Therapeutic abortion, part II: paper vs. practice

Part II of a three-part series published in English at The Tico Times by permission of journalism student Paula Umaña; the mentoring program Punto y Aparte; and Semanario Universidad , where Paula published the original piece. Read Part I here.

Because of a lack of knowledge and fear of legal consequences, health care professionals in Costa Rica often bolster obstacles to pregnancy interruption in Costa Rica, even though the practice is legal when it is carried out to protect the health of the mother.

In one case studied by Semanario Universidad, a pregnant woman was hospitalized because of complications as a result of heart disease. Her life was in danger and her pregnancy had to be terminated. The patient’s discharge papers describe her treatment; however, the abortion wasn’t registered as such in the medical record. According to those records, she was treated for heart disease.

“At this moment I wouldn’t be able to give you real statistics on how many [therapeutic] abortions are performed because often, because of the lack of norms [for abortion], the discharge records indicate the pathology that caused the interruption of the pregnancy” without listing the abortion itself, said Allan Varela, chief of the Health Services Unit of the Caja, or Costa Rican Social Security System.

In total, the number of medical abortions registered since 2007 doesn’t even reach 30. Since 1997, only 78 cases have been documented by the Caja’s statistics department. That’s about four therapeutic abortions per year in a country that attends, on average, 70,000 births per year, and in which the National Statistics and Census Institute (INEC) has reported approximately 1,190 child deaths from congenital malformations since 2011.

The hospitals that register the most abortions are the México (26), the San Juan de Dios and Calderón Guardia (9 each), and the Adolfo Carit Hospital (8), all in San José, and the Max Peralta Hospital in Cartago (5). Medical centers outside the Central valley have reported between one and four therapeutic abortions each during the past two decades.

Some practicing doctors told us that there is also a “black number,” given that fear knocks on doctors’ doors when it comes time to register abortions on paper, even if they are sheltered under Article 121, the section of the Penal Code that makes therapeutic abortion legal.

For that reason, knowing the exact number of therapeutic abortions that have been performed, or showing the quantity of women who have solicited, is as impossible as traveling to the past. The statistic is highly uncertain.

“Only in a hospital it would be that number (80),” said one of the doctors interviewed. The doctor added that ectopic pregnancies – when the fertilized egg is implanted outside of the uterus, especially on the Fallopian tube – and molar pregnancies – the growth of abnormal tissue inside the uterus – are not being taken into account, either.

For her part, María Carranza of the Costa Rican Research and Teaching Institute in Nutrition and Health (INCIENSA), who analyzed therapeutic abortion egress records between 1994 and 2003, says that the cases on record are unquestioned given that they were carried out in women with serious diseases such as cancer or heart disease.

“In the cases where [an abortion was] not performed… we don’t have much knowledge, because mental health is not conceived as being part of the health that has to be protected. You find a very limited interpretation of the potential causes of therapeutic abortion,” Carranza explains.

Stay tuned for Part III in this series.