What Colombia Can Teach the US About Abortion

You don't have to imagine what it would be like if abortion rights in the U.S. were widely curtailed. All you have to do is look at the countries that currently have restrictive laws. What you will find is that abortion still happens. It's just secret and illegal, and more often than not, highly unsafe.
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Abortion is the issue that never leaves the headlines. Given recent statistics, its newsworthiness is well deserved. Last year, 19 states passed 43 measures to restrict access to abortion. This was the second highest total after the record-breaking 92 restrictions enacted in 2011. In 2013, legislators have -- at the midyear point -- already equaled the total enacted last year. Legislators in 10 states introduced total or near-total bans in the first three months of this year. In places like Texas, North Carolina, Wisconsin, Ohio, Florida, and Congress, the fight to protect abortion access in the face of a multi-year onslaught continues.

Yet, admittedly, sometimes it feels like nothing new is being said. As someone who has worked to protect reproductive freedom -- first as chief lobbyist for the ACLU of Florida and subsequently as an independent consultant for the Florida Alliance of Planned Parenthood Affiliates -- I thought I'd seen all the angles on this issue. At least I felt that way until I moved to Colombia.

The legal landscape of abortion in Colombia is similar to what many politicians would have it be in the U.S. Induced abortion is allowed if the pregnancy was caused by rape or incest, the woman's life or mental health is in danger, or there is a fetal malformation incompatible with life outside the womb. All the permissible circumstances -- with the exception of mental health, which was added last year - resulted from a 2006 Constitutional Court decision. The decision was in response to the case of Martha Sulay González, a mother of three who discovered six weeks into her fourth pregnancy that she had cancer. Martha wanted to abort in order to be there for her three children. While the court's decision was in her favor, it came too late - Martha's cancer spread during her pregnancy and she died in June 2007. Her four children were left motherless.

Before 2006, Colombia was one of three Latin American countries (El Salvador and Chile were the other two) and part of only 4% of the world population where abortion was completely banned. Even now, the obstacles to obtaining a legal abortion in Colombia are so numerous -- bureaucracy from health insurers and providers, widespread refusal by doctors to perform abortions or to refer to those who will, delays in the judicial system - that many women either continue the pregnancy or undergo an illegal abortion anyway. Lack of public awareness and understanding of the new laws is another obstacle, as are entrenched cultural and societal attitudes. The Catholic Church hasn't helped; in 2006, Church officials threatened to excommunicate the medical team that performed Colombia's first legal abortion. The patient was an 11 year-old girl who had been raped by her stepfather.

Notably, as this 2006 New York Times editorial recognized, the Constitutional Court's decision was based not on the right to privacy, as abortion rights are in the U.S., but on a woman's right to health, life, and equality. The editorial highlighted that the basis for the decision was in part a reflection of officials' recognition of the public health crisis created by illegal abortion in Colombia. That public health crisis continues today.

A 2011 Guttmacher Institute report estimates that some 400,400 induced abortions are performed in Colombia each year. In 2008, only 322 were reported as legal. This means that 99.9% of abortions in Colombia occur, in the words of the report, "outside the law." Women who cannot afford a secret clinic or a trip to another country may self-induce, turn to traditional midwives, or use the drug misoprostol (one half of the two-part medical abortion with mifepristone, or RU486) without adequate, or often any, medical supervision. An estimated half of abortions in Colombia occur through misoprostol -- a method predicted to increase in Texas in the wake of the state's new law. An estimated one-third of Colombian women who undergo a clandestine abortion develop complications that require treatment in a medical facility. Sadly, one-fifth of women with complications receive no treatment at all.

While Colombia has made progress toward the United Nation's 2015 Millenium Development Goal of reducing maternal mortality by 3/4's, unsafe abortion was estimated by Colombia's Ministry of Social Protection (now the Ministry of Health and Social Protection) to be the third leading cause of maternal mortality in 2006. An April 2012 Guttmacher Institute report notes that while Colombia's reforms have not been in place long enough for reliable impact measurements: "In Colombia, the narrow terms of the law reform preclude any notable impact on the incidence of safe and unsafe abortions or on related maternal mortality or morbidity."

Maternal mortality. That means women die. They die.

To those politicians and the voters that support banning or severely limiting access to abortion in the United States, I would say the following:

You don't have to imagine what it would be like if abortion rights in the U.S. were widely curtailed. All you have to do is look at the countries that currently have restrictive laws. What you will find is that abortion still happens. It's just secret and illegal, and more often than not, highly unsafe. Ask yourself if you are prepared for the public health crisis. Start examining the morality of a reality in which abortion is illegal and it still happens and more people suffer and more people die.

That is the bottom line. More people will be hurt, and more people will die. Until I moved to Colombia, I did not understand this in such clear terms. I only hope that elected officials in the U.S. will be able to grasp this before it's too late. There are some lessons that we shouldn't have to learn the hard way.

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