Latin American women denied abortions despite decriminalisation

• Women struggle to access legal abortion in public system
• Doctors opposed to abortion turn women away, advocates say
• In poor rural areas, activists continue to provide pills

MEXICO CITY/BOGOTA - Two years since the Mexican state of Veracruz legalised abortion, reproductive rights activist Metzeri Ávila still travels for hours into remote areas to deliver free abortion pills to women excluded by the public healthcare system.

Some women cannot afford to travel to a public hospital or do not know they are allowed to terminate their pregnancies, but others are being turned away by medical staff opposed to the procedure, Ávila said.

"Abortion is decriminalised but still clandestine and socially punished," said Ávila, a member of Lxs + Despenalizadxs (The Most Decriminalised), an activist group that provides free abortion pills and safe spaces for medical abortions in Mexico.

Despite the decriminalisation of abortion in seven Latin American countries, reproductive rights advocates say some women are being denied access due to resistance from doctors, bureaucratic hurdles and inadequate public health information.

This has led many women to depend on networks of activists who distribute misoprostol and mifepristone for free to carry out medical abortions at home.

In September, the Mexican Supreme Court struck down a law criminalising abortion, opening the door for the federal healthcare system to start providing pregnancy terminations.

Twelve of the country's 32 states had already repealed their penal codes following a 2021 ruling by Mexico's highest court that local criminal penalties for abortion were unconstitutional.

But implementing the changes has been slow – with many poor, rural and Indigenous women still dependent on independent networks of activists and doctors to access abortion.

Legal reforms are "pretty on paper, but the reality we are living is very different", Ávila said.

'A crime and a sin'

Following a ruling by Colombia's constitutional court in February 2022, the country now has one of Latin America's most liberal abortion laws - allowing terminations under any circumstances up to 24 weeks of pregnancy.

After that, abortions are only allowed in cases of rape, if a mother's life is at risk or if a foetus is malformed.

But nearly two years since the ruling, there is still confusion about the rules and stigma against women who seek an abortion in the majority Roman Catholic nation.

"Many women, particularly in rural areas, still don't know their rights ... and some women think abortion is a crime and a sin," said Laura Castro, a coordinator at the Committee for Women's

Life and Health, part of the Causa Justa (Just Cause) coalition of abortion rights groups.

In Uruguay, abortion before 12 weeks of gestation has been legal since 2012 – but legally protected conscientious objection allows healthcare workers to inform authorities of their refusal to perform abortions due to moral or religious reasons.

More than half of available gynaecologists in 22 public hospitals have cited the exemption to refuse to perform abortions, according to 2022 government data obtained by Mujer y Salud (Woman and Health) Uruguay, a reproductive rights organisation.

In three of Uruguay's 104 hospitals, there are no gynaecologists willing to provide the procedure, the data shows.

In Colombia, healthcare providers have to publish the names of doctors who refuse to carry out abortions on the grounds of conscientious objection, but many women struggle to find out who will treat them and face a long search and multiple referrals.

"Some doctors claim not to know about the changes in the law as a way to get out of performing the procedure," Castro said.

Although not necessary by law, some healthcare providers are also asking girls seeking to terminate a pregnancy for parental permission, she told Context.

For doctors in public hospitals in Mexico, performing abortions can sometimes result in harassment from colleagues, said Suzanne Veldhuis, co-founder of a network of more than 100 doctors who support and accompany medical abortions.

"They stop talking to you, you're not assigned surgeries anymore, they threaten to fire you," said Veldhuis, who has also accompanied medical abortions outside the public health system.

Research in Bolivia and Mexico shows that many healthcare providers refuse to provide abortions simply because they do not understand the law and fear legal repercussions.

Furthermore, some refuse to carry them out in public hospitals but perform them privately, found a report by reproductive rights organisation Ipas.

"Then the conscientious objection doesn't really exist," Veldhuis said.

Undeterred

Though accessing abortion in public health systems might be difficult for many, advocates say this has not deterred women from getting them.

In Uruguay, the number of legal abortions increased 46% between 2013 and 2022, with 10,505 terminations carried out last year, government statistics show.

Since abortion was decriminalised in Mexico City in 2007, more than 263,000 abortions have taken place, according to official data updated to June 2023.

Advocates have also developed alternatives for those who cannot access the service in a public hospital.

In 2021, ProFamilia, a Colombian nonprofit that provides sexual and reproductive services, launched a telemedicine service for women and girls seeking to terminate their pregnancy up to 12 weeks, reaching about 15,000 women so far.

Women and girls receive drugs - usually mifepristone and misoprostol - by post, a service that particularly benefits those living in remote areas that lack healthcare services.

"Since COVID, more women are having online appointments with doctors allowing them to self-manage their abortions safely at home," said medical doctor Juan Carlos Vargas, a consultant for ProFamilia.

Despite such initiatives and a major legal shift in the region, abortion rights campaigners said their fight was far from over.

"We are now focusing our efforts on ensuring that these public policies are applied without discrimination, reaching women and girls who live in rural areas, and migrants who suffer racial discrimination, and even transgender men," said Catalina Martínez Coral, regional director of the U.S.-based Center for Reproductive Rights.

"Now we have constitutional protections to demand the rights of all without excuses," Martínez added.

(Reporting by Diana Baptista in Mexico City and Anastasia Moloney in Bogota; Editing by Helen Popper)