As the Zika Virus Spreads, the Salvadoran Government Needs to Rethink its Approach to Women’s Health

As the Zika virus ravaging Latin America moves northward, renewed attention has focused on the struggle for reproductive justice in El Salvador. In the face of alarming suggested (if contested) links between the mosquito-borne virus and microcephaly in infants, El Salvador’s Ministry of Health recommended that women delay pregnancy for two years; officials in Brazil, Colombia, Jamaica and elsewhere have since issued similar warnings. And on February 1, the World Health Organization declared that the virus poses a global public health emergency.

Reproductive rights’ advocates both locally and abroad have objected to El Salvador’s calls for family planning: In El Salvador, abortion is defined by law as a criminal act, without exception.

Some important context: In 2009, the leftist Farabundo Martí National Liberation Front (FMLN) party was elected to the presidency in Salvador, unseating the U.S.-backed, right-wing Nationalist Republican Alliance (ARENA) party after 20 years of consecutive rule. The FMLN’s election marked the first time in El Salvador’s history that a progressive administration governed the country. In 2014, the party won another five-year term.

Since taking office in 2009, the FMLN has overseen unprecedented gains for women’s healthcare— rarely reported on both domestically and abroad. The National Healthcare Reform of 2010 established over 600 community health clinics in rural and underserved areas, with healthcare promoters bringing pre- and post-natal care to women’s homes. In addition, the number of women seeking gynecological services in local public clinics rose from 30,154 in 2009 to 313,521 in 2014. These programs, along with the creation of maternal pre-birth centers for women living in areas with difficult hospital access, have reduced maternal mortality by an astounding 68% since 2009.

What’s more, the FMLN government inaugurated a new state-of-the-art National Women’s Hospital to replace the old Maternity Hospital, which languished in disrepair for years following a 2001 earthquake. The FMLN has also pioneered a groundbreaking model of ​“Women’s City” service centers, which provide mental and reproductive healthcare, legal support, childcare, credit and job training in six sites across the country, with three more planned for 2016. And FMLN-sponsored legislation, such as the Gender Equity, Equality and Nondiscrimination Law and the Life Free of Violence against Women Law, has provided an important legal framework for women’s advocates.

But these impressive advances stand in stark contrast to the persistent criminalization of abortion in El Salvador. In 1997, the right-wing controlled legislature voted to criminalize abortion without exception, joining neighboring Honduras and Nicaragua along with Chile and the Dominican Republic in a disgraceful regional club of nations with absolute abortion bans. At the time, the FMLN divided its votes, with some legislators joining the right-wing parties in favor of criminalization and others voting against. Since the law went into effect in 1998, countless women have been forced to attempt to terminate pregnancies in unsafe clandestine conditions. Over two dozen women have been imprisoned for the crimes of murder or abortion — many apprehended while seeking healthcare in the wake of a miscarriage. With so much progress for women in other areas, how has this inhumane abortion ban remained intact?

On February 3, I sat down with Sara García of the Citizen Group for the Decriminalization of Abortion in the capital city of San Salvador, El Salvador, to discuss the movement for reproductive justice and the political power dynamics behind one of the world’s most restrictive anti-choice laws. The following are excerpts from our conversation.

Can you start by explaining the Citizen Group for the Decriminalization of Abortion?

The Citizen Group for the Decriminalization of Abortion arose in the framework of a binational summit in Nicaragua. Both El Salvador and Nicaragua have very similar legislation; in both countries no alternatives exist even when the life or the health of a women is at risk. So in 2009 there was this summit of social organizations to see what could be done.

Also in 2009, after a broad social movement mobilization, we achieved freedom for Karina, a woman who was incarcerated for seven and a half years. Many feminist compañeras knew this case well before 2009. They got involved, documented and reconstructed the entire path and history of her case. This was a young woman who turned to the public healthcare system — the same system under which she had been sterilized. And later she gets pregnant. She didn’t know she was pregnant, then she lost the pregnancy, and when she got to the hospital, basically what they said to her was, ​“You have committed murder.” They attribute guilt to women for the mere fact of being women, and thus they violate the presumption of innocence. After reviewing the sentences they were able to prove that Karina was innocent, that there had been errors throughout the judicial process, and that there was a clear gender stereotype that had ultimately ended with her unjust imprisonment.

El Salvador didn’t always have these laws. Before 1998, alternatives did exist. Therapeutic abortion, when the life or the health of the mother was at risk, was recognized, as was ethical abortion — when the pregnancy was the product of sexual violence — and eugenic abortion, when the fetus was incompatible with extra-uterine life. So these three grounds existed before 1998, the year that the prohibition entered effect. In 1999, another important change occurred at the constitutional level when it became recognized that human life begins at the moment of conception. Those two changes were intended to be the end any discussion about reproductive rights in this country.

In the midst of all this a group of citizens and compañeras from different backgrounds— lawyers, theologians, psychologists, philosophers— decided to say, ​“Okay, let’s unite, and let’s see how we can work on this issue.” We started with this need to fight for the women who are in prison, to bring them back, but also to recuperate what we used to have. As the Citizen Group, we have to regain what we used to have in our country. We’re not inventing anything new, since we used to have legislation that at least gave us alternatives in extreme cases.

We needed to be able to build a voice that no longer spoke of abortion as a sin but that spoke of abortion as a right. I think we’re also trying to build dialogue, since these laws are so biased. […] In the end, without dialogue, we will never build that democracy, or that justice and peace that we want to talk about, if all voices are not heard.

Who are the actors and political forces that are obstructing reproductive justice in El Salvador today?

The case of Beatriz [in 2013] allows you to see precisely how women have trouble accessing reproductive justice. She was a 22-year-old woman, pregnant with an anencephalic fetus, which is to say that it had no brain. She also had lupus. Beatriz requested an injunction because she couldn’t interrupt her pregnancy. Several different human rights organizations supported this injunction. However, the process went before the Constitutional Chamber of the Supreme Court, and the Chamber delayed this process for 81 days while her life was in danger. They made her wait 81 days for a response, and in those 81 days several different actors intervened.

The Chamber requested an opinion from the National Forensics Institute, which said that Beatriz should continue her pregnancy because her life wasn’t at risk. This opinion was written by the director of the Institute at the time, [Miguel] Fortin Magaña, a person who has been very open about his Opus Dei views. He went to the press saying, ​“No, Beatriz can live, she’s fine.” And that was quite contradictory, because in the hospital where Beatriz was — a public hospital — a team of 15 doctors signed a statement saying that it was necessary to interrupt the pregnancy. The Minister of Health at the time was in favor as well. Even the Director of the hospital came out telling Fortin Magaña: ​“You attend to dead people, we attend to the living. How can someone who attends to the dead say that she can continue living?”

In addition to this, there were the fundamentalist groups, who went to the extreme of holding press conferences in which they said they’d donate hats to Beatriz for her to put on the infant in order to hide the fact that it had no brain. It’s a level of cynicism that’s hard to imagine.

So this was a woman who was even supported by the Ministry of Health, because they understood her case. This case demonstrates how difficult it is for women to have access to justice, because these fundamentalists have permeated certain institutions and they have power. They’re part of the mass media, and they even collude with institutions like the Constitutional Chamber, which may well be respectable on other issues, but on the matter of reproductive rights they have enormous debts to women, to their citizens, to human rights, in general.

In the end, Beatriz was able to interrupt the pregnancy, but only after waiting all that time. But I think it’s important to reflect on this case, because these institutional obstacles come from a fundamentalist ideology that has materialized in legislation and in policies that are absolutist and absolutely prohibitive.

Can you explain some of these contradictions within the State? Often in the international community they talk about the Salvadoran government as though it were monolithic, but what about this role of the judicial system versus the legislature versus the executive?

Yes, I think it’s very important to parse that. We’re talking about a justice system that has clear and enormous debts, but certainly I think that this leftist government, which is now in its second term, has had women’s struggle or women’s rights at the center of its policy and vision. This has been clearly demonstrated through a wide range of programs. And I think it is important to show these contradictions. There’s the judicial system and the Court’s behavior, which I think is fairly reproachable, and the legislature, which is diverse and can’t be generalized. There have been important actions [in the legislature]. For example last year a legislator from the leftist party sponsored an initiative to modify the Penal Code to enhance penalties for hate crimes [based on sexual orientation or gender identity]. And this allows us to see that there are changes happening in this country that are very important, and these are changes that were never before seen — the whole issue of sexual diversity and LGBTQ people is another debt pending to the population and is very important to mention. There is indeed a progressive effort to promote these rights that have historically been denied.

Nevertheless, I think that the international community – and national organizations as well – must continue to advocate for these rights. Like I said before, the issue of abortion has been become a politically dangerous one to support, and that must be upended: the political danger should be for those legislators who are not in favor of women’s lives, for those who are not in favor of saving a life that is at risk. We need to make that a political cost.

The current political panorama in the Assembly offers opportunities; the President of the Assembly [Lorena Peña of the FMLN] is committed to the struggle for women’s rights.I think the fact that the legislators from the FMLN have an historic commitment to human rights could allow for discussion, debate, and changes in the law in 2016 – as a matter of social justice and public health. Even within the right-wing parties we know that there are dissident positions, and some of the legislators have spoken out on this issue and on issues of sexual diversity.

What legal mechanisms are required to achieve the Citizen Group’s objective? How are you working as a social movement to achieve it?

More than a legal mechanism, we’ve been working for a political mechanism, and one of social movement, dialogue, and discussion. It could be through a reform to the Penal Code that we recover those three grounds for abortion that were struck down in 1998. It could be by way of rulings of unconstitutionality: we have filed two claims of unconstitutionality with the Chamber, and in both they have clearly responded by saying, ​“This is an issue that corresponds to the Legislative Assembly, not us.” However, in these claims, we are saying is that in this country women’s lives do not matter, which is a violation of Article 1 of the Constitution [which places human life at the center of State functions and mandates the State ensure its citizens’ health]. Article 3 is also not being respected because we are not being treated equally before the law.

Representatives in the Assembly should take up this issue as a matter of public health. Because in reality, this absolutist legislation impacts those of a specific profile: women who use the public healthcare system, women with lupus who are denied abortion, women and girls who are raped and impregnated and systematically denied alternatives; it’s a very specific profile.If a woman has economic resources, she can easily go to any country in the region where abortion is legal. The Legislative Assembly, through dialogue and from a human rights perspective, should take responsibility for this by passing legislation that guarantees that all women can have alternatives in these types of cases.

I think that nationally and internationally we have to call on the representatives of the FMLN and ARENA and the other parties to take up this issue from a human rights perspective. We have a secular State, but so often when it comes to issues regarding abortion or LGBTQ people, the Bible is used as a political resource by these right-wing groups. And we have to denounce that.

I invite everyone to join two campaigns that we are carrying out. One is the Campaign for Women’s Life and Health, in which we demonstrate precisely what is happening here: women with pregnancies that endanger their lives and their health in a system that isn’t allowed to save their lives. We are promoting this statement: ​“I support that when a woman’s life and health is at risk, the pregnancy can be interrupted.” This is a campaign that began in January and is seeking to generate conversation about and changes in Salvadoran public policy and legislation. And then there’s a campaign that’s been going on for a while to free ​“the 17 and more” — we’re talking about the consequences of this totally absolutist legislation, which is women who are imprisoned. In this case it’s 17 and more, because in fact there are 21 women who are imprisoned at this moment.

So what about Zika? How has the issue of Zika impacted the abortion debate, and how do you evaluate the Ministry of Health’s actions?

In the face of the so-called Zika emergency, the Ministry of Health in our country has responded with various actions: It has informed the population of the risks of pregnancy while high rates of Zika infection exist, calling on women not to get pregnant over the next two years. In order to facilitate people’s access to family planning, it has supported the distribution of contraceptives, and it is also providing monitoring and care for pregnant women who have had Zika. To date no [pregnancy] has been determined to be affected by microcephaly; it wouldn’t be until August 2016 that the impact of this epidemic could be seen. At the same time, campaigns to eradicate the Aedes aegypti mosquito, which transmits Zika, have intensified. The Ministry of Health has stated that current legislation prevents women infected with Zika from carrying out a legal and safe interruption of their pregnancy in the public healthcare system.

We think that it is correct for the Ministry to inform the public about the effects of Zika on the fetus when a pregnant women contracts the disease. However, we think that advising women not to become pregnant is an insufficient and difficult measure to apply for several reasons. First and foremost, the State should guarantee the health of the population, eradicating the disease and risks of contagion, although citizen participation is also important in achieving that. The responsibility of not getting pregnant shouldn’t fall on women, because all pregnancies involve a man who should also assume responsibility. We also need to consider that in this country 39% of pregnancies are unplanned, due to a lack of sexual and reproductive information, difficult access to contraception, and in many cases sexual violence, abuse, rape, incest, or non-consensual relations that go unpunished.

This situation could create a serious public health problem in El Salvador, given that the birth of a high number of infants with microcephaly would require specialized education and healthcare that the State should guarantee. In addition, like in other Latin American countries, we could expect an increase in unsafe abortions carried out by women who are unable to carry on the pregnancy with fetal deformations but can’t find a way to end it safely and legally – thus increasing maternal mortality.

Finally, how do you see the struggle for reproductive rights here in El Salvador connecting to the struggle in the United States, for example?

I think there is a regional strategy against our struggle that we need to respond to regionally. We need to unite our struggles through social movements, because fundamentalist groups are obstructing the defense of our rights; they block women from accessing these services and from accessing reproductive justice. Our experiences are interconnected in both countries. The United States is at a critical moment with regards to access; we are watching what is going on in Texas with great concern. As feminist organizations, we are observing this process because it could signify a setback not just in the United States but regionally. It’s not enough to support in silence: we need to encourage each other to speak out and to take a stand.

This interview first appeared at nacla​.org.