How difficult is it to get a legal abortion in Bolivia? Well, as shown by a recent ordeal an 11-year-old child had to go through, it took weeks of mass national protests, government intervention, and international media attention.
In October 2021, an 11-year-old Bolivian girl, unnamed due to privacy concerns, became pregnant after repeatedly being raped by her step-grandfather.[1] Abortion is legal in the country when the pregnancy is a result of incest or rape, or if the pregnancy is life-threatening.[2]
As such, why did it take such a state effort for a child to terminate a pregnancy?
In Bolivia, 90% of healthcare personnel are reportedly unaware of the circumstances in which abortion is legal.[3] Pregnant individuals also face significant stigma for seeking abortions. As a consequence, many women turn to clandestine forms of abortion to terminate their pregnancies, making unsafe abortion the third most common cause of maternal death in Bolivia. The current maternal mortality rate stands at 155 maternal deaths per 100,000 births—one of the highest in Latin America and the Caribbean.[4] Bolivia’s restrictions on abortions have dire consequences, as 60% of OBGYN health funds spent in the country are for treating complications from unsafe, clandestine abortions.[5]
All of these tell part of the story as to how this 11-year-old Bolivian girl was stripped of her fundamental human rights concerning her reproductive autonomy.
The 11-year-old girl, who we shall refer to as Maria, had been living under the care of her 61-year-old step-grandfather in Yapacaní while her parents worked in La Paz. Maria told her cousin that she experienced unusual movements in her belly that scared her. Following their conversation, the cousin informed her mother about the situation, who contacted authorities.[6] Maria was brought to the children’s Ombudsperson’s Office, whose role is to protect and promote human rights in Bolivia.[7] There, she underwent an interview with a psychologist. In Maria’s meeting with the psychologist, she cried and noted that she wanted to have what was in her body removed and resume her studies.
Consequently, the step-grandfather was brought into custody and Maria’s mother took her to the Percy Boland Women’s Hospital in Santa Cruz to terminate her pregnancy, where she was given mifepristone to induce medical abortion on October 22.[8]
The next day, Maria was visited at the hospital by officials claiming to be attorneys for an organization affiliated with the Catholic Church. Despite her evident fear and desire to move past the pregnancy, she stated on the next day that she wanted to pursue her pregnancy.[9] In a separate meeting without the presence of Maria and her mother, the Church representatives consulted with the hospital personnel, who decided to discontinue the abortion.
According to a second psychological review that Maria had undergone on October 25, the psychologist learned that the Church representatives had influenced Maria to suspend her abortion. Reportedly, the representatives characterized an abortion in a manner that scared her and pressured Maria to sign a statement indicating her desire to move forward with the pregnancy. Consequently, she was brought into the care of a Catholic shelter on October 26.[10]
In response to the mistreatment of Maria and the deprivation of her reproductive rights, demonstrations broke out in Bolivia. Activists, such as the humanitarian organization Plan Internacional, who chanted “Save the two lives”, “child pregnancy is torture,” and “Niñas, No Madres” (“Girls, not Mothers” in Spanish) gathered and wore green scarves—an emblem of mobilization for abortion criminalization across Latin America.[11] Demonstrators such as activist Carmen Sanabria also asserted that the mistreatment of the young girl’s case ultimately condones acts of rape.[12]
Additionally, due to a petition made by the Ombudsman, a La Paz court required that Maria be removed from the Catholic shelter and re-examined by medical personnel on November 2. Finally, Maria received a safe abortion with both her consent and support from her mother, and the Bolivian government called for the punishment of those who infringed on her reproductive rights.[13]
Subsequently, Bolivian Human Rights Ombudswoman Nadia Cruz asserted in a news conference that the Ombudsperson’s Office was filing criminal complaints against the Maria’s mother, the Children’s Ombudsman in Santa Cruz and Yapacaní, the hospital personnel, the Santa Cruz Bishop’s Conference and the church who intervened. According to Cruz, these individuals should be criminalized “for breach of duties, and human trafficking with the purpose of forced pregnancy.”[14] The United Nations in Bolivia asserted in a statement that forced pregnancy of a minor is categorized as a form of torture.[15]
Yet, Maria’s case could have been much different if the Ombudsperson had not intervened and if her case was not at the center of fiery nationwide protests. It took public outcry, intervention from the Ombudsperson, and support from activists nationwide for a single abortion to get through, while thousands of other Bolivians’ unwanted pregnancies are left unnoticed. Unfortunately, Maria’s situation is all too prevalent in Bolivia.[16] Specifically, around 185 women receive clandestine abortions in Bolivia every day.[17]
In addition, another barrier in abortion access arises due to medical personnel’s refusal to provide abortions.[18] Often, these refusals of providing abortion services can be adduced on the grounds of conscientious objection, or CO, which medical personnel have the legal right to invoke when providing a particular service clashes with their religious, moral or ethical beliefs. In fact, CO is widespread in Bolivian health facilities and its usage is most commonly based on issues such as misinformation and misunderstanding of abortion laws, stigma and fear of legal repercussions.[19]
It is crucial that legislators first focus on improving the health system’s preparedness to provide reproductive care. Specifically, legislators must expand accessible information regarding the legality and safety of abortions and abortion pills, as well as the rights of pregnant individuals and medical personnel who may need to provide abortion services. Placing a renewed focus on educating medical personnel on abortion laws will dispel misinformation and misconceptions concerning the legality of abortion services. Lawmakers must also prioritize the expansion of this information in poor and indigenous communities, who disproportionately endure poor reproductive and maternal health consequences due to inaccessible health services and lack of information.[20]
It is also critical that legislators assess the available data and stories of Bolivian women and girls who experienced the consequences of unsafe abortions, denial of abortion services or died due abortion criminalization in the country. Lawmakers must advocate for the full decriminalization of abortion so that pregnant individuals can receive safe and legal abortions without discrimination, outside influence and stigma.
Furthermore, legislators must also scrutinize the role that religious influence has in controlling the personal decisions of Bolivians. The Latin American and Caribbean Committee for the Defense of Women’s Rights issued a statement condemning the intrusion of the Catholic Church in Maria’s case.[21] Similarly, Bolivian legislators must also voice opposition to the Catholic Church’s interference in Maria’s case. Legislators must come together to form a committee specifically to protect the rights of pregnant individuals and their individual right to make decisions regarding keeping or terminating their pregnancies. Additionally, legislators must strengthen patients’ privacy rights policies so that hospital officials will not be able to discuss with third parties—such as Catholic Church representatives—whether or not patients should terminate their pregnancies, without the patient present in the room. The decision to terminate or continue a pregnancy should be a judgment of the pregnant individual, not religious third parties.
Access to safe reproductive health services is a fundamental human right—not one that should be at the crux of undue influence from Church officials and national demonstrations urging medical personnel and the Bolivian government to act. Maria endured sexual abuse, medical mistreatment and violation of her reproductive autonomy. If Bolivia wants to protect its children, women and other individuals who find themselves experiencing an unwanted pregnancy, its legislators must immediately make it a national priority to expand comprehensive reproductive services. Otherwise, they will continue to uphold their limited, inequitable and unsafe abortion laws that endanger many Bolivians every day.
Photo credit: Juan Karita via AP Photo
[1] “Girl’s Ordeal Exposes Bolivia’s Failure on Reproductive Rights,” Human Rights Watch, 6 December 2021, https://www.hrw.org/news/2021/12/06/girls-ordeal-exposes-bolivias-failure-reproductive-rights.
[2] “Bolivia,” Ipas 50. https://www.ipas.org/where-we-work/the-americas/bolivia/.
[3] “Girl’s Ordeal Exposes Bolivia’s Failure on Reproductive Rights.”
[4] Singh, Kavita, et. al. “A comparison of approaches to measuring maternal mortality in Bangladesh, Mozambique, and Bolivia,” Population Health Metrics, 15 January 2022. https://pophealthmetrics.biomedcentral.com/articles/10.1186/s12963-022-00281-8#:~:text=Maternal%20mortality%20in%20Bolivia%20currently,100%2C000%20live%20births%20%5B12%5D..
[5] Billings DL, et al. Scaling-up a public health innovation: a comparative study of post-abortion care in Bolivia and Mexico. Soc Sci Med, 2007. 64(11): p.2210-22.
[6] Fernández Simon, Maite. “Rape and pregnancy of 11-year-old reignites abortion debate in Bolivia,” The Washington Post, 29 October 2021, https://www.washingtonpost.com/world/2021/10/29/abortion-bolivia-girl-catholic-church/.
[7] “BOLIVIA Torture and Ill-Treatment: Amnesty International’s Concerns,” Amnesty International, June 2001. https://www.amnesty.org/es/wp-content/uploads/2021/06/amr180082001en.pdf.
[8] Id.
[9] Id.
[10] “Girl’s Ordeal Exposes Bolivia’s Failure on Reproductive Rights.”
[11] EFE. “Violación y embarazo de niña de 11 años: estallan las protestas en Bolivia,” Telemundo 51, 27 October 2021, https://www.telemundo51.com/noticias/mundo/bolivia-santa-cruz-caso-nina-violacion-embarazo-aborto-protestas/2242229/.
[12] Id.
[13] “Girl’s Ordeal Exposes Bolivia’s Failure on Reproductive Rights.”
[14] Fernández Simon, Maite.
[15] Collyns, Dan. “Bolivia: fate of 11-year-old girl raped by family member sparks abortion debate,” The Guardian, 29 October 2021, https://www.theguardian.com/global-development/2021/oct/29/bolivia-11-year-old-girl-rape-catholic-church#:~:text=%E2%80%9CBolivia%20is%20a%20secular%20state,pregnancy%20was%20classified%20as%20torture%E2%80%9D..
[16] “Bolivia.”
[17] “Bolivia.”
[18] “General Discussion on the preparation for a General Comment on Article 6 (Right to Life),” Ipas Bolivia. https://www.ohchr.org/sites/default/files/Documents/HRBodies/CCPR/Discussion/2015/Ipas_Bolivia.docx.
[19] Küng, S.A., Wilkins, J.D., de León, F.D. et al. “We don’t want problems”: reasons for denial of legal abortion based on conscientious objection in Mexico and Bolivia. Reprod Health 18, 2021, https://doi.org/10.1186/s12978-021-01101-2
[20] Thurston, S, Morales RC, Ngo TD.
[21] EFE.