Shaming El Salvador on the Global Stage

Manuela’s story is the stuff of nightmares. The young mother from El Salvador had not been feeling well for several years. She sought medical attention for what seemed to be tumors on her neck, but received no treatment or diagnosis—just some pain killers. Then one day in February of 2008, while pregnant with her third child, she experienced intense abdominal pain. Later, in the outhouse at her home, she miscarried into the toilet and fell into unconsciousness from shock and hemorrhaging.

When Manuela came to, she was hospitalized. But rather than receiving care and counseling for the trauma she had just endured, she found herself under investigation by the police. The hospital’s attending physician had reported her on suspicion of abortion.

Since 1998, El Salvador has enforced one of the most extreme abortion bans in the world—prohibiting abortion even to save a woman’s life and threatening harsh criminal penalties on both women and physicians. Recently, the Center for Reproductive Rights and its partner, La Agrupacion Ciudadana continued their campaign to expose the severe violations of women’s rights as a consequence of the abortion ban, testifying before the United Nations Committee on Economic, Social and Cultural Rights (CESCR). The CESCR oversees compliance with the International Covenant on Economic, Social and Cultural Rights, a treaty obligating member states to ensure equal enjoyment of economic, social and cultural rights for all individuals.

In her oral intervention, Monica Arango, regional director for Latin America and the Caribbean, argued that according to the International Covenant on Economic, Social and Cultural Rights, El Salvador is required to take steps to guarantee everyone’s right to the highest attainable standard of physical and mental health, which includes “…the right to control one’s health and body, including sexual and reproductive freedom, and the right to be free from interference, such as the right to be free from torture”.

But Arango told the committee, “El Salvador’s restrictive abortion law denies women the right to decide whether to carry a pregnancy to term, even in cases where their life or health is at risk or when they have been sexually assaulted—directly affecting women’s right to physical and mental health and is in itself a violation of the principle of non-regression in social rights.”

Arango also presented before the experts on the committee a video that featured stories of women affected by the ban, including Manuela.

She urged the CESCR to recommend that El Salvador liberalize its abortion ban to allow women to access essential medical care, particularly when a woman’s health or life is at risk, in cases of rape, or when there are fetal malformations. “It is not only about a woman’s right to life and health,” Arango asserts. “There are other human rights violations as consequences to this ban.”  

The CESCR agrees. In its concluding observations, the committee expressed grave concern, noting that the ban offers no consideration of exceptional situations, triggering “serious cases of suffering and injustice.” By criminalizing all abortions, the ban allows women to be prosecuted for a pregnancy loss under any circumstance, including miscarriage. In Manuela’s case, she was grilled by police then swiftly charged and convicted of murder. She received a thirty-year sentence. After two years in prison, Manuela died—handcuffed to her hospital bed—of Hodgkin’s lymphoma. The undiagnosed cancer was likely the cause of the obstetric emergency that resulted in her miscarriage.

“Women with completely natural health conditions that prevent them from carrying a pregnancy to term are being prosecuted—prosecuted unjustly for a crime they did not commit.” Arango states.

From 2000 to March 2011, 129 women were indicted on charges of abortion or aggravated murder in El Salvador. Seventeen of them remain imprisoned today. Aside from the unjust incarcerations, the ban has also provoked clandestine abortions. The committee articulated concern regarding the high rates of illegal abortions in the country, and acknowledged that the ban disproportionately affects young, poor women with a lower level of education.

In a significant step toward recognizing that a complete ban on abortion is a violation of the right to health under the obligations of the International Covenant on Economic, Social and Cultural Rights, the committee urged El Salvador to review the legislation to “make it compatible with other fundamental rights such as health and life of the woman, as well as with their dignity.” Further, it recommended that the state provide “quality care for the treatment of complications from unsafe abortions in conditions of risk rather than prioritizing its criminal prosecution.”

The Center considers this excellent progress. “The committee is taking up a central problem for women´s health in El Salvador and recommending legal reform in order to be in compliance with the treaty,” says Arango. “Moreover, it is addressing the question of the disparate criminal sanctions and the due process violations which have been central to the Center´s work.”

The Center has fought for more than a decade to expose the consequences of the abortion ban in El Salvador, and our battle will not end here. “Compliance with international law is, of course, a challenge,” Arango notes. “There are no police or other bodies to enforce the decision.” However such a recommendation shames the government on the global stage and therefore, creates international pressure, which can catalyze internal change.

“Now it’s important that El Salvador address the Committee´s concluding observations and take all the steps to implement those very much needed changes,” says Arango.

Today, Manuela’s surviving children are being raised by her parents in El Salvador. In 2012, the Center, along with La Agrupacion Ciudadana a local group, filed a case seeking justice on Manuela’s behalf before the Inter-American Commission on Human Rights. The case, still awaiting review, marks the first legal action before an international judicial body of a woman imprisoned for seeking medical care due to an obstetric emergency, as the result of a total abortion ban.