What of the Debate on Abortion in Countries where its Practice has been Decriminalized?

One of the striking facts in the bibliographical review carried out in this study is the relative lack of literature describing the existence or lack thereof of public debate on abortion in countries such as Cuba, Puerto Rico, Barbados and Guyana, where abortion is available at the woman’s request. Obviously, despite the fact that behind an abortion there is often an unplanned pregnancy and this signals unwanted, sometimes avoidable events in women’s lives, one could ask at least four questions: does the debate on abortion end with its absolute decriminalization and legalization? Is the significant progress implied by a legal framework without restrictions on abortion also reflected in sex education and reproductive rights, particularly among the teenage population? Does this framework permits a better quality health services for performing less risky abortions and with less adverse consequences at the individual, family and social levels? What are the views of the groups and actors that oppose abortion being made available at the women’s request?

In Puerto Rico the arguments wielded by anti-abortion forces and the counter-arguments of those that support the interruption of unwanted pregnancies as a choice are located within the context of the laws that govern Puerto Rico and the influence of the US. Although abortion is legal in Puerto Rico, the right to abortion has been attacked and its accessibility affected. The debate on abortion has adopted a symbolic nature and its arguments refer to broader situations within society, such as female and male identity and roles, sexuality, reproduction, family and social problems. The main argument of the anti-abortion offensive lies, as in other countries in the Latin American and Caribbean region, in stipulating that human life begins at the point of conception and that the fetus has the right to the protection of its life. Women’s control of their reproductive capacity and rights over their bodies and lives are regarded as secondary issues. The social factors that favor the legal practice of abortion argue that the choice of abortion is essential for women to be treated as equals, people with all their human potential and prerogatives. They also emphasize the adverse consequences of abortion preformed in risky, illegal circumstances, translating into hundreds of thousands of maternal injuries and deaths. Likewise, other issues that become part of the debate include the need to respect the various positions regarding the definition of human life and the separation between Church and State, the biological reductionism of asserting that the fetus is a human being, and the dehumanization of women implied by the humanization of the fetus (Cólon Warren et al., 1998; Cólon Warren and Planell Larrinaga, 2001; Profamilia, 1993; Azize Vargas, 1993).

In the case of Cuba, given that abortion is not punished by law or persecuted, there is no public debate on the subject. The importance of the legalization and decriminalization of abortion that took place in 1965, protecting a women’s unalienable right to abortion, is recognized (González Labrado et al., 2001; Mayo Abad, 2001). Nevertheless, it has also been pointed out that, despite the significant decrease in maternal mortality in general, particularly related to abortion, the morbidity associated with it has not been as drastically reduced (MINSAP, 1999). Given the permanence of high abortion rates, the concerns and discussions (mainly of health professionals) focus on the insufficient, inadequate access to and use of family planning methods (González Labrador et al., 2001). Such discussions also highlight the failure of sex education programs, particularly among teenagers, who receive very little education in this respect (Aguilar Acebal and Neyra Reyes, 1999; Cortés Alfaro et al., 1999; Fonseca Fernández de Castro et al., 1999; Libertad and Reyes Días, 2003). As Mayo Abad points out (2002), “if the conscious, responsible use of contraceptive measures to prevent untimely pregnancies is the most appropriate form of family planning, we must accept that we are not satisfactorily implementing existing possibilities. Our obligation is to reduce the incidence (of abortion) through the implementation of coordinated educational measures combined with accessibility of a wide range of contraceptive methods within the entire population. The current situation poses a challenge to our national health system.” (p. 130). According to Álvarez (2001), in this country, where abortion is legal and there are established institutions that provide state-mandated medical services, abortion is considered a problem for different reasons. The author says that it is, “an economic problem, because many material and human resources are invested in it; psychological and social, because it is the recourse of so many women, predominant among them being young women who have not yet begun having children…”(p.88).

Guyana is a good example of the fact that the approval of a liberal abortion law is barely the start of achieving timely, quality abortion services. Debate in this case continues through the implementation of services and assuring that the government leads that implementation, as pointed out by Nunes (2001). Five years after the current Guyanan abortion legislation was passed, its implementation was still scant, according to Nunes and Delph (1995) in their account of the trajectory of this legal reform. The Pro Reform Group, the leader of the movement that achieved abortion’s decriminalization, paid close attention to the health minister but ignored the commitment of the Health Ministry’s technical teams. This group stated in 2000 that unsafe abortion was not a health priority which is why no public hospital in Guyana offered services in keeping with the law or reported cases of abortion complications to the Ministry. Poor women in Guyana know that they cannot interrupt their pregnancies in the country’s public hospitals because the service is not provided. This situation lends itself to abuse and doubts on the part of hospital administrators regarding the authority to provide the service. Other issues under discussion were the methods the law provided for performing abortions (manual aspiration instead of dilation and curettage), the drawing up of abortion registration to submit reports to the Health Ministry, the waiting period and obligatory counseling.

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