Abortion Access in Latin Migration Routes

At Ipas Central America and Mexico (CAM) we work to ensure that women and all people who can get pregnant have the correct information, feel supported in their decisions, and have the confidence to access safe abortion and contraceptive services when they need them. Our approach starts by centering on the individual, with the goal of achieving a better understanding of the complexity of the environment in which people make abortion decisions—or, as we call it, the abortion ecosystem. We are working toward the sustainability of the abortion ecosystem, a “dynamic condition in which resilient local stakeholders and systems are actively accountable and committed to abortion rights and responsive to everyone’s abortion needs.”

During the COVID-19 pandemic, the health, safety, and well-being of many people were threatened by the effects of the public health and economic crises that disproportionately affect women, especially those from historically underserved groups. Ipas CAM strengthened our efforts to respond directly to women’s needs during the pandemic, defend human rights, and support access to safe reproductive health care in a timely manner. Despite a significant reduction in sexual and reproductive health services reported in 2020, Ipas-supported health facilities provided 25,724 abortions and 46,837 contraceptive care methods. The abortion accompaniment networks we work with supported 498 women to self-manage their abortions with pills. To achieve these results, we targeted our actions using the eight components of the sustainable abortion ecosystem so that all people can make informed decisions and access abortion care that meets their needs. Some of our key results are as follows:

• We shared information with more than 40 million people on Facebook and 59,000 people on Instagram.
• Our posts on Twitter received almost 1,700,000 impressions.
• We increased online support to women seeking abortion information and accompaniment, from 129 in 2019 to 1,489 in 2020, and we responded to 402 women seeking information on sexual health and violence. We launched a new video on safe abortion with pills with Spanish and English voiceover and subtitles that describes how to terminate a pregnancy using misoprostol.
• The YouTube video surpassed one million views organically and received over 9,500 comments in just seven months. We shared the video with 9,968 people during a webinar with safe2choose, Hablemos de Sexo y Amor, and Hesperian Health Guides. Our participation in 141 media interviews was shared with 1,455,911 people.
• We trained and supported 46 members of nine safe abortion accompaniment networks from El Salvador, Guatemala, Honduras, Mexico, and Nicaragua.
• We provided grants and technical assistance to 48 grassroots organizations with 9,269 members in El Salvador, Guatemala, Honduras, Mexico, and Nicaragua. Through media outreach activities, organizations share information on sexual and reproductive health and rights with 1,088,228 people. Another 14,658 people were reached through workshops, meetings, and public events.
• Ipas CAM provided support to 10 grantees to develop 18 educational materials for community dissemination. To respond to COVID-19, we helped design and distribute face masks, bags, t-shirts, cups, and bottles of hand sanitizer with messages on sexual and reproductive rights.

Links:

• https://www.ipas.org/
• https://abortoenmipais.ipascam.org/
• https://ipascam.org/

I want to start this report by thanking you for your commitment and support to reproductive rights in Central America and Mexico. At Ipas CAM, we are grateful for you and know that we can count on you to advance our agenda in the region. This year has been extremely challenging but also exciting and your support through GlobalGiving has helped us to keep the hard work going even in these times of uncertainty. Below, you will find some updates from our work.

Mexican Supreme Court ruled in favor of decriminalizing abortion and more states passed legislation to make abortion legal and safe.

The recent months have been extremely intense on the sexual and reproductive rights agenda in Mexico. The Mexican Supreme Court ruled anti-constitutional the criminalization of women, medical staff, and anyone who supports women getting a voluntary abortion, opening the way for all Mexican states to follow the steps of Mexico City, Oaxaca, and Hidalgo. In the past six months the states of Veracruz, Baja California and Colima had decriminalize abortion and more than ten states Congress are analyzing bills on this issue.

On September 7, the Mexican Supreme Court unanimously ruled that it is unconstitutional to criminalize abortion. The Court declared the invalidity of Article 196 of the Penal Code of Coahuila, which established a prison sentence for a woman who voluntarily performs an abortion or anyone who helps her have an abortion. From now on, when deciding future cases, Mexican judges will have to consider as unconstitutional the penal norms of the states that criminalize abortion in an absolute manner.

During the same week, the Court invalidated an article of the Sinaloa State Constitution, which established the protection of the right to life from the moment of conception, declaring that the State Congress’s do not have the power to create legal personhood.

Finally, in the same month, the Court also declared invalid the conscientious objection article of the General Health Law and asked Congress to review it as it was a "blank check" for health care providers to deny abortion services. Congress must now review the article to limit conscientious objection and ensure that it is not a barrier to access to safe and legal abortion services.

The decisions of the Court sent a clear message to state legislators on the importance of decriminalizing abortion. On December 1st the congress of Colima approved reforms to the Penal Code of the State, which decriminalize voluntary abortion in the first twelve weeks of gestation and expand the circumstances under which abortion is legal with two exceptions, on top of the ones that already exist in the State:

• When the authority had previously denied the legal abortion service within the first twelve weeks of gestation.
• When during the provision of the service, the medical or nursing personnel had omitted to correctly and timely inform the pregnant woman of her right to terminate her pregnancy legally and safely within the first twelve weeks of gestation.

The reforms also reduce the penalties for pregnant women who consent to abortion after twelve weeks of gestation and increase the penalty for the crime of forced abortion.

In addition, amendments to the State Health Law were approved to include a chapter on the provision of pregnancy termination services, to consider sexual and reproductive health and family planning as a priority, and to ensure the provision of abortion services in the event of conscientious objection by medical personnel. Colima thus becomes the sixth state to recognize women's autonomy to decide whether to terminate a pregnancy in the first twelve weeks of gestation.

Inter-American Court rules in favor of Manuela a woman who was unfairly incarcerated under the El Salvador abortion law

The Inter-American Court has ruled in the case of Manuela and family members v. El Salvador for criminalizing women's access to emergency obstetric services and forcing health professionals to denounce women who seek care.

In the judgment, the Court recognizes that "...the ambiguity of medical professional secrecy [in Salvadoran law] ... implies that health personnel, to avoid being sanctioned, denounce women suspected of having committed the crime of abortion." At the same time, it recognizes that the confidentiality of medical records and the exceptionality of their disclosure are not sufficiently regulated in the country. It, therefore, recommends that the state adopt, within no more than two years from the notification of the judgment, clear regulations on the scope of medical professional secrecy, the protection of medical records and their exceptions to disclosure, following the standards developed in the decision, establishing that:

• Medical and health personnel do not have an obligation to denounce women who have received medical care for possible abortions.
• Health personnel must maintain professional secrecy in these cases in the face of questioning by the authorities.
• Failure to report by medical or health personnel should not result in administrative, criminal, or any other type of sanction.

On the other hand, the Court recognized that Manuela suffered an obstetric emergency caused by pre-eclampsia due to health conditions before pregnancy that the health system in El Salvador failed to detect in time.

As a result of the actions of medical personnel, authorities, and the state in general, the Court recognizes that Manuela's human rights were violated, especially her right to life, to health, to judicial protection and guarantees, and to be free from discrimination and gender-based violence, among others.

Ipas Central America and Mexico collaborated with petitioning organizations by participating as an expert witness during the trial. During the hearings, Guillermo Ortiz, Ipas Global Medical Advisor, stated that based on scientific evidence, Manuela suffered an obstetric emergency due to her deteriorated state of health and the lack of timely medical attention. He also recalled as standard practice the denunciation by health personnel of any woman who comes to seek obstetric care as a possible commission of a crime, under threat of severe sanctions if she does not do so.

We applaud the work of the Center for Reproductive Rights and the Feminist Collective for Local Development, which with the support of the Citizens' Group for the Decriminalization of Abortion in El Salvador, have achieved #JusticeForManuela and her family. This case will be paramount to the defense and promotion of reproductive rights in the region.