Abortion in Latin America illegal, risky - but not rare

Chicago Tribune

(MCT)

SALVADOR, Brazil - Abortion is mostly illegal in Brazil, but you would not know it from the numbers.

Every year an estimated 1.4 million Brazilian girls and women take the law into their hands, and often put their health at risk, to terminate their pregnancies. This gives Brazil an abortion rate much higher than that of the United States, even though one country allows the procedure and the other all but bans it.

Illegal abortion has become a fact of life, and not just in Brazil. Across much of Latin America, even as judges, legislators and activists debate whether abortion laws should be tightened or loosened, millions of women are finding clandestine ways to end their unwanted pregnancies.

For Brazilians such as Marta Leiro, the question is not whether to break the law but how.

There are strong teas and herbal mixes designed to cause miscarriage. There are potent prescription medicines, purchased illegally but easily found.

There are private clinics with willing, if expensive, doctors. And then, if absolutely necessary, there is someone around the corner, around some corner in most Brazilian communities, who will put the girl or woman up on a table and end her pregnancy.

"My first choice was a safe abortion, an abortion done in a special clinic," said Leiro, a 38-year-old community activist and mother of two who was jobless when she became pregnant in September 2004.

"But I was in no condition to pay," she said. "And so I chose this other method, the one that's used the most. And I did it while terrified of dying."

Leiro lives in Salvador, the biggest city in the poorest region of Brazil, and a place believed to have one of the highest abortion rates in the country.

Though no official figures exist, a recent survey indicated that 1 in 5 women under age 20 in Salvador has had an abortion.

Internationally, Brazil's estimated national abortion rate puts it above the United States, which is in the middle of the pack, but below the world leaders in abortion, which are dominated by the countries of the former Soviet Union and their former allies in Eastern Europe.

The vast majority of Brazil's abortions are illegal, as they are almost everywhere in Latin America except Cuba.

Abortion-rights activists are trying to change that, with advertising campaigns, lobbying efforts and court challenges from Mexico City down to Santiago, Chile. They held events marking Latin American and Caribbean Day for the Decriminalization of Abortion on Sept. 28, part of a strategy to focus on abortion as a leading cause of maternal death, especially for young and poor women.

In an article released last week in the medical journal The Lancet, a group of public health experts and obstetricians estimates that worldwide about eight women die every hour from complications of unsafe abortion.

Abortion-rights activists argue that the laws fail to stop abortion: The United Nations estimates the number of abortions at 4 million a year across Latin America, despite some of the severest restrictions in the world.

The activists have had some success: In May, a top court in Colombia made abortion legal in cases of rape or other limited circumstances.

But abortion opponents also have scored victories. Last month, Nicaragua's congress voted to strip away all exceptions to the country's abortion law. If signed into law by the president, the measure would make all abortions punishable by prison, even those designed to save the woman's life.

"Abortion has always been an issue here. It just hibernates from time to time," said Jacqueline Pitanguy, a Rio de Janeiro sociologist who runs a group called Citizenship Rights, Information and Action.

Pitanguy said certain incidents, such as the arrest of a woman or a court challenge, can re-ignite the debate. But little changes.

"We take two steps ahead and two steps back," Pitanguy said. "We just do not move here."

Religious groups opposed to abortion, from traditional powers such as the Roman Catholic Church to growing forces such as Latin America's evangelical churches, wield considerable influence in Brazil and the rest of the region.

Even nations that have elected leftist politicians, such as Brazil and Bolivia, remain socially conservative. Abortion opponents say the strict laws reflect the wishes and the values of the people.

"The right to life is inviolable," said Geraldo Cardinal Majella Agnelo of the National Conference of Bishops of Brazil.

"It is necessary to reaffirm the ethical principle of respect for the dignity of human life, no matter in what stage of development or in what condition that life is found," Agnelo said.

Maria Helena Souza, who heads a newly created department in the Salvador city government dedicated to women's issues, says surveys show that Brazilian voters want abortion laws relaxed.

A pregnancy can be terminated legally in Brazil only if it was caused by rape or incest or if it threatens the woman's life. Souza and others are backing a law that would lift criminal penalties, including possible prison terms, for other women who undergo abortions.

"We are building up our strength in Congress, and the long-term goal is to legalize abortion," Souza said. "But that is not going to happen today or next week. We don't have enough votes."

Despite the strict laws and potential prison terms, hundreds of thousands of women in Brazil end their pregnancies each year, sometimes at great risk.

Catholics for the Right to Choose, a group working to have abortion de-criminalized, estimates that each year in Brazil 250,000 women suffer health complications from secret abortions. Across Latin America, abortion-rights groups attribute 10,000 deaths a year to unsafe abortion.

The favored method for that in Brazil is to do what Leiro did. Take pills.

Leiro used a drug for treating ulcers that some obstetricians use to induce labor. An abortion in a private clinic would have cost at least $1,000. The pills cost her $120 for eight.

Leiro swallowed some and inserted others in her cervix. And then she waited.

"It's a lot of pain," said Leiro, who was three months pregnant. "It's like the contractions of giving birth."

Among her other community activities, Leiro now runs a support group for women who have gone through abortion. She knows she was lucky her health did not suffer.

Many women who go through secret abortions suffer severe complications. And some of them end up in the Institute of Perinatology of Bahia, a maternity hospital that is also the lone clinic in Salvador that legally performs abortions.

Among the potential problems: cardiac trouble, hemorrhaging and infections, said Eliana de Paula Santos, the hospital director.

"Sometimes part of the fetus remains in the uterus," Paula Santos said. "So she will keep bleeding, because the body wants to eliminate the placenta. Or after some time an infection will occur."

Hospital figures show that nearly 100 times as many women are admitted for complications from clandestine abortions as women who are provided legal abortions.

Paula Santos said there is no way to estimate how many women undergo secret abortions, in part because the medicines used to cause the abortions are often contraband brought in from Paraguay.

"Abortion is an important problem that we cannot sweep under the rug," Paula Santos said.

"I see a lot of hypocrisy in the discussion because at times a person will have an individual position in favor of abortion, for oneself, or for a friend, or for a daughter.

"But as a leader, that person is distant and opposes abortion, alleging religious or moral questions," she said. "Because that was the dominant position for so long, it's necessary to promote a debate, a discussion, with all sectors of the population. We have to bring this to light."

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(c) 2006, Chicago Tribune. Distributed by Mclatchy-Tribune News Service.