Manuela v. El Salvador (Inter-American Court of Human Rights)

(Updated 12.02.21) In a landmark ruling, on November 30, 2021, the Inter-American Court of Human Rights has for the first time established standards throughout the region to help protect women seeking reproductive health care, including abortion.

The ruling by the Court—which is the highest judicial body for human rights in the Americas—came on November 30 in Manuela v. El Salvador. The case was brought by the Center for Reproductive Rights and its partners in El Salvador, the Colectiva Feminista para el Desarrollo Local and the Agrupación Ciudadana por la Despenalización del Aborto.

In a ruling that applies to countries throughout Latin America and the Caribbean under the Court’s jurisdiction, health care staff can no longer refer women to law enforcement who come to the hospital seeking abortion care and other reproductive health services.

The Court deemed El Salvador responsible for the death of a Salvadoran woman, Manuela, who in 2008 was unjustly sentenced to 30 years in prison for aggravated homicide after suffering an obstetric emergency that resulted in her pregnancy loss. Manuela died imprisoned two years later from cancer, after receiving inadequate medical diagnosis and treatment. The State was found to have violated Manuela’s rights to life, health, judicial protections and guarantees, freedom from discrimination and gender violence, and other rights.

El Salvador was ordered to make full reparations to Manuela’s family and to reform its legal and health care policies, which criminalize women for seeking reproductive health care.

“There is no doubt that Manuela suffered an obstetric emergency […] Such situations, as they are medical conditions, cannot lead to a criminal sanction,” stated the ruling.

The Court ordered El Salvador to adopt structural measures towards banning the criminalization of women due to obstetric emergencies. The Court understood that given the situation of structural discrimination impoverished women face, in order to avoid arbitrary criminalization of these women, the State must:

• Develop comprehensive sexual education policies.
• Modify its legislation on doctor-patient confidentiality towards assuring that women are not denounced by the medical personnel who care for them.
• Remove legislation that provides for automatic detention of women who are denounced for having committed abortion. 
• Make sure that public policies are adopted to ensure full access to health care is guaranteed to women who suffer obstetric emergencies.

To ensure that Manuela’s case is not repeated, the Inter-American Court of Human Rights Court also ordered all States under its jurisdiction to:

• Make sure that doctor-patient confidentiality is specially protected in cases in which reproductive rights are a matter of concern, and as a consequence, that women are not denounced by their medical personnel for allegedly having committed abortion.
• Ensure that adequate health treatment is given to women who suffer obstetric emergencies, free from any forms of gender violence.

In March of 2021, the Center for Reproductive Rights and partners presented oral arguments before the Inter-American Court of Human Rights asking that the Salvadoran State be held responsible for violating the human rights of Manuela, a Salvadoran woman who was unjustly sentenced to 30 years in prison for aggravated homicide after suffering an obstetric emergency that resulted in her pregnancy loss. A decision, expected by the end of 2021, could have far-reaching impacts in Latin America and the Caribbean. 

In this case, the Court for the first time will have the opportunity to recognize how the absolute denial and criminalization of reproductive health services in El Salvador discriminates against and causes violence against women who suffer obstetric emergencies, denying them due process.  

Manuela, a 33-year-old Salvadoran woman with limited economic resources, experienced an obstetric emergency and pregnancy loss. At the hospital, staff failed to provide her with timely treatment and instead subjected her to verbal abuse and accused her of having an abortion. She was arrested by the police, who shackled her to the stretcher and interrogated her without the presence of a lawyer. Manuela was convicted of aggravated homicide and unfairly sentenced to 30 years in prison. Two years later, during her imprisonment, Manuela died of cancer after receiving inadequate medical diagnosis and treatment, leaving her two children orphaned. 

Case background:

• In March 2012, the Center and the Colectiva Feminista para el Desarrollo Local presented Manuela’s case before the Inter-American Commission of Human Rights, on behalf of Manuela’s family.
• In 2019, the Inter-American Commission on Human Rights (IACHR) advanced the case to the Inter-American Court of Human Rights, contending that the Salvadoran State had violated several of Manuela’s human rights, including the right to life, health, judicial protections and guarantees, and freedom from discrimination and gender-based violence. 
• The Court heard oral arguments in Manuela v. El Salvador in March of 2021.  
• In November 30, 2021, in a landmark ruling, the Inter-American Court of Human Rights for the first time established standards throughout the region to help protect women seeking reproductive health care, including abortion.

Plaintiff(s): Family of Manuela 

Center Attorney(s):  Catalina Martínez and Carmen Martínez

Partners: Colectiva Feminista para el Desarrollo Local and the Agrupación Ciudadana por la Despenalización del Aborto 

Case Documents

• Petition, Manuela-IACHR, 03.18.17
• Background report issued by the Inter-American Commission of Human Rights, 12.7.18 
• Judgment: Inter-American Court of Human Rights Ruling: Manuela v. El Salvador, 11.02.21

News on the Case

• Inter-American Court of Human Rights Ruling Will Help Protect Women Seeking Reproductive Health Care, Including Abortion, 12.02.21
• Center to Argue at Inter-American Court of Human Rights for Salvadoran Woman Imprisoned After Suffering Obstetric Emergency (03/04/21) 
• Center Appeals to Inter-American Commission on Human Rights for Release of Unjustly Imprisoned Salvadoran Women (12/08/20)  

Press Releases 

• Inter-American Court of Human Rights Orders El Salvador to Reform Policies That Criminalize Women for Accessing Reproductive Health Care, 11.30.21
• Inter-American Court of Human Rights Hears Case of Salvadoran Woman Imprisoned After Obstetric Emergency (03/10/21) 
• Inter-American Commission on Human Rights files case of Manuela vs. El Salvador before the Inter-American Court of Human Rights (10/10/19) 

Fact Sheets 

• Manuela v. El Salvador: The Impact of blanket abortion bans on women experiencing obstetric emergencies (English)  
• Manuela vs. El Salvador: El Impacto De La Prohibición Absoluta Del Aborto Sobre Las Mujeres Que Sufren Emergencias Obstétricas (Spanish)