Uruguay Has Become a World Leader in Safer Abortions

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It was late June. I could see my breath when I took one sleepy step off the boat from Argentina to find my Buquebus that’d take me another two hours from the coastline town of Colonia to Emilio Frugoni, a quiet street in Uruguay’s capital, Montevideo—a place of tranquility and serenity by day and pulsating revelry by night, stretching just about 12 miles east to west on the eastern bank of the Río de la Plata.

I’d been on the road a bit, backpacking through Latin America—curious, asking relentless questions in San Salvador, the murder capital of the world, researching the then-imminent legalization of sodomy and ensuing gay rights in Belize, studying sexual harassment in Argentina’s public domains.

To be honest, Uruguay felt like a respite from the many conformist views of the starchily catholic region. Montevideo, a sandy industrial port and neoclassical concrete jungle jostling for space, felt liberal. I spent most of my days drinking mates with locals and inquiring about what makes Uruguay so uniquely safe for women. A recurring response: Accessible healthcare.

Uruguay is deemed among the most democratic countries in the region, attributed largely to the long separation of religion and government. It’s remained a secular state for over 100 years, and the ideals that ensue are well-integrated into society. It’s perhaps for that reason that women in Uruguay have rights to their bodies.

Just two countries in Latin America have made abortion legal and widely available: Cuba came first in 1979 and Uruguay followed suit in 2012. It’s the experience of the latter, however, that has set a precedent for reform across Latin America.

For example, in 2013, an attempt to overturn the decriminalization of abortion through a referendum secured the support of just nine percent of voters. Today, Uruguay has the lowest rate of maternal deaths in Latin America, which is indicative of its availability of safe abortions.

“I agree with the law,” Paula Niño, one 30-year-old Montevideo-based woman told Her Report. “People that can pay for it will have abortions, and people that can’t pay will have abortions, too, but it is probably that they would die because of the type of abortions that they can manage.”

Likewise, 32-year-old Meri Dutra da Silveira adds, “Despite the controversial topic, I think is a right of every woman to decide what to do with her body and life.”

But it wasn’t always this way. According to the World Health Organization (WHO), an estimated 22 million unsafe abortions take place worldwide every year, resulting in around 47,000 women dying and another 5 million suffering from disabilities. In the Latin America and Caribbean region alone, according to the Guttmacher Institute, at least 10 percent of maternal deaths result from unsafe abortions. In Uruguay, unsafe abortion was the leading cause of maternal death in the decade up to 2000. In the late 1990s, unsafe abortions accounted for nearly 30 percent of maternal deaths. Nowhere was the problem more pronounced than at the Pereira Rossell Hospital, Uruguay’s main public maternity hospital, which serves a primarily low-income population in Montevideo. There, nearly half of all maternal deaths were results of unsafe abortions.

In 2004, a team of Uruguayan physicians, nurses, midwives, psychologists and social workers established Iniciativas Sanitarias, a nonprofit organization that would address unintended or unwanted pregnancies and their consequences by focusing on sexual and reproductive health as a basic human right. The model is known as the “harm-reduction approach,” and, more commonly, “The Uruguay Model,” in which abortion is considered a public health concern rather than a moral one. And, as anticipated, maternal deaths by way of unsafe abortions have plummeted since its inception.

The concept was adopted from ample attempts to alleviate alcoholism. Pioneered in Canada, the idea is simply to manage the supply of alcohol in order to reduce the associated harms that come with excessive drinking, without totally eradicating alcoholics’ behaviors. The strategy intends to lead to gradual improvements to health, while simultaneously reducing public costs that come with emergency room visits, police contacts, court visits and jail-time.

Women who sought abortions were offered counseling and post-abortion healthcare. They were also provided with information about drugs used for abortions, such as misoprostol (Cytotec), which was originally developed as an anti-ulcer therapy and arrived on the market in 1985.

Shifting to what Iniciativas Sanitarias refers to as an “ethical commitment to sexual and reproductive health” had allowed medical professionals to provide care and free, factually accurate information without focusing on the legality of abortion. Health officials neither offered advice nor promoted or prescribed drug-use, but gave women access to information with neutrality, confidentiality and humanity.

Then, in 2012, Uruguay made safe abortion widely available in the first 12 weeks of gestation (14 weeks in the case of rape). The parliament passed a law that waived criminal penalties for abortion in the first trimester, with certain procedural requirements, although abortion remains a crime under the criminal code.

Of course, Uruguay’s approach to abortions is not without flaws. Today’s law does require a woman seeking an abortion to first explain her situation to a review panel made up of a gynecologist, a mental health expert and a social worker, and describe “how the pregnancy happened and any difficulties she faces in terms of finances, social and family situations, age or other issues that prevent her from wanting to continue the pregnancy.”

It also says that, “the interdisciplinary panel must create an atmosphere of psychological and social support for the woman to enable her to overcome the causes that led her to want to abort the pregnancy and guarantee that she makes a conscious and responsible decision,” which some argue perpetuates the notion that women who choose to have abortions are inherently irresponsible. Then the woman must wait at least five days before confirming her decision, which could arguably be psychologically unhealthy.

And, lastly, doctors can opt out of performing the procedure if they’re personally against doing so—though, those who do refuse must register themselves as conscientious objectors, and those who do not opt out cannot then refuse abortions at random. Outside of major cities, the majority of physicians say they will not participate in abortions and, in some medical centers, rejection rates reach 100 percent. In Uruguay as a whole, a reported 30 percent of gynecologists have refused to participate.

That said, Uruguay nonetheless stands as an example of a country where abortions were gradually made safer and maternal deaths have dropped significantly.