After Victory in Uruguay: Addressing Gaps Between the Right to Abortion and Access to Services

Little more than a year ago, in October 2012, reproductive rights activists in Uruguay celebrated the passage of Law 18.987 (known as the “Law of Voluntary Interruption of Pregnancy”), which permits abortion on any grounds in the first trimester, during the first 14 weeks in the case of rape, and with no restrictions when a woman’s life is at risk or there are severe fetal anomalies.

Feminist groups like IWHC’s longtime partner MYSU (Mujer y Salud-Uruguay) helped make this law a reality. But it wasn’t long before anti-choice forces mobilized, triggering a consultation ballot in June 2013 that asked the electorate if they wished to hold a referendum to repeal the law.

In response, MYSU and its allies launched a highly effective campaign, primarily disseminated by word-of-mouth and through social media, called, “I’m not voting. And you?” (“Yo no voto. ¿Y vos?”). Less than 9 percent of the electorate voted in the June 2013 election, far below the 25 percent required to hold a referendum to repeal the law. The low voter turnout was a resounding victory for Uruguayan women and for our partners who had fought for greater reproductive rights over the past 12 years.

Despite these remarkable accomplishments, MYSU recently told IWHC that there is still much work to be done to ensure that the progressive legislation translates into high-quality, equitable abortion services throughout the country. Lilián Abracinskas, the founder and executive director of MYSU, told us about some of the hurdles women continue to face in accessing services, and what still needs to be done going forward.

MYSU admits the abortion law is flawed. It does little to remove the stigma associated with abortion, which is still technically a crime in Uruguay’s penal code (the law only broadened the exceptions in which a woman can obtain an abortion). The new law also requires a woman to undergo intrusive measures to access abortion services, such as a consultation with a three-person panel composed of a gynecologist, psychologist, and social worker. This consultation is meant to inform women about the law, alternatives to abortion, and the procedure and its possible risks. But Abracinskas notes that not all medical facilities were fully prepared to comply with this part of the law: many, in fact, did not have enough professionals to form the three-person panel, and some lacked even a single gynecologist working in the area.

The implementation of services has been further complicated by the fact that 30 percent of gynecologists nationwide have exercised conscientious objection to the law. In the city of Salto, for example, all gynecologists have objected to the abortion law. In some cases, medical professionals have chosen to participate in the three-person panel described above, but refused to provide abortion services, meaning that they may be imposing their own beliefs on women through the consultation process. Furthermore, as our colleagues noted, outside of major cities, many women are not fully informed of their legal right to abortion under the current law.

This confluence of hurdles may be limiting how many women are actually utilizing the public health system for abortion services versus those who continue to resort to other methods. Prior to the passage of the law, there were between 16,000 and 36,000 abortions per year; as of January 2014, the Ministry of Public Health were reporting between 420 to 450 abortions per month, for an annual total of 5,040 to 5,400 abortions provided within government services. This indicates that many women continue to go outside the public health system and resort to unsafe abortion in clandestine clinics or use to induce abortion.

Going forward, MYSU will continue to work to ensure that services are high quality and accessible throughout the whole country through three primary strategies. First, through public events and the distribution of informative materials, MYSU will work to ensure that women are informed of their rights so they can demand quality abortion services. Secondly, along with its allies, MYSU has formed the National Coalition in Defense of Sexual and Reproductive Rights and Health, which recently met to develop a comprehensive strategy to better monitor the current situation. Finally, MYSU plans to research the use of conscientious objection in Salto and develop a system to monitor and compare women’s experiences obtaining services and the treatment they receive from health professionals.  

While the case in Uruguay is an inspiration for other pro-choice advocates in the region, it also is testament to the fact that the struggle to ensure access to safe, legal abortion does not end with legislation. As our Uruguayan partners know, this struggle includes defending the law from reactionary, anti-choice movements, as well as ensuring that geography and lack of information do not determine the services women receive.

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