Reproductive rights in Latin America

While feminist movements became prevalent in Europe and North America in the 1960s and 1970s, the women of Latin America were gathering to oppose dictatorships and civil wars. As democracy began to spread across the region, feminist movements gradually began to push for reproductive rights.

In the 1990s, many of the groups that made up the women's movement began to evolve in order to adapt to a changing political climate. These groups focused on specific policy issues, such as abortion, and were not composed exclusively of civil society actors. During this same time period, anti-abortion activism was also beginning to gain momentum. The Vatican replaced hundreds of progressive clergy and summarily repressed discussions of reproductive issues. Groups continuing to fight for reproductive rights across the region have faced a strong resistance from the Catholic church as well as the religious right in the United States. Although a majority of countries within the region are officially secular, the church continues to have an extensive influence within the region due to Latin America being the largest Catholic region in the world. The religious right in the United States holds substantial clout over the political right in its own country, which has resulted in the United States banning federal funding for international NGOs. Considerably damaging to groups in Latin America was Ronald Reagan's 1984 Global Gag Rule which prohibited international organizations receiving US federal funds from performing or promoting abortion as a method of family planning.

Currently the divide is between the right of the woman to choose and the right to life of the unborn child, with countries such as Argentina, Ecuador, El Salvador and Peru revising their constitutions and civil codes to push juridical rights back from birth to conception.

Defining reproductive rights

During the Cold War, reproductive policies were directed at controlling overpopulation through technocratic regulatory mechanisms and vertical population control campaigns. The United Nations International Conference on Population and Development of 1994 held in Cairo, Egypt established the first global agenda for sexual and reproductive health and rights. The agreement marked a paradigm shift away from a narrow approach based on delivery of services and numbers rather than well-being. It placed rights at the center of population and development and defined reproductive health as "a state of complete, physical, mental and social well-being and not merely the absence of disease of infirmity, in all matters relating to the reproductive system and to its functions and processes." This broader approach to reproductive health moved the Cairo Agenda into political and economic debates over access and rights to knowledge, resources, and appropriate services. Thus, women and health movements in civil society and their allies in the United Nations and national bureaucracies have undertaken strong campaigns to link public health, gender equality, and development policy.

This cross-cultural consensus focuses on the importance of one particular capability, that of bodily health. Recognizing the many areas reproductive health has influence over serves to exemplify its importance as well as gives some understanding as to what necessary improvements need to be made to a society.

Current strategies

International Conference on Population and Development (ICPD)

The 1994 International Conference on Population and Development defined reproductive health as noted above. It also defined strategies and goals for advancing such reproductive health and rights in Latin America through what is called the Cairo Programme of Action (CPA). The CPA has three quantitative targets: (1) Reducing overall mortality, which implies an increase in life expectancy, reducing specific mortalities (2) Universal access to education, especially for girls (3) Universal access to reproductive health services, including family planning. Adopted by the region at the conference, some improvements have been seen since the adoption of the CPA. Reproductive rights have become recognized in the constitutions of Bolivia, Ecuador and Venezuela. The Environmental Commission for Latin America and the Caribbean Ad Hoc Committee on Population and Development is responsible for official follow-up to the implementation of the CPA in Latin America as well as the Caribbean.

Millennium Development Goals in Latin America

The Millennium Development Goals are a descriptive framework by which to monitor response to eight specific goals. They were announced in the Millennium Declaration in September 2000. Whether or not a country is on track to meeting these goals—in the case of Latin America—is tracked by the Economic Commission for Latin America and the Caribbean (ECLAC). One particular goal in regard to reproductive health, Goal 5, seeks to improve maternal health within the region. The first target of Goal 5 is to reduce the maternal mortality ratio by three quarters between 1990 and 2015. In order to assess the progress towards this goal, ECLAC monitors maternal mortality ratios and the proportion of births attended by skilled health personnel. The second target of Goal 5 is to achieve universal access to reproductive health by 2015. This target is assessed by viewing contraceptive prevalence rates, adolescent birth rates, antenatal care coverage and percentages of unmet need for family planning. In order to achieve these goals, many actions have been taken, including the growing institutionalization of deliveries and the increased number of personnel trained to provide care during childbirth and emergency obstetric care.

Maternal health and mortality

According to the World Health Organization (WHO) in 2010, about 9,200 women are dying annually from pregnancy-related causes. These deaths have a variety of causes that can occur as a result of complications during and following pregnancy and childbirth. The World Health Organization estimates that around 80% of all maternal deaths are a result of severe bleeding, infections, high blood pressure during pregnancy and unsafe abortions. According to a report by the Guttmacher Institute, more than 20% of women who gave birth in 2008 did not make the recommended four antenatal visits and 13% did not deliver in a health facility.

None of the Latin American countries will reach the Millennium Development goal target specifically for maternal mortality, as well as it continues to be both a health and social challenge in Latin America. Research indicates that the numbers are disproportionately high within the indigenous and afro-descendant populations among the very poor. For indigenous populations as well as adolescents and young people, the rate of unmet family planning need also remains high. Latin America has the second highest fertility rates among adolescents and the highest unsafe abortion rates in the world.

Overall, the maternal mortality rate in Latin America is relatively low compared to other regions with a rate of 80 death per 100,000 live births. However, if one were to break down the region's mortality rate by country, one could easily demonstrate that the there exists a large disparity between affluent and poor countries. For example, in Haiti the rate was closer to 350 deaths per 100,000 live births. The disparity between wealthy and poor areas likely exists due to the differences in access to services and skilled professionals. Women in the highest income quintile have far easier access to such health services than women in the lowest income quintile. The same class-based disparity exists when analyzing the use of contraceptive methods.

Adolescent maternity and reproductive health

Protecting the health of adolescents is an important public health priority. Increased investment in adolescent reproductive health contributes to improving the overall status of women as well as the reduction in poverty among families.

In Latin America, 38% of women become pregnant before the age of 20 and almost 20% of births are to teenage mothers. Each year there are estimated to be 1.2 million unintended pregnancies among adolescent women living in Latin America and the Caribbean. Although overall fertility rates have largely dropped within the region, adolescent maternity is following an opposite trend. The Gender Equality Observatory for Latin America and the Caribbean reports that as of 2011, in Nicaragua approximately 2 in 10 women between the ages of 15 and 19 is a mother. In places such as Chile, Mexico, Paraguay and Peru the percentage is close to 12% while in Belize, Venezuela, Colombia, Guatemala and El Salvador reach percentages close to 15%. Inequality is also present in the issue of adolescent maternity, with pregnancy rates being three to five times higher among poor adolescents.

According to the UN Population Fund, education and access to information and services young people need in order to make responsible decisions remains insufficient. Further, many young girls are dying because their bodies cannot support pregnancies. The same fund reports that the risk of complications during pregnancy and delivery for girls aged 15 to 19 is double the rate for women in their 20's, and five times as high for girls under 15. Research reveals that there are several major barriers that young people face to accessing contraception, primarily with acquiring services. For example, facilities are frequently in areas inaccessible to young individuals. For the purpose of privacy from their communities and families, young persons often seek services from facilities not located directly in their own neighborhoods. There are also legal barriers preventing youth's access. Many policies limit or prohibit confidential services for youths.

Aside from a lack of information, young people who seek contraception are often denied by health workers acting out of their own moral convictions. It is clear that religious attitudes are very much present in society, which often deters young persons from seeking reproductive services and contraception.

Family Planning

Contraceptives

Use of modern contraceptives has increased to 62.5% (CITE: Population action) giving the region as a whole the highest contraceptive prevalence rate in the developing world. The increased uptake of sexual and reproductive health and family planning services has resulted in a marked drop in total fertility rates from approximately 4.6 children per woman in the 1970s to about 2.5 in 2013. In Latin America, multiple court decisions have granted personhood to fertilized eggs. These court decisions have been responsible for the extreme restrictions on access to emergency contraception within the region. The legal status of oral contraception in Latin America varies by country. In 2009 Honduras banned the free distribution and sale of emergency contraceptives That same year, the Constitutional Court of Peru ordered the Health Ministry to refrain from distributing emergency contraceptives to the public sector. In Costa Rica, where emergency contraceptives are not blatantly prohibited, the popular emergency contraceptive levonorgestrel is not registered as a product, which impedes access to the drug from within the public health system as well as the private market. Although the remaining countries in the region allow for the free distribution of emergency contraceptives, they do not have uniform regulations. In Chile, Colombia and Ecuador, the right to have access to emergency contraceptives is recognized. In Nicaragua and Bolivia, the protocols of their respective health ministries are essentially law. In Argentina and Brazil, the distribution of emergency contraceptives is not legally recognized except in protocols and informative guides.

Abortion

In 2011, the number of unsafe abortions in Latin America rose to 4.2 million annually. Unsafe abortions account for a large proportion of maternal deaths. For example, in Argentina unsafe abortions account for 31% of the maternal mortality rate.

Reason required for a legal abortion	Countries
Prohibited altogether; no legal exceptions	Chile, Dominican Republic, El Salvador, Honduras, Nicaragua
To save the life of the mother	Brazil, Guatemala, Mexico, Panama, Paraguay, Venezuela
To preserve the mother's health (as well as save her life)	Argentina, Bolivia, Costa Rica, Ecuador, Peru, Uruguay
To preserve mental health (and all above reasons)	Colombia
Without restriction	Cuba, Puerto Rico

Only two countries within Latin America allow for legal abortion without restriction. However, these countries are home to less than 5% of women between the ages of 15-44. According to a report released by the Guttmacher Institute, 95% of abortions in Latin America are unsafe. Nearly one million women are hospitalized each year because of complications from unsafe abortion. Overall, Latin American rates of death related to illegal abortions rank among the highest in the world.

Comprehensive Sexual Education

In 2012 a report presented to the Inter-American Commission on Human Rights (IACHR) found that access to information remains a significant roadblock to sexual and reproductive health, particularly in Latin America.(CITE HR BRIEF) The report noted that even when a state has a comprehensive legal framework guaranteeing access to information, in practice the individual’s health is endangered by uninformed decisions made by individuals and policymakers based on inadequate information regarding sexual and reproductive health. In 2011, IACHR issued a report on access to information on reproductive health and found that the situation is compounded when women are poor, indigenous, of African descent, live in a rural area, or are a migrant.

In 2008, the region adopted "Miniseria Declaration, 'Prevention through Education,'" in response to a lack of comprehensive sexuality education. While there have been some setbacks and delays regarding implementation, there have also been key improvements. In 2013, the ministries of health and education of Guatemala reaffirmed their commitment to working together in order to ensure the goals of the Ministerial Declaration are the met. In addition, the government of Guatemala is implementing a comprehensive sexuality education program for young people in nine regions of the country. Actions aimed at promoted comprehensive sexual education can be seen in multiple areas of the region, demonstrating that leaders are indeed dedicated to making such improvements. Earlier in 2012, Costa Rica adopted a national sexuality program for the first time in history. More notably, the curriculum approaches human sexuality in a comprehensive way; it includes lessons on human rights, gender equality, power, interpersonal communication, respect for diversity and pleasure. Also making a critical first step that year was El Salvador with its General Youth Act, legislation which recognizes and guarantees the right of young persons to receive comprehensive sex education. Implementation will be an ongoing challenge, however, recognition is important step toward meeting the needs of youth.

See also

• Reproductive rights in Brazil