Innocents: El Salvador, where pregnant women have more to fear than Zika

Rachel Nolan, Innocents. Harper’s, October 2016. “There are six countries in the world that prohibit abortion under all circumstances, without exceptions for victims of rape or incest or for cases in which the pregnancy threatens the life of the mother: El Salvador, the Dominican Republic, Chile, Nicaragua, Malta, and Vatican City. In the United States, even the most fervent antiabortion groups maintain that women who have abortions are victims, instead directing their attacks at doctors. Earlier this year, when Donald Trump suggested that if Roe v. Wade were reversed, women who choose to terminate a pregnancy should be subject to “some form of punishment,” he was denounced across the political spectrum.

That scenario already exists in El Salvador, a country of 6.3 million, where an active medical and law-enforcement system finds and tries women who are suspected of having had abortions. Public prosecutors visit hospitals to train gynecologists and obstetricians to detect and report patients who show “symptoms of abortion.” Doctors are legally obligated to be informants for the police.”

The sentence is two to eight years in prison. But because El Salvador’s constitution classifies a fertilized egg as a legal person, in many cases prosecutors arbitrarily upgrade the charge to aggravated homicide, which carries a penalty of between thirty and fifty years in jail. (The aggravated-homicide charge is meant to apply to cases in which the fetus is more than twenty-two weeks old, but judges rarely learn the details of a pregnancy.) In July, the conservative party ARENA proposed to the Legislative Assembly that the minimum prison sentence for women convicted of abortion be raised to thirty years….

San Salvador’s main public maternity hospital, a drab building of concrete and brick, is situated in the Plaza de la Salud (“Plaza of Health”), across from the general and surgical hospitals….

The current [hospital] policy is to emphasize doctor–patient confidentiality as a defense against having to report women to the authorities. As a practical matter, [Dr. Roberto] Águila [the head of gynecology residents] said, it can be hard to tell how exactly a pregnancy ended. Some women try home remedies, potions bought at the market, jumping down from chairs, or using ulcer pills known to induce miscarriage — unless a doctor finds a pill partially dissolved in a woman’s vagina, evidence of intent can be difficult to spot. Still, arguments arise with older staff at the hospital, who were trained to call the police at the first possible sign of wrongdoing. Nurses threaten to report doctors for not informing on patients. “Sometimes they scare the residents,” Águila told me. “They get to the bedside and say, ‘You have to denounce her!’ ” The residents come to him for backup. “It’s difficult,” he said. “We have to wait for a generational change.”…

There are only three lawyers who have built their careers seeking out cases of women accused of abortion in El Salvador. They team up with the Agrupación Ciudadana por la Despenalización del Aborto, or the Citizens’ Association for the Decriminalization of Abortion, an activist group, to provide free legal counsel. The lawyers find out about cases through family or friends of the accused, human-rights workers, or sensationalist newspaper reports about “baby killers.” Many women don’t seek their help, either because they don’t know about it or because of the stigma of the crime. Some of the accused and their families believe that abortion is a sin — those who cannot abide the group’s politics turn away their best chance at exoneration….

The government of El Salvador does not release statistics on the number of women reported for suspected abortion, or of those tried, sentenced, and incarcerated. A review of available judicial records suggests that from 2000 to 2011, at least 129 women were prosecuted for abortion-related crimes. Twenty-three were convicted of abortion, and nineteen were found guilty of aggravated homicide. Seventeen were put in jail following reported stillbirths or other complications — they became known as Las 17. Agrupación’s lawyers, who work between twenty and thirty cases at a time, say there are probably many more women accused each year than they know about, let alone are able to defend….

Even before the onset of Zika, Catholics in Latin America were known to diverge from the Vatican on certain points, picking and choosing which principles to follow. In El Salvador, the Church’s ban on abortion is upheld to the extreme, even as the government has — to the disappointment of fundamentalists — systematically ignored its advice on contraception. By law, free condoms and temporary sterilizing injections are to be distributed at health centers, no questions asked….

Murder makes headlines, but rape does not. Gang members rape one another’s girlfriends or sisters as revenge or punishment, and initiate new boys by finding a woman or girl for them to rape — perhaps together, to really feel close. Or they will rape simply because they are in control of whole city blocks and they can. The commonly cited number is that five Salvadoran women are raped per day, but those are only the reported cases. Indeed, rape is so common that, were there an abortion-law provision for victims, it is easy to imagine that a substantial proportion of pregnant women and girls would qualify.