Commentary Abortion

How Many Amalias, Karinas, and Savitas Must There Be? Las Savitas de Centroamérica

Marta María Blandón

Here in Central America, women are denied life-saving treatment every day. Women with life-threatening illnesses are denied treatment because to do so might harm their pregnancy—just the same explanation that Savita’s husband received from their doctors in Galway.  [This article is published in both English and Spanish.]

See all our coverage of the tragic case of Savita Halappanavar here.

For the past two weeks, women’s rights advocates in Nicaragua have been watching with sorrow and frustration as the news about Savita Halappanavar has been unfolding. Savita, an Indian national living in Ireland, died of septicemia following a miscarriage—a miscarriage that was undeniable and unpreventable, and yet doctors denied her appropriate medical treatment rather than end a doomed pregnancy.

Here in Central America, women are denied life-saving treatment every day.

In Nicaragua and El Salvador, abortion is outlawed under any and all conditions—two of only four countries in the world to do so. And while the laws of other countries in the region may allow for abortion under certain, very narrow conditions, in practice very few women can receive an abortion under such “exceptions.” Women who have suffered from pregnancy complications are accused of trying to “murder” their unborn children. Women with life-threatening illnesses are denied treatment because to do so might harm their pregnancy—just the same explanation that Savita’s husband received from their doctors in Galway.

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At Ipas, we saw this firsthand with a young woman called Amalia. Amalia was 27, and eight-weeks pregnant with her second child when she was diagnosed with cancer—an aggressive recurrence of a cancer treated 10 years earlier. Because she was pregnant, the public health service denied her treatment because it might harm the fetus. Ipas and other human rights groups brought the case to the Inter-American Commission on Human Rights, to seek a precautionary measure that would compel the state to provide treatment—a request that was quickly granted. Under public and international scrutiny, the state then provided Amalia with the gold standard of care—treatment received by few others in Nicaragua. Under this treatment, the government maintained, the fetus would survive and thrive.

Sadly, the government was proven incorrect. Amalia delivered a severely malformed baby at seven months. She lived another 17 months. Throughout the case, the government maintained that an abortion was not necessary. The result of Amalia’s case speaks for itself; women undergoing cancer treatment still need the option of therapeutic abortion.

In El Salvador we met Karina, a woman with three children who was arrested after she was found hemorrhaging as a result of an unsafe abortion. She had become pregnant after receiving a tubal ligation (a procedure that is almost, but not entirely, 100 percent effective). Her mother had told her she would not be allowed home if she became pregnant again, and she was so ashamed that she told no one. Police determined that she’d induced an abortion, and she was prosecuted and sentenced to 30 years in prison without ever being allowed to speak to a lawyer, or testify on her own behalf.

After we learned about her, Ipas, the Center for Reproductive Rights and a number of other NGOs worked with Karina to bring a review of her case. With the legal representation and fact finding that she had been denied eight years earlier, we were able to win her freedom. But other women continue to face scrutiny and harassment over their pregnancy complications: Approximately 600 women in El Salvador are under investigation or being prosecuted for suspected abortion.

Women and doctors alike live in a culture of fear in countries that outlaw abortion. Doctors are afraid to provide any medical treatment that might harm or end a pregnancy. And women who have pregnancy complications are afraid to seek treatment for fear that they will be accused of inducing an abortion. The result? Women, like Savita, who are unnecessarily injured or die.

What is more frustrating is that numerous human rights bodies have ruled that to deny abortions to women whose lives and health are endangered by their pregnancies is a violation of their human rights. Ireland was told directly by the European Court of Human Rights that they must provide mechanisms to provide abortions under the law (abortion is legal in Ireland if a woman’s life is in danger). Nicaragua has been questioned repeatedly by international human rights bodies about its total ban on abortion, which runs contrary to multiple international agreements.

How many Amalias, Karinas or Savitas must there be before nations take women’s human rights seriously?


en Español

Durante las últimas dos semanas, defensoras y defensores de los derechos de las mujeres en Nicaragua han estado obervando con angustia y frustración el desenlace de las noticas sobre Savita Halappanavar. Savita, ciudadana de la India que vive en Irlanda, falleció a causa de una septicemia después de una pérdida del embarazo, la cual fue innegable e inevitable. Sin embargo, los médicos le negaron el tratamiento médico que necesitaba en vez de poner fin a un embarazo predestinado al fracaso. Pero aquí en Centroamérica, todos los días se les niega a las mujeres tratamiento esencial para salvar vidas.

La interrupción del embarazo es ilegal bajo todas las circunstancias en Nicaragua y El Salvador: dos de solo cuatro países del mundo donde existe una prohibición total del aborto. Y mientras que las leyes de otros países en la región permiten el aborto bajo ciertas condiciones muy limitadas, en la práctica se concede la excepción necesaria a muy pocas mujeres. A las mujeres que sufren complicaciones del embarazo se les acusa de tratar de “asesinar” a sus hijos no natos. A las mujeres con enfermedades con riesgo de muerte se les niega tratamiento porque éste podría poner en peligro su embarazo, justo la misma explicación que el esposo de Savita recibió de sus médicos en Galway.

En Ipas, presenciamos esto de primera mano con una joven llamada Amalia. Amalia tenía 27 años de edad y ocho semanas de embarazo de su segundo hijo, cuando fue diagnosticada con cáncer: una agresiva reaparición de un cáncer tratado 10 años antes. Debido a su embarazo, en el servicio de salud  pública se le negó tratamiento porque éste podría perjudicar al feto. Ipas y otros grupos de derechos humanos presentaron el caso ante la Comisión Interamericana de Derechos Humanos, en búsqueda de una medida cautelar para convencer al Estado de brindarle tratamiento, una petición que rápidamente fue concedida. Una vez bajo tela de juicio del público tanto a nivel nacional como internacional, el Estado le brindó a Amalia la mejor atención posible: tratamiento que reciben muy pocas personas en Nicaragua. Con este tratamiento, sostuvo el gobierno, el feto sobreviviría y se desarrollaría.

Infelizmente, se comprobó que el gobierno estaba equivocado. Amalia dio a luz a un bebé con graves malformaciones a los siete meses. Ella vivió otros 17 meses. A lo largo del caso, el gobierno sostuvo que no era necesario realizar un aborto. El resultado del caso de Amalia habla por sí solo; a las mujeres que reciben tratamiento del cáncer también se les debe ofrecer la opción de tener un aborto terapéutico. 

En El Salvador, conocimos a Karina, una mujer con tres hijos que fue arrestada después que fue encontrada desangrando producto de la práctica de un aborto inseguro. Había quedado embarazada después de tener una ligadura tubaria (un procedimiento que es casi, pero no totalmente, el 100% eficaz). Su madre le había dicho que no podría regresar a la casa si quedara embarazada de nuevo y ella estaba tan avergonzada que no se lo contó a nadie. La policía determinó que ella se indujo un aborto y fue enjuiciada y condenada a 30 años de prisión, ni siquiera le permitieron hablar con un abogado o testificar a su favor.

Después que en Ipas nos enteramos de su caso, el Centro de Derechos Reproductivos y varias otras ONG trabajaron con Karina para presentar una revisión de su caso. Con la representación procesal y la investigación que le negaron ocho años antes, logramos ganar su libertad. Pero otras mujeres continúan enfrentando acoso y siendo enjuicidas por complicaciones del embarazo: aproximadamente 600 mujeres en El Salvador están siendo investigadas o enjuiciadas por sospecha de aborto.

Tanto las mujeres como los profesionales médicos viven en una cultura de temor en los países donde el aborto es ilegal. Los médicos temen brindar cualquier tratamiento médico que pueda perjudicar o poner fin a un embarazo. Y las mujeres que presentan complicaciones del embarazo temen buscar tratamiento por temor a ser acusadas de inducirse un aborto. ¿El resultado? Mujeres como Savita son lesionadas o mueren innecesariamente.

Aun más frustrante es el hecho de que numerosos organismos de derechos humanos han determinado que negar un aborto a una mujer cuya vida y salud corren peligro a causa de su embarazo es una violación de sus derechos humanos. La Corte Europea de Derechos Humanos le dijo directamente a Irlanda que deben ofrecer mecanismos para realizar abortos permitidos por la ley (la interrupción del embarazo es legal en Irlanda si la vida de la mujer corre peligro). Nicaragua ha sido cuestionada repetidas veces por los organismos internacionales de derechos humanos respecto a su prohibición total del aborto, la cual va en contra de múltiples acuerdos internacionales.

¿Cuántas Amalias, Karinas o Savitas debe haber antes que las naciones tomen en serio los derechos humanos de las mujeres?

Analysis Human Rights

El Salvador Bill Would Put Those Found Guilty of Abortion Behind Bars for 30 to 50 Years

Kathy Bougher

Under El Salvador’s current law, when women are accused of abortion, prosecutors can—but do not always—increase the charges to aggravated homicide, thereby increasing their prison sentence. This new bill, advocates say, would heighten the likelihood that those charged with abortion will spend decades behind bars.

Abortion has been illegal under all circumstances in El Salvador since 1997, with a penalty of two to eight years in prison. Now, the right-wing ARENA Party has introduced a bill that would increase that penalty to a prison sentence of 30 to 50 years—the same as aggravated homicide.

The bill also lengthens the prison time for physicians who perform abortions to 30 to 50 years and establishes jail terms—of one to three years and six months to two years, respectively—for persons who sell or publicize abortion-causing substances.

The bill’s major sponsor, Rep. Ricardo Andrés Velásquez Parker, explained in a television interview on July 11 that this was simply an administrative matter and “shouldn’t need any further discussion.”

Since the Salvadoran Constitution recognizes “the human being from the moment of conception,” he said, it “is necessary to align the Criminal Code with this principle, and substitute the current penalty for abortion, which is two to eight years in prison, with that of aggravated homicide.”

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The bill has yet to be discussed in the Salvadoran legislature; if it were to pass, it would still have to go to the president for his signature. It could also be referred to committee, and potentially left to die.

Under El Salvador’s current law, when women are accused of abortion, prosecutors can—but do not always—increase the charges to aggravated homicide, thereby increasing their prison sentence. This new bill, advocates say, would worsen the criminalization of women, continue to take away options, and heighten the likelihood that those charged with abortion will spend decades behind bars.

In recent years, local feminist groups have drawn attention to “Las 17 and More,” a group of Salvadoran women who have been incarcerated with prison terms of up to 40 years after obstetrical emergencies. In 2014, the Agrupación Ciudadana por la Despenalización del Aborto (Citizen Group for the Decriminalization of Abortion) submitted requests for pardons for 17 of the women. Each case wound its way through the legislature and other branches of government; in the end, only one woman received a pardon. Earlier this year, however, a May 2016 court decision overturned the conviction of another one of the women, Maria Teresa Rivera, vacating her 40-year sentence.

Velásquez Parker noted in his July 11 interview that he had not reviewed any of those cases. To do so was not “within his purview” and those cases have been “subjective and philosophical,” he claimed. “I am dealing with Salvadoran constitutional law.”

During a protest outside of the legislature last Thursday, Morena Herrera, president of the Agrupación, addressed Velásquez Parker directly, saying that his bill demonstrated an ignorance of the realities faced by women and girls in El Salvador and demanding its revocation.

“How is it possible that you do not know that last week the United Nations presented a report that shows that in our country a girl or an adolescent gives birth every 20 minutes? You should be obligated to know this. You get paid to know about this,” Herrera told him. Herrera was referring to the United Nations Population Fund and the Salvadoran Ministry of Health’s report, “Map of Pregnancies Among Girls and Adolescents in El Salvador 2015,” which also revealed that 30 percent of all births in the country were by girls ages 10 to 19.

“You say that you know nothing about women unjustly incarcerated, yet we presented to this legislature a group of requests for pardons. With what you earn, you as legislators were obligated to read and know about those,” Herrera continued, speaking about Las 17. “We are not going to discuss this proposal that you have. It is undiscussable. We demand that the ARENA party withdraw this proposed legislation.”

As part of its campaign of resistance to the proposed law, the Agrupación produced and distributed numerous videos with messages such as “They Don’t Represent Me,” which shows the names and faces of the 21 legislators who signed on to the ARENA proposal. Another video, subtitled in English, asks, “30 to 50 Years in Prison?

International groups have also joined in resisting the bill. In a pronouncement shared with legislators, the Agrupación, and the public, the Latin American and Caribbean Committee for the Defense of the Rights of Women (CLADEM) reminded the Salvadoran government of it international commitments and obligations:

[The] United Nations has recognized on repeated occasions that the total criminalization of abortion is a form of torture, that abortion is a human right when carried out with certain assumptions, and it also recommends completely decriminalizing abortion in our region.

The United Nations Committee on Economic, Social, and Cultural Rights reiterated to the Salvadoran government its concern about the persistence of the total prohibition on abortion … [and] expressly requested that it revise its legislation.

The Committee established in March 2016 that the criminalization of abortion and any obstacles to access to abortion are discriminatory and constitute violations of women’s right to health. Given that El Salvador has ratified [the International Covenant on Economic, Social and Cultural Rights], the country has an obligation to comply with its provisions.

Amnesty International, meanwhile, described the proposal as “scandalous.” Erika Guevara-Rosas, Amnesty International’s Americas director, emphasized in a statement on the organization’s website, “Parliamentarians in El Salvador are playing a very dangerous game with the lives of millions of women. Banning life-saving abortions in all circumstances is atrocious but seeking to raise jail terms for women who seek an abortion or those who provide support is simply despicable.”

“Instead of continuing to criminalize women, authorities in El Salvador must repeal the outdated anti-abortion law once and for all,” Guevara-Rosas continued.

In the United States, Rep. Norma J. Torres (D-CA) and Rep. Debbie Wasserman Schultz (D-FL) issued a press release on July 19 condemning the proposal in El Salvador. Rep. Torres wrote, “It is terrifying to consider that, if this law passed, a Salvadoran woman who has a miscarriage could go to prison for decades or a woman who is raped and decides to undergo an abortion could be jailed for longer than the man who raped her.”

ARENA’s bill follows a campaign from May orchestrated by the right-wing Fundación Sí a la Vida (Right to Life Foundation) of El Salvador, “El Derecho a la Vida No Se Debate,” or “The Right to Life Is Not Up for Debate,” featuring misleading photos of fetuses and promoting adoption as an alternative to abortion.

The Agrupacion countered with a series of ads and vignettes that have also been applied to the fight against the bill, “The Health and Life of Women Are Well Worth a Debate.”

bien vale un debate-la salud de las mujeres

Mariana Moisa, media coordinator for the Agrupación, told Rewire that the widespread reaction to Velásquez Parker’s proposal indicates some shift in public perception around reproductive rights in the country.

“The public image around abortion is changing. These kinds of ideas and proposals don’t go through the system as easily as they once did. It used to be that a person in power made a couple of phone calls and poof—it was taken care of. Now, people see that Velásquez Parker’s insistence that his proposal doesn’t need any debate is undemocratic. People know that women are in prison because of these laws, and the public is asking more questions,” Moisa said.

At this point, it’s not certain whether ARENA, in coalition with other parties, has the votes to pass the bill, but it is clearly within the realm of possibility. As Sara Garcia, coordinator of the Agrupación, told Rewire, “We know this misogynist proposal has generated serious anger and indignation, and we are working with other groups to pressure the legislature. More and more groups are participating with declarations, images, and videos and a clear call to withdraw the proposal. Stopping this proposed law is what is most important at this point. Then we also have to expose what happens in El Salvador with the criminalization of women.”

Even though there has been extensive exposure of what activists see as the grave problems with such a law, Garcia said, “The risk is still very real that it could pass.”

Analysis Maternity and Birthing

Government Recommendations on Zika Virus Not Grounded in Reality, Say El Salvador Locals

Kathy Bougher

The country’s Ministry of Health recommended last week that women should avoid becoming pregnant until 2018. But local feminist groups say this guidance doesn’t reflect the needs of Salvadoran women, especially where reproductive health is concerned.

Read more of our articles on the Zika virus here.

The presence of the Zika virus in El Salvador, along with the evidence that it may be causing microcephaly in fetuses and babies, led the country’s Ministry of Health to recommend last week that women should avoid becoming pregnant until 2018. But local feminist groups say this guidance doesn’t reflect the needs of Salvadoran women, especially where reproductive health is concerned.

Last May, there was a Zika outbreak in Brazil; in October, a large number of babies there were born with microcephaly, a condition in whichthe head is smaller than normal because the brain has not developed properly or has stopped growing.” According to the New York Times, Zika has existed since about 1947 in Africa. It was not particularly linked to microcephaly until last year, however, because most people had mild cases as children, and had immunity when they reached childbearing age. Still, as the Times notes, “Investigators may even find that Zika virus is not the main cause [of microcephaly], although right now circumstantial evidence strongly suggests that it is.”

The Centers for Disease Control and Prevention reports that an understanding of the links between Zika and microcephaly is “evolving,” but that preventive measures, such as avoiding mosquito bites, are appropriate.

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Since the virus has only recently arrived in El Salvador, the Ministry of Health does not yet have records of fetuses diagnosed with microcephaly as a possible result of the Zika virus. However, the data reflect that 96 pregnant women have the virus, and the total number of cases continues to rise.  

El Salvador Vice Minister of Health Eduardo Espinoza announced on behalf of the Ministry of Health last week that “We are recommending that women of childbearing age take the precaution of planning their pregnancies and try to avoid pregnancy this year and next.”  

As reported in Spanish by La Prensa Gráfica, “The official also [reissued] the call that the Ministry made a few months earlier to women who were already pregnant and could be susceptible to acquiring Zika to ‘cover as much of the body as possible, use pants and long-sleeve blouses to limit the possibility that mosquitoes infected with Zika can affect them.’”

Sara García, coordinator of the feminist group Agrupación Ciudadana por la Despenalización del Aborto (Citizen Group for the Decriminalization of Abortion), says that the recommendation seems directed primarily at adult married women or women who have a stable, cooperative male partner. She noted to Rewire in an on-the-ground interview, “Paternal responsibility is not included. Where are the men in this process?”

Furthermore, about 31 percent of females with pregnancies registered with the El Salvador Ministry of Health in 2014 were ages 10 to 19. Many of these pregnancies, García argued, could have been “imposed,” or nonconsensual. “What happens with an imposed pregnancy?” she said. “What happens when contraceptives fail?  We can’t just think about the ideal and assume that everyone can plan pregnancies.”  

“This recommendation is not grounded in the realities and the context of El Salvador,” García concluded.

The potential inability to plan for pregnancies—or prevent them—is exacerbated by El Salvador’s weak policies around sexual and reproductive health services. Both García and Salvadoran OB-GYN and specialist in women’s health, Dr. Aleida Marroquín, noted to Rewire that comprehensive sexual education that includes contraception is not available in schools.

Such barriers to access are not limited to education, however. Contraception is not legally restricted in the country. Even so, in a study-in-progress carried out by the feminist organization Organización de Mujeres Salvadoreñas por la Paz (Organization of Salvadoran Women for Peace, known as ORMUSA), which shared a preliminary draft with Rewire, early findings based on interviews indicate that although local health centers might prescribe contraceptives, centers can go for months at a time without actually having any in stock. Young women say they routinely encounter humiliating treatment or have their requests to purchase contraception denied at public clinics and private pharmacies.  

In addition, the study reports, although the country’s policies direct that there be specialized services and personnel trained to serve adolescents and young adults, in reality those services rarely exist. Gang violence and territoriality also impact clients’ ability to physically access clinics, and the reporting of rapes for fear of retribution.  

And if a person does not prevent pregnancy and discovers that her fetus is showing signs of microcephaly—which, as Marroquín noted, is not possible until the second trimester—El Salvador’s absolute ban on abortion means that she has no choice apart from giving birth.

Marroquín explained, “The symptoms [of microcephaly] can run a continuum from extremely severe with an early death to practically non-detectable and a relatively normal life.  However, most babies affected need specialized care from birth, and some will need round-the-clock care all their lives.”  

She emphasized that El Salvador has “almost no resources to meet such extensive medical and social needs. What happens to a woman who is an agricultural worker or a vender in the market who must work long hours every day to feed her children?”

Although a woman may or may not wish to interrupt the pregnancy if she were to discover that her fetus was microcephalic, the option does not even exist in the country. This, activists say, reflects the broader problem of denying women access to potentially life-saving care.  

“In addition to Zika,” García pointed out, “When we talk about a nonviable pregnancy, about risk, Salvadoran women are confronting other situations too. A major example is ectopic pregnancy, where any medical textbook will tell you that the only way to treat it is to interrupt the pregnancy. Otherwise the fallopian tubes can rupture and cause much graver problems, including the possible death of the woman.”

“What happens in this country?” García continued, referencing anecdotes medical providers had relayed to the Agrupación. “The woman arrives at the hospital. The doctor tells her that they cannot interrupt the pregnancy as long as they can detect a heartbeat. ‘You can stay here in the hospital and wait,’ the doctor tells her. But she has other children to care for at home.  If she doesn’t work, they don’t eat. So she goes home and runs the serious risk of having her fallopian tube rupture at home, far from medical help. In cases of ectopic pregnancies, there is no question about what is going to happen, but doctors have their hands tied by the law.”  

García also mentioned Beatriz, who turned to international courts for help in 2013 when medical personnel refused to let her terminate a pregnancy of an anencephalic fetus. Beatriz was threatened with prison if she took any action to do so; many other women in the country are currently incarcerated on abortion-related charges because of pregnancy complications.

García linked the Zika issues to the long-term work of the Agrupación to decriminalize abortion and recognize the negative health consequences for women of the absolute ban.

“We need to push the conversation beyond the question of Zika, and talk about the consequences of a law that gives women no options for interrupting a pregnancy, especially when the conditions to prevent pregnancies are almost nonexistent,” she said.

“Other countries in the region have laws that permit therapeutic abortions, abortions in case of rape or incest, and abortions in case of severe fetal abnormalities. We used to have that,” García said.

Since making its initial recommendation that women avoid becoming pregnant, the Ministry of Health has backed off a bit from that stance, instead emphasizing its campaign to eradicate the breeding grounds of the Aedes aegypti mosquitoes that carry Zika. The same insects also transmit dengue fever and Chikungunya, related viruses that have been present for much longer in the country. The government has also recommended that female students be allowed to wear pants as part of their school uniforms rather than the required skirts as one more preventive measure.  

However, public officials have yet to suggest proposals for workable policies and practices to prevent unwanted pregnancies, and to provide women options that include abortion.