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Beatriz was just 21 years old with a nine-month-old son and a lot of financial difficulties when she was diagnosed with lupus. A year later, in March 2013, she found out in the emergency room of a Salvadoran hospital that she was pregnant for the second time. When the first ultrasounds were performed, up to 15 doctors recommended an abortion because the fetus was growing without a skull or brain and the pregnancy would further weaken her delicate health. If she reached labour, she would not survive. But in one of the five Latin American and Caribbean countries where abortion is banned under all circumstances, the woman found it very difficult to terminate the life-threatening pregnancy. In El Salvador, despite all the warnings, everyone has turned their backs on Beatriz: the state, health workers and the judiciary. And although the inter-American judiciary finally intervened, it was already too late. The result was irreparable: the preventable deaths of a young woman, a ten-year-old orphan boy, and a life-changing family. However, the legislation remains in place.
The Salvadoran Constitution does not allow the termination of pregnancy under any circumstances, since life begins at conception. According to the penal code of this country, women who abort voluntarily or involuntarily are murderers. “Mataniños” are what they call those accused of abortion on the streets and in prison, including women who have suffered obstetric emergencies. The sentences are 50 years for them and 12 years for the doctors who help them. “In the case of Justice,” Humberto, Beatriz’s brother, murmurs over the phone, “they just put the life of the fetus before that of my sister.”
Despite the total ban, Beatrice’s story touched part of a country that for decades fought for the sexual and reproductive rights of half the population. In 2013, her case reached the Inter-American Human Rights System through attorneys from the Citizen Association for the Decriminalization of Therapeutic Abortion of El Salvador, the Center for Justice and International Law (CEJIL), Ipas, and the Feminist Collective. The Inter-American Court of Human Rights (IACHR Court) compelled the state to facilitate her abortion. Beatriz managed to terminate her pregnancy 81 days after being told, but her body couldn’t withstand the disease she was already suffering from, which doctors said was made worse by the pregnancy. On October 8, 2017, the woman died after a minor traffic accident due to her extremely weak physical condition.
“I hope my example will help other women not go through what I suffered,” Beatriz wrote in a letter in mid-2013. Your wish could come true this Wednesday. The Inter-American Court of Justice will hold the first hearing in a historic case: Beatriz v. El Salvador, in which the region’s highest judicial body discusses for the first time the serious implications of the outright criminalization of abortion in the Central American country. The verdict could break one of the most restrictive laws in the world and set a precedent for the other four Latin American countries that still condemn women for abortion: Nicaragua, the Dominican Republic, Haiti and Honduras.
“In Central America we are witnessing a decline in women’s human rights. The resurgence of conservatism and authoritarianism means an enormous loss of rights. And the first to fall are always ours,” Claudia Paz y Paz, former attorney general of Guatemala and current director of the CEJIL program for Central America and Mexico, said in a statement to América Futura. “We are facing a crucial moment for the validity of our rights.”
Her story is the latest in a long line of women who have also taken on Goliath. Manuela in El Salvador, Esperancita in the Dominican Republic, Amelia in Nicaragua or Ana and Aurora in Costa Rica. They all lost their lives or sanity due to draconian laws preventing them from making decisions about their bodies. The Inter-American Court has in its hands the history of many like her.
These are their cases:
“The state failed him”
Manuela, El Salvador. He died in prison at the age of 33.
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Manuela died in prison on April 30, 2010. Two years earlier she had been sentenced to 30 years in prison for aggravated manslaughter. The crime she was accused of: being the victim of an obstetric emergency in the latrine of her modest home in rural El Salvador. The applicant, the doctor she was seeking help from, explained that she had arranged for the abortion herself to conceal infidelity. His case was brought before the Inter-American Court of Justice, which issued a historic verdict. “The court notes that obstetric emergencies, because they are a medical condition, cannot automatically give rise to a criminal sanction,” the court said. Although the ruling did not have the right to abortion at the heart of the debate, it did focus on the persecution women suffer, even when they suffer one involuntarily. This is how the shielding of the absolute penalty in the region began to crumble.
From the doctor’s decision, all violated Manuela’s rights. Medical professional secrecy was ignored, a police interrogation was prioritized despite convalescence, she was handcuffed to the stretcher for several days, the parents – who, like Manuela, could neither read nor write – were asked to sign a testimony against their daughter, the police and lawyers who went to the hospital called her a “light woman”…
“The entire state aid chain has failed him. Also, her trial was riddled with gender stereotypes,” said Fernanda Vanegas, associate director of advocacy and external relations at the Center for Reproductive Rights, the trial team on the case. The 2021 Inter-American Court ruling ordered regulation of medical professional secrecy, development of a protocol for attending to obstetric emergencies, training of health workers, and establishment of a comprehensive training curriculum. A year later, El Salvador only “timidly” implemented the first two points. “The protocols are not perfect, but they are, they already exist. There are other considerations as to how widespread they are, but they are subject to other pending actions.”
Another major milestone in the litigation was that the court recognized that the trials were biased by the fact that Manuela was a woman. Therefore, the Inter-American Court urged that judges be trained to get rid of these gender stereotypes “which judges and prosecutors tend to create what they see as appropriate behavior for women”.
The Civic Association for the Decriminalization of Therapeutic Abortion has identified at least another 140 women as victims of obstetric emergency persecution over the past 20 years. Rosita was the last to be released from prison on a similar case, also the result of a rape. Six other women remain behind bars.
“You put the life of a fetus above that of my daughter”
Esperancita, Dominican Republic. He died at the age of 16.
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For 11 years, Mrs. Rosa has gotten up and gone to bed, feeling the weight of the other side of the empty bed. On July 2, 2012, Rosaura Almonte Hernández, known as “Esperancita,” went to the doctor because of a high fever and received two diagnoses: seven weeks pregnant and “a serious blood problem.” Weeks later, they discovered it was acute lymphoblastic leukemia. She urgently needed chemotherapy, but was refused because her treatment was incompatible with the life of the fetus. On August 17, 46 days after her hospitalization, she suffered a miscarriage and respiratory failure that ended her life. “You are putting the life of a fetus above that of my daughter. My daughter was killed. The Dominican State killed her,” says Doña Rosa, who lost her only daughter, via video call.
Esperancita’s case went around the world, highlighting the situation in a country that does not guarantee women sexual and reproductive rights. Almost two months ago, the reform of the penal code once again left behind one of the key social demands of the Caribbean country: that abortion should be allowed if the life of the mother is in danger, the fetus has a condition that is incompatible with life, or if the pregnancy is the result of rape or incest; which is known by the three causes. However, it continued as it was written 139 years ago: calling those who terminate pregnancy murderers.
“When abortion is punished, it is difficult to know exactly stories like Esperancita’s. As women are forced to resort to unsafe abortions outside of the health care system, there is tremendous underreporting. Many die or have health complications and we don’t find out,” said Marcia Aguiluz, legal director for Latin America at Women’s Link Worldwide. “It is necessary that we discuss access to voluntary abortion on the basis of evidence, not opinion,” he notes.
Doña Rosa filed two lawsuits in the Dominican Republic: a criminal complaint for medical negligence and another in an administrative dispute to assert the Ministry of Health’s responsibility for inadequately regulating the hospital where Esperancita was treated and ensuring the care she needed explain. The first lawsuit has gone unpunished and the last case is awaiting trial in the Supreme Court after two initial dismissals. In addition, the case was recently admitted for review by the Inter-American Commission on Human Rights (IACHR). “In my country, they ignore me. But if I have to go from country to country to tell what they did to my daughter, I will. justice must be done. I need someone who recognizes him,” he says.
“You told him [el embarazo] It was compatible with chemotherapy.
Amelia, Nicaragua. He dies at the age of 28.
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In 2007, Nicaragua took a step back on women’s sexual rights by including abortion interruption as a crime in penal code reform. Two years later, Amelia embodied this huge legal setback in a case very similar to Esperancita’s. She was diagnosed with pregnancy and cancer, which required urgent chemotherapy. After several refusals by the state to give her access to treatment, and only after the IACHR’s swift intervention, was she able to receive medication for her illness on one condition: that she carry out her pregnancy, as the two were “perfectly compatible.” “
The then health minister and now head of the department of the National System for Disaster Prevention, Mitigation and Awareness, Guillermo González, announced that he himself would pull the money for these “special drugs” out of Europe. Seven months after accessing treatment, with no more information than media echoes about the case, and with unstable and precarious medical care, she had a spontaneous abortion at home and died at the age of 28, leaving a 1-year-old girl orphaned eleven.
“They forced her to continue the pregnancy because they lied to her,” Mayte Ochoa, a Nicaraguan feminist and part of the IPAS Latin American team, explains via video call. “You have violated all his rights. They didn’t let her decide, they hindered conversations with her lawyers and other feminist organizations, they denied her medical care and when they gave it to her, they did it wrong… They also infantilized her by giving her false information,” she said says. Amelia’s case was the first in the region to be treated with precautionary measures by the IACHR. “It’s a clear precedent and an example of states doing everything they can to ignore them. In similar scenarios, only the Inter-American system has made room for justice.”
“There are therapeutic abortions, but they get lost in bureaucracy”
Ana and Aurora, Costa Rica. Both still suffer from severe mental health problems.
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Although the vast majority of the region has decriminalized abortion, the latest data shows that in Latin America and the Caribbean alone, 757,000 women are treated for complications from clandestine abortions each year. Behind these alarming numbers lies the lack of regulation and care protocols, as well as the lack of healthcare infrastructure to ensure access to this right. Costa Rica is a clear example of what happens when the exception to the crime of abortion is collected only on paper.
This country is one of the few in Central America to allow therapeutic abortion under Article 121 of the Penal Code, but the rule has more of a legal vacuum than guarantees. In Costa Rica, there are no hygiene guides that advise health workers on how to perform an abortion when the woman’s life or health is at risk. This enormous gap in legislation was suffered in 2007 and 2012 by Ana and Aurora, two women who became pregnant and whose fetuses were diagnosed with deformities incompatible with life outside the womb. Despite this diagnosis, both were forced to sustain a non-viable pregnancy and endure the numerous physical and psychological consequences of delivering a stillborn fetus. Consequences, which are currently manifested as anxiety attacks, depression and social inhibition. Ana even decided to get spayed in 2013 because she can’t imagine getting pregnant and having to go through something like this again. “Although therapeutic abortions exist, they get lost in bureaucracy,” explains Cristina Rosero, legal counsel for the Center for Reproductive Rights.
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The families of both women and the entity brought the case to the IACHR, which has already admitted and is investigating the case. But in Costa Rica, the exception to the rule is far from armored. “Women’s rights are usually the most fragile,” Rosero laments. “These advances are never complete achievements; It’s time to stay alert. Ours are the first to lie down.”