Sunday, April 09, 2006

The Women of El Salvador

Today's New York Times Magazine has a 9-page story, "Pro-Life Nation," profiling El Salvador's complete ban on abortion, its historical and religious roots, and the effect on the nation's women, as well as one woman under investigation. According to the story, El Salvador's ban (which allows no exceptions, even for the life of the mother) became law in 1998, following the end of a civil war and the appointment of a new archbishop who strongly supported the legislation. A few notable excerpts of the story:

"Today, Article 1 of El Salvador's constitution declares that the prime directive of government is to protect life from the 'very moment of conception.' The penal code detailing the Crimes Against the Life of Human Beings in the First Stages of Development provides stiff penalties: the abortion provider, whether a medical doctor or a back-alley practitioner, faces 6 to 12 years in prison. The woman herself can get 2 to 8 years. Anyone who helps her can get 2 to 5 years. Additionally, judges have ruled that if the fetus was viable, a charge of aggravated homicide can be brought, and the penalty for the woman can be 30 to 50 years in prison."

Other folks have posed the question of whether women would be treated as criminals under U.S. abortion bans, with mostly mixed or uncertain responses. El Salvador does criminalize the woman, although they are often allowed to avoid jail time if they name the person who probided the abortion. As for the frequency of prosecutions, "In 2004, the most recent year for which any statistics are available, there were 93 investigations of people associated with a clandestine abortion. In 2003, there were 111 investigations; in 2002, there were 85. (El Salvador's population is 6.5 million, roughly that of Massachusetts.)" The NYT Magazine story goes on to discuss ways that hospital clinicians will try to avoid turning in women, clinicians who feel it is their duty to report, and women who turn up at emergency rooms and claim to have attempted suicide or have had a miscarriage in order to attempt to avoid prosecution. When a hospital detects a possible abortion, the authorities are called and the woman is detained, in some cases handcuffed to the hospital bed. Based on the next snippet, Salvadoran women may be at higher risk for prosecution (through exposure to less discreet and less skilled providers) if they have fewer economic resources.

"Abortion as it exists in El Salvador today tends to operate on three levels. The well-off retain the 'right to choose' that comes of simply having money. They can fly to Miami for an abortion, or visit the private office of a discreet and well-compensated doctor. Among the very poor, you can still find the back-alley world described by D.C. and the others who turn up in hospitals with damaged or lacerated wombs. Then there are the women in the middle; they often rely on home-brewed cures that are shared on the Internet or on a new underground railroad that has formed to aid them."

Some Salvadoran women have begun buying misoprostol and using it vaginally in order to medically abort. Says the article, "The consensus was that more and more women were learning about misoprostol. In El Salvador, misoprostol is sold under the name Cytotec. Type that word alongside "abortion" into Google, and it becomes apparent that the old back alley of witch doctors with coat hangers could be deserted soon, replaced by online dealers peddling ulcer drugs." (try the search)

Related to this, the story reports, "For the most part, the new law has not resulted in a spike in horror stories of painful and botched clandestine procedures."

Regarding the process of enforcement: "During the first round of investigations, police officers interview the woman's family and friends... As they do in any investigation, the police collect evidence by interviewing everyone who knows the accused and by seizing her medical records. But they must also visit the scene of the crime, which, following the logic of the law, often means the woman's vagina...'Yes, we sometimes call doctors from the Forensic Institute to do a pelvic exam,' Tópez said, referring to the nation's main forensic lab... In the event that the woman's illegal abortion went badly and the doctors have to perform a hysterectomy, then the uterus is sent to the Forensic Institute, where the government's doctors analyze it and retain custody of her uterus as evidence against her."

In some cases, the abortion law interferes with the emergency medical care of women: "A policy that criminalizes all abortions has a flip side. It appears to mandate that the full force of the medical team must tend toward saving the fetus under any circumstances. This notion can lead to some dangerous practices. Consider an ectopic pregnancy, a condition that occurs when a microscopic fertilized egg moves down the fallopian tube — which is no bigger around than a pencil — and gets stuck there (or sometimes in the abdomen). Unattended, the stuck fetus grows until the organ containing it ruptures. A simple operation can remove the fetus before the organ bursts. After a rupture, though, the situation can turn into a medical emergency. According to Sara Valdés, the director of the Hospital de Maternidad, women coming to her hospital with ectopic pregnancies cannot be operated on until fetal death or a rupture of the fallopian tube."

So I ask, is this how things will play out in the United States? Is there a tolerance for criminalizing women (rather than solely providers) that would lead to handcuffing hospitalized women and jailing those who obtain abortions? Are U.S. voters willing to tolerate bans that do not leave any exceptions for the woman's health? Has anyone considered the secondary effects of such a ban, when women are delayed in receipt of life-saving treatments in favor of the nonviable fetus (such as in ectopic pregnancies or serious congenital defects)?

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MeSH Tags: Abortion/legislation and jurisprudence; Abortion, Criminal; El Salvador


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