Nearly three years ago, Uruguay passed a landmark law permitting abortion on any grounds in the first 12 weeks of pregnancy, in the first 14 weeks in the case of rape, and with no restrictions when a woman’s life is at risk or if there are severe fetal anomalies.
Some thought that was the end of the story—a hard-won victory for women’s rights in Latin America. The reality, however, is not that simple. IWHC’s long-term partner, MYSU (“Mujer y Salud en Uruguay”), along with other allies, has had to fend off threats to the landmark legislation ever since. And it is a far from a perfect law; MYSU continues to bring attention to its flaws and remaining barriers to services.
One such barrier comes from a recent court decision. At the end of August, a Uruguayan court ruled in favor of a group of gynecologists who claimed that the law violates their right to conscientious objection (an objection on moral or religious grounds). This decision will only make it harder for women to access abortion services in Uruguay. MYSU’s Director, Lilián Abracinskas, says that the ruling prioritizes the rights of doctors at the expense of the rights of women. (You can read a statement from MYSU on the ruling in English and Spanish.)
The ruling applies to all of the country’s gynecologists—the only medical professionals permitted to provide abortions—and allows them to abstain from all stages of the process. As per the law, women who seek abortion services must first go before a three person panel –comprised of a social worker, psychologist and gynecologist. Originally, gynecologists expressing conscientious objection were only permitted to abstain from specific steps in the process that involved them directly—namely writing a prescription for medical abortion or performing an abortion. They were originally obligated to see patients for the initial consultation, as well as various preliminary and subsequent steps in the process. But now these doctors can object to any step along the way.
While Uruguay’s Ministry of Health reminded the public that the law remains in effect and reiterated women’s right to safe, legal abortion services, this new ruling is likely to limit women’s ability to realize this right. Conscientious objection has been identified by pro-choice advocates in Uruguay as one of the primary barriers for women seeking to terminate their pregnancies. MSYU’s Observatory of Gender and Sexual and Reproductive Health found that in some regions of the country conscientious objection is very high. In Salto, 92% of gynecologists expressed conscientious objection, and in other regions (Soriano and Paysandu for example) over 80% expressed conscientious objection. Many activists suspect that gynecologists are using conscientious objection as an excuse to not provide legal abortions and avoid administrative hassles, thus allowing them to focus on more lucrative services; and other reasons that have little to do with actual religious or moral objections.
Because abortion is only permitted in the first trimester, not having a local gynecologist could have significant ramifications on women’s health; longer wait times and inconveniences may force some women to seek clandestine, and often unsafe, abortions.
Uruguay reported there was not a single death due to unsafe abortion in 2014, and Uruguay currently has one of the lowest maternal mortality rates in the region. But this could change if this new ruling stands, gynecologists continue to cite conscientious objection, and other barriers remain in place and limit women’s access to services.
We have seen time and time again how reproductive rights gains are tenuous. As MYSU and its allies know all too well, the passage of the law in Uruguay was not the end of the story but really just the beginning of a quest to ensure that all women in Uruguay, regardless of their circumstances or where they live, have the same access to safe, legal abortion services.