The UN has told Latin American countries that simply advising women not to get pregnant fails to address the widespread and unjust denial of rights to women and girls.’ Latin America has the most restrictive laws on abortion and access to contraception is severely limited and frowned upon for poor women and girls. To add to this UN’s High Commissioner Zeid said that recommendation “ignores the reality that many women and girls simply cannot exercise control over whether or when or under what circumstances they become pregnant, especially in an environment where sexual violence is so common.”
In Peru for example [according to Gallup polls], half of women say their first sexual experience was forced [rape]. In Latin America, 38% of women become pregnant before the age of 20 and almost 20% of births are to teenage mothers. Half of pregnancies are unplanned. Despite the region’s severely restrictive anti-abortion laws, there are an estimated 4.4 million illegal abortions every year in Latin America and the Caribbean, 95 percent of them unsafe with 2,000 women dying every year. Abortion carries a life sentence in El Salvador. It the only country with more women than men serving long sentences in its prisons, according to Amnesty International.
Latin America – rules on abortion
|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|
In Nov 2015 Amnesty International highlighted the following examples in El Salvador. ‘María Teresa is serving a 40-year prison sentence for having a miscarriage. Beatriz nearly died because the government refused to let her terminate the pregnancy that was going to kill her. Liliana, who became pregnant after being raped by gang members when she was 13 years old, was forced by her government to give birth.’If you are a woman or girl in El Salvador, it doesn’t matter if you’re pregnant as a result of rape, whether you’re a child, or whether the pregnancy is a risk to your life: the government demands you give birth.
Abortion in the UK
Abortion is the only procedure that a doctor can opt out off. However the GMC is clear that your personal beliefs should not affect your treatment of a patient. Even if you disagree with a patient who requests an abortion that patient should be treated with consideration and empathy. It may be reasonable to ask her to consider other options if she does not seem completely sure but that should not result in any significant delay. The patient should be quickly referred to a colleague who is willing to help her. You should never impose your views or personal beliefs.
The Abortion Act in the UK makes abortion legal up to 24 weeks gestation,
1 If there is greater physical or mental risk or harm to the mother by continuing the pregnancy.
2. At any stage if there is serious risk to the health of the mother
3. At any stage if the foetus is likely to be born with severe physical or mental abnormalities.
Pregnancy and delivery is more dangerous than a termination so reason number one suggests that provided the pregnancy has not gone far there is effectively abortion on demand. However late terminations, beyond 12 weeks are rare. 90% are before 12 weeks in the UK.
The major organs are formed by 12 weeks. We think that the foetus may begin to feel pain at 20 weeks when the nervous system begins to mature. When recognisably human life truly begins is very controversial. Many believe it begins at conception, HFEA [Human Fertilisation and Embryology allows embryo research till the primitive streak forms [the cells which form the trilaminar embryological disc which becomes the baby] on day 15, others believe the cut off should occur when the nervous system forms. British law recognises that despite modern advances independent life under 24 weeks outside the uterus is difficult for a foetus so the limit remains 24 weeks.
As we have discussed different countries have widely differing rules regarding abortion. The relative rights of a woman v those her unborn child is referred to in ethical terms as maternal: foetal conflict. In many Latin American countries foetal rights have precedence over maternal rights. In the UK the foetus has no rights till 24 weeks. However just across the water in Ireland an abortion could only take place once the foetus is definitely not viable [dead]. As a result the dentist Savita Halappanava died. This led to protests in 2012 demanding changes to Ireland’s anti-abortion laws and a highly public investigation, because after a miscarriage had been diagnosed, she was denied an abortion because the foetus’s heart was still beating although she was bleeding heavily. This led to ‘The protection of life in pregnancy bill’ in 2013.
Abortion is always a topical subject. It will feature in the upcoming US presidential elections and Zika is high lighting the very different laws regarding it.