http://allafrica.com/stories/201201250342.html

Abdulwakil Saiboko

25 January 2012


A LAW to protect rights of mothers and adolescent girls in accessing reproductive health services is in the offing.

A draft bill will be presented to a group of Parliamentarians in February, this year, to kick-start the process of enacting the law.

Presenting the summary of the Bill to Enact the Safe Motherhood Law (2012) in Dar es Salaam on Tuesday, the Care International Project Officer, Mr Kanuth Dimosi noted that the bill intended to protect the rights of mothers, adolescent girls men and boys in accessing reproductive health services.

Mr Dimosi who was speaking at a safe motherhood stakeholders’ meeting to discuss the draft of the bill in question, noted that the final draft would be presented to the Parliamentarians for Safe Motherhood Group (PSMG).

The move stems from another stakeholders’ meeting held in June, last year, which underscored the need to formulate a law that would protect pregnant women from maternal mortality and infant mortality. According to Mr Dimoso, the bill has various parts which address issues of access to contraceptives and family planning, maternal and new born health as well as sexual and reproductive health of adolescents.

Others include, termination of pregnancy, HIV/AIDS and other sexually transmitted infections, harmful practices affecting sexual and reproductive health as well as implementing and enforcement mechanisms. Earlier, while presenting the safe motherhood bill concept and rationale, the Care International Technical Coordinator, Ms Rachael Boma noted that the move had been necessitated by gaps found in various laws.

“The Law of Marriage Act of 1971 encourages early marriages on the part of girls. It allows girls to get married at the age of 14 or l5 which is unacceptable as girls at the said ages are still in adolescent,” she said. Ms Boma noted that the Education Act of 1978 could also feature in a group of bad laws, as it does not include protection measures for girls who get pregnant while in school.

“The Law of the Child Act of 2009 lacks effective enforcement because Tanzania does not have a children’s court which is user friendly for adolescent girls and boys and at the same time the Prisoners Act of 1967 is silent with regard to Maternal Sexual and Reproductive Health (MSRH) of the female prisoners,” she added.

Ms Boma also noted that the Public Health Act of 2009 does not explicitly provide for the enforcement of the right to health such as the right to be treated well by a professional medical officer, the rights to medication and care. “From reviews made in various laws, it is vivid that there are a good number of contradictions and gaps in the existing laws, making the need for MSRH comprehensive legislation apparent,” she said.

According to her, other countries such as Benin, Chad, Mali, The Philippines and South Africa already have comprehensive MSRH laws and general research shows improved MSRH services with enactment of the laws. At the last June’s meeting which called for the formulation of the Bill, the Legislator for Peramiho who is also the chairperson of the Bunge group for safe motherhood, Mrs Jenista Mhagama said that coming up with a specific law on safe motherhood was vital to protect mothers and their babies from preventable loss of lives.

“It is a bad experience looking at how we lose hundreds of women during birth every year, when it has been repeatedly stated that no woman should die while giving life. We really need to have this law in place,” she said.

 

Published January 24, 2012

| Reuters

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Getting a legal abortion is much safer than giving birth, suggests a new U.S. study published Monday.

Researchers found that women were about 14 times more likely to die during or after giving birth to a live baby than to die from complications of an abortion.

Experts say the findings, though not unexpected, contradict some state laws that suggest abortions are high-risk procedures.

The message is that getting an abortion and giving birth are both safe, said Dr. Anne Davis, who studies obstetrics and gynecology at the Columbia University Medical Center in New York, and wasn’t involved in the new study.

“We wouldn’t tell people, ‘Don’t have a baby because it’s safer to have an abortion’ — that’s ridiculous,” she told Reuters Health. “We’re trying to help women who are having all reproductive experiences know what to expect.”

An induced abortion, like any other medical procedure, requires getting informed consent from the woman, said Dr. Bryna Harwood, an ob-gyn from the University of Illinois in Chicago who also didn’t participate in the new research.

That means women understand and acknowledge the risks of their different options.

What makes it complicated, Harwood added, is when the law interferes and requires doctors to state information that isn’t always balanced or medically sound, usually exaggerating the risk of abortion.

The researchers on the new study combined government data on live births and pregnancy- and abortion-related deaths with estimates on legal abortions performed in the U.S. from the Guttmacher Institute, which conducts sexual and reproductive health research and education.

Dr. Elizabeth Raymond from Gynuity Health Projects in New York City and Dr. David Grimes of the University of North Carolina School of Medicine, Chapel Hill, found that between 1998 and 2005, one woman died during childbirth for every 11,000 or so babies born.

That compared to one woman of every 167,000 who died from a legal abortion.

The researchers also cited a study from the Centers for Disease Control and Prevention which found that, from 1998 to 2001, the most common complications associated with pregnancy, including high blood pressureurinary tract infections and mental health conditions, happened more often in women who had a live birth than those who got an abortion.

In their report, published in the journal Obstetrics & Gynecology, Raymond and Grimes write that the findings aren’t surprising given that women are pregnant for a lot longer when they decide to have a baby and so have more time to develop complications.

Harwood said previous studies have also shown the safety of legal abortions.

Most abortions have typically been done surgically, she told Reuters Health. But since the abortion drug mifepristone was approved for use in the United States in 2000, the number of medically-induced abortions has been on the rise.

Both methods are now considered equally safe, she said, with the main risk, though very small, coming from medication- and procedure-related infections.

Depending on the state, however, doctors legally must go over the risks of abortion in language that may be misleading, researchers said, with skewed lists of possible complications. Others require a 24-hour waiting period in between the counseling and the abortion itself.

Harwood said that laws regarding what’s said between the doctor and a woman seeking an abortion often hamper doctors’ attempts to inform patients in a balanced way.

“It is certainly an impediment to have the state dictate my informed consent process beyond the usual,” Harwood told Reuters Health.

“Abortion care and pregnancy care should not really be any different than consenting people for any other procedure.”

Davis agreed that state-mandated discussions have no place in abortion counseling. She said she was glad to see the new report, which helps dispel “misinformation” and “lies” about abortion risks included in some state laws, such as the idea that abortion is linked to cancer.

“Women who are having abortions are having a safe, common surgical procedure or taking medication for the same reason,” she told Reuters Health

“They should feel confident that the medical care they’re having is safe, long-term and short-term.”

January 17, 2012 – 10:23pm

It’s been almost three years since President Obama repealed the global gag rule, one of the most ludicrous and paternalistic U.S. foreign policies in history. But as we celebrate the anniversary of its repeal, just one day after the anniversary of Roe v. Wade on January 22nd, another matter deserves our attention.

The last stronghold of America’s oppressive overseas reproductive health policies, the Helms Amendment, is still alive and well. The 1973 amendment to the Foreign Assistance Act restricts U.S. funding for abortion overseas – even in countries where abortion is legal. Specifically, it states:

“No foreign assistance funds may be used to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortions.”

The Helms Amendment invented what the global gag rule caricatured: a foreign policy that explicitly intrudes on the lives of women in developing countries, singling out and stigmatizing ‘abortion’ from the continuum of reproductive care necessary for a healthy life. Yet we’ve heard relatively little of this “grandfather” of anti-choice policies over the past 40 years, and all the while its colonial specter has continued to haunt the United State’s legacy of global reproductive rights.

Some are now aruging publicly for change. In late-December, 12 Members of Congress, including Representatives Lois Capps, Pete Stark, and Jan Schakowsky,  sent a letter to President Obama  asking for a formal review of the policy for the first time in history.

“We are concerned that the Helms Amendment – which restricts but does not prohibit abortion funding – is being implemented as though it were an absolute ban,” the letter stated.

The letter is a first step toward addressing a policy that has undermine the rights and health of women throughout the world for far too long.

Although Helms prohibits U.S. aid from directly supporting abortion services, it is supposed to allow for the provision of abortion counseling and referrals, post-abortion care, and abortion in cases of rape, incest, and danger to the life of the woman. Years of careful tracking and documentation work on the part of reproductive rights groups, spearheaded by Ipas and the Center for Reproductive Rights (CRR) have produced clear evidence that in reality, these exceptions exist in theory but not in practice.

“Despite provisions allowing foreign-assistance funding for abortion services under certain circumstances, for almost 40 years the Helms Amendment has been implemented improperly as a total ban on all abortions,” CRR said in a statement released last month.

If this sounds eerily familiar, it should. While the gag rule has been officially rescinded, it seems the Helms Amendment has continued to function in effectively the same way. Primarily due to the clumsy wording of the amendment (what constitutes “abortion as a method of family planning” and what counts as “motivating” abortion?), and the long history of the use of women’s rights to full reproductive health care as a political football, application of the policy in-country among aid workers and recipients has veered drastically toward banning and self-censorship. Ipas and CRR, along with a small group of legislators, are asking President Obama to issue clarifying guidance to ensure the proper implementation of the policy.

The groups suggest that the Helms Amendment has contributed to an overall environment of censorship, stigma, and misinformation around abortion, resulting in barriers to services and consequent deaths and injuries. For example, Nepal’s abortion law was liberalized in 2002. Yet Ipas found that despite this, and even after the repeal of the global gag rule, abortion was omitted entirely from formal USAID trainings, discussions, and manuals, and abortion groups were informally excluded from partner meetings on national reproductive health strategies.

As abortion is singled out, reproductive health services become fragmented, drastically reducing the likelihood that women will receive these services at all even under “legal” circumstances. The situation is not likely to be much better in any other country receiving U.S. international assistance, including countries where rape is being regularly employed as a weapon of war. This is disturbing when you consider that global aid funding is supposed to “help” in the most fundamental way, not harm. Unsafe abortion remains a leading cause of maternal mortality in the developing world, and that is clearly thanks in part to the Helms Amendment.

This seems to be something that everyone should care about. That the Helms Amendment exists in the first place should incite reproductive (and human) rights advocates – it is ties assistance to an ideology that flouts medical and scientific evidence and the reality of women’s lives. It should further incite us that this policy is being twisted to create additional obstacles for women in some of the most vulnerable places in the world. Yet the Helms Amendment remains a policy largely un-touched by pro-choice groups and rarely covered in the media.

The Hyde Amendment, which is basically the domestic version of the Helms Amendment, turned 35 just months ago, an anniversary that provided an opportunity to highlight the unjust, classist, and oppressive nature of a policy that most deeply affects low-income women in the United States. The coverage was terrific and widespread, delving into the history and implications of the policy, and even providing a helpful framework of lessons for activists.  Yet in all this, Helms was barely mentioned.

This is disappointing and problematic, because the two are so intimately connected. The Congressional letter to President Obama begins, “We are Members of Congress committed to reproductive rights at home and abroad…”. That line, at home and abroad, is pivotal. These policies do not exist in a vacuum, and neither do the anti-woman ideologies propelling them and keeping them in place. Their inceptions were related and if advocates are to successfully repeal them, those efforts, too, may have to be related.

Recent efforts to drag the Helms Amendment into the light come at a critical time.  Last month, the administration announced an historic National Plan of Action on Women, Peace, and Security, an executive order that puts women at the center of U.S. foreign policy. President Obama has talked the talk, now he is being asked to walk the walk. The president can ask the relevant agencies to review their policies and make guidance on the Helms Amendment and its exceptions crystal clear. He can issue an executive order ensuring that funding streams are not burdened by overly broad interpretations of an already-heninous law. The decision is in the Administration’s hands.  It is too soon to know what the outcome will be, but it seems at least the wheels may be starting to turn.

Follow Jessica Mack on Twitter, @fleetwoodjmack

Kelsey Holt and Kate Grindlay, Ibis Reproductive Health

(Full article here: http://www.rhrealitycheck.org/article/2012/01/10/supporting-our-troops-includes-protecting-their-reproductive-health-and-rights)

At the end of last year the Senate blocked the Shaheen Amendment to the 2012 National Defense Authorization Act, which would have restored insurance coverage of abortion for women serving in the military who are raped—giving military women the same benefits that federal employees, women enrolled in Medicaid, and women in federal prison receive.

The lack of support for this bill is shocking given the high rates of sexual assault and rape in the military that put the nearly 300,000 women serving in the US military (97 percent of whom are of reproductive age) at increased risk for unintended pregnancy. While the Shaheen Amendment would have been an important step forward in ensuring comprehensive health care for servicewomen, our research at Ibis Reproductive Health has documented a number of other gaps in access to reproductive health care that also need to be addressed. We urge policymakers in 2012 to put politics aside and support the women serving our country through policies that meet their needs and promote their health and well-being.

Servicewomen need access to abortion in military medical facilities to ensure safe, confidential, and timely access to care

In addition to military insurance not covering abortions except in cases where the servicewoman’s life is in danger, current federal policy also prohibits abortions from being performed in military facilities overseas even if a woman pays for it herself, with narrow exceptions for life endangerment, rape, and incest.

In a recent study we conducted with military women and dependents seeking abortion during overseas deployment, women with an unintended pregnancy overwhelmingly wanted to complete their tour of duty and continue serving their country, and did not want to interrupt their service by returning home because of the pregnancy. The majority, however, were stationed in countries where abortion is prohibited, such as Iraq and Afghanistan, where abortion is banned except to save the life of the woman.

Women furthermore reported difficulties leaving their military bases due to combat operations and other unsafe conditions that limited their mobility. In the face of these obstacles to in-country abortion care, they had to leave to return to the US for an abortion. These circumstances adversely affect the ability of the woman’s unit to accomplish its mission, and a soldier’s travel to the United States for an abortion also delays access to this time-sensitive procedure, creates confidentiality concerns, and can negatively affect the soldier’s career.

We found that even in circumstances of rape, when women should, under current law, be entitled to abortion services at military facilities (if they pay for it themselves), many servicewomen were still seeking to terminate their pregnancy outside of the military system because they feared their account of the rape would not be believed and that the pregnancy could negatively affect their careers. More efforts are needed to ensure that servicewomen who experience military sexual trauma receive the timely care and support that they need and deserve. Moreover, military policies prohibiting or discouraging sexual activity during deployment create an environment of fear for some women, and the military should instead emphasize making reproductive health services, including the full range of contraceptive methods and abortion care, available rather than punishing the women (and men) who have unintended pregnancies.

Servicewomen need access to the full range of contraceptive methods for deployment

According to a literature review we recently published, U.S. military women experience higher rates of unintended pregnancy than women of reproductive age in the US overall, and though this may in part be due to disproportionate numbers of young women serving in the military, these rates signal health care needs that are not being met. Our research on the experiences of US military women seeking health care during deployment has found that women face a number of challenges to accessing contraceptives during deployment. Preliminary results from an online survey and telephone interviews with servicewomen show that women do not get routine counseling about contraceptive options as part of pre-deployment preparations; they do not always have access to the full range of contraceptive methods—in particular IUDs—for deployment; and they face challenges getting refills and consistently using their method during tours of duty.

Servicewomen should be able to access the full range of reproductive health care services so that they can decide if and when to have children, and can lead safe, healthy reproductive lives during and after their military service. All women in the military need to know about and have access to the full range of contraceptive methods and abortion services during overseas deployment, when they may have no other source of health care than military medical facilities. Allowing abortions to be provided in military medical facilities (and ideally be covered by military insurance to prevent financial barriers) would ensure safe, timely access to abortion care—either in-country or on a military base in the United States.

Improved reproductive health care access during deployment would not only meet the needs of servicewomen, but also help promote troop readiness, ensuring women who serve their country can do their jobs and that their units do not suffer their absences any longer than necessary. Finally, it is critical that sexual assault in the military continues to be addressed and that sexual assault survivors have access to high-quality prevention and treatment services.

Women in the military serve their country with distinction and protect our rights. We should support their rights and health, and ensure they have access to the reproductive health information, services, and products they need.

 

Faiza Ilyas | Metropolitan > Karachi |

KARACHI, Jan 14: Although abortion is legal in Pakistan and a consensus exists among Islamic scholars on its permissibility in certain conditions, a majority of medical professionals look upon it as an un-Islamic act and refuse treatment to women, compelling them to seek the help of untrained healthcare providers and risk their lives.

According to estimates, about 890,000 induced abortions are carried out every year in the country and the procedure — contrary to the general perception that it is sought by unmarried women — is wanted by married women, with four to five children, who consider abortion an ‘easier family planning tool’ rather than using contraceptives.

These were some of the points highlighted at a seminar, The politics of abortion, organised by the Society of Obstetricians and Gynecologists of Pakistan (SOGP) at the PMA House on Saturday.

Giving a presentation on abortion and maternal health in Pakistan, Dr Shershah Syed, a senior gynaecologist, said most victims of the ailing social mindset were poor women because the rich could pay huge amounts to get the procedure done by trained professionals.

“The politics of abortion is that to keep silent and not to create awareness of the subject,” he said.

Giving some statistics, he said 30,000 women died every year in Pakistan because of pregnancy-associated complications that put the maternal mortality rate to about 276 per 100,000 live births.

Complications of miscarriages/ abortions, he said, accounted for 10 to 12 per cent of maternal deaths while one out of six pregnancies was terminated by induced abortion through a risky method.

“Due to a lack of health services and access to modern family planning methods, a large number of abortion-related complications worsen the maternal health situation in our country. Besides, cases of abortion are mismanaged by untrained healthcare providers,” he said, adding that about 36.81pc of abortions were conducted by unskilled traditional birth attendants.

Reproductive and sexual health issues, including early marriages, unplanned pregnancies and sexually transmitted diseases, he said, increased the burden on women’s health.

Referring to a report in a foreign publication, he said about 75,000 women who tried to abort pregnancies by inserting different objects into their bodies died every year worldwide. Most of them, he said, belonged to South Asian and African countries.

Painting a picture of what’s happening in the United States, Dr Huma Farid, clinical fellow in obstetrics, gynaecology and reproductive biology, Brigham Women’s Hospital in Boston, Massachusetts, said the abortion issue had been politicised in America and it was no longer viewed as a health subject.

“The US is perceived as a liberal country, but what is happening there on the abortion issue could have dangerous repercussions in the coming years,” she said, while explaining that though abortion was legal in the US, a number of states under the strong influence of conservative Christians had started passing anti-abortion laws.

“The risk of death from a legal abortion performed by a licensed provider is 0.4 per 100,000 cases while the risk increases to 17pc in cases of illegal abortion,” she said.

The US, she said, had a high rate of unplanned pregnancies (49pc); of those unplanned pregnancies, 42pc ended in abortion; 19pc of abortions were among teenagers; 67pc of women who sought abortions were unmarried and almost half of American women had terminated at least one pregnancy.

She also traced the history of abortion and pointed out that in the early 1600s the procedure was legal. Two centuries later, the states started passing anti-abortion laws and by 1900 abortion was illegal in every state in the US.

“Since abortions were illegal, the procedure was performed in hiding (about 200,000 to 1.2 million cases annually) and in a highly unsafe environment and represented 18pc of maternal deaths in 1930,” she said.

The case, she said, finally went to the US Supreme Court, which ruled in 1973 that the right of personal privacy included the abortion decision.

Citing a survey, Dr Nighat Shah, representing the SOGP, said that 80pc of doctors wanted stricter laws on abortion instead of favouring relaxation of rules. She also stressed that abortion was purely a health issue and must not be confused with religion and culture.

Imtiaz Kamal, president of the Midwifery Association of Pakistan, said Pakistan laws permitted that abortion could be done to save a life and to carry out necessary treatment.

Islamic scholars, she said, permitted the procedure to be done within 120 days of pregnancy.

“Professional values are more important than personal beliefs. Healthcare providers must refer the patient seeking abortion to the right place if they are not willing to carry out the procedure,” she said.

December 31, 2011

Medical experts say unsafe abortion is a leading cause of maternal deaths in Malawi

Lameck Masina | Blantyre, Malawi

The United States-based reproductive rights organization Ipas in collaboration with the Malawi’s Ministry of Health recently conducted the study entitled Abortion in Malawi: Results of a Study of Incidents and Magnitude of Complications Due to Unsafe Abortions.

Godfrey Kangaude was one of the researchers of Ipas. He said the study wanted to find out how many women are inducing abortions which can in turn lead to deadly complications.

“Part of the findings is that in 2009 alone 70,000 women had induced abortion,’ he said, “and we also estimated that the abortion rate is about 24 abortions per 1000 women of child bearing age. So you can see that this is a high number of induced abortions.”

However, abortion is illegal in Malawi except under circumstances where it threatens the life of a mother.

 

 

Section 149 of the country’s penal code penalizes anyone who performs an abortion to 14 years imprisonment, while any woman who solicits one can be put in jail for up to seven years.

However Kangaude said despite the penalties, many women still seek to have the procedure.

“[My] first concern is that the law despite being restrictive does not prevent women from accessing abortions,” he explained. “What just happens is that these induced abortions tend to be clandestine and unsafe (which results in deaths of many women).”

Statistics from the country’s public hospitals show that 17 percent of maternal deaths are because of complications due to unsafe abortions.

Kangaude said this means that the law does not support the reproductive health rights of the women but instead infringes the rights of these women.

“Because instead of accessing safe abortion services,” he said, “they (women) go for other services since the public health systems do not provide these safe abortions to women who need them”.

He said the danger is that most of these women develop fatal complications like hemorrhage, ruptured uterus and infertility.

The study has therefore asked government to consider liberalizing abortion laws so that all women should have access to abortion using safe methods from trained medical practitioners.

“For example,” he said, “if the woman feels that she has ill health and needs an abortion and if the pregnancy is as a result of sexual coercion or if  indeed the woman really feels that she cannot carry on with the pregnancy due to economic reasons”.

National Coordinator of the Islamic Information Bureau Sheikh Dinala Chabulika said it would be inhumane for Malawi to legalize the procedure.

“In Islam, he explained, “abortion is only allowed when there is proof from a medical doctor that the life of a mother will be in danger during delivery.”

Some people commenting on social networks like Twitter and Facebook say Western religious views were imposed on Africans during colonialism and do not understand why people still cling to them today.

They say it’s time for African countries with restrictive abortion laws to revisit them just as many former Western colonizers have.

African countries which have liberalized them include Zambia and South Africa.

Human rights campaigners say one of the pacts Malawi has signed, the Maputo protocol, supports greater reproductive rights for women.

Grace Malera is the Executive Secretary of the Malawi Human Rights Commission.

“The Maputo protocol has got an article that is subscribing to liberalization [not only],” he said, ” when the pregnancy is threatening the life of the mother but [also when there are pregnancies] resulting from rape and incest.  In terms of the human rights, that’s a right to health issue and we need to address it.”

But Ministry of Heath spokesman Henry Chimbali says government authorities are currently looking at the findings of the study before they take next course of action.

www.thenation.com/article/165436/mexicos-anti-abortion-backlash?page=full

Mary Cuddehe

January 4, 2012   | 

This article was reported in partnership with the Investigative Fund at The Nation Institute.

Daniela Castro, a 21-year-old administrator for a Mexican children’s charity, got to the hospital just before dark. It was a warm, cloudless July night in 2010, and Daniela grabbed the arm of her boyfriend of three years, a handsome architecture student named Carlos Bautista. The two walked through the entrance confidently. If anything, they looked more like a pair of teen models than a couple of criminals. But Daniela was at the hospital that night because she had taken abortion pills that made her sick. Abortion is banned throughout Mexico, and authorities in her native Guanajuato, a mid-sized state in the center of Mexico with an ultraconservative reputation, like to enforce the law.

 

The state has opened at least 130 investigations into illegal abortions over the past decade, according to research by women’s rights groups, and fourteen people, including three men, have been criminally convicted. Given Mexico’s 2 percent national conviction rate during its most violent period since the revolution, that’s a successful ratio.

But Daniela did not have such numbers in her head when she told the attending physician her story. A few days earlier, she and Carlos had turned to Carlos’s mother for help. Of their parents, Norma Angelica Rodriguez, 41, was the most likely to be sympathetic. She had been a young mother herself, and she knew of a pharmacy in town that would sell Misoprostol—an over-the-counter ulcer drug that women take to induce labor—without asking a lot of questions. Rodriguez knew this because, like the estimated 875,000 Mexican women who have abortions every year, she had once needed the drug herself.

The doctor listened to Daniela, then slipped out of the room and made a call. Guanajuato hospitals are expected to report suspicious miscarriages just as they would a gunshot wound. It wasn’t long before a couple of officers arrived, followed by a lawyer from the district attorney’s office, who took out a note pad. “So, Daniela, how many people have you had sex with?” he asked, jotting down the answers. “And who gave you those pills?” That night, the DA opened an official probe into Daniela’s case. If convicted, both she and Carlos’s mother—though not Carlos—faced up to three years in prison.

* * *

Mexico has thirty-two states if you include Mexico City’s federal district, and until the spring of 2007, when Mexico City legalized it during the first twelve weeks of gestation, abortion was illegal in all of them. It was rarely prosecuted, though, and there were also legal exemptions. Every state had one for rape, and many to save the mother’s life; one state even had an exemption for economic hardship. Access, though, was another story. I once asked Rigoberto Velarde, the silver-haired state coordinator for Guanajuato’s Maternal Health Program, where a pregnant rape victim could get the procedure that was her legal right. Velarde drew back in his chair, widened his eyes and looked at me like I was crazy. “She can’t do that!” was his reply. Mexico’s abortion laws date back to the 1930s, and in the intervening decades two parallel systems have developed. Wealthy women could go to a private doctor or, since Roe v. Wade, travel to the United States. But any woman at the mercy of the public health system was pretty much on her own.

Mexico City’s legalization law, which required city hospitals to provide the service free, was the first in Mexico and one of few like it in Latin America (in many states the tide is turning in the other direction: in 2008 Nicaragua instituted a criminal prohibition on abortions, with no exemptions; in 2009 the Dominican Republic did the same). A month later, the National Human Rights Commission, whose director opposed the law, and the attorney general filed appeals with the Supreme Court, arguing that the law was unconstitutional. A long and closely watched debate roiled Mexico off and on for a year, until the justices finally voted to uphold the law, in August 2008. Abortion was now legal—and free—in the capital of one of the world’s most Catholic countries. It looked like a great victory for feminists.

* * *

Up until 2007 there had only been advances on abortion,” Elsa Conde, a former Mexico City legislator and the director of the National Alliance for the Right to Choose, one of the country’s leading abortion rights groups, told me in the summer of 2010. Advocates like Conde had spent decades chipping away at state-level bans. In 2004, for example, they got Baja California Sur to amend its rape exemption so that victims would actually be able to get legal surgeries at public hospitals; the following year the state reduced its maximum penalty to two years in jail. “But then we started seeing setbacks,” Conde went on. “And since October 2008, all we’ve seen is setback after setback after setback.” That year, lawmakers next door, in Baja California, passed a controversial fetal-rights constitutional amendment. While it did not technically change the existing rules—abortion could not become more illegal, after all—it codified one of the key goals of the US Christian right since Roe v. Wade: legally protected life beginning at “the moment of conception.” And an amendment is much harder to overturn than a law. By the end of 2009, fifteen more states had passed versions of this extreme ley anti-aborto.

The amendments were similar to a measure recently defeated in a Mississippi referendum but being prepared in other parts of the United States. In fact, the US “personhood” movement has been taking lessons from its neighbor to the south. In September Mexico’s Supreme Court rejected constitutional challenges to the ley anti-aborto in two states, providing a new spring of confidence for US anti-choicers. “This decision in Mexico provides proof that it is a viable strategy that is working in other places,” said Gualberto Garcia Jones, a legal analyst with Personhood USA. “If it had gone the other way, we would have seen pro-lifers say, If it can’t work in Mexico, it can’t work in the US.” Seventeen Mexican states—more than half the country—now have a fetal-rights amendment on the books. (Chihuahua has had one since 1994, and the seventeenth state, Tamaulipas, approved one in 2010.) This would be like the Mississippi ballot succeeding and then spreading to twenty-five states between now and the end of 2012.

The sweep was so fast and successful that no one had ever seen anything like it. Two of the three main national parties sponsored the amendments—President Felipe Calderón’s National Action Party (PAN) as well as the Institutional Revolutionary Party (PRI). Being anti-abortion was inherent in the PAN agenda, and the party’s state congressmen were strategizing about how to fight Mexico City’s legalization law at national meetings as early as the fall of 2007, according to a legislator who attended. (“Vicente Fox made ‘the Catholic look’ fashionable again,” Roberto Hernandez, a political analyst based in Mexico City, once told me.) The PRI’s participation was more of a departure from that party’s centrist foundations, and not all the rank and file were on board, but the PRI had been badly splintered since losing the presidency to the PAN in 2000, and the party core, perhaps sensing a change in the public mood and determined to take back the presidency in 2012, has supported the ley anti-aborto.

Catholic civic groups had done their part. Jorge Serrano, the skinny, flat-topped director of Pro-Vida, a prominent anti-abortion group based in Mexico City, became a fixture as he choreographed protests against the capital’s legalization law (one day a group of women who had had enough of his crusading showed up to taunt Serrano with a “rainstorm of thongs”—bunches of thong underwear stapled to their placards). The Mexican division of the Knights of Columbus got involved, too, mailing lawmakers plastic fetuses representing the various stages of gestation.

But as far as the feminist movement was concerned, the Catholic Church played the lead role. This was so widely believed, it was taken as fact. I was told more than once, for example, that Norberto Rivera, Mexico City’s archbishop, had hosted a fancy dinner for PAN governors and their wives during which he urged them to pass the ley anti-aborto as he pressed special rosaries from the pope into their hands. A PRI state congresswoman told me she had met a Vatican emissary who was traveling from state to state on a hush-hush lobbying mission. More recently, a bishop from Mexicali spurred the conspiracy mill when he implied that the pope had called the Supreme Court justices to influence their votes to support the ley. (The diocese declined to speak with The Nation.) But, as I learned one morning in the summer of 2010, a concentrated effort like this may not have been necessary.

That day I took a bus from Mexico City to Aguascalientes, a tiny, landlocked state in the heart of the country’s Bible Belt. Monica Delgado, the fresh-faced, preppy PAN congresswoman who drafted the Aguascalientes version of the ley, ushered me into her office in the Congressional building. There were different floors for the different parties, and the PAN floor was decorated with posters for an anti-abortion group called Vifac, whose motto is “We celebrate life.” Delgado explained that, like most PANistas, she was disturbed by the Supreme Court decision upholding Mexico City’s abortion-rights law and wanted to “bulletproof” her state against any progressive incursions. After she had finished drafting the amendment, Delgado said, she and the eight other PAN state lawmakers walked across the plaza to meet the local prelate. It sounded like the beginning of a joke: nine congressmen go to see a priest. But Delgado didn’t see anything funny or strange about the visit. The prelate had been nagging her and her colleagues in his weekly radio address, and the meeting was a “courtesy,” she said. “We had to go over and tell him, ‘It’s already been presented!’” Delgado’s proposal eventually stalled because of resistance from local feminist groups and one liberal PRI congresswoman who controlled a crucial committee. But with priests and politicians this close, it wasn’t hard to imagine the same scene playing to a different outcome in other states, regardless of any organized intervention by high-ranking clergy.

* * *

According to Diego Valadés, a legal scholar at the National Autonomous University of Mexico, state constitutional amendments nearly always take at least a couple of months to be approved. And yet when it came to fetal rights, lawmakers in most states where the ley anti-aborto passed managed to muscle it through in a matter of days. “There has never been anything like it; it was an almost synchronized series of events,” said Valadés. But like any work hastily composed, the ley was imperfect and seemed to place the IUD and in-vitro fertilization—not to mention exceptions to the abortion restrictions that were still on the books in many states—into a legal gray zone. “They say we protect life since conception—except for these causes that we already had,” said Fatima Juarez, a demographics expert at the Colegio de Mexico, in Mexico City. “How can you reconcile ‘We protect since conception’ and ‘You can [terminate a pregnancy] for economic reasons’? It’s illogical.” Now many fear that women who terminate a pregnancy for any reason can be prosecuted for infanticide.

Instead, state prosecutors dusted off the old abortion penal codes—most of which call for prison terms or fines—and opened investigations: ten in Veracruz, thirty in Puebla and thirty-one in Hidalgo. In 2009 in the southern state of Quintana Roo, a Mayan woman was wrongfully jailed for what turned out to be a spontaneous miscarriage, and in 2010 an 11-year-old girl who was raped and impregnated by her stepfather was denied an abortion because she was four months pregnant—one month past the allowable twelve weeks. The cases became a flashpoint in the national debate over abortion and the fairness of the ley, and when I called Elsa Conde again this past August, she described what she said was a mini-backlash to the backlash: four more states had strengthened access to abortion for rape victims. But Conde was quick to add that pro-choice advocates remain in a “position of defense.” “Basically,” she said, “we’re just trying to make sure no other states adopt the ley anti-aborto.”

In May 2009 the ley was approved with a two-thirds majority in Guanajuato. Just nine years earlier, the state congress had voted to eliminate the exemption for rape victims, but the governor was forced to veto it after a public outcry. In 2009 public school teachers staged a bonfire of middle school biology textbooks, and subsequent editions had some noteworthy changes in the chapter on sex: life now begins at the “moment of conception,” and virginity is “a treasure.”

But if one episode cemented Guanajuato’s conservative status, it came in the summer of 2010, when Centro Las Libres, a women’s health group in Guanajuato City, broke the news that seven women were in prison on a charge that amounted to infanticide—homicidio con razón de parentesco, or homicide of a family member—with a maximum penalty of twenty-nine years. Some had already spent more than six years in prison, so their sentences said more about the cruelty of the Mexican criminal justice system than the new ley anti-aborto. But the women became symbols of the dangerous consequences of criminalizing abortion and a focal point for the left in organizing against the ley. All the women said the fetuses they were accused of murdering were stillborn or miscarried. Yolanda Martínez, who says she didn’t even know she was pregnant, was alleged to have left a nearly full-term fetus to die in an outhouse. But police had first arrested her on suspicion of abandoning another infant—not hers, it turned out—found that day in a different part of town. Once she was in custody, her house was searched, and officers emerged with blankets that they claimed had held her dead newborn. Susana Dueñas says three experts declared the baby she was accused of killing a stillbirth, but the judge sided with a fourth opinion, of a doctor on the prosecutor’s payroll. After a media outcry, the state reduced the penalty for the type of homicide they had been charged under—from twenty-nine to eight years. In September 2010 all seven women were released for time served.

* * *

Las Libres is not the only women’s rights group in Guanajuato, but it is the most vocal. It was the unrelenting campaigning of Las Libres that was crucial in getting the seven women released, and when the New York Times ran a story about it, the group’s director, Veronica Cruz, appeared in the accompanying photo, protectively embracing one of the newly released women.

The first time I met Cruz was on an overcast morning in the summer of 2009. Forty years old, with a round face and light brown hair, she has the energy of a longtime activist. She is earnest but cynical. Inside the Las Libres headquarters on the outskirts of Guanajuato City, she introduced me to a petite woman dressed in white named Rosario. She was 20 and had recently completed a nine-month probation sentence. Her story was shocking to me at the time. She had taken abortion pills, fallen ill with nausea, gone to the hospital and been reported to the police. She said the staff had mistreated her, calling her names, completing the abortion surgically without anesthesia (which is standard) and allowing medical students into the room to take pictures with their cellphones. She paused and started to cry. About a month after the surgery, she said, she was lured out of her house in her slippers by men in an unmarked van and taken to jail in handcuffs. Her family borrowed the money to pay the $800 bond.

But it turns out that going to the hospital is a common way for Mexican women to get caught. According to the US-based Guttmacher Institute, a sexual and reproductive health and rights organization, the abortion-related hospitalization rate in Mexico is high—17 percent in 2006 (it is 0.3 percent in the United States). This is because so many abortions are clandestine, exposing women to physical as well as legal risks.

This past June I went back to Guanajuato to see Cruz. I found her curled up in a chair, gossiping with her sister, who helps run the office, and another volunteer. Cruz said that a couple of women had recently been arrested but that she wasn’t following their cases. “Honestly, it’s just too many to keep up with,” she said with a shrug. Daniela Castro’s was one of the last like it that Las Libres had pursued, so she picked up the phone to call her.

Daniela agreed to meet me at a cafe across from a large salmon-hued cathedral in the plaza of a nearby town. She looked carefree and summery in a floral A-line skirt and a fitted white T-shirt. But it was just a year before that Daniela woke up every morning worried that she was going to prison, and her life seemed to be falling apart. “My friends stopped talking to me, and they even wrote messages on my Facebook,” she said. Carlos quit the local university for a cheaper school two hours away so they could afford a private attorney, but he proved as useless as the public defender. For a while, they had no idea what to do. “We were thinking about running away to the United States—like wetbacks,” Daniela said, shaking her head. Las Libres heard about the case and connected Daniela with a group of pro bono lawyers from Mexico City who complained to the state Human Rights Commission. They argued that Daniela’s hospital interview was inadmissible because she hadn’t had a legal representative present. That small oversight seemed to be all that was needed: a few weeks later, Daniela’s case was closed for lack of evidence.

After we talked, Carlos and Daniela offered me a ride to the bus station. Carlos had been quiet most of the afternoon, but he suddenly chimed in as he was driving. “At the time there were all these kidnappings going on, all these people on the street kidnapping and murdering,” he said. “And yet we were the ones they had down at the prosecutor’s office.” Then he fell silent again, edging the truck around a corner.


August 2, 2011, 5:53 pm 

by Ramya Kumar
The absence of safe abortion services in the public sector has obvious implications for both gender and class. First abortion, a health service required only by women, continues to be criminalized and second “safe” abortion services are currently only accessible to women who can afford them in the private sector. With the clamp down on Marie Stopes clinics that had provided abortion services at relatively low cost for more than 20 years, medical abortion has become an alternative that women in Sri Lanka have begun to explore. The drugs used for medical abortion, mifepristone and misoprostol, are reportedly available in private hospitals and pharmacies across the country at exorbitant prices. Both of them are currently unregistered for use in Sri Lanka although misoprostol was recently considered for registration. Their use in Sri Lanka is therefore technically illegal. Further, since Article 303 of the Penal Code states that abortion is permitted only to save a woman’s life, the use of these drugs for medical abortion (except to save a woman’s life) is unlawful in Sri Lanka. Why are these drugs not registered although widely available? And why is there no public debate on abortion law reform in Sri Lanka today?
Swarna: a forgotten statistic
The case of a woman, who I will call Swarna, illustrates some of the social problems associated with unsafe abortion. Swarna was admitted to the Surgical Intensive Care Unit (SICU) of a provincial hospital where I worked as a medical officer. Swarna, a resident of the Uva province, had three children, was poor and could neither read nor write. She had been transferred from a base hospital where she was suspected to have had a reaction to blood transfusion. While family planning services were provided free of charge through the public sector to Swarna, her social situation made her vulnerable to an unintended pregnancy. Criminalized abortion and the fear of law enforcement prevented Swarna from accessing post-abortion care until she was very ill and when she did she strongly denied having had any such intervention. The consultant obstetrician who had seen a similar clinical picture in other women who were admitted after unsafe abortion, decided Swarna should undergo a lifesaving surgical procedure in spite of her denying that she had had an induced abortion. Swarna remained in the SICU for two weeks with multi-organ failure and was lucky to have survived. Swarna and other such women who face the consequences of unsafe abortion are not included in the tally of deaths from unsafe abortion because they survive. When we talk about low mortality from unsafe abortion in Sri Lanka, the stories of Swarna and many others like her are overlooked or forgotten.
Global abortion politics
Abortion is a contentious issue globally. Intergovernmental organizations like the United Nations and the World Health Organization (WHO) are restricted in their dealings with the issue due to strong pro-life lobbies in powerful countries like the United States that impose funding restrictions on providing abortion services. The International Conference on Population and Development Programme of Action (1994) that was endorsed by Sri Lanka and many other countries incorporated a rights perspective on population issues including reproductive health. Although it was considered a watershed for reproductive rights, this document did not address abortion in any significant way. While its focus is on the prevention of unintended pregnancies and implementation of post-abortion care, it states that safe abortion services should be provided in countries where abortion is not against the law. This leaves women in countries like Sri Lanka, where abortion laws are very restrictive, with limited options.
Situation in Sri Lanka
Sri Lanka is doing extremely well in terms of maternal health. We have been able to achieve reductions in maternal mortality without addressing unsafe abortion. In fact our maternal mortality rate is the lowest in the South Asian region. Research shows that there is a high prevalence of abortion (a 1998 estimate suggests 650 abortions per day) and that most women resort to abortion to limit or space their families. In 2006, unsafe abortion became the second highest cause of maternal mortality in the country. While unsafe abortion was identified to be a problem on a review on maternal mortality published by the Ministry of Healthcare and Nutrition in 2009, the strategies they recommended included improving access to family planning and improving post-abortion care. There was no recommended strategy for abortion law reform. It is perhaps surprising that a government that shows much commitment to providing healthcare would leave unsafe abortion off the health agenda. Why does abortion law reform remain on the backburner? And could the potential use of misoprostol for medical abortion have influenced the recent decision on misoprostol registration?
Medical abortion and misoprostol
The WHO recommended regime for medical abortion includes two medications: mifepristone and misoprostol. While the combined regime has a success rate of over 95% in the first 9 weeks of gestation, misoprostol has been used alone for medical abortion in many settings with success rates roughly between 85 and 90%. Although less effective, it is used alone for medical abortion because it is cheaper and also because in many countries misoprostol is registered and freely available while mifepristone is not. The WHO does not recommend misoprostol alone regimens for medical abortion claiming the evidence for such a recommendation is inadequate.
Misoprostol is listed in the WHO Essential Medicines List (EML) for many indications. In 2005, misoprostol was listed for labour induction and with mifepristone for medical abortion, where legal and culturally acceptable (other drugs on the WHO EML do not include notes on cultural acceptability). In 2009, the EML listed misoprostol for incomplete abortion and this year in May for post-partum hemorrhage. Since misoprostol was initially developed for the treatment and prevention of gastric ulcers in 1988, it had been registered without controversy in many countries before its use for medical abortion was discovered. Therefore, today it is widely used by women for abortion in countries where it is registered but abortion laws restrictive. Such use without access to information could result in incorrect dosing with adverse consequences such as increasing rates of incomplete abortion and the occurrence of birth defects in fetuses that are not aborted.
Registration of misoprostol in Sri Lanka
Why was misoprostol, a drug with several obstetric indications, not registered in Sri Lanka? In my study, I focused on the misoprostol policy because it is the only policy related to abortion currently under review. Ten medically qualified experts engaged in women’s health policymaking and four women’s rights advocates with expertise in the social sciences and law were interviewed for this study.
Misoprostol (and mifepristone) is available although unregistered in Sri Lanka and is being widely used in the private sector. An application to register misoprostol was submitted to the National Drug Regulatory Authority (NDRA) by a pharmaceutical company in 2010. The decision to approve a drug for registration lies with the Drugs Evaluation Subcommittee of the National Drug Regulation Authority (NDRA) which consists of medical specialists from various fields and pharmacists. The misoprostol situation was described by one participant to be “tricky” because obstetricians have access to the drug through representatives of pharmaceutical companies who supply the drug to them directly. The drug is also believed to be smuggled into the country from India and Pakistan in “suitcases”. The NDRA wished to register the drug for regulatory purposes and quality assurance because it was known to be widely available in the country. The obstetricians probably wanted it registered so that they could use it legally in their obstetric practice.
The NDRA sought the opinion of the Sri Lanka College of Obstetricians and Gynaecologists (SLCOG) on registering misoprostol due to a conflict of opinion within the Drugs Evaluation Subcommittee. In November 2010, the SLCOG recommended misoprostol be registered with restrictions to be used only in the public sector. However, when the Drugs Evaluation Subcommittee met a month later, they could not reach a consensus on registration due to opposition from within the subcommittee. While complications of misoprostol (specifically maternal deaths from using misoprostol for labour induction) had been discussed at the meeting, the potential for using misoprostol for medical abortion had not come up for discussion. Eventually it was decided to keep the decision pending and the decision is still pending today.
Implications on health policymaking
The policy decision on misoprostol appears to have been a result of an undemocratic process based on obscure social values held by a few members of the Drugs Evaluation Subcommittee at the NDRA. Under these circumstances, it seems unlikely that misoprostol will be registered anytime soon.
It would be unfair to say that this policy making process exemplifies health policymaking in general in Sri Lanka. The controversial nature of this drug is likely to have influenced the process. But note that this was a closed process with little input from nonmedical experts. Even the recommendation of the SLCOG, the professional body of obstetricians and gynaecologists in the country, was overlooked. There was no contribution from women’s advocacy groups to the decision making process. Many policymakers in the sample believed that the policy decision on misoprostol was influenced by its possible use for medical abortion.
I would argue that the reason misoprostol registration became controversial in Sri Lanka was because both the NDRA and the SLCOG wished to register the drug for different reasons. Health policymaking is controlled by the Ministry of Health; the public has little access to information on who and how these decisions are made.
Implications for abortion policy
The Ministry of Health’s strategy to address unsafe abortion focuses on preventing unintended pregnancies and providing post-abortion care (PAC). Arguably, this narrow focus may be justified given the restrictive abortion legislation in Sri Lanka. Under these circumstances, one would expect a dynamic family planning programme and accessible sexual and reproductive health education and services. One would also anticipate the institution of effective PAC. However there is no evidence to show that this is happening.
Participants expressed concerns about contraceptive services targeting only married women and the absence of a state sponsored comprehensive sexual and reproductive health education program for adolescents. There is in fact a complete silence on sexual health in existing policy documents. Further, participants expressed concerns about the inadequacy of existing PAC services and the stigma and discrimination experienced by women who seek PAC. The interviews also demonstrated gaps in research on unsafe abortion, specifically current prevalence and groups most vulnerable to the problem. Significantly, Ministry of Health has not taken an official position on the need for abortion law reform in their policy documents. To compound the situation, in 2007 the government closed down clinics that were providing abortion services or “menstrual regulation” to a less well-off clientele while turning a blind eye on less affordable abortion services provided in private hospitals. All this suggests that addressing unsafe abortion even within the existing legal framework has not been prioritized in state policy. Addressing issues of health equity and gender/class based discrimination are clearly not on the health agenda.
Given this situation, leaving unsafe abortion to be addressed as a policy level debate restricted to the Ministry of Health is unlikely to be effective. The issue of unsafe abortion will not be addressed unless the debate becomes far more broad based than it is now. We need to advocate abortion law reform and the registration of abortion medicines now instead of reinforcing the silence by pretending that abortion does not take place in Sri Lanka. In reality women will access abortion services if they need them whether we like it or not. Decriminalization and registration will only make existing services cheaper and safer.
Ramya Kumar, MBBS is a graduate student in Public Health. This article is based on a presentation she made at the International Centre for Ethnic Studies, Colombo on July 13, 2011.

Polands Health Minister threatend its citizen with a registration once but now it is becoming reality in Brazil: A compulsory registration of all pregnant women will make it easy to track down women who illegally abort.

by Beatriz Galli

January 6, 2012 – 10:46pm (Print)Donate!

In the dead of night on December 27, Brazilian President Dilma Rousseff enacted legislation that will require all pregnancies to be registered with the government. Provisionary Measure 557 (PM 557) created the National System of Registration, Vigilance and Monitoring Women’s Care during Pregnancy and Post Childbirth for the Prevention of Maternal Mortality (National Registration System).

She used a provisionary measure—intended only for urgent matters—that allows the president to pass a law without congressional approval. Congress only gets to debate and approve the law once it has been enacted. Rousseff claims that PM 557 will address Brazil’s high rates of maternal mortality by ensuring better access, coverage and quality of maternal health care, notably for high-risk pregnancies. Both public and private health providers must report all pregnancies—providing women’s names—with the National Registration System so the state can then track these pregnancies, from prenatal to postpartum care, presumably to evaluate and monitor health care provided.

How does simply monitoring pregnancies reduce maternal mortality? There is no guarantee that care will be available to all pregnant women and no investment in improving health services included in the legislation.

And what’s the benefit to women? PM 557 does authorize the federal government to provide financial support up to R$50.00 (roughly US$27) for registered pregnant women for their transportation to health facilities for pre-natal and delivery care. However, to receive the stipend women must comply with specific conditions set by the state related to pre-natal care. Let’s face it, that paltry sum may not even cover the roundtrip for one appointment depending on where a woman lives.

In fact, PM 557 does not guarantee access to health exams, timely diagnosis, providers trained in obstetric emergency care, or immediate transfers to better facilities. So while the legislation guarantees R$50.00 for transportation, it will not even ensure a pregnant woman will find a vacant bed when she is ready to give birth. And worse yet, it won’t minimize her risk of death during the process.

The biggest problem with maternal mortality in Brazil is not access to health-care services but rather the quality of health care in public health facilities. The majority of preventable maternal deaths actually take place in public hospitals, disproportionately affecting poor women, women who live in rural areas, youth and minorities.
Last but certainly not least, MP 557 violates all women’s right to privacy by creating compulsory registration to control and monitor her reproductive life. In fact, it places the rights of the fetus over the woman, effectively denying her reproductive autonomy. A woman will now be legally “obligated” to have all the children she conceives and she will be monitored by the State for this purpose.

It’s unclear why Rousseff sought to enact this legislation so quickly and with so little opportunity for debate or public opinion. What is clear though is that women’s real interests and health needs are not the focus here—just their uteruses.

Good news to start the new year

Uruguay’s senate passed a bill Tuesday to legalize abortion in the first 12 weeks of pregnancy.

December 28, 2011 07:17

Anti-abortion activists protest outside the Uruguayan Congress building in Montevideo on Dec. 27, 2011. (Daniel Caselli/AFP/Getty Images)

Uruguay’s senate has passed a bill to legalize abortion in the first 12 weeks of pregnancy.

Currently, abortion is legal only in cases of rape or when the woman’s life is at risk, and both women who have an abortion and those who assist them face prison.

Yet on Tuesday senators voted by 17 to 14 in favor of legislation to decriminalize abortion in the first trimester.

According to Reuters, the debate lasted 10 hours and saw heated discussion between supporters and opponents of the bill.

Senator Monica Xavier, a member of the ruling left-wing coalition, told her colleagues, “We’re not moral censors, we’re congressmen:”

“We don’t have the right to pass moral judgment by saying that the woman who continues her pregnancy and has her baby is in the right whereas the one who doesn’t, for whatever reason, is in the wrong.”

Opposition senator Alfredo Solari argued that the bill discriminated against men, by leaving “the decision to end a pregnancy with the woman alone.”

The bill will next go to the lower house. Both houses are controlled by allies of President José Mujica, who according to the BBC has signaled he plans to approve the bill.

His predecessor, Tabaré Vázquez, in 2008 vetoed an attempt to make abortion legal on the grounds that it violated the right to life. However, the latest opinion polls indicate that most Uruguayans support greater access to abortion, the BBC said.

If the bill passes, it will reverse the ban on abortion that has been in place in Uruguay since 1938, and make the country one of the few in Latin America to allow the practice without restriction.

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