In late February 2008, Manuela fell down and found out she was bleeding. The following day, she fainted in a latrine after feeling intense abdominal pain. She got back home, fainted on her bed and woke up at the National Hospital San Francisco Gotera—one of the poorest districts of El Salvador.
Someone from the personnel had called the police. They were suspicious that she had undergone an abortion. Agents handcuffed Manuela to her hospital bed. Based on traces of the umbilical cord, the absence of a fetus and rumors on her pregnancy out of wedlock, she was accused of aggravated homicide and sentenced to 30 years of prison.
El Salvador’s Penal Code calls for two to eight year prison sentences for women terminating their pregnancies. Abortion has been banned, with no exceptions, since 1998. However, it is not unusual for women to be judged for homicide instead of abortion before El Salvador justice. “There are some women now serving 30 year sentences for murder—not abortion,” Guillermo Ortiz, an ob-gyn specialist with more than 20 years experience working in the greatest national maternity hospital in El Salvador, told Ms.
A year into Manuela’s imprisonment, medical checks confirmed that she was suffering from an advanced stage of Hodgkin’s lymphoma—a kind of cancer that has a 65 to 90 percent rate survival in the U.S. and could have been the cause of her miscarriage. She died at the age of 33 in 2010, leaving two kids behind.
Last month—almost seven years later—the Inter-American Commission On Human Rights (IACHR) admitted Manuela’s case, investigating whether the government of El Salvador failed to provide access to health, justice and defense counseling to Manuela and her family. Once the IACHR has reviewed the arguments, it will apply the mechanisms within the Convention of Belém do Pará, the international human rights instrument meant to protect women internationally. Justice, though delayed and now tinged by tragedy, may finally prevail.
And justice may come, too, for even more women in El Salvador this year who are impacted by its suffocating reproductive rights restrictions. In February, the nation’s Ministry of Health invited the Legislative Assembly to review a reform legalizing abortion in four cases: when the life and health of a woman are in danger, when there is evidence of fetal malformation and for pregnancies resulting from sexual relations between adults and minors, sex trafficking or rape. The reform comes nearly a year after lawmakers proposed increasing the penalty for women if they terminate a pregnancy—allowing them to serve for up to 50 years in prison.
Manuela was prosecuted for a crime she did not commit, and she was left unprotected. If this reform had been in place in 2008, she would have had more chances of beating her illness—and beating the institutional violence she suffered.
‘Las 17’ is the campaign claiming liberty for the 17 women wrongly imprisoned for miscarriages. “We know there are more than 200 cases of women processed, and more than 45 women who went until the end of their trials,” Ortiz said. “Some of them are in jail. Because the word ‘abortion’ has been criminalized, someone not directly related to the subject will think of abortions as induced abortions, and will report the woman.”
33 percent of Salvadorans live in rural areas. Until 2014, there was only one single highly specialized maternity hospital, or third level hospital, even in the capital city of San Salvador—serving a population of more than 3 million women. “It is a very thin line between action and omission,” Ortiz said, “where women always lose.” Health suppliers are scared not just of being prosecuted, but are also worried of social judgement and stigma. When they find a complicate case, their solution might be to wash their hands, sending women to the only third-level hospital. Or to call the police, as happened to Manuela. Since misoprostol pills were introduced in Latin America, it is difficult to say if an abortion is provoked or natural—but women accused of terminating their pregnancies are still landing in jail.
“To penalize abortion is to criminalize poverty,” Olga María Sánchez, former Mexican Supreme Court Justice, recently remarked at a conference in El Salvador. Ortiz echoed her when he spoke to Ms. “They are very poor women who sometimes do not even have cash to travel to the hospital, or to eat during that trip,” he said.
That criminalization comes at too high a cost for the women of El Salvador. “Many women died in the hospital,” Ortiz told Ms., “in front of us, for situations that could have been prevented if the law allowed these women to interrupt their pregnancies, to prevent their deaths. Women with cancer who could not receive treatment, women with heart diseases who did not have access to contraception or sexual education.”
Ortiz remembers Beatriz very well, a pregnant young woman from El Salvador who was suffering from Lupus and put at serious risk when the state did not allow her to terminate her pregnancy until the very last minute. The fetus had no brain and no chance of surviving. Ortiz treated her and started the request to terminate her pregnancy.
In 1973, El Salvador allowed abortion in the kinds of scenarios now being discussed as exemptions from its ban. In 1998, the constitution was revised to define life as beginning at the moment of conception—banning abortion in all cases. Now, sexual and reproductive rights are barely taught to future doctors, and induced abortions do not appear on the books. 96 percent of nations permit abortion to save a woman’s life. A sizable number of those that don’t are in Latin America: Chile, the Dominican Republic, El Salvador, Honduras and Nicaragua.
How can it be possible that El Salvador place women at such risk? “This is all a consequence of a law that was reformed without thinking on the medical consequences,” Ortiz explained, “or the consequences to women’s rights.” He believes that most doctors support admitting abortion in some cases.
Keyla Cáceres, who is involved with the citizen’s initiative Seguimos Unidos, explained that the severe anti-abortion restrictions in El Salvador are borne of many factors—including lack of information, the power of the Catholic church, machismo and a disconnect between the experiences of the political class and most Salvadoran families. “It is likely that if one of the four cases happened in their families, they would like to have a law that allowed them to decide as a family, and to receive medical advice,” she told Ms. “But in fact if the law does not exist, and the congressmen and congresswomen will have the means to travel abroad or to pay under-the-table for medical services that would protect their families—so it is very easy for them to say no.”
Cáceres also knows that that perceived political costs hold politicians back from rising up and fighting for women’s rights—but she believes the cost is diminishing. “In some years, we will look back and will say ‘how could those severe laws exist?'” she told Ms. “The ones supporting the reform are the progressives shaping the future of El Salvador.”
Cáceres believes this is the right moment for a change. “There are four countries in Latin America discussing similar reforms,” she noted, “and only 3 percent of countries in the world have legislation that does not protect the lives and health of women in the cases this reform proposes. Change is happening. It is a matter of deciding if El Salvador will stand up in history supporting this reform.”
No anti-abortion parties or organizations contacted agreed to be interviewed by Ms. for this piece.