Who are the main protagonists in the debate?

Several extremely varied protagonists and organizations have taken part in the debate on abortion. These include international and regional organizations, the executive, legislative, and judicial branches of the state, lawyers, political parties, health institutions and professionals, experts on human rights, the mass media, civil organizations, academia and researchers (Hessini, 2005). Certain foreign governments have also participated in this debate, as when President Bush of the United States reinstalled the so-called Gag Law at the beginning of his presidency.

As part of the scenario, there are two main social forces: on the one hand, “progressive” civil society organizations (particularly national and regional feminist groups and networks), and on the other hand, the Catholic church hierarchy, together with right-wing conservative groups in the society at large. These have had the most influence generally speaking on some of the other actors, particularly the state and certain sectors of the population.

It is in these two antagonistic groups that the terms of the debate are crystallized into the two most polarized positions, the misnamed pro-abortion stance and the so-called, perhaps more correctly, anti-abortion stance. As various authors have so rightly pointed out (Bernal, 2003; Faúndes and Barzelatto, 2005), focusing the debate in terms of the first position constitutes a serious mistake, “creating a false disjunctive”. No one is in favor of abortion, no one regards it as a good in and of itself, no one promotes it, and there are no “abortionist” groups. In the same way, Lamas (2003) argues and clarifies that when debate is advanced in terms of favoring or opposing abortion, the issue is being treated erroneously, since favoring the decriminalization and legalization of abortion is not equivalent to favoring abortion, much less promoting it. That is why, in this chapter, the authors of these antagonistic positions are dealt with or described as being “in favor of the decriminalization and/or legalization of abortion” or “against it”.

Feminist Groups

As several authors have pointed out, the Feminist Movement in Latin America, particularly as developed in recent years by women’s non- governmental organizations, has become one the most influential social interlocutors involved in public opinion in the sphere of reproduction and sexuality as well as women’s human rights (Scavone, 1999; Correa et al., 1998; Gruskin, 2001; Lamas, 2001; Pitanguy, 1999). In many countries in the region, their intervention in the abortion debate has been crucial in the construction of a broader framework for the analysis of and actions regarding this problem. Within the conceptual field, as Alfarache (2003) points out, the harsh criticisms that have been made of the public-private dichotomy  from feminist positions within the abortion debate have spread the idea that “if women’s rights are violated in private spaces, this exercises great influence on their possibilities of acting in public spheres” (p.148). In the arena of actions, these groups advocate and have fought for the legalization and decriminalization of abortion, thereby managing in some cases to block the legal initiatives that tend to restrict abortion rights, and in other cases to expand the grounds on which its practice is permitted (Lamas, 1997 and 2003; D’Atri, 2004; Profamilia, 1993; Htun, 2003; and 1999). At the same time the work of these groups with international organizations to ensure that the issue was dealt with at the international conferences promoted by United Nation entities has been widely recognized. Likewise, their continuous participation in discussions and negotiations is reflected in the agreements achieved in the plans and programs of action derived from the International Conference on Population and Development held in Cairo in 1994 and the World Conference on Women held in Beijing in 1995, as well as in the regional and international forums and conferences that followed. (Ipas, 2002; Rayas and Catotti, 2004; Rayas et al., 2004; Women’s Health Journal, 1999 and 2003; Gómez, 2000; and 2003; Kulczycki, 2003; Scavone, 1999). Their continuous presence in the press and various public organizations through campaigns and numerous publications and their constant participation in regional and national forums and seminars have been widely documented.

It is worth noting that many of these groups have embarked on the task, among many others, of publishing materials aimed at collaborating in activities generally involving management and defense of their position regarding the abortion issue. The idea behind such publications is that not all the organizations in the general population need answer the same questions or learn things from scratch. Thus, there are materials such as Increasing Access to Safe Abortion: Strategies for Action, published by the International Women’s Health Coalition (Germain and Kim, 1999), whose aim is to show the different alternatives for increasing access to safe abortions when legislation contains at least one exception to the prohibition, including recommendations and agreements signed at conferences and other international instruments. It provides examples of strategies used in other countries and offers a selection of extracts from conferences or treaties that may help establish the need for safe abortion services.

Among other publications there are many accounts of how abortion bills are being submitted and discussed, along with materials whose aim is to present the status of legislation on this topic (Centre for Reproductive Rights, 2003; Faúndes and Barzelatto, 2005; Rocha, 2005). These are useful sources that provide specific strategies and situations.

The Catholic Church: Different Protagonists

The Church Hierarchy and Conservative Groups

In most Latin American and certain Caribbean countries, the Catholic Church has a significant presence through millions of followers. Several of these countries are characterized by an extremely conservative climate, which in matters of sexuality and reproduction is characterized by deep-seated Catholic morality and teachings. The Catholic Church has maintained and attempted to increase its influence on society. Toward this end, the official Church has encouraged the creation of a network of lay organizations that have managed to position themselves as a significant force in the political panorama of several countries in the region. This in turn has generated the support they have received, whether implicitly or explicitly, from certain governments and political figures in the region and from other organizations outside it (Kulczycki, 2003; Htun, 2003). The Church’s powerful influence has led certain governments to redefine their interventions in the fields of reproductive health. Such was the case in Argentina during Menem’s government and in Peru under Fujimori and Toledo. It is also the case in Mexico, where the current party in power, the National Action Party, which represents the most conservative positions, has encouraged greater participation and activism on the part of the Catholic Church hierarchy and its related lay organizations, some of which, such as “Provida (Prolife)”, have received considerable financing from federal government (Rayas and Catotti, 2004; Rayas et al., 2004; Kulczycki, 2003; Women’s Health Journal, 2003; Bianco, 2002; Borland, 2002).

Moreover, the power of Catholic organizations has been clearly documented insofar as the Church has managed to block, and in some cases reverse, legislative initiative tending towards the decriminalization or legalization of abortion. This is why the Church hierarchy, together with ultra conservative groups such as “Opus Dei” and “Provida”, which define themselves as lay associations, but are clearly linked to the most old-fashioned thinking of the Church, are the main exponents of the anti-abortion position. Provida has been one of the most widely recognized, visible and constant actors in the debate on abortion. Because of the enormous support this last association receives from the Church, as well from other conservative groups  Provida has been described as “the civil armed force of the Catholic Church” (p. 369) (Kulczycki, 2003). Found in at least 15 countries, it has a widespread presence in the region and its activism and the defense of its arguments and positions are manifested in numerous spheres. Nor has it restricted itself to influencing decision-making on policies, recommendations and actions related to sexuality and reproduction in the government spheres, health professional organizations and international conferences, or attempting to restrict financial support for action and research, it has also engaged in harassment and violent acts inflicted on abortion clinics in various countries in the region (Htun, 2003).

Despite this, evidence from various surveys undertaken in the region concerning Catholics’ views on sexuality, contraception and abortion (see below) reveal a paradoxical situation, as studies show high rates of modern contraceptive use, the occurrence of voluntary abortions, and a general failure on the part of the majority of the nominally Catholic population to comply with Church norms.

An Expression of Dissidence within the Catholic Church

It is worth underlining and highlighting the presence of another protagonist in the abortion debate; Catholics for the Right to Decide (CDD in Spanish Católicas por el Derecho a Decidir)). CDD is a Catholic women’s movement committed to searching for social justice and changing the cultural and religious patterns in force in contemporary societies. It is oriented towards promoting women’s rights, as well as increasing levels of equity in gender relations and fighting for women’s full entitlement in society and within Churches. This organization has been very important and active in the region, despite lacking the resources and political power of the Catholic Church hierarchy. Their position regarding religious teaching and norms in sexuality, reproduction and abortion differs from that of the Church. Its presence indicates a variety of positions on these issues within the church membership, not just one hegemonic position (Mejía, 1996; Güereca Torres, 2003).

From the outset, CDD has been linked to other regional networks, such as the “Latin American and Caribbean’s Women’s Health Network,” “The Committee for Latin America and the Caribbean for the Defense of Women’s Rights” and the September 28th campaign for decriminalizing abortion in Latin America and the Caribbean. It has also played an extremely active role in the national, regional and international debate on abortion and issues related to reproduction, sexuality and women’s health. At international conferences, it used well-founded theological arguments to confront the Vatican’s positions. Its presence in the national public debate of the various Latin American countries in which it works includes activities such as the publication of “Conciencia Latinoamericana” “(Latin American Conscience”), which publicizes ethical and religious reflections, as well as reporting on numerous issues related to the sexual and reproductive sphere of women. This organization also participates in the creation of spaces to discuss the issues mentioned earlier (Mejía, 2003; Rosado Núnes and Soares Jurkewicz, 1999). Both CDD and its counterpart, “Catholics for a Free Choice” have an extremely wide variety of publications in several languages covering topics such as their positions regarding various issues, guidelines for undertaking activities for management and defense of these positions, and the analysis of Catholic Church’s performance in various fields (Kissling, 1998; and 2001), and others.

International and Regional Organizations

One of the main international organizations that has promoted, encouraged and intervened in this debate by providing information and means to modify positions at the international level, primarily in events like the World Population Conference held in Cairo in 1994, is the United Nations Population Fund. The international conferences it has organized, like the national and regional preparatory meetings leading up to them, have not only illuminated the confrontation between various positions, but have, above all, managed to reach agreements. These have culminated in the assumption of commitments by governments through programs of action derived from these conferences. Their contributions in the field of sexuality and reproduction were the first of their kind. These events offer a conceptual and operational framework focusing on the right to free, responsible decisions about the number and spacing of children (but without considering the right of abortion); the governments’ obligation to provide the population with information, education and other means of guaranteeing the exercise of sexual and reproductive rights acknowledged in the conferences; promoting women’s participation in making the decisions that affect their health and rights; and the equal incorporation of men, all as part of an integral approach to reproductive health (Rayas and Catotti, 2004; Rayas et al., 2004).

The agreements signed regarding abortion in the Program of Action of the ICPD (International Conference on Population and Development), held in 1994, stipulate that in no case should abortion be promoted as a family planning method, but that the occurrence of abortion in inadequate conditions is a significant public and women’s health problem (United Nations, 1995) (§ 8.25 y 8,26). The recommendations derived from this are aimed at encouraging governments and non-governmental organizations to increase their commitment to deal with the health effects of abortions performed in inadequate conditions, and to reduce the abortion rate through greater access to family planning services and improved quality of the latter. It clearly states that abortion care or treatment for the complications derived from the latter in health services must be provided in keeping with each country’s legislation. The ICPD+5 reiterates this consensus by urging governments to use their health systems to train and equip health service providers and take other measures to protect women’s health and ensure that abortion is performed in appropriate, affordable conditions in the cases permitted by law (Rayas and Catotti, 2004; Rayas et al., 2004).

For its part, the Beijing Platform for Action, in addition to endorsing the previous agreements, emphasizes the conditions of inequality between men and women, social classes and ethnic groups, acknowledging the fact that in case of abortion in unsafe situations, it is the poorest, youngest women who are exposed to the greatest risk (United Nations, 1996). Government commitments in the spheres of reproductive health in general and abortion in particular, resulting from these international conferences, have become significant elements of the public debate and support the actions of the feminist movement, because in most developing countries these commitments had not been translated in government actions.

It is interesting to note the synergy between other international organizations, such as the various committees responsible for following up national commitments after the United Nations pacts and conventions, which are binding, unlike those of the women’s movement and conferences. Many committees receive documentation from organized civil society and sometimes even meet with people that represent it and attend meetings to review the situations in different countries. On the basis of this information and the information submitted by States, committees submit recommendations to the governments of countries that can, and in fact usually do, include the points highlighted by civil society groups. One example of the successful use of these recommendations can be seen in a recent modification to abortion legislation in Colombia on May 11, 2006. Monica Roa, the lawyer who presented the appeal arguing the non-constitutionality of Colombian legislation on abortion to the Constitutional Court, used observations from United Nations organizations that follow up human rights, which mentioned that Colombian laws violated women’s fundamental right to life and health, as well as previous decrees on other cases from the Constitutional Court that stated that international law takes precedence over national law (The Economist, 2005).

It is important to realize that, although organizations linked to the United Nations usually distance themselves from the debate regarding abortion, the UN’s concern for human rights, as expressed in pacts, conventions, conferences, etc. does constitute usually favorable statements that persons advocating the right to safe abortion can use to promote their agenda, as we have seen. The importance of these multilateral organizations forces UN member governments to follow up their recommendations, at least to a certain level, although the difficulty of transforming these agreements into practice, not only in terms of legal regulations but also in terms of concrete reality, has been widely acknowledged.

Among other non-UN international and regional organizations and agencies that have played a key role in the debate on abortion in the region are the World Health Organization, The Population Council, The Ford Foundation and the MacArthur Foundation. Through their own research, the organization of academic events and the support given to academia and non-governmental organizations, these groups have promoted and supported the analysis of key aspects of abortion and its implications for the population, as well as the dissemination of this analysis. Certain institutions devoted strictly to research, with an emphasis on action research, have also published extremely important material as input for the abortion debate. An invaluable example is the Alan Guttmacher Insititute, whose publications usually become landmarks for colleagues in the pro-reproductive rights movements. These contributions have usually been of utmost importance in sustaining management and debate activities organized by non-governmental organizations (Kulczycki, 2003).

The State and its Executive, Legislative and Judicial Bodies. Political Parties

Through its various branches, the State constitutes one of the most important agents since, in addition to being the interlocutor of the various political forces, it is the institution on which pressure has to be exerted to modify the legal status of abortion as well as to undertake other types of intervention in the sphere of health service provision, law, education or information. The State is the entity that possesses the material and political resources required to implement interventions and solutions regarding abortion, which is why political will, particularly that of the executive branch, is a crucial factor. Nevertheless, in certain countries, such as Mexico, the state has played a controversial role in the debate on abortion –as differentiated from its role in population growth and family planning. For Kulczycki (2003), in Mexico “the State has not yet conceived its own discourse on the matter. The State has mediated between the actors involved…yet its growing inability to immediately neutralize the conflict shows its lack of control over the course of the debate” (pp.366-367). Within the framework of the commitments adopted by governments as a result of the Population Conferences in the last decade, in several countries in the region the State has admitted that abortion is a public health problem, although it has done very little to guarantee legal, safe access to the procedure at public health institutions in the cases where it is permitted by the legislation. At the same time, although it is often true that in practice the crime of abortion is not punished, nor are the sanctions prescribed by the laws of each country always applied, it is also true that “a series of political obstacles noticeably block the legal reform of abortion; among these being the use of the abortion issue for other purposes” (Kulczycki, 2003) (p.353).

The debate on legislative changes has been and continues to be an important issue in the political discussions of the legislative branches of Latin American governments. This has been intensified in the past two decades in certain countries, particularly in those where legislation is more restrictive, where there are more established, better organized feminist movements, and where more democratic conditions have been achieved (Rocha, 1996; Casanova Guedes, 2000; Nunes and Delph, 1995; Rayas and Catotti, 20004; Rayas et al., 2004). However, the consideration of abortion issues in the agendas and proposals of political parties continues to be too controversial and with insufficient political gain (Kulczycki, 2003). In this circle, political parties as well as executive branches do not escape from the direct or indirect influence of social and political extra-parliamentary groups, particularly the Catholic Church and other conservative groups.  Despite the efforts of feminist groups and the international consensus and commitments assumed by governments, very few political parties and executive bodies feel they should reform laws. Their performance concerning abortion  has been characterized by political use of the issues for electoral purposes, reflecting party interests (Latin American Weekly Report, 1991; Lamas and Bissell, 2000; Lerner and Salas, 2003; Ortiz Lemus, 1992; Ortiz Ortega, 2001). Nevertheless, as Htun (2003) points out in his analysis of the situation in Argentina, Chile and Brazil, there are significant differences between these countries in terms of the political and ideological climate and the participation of these political actors in the issue of abortion, something that is also true of the rest of the countries in the region. Brazil has undoubtedly been one of the countries where the influence of progressive forces has managed not only to maintain an intense, continuous public debate in government organizations and among other actors, but has also managed to achieve the expansion of the health conditions in which abortion is permitted and performed.

In other countries in the region, such as Peru, despite the transformations in favor of democracy, there has been a paralysis created by forces, identified as fundamentalist, that systematically disarm  the advances that have been made in the country regarding sexual and reproductive issues (Chávez, 2003).

As part of the implications of State intervention in the debate, we cannot ignore the positions and restrictive policies over the past decade of the US government, which has refused to reaffirm commitments made as a result of international conferences. Its influence has not only contributed to blocking and reversing achievements in the area of health and reproductive rights by reestablishing the Gag Rule, which prohibits organizations that receive funds from that country to touch the abortion issue, but has also had devastating effects on the activities of feminist associations and certain reproductive health programs, both governmental and private. Opposition to the reproductive health agenda has also become more visible as a result of conservative presidents in several countries in the region, because of the presence of representatives of ultra right-wing groups in government positions (as in Mexico and Nicaragua) and, in general, due to the growing influence of conservative forces (Rayas and Catotti, 2004; Rayas et al., 2004).

Health Professionals

Health institutions and professionals have been controversial actors in this debate, in which they occupy a unique position. Either actively or through omission, they mediate the reproductive decisions of their patients both in population and reproductive health policy (Gogna et al., 2002). Although they have played an active role in various countries in the region in supporting family planning (Mundigo, 1996), they have generally been far more passive and conservative about assuming and defending a position regarding abortion. As a guild, health professionals in the region are a long way from having a single position regarding the decriminalization and legalization of its practice. Although the majority of these professionals admit that unsafe abortion is a public health problem, this has been insufficient to increase their visibility and strength as actors in the debate. The literature describes the intermittent, reserved and relatively isolated role in the debate of the majority of physicians who have occupied and occupy positions of power and have failed to create important changes in the practice and treatment of abortion. The reasons for this range from their own convictions regarding such issues as sexuality, reproductive health and motherhood, to fear of legal of moral sanctions or the stigmatization to the economic advantages they obtain from performing illegal abortions (Elú, 1992; Gogna et al., 2002; McNaughton et al., 2002; González de León-Aguirre, 1994).

In certain countries, the medical community has only just begun a more organized mobilization to deal with the problem of abortion performed under risky conditions, highlighting, as one of their central arguments, the fact that abortion in such conditions is one of the main factors contributing to the high degrees of morbidity and mortality of women, especially maternal morbi-mortality (Rayas and Catotti, 2004; Rayas et al., 2004). In this respect Uruguayan and Brazilian medical personnel have played a key role. The former were crucial in creating their group, “Health Initiatives against Abortion in Risky Conditions”, and they undertook a research project on the reasons for the 47% increase in maternal mortality in 2001. The result was the publication of a book describing the consequences of unsafe abortion and the drafting of pre- and post-abortion healthcare norms in order to deal with the increase in abortions performed in risky conditions as a factor related to maternal mortality (Rayas and Catotti, 2004; Rayas et al., 2004). In Brazil, the medical sector has proved sensitive and active in women’s reproductive rights and health issues. The Brazilian Federation of Societies of Gynecology and Obstetrics has played a key role in shaping public opinion on issues related to legal abortion as well in shaping the stance of similar associations of doctors in the region (Rayas and Catotti, 2004; Rayas et al., 2004). Their production of material on abortion is unusual compared with that of health professionals in other countries in the region.

Health professionals include not only male and female doctors but also others such as nurses, midwives, medical students, pharmacists, and also members of the informal sector (medicinal plant sellers, folk healers, etc) that act as suppliers. Pharmacists play a key role in certain countries through the sale of abortive products or products that are used for these purposes (Pick de Weiss, 1999).

Academia / Researchers

The difficulties and limitations existing in Latin American and Caribbean countries, as well as countries in other regions, in obtaining accurate information on the scope of abortion, its characteristics and consequences are well known. The contribution of researchers in both the medical and, in particular, the social sciences has been crucial to shedding light on theoretical, methodological, social, cultural, legal, philosophical, political and ethical aspects of the study of abortion. The literature on the subject shows the contributions made by these actors in measuring the incidence of abortion: in developing methodologies and innovative techniques to obtain better estimates, in the knowledge of the characteristics and motives of women who seek abortion, in revealing the consequences associated with the matter, particularly as a result of the higher risk conditions in which abortion is performed, in examination of the link between abortion and contraception; and in understanding of the effectiveness and effects of the various abortive methods. From a broader perspective, issues such as the role of social inequity, gender, and the role of men and other actors in decisions surrounding reproduction and abortion have been dealt with. Academic research has also addressed the circumstances of access to quality service in abortion and post-abortion hospital care, and the social, psychological and legal problems derived from the conditions in which abortion is performed. Moreover, research agendas have been proposed and recommendations made for the design and implementation of interventions in this field. It is in these aspects that researchers have played a key role in the debate by providing the results of their research and their different points of view, permitting an increasingly broad discussion that is both largely scientifically based and objective. Proof of the participation of these actors is the broad base of bibliographical reference presented in this publication.

Researchers on the issue of abortion in the region have historically been linked to other actors, such as feminist groups and international organizations, in joint projects that have enabled both to gain visibility through the presentation of arguments in favor of the decriminalization or legalization of abortion and its implications. However, as LLovet and Ramos (2001) so rightly point out, the political and public aspects of abortion have not been a key or a systematic line of research in the region. This is partly due to the virtually total absence of political scientists among the various researchers and disciplines that work in the fields of reproduction. It is also worth mentioning the role, albeit small, of legal specialists and lawyers responsible for drafting laws and imparting justice, whose contribution to the analysis and reflection on  the right to life (of the mother’s life in contrast to the fetus life) on the basis of the concept of human dignity and of the rights of individuals is extremely necessary and crucial (Rosas Ballinas, 1998; Ugaz, 2000).

The Media

The media have played a key role in recent public debate. As transmitters of various opinions on the subject, they have managed to lend visibility to the actors and the various positions both in favor of the liberalization of laws and the decriminalization of abortion, as well as the attempts to reform them and make them more restrictive in order to punish the practice of abortion under any circumstances. Key examples include the dissemination of discussions triggered by specific events, such as the case of Paulina in Mexico or Rosa in Nicaragua, or the attempts either to reduce the grounds on which abortion is permitted in the state of Guanajuato, or to extend them in the state of Chiapas in Mexico (www.gire.org.mx; López Vigil, 2003).

For their part, the analyses that have  subtended public debate in the national press in several countries illustrate the plurality and richness of the discussion, the arguments, the replies and rejoinders by various sectors (GIRE, 1997; Castillo, 2001; Tarrés Barraza, 1993; Tarrés, 1995; Yam et al., 2005). The expression of the debate surrounding abortion in the media is important, as Monsivaes points out, because it is a way in which public debate becomes a crucial political instrument for treatment of and interventions in social and political problems, since it can acknowledge bridges of understanding and play a key role in forming citizenship (GIRE, 2001).

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