Confronting the Reality of Abortion in Latin America

Lisa C. Remez
1995 International family planning perspectives  
productive health and population field has confronted the issue. The impetus for the conference grew from the sense that the epidemic is so vast and that enough research has been conducted by individuals, universities and organizations-much of it under the auspices of the WHO programme and through AGI's multicountry research project on abortion-to call a meeting to assess the findings and the state of abortion research in Latin America. According to Axel Mundigo, head of social science research
more » ... al science research at HRP, the purpose of the conference was, more than anything else, to exchange knowledge on clandestine abortion in the region-its incidence, determinants, consequences, and social and economic costs. In doing so, Mundigo affirmed, the conference would "synthesize the experience [of induced abortion] and communicate it to senators, deputies and others who can exert their influence to change very outdated laws." 3 In addition to researchers, the organizers invited elected officials from national and regional parliaments and representatives from women's groups and activist organizations to help develop joint strategies of how best to use data on abortion to effect change. The sheer volume of papers the conference attracted and the range of subjects they encompassed-not only the expected studies of incidence, determinants, consequences, service provision and treatment of complications, but new research on the role of men in the abortion decision, the attitudes of the general public and the opinions of Catholic priestsindicate that the organizers knew that the time for such a gathering had come. Lisa C. Remez is an associate editor of International Family Planning Perspectives. T he Spanish-and Portuguese-speaking nations of Latin America share a broad cultural heritage; they also share an epidemic of clandestine abortion. Although in none of these countries, except Cuba, are women given wide legal access to abortion, an estimated four million procedures are performed in Latin America each year. 1 Clandestine abortions are not necessarily unsafe ones, but the high levels of abortion-related morbidity and mortality in the region stem from the dangerous conditions that still surround a high proportion of clandestine procedures. 2 Often the only way to determine the incidence of induced abortion is indirectly, through the hospital records of women who receive substandard care and then need treatment for complications; hospitals, however, are believed to seriously misclassify such cases, and on a lesser scale, to underreport them. Efforts to reduce the deleterious effects on women's health caused by clandestine abortion have to start somewhere-perhaps just by identifying and quantifying the problem. But even this is a daunting task. Incidence A first step toward analyzing the problem of clandestine abortion is quantifying it. The conference opened with a session devoted to the incidence of abortion, with two presentations that employed different strategies for collecting hidden and sensitive data. In the AGI study conducted in six Latin American countries, data on hospitalized abortion cases were adjusted for incomplete and inaccurate reporting and for misclassification of induced abortion as spontaneous abortion (since women rarely report that an abortion has been illegally induced, and many of the clinical symptoms are the same). Depending on the proportion of all induced abortions that were thought to result in complications serious enough to warrant hospitalization, 4 the data were then multiplied by the appropriate factor to get the total number of induced abortions. These multiplication factors reflect the degree to which safe abortions are available in individual countries and may range from three, in countries where the majority of procedures are performed in unhygienic conditions by nonprofessionals to seven, in countries where relatively safe, although clandestine, abortion services are available. Table 1 presents the estimated annual abortion rates from this indirect technique in six countries using a uniform multiplier of five, on the assumption that about one in five women who obtain clandestine abortions are hospitalized. A second methodology, a direct household survey of 22 major cities in Colombia conducted by the Center of Social Dynamics Research at the Universidad Externado in Bogotá, solicited abortion history SPECIAL REPORT
doi:10.2307/2133603 fatcat:ghuxgnwqo5ggnjuwyv7tcc3qei