided substantive guarantees of gender equality.19 Two articles in the constitution spell this out:

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Article 13: All individuals are born free and equal before the law, shall receive equal protection and treatment from the authorities, and shall enjoy the same rights, freedoms, and opportunities without any discrimination on account of gender, race, national or family origin, language, religion, political opinion, or philosophy. The state shall promote the conditions so that equality may be real and effective and shall adopt measures in favor of groups that are discriminated against or marginalized. The state shall especially protect those individuals who on account of their economic, physical, or mental condition are in obviously vulnerable circumstances and shall sanction the abuses or ill-treatment perpetrated against them. Article 93: International treaties and agreements ratified by Congress that recognize human rights and prohibit their limitation in states of emergency have domestic priority. The rights and duties mentioned in this Charter shall be interpreted in accordance with international treaties on human rights ratified by Colombia.20

By including passages that articulate Colombia’s adherence to international rights treaties such as CEDAW, as well as other articles referring to reproductive choice and gender equality, the constitution established a solid legal platform from which to address the abortion rights litigation that followed. For example, Article 42 guarantees couples’ right “to freely and responsibly decide the number of their children.” Articles 43 and 44 establish that, during and after pregnancy, the state will provide women with special assistance and protection, as well as help female heads of family. Other provisions also reinforce areas of women’s rights, among them Article 53, which makes specific reference to women and mothers in the creation of labor laws.21 In addition to producing a charter that reflected societal demands for equality and social justice, the Constitutional Assembly created two progressive bodies that facilitated future abortion rights advocacy: the Constitutional Court and the tutela process. The Constitutional Court is a testament to Colombia’s commitment to a separation of government powers, established in part as a response to the “hyper-presidentialism” that oversaw many decades of armed conflict. Although the country always had a relatively independent judiciary, its presidents had regularly deployed emergency powers (known in Colombia as a “state of siege”) to suppress many of the citizenry’s basic civil rights. In fact, from 1949 to 1991, Colombia was under a state of siege for more than thirty years. 22 The Constitutional Court sharply curtailed the executive branch’s authority to impose such restrictions; it also promoted an open dialogue between the population and the judiciary.

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Although, in 1994, the court initially upheld a ban on abortion as constitutional, it created a space where the topic could be discussed openly and publicly. When the abortion issue came before the court again in 2006, the justices allowed an expansive liberal debate with input from many sectors of society, ultimately ruling in favor of the pro-choice group. The 1991 constitution further facilitated access to the judiciary by creating the tutela, a process by which people may directly request assistance from the Constitutional Court when they feel their rights have been violated. The court can then act on an individual’s case in a short period, providing important relief in resolving rights-based complaints such as the denial of access to abortion. During the decade following the court’s ruling on abortion, Colombian women have enjoyed greatly expanded reproductive rights. The case is instructive in its keen pinpointing of a government institution, coupled with strategic alliances and extraordinary legal legwork, that other advocates can most certainly emulate. Equally useful, although a great deal more disheartening, is the fact that, even after a decade of legalization, more than 90 percent of abortions in Colombia take place illegally. There were approximately 50,000 legal abortions in the decade following the 2006 legalization of the procedure, but 400,000 illegal abortions continue to be performed each year. According to Catalina Martínez, the Center for Reproductive Rights’s regional director for Latin America and the Caribbean, “Women in Colombia still face barriers to accessing safe abortion services, such as onerous medical requirements to prove they qualify for a legal abortion, as well as refusals to provide safe abortion services by doctors, medical institutions—and even judges—based on their personal or moral objections.”23 Meanwhile, stories such as that of Paula, reported by Reuters,24 are all too common. Paula sought a legal abortion in a public hospital in Bogota where nurses showed her baby dolls and photos of newborn babies, and a doctor told her she would be committing murder if she went through with the procedure. Paula was passed from one doctor to another and to several hospitals. She was evaluated by three psychologists, two of whom determined that the thirty-one-year-old single mother was eligible for an abortion on the grounds that the pregnancy threatened her mental health. As the weeks passed, Paula filed a lawsuit against one health-care provider and eventually won. But by the time the case was decided, she was already twenty-two weeks pregnant. Doctors refused to perform the abortion because the pregnancy was too advanced. As Paula’s case clearly shows—and she is just one among millions—the struggle for abortion rights in Colombia is far from over.

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The Chilean and Colombian cases are but two examples that demonstrate that there is no simple formula for deciphering the politics around abortion rights. The following chapters throw even more variables into the mix as a former revolutionary, Ortega, packs the Nicaraguan government with women officials and then imposes a total abortion ban; a leftist progressive, Medina, initiates reforms in the Dominican Republic and is repeatedly rebuffed by the legislature; and Argentina leads the world in gender-based quota laws but could not make progress with a woman in the presidency. Latin America is a region of political contradictions. Historically, it has been marked by strong executive branches coupled with relatively weak judiciaries and legislative branches, at both the national and subnational levels. However, for every example there is an exception. Furthermore, since the policymaking bodies vary from country to country, efforts to reform simultaneously are more challenging. That said, the variations between and among countries also provide more institutional openings for change. In Chile, the executive branch was a change maker; in Colombia, it was the judiciary. This chapter concludes with a look at one stakeholder that has profoundly influenced abortion rights reform across the region: the Ministry of Health. Interestingly, many of the ministers who have bridged the gap between politics and public health are women. The Health Ministers: Playing the Role of Disrupters Reproductive rights fall under the purview of public health, opening the way for health ministries to play a critically important role in determining how abortion rights policies are created or presented to the public. Some presidents have appointed health ministers who supported their positions on reproductive rights. Other health ministers have actively opposed their presidents’ positions or, when a president has been silent on the issue, pioneered policy. One such case occurred in Peru, where Minister of Health Midori de Habich oversaw the creation and dissemination of a legal protocol that detailed how healthcare workers should handle cases in which abortion procedures could be legally administered. Such documents are critically important since a lack of awareness about proper procedures often makes health-care workers reticent to provide treatment. In Chile, a progressive minister of health, Helia Molina, came up against such powerful conservative forces when speaking out about access to abortion that she was forced to resign. Molina, who took office soon

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after Bachelet’s second inauguration, was ousted because of an off-therecord comment at the end of an interview with daily newspaper La Segunda. She told the reporter, “In all upper-class clinics, many conservative families have had their daughters abort. The people with money do not need laws because they have the resources.” By publicly drawing a class distinction when referring to abortion access, Molina hit a nerve in Chilean society, where it is commonly known that wealthy women can terminate pregnancies through private clinics or private physicians, while their less-well-off counterparts run the risk of medical practitioners in public hospitals reporting them to the authorities. The minister’s explicit statement about this inequity—and the assertion that families with money were getting abortions—rankled the president’s well-heeled constituents.25 Interestingly, throughout Bachelet’s push to advance abortion rights, her public appearances included the presence of the health minister (as well as other cabinet members) to provide an important “visual,” or public symbol, of support. In El Salvador, one of a handful of countries living with a total ban on abortion, a brave health minister, Dr. Violeta Menjívar, has voiced support for a proposal to have the Legislative Assembly study the decriminalization of abortion. Her announcement came on the heels of an October 11, 2016, bill to decriminalize abortions for women and girls who were sexually abused or faced serious or potentially fatal health risks. The bill had been introduced by FMLN congresswoman Lorena Peña, who was then president of the Legislative Assembly. In advocating the change, Menjívar said the Ministry of Health had registered 17,793 women of reproductive age with chronic illnesses such as hypertension, diabetes, obesity, or cancer. Of these, 389 were pregnant and had been admitted to intensive care units at hospitals. She also revealed that between 2011 and 2015, at least forty-two females had committed suicide because of their pregnancies; of these, 54 percent were preteens and adolescents.26 Health ministers, many of whom are physicians, can inform the abortion debate from a medical perspective and bridge the gap between politics and the health-care community. In addition, they see firsthand the potential harm that medical epidemics can have on pregnant women and children. That occurred during the Zika outbreak, when public health officials immediately recognized the severe birth defects caused by the virus, although their responses diverged considerably. In Cuba, public health officials screened pregnant women and allowed them to abort affected fetuses in light of the disease’s catastrophic effects. In Colombia and Brazil, health officials’ initial reaction was simply to advise women to “delay getting pregnant.” (In fact, when asked about

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abortion in 2016, Brazilian health minister Ricardo Barros advocated the need to open a dialogue with the Catholic Church, despite the nation’s explicit separation of church and state.) No Cookie-Cutter Solutions

Abortion rights advances in Chile and Colombia offer strategies for other countries to study, but the complexities of Latin America almost ensure that every nation will need a customized approach that takes into consideration its unique histories and constituencies. One key consideration seems to be the abandonment of an all-or-nothing approach. Rather than “abortion, yes or no,” the discussion becomes the more nuanced “abortion under what circumstances.” That approach puts the dialogue about reproductive rights into the public space and, to a large degree, “normalizes” the issue. It becomes easier to change a law step-by-step than to replace it with something radically different, particularly in a country with a strong constitution, such as the one Chile had as a result of the Pinochet dictatorship. Latin America’s caudillo traditions have bred strong presidencies (often to the detriment of legislatures), and Chile’s president took advantage of this when she became the voice for a change in the country’s abortion law. But make no mistake, the legislative debate in Chile over abortion was brutal at times. Still, Bachelet was persistent, and her long effort pulled in support from the center and won over the all-or-nothing groups that thought legalizing abortion under only three circumstances was either too little or too much, depending on whether they were proor anti-choice. In addition, a lot of legwork was done to set the stage even before the proposal was presented to the legislature. The decriminalization of abortion also gains traction when abortion is viewed through the lens of human rights—as the Colombian judiciary showed—and/or framed as a public health, rather than a moral, issue. The case of Colombia, in particular, was marked by a keen understanding of what was possible given the political landscape, deep knowledge about the court system, and well-thought-out advocacy by pro-choice forces. By underscoring Colombia’s position as a signatory to international human rights treaties, that country’s pro-choice effort also raised the question of how Colombia wished to be seen on the world stage. Notes

1. Ley 21030, “Regula la despenalización de la interrupción voluntaria del embarazo en tres causales,” published in Diario Oficial de la República de Chile, No. 41.866 (September 23, 2017).

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2. See Blofield and Ewig, “The Left Turn,” for an excellent analysis of the relationships among leftist governments and abortion reforms. 3. Excellent resources on the nature of the “New Left” include Levitsky and Roberts, The Resurgence; Weyland, Madrid, and Hunter, Leftist Governments; FloresMacias, After Neoliberalism; Shifter, “A Surge,” 107–121; and Queirolo, The Success. Bruhn, “Defining the Left,” 243–249, offers a thoughtful review of the literature on “defining the Left.” Analyses range from typologies that categorize types of contemporary leftists to rejecting the notion that there was anything “leftist” about these new leaders at all. 4. By 2008, eleven of eighteen major countries in Latin America were ruled by left-of-center presidents, accounting for 65 percent of the region’s 350 million residents (Stokes, “Globalization and the Left”). 5. Sankey, “What Happened.” 6. Molyneux, “Mobilization Without Emancipation,” 229. 7. There are numerous excellent studies on the rise and role of women in politics. See, for example, Jalalzai, “Women Political Leaders,” 85–108; Jaquette, Feminist Agendas; González and Kampwirth, Radical Women; and Escobar-Lemmon and Taylor-Robinson, Representation. On gender quotas, see Franceschet, Krook, and Piscopo, Impact of Gender Quotas. 8. I am grateful to Joan Caivano at the Inter-American Dialogue for her invaluable contribution to this analysis of Chile’s abortion debate. 9. Thomas and Adams, “Breaking the Final,” 107, observe that Bachelet’s election was especially noteworthy since she was elected through popular vote. They report that 73 percent of women executives who took power between 1960 and 2002 were elected in parliamentary systems, while only 23 percent did so in presidential systems. They note that it may be easier for women to rise to power as the heads of parties and win votes from colleagues than to win the support of the electorate at large. 10. For in-depth analysis of the Bachelet presidency and Chilean politics in general, see Siavelis, “How New,” 70–76; Sehnbruch and Siavelis, Democratic Chile; Siavelis and Morgenstern, Pathways to Power; and Weeks and Borzutsky, “Michelle Bachelet’s Government,” 97–121. 11. Altman, “Political Recruitment,” 241–270. 12. Barot, “Past Due.” 13. See “Chile Moves Toward Legalising Abortion in Limited Cases,” BBC News, July 19, 2017, http://www.bbc.com/news/world-latin-america-40653903. 14. Author’s interview with Monica Roa, Washington, DC, June 10, 2014. 15. Roa, “From Constitutional Court,” 83–87. 16. Women’s Link Worldwide, C-355/2006; Ruibal, “Movement and Countermovement,” 42–51; Ordolis, “Lessons,” 263–288; Reuterswärd et al., “Abortion Law Reforms,” 805–831. 17. Ordolis, “Lessons,” 264. 18. Morgan, “Constitution-Making,” 353–413; Morgan, “Emancipatory Equality,” 75–98. 19. Morgan, “Emancipatory Equality,” 75–98. 20. Constitute, Colombia’s Constitution. 21. Morgan, “Constitution-Making,” 353–413; Morgan, “Emancipatory Equality,” 75–98. 22. Uprimny, “The Constitutional Court.” 23. Center for Reproductive Rights, “10 Years of Legal Abortion.” 24. Moloney, “Rape, Abortion.” 25. “Chilean Health Minister Resigns Following Abortion Comments,” Telesur, December 30, 2014, http://www.telesurtv.net/english/news/Chilean-Health-Minister -Resigns-Following-Abortion-Comments-20141230-0046.html. Dr. Ramiro Molina,

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quoted in the Diario Uchile, observed, “Helia Molina’s departure reveals the hypocrisy of the country.” He said, “Of the 334,571 abortions tracked by the Ministry of Health between 2001–2010, 40 percent were provided by private clinics and the other 60 percent by public hospitals. . . . Today, the place where clandestine abortion is practiced has diminished dramatically, so that the quantity of complications from abortion we used to see 20 or 25 years ago, where women died as a result of irresponsible or ignorant practitioners, are simply not seen any more . . . with pharmacological abortion with the use of misotrol . . . in 95 percent of the cases.” He ended the interview by congratulating ex-minister Molina “for her courage in the midst of a world of hypocrisy.” “Dr. Ramiro Molina por aborto: ‘La salida de Helia Molina revela la hipocresía del país,’” Diario Uchile, January 5, 2015. See also “Abortion Gaffe Claims First Cabinet Casualty,” Latin American Weekly Report, January 8, 2015, http://latinnews.com/media/k2/pdf/tstst.pdf. 26. Cornejo, “Menjivar Insiste.”

3 From Revolution and Reform to “Right to Life”

experienced abdominal pains so severe that she sought treatment in a local hospital. The physician on duty quickly determined the cause: an ectopic pregnancy. This type of pregnancy, where a fertilized egg lodges outside the uterus, can be fatal if not treated immediately. However, since Nicaragua is one of the world’s few countries that bans abortion in all circumstances, the doctor also told Briceño that the pregnancy could not be terminated. As the hours passed and the pain increased, Briceño, certain she would die, spoke with her mother about the possibility of her raising Briceño’s nine-year-old son. Eleven hours after the doctor refused to provide care, the hospital had a shift change. The new team on duty included a doctor—Briceño calls him her “hero”—who performed a procedure to end the pregnancy and save the woman’s life.1 Nicaraguan president Daniel Ortega, who led his country from 1985 to 1990 and was reelected in 2007, supported the no-exceptions abortion ban during his second presidential run and has overseen its execution for over a decade. In this rigid position on reproductive choice, he is far from alone among Latin America’s leaders. This chapter examines Latin American government actors and institutions, beginning with the Ortega administration, that have blocked abortion reforms. The Nicaraguan case is one in which an increasingly autocratic regime has permitted fewer and fewer challenges to its authority and has aggressively persecuted those who have called for debate on the subject. The example is juxtaposed to that of the Dominican Republic, where the other extreme holds true: facing a total ban,

In June 2010, a Nicaraguan mother named Leslie Briceño

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President Danilo Medina has advocated for abortion rights liberalization in opposition to his national congress, with his stance resulting in a lengthy stalemate for badly needed reforms to the nation’s criminal code. And Argentina, the chapter’s concluding example, rounds out the case studies by addressing the shifting interactions among presidents, legislators, subnational officials, and civil society in an ongoing, contentious, and very public debate on abortion politics. As Chapter 2 discusses, government actors’ abortion politics do not fall neatly into a left-right binary. Studies show that other factors, such as party composition, the power of subnational officials in federal versus unitary states, state relations with civil society movements, and the relative strength of branches of government all contribute to abortion policymaking.2 In fact, contrary to what many reproductive rights advocates would expect, Latin America’s left-wing presidents and female lawmakers count themselves among the region’s outspoken opponents of abortion. The prime example is Ortega himself, who has propelled a high percentage of women into positions of political power and whose leftist credentials include his status as the former guerrilla leader of the revolutionary Sandinista Front for National Liberation (FSLN). The region’s anti-abortion leftists span the continent. Ortega’s Ecuadorian counterpart, President Rafael Correa, had nearly four years left in his presidential term when, on October 13, 2013, he vowed to resign if the National Assembly moved to decriminalize the nation’s strict anti-abortion laws. This threat by the twice-elected, self-described “left-wing humanist”3 worked. Abortion remains illegal in Ecuador except when the life or health of a pregnant woman is in jeopardy or in cases of rape or incest involving females with mental disabilities. In all other circumstances, women found guilty of having abortions can be sentenced to up to two years in prison. In 2015, nearly a hundred cases of allegedly illegal abortion were under investigation in Ecuador. Elsewhere in South America, Uruguay’s progressive president, Tabaré Vázquez (2005–2010 and 2015–present), vetoed pro-choice legislation introduced by his own party, the Frente Amplio, in 2008. And, as previously mentioned, during a heated campaign, Brazil’s former president Dilma Rousseff reversed her position and joined abortion opponents to secure her election. That nation’s first female president and a member of the Workers’ Party, she served from 2011 until her impeachment in 2016 during a corruption scandal. South America may be tough on abortion, but Central America distinguishes itself as the epicenter of the world’s most drastic antiabortion laws. Like Nicaragua, El Salvador also bans abortion under all conditions. Until 2019, Salvadoran president Salvador Sánchez

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Cerén led a nation where more than thirty women have been charged with homicide in recent years for allegedly terminating their pregnancies; some of their “crimes” have been documented miscarriages. Sánchez Cerén is a member of the Farabundo Martí National Liberation Front, a political party that grew out of the insurgent group formed in 1992 at the end of the country’s civil war. His successor, Nayib Bukele, although not affiliated with parties either on the right or the left, has expressed unclear views as to whether or not he will alter the nation’s abortion prohibition. Recalibrating the Revolution: Denying Women’s (Basic?) Rights At first glance, Nicaragua and its president, Daniel Ortega—revolutionary comandante and legendary leader of the anti-imperialist FSLN—would appear to be ideal sponsors of progressive social policies. The leftist government’s inclusion of women in political posts far outshines that of Chile’s Michelle Bachelet, and grassroots social movements have formed the backbone of Ortega’s political party for decades. Placed in this context, the story of Leslie Briceño at the beginning of this chapter seems oddly incongruous. Why would a self-proclaimed socialist, who has achieved gender parity in many areas of the public sphere, reverse longstanding laws and impose a draconian ban on abortion? Nicaragua’s policy on reproductive rights, dating back to Ortega’s 2006 presidential campaign, cannot be understood without examining the Catholic Church’s role in the country’s politics in recent decades. Ortega’s first term in office lasted over ten years (1979–1990), during which the country confronted a US-backed counterrevolutionary (Contra) insurgency and a crippling economic blockade. The Catholic Church in those days was divided. One side held a large group of politically active priests who supported the doctrine of liberation theology, an articulation of Catholicism that emphasizes the church’s “preferential option for the poor.” The other side drew Catholics aligned with the church’s anti-Communist right wing. 4 Among the most outspoken leader of the latter was Archbishop Miguel Obando y Bravo, an influential critic of the revolution and enemy of the FSLN government who eventually sided with Ortega to facilitate his ascension to the presidency. By 1990, the economic blockade and Contra War had taken its toll on the Sandinista government, and the conservative factions in both the church and government had won. Ortega lost the election that year

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to a woman, Violeta Chamorro, who garnered over 55 percent of the vote. Doña Violeta, as she was commonly known, was the widow of one of the most famous martyrs of the Nicaraguan revolution, Pedro Joaquín Chamorro. Usually dressed in white, she portrayed herself as a type of Virgin Mary whose mission was to bring peace and reconciliation to war-torn Nicaragua. Bringing no political experience to the presidency, Chamorro emphasized her skills as a mother and a wife. She explicitly asserted that she was not a feminist: she had dedicated her life to the home. Upon assuming the presidency, she set out to impose an antifeminist agenda that dismantled many gains of the Sandinista years, including in health care, education, and social welfare.5 She remained distant from the increasingly active women’s movements that emerged in the 1990s when women, freed from the control of the FSLN, were positioned to organize more autonomously and militantly than ever before. In 1996, Managua mayor Arnoldo Alemán of the Liberal Party (Partido Liberal Constitucionalista, PLC) succeeded Chamorro. He continued many of his predecessor’s conservative policies and distanced the government even more from progressive social causes, strengthening the role of the Catholic Church in government. Indeed, one of his first presidential acts was to replace the nonreligious members of his cabinet, leaving only his minister of education, Humberto Belli, who was a member of Opus Dei.6 Backed by strong allies in the church, Alemán went on the offensive against the country’s nongovernmental organizations (NGOs), especially those representing women’s movements. In September 2000, the president took the unusual step of joining Cardinal Obando y Bravo in a street demonstration in support of a proposal that would end a constitutional provision allowing therapeutic abortions. In addition, Alemán declared March 25 to be the National Day of the Unborn Child (Día Nacional del Niño por Nacer), coinciding with a Catholic holy day, the Feast of the Immaculate Conception.7 While attacking NGOs and feminists, Alemán also oversaw one of the most corrupt administrations in Nicaraguan history. 8 He realized early on that his political survival depended on forging a pact between the Liberal Party and the FSLN, as the latter (still led by Ortega) continued to represent the nation’s second-largest political force. Ortega, meanwhile, found himself embroiled in a sexual-abuse scandal involving his adopted stepdaughter. Zoilamérica Narváez publicly alleged in 1998 that Ortega had begun abusing her when she was only eleven, and continued the abuse for more than a decade, until 1990. Ortega enjoyed parliamentary immunity as an ex-president, but he knew the Liberal Party could vote at any time to revoke it. It became clear that

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for these and other reasons, Alemán and Ortega—historical adversaries— needed to forge a governmental power-sharing agreement. Alemán was replaced in 2002 by his vice president, Enrique Bolaños, who sought to clean up government malfeasance. But the Alemán-Ortega alliance persisted, despite the fact that Alemán was serving a twenty-year prison sentence for corruption. Ortega and the FSLN became increasingly alienated from formerly loyal comrades now engaged in the women’s movements. Feminists were particularly enraged by the party’s unwillingness to respond to Narváez’s allegations against Ortega, and they rallied against him at every opportunity. However, since the PLC-FSLN agreement had reshaped Nicaragua’s political and economic landscape in favor of the two powerful caudillos, by mid-decade both Alemán and Ortega were back on the campaign trail seeking reelection. And both actively curried the support of the Catholic and evangelical churches. A turning point in the abortion debate occurred in 2003 when news reports emerged about a nine-year-old rape victim, “Rosita,” who had undergone an abortion.9 The girl was the daughter of a Nicaraguan migrant laborer working in Costa Rica. Upon discovering that she was pregnant, Rosita’s family sought an abortion in a local hospital, but the Costa Rican medical authorities did not permit it. With the help of the Women’s Network Against Violence (Red de Mujeres Contra la Violencia), she was brought home to terminate the pregnancy in Nicaragua. When the media learned of her situation, an intense debate erupted. The government human rights prosecutor supported the girl’s right to an abortion. Government-sanctioned medical experts warned that both continuing the pregnancy and terminating it might jeopardize Rosita’s health. Eventually, Health Minister Lucia Salvo, who opposed the abortion, resigned, claiming President Bolaños had failed to support her anti-abortion stance. As the debate raged, the Women’s Network quietly removed Rosita from the public hospital and arranged for the abortion. Cardinal Obando y Bravo quickly excommunicated all of those involved in the abortion, prompting tens of thousands of Nicaraguan women and their allies overseas to sign petitions demanding that they, too, be excommunicated. Advocates on both sides of the issue mobilized on the streets, in religious institutions, and in the halls of government. The Rosita case propelled the abortion debate into the limelight, where it remained until the following presidential election. In August 2006, the Catholic Church used the day of Managua’s patron saint festival to launch a powerful anti-abortion campaign. The issue quickly became an electoral hot button, with every candidate except one—Edmundo Jarquín of the Movimiento de Renovación Sandinista—

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supporting abolition of the right to therapeutic abortion. Ortega and his wife, Rosario Murillo, declared their anti-abortion position, and the FSLN fell in line with its leader. On September 13 of that year, Ortega signed a document created by five hundred evangelical leaders from the Assemblies of God that proposed penalizing abortions with sentences of at least twenty years in jail. Ortega pledged that the thirtyeight FSLN members in congress would vote to change the criminal code to outlaw therapeutic abortions, eliminating a law that had been in place for more than a century. On October 6, emboldened by support from the major political parties, the Catholic and evangelical churches organized a march that culminated with the presentation of a document calling for the criminalization of abortion. The Sandinista president of the National Assembly, René Nuñez, and his fellow legislators received the religious leaders and offered to reverse Article 165 of the criminal code, which legalized therapeutic abortion. (During the same period, the assembly refused to meet with representatives of women’s movements or the medical community, both of which attempted to stop the law’s reversal.) On October 26, 2006, Nicaragua became one of only a handful of countries in the world to outlaw abortion under all circumstances.10 Less than two weeks later, wrapped in the mantle of his newfound Catholic piety, Ortega was reelected president. Maintaining the total abortion ban, Ortega won the presidency again in 2011 and 2016, with his wife, Murillo, elected as his vice president in the most recent election. Vice President Murillo is only one of many women in positions of political power in the Ortega administration. In fact, by most measures, the Nicaraguan government is among the most gender-equitable on earth. In October 2015, during testimony before the Inter-American Commission on Human Rights, Nicaragua’s minister of family, adolescence, and childhood, Marcia Ramírez, praised the Ortega administration’s record by citing a laundry list of achievements: In 2013, UN Women ranked Nicaragua in ninth place with the greatest percentage of women in ministerial positions and in fifth place for women in legislative power. The World Economic Forum in its 2013 report places Nicaragua in tenth place for gender equality in public office. According to the Inter-Parliamentary Union’s “Map of Women in Politics” January 2014 report, it puts Nicaragua in first place in the world for women in ministerial positions, with 57.1 percent. In 2007, there were 18.5 percent women in parliament; today we have 42 percent. The integration of women in legislative power is not solely quantitative, it is also qualitative. . . . We currently have 50 percent women in charge of town mayoralties, 43.7 percent of

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judges in the Supreme Court, 39 percent of judges in appeals courts, 61 percent of judges in local districts, 61.5 percent of public defenders. The president of the Supreme Court is a woman. The public ministry has 63 percent of women prosecutors, with a woman being the nation’s attorney general. Of all of the people in the National Police, 34.6 percent are women; its general director is a woman. Sixty-one percent of state workers are women. More than 50 percent of titled positions in ministries are occupied by women.11

The minister’s graphic statement illustrates an increasingly obvious fact: placing women in leadership positions does not automatically ensure that they will act to protect women. While women have a significant representation in the Nicaraguan legislature, the majority of them are members of the FSLN, and none dare to challenge the party’s strident anti-choice position. Feminist causes, much less abortion rights, find little support from women in Nicaragua’s government. The Ortega administration’s policy on abortion, juxtaposed with its high level of female participation in government and otherwise progressive ideology, also sheds light on two critical shortcomings in some contemporary Latin American regimes: presidentialism and a democratic deficit. Nicaragua in the post–Cold War period has fallen into the category of a “competitive authoritarian” government.12 While the state conducted elections that have been extensively monitored and verified by international observers and the FSLN legitimately lost elections on several occasions, all attempts at open discussion of abortion rights and other issues not favored by the president are blocked. The executive branch has harassed and intimidated feminist groups, limited freedom of the press, and censured (and at times removed from office) legislators who oppose governmental policies. On June 24, 2013, FSLN congressional deputy Xochilt Ocampo was ousted from office by the Supreme Electoral Council, widely viewed as an institution firmly under the control of the presidency. No explanation was given, but Ocampo had disagreed on several occasions with party authorities. One of these disputes came in a law affecting firefighters when she requested inclusion of both feminine (bomberas) and masculine (bomberos) language, in recognition of the work of women in the profession. Her suggestion was defeated; only the masculine form of the job appeared in the law’s final version. The second flare-up occurred when Ocampo broke with her party and abstained from voting in favor of the concession to build the proposed interoceanic canal supported by the Ortega government. Several days later, her election to office was unceremoniously revoked.13

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Strong presidencies, rigid political parties, and powerful conservative religious groups all impede progress on reproductive rights. In Nicaragua, the “revolutionary” ruling party and its allies have consolidated their grip on the nation’s politics, making abortion rights reform an onerous challenge. Notwithstanding this, there are many pro-choice advocates and committed health-care professionals who work tirelessly to address the problem of unintended pregnancies. Their efforts and accomplishments are discussed in the following chapters. In examining the political forces that impede progress on abortion rights, it is useful to look at the case of the Dominican Republic, where a president representing a dominant political party faces intractable legislative opposition. The Death of Esperanza and the Birth of Hope in the Dominican Republic On August 17, 2012, a Dominican teenager known publicly as “Esperanza” died of leukemia.14 She had entered the hospital on July 2, then seven weeks pregnant. The medical staff quickly diagnosed a rare form of the blood disease that, if not immediately treated, had a mortality rate of 100 percent within weeks. There was also evidence of fetal damage, vaginal bleeding, and a closed cervix—all of which led her doctor to recommend a therapeutic abortion and aggressive chemotherapy. When he moved to administer the medical remedy that might have saved Esperanza’s life, hospital authorities blocked him. They asserted that the treatment violated the country’s complete ban on abortion. Their fear of prosecution and the lack of clarity surrounding medical protocols in such cases effectively prevented the doctors from treating the teenager. After much debate, on July 18 the hospital began a regimen to address Esperanza’s leukemia. A day later, it abruptly ended the treatment, ordering doctors to wait until the twelfth week of the pregnancy to avoid damage to the fetus. On July 26, twenty-four days after she was hospitalized, Esperanza began to receive chemotherapy. However, the extended delay in administering treatment had sealed the fate of the sixteen-year-old girl. She suffered a miscarriage and died three weeks later.15 Although tragic, the case’s outcome is not surprising. Just two years earlier, Article 37 of the nation’s new constitution had enshrined so-called personhood protections for fetuses by declaring that “the right to life is inviolable, from conception to death.” 16 More unexpected, however, was the public outcry sparked by Esperanza’s plight, which received extensive domestic and international attention. And the

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response from the Dominican government has been decidedly mixed, providing an illustrative example of the power—and limitations—of executive authority in this area. Much like the Nicaraguan case, the historical relationship between the Catholic Church and elected officials has played a key role in shaping the abortion rights debate in the Dominican Republic. Opposition to abortion can be traced to the legacy of dictator Rafael Trujillo (1930–1961), who signed a “concordat” with the Vatican in 1954. A concordat is an agreement that establishes the bond between the church and the state, officially protects the religion, recognizes the church’s rights, and provides economic support for the bishop, priests, and others in the institution.17 Over the years, the concordat has faced numerous court challenges on a range of issues from groups claiming discrimination against evangelical churches to those alleging sexual misconduct by priests. As recently as October 21, 2008, however, the Supreme Court of the Dominican Republic upheld the constitutionality of the concordat in a 15–2 vote.18 The church’s influence was further enshrined the following year with the passage of the constitutional amendment that stated every person has a right to life that begins at conception. 19 Then president Leonel Fernández (2004– 2012), representing the left-of-center Dominican Liberation Party (Partido de la Liberación Nacional, PLD), introduced the amendment. Legislators approved it by a 167–32 vote. The PLD maintained its hold on Dominican politics with the subsequent election of its candidate, Danilo Medina, and a majority of seats in the legislature. But Medina took office the same year as the death of Esperanza, and he began to make slow steps toward reforming the country’s zero-sum prohibition of abortion. In December 2014, the government approved a new criminal code, promulgated by the president, that included the decriminalization of abortion when a woman’s life is at risk, when a fetus is deemed unviable, and in cases of rape or incest. Congress passed the legislation, and President Medina signed it into law. A year later, just as the law was about to take effect, the Constitutional Court declared it unconstitutional, leaving in place the previous criminal code that dated to 1884. In December 2016, President Medina vetoed the new version of the criminal code and again submitted recommendations that would permit abortions in the three instances previously outlined. On May 31, 2017, the Senate again rejected the president’s proposed modification to the criminal code, specifying that women who caused themselves to have abortions and those who helped them would be subject to two to three years in prison. Health-care practitioners, including pharmacists, could

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be sentenced to four to ten years. The recommendations were sent to the Justice Commission of the lower house, the Chamber of Deputies, which presented a report to the house upholding the Senate’s vote to reject the modifications. But on July 11, 2017, the house voted 84–63 (with 14 abstentions) to reject the Justice Commission’s report. As the debate continued, several instructive lessons emerged. Despite the country’s history of dictatorship and the Trujillo legacy, the government’s system of checks and balances appeared to be functioning. All three branches of government weighed in on the issue, indicating both a separation of power as well as (to differing degrees) autonomy from the influence of religious pressures. In addition, the fact that the president is a man and the vice president is a woman (a former first lady, the wife of Leonel Fernández) indicated that gender was not predictive of the executive branch’s stance on abortion rights. Finally, although the president’s party had the majority in both congressional chambers, legislators were not bound to vote strictly in accordance with their president’s position. These degrees of separation manifest themselves differently throughout the region in both the unitary and the federal systems. In the former, policies are generally centralized within the national government. The Dominican Republic is unusual in that it explicitly articulates the separation of powers in its constitution, which few countries spell out. But in federal systems, the dynamic can be different, more decentralized, and even more unpredictable. In federal Argentina, for example, where the abortion debate takes place at the provincial and national levels, the results are at once complex and bewildering. Argentina: Centralized Decentralization and Gridlock Argentina’s enigmatic politics have been the subject of scholarly scrutiny for decades, and the abortion rights debate accurately mirrors its labyrinthine panorama. On the one hand, Argentina was the first country to introduce gender-based quota laws, and its representation of women in political offices places it in a prominent and positive place in global rankings. Yet the rest of Argentina’s story is one of contradictions. It had Latin America’s first female president (Isabel Perón, 1974– 1976). Its most recent female leader, political veteran Cristina Fernández de Kirchner (2007–2015), distinguished herself by her strictly anti-choice position. Argentina was one of the last countries in Latin America to legalize contraception and one of the first to allow same-sex marriage. Furthermore, Pope Francis, the leader of the Catholic Church,

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is a native son of this country, which has one of Latin America’s lowest church-attendance rates. To further complicate matters, Argentina’s federal system provides for a national-level criminal code and a decentralized health-care system, a structuring that guarantees difficulty when it comes to legislating reproductive rights policies. Like many Latin American countries, Argentina kept its existing abortion laws—which allowed the procedure under certain circumstances— intact throughout the tumultuous decades of the twentieth century. Its policy of permitting abortion for reasons of medical necessity and in cases of rape dates back to the criminal code of 1922 (although the latter condition originally referred specifically to the rape of women with mental disabilities). The military governments made small alterations to the laws, but civilian president Raúl Alfonsín restored the original form of the code—and Article 86, which addressed abortion—upon the country’s return to democracy in 1983.20 There were several challenges to the laws throughout the 1980s, and the Catholic Church remained vigilant and poised to influence politicians who attempted any sort of reforms.21 The laws began to change in 1989 with Carlos Menem’s election to the presidency. Abortion rights policies began to shift as soon as Menem took office.22 The new Peronist president sought close ties with the Vatican by quickly taking a strict anti-abortion stance. The church needed an ally to advocate its position at international women’s conferences unfolding throughout the decade, and Menem needed the church’s backing of a neoliberal economic “shock” program, particularly in the working-class communities dominated by Peronist supporters. Menem also calculated that an anti-abortion message would carry little political cost since it would primarily affect low-income women. The partnership was forged. As part of the 1994 constitutional reform process, the church joined Menem’s government to push for a clause in the amended constitution stating that life begins at conception. (An alliance of over a hundred women’s groups ultimately managed to defeat this effort.) The following year, Menem stood fast with the Vatican and Iran at the UN’s Fourth World Conference on Women in Beijing to fight against pro-abortion language in the final platform for action. In 1999, he finished his tenure in office with what would be his seventh presidential trip to the Vatican. One of his final acts was to declare March 25 as National Day of the Unborn Child, making him the first Latin American president to do so. In fact, Menem turned out to be a more useful friend to the church internationally than at home.23 Domestically, the Peronists (also known

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as the Justicialist Party) introduced few legislative actions affecting abortion rights, although those that were taken generally aligned with Menem’s anti-abortion posture. For its part, the left-leaning opposition that challenged Menem and eventually won the presidency in the early 2000s, while ostensibly pro-choice, did little to advance changes in the status quo.24 One reason that abortion rights have been such an intractable problem may lie in the nature of the country’s political party system. Peronism itself, although not occupying the presidency since 2015, has long been the most powerful political force in Argentina. It consistently appeals to a wide swath of the population but without a clear ideological compass. The party’s elected officials include members from both the left and right wings of the political spectrum, united by loosely defined themes of support for labor, economic independence, and nationalism. Throughout the first decade of the 2000s, Peronist presidents (Eduardo Duhalde, 2002–2003; Néstor Kirchner, 2003–2007; and Cristina Fernández de Kirchner, 2007–2015) expressed varying degrees of opposition to abortion rights but allowed the debate to take place. In fact, even staunchly Catholic Duhalde chose a pro-choice health minister, Dr. Ginés González García, during his short stint in office. Continuing into the first Kirchner administration, the minister endorsed sex education, free contraception, and condom distribution. When head military chaplain Antonio Baseotto verbally attacked González García in February 2005 over his support for legalizing abortion, Kirchner—the most progressive of the decade’s three Peronist presidents—promptly dismissed the religious leader. In another pro-choice gesture, Kirchner nominated Carmen Argibay, an atheist and abortion rights supporter, to the nation’s Supreme Court in 2003. Argibay was the first woman put forward for that position by a democratic government in Argentina. She was on the high court in March 2012 when it ruled that abortion was legal if pregnancy resulted from rape. The decision came in the case brought by “A. F.,” the mother of “A. G.,” who had been victimized by her stepfather. Prior to the decision, abortion in cases of rape had only been permitted when the victim was deemed to be mentally deficient. A. G.’s case had been appealed to the high court following a lower court’s decision, and the Supreme Court found in her favor. The Supreme Court further ruled that a judicial decision was not necessary for petitions for abortion to take place in these cases; the doctor’s verification that a rape had occurred was sufficient.25 When Kirchner died in 2007, his wife succeeded him. She was president during the 2012 Supreme Court decision and did not openly

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dispute it, but she generally assumed a much more explicitly antiabortion stance. Her presidency faced formidable opposition in its position on abortion, arising, first, from the emergence of the umbrella group known as the National Campaign for the Right to Legal, Safe, and Free Abortion (Campaña Nacional por el Derecho al Aborto Legal, Seguro y Gratuito), a daunting network of more than three hundred pro-choice associations and individuals from throughout Argentina; second, from pressure by human rights organizations to acknowledge that approximately 500,000 illegal abortions were being performed annually in the country (about 40 percent of all pregnancies); and, finally, from increasingly close ties between legislators and advocates that were growing in both numbers and influence. In fact, with the support of women legislators and other progressive congress members, the National Campaign introduced an abortion rights bill in the legislature’s lower house, the Chamber of Deputies, six times between 2006 and 2017. But the issue was never debated by the full body during the Kirchner years, supporting the contention that the president’s stance— even in a relatively decentralized federal system—may strongly influence the fate of such contentious proposals. (At least twenty-five bills to legalize and/or decriminalize abortion have been introduced since the return to civilian rule in 1983). 26 By the time President Mauricio Macri took office in 2015, the push to debate abortion rights had gained considerable momentum. The number and intensity of protests rose, and legislators increasingly declared themselves in favor of decriminalizing abortion. Still, the president himself, along with Vice President Gabriela Michetti, was positioned firmly in the anti-abortion camp. They were joined by another influential female leader, María Eugenia Vidal, governor of the province of Buenos Aires. By March 2018, the governors of seven of Argentina’s twenty-four provinces had joined her in opposing decriminalization. Only one, Santa Fe governor Miguel Lifschitz, supported the proposed law; the others had not taken a stand.27 But public opinion was trending against them. By February 2018, over 5,000 protesters had gathered in front of the nation’s congress to call for debate on an abortion rights bill, and eventually, Macri was forced to voice his approval for the debate during his 2018 State of the Nation address. By that juncture, the membership of the National Campaign for the Right to Legal, Safe, and Free Abortion included organizations from throughout civil society, from anarchist groups to political parties, from gay rights groups to urban taxi drivers. Broadly reflecting Argentina’s decentralized federal structures, the campaign also encompassed representative organizations from throughout the provinces, resulting in a

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network of lawyers, activists, lobbyists, political party members, and others who joined forces for one specific goal: the reform of abortion rights laws. By March 2018, more than seventy legislators had signed on to the bill to decriminalize abortion, and the nation’s ministers of health and of science and technology had added their support. Importantly, many celebrities—among them actors, journalists, and influential members of civil society—publicly endorsed the pro-choice agenda. When the bill was put forward in March (for the seventh time), the legislature was divided into three distinct camps: 30 percent in favor, 30 percent against, and 40 percent undecided. That level of pro-choice support was unprecedented, indicating momentum for reforms. The March vote also set the stage for an unexpected development a month later when lawmakers began considering a bill that would allow legal abortions in the first fourteen weeks of pregnancy, a huge leap forward for the pro-choice movement in Latin America. The prospect of legalized abortion gained traction earlier in the year when Macri, despite his personal opposition to abortion, told lawmakers to “vote their conscience” rather than, presumably, along party lines.28 This opened the door to an unlikely set of allies within the fractionalized congress. Interestingly, four prominent women crossed party lines to join forces to advocate for choice: Brenda Austin from Macri’s Cambiamos coalition, leftist Victoria Donda, Romina del Plá from the Workers’ Party, and Mónica Macha, who had been an ally of Cristina Fernández de Kirchner (who had been consistently antiabortion during her presidency). The impetus for the shift seemed to be to save lives, echoing the sentiment of the antifemicide “Ni Una Menos” campaign. In June 2018, the lower house of congress approved the bill to permit abortions during the first fourteen weeks of pregnancy. The vote paved the way for the issue to move to the Senate, which agreed to deliberate the bill and scheduled a vote in August. In preparation for the legislative debate, tens of thousands of protestors and grassroots organizers worked feverishly to influence lawmakers, who were narrowly divided. Wearing green handkerchiefs to symbolize their pro-choice fervor, the advocates received unprecedented support from celebrities, politicians, and activists from across Latin America and the world. On August 7, Amnesty International published a full-page advertisement in the New York Times international section (which appeared in 134 countries) in support of the legislation. The ad, which featured a hanger and the word Adiós, warned, “The World Is Watching.”29 The Senate debate, which was televised live, lasted sixteen hours. Thousands of activists on both sides of the issue held vigils throughout

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the rainy, cold night. In the end, the measure was narrowly defeated, with a final vote of thirty-eight opposed, thirty-one in favor, and two abstentions. Even Fernández de Kirchner, by then a senator, voted in favor of the bill. Confirming the critical role of civil society activism in influencing the debate, she commented, “The young people, once again, warn of changing times and demand to be listened to. If you want to know who made me change my opinion, it was the thousands and thousands of girls who poured into the streets.”30 In the end, however, the abortion debate clearly voiced the will of senators’ local constituents—who may be more traditional or conservative than national leaders. Their votes confirmed the assertion that subnational parties and institutions influence representatives in Argentina’s federation in deciding controversial issues such as reproductive rights and that the government actors’ normative principles reflect the diversity of their decentralized system.31 Individual Stories Fuel the Impetus The battle for abortion rights continues to be hard-fought in Argentina. Women’s movement activists have worked tirelessly for decades in a complicated and capricious political arena. The much-publicized case of a young woman played a critical role in swaying public opinion, just like the stories of Rosita in Nicaragua and Esperanza in the Dominican Republic. In 2014 in the northern province of Tucumán, a twenty-sevenyear-old woman, known by the pseudonym “Belén,” sought medical attention for vaginal bleeding. Unaware that she was pregnant, she suffered a miscarriage; she was subsequently convicted of aggravated homicide and sentenced to eight years in prison. Her case received a tremendous amount of attention at both the provincial and national levels. The public understood that her rights had been violated because she had suffered a miscarriage—not an illegal act—and because the hospital had contacted the police rather than respect her confidentiality as a patient. On the legal front, Belén could not afford to pay her attorney, and her defense was initially horribly botched. (She was later represented by the pro-choice group Católicas por el Derecho a Decidir, which eventually led to a reexamination of her case). Human rights groups organized a well-coordinated campaign demanding her freedom. Ten domestic, regional, and international organizations, including Amnesty International, presented amicus briefs, and over 100,000 signatures of people calling for her release were delivered to Tucumán’s Supreme Court. 32 In addition, the UN Human Rights

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Committee included the case in its report on Argentina, urging the state to review the woman’s sentence; at the same time, it called for the country to ease its restrictions on abortion, citing the high level of clandestine procedures and the elevated incidence of teen pregnancies.33 Throughout the nation, thousands of Belén’s supporters took to the streets to clamor for her release. Her situation catalyzed a movement that had already gained momentum, despite the lack of support from the executive branch of government and the principal political parties. In August 2016, after serving more than two years in prison, Belén was set free. Tucumán’s Provincial Supreme Court ordered her release and eventually overturned her conviction in March 2017. Belén’s case struck a chord in Argentine civil society and politics, and important lessons from the case may shed light on the country’s potential for reform. Although the Peronists and other major parties may not be as strictly defined by ideology as other Latin American groups, three principles dominate Argentina’s political culture: social justice, human rights, and gender equity. Social justice discourse and policies permeate most areas of Argentine political life: Peronism itself was formed on the ideal of empowering the “masses.” Throughout the twentieth century, the state provided expansive social programs, promoted powerful unions, and dedicated itself to meeting the needs of its largely European immigrant population. Massive mobilizations for workers’ and students’ rights, pioneering legislation for marriage equality, and broad-based social and political movements are evidence of a deeply held commitment to alleviating class-based injustice. The often-viewed contemporary feminist slogan “Rich women abort, poor women die” (“Las ricas abortan, las pobres mueren”) further demonstrates the emphasis that pro-choice advocacy puts on equal treatment for all. Argentina has shown itself to be a leader in human rights since its transition to civilian rule in the early 1980s. It was the first Latin American country to hold public trials for the dictators in its military juntas, establishing a National Commission on the Disappearance of Persons in 1983. The prosecution of former leaders for human rights violations and, especially, the highly visible role of its enigmatic Madres of the Plaza de Mayo have placed Argentina at the forefront of human rights regimes globally. Thus, while sectors of the society continue to oppose abortion rights on religious grounds, the rights-based argument holds a great deal of weight (as evidenced, for example, in the legal defense of Belén). The final, and perhaps most paradoxical, principle is the nation’s perseverance in the area of gender equity. Women play an enduring

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key role in Argentine politics, starting with the mythical figure of Evita Perón, who looms large as a champion of poor and marginalized workers. She remains a (symbolically) commanding presence in Peronist political legitimacy. Perón’s next wife, Isabel (whom he married after Evita’s untimely death), became one of the first women presidents in the world. Indeed, women’s roles in politics have been complicated for decades. On the one hand, gender quotas have significantly increased the number of female elected officials. But their effectiveness in “substantive” areas, including abortion rights, has been limited. Of the two Kirchner presidents, the husband (Néstor) achieved more progress in contraception, sexual education, and condom distribution than his wife (Cristina) during the latter’s administration. Still, the role of women in Argentine civil society should not be underestimated; it counts as a critical and growing factor in the confluence of pressures in public policymaking. These contradictions underscore the importance of analyzing gender’s role in politics from a multifaceted and intersectional perspective. Nowhere is this more evident than in the abortion rights debate. The overall examination of government officials vis-à-vis the abortion debate offers lessons and legacies while perhaps, in many ways, raising more questions than answers. It demonstrates that women in politics may serve as engines for reform, or they may actively prevent progress. Leftist leaders may achieve revolutionary change to liberate their societies and then impose severe restrictions on women’s rights. And right-wing leaders may stand aside and let their judiciaries bring about sweeping pro-choice policies. Major cities may legalize abortion, with the rest of the country leading a backlash with “right-to-life” amendments. Abortion reforms may gain momentum at the national level, only to be dashed by subnational powers. And pro-choice legislation may be introduced dozens of times, with little or no success. The overriding lessons from these cases demonstrate that change in abortion politics can take years (sometimes decades) of persistent, gradualist strategies involving political leaders backed by organized members of civil society. Politicians are helped and hindered by religious beliefs and institutions as well as by entrenched political parties that firmly guide their hands. Leaders also recognize that their electoral futures are determined by voters, so public opinion on contentious issues matters. Finally, in democracies, the branches of government do not wield equal amounts of power. But the give-and-take among them is critical to public debate. The richness of that exchange is fundamental to understanding the qualities of good governance and to progressing toward equitable policies for all members of society.

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Notes 1. Author interview with Leslie Briceño, Managua, Nicaragua, August 14, 2015. 2. See, for example, Weldon and Htun, “Feminist Mobilisation”; Lopreite, “Explaining Policy Outcomes”; Franceschet and Piscopo, “Federalism, Decentralization”; and Blofield and Ewig, “The Left Turn.” 3. “Ecuador Abortion: President Correa Threatens to Resign,” BBC News, October 11, 2013, http://www.bbc.com/news/world-latin-america-24499248. 4. For descriptions of liberation theology and its role in the Latin American Catholic Church, see the writings of Gustavo Gutierrez and also Cleary, How Latin America Saved. 5. Kampwirth, “Feminismo,” 83–115. 6. Kampwirth, “Arnaldo Alemán,” 133–158; Kampwirth, “Feminismo,” 94. 7. The International Day of the Unborn Child was declared by Pope John Paul II and first celebrated in Argentina in 1999. It is observed annually in many countries on March 25. For information, see http://www.dayoftheunbornchild.com. 8. See Tim Rogers, “Why Nicaragua’s Caged Bird Sings,” Time Magazine, May 2, 2007. Rogers writes, “Transparency International awarded [Alemán] the dubious distinction of including him in its list of the World’s Ten Most Corrupt Leaders of all time.” 9. See Goldberg, The Means of Reproduction; Sue Chan, “Nicaragua Shaken by Child’s Abortion,” CBS News, March 23, 2003, https://www.cbsnews.com/news /nicaragua-shaken-by-childs-abortion. 10. Ortega Hegg, “Nicaragua,” 205–219. 11. Testimony of Marcia Ramírez, Nicaragua’s minister of family, adolescence, and childhood, speaking before the Inter-American Commission on Human Rights 156th period in a session titled “Situation of Human Rights of Women and Girls in Nicaragua,” October 20, 2015, http://www.oas.org/es/cidh/multimedia/sesiones/156 /default.asp. 12. According to Levitsky and Way, Competitive Authoritarianism. 13. See “Destituyen a diputada Sandinista,” La Prensa, June 24, 2013; “Destituyen a diputada,” El Nuevo Diario, June 25, 2013. 14. See Wurth, It’s Your Decision, for an overview of the human rights consequences of the Dominican Republic’s abortion ban. In 2016, Amnesty International identified “Esperanza” by her real name, Rosaura Arisleida Almonte Hernández. 15. Reported by Michelle Castillo, “Dominican Republic Teen at Center of Abortion Debate Dies from Leukemia,” CBS News, August 20, 2012, https://www .cbsnews.com/news/dominican-republic-teen-at-center-of-abortion-debate-dies -from-leukemia-complications; Rafael Romo, “Joven dominicana embarazada muere en medio de debate sobre el aborto,” CNNespañol, August 17, 2012, http:// cnnespanol.cnn.com/2012/08/17/joven-dominicana-embarazada-muere-en-medio -de-debate-sobre-el-aborto; Amnesty International, The State. 16. Manian, “Lessons,” analyzes the catastrophic effect of “personhood” legislation, such as that established in the Dominican constitution, on abortion rights and women’s health. 17. Betances, The Catholic Church. 18. For more information, see “Trujillo’s Concordat (1954),” Dominican Republic, Concordat Watch, http://www.concordatwatch.eu. 19. Larios, “Roe v. Wade’s Nightmare” outlines the consistent trajectory of the Dominican government’s “right-to-life” stance as reflected in its contributions to documents elaborated at International Women’s Conferences in Beijing and Cairo, as well as its interventions in international conventions and protocols.

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20. See Htun, Sex and the State, for an excellent analysis of abortion policies in Argentina, Brazil, and Chile during the region’s transition to democracy. 21. Much of this section on Argentine policies of the 1980s and 1990s is drawn from Blofield, The Politics of Moral Sin. 22. Blofield, The Politics of Moral Sin, 133–134. 23. Blofield, The Politics of Moral Sin. 24. Lopreite, “Explaining Policy Outcomes,” 389–404, notes that despite the lack of progress in abortion rights, steps were taken to increase access to and information about contraception in the early 2000s. 25. “La corte suprema precisó el alcance del aborto no punible y dijo que estos casos no deben ser judicializados,” Centro de Información Judicial, March 13, 2012, http://www.cij.gov.ar/nota-8754-La-Corte-Suprema-preciso-el-alcance-del-aborto -no-punible-y-dijo-que-estos-casos-no-deben-ser-judicializados.html. 26. Lopreite, “Explaining Policy Outcomes.” 27. Federico Mayol, “El debate por la despenalización del aborto no figura en la agenda de los gobernadores: la mayoría aún no fijó posición,” Infobae, March 4, 2018, https://www.infobae.com/politica/2018/03/01/el-debate-por-la-despenalizacion-del -aborto-no-figura-en-la-agenda-de-los-gobernadores-la-mayoria-aun-no-fijo-posicion. 28. Politi, “Legal Abortion in Argentina?” 29. “Argentina: Senators Have a Chance to Say Goodbye to Unsafe Abortion,” Amnesty International, August 7, 2018, https://www.amnesty.org/en/latest/news/2018 /08/argentina-new-york-times-advert-calls-on-senate-to-decriminalize-abortion. 30. “Cristina Kirchner votó a favor del aborto legal y explicó por qué cambió de opinion,” Infobae, August 9, 2018, https://www.infobae.com/politica/2018/08/09 /cristina-kirchner-anuncio-que-votara-a-favor-de-la-ley-de-aborto-legal. 31. Franceschet and Piscopo, “Federalism, Decentralization.” 32. “Caso Belén: diez organizaciones nos presentamos como amicus curiae en favor de su liberación,” Amnistía Internacional, July 21, 2016, https://amnistia.org .ar/12684-2. 33. United Nations Human Rights Committee, “Observaciones finales sobre el quinto informe periódico de la Argentina,” CCCPR/C/ARG/CO/5, August 10, 2016.

4 Pressure from Below

Undoubtedly, the establishment of the legal interruption of pregnancy signified the assertion of a right for which we feminists had been fighting for a long time, and one that is seen as a hallmark of the left (or should be). —GIRE founder Marta Lamas1

with the state to make them happen, and there is no set algorithm that can predict success. In Latin America, civil society actors in the abortion debate range from midwives and pharmacists to academicians and from presidents of nongovernmental organizations (NGOs) to journalists. Some lawyers argue for the liberalization of reproductive rights, others for their restriction. And newspapers, billboards, advertisements on the sides of buses, newscasts, and social media add their loud voices to the conversation. At times, among the most influential players in society are religious institutions, which tend to play an outsized role in shaping public opinion. While these participants may vary, one critical component is essential for pro-choice progress: the presence of strong, consistent feminist mobilization.2 This chapter and the next examine civil society stakeholders who play critical roles in Latin America’s abortion politics. The discussion begins with an overview of women’s movements and their relationships with the state, focusing on the trajectory of their participation. It argues that Latin American feminists have engaged in political practices in a wide variety of spaces and have been strategic in finding ways to adapt

Abortion rights reforms occur when advocates interact

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to changing dynamics in state-societal interactions—even when political economic factors (such as globalization and neoliberalism) challenge the integrity of movements. It further emphasizes the importance of networks in effecting reforms—as evidenced by the successful examples of legislative change.3 As Sylvia Walby has written, Concepts of networks, alliances and coalitions are more helpful in an analysis of feminist politics than those of identity or difference because they foreground the practice of recognizing differences and commonalities simultaneously. They point up the social and political work that is done when engaging across difference. They are suggestive of the contingency and of the potential for both fragility and resilience of the grouping of those supporting a political project, especially over time and space.4

The success or failure of abortion rights politics depends on their advocates’ ability to wield more political influence than their antichoice adversaries. This chapter presents two cases that demonstrate different strategies toward that end. The first is that of Mexico, where the rape and pregnancy of a teenager catalyzed grassroots mobilization that contributed to abortion legalization in the capital. The other case examines the situation of Bolivia’s indigenous women, whose participation in and perception of reproductive rights reform are reshaping the abortion debate from the bottom up. Throughout the region, pro-choice feminist advocates serve as frontline interlocutors for individuals and groups of women, for governments, and for international institutions. The alliances (“policy communities”)— networks of individuals and organizations—they form are the backbone of the abortion rights debate.5 Often less visible, but equally vital, is the health-care community, the work of which has the most immediate impact on women facing unintended pregnancies. Physicians, nurses, hospital administrators, pharmacists, clinic staffers, midwives, and the associations that collectively represent them influence both laws and public sentiment through their words and actions. It is their perspective that provides the strongest argument for shifting the abortion debate to the medical and public health realm. These are the people who, often on a daily basis, save or dramatically affect the lives of pregnant women and girls. Social movements, NGOs, and doctor-patient interactions are all examples of how civil society mediates the role of the state in people’s private lives. Although most low-income women in Latin America seek medical treatment in public hospitals, they have a right to privacy in the decisions they and their doctors make about their health. In fact, the right to privacy over one’s health-care decisions forms the backbone of

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the 1973 US Supreme Court ruling that legalized abortion in the United States. That landmark Roe v. Wade court case elevated the notion of privacy and limited government interference in private lives. The abortion rights debate, taken at face value, concerns the right to terminate an unwanted pregnancy, but its ramifications extend to the very shape, breadth, and reach the state has into an individual’s private life, in this case her body and her reproductive decisions. Latin American governments do change in response to pressures from the grass roots. Institutionally and discursively, each state is evolving in its interactions with society on multiple levels, and this necessitates an assessment of the nature of the state itself vis-à-vis societal participants, as constitutions, roles, and structures have themselves transformed in recent decades. Importantly, contemporary pro-choice advocacy operates under the assumption that the state is not monolithic and can be approached from a number of vantage points. The state is changing, and civil society’s strategies to access power are adapting. But before we turn to an examination of civil society roles in the abortion debate, it makes sense to look briefly at the backdrop of relationships between the neoliberal state and nonstate actors. Women’s Movements, Civil Society, and the Neoliberal State Latin America’s pro-choice proponents are direct descendants of the region’s fiercely active feminist movements, with women’s rights advocacy dating back to the early twentieth century.6 The forbearers of today’s activists can be traced to organizations that emerged during periods of military dictatorship and often represented some of the strongest resistance to authoritarian rule. The return to civilian rule in the 1980s brought the reemergence of political parties, pushing movements out of the political arena’s center and reducing their leverage as “sources of new ideas and as arbiters of the political agenda.”7 At the same time, since the movements were formed during dictatorships, they saw themselves as oppositional and antistate, a stance at odds with the new role available to them via the reestablishment of civilian governance. In this new environment, women’s movements regrouped and adapted, participating in the democracy-building process. They had achieved three fundamental inroads into political life: universal suffrage, formal integration into the state apparatus through institutions addressing “women’s issues,” and quota laws to ensure women’s participation in electoral politics.8 And states began to integrate women’s interests into

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their formal bureaucracies. By the end of the century, more than 90 percent of contemporary states worldwide—including nearly all the Latin American nations—had created public institutions to address women’s issues, entities known individually as a national women’s machinery.9 Although these bureaus vary in their mandate, size, and scope, they formally integrate women’s concerns and status into the bureaucratic apparatus of the state. At the same time, in the 1990s and early 2000s, Latin America led the world in the introduction and implementation of legislature gender quotas, guaranteeing an increase in the number of female congressional members throughout much of the region. The increased participation yielded mixed results, both in the movements’ strategies and in their approaches to gender-based issues. For some feminists, the inchoate democracies offered opportunities for them to access political power by allowing them to integrate into political parties or government institutions. Others opted for a militantly autonomous stance. Their discussions began in earnest in a series of regional conferences (encuentros) that helped redefine their strategic directions. At the same time, the meetings opened up avenues of participation for historically excluded sectors, including rural, indigenous, and Afro-descendant women. While the movements were adapting, however, the nature of the state was also shifting. On the political economic front, the years of “structural adjustments” in the region, principally in the 1990s, resulted in a state apparatus that was significantly smaller in size and scope. Many of its functions had been dismantled or shifted to the private sector, with diverse repercussions for social programs and policies. The rolled-back states increasingly depended on women’s NGOs as technical gender experts and provided them with contracts and financial support, at times compromising their independence. The resulting emergence of issue-specific NGOs was of concern to many social movement activists who feared they would lose their agenda-setting edge by cooperating with the state.10 Others worried that the dominance of NGOs had crowded out traditional forms of feminist mobilization, like marches in the streets or consciousness-raising groups.11 Indeed, some of the groups lost their connections to women on the ground, responding instead to the demands and agendas of the governments and international aid agencies that financed them. These trends had implications for the nature of the policies and programs enacted by governments and may be partially responsible for the failure to liberalize abortion laws in many countries, including those led by left-leaning governments. The increasing “professionalization” of women’s movements politics was seen, at times, to undermine the capacity of women’s NGOs to

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effectively monitor and critique government policy. Sonia Alvarez, director of the Center for Latin American, Caribbean, and Latino Studies at the University of Massachusetts, Amherst, famously argued that the women’s movements in the 1990s had been somewhat depoliticized by collaborating with the state in the provision of services, a process she deemed “NGO-ization.”12 By this time, many of the organizations that made up the women’s movements began to change in order to survive and continue pursuing their goals in the new political context. In some cases, groups that managed to maintain linkages to larger constituencies—such as poor women’s organizations or avowedly feminist groups critical of the state’s agenda—were not consulted because they lacked the technical capacity of the more professional NGOs. Women’s movement groups that were critical of the government also found they were neither consulted nor selected as partners to carry out programs. In other words, the groups that truly represented the grass roots were cut from the process of formulating gender policy. The independence of the “expert” NGOs was further undermined by their reliance on the state for financing. International donors reduced their foreign aid to countries in Latin America at the same time the state was shrinking its social service activities and increasingly relying on professional NGOs to carry out training and other programs. As the public sector outsourced its work, it influenced the NGOs’ missions and operations. Thus, results-oriented technical NGOs that were focused on policy impact were more likely to attract funding and have an influence than traditional women’s movement groups, which were geared more toward feminist consciousness-raising and antiestablishment mobilizations.13 While this altered role for gender-based organizations presented challenges for the women’s movements, it also created new opportunities for feminist political action. As Lynne Phillips and Sally Cole have argued, feminists in Latin America have always chosen a “politics of presence”—pragmatically “choosing to be present in a diversity of mixed spaces in order to advance gender equity goals directly and in concrete ways.” 14 Contemporary abortion rights advocacy takes place through collaborations among groups and individuals from throughout civil society. While still primarily dominated by white, mestiza, and urban feminists, abortion rights movements have taken deliberate measures toward increasing diversity. In fact, in 2017, Alvarez and other scholars reassessed the relationship between civil society and the Latin American state that emerged from the assorted contemporary collaborations. Labeling it the “Civil Society Agenda”—one that allowed states to withdraw from the arena

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of social policies, letting NGOs and other cooperative actors pick up the slack—the analysts articulated a dialectic between two camps. They documented very visible on-the-ground mass mobilizations in the realm of confrontational collective action (deemed “uncivic” by some) as well as the type of civic participation promulgated by neoliberal governments and international agencies. Contemporary pro-choice politics gathers strength from diverse corners of feminism. Reproductive rights advocates unite coalitions from the issue-focused, autonomous women’s movements as well as the groups, organizations, and individuals participating in state- and interstate institutional structures. Abortion advocacy takes place on both the “civil” and “uncivil” sides of this involvement (which are not always mutually exclusive). The “civil” side of the argument reflects a larger discourse of women’s rights and feminist organizations that operate in and around political institutions; the “uncivil” side mobilizes activists and struggles to disrupt the status quo. Both sides contribute to abortion politics, with varying strategies and outcomes throughout the region. Furthermore, while reproductive rights and other gender-based organizations and networks take center stage, they do so in concert with a wide spectrum of stakeholders. Strategic alliances and support for abortion rights have emerged from many quarters. In Uruguay, for example, unions played a valuable role in the passage of pro-choice legislation. In Nicaragua, where the traditional women’s movement is estranged from the Daniel Ortega government, supporters have come from the media and other camps. Their work has included the production of pro-choice telenovelas and radio programs. And, in important and diverse ways, indigenous and Afro-descendant groups have raised their voices both in favor of and against abortion rights. Indigenous women in Bolivia (discussed later in this chapter) have been especially influential in the debate. Social movements and networks in Latin America are as diverse as the region’s inhabitants. While the majority was historically united in opposition to authoritarian rule, contemporary grassroots activists range from environmentalists to disenfranchised victims of economic inequities. Class, race, ethnicity, and religion can sharply separate groups when it comes to advocacy on gender-related issues, but the cacophony of voices ultimately strengthens the debate. The following case studies illustrate how the agonistic discourses among grassroots organizations, “professional” NGOs and advocacy groups, traditional women’s movements, and issue networks weave together into the fabric that is the abortion rights debate in civil society.

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Mexico City: From Paulina to a Pro-Choice Capital On July 31, 1999, a burglar raped thirteen-year-old Paulina del Carmen Ramírez Jacinto in front of her family members. The girl reported the crime to Mexican police right away. Within a few weeks, she discovered that she was pregnant as a result of the attack. Since abortion was legal in rape cases in the state of Baja California where she lived (as well as in all thirty-one states and Mexico City), Paulina immediately applied to the authorities for permission to terminate the pregnancy. The attorney general’s office granted her petition, but public health officials pressured her to withdraw the request, a clear violation of her rights. The following are the details of Paulina’s case, highlighting the role of government authorities, health-care providers, and the critical intervention of feminist NGOs on her behalf. On September 3, 1999, Paulina’s mother requested authorization for her daughter’s abortion from the state prosecutor’s Special Agency for Sex Crimes. The prosecutor’s office approved the petition and ordered Dr. Ismael Avila Iñiguez, the director of Mexicali General Hospital, to schedule the procedure, telling Paulina and her family that only state public health authorities could perform the abortion. In the following weeks, Dr. Avila Iñiguez refused several times to carry out the order. In October, Paulina was admitted twice to Mexicali General Hospital, where she was treated poorly and housed in the maternity ward. By mid-month, the state issued an arrest warrant for Dr. Avila Iñiguez for disobeying the order for the abortion. While in the hospital, Paulina was visited by two women, Mayra Topete and Marcela Vaquera, allegedly without the hospital’s permission, who claimed to work for the government’s Comprehensive Family Development Agency. (They were associated with Provida, an organization linked to the anti-abortion group Human Life International.) The women attempted to persuade Paulina not to have the abortion, showing her the video “The Silent Scream.” They returned later to present their arguments to Paulina’s mother. State Attorney Juan Manuel Salazar Pimentel then arranged for Paulina and her mother to meet with a priest. After hearing the story of the rape, the priest told them that what they were contemplating was a “crime” and a “murder.” But, despite his admonitions, the girl proceeded with her plan to terminate the pregnancy. Moments before the abortion was finally to take place, Dr. Avila Iñiguez met privately with Paulina’s mother and told her that if Paulina were to have the abortion, she might die or be left sterile. The doctor further asserted that if Paulina were to die, it would be the mother’s

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fault. Paulina’s mother later asserted that she was forced to waive her daughter’s right to an abortion. The procedure was canceled. On October 25, 1999, Paulina’s attorneys filed a complaint with the state’s Law Office for Human Rights and Citizen Protection, detailing the violation of Paulina’s human rights. After hearing arguments on both sides, on March 3, 2000, the director of the Law Office issued five recommendations to compensate Paulina, her mother, and her unborn baby, as well as to sanction the hospital and to organize training courses for health workers to address such matters in the future. But the victory was short-lived: on March 13 the government of Baja California, after reviewing the Law Office’s recommendations, denied the petition and ruled that the state had no obligation to compensate Paulina in any way. At that point, two pro-choice organizations—reading about Paulina in the media—took action on the girl’s behalf, with representatives from the Grupo Feminista Alaíde Foppa and the Grupo de Información en Reproducción Elegida (GIRE) bringing the case before Mexico’s National Commission for Human Rights. In April, Paulina signed a complaint against the attorney general’s office and public health sector for violating her right to an abortion. Three major newspapers published a letter, signed by thirty-two public figures, supporting the recommendations of the state’s Law Office for Human Rights and Citizen Protection that the state government rejected. The Mexican press portrayed the case sympathetically, and media support played a key role in swaying public opinion in her favor.15 On the international front, the New York Times published an article about the case.16 That month, Paulina gave birth to a boy by cesarean section. The Baja California Women’s Network held a press conference calling for the dismissal of the state’s attorney general and director general of its Institute of Health Services. Although this case focuses on the pro-choice efforts exerted on Paulina’s behalf, it is important to locate her struggle in its sociopolitical context. In July 2000, right-wing candidate Vicente Fox of the National Action Party (Partido Acción Nacional, PAN) won the presidential election, overturning more than a half century of one-party rule in Mexico. (The majority of the Baja California officials implicated in Paulina’s case were from his party.) The following month, the Vatican designated Mexicali as a “Cathedral of Life” for its refusal to grant an abortion to Paulina. While the girl’s plight catalyzed an upswell of supportive activism, wide swaths of civil society also mobilized on the opposing side. Two years later, in 2002, in a case that eventually reached the Superior Court of Justice of Baja California, Paulina’s rapist was sentenced to sixteen years in prison. That year, three attorneys, Mónica Roa of the

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Center for Reproductive Rights (then known as the Center for Reproductive Law and Policy), Socorro Maya of Alaíde Foppa, and Regina Tamés of Epikeia, filed a complaint on Paulina’s behalf at the InterAmerican Commission on Human Rights (IACHR). Among other assertions, the complaint declared that the state violated Paulina’s rights under international human rights provisions. It further accused the Mexican state of failing to have clear abortion regulations in cases of rape. Finally, it insisted that the state must comply with its ratification of international treaties, including the American Convention on Human Rights, the Convention of Belém do Pará, and the Convention on the Elimination of All Forms of Discrimination Against Women. In the following months, seventy Latin American organizations sent the IACHR a letter requesting that it give Paulina’s case “special attention.” On March 8, 2006, seven years after the assault, Paulina and the Mexican state reached a “friendly settlement” agreement during the IACHR’s 124th session. The agreement carried three important elements: payment of damages to Paulina and her son, public acknowledgment that Paulina’s rights had been violated when authorities denied her an abortion, and a commitment to implement measures to remove obstacles to other women’s exercise of their reproductive rights. Paulina’s case is significant for a number of reasons. It illustrates the way that Mexican officials, including doctors and hospital administrators, frequently treat low-income, pregnant rape victims, even juveniles.17 It reveals disconnects between and interactions among government officials, public health authorities, religious figures, private citizens, and advocacy groups. Importantly, it shows the wide gap that separates legal abortion rights and their application on an everyday basis. At the same time, it exemplifies successful coordination among domestic reproductive rights groups: first, local NGOs Grupo Feminista Alaíde Foppa and Epikeia, and then GIRE and an international NGO, the Center for Reproductive Rights. Finally, the settlement brokered by the Inter-American Commission on Human Rights clarifies ways that international human rights treaties and protocols can be brought to bear in such cases. Paulina’s victimization and subsequent treatment became a rallying cry for Mexican reproductive rights advocates. One of the country’s most renowned authors, Elena Poniatowska, wrote about the case in a widely read book, La herida de Paulina (Paulina’s Wound).18 The case’s notoriety provided the impetus that the pro-choice movement needed. In 2003, Mexico City’s progress on the reproductive rights front received a major boost as the municipality, under the leadership of the Party of the Democratic Revolution, decriminalized the act of seeking

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an abortion.19 In the years that followed, with the support of international and domestic philanthropies, a successful campaign was carried out by well-organized groups, including the Consorcio para el Diálogo Parlamentario y la Equidad (Consortium for Parliamentary Dialogue and Equity), Ipas Mexico, Católicas por el Derecho de Decidir (Catholics for the Right to Choose), and GIRE, among others. These organizations coordinated their efforts in a mass campaign that assigned specific roles based on each group’s area of expertise: lobbying, research, grassroots outreach, and so on. They worked closely with the city’s government, major political parties, and media outlets, eventually participating in over a dozen public hearings in which the abortion issue was debated. Despite intense opposition from the Vatican and conservative political actors, the historic abortion rights legislative reform was upheld by an 8–3 Supreme Court decision. The April 2007 legalization of abortion in Mexico City marked a watershed in Latin American reproductive rights for both its breadth and its scope. The following year the nation’s Supreme Court strengthened it by voting to uphold its constitutionality. The law paved the way for approximately 10 million women—the largest group in the region outside Cuba and Puerto Rico—to have access to free, safe, and legal abortions in their first trimester. The case also presents an effective model for reproductive rights advocacy in contemporary Latin America, with strategies coordinated on the local, national, regional, and international levels, as well as multilaterally within a matrix of interests, groups, classes, and media.20 Pro-choice advocates worldwide could learn a great deal from this legislative success in a predominantly Catholic country. The driving force behind this collective action was a simple message of social justice arguing that women from every socioeconomic class have the right to equal access to safe, affordable health care. Proponents of abortion law reform advocated for the same access to services for the poor that their middle-class compatriots enjoy. (Middle-class women in Mexico have always been able to pay for abortions in private clinics or to travel to the United States for the procedure.) Advocates also reminded legislators that Mexico is a secular state with a strong tradition of separation of church and state, despite the powerful influence of the Catholic Church. The persuasiveness of these positions, coupled with more than three decades of a well-established women’s movement promoting a feminist agenda, contributed to this landmark reform. Still, the 2008 court decision did not end the abortion debate in Mexico. The law has faced numerous challenges, along with a flurry of pro-

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posals for anti-abortion amendments to the constitution. Because Mexico is a federation, abortion laws are determined at the state level, rather than the national level, and Mexico City’s legalization of abortion sparked a widespread anti-choice backlash throughout the country. To their credit, women’s organizations in the Federal District quickly responded to assist those in need of abortion services from outside the city. One such group, the Fondo de Aborto para la Justicia Social María, provided transportation, housing, and financial support so that pregnant women could travel to Mexico City for legal abortions. The group created a network of volunteers who accompanied women to hospitals and provided them and their partners with information about reproductive rights options. After passage of the Mexico City law, sixteen of Mexico’s thirtyone states responded with “ right-to-life” constitutional amendments. (A seventeenth state, Chihuahua, already had such an amendment in place since 1994.) Each state’s criminal code determines its penalization of abortion, so the battle for rights is exceptionally arduous. The overall result was that while women in the capital could access abortion services safely and without charge in public hospitals, women elsewhere in the country faced tighter restrictions than ever. At the same time, presidents from the conservative PAN, who led the country from 2000 to 2012, cut federal funding for family planning, an important source of support in that area.21 In many ways, the Mexican political system mirrors that of the United States and other federal systems. While the national government has a degree of control over how programs are funded and policies are made, the subnational states retain a great deal of power over abortion rights. This arrangement serves as a double-edged sword. On the one hand, states can enact legislation in reaction to reforms in neighboring states (as was the case in Mexico), tightening restrictions in response to constituents’ outcries against changes in the laws. On the other hand, the ability to change laws at the state level allows for reforms to be enacted at multiple locations in a country, providing more opportunities in places with a progressive government or citizenry. In a 2017 interview, GIRE director Regina Tamés described some of the challenges and recent progress in her organization’s reproductive rights efforts: “The case of Mexico, which makes it different from El Salvador, Nicaragua, and Honduras, is that they have an absolute prohibition of abortion. It’s different in Mexico, which doesn’t have an absolute prohibition in any state. But the difficulty is that we have to work state by state. We have to focus our efforts in thirty-two federal entities. It’s actually thirty-one, because Mexico City already has more open legislation, and it’s not restricted to certain cases.”22 Tamés went

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on to outline the daunting strategies and challenges proponents face when advocating for reform at multiple levels. As she explained, the difficulties in the legal arena are numerous: first, civil society organizations must be aware of the legislation and criminal procedure codes in each state, as well as at the national level— along with the federal constitution. Not all organizations, much less the women themselves, are necessarily familiar with the legal aspects of the issue, as Mexico operates in a system that the activist characterized as “very strong federalism.” At the same time, doctors are not always familiar with the laws, so they may be reticent to perform abortions. Tamés further emphasized the problematic gap between the “law and reality,” which she called an “abyss.” While laws may exist that help women and girls in a number of areas, including gender-based violence and abortion, they are not consistently enforced (as in Paulina’s case). Since 2000, Mexico has created a number of strong institutional and legal mandates to support women, but data evaluating their effectiveness are scarce. These resources may actually exacerbate the situation in some ways, since the authorities believe that their existence “solves” the problem, and they no longer pay attention to what is actually taking place. In the area of abortion, Tamés explained the way that GIRE had worked to streamline the process for women to navigate legal hurdles. One of the main obstacles had been in the area of guidelines or protocols in place: all petitions for legal abortions (as in cases of rape) originally had to be adjudicated by the public ministries. But the officials did not always know if they had to send the pregnant women or girls to the ministries of health for further approval. For their part, the ministries of health did not always know how much time had to pass for them to make a decision and how to determine whether a victim had told the truth about the rape allegation. There were many steps that had to be taken, and there were many delays. GIRE explored the question of why, if abortion is legal throughout the country in cases of rape, one must file a complaint to the authorities before being allowed to have an abortion. Tamés spoke of her organization’s solution in the interview: The worst thing in this country is the administration of justice. They re-victimize you, they question you. If I don’t want to file a complaint against my father, my mother’s boyfriend, my uncle, my brother ... [w]hich are the biggest majority in these cases, if the girl didn’t press charges, she couldn’t have an abortion. So we got rid of the [requirement to file] complaints, we got rid of the permissions from the public ministries, and we copied the models of Brazil and Argentina where women and girls go directly to the

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health system. So now you can go argue with the health authorities instead of the justice system. We managed to get rid of the requirement of the formal complaint for the whole country. And now you only have to go to the health system and say that the pregnancy is the result of rape. And you make your sworn statement. If they find out after an investigation that it’s not true, then they charge you, not the doctor.

Tamés’s comments underscore strategies that proponents must adopt simultaneously at the subnational and national levels to facilitate access to legal procedures. Importantly, GIRE’s efforts also succeeded in placing requests for abortions in cases of rape squarely in the medical realm, removing other intervening (and cumbersome) public institutions. As Tamés noted, Mexican women still face significant barriers in accessing abortion services in nearly every part of the country. Some obstacles are structural. Others stem from a lack of information and reticence to implement laws. Still, strategic alliances and the meticulous coordination of civil society groups—working closely with international organizations and government officials—make the Mexico City abortion legalization process a model for others to emulate. The situation in urban-based Mexico City stands in sharp contrast to that of Bolivia, where rural sectors added traditionally underrepresented voices to the debate. Its advocates, who come from very different demographic and political contexts, have also made inroads in abortion rights reform. Their efforts point to the need for the abortion debate to address inclusion and social justice. Bolivia’s Plurinational Progress

On December 15, 2017, a diverse coalition of pro-choice advocates witnessed the culmination of many years of intense political efforts: the Bolivian government broadened the right to abortion in the first eight weeks of pregnancy. The country had previously permitted abortions in cases of rape and incest and when a pregnancy endangered a woman’s life. The new law, signed into a revised penal code, expanded to allow girls and adolescents, as well as women who are students or caregivers for the elderly or for children, to terminate unwanted pregnancies.23 The broadened law followed a 2014 Constitutional Court decision ending a requirement that women receive judicial authorization to have an abortion. Women from throughout Bolivia took part in effecting these legal reforms, but the case is especially significant because of the role that rural indigenous women played in the process.

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As previously discussed, Latin American feminism—and women’s movements globally—came under fire in the late twentieth century for ignoring and excluding large swaths of the population, including rural, indigenous, Afro-descendant, and other marginalized women. The movement’s oversight mirrored that of the state, which historically provided few services to those groups and had retreated even further under sweeping neoliberal restructuring. Poor access to health care, education, and other social and economic programs left broad sectors impoverished and underserved, with women inordinately shouldering the consequences. The situation of unintended pregnancy among the region’s indigenous women is especially distressing. Throughout Latin America, indigenous women have worse reproductive health than the population as a whole. Their rates of unintended pregnancy, especially among adolescents, are high, and they face more risks of abortion-related complications and mortality than the rest of the population. Unsafe pregnancy terminations occur at “dangerously” high rates, with studies showing that indigenous women are many times more likely to undergo unsafe abortions than nonindigenous women.24 The incidence of intimate and sexual violence is also elevated for these women.25 Indigenous women’s beliefs and traditions about contraception, fertility, and abortion are often at odds with those promoted by the conventional (i.e., urban-based or so-called Western) health-care regimes, a fact that has been overlooked in addressing health-care needs specific to their communities. Against this backdrop and bolstered by the rise of President Evo Morales’s Movimiento al Socialismo (Movement Toward Socialism) party, Bolivia’s indigenous women seized the opportunity of their country’s constitutional reform to assert their rights. As Stéphanie Rousseau observes, during the constituent assembly process that took place between August 2006 and December 2007, the women found themselves wedged between a male-dominated ethnic movement and a gender-based, mestiza-dominated one.26 The indigenous women engaged in an extremely effective campaign of organized activism and political engagement to ensure that constitutional reform would reflect their unique worldview. The resulting 2009 Bolivian constitution contains gender-based and indigenous rights elements previously unheard of in national charters. Although not all Bolivian indigenous women’s groups supported abortion rights—some were vociferously anti-abortion—their participation in the debate was tremendously instructive and highlighted a fundamental shift in the discourse surrounding the issue. No longer could reproductive rights, or family planning, be argued from a Western,

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urban, or mestiza perspective. The new diversity of voices strengthened and informed the process, clearly engaging the three ideational frames of the abortion debate described at the beginning of this book: the rights frame, the medical frame, and the moral frame. Within the rights frame, indigenous women activists demanded the concrete intersectionality of gender-based rights espoused by thirdwave feminists. They asserted the needs and perspectives of lowincome, rural, and ethnically diverse people whose voices had previously been marginalized by mainstream feminism. Regarding abortion specifically, they were powerful enough to compel reproductive rights activists to come to their communities to gain an understanding of their perspectives, not just to co-opt them or convince them to adopt the Western, ethnocentric position. By the time that the 2017 penal code reform was signed, reproductive rights organizations had spent more than eight years building an inclusive grassroots movement that reflected the country’s diverse worldviews. With the support of an assortment of indigenous women leaders, the groups formed a Pact for the Decriminalization of Abortion, a grassroots coalition of more than fifty organizations. At the conclusion of the constitutional reform process, the organizations worked together to develop a Sexual and Reproductive Rights Draft Bill, a comprehensive document addressing sexual violence, HIV/AIDS, abortion, and family planning—in other words, a legal framework for sexual and reproductive rights. The indigenous leaders involved in the abortion rights movement stand out for the wide landscape they encompass. They include representatives from the mining unions, the head of the Women’s Confederation of Intercultural Communities of Bolivia, a spiritual leader in the Kallawaya Nation and a member of the National Council of Ayllus and Markas of Quollasuyu, Quechua speakers, and Aymara activists.27 In fact, Bolivia has emerged as a pioneer in what Aída Hernández Castillo has termed “indigenous feminism.”28 She describes the movement as follows: Although in some ways the demands of indigenous feminists coincide with those of urban feminists, they have substantial differences as well. The economic and cultural context in which indigenous women have constructed their gender identities marks the specific forms that their struggles take, as well as their conceptions of women’s dignity and their ways of building political alliances. Ethnic, class, and gender identities have determined indigenous women’s struggle, and these women have opted to incorporate themselves into the broader struggle of their communities. But, at the same time, they have created specific spaces to reflect on their experiences of exclusion as women and as indigenous people.29

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The Bolivian indigenous women’s participation in the abortion rights debate represents a critical shift in strategies for reform. It has altered the often monolithic perspective of reproductive rights advocacy, highlighting the agency and political might of civil society’s diverse stakeholders. In addition, on a political level, indigenous women may not engage in the discourse of “choice” articulated by their westernized counterparts. Writing about ethnographic interviews with Bolivian women, Natalie Kimball explains their attitudes toward abortion as follows: While some women facing unwanted pregnancy in Bolivia articulated their desires to continue or to terminate their pregnancies in terms of “choice,” most did not. Many women I interviewed in Bolivia who continued unwanted pregnancies felt that they had no other option but to do so, as did many women who sought abortion. In addition, whether a woman continued or terminated a pregnancy often had little to do with her personal stand on abortion. Conditioned by a range of personal circumstances and by broader, societal conceptions of motherhood, women’s experiences with unwanted pregnancy suggest the need for a new analytical framework that pushes beyond either medical considerations or a politicized language of choice.30

Notions of rights and the very concepts of abortion and “choice” certainly merit a great deal more attention from abortion rights advocates. If women’s rights advocates have learned anything from third-wave feminism, it is to reflect upon the decades of hegemonic domination of discourse by middle-class and elite Western activists—and to strive to incorporate historically marginalized sectors into political debates. Just as the Bolivian case enlightens the abortion debate from a rights perspective, it is also instructive in understanding the issue within a medical frame. This becomes clear in the historical context of indigenous women’s health in the region. In addition to limited access to health-care services, resulting in lower rates of contraceptive use, higher levels of maternal mortality, and increased complications during pregnancy, indigenous communities have suffered from a lack of sexual education and information. Alarmingly, some state-sponsored “family planning” programs (at times backed by international sponsors) resulted in large-scale forced sterilizations of indigenous women at different points in history. It comes as no surprise, then, that top-down initiatives to promote contraception have been met with skepticism and distrust.31 Until recent decades, public health initiatives had also shown little regard for indigenous communities’ traditions, practices, and expertise in managing their reproductive lives. Sexual and reproductive health services for indigenous women remain woefully inadequate. However, providers and funders—from grassroots to

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international institutions—have recognized the need for a paradigm shift. There has been an acknowledgment, due to both the dire situation and the political efforts of indigenous women’s organizations, that an intercultural, community-based approach to women’s health bears the best results. This may require overcoming linguistic or cultural barriers, enlisting traditional parteras (midwives) or promotoras (community health promoters), or conducting interviews to identify challenges and experiences with health-care services.32 By actively participating in the public sphere, indigenous women’s groups provide leadership that helps address the unique exigencies of their communities. In the same vein, indigenous women’s activism has exposed the need to understand the distinct perceptions of reproductive health. Heather Wurtz insightfully reviews recent scholarship on the medical aspects of abortion among the region’s indigenous women. She observes, “Some studies indicate that in many communities in South America, fertility regulation may primarily be conceptualized and practiced in terms of postconception methods,” with many indigenous women describing abortion as a way to regulate menstruation. Wurtz continues, In Hammer’s research among Quechua women in Bolivia, most conventional contraceptive options conflicted with women’s ethnophysiological understandings and were perceived to threaten their fertility. For fear of the risks of childbirth and the strains of poverty, women welcomed early-term abortions and sometimes tried to induce them. Women in this community do not perform naming rituals for fetuses less than six months, which are viewed as watery, expelled substances (yakulla) and are, therefore, unceremoniously discarded.33

In other words, indigenous women’s notions of abortion may not neatly line up with conventional medicine. The number of women seeking postabortion medical attention indicates that there is a great need for further communication and education surrounding reproductive health. Recent experiences show that the best way to serve indigenous populations is for health care to be holistic, community based, and responsive to their diverse traditions and practices. Finally, the Bolivian indigenous women’s movements inform the moral frame, which is far from monolithic on either the pro-choice or anti-abortion side of the debate. Indigenous women may not uniformly accept the Catholic-driven belief system of when life begins and its implications for abortion. Although it is far beyond the scope of this study to delve into the moral philosophies of indigenous people, much more scholarship is clearly needed to differentiate perspectives on abortion held by Latin America’s multitude of diverse communities.

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The facts are compelling. As in other communities marked by poverty and poor access to public services, indigenous women experience high rates of unintended pregnancies. They frequently seek to terminate them and often blame having too many children as the root of their economic ills. As women have become more politically engaged, aspects of their activism reflect a worldview that seeks to free them from the yokes of colonialism, economic oppression, and gender- and ethnic-based discrimination. They are also actively asserting their own beliefs about personhood, health, and motherhood, and those, too, are shaping the way forward in the abortion rights debate. Abortion rights’ strategies reveal the complexity of both the relationships between the citizenry and the state and the links—and disconnects—between and among diverse populations within that citizenry. Civil society’s role in the debate reveals both obstacles and opportunities. Progress in the area of abortion rights, as work in Mexico and Bolivia has demonstrated, results from approaches that involve numerous stakeholders from diverse sectors. In both countries, advocates partner with allies in activities that range from filing legal briefs to staging street protests. While change is gradual, there are signs that abortion rights are advancing in most of Latin America. That said, the next chapter acknowledges that some cases are more intractable than others, notably in most of Central America. Notes

1. Lamas, La interrupción legal, 44. 2. Blofield and Ewig, “The Left Turn.” 3. The notion of issue networks and the foundation of this argument as it pertains to abortion rights in Latin America are drawn from Htun, Sex and the State. 4. Walby, “Feminism in a Global Era,” cited in Phillips and Cole, “Feminist Flows,” 188. 5. Shiffman and Smith, “Generation of Political Priority,” 1371. 6. An earlier version of this historical overview appeared in Caivano and MarcusDelgado, “Time for Change.” 7. Jaquette, Feminist Agendas, 5. 8. Jaquette, Feminist Agendas. 9. Towns, Women and States. 10. Jaquette, “Feminism,” 342. 11. Ríos Tobar, “Chilean Feminism(s),” 365–366. 12. Alvarez, “Advocating Feminism.” 13. Alvarez, “Advocating Feminism.” 14. Phillips and Cole, “Feminist Flows,” 187. 15. Taracena, “Social Actors,” provides excellent analysis of the role of the Mexican press in swaying public opinion in Paulina’s favor. 16. Preston, “Rape of Mexican Teenager.”

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17. See, for example, Human Rights Watch, The Second Assault. 18. Poniatowska, in La herida de Paulina, 63, poignantly writes about the hypocrisy of Mexico’s health practitioners who refuse to perform abortions: It is very serious when public officials confuse their personal convictions with the law and don’t carry out their medical duties. In Paulina’s case, raped at 13 and a mother at 14, the gynecologists of Mexicali’s General Hospital forgot that every day the hospital treats many women due to a badly performed abortion and so they do a [dilation and curettage] without acknowledging that they are aware or judging the woman. In Paulina’s case, isn’t that pharisaism? In this type of abortion, the midwife inserts a probe or a catheter that just starts the abortion and advises the woman that she go to the hospital as soon as it starts bleeding. In some desperate cases, the women go so far as to insert crochet hooks, knitting needles, wire, spoons, clothes hangers, pencils, umbrella or sunshade rods, or other sharp objects, and run the risk of perforating not only the uterus, but also the intestines. Abortive teas are another resource, as are laxatives, injected bleach, caustic substances, and even dyes. In their anguish, some women go so far as to strike themselves in the stomach or ask others to do so, they throw themselves down the stairs or out of trees, and the hospitals are filled with intentional falls. Quinine, Ergotrate, and Pitocin are other pharmaceutical techniques that work in some cases. What no one doubts is the horrible trauma that a woman experiences when she’s fallen into the well of anguish of an unwanted pregnancy.

19. Lopreite, “Explaining Policy Outcomes,” emphasizes the role of political parties in abortion rights reforms, which was significant in the Mexico City case and less so in another federal system (Argentina). 20. Sources of information on the Mexico City abortion law reform were drawn from the author’s interviews with Ana Anuchastegui Herrera (Universidad Autonoma Metropolitana—Xochimilco), Daptnhe Cuevas (Consorcio para el Diálogo Parlamentario y Equidad), Maria Luisa Sanchez Fuentes (Instituto Liderazgo Simone de Beauvoir), Eugenia López Uribe (Red Balance), María Mejia (Católicas por el Derecho a Decidir), and María de la Luz Estrada (Observatorio Ciudadano Nacional del Feminicidio), Mexico City, November 9–11, 2011. 21. Lopreite, “Explaining Policy Outcomes.” 22. Author’s interview with Regina Tamés, Mexico City, May 23, 2017. 23. Fernando Molina, “Bolivia amplía los casos de aborto legal,” El País, September 30, 2017, https://elpais.com/internacional/2017/09/29/america/1506707616 _443555.html. 24. Wurtz, “Indigenous Women.” 25. Wurtz, “Indigenous Women.” 26. Rousseau, “Indigenous and Feminist Movements”; Rousseau and Morales Hudon, “Indigenous Women’s Movements.” 27. “Meet Bolivia’s Champions for Abortion Rights,” Ipas, December 18, 2017, https://spotlight.ipas.org/meet-bolivias-champions-for-abortion-rights; “Behind the Scenes of Bolivia’s Historic Abortion Law Change,” Ipas, December 18, 2017, http:// www.ipas.org/en/News/2017/December/Behind-the-scenes-of-Bolivia-s-historic-abortion -law-change.aspx. 28. Hernández Castillo, “The Emergence.” 29. Hernández Castillo, “The Emergence,” 542–543. 30. Kimball, “The Landscape,” 220.

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31. Programs carried out in Peru during Alberto Fujimori’s government are estimated to have sterilized over 300,000 women from 1990 to 2000. Forced sterilization of Native Americans has taken place in the United States, Canada, and other Latin American nations. A 1969 Bolivian movie, Blood of the Condor (Yawar Mallku/Sangre de Cóndor), depicted US volunteers secretly sterilizing indigenous women. In 1971, possibly due to the outcry from the film, the US Peace Corps was expelled from the country. 32. Wurtz, “Indigenous Women.” 33. P. Hammer, “Quechua Abortion: Hidden Paths Toward Desired Fertility” (unpublished paper presented at the Society for Applied Anthropology Annual Meetings, Baltimore, Maryland, 1996), cited in Wurtz, “Indigenous Women,” 275.

5 When Civil Society Meets Uncivil Opponents

“Manuela,” slips and falls while washing clothes in a local river, accidently hitting her stomach.1 The next day, the single mother begins to bleed lightly, drags herself to the latrine behind her house, and feels that she has evacuated something. She faints. Upon awakening, she makes her way inside, where the bleeding intensifies. Her family takes her to the hospital for medical treatment, but from the moment she arrives, she faces accusations from the staff that she self-induced an abortion. The attending physician, a woman, records opinion-laded value judgments in her file, including the observation that the pregnancy was the product of “infidelity,” since Manuela is technically still married (although her husband emigrated to the United States several years before the incident). That same day, the hospital contacts the public prosecutor’s office, and the police begin an investigation. After obtaining a search warrant, the authorities find the remains of a fetus in the latrine. Manuela, still hospitalized, is handcuffed to her bed for over a week. She is subsequently charged with homicide for the fetus’s death. She is illiterate and has no legal representation during the initial investigation; she is found guilty and sentenced to thirty years in prison. After two years of inadequate health care, Manuela dies of Hodgkin’s lymphoma—which probably caused the original miscarriage but was not diagnosed in time—while incarcerated. Unfortunately, Manuela’s case is far from unique. As the previous chapter describes, Latin America’s pro-choice advocates have mobilized for decades on behalf of victims like her. They have formed alliances,

In rural El Salvador, a thirty-three-year-old pregnant woman,

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developed strategies, and adapted well to changing political contexts and settings. But their success is contingent on two principal factors: their ability to access state institutions to effect change and the strength of oppositional forces relative to their own.2 This chapter examines two countries with total abortion bans and civil society’s efforts—led by reproductive rights organizations—to break through their seemingly impenetrable political walls. It concludes by addressing ways in which Peru’s crisis of sexual violence, especially the rape of minors, has catalyzed public opinion and activism. Barriers to political change, however, remain formidable. El Salvador: Facing the Righteous Right Several countries in the region outlaw or restrict reproductive rights, but El Salvador stands out as the one that has most aggressively persecuted and prosecuted women and girls for violating its abortion ban. Punishments range from excommunication to, as in the case of Manuela, thirty-year prison sentences for homicide. Even under presidents from the Farabundo Martí National Liberation Front (FMLN), the former leftist guerrilla movement, the path for reforming abortion laws has remained stubbornly arduous. The ascension of the FMLN’s Mauricio Funes to the presidency in 2009 marked the first time in the country’s history that a left-wing candidate had been elected to lead the nation.3 Women in El Salvador had reason to be hopeful. The FMLN had a history of intolerance for violence against women, had incorporated women into nontraditional military roles within its ranks, and had provided education on how to prevent unwanted pregnancies. But, as Jocelyn Viterna observed, “feminism and the Left have always had a complicated relationship, and the FMLN is no exception.”4 In fact, the party’s rise to power demonstrates the political cost of abortion rights reform in relationship to other leftist priorities. When faced with stiff opposition, the FMLN (as did Daniel Ortega in Nicaragua, Dilma Rousseff in Brazil, and others) abandoned its position on reproductive rights in the pursuit of electoral expediency. The party won the presidency but sacrificed women’s rights in the process. Earlier, during the country’s period of military rule and its twelveyear civil war that ended in 1992, Salvadoran law permitted abortion in cases of rape and incest, when a woman’s life was in jeopardy, or if a fetus was malformed or impaired. But in the 1990s, two events precipitated a crackdown on abortion rights. The first was the emergence of the

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anti-abortion movement, which became more vocal in response to the international women’s conferences of the decade. This anti-choice movement was bolstered by the appointment of a new Opus Dei–linked archbishop, Fernando Sáenz Lacalle, shifting the church to a much more ideologically conservative position. By 1992, the FMLN had morphed from a guerrilla movement into a political party, with the anti-choice Nationalist Republican Alliance (Alianza Republicana Nacionalista, ARENA) party as its principal opposition. In 1994, as El Salvador worked to rebuild after the war, it began reforming its criminal code. Among proposed legislation was a modest liberalization of abortion rights. This sparked ARENA to quickly introduce a bill to criminalize abortion in all circumstances. Although the FMLN supported the initial reform effort, ARENA’s heavy-handed proposal eventually prevailed, and in 1997 El Salvador imposed a total ban on abortion, joining only a handful of countries with such extreme laws.5 Two years later, ARENA reopened the debate, this time seeking to amend the constitution to protect life from the moment of conception. The FMLN by now was split between its pro-choice members and those espousing a “moral” argument against abortion. Political pragmatism became an issue too, once the party realized it would not win elections if it maintained a reformist stance. The life-beginsat-conception constitutional amendment drew seventy-two favorable votes in an eighty-four-member legislature. There were twelve abstentions and no negative votes.6 The abortion ban became law, backed by the weight of the national constitution. The ban dealt a serious blow to El Salvador’s feminist organizations, but it marked neither the beginning nor the end of their advocacy work. In a 2017 interview, Morena Herrera, one of El Salvador’s leading voices in the abortion rights struggle, described the arduous journey she and her colleagues have traversed. She recalled an early 1990s landscape not unlike that of other Latin American nations, one in which abortion was permitted under three circumstances (in cases of rape, when the woman’s life was in danger, or where a fetus was impaired). Still, hospitals were reticent to perform even legal abortions because the guidelines were unclear or not accessible: In the feminist organizations at the beginning of the 1990s, we began to talk and reflect about abortion, about the need for there to be clearer laws. We had three exceptions of criminal responsibility, but there were no procedures by which to apply them. So many times we arrived at the hospitals with pregnant girls, girls who had been raped, and we were told that without a judicial order, they could not interrupt the pregnancy. We would go look for a judge,

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to seek a judicial order, and they would say to us that if there was no verdict or judicial resolution, they couldn’t give us a judicial order. And many times the trials would last longer than the pregnancies. So it wasn’t viable to apply the law. It depended on the discretion of the official who attended the case.7

As the country launched peace accord negotiations in the postconflict period, pro-choice advocates called for clarity in the application of the “three exceptions” allowed by law. They also pushed for additional areas of decriminalization. The women’s organizations never demanded free, unrestricted abortions, but managed to integrate their pro-choice agenda into the platform set forth by civil society groups for the 1994 elections, which were dubbed the “Elections of the Century” since they were the first to occur after the peace accords. Although the platform that women’s organizations supported failed to gain traction, the women’s groups were instrumental in the creation of the Instituto Salvadoreño para el Desarollo de la Mujer (Salvadoran Institute for Women’s Development), in recognition of the goals of the Beijing Declaration and Platform for Action (that came out of the UN’s Fourth World Conference on Women in 1995), and in other actions that addressed women’s concerns. Herrera described the first postconflict legislative period: The first legislature was the one that had the task of creating the new criminal code. . . . [B]ased on the assumption that we were coming from a situation in which human rights had been violated by the armed conflict, that’s why they created the new criminal code. . . . [T]he debate turned to the subject of abortion. But it wasn’t a big debate, like in 1994. In that legislative session, there was a big mobilization of ecclesiastic groups. They mobilized the students, who marched right past this house. At that time there was no Child and Adolescent Protection Act [which barred the mobilization of students for rallies] . . . and the churches could mobilize the Catholic school students. The girls and boys passed by here, and I’d say, “These kids don’t even know what they’re marching about.” . . . It was a manipulated mobilization, but it had an effect in the legislative assembly. And with the exception of the FMLN, which had few Congress members in the assembly at that time, the rest of them lined up to eliminate all types of abortion. . . . At the end, in the very plenary session where this [abortion ban] was approved, it was late at night when we got to the end . . . but we insisted on speaking. And they gave us the floor, just because of our sheer pressure. We did it, even though we were already convinced that what we were about to say wasn’t going to change the vote. It was important to have clearly on the record that

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there were other points of view in the country . . . and that, with this measure, they were taking one of the achievements of the peace agreements away from us.

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Many women’s organizations were reticent to tackle abortion rights reform in the years that followed, but Herrera and other feminists continued to take action. Out of their original organization, Las Dignas, they created the Agrupación Ciudadana por la Despenalización del Aborto (Citizen’s Association for the Decriminalization of Abortion). A small group of dedicated women began to protest the detention and sentencing of women on homicide charges in cases related to abortions and to pressure the government to reform the severe ban. By the time that Funes assumed the presidency in 2009, El Salvador had become infamous for what was one of the world’s harshest antiabortion laws. Funes’s left-leaning FMLN party continued to win elections, but it did so without any concessions toward liberalizing abortion rights. The two FMLN presidents, Funes and Salvador Sánchez Céren (2014–2019), neglected the issue almost entirely, allowing punitive state policies to remain in place. Women found guilty of abortion received jail sentences of two to eight years. However, if the fetus was deemed to have been “viable” at the time of the termination, the charge became homicide. As of 2017, twenty-seven women were serving prison terms on abortion convictions. The charges came both in cases where women intentionally terminated the pregnancy as well as when they suffered involuntary miscarriages. Health-care workers refuse to perform abortions or to assist women suffering from obstetric emergencies since they, too, can face stiff legal consequences. In fact, the law punishes not only doctors who provide abortions, but also those who fail to report illegal pregnancy terminations to the authorities. Frontline activists such as Herrera have drawn the world’s attention to the dire situation of women with unintended pregnancies. The activists waged a campaign to secure freedom for Las 17, named for seventeen young women (mainly from impoverished backgrounds) who were put behind bars for decades for what they insist were miscarriages. Although a few have subsequently been released or seen their sentences reduced, additional women have been sent to prison with long sentences. Beyond battling to free these women and girls, the Agrupación has fought for the right to therapeutic abortions based on medical exigencies. The Salvadoran government became the target of sharp criticism from the international human rights community as a result of one such case involving a low-income woman with the autoimmune disease lupus.8 In March

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2013, Beatriz Garcia fell ill and suspected she might be pregnant. She was admitted to the hospital in San Salvador and was found to be thirteen weeks pregnant. Tests showed that the fetus suffered from anencephaly: it had no brain or skull and would not be viable outside the womb. To its credit, the Maternity Hospital’s Legal Unit quickly filed a writ on Garcia’s behalf, arguing that a continuation of the pregnancy could prove fatal for the woman. But the only authorities empowered to rule on the case were judges of the Supreme Court’s constitutional branch, and they dragged their feet. They sought an expert opinion from the Institute of Legal Medicine (IML), which was directed by Fortin Magaña, a member of the conservative Catholic group Opus Dei. The IML, not surprisingly, rejected the argument that the pregnancy could trigger serious health complications, including renal failure, as hospital officials feared. Working with the Agrupación and other advocacy groups, Garcia went so far as to appear on television to appeal to the president directly for relief. Her attorney sought an amparo, a legal injunction that would have precluded the state from taking action against Garcia. In fact, Minister of Health Maria Isabel Rodriguez supported the pregnant woman’s appeal and advocated on her behalf. Garcia also sought assistance from the Inter-American Commission on Human Rights (Comisión Interamericana de Derechos Humanos, CIDH, also abbreviated as IACHR in English), which attempted—unsuccessfully—to get assurance from the Salvadoran state that the pregnancy would be terminated if the CIDH issued a ruling in Garcia’s favor. At the end of May, the CIDH instructed the state to permit doctors to carry out the medical procedures necessary to protect Garcia’s health and save her life. But El Salvador’s Constitutional Court ruled that the mother’s rights could “not be given preference over those of the nasciturus (unborn child) or vice versa.”9 By now in her twenty-seventh week of pregnancy, Garcia was in failing health. On June 3, doctors performed an operation they called an “induced labor” rather than an abortion. The infant delivered by cesarean section weighed just over one pound (five hundred grams) and lived only five hours. By the time Garcia was discharged from the hospital a week later, entities from the United Nations to the Spanish Socialist Party to Amnesty International had come out in public support of the woman. On the other side, however, were the heavyweight Salvadoran Bishops’ Conference and the Yes to Life Foundation (Sí a la Vida), both of which loudly opposed Garcia’s right to terminate the dangerous pregnancy. The CIDH reviewed the merits of Garcia’s situation to determine whether a lawsuit against the Salvadoran state could be heard by the

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Inter-American Human Rights Court. If the case were accepted and a judgment was brought against the government, El Salvador’s government might be liable for reparations to Garcia’s family, possibly including provisions for her five-year-old son. On September 7, 2017, the court accepted the case. The following month, Garcia died from complications following a motorcycle accident, never having received the news from the CIDH. Garcia’s private tragedy, which unwittingly made a significant contribution to the abortion rights cause in her country, speaks volumes within the cacophonous public debate. Garcia did not die from an illegal abortion, but the denial of her rights undoubtedly contributed to the rapid deterioration of her health. Her situation is all too common among low-income women in Central America. Even when medical complications from abortion prohibitions do not kill them, the other repercussions can still be devastating. These may range from excommunication from the church and an end to schooling to economic hardship and exposure to violence within families, incarceration, and even severe physical or psychological infirmities. El Salvador is not the only country that has inflicted all these forms of suffering on its girls and women. Neighboring Nicaragua joins it among the handful of the world’s nations that totally ban abortion. These two Central American countries also share the historical trajectories of their ruling parties. Both the Sandinista Front for National Liberation (FSLN) and the FMLN fought against US-backed aggressors in the 1980s and rose to power with the support of low-income sectors of the population. The countries have progressive members in their governments. And each faces tough opposition from the Catholic Church and other religious actors vis-à-vis reproductive rights reforms. The similarities between the two countries part, however, in two important aspects: strength of opposition in the political arena and relations with civil society. While Nicaragua has virtually eliminated any real challenges to the FSLN regime, the Salvadoran government had to contend with the formidable challenges of the right-wing ARENA party, severely restricting its ability to implement social changes. In 2019, the country elected a new young, populist president, Nayib Bukele. Although originally an FMLN member, the thirty-seven-year-old pro-business politician aligned himself with the conservative Great Alliance for National Unity party for the election. During the campaign, he declared himself publicly to be in favor of abortion rights when a pregnancy puts a woman’s life in danger. But with few seats in the legislature, the executive will need to seek allies to advance his political agenda, and whether he will challenge the existing ban remains to be determined.

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At least El Salvador’s competitive elections provide the possibility of a political opening and a new generation of actors on the public stage. It stands in sharp contrast to the increasingly autocratic government of Nicaragua, where the Sandinistas have maintained their political primacy since the 1980s. Nicaragua’s relationship with its civil society is complicated as its social movements, nongovernmental organizations (NGOs), and progressive activists struggle to make policy inroads with the ever more authoritarian Ortega regime. Nicaragua’s Autonomous Advocates and Activist Adversaries Dr. Carla Cerrato and her small obstetrics-gynecology team at the Hospital Alemán Nicaraguense attend to approximately a hundred women and girls per day, delivering about 6,000 babies each year. Their patients’ average age is around fifteen, and the doctors work around the clock.10 On a regular basis, people with unintended pregnancies, botched abortions, and life-threatening obstetric crises appear at the Managua hospital. Many of them receive excellent medical care, but others are turned away because of the country’s ban on abortions. “We have to individualize patients, and we have to prioritize the life of a pregnant girl,” Cerrato explained in a 2015 interview. “If not, she might die.” For the medical community faced with life-or-death decisions, the political ramifications take a back seat to more pressing concerns. When viewed from the governmental perspective, the Nicaraguan abortion prohibition looks straightforward: no voluntary interruptions of pregnancies under any circumstances. There is very little debate in official circles, and the Ortega administration shows no apparent willingness to change. But seen through the lens of civil society, the situation is much more complex. Medical professionals face the pragmatic need to provide for their patients. Many of them participate in abortion rights activities not through protests or lobbying but instead through their dayto-day work. In contrast, among feminist groups and reproductive rights activists, there are great debates raging over how best to confront the country’s seemingly intractable laws. As noted in Chapter 3, the government’s relationships with nongovernmental groups, especially feminists, have disintegrated during Ortega’s time in office. Although the Sandinista government did not institute the abortion ban during its first administration, the party’s record on women’s rights is marked by ups and downs. The 1979 revolution and the eleven years of government that followed achieved great strides in women’s leader-

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ship and education, but it consistently fell short in the areas of contraception, sex education, and abortion. The FSLN government had five reasons for this shortcoming. First, it articulated a need to increase the nation’s population and strengthen its workforce; second, it did not wish to risk alienating the more progressive members of the Catholic Church’s hierarchy; third, persistent machismo encouraged pregnancy and motherhood; fourth, the realities of poverty meant that more children translated into more workers to help support the family; and fifth, there was a fear of repressive population-control programs coming from outside the country. (Many in Nicaragua believed that the US government was involved in a widespread involuntary sterilization program prior to the revolution.) At the same time, as the 1980s progressed, the Contra War and US embargo placed a strain on the country’s medical system and made contraceptives scarcer.11 During the years of the revolution, a number of women’s groups formed within the labor unions and in movements associated with the FSLN. The biggest of these was the Asociación de Mujeres Nicaraguenses Luisa Amanda Espinosa (AMNLAE), which engaged large numbers of party members and supporters in discussions covering gender-related issues, including family planning and therapeutic abortions. Although the latter were still legal in the 1980s, many in AMNLAE were anti-choice. There were ongoing divisions among women’s groups and political leaders regarding their positions on abortion, an issue that would further splinter the women’s movement in later years. Within the FSLN, according to longtime activist Sofia Montenegro, there was always a great debate between prioritizing class- and gender-based rights. Besides, embroiled in the war with the “gringos,” the Sandinistas were reticent to take on a battle with the Vatican over reproductive rights.12 After the Sandinistas’ electoral defeat in 1990, the party and the women’s movement split, and, as previously described, the party’s leaders formed pacts with members of the political opposition and the more conservative hierarchy in the Catholic Church. According to Montenegro, Ortega agreed to the total abortion ban during his 2006 reelection bid in order to show his faith. “They wanted to appear more Christian than the pope,” she explained. In tandem, links were forged between Daniel Ortega and the rapidly expanding evangelical movement, which was staunchly anti-abortion. A faction of the women’s movement remained loyal to the FSLN, which integrated many of its members into the government after returning to power in 2006, but some of the traditional feminist organizations distanced themselves from the government. Their antagonism toward Ortega and his administration grew over the years, culminating

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in a final rupture after the president’s stepdaughter accused him of repeated sexual abuse. One group, the Movimiento Autónomo de Mujeres (MAM), has been involved in pro-choice activism and vocal in its opposition to the Sandinista government. In an interview, MAM member and attorney Azahalea Solís described the government’s resulting persecution, which has ranged from raids on MAM’s offices to false accusations of financial mismanagement—all aimed at disrupting the group’s activities and harassing its members.13 Both Solís and Montenegro formulate their involvement with feminism and gender-based rights from a comprehensive and traditional movement perspective. In some ways, these longtime feminists, with their holistic, structural approach to change advocated by social movements, exemplify the sharp disjuncture that exists between them and the issue-based “network” strategies of many abortion rights groups. Their stance vis-à-vis the state is antagonistic; in the face of increasing antidemocratic government actions, the women’s movements have become correspondingly strident. Their advocacy covers a wide swath of demands, and they are among those criticized for an “essentialist” position, an arguably old-fashioned grouping of women’s issues that third-wave feminists may tend to see as reductionist and nondiverse. Their combat against a common adversary, in this case the state in its battle against gender-based rights, can be seen as a form of “strategic essentialism,” which advances their cause on behalf of the shared identity of all women.14 (Strategic essentialism is a tactic that brings together divergent groups, which are otherwise separated by strong differences, on the basis of their shared cultural, political, or gender identities so that they can achieve social justice goals or human rights guarantees.) Importantly, it forms part of a multifaceted approach that confronts the state from diverse vantage points. Women’s movements in Nicaragua have undoubtedly laid the foundation for abortion rights advocacy. Those working solely for reproductive rights acknowledge the critical role that traditional women’s movements play, but they also recognize that progress must be gradual and less adversarial. Given the Ortega administration’s strained relationship with the “old-time” feminists, the abortion rights advocates seem to have opted for a tactic of “strategic distancing” rather than “strategic essentialism.” Strategic distancing can be seen as a way for groups to keep themselves apart from one another, despite their many overlapping goals and missions, to use discrete means toward similar ends. As in other parts of Latin America, the reproductive rights groups in Nicaragua have sought to align themselves with members of civil soci-

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ety who are not branded as feminists. They have forged networks with NGOs and other members of society, including attorneys, academics, health-care workers, and people from the arts, to create broad coalitions of citizens seeking change. Unlike the feminist movements that generally demand full legalization of abortion, the reproductive rights groups employ a step-by-step approach. As a first step, they are seeking to restore therapeutic abortion, which was legal prior to 2006. The principal groups in this effort coordinated their advocacy work in December 2006 under the umbrella of the Grupo Estratégico por la Despenalización del Aborto Terapéutico (Strategic Group for the Decriminalization of Therapeutic Abortion). One of its strongest voices is Marta María Blandón of Ipas Central America. Unlike feminists who work strictly in opposition to the government, in a 2015 interview Blandón stated the Strategic Group’s objective was to rally civil society so as to gradually move the regime toward eased restrictions. One victory in that direction has been Ipas’s agreement with the government to train professionals in postabortion family-planning services.15 In 2012, Ipas interviewed people from diverse sectors of Nicaraguan society who supported decriminalizing therapeutic abortions. The resulting publication, Aborto terapéutico: 24 voces (Therapeutic Abortion: 24 Voices), profiled politicians from the opposition Constitutionalist Liberal Party, male and female lawyers, sociologists, academicians, and a Jesuit priest, among others.16 In a similar vein, in October 2015, a group of citizens collected more than 6,000 signatures from a cross section of society in support of a bill before the National Assembly that would decriminalize abortion in cases of rape or when a pregnancy endangers a woman’s life. The two groups have not adopted the confrontational tactics of their traditional movement counterparts but, instead, have opted to develop a broad base of support in civil society in order to move toward stronger abortion rights. In the end, concrete actions come down to physicians such as Cerrato, on the front lines treating women and girls dealing with unintended pregnancies and the aftermath of clandestine abortions. Cerrato and her colleagues are well aware of the parameters of the treatments they may legally provide. In the 2014 documentary A Quiet Inquisition, the soft-spoken doctor clearly articulated the quandary she faces.17 Health-care professionals are caught between medical norms and laws written by nonmedical legislators. When a pregnancy endangers a woman or girl’s life, as the film shows, Cerrato opts to save the life, knowing that she is violating the abortion ban. In fact, as both she and Dr. Ligia Altamirano, a former administrator at the Ministry of Health (MINSA), acknowledged, the law contradicts the protocols issued by

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the government for how health-care workers are to manage obstetric complications, including instructions for terminating pregnancies when a woman’s life is in danger.18 Nicaragua has cut its maternal mortality rate in recent years, but the statistics surrounding unintended pregnancy remain staggering.19 Teenagers count for about 20 percent of all maternal deaths. Approximately one-quarter of all births annually are to adolescents, and about one-half of all girls have had a baby before their twentieth birthday, placing Nicaragua just behind sub-Saharan Africa in terms of the highestpercentage of teen pregnancies. The country also records an alarming number of pregnancies resulting from rape. According to MINSA statistics for 2009 to 2012, there were 6,404 reported victims of sexual violence between the ages of ten and fourteen who became pregnant. The struggle for abortion rights is fought on many fronts, by stakeholders ranging from on-the-ground physicians such as Cerrato, to dedicated feminists like Solís. In Nicaragua, the ranks of reproductive rights advocates include activists from the original women’s movement as well as loosely knit groups of professionals. While many practitioners in the medical community remain steadfastly anti-abortion, major associations and experts publicly recognize the abortion ban’s harmful effects. These include the Nicaraguan Society of Gynecology and Obstetrics, the Nicaraguan Society for General Medicine, the medical faculties at the Universities of León and Managua, and the Nicaraguan Nurses Association.20 Pro-choice groups and individuals may play different roles in the abortion debate in Nicaragua, but they share a common characteristic: they are relentless. Even when faced with formidable adversaries and a reproductive rights landscape that can only be described as grim, prochoice civil society is unyielding in its pursuit of legal remedies. The final case study in this chapter looks at another country where civil society has played a transformative role: Peru. The Andean country’s complex yet extremely well-organized pro-choice efforts extend from local grassroots groups to transnational regional leadership. Interestingly, the devastating impact of sexual violence in Peru has emerged as a principal driver in the push for abortion rights. Stolen Lives in Peru In January 2018, Pope Francis returned to Latin America to continue his dialogue with civil society. At an enormous mass in Peru’s northern city of Trujillo, he called for an end to gender-based violence: “I want to invite you to fight against a plague that affects our Latin American con-

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tinent, the numerous cases of femicide. There are so many cases of violence that remain silenced behind so many walls. I am calling on you to fight against this source of suffering, asking that legislation and a culture be promoted that rejects every type of violence.”21 The pope’s remarks steered far away from abortion rights reform, but his words conveyed an important message. A recent congressional debate in the country centered on the right to abortion in cases of rape, one of the most consequential violations of women’s rights. While femicide is prevalent throughout the region, another gender-based crime—rape—is especially rampant in Peru. And the frequent incidence of pregnancy among rape victims is especially horrendous, negatively impacting females, especially teenagers, for the rest of their lives. In a 2016 interview, Congresswoman Marisa Glave of the Frente Amplio (Broad Front) political party underscored the gravity of the situation, noting that the majority of sexual violence cases (62 percent in 2014) affect girls between fourteen and seventeen years old.22 The pope, by highlighting the problem of violence against women, perhaps unwittingly contributed to the debate in favor of reproductive rights reforms. In fact, the right to abortion in cases of sexual violence is one of the strongest rallying cries among Peruvian reproductive rights advocates, especially when the victims are adolescents or even younger girls. At a November 2015 conference in Lima, Ximena Casas, the senior advocacy program officer for Latin America at Planned Parenthood Global, presented a multicountry report titled Vidas robadas (Stolen Lives), documenting the link between sexual violence and pregnancy among girls aged nine to fourteen.23 She noted that Latin America is the only region where the number of births to girls under fifteen has risen in recent years, and it ranks second in the world for incidences of teenage pregnancy. Casas also illustrated the connection between teen pregnancy and poverty, describing the vicious cycle that is created by these unplanned pregnancies. Girls who become pregnant often face a future marked by lowered academic achievement and reduced financial stability. She added that girls from the poorest tiers of society were three to five times as likely to become pregnant as those in the top quintile of income, and too often those pregnancies were a consequence of rape. The report states that approximately 50,000 births in Peru each year are to mothers under twenty years old. In 2013, the Ministry of Health documented more than 1,100 births to mothers twelve and thirteen years old. “In other words,” Casas said, “three or four girls between twelve and thirteen become mothers every day in Peru.”24 In response to this crisis, pro-choice advocates have developed a well-organized public campaign to press for abortion rights in cases of

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sexual violence. Déjala Decidir (Let Her Decide) is a broad-based movement whose supporters include traditional feminist organizations, sexual and reproductive rights NGOs, and famous authors, artists, and celebrities. Even Nobel Prize–winning author Mario Vargas Llosa, who once ran for the presidency as a conservative candidate, recorded a video of support for the campaign’s Facebook page. Unlike in Nicaragua, Peru’s pro-choice civil society generally speaks with a diverse but unified voice. Advocacy work takes place on the local, national, and regional levels. Two traditional women’s movement NGOs, the Flora Tristan Peruvian Women’s Center and the Manuela Ramos Movement, both founded in the late 1970s, mobilize activists and take part in initiatives led by sexual and reproductive rights organizations. Other major organizations on the women’s rights front, such as the Center for the Promotion and Defense of Sexual and Reproductive Rights (Promsex) and Center for Reproductive Law and Policy, play pivotal roles among regional advocacy groups. One of these advocacy organizations, the Latin American Consortium Against Unsafe Abortion, is housed at Promsex in Lima. The Peruvian groups appear to broadly tackle gender-based issues beyond abortion rights, extending their reach into marriage equality and, importantly, violence against women and girls. When it comes to abortion rights specifically, they frame the debate from medical, human rights, political lobbying, and legal vantage points. Although Peru’s pro-choice advocates have yet to reform current abortion laws, which allow the procedure only when a woman’s life is in danger, they have made important inroads in defining the parameters of the existing law. The next chapter drills down on two victories, those of women known as “L. C.” and “K. L.,” who garnered international attention and won favorable decisions from global human rights institutions. The two cases illustrate the lack of clarity regarding the duties of and risks faced by medical providers when confronted with demands for abortion services. For instance, although medical ethics and basic human rights have long dictated respect for patients’ confidentiality, many Latin American governments require health-care providers to report women and girls who seek abortions or postabortion treatment. 25 In Peru, the 1997 General Health Law dictates that doctors must report “criminal” abortions.26 Unsure of the legal parameters in individual cases where a termination is sought, many health-care workers have denied services for fear of prosecution. Abortion rights advocates pressured the government to issue clear guidelines delineating the protocols surrounding the provision of services.27 Working closely with a female health min-

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ister, Midori de Habich, Promsex and other groups managed to get protocols published in June 2014.28 Other than articulating the guidelines, the Peruvian government has been slow to enact abortion rights reforms. Advocates have faced significant pressure from major political blocs in congress, especially those aligned with former president Alberto Fujimori. Although Fujimori was incarcerated for years on charges of corruption and human rights violations (and pardoned only in January 2018), his followers have dominated Peru’s legislature for quite some time. His daughter, Keiko Fujimori, was a frontrunner in the 2016 presidential election. Faced with stiff opposition from the eventual winner, Keiko Fujimori signed a public pledge affirming her “pro-life” commitment. (A powerful conservative evangelical group, the Civic Christian Coordinator for Values, led by pastor Alberto Santana, had created the document.) Keiko Fujimori’s stance mirrored that of her party, which has consistently rejected the legalization of abortion in cases of rape.29 Despite these obstacles, Peruvian advocates have emerged as leaders in regional and global pro-choice jurisprudence. The Lima conference at which Casas presented the Stolen Lives report was a major international gathering sponsored by the Andean Jurists Commission and the Association of Judges for Justice and Democracy. The Legal Conference on Reproductive Rights focused on violence against women and reproductive justice viewed from a legal perspective. The conference organizers described the assembly as a “high-level forum that . . . gathers academics, justice officials (judges, magistrates, prosecutors), legislators, activists specialized in strategic dispute resolution and incidence, professional colleges, and civil society representatives involved in the defense and promotion of reproductive rights in the region from a perspective of human rights and comparative law.”30 The conference included workshops and presentations by politicians and experts from all levels of NGOs, intergovernmental judicial systems, public health organizations, and scholarly communities. The tone of the conference was far from that of the impassioned protests that have for years filled Latin America’s streets to demand reproductive justice and women’s rights. But it must be remembered that the lessons and legacies of those women’s movements are the rocksolid shoulders upon which all progress in abortion rights rests in the region and around the world. Some strategies remain constant, such as mass protests, collecting signatures, and widely publicized acts of civil disobedience. Such actions took place in Argentina throughout 2018, with thousands of pro-choice supporters taking to the streets waving green handkerchiefs and demanding that congress debate an abortion

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rights bill. While academics, lawyers, and NGO leaders work doggedly behind the scenes to influence policymakers, huge mobilizations still hold tremendous sway in the courts of public opinion. Latin American civil society has become highly sensitized to the injustice and deep damage that results from harsh anti-abortion laws. Along with information about teen suicides, children born from rape, and thousands of nameless victims of botched illegal abortions, there is a growing effort to demonstrate the much broader impact that comes when laws are applied unequally due to gender and socioeconomic status. And this awareness is coming through civil society coalitions and collaboration. Heinous cases, such as eleven-year-old rape victims forced to give birth31 or that of Beatriz Garcia, the lupus patient forced to carry an anencephalic fetus, are powering civil society’s increasing support for abortion rights. Public campaigns against sexual violence, which unfolds on a continuum of crimes, have garnered sympathy for its victims because of the devastating impact it leaves in its wake. Importantly, as the following chapters examine, the international community is hearing Latin American women and girls. The response mirrors that of domestic stakeholders: advocates and adversaries weigh in vociferously, from the courts to social media and from churches to global feminist gatherings. And while every day women and girls continue to face unintended pregnancies, their collective voices are now heard more loudly and broadly than ever before in history. Notes 1. For details on the case of Manuela, see Center for Reproductive Rights, Marginalized, and Bougher, “Quién es Manuela?” The story is fully documented at “Manuela Toolkit,” Center for Reproductive Rights, https://www.reproductiverights .org/document/manuela-toolkit-english (accessed January 5, 2016). 2. Aspects of this argument were originally articulated in Htun, Sex and the State, and Blofield, The Politics of Moral Sin. It has been reiterated in numerous studies, including Reutersward et al., “Abortion Law Reforms”; Blofield and Ewig, “The Left Turn”; Htun, Lacalle, and Micozzi, “Does Women’s Presence”; Sánchez Fuentes et al., “The Decriminalization of Abortion”; Kane, “Abortion Law Reform.” 3. See Viterna, “The Left,” for analysis of the FMLN’s stance on women’s and reproductive rights. For extensive information on the consequences of El Salvador’s total abortion ban, see Center for Reproductive Rights, Marginalized. 4. Viterna, “The Left,” 250. 5. Article 312 of the Salvadoran Penal Code of 1998. 6. See Viterna, “The Left,” 251. Also see Constitution of El Salvador, Article 1, January 1999. 7. Author interview with Morena Herrera, San Salvador, El Salvador, May 26, 2017.

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8. Local and international press widely documented Garcia’s case. This account is primarily drawn from Freedman, “The Case of Beatriz.” 9. Freedman, “The Case of Beatriz.” 10. Author interview with Carla Cerrato, Managua, Nicaragua, August 14, 2015. 11. This argument is drawn from Wessel, “Reproductive Rights.” 12. Author interview with Sofia Montenegro, Managua, Nicaragua, August 13, 2015. 13. Author interview with Azahalea Solís, Managua, Nicaragua, August 12, 2015. 14. On “strategic essentialism,” see Spivak, Outside. 15. Author interview with Marta Maria Blandón, Managua, Nicaragua, August 14, 2015. 16. López Vigil, Aborto. 17. A Quiet Inquisition, documentary, written and directed by Holen Kahn and Alessanda Zeka, Adrenaline Films, 2014. 18. Author interview with Dr. Ligia Altamirano, Managua, Nicaragua, August 17, 2015. The guidelines are outlined in Ministerio de Salud, “Protocolos para la atención de las complicaciones obstétricas,” Normativa 109, Managua, Nicaragua, April 2013, and “Normas y protocolos para la atención de complicaciones obstétricas,” December 2006. 19. Data drawn from Bliss, Addressing. 20. Amnesty International, La prohibición. 21. “Pope in Peru: Francis Speaks Out on Violence Against Women,” BBC News, January 21, 2018, http://www.bbc.com/news/world-latin-america-42763291. 22. “Congresistas presentan proyecto de ley que despenaliza aborto en casos de violación sexual,” Perú21, October 12, 2016, https://peru21.pe/politica/congresistas -presentan-proyecto-ley-despenaliza-aborto-caso-violacion-sexual-230613. 23. Casas Isaza et al., Stolen Lives (presentation at the IV Latin American Legal Congress on Reproductive Rights, Lima, Peru, November 2–4, 2015). 24. Casas Isaza et al., Stolen Lives, 13. 25. See Ipas, Betraying Women, for the legal and health implications of abortion laws for providers and patients in Latin America. 26. Ley General de Salud (Ley No. 26842), Article 30, 1997. 27. Author interview with Rossina Guerrero of Promsex, Lima, Peru, June 18, 2013. 28. Guía Técnica Nacional para la estandardización del procedimiento de la atención integral de la gestante en la Interrupción Voluntaria por Indicación Terapútica del Embarazo menos de 22 semanas con consentimiento informado en el marco de lo dispuesto, Ministry of Health, Article 119 of the Penal Code, June 2014. 29. “El pastor de Keiko: ‘Hablar de derechos de homosexuales es aberración,’” La República (Lima), May 14, 2016, http://larepublica.pe/politica/936314-el-pastor-de -keiko-hablar-de-derechos-de-homosexuales-es-una-aberracion-video. 30. “Presentación,” program of the IV Latin American Legal Congress on Reproductive Rights, JUSDEM and the Comisión Andina de Juristas, Lima, Peru, November 2–4, 2015. 31. “Girl, 11, gives birth to child of rapist after Argentina says no to abortion,” The Guardian, March 1, 2019, https://www.theguardian.com/global-development /2019/feb/28/girl-11-gives-birth-to-rapists-child-after-argentina-refuses-abortion.

6 Private Lives on the Global Stage

devastating news. Her doctors had determined that her three-month-old fetus was anencephalic, incapable of fully developing a brain, with no chance of survival. Under Peruvian law, K. L. was entitled to terminate the pregnancy and decided to do so. But the public hospital in Lima refused to grant her request on the grounds that the state’s regulations for abortion were unclear. After a full-term pregnancy, K. L. gave birth and was forced to breastfeed the baby for four agonizing days before the infant died. It was later determined that the teenager suffered severe mental and physical health consequences as a result of being denied the right to an abortion.1 Unlike thousands of girls whose abortion rights are violated every year, K. L. sued her government before the United Nations Human Rights Council (UNHRC) and won. The case marked the first time that an international human rights body had found a national government responsible for failing to uphold a woman’s right to choose. The 2005 decision made history for recognizing abortion as a human right and established an important precedent for future legislative and constitutional reforms. It was also distinctive for the way local organizations and international nongovernmental organizations (NGOs) and institutions collaborated over the issue, in effect recalibrating their power relationships to produce results on a complicated playing field. Although it took until January 2016—a decade after the UNHRC ruling—for the Peruvian state to agree to pay reparations for having unjustly denied K. L. an abortion, the momentum had begun. Following

In 2001, a Peruvian teenager known as “K. L.” received

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their success in the K. L. case, Peruvian and international NGOs brought a similar suit on behalf of a thirteen-year-old, “L. C.,” who had been repeatedly raped over the span of two years by a thirty-four-yearold neighbor. After an attack resulted in pregnancy, L. C. attempted suicide by throwing herself off the roof of a nearby building. She survived, but the fall broke her spine, and when she sought medical assistance, doctors refused to perform surgery. The reason? She was pregnant. Since the pregnancy was preventing her from getting the treatment she needed to recover, L. C. requested a therapeutic abortion. The request was denied. The girl eventually miscarried and was able to receive surgical care, but it was too late. The injuries to her spine had made her a paraplegic, confined to a wheelchair for life. This chapter highlights the role of the international community in the abortion rights debate in Latin America. It begins with the issue’s appearance on the global stage in the 1990s and ends with the 2015 Zika outbreak, demonstrating the diverse roles of global stakeholders in confronting a medical epidemic. By tracing the evolution of global discourse about abortion rights, the discussion illustrates the ways in which the debate is changing. As intergovernmental organizations quarrel with intransigent domestic leaders, science and medicine clash with discriminatory practices in public health, and religious dogmas fight for their place in the political arena, the abortion conversation grows and deepens around the world. In L. C.’s case, Peru’s Center for the Promotion and Defense of Sexual and Reproductive Rights (Promsex) partnered with the New York– based Center for Reproductive Rights to jointly pursue legal action under the United Nation’s Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW).2 In July 2011, CEDAW’s committee ruled in L. C.’s favor, recognizing numerous violations of the convention protocols, including L. C.’s right to nondiscrimination on the basis of gender in receiving health care. The committee recommended that Peru adjust its law to allow women to obtain abortions in cases of rape and sexual assault. (Peruvian law allows abortion only in cases in which the mother’s life or health is in danger.) In addition, CEDAW instructed the Peruvian state to pay damages to L. C. Like the ruling in K. L.’s case before it, the scope of the decision carried repercussions that extended far beyond one pregnant girl. According to the Center for Reproductive Rights, it was the “first U.N. decision in history requiring a country to protect women’s health and human rights by changing its abortion laws. And for the first time in history, the U.N. has called the denial of legal abortion what it is: discrimination.” The group’s report concludes, “Sometimes, one girl can change the world.”3

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Carrying Private Lives to the Global Stage The abortion rights debate involves individuals, nonstate actors, and international advocates and institutions, all of which interact with the state in complex ways. Every case starts in private. Some are then propelled onto the domestic or global stage. Those which enter the public arena can gain increasing access to international resources while simultaneously paving the way for expanded social and political changes. In twenty-first-century Latin America, the vast majority of reproductive rights proponents operate transnationally in advocacy networks, sharing strategies, expertise, ideas, and experiences.4 In addition to their precedent-setting decisions, the lawsuits underscore many of the most positive elements of the pro-choice agenda in Latin America today. They demonstrate the efficacy of partnerships among local groups, international organizations, and institutions of global governance. When Peru’s Promsex joined forces with the regionally and nationally based Center for Reproductive Law and Policy and the Latin American and Caribbean Committee for the Defense of Women’s Rights, it was able to bring the cases to the United Nations. Other groups also formed game-changing alliances. The Madridbased Women’s Link Worldwide, for example, partnered with Bogota’s Mesa por la Vida y la Salud de las Mujeres (Table for the Life and Health of Women) to initiate the legislation that legalized abortion in Colombia.5 Human Rights Watch (HRW), the International Women’s Health Coalition, Catholics for Choice (and its regional counterpart, Católicas por el Derecho a Decidir), Amnesty International, Ipas, and numerous affiliates of International Planned Parenthood have also engaged in collaborative activities, from participating in court cases to sponsoring workshops, educational programs, and media campaigns. In fact, in the past decade HRW has filed amicus curiae briefs in cases before courts in Nicaragua, Colombia, and Argentina, urging their compliance with global treaties in reproductive rights cases. HRW also sent a letter to the president of Ecuador’s National Assembly in July 2012, supporting reform of a penal code (Article 142) in order to guarantee abortion services in cases where a woman’s life is in danger or where pregnancy results from rape.6 Collaboration also takes place at the grassroots level. In 2008, Ecuador’s nonprofit Coordinadora Juvenil por la Equidad de Género (Youth Coordinator for Gender Equity) invited the Netherlands-based NGO Women on Waves to set up an abortion rights hotline. Unfurling a banner wrapped around Quito’s Virgen del Panecillo statue, an iconic monument in Ecuador, local and global activists publicized a phone

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number that women could call for information about Cytotec, a legal medication that safely terminates unwanted pregnancies.7 In other words, while Ecuador’s government continued to prohibit abortion in most cases, international groups and local organizers provided options for women in need. In discussing L. C.’s case, Promsex director Susana Chavez emphasized the critical relationships between her domestic NGO and the international community. “The alliance we’ve created between the Center for Reproductive Rights and Promsex is essential for us because, I believe, it’s given us many of the conceptual and pragmatic elements needed to access the system of justice. I’m talking about justice on a national and international level.”8 The Peruvian government continues to resist legislative reforms, but it faces unprecedented pressure to comply with UN mandates. Peru is not alone in experiencing a push for reform from international forces. The past few decades have spawned converging phenomena related to the globalization of women’s rights: increasingly influential policymaking exerted by intergovernmental organizations, a rise in the visibility and sophistication of transnational women’s movements, growing vociferous support for abortion rights in global civil society, and, importantly, increased advocacy from the international health-care community. Globalizing Choice Globalization and its accompanying boom in technology gave feminism a worldwide platform upon which to make itself heard. In the 1990s, the global landscape exploded with international conferences, agreements, and declarations that forced the world to wake up and seriously consider women’s rights as basic human rights. Supported by skyrocketing levels of NGO involvement and donor funding, the United Nations sponsored a series of pivotal gatherings that “opened new arenas for action and debate at the global level and helped shape the new feminist perspectives and strategies that were taking form in the region.”9 Among the key gatherings were the 1992 United Nations Conference on Environment and Development in Rio de Janeiro, the World Conference on Human Rights in Vienna the following year, the 1994 International Conference on Population and Development (ICPD) in Cairo, and the Fourth World Conference on Women in Beijing in 1995. These meetings did not in themselves invent Latin America’s advocacy networks or explicitly support abortion rights, but they did legitimize

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feminist issues and bring together like-minded activists and policymakers from around the world.10 Beginning with the ICPD in Cairo, the gatherings acknowledged that reproductive rights—articulated for the first time in a comprehensive framework as “reproductive health”—are grounded in existing human rights obligations.11 The conferences established global norms on gender equality that served as catalysts for action, backed by the weight of treaties and protocols promulgated by the United Nations and other international institutions. As reproductive rights advocates gained unprecedented momentum, so did their opposition. In the Beijing Declaration and Platform for Action, the international community declared that women’s rights are human rights, fostering a rights-based agenda that subsequently has been used to argue both sides of the abortion debate. These international conventions established the framework that has been successfully used to argue for reproductive rights in international courts and institutions in cases around the world. However, at the same time that globalization of the feminist agenda effectively advanced the cause of reproductive rights, it also created opportunities and political space for an intense anti-abortion backlash. This backlash has manifested itself internationally and within networks of social and political movements; it has diametrically opposed campaigns for women’s electoral participation on both sides of the issue. In Latin America, the appearance of feminist issues on the global stage coincided with extraordinary advances in women’s participation in electoral politics. In 1991, Argentina became the first country to establish a gender-based quota law, four years before the concept gained visibility at the UN’s Fourth World Conference on Women. The Beijing platform called on governments to ensure “women’s equal access to and full participation in power structures and decision-making” and to consider adopting affirmative action policies to achieve equal representation of women and men. Hence, the Beijing platform legitimized the idea of quotas at the international level and served as a focal point for domestic mobilization. The region’s return to democracy during that period also provided political opportunities for legal issue networks to form and committed states to comply with international agreements such as CEDAW. When the UN General Assembly endorsed CEDAW in 1979, signatory governments agreed to eliminate all legal obstacles to women’s full and equal participation in the economy and society. Importantly, as Mala Htun observed, CEDAW “carries the weight of law in signatory countries . . . [so] citizens may file suits in national courts on the grounds that their rights have been violated under CEDAW, and judges may make decisions based on CEDAW in addition to (or instead of) local

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laws.”12 In recent decades, CEDAW has become the legal basis upon which major abortion rights cases have been brought in Latin America. At this writing, approximately thirty-three of the Western Hemisphere’s nations have ratified or acceded to the convention. Abortion rights proponents most frequently rely upon CEDAW in verifying governments’ compliance with human rights law, but there are numerous treaty-monitoring bodies and committees that use language relevant to the issue. Table 6.1 lists them and their acronyms or abbreviated names. Each of these bodies has weighed in, implicitly or explicitly, on the abortion issue in its committee’s decisions, actions, or comments. And although the political clout of the United Nations has waxed and waned during the post–Cold War period, these treaties together represent a significant contribution to global governance on reproductive rights. As these documents and committees attest, intergovernmental institutions have provided the legal foundation, global forums, and organizational structures for feminist activism and debate since the late twentieth century. In looking at the advances under these bodies, it is especially important to emphasize the work of the Inter-American System of Human Rights in ensuring the region’s sexual and reproductive rights. Indeed, Latin America was a pioneer in establishing human rights protections for its citizens. In April 1948, the Organization of American States (OAS) issued the American Declaration of the Rights and Duties of Man in Bogota, Colombia. The document was the first general human rights instrument in the world. Its principal institution, the Inter-American Commission on Human Rights (IACHR), first met in 1960 and has since received thousands of complaints and petitions regarding human rights violations.13 In 1969, the IACHR approved the American Convention on Human Rights, which defines ratifying states’ obligations to its principles. In addition, the convention created and determined the functions of the InterAmerican Court of Human Rights, which has set forth important protocols to guarantee the rights of women and girls. The Convention of Belém do Pará in 1994 became the first international agreement that specifically referred to gender-based violence: This instrument defines in detail the forms of violence against women, including physical, sexual, and psychological violence, based on gender, whether in the public or private sphere, and establishes that all women have the right to a life free from violence, in addition to all the human rights enshrined by the regional and international instruments. Furthermore, the Belém do Pará Convention establishes that the right of women to be free from violence includes, among others, their right to be free from all

109 Table 6.1 Treaties and Conventions Relevant to Reproductive Rights Short Title

Name and Year Adopted

International Treaties and Conventions Universal Declaration of Human Rights (1948) Universal Declaration Civil and Political Rights Covenant International Covenant on Civil and Political Rights International Covenant on Economic, Social and Economic, Social, and Cultural Cultural Rights (1966); Committee on Economic, Rights Covenant Social, and Cultural Rights (CSECR) International Convention on the Elimination of Convention Against Racial All Forms of Racial Discrimination (1965); Discrimination Committee on the Elimination of Racial Discrimination (CERD) Convention on the Elimination of All Forms of CEDAW Discrimination Against Women (1979); CEDAW committee Convention Against Torture and Other Cruel, Convention Against Torture Inhuman, or Degrading Treatment or Punishment (1984); Committee Against Torture (CAT) Convention on the Rights of the Child (1989); Children’s Rights Convention Committee on the Rights of the Child (UNCRC) Rome Statute of the International Criminal Rome Statute of the ICC Court (1998) Convention on the Rights of Persons with Disability Rights Convention Disabilities (2006) Regional Treaties and Conventions (Americas Region) American Convention on Human Rights (1969) American Convention Additional Protocol to the American Convention Protocol of San Salvador on Human Rights in the Area of Economic, Social, and Cultural Rights (1992) Inter-American Convention on the Prevention, Convention of Belém do Pará Punishment, and Eradication of Violence Against Women (1994) Convention for the Protection of Human Rights and Convention on Human Rights Dignity of the Human Being with Regard to the and Biomedicine Application of Biology and Medicine (1997) International Conference Documents Vienna Declaration and Programme of Action, United Vienna Declaration Nations World Conference on Human Rights (1993) Vienna Declaration and Programme of Action, United Vienna Programme of Action Nations World Conference on Human Rights (1993) Programme of Action, United Nations International ICPD Programme of Action Conference on Population and Development (1994) Beijing Declaration and Platform for Action, United Beijing Platform for Action Nations Fourth World Conference on Women (1995)

Source: “Repro Rights Are Human Rights,” Center for Reproductive Rights, 2009, http://reproductiverights.org/en/feature/repro-rights-are-human-rights.

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forms of discrimination. The State parties to this instrument agree to condemn all forms of violence against women and to investigate, prosecute, and punish such acts of violence with due diligence; accordingly they must both adopt policies and take specific measures aimed at preventing, punishing, and eradicating such violence against women.

Significantly, the convention notes the right of women “to a life free from violence, in addition to all the human rights enshrined by the regional and international instruments” and their right to be “free from all forms of discrimination.” In calling upon states to condemn, investigate, prosecute, and punish acts of violence, it also instructs them to “adopt policies and take specific measures” to address the problem. These lines are noteworthy. They go beyond simple recognition of the issue to explicitly direct Latin American governments to take action, including protective action. On the abortion side, countervailing forces also gained rapid momentum during the same period, with an unprecedented number of groups springing to action between the 1970s and the 1990s. Some of this activism may be attributed to the 1973 US Supreme Court decision in Roe v. Wade, which guaranteed a woman’s right to abortion and disallowed state or federal restrictions on abortion in the United States. The ruling prompted thousands of abortion foes to join the movement domestically and globally. UN conferences in the 1990s also exposed the issue to public scrutiny and debate as never before. Additionally, and perhaps more importantly, this mobilization unfolded against the backdrop of one of the most significant political and religious events to shape the region’s views on reproductive rights: the 1978 election of John Paul II to the papacy, marking a reaffirmation of the Catholic Church’s unequivocal opposition to abortion. The church launched a strident rejection of liberation theology, replacing hundreds of progressive bishops with the most conservative elements of the clergy. Accompanying this was a rise in evangelical Protestantism, as bornagain Christians used their pulpits to promote an anti-choice agenda in the region’s congregations and among the political elite. Religious leaders found support in the international political arena, especially in the United States. Thus, the stage was set for the competing agendas of the new century, pitting church congregations against human rights workers and fervent anti-abortion activists against a determined transnational feminism. Pro-choice advocates and opponents seized the momentum of this juncture to realign interactions among nonstate actors, intergovernmental institutions, and governments. The state itself, in a context of

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neoliberal restructuring and an altered scope of activities and services, joined in the reshaping of the public/private divide. And new technologies in health, media, and jurisprudence irrevocably transformed the status quo of abortion rights politics. Slowly Shifting Global Tides

The global state of abortion rights closely reflects the issue’s polemic divisions at the local level. The majority of the world’s people live in countries where abortion is legally permitted for a wide range of reasons; in 60 percent of the countries of the world, abortion is allowed with no strictures. Still, a quarter of the world’s residents, most of them in the global South, live in countries where abortion rights are restricted or prohibited.14 As a result, at forums such as those organized by the United Nations, members bring a cacophony of viewpoints. Certain countries, among them some European representatives, advocate for an explicit recognition of reproductive rights, while others align themselves closely with the Vatican’s delegation to block passage of any pro-choice resolutions. The Holy See is a nonvoting member of the United Nations, but it wields considerable clout at international gatherings. At the June 2012 Rio+20 Conference on Sustainable Development, the Vatican’s delegation—with the support of Canada and the G77, a UN organization of mostly Latin American, Middle Eastern, and African nations—managed to have all references to reproductive rights removed from the gathering’s final document. This contrasts to the global community’s position in 2005, when the United Nations affirmed its support for reproductive health as part of its Millennium Development Goals (MDGs), although it did not go so far as to endorse the legalization of abortion. This reversal also illustrates the ambiguity blanketing this issue. In a resolution in the 2005 World Summit Outcome report, the UN General Assembly committed itself to “achieving universal access to reproductive health by 2015, as set out at the International Conference on Population and Development, integrating this goal in strategies to attain the internationally agreed development goals, including those contained in the Millennium Declaration, aimed at reducing maternal mortality, improving maternal health, reducing child mortality, promoting gender equality, combating HIV/AIDS and eradicating poverty . . . [and] [e]nsuring equal access to reproductive health.”15 Thus, the United Nations explicitly asserted a woman’s right to reproductive health while grappling with strong disagreement among its membership about the issue. But by 2015, when the nations convened to

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craft the MDGs’ successor—the Sustainable Development Goals (SDGs)—pro-choice support appears to have strengthened. Target 5.6 of the SDGs calls for universal access to reproductive rights, a term more generally associated with abortion legalization: “Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences.”16 In the same vein, the bodies within the Organization of American States that are charged with overseeing human rights issues—the InterAmerican Commission on Human Rights and the Inter-American Court of Human Rights—and the document that authorizes them, the American Convention on Human Rights, similarly reflect the contradictory nature of the debate at the institutional level. On one hand, the original convention, also known as the 1969 Pact of San José, Costa Rica, states in Article 4, “Every person has the right to have his life respected. This right shall be protected by law and, in general, from the moment of conception.”17 This article notwithstanding, the convention’s legislative agency, the IACHR, has ruled in favor of a woman’s right to an abortion in several of the region’s most influential cases. In 2006, the IACHR heard the case of Mexican rape victim Paulina Ramirez, which was brought to the commission by the Center for Reproductive Rights in partnership with the Grupo de Información en Reproducción Elegida. The action contributed to the legalization of abortion in Mexico City, one of the most significant pieces of legislation in the region in recent decades. The commission and the court have been receptive to cases about sexual and reproductive rights. They have also carved a space as defenders of gender-based claims on the regional level. The body’s representatives have made countless trips to investigate complaints about the consequences of severe abortion restrictions, and they have urged states to institute reforms. For example, on January 29, 2018, IACHR rapporteur on the rights of women Margarette May Macaulay called upon the Salvadoran government to review its total ban on abortion.18 A Jamaican-born attorney, Macaulay had headed a delegation that traveled to El Salvador in November 2017, reporting the following: During its visit to El Salvador, the IACHR was very concerned to learn about the laws that penalize abortion in all circumstances. As the Commission has reiterated in previous reports, the absolute criminalization of abortion has direct consequences on maternal morbidity and mortality rates. Without legal, safe, and timely options, many women have to subject themselves to dangerous and even fatal practices; they refrain from seeking medical services or

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experience obstetric emergencies without the medical care they need. The girls and women who are more vulnerable because of their socioeconomic situation and their lack of access to educational and health services are those who most suffer the effects of the total criminalization of abortion.

The report further reminds the Salvadoran state of its obligations under human rights treaties, citing a previous Inter-American Court of Human Rights judgment that concluded, “An embryo cannot be considered a person in the terms of Article 4(1) of the American Convention.” In addition, the delegation expressed alarm about the incarceration of women for abortion-related crimes: The Commission expresses its concern over the fact that, even though the Criminal Code establishes sentences of up to 12 years for abortion, many women who suffer obstetric complications or miscarriages are convicted of aggravated homicide and sentenced to up to 40 years in prison, based on the suspicion of having induced an abortion and in possible violation of their right to due process. These sentences are said to be occurring in the context of proceedings that allegedly fail to respect the right of the accused to a fair trial by not recognizing the principle of presumption of innocence and not assessing the evidence in accordance with interAmerican standards on due process protections. Moreover, negative stereotypes around the concept of the “bad mother” and the “murderous mother” are said to prevail in these sentences. In addition, the law on which these sentences are based appears to be in clear contradiction to the right to medical privacy, which reportedly keeps health professionals from having the necessary conditions of legal certainty to be able to properly exercise their responsibility as guarantors of their patients’ health.

According to information obtained by the IACHR during the 2017 visit, at that time twenty-seven women were serving sentences in abortion cases. Sharing the recommendations made following the United Nations high commissioner’s visit to El Salvador, the IACHR urged the country to impose a moratorium on the application of Article 133 of the criminal code; carefully review the convictions in each of these twentyseven cases mentioned to ensure that each woman had a fair trial, free of stereotypes; and, should it be established that this was not the case, release the women. On February 27, 2018, an IACHR public hearing schedule illustrated the coordination of regional abortion rights groups. Titled “Situation of Sexual and Reproductive Rights of Girls and Women in the

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Americas,” the session’s participant list was a who’s who of sexual and reproductive rights advocacy: Ipas, Centroamérica; Grupo Estratégico por la Despenalización del Aborto Terapéutico (GEDAT) in Nicaragua; Católicas por el Derecho a Decidir, Nicaragua; Colectiva Feminista por el Desarrollo Local, El Salvador; Agrupación Ciudadana por la Despenalización del Aborto, El Salvador; Centro de Derechos de Mujeres, Honduras; Organización de Mujeres Tierra Viva, Guatemala; Asociación Ciudadana Acciones Estratégicas por los Derechos Humanos (ACCEDER) in Costa Rica; Grupo Guatemalteco de Mujeres (GGM) in Guatemala; Red de la No Violencia Contra las Mujeres (REDNOVI) in Guatemala; the Center for Justice and International Law (CEJIL), Mesoamerica; Incide Joven, Guatemala; Espacio Encuentro de Mujeres, Panama; Movimiento Autónomo de Mujeres, Nicaragua; and others.

By addressing their common concerns before the regional body, the groups drew sharp attention to the problem’s severity. The IACHR has become a key intermediary between Latin American civil society and the state, and its involvement bodes well for the pro-choice side of the public debate. Examination of the actions of these multinational institutions reveals a trending pattern that, for the most part, favors abortion rights. Global bodies are increasingly working in concert with likeminded local movements, organizations, and other stakeholders. Although the era of industrialized countries’ unilateral, top-down imposition of policies, campaigns, and values has waned, the views and resources of US and European pro-choice advocates remain an omnipresent reality. Communication and collaboration among global, regional, national, and local advocates on both sides of the issue have made great strides in democratizing the policy process, with visible concerted efforts toward increased inclusion and egalitarianism at all levels. These partnerships are determining factors in the success or failure of international organizations’ work, according to Carmen Barroso, former Western Hemisphere regional director for the International Planned Parenthood Federation. In an interview, Barroso emphasized the importance of the give-and-take between the global and local organizations, stressing that while the international community impacts Latin American groups, local activists have an equally influential effect on the work of the international community.19 The United Nations, the OAS, and their affiliated organizations address the rights-based aspects of the abortion debate, supported and informed by global civil society. Much of their argument centers on one of the basic principles enshrined in protocols and conventions: the right

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to good-quality, publicly accessible health care for all members of society. This is the crux of the medical argument, and it is one that may prove most compelling in the global arena, complementing and validating other aspects of pro-choice discourse. International jurisprudence engages the three “frames” introduced at this book’s beginning. In the moral frame, there have been anti-choice arguments that the law serves as a legitimate instrument through which to exert authority over women’s immoral behavior (i.e., abortion) by applying criminal sanctions. This logic has empowered states in justifying punitive actions in abortion cases. The opposing viewpoint posits that not terminating pregnancies may carry consequences that are detrimental or fatal to women, girls, and their families, resulting in an equally immoral outcome. In the rights frame, meanwhile, issues of women’s autonomy and decisionmaking authority, as well as questions of social justice, are under the spotlight. For example, CEDAW has been invoked in abortion cases on the grounds that sex discrimination is at issue: denial of an abortion is denial of a procedure that only women require. And, as Rebecca J. Cook and Bernard M. Dickens observed over a decade ago, international women’s conferences have shifted thinking on abortion law toward women’s health concerns, focusing on protecting and promoting health and preventing unsafe abortions.20 They describe the introduction of a comprehensive reproductive health framework set forth in the 1994 ICPD, which asserted that abortion should be safe in places where it is performed legally and that postabortion counseling and family-planning services should be offered in all cases (even where abortion is illegal). That groundbreaking document laid the foundation for future discourse that placed abortion rights squarely in the medical realm. Perhaps the greatest strength of the medical frame lies in its reliance on scientific evidence. With data from the World Health Organization, the Pan American Health Organization (PAHO), and associations such as the International Federation of Gynecology and Obstetrics, the weight of the global medical community’s backing lends credence to the urgency of the abortion debate. These voices become all the more amplified when the world’s attention turns to insidious public health challenges with implications for abortion rights. This is what occurred during the recent outbreak of the Zika virus. When Health Threats and Human Rights Collide In November 2015, the Pan American Health Organization issued an alert following an unexpected development in Brazil. An alarming number of

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women in the northeastern part of the country were giving birth to babies with severely abnormal brain development, a consequence of exposure to the Zika virus. Within months, thousands of pregnant women were affected by the mosquito-borne disease, frequently with devastating consequences. Public health officials were soon overwhelmed by the emergence of newborns with microcephaly, abnormal brain development that causes babies’ heads to grow to a significantly below-average size. The condition, which can result in severe physical and mental developmental delays, presented daunting challenges to the region’s families, many of whom came from the lowest economic strata. Epidemics can act as catalysts for political change. Leslie J. Reagan, who has written extensively on the history of abortion rights in the United States, makes a compelling argument for the role that the rubella virus, commonly known as German measles, played in changing US abortion laws.21 She describes how the specter of severely disabled children propelled the abortion rights argument into the mainstream media, eventually swaying public opinion and influencing legislation. The difference between that disease and Zika, however, is that the former was an infectious disease and, as such, cut across US socioeconomic lines. In contrast, vector-borne Zika is a disease primarily afflicting lowincome families, who frequently live in areas where there are more mosquito-breeding conditions and for whom screens on windows and insect repellant are beyond economic reach. The decision to abort a fetus with severe birth defects raises difficult questions for potential parents, as well as for disability rights advocates.22 But the key to the argument has to center on the moral authority and responsibilities of pregnant women to make that choice. In the case of Zika, especially in Latin America, there is a dearth of resources available for severely disabled children, especially if lifelong care will be needed. The disease has disproportionately struck low-income residents who may already lack access to basic needs such as food, housing, health care, child care, and social and emotional support. And the cost of caring for a child with microcephaly and other Zika-related anomalies is staggering.23 The case of K. L., described at this chapter’s outset, did not involve a Zika victim, but her pregnancy with a severely deformed fetus closely mirrors the pregnancies of women exposed to the disease.24 Like K. L., most pregnant women affected by Zika live in areas where access to contraception, adequate medical care, and safe, legal abortion services is severely circumscribed. Zika is a disease that disproportionately affects marginalized and impoverished women, such as those in Recife, Brazil, who live in houses on stilts perched over mosquito-infested marshlands.25

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In recent years, several high-profile cases in the abortion rights debate have involved the treatment of women carrying microcephalic or anencephalic fetuses. In addition to the case of K. L., which sparked the UN-mandated order for the Peruvian government to pay reparations for the denial of health care, there is the case of Beatriz Garcia (described in Chapter 5), which was also thrust onto the world stage. Beatriz suffered from lupus, nephritis, and hypertension, all conditions that can contribute to maternal mortality. Her attempts to obtain an abortion were thwarted at every turn and, when her anencephalic fetus was finally delivered via an “induced labor” after twenty-six weeks of gestation, it died shortly after birth. The argument for terminating Garcia’s pregnancy had been compelling, given both the unviability of the fetus and the danger that the pregnancy posed to Garcia’s health. Advocates advancing reproductive rights point to the Zika outbreak as a clear illustration of the urgent need to expand health-care responses when it come to the human rights protections guaranteed to women. Writing about the connection between the disease and women’s reproductive rights, Beatriz Galli of Ipas and Christina Ricardo of Yale Law School assert, “States must be accountable to their obligations to all affected women. They must ensure women’s rights to autonomy and self-determination— including the right to the necessary information, counseling, and services to have full control over their bodies and reproductive lives, be it to access quality prenatal care, or to prevent or end a pregnancy.”26 While it has been established that Zika during pregnancy does not guarantee that a fetus will develop birth defects, women must be apprised of the risks involved. They must be provided with the information and services they need to make informed decisions. And, above all, they must be legally empowered to make choices in their own best interests. The Zika crisis has forced a number of Latin American governments to reexamine their abortion rights laws, pushing the contentious debate into the political limelight. International institutions have pressured officials to reconsider the region’s harsh responses to women who seek to terminate pregnancies involving significantly impaired fetuses. The global community—from the World Health Organization to academic and scientific bodies—has sought allies from among elected leaders and civil society to advocate at the national level for reform. Governments’ initial responses to the Zika outbreak were woefully inadequate. Indeed, most issued general statements recommending that women delay getting pregnant if they lived in areas where Zika had been detected. The advice failed to acknowledge that, given a dearth of educational and contraceptive resources, many of the region’s girls and women have limited control over whether or when to get pregnant. In

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addition, the “delay pregnancy” advice ignored the high levels of rape and sexual violence in some areas of the region. The prevalence of such violence makes restrictions on women’s reproductive rights, particularly when Zika is a factor, even more devastating. Providing a contrast to national-level responses on Zika, UN High Commissioner for Human Rights Zeid Ra’ad Al Hussein quickly reaffirmed the importance of upholding women’s reproductive rights. In a February 5, 2016, statement, Zeid asserted, “Laws and policies that restrict access to sexual and reproductive health services in contravention of international standards must be repealed and concrete steps must be taken so that women have the information, support and services they require to exercise their rights to determine whether and when they become pregnant.”27 In parallel with Zeid’s statement, the international and Latin American public health and human rights communities mobilized to pressure the region’s governments to reform abortion laws. After the November PAHO announcement, a study published in the New England Journal of Medicine documented an uptick in the number of women seeking abortion medications (mifepristone and misoprostol) through an online service provided by Women on Web, a Netherlands-based nongovernmental project. The study discovered a statistically significant increase in the number of Latin American women who were forced to rely on assistance from outside their country’s formal health-care system in order to terminate their pregnancies. The finding highlighted the urgency of their need for services. A concurrent rise in illicit, unsafe abortions has not been documented, but it is logical to assume that these, too, would have increased with the advent of Zika.28 Zika also brought a response from the scientific, academic, and medical communities, all of which entered the abortion debate with the full weight of their professional expertise. Debora Diniz, herself an anthropologist and professor, observed the following about the academic reaction: “If journal articles can be considered a measure, the academic community’s interest in the Zika virus . . . held steady for several years, until soaring in 2016: two articles were published in 2009; none in 2010; . . . 41 in 2015; and 646 from January to June 2016.”29 While academic research may not be intended specifically for political activism, it can serve an important function in bolstering arguments in the public arena. For her part, Diniz embodies the transnational and multifaceted qualities of reproductive rights work. She is a cofounder of the Brazilian NGO Instituto Anis: Institute for Bioethics, Human Rights and Gender and a law professor at the University of Brasilia. She also serves on the board of directors of the International Women’s Health Coalition

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and is a documentarian whose film Zika has been shown extensively since the virus’s outbreak.30 Around the time of the outbreak, Diniz became a visiting fellow at Yale Law School’s Global and Health Justice Partnership (GHJP), which has played a critical role in the international community’s response to Zika. In 2016, the GHJP partnered with Instituto Anis and the Brazilian National Association of Public Defenders to petition the Brazilian Supreme Court on behalf of Zika victims. Their document requested expanded health services for women, including the right to terminate their pregnancies, and social services and support for the families with children affected by Zika. They have also written academic papers and conducted extensive research in Brazil on the public health effects of the virus.31 The impact of involvement from the global academic community is difficult to measure, but its data—added to those of dedicated organizations such as the New York–based Guttmacher Institute—provide concrete input for the abortion debate. The Brazilian Supreme Court has yet to rule on the Zika victims’ petition. And the country’s elected officials stand as tremendous obstacles to abortion rights reform. The country unceremoniously removed its female president, Dilma Rousseff, from office in 2016. Despite a gender quota law enacted in the 1990s, its legislature boasts one of the lowest percentages of women lawmakers in the region (approximately 10 percent). While Rousseff herself had adopted an anti-abortion stance in order to get elected—and a female official’s gender does not guarantee pro-choice advocacy—the Zika epidemic could have presented a compelling case for women politicians to help impoverished women in crisis. At the same time, although there is a formal separation of church and state, the presence of a conservative evangelical bloc in parliament has stymied attempts to liberalize reproductive rights laws. In November 2017, a special congressional committee dominated by evangelical Christians approved a constitutional amendment that would impose a total ban on abortion. The vote was 18–1, with the lone dissension coming from the only woman present, Erika Kokay of the Workers Party.32 At this writing, the full congress has yet to consider the measure. It would require a two-thirds majority for the congress to amend the constitution to reflect this anti-abortion sentiment. For the half million Brazilian women and girls who have abortions each year, the consequences of such a change in the law would be unimaginable. While facing significant challenges—and despite domestic and global obstacles—abortion rights advocates in Brazil are making headway. International partnerships with NGOs, foundations, and universities join growing support from intergovernmental institutions in strengthening the

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reformers’ hands. The medical community wields considerable clout, and its research contributes prominently to the shaping of public opinion on reproductive rights. The Zika victims, both the severely handicapped babies and the economically needy families that care for them, are an unadulterated reminder of the failure of public policies to protect the most vulnerable members of society. One lesson from the Zika crisis is clear: civil societies are no longer territorially bound, and the Zika victims’ plight extends beyond Brazil and the other affected countries. As the international community acts more and more like a global village, fault lines in the abortion rights debate appear to simultaneously harden and blur. On the one hand, rights-based arguments in international jurisprudence are leading to unprecedented decisions affecting women, collectively and individually. International bodies are setting goals for equal access to health care that cut across social, cultural, and political lines. At the same time, the emergence of neoliberal policies stressing individualism are pressuring states to cut publicly funded programs in health, leaving the poor— especially women—to fend for themselves and their families. Ties among global and local movements and actors are stronger than ever, both to the benefit and the detriment of the abortion rights cause. The globalization of abortion rights also runs in tandem with public health, so innovations in technology and medicine are disseminated (albeit unequally) in a broad-based, comprehensive manner. And while the debate advances on some fronts, the rise of misogynistic, right-wing politicians and religious fundamentalists presents formidable obstacles to progress in all areas of women’s rights. In acknowledging the road ahead, UN Secretary-General António Guterres declared the following in his March 8, 2018, message on International Women’s Day: “Achieving gender equality and empowering women and girls is the unfinished business of our time, and the greatest human rights challenge in our world.” Within that great challenge lies abortion rights, among its most intractable and complex unresolved hurdles. Notes

1. United Nations Human Rights Committee, International; UN News Center, “UN Announces”; Center for Reproductive Rights, Journey. 2. The group is the Committee on the Elimination of Discrimination Against Women. It enforces the Convention for the Elimination of Discrimination Against Women (CEDAW). 3. Center for Reproductive Rights, Girl Who Changed. 4. On transnational advocacy networks, see Keck and Sikkink, Activists Beyond Borders.

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5. On the networks involved in the Colombian process, see “LAICIA Project— High Impact Litigation on Abortion in Colombia,” video posted to Vimeo by Women’s Link Worldwide, September 8, 2010, https://vimeo.com/14803953. 6. Vivanco and Gemtholtz, “Letter.” 7. See Caivano and Marcus-Delgado, “Public Debate.” 8. Susana Chavez, interviewed in “L. C.: I Have to Tell What Happened to Me,” video posted to Vimeo by the Center for Reproductive Rights, October 6, 2010, https://vimeo.com/15606635. 9. Vargas, “International Feminisms,” 146. 10. Keck and Sikkink, Activists Beyond Borders, 168. 11. Center for Reproductive Rights, “Repro Rights.” 12. Htun, Sex and the State, 117. 13. “What Is the IACHR?,” Organization of American States, http://www .oas.org/en/iachr/mandate/what.asp (accessed January 18, 2018). 14. Center for Reproductive Rights, Girl Who Changed. 15. United Nations, “Resolution.” 16. “Sustainable Development Goal 5, Achieve Gender Equality and Empower All Women and Girls,” United Nations Sustainable Development Knowledge Platform, https://sustainabledevelopment.un.org/sdg5 (accessed February 4, 2018). 17. Organization of American States, “American Convention.” 18. “Conclusions and Observations on the IACHR’s Working Visit to El Salvador,” Organization of American States, January 29, 2018, http://www.oas .org/en/iachr/media_center/PReleases/2018/011A.asp. 19. Author interview with Carmen Barroso, Washington, DC, July 25, 2012. 20. Cook and Dickens, “Human Rights,” 1–59. 21. Reagan, Dangerous Pregnancies. 22. Reagan, Dangerous Pregnancies, 223, writes, “Since Down syndrome is the number one anomaly detected through genetic testing, and 90 percent of those who receive this diagnosis terminate their pregnancies, some parents of children with Down syndrome fear that expanding the use of genetic testing will mean fewer friends and fewer services for their own children. They hope to convince other parents to have a child with Down.” 23. The US Centers for Disease Control and Prevention estimate that the cost of raising a child with Zika-related microcephaly is $10 million over a lifetime (reported in Santora, “One Family’s Struggle”). 24. Despite the parallels between K. L.’s case and that of the Zika victims, it is important to distinguish between “anencephaly,” which afflicted K. L.’s fetus, and “microcephaly,” which occurs in some fetuses developing in Zikaaffected pregnancies. While the former is almost always fatal, the latter is a birth defect that can range from mild to severe, but babies born with it can generally survive. For this reason, legislation and public opinion on abortion in cases of microcephaly vary more than views on cases of anencephaly, where survival rates are significantly lower. 25. Almeida, “Poverty”; Eisenhammer, “Zika”; Diniz, Zika. 26. Galli and Ricardo, “Using a Human Rights,” 2. 27. UNOHCHR, “Upholding.” 28. Aiken et al., “Requests.” 29. Diniz, Zika, Location 411 (Kindle). 30. Zika, documentary, directed by Debora Diniz, Itinerante Filmes, 2016.

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31. “Ensuring a Rights-Based Response to Zika,” Global Health Justice Partnership, Yale University, https://law.yale.edu/ghjp/projects/gender-sexuality -and-rights/ensuring-rights-based-response-zika (accessed March 17, 2019). 32. “Brazilian Congressional Committee Votes to Ban All Abortions,” Reuters, November 9, 2017, https://www.reuters.com/article/us-brazil-abortion/brazilian -congressional-committee-votes-to-ban-all-abortions-idUSKBN1D90OZ.

7 Outside Forces at Work

ernmental institutions are signaling support for abortion rights. The global community has rallied around domestic actors, pressuring Latin American states to fulfill their gender-based human rights commitments, especially in the area of reproductive health. Nearly all the region’s governments have responded by ratifying legally binding conventions and protocols and by signing onto declarations, resolutions, and related codes of conduct, often integrating them into their constitutions and other legislation. Given all that action, why have states been so slow to incorporate the international norms underlying these commitments into their policies and practices? What drives the inconsistency between what is promised globally and what is carried out at home? Conflicting and contradictory political forces may explain part of the disconnect, with clashes between interstate players and domestic social pressures playing a key role. The principal force consists of powerful anti-abortion stakeholders who stand diametrically opposed to global pro-choice advocates. They are often represented by conservative governments (such as that of the United States) and by nonstate actors, including religious institutions. Their position wields considerable diplomatic, financial, and moral clout in Latin American political circles. This chapter examines the formidable political obstacles to progress in abortion rights on the global stage. It begins with an overview of antiabortion dogma that drives ostensibly nonsectarian US policies because, while this book’s focus is on Latin American politics, US actions have

More and more, international laws, norms, and intergov-

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had a profound effect on access to abortion in the region. Notably, the United States has created obstacles by its refusal to ratify the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) and other major rights protocols, by its imposition and broadening of the global gag rule, and by its 2017 suspension of funding to the United Nations Population Fund (UNFPA). The influence of the United States also permeates the application of women’s rights jurisprudence and debate within the moral and medical realms. In cutting funds and rejecting CEDAW, the United States both denies Latin Americans the critically important reproductive rights services they seek and undermines the credibility and legitimacy of women’s rights norms in a more general sense. US clout is complemented by that of another anti-choice powerhouse engaged in a ubiquitous campaign against abortion: the Vatican. These two are critically important global forces, one an ostensibly nonsectarian state that promotes an ideological (religious) agenda and the other a religious institution that performs like a nation-state. In the interest of religious freedom, not to mention secularism, it seems problematic to justify international relations that advocate a particular dogma, especially when they overlap into the areas of health and human rights. At the same time, though, it is important to caution against creating a simplistic “religionversus-secularism” dichotomy, as if theists were the sole source of antiabortion sentiment.1 While religious institutions and actors play a key role in opposing pro-choice progress, they do not hold a monopoly on the wholesale denial of reproductive rights. Lack of access to power, differences in broadly held gender roles, pro-natalist policies, and discriminatory practices against women worldwide take place in both secular and religious societies. Thus, “modern” (read: nonreligious) industrialized states are at times indistinguishable from their holy counterparts when it comes to women’s rights on the global stage. The US Global Anti-abortion Crusade On January 23, 2017, his first full day in office, President Donald Trump reinstated the so-called global gag rule. The executive order, also known as the Mexico City policy, prohibits US federal funding of international organizations that provide information about, or in support of, abortion. In March of the same year, the White House went a step further and suspended funding for UNFPA based on the fallacious assertion that the UN’s reproductive health and rights agency organization “supports or participates in the management of a programme of coercive abortion or involuntary sterilization” in China. 2 As UNFPA’s second-

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largest donor, the United States, in deciding to cut aid, significantly hindered the fund’s ability to safeguard women around the world from death and disability (especially in areas of conflict or natural disasters), to fight gender-based violence, and to reduce maternal mortality rates. The backdrop against which the US actions were taken is also important. The United States has declined to join major UN treaties affecting women’s and girls’ rights, including CEDAW and, amazingly, the Convention on the Rights of the Child. The US president’s authority may rest within his own country, but he claims a powerful place in the larger context of the abortion rights debate directly affecting Latin America. Like some of his hemispheric counterparts, President Trump appears to have adopted an anti-abortion stance solely for the sake of political expediency. His “pro-life” posture is a reversal of his past public position. In an October 24, 1999, interview with the US news program Meet the Press, Trump declared that while he “hated” abortion, he was emphatically “very pro-choice.”3 However, a few decades later, when weighing his electoral prospects, then presidential hopeful Trump calculated the political leverage of the anti-abortion vote, and he selected as his vice presidential running mate Mike Pence, who as governor of Indiana had carved a rabidly anti-choice reputation. During the election campaign and upon taking office, Trump and Pence fervently embraced the anti-abortion crusade. In fact, in January 2018, Trump spoke via satellite to the annual anti-abortion March for Life gathering that assembles on the National Mall in Washington, DC, becoming the first sitting president in the event’s forty-five-year history to do so. There is no religious background, prior statement of opposition to abortion rights, or other personal history to explain Trump’s antiabortion stance. Nonetheless, the president has advanced his newfound ideology in ways that carry far-reaching political ramifications, not just nationally but also internationally. An anti-abortion Trump and the anti-choice political appointees that surround him embolden like-minded activists around the world. The use of their bully pulpit to espouse an anti-choice platform causes considerable damage. But their ideologically driven foreign policies and the billions of dollars in funding attached to them create even greater injury. These policies are threats to the health and safety of millions of women and girls. In extreme cases, they can be fatal to females around the world. As mentioned earlier, every Democratic president has lifted the abortion gag rule, and for more than three decades, each successive Republican president has reinstated it. But the Trump-Pence version sparks greater concern because it significantly broadens the ban, requiring foreign nongovernmental organizations (NGOs) to certify that they

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do not perform or actively promote abortion as a method of family planning. It also prohibits pro-abortion funding from any source (including non-US suppliers) as a condition for NGOs to receive not only US government global family-planning support but any other US global health assistance.4 This means, for example, that a nongovernmental organization that receives US funding for an antimalaria project is precluded from also accepting Dutch or Canadian funding for a family-planning initiative that includes abortion information. The global gag rule has a long and sordid history. President Ronald Reagan introduced it in 1984 at the Second International Conference on Population in Mexico City, which is why it bears that city’s name. It has been promulgated and rescinded by US presidents according to party lines since then for three decades. Except for a few years during the Bill Clinton administration, when the US Congress temporarily imposed the ban, the policy has been instated or withdrawn by executive action. It is also a redundant political action. The 1973 Helms Amendment to the Foreign Assistance Act, enacted to respond to the US Supreme Court’s Roe v. Wade decision legalizing abortion, already bars US foreign aid funds from being used to pay or advocate for abortions. When Trump expanded the US position in 2017, officially renaming the Mexico City policy as the “Protecting Life in Global Health Assistance Policy,” the gag rule applied to a broad range of US government agencies, among them the United States Agency for International Development (USAID) in the State Department, including the Office of the Global AIDS Coordinator; the Centers for Disease Control and Prevention and the National Institutes of Health, both of which are divisions of the Department of Health and Human Services; and the Department of Defense. The repercussions may be staggering as “in FY 2017, bilateral global health assistance totaled more than $8 billion (family planning assistance accounted for approximately $600 million of that total).”5 The Guttmacher Institute analyzed the destructive effects of the global gag rule, enumerating its major impacts: “The global gag rule threatens the provision of health services in developing countries. . . . The vast global health portfolio, supported by billions of dollars of U.S. funding, covers health-related activities in about sixty low- and middleincome countries, including programs on HIV/AIDS, Zika, maternal and child health, malaria, nutrition, and others.”6 In particular, the report underscored the policy’s damage to public health strategies: The trend toward integrated health programs or co-located health services in low-income health settings means that NGOs often offer an array of services to patients—such as contraceptive care,

Outside Forces at Work

HIV prevention or treatment, prenatal check-ups, immunizations, and information or referrals on safe abortion care—all in one facility. Under the Trump global gag rule, these NGOs would be denied any global health funding from the United States.

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The funding sanctions also affect development assistance aimed at improving the self-sufficiency of health-care facilities in lower-income countries. USAID funding previously funneled through US NGOs, which were exempt from the Mexico City policy, was more recently channeled directly to the local organizations to help build their institutional capacity. This support was terminated under the expanded policy. As the world moves toward more liberalization of abortion laws, the gag rule puts up roadblocks for an increased number of countries. “Among the sixty-four countries that received U.S. bilateral assistance for global health programs in 2016, thirty-seven have laws allowing for abortion beyond the limited exceptions permitted under the gag rule (cases of rape or incest, or complications that threaten the life of the pregnant woman).”7 The result is that more countries are affected by the policy than ever before. Thus, as the quantity of organizations and services rises, the impact of the draconian US measures is multiplied. The Trump-Pence version of the Mexico City policy is especially dangerous since it casts a wide net that also effectively limits the provision of contraception, a move that inevitably leads to higher numbers of unintended pregnancies. Ann Starrs, president and CEO of the Guttmacher Institute, said the last application of the global gag rule “crippled family planning programs.” She wrote in February 2017 that “many foreign NGOs . . . refused to let the U.S. government muzzle their abortion advocacy efforts or dictate what services or counseling they provided using their non-U.S. funds. These health providers were forced to reduce staff and services, or even shut clinics.” Starrs noted that the United States is the largest funder of global health programs worldwide, and the “disruption this aid effort will suffer is massive.”8 By January 2018, the London-based NGO Marie Stopes International reported that, as a result of the US funding cut, it faced an $80 million shortfall in thirty-seven countries where it operates. The NGO said more than 2 million women were, as a consequence, in danger of losing family-planning services, and some 870,000 were at risk for unsafe abortions.9 The consequences for Latin America vary from mild, where there are other funding sources that can fill in, to devastating, where thousands of lives are acutely affected. Colombia is an example of the latter. The nation’s largest family-planning organization, Profamilia, provides

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safe and accessible abortions in accordance with the law. Having decided that it would not comply with the US directive, the group was forced to close ten sites where community-based educational and health-related activities were taking place. In rural areas slowly emerging from decades of war and displacement, Profamilia had provided badly needed services addressing problems of gender-based violence, adolescent pregnancy, and family planning. The organization’s operations continue, but it forfeits $1.5 million earmarked for a national maternal mortality program as well as additional funding for Zika prevention.10 For women and girls in Colombia, the consequences are dire. The abortion rights effort could face an equally foreboding future if such sweeping measures remain in place. Indeed, one of the biggest problems with the global gag rule is its chilling political effect on Latin America’s pro-choice momentum. For example, the policy prevents non-US reproductive rights proponents receiving US government support from using even their own funds to lobby their governments or to participate in other areas of pro-choice advocacy. The organizations and individuals most familiar with the need for abortion services cannot provide information to the public or in any way educate their communities about reproductive health decisions. Their ability to influence public opinion and lawmakers and their rights to free speech, expression, and opinion are all silenced. Obviously, this gives anti-choice activists the upper hand in the abortion debate, as they face no such limitations. This tipping of the political scale promises to have a consequential impact in lower-income countries where opposition to abortion is strident. Following Trump’s reinstatement of the global gag rule, US and international reactions were swift and decisive. A coalition of approximately 140 civil society organizations based in the United States immediately issued a letter condemning the policy. Within the US Congress, Senator Jeanne Shaheen, a Democrat from New Hampshire, and Representative Nita Lowey, a Democrat from New York, drafted the Global Health, Empowerment, and Rights Act, a bipartisan measure designed to put an end to the global gag rule. The bill, introduced the same day as the Trump order, had forty-two cosponsors in the Senate; the House bill had 121 cosponsors.11 Other countries joined the response. On January 25, 2017, just two days after the gag rule announcement, the Netherlands launched a fund to fill the financial gap left by the US policy. Several other countries stepped forward in support of the Dutch effort to help women exercise family planning and abortion rights. On March 8 of that year, International Women’s Day, Canadian prime minister Justin Trudeau announced

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that his government would spend $650 million over the following three years to support international sexual and reproductive health initiatives.12 The resistance to the US policy has unfolded on several fronts, large and small alike. For example, on the one-year anniversary of the Trump gag order, Swedish feminist organization Riksförbundet för sexuell upplysning (National Association for Sexual Enlightenment) wrote an open letter to Trump. It appeared on YouTube as part of a global campaign to condemn the US policy and influence public opinion on the topic: Dear Mr. Trump, It’s been a year since you reintroduced the global gag rule, cutting all U.S. funding to organizations across the world that so much as mention the word “abortion.” Ironically, this will not reduce the number of abortions; instead they will increase and become more dangerous. When laws go low, unsafe abortions go high. Let’s grab this matter by the facts: The global gag rule is projected to contribute to more than 3 million unsafe abortions and more than 15,000 maternal deaths. People living in poverty are most vulnerable. Millions and millions of lives are at stake. That’s a huge number, a very, very big number. You can’t make abortions go away, believe me, but you can make them safe again. From our point of view: Choice Trumps All.13

In general, the international community has united to aid the organizations that refuse to comply with the terms of the global gag rule. Importantly, these campaigns involve not just financial contributions but also social media and publicity initiatives to influence public opinion. This means that the abortion rights debate is taking place on many levels. Global stakeholders run the spectrum from policymakers at the highest levels of government to grassroots activists—with formidable opponents on both sides. Parallel to this, the US decision to suspend funding to UNFPA has been devastating for the millions of families who benefit from the UN agency’s work. The organization’s largest expenditure comes in the area of family planning, followed by maternal health, sexual and reproductive health (for routine care and for emergencies), and HIV and AIDS programs.14 The US contribution to UNFPA exceeded $63 million in 2016. In Latin America, UNFPA works in thirty nations on a wide range of programs. Even in countries such as El Salvador, with its total abortion ban, UNFPA collaborates with government agencies to reduce the incidence of adolescent pregnancies and gender-based violence. In Panama, UNFPA supports local initiatives to provide health services for pregnant women and girls in the most remote communities, such as the Comarca Ngäbe-Buglé, one of the nation’s indigenous territories. UNFPA engages in these activities and others to benefit

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family-planning programs, provide sexual and reproductive health education, train public officials in the judiciary and other sectors, and collect data on related issues. UNFPA’s policy on abortion is clear: it does not provide or promote the procedure. Instead, it seeks to 1. Prevent recourse to abortion by promoting universal access to voluntary family planning, and 2. Deal with the consequences of unsafe abortions to save women’s lives.15

The Trump White House’s withdrawal of support from UNFPA is part of its larger contentious relationship with the United Nations. In many areas of human rights, as well as in other sectors, the United States has declined to ratify the most important treaties and protocols. For abortion rights advocates, the most odious of these refusals is CEDAW, which is widely seen as the most important global document created to protect women’s rights. Since the UN General Assembly adopted CEDAW in 1979, more than 180 countries have approved it. Former US president Jimmy Carter signed the treaty, but the US Senate did not ratify it, so the United States has never been subject to the convention’s oversight. In fact, the US Senate Foreign Relations Committee has voted favorably on CEDAW, but it has never gone to the full Senate for approval. Conservative politicians have consistently argued that such treaties (and the United Nations itself) undermine the US legal system and threaten its sovereignty. In the case of CEDAW, they also contend that the document forces countries to legalize abortion. These arguments are clearly specious since UN treaties cannot supersede US laws, and countries with severe restrictions on abortion are CEDAW signatories, including El Salvador, Honduras, Nicaragua, and others. The US position stems from its anti-choice foreign policy agenda. As the United States is an extremely influential actor in international institutions, its rejection of basic rights for women weighs heavily in the abortion rights debate. The US “morality-driven” position on abortion is also ironic, given the country’s founding (and often-cited) separation of church and state (although the wall between the secular state and religion has seen erosion under the Trump administration). The US principle that places a wall between church and state stands in sharp contrast to the position of theocratic monarchy of the Vatican. The latter is a miniscule sovereign state with a population of 1,000 but home to a religion with more than a billion followers worldwide, all of whom march to a common set of nonsecular instructions.

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The Mouse That Roars On July 11, 2015, Pope Francis celebrated a mass in Asunción, Paraguay. It marked the last stop on a whirlwind tour that had taken the pontiff to Ecuador and Bolivia before sending him to devoutly Catholic Paraguay, where hundreds of thousands of his devotees packed a stadium. The pope’s homily, billed as his “Address to Civil Society,” called for dialogue: Dialogue is for the common good and the common good is sought by starting from our differences, constantly leaving room for new alternatives. In other words, look for something new. When dialogue is authentic, it ends up with … a new agreement, in which we all agree on something. Are there differences? They remain to one side, to be looked at again later. But on those things that we are agreed, we are committed and we defend them. This is one step forward. This is the culture of encounter.16

Pope Francis has shown himself to be slightly more open to dialogue about reproductive rights than his predecessors, even going so far as to “grant to all priests the faculty to absolve those who have committed the sin of procured abortion” in a 2016 apostolic letter.17 But for girls like the ten-year-old rape victim sitting in a Paraguayan shelter during the papal visit, the words offered little consolation. Since abortion is only allowed in Paraguay in cases where a mother’s life is in danger, this preteen was deemed healthy enough to bear a child. She gave birth at the age of eleven. In fact, her plight mirrors that of an eleven-year-old in Bolivia, raped in April 2015 by a motorcycle-taxi driver who was supposed to be taking her home. In the Bolivian case, the archbishop of Santa Cruz de la Sierra even cited the girl’s story in reiterating his opposition to abortion, stating, “We cannot think that the problem is solved by eliminating an innocent life.”18 Since 2013, when Argentine-born Jorge Mario Bergoglio became the first Latin American pontiff and chose the name Francis, he has traveled extensively in the region, from Brazil to Mexico and Cuba to Paraguay. He does not directly engage in the abortion debate on the domestic level. Rather, his representatives deliver his message in the pulpits in the smallest rural parishes and in the offices of the nations’ power brokers. The Catholic Church’s influence is ubiquitous and deeply rooted, and any examination of civil society’s role in the abortion debate must acknowledge the breadth of its influence. The millions who appear at the pope’s outdoor rallies are a stark reminder of the church’s extensive reach across gender, class, politics, and race. From the upper echelons of Latin America’s elite classes to its

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most remote, marginalized communities, the church wields power. Its members’ everyday activities—whether participating in anti-abortion rallies, protesting in front of clinics, stuffing envelopes and distributing anti-choice fliers, or paying for anti-abortion billboards—attest to the huge human capital force the institution can deploy.19 The church’s antiabortion discourse is further bolstered by that of conservative evangelical Protestant churches, many of which are well funded and growing in number. They have partnered with powerful Catholics to participate in electoral politics, as was the case in the 2006 Nicaraguan presidential election, to promote a steadfastly anti-choice agenda. As the pope proclaimed, dialogue is for the public good. However, avenues for debate in some parts of Latin America have been severely circumscribed. When one looks at interactions in civil society, the church emerges as a powerful actor. Rights advocates necessarily confront that influence when challenging noninclusive political regimes and their draconian laws. With a territory that occupies less than a hundred acres, Vatican City is the world’s smallest sovereign state and home to the Holy See, the central governing body of Roman Catholicism. The Catholic Church is itself considered a sovereign entity that enters into diplomatic relations with countries and holds permanent observer status in the United Nations. (Vatican City and the Holy See are two separate administrative entities, both headed by the pope.) Despite its tiny size, the Vatican’s voice is deafeningly loud when it comes to global discourse on abortion rights. Latin America’s Catholic roots date to the arrival of European conquerors in the fifteenth century. The church’s influence in all aspects of society—from land distribution to government and media—varies among the countries but remains conspicuously strong throughout the region. Approximately 40 percent of the world’s Catholics, or more than 400 million people, live in Latin America. (While Latin America’s population remains 90 percent Christian, the number of Catholics has declined to 72 percent in recent decades, losing ground to burgeoning Protestant congregations). Half that Catholic population is anchored in two Latin American countries, Brazil (127 million) and Mexico (96 million).20 Importantly, the 2013 election of Pope Francis, the Argentine who became the first Latin American pope, energized the church’s followers, including those in the anti-choice masses—both literally and figuratively. The Holy See’s status as a “non-member-state permanent observer” in the United Nations is itself curious, as it is the only church to hold such a position. Other religions participate in the intergovernmental institution as registered NGOs but not on par with national governments. The Catholic Church’s privileged position, which it has held since 1964, places it on a level playing field with nation-states, even though it has no

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citizens of its own. The church uses its leverage in the United Nations to exert considerable religious influence among the world’s governments, both Catholic and non-Catholic. Nowhere is that clout more apparent than in the area of global sexual and reproductive rights, an arena in which the Vatican is a vociferous and active participant. The Holy See first used its UN status—publicly and forcefully—to globally advance its anti-abortion agenda during the 1990s when international women’s conferences were in the spotlight. During the 1994 International Conference on Population and Development (ICPD) in Cairo and the 1995 Fourth World Conference on Women in Beijing, the church deployed several strategies to thwart pro-choice outcomes. It initially attempted to prevent accreditation of pro-choice delegates to the Beijing meeting. And at both conferences, Catholics and their affiliated NGOs pressured countries to block abortion rights language in any declarations or agreements coming from the meeting. Afterward, the Vatican worked doggedly to persuade countries not to implement provisions of the conferences’ documents with which it did not agree.21 Although the Holy See is technically not a member of the United Nations, its representatives actively participate in all areas of the institution. Roman Catholic popes have addressed the UN General Assembly five times, including in September 2015 when Pope Francis referred to the earth as a home and exhorted the group to respect the “sacredness” of the unborn: “The common home of all men and women must continue to rise on the foundations of a right understanding of universal fraternity and respect for the sacredness of every human life . . . the poor, the elderly, children, the infirm, the unborn, the unemployed, the abandoned, those considered disposable because they are only considered as part of a statistic.”22 The church enjoys unparalleled access to world leaders through its involvement in the United Nations. One report estimates that a Vatican representative addresses the General Assembly or a UN committee an average of eleven times annually. It also takes part in the special sessions of the General Assembly during the review and appraisal of conferences and summits.23 Additionally, the Holy See has the same power as member states to negotiate and ratify international lawmaking treaties. (Like the United States, it has yet to ratify CEDAW.) The Vatican is not eligible to vote on General Assembly resolutions, but that restriction does not seem to have hindered its role as a constant antiabortion advocate throughout the halls of the United Nations. In fact, in addition to being increasingly visible, the Holy See’s interventions in the United Nations have become more “scientific” and sophisticated since the women’s conferences of the 1990s, according to a 2014 study:

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The Holy See mission communicates a constant and conservative position across all U.N. forums on a range of agendas concerning sexual and reproductive health rights. However, the language used to assert these positions has evolved over time to shift away from doctrinal arguments towards the use of more secular rhetoric, using sophisticated technical evidence and strategic interpretations of international human rights standards in order to communicate its position. However, the doctrinal underpinnings of the Holy See’s position have not been abandoned; rather, the Holy See has selectively appropriated accepted U.N. language to bolster its own arguments to gain influence in sexual and reproductive rights debates.24

The discursive shift toward more technical and scientific analysis, as well as UN legal analyses, opens channels through which the Vatican can dissect rights- and medical-based aspects of the abortion debate. The Permanent Observer Mission of the Holy See holds events and publishes documents demonstrating its concern for reproductive and women’s rights, but its anti-abortion crusade has not changed. A March 17, 2016, program illustrated this clearly, carrying the headline “Holy See Event Promotes Holistic Women’s Sexual and Reproductive Healthcare.” But the Vatican’s description of the event hinted at its true intention, which was to rebrand or repackage church-approved strategies for managing family size (such as the so-called rhythm method of birth control) as technology-linked: “New technologies in sexual and reproductive healthcare give women greater access to choose holistic and affordable options to manage an array of medical issues, including fertility, according to women’s healthcare professionals at a U.N. event.”25 Held during the sixtieth session of the Commission on the Status of Women at the UN headquarters in New York, the event was a collaborative effort with a pro-life organization called Fertility Education and Medical Management (FEMM). FEMM describes itself as a “comprehensive women’s health program,” asserting on its website, “We understand the central role of reproductive endocrinology in the management of women’s health. Our goal is to empower women in the achievement of their health and reproductive goals by helping them gain a better understanding of their biology and monthly cycles.”26 The organization promotes new “technologies” in “natural” family planning, such as cell phone applications that track ovulation, as a way for women to gauge their fertility through occurrences like menstrual cycles, hair growth, and hormone levels. To complement its “pro-life” services, FEMM positions itself as an option for low-income and college-age girls and women seeking reproductive rights services, marketing itself as an alternative to Planned Parenthood and other pro-choice organizations. Writ-

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ing in the National Review, Mary Hasson, a Catholic conservative, promotes FEMM as follows: Fortunately, some visionaries have been working for a while to provide better alternatives. One of the most promising—FEMM Health (Fertility Education & Medical Management)—has opened its first U.S. health clinic in Columbus, Ohio, providing a model for what could be the future of pro-life women’s health care. Like Planned Parenthood, FEMM offers a “place” for women to go for gynecological health care, with easy access and a convenient location. But the similarities stop there. Where Planned Parenthood treats “symptoms” . . . with one “solution”—contraception— FEMM is a knowledge-based health program for women. It offers testing, diagnosis, and treatment for women’s health issues, all based on cutting-edge reproductive endocrinology. FEMM Health empowers women, respects life, and leads to better health. (And yes, there’s an app.) Donors? Invest in FEMM—it’s what women need. In fact, they needed it yesterday.27

With FEMM as its partner, the Holy See shifts its discourse from doctrine-fueled rhetoric to science-based language, driven by a mission to “protect” women’s health holistically. Even Archbishop Bernardito Auza, the Holy See’s permanent observer to the United Nations, expressed support for “natural” alternatives to medical contraception. In a press release, he argued that the use of such resources can help countries meet the goals of the 2030 Agenda for Sustainable Development, which were adopted by UN member states in September 2015. The view was reinforced by a member of the medical community, Dr. Robert Graebe, an obstetrician-gynecologist whose practice uses the same approach as FEMM. Dr. Graebe went so far as to explain how women can trace “biomarkers” triggered by hormones, allowing them to distinguish which days they are fertile in order to avoid or achieve pregnancy by observing and tracking cervical mucus.28 The so-called fertility awareness methods are rudimentary forms of birth control that the Vatican appears to condone, as the March event demonstrated. The rhythm method, which falls into this category, is one of the least effective forms of birth control. However, by positioning it as a “scientific” approach and by expressing enthusiasm for the Sustainable Development Goal on sexual and reproductive health, the Catholic Church makes itself an active participant in the institutional debate. Unfortunately, the program it advocates continues to preclude access to abortion. In Latin America, where adolescent pregnancies, sexual violence, the spread of sexually transmitted diseases (including HIV and AIDS), and

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low levels of sexual education are prevalent, these church-sanctioned methods are markedly inferior to conventional birth control. The Vatican’s foreign policy program, coupled with its powerful opposition to abortion, influences stakeholders—from teenage girls to delegations in the United Nations—much to the detriment of the health and well-being of women and girls worldwide. And while the church and its representatives lobby for their agenda at the highest levels of global governance, they simultaneously deploy an army of foot soldiers into every corner of Latin America to spread the anti-choice gospel. One such highly mobilized NGO is Human Life International (HLI), which collaborates with its regional partner, Vida Humana Internacional. The groups together work broadly with Catholic archdioceses to advocate for their anti-abortion position, and their efforts are relentless. HLI describes the work of its Latin American regional director, Mario Rojas, as follows: Mario was an excellent candidate to oversee HLI’s increasing outreach in Latin America, and since September 2009 he has visited over 33 countries of the region and travelled more than 223,000 miles by air. He has spoken to more than 4,700 seminarians of 93 seminaries, over 800 priests, 135 bishops, 6 cardinals, over 800 nuns, 19,000 students of high school and universities, and over 18,000 persons from pastoral groups and members of evangelical churches. Mario had [sic] done hundreds of interviews via radio, TV, and newspapers. He focuses on strengthening and assisting HLI affiliates, participating in fundraising efforts, providing EWTN radio and TV interviews, and speaking at pro-life events. In coordination with REDESSVIDA, HLI’s Latin American Priests and Seminarians for Life Network, he is working to bring the message of life to this predominantly Catholic region.29

HLI’s Hispanic division runs a website aimed specifically at Latin America (www.hli.org). It features celebrity testimonials, “journalistic” accounts of women who suffered emotionally or physically after having abortions, and descriptions of alternative forms of family planning. The organization is an effective user of the internet and social media, much like other anti-choice outlets, among them ACI Prensa (the Catholic Information Agency in Latin America) and LifeSiteNews .com. The latter is an international daily news service started by the Canadian anti-abortion organization Campaign Life Coalition, with ties to anti-choice lobbyists at the United Nations and the International Right to Life Federation. Nearly every action, report, or event that takes place in the abortion rights advocacy community is counteracted by opposition. One

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organization, the Catholic Family and Human Rights Institute, has as its mission and motto, “Defending Sovereignty and Human Dignity at International Institutions.” It carries out this work through advocacy at the United Nations, regional organizations, political lobbying, and critiques of bodies such as the World Health Organization. And, like its counterparts in the pro-choice movement, the Catholic Church cuts a wide swath in Latin American society, transcending socioeconomic classes, political groupings, and gender and ethnic divisions. Its ideological and historical role in the region guarantees it millions of followers. With the support of its global partners, it mounts a formidable challenge to pro-choice advocates.30 Additionally, no discussion of religion’s role in the global abortion debate would be complete without acknowledging the dramatic rise of evangelical Protestantism in the region. For over three decades, alliances between conservative Catholics and evangelicals have markedly strengthened around issues such as marriage equality, traditional social issues, and especially, abortion rights. The case of Nicaraguan president Daniel Ortega, discussed in Chapter 3, is a graphic example of the two-fisted collaboration between the groups. His draconian stance emerged from pressure by both the Catholic Church and a powerful council of five hundred evangelical leaders. During his 2006 presidential campaign, Ortega signed the council’s pledge to significantly restrict reproductive rights and to ensure his party’s adherence to the policy. Soon afterward, in October 2006, the evangelical leaders mobilized thousands of their congregants in the streets of Managua, culminating in an even harsher petition presented to the president of the National Assembly. The evangelical movement has grown exponentially in recent decades throughout Latin America. But perhaps the most dramatic expression of its emergence is in Brazil, where the percentage of evangelical Protestants rose from 5 percent to approximately 30 percent between 1970 and 2017. The evangelical communities have very close ties to US Christian groups, which send thousands of missionaries to the country every year. The world’s largest religious broadcaster, Trinity Broadcast Network, is based in California but “reaches 220 Brazilian cities in 23 Brazilian states, covering 45 million people.”31 In addition to adding millions to the ranks of Protestant converts, the churches promote an agenda that is notoriously conservative in gender- and sexuality-based matters. Evangelical politicians play a decisive role in Brazil’s government. One beneficiary of their influence was former president Michel Temer, who was instrumental in removing his predecessor, Dilma Rousseff, from office in 2016. Temer sought and received the backing of evangelical leaders in his takeover of the presidency, and he rewarded them by

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appointing several members of their ranks to his cabinet. But their most visible presence is in the powerful Brazilian National Congress, in the bancada evangélica (evangelical bloc), which has grown at the same pace as the movement’s national membership. According to Brazilian sociologist and political scientist Jacqueline Pitanguy, the bloc was instrumental, along with conservative Catholics, in preventing reforms to the country’s strict abortion laws during the Zika crisis of 2016. Pitanguy said the evangelical legislators are part of a coalition known as BBB, for boi, bíblia, and bala (beef, Bible, and bullets). They earned that nickname because of their alliances with groups that advocate the lifting of environmental restrictions on the cattle and agriculture sectors, their “traditional” religious beliefs, and their pro-gun stance. Regarding abortion, Pitanguy makes the following observations: “There have been no advances in Brazil in relation to legislation concerning abortion since the 1940 penal code that [decriminalizes] abortion only in cases of rape and risk to a woman’s life. In 2012, we had a victory as the Supreme Court ruled in favor of the right to interrupt the pregnancy in cases of an anencephalic fetus. These are the only circumstances and in spite of the fact that Zika led to severe fetus malformation . . . there have been no positive changes in abortion laws.”32 In November 2017, a committee of the Brazilian National Congress’s Chamber of Deputies voted 18–1 for a total ban on abortions in all circumstances. During the vote, an evangelical lawmaker waved a replica of a twelve-week-old fetus and called the procedure “diabolical and Satanic.” Although evangelical Protestants are not unanimous in their opposition to abortion, there are enough socially conservative congregants to have a loud voice in the debate. Working in tandem with their strictly anti-choice Catholic partners, the groups are well represented in Latin America’s political arena. The Global Debate Rages On International actors play an outsized role in the Latin American abortion debate, representing stakeholders operating from the highest levels of global governance to the tiniest churches in remote villages. They exert influence in the three frames of deliberation: morality/religion, rights, and science/medicine. This chapter has explored the ways that a powerful “secular” country can export an ideologically driven dogma within its foreign policy agenda as well as the breadth of religious institutions’ influence. As far as a rights-based argument is concerned, global bodies strongly assert a fetus’s “right to life” and use personhood definitions to counter-

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attack claims focused on individual rights. At the same time, international jurisprudence has repeatedly demonstrated that abortion restrictions violate human rights on numerous fronts, including those concerning gender equality, privacy, and basic health care. Those issues continue to be hammered out broadly in many venues and formats. In the medical realm, ample scientific evidence appears in three areas. First, clandestine and illegal abortions are recognized as a global threat to women and girls’ health and survival. Restricting access does not decrease the number of abortions, but it does increase the likelihood of complications and adverse repercussions. Second, global public health institutions have proven that the earlier a pregnancy is terminated, the fewer the health risks and hazards. This means that when laws impose barriers and delays on the procedure, women and girls suffer unnecessary complications and difficulties. Third, abortion restrictions exacerbate problems related to gender-based sexual violence, incest, and high levels of adolescent pregnancy. The consequences for women and their families can include serious concerns about mental and physical health, ranging from inescapable cycles of poverty to depression and suicide. While global institutions may couch their rhetoric in “scientific” language asserting a preoccupation with women’s health, they are no substitute for decisions that must be made by women, girls, physicians, and families. Finally, it would be remiss to consider the global community as a stakeholder in Latin America’s abortion debate and to exclude considerations of political economic policies. While the majority of the rhetoric surrounding reproductive rights is couched in moral/religious language, the international hegemony of neoliberalism also plays a critical role. Since the 1990s, its effects on Latin American women have been profound: health-care privatization, the shrinking of state-sponsored social programs, a widening gap between the rich and the poor, and an emphasis on the individual as opposed to the collective (which ultimately weakens claims for equal justice in the eyes of the law). As I have argued in this book, sexual and reproductive rights affect all women in the region, but the denial of abortion rights disproportionately hurts the poor. Among other damaging consequences, globalization-driven neoliberal policies that slash the public sector result in fewer services that protect, defend, and care for all disadvantaged and marginalized members of society. Women and girls facing unwanted pregnancies may be the most vulnerable among them. Notes

1. See Scott, Sex and Secularism. 2. UNFPA, “Statement by UNFPA on U.S. Decision to Withhold Funding,” April 4, 2017.

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3. “Interview with Donald Trump,” Meet the Press, October 24, 1999, https:// www.nbcnews.com/meet-the-press/video/trump-in-1999-i-am-very-pro-choice -480297539914. 4. “The Mexico City Policy: An Explainer,” Henry J. Kaiser Family Foundation, January 28, 2017, http://kff.org/global-health-policy/fact-sheet/mexico-city -policy-explainer. 5. “The Mexico City Policy.” 6. Much of this discussion on the global gag rule is drawn from Barot, “When Antiabortion Ideology.” 7. Barot, “When Antiabortion Ideology,” 74. 8. Starrs, “The Trump Global Gag Rule.” 9. “Trump’s Gag Rule One Year On: Marie Stopes International Faces $80m Funding Gap,” press release, Marie Stopes International, January 19, 2018. 10. Rogers, “In Colombia.” 11. S. 210, “Global Health, Empowerment and Rights (HER) Act,” 115th Congress (2017–2018). See also Center for Reproductive Rights, “New House and Senate Bills Would Repeal Global Gag Rule,” press release, January 24, 2017. 12. Gajanan, “Justin Trudeau.” 13. “Mr. Trump, Make Abortions Safe Again!,” video posted to YouTube by RFSU, January 22, 2018, https://www.youtube.com/watch?v=nCMltmhkh6s. 14. “Transparency Portal,” UNFPA, https://www.unfpa.org/data/transparency -portal (accessed September 10, 2018). 15. “Frequently Asked Questions,” UNFPA, https://www.unfpa.org/frequently -asked-questions#abortion (accessed September 10, 2018). 16. “Meeting with Representatives of Civil Society: Address of the Holy Father” (Apostolic Journey of His Holiness Pope Francis to Ecuador, Bolivia, and Paraguay, León Condou Stadium, Colegio San José, Asunción, Paraguay, July 11, 2015), https:// w2.vatican.va/content/francesco/en/speeches/2015/july/documents/papa-francesco _20150711_paraguay-societa-civile.html. 17. His Holiness Pope Francis, Misericordia et misera, Apostolic Letter, November 20, 2016. 18. “La iglesia boliviana rechaza que aborte una niña de 11 años violada,” 20 Minutos, June 19, 2015, http://www.20minutos.es/noticia/2493164/0/iglesia-boliviana /rechaza-aborto-nina-11-anos/violada-embarazada. 19. Frances Kissling, former president of Catholics for Choice, emphasized the extent of the church’s “human capital” in an interview with the author and Joan Caivano, Washington, DC, July 26, 2012. 20. See “Religion in Latin America: Widespread Change in a Historically Catholic Region,” Pew Research Center, November 13, 2014, http://www.pewforum .org/2014/11/13/religion-in-latin-america. 21. See Jennifer Butler, “For Faith and Family: The Christian Right Advocacy at the United Nations.” Political Research Associates, September 2000, https://www .politicalresearch.org/2000/09/01/for-faith-and-family-christian-right-advocacy-at -the-united-nations (accessed November 5, 2018); Coates et al., “The Holy See”; Center for Reproductive Rights, “The Holy See at the United Nations: An Obstacle to Women’s Reproductive Health and Rights,” briefing paper, August 2000. 22. “Address of the Holy Father,” United Nations Headquarters, New York, September 25, 2015. 23. Center for Reproductive Rights, “The Holy See at the United Nations,” 4. 24. Coates et al., “The Holy See.” 25. “Holy See Event Promotes Holistic Women’s Sexual and Reproductive Healthcare,” Permanent Observer Mission of the Holy See to the United Nations, March 17, 2016, https://holyseemission.org/contents//events/56ec82154e6e11.86682287.php.

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26. “What Is FEMM?” FEMM, https://femmhealth.org/about-us/what-is-femm (accessed November 5, 2018). 27. NR Symposium, “If Planned Parenthood Goes.” 28. “Holy See Event Promotes Holistic Women’s Sexual and Reproductive Healthcare.” 29. “Mario Rojas, Regional Director for Latin America,” REDESSVIDA, http:// www.redessvida.org/nosotros-red-de-sacerdoctes-y-seminaristas-vida/462-mario -rojas-regional-director-for-latin-america (accessed November 5, 2018). 30. Some of the international antiabortion organizations are C-FAM Catholic Family and Human Rights Institute, Human Life International, Birthright International, Heartbeat International, Knights of Columbus, LIFE International, International Right to Life Federation, Life Decisions International, World Federation of Doctors Who Respect Human Life, and Population Research Institute. 31. Encarnación, “Amid Crisis in Brazil.” 32. Author’s correspondence, March 29, 2018.

8 The Promise of Public Debate

On March 14, 2018, Maira Veronica Figueroa Marroquín walked out of a Salvadoran prison after serving half of a thirty-year sentence for abortion. At the age of nineteen, she had suffered a miscarriage during her shift as a domestic worker. Upon arrival at the hospital, she was arrested and eventually charged with aggravated homicide. Her release followed on the heels of another victory for pro-choice advocates—the February liberation of Teodora Carmen Vásquez, who had been jailed under similar circumstances—but, at the time, over two dozen other Salvadoran women remained incarcerated for abortion-related crimes, serving extensive, unjust sentences. Six days later, more than 6,000 kilometers away, abortion rights were also in the spotlight: The Argentine Congress finally began to consider liberalizing its laws. The March 20, 2018, hearing was the seventh time in a decade that a bill—the latest version of which was co-sponsored by over seventy lawmakers from across the political spectrum—had been submitted for the legislature’s consideration. President Mauricio Macri, from the center-right Republican Proposal party, approved the debate, despite his personal opposition to the initiative. The slow, steady determination of the pro-choice National Campaign for the Right to Legal, Safe, and Free Abortion had continued to gain momentum, garnering the support of over 500 civil society organizations. Two days later, on March 22, 2018, an unidentified rape victim in neighboring Paraguay died needlessly in childbirth. She had been hospitalized for twenty days with pregnancy complications. Doctors initially tried to deliver the baby vaginally, but she showed signs of respiratory distress so they attempted an emergency cesarean section. She suffered an embolism and three cardiac arrests. After her

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death, the hospital director commented that, “Her body was not ready for a pregnancy.” She was 14.1

March 2018 was not a particularly remarkable month for the abortion rights debate. Still, its headlines reflected the relentless, quotidian struggle roiling in Latin America. For decades, the Salvadoran state has incarcerated women unjustly accused of abortion-related crimes. Congresses and courts in every country of the region have launched countless sessions of pro-choice and anti-abortion legislative arguments. Argentina is no exception. And, tragically, adolescent rape victims, day after day, die during childbirth after being denied the right to terminate a pregnancy. The events that unfolded during those eight days in March 2018 are a vivid snapshot of the stakeholders’ Sisyphean fight for reproductive rights in Latin America. The Abortion Debate: What’s at Stake? The consequences and conditions facing individuals who find themselves with unplanned pregnancies are as diverse as the women and girls themselves. Some of the more affluent will end their pregnancies safely, with minimal aftereffects, in their home countries or by crossing borders. A few will find help from nongovernmental organizations (NGOs), access networks of pro-choice women, or buy abortioninducing drugs online. Those left out, often low-income and rural women, will fall prey to caregivers and procedures utilizing medications or home remedies that can be ineffective, toxic, or fatal. There will be women and girls who try to induce their own abortions, using wires or sticks or potions or coat hangers. Some will end up in filthy rooms with unsterilized equipment and untrained personnel, and the experience may result in grave and prolonged mental or physical illness—or even death. 2 A number of women and, especially, adolescent girls, seeing no viable solution to their situation, will commit suicide. Others will be forced to carry to term unwanted pregnancies, altering their lives and future plans in often dramatic ways. These scenarios have become untenable in Latin America, putting abortion at a crossroads. Globalization, transnationalism, changing relationships between civil society and the state, and decentralization have all contributed to new spaces from which reproductive rights proponents can now act. At the same time, civil society activists for women’s rights in Latin America are forging new paths for their work,

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bringing promising opportunities that cut across traditional lines of class, race, ethnicity, and territory. Although this book spotlights the politics of abortion rights, its aim is much broader. It seeks to highlight the ways in which contentious political issues are addressed, with an understanding of the shifting roles of gender in civil society, of the influence of international actors, and of the new configurations of state power and institutions. It highlights the inequities in social policies, calling not only for individual rights but for an overall assertion of reproductive justice for every sector of society. Finally, it acknowledges that while the fight for abortion rights is a public one that can only be won through political debate, the victory in that struggle will only be achieved when abortion itself returns to the private, personal, therapeutic realm of commonplace medical treatment. This final chapter surveys the complex and contradictory landscape of the contemporary debate. It begins by looking at the progress and setbacks in the region overall, with a comparative glance at the global context. It then broadens the analysis to include perspectives on where the issue sits—and the critical role it plays—in twenty-first-century articulations of the public realm. The study concludes by acknowledging that the three “frames” outlined at the book’s outset—the human rights frame, the public health frame, and the moral frame—are ultimately encompassed by a larger picture of social justice. There can be no choice, no rights, no moral arguments, and no fundamental change in women’s reproductive lives without that perspective. The State of the Debate The overall outlook for abortion rights worldwide is increasingly positive, but Latin America lags behind this encouraging trend. According to a 2018 study by the New York–based Guttmacher Institute, twentyeight countries have changed their abortion laws since 2000.3 Of these, twenty-seven loosened restrictions to allow increased access to the procedure. The one holdout, Nicaragua, tightened its laws by imposing a total ban on the procedure. Among the countries revising their laws, most expanded the grounds for abortion beyond protection of a woman’s life. Two dozen opened permission for abortion in cases of rape or incest or when a fetus is deemed to be severely impaired. Parallel to these legal shifts, abortions have mostly become safer, even in clandestine settings, because of the rise in medical-abortion methods. (These generally take

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place through use of the drug misoprostol and, somewhat less commonly, a combination of mifepristone and misoprostol.) At the same time, the rate of unintended pregnancies has dropped significantly since the 1990s, reflecting improved access to contraception.4 Unfortunately, the scenario dims when international statistics are disaggregated. Indicators for “developed” regions may have improved markedly, but their counterparts for “developing” regions have either stagnated or declined. Latin America falls into the latter category. For example, the Guttmacher study reports that by 2014 the rate of abortions in developed areas had decreased significantly in comparison to the 1990s, while there was no real change in the developing world. (The rates were approximately 36 abortions per 1,000 women aged fifteen to forty-four in the poorer regions, compared to 27 per 1,000 in the wealthier ones.) In the same vein, unintended pregnancies also declined worldwide, with 45 per 1,000 women in developed countries and 65 per 1,000 in the developing ones. Latin America compares unfavorably even when viewed against the other developing regions. It leads the world in unintended pregnancy rates (96 per 1,000), exceeding the numbers in Africa, its closest contender. It also holds another dubious distinction: the top global spot in the number of abortions performed, at 44 per 1,000 women. (This number varies within the region, with the Caribbean far outranking Central America, for example.) Meanwhile, sexual activity among adolescents continues to rise in the region, while the unmet need for effective contraception hovers between 26 and 58 percent, depending on the country, for young, single women.5 The illegality of abortion, coupled with inadequate services in family planning, education, and contraception, has resulted in stubbornly sobering statistics for Latin America’s women and girls. What the data do not reveal, however, is how tremendously dynamic and varied abortion rights are across the region. Pro-choice advocates measure progress on a case-by-case and country-by-country—sometimes even city-by-city— scale. They know that a legislative victory can be reversed with the stroke of a pen, and judicial decisions can be circumvented, violated, or ignored. With this in mind, two of the issue’s most influential proponents, Colombia’s Monica Roa and Chile’s Claudia Dides, both of whom have successfully influenced abortion legislation in their countries, analyzed the state of the debate at a December 2017 forum in Washington. Speaking a dozen years after successfully litigating the legalization of abortion in Colombia, attorney Roa reflected on the progress and pitfalls of the contemporary reproductive rights arena.6 She traced the evolution of abortion rights advocacy, comparing progress in Mexico City

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and Uruguay’s first-trimester abortion legalization to the dreadful situation in Nicaragua and El Salvador. Her assessment: “The situation has gone from bad, to worse, to intolerable.” She then highlighted changes that have occurred both for and against the pro-choice agenda.

• In a paradigm shift, the abortion debate has moved from a zerosum yes-or-no argument to a more nuanced discussion of causes or instances (causales) in which abortion is permitted. This has allowed advocates to provide responses to opponents and move to a more constructive dialogue. • A “minimal” definition of abortion rights has emerged for therapeutic abortions, with more places permitting or contemplating pregnancy terminations when a woman’s life is at risk, in cases of rape, or when a fetus is determined to be unviable. These conditions were included in the successful reforms in Chile and are under discussion in the Dominican Republic and elsewhere. • There is a changing notion about life beginning at conception. At the same time, the “protection of life” argument is shifting away from the embryo to focus on the lives of pregnant women and girls. • Medical abortions—nonsurgical procedures carried out in the early weeks of pregnancy through the use of pharmaceuticals—have changed the panorama dramatically. Health-care providers and women’s organizations are becoming equipped to provide women with the ability to safely terminate pregnancies on their own.

On the negative side, the region’s anti-choice politicians and activists have promoted critiques of a so-called gender ideology (ideología de género) in society. Organized groups have fought to impose their definition of “traditional family” norms and values that oppose marriage equality, other LGBTQ rights, and abortion. Using language about motherhood, children, and religion, the conservative voices have gained significant traction in the global public arena, and Latin America has been no exception. To address this onslaught, Roa proposed an intersectional response. Two pronged, it reinforces policies where there has been progress and connects like-minded sectors in order to unite forces. This approach moves beyond gender-based rights to find broad common ground, manifesting itself in support for those fighting for environmental justice, as well as rural, racial, and indigenous rights. This “strength in numbers” path brings to mind feminist Audre Lorde’s famous exhortation, “In our world, divide and conquer must become define and empower.” 7 Any progress already made on abortion rights in Latin

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America has demonstrated that advances can only be achieved by channeling many forces from diverse—and often unexpected—political and civil society actors. Dides, director of the reproductive rights organization MILES Chile, spoke at the same Washington, DC, forum, and her comments echoed Roa’s sentiments. Dides revisited the abortion rights victory in Chile’s legislature, noting the length of the struggle: “Twenty years is a long time.” Like her Colombian counterpart, she reiterated the importance of civil society interlocutors in the process, which she stressed must necessarily be democratic and inclusive. She added that academic communities also play a critical role by conducting surveys, assembling scientific data, and building arguments for public debate. Like other long-term advocates, both Roa and Dides also pointed out the specific obstacles faced by individual countries. For example, in the case of Colombia, decades of armed insurgency caused tremendous upheaval, contributing to internal displacement, migration, shortages in services and education, and other factors that have exacerbated public health deficiencies and polarized the political environment. Dides pointed to the damage wrought by years of dictatorship in Chile, including the lack of adequate medical and social services, coupled with the political parties’ turbulent process of democratic transition. In other countries, the role of religious institutions and high levels of stigma preclude the majority of women and girls from accessing legal abortions. The barriers to implementing laws often surpass the challenge of passing them. In every case where abortion restrictions have been loosened or tightened, there have been immediate public outcries to reverse those decisions. In federal systems such as Mexico, the apparently never-ending battle is fought and refought at the state and national levels. In Uruguay, which, since 2012, ranks among the least restrictive of the region’s countries in terms of its abortion legislation, significant obstacles persist. In fact, Uruguay presents a compelling example of the difficulty in accessing abortion services. In 2012, after three decades of pro-choice advocacy, the Congress approved Law 18987, the Voluntary Termination of Pregnancy Law. The legislation allows for pregnancy termination up to twelve weeks at a woman’s request and up to fourteen weeks in cases of rape, and it carries no gestation limit if the pregnancy endangers a woman’s health or if a fetus is unviable. By most measures, it seems ahead of most of the region’s nations in abortion rights. Uruguay is the second-wealthiest nation in Latin America in GDP per capita (after Chile), and the law stipulates that abortion services be provided for free. With its tiny population and progressive politics, the country’s public health system covers abortion services primarily through medical

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abortions. Despite this liberalization, obtaining an abortion remains a daunting challenge. A woman seeking an abortion must undergo a consultation with a panel made up of a gynecologist, a mental health expert, and a social services provider. During those sessions—which can be delayed, humiliating, or difficult to schedule—women are given information about the risks associated with unsafe abortion, alternatives such as adoption, and maternity support services. After the review process, there is a “reflection” period of at least five days before the woman can receive medication to terminate the pregnancy. There are also many caveats. Only gynecologists can perform abortions. Noncitizens who have been in Uruguay less than a year are not eligible for the services. Although institutions (public and private) within the state health-care system must provide abortion services or refer women elsewhere, even when the institution objects to abortion on religious grounds, some 30 percent of physicians (and up to 80 percent in small towns) express conscientious objections, effectively circumscribing women’s access. The fact that abortions must be performed at no cost also creates an economic disincentive for physicians to perform them. Indeed, many women are not even aware that abortions are legal, and there remains a significant stigma associated with the procedure.8 The case of Uruguay underscores the obstacles to abortion that can exist even under relatively advantageous legal and political conditions. As this book has noted, there are places where abortion is permissible, and yet legal hurdles make it nearly impossible to obtain one. In other places, abortion is illegal in most cases, and yet it may be practiced routinely and in generally safe surroundings. That said, in every setting, there are formidable anti-choice opponents pushing against abortion rights, so the issue is rarely (if ever) a completely resolved societal concept. Entre el Dicho y el Hecho . . . If clandestine abortions are widely performed and increasingly less risky, why debate the issue in the public arena? Why is the state involved in abortion rights at all? The answers lie in a basic comprehension of the state’s role as a guarantor of equal protection under the law. The answers are also anchored in an understanding of basic human rights and services, especially as safeguards for the most vulnerable members of society. In most Latin American nations where abortion rights are restricted, systems of “double discourse” exist. The state maintains a discriminatory prohibition in its public policies but privately tolerates the illegal

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mechanisms that expand reproductive choice.9 For the most part, this construct hurts only low-income women. In fact, the benign neglect system works quite well for wealthier women who terminate their pregnancies behind the doors of private clinics or travel abroad for such services. They can continue to espouse “moralistic” anti-abortion rhetoric, and the government stays out of their reproductive lives. But the majority of the population does not have that luxury, and that is where the state plays a critical role. In its regulatory capacity, the state oversees the provision of medical services, preventing “practitioners” from preying upon vulnerable women and girls in need of abortions. It sets standards for medical interventions, from the operating room to the pharmacy. In addition, most Latin American governments have incorporated into their jurisprudence a responsibility for the delivery of basic human rights, including health care. Free access to public health-care systems is generally the only guarantee that all members of society (regardless of economic status or gender) will have the same ability to exercise that right. Finally, if abortions remain “officially” illegal, then sanctions against them will continue to be applied almost exclusively to marginalized women and those who assist them in terminating pregnancies. In the same vein, the “double discourse” quandary replicates itself on the individual level.10 In places where abortion is illegal, considered immoral, and stigmatized, women may be loath to articulate a prochoice position. Previous chapters have cited examples where people have been excommunicated for having an abortion or even assisting someone in some aspect of the procedure. There is far-reaching social pressure to echo the religious doctrine that restricts reproductive choice; yet it is widely known that women and girls privately use contraception and have abortions. In fact, at the individual level, it is not unusual for Catholic priests to grant absolution to “sinners” who admit to abortions in the confessional, even as the church instructs that they should be excommunicated.11 The problem with this disconnect entre el dicho y el hecho (between what’s said and what’s done) is the crux of the argument for public debate. Without telling the stories of women and girls facing unintended pregnancies and deprived of the transparency afforded by public discourse, contentious issues such as abortion rights are unlikely to see the light of day. The gap between “what’s said and what’s done” becomes dramatically magnified when we place the debate in the context of broader societal contradictions. Although the divide has narrowed somewhat in recent years, Latin America remains the most economically unequal region in the world.

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Access to education, housing, employment, child care, and health services is disproportionately skewed toward wealthier citizens, and women hold a persistently disadvantaged position on the income pyramid. Poor, rural, disabled, indigenous, and Afro-descendent women lead very different lives than their higher-income counterparts. State-provided services can be woefully inadequate or nonexistent, and consistent availability of reliable contraception falls squarely within that shortfall. Ironically, nowhere is the relationship between economic conditions and reproductive choice more poignant than in Cuba, which places the fewest restrictions on abortion in Latin America. On the island, the procedure is legal on demand and free of charge; the national health-care system has been providing abortions since 1965. Cuba has one of the world’s highest rates of abortion, but it also has an extremely low percentage of unmet need for contraception, at approximately 9 percent.12 This means that among women who are not seeking to become pregnant, less than one woman in every ten is having unprotected sex. Yet, despite government services that facilitate the right to prevent or terminate pregnancies, women’s freedom to choose motherhood is severely circumscribed by economic limitations. The abortion debate in Cuba differs from that in the rest of Latin America, given that the state freely administers abortions and women access services openly, apparently without much of the stigma experienced elsewhere. Discussions about the high rate of abortion tend to focus not on its legality but, instead, on its possible health ramifications and the problems posed by the nation’s declining birthrate and shifting demographics.13 Economically, the socialist state is falling short of its commitments in social reproduction, not only in the sense of sustaining children and families but also in its obligation to support a labor force that will maintain the viability of its revolutionary project. 14 The dual economy, migration, housing shortages, and other poverty-related conditions all present obstacles to reproduction. These may be outside the realm of abortion legislation but they can be equally (or more) oppressive. If women are terminating pregnancies because they do not have the resources and support to raise children, then the notion of “choice” becomes a fallacy. This book has stressed the economic injustices of Latin America’s abortion rights policies, which take many forms. Reproductive choice cannot exist if women from every sector in society are not given the same access to, and opportunities for, safe and good-quality health care. However, education, employment, child care, housing, and other social services also play a role in the question of choice. By the same token, if patriarchal societies or religious doctrines leave women and girls few options

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when it comes to whether or when to have sexual relations or children, it is a misnomer to characterize their reproductive decisions as choices. Lessons Learned Pave the Road Ahead Every day in Latin America, pregnant women and girls are punished for seeking reproductive health care, in violation of their human rights. In far too many cases, these sanctions result in life-changing consequences, including unwanted pregnancies accompanied by physical, mental, and financial setbacks; unsafe or even deadly illicit abortions; and shocking prison sentences. These consequences affect not only the women themselves but spill over to touch their families and the health-care community. In the broadest sense, they limit women’s full participation in the social and economic activities of their countries and prevent Latin America from leveraging its full potential, regionally and on the world stage. Latin America’s abortion debate sits at the intersection where morality meets political calculation rather than where it should be anchored, in the arenas of human rights, social justice, and public health. The Catholic and evangelical Christian churches play an oversized role in feeding the “morality” script. The religious institutions may wield considerable influence when its representatives are powerful members of civil society or, as in the case of the Brazilian National Congress, serve as elected officials themselves. Activists fighting for abortion rights continue to push to reframe this debate as a human rights and public health issue, not a morality issue. However, they have come to recognize that there is no one-sizefits-all formula for revision of the region’s archaic laws. Latin America’s return to democracy transformed the region, reinstituting rights and transparency to some degree, but notably not in the area of reproductive rights. In some countries, where the executive branch of government has disproportionate power, the viewpoint of a single person— the president—can define how abortion rights are addressed. In others, as in the case of Colombia, the judiciary is the branch of power that rises to defend women’s right to choose. In still others, the legislatures— sometimes nationally, occasionally even at the state or city level, such as in the case of Mexico City—lead the vanguard of change. Interestingly, within government, the battle for women’s rights is not necessarily led by women. In fact, some women in elected office have proven to be the biggest obstructionists. Argentina’s Cristina Fernández de Kirchner and Nicaragua’s Violeta Chamorro are prime

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examples. And even women leaders who support abortion rights have had to tread carefully or risk jettisoning their political careers. Chile’s Michelle Bachelet waited until her second administration to push for the changes in Chile’s law. Brazil’s Dilma Rousseff, meanwhile, distanced herself from her previous pro-choice stance during her presidential campaign, publicly reversing her position to win the election. Advocates of women’s reproductive rights have maneuvered this very complex landscape with growing effectiveness. They have embraced coalition building, including outside the arena of women’s rights. They have elevated the tragic stories of individual women and girls—Paulina Ramirez, Leslie Briceño, “Esperanza,” “Manuela”—to personalize the dire consequences wrought by the archaic laws. They have deepened their understanding of the political process, identifying key power brokers who are sympathetic and forging connections. They also have evaluated the pros and cons of aligning with NGOs and other international abortion rights advocates to transform attitudes and change laws. By elucidating the linkages—abortion rights, women’s rights, human rights—pro-choice advocacy groups and movements have become mechanisms for political participation and mobilization, disseminating democratic norms. But the walls they confront are formidable, particularly in Central America, where women’s glorified roles as mothers, the power of the church, and the notion of machismo are deeply entrenched. Still, Latin American governments can and do change in response to pressures from civil stakeholders. In many important ways, the tenor of the overall debate has shifted. The once-strict yes-or-no—pro-choice versus anti-abortion—positioning has given way to more nuanced rhetoric. At the same time, the discussion has become more democratic, with a wider and more diverse range of voices being heard. One repercussion, of course, has been more powerful pushback from anti-choice proponents. Globalization has played its own role in supporting the pro-choice movement. Latin America cannot afford to be economically isolated from the rest of the world, and that means it must be a signatory to international conventions and international courts and legal protocols. This exposure has brought the dire consequences of the region’s anti-choice criminal codes to the attention of entities such as the Inter-American Commission on Human Rights and the ruling committee of the United Nation’s Convention on the Elimination of All Forms of Discrimination Against Women. It has also made the region’s repression of women’s reproductive rights a target of international public opinion. Women and girls have had abortions throughout human history, and they will continue to do so. Fortunately, many roads to reproductive

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autonomy appear to be converging in Latin America, despite the rocky and convoluted journey. Medical technology, public opinion, education, advocacy, and voices that will not give up will eventually render the debate a regrettable relic of the past. In the future, abortion rights will be exercised not in Latin America’s hidden back alleys but in its public hospitals and clinics, and justice will be served. Notes 1. “Paraguayan Rape Victim, 14, Dies Giving Birth,” The Guardian, March 22, 2018, https://www.theguardian.com/global-development/2018/mar/22/paraguayan -rape-victim-14-dies-giving-birth. 2. The principal causes of death from illegal abortions include hemorrhage, infection, and poisoning. Nonfatal complications include hemorrhage, sepsis, peritonitis, and trauma to the cervix, vagina, uterus, and abdominal organs. In addition, illegal abortions have been linked to mental health issues such as anxiety and depression, among others. See Osorio Calderón, “The Right to Health.” 3. Singh et al., Abortion Worldwide. 4. Singh et al., Abortion Worldwide. 5. Singh et al., Abortion Worldwide, 4–8. 6. Roa, “Sexual and Reproductive Rights.” 7. Lorde, “The Master’s Tools.” 8. Wood et al., “Reform of Abortion Law in Uruguay,” 109–110. 9. Shepard, “Double Discourse,” 111. 10. Shepard, “Double Discourse,” 113–116. 11. Shepard, “Double Discourse,” 117. 12. “UNFPA Cuba,” UNFPA, https://www.unfpa.org/data/CU (accessed January 26, 2019). 13. See Andaya, Conceiving Cuba, 68–92; Díaz-Briquets, “Major Problems,” 3–5. 14. Andaya, Conceiving Cuba, 1–7.

Acronyms

AMNLAE CEDAW CRR FEMM FMLN FSLN GEDAT

GHJP GIRE HLI HRW IACHR ICPD IML MAM MDGs MINSA NGO OAS PAHO PAN PLC

Asociación de Mujeres Nicaraguenses Luisa Amanda Espinosa Convention on the Elimination of All Forms of Discrimination Against Women Center for Reproductive Rights Fertility Education and Medical Management Farabundo Martí National Liberation Front Sandinista Front for National Liberation Grupo Estratégico por la Despenalización del Aborto Terapéutico Global and Health Justice Partnership Grupo de Información en Reproducción Elegida Human Life International Human Rights Watch Inter-American Commission on Human Rights International Conference on Population and Development Institute of Legal Medicine Movimiento Autónoma de Mujeres Millennium Development Goals Ministry of Health nongovernmental organization Organization of American States Pan American Health Organization National Action Party Partido Liberal Constitucionalista 155

156

Acronyms

PLD Promsex

SDG SERNAM UNFPA UNHRC USAID WHO WMA

Dominican Liberation Party Center for the Promotion and Defense of Sexual and Reproductive Rights Sustainable Development Goals Servicio Nacional de la Mujer United Nations Population Fund United Nations Human Rights Council United States Agency for International Development World Health Organization World Medical Association

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Index

Alemán, Arnoldo, 48 Almagro, Luis, 13–15 Altamirano, Ligia, 95–96 Alvarez, Sonia, 69 American Convention on Human Rights, 108, 112 American Declaration of the Rights and Duties of Man, 108 Amnesty International, 26(n20), 58–59 anencephaly, 90–91, 100, 103, 117, 121(n24), 138 anti-abortion activism: Catholic Church mobilization of anti-choice groups, 23– 24, 136–137; conservative backlash against Chile’s progressive reforms, 34– 35; far-reaching effects of anti-choice policies, 152–154; globalization of, 23– 24; growth of El Salvador’s, 87; right-wing opposition to abortion, 28– 29; US global crusade, 124–130. See also Catholic Church; pro-life advocacy; Protestant groups Argentina: abortion debate gridlock and decentralized power, 54–59; criminalization of miscarriages, 59–60; differing platforms among government institutions and actors, 46; effect of women in politics on reproductive rights, 20; history of reproductive rights legislation, 17; international appearance of feminist issues, 107; legal abortion access, 3(table); political complications of abortion debate, 21, 40; pro-choice pressure on lawmakers, 143 Argibay, Carmen, 56

armed conflict, abortion policy and, 47–49, 86–88, 92–93, 148 Asociación de Mujeres Nicaraguenses Luisa Amanda Espinosa (AMNLAE), 93 authoritarian rule: effect on Chile’s abortion rights reform, 148; feminist movements and, 67–68 Auza, Bernardito, 135 Avila Iñiguez, Ismael, 71

Bachelet, Michelle: Chile’s abortion legislation liberalization, 27; Chile’s emergency contraception legislation, 33–35, 34(table); Chile’s health ministry, 41; election dynamics, 43(n9); political constraints on abortion policy debate, 28, 153; prochoice political stance, 20. See also Chile Barros, Ricardo, 42 Barroso, Carmen, 114 Baseotto, Antonio, 56 Beijing Declaration and Platform for Action, 18, 88, 112 “Belén,” 59–60 Belli, Humberto, 48 benign neglect system of abortion, 149–150 birth defects: Down syndrome, 121(n22); effects of the Zika virus, 10, 41, 115– 117, 121(n24) Bolaños, Enrique, 49 Bolivia: church stance on abortions for rape victims, 131; early-term abortion legislation debate, 77–82; indigenous women’s reproductive health, 77–79; legal abortion access, 3(table); sexual violence against minors, 13

169

170

Index

Brazil: Catholic population numbers, 132; effects of the Zika virus, 10; growth of evangelical Protestantism, 137–138; leftist opposition to abortion policy reform, 46; legal abortion access, 3(table); Rousseff’s shifting stance on reproductive rights, 20– 21; Zika virus outbreak, 41–42, 115–120. See also Rousseff, Dilma Briceño, Leslie, 45, 47 Bukele, Nayib, 47, 91–92 Bush, George W., 26(n40)

Canada: forced sterilization of indigenous individuals, 84(n31); pushback against the US global gag rule, 128–129 Caribbean states, 25(n1) Casas, Ximena, 97 Catholic Church: anti-choice NGOs, 136– 137; Argentina’s partnership over economics and abortion, 55; backlash against global abortion law liberalization, 18–19; Chile’s church-state relations obstructing pro-choice policies, 33; controlling reproductive rights in the Dominican Republic, 53; creating El Salvador’s criminal code, 88–89; declining membership and increasing political authority, 17–18; global reach and influence, 124, 131–137; interference in a legal abortion for rape victim, 71–72; international figures on abortion rights, 111; international mobilization of reproductive rights debates, 110; liberation theology, 23–24; members’ support of abortion rights, 26(n36); Mexico City’s abortion legalization, 73– 74; Nicaragua’s criminalization of abortion, 50; Nicaragua’s revolutionary history, 47–49; opposition to a Salvadoran therapeutic abortion, 90; Pope Francis’s call for reproductive rights dialogue, 131–132; pro-choice Catholic organizations, 105; public debate as a moral and political issue, 152; religious pressure on individuals having or assisting with an abortion, 150; right-tolife medical providers, 8–9; right-wing opposition to abortion, 28–29 Catholic Family and Human Rights Institute, 137 CEDAW. See Convention on the Elimination of All Forms of Discrimination Against Women center-right leaders, varied abortion stances of, 20, 28, 143 Cerrato, Carla, 92, 95 Chamorro, Joaquín, 48

Chamorro, Violeta, 48 Chavez, Susana, 106 child mortality, 12. See also fetal impairment Chile: Bachelet’s gradualist strategy in prochoice legislation, 32–36; civil society mobilization in the abortion rights struggle, 148; conservative backlash against the health minister’s progressive perspective, 40–41; effect of women in politics on reproductive rights, 20; emergency contraception legislation, 33–35, 34(table); evolution of the public abortion debate, 147; fetal rights in the constitution, 19(table); legal abortion access, 3(table); religious-political complexity in abortion legislation, 27– 29; selective abortion legalization, 27, 34(table); therapeutic abortion law, 17. See also Bachelet, Michelle China: US suspension of family planning funding, 124–125 church-state relations: Brazil’s conservative stance on abortion rights, 119; Dominican concordat, 53; erosion of US church-state separation, 130; obstructing Chile’s pro-choice policies, 33. See also Catholic Church; Protestant groups civil society: actors and movements, 21–23; addressing gender-based violence in Peru, 96–101; advocating liberalization of Nicaragua’s abortion laws, 94–96; Argentina’s abortion rights debate support, 57–59; Bolivia’s indigenous women’s coalition for reproductive rights reform, 78–80; emergence of pro-life advocacy, 19; global reach and influence of the Catholic Church, 132; international response to Brazil’s Zika virus outbreak, 120; intersectional response to anti-choice activism, 147–148; local, regional, and international advocacy groups, 105–106; Mexico’s federal system complicating legislation, 76; mobilization at the Legal Conference on Reproductive Rights, 99– 100; Nicaraguan reproductive rights groups and, 94–95; Nicaragua’s medical pragmatism, 92; opening space for the abortion debate, 144–145; opposing Mexican officials’ obstruction of a legal abortion, 72–74; pushback against the US global gag rule, 128; replacing state function in social policies, 69–70; women’s movements, the neoliberal state, and, 67–70. See also international community; nongovernmental organizations; women’s movements

Index Clinton, Bill, 26(n40) collective action, 70 Colombia: constitutional stance on abortion rights, 36–38; current progress of reproductive rights, 146–147; left-right politics and abortion policy, 20, 29; legal abortion access, 3(table); legislative and judiciary progress in abortion rights, 36–40; local, regional, and international alliances effecting change, 105; unique obstacles to abortion rights reform, 148; US defunding family planning, 127–128 Communist Party (Chile), 33, 35 conditional abortion. See fetal impairment; maternal health; rape/incest conscientious objection, 22 conservative backlash, 153; against Chile’s progressive reforms, 34–35; to growth of international reproductive rights advocacy, 107; Mexico City’s abortion legalization, 75; Peru’s progressive perspective on abortion access, 40–41; response to loosening legislation, 148– 149; women’s increasing political participation, 31 Constitutional Court (Colombia), 37–38 Constitutional Court (Dominican Republic), 53–54 constitutionality of abortion legislation: Argentina’s reforms, 17, 55; Bolivia’s liberalization, 77–79; Brazil’s total abortion ban, 119; challenging Colombia’s abortion ban, 36–39; challenging Nicaragua’s therapeutic abortion provision, 48–49; Chile’s emergency contraception debate, 34–35, 34(table); Dominican Republic’s Catholic concordat, 53; El Salvador’s total abortion ban, 87–88; fetal rights in Latin American constitutions, 19(table); Mexico City’s legalization, 74–75; subnational amendments, 28 Contra insurgency (Nicaragua), 47–48 contraception: Bachelet’s insistence on Chile’s liberalization, 33; Catholic Church’s discursive shift on the abortion debate, 134–135; Catholic Church’s suppression of, 23–24; Chile’s emergency contraception legislation, 33–35, 34(table); Cuba’s high use of, 151; evaluating Latin American abortion rights and services, 146; indigenous views on early-term abortion, 81; lack of accessibility and reliability, 1; rhythm method, 134–136; social stigma and, 16. See also family planning

171

Convention of Belém do Pará (InterAmerican Convention on the Prevention, Punishment, and Eradication of Violence Against Women), 14, 108–109 Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW): democratization in Latin America, 107–108; global exposure of Latin American abortion policies, 153; globalization of choice, 23; Holy See’s failure to ratify, 133; judicial challenge to Colombia’s anti-choice laws, 36–38; legal action against Peru’s violations of a raped teen’s rights, 104; rights-based arguments for women’s right to choose, 115; US failure to ratify, 124, 130 Convention on the Rights of the Child, 125 Correa, Rafael, 28, 46 Costa Rica: legal abortion access, 3(table); Nicaragua’s nine-year-old rape victim, 49 Cuba: economic conditions affecting reproductive choice, 151; health ministers informing the abortion debate, 41; legal abortion access, 3(table); women’s right to choose, 3; Zika virus, 41–42 cultural factors. See indigenous women

de Habich, Midori, 40, 99 death. See mortality, maternal decentralization: Argentina’s federal system leading to legislative gridlock, 54–59; Mexico’s sub-national decriminalization of abortion, 20, 75–76; opening space for the abortion debate, 144–145 democracy building: democratizing the prochoice policy process, 114; excluding reproductive rights from democratic transitions, 152; leading to international agreement compliance, 107–108; role of women’s movements, 67–68 democratic deficit: Nicaragua, 51 Dides, Claudia, 146, 148 Diniz, Debora, 118–119 disappeared persons, Argentina’s, 60 discrimination: basis of Colombia’s prochoice reforms, 36–37; denial of legal abortions as form of, 104, 115. See also inequalities, social and economic; social and economic justice domestic violence. See gender-based violence; rape/incest Dominican Republic: evolution of the public abortion debate, 147; fetal rights in the constitution, 19(table); legal abortion access, 3(table); maternal death from a treatable illness, 52–53; opening the abortion rights debate, 57–58;

172

Index

political complications of abortion debate, 40, 45–46; pro-choice executives and anti-choice legislatures, 45–46; total abortion ban, 3, 52–54 Donda, Victoria, 21 Down syndrome, 121(n22) Duhalde, Eduardo, 56

early-term abortion: Bolivia’s broadened abortion rights, 77; indigenous women’s views on, 81; obstacles to accessing Uruguay’s legal abortions, 148–149; opposition to Chile’s decriminalization, 34 economic factors in abortion regulation: choice as a moral issue, 9; costs of abortion restrictions, 2–3, 15–16; effect of Cuba’s liberal abortion policy on the labor force, 151–152; indigenous women’s large families, 82; neoliberal economics in the abortion debate, 29– 30, 55, 67–70, 139; obstacles to abortion access in Uruguay, 149 ectopic pregnancy, 45 Ecuador: fetal rights in the constitution, 19(table); grassroots collaboration for abortion reform, 105–106; leftist opposition to abortion policy reform, 46; legal abortion access, 3(table) education: costs of abortion restrictions, 2, 12, 15–16; limited opportunities for teen mothers, 12 El Salvador: current state of the abortion debate, 147; fetal rights in the constitution, 19(table); health minister’s support for decriminalization study, 41; history, context, and implementation of the abortion ban, 3, 46, 86–92; incarceration for abortion-related crimes, 144; international delegation calling for abortion policy review, 112–113; legal abortion access, 3(table); political complexity in the abortion debate, 91– 92; post-revolutionary political agendas, 30–31; right-wing opposition to abortion, 28–29; suicide and teen pregnancy, 12; therapeutic abortion law, 17; UNFPA collaboration, 129 electoral reform: Chile, 35 emergency contraception legislation (Chile), 33–35, 34(table) “Esperanza,” 52–53, 59, 62(n14) European Union: globalization of the abortion debate, 24. See also international community excommunication from the church, 49, 150

executive authority, 6; Argentina’s decentralized federal structures, 57–58; Chile’s proposed progressive reforms, 35; excluding reproductive rights from democratic transitions, 152; harassment of feminist groups and political opposition in Nicaragua, 51–52; health ministers’ positions on abortion rights, 40; presidents’ outsized role in abortion policy, 29–32; pro-choice executives and anti-choice legislatures, 45–46; US global crusade against abortion, 124– 126; variations in abortion stances and policies, 28. See also presidentialism

family planning: to avoid contracting Zika virus, 117–118; Catholic Church’s suppression of, 23–24; Colombia’s constitutional rights to, 38; forced sterilization of Bolivia’s indigenous women, 80–81, 84(n31); limited opportunities for teen mothers, 12; Mexico defunding, 75; US defunding, 24, 127–128. See also contraception federal systems: Argentina’s decentralized federal structures, 57–58; backlash against abortion legislation reform, 148; Mexico City’s abortion debate, 75–76. See also executive authority; presidentialism Federation of Latin American Catholic Medical Associations, 8–9 femicide, 13–14, 96–97 feminism and feminist groups: Bolivia’s indigenous women’s organizations, 77– 79; driving pro-choice and anti-abortion debates, 21–22; harassment of feminist groups and political opposition in Nicaragua, 51–52; mobilization for prochoice progress, 65–66; Nicaraguan women’s traditional alignment, 94; opposition to El Salvador’s total abortion ban, 87–89; Peru’s pro-choice advocacy, 98; pink tide presidents’ liberalization, 30; sexuality and genderbased violence, 16; women’s increasing political power, 15. See also women’s movements and organizations Fernández, Leonel, 54 Fernández de Kirchner, Cristina, 56, 59 fertility awareness methods of birth control, 135–136 Fertility Education and Medical Management (FEMM), 134–135 fetal impairment: carrying an unviable fetus to term, 103–104; Chile’s pro-choice

Index policy, 32–33; Chile’s proposed progressive reforms, 35; Colombia’s conditional abortion laws, 37; Dominican Republic’s decriminalization of abortion for, 53–54; evolution of public debate, 147; jeopardizing the mother’s life, 89–91; legal access to abortion by country, 3(table); maternal death from a treatable illness, 52–53; recent loosening of abortion laws, 145– 146; Zika virus, 41–42, 115–117, 121(n24) fetal rights. See also pro-life advocacy fetal rights in Latin American constitutions, 19(table) Figueroa Marroquín, Maira Veronica, 143 foreign aid, 69, 124–127 foreign policy of the Holy See, 136 Fourth World Conference on Women (1995, Beijing), 18, 23, 88, 106–107, 133 Fox, Vicente, 72 Francis (pope), 131–133 Frei, Eduardo, 33 Fujimori, Alberto, 99 Fujimori, Keiko, 99 Funes, Mauricio, 86, 89

gag rule. See global gag rule Galli, Beatriz, 117 Garcia, Beatriz, 90–91, 100, 117 gender equity: Chile’s proposed progressive reforms, 35; importance in Argentina’s political life, 60–61; the politics of presence, 69 gender ideology, 147 gender quotas, 18, 30; Argentina, 61; Chile, 35; coinciding with expansion of global women’s movements, 107; role of women’s movements in achieving, 67–68 gender-based violence: abortion restrictions exacerbating, 139; against Bolivia’s indigenous women, 78; correlating with abortion demand, 13–15; correlating with teen pregnancies, 13; economic and health impacts of Paraguay’s abortion ban, 11; increased pregnancy rates among victims of, 14–15; international treaties, agreements, and organizations opposing, 108, 110; Legal Conference on Reproductive Rights, 99–100; parental rights of rapists, 26(n29); Peru, 96–101. See also rape/incest Glave, Marisa, 97 Global and Health Justice Partnership (GHP; Yale University), 119 global gag rule, 24, 26(n40), 124–127

173

Global Health, Empowerment, and Rights Act (United States), 128–129 globalization: acceleration of abortion rights advocacy, 19–20; global women’s gatherings, 106–107; opening space for the abortion debate, 144–145; as pressure for abortion rights reform, 153– 154. See also international community González García, Ginés, 56 government actors and institutions: accountability to women and children affected by Zika virus, 117–118; blocking abortion reforms, 45–46; CEDAW compliance, 108; Cuba’s free and accessible abortions and contraception, 151; as the enemy of Nicaraguan feminists, 94–95; factors affecting legislation liberalization, 27– 28; gender-based institutions for women’s advocacy, 18; the Holy See, 132–133; increasing friction with medical providers in Nicaragua, 92–93; interference in a legal abortion for a raped teen, 71–74; local, regional, and international advocacy groups providing medical information, 105– 106; obstacles to abortion access in Uruguay, 149; obstacles to implementing Peru’s abortion rights reform, 98–99; political expediency constraining reform, 20; regulatory capacity for legal abortions, 150; rise of women’s political leadership, 31–32; stakeholders and context of abortion debate, 5–7. See also executive authority; health ministers; presidentialism; women in politics gradualist strategies towards legalization, 32–36, 61 Graebe, Robert, 135 Guatemala: fetal rights in the constitution, 19(table); legal abortion access, 3(table) Guterres, António, 120 Guttmacher Institute, 119, 126–127, 145–146

Haiti: legal abortion access, 3(table); total abortion ban, 3 Hasson, Mary, 135 health, women’s right to, 36–37, 114–115 health ministers: advocating for a therapeutic abortion in El Salvador, 90; Bachelet’s background, 32, 34(table); informing the abortion debate, 40–42; Mexico’s abortion protocols and legal obstacles, 76–77; political debate over abortion for a young rape victim, 49; political-

174

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religious conflict in Argentina’s abortion debate, 56; prioritizing women’s health over an abortion ban in Nicaragua, 95–96 health-care providers: Argentina’s decentralized health-care system, 55; Bachelet’s background, 32; clarifying Peru’s abortion laws, 98–99; criminalization of miscarriages, 59; effect of the global gag rule, 126–127; foundation and impetus for abortion rights, 22; health ministers informing the abortion debate, 41–42; inadequacy of service for Bolivia’s indigenous women, 81; legal obstacles to abortion provision in El Salvador, 87–88; obstacles to abortion access in Uruguay, 149; obstruction of legal abortions, 71–74, 76, 87–88, 149; political-medical conflict in abortion, 8; prioritizing health over politics in Nicaragua, 92–93, 95–96; as pro-choice advocates, 66; regulation and oversight of legal abortions, 150; Salvadoran workers’ refusal to perform emergency abortions, 89; treating survivors of illegal abortions, 83(n18) Helms Amendment to the Foreign Assistance Act (1973), 126 Herrera, Morena, 87–90 High Impact Litigation in Colombia for the Unconstitutionality of Abortion, 36–37 HIV/AIDS, 126–127, 129 Holy See, 111, 132–135 homicide, miscarriage as, 47, 59, 85–86, 89, 113, 143 Honduras: legal abortion access, 3(table) Human Life International (HLI), 71, 136–137 human rights, 7–8; abortion bans as violations of, 139; Argentina’s pro-choice associations, 57; Bolivian women’s reproductive lives and health, 79–80; carrying an unviable fetus to term, 103– 104; the Catholic Church’s discursive shift on the abortion debate, 134–135; Colombia’s limited legalization of abortion, 36–37; global norms grounding reproductive rights in, 107; globalization of the abortion debate, 24–25; importance in Argentina’s political life, 60; international jurisprudence engaging, 115; international review of Salvadoran abortion laws, 113; international treaties, agreements, and organizations, 108–110; medical and legal issues in Peru’s abortion policy implementation, 98–99; Nicaragua’s nine-year-old rape victim, 49; opposing criminalization of miscarriages, 59–60; pink tide presidents’

abortion rights liberalization, 30; reducing gender violence in Latin America, 14; US failure to ratify UN treaties and protocols, 130. See also medical frame; moral frame Human Rights Watch, 105 Humanae vitae (Of Human Life) papal encyclical, 19

illegal abortions: Argentina’s statistics on, 57; causes of death during, 154(n2); Chileans’ unequal access to abortions, 41; Colombia’s statistics on, 39; as factor in public abortion debate, 149– 150; Latin American and global statistics, 4, 146; medical treatment for, 83(n18). See also unsafe abortions illness. See maternal health incarceration: of Argentine women for abortion-related crimes, 59–60; of Ecuadoran women for abortion-related crimes, 46; health-care providers’ fear of, 8, 53–54; international review of Salvadoran abortion laws, 113; maternal death during, 85–86, 91; for miscarriages, 2, 47, 59–60, 85–86, 89, 113, 143; of Salvadoran women for abortion-related crimes, 89–90, 113, 143–144 incest. See rape/incest indigenous feminism, 79–82 indigenous women: Bolivian women’s discourse of “choice,” 80; civil society support for pro-choice legislation, 70; forced sterilization, 80–81, 84(n31); pro-choice feminist advocates, 66; reproductive health of Bolivia’s, 78; UNFPA collaboration and support, 129– 130 inequalities, social and economic: barriers to reproductive rights reform, 7; Chileans’ unequal access to abortions, 41; government’s responsibility for equal protection, 149–150; long-term impact of unequally applied laws, 100; safe abortions for the wealthy, 144, 149– 150; social stigma of contraception, 16; societal contradictions of the abortion debate, 150 Inter-American Commission on Human Rights (IACHR), 23, 50, 73, 90, 108, 112–114, 153 Inter-American Convention on the Prevention, Punishment, and Eradication of Violence Against Women, 14, 108–109 Inter-American Court of Human Rights, 108–109, 112–113

Index Inter-American System of Human Rights, 108 international agreements, 18, 107–110, 112. See also Convention on the Elimination of All Forms of Discrimination Against Women international community: anti-abortion organizations, 141(n30); Argentina’s prochoice legislation, 58–59; conservative governments standing against global prochoice advocates, 123–124; evangelical Protestants’ anti-choice agenda, 137– 138; far-reaching power of the Catholic Church, 131–137; globalizing choice, 23–24; impact of the Zika virus on the abortion rights debate, 117–120; international stakeholders in Latin America’s abortion debate, 138–139; legal action on behalf of victims, 103– 104; local and national divisions over the abortion rights debate, 111–115; maternal death from a treatable illness, 52–53; opposing criminalization of miscarriages, 59–60. See also globalization International Conference on Population and Development (ICPD; 1994), 107, 133 International Planned Parenthood Federation, 24 International Women’s Conferences, 6 International Women’s Day, 120, 128–129 Ipas, 95

Jamaica: legal abortion access, 3(table) Jarquín, Edmundo, 49–50 John Paul II, 62(n7), 110 judicial systems and organizations: Brazil’s response to the Zika virus outbreak, 119; Chile’s underrepresentation of women, 36; Colombia’s constitutional rights to abortion, 36–40; Colombia’s tutela process, 38–39; Dominican Republic’s total abortion ban, 53–54; enacting Peru’s abortion rights reforms, 99–100; fetal impairment jeopardizing the mother’s life, 90–91; lawyers driving the abortion rights debate, 22; legal obstacles to abortion provision in El Salvador, 87– 88; Nicaragua’s total abortion ban despite political gender equity, 50–51; upholding Argentina’s progressive policies, 56–57; upholding Mexico City’s legalization of abortion, 74 jurisprudence, regional and international: abortion restrictions as human rights issue, 139; global response to the Zika virus crisis, 120; health care as human right, 150; international engagement of the three pro-choice frames, 115;

175

Peruvian pro-choice advocacy, 99; US anti-choice policy, 124; women’s rights, 7–8

Kirchner, Néstor, 56 “K.L.,” 103–104, 116–117 Kokay, Erika, 119

labor unions, 22, 70 Las 17 (El Salvador), 89 lawyers driving the abortion rights debate, 22 “L.C.,” 104, 106 left-right political dichotomy: Argentina’s reproductive rights debate, 61; Chile’s progressive policies under Bachelet, 33; differing platforms among government institutions and actors, 46; El Salvador’s leftist government controlling women’s rights, 86–87; political factors affecting abortion policymaking, 46; presidential power over abortion policy, 29–30; rise of women’s political leadership, 31 legal access to abortion by country, 3(table) legal action: delaying a Colombian woman’s legal abortion, 39; forcing a Salvadoran woman to complete a pregnancy with an unviable fetus, 90–91; global expansion of the abortion debate, 105–106; against governments for abortion rights violations, 24–25; against Mexican officials for obstructing a legal abortion, 72–73; against the Peruvian government, 103–104; women’s fundamental right to health, 36–37 Legal Conference on Reproductive Rights (Lima), 99 legislative bodies: Argentina’s abortion debate, 57–59; creating El Salvador’s criminal code, 88–89; Dominican Republic’s total abortion ban, 53–54; pro-choice executives and anti-choice legislatures, 45–46; US failure to ratify UN treaties and protocols, 130. See also political context; women in politics liberation theology, 23–24, 47, 110 Lifschitz, Miguel, 57 Lorde, Audre, 147 Lowey, Nita, 128

Macaulay, Margarette May, 112–113 Macri, Mauricio, 57–58, 143 Madres of the Plaza de Mayo, 31, 60 Magaña, Fortin, 90 “Manuela,” 85 March for Life, 125 Marie Stopes International, 127 Martínez, Catalina, 39

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maternal health: Chile’s pro-choice policy, 32–33; Chile’s progressive reforms, 35; clarifying Peru’s abortion laws, 98; Colombia’s conditional abortion laws, 37; cycle of teen motherhood and poverty, 12; Dominican Republic’s decriminalization of abortion for, 53– 54; effect of the global gag rule, 129; ending a pregnancy despite a total ban, 45; expanding legislation beyond safety and, 145–146; giving birth to an anencephalic fetus, 117; health implications of pregnancies, 1–2; impact of abortion bans, 2–3, 16, 139; legal access to abortion by country, 3(table); legal action over endangerment of, 103–105; maternal death from a treatable illness, 52–53; mental health, 39, 103–104, 154(n2); miscarriages stemming from maternal health issues, 85–86, 89–90; Nicaragua’s nine-yearold rape victim, 49; Salvadoran health minister’s support for decriminalization study, 41; teen mothers, 11–12; unsafe abortions and maternal mortality, 4–5. See also mortality, maternal maternalism: motherhood as symbol of political resistance, 30–31; Nicaragua’s anti-feminist agenda, 48 Maya, Socorro, 73 media: driving the abortion rights debate, 22; Mexican officials’ obstruction of a legal abortion, 72; Peru’s abortion access, 41 medical abortions. See therapeutic abortions medical frame of pro-choice activism, 7–9; Argentina’s political history, 17; Bolivian women’s reproductive lives and health, 80–81; Bolivia’s indigenous women’s pro-choice advocacy, 79; Catholic Church’s discursive shift on the abortion debate, 134–135; international jurisprudence engaging, 115; medical and legal issues in Peru’s abortion policy implementation, 98–99; scientific evidence informing reproductive rights, 115, 139. See also human rights; moral frame of pro-choice activism medical personnel. See health-care providers Medina, Danilo, 46 Meet the Press news program, 125 Menem, Carlos, 55–56 Menjívar, Violeta, 41 mental health: Colombia’s conditional abortion rights, 37–39; as condition for legal abortion, 39; effects of illegal abortions and abortion restrictions, 139, 144, 152, 154(n2); forcing a mother to

carry an unviable fetus, 103–104; legal access to abortion by country, 3(table) Mexico: abortion protocols and legal procedures, 76–77; Catholic population numbers, 132; gender violence statistics, 14; government interference in a legal abortion, 71–74, 83(n18); legal abortion access, 3(table); Mexico City’s pro-choice legislation, 71–77; pro-choice grassroots mobilization, 66; sub-national decriminalization of abortion, 20, 75–76 Mexico City, 3(table); abortion legalization, 71–77, 83(n18), 112 Mexico City policy. See global gag rule Michetti, Gabriela, 57 microcephaly, 116–117, 121(n24) Millennium Development Goals (MDG), 111 Minister of Health. See health ministers miscarriage, criminalization of, 2, 47, 59– 60, 85–86, 89, 113, 143 Molina, Helia, 40–41, 43–44(n25) Molina, Ramiro, 43–44(n25) Montenegro, Sofia, 93–94 moral frame of pro-choice activism, 7–8; Bolivia’s indigenous feminism, 81–82; Bolivia’s indigenous women’s prochoice advocacy, 79; Colombian women’s access to legal abortions, 39; El Salvador’s total abortion ban, 87; farreaching effects of anti-choice policies, 142; impact of Zika virus on low-income families, 116; international jurisprudence engaging, 115; sectarian perspective on reproductive rights legislation, 9; social stigma of contraception, 16; US global anti-abortion crusade, 130. See also human rights; medical frame of prochoice activism; political-moral intersection in the abortion debate Morales, Evo, 78 morning-after pill, 33 mortality, maternal: anti-choice activists’ gender ideology, 147; Bolivia’s indigenous women, 78; criminalization of abortion contributing to, 4–5; effect of the global gag rule, 129; home abortions, 144; from illegal abortions, 2, 154(n2); maternal death from a treatable illness, 52–53; needless death of a pregnant rape victim, 143–144; Nicaragua’s decline, 96; Paraguay’s teen pregnancies, 11–12; through failure to perform therapeutic abortions, 89–90 motherhood as symbol of political resistance, 30–31 Mothers of the Heroes and Martyrs, 31

Index Movimiento Autónomo de Mujeres (MAM; Nicaragua), 94 Mujica, José, 29 Murillo, Rosario, 50

Narváez, Zoilamérica, 48–49 National Campaign for the Right to Legal, Safe, and Free Abortion, 57–58, 143 National Day of the Unborn Child, 48 neoliberal economics in the abortion debate, 29–30, 55, 67–70, 139 Netherlands: grassroots collaboration for abortion reform, 105–106; pushback against the US global gag rule, 128–129 networking: individuals and organizations, 6–7, 66; local, regional, and international alliances effecting change, 105–106 Nicaragua: civil society support for prochoice legislation, 70; current state of the abortion debate, 147; exclusion of reproductive rights in leftist politics, 20; international advocacy for therapeutic abortions, 8; legal abortion access, 3(table); medical pragmatism despite an abortion ban, 92–93, 95–96; political history of the abortion debate, 91–92; post-revolutionary political agendas, 30–31; Protestant support for Ortega’s anti-choice agenda, 137; therapeutic abortion law, 8, 17; tightening existing abortion laws, 145; total abortion ban, 45, 49–51 nongovernmental organizations (NGOs): Catholic Church mobilizing anti-choice groups, 136–137; legal action for reparations, 103–104; mediating the state role in individuals’ lives, 66–67; professionalization of women’s movements, 69; social movements, 6–7, 57, 66–67, 70; US global gag rule, 125– 126. See also civil society; women’s movements and organizations Nuñez, René, 50

Obama, Barack, 26(n40) Obando y Bravo, Miguel, 47–49 Ocampo, Xochilt, 51 Opus Dei, 48, 90 Organization of American States (OAS), 13–14, 108, 112 Ortega, Daniel, 20, 28, 40, 45–49, 92–94

Pact for the Decriminalization of Abortion (Bolivia), 79 Pact of San José, Costa Rica (1969), 112 Pan American Health Organization (PAHO), 115–116

177

Panama: legal abortion access, 3(table); UNFPA collaboration and support, 129–130 Paraguay: death of a pregnant rape victim, 143–144; economic and health impacts of the abortion ban, 11; fetal rights in the constitution, 19(table); legal abortion access, 3(table); papal visit, 131 parental rights of rapists, 26(n29) Pascual Grau, Claudia, 35 Paul VI, 18 Pence, Mike, 125 Perón, Evita, 61 Perón, Isabel, 61 Peronists, 55–56 personalistic politics, 29 personhood protections, 52, 138–139 Peru: addressing gender-based violence, 96–101; clarifying abortion protocols, 98–99; creating safe abortion procedures, 40; fetal rights in the constitution, 19(table); forcing a mother to carry an unviable fetus, 103–104; international forces calling for reforms, 106; legal abortion access, 3(table) pharmacological abortions, 4; Chile’s health minister advocating, 43–44(n25); grassroots information campaign, 106; health-care providers involved in, 22; increasing safety of legal abortions, 146; medications used in, 25(n5); for Zika virus, 118 pink tide, 20, 27, 30–32 Pinochet, Augusto, 27, 32 Planned Parenthood, 24, 97, 105, 134–135 policy communities, 6–7, 10, 66 political context of the abortion debate: Argentina’s political system, 54–55; Colombia’s pro-choice reforms, 36–37, 40; feminist movements, 67–68; history of the abortion debate in Latin America, 17–20; leftist opposition to abortion policy reform, 46; Nicaragua’s revolution and post-conflict policies, 47–49; Nicaragua’s total abortion ban, 50–52; normalizing the debate, 42; stakeholders and context of abortion debate, 5–7. See also executive authority; government actors and institutions political economy in the abortion debate, 139 political-moral intersection in the abortion debate: Chile’s ties to the Catholic Church opposing Bachelet’s progressive policies, 32–36; effects of the global gag rule, 128; enacting Peru’s abortion rights reforms, 99; evangelical Protestants’ support of Brazil’s anti-choice policies,

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137–138; political and personal factors in abortion policymaking, 27–29; presidential power over abortion rights, 29–32; rights-based argument against Colombia’s total abortion ban, 36–40; US global crusade against abortion, 125 populism, 6, 29–30 poverty: limited opportunities for teen mothers, 12; Nicaragua’s attempts to build larger families, 93; teen pregnancy in Peru, 97 presidentialism, 6; Colombia’s hyperpresidentialism, 38; Nicaragua’s total abortion ban, 51; women in power, 43(n9). See also executive authority prison. See incarceration privacy, right to, 66–67, 98 pro-choice advocacy: advocating liberalization of Nicaragua’s abortion laws, 94–96; Argentina’s political history, 56; Bachelet’s gradualist strategy in prochoice legislation, 32–36; Bolivian women’s discourse of choice, 80; Colombia’s pro-choice reforms, 36–37; conservative governments standing against global pro-choice advocates, 123– 124; costs of abortion restrictions, 16; gender violence and abortion rights, 15; gender violence and abortion rights in Peru, 97–98; growth of international support, 111–115; measuring progress in regulating abortion rights, 146–147; mobilizing for incarcerated victims, 85– 86; morality of abortion, 9–10; opposition to El Salvador’s abortion ban, 87–89; political consequences to individuals, 20– 21; regional rights groups involved in, 113–114; women’s reluctance to admit support for, 150. See also human rights; medical frame; moral frame Profamilia, 128 pro-family traditions, 9 pro-life advocacy: backlash against global reproductive rights liberalization, 19; blocking Peruvian reforms, 99; fetal rights in Latin American constitutions, 19(table); Holy See’s women’s health care campaign, 134–136; Trump’s political expediency, 125. See also antiabortion activism; right-to-life proponents and arguments Promsex, 98–99, 104–106 Protestant groups: backlash against global reproductive rights liberalization, 19; Brazil’s conservative stance on abortion rights, 119; declining participation in the Catholic Church, 17–18; global antichoice agenda, 137–138; intersection

with international politics, 110–111; Nicaragua’s criminalization of abortion, 50; political engagement in the abortion debate, 24; sectarian perspective on reproductive rights legislation, 9 public debate on abortion: economic injustices of Latin American policies, 151–152; far-reaching effects of antichoice policies, 152–154; regional legislative status and figures on, 145– 149; regulatory and oversight capacity of the state, 149–151; stakes for Latin American women, 143–145

Ramirez Jacinto, Paulina, 71–73, 76, 83(n18), 112 rape/incest, 1–2; allegations against Nicaragua’s Ortega, 48–49, 94; Argentina’s abortion policies, 55–57; Catholic Church’s stance on abortion for victims of, 131; Chile’s pro-choice policy, 32–33; Chile’s proposed progressive reforms, 35; Colombia’s conditional abortion laws, 37; Dominican Republic’s decriminalization of abortion for, 53–54; economic and health impacts of Paraguay’s abortion ban, 11; El Salvador’s history of abortion rights, 86– 87; gender violence in Mexico, 14; history of reproductive rights legislation, 17; legal access to abortion by country, 3(table); legal action on behalf of victims, 104; Mexico’s abortion protocols, 76–77; needless death of pregnant victims, 143– 144; Nicaragua’s nine-year-old rape victim, 49; Nicaragua’s statistics, 96; parental rights of rapists, 26(n29); Peru’s demographics and statistics, 97–98; prompting Mexico City’s progressive legislation, 71–74; recent loosening of abortion laws, 145–146; suicide and teen pregnancy, 12–13. See also gender-based violence Reagan, Ronald, 24, 26(n40), 126 regime change: history of reproductive rights legislation, 17 regulation and oversight of legal abortions, 150 religion: health-care providers as obstacles to abortion access, 22; presidential power over abortion policy, 29. See also Catholic Church; Protestant groups reparations for forcing a mother to carry an unviable fetus, 89–91, 103–104, 117 reproductive rights movement, 6 rhythm method of birth control, 134–136 Ricardo, Christina, 117

Index rights-based arguments. See human rights right-to-life proponents and arguments: abortion ban despite fetal impairment, 52–53; Argentina’s partnership with the church over economics and abortion, 55; backlash against Mexico City’s abortion legalization, 75; fetal rights in Latin American constitutions, 19(table), 55, 87, 112; international stakeholders in Latin America’s abortion debate, 138–139; maternal rights and fetal rights, 147; medical providers as proponents, 8–9; personhood of a fetus, 8, 19, 52, 138–139 Rio+20 Conference on Sustainable Development, 111 Roa, Monica, 36, 72–73, 146–148 Roe v. Wade, 6, 18, 67, 110, 126 Rojas, Mario, 136 “Rosita” (Nicaraguan rape victim), 49–50, 59 Rousseff, Dilma: abortion rights debate threatening political careers, 153; antiabortion stance, 119; Protestants’ role in the ouster of, 137–138; shifting stance on reproductive rights, 20–21, 28, 46. See also Brazil rubella virus (German measles), 116

Sáenz Lacalle, Fernando, 87 Salazar Pimentel, Juan Manuel, 71 Salvo, Lucia, 49 Sánchez Céren, Salvador, 89 Sandinista government, 92–93 science-based rhetoric of the Catholic Church, 134–136 Second International Conference on Population (Mexico City), 126 secularism: anti-choice rhetoric of the Holy See, 134 separation of powers, 54 Serra, José, 21 sexual violence. See gender-based violence; rape/incest Shaheen, Jeanne, 128 social and economic justice, 7–8; choice as a moral issue, 9; Colombia’s constitution reflecting abortion rights, 36–40; costs of abortion restrictions, 15–16; human rights frame of the abortion debate, 115; importance in Argentina’s political life, 60; liberation theology, 23–24; Mexico City’s prochoice legislation, 74; pink tide presidents’ liberalization, 30; the state of the global abortion debate, 145–149. See also human rights social movements, 6–7, 57, 66–67, 70 Socialist Party (Chile), 33

179

societal contradiction of the abortion debate, 150 socioeconomic status and class: Argentina’s human rights policies, 60; Bolivia’s indigenous feminism, 79–80; Chileans’ unequal access to abortions, 41; longterm impact of unequally applied laws, 100; safe abortions for the wealthy, 144, 149–150; unequal access to abortion services, 151; Zika virus affecting lowest economic strata, 116 Solís, Azahalea, 94 Starrs, Ann, 127 sterilization, forced, 80–81, 84(n31), 93 structural adjustments, 68 suicide, 12, 41, 100, 104, 139, 144 surgical abortions, 2 Suriname: legal abortion access, 3(table) Sustainable Development Goals (SDGs), 8, 112, 135 Sweden: pushback against the US global gag rule, 129

Tamés, Regina, 73, 75–77 teen pregnancies: Bolivia’s liberalization of early-term abortion policy, 77–78; church stance on abortions for rape victims, 131; Nicaragua’s statistics, 96; Peru’s cycle of poverty and, 97; Salvadoran health minister’s support for decriminalization study, 41; statistics on, 11–12 Temer, Michel, 137 therapeutic abortions, 1–2; advocacy for Salvadoran practices, 89–91; Argentina’s abortion policies, 55; Catholic opposition to Nicaragua’s, 48; Chile’s history, 32– 35; evolution of the public abortion rights debate, 147; legal action on behalf of victims denied abortions, 104; Nicaragua criminalizing, 50; obstacles to abortion access in Uruguay, 148–149; politicalmedical conflict in abortion, 8; presidential power over policies, 29; state of current public abortion debate, 147 Topete, Mayra, 71 total abortion bans: Brazil, 138; Chile under Pinochet, 27, 32; Dominican Republic, 52–54; effect on maternal and fetal health, 45; El Salvador, 46–47, 87, 89, 112–113; maternal death from a treatable illness, 52–53; Nicaragua, 50–51; unconstitutionality of Colombia’s, 36–37 traditional family norms and values, 147 transnational activists, 6–7, 144–145. See also globalization; international community Trinidad and Tobago: legal abortion access, 3(table)

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Trudeau, Justin, 128–129 Trump, Donald, 24, 26(n40), 124–130 tutela process, Colombia’s, 38–39

UN High Commission for Human Rights, 118 UN Human Rights Council (UNHRC), 103–104 UN International Conference on Population and Development (1994), 23 UN Millennium Development Goals (MDG), 111 United Nations: Catholic Church’s observer status, 132–135; global expansion of the abortion debate, 105–106; global women’s gatherings, 106–107; international mobilization of reproductive rights debates, 110; intervention in national abortion policy, 104; US failure to ratify treaties and protocols, 130 United Nations Population Fund (UNPFA), 24, 124–125, 129–130 United Nations Sustainable Development Goals (SDGs), 8, 112, 135 United States: anti-abortion movements, 110; conservative governments standing against global pro-choice advocates, 123– 124; forced sterilization of Native Americans, 84(n31); global anti-abortion crusade and the global gag rule, 24, 26(n40), 124–130; history of reproductive rights legislation, 18; political engagement in the abortion debate, 24 United States Agency for International Development (USAID), 24, 126–127 unsafe abortions: abortion figures in Latin America, 4–5; Bolivia’s indigenous women, 78; global gag rule defunding family planning programs, 127, 129; legal abortions reducing complications, 43–44(n25); medical treatment for, 83(n18); public abortion debate, 144. See also illegal abortions Uribe, Álvaro, 28–29 Uruguay: current state of the abortion debate, 147; leftist opposition to abortion policy reform, 46; legal abortion access, 3(table); obstacles to abortion access, 148–149; presidential power over abortion policies, 29; union support for pro-choice legislation, 70

Vaquera, Marcela, 71 Vargas Llosa, Mario, 98 Vázquez, Tabaré, 20, 46

Venezuela: legal abortion access, 3(table) Vida Humana Internacional, 136 Vidal, María Eugenia, 57 Vidas robadas (Stolen Lives) report, 97 Voluntary Termination of Pregnancy Law (Uruguay), 148

wage inequality: limited opportunities for teen mothers, 12 women in politics: abortion rights debate threatening political careers, 152–153; Argentina’s history of gender equity, 61; Argentine support for pro-choice legislation, 58; Chile’s elected officials, 35–36; Dominican Republic’s liberalization of abortion laws, 54; growth of international reproductive rights advocacy, 107; increasing political power, 15; Nicaragua’s total abortion ban despite, 48, 50–51; presidential and parliamentary systems, 43(n9); upsurge in women’s leadership and women’s issues, 31; varied stances on reproductive rights, 20–21. See also Bachelet, Michelle; gender quotas; Rousseff, Dilma Women’s Link Worldwide, 36–37, 105 women’s movements and organizations, 6; addressing gender-based violence in Peru, 98; Bolivia’s liberalization of earlyterm abortion policy, 77–78; Colombia’s abortion reform, 37; global pro-choice gatherings, 106–107; history of reproductive rights legislation, 18; Mexico City’s abortion legalization, 75; the neoliberal state, 67–70; Nicaragua’s anti-feminist agenda, 48–49; Nicaragua’s postconflict abortion debate, 93–94; professionalization of, 68–69 World Federation of Catholic Medical Associations, 9 World Health Organization (WHO), 4, 115 World Medical Association (WMA), 8

Zeid Ra’ad Al Hussein, 118 Zika virus: birth defects resulting from, 121(n24); health ministers informing the abortion debate, 41–42; religious groups blocking abortion law reform despite, 138; social and financial costs of abortion restrictions, 15–16, 121(n23); stimulating Brazil’s abortion debate, 10, 115–120; US defunding public health organizations, 128

About the Book

bans on abortion in the world, abortion rights is one of the most controversial and hotly contested topics in Latin American politics today. Jane Marcus-Delgado explores the ways in which key actors—from politicians to grassroots activists to the global community—participate and shape strategies in the ongoing debate. Marcus-Delgado sheds new light on the dire situation of Latin American women facing unwanted pregnancies, and on the interactions between the state and its most vulnerable members of society.

With Latin America home to some of the most draconian

Jane Marcus-Delgado is professor of political science and director of

the International Studies Program at the College of Staten Island, City University of New York.

181