In what might come as a surprise to many, the relatively small Latin
American country of Uruguay is considered by many pro-abortion activists as a
model country for access to abortion. After years of implementing a strategy
dubbed the “risk and harm reduction strategy” devised by Iniciativas
Sanitarias, the country affiliate of International Planned
Parenthood Federation, Uruguay decriminalized abortion in 2012 allowing it on
demand during the first 12 weeks of pregnancy and for the rape exception up to
the first 14 weeks of pregnancy. In the “risk and harm reduction strategy” government
health providers issue advice to women on how to induce illegal abortion via
medication and urge them to go to the hospital if they encounter complications.
This
month, the International Journal of Gynecology & Obstetrics, published by
the radically pro-abortion International Federation of Gynecology and
Obstetrics (FIGO), has a special issue detailing the Uruguayan Experience, including
highlights of the FIGO role in overturning the country’s pro-life policy. Reducing Maternal
Mortality by Preventing Unsafe Abortion: The Uruguayan Experience, edited
by Anibal Faúndes of Brazil, chair of the FIGO Working Group for the Prevention
of Unsafe Abortion, contains nine articles that look at different aspects of
the process in Uruguay to promote access to and use of abortion-inducing pills
and to change the law.
The role of
medical abortion in the implementation of the law on voluntary termination of
pregnancy in Uruguay reports that an abortion study for the first two years
under the new abortion law from December 1, 2012 to December 31, 2014 and found:
“A total
of 15,996 abortions were performed during the study period; only 1.2% were surgical and 98.8% were medical. Of
the latter, only 3.4% required hospitalization.
Less than half of the pregnancies were terminated up to 9 weeks of gestation and 54% were at 10 to 12 weeks in a
sample from the Pereira Rossell Hospital.
Conclusion: The rapid nationwide rollout of voluntary termination of pregnancy services to all women was possible to
a large degree thanks to the availability
and broad acceptance of medical abortion, facilitated by the prior experience in applying the risk and harm
reduction strategy.”
The article discusses the impact of
conscientious objection to abortion and somewhat gleefully notes that self-induced
abortion by a woman at home removes the doctor from the actual abortion
procedure suggesting that distance reduces culpability for the doctor,
“The other feature of medical
abortion that assists in the application of the law is that it puts a certain distance
between the professional and the
abortion. Prescribing some pills
that the woman will take herself at home is a
very different experience for the
physician than removing the uterine
contents in a surgical abortion. The distance that
is achieved when prescribing drugs
increases the percentage of physicians who are willing to provide these services.”
Conscientious
objection as a barrier for implementing voluntary termination of pregnancy in
Uruguay: Gynecologists’ attitudes and behavior takes a very
negative view of conscientious objection and reports on the findings of the
panel tasked with clarifying the meaning of conscientious objection, organized
by the IPPF affiliate Iniciativas Sanitarias Contra el Aborto en Condiciones de
Riesgo (Health Initiatives against Abortion in Risk Conditions). One the conclusions
reached is that “when the professional
who is being asked to terminate a pregnancy is a conscientious objector, this
professional has the obligation to refer the patient to an appropriate
non-objecting practitioner, which resolves the problem of conflict of
interest.”
Concerns about the policy by objecting
pro-life doctors led to a decision by the Administrative Court to make it “compulsory
that conscientious objection be presented by a written declaration”.
Additionally, institutions that provide abortion must create “registers of
objectors” so institutions “will know who the objectors are, so that they can
organize their services accordingly.”
The Uruguayan model has been implemented in
the province of Buenos Aires in Argentina with the assistance of FIGO since
2012, the year that Argentina’s Supreme Court “ratified the legality of
abortion in cases of rape and stated that the woman’s sworn declaration
presented to the attending health professional was sufficient.” A replication of
the Uruguayan model in the province of Buenos Aires, Argentina, as a public
policy for reducing abortion-related maternal mortality reports that
the province followed two main strategies.
First it instituted a “risk and harm reduction strategy” in primary
health care with general physicians and midwives and began to provide abortion services in primary health care centers in
2012 with the assistance of the Argentine Federation of Societies of Gynecology and Obstetrics (FASGO) and FIGO. The advice offered also “enabled detection of
situations in which the law allows legal abortion”.
The article elaborates on the justifications for legal termination
of pregnancy (LTP) stating that “indication
justifying LTP has also changed in recent years. Until 2011, there were no LTPs for health reasons and all
were for rape. The first cases arose
in 2012 and their number gradually increased until, in 2015, they accounted for almost three quarters of all
cases”. It also finds that legal termination of pregnancy can be dealt with at primary care level, “given the low complexity
of the procedures recommended, whether medical abortion or MVA”.
The experience in Buenos Aires leads the
authors to conclude that “data concerning
the experience of the Province of Buenos Aires strongly suggest that the
Uruguayan risk and harm reduction model applied to abortion can be replicated
in other contexts, at least in the Latin American region. This experience also
shows that, as happened in Uruguay, spending a number of years applying this
strategy brings health professionals into contact with unplanned pregnancies
and how women who decide to abort feel, making them more willing to provide
pregnancy termination services to the full extent allowed by the law.
On the world stage, the Uruguayan
government promotes abortion at various venues including the United Nations,
the World Health Assembly and the Organization of American States where
Uruguay’s former Minister of Foreign Affairs, Luis Almagro, now serves as Secretary General.
Almagro has let it be known
that he would like to see changes in the regions’ laws and policies on
abortion.