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Therapeutic abortion, part III: looking ahead

March 6, 2018

Part III 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 and Part II here.

The series explores the ways in which a lack of knowledge and fear of legal consequences lead 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.

The government stays mum on the topic of therapeutic abortion, saying it can’t comment because it is amidst a resolution process with the Inter-American Human Rights Commission (CIDH). The case deals with the denial of pregnancy interruption for a woman whose fetus had no possibility of living outside the uterus, a situation that affected her physically and psychologically. Fernando Llorca, executive president of the Social Security System, or Caja, says that the institution cannot discuss the norms surrounding therapeutic abortion.

When Aurora, whose wanted pregnancy was doomed because her fetus suffered from an abdominal wall defect, and A.N., another woman with a similar case, sued the government for denying their abortions, their objective was simple: that no other woman would face the torture they experienced for months, and continuing experiencing today, because of a medical sector that did not know how to act in their cases.

“Both had the primary objective that a protocol or norm could be approved to ensure that no other woman would live what they lived: that inhumane, cruel and degrading treatment, that torture to which they had been exposed,” explained Larissa Arroyo, legal representative of both.

In 2015, the government offered an amicable resolution and committed to creating a norm that standardizes the application of Article 121 in all of the country’s hospitals. A draft was finished more than a year ago by the commission created by the Health Ministry for this purpose. Now, it’s been passed on to the Foreign Ministry, or Cancillería, which would not allow us access to the document because it’s under review.

Some religious groups assert that the regulation could open doors to broaden the application of therapeutic abortion in Costa Rica, according to Gabriela Arguedas, expert on public health at the University of Costa Rica (UCR).

However, according to Allan Varela, chief of the Caja’s Health Services Unit, abiding by international organisms’ recommendations – such as the World Health Organization (WHO) and the Convention About Eliminations in all its Forms of Discrimination Against Women (CEDAW) – to include more reasons for legal abortion would require the modification of the Penal Code, an opinion refuted by some medics.

“The norm [developed by the Caja] is the regulation for the application of Article 121. There are leaders on human rights and in favor of women who have to be very clear that this norm is not the instrument to open [abortion] to many more cases. What has to be modified is the Penal Code,” he opined.

The national political context and escalating religious influence make this an improbable moment for legal reform on a topic that awakens passions and moral condemns. For now, both health professionals and activist groups in favor of the procedure await the final resolution of the norm so they can understand the action framework they have to stick to if the plaintiffs accept the result.

Illustration by Manuel Hernández

What did the candidates say?

In late 2017, Semanario Universidad asked the presidential candidates about therapeutic abortion, and obtained an answer from 10 of them. While only two candidates, Fabricio Alvarado and Carlos Alvarado, now remain in the ongoing runoff campaign, the broader group’s opinions help illustrate the stance of a broad range of Costa Rican political parties on the issue.

Mario Redondo, Christian Democrat Alliance Party

Mario Redondo, presidential candidate for the Christian Democrat Alliance Party. Via Semanario Universidad’s archive

“We’re clear that in our legislation there’s a regulation about that topic in particular on the cases that there are risks for the mother’s life. We believe it mustn’t go beyond that.”

Sergio Mena, New Generation Party

Sergio Mena, presidential candidate for the New Generation Party. Via Semanario Universidad’s archive

“A woman whose life is endangered when giving birth has all the rights, according to Costa Rica’s Penal Code and the laws to solicit the practice of a therapeutic abortion.”

Carlos Alvarado, Citizen Action Party

Carlos Alvardo, presidential candidate for the Citizen Action Party Via Semanario Universidad’s archive

“I don’t propose changes in the law, but rather a protocol to be implemented to comply with what’s been in the law since 1971.”

Stephanie Campos, Costa Rican Renovation Party

Stephanie Campos, presidential candidate for the Costa Rican Renovation Party. Via Semanario Universidad’s archive

“It’s a decision that the doctor has to make when the mother’s life really is in danger.”

Jhon Vega, Workers Party

Jhon Vega, presidential candidate for the Workers Party. Via Semanario Universidad’s archive

“We believe it’s a necessity. It’s not being applied due to a lack of regulations, but also because of personal resistance from health personnel who assume religious criteria, and we believe that is a mistake.”

Rodolfo Hernández, Social Republican Party

Rodolfo Hernández, presidential candidate for the Social Republican Party. Via Semanario Universidad’s archive

“It’s very defined (…) I support therapeutic abortion in the understanding that it’s to save one of the lives, and with the consent of the mother.”

Otto Guevara, Libertarian Movement Party

Otto Guevara, presidential candidate for the Libertarian Movement Party. Via Semanario Universidad’s archive

“If the mother’s life is at stake and if there’s information available from the doctors that point this out, and if the mother agrees, in that case the therapeutic abortion proceeds.”

Antonio Álvarez, National Liberation Party

Antonio Álvarez Desanti, presidential candidate for the National Liberation Party. Via Semanario Universidad’s archive

“Therapeutic abortion is for situations when the mother’s life is in danger, independent of her emotional state.” (This declaration was provided by spokeswoman Andrea Álvarez.)

Edgardo Araya, Broad Front Party

Edgardo Araya, presidential candidate for the Broad Front Party. Via Semanario Universidad’s archive

“It’s always at the doctor’s discretion.”

Fabricio Alvarado, National Restoration Party

Fabricio Alvarado, presidential candidate for the National Restoration Party. Via Semanario Universidad’s archive

“It’s a simple form of legalizing pure abortion.”

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