Commentary Abortion

It’s Time to Strip Catholic Hospitals of Their Right to Provide Maternity Care

Marge Berer

Beatriz’s treatment should be considered cruel and degrading and a violation of the Hippocratic oath to do no harm.

See all our coverage of Beatriz here.

The May 31 announcement regarding the decision to allow Beatriz in El Salvador to have a “premature delivery” requires a continuing response from the abortion rights community.

1. The article states: “The medical team at the Maternity Hospital is ready to act immediately at the slightest sign of danger.” In fact, the opposite is true. Danger signs have existed in Beatriz’s pregnancy from the beginning. Instead of acting on them and terminating the pregnancy as soon as it was known that the embryo had no chance of survival, if not sooner, the medical team of the hospital has put her life at constant risk. Like Savita Halappanavar in Ireland, Beatriz’s condition could suddenly worsen, e.g. her blood pressure could go out of control, her kidneys could fail, and she could die in a short space of time.

No one in the hospital or the Ministry of Health of El Salvador should be allowed to get away with the falsehood that her care is in good hands. Her care is in the hands of people who have been prepared to let her die for the sake of a fetus with no brain, but with only a heartbeat and without the chance of a life.

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2.  She will be “allowed” to have a caesarean section, described as a “premature delivery.” Why a c-section, why surgery? Is this justified because it is the safest possible form of delivery for her? Can someone explain this please? What is wrong with either a dilatation & evacuation, or induction with mifepristone and misoprostol? Both surely carry fewer risks?

Please recall the case of “Aurora” in Costa Rica, at the end of 2012, who was also carrying a fetus with no chance of life, a fetus whose heartbeat stopped only at 29 weeks of pregnancy. She also was then given a c-section. Some of us asked why that was necessary at the time, but no one raised the question or challenged it publicly. It is time to ask publicly: why is a c-section the delivery method of choice? Is it only because it is the only form of termination of the pregnancy that they think cannot be labelled abortion?

3.  Are these two cases representative of a new “Catholic health policy” for pregnant women with an emergency obstetric situation involving a non-viable embryo/fetus – that they are imprisoned in a hospital, in some cases  for months,  denied a life-preserving abortion until the fetal heartbeat stops, and then delivered of the dead baby by the highest risk procedure possible for the woman, a caesarean section??

Beatriz’s treatment should be considered cruel and degrading treatment and a violation of the Hippocratic oath to do no harm. The protest here is not finished; it is only beginning because cases like Beatriz’s and Aurora’s are only just coming to light through the vigilance and action of human rights and women’s abortion rights groups.

We need to challenge the abortion laws of El Salvador, Costa Rica, Ireland and other countries where even abortion to save the life of the woman is not permitted. But we also must challenge Ministers of Health, parliaments, Supreme Courts, hospitals, and clinicians in every country whose clinical decisions and actions are subservient to the dictates of the Roman Catholic Church’s “health policy” on abortion, which blatantly and cruelly disregards the right to life and health of pregnant women. Whose bottom line is that even with a non-viable embryo/fetus with a heartbeat but no chance of survival a termination is never permissible.

Reproductive Health Matters has just published my paper analyzing Catholic health policy on emergency obstetric care involving termination of pregnancy which discusses all the cases I could find that have come to light up to several months ago. The paper is entitled: Termination of pregnancy as emergency obstetric care: the interpretation of Catholic health policy and the consequences for pregnant women: An analysis of the death of Savita Halappanavar in Ireland and similar cases

This is a common problem. If health professionals systematically put the lives of their patients at risk for any other ideological non-clinically justifiable reason, it would not be tolerated. I believe any Catholic health professionals and/or hospitals refusing to terminate a pregnancy as emergency obstetric care should be stripped of their right to provide maternity services. In some countries these are the main or only existing maternity services. Even so, governments should refuse to fund these services, and either replace them with non-religious services or require that non-religious staff are available at all times specifically to take charge of such cases to prevent unnecessary deaths. At issue is whether a woman’s life comes first or not at all.

News Human Rights

Lawsuit: Religious Groups Are Denying Abortion Care to Teen Refugees

Nicole Knight Shine

The suit accuses the federal government of paying millions to religious grantees that refuse to provide unaccompanied minors with legally required reproductive health services.

Two years ago, 17-year-old Rosa was raped as she fled north from her home country in Central America to the United States. Placed in a Catholic shelter in Florida, the teen learned she was pregnant, and told shelter officials that if she couldn’t end the pregnancy, she’d kill herself. She was hospitalized for suicidal thoughts. Upon her release, the facility in which she’d been originally placed rejected her because of her desire for an abortion, according to a federal lawsuit filed Friday. So did another. Both, reads the lawsuit, were federal contractors paid to care for unaccompanied minors like Rosa.

Rosa’s story is one in a series sketched out in a 16-page complaint brought by the American Civil Liberties Union (ACLU) against the U.S. Department of Health and Human Services (HHS). The suit accuses the federal government of paying millions to religious grantees—including nearly $20 million over two years to the U.S. Conference of Catholic Bishops (USCCB)—that refuse to provide unaccompanied minors with legally required reproductive health services, including contraception and abortion. The grantees are paid by the federal Office of Refugee Resettlement (ORR) to house and care for young refugees.

The lawsuit, brought in U.S. District Court in San Francisco, amounts to a fresh test of the degree to which Catholic organizations and other faith-based groups can claim exemptions from federal laws and regulations on religious grounds.

“Religious liberties do not include the ability to impose your beliefs on a vulnerable population and deny them legal health care,” said Jennifer Chou, attorney with the ACLU of Northern California, in a phone interview with Rewire. “The government is delegating responsibility … to these religiously affiliated organizations who are then not acting in the best interest of these young people.”

Mark Weber, a spokesperson for the HHS, which includes the ORR, told Rewire via email that the agency cannot comment on pending litigation.

Escaping turmoil and abuse in their home countries, young refugees—predominantly from Central America—are fleeing to the United States, with 33,726 arriving in 2015, down from 57,496 the year before. About one-third are girls. As many as eight in ten girls and women who cross the border are sexually assaulted; it is unknown how many arrive in need of abortion care.

The federal ORR places unaccompanied minors with organizations that are paid to offer temporary shelter and a range of services, including reproductive health care, while the youths’ applications for asylum are pending. But documents the ACLU obtained indicate that some groups are withholding that health care on religious grounds and rejecting youths who request abortion care.

The 1997 “Flores agreement” and ORR’s contracts with grantees, which the ACLU cites in its lawsuit, require referrals to “medical care providers who offer pregnant [unaccompanied immigrant minors] the opportunity to be provided information and counseling regarding prenatal care and delivery; infant care, foster care, or adoption; and pregnancy termination.”

In 2016, the federal government awarded 56 grants to 30 organizations to provide care to unaccompanied minors, including 11 that the ACLU claims impose religious restrictions on reproductive health care.

In one case, ORR officials struggled to find accommodations for 14-year-old Maria, who wanted to end her pregnancy, according to the complaint. An ORR official wrote, according to a document the ACLU obtained, that the agency would have liked to transfer Maria to Florida to be near family, but “both of the shelters in Florida are faith-based and will not take the child to have this procedure,” meaning an abortion.

In another, the complaint reads, 16-year-old Zoe was placed with Youth for Tomorrow, a faith-based shelter in Virginia, where she learned she was pregnant. She asked for abortion counseling, which was delayed nearly two weeks, the complaint says. Learning of her decision to end the pregnancy, Youth for Tomorrow asked to transfer Zoe elsewhere because of its abortion prohibition, even though Zoe said she was happy at the shelter.

For vulnerable youths, such transfers represent a form of “secondary trauma,” according to the ACLU’s Chou.

“These women have already endured so much,” she told Rewire. “The process of transferring these youths from shelter to shelter tears them away from their only existing support system in the U.S.”

Federal officials, according to the complaint, were aware that the religious grantees would withhold abortion referrals. In one case, the Archdiocese of Galveston-Houston was awarded more than $8 million between 2013 and 2016, although it stated in its grant application that rape survivors wouldn’t be offered abortion care, but instead permitted to “process the trauma of the rape while also exploring the decision of whether to keep the baby or plan an adoption.”

The lawsuit also claims that a contract with the U.S. Conference of Catholic Bishops included language requiring unaccompanied minors who were pregnant to be given information and counseling about pregnancy termination, but the ORR removed that language after the USCCB complained.

The USCCB did not respond to Rewire‘s request for comment. But in a letter last year to the ORR, the USCCB and five religious groups, including some ORR grantees, wrote they could not facilitate health-care services for unaccompanied minors that run contrary to their beliefs.

The lawsuit is the second the ACLU has filed recently against the federal government over religious privileges.

Last month, the ACLU filed a Freedom of Information Act suit demanding that the federal Centers for Medicare & Medicaid Services release complaints against federally funded Catholic hospitals, where patients have reported being denied emergency medical care in violation of federal law.

In 2009, the ACLU also sued the federal government for allowing USCCB to impose religious restrictions on a taxpayer-funded reproductive health program for trafficking survivors. In 2012, a district court ruled in the ACLU’s favor, and the government appealed. The First Circuit Court of Appeal later dismissed the case as “moot” because the government did not renew USCCB’s contract.

Analysis Human Rights

Sentenced to 40 Years After a Miscarriage, Maria Teresa Rivera May Have Chance to Go Free

Kathy Bougher

In El Salvador, Maria Teresa Rivera was convicted of aggravated homicide after experiencing an obstetrical emergency. She is scheduled to have a new day in court on May 11, when she will argue that there were judicial errors in her original trial.

Read more of our coverage on the campaign for Las 17, the 17 Salvadoran women imprisoned on abortion-related charges, here.

In November 2011, Maria Teresa Rivera unexpectedly went into labor, giving birth in the latrine of her home. The birth was dangerous and unattended by any medical professionals; the fetus died. Like many women in El Salvador, where abortion is completely illegal, Rivera’s medical crisis led to her being charged with and convicted of aggravated homicide; she was sentenced in 2012 to 40 years in prison.

Rivera’s sentence is the most extreme of “Las 17,” a group of women who have been imprisoned after obstetrical emergencies. Now, she is scheduled to have a new day in court on May 11, when she will argue that there were judicial errors in her original trial. If the judge rules in her favor, she will be freed from prison. Advocates say that her case could influence public sentiment about other similar cases around the country.

With the support of the Agrupación Ciudadana por la Despenalización del Aborto, a Salvadoran feminist organization, Rivera has been fighting her case for several years, as reported earlier in Rewire. Along with the rest of Las 17, she requested a pardon from the Salvadoran government in 2014, but her request was denied.

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“Rivera represents the maximum will of the state to criminalize women in this country,” Morena Herrera, president of the Agrupación, explained in an on-the-ground interview with Rewire. “Her sentence is the longest of any of the women with similar convictions; at 40 years, it is practically a life sentence.”

Fortunate To Be Alive

Maria Teresa Rivera, who shared her story on camera from prison in 2013, was a 28-year-old factory worker in 2011. She was living with her young son and his grandparents, her ex in-laws, in a very modest home in the outskirts of San Salvador. Rivera, the sole provider for the family, supplemented her factory work with house-cleaning in order to pay $13 a month to keep her son in a neighborhood Catholic school and purchase his asthma medication.

One night, according to court documents, Rivera said she awoke with intense thirst. But when she arose from her bed, she felt dizzy and then fainted. When she regained consciousness, she felt a strong urge to defecate and went to the latrine outside the house. As she sat in the latrine, she had intense cramping and “felt as if a little ball fell from her body.” Then she fainted and fell to the ground, where her mother-in-law found her in a pool of blood and called an ambulance to take her to the hospital. No one at the scene—family or paramedics—reported hearing any sounds of a baby, and no one realized she had given birth.

Rivera told doctors, attorneys, and others that did not know she was pregnant. She had been experiencing bleeding during the time of the pregnancy, which she interpreted as her menstrual cycle. Neither she nor any friends, relatives, or co-workers noted any physical changes that would indicate a pregnancy. She had also had two doctor visits for other complaints during those months, and no doctor had diagnosed her pregnancy. According to her own estimations, the last sexual contact she’d had that could have resulted in pregnancy had been six months earlier.

She arrived at the hospital in a severe state of shock from extreme blood loss, fortunate to still be alive. Doctors told her she had given birth and wanted to know where the baby was. Medical personnel contacted police, who went to her home to locate the deceased fetus. Rivera was detained by police at the hospital and has been imprisoned since that time.

Interrogation While Hospitalized

Multiple national and international organizations, including Amnesty International and the Center for Reproductive Rights, along with numerous medical, legal, human rights, and academic experts, have analyzed Rivera’s case in the years since her conviction. Harvard University sociologist Jocelyn Viterna and Salvadoran lawyer Jose Santos Guardado Bautista, for example, used parts of Rivera’s story and court documents in their 2014 analysis of systematic gender discrimination toward Las 17 within the judicial system.

Viterna and Bautista noted, for example, that the only witness testimony the judge considered credible was a supervisor from human resources at the factory where Rivera worked. Contrary to Rivera’s testimony, the supervisor testified that Rivera asked for time off for doctor appointments in January 2011 because she was pregnant. The judge refused to allow testimony from neighbors and friends who stated that they had never seen Rivera show any signs of pregnancy.

“Had Maria Teresa truly reported a pregnancy to her employer in January of 2011, she would have been 11 months pregnant when the birth occurred in November,” Viterna and Bautista observed. “This testimony is nothing short of preposterous. Nevertheless, this is the only witness testimony that the judge deems ‘credible’ in the final sentencing.” 

According to Viterna and Bautista’s report, “The judge admitted that there was no evidence that Maria Teresa had done anything to hurt her baby. The judge also admitted that there was no evidence of any motive for why she would want to kill her baby.” However, he still convicted her of aggravated homicide.

A 2015 resolution from the Salvadoran Attorney General for Human Rights (Procuradoría Para la Defensa de los Derechos Humanos or PDDH in Spanish), which provided a formal opinion on violations of Rivera’s human rights, supports Viterna and Bautista’s findings.

The PDDH resolution observed that Rivera faced a slanted system even before she got to court:

At the First of May Hospital where Rivera was taken, the criminal investigation was prioritized over her right to health. She was subjected to interrogation when she was still in Intensive Care and without legal representation. In addition, the medical personnel did not seek information about her health history; they limited themselves to examining the birth canal, carrying out the extraction of the remaining placenta, and discharging her the following day, without attending to her overall health.

Both the PDDH and Viterna-Bautista reports noted that the judge relied on shoddy, unscientific evidence to convict Rivera. According to court records, the autopsy report for the fetus said its cause of death was “perinatal asphyxia.”

“It is perhaps worth reiterating that there were no signs of trauma on the [fetus], either externally or internally. It is perhaps worth reiterating that, despite the judge’s conclusion that the [fetus] died from suffocating within the latrine, the fetal lungs were clean with no sign of fecal matter or other materials inside them. Rather, the autopsy concluded that the [fetus] died of a medical condition—perinatal asphyxiation—that could have occurred before, during, or after the birth. Clearly, there is no evidence in these documents proving homicide,” Viterna and Bautista wrote. “Perinatal asphyxiation,” they said, “is a medical condition.”

Still, the judge interpreted the autopsy report to mean that Rivera had carried out an intentional criminal act. He also ignored the portion of the autopsy report stating that the umbilical cord could have been separated by its fall into the latrine. As quoted by the PDDH resolution, he wrote:

There is no doubt that the baby was born alive and was full-term and that the detached umbilical cord was cut by the mother …. This judge does not give credibility to what the accused says when she states she did not know she was pregnant …. She knew she was pregnant and that brought with it the obligation to care for and protect this young person she carried in her womb. In this sense, the fact that she went to the latrine, she did it with the intention of violently expelling [it] so that inside the latrine there would be no opportunity to breathe and in that way cause its death and then be able to say it was a [spontaneous] abortion.”

The judge also based his conviction, the PDDH resolution said, on the results of a DNA test showing the fetus was genetically related to Rivera.

“No evidence was introduced to show that Rivera had taken any intentional action to cause the death,” the PDDH resolution concluded.

Convicted by Patriarchy

Rivera’s legal representatives will likely use many of these inconsistencies as evidence for procedural judicial error in court this week. A favorable outcome in her trial can represent a significant step forward for women’s human rights, particularly sexual and reproductive rights in El Salvador. The country’s 1997 absolute ban on abortion, along with a 1998 constitutional modification to declare that life begins at conception, created the social, cultural, and legal environment that has justified courts sending women such as Rivera to prison for documented obstetrical emergencies, not even attempted abortion. According to the global organization Ipas, more than 600 women were incarcerated between 1998 and 2013 under the abortion law.

As the PDDH resolution noted, “in El Salvador, there exists a culture of the promotion of motherhood as the only form of self-realization for women, and the creation of the binomial ‘woman-mother,’ which locates women as instinctive and not rational. This imposes upon women [duties of] sacrifice, abnegation, and the prioritization of children over their own human conditions, behaviors that are not demanded in equal proportions from men.

“Women find themselves with a social expectation to comply with the role ‘woman-mother,’ even in the health system where women should be assured of conditions free of discrimination and obstetric violence,” it continued.

Advocates and researchers have argued that this sexist framework contributed to Rivera’s conviction. As Viterna and Bautista wrote, the trial judge claimed that Rivera “‘decided to carry out her criminal plan within the area of her household, looking for a moment during which there weren’t any other persons around to carry out this homicide,’ as if a woman has complete control over when, where and how her body will give birth.”

The PDDH concluded that “the judge convicted Rivera under subjective criteria with a heavily sexist ideology,” saying that Rivera’s rights to the presumption of innocence were overruled by such an ideology, unsupported by any medical or scientific evidence.

Rivera’s case, along with that of Carmen Guadalupe Vazquez (who was one of Las 17 granted a pardon in 2015 when the Salvadoran Supreme Court recognized judicial errors in her case), is representative of a consistent pattern toward this group of women that the Agrupación has been documenting.

“Correcting these judicial errors is very important, first of all for Rivera and her young son, so that she can go free, but also for all the other women in similar circumstances. It’s also necessary for those who work for justice in this country, particularly women’s reproductive justice, to see that the work has concrete results,” Herrera said.

Herrera hopes that a positive outcome will continue to make visible this pattern of judicial error and “move other cases [of Las 17] forward more rapidly and bring greater justice to the judicial system.”

According to IThe Agrupación is currently representing more than 25 women imprisoned with similar convictions: the original 17, two of whom received pardons, and others who have entered the system more recently.

“Maria Teresa’s story illustrates the systematic ways that women’s rights are violated: the right to health, the right to privacy in one’s life, the right to doctor-patient confidentiality, along with all the judicial procedural rights such as the presumption of innocence,” Herrera said in an interview with Rewire.

“The judicial system in El Salvador is the part of the state that has changed least since the signing of the 1992 peace accords” that ended the Salvadoran civil war, Herrera said. “Not just in how it deals with women, but how little sensitivity it demonstrates overall with regard to human rights.”