Reproductive Rights and Violence against Women in Latin America: Spotlight on Paraguay
As the pro-choice versus pro-life debate surrounding abortion continues in the United States, the status of reproductive rights in Latin American remains highly restricted. The politically conservative and predominately Catholic continent generally restricts access to contraceptive and family planning services, and denies abortions except when the mother’s life is in immediate danger.
The cultural and legal taboo of abortion is exemplified by the tragic case of an eleven-year-old Paraguayan girl who gave birth in 2013. According to Amnesty International, the girl was taken to the hospital by her mother in April, when she was then only ten-years-old, and was found to be 21 weeks pregnant. The father of the child is alleged to be the girl’s own stepfather, who raped her on several occasions. An international outcry among human rights groups and pleas from the girl’s mother to terminate the pregnancy proved unsuccessful. In Paraguay, abortion is restricted only in cases of serious danger to the mother’s life. The girl carried the pregnancy to full term, and was placed in a center for young mothers. The girl’s mother has been arrested and charged with negligence, despite reporting the sexual abuse of her daughter in 2013. Her stepfather has been arrested, though he denies the allegations, and it is unclear whether he will face time in prison.
This case hinges on the fact that, despite the girl’s young age, doctors ruled that she did not face immediate physical danger from carrying the pregnancy to full term, the only permissible reason for abortion under Paraguayan law. However the risk of maternal death in Latin America is four times higher among girls under sixteen years of age than among women in their twenties. This is due to complications of underdeveloped reproductive organs and physical immaturity among younger girls. Paraguay’s record for maternal and reproductive health is troubling, especially in comparison to regional, albeit more developed, neighbors.
The maternal mortality rate is extremely high, with 132 deaths per 100,000 live births, compared to 22 in nearby Chile and 14 in the United States. Infant mortality is in the double digits, at 18 per 1,000 live births, compared to a rate of seven in Chile and six in the United States. Instances of infant and maternal mortality are even more likely among younger mothers. It is crucial that women have access to quality health care to reduce these rates--especially family planning services and prenatal care.
Contraceptive prevalence in Paraguay was 79 percent among married women ages 15 to 49 in 2008. While 79 percent represents relatively good access, there are many problems with this indicator. First, it only includes married women. Most statistics regarding contraceptive prevalence only measure married populations, making it difficult to estimate prevalence among single, or cohabiting populations. This is a group that has an arguably higher demand for contraceptives because they are not in a traditional union that signals a readiness to settle down and have children. This group may also face greater stigma and challenges in obtaining and using contraceptives. This indicator also does not include access or availability of emergency contraception, such as the “Plan B” pill, which is often outlawed in Latin America. Finally, this indicator does not capture girls younger than fifteen who are likely survivors of rape and sexual assault, such as the eleven-year-old girl mentioned previously. In order to address the contraception needs of a modern and diverse population, better indicators must be developed to uncover and close the gaps. Survivors of sexual assault and rape should be offered every possible option -- including emergency contraception and abortion, or pre-natal care if she chooses to continue the pregnancy.
The measures of physical health determined by Paraguayan doctors in evaluation of eligibility for an abortion do not take into consideration the mental health of these mothers, who may be victims of rape and sexual assault. According to Amnesty International spokesperson Guadalupe Marengo, in the case of the Paraguayan girl, “the physical and mental repercussions of continuing with…high-risk pregnancy could be devastating and are akin to torture.” The World Health Organization finds that violence, including sexual violence, by an intimate partner is related to higher instances of injury and death, depression, alcohol abuse, sexually transmitted infections, unwanted pregnancy, and low birth-weight babies. Among women in Paraguay who had experienced partner violence in the past twelve months, 68 percent reported severe anxiety or depression and 14 percent had considered or attempted suicide.
Systematic denial of quality health care services and reproductive rights in Paraguay is related to the larger crisis of violence against women. Violence against women is a form of gender-based violence and “refers to any act that results in, or is likely to result in, physical, sexual and psychological harm to women and girls, whether occurring in private or in public.” It is a not unique to Paraguay, and plagues societies all around the globe. Sexual violence can cause unwanted and unintended pregnancy leading to devastating results if women cannot access health care that prioritizes their psychological and physical health, as well as their quality of life.
It is estimated that one in three women ages 15 or older in Latin America has experienced physical or sexual violence in their lifetime. Most of these transgressions are not committed by strangers in dark alleyways, but rather by men who have close relationships to the survivor. In Paraguay, prevalence of intimate partner violence is highest among girls aged 15 to 19, and this trend is fairly consistent across Latin America. The 20 to 24 age bracket also experiences high levels of intimate partner violence. As can be seen, violence against women starts disturbingly young. Among women ages 15 to 24 who have had sexual intercourse, 2.2 percent reported that their first experience was forced or rape, and 14 percent reported that their partner “convinced them.” Power inequality dominates young women’s intimate experiences, and it persists throughout their lives.
According to a report by WHO/PAHO, almost 8 percent of women in Paraguay reported unwanted sexual intercourse with a partner out of fear of what he might do if they refused. Even more troubling, only 12 percent of women sought help in dealing with sexual assault from police, a hospital, a religious group, or a women’s organization. The most common reasons women did not seek advice or assistance were that they “thought she could solve it alone,” “shame,” and “fear of retaliation.” These last two responses are indicative of the social stigma placed on survivors of assault. Women who seek help or report the crime often face humiliating questioning by officials who do little to investigate. Perpetrators then benefit from high levels of impunity. Cases of sexual assault are frequently characterized by victim blaming and “he-said-she-said” adage. Although Paraguay’s parliament passed a law against domestic violence in 2000, it does not outline avenues for justice by including criminal repercussions. Without proper institutional support and policies that act in the survivor’s best interest, it is unlikely that assault reporting will increase and impunity will be reduced.
As stated previously, limited reproductive rights and violence against women is not unique to Paraguay. The situation is similar across the Americas. Latin America has the highest rate of maternal death (an estimated 2,000 women annually) from attempting to obtain an unsafe abortion. Only three regional bodies-- Cuba, Uruguay, and Mexico City-- permit abortions within the first term of pregnancy for any reason. On the other hand, El Salvador, the Dominican Republic, and Chile prohibit abortion under all circumstances, including risk to the mother’s life, rape, and unviable fetus. El Salvador has come under scrutiny for imprisoning women who have miscarried naturally, under allegations that they induced an abortion. In Honduras, it is even illegal to provide women with information about emergency contraception (which does not terminate an already fertilized egg) and abortion. Millions of women experience physical and sexual abuse each year across the region, with high rates of impunity and few options to bring their abuser to justice.
The case of the eleven-year-old Paraguayan girl who was denied an abortion is just one example of the perils of allowing violence against women to persist while systematically stripping them of their right to chose how, when, and if they have children. Regardless of an individual’s view on the morality of abortion (which is outside the scope of this article), it is morally unquestionable that women should be provided with quality healthcare that prioritizes their health and wellbeing, as well as resources for support and justice in the case of rape or assault. Paraguay, along with the rest of the region, should work to improve the lives and health of its women by introducing effective legislation that condemns gender-based violence, and providing resources for women to control decisions about their bodies and health.