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Seven months after the decriminalization of abortion: from prohibition to facing fear

2022-09-28T10:54:05.960Z


Although there are still barriers to accessing an abortion, the country is in the midst of a social and cultural transformation to protect women's decisions


Seven months have passed since Colombia decriminalized abortion until week 24, seven months in which what those who opposed decriminalizing it feared did not happen: women did not run en masse to abort, nor did they begin to use abortion as a contraceptive , nor did they wait until week 24 to terminate their pregnancy.

But for Laura Gil, a Colombian gynecologist who has treated women seeking an abortion for several years, she did change something fundamental: "Now my patients are calm."

Gil has observed, from his office, a series of changes that go beyond what is legal.

Before the sentence of February last year, abortion was only allowed on three grounds: in case of rape, risk to the health of the mother and malformation of the fetus.

At that time, Gil attended between three and five women each week, some with fear to justify his situation.

Since the decision of the Constitutional Court in February —which decriminalized abortion until week 24 and allowed it in the three cases in the following weeks— the number of consultations for Gil increased from six to ten women per week, women without fear of ending in jail.

These new women, they tell her, would have had an abortion without the Court's ruling, although perhaps with a less secure procedure.

“I ask them what they would have done before and they tell me that they still would have had an abortion, and that is what I think people are beginning to understand: the decision of women never depends on whether abortion is legal or not, only that now they can exercise their right to a safe abortion,” Gil tells EL PAÍS.

“Now we are in a phase of implementation, but above all of normalization: that all people understand that this is a right.

In the movement we always talk about legal decriminalization, but what is missing is a society that stops giving abortion the social and cultural burden it has always had.”

Cultural changes are slower than legal ones, but even in the gynecologists' guild it is happening.

Gil's colleagues have called her in recent months to ask what the best practices are, or if there are risks with one method or another.

She is part of the Medical Group for the Right to Decide, which in 2020 conducted a survey with hundreds of Colombian gynecologists and obstetricians, and found that 25% do not know or do not handle the modern techniques recommended by the WHO for an abortion (such as uterine aspiration or misprostol pills), and end up practicing outdated techniques such as curettage.

"An academic transformation is still needed, because we studied in times when abortion was illegal," adds Gil.

Transforming and training the health system has been one of the main challenges in recent months.

María Mercedes Vivas is the director of Oriéntame, a private foundation that provides medical services to women seeking to end their pregnancy.

Vivas explains that abortion is a procedure included in the Health Benefits Plan (PBS), and therefore all women affiliated with the system should be able to access one through their health provider companies (EPS).

"But many of these companies have not yet been trained, they have not updated their protocols, and we continue to see health providers that continue to use obsolete technology such as curettage," says Vivas.

For a foundation like Oriéntame, however, the February ruling allowed them to serve women much more quickly,

“We changed our protocols, the way of handling the clinical history, and we no longer have to verify reasons but only focus on the user.

What those who opposed abortion said did not happen, who thought that women were all going to run away to abort, "adds Vivas.

"Nor has the other thing they said happened, which was that women were going to abort in week 24. Nobody has abused the system, that did not happen, the news is that there is no news."

According to a report by Oriéntame, the foundation assisted 2,902 women from February to May of this year, and more than 90% of them agreed to an abortion in the first 12 weeks of pregnancy.

According to a statement from Profamilia, another organization that offers services to interrupt a pregnancy, 94% of abortions were performed in the first weeks of pregnancy.

According to data from ACEMI, the largest EPS union, most of the abortions that have occurred have occurred before week 15 (When consulting five EPS from ACEMI, who care for 30% of the country's population, they confirmed that, from January to July, 93% of abortions were performed before week 14; 6% before 24; and only 1% above week 24).

A protester celebrates after the Colombian Constitutional Court voted in favor of decriminalizing abortion. LUISA GONZALEZ (REUTERS)

In other words, according to several health-providing institutions, women have managed to abort their unwanted pregnancies earlier since the Court's ruling.

Orient me showed a 15% increase in the number of women who were able to finance their abortion through their healthcare provider.

Profamilia evidenced an 18% increase in access to abortions through its IPS—Health Provider Institutions.

For Juan Carlos Vargas, gynecologist and scientific advisor to Profamilia, these figures show that "women did not use abortion as a method of planning, contrary to what was said would happen."

He also referred to the challenges that the entity has shown: "one of these is that the EPS commit to combating the barriers to accessing a voluntary interruption of pregnancy, so that they ensure that this procedure can be carried out in the first five days from the request.

César Castiblanco is the health manager of ACEMI, the EPS union that brings together some eleven companies and covers some 35 million members, and explains that several EPS have sought to streamline the procedure—with fewer bureaucratic obstacles—and that it is more difficult to get health providers who agree to perform an abortion at week 24,

"We did see that different EPS tried to carry out an adaptation process after the sentence," says Castiblanco.

“The procedure before week 15 can be performed without hospitalization, it is simpler.

As gestational age advances, availability is played more: despite the fact that conscientious objection is not institutional, it is more difficult to have available professionals, and there are entities that are more reluctant to carry out this type of intervention” .

"This is an issue that continues to be extremely controversial," adds Vivas, from Oriéntame, about the difficulty for women in more advanced weeks of pregnancy.

“I think it is a stigma issue, because hospitals are trained.

A hospital that can attend births can also attend an IVE in advanced stages and if they do not do so, it is due to political will.”

The Roundtable for Women's Life and Health, and the Oriéntame Foundation published a report this year that lists the main barriers that women continue to encounter in health companies.

Among these is also misinformation: doctors who do not know the Court's ruling, nor that it was immediately enforceable since February, or who do not guarantee truthful information to women on how to access an abortion.

Venezuelan migrant women have also faced cases of xenophobia in the health system.

"We know that these barriers harm the health system itself and women, because they push them to go later to that interruption," says Ana Cristina González, a doctor and pioneer of the Just Cause movement that achieved the decriminalization of abortion.

"Of course there are still barriers, so we know that part of the work we have to do now is pedagogical."

González says that “it is impossible to achieve a cultural change in seven months, but I do believe that a change has come from decades of struggle by feminist women's movements.”

She has been fighting for decriminalization for more than 25 years, and says that “this transformation is reflected in opinion polls that we have been doing since 2017, which show an increasingly growing number of people who are against it, at least half of the population. , of a woman going to jail for having an abortion.

This cultural change occurs because feminism has placed reproductive freedom and freedom over the body as a strategic axis of the democratic agenda.

Cultural change, adds González, involves changing the concept of freedom, understanding it "as the possibility of imagining a life project, and being able to carry it out".

She now sees a new generation of young women who were born with this broader concept of freedom, a generation "that does not understand who can prohibit something that has to do with her life project."

Two more things have changed in the last seven months.

The first was that the new government of Gustavo Petro repeatedly pledged to respect the Court's ruling and protect women's right to abortion, and several congresswomen from his coalition have pledged to promote a comprehensive public policy to regularize routes for women.

And the second, that the Supreme Court of the United States overturned the 1973 ruling known as Roe v Wade that allowed legal abortion throughout the country, news that fueled the hopes of the anti-abortion movements to reverse decisions like the one that took the Constitutional Court in February.

"But the decision of the United States, legally, is very different," explains González.

“The arguments with which abortion had been decriminalized there were related to privacy, while the decision in Colombia is rooted in fundamental human rights protected by our Constitution: equality, health, dignity of women and freedom of expression. awareness.

What happened in the United States is disastrous, it should concern all women, but it is an opportunity for the north to look to the south, learn from our strategies, our movements, how we are leading this public discussion.”

The activist recently reviewed how since 1994 – when the UN conference in Cairo that adopted a program of action on criminalizing abortion took place – 58 countries have liberalized their abortion laws, and only four have rolled back.

"That's why I remain optimistic," she adds.

Women belonging to the 'Causa Justa' movement demonstrate during a symbolic act in Bogotá, November 11, 2021. LUISA GONZALEZ (Reuters)

The legal crusade against abortion

In the seven months since judgment C-055 of 2022 was issued, the Constitutional Court has received around 30 nullity incidents seeking to overturn the decision.

Most of the lawsuits have been filed by citizens and religious organizations.

The petitions point to two main arguments: the Court's lack of jurisdiction to eliminate the crime of abortion from the penal code (for the plaintiffs, this is a function that falls exclusively to the Congress of the Republic);

and the supposed violation of the right to life of the fetus, since for the 'pro-life' organizations, life originates from conception and not from birth.

Most of these requests have been denied.

The strategies of these movements have reached other instances, such as suing before Congress the magistrates who voted in favor of decriminalization, accusing them of libel and slander.

Although these types of strategies by anti-abortion groups are not new in the region, so far in Colombia these attempts have not prospered.

Meanwhile, the administrative and political scaffolding that the sentence needs to materialize effectively continues to await concrete measures from national instances of the new government.

Without losing sight of this panorama of challenges and transformations, from the feminist movement and different women's organizations, mobilizations were announced in different cities of the country this September 28,

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Source: elparis

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