Reproductive rights in Latin America

While feminist movements became prevalent in Europe and North America in the 1960s and 1970s, the women of Latin America were gathering to oppose dictatorships and civil wars.[1] As democracy began to spread across the region, feminist movements gradually began to push for more reproductive rights.

Latin America is a predominantly Spanish speaking and predominantly Roman Catholic region

In the 1990s, many of the groups that made up the women's movement began to evolve in order to adapt to a changing political climate. These groups focused on specific policy issues, such as abortion, and were not composed exclusively of civil society actors. During this same time period, anti-abortion activism was also beginning to gain momentum. The Vatican replaced hundreds of progressive clergy and summarily repressed discussions of reproductive issues. Groups continuing to fight for legal abortion across the region have faced a strong resistance from the Catholic church as well as the religious right in the United States. Although a majority of countries within the region are officially secular, the church continues to have an extensive influence within the region due to Latin America being the largest Catholic region in the world. The religious right in the United States holds substantial clout over the political right in its own country, which has resulted in the United States banning federal funding for international NGOs.[2] Considerably damaging to groups in Latin America was Ronald Reagan's 1984 Global Gag Rule which prohibited international organizations receiving US federal funds from performing or promoting abortion as a method of family planning.

Latin America is home to some of the few countries of the world with a complete ban on abortion, without an exception for saving maternal life.[3]

Defining reproductive rights

During the Cold War, reproductive restrictions were directed at controlling overpopulation through technocratic regulatory mechanisms and vertical population control campaigns. The United Nations International Conference on Population and Development of 1994 held in Cairo, Egypt established the first global agenda for sexual and reproductive health and rights.[4] The agreement marked a paradigm shift away from a narrow approach based on delivery of services and numbers rather than well-being. It placed rights at the center of population and development and defined reproductive health as "a state of complete, physical, mental and social well-being and not merely the absence of disease of infirmity, in all matters relating to the reproductive system and to its functions and processes." This broader approach to reproductive health moved the Cairo Agenda into political and economic debates over access and rights to knowledge, resources, and appropriate services.

Thus, women and health movements in civil society and their allies in the United Nations and national bureaucracies have undertaken strong campaigns to link public health, gender equality, and development policy. By understanding reproductive rights in the broader context of human rights, governments are able to create a standard of health that ensures development.[5] Similarly, this broader understanding of reproductive health places a certain level of responsibility on the government in ensuring this aspect of health for its citizens.

This cross-cultural consensus focuses on the importance of one particular capability, that of bodily health.[6] Recognizing the many areas reproductive health has influence over serves to exemplify its importance as well as gives some understanding as to what necessary improvements need to be made to a society.

Reproductive health also encompasses knowledge production and knowledge consumption. In order to obtain reproductive rights, quality information and services must be made available to all citizens of a society.[5]

Current strategies

International Conference on Population and Development (ICPD)

The 1994 International Conference on Population and Development defined reproductive health as noted above. It also defined strategies and goals for advancing such reproductive health and rights in Latin America through what is called the Cairo Programme of Action (CPA). The CPA has three quantitative targets: (1) Reducing overall mortality, which implies an increase in life expectancy, reducing specific mortalities (2) Universal access to education, especially for girls (3) Universal access to reproductive health services, including family planning.[7] Adopted by the region at the conference, some improvements have been seen since the adoption of the CPA. Reproductive rights have become recognized in the constitutions of Bolivia, Ecuador and Venezuela.[8] The Environmental Commission for Latin America and the Caribbean Ad Hoc Committee on Population and Development is responsible for official follow-up to the implementation of the CPA in Latin America as well as the Caribbean.

Millennium Development Goals in Latin America

The Millennium Development Goals are a descriptive framework by which to monitor response to eight specific goals. They were announced in the Millennium Declaration in September 2000. Whether or not a country is on track to meeting these goals—in the case of Latin America—is tracked by the Economic Commission for Latin America and the Caribbean (ECLAC). One particular goal in regard to reproductive health, Goal 5, seeks to improve maternal health within the region.[9] The first target of Goal 5 is to reduce the maternal mortality ratio by three quarters between 1990 and 2015. In order to assess the progress towards this goal, ECLAC monitors maternal mortality ratios and the proportion of births attended by skilled health personnel. The second target of Goal 5 is to achieve universal access to reproductive health by 2015. This target is assessed by viewing contraceptive prevalence rates, adolescent birth rates, antenatal care coverage and percentages of unmet need for family planning. In order to achieve these goals, many actions have been taken, including the growing institutionalization of deliveries and the increased number of personnel trained to provide care during childbirth and emergency obstetric care.[10]

Maternal health and mortality

According to the World Health Organization (WHO) in 2010, about 9,200 women are dying annually from pregnancy-related causes.[11] These deaths have a variety of causes that can occur as a result of complications during and following pregnancy and childbirth. The World Health Organization estimates that around 80% of all maternal deaths are a result of severe bleeding, infections, high blood pressure during pregnancy and unsafe abortions.[12] According to a report by the Guttmacher Institute, more than 20% of women who gave birth in 2008 did not make the recommended four antenatal visits and 13% did not deliver in a health facility.

None of the Latin American countries will reach the Millennium Development goal target specifically for maternal mortality, as well as it continues to be both a health and social challenge in Latin America. Research indicates that the numbers are disproportionately high within the indigenous and afro-descendant populations among the very poor. For indigenous populations as well as adolescents and young people, the rate of unmet family planning need also remains high. Latin America has the second highest fertility rates among adolescents and the highest unsafe abortion rates in the world.[13]

Overall, the maternal mortality rate in Latin America is relatively low compared to other regions with a rate of 80 deaths per 100,000 live births. However, if one were to break down the region's mortality rate by country, one could easily demonstrate that there exists a large disparity between affluent and poor countries. For example, in Haiti the rate was closer to 350 deaths per 100,000 live births. The disparity between wealthy and poor areas likely exists due to the differences in access to services and skilled professionals. Women in the highest income quintile have far easier access to such health services than women in the lowest income quintile. The same class-based disparity exists when analyzing the use of contraceptive methods.

Adolescent maternity and reproductive health

Protecting the health of adolescents is an important public health priority. Increased investment in adolescent reproductive health contributes to improving the overall status of women as well as the reduction in poverty among families.[14] Adolescent health must be contextualized within reproductive health and thus public health. Latin American government as a whole did not recognize early pregnancy in adolescents to be an issue until 1984 during the International Conference on Population in Mexico City.[5]

In Latin America, 38% of women become pregnant before the age of 20 and almost 20% of births are to teenage mothers.[15] Each year there are estimated to be 1.2 million unintended pregnancies among adolescent women living in Latin America and the Caribbean. Although overall fertility rates have largely dropped within the region, adolescent maternity is following an opposite trend. The Gender Equality Observatory for Latin America and the Caribbean reports that as of 2011, in Nicaragua approximately 2 in 10 women between the ages of 15 and 19 is a mother. In places such as Chile, Mexico, Paraguay and Peru the percentage is close to 12% while in Belize, Venezuela, Colombia, Guatemala and El Salvador reach percentages close to 15%. Inequality is also present in the issue of adolescent maternity, with pregnancy rates being three to five times higher among poor adolescents. While an overall universal trend towards earlier average age of menstruation can be seen, the mean age of marriage has declined. This implies that adolescents who are coerced into marriage are unprotected in terms of reproductive rights for longer periods of time.[5]

According to the UN Population Fund, education and access to information and services young people need in order to make responsible decisions remains insufficient. The importance of education is exemplified by how girls in Latin America who have completed only up to primary education or less have a higher probability of adolescent pregnancy.[5] Further, many young girls are dying because their bodies cannot support pregnancies. The same fund reports that the risk of complications during pregnancy and delivery for girls aged 15 to 19 is double the rate for women in their 20s, and five times as high for girls under 15.[16] Research reveals that there are several major barriers that young people face to accessing contraception, primarily with acquiring services. For example, facilities are frequently in areas inaccessible to young individuals. Due to a lack of information, adolescents often incorrectly use or do not use contraceptives at all.[5] For the purpose of privacy from their communities and families, young persons often seek services from facilities not located directly in their own neighborhoods.[17] There are also legal barriers preventing youth's access. Many policies limit or prohibit confidential services for youths.

There is also a swath of data that is not collected by hospitals on abortions that are particularly "clandestine" / "backstreet". Studies have shown that in several Latin American countries, young single women are at a high risk for abortion which is not reflected by the amount of married, older women who were hospitalized for abortions.[18]

Aside from a lack of information, young people who seek contraception are often denied by health workers acting out of their own moral convictions. It is clear that religious attitudes are very much present in society, which often deters young persons from seeking reproductive services and contraception.

Family Planning

Contraceptives

Use of modern contraceptives has increased to 62.5% (CITE: Population action) giving the region as a whole the highest contraceptive prevalence rate in the developing world. The increased uptake of sexual and reproductive health and family planning services has resulted in a marked drop in total fertility rates from approximately 4.6 children per woman in the 1970s to about 2.5 in 2013. In Latin America, multiple court decisions have granted personhood to fertilized eggs. These court decisions have been responsible for the extreme restrictions on access to emergency contraception within the region.[19] The legal status of oral contraception in Latin America varies by country. In 2009 Honduras banned the free distribution and sale of emergency contraceptives That same year, the Constitutional Court of Peru ordered the Health Ministry to refrain from distributing emergency contraceptives to the public sector. In Costa Rica, where emergency contraceptives are not blatantly prohibited, the popular emergency contraceptive levonorgestrel is not registered as a product, which impedes access to the drug from within the public health system as well as the private market. Although the remaining countries in the region allow for the free distribution of emergency contraceptives, they do not have uniform regulations. In Chile, Colombia and Ecuador, the right to have access to emergency contraceptives is recognized. In Nicaragua and Bolivia, the protocols of their respective health ministries are essentially law. In Argentina and Brazil, the distribution of emergency contraceptives is not legally recognized except in protocols and informative guides.[20]

Abortion

Abortion is a highly controversial aspect of reproductive rights. While every country in Latin America has differing laws and regulations regarding abortion, the general sentiment is that of disapproval. Abortions in Latin America have had a history of being unsafe and illegal (especially for poor women), with recent improvements in both of those areas.[21] Most of these improvements can be attributed to modern contraception, emergency care, as well as education. Similarly, advocacy and national conflict has grown surrounding abortion rights in Latin America. The region has seen a steady increase of feminist abortion activists, despite religion making the issue taboo.[21] Even when legislation has become more lenient (as has been the case recently with Mexico City and Chile), women often face institutional barriers to gaining access to abortions. When it comes to reporting data on abortions in Latin America, estimated abortion levels are often heterogeneous and highly variable due to legal frameworks and social stigmas.

According to the World Health Organization, in 2008, approximately "4.2 million abortions were conducted in Latin America and the Caribbean, almost three-fourths of them in South America. Virtually all these procedures were illegal and many were unsafe."[21]

In 2011, the number of unsafe abortions in Latin America rose to 4.2 million annually. Unsafe abortions account for a large proportion of maternal deaths. For example, in Argentina unsafe abortions account for 31% of the maternal mortality rate.[22]

In Latin America abortion is:[23]

  • completely prohibited: El Salvador, Dominican Republic, Nicaragua
  • allowed only to save the mother's life: Guatemala, Honduras, Paraguay, Venezuela,
  • allowed only to save the mother's life and in case of rape: Brazil
  • allowed only to save the mother's life or health: Costa Rica, Peru, Ecuador (and rape of disabled women)
  • allowed only to save the mother's life and in case of rape or fetal malformation: Chile (since 2017), Panama
  • allowed only to save the mother's life or health, and in case of rape: Argentina, Bolivia
  • allowed only to save the mother's life or health, and in case of rape, or fetal malformation: Colombia
  • allowed on request: Cuba, Uruguay, Mexico City (in Mexico law varies by state)

Only two countries within Latin America allow for legal abortion without restriction. However, these countries are home to less than 5% of women between the ages of 15-44. According to a report released by the Guttmacher Institute, 95% of abortions in Latin America are unsafe. Nearly one million women are hospitalized each year because of complications from unsafe abortion. Overall, Latin American rates of death related to illegal abortions rank among the highest in the world.

Strict abortion laws are accompanied by strict punishments. In El Salvador, for example, a woman can be jailed for up to 40 years for aborting while in Mexico, she could be jailed for up to 50 years. These punishments do not take into consideration the cause of the pregnancy, due to the fact that many of the imprisoned women were raped or had involuntary abortions[24]

International legislations also have an effect on abortion rights in Latin America. When U.S. President Donald Trump reinstated the Global Gag Rule on January 23, 2017, he prohibited all U.S. federal money from funding international organizations such as NGOs that "perform or actively promote abortion as a method of family planning".[25] Due to the fact that abortion regulations are already extremely strict in Latin America, this legislation disproportionately affects Latin American organizations that try to provide abortion services to women either legally, or illegally.

Comprehensive Sexual Education

In 2012 a report presented to the Inter-American Commission on Human Rights (IACHR) found that access to information remains a significant roadblock to sexual and reproductive health, particularly in Latin America.(CITE HR BRIEF) The report noted that even when a state has a comprehensive legal framework guaranteeing access to information, in practice the individual's health is endangered by uninformed decisions made by individuals and policymakers based on inadequate information regarding sexual and reproductive health. In 2011, IACHR issued a report on access to information on reproductive health and found that the situation is compounded when women are poor, indigenous, of African descent, live in a rural area, or are a migrant.

In 2008, the region adopted "Miniseria Declaration, 'Prevention through Education,'" in response to a lack of comprehensive sexuality education. While there have been some setbacks and delays regarding implementation, there have also been key improvements.[26] In 2013, the ministries of health and education of Guatemala reaffirmed their commitment to working together in order to ensure the goals of the Ministerial Declaration are the met. In addition, the government of Guatemala is implementing a comprehensive sexuality education program for young people in nine regions of the country. Actions aimed at promoted comprehensive sexual education can be seen in multiple areas of the region, demonstrating that leaders are indeed dedicated to making such improvements. Earlier in 2012, Costa Rica adopted a national sexuality program for the first time in history. The curriculum approaches human sexuality in a comprehensive way; it includes lessons on human rights, gender equality, power, interpersonal communication, respect for diversity and pleasure. Also making a critical first step that year was El Salvador with its General Youth Act, legislation which recognizes and guarantees the right of young persons to receive comprehensive sex education. Implementation will be an ongoing challenge, however, recognition is important step toward meeting the needs of youth.


Disproportionate Effects of Reproductive Injustice

In Latin America, indigenous womxn lie at the intersection of various systems of oppression in place. Indigenous womxn are discriminated based upon their ethnicity, their gender, and because indigenous folk are the poorest sector of the overall population, indigenous womxn are also discriminated upon their income and class. In the healthcare industry, discrimination can manifest in forms of diminishing pain and experience, abuse in all forms by healthcare providers, to medical mistreatment. With the costs of reproductive healthcare constantly on the rise within Latin America, this creates additional inaccessibility for hundreds of indigenous womxn. There also remains very little medical research or representation for indigenous folk within the healthcare field and this creates distrust and miscommunication between the healthcare providers and the indigenous patients.


Religion in Latin America
Further information: Religion in Latin America and Catholic Church in Latin America

Religion in Latin America is characterized by the predominance of Roman Catholicism, although there is also increasing Protestant influence (especially in Central America and Brazil) as well as by the presence of other world religions. Catholicism was introduced in Latin America with the Spanish colonization of the Americas and continued through the independence movements of the Spanish-American colonies up to the present day. Critics of the restrictive abortion laws of Latin America argue that this situation is created by the strong influence of the Catholic church in the region.[27] El Salvador and Nicaragua have drawn international attention for strong enforcement of their complete bans on abortion. In 2017, Chile relaxed its total ban, allowing abortion to be performed when the woman's life is in danger, when a fetus is unviable, or in cases of rape.[28]

International Influence

While many of Latin America's reforms in regards to reproductive rights have happened internally, the broader international community plays an important role as well. The Center for Reproductive Rights, for example, has used international litigation as a way to reinforce national legislation surrounding reproductive rights.[29] Legal policy plays an important role in establishing a standard of reproductive rights internationally as well as within Latin America itself. This implies that over time, reproductive rights will be integrated into a broader framework of human rights.

See also

References
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  2. Pothecary, Sam. "Abortion Rights in Latin America: A Tale of Varying Woes".
  3. https://www.bbc.com/news/world-latin-america-41005517
  4. "Sexual and Reproductive Health" (PDF).
  5. Raguz, Maria (2001). "Adolescent Sexual and Reproductive Rights in Latin America". Health and Human Rights. 5: 30–63. doi:10.2307/4065364. JSTOR 4065364.
  6. Nussbaum, Martha. Promoting Women's Capabilities.
  7. "Implementation of the Programme of Action of the International Conference on Population and Development in Latin America and the Caribbean: Review of the period 2009-2013 and lessons learned" (PDF). Economic Commission for Latin America and the Caribbean.
  8. Richardson, Emma; Anne-Emanuelle Birn (2011). "Sexual and Reproductive health and rights in Latin America: an analysis of trends, commitments and achievements". Reproductive Health Matters: 183–187.
  9. "MDG Goals, targets and indicators". Millennium Development Goals in Latin America and the Caribbean. Economic Commission for Latin America and the Caribbean.
  10. "Maternal Mortality in Central America: The need to accelerate efforts by 2035". The Maternal Health Task Force. Archived from the original on 2014-04-29.
  11. Kulczycki, Andrzej (21 September 2011). "Abortion in Latin America: Changes in Practice, Growing Conflict, and Recent Policy Developments". Studies in Family Planning. 42 (3).
  12. "Maternal Mortality". World Health Organization.
  13. "Latin America and the Caribbean". International Conference on Population and Development Beyond 201. International Conference on Population and Development Beyond 201.
  14. "Facts on the Sexual and Reproductive Health of Adolescent Women in the Developing World" (PDF). Guttmacher Institute. International Planned Parenthood Federation.
  15. "Maternal Health: A Priority to Ensure the Health and Rights of Women". International Planned Parenthood Federation.
  16. Edgerton, Anna; Ina Sotirova. "Sex and the Barrio: A Clash of Faith in Latin America". World Policy Journal (Winter 2011/2012 Faith Issue).
  17. Moya, Cecilia. "Improving Youth's Access to Contraception in Latin America". Advocates for Youth. Advocates for Youth.
  18. Strickler, Jennifer; et al. (2001). "Clandestine Abortion in Latin America: A Clinic Profile". International Family Planning Perspectives. 27: 34–36. doi:10.2307/2673803. JSTOR 2673803.
  19. "Access to EC in Latin America Takes Center Stage at the Inter-American Commission on Human Rights". Center For Reproductive Rights.
  20. Hevia, Martin (2012). "The legal status of emergency contraception in Latin America" (PDF). International Journal of Gynecology and Obstetrics: 87–90.
  21. Kulczycki, A (2011). "Abortion in Latin America: Changes in Practice, Growing Conflict, and Recent Policy Developments". Studies in Family Planning. 42: 199–220. doi:10.1111/j.1728-4465.2011.00282.x.
  22. Caivano, Joan; Jane Marcus-Delgado (May 2012). "Time for Change: Reproductive rights in Latin America in the 21st Century" (PDF). Reproductive Laws for the 21st Century Papers. Archived from the original (PDF) on 2014-03-07.
  23. https://web.archive.org/web/20160415084202/http://www.un.org/en/development/desa/population/publications/pdf/policy/WorldAbortionPolicies2013/WorldAbortionPolicies2013_WallChart.pdf
  24. "The right to health and safe abortion in Latin America: still a long way to go". IHP. 2017-09-29. Retrieved 2018-04-12.
  25. "The global gag rule: Women's health at risk in Latin America?". Global Americans. Retrieved 2018-04-12.
  26. "Five Sex Education Successes in Latin America". International Planned Parenthood Federation.
  27. https://www.theguardian.com/commentisfree/2013/aug/27/abortion-rights-latin-america
  28. https://www.independent.co.uk/news/world/politics/chile-the-long-road-to-abortion-reform-a7917791.html
  29. Cabal, Louisa; et al. (2003). "What Role Can International Litigation Play in the Promotion and Advancement of Reproductive Rights in Latin America?". Health and Human Rights. 7: 50–88. doi:10.2307/4065417. JSTOR 4065417.
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