Abortion lessons from Latin America

(Originally published in the Los Angeles Times)

IT'S BEEN A LONG time since the days of back-alley abortions in the U.S. Perhaps that's why South Dakota Gov. Michael Rounds signed into law a ban against abortion in his state, with one narrow exception: protecting the life of the pregnant woman. Perhaps Rounds, who was only 19 when Roe vs. Wade was decided in 1973, doesn't remember what it was like to live in a country where women had no right to a safe, legal abortion.

But there is a place he could visit if he wants to refresh his memory: Latin America.

Abortion is illegal in most countries in Central and South America, though the law waives criminal penalties for women who have abortions in certain circumstances: after rape or incest or if their life or health is endangered by the pregnancy. Over the last five years, I have interviewed dozens of women and girls who faced unwanted pregnancies and had abortions in Argentina, Mexico and Peru, all countries that limit access to contraceptives, sex education and abortion. The most common tale I heard was one of desperation.

"I don't have $10 a month for contraceptives -- I need that money for milk for my children." "I didn't even want to have sex, let alone become pregnant." "If I have this child, I won't be able to take care of the others." "My father raped me." The list goes on.

My experience in Latin America carrie with it three clear lessons for South Dakota.

Lesson 1: Outlawing abortion does not stop women from having them. "What do I care if abortion is legal or illegal?" Marcela E. told me in 2004 in Argentina, where abortion generally is banned. "If I have to do it, I have to do it." The 32-year-old mother of three had a clandestine abortion after her husband raped her.

A community organizer in Argentina told me: "You will not believe what women end up putting in their uteruses to abort." I wish I didn't.

I have spoken to women who used knives, knitting needles, rubber tubes, even pieces of wood to pry open their uteruses. Some got access to abortive medicines that in theory lower the possibility of direct infection but that caused serious complications when they took them without medical assistance. Affluent women suffered fewer traumatic ordeals, often traveling to the U.S. for the procedure or sneaking off to upscale private Latin America clinics where, on paper, they had surgery for appendicitis.

Lesson 2: Providing limited exceptions to an abortion ban does little to improve access to safe abortions.

In reality very few, if any, women get such "non-punishable" abortions because there are no clear procedures. Fearing that they'd be charged with a crime, many of the women I interviewed who might have qualified for a legal abortion because they had been raped or because their health was endangered by the pregnancy did not dare to out themselves as potential abortion candidates. They went straight for the illegal and mostly unsafe back-alley abortions. A large proportion of maternal mortality in Latin America is caused directly by the consequences of such unsafe abortions.

Lesson 3: In Latin America, as everywhere else, the best way to stop abortion is to prevent unwanted pregnancies.

Women and girls act within the circumstances imposed upon them. In Latin America, where contraceptives are inaccessible and sex is stigmatized (through cultural expectations that they be virginal and uneducated about sex), unwanted pregnancies are more common; not surprisingly, there is a higher proportion of abortions to pregnancies than in, for example, the U.S. The simple fact is that women with unwanted or imposed pregnancies would have preferred not to need abortions.

South Dakota's abortion ban won't end or even cut down on abortions among the women in that state, and it probably will have disastrous effects on their health and lives. Laws and policies on abortion and contraceptives should not punish women and girls for doing what they feel they must to live with dignity.