Abortion Battles in Mexico and Beyond: Sexual & Reproductive Health & Rights in Challenging Contexts
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Abortion Battles in Mexico and Beyond: Sexual & Reproductive Health & Rights in Challenging Contexts

October 26, 2019

CRISTINA ALONSO: Jocelyn Viterna is a professor of
sociology and co-director of the transnational studies initiative at
Harvard University. Her research examines how social
mobilization affects gender norms, gender practices and states in welfare and
institutions and in communities. Currently, Viterna is developing two new
research projects. The first investigates the effects of revolution on the social
organization of medicine. The second demonstrates how potential aid
recipients in developing nations actively recruit transnational NGOs to
place development projects in their communities and details the consequences
of winning or losing these local level competitions for foreign resources.
Vaterna’s work has been published in the American Journal of Sociology, the
American Sociological Review, Politics and Gender and the Latin-American
Research Review among other journals. Her book women and war the micro processes
of mobilization in El Salvador, 2013 oxford university press. Won four
distinguished book awards: the ESS Mirra Komarovsky award, the ASA Section on Sex and Gender award, the ASA Section on Political Sociology award and the SSSP global division award. And one honorable mentioned in the ASA Section on the Sociology of Development. It’s currently being translated for publication in
Spanish. And our second distinguished guest this morning is Marlene
Gerber Fried is a professor of philosophy and faculty director for the
civil liberties and public policy program in Hampshire College, a program
for education and activism about reproductive health, rights and justice.
She received her PhD in philosophy from Brown University. In 2010 to 13, she was
interim president of Hampshire College. Her scholarship in teaching is focused
primarily on abortion rights and access reproductive and sexual rights and
health and legal theory. She edited “From Abortion Rights to Reproductive Freedom:
Transforming the Movement and is co-author with Jael Silliman, Loretta Ross, and Elena Gutiérrez of “Undivided Rights: Women of Color Organize for Reproductive Justice,” November, 2004 awarded the Myers
outstanding Book Award by the Gustavus Myers Center for the Study of Bigotry and
Human Rights and is currently co-authoring a book on abortion with
Loretta Ross. She’s also a longtime reproductive rights activist and is the
founding president and served 21 years on the board of the national network for
abortion funds and also the founding president and continues to serve on the
advisory board of the abortion rights fund of Western Massachusetts. She works
on abortion advocacy internationally previously with a women’s global network
for reproductive rights and currently with the women help women. She has
received several rewards for her activism including Felicia Stewart
Advocacy Award, APHA population reproductive and sexual health section
of APHA, Evidence and Activism award at the Ibis
reproductive health and Women Warrior Award, Sistersong Women of Color
Reproductive Justice Collective. And in case you’re wondering why I’ve been up
here all morning, aside from being bilingual, I’m a midwife and I’ve worked
in Central America and Mexico training midwives, doctors, and community health
workers on full-scope practice from respectful maternity care and access to
abortion I opened birth centers in Mexico in the highlands of Chiapas,
Mexico City and have supported birth centers in all of Latin America and
currently in Haiti. Right now I’m a doctoral student at the School of Public
Health and super honored to be under the wings of Alicia Yamin, so please help me
in welcoming is amazing women that make the world a better place for all of us. JOCELYN VITERNA: Thank you so much to my fellow panelists, to
Alicia and to the exceptional panels that have come before. I’ve learned so
much today. I’ve been working for the last 25 years in El Salvador and
specifically about the last six years on cases of abortion and reproductive
justice and so I wanted to start out today talking about a couple of
different cases that really illustrate how things have been changing in El
Salvador. So I want to start out with the first the case of Maria Biertude. This
is a case that I found in a 1991 newspaper article in the primary daily
of El Salvador called El Diario De Hoy and essentially what happened in this
case was Maria was pregnant with her eighth child, she had gone to the health
clinic the help the doctor had said she was quite a ways away yet from going
into labor so the next day when she felt the urge to defecate she didn’t think
much about it she went to the pit latrine toilet behind her house, but she
accidentally birth the baby into the latrine. She called the
neighbors for help, they called the Red Cross of El Salvador and within a few
hours they were able to extract the baby and although he was sick, he survived and
that was it. This was a sort of a human interest story that came out in the
newspaper in El Salvador. And certainly, I’m sure most people here know this, but
it’s not unusual for the urge to have a bowel movement to be the first sign that
a baby is coming. You can see in these pictures that when the baby’s head is
passing through the birth canal, it passes right over the rectum. And if you
start to look you actually find a tremendous number of news stories about
babies who are born in a toilets, even when women know they’re in labor even
when they’re in US hospitals under the care of doctors. In fact, I was telling
this story to a the mother of one of my daughter’s friends and she told me that
the same thing had happened to her she was in the hospital she said she had to
go to the bathroom the doctor evaluated her she was only four centimeters
dilated she went into the bathroom and boom the next thing you know her baby
was in the toilet of course she was fine it was in, a under medical care and in a
very clean institution. But now let’s fast-forward to 2002 in El Salvador in
2002 Mirna was 34 years old and she was living in a poor province of Cuscatancingo. Very poor family she had had to leave school in fourth grade to
start working in a sewing factory. Since then she had began to run a small store
out of her home and she was very enterprising. She was only 19 when she
married Miguel, someone that her church had set her up with and for the next 15
years, I’m sorry, next 11 years they had a relationship they had where she had a
lot of miscarriages, but she never actually had a child, right. She had one
child that was born but died shortly after birth so this is of course what
doctors will tell you one of the key reasons to suspect that a pregnancy is
going to be problematic is if the woman’s had problematic pregnancies in
the past. So Mirna certainly has had difficulties. When she was 34 years old,
she realized she was pregnant again and, perhaps not surprisingly, she didn’t tell
many people outside of her her initial family she did not go to prenatal care
because it costs a lot of money to travel there and to take time off work
and she had had so many disappointments in the past. She continued to have back
pains in vaginal bleeding throughout the pregnancy but she decided that she and
her husband decided they were just going to leave this in the hands of God, as
they tell it. In 2002 Mirna felt a sharp stomach pain, she thought she was
about seven months pregnant and she went to the latrine, again a pit toilet in the
back of her house, to have what she thought would be a bowel movement and to
her horror, she accidentally birthed very small fetus into the latrine. She
returned to the house. Pale, traumatized, bleeding, sweating. She called her little
sister told her what happened the little sister went and got the help of some
neighbors, the neighbors came. One of them used a lasso, they managed to pull the
baby out of the latrine and the the baby was crying, it did have sepsis and some
problems and it was very premature, but it was fine.
However, when the police came because the police had been notified that this was
going on. One of the neighbors told Mirna that she was quite
clear that Mirna had thrown the baby away on purpose because the baby was the
result of an infidelity with her husband that Mirna had told her, her husband
could not.. was sterile and couldn’t get her pregnant and her husband was going
to know she was cheating if she was pregnant and so she was sure that she
threw this baby away. Of course we already know if you just look at Mirna’s
medical record that this is wrong right she’s been pregnant multiple times in
the past, she’s just had problematic pregnancies. The story gets weird here
but I only have ten minutes, so I’m not going to go into it, but basically this
neighbor tells the story where she personally was one who heard the baby
cry and rescued the baby and gave it CPR and things that don’t come out anywhere
else in the testimony. But by the time that the baby and Mirna get to the
hospital doctors are actually writing on the baby’s medical file that the baby
had apparently been thrown away by her mother.
When the case goes to court, Mirna was originally charged with abortion, but
in the process of the trial, the charge was upgraded to aggravated homicide…
excuse me, attempted aggravated homicide and doctors testified some of the most
incredible things. For example, remember that Mirna has said that she thought
the baby was she was about seven months pregnant, and of course their way we know
the gestation of a baby is we ask a woman when her last menstrual period was
and we do the math, right. The doctors who testified in the trial said that the
baby was actually eight months of gestation but it was only the size of a
seventh month fetus because it had suffered from intrauterine growth
restriction. Okay, so first of all they couldn’t have known that, right ,because
they didn’t know when the date of the last period was. All they had to go off
of was the size and what they’re saying is the size of the baby decides the
fetus the baby is seven months of gestation, which is exactly what Mirna
says, but they’re saying it was eight months of gestation but the reason it
had intrauterine growth restriction is because Mira obviously didn’t want the
baby and her not wanting the baby limited the auction and the ability of the baby
to grow and they use that as sort of evidence against her. Wventually Mirna was
found guilty of the attempted aggravated homicide of her daughter and she was
sentenced to twelve and a half years in prison. In November of 2014, the Supreme
Court did finally issue a pardon to Mirna for this crime but it was after she had
served the entirety of her sentence. So this is Mirna now, she’s in the black
shirt here it’s her daughter Bruceada, who was born into the latrine. This in the
middle is her little sister who went to get help is to the side and if you talk
to Bruceada, now who is actually an incredible student, she’s a senior in
high school right now and say how this start affected her life, she’ll tell you
that she has absolutely no memory of being born into a latrine that that wasn’t
a problem, but the fact that her mother spent the first 13 years of her life in
prison and that all the neighbors talked about her mother as a baby killer, that
was really a traumatic aspect. Not to mention the dact
that Mirna lost everything: her husband left her and took everything with her,
her job, her spouse, her money. She jokes that he left a bed, right, but took the
dishes… everything else. Mirna also lost her health, she’s in need of a… she’s had
some small heart attacks since then and just the prison conditions were really
hard on her health today. So I think the question here and I know I’m already
really close on out of time, so I’m going to go quickly, yes: What happened
between 1991 when Maria Bertud had a baby into latrine and it was a human
interest story in 2002 when Mirna was sentenced to 13 years for the attempted
aggravated homicide of her baby? And part of the story is a legislative story.
Prior to 1997 in El Salvador, abortion was only legal in these three
circumstances or “causales.” Uou could have an abortion when the life
of the mother was at risk, when the pregnancy was the consequence of rape, or when the fetus had abnormalities incompatible with life outside the
uterus. In 1997, there was a criminal code reform where they just essentially took
out these exceptions. so there’s no abortions, no exceptions, not even when
the life of the mother is at risk. And in 1999, the same Legislature passed a
constitutional amendment saying that life begins at the moment of conception.
But I think it’s not enough just to talk about the change in the law for two
reasons: One, most of these women, like Mirna, they did not have an abortion, right.
Most of them were very far along in their pregnancies and they had a
difficult birth or an obstetrical emergency and – Two: we also can see that
places like Nicaragua, right next door, have the same law now, but they’re not
sending women to jail and women still are getting life-saving pregnant… or
abortions. And so what I think is happening is that there’s also we have
to look at what the political context, the public opinion has been around this.
I’ve been analyzing 25 years of newspaper articles about this and I’m
gonna go through this quickly, but what I basically find is that there was this
powerful pro-life movement that started in the early 1990s in El Salvador and
when they started in 1994 to 1996, the story was really a story of these
powerful global forces that are trying to force abortion onto El Salvador, right.
What the they would say is…This was really the narrative of Pope John Paul
ii in El Salvador… those powerful global nations the force didn’t want poor brown
people migrating to their countries they were really trying to push population
control on these countries and force them to kill their unborn babies and you
start to see this getting taken up in the legislature. It’s interesting that
1994 is also when Newt Gingrich and the Republicans in the
united states came up with a term partial birth abortion, so there’s a lot
happening in this time period. Once the elections came, it really became a part…
of a sort of a story of right versus left so the right wing party arena
started saying the FMLN, the left-wing party, you can’t vote for them because
they’ll kill unborn babies. Here’s a newspaper article, if you can read it, it
says arena proposes to defend the life of the unborn by criminalizing abortion
but the FMLN in contrast pronounces itself in favor of extracting fetuses,
right, it’s a really crazy language. But there’s an interesting thing that
happens right before the 1999 elections in El Salvador and that’s that the FMLN
says to the feminists, look, we really want to be elected we want to rule, we
want to be the party of women, but if you keep touching abortion we’re never going
to be elected, so let’s just drop the issue. And so, the FMLN kind of was told
that they could vote their conscience. Most of them ended up upholding… all of
them ended up holding the the criminalization of abortion. The feminist
movement went silent on the issue and yet, these pro-life mobilizers kept
getting out of bed every day and looking for how they were going to fight for the
lives of the unborn babies and one of the things i’ve been arguing is that they
needed that target they didn’t have the FMLN, they didn’t have the feminists, and
so they started sort of targeting these evil mothers, right. And so here’s an
article i found in 2001 and the title is “Crimes without Punishment.” In the
introductory blurb of this first one says, “the numbers of newborns being
thrown into latrines, trash receptacles, or vacant lots by their own mothers is
alarming. The authorities need to capture these women red-handed to process them
for aggravated homicide but to the contrary these crimes never come to
light and they’re given complete immunity.” And then the story starts…
“Imagine yourself naked, tied at hands and feet without being able to
speak or see. Suddenly you feel yourself being thrown into a hole and upon
falling to the bottom you realize you’re surrounded by feces in urine.
Little by little you begin to drown. Soon various insects like cockroaches begin
to climb on your body. Worms and rats begin to bite you and pulling off your
skin and nobody hears your painful cries.” Right, and so there’s no statistics at
all but this article says that you know thousands of babies are being… finding
themselves in this fate in El Salvador. Quickly, the one at the bottom says
histories of hearts and stone and the little sub thing under that says: “they’re
human beings that waited nine months in their mothers wombs for the sweet hands
of a… or for the hands of a sweet mother but what they found instead were the
talons of soulless women,” right. So it was a very sort of powerful language that
came. I also found some pressure to prosecute. This is in 2003, you see the
the the human rights ombudsman at the bottom, who has started an actual part of
the Ombudsman’s office for human rights for the human rights of the unborn and
she’s pressuring the head of the police and the Attorney General to do more to
shut down abortion clinics and they’re saying we’re trying, we’re doing all
we can. There’s some incredible stories about
this as well, but what they actually say here is that if you want us to actually
stop abortions you, have to make the law even stricter. You have to make intention
to abort in a crime and then we can get those women for abortion. Really quickly,
my students and I have now found 71 cases like this. We’ve actually found
over 80 now, which is why I don’t want you to cite this because the numbers keep
changing, but what you can see in the first column is that most of these women
are initially charged with abortion, and then over time the charges get upgraded
to attempted or aggravated homicide and whereas the abortion charges are not
often found guilty, the aggravated homicide, three-quarters of those are
found guilty and they’re getting an average of 29 years in prison for this.
This basically says that they’re very young women with low education, working
in very… the jobs that don’t give them many
protections, oftentimes domestic workers and they oftentimes are already mothers
at the time of the incident and they typically almost always require a public
defender. This is just the 41 women who were found guilty. Most of them are
turned into… they are reported to the police by the health care professional
who treats them in the moment of emergency.
So someone finds them bleeding, unconscious, takes under the hospital. The
doctors have been told that if they don’t report a suspected abortion, that
they will be guilty of being accomplice, an accomplice under the law, and they
called a report of suspected abortion and then that starts the process that
they get upgraded to aggravated homicide. I don’t have time to talk about this,
suffice it to say that women do die in the hospitals because they don’t get
access to abortion, but I think what’s more interesting in some ways or more
common is that women who have fetal malformations that are incompatible with
life, actually… we don’t know what happens in those pregnancies after about 20
weeks because in most of the world those, pregnancies are interrupted and we’re
starting to find that those pregnancies, if you let a woman go to the full 40
weeks, that there are tremendous complications on women’s bodies and you
know, young girls, 18 years old, suddenly are having their uterus is removed and
other kinds of bodily mutilations that happen with these pregnancies. So it’s
not just a matter of life, but actually sort of bodily integrity as well. And so
I think to sum up, because I’m way over time, the changes in the law or horrific
and we need to change the law back but I think what El Salvador shows u,s both in
terms of the timing when women started to go to jail and in comparing El
Salvador to other nations, is that it’s not just the laws, but it’s this
accompanying narrative. It’s the fact that the police officers and the doctors
and the judges all actually operate in the society where these narratives of
these evil women are circulating and that that has had a really profound
effect on how the police investigate the crime scene of a uterus and how the
doctors decide whether or not to report a patient and and how judges
hear the cases. And so, if we change the law, I think obviously lives would be saved particularly, in hospitals but I think
the practices outlined here that have become very institutionalized in the
criminal justice system are unlikely to change, in part because most of these
women didn’t have abortions in the first place but also because we’ve now
institutionalized these understandings of what constitutes a crime and I think
there’s also, I should say, just when you say life begins at the moment of
conception, it becomes very very difficult to determine what’s the
difference between abortion and homicide, right. And so there’s a lot of difficulty
going on here that’s really being born on the backs of low-income, uneducated
women. thank you very much. MARLENE FRIED: I’m not gonna use slide so we can do whatever we need
to do to not do that. Hello everyone, I’m very honored to be here and to be part
of this important discussion, Thank You Ali, thank you Chris, and thank you
Jocelyn for that great talk. It has been very inspiring to hear about the
significant legal changes in Mexico and in the European Court, but I think or no,
and not but, and what Jocelyn and I are doing is talking about the importance of
thinking outside the law and in into the politics of abortion. So first, I want to
say that I think it’s really important to ground these discussions in the lived
experiences of people who are seeking abortions, sometimes getting them, a lot
of times not. And this sort of larger global reality which is that one in four
pregnancies end in an induced abortion. In developing country… in developed
countries it is one of the safest medical procedures, but half of all
abortions in the world are still unsafe. The World Health Organization estimates
about 22 million, a year which is probably a very low estimate, mostly in
Africa and Latin America, which had the highest
rates of maternal mortality from unsafe abortion. This is a thing I’m about to
say I think is the most important thing, if you take away nothing else take this
away: that no person today, anywhere in the world, should die from an unsafe
abortion. This is not a disease without a cure, these people are dying from…
they’re being murdered by the law and by poor health systems. So we have that we
have the means to completely eradicate maternal mortality from abortion and
we’re just not doing it. Even where abortion laws are liberalized, there’s as
we have heard a bit in the earlier panels but I want to really focus on it.
My political work and most of my adult life has been spent in this tremendous
chasm between formal legal constitutional rights and whether you
can access them whether you can have an abortion, and as we heard earlier today
there is no affirmative duty in the United States for abortion to be
provided. And so, so many people are living with the consequences of the
restrictions. Yes we are a legal system that’s built on precedent, but right now
I think most reproductive health rights and justice advocates are much more
focused on the fragility of precedent rather than it’s staying power. And I’m
going to just quickly run through the kinds of restrictions and I don’t want
to rest with the restrictions, I want to turn to the importance of
different kinds of resistance outside the law. So restrictions on funding is,
this was just this week, was the 43rd anniversary of the restriction ban on
federal funding for abortion. It’s called the Hyde Amendment it came just three
years after legalization and for poor women, and who are disproportionately in
this country women of color,that was pretty much their right to legal
abortion not being upheld. Parental involvement laws, which require
that parent be informed or give consent. Inform… so called informed consent, which
is forcing doctors to lie to tell people that abortion causes mental health
problems in breast cancer. The expansion of religious refusals. The opponents of
abortion call these conscience clauses, but really they are refusals based on
religion of the provider and the religion of the pregnant person doesn’t
seem so important. Targeted restrictions of abortion
providers, these are so-called trap laws. These are medically unnecessary, hyper-regulations of abortions, abortion clinics, which cause a lot of clinics to
close because they can’t afford to stay open. And finally and tremendously
emboldened by the current political situation in the United States and the
occupant of the White House, the anti-abortion movement is getting bolder
in terms of the kinds of laws it’s trying to pass. So passing bans as early as six
weeks of pregnancy, which probably you all know, is before most people actually
know they are pregnant. So if you’re banning at six weeks, you’re effectively
banning all abortion. And lastly the restrictions on telemedicine. We have
just learned that about 40% of abortions in the US are abortions with medicines,
with pills, and a combination of mifepristone and misoprostol. In much
of the world, misoprostol alone is used and I’m not going to talk much about
that but I think people can ask about it if they want.
And so the restrictions on telemedicine are really aimed at trying to shut down
what is becoming increasingly common abortion practice. So, what to do about
all… These are all the trends trends in restricting abortions, which we are
facing as legal challenges to to legal abortion in the United States. So I want
to first do some… say some things about how what it means
to ground abortion in real people’s lives. I think the first thing it tells
us… and I think these are guides to how we should think and act, so it tells us
that we need to look intersectionally to understand that the people who are most
vulnerable because of their class, their race, their age, their gender and sexual
identity are the people who are most harmed by all the restrictions. People of
with economic security, can almost always get an abortion anywhere in the world no
matter what the law. So really, what we’re talking about is using the bodies of the
most vulnerable people in society as political footballs in this battle.
Secondly, increasingly, activists are adopting a reproductive justice
framework which brings abortion into the realm of human right and social justice. It’s a broad approach. And I just want to read something from a press release a court
just blocked a six-week ban in Georgia. It’s not the end of the story so it’s
not.. you know it’s going to come back, but the press release which was issued by
Sistersong, women of color for reproductive justice, reads very
differently from the way these things have usually read. It says, “we refuse to
go back to days where bodies are controlled by the state and we oppose
any policy violating bodily autonomy and human rights,” so invoking these very
broad… it’s not using the language of choice right, it’s not… it is look… it’s
going for a much bigger understanding of where abortion sits in the lives of
people. I want to say that this… a lot of people are afraid of of
broadening the frame for abortion, afraid people, especially of my generation,
who are afraid that if you get too broad you’re abandoning the fight for abortion
and really I don’t see it that way. I think emphasizing the interconnections
of how abortion takes you to all of these other rights and needs is actually
going to protect it more. And this to me takes it… oh I think
an obvious and a really obvious point but sometimes an obvious point has to be
belabored: The need or demand for abortion does not change with restricting it by
law. That is so obvious everywhere in the world and here too.
All it does is either force people to have babies that they did not plan or
want to have or which they and pregnancies they consider unsupportable
or to go outside the law, sometimes having a dangerous procedure, or not. So I
want to now move to the importance of feminist activism outside the formal
medical system and often outside the law. And just one last thing about the courts,
I wish I could adopt all the judges we’d heard from this morning and put them on
the Supreme Court of the United States, but that is not gonna happen.
And right now, activists, we’re really afraid of our Supreme Court, we don’t
want to take cases to it because it’s a dangerous place. So the the call… and I
hear all of these facts and and cases and and the picture of abortion globally,
I actually hear this as a call to action and I think that where we see that there,
you can act in many different ways to achieve reproductive health rights and
justice, but in order to do that you really need to go to to go beyond the
law. It’s… it is actually the activism that motivates the changes in the law
and unfortunately in this country there’s been a lot of persistent
activism on the opponent… by the opponents of abortion. I think it’s also
a time for a really bold action. Many of, us in some of us in this room, it’s a young
crowd, spent a lot of time in the 80s and 90s outside of abortion clinics doing
what was called clinic defense, which is putting our bodies in front of the
clinics. I was thinking when you gave that admonition in the beginning whether
it was directed at us, the thing about not being disruptive.
We were disruptive because we were trying to ensure that people could get
what they needed against others who were trying to shut the… shut the system
down. And I think that same determination and commitment to people being able to… to bodily integrity, bodily autonomy, people being able to manage their own
reproductive lives in future. I think that is what is driving today, the
activists who are assisting people in self managing their abortion with pills.
So there is abortion with pills inside the medical system and then there is
abortion with pills outside the medical system. You could buy them on the
internet, you can find the protocols on the World Health Organization’s website,
you can Google SASS. S-A-S-S, self managed abortion safe and supported to find this
out. And so many countries in the world, no matter what the status of
abortion, advocates are supporting people in this way. Twenty countries have
hotlines, even ones where abortion is highly restricted. Women help women on
something called WOW, women on web, work with local networks to distribute pills. These pills, I should say or in most states in the United States, highly regulated and are a felony. So this is… this is really… it is a place
where law could change and policy. It does involve risk, but again, the risks
here are not risks of the medical aspects of abortion or the biological
aspects, they are risks imposed by law. For those of you in the audience who are
going to be lawyers, there’s a lot to do and you can work directly with
individuals and advocates. 21 people in the United States have been prosecuted
in the way that Jocelyn describes for self-managing… for allegedly self
managing their abortion or having miscarriages and I think
there’s a there’s a group called “If When How” which are… these are activist
lawyers who are defending women who are in that situation and I just want to
close by reminding us, September 28th was the day of action for safe abortion
everywhere. I feel like all over the world people are answering the call to
action, which gives me hope and inspiration. September 28th was picked it,
started in Brazil, because it was the day that slavery ended in Brazil and
compelling someone to carry a pregnancy to term against their will is in effect
a form of slavery. thank you. ALONSO: Do we have time for a couple
questions? Maybe one? Yeah how about we take one question then I have a bunch to
add, so let’s take a question then we can weave it in from there
yeah go ahead. AUDIENCE MEMBER: [Inaudible] fellow the particular center. I have a
question that I listen with lots of intention to your very inspiring talks and thank you for
sharing. And I have a question, it’s also relevant to the previous panel and needs
to do with intersectional issues in abortion as you rightly mentioned this
has a disproportionate effect in the most vulnerable part of the population and
also what are your thoughts, if even if legislation is achieved, and we know
that obstetric violence is a big issue in Latin America, institutional
discrimination is a big issue in Latin America, and physicians and other health
professionals imposing their views despite the law is something that it’s
very difficult to to address. And very difficult to battle and I would like to
have you if could elaborate on that, please. VITERNA: Thank You, excellent question. One of the things that I have been noticing you in in evaluating the many court cases with
these women is that there is definitely an issue of discrimination but there’s
also definitely an issue of training, right. And so for the case of Imelda
recently, one of the things that the the prosecution was arguing… or excuse me the
the medicina legal, so like the state forensics expert supposedly was arguing
they said that there’s no way that a friend’s… that an umbilical cord would
rupture in a situation where a woman sat down like this therefore, she had to have
cut the umbilical cord with a knife or with scissors and therefore that proves
that she’s guilty, right. So all I had to do… I’m a sociologist right but I’ve
learned, you know, tremendous things. So one of the things I do is I just go to
the PubMed database and I put in rupture of umbilical cord and 17 articles come
up that all say that umbilical cord would absolutely break in this situation.
There’s even like diagrams of you know, they’ve had all these simple cords
donated and they’re stretching them to see when they’ll break and they
think things like this. And so what I do is I take those relevant parts, and I
translate them into Spanish, and I send them off to be used in the defense of
these women. So I think, and when you start looking into it, you realize that
none of the forensic pathologists in the court systems in El Salvador have ever
had any training in forensic pathology, which is actually a huge problem in the
United States as well. We have a huge dearth of forensic pathologists in the
United States. So you have people who have no training, they don’t have access
to PubMed and they have to come up with their arguments and so that’s when these
very discriminatory ideas about gender that are informed by what’s going on in
the public, I think come into the court situation. I don’t know if you’ve heard
of the case of Evelyn she’s been in the news a lot lately. The forensic
pathologist in that case actually made a statement that says a woman cannot give
birth sitting down, right. Like just like they actually are coming up with
birthing chairs right now, so that you can give birth sitting down because it’s
one of the best… So so I think there’s, um, it is a huge
problem… I’m sorry I don’t yes there you are – thank you. It is a huge problem, right,
it’s not just combating the discrimination, its combating training
and I want to make clear that this is not just in Latin American countries,
this is true in our nation as well and I think this is also a call for us as
universities, right, like what I found in these cases is that I need to get this
forensic pathologists and this psychologist and this OBGYN to come
together and to read these cases and to help us fight for these women but I’ve
also been able to sort of pull that information into training programs. And is there a way that we can use Harvard X, or that we can use the
resources as a law school to make the information that’s so easily accessible
to us, more accessible to the people who use it on the ground in the US and
abroad? So that there when there is that one person in the office who says, that
doesn’t really sound right to me that an umbilical cord can’t break, that they
will actually have the ability to go get that information themselves and so I’d
like us to think about ways that information could be better distributed.
It is also a problem I think in El Salvador that they don’t train anyone
how to do an abortion anymore so even in the cases when the life of a woman is at
risk and and they get some sort of permission to interrupt the pregnancy
the only option they have is they give her pitocin and they instigate an early
labor, which is much more difficult for the body than than other aspects. FRIED: Yes to
all of that… and I think we just really do have to continue to call out the
devaluation of women, women’s bodies, women’s ability to make their own
decisions. I was struck this case… there was a case
recently the summer of a woman named Marche Jones in Alabama and she was in a
argument with another woman the other woman shot her in her pregnant stomach
and then Marche was charged with damage to the fetus because they said she
started the fight. So to me, what this says, more anything, is that even a dead fetus is more worthy, has more value than a living
woman. So I guess, I think a lot of this is we can help by giving information and
knowledge but until we completely destabilize the system which
devalues the ability of a person who is pregnant to make their own decisions
about their lives, I don’t think we’re going to get very far. And I from… I mean,
I’m sort of heartened to hear about the invoking bodily autonomy and human
rights, you don’t hear that in US courts but you know there’s a new generation
here so you go go get them. ALONSO: For me what this…. what this question brings up is the
systemness of the abortion issue and I think what we’ve done is state… when we…
when we’ve discussed abortion is whether or not women should have the right to
decide whether or not they can do it, the public health and health care system has
then extracted itself from the conversation and it’s kind of left of,
well then when the judges decide what to do then we can figure out what we do. In
the meantime, as we’ve seen, women aren’t getting the
services. And from a clinical perspective, you know when you say, doctors in El
Salvador don’t know how to do abortions, I would say that across, the world
midwives and nurses are not trained to do abortions. It’s a doctor thing, you
have to be a doctor to administer four pills of misoprostol, which apparently
require high level of training. Canada and the US, the midwifery associations have
argued this and are trying to legislate an expansion and prescriptive capacity
to be able to prescribe misoprostol, but heaven forbid that we actually learn how
to do a manual vacuum expiration. We can actually do a delivery, but we can’t do
manual vacuum aspiration. And this also has to do with who’s going to the
hospital in order to train to do any clinical procedure, you need to be able
to do it and do it a lot. When I was trained, I I was trained in a place where
I did 17 abortions a day, and that’s a lot. And by the end of two weeks, I pretty
much knew what I was doing. Unless you have that level of clinical experience,
you’re not going to be safe provider. And if you’re working in
isolation, in a place where your colleagues are looking at you and
they’re pressuring you not to do this… I get calls all the time from women in
hospitals in Mexico they’re like, I’ve been sitting here for three days leading
and nobody’s taking care of me… and they will have to sign to leave the hospital
and come to a place where we can finish the miscarriage or the abortion or
whatever you want to call it. In terms of systemness too, I think that removing it
from the sphere of public health, we’ve actually removed it as as who… we’ve
removed the conversation of what happens when people fall in the cracks between
the legal decision and the actual clinical access to it.
So just as you were saying Marlene between the time that the courts are
deciding, the years are passing, the years are passing and every month women are
getting pregnant. And I want to call into that, just mention the fact, that not only
is it intersectional, where it’s obvious that the most vulnerable are most
affected by this and I just want to point out an example in the highlands of
Chiapas, women don’t monitor their period, usually because they’re breastfeeding
from the time they’re 15, till about the time they go into menopause, their
periods are pretty irregular, they during the coffee season will definitely see
the ovulation happens less because they’re working long hours and eating a
lot less. It’s very difficult to realize that you’re pregnant, there aren’t
pregnancy tests at CVS because aren’t that many pharmacies, you wouldn’t spend
your money on a pregnancy. By the time indigenous women in the highlands
realize that they’re pregnant, they’re very far along and by the time they
start asking in secret and network, where can I go? Can you drive me somewhere? Where can I go where they want where I won’t die
because I have four other kids, because the coffee season is coming up… By the
time women are actually accessing care they’re very very far along in their
pregnancy… So again, going back to the systemness it’s not just about ensuring
access, it’s ensuring that access is tangible in the way that we understand
what conception, is what pregnancy is, and when and how and where to access that
care as quickly as possible we’ve talked a lot about time. FRIED: You know another thing
to add, in terms of the public health professionals and in El Salvador,
in the United States in South Carolina where women are prosecuted for taking
illegal drugs while pregnant, it’s … it’s doctors and nurses and people
who are working in the hospital who are turning these people in. And so part of
the educational process here is again, not just knowledge and information, but
values and morality and sort of centering people in suits
so that medical professionals don’t actually feel so emboldened to take
charge of decisions over other people’s bodies and lives. ALONSO: We certainly,
in in the world of maternal and sexual and reproductive health, we feel the need
to have opinions about all the processes that women go through. Which doesn’t
happen in oncology er you know in other fields. Does anybody else have any
questions? Okay, I do want to, as a matter of closing, I do want to highlight
that we’re all involved in this and to me this is such a global issue and
I’m gonna cite another example. There’s a network in Mexico that was actually
mentioned by one of the justices. There’s a hotline in Mexico, where you can call
and they will get you to Mexico City, get you to a safe abortion, and get you home
that service is completely free. It’s completely anonymous and you actually
get to choose what clinic you go to, it can be public or private you get an
abortion doula who’s with you the whole time and you get a hotel room the night
before so that you can rest, if you actually have time. Most of the women
spend the night on the bus coming to Mexico City and then go home as quickly
as possible because they’ve jobs and children. That network is funded by
donors in the US and it only exists because of donors in the US. If those
donors need to start funding the same network to exist in the US, it probably
will stop existing in Mexico. The reason that we get mifepristone is because
there’s a donor in London that sends it through suitcases and we get it, until it
was it was recently legalized in Mexico, but until then, people were bringing them
mifepristone in suitcases and we used to send misoprostal to Chile
stuck on t-shirts so that would get through the mail to midwives and doctors
there. so I just want to talk about that you know, Women on Wave is a perfect example of this, but all of us are implicated in the global
capacity, restriction, access to whether or not women die of an abortion or they
actually survive it. FRIED: Right and the network of abortion funds that I work with in the US and the Maria fund is part of that network and basically it’s
doing what the state doesn’t do. Unlike in other places, where abortion is made
legal and then it becomes an affirmative part of the public health system, in the
u.s. having the right to an abortion never meant that you had the right to
access abortion. So again, that discrepancy between the two means that
private actors and activists are trying to fill the gap, which is enormous you
can’t do what the state should do in this in these cases. So I think again
it’s like in until we are living in that world of justice and reproductive
justice where all these things are available and paid for, all of us need to
do what we can do to make it happen. ALONSO: So, thank you everybody for being here this morning it was a really productive discussion. ALICIA YAMIN: I really want to thank that last panel for bringing to life some of the
issues that we’ve been discussing throughout the morning with extremely
passionate and articulate stories. I think it’s, throughout the morning
we’ve seen that this issue has so many different facets from which you can
understand it, and looking at it sometimes from the local, very contextual
perspective, to the global trends, it’s not just the women’s movement and the
funding in terms of progressive abortion forces, but also the anti-abortion forces and the forces that are at the European Center for Law and
Justice, through the American Center for Law and Justice in which the president’s
personal lawyer sits, foment anti-abortion legislation that has cut
and pasted and other funding of networks. I think it’s also brought to light the
kind of inextricable relationship between how we think about health policy
and health system organization and the legal frameworks that organize that, but
also the gaps between permissive legislation and effective enjoyment of
women’s rights and practice. And finally, I want to just underscore what a
privilege it has been to hear sitting justices of the Mexican Supreme Court
speak so candidly and openly about, you know, the work that they are doing now
and faces them now and to have judge Sajó join in that conversation, so thank you
very much.

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