Bioethics in Latin America and the Caribbean

1. Bioethics in Latin America and the Caribbean Sexual and Reproductive Health Ruth Macklin Albert Einstein College of Medicine

2. Trends in past 10 years • Dual picture • Laws and policies have become more restrictive • Power and influence of Catholic church • Conservative legislatures • Unsafe abortion a leading cause of maternal mortality • Several countries have passed laws prohibiting abortion altogether, without exception • Chile and El Salvador

3. Trends in past 10 years • Dual picture • Some countries have passed laws increasing access to abortion services • Barbados and Guyana • Peru apologizes for past sterilizations • Public awareness of reproductive rights heightened • Empowerment of women • Greater public discussion

4. Definition of ‘reproductive health’ • Reproductive health [means] that people have the ability to reproduce, to regulate their fertility; and that women are able to go safely through pregnancy and childbirth; and that reproduction is carried to a successful outcome through infant and child survival and well-being. To this may be added that people are able to enjoy and are safe in having sex.

5. Definition adopted in UN programmes • Programme of Action for the 1994 Cairo International Conference on Population and Development (ICPD) • 1995 International Conference on Women in Beijing • But the definition adopted stipulated that actions in pursuit of reproductive health not be against the law

6. Reproductive rights as human rights • Violations of reproductive rights • Programme in Peru that forcibly sterilized indigenous women • Law in Argentina that prohibits voluntary sterilization and makes it punishable • Upholding women’s rights • 1994 Constitutional reform in Argentina • Included CEDAW and other human rights treaties in the constitution

7. Catholic church and reproductive rights • Influence of the church on matters relating to abortion, contraception, and HIV/AIDS • “Day of the unborn child” • Judges in Argentina interpret the constitution as protecting the “right to life” of the fetus • Judges use theological arguments in favor of supremacy of the fetus

8. Views of women and physicians • Survey in Argentina revealed a majority of women in favor of decriminalization of abortion • Physicians refuse to perform abortions sanctioned by law even when ordered by a judge • Some local laws require physicians to report women with suspected induced abortions to the police

9. The Church and HIV/AIDS • Church hierarchy in Brazil opposed prevention plan that promoted the use of condoms • Bishops in Guatemala opposed plan to reduce maternal-infant mortality and combat the spread of AIDS • However, priests and nuns at grass roots level counsel people to use condoms

10. Emergency Contraception • Not legally prohibited in Latin American countries • Church-sanctioned opposition to this method • False claims that EC is abortifacient • Multicenter study in three countries showed widespread support of education about and use of the method

11. Some good news • Success in Mexico of program for education about and promotion of emergency contraception • Transition taking place in Argentina • Passage in legislature of bill on responsible procreation • Public debates about reproductive and sexual rights

12. Need for ongoing actions • Reproductive and sexual rights continue to be violated with impunity • Rape of adolescent in Mexico • Girl’s request for legally permitted abortion denied • Petition signed by 70 Latin American women’s groups, sent to Interamerican Commission for Human Rights

13. Hopes for the future • Mechanisms in place in the Federal District (Mexico City) do provide legal assistance and recourse for women and adolescents in such cases • Hopes for the future in Latin America lie in efforts by women’s groups and networks, and human rights organizations