With a Little Help from Their Friends

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abortion, abortion access, abortion laws, Colombia, Dr. Jorge Villareal, Latin America, Oriéntame, reproductive health, Roe v. Wade

Latin American reproductive health rights activists have logged another victory.  Last week the Constitutional Court of Colombia (the highest court in the country) voted five to four to decriminalize abortion in the first twenty-four weeks of pregnancy.  Colombia thus joins Mexico and Argentina in decriminalization, which means that three of the four most populous countries of the region have taken a major step toward making abortion legal and accessible.  (Brazil’s vocal feminist movement is pushing for legalization, but so far has had no success.)

Colombian reproductive health rights activists are quick to point out that their victory owes a lot to their relationships with activists in other parts of Latin America.  The Colombians consulted with movement lawyers from Mexico, adopted street theatre performances originating in Chile, and wear the distinctive green kerchiefs first used by women activists in Argentina.

Latin American feminists know that the constant sharing of strategies and tactics across the region has made all of their movements stronger and more vibrant.  They contrast their recent successes with the string of TRAP laws in many U.S. states and the ominous probability that the U.S. Supreme Court will reverse Roe v. Wade this summer.  Catalina Martínez Coral, a lawyer and member of Causa Justa, the coalition of abortion rights groups that brought the relevant case to the Colombian Constitutional Court, noted that the waves of feminist activism are “now an inspiration going south to north… We are going to inspire people in the United States to defend the rights set out in Roe v. Wade.”  Serra Sipel, the chief global advocacy officer at Fòs Feminista, an international alliance of reproductive rights groups, agrees, saying “We in the U.S. can really learn a lot” from Latin American feminist organizations.

Some of the roots of Colombia’s reproductive rights movement can be traced back to a visit to the U.S. by the eminent Colombian obstetrician/gynecologist Dr. Jorge Villareal Mejía.  Dr. Villareal toured some of the first legal abortion clinics that opened after the Roe v. Wade decision and decided to find a way to offer similar services in his homeland.  In 1977, he opened the first of his Oriéntame clinics in Bogotá.  The clinics offered a full range of reproductive health services, including abortion.  They charged on a sliding scale, and their promotional materials delicately urged their more affluent clients to contribute to the costs of procedures for poorer women.

Dr. Jorge Villareal Mejía (1927-2001)

I have known about Oriéntame since the early 1990s. Before full legalization of abortion in Colombia I referred to it by a pseudonym in my writing, in particular in my book Sex and Herbs and Birth Control.

Under Dr. Villareal’s direction the clinics pursued a remarkable two-pronged strategy.  On the one hand, Oriéntame skirted the question of illegality of abortion by labeling its services as “walk-in patient treatment of incomplete abortion.”  As a medical director of the organization once explained to me, a sympathetic Jesuit priest reconciled his support for Oriéntame with the Catholic view of abortion as a sin by reasoning that once a woman decided in her mind to have an abortion, she had begun the process.  Oriéntame personnel were merely aiding her to complete her abortion safely.  And indeed, in the forty-five years of their existence the clinics have performed close to a million abortions with a vanishingly small number of serious complications.

The second aspect of Dr. Villareal’s vision involved a brilliant outreach program.  To quote from Sex and Herbs and Birth Control (in which I referred to Oriéntame as CRH, or Centers for Reproductive Health): “CRH offers scholarships to midwives and doctors from other areas of Central and South America who might want to set up similar clinics.  They have trained over 600 physicians, nurses, physicians’ assistants, and traditional as well as licensed midwives in vacuum aspiration abortion techniques; their students perform abortions in clinics in Bolivia, Colombia, Ecuador, Guatemala, Mexico, Paraguay, Peru, Uruguay, Venezuela, and elsewhere…. In Peru I met a director of the country’s society of women obstetricians who had attended the program and was an enthusiastic advocate of the idea; I’ve run into CRH graduates in Nicaragua and Chile as well.”

Oriéntame personnel have not only trained numerous reproductive health specialists from all over the region in the latest abortion techniques.  They have also shared their expertise in how to make use of the legal exceptions in various law codes to increase women’s options.  As Giselle Carino, an Argentinian activist in Fòs Feminista, noted: “Without a doubt, we learned from the Colombians.”

Although for large portions of its history Oriéntame managed to steer clear of police harassment, a spate of incidents in 1994 encouraged Dr. Villareal’s daughter Cristina, who was taking over directorship of the organization from her father, to reach out to feminist groups in order to unite with medical practitioners to try to change Colombia’s laws.  Cristina Villareal joined with others to form the coalition La Mesa por la Vida y la Salud de las Mujeres.  In 2006 the group’s efforts caused a broadening of legal exceptions in which abortion was permitted in Colombia, and full decriminalization through twenty-four weeks was achieved in late February of this year.

Oriéntame and its international training program continue to offer reproductive health services in Colombia, train physicians, midwives, and healers, and advise affiliates on the best ways to navigate legal pitfalls.  But, as feminist activists in Latin America know and their counterparts in the U.S. are finding out, it does not pay to be too complacent.  As Cristina Villareal warns, “This is a battle that is never completely won… You can’t let your guard down.”

Sources for direct quotes are February 21 and 23, 2022 New York Times articles by Julie Turkewitz.  Additional information can be found at https://orientame.org.co (Spanish) and https://orientame.org.co/en (English).

Huge Victory for Argentinian Women

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abortion, Argentina, Colombia, legalization, Ni Una Menos

In the final days of 2020, Argentinian lawmakers resisted pressure by Catholic and evangelical Protestant abortion opponents, ignored a last-minute intervention by Pope Francis, and approved a bill legalizing abortion for any reason up to fourteen weeks of pregnancy.  After that time, abortion will be prohibited except in cases of rape or danger to the woman’s health.  The abortion bill, versions of which had been rejected by previous legislatures for several years, was, according to The New York Times, passed by a “wider-than-expected” margin of 38 to 29.  Some senators attributed their change of heart to the efforts of feminist activists to paint an accurate picture of the experiences of Argentinian women.  Reproductive rights organizations stressed that hundreds of thousands of clandestine abortions are performed in the country every year.  In 2016, approximately 40,000 women were hospitalized with abortion complications.  

Reproductive rights activists have been pushing for abortion legalization for decades, but since 2015 the campaign has been fortified by the feminist organization Ni Una Menos, which has combined campaigns for abortion law reform with increasing protests against rape, domestic violence, and sexual discrimination in all areas of Argentinian life.  The green scarves and handkerchiefs favored by Ni Una Menos have been adopted as a symbol by feminists in many countries of Latin America.

Argentina is the largest country in the region to enact an abortion-on-demand policy in the first trimester of pregnancy; Cuba, Uruguay and Guyana are the only other countries with similarly progressive laws.  There are, however, other places that in practice afford women reproductive rights even if the law codes do not give the same blanket permissions as Argentina’s or Cuba’s.  In Colombia, for example, a measure passed in 2006 was hailed by physicians and reproductive rights organizations as a great victory, because it allows abortion in the first trimester under broadly defined mental and physical indications. It should also be noted that even before the Colombian legislature liberalized abortion restrictions, hundreds of thousands of women received safe abortions administered by qualified personnel. The authorities for the most part looked the other way.

Another example concerns Mexico.  Feminist activists are engaged in ongoing struggles to legalize abortion at the national level.  But meanwhile Mexico City and the state of Oaxaca have abortion on demand to twelve weeks.  Mexico City offers safe and affordable abortion access (covered by state medical insurance) to well over twenty million people.

As I have stressed on numerous occasions, legality of abortion by no means guarantees that the procedure will be readily available, safe, and affordable for the vast majority of women.  The depressing situation in most areas of the U.S. certainly bears witness to that fact.  Nor does illegality always mean that abortions are necessarily performed under unsafe conditions, as we see from the example of Colombia in the decades before liberalization in 2006.  What is abundantly clear is that women of all countries, economic circumstances, races, religions and ethnicities will sometimes find themselves in unfortunate situations and see abortion as their only reasonable alternative.

Abortion Access During the Pandemic

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abortion access, Colombia, COVID-19, Germany, U.S., unwanted pregnancy

Last time, I commented on the efforts of anti-abortion politicians in Alabama, Oklahoma, Texas, and other U.S. states to restrict women’s reproductive rights by declaring abortion a “nonessential” procedure. An article that appeared on 14 June 2020 in The New York Times (“Coronavirus Created an Obstacle Course for Safe Abortion”) discusses the obstacles that exist in some other countries as well. That article, along with websites of UNFPA, WHO, and NPR, are the sources for this post.

Julie Burkhart, a former associate of the murdered abortion doctor George Tiller, founded “Trust Women,” a group that operates clinics in Oklahoma and Kansas. She has commented on the ways that anti-abortion forces are using the COVID-19 pandemic as an excuse to further corrode women’s abortion access. Desperate women have no choice but to travel hundreds of miles in search of abortion. Burkhart’s Kansas clinic has been registering huge increases in patients, many of whom are fleeing from the lockdowns in other jurisdictions. In a recent week, she noted, her clinic saw 250 women, compared to forty per week in more normal times.

The U.S. situation is particularly bleak for a so-called “developed” country, both because of the pandemic’s economic consequences falling disproportionately on poor women and women of color, and because of the highly politicized nature of abortion access here. But even in countries such as Germany and Austria, where women’s reproductive rights are less restricted, public health officials apparently forgot about abortion when they made lists of time-sensitive procedures that should be available immediately rather than postponed. Feminist activists had to remind regional governments and individual hospitals to consider women’s reproductive health and include abortion as an essential, time-sensitive medical need. Another problem in Germany is that some abortion providers themselves are in at-risk categories. In one rural district of Bavaria, for example, the only abortion doctor is over seventy and so had to stop to guard his own health.

There have been some bright spots. France, Ireland, England, Scotland, Wales and Colombia have loosened their restrictions on telemedicine. They now permit at-home use of pills for early abortions after a phone or online consultation with a doctor. Health activists are hopeful that this relaxation will continue after the dangers of the pandemic have passed.

In Colombia, professionals in the Orientame reproductive health clinics note that contraceptive access in rural and underserved areas can be erratic under the best of circumstances, so telephone and online consultations for early medical abortions are an important aspect of women’s reproductive health services in the country.

Dr. Natalia Kanem, Executive Director of UNFPA

As always, the worst effects of the coronavirus and the accompanying economic dislocations have hit and will continue to hit women of scarce resources all over the world. Women’s health rights activists and officials of the United Nations sexual and reproductive rights agency UNFPA have been sounding the alarm for months. In April UNFPA’s executive director Dr. Natalia Kanem warned that the travel restrictions and disruptions to regular clinic services caused by the pandemic could result in an added seven million unintended pregnancies worldwide. “As a corollary,” Kanem noted, “unsafe abortions will increase.” Earlier this month the World Health Organization went further, predicting dire consequences if poor countries either cannot or will not support continuing reproductive health services at pre-pandemic levels. “Even a 10 percent reduction in these services could result in an estimated 15 million unintended pregnancies, 3.3 million unsafe abortions and 29,000 additional maternal deaths during the next 12 months,” the WHO warned.