Conclusions

The social, cultural and institutional barriers to obtaining access to contraception largely explain the scarcity or total lack of preventive culture and behavior for reducing the incidence of abortion.

Although modern contraceptives are crucial in preventing unwanted pregnancies, access to them and their effective use continue to be insufficient in Latin America and the Caribbean. This is one of the factors that largely explain why the region has the world’s highest rate of abortions, most of which are clandestine and unsafe, as has been seen in previous chapters. Various factors combine to make the use of effective contraceptives in the region much lower, despite the advances and success achieved in this respect. One of the main factors is the lack of clear, accurate information on these methods. Many Latin American women still express reticence and fear about effective methods and therefore stop using them, since they attribute side effects to them which they usually do not have. This is closely linked to the lack of reproductive health services in which, among other things, clear and precise orientation is provided in contraceptive use that will enable women to choose the one best suited to them, according to the frequency with which they have sex, their age and other circumstances.

The situation is most worrying for young women and adolescents, for whom access to modern contraceptives tends to be more difficult than for other women. Serious obstacles to obtaining access to these methods are also faced by women in vulnerable groups, such as indigenous women or residents in isolated communities, which family planning programs either do not reach or scarcely influence. Another factor that discourages contraception using modern methods is the permanent campaign by conservative actors calling for abstinence or the use of natural methods that are less effective in controlling women’s fertility. Far from achieving their aim, however, these calls only help increase the number of unwanted pregnancies and therefore of abortions. Faúndes and Barzelatto (2004) highlight “the paradox between declaring oneself against abortion and opposing the prevention of unwanted pregnancies” referring to the arguments of conservative groups: opposition to the use of modern contraceptive methods, calling them artificial or attributing an abortive effect to some of them, as well as opposition to sex education, on the grounds that this encourages earlier sexual initiation. As the authors state, these are arguments that eventually encourage abortion with all the adverse consequences this has in countries with restrictive legislation.

Added to this is an undeniable fact: there will always be a possibility, however remote, that contraceptive methods, even those that have proven effective, will fail. And this may happen even if women use them correctly, precisely to avoid getting pregnant. This makes it essential to guarantee access for all women to quality medical services that provide safe abortions, since there will always be unwanted pregnancies, which in many cases will have to be interrupted.

In order to substantially reduce the number of unwanted pregnancies, Latin American countries must extend reproductive health services, together with family planning programs. At the same time, it is important to facilitate access to contraceptive methods. They should also be distributed free or at very low cost to low-income sectors, which constitute the majority in most of the countries in the region. It is also necessary to improve contraceptive practice and diversify the choice of methods offered to women, so that resorting to abortion stops being the only choice available to women for regulating their fertility. The resistance of many of these women to using contraceptives could be reduced if they were offered a wide range of methods, adapted to their needs. These methods include emergency contraception, which, as has been discussed, is particularly useful in the events of unprotected sex and rape.

Another extremely important action consists of offering reliable, easy to understand information on the use of contraceptive methods to all women that have aborted, in order for them to prevent unwanted pregnancies and therefore not have any more abortions, as still often happens. Evaluations of the quality of post-abortion care in Latin American countries confirm that the proportion of women seeking this type of service who are given this information is still low. At the same time, many studies on PAC clearly show the users’ manifest intention of using a safe method. However, there are as yet no follow-up studies to assess this intention and the factors that prevent women from achieving their goals in this respect. An examination of the occurrence of repeat abortions in the same person could shed light on this.

The death of a woman as a result of an unplanned, unwanted pregnancy, is the most obvious and crude manifestation of the lack of access to contraceptive methods. It also constitutes a clear violation of human rights, of which reproductive rights form part (Padilla and McNaughton, 2003). Creating broad access to modern contraceptive methods and quality reproductive services would help substantially reduce maternal morbid-mortality in Latin America, where many women suffer the effects of undergoing abortions in poor conditions. This would also make it possible to fulfill the commitments made by the countries in this region as a result of conferences such as those in Cairo (1994) and Beijing (1995) that confirm international recognition of reproductive rights, which includes universal access to quality medical services that ensure safe abortions.

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