Legal Abortion Care in Bolivia Often Denied

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Legal Abortion Care in Bolivia Often Denied

Angela Castellanos

Although abortion is permitted in Bolivia in three cases, just six women have had access to legal abortion in this country. The reasons: judicial barriers as well as doctors who oppose abortion.

Although in Bolivia abortion is permitted
in three cases, just six women have had access to legal abortion in this
country, says Ipas. The reasons: judicial barriers as well as
doctors who oppose abortion. 

In fact, according to Bolivia’s current
Penal Code, which was adopted in 1973, abortion is permitted only when
the life or health of the woman is in danger, or when pregnancy is a
result of rape or incest. The legislation also allows abortion in the
case of abduction not followed by marriage.  

However, a judicial order has to be
issued before a physician may terminate a pregnancy. Such authorization has been denied or delayed by many judges. This is expected to change as a result of the recent order issued
by the Supreme Court of Justice of Bolivia.

According to Ipas, "one reason women
have been unable to access safe and legal abortion care is because of
delays in the judicial authorization process. This includes delays by
district attorney offices, by the ways in which rape cases are characterized,
and by the sentences or judgments made. Staff may know the existing
standards and legal frameworks but do not observe these and public servants
often do not oppose violations of human rights but rather tend to negotiate
and seek compromises in these cases."  

Sex. Abortion. Parenthood. Power.

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This "historic event" – as it is
called by Ipas – comes just ten month after the CEDAW Committee expressed its concerns about access to abortion in Bolivia, stating, "The
Committee urges the State party to adopt implementing regulations for
existing laws on Bolivian women’s right to therapeutic abortion. The
Committee also urges the State party to afford women access to high-quality
services for the treatment of complications resulting from unsafe abortions
with a view to reducing maternal mortality." 

In addition to judicial permissions,
Bolivian women and girls face barriers legal and safe
abortion, since many doctors are opposed to abortion – even in the
legal cases – and claiming "conscientious objection" refuse
to provide the medical service. In other countries, including in Colombia,
the medical center or hospital has to find another physician to provide the medical service. In Bolivia, referral is not required.

In this context, unsafe abortion is
a common practice. Raúl Hevia, director of the Hospital de la Mujer
(Santa Cruz, Bolivia), told the Bolivian daily El Deber that 99.5%
of the cases of abortions received in this hospital are induced abortions.  

Many women obtain abortions in a clandestine
manner, often in septic conditions, which ended in serious health
complications, including death. Bolivia has one of the highest maternal
mortality rates in Latin America (230 deaths per 100,000 births, while
the average in the region is 190), and complications from unsafe abortions
account for approximately one-third of maternal deaths.  

According to Elizabeth Salguero of the Bolivian Human Rights Commission of the Lower Chamber, 30,000
to 40,000 clandestine abortions occurred annually. "This is a matter
of public health because of the considerable number of abortions, and
a matter of social justice since poor women account the most of the
mortal victims resulting from abortions," she says. Salguero also called for
the legalization of the abortion. And she is not the only one. 

Since 1996, the Campaña 28 de Septiembre
(28th of September Campaign) has been fighting for the decriminalization
of abortion in Bolivia. In 2006, this movement submitted to the Asamblea
Constituyente (a group in charge of reforming the Constitution) a proposition regarding
women’s rights, particularly the right to make decisions about their bodies
and to determine the number of children they want to have. 

Moreover, in 2005, Movimiento al Socialismo,
the political party of the current President Evo Morales, submitted
a bill to legalize abortion, which soon after was rejected.  

However, the Bolivian government has
succeeded in including postabortion care (PAC) as a basic service within
its Universal Health Insurance package. Nevertheless, "although PAC
is routinely part of emergency obstetric services, many Bolivian women
delay going to the hospital after an unsafe abortion because they fear
poor treatment from healthcare professionals," Ipas says.  

The Court undertook this new measure
as part of a judicial sector commitment made during a March 2008 national
symposium on sexual violence. 

For Ipas, "it is remarkable that the
Supreme Court has intervened to mandate that the entire judicial system
is responsible for guaranteeing an aspect of women’s human rights. And
it is notable that in their letter to the lower courts the Supreme Court
specifically cited the state’s responsibility to uphold international
human rights treaties ratified by the Bolivian government." 

Although the order from the Court is
an important step, it has to be followed by an appropriate information
strategy within the judicial structure. Ipas announced a monitoring
process to ensure that all lower courts receive relevant information,
so they can implement the law. Bolivian NGOs can apply experiences from other Latin American countries, where women’s
organizations have contributed to such information not only to judges but also to medical health staff.