Consequences for Women and Families

The Impact on Families’ Budgets

Abortion has a significant economic impact on women’s and families’ budgets, particularly among the most disadvantaged sectors of the population, since they not only have to pay for the abortion, but often also have pay for the medical cost of complications. There are also indirect economic costs, such as transport, those derived from the woman’s absence from her economic and domestic activities, or the absence from work of other family members accompanying her. According to Pine (2003), clandestine abortions performed by health workers may cost between a quarter and half a woman’s monthly salary (p.80). However, Langer (2003) notes that “In some contexts, the cost of a clandestine abortion performed by a doctor in a private clinic is equivalent to the annual income of an average family”. There are obviously widely varying prices for clandestine abortion, but when they are attended by specialized medical personnel they are often unaffordable for many women, particularly adolescents in the poorest groups. The absence or loss of a mother should also be regarded as part of the cost (Langer, 2003).

In a study on the laws affecting women’s reproductive lives, particularly those related to abortion, the Legal Center for Reproductive Rights and Public Policies notes that the interruption of pregnancy “is a practice which, despite its legal prohibition, extends to women of all social classes, with more serious consequences for poor women” (Centro Legal para Derechos Reproductivos y Políticas Públicas, 2001; Center for Reproductive Law and Policy, 2000). As pointed out in another study, women with few resources often resort to clandestine abortions even when in actual fact they are entitled to a safe, low-cost procedure (p.80) (Pine, 1993). Access to abortion for a large number of women in the region, even in cases provided for by law and therefore having the right to abort, continues to depend on the will of state of medical personnel, the users of which are usually women of slender means (Faúndes and Hardy, 1997).

There are several studies documenting the enormous scope and variability of the financial costs of clandestine abortion in countries in the region. According to data from an opinion survey mentioned earlier on abortion in six countries in the region, these costs vary from payment in kind or approximately 10 USD for the purchase of medicinal herbs, to extremely high amounts (Allan Guttmacher Institute, 1994). On the basis of this source, the cost of an abortion performed by a trained person appears to be much lower in Colombia (approximately 44 USD) than in other countries in the region, which may be due to the fact that this is the country with the highest proportion of poor urban women that apparently have access to services offered by trained personnel. According to Strickler et al. (2001), the cost of an urban clandestine abortion in South America varies from 20 to 200 USD.

In Mexico, this situation is compounded by the fact that women that go to public health services after having had an abortion are only granted leave from work for an average period of 10 days (López García, 1994). The cost of an abortion is lower when products prescribed at pharmacies are used (ranging from 30 cents to 3 USD) but is estimated to be much higher if a woman uses products obtained from medicinal herb sellers (between 13 and 23 USD), who tend to prescribe as abortifacients one or several of the approximately ten plants commonly used for this purpose, in addition to certain medication. These costs are high in comparison with the Mexican minimum salary, which is approximately 4 USD a day. However, these procedures are more affordable than those performed in hospitals, which cost approximately 160 dollars, an amount that may double if the interruption of a pregnancy is performed clandestinely (Pick, 1999).

In Chile, the cost of an abortion for women of a low socio-economic status may range from 50 to 200 dollars, constituting an enormous expense for them (Casas Becerra, 1997). A regional study points out that in Uruguay, there are many clandestine abortion clinics. If a woman can afford it, she can obtain a safe, if illegal abortion. Otherwise, women resort to traditional folk healers, unqualified service providers or provoke an abortion themselves. It is estimated that in Uruguay, a safe but illegal abortion costs between 200 and 800 dollars (Rayas and Catotti, 2004; Rayas et al., 2004) (the current minimum salary being approximately 110 dollars a month). This same study points out that in Bolivia, abortion services available on the black market cost between 50 and 300 dollars. Despite their cost, these services endanger the health and lives of women and adolescents, particularly those with the least resources, which increase the costs to public health services and society in general.

In Brazil, although Cytotec is exclusively supplied to people with medical prescriptions and its use in abortions is expressly forbidden, the drug can be obtained on the black market for approximately 70 dollars. It is estimated that of the 600,000 women that have abortions in Brazil (IAG suggests that this figure may be as high as 1,400,000) 75% use this medication (Coeytaux, 2002; Rayas and Catotti, 2004; Rayas et al., 2004).

Uruguayan clinics use MVA, costing approximately 400 dollars per woman. Sanseviero (2003) notes that “those that perform abortions […] estimate the total costs of treatment at certain clinics or hiring ITC (Intensive Therapy center) for emergencies at between 13,500 and 25,000 USD” (p. 54).

In Peru, Li (1994) notes that abortion costs are an important factor in the quality of the care provided, in addition to having a significant economic impact on the family budget. He estimates that the cost of an abortion is between half and 11 times the minimum salary and that if one includes the woman’s expenses before she is admitted to hospital, this may rise to between 214 and 278 dollars.

In Nicaragua, the costs of private clinics range from 500 to 1,000 USD, which is virtually unaffordable for most women. The price of an abortion performed in risky conditions ranges from 7 to 150 USD (McNaughton et al., 2003; Rayas y Catotti, 2004; Rayas et al., 2004).

Nevertheless, when calculating the cost of an unsafe abortion, one should not restrict oneself to looking at a single method, since this could be a deceptive indicator of the accumulated financial cost involved in interrupting a pregnancy. A woman often goes through various stages, each more dangerous and costlier than the previous one, until she achieves an abortion: ranging from falling down stairs, eating herbs or purchasing pseudo-abortive or abortifacient products at pharmacies. She may also pay for the service of an unqualified person or a trained doctor. In addition to this, one should add the cost of medical services needed because of an abortion or those necessitated by an incomplete abortion (Alan Guttmacher Institute, 2004).

Social and Psychological Effects

As pointed out earlier, abortion has produced discriminatory practices against women, particularly those belonging to the most disadvantaged classes. That is why in Latin America, as noted in Chapter 2 -Public Debate on Abortion-,”Abortion has become a problem of social justice in countries where this practice is penalized. In them, women from the lower social classes that lack sufficient financial resources are forced to resort to clandestine abortion, unlike those that can afford to have a safe abortion or travel to countries where it is legal”. Likewise, since the laws penalizing abortion are only applied in exceptional cases, in practice, this makes the law ineffective regarding the total number of abortions performed daily. Poor women also run a greater risk of being denounced to the authorities and sanctioned with prison sentences, since in the event of complications related to an unsafe abortion, they are obliged to seek care at public institutions, where most of these denunciations take place (Center for Reproductive Law and Policy, 1999). Medical professionals’ behavior also violates women’s right to privacy and confidentiality, since the laws that penalize abortion create an ethical dilemma that is difficult to resolve.  They trap the doctor between his duty as a citizen to report an illicit event to the authorities and his duty as a doctor to preserve the confidentiality of those he attends (Center for Reproductive Law and Policy, 2000).

The implications of a poorly performed abortion may also affect other spheres of women’s lives: they may interrupt their economic or academic activities and thereby compromise their future opportunities. Fear of having to drop out of school due to an unplanned pregnancy is one reason for seeking an abortion, often mentioned by adolescents and young women (Díaz Sánchez, 2003). Likewise, in these types of cases, deaths from abortions involve young women who are often responsible for looking after small children or other family members (Langer, 2003).

At the same time, the practice of abortion also entails psychological consequences, which depend on the woman’s freedom of decision and the possible pressures she may be under. Some women may experience negative feelings such as guilt, depression, anxiety and fear, especially when the abortion is performed in traumatic conditions (Langer, 2002). It has also been pointed that if the abortion is carried out against the woman’s will (due to family pressure, economic problems, etc.) it may constitute a cause of depression (GIRE, 2000). However, the psychological consequences of abortion may even be positive when the woman puts an end to a pregnancy in good sanitary conditions and above all, when she chooses this practice in a conscious, free and informed way (GIRE, 2005). In a study on clandestine abortion in Mexico (Amuchástegui and Rivas, 2002), the authors include testimonies from women who said they felt extremely calm after having an abortion outside the law, but when it was performed safely and they were treated respectfully by the medical personnel attending them.

It is important to consider that after an abortion, many women feel relief, because the obligation to continue with an unplanned pregnancy can have more important emotional consequences than the interruption of one (Langer, 2003). The author also points out that one subject absent from studies on maternal mortality and associated with abortion are cases in which women end up committing suicide due to the pressure they experience when they have an unwanted pregnancy or are murdered by their spouses or other persons unwilling for them to continue their gestation.

Other studies emphasize the conflicts women experience over the social, cultural and religious values regarding motherhood (Cardich and Carrasco, 1993), as well as feelings of guilt and a tendency towards self-recrimination experienced by some women who resort to abortion (Kennedy, 1994). In addition, many women experience situations of powerful emotional conflict in the face of an unwanted pregnancy, encouraged by cultural patterns that prevent or hamper the possibility of making autonomous decisions regarding sexuality and reproduction. They are also the object of social stigmatization, perceived as transgressors of the religious and moral values that are deeply rooted in Latin American societies (Rivas and Amuchástegui, 1998).

It is also important to note the psychological and social consequences of a refusal to perform an abortion, particularly when the pregnancy is the result of rape. Many women suffer damaging pressure from civil and religious authorities and health personnel, even if they ultimately succeed in obtaining an abortion.  The cases of Paulina in Mexico or Rosa in Nicaragua are examples of worst-case scenarios in which women were forced to add the burden of continuing their pregnancies to the burden of having been sexually assaulted.

Fortunately, after a long legal battle and due to the support of civil organizations, the Mexican authorities agreed to pay reparations for the damage inflicted to Paulina as a result of their having prevented her from aborting. This, however, required six years and the intervention of the Inter-American Commission of Human Rights, in order for the governor of the northern Mexican state of Baja California, where the rape took place, and the Federal Government to acknowledge the fact that an injustice had been committed for which compensation should be paid (Human Rights Watch, 2006).

As in other Latin American countries, rape is a fairly common event in Mexico, and in 2001 it “was the seventh most common crime,” according to government sources (GIRE, 2004). In addition, children resulting from unwanted pregnancies run the risk of suffering rejection or mistreatment at the hands of their mothers and experience greater difficulties in their social and interpersonal relations (Faúndes and Barzelatto, 2005).

It is also worth noting that the treatment received by women at the facilities where they seek abortions is not always optimal: women may be criticized, stigmatized or treated without respect by medical personnel, in addition to often having to wait a long time to be attended. The qualitative study by Steele and Charotti in Argentina includes testimonies on the cruel, humiliating treatment received by women in health facilities, where they suffer isolation and lack of attention even when they arrive in poor physical condition (such as when they are bleeding). They are not always given medication for pain or anesthetized during operations. Added to this, their privacy is not respected and they are punished because of suspicion that they provoked the abortion themselves (Steele and Charotti, 2004).

As certain studies rightly point out, the high number of women hospitalized for abortion complications shows that the motivations for interrupting pregnancies continue to be as powerful as or even more powerful than they were in the past (Alan Guttmacher Institute, 1994). Likewise, the use of obviously ineffective, risky methods reflects the desperation of many women to put an end to an unwanted pregnancy (Langer Glas, 2003).

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