Air Date: Week of August 11, 1995

Each year, as many as 15 million women around the world risk their health and even their lives to illegally terminate unwanted pregnancies. Mexico is one country where abortion is generally illegal but still commonplace. Reporter Martha Honey explores the veiled world of abortion there. *This piece originally aired August 1994.

Transcript

NUNLEY: This is Living on Earth. I'm Jan Nunley, in this week for Steve Curwood.

In the debate over the world's environmental future, there are few issues more troubling than human population growth, and in the debate over population policy there are few issues more contentious than abortion. Supporters of population control say safe and legal abortion is essential to reducing high birth rates. Feminists say it's crucial to improving the status of women. Meanwhile, conservatives around the globe have strongly opposed efforts to ease restrictions on abortion.

But behind the fractious debate there's a stark reality. Faced with unwanted pregnancies, millions of women around the world undergo abortions every year, often illegally, and often at risk to their health and even to their lives. According to one recent study, 15 million women a year have unlawful abortions. Millions suffer health problems as a result and at least 200,000 die. Mexico is one country where the needs of population policy and religious faith collide over abortion. It's a conservative country with a strong Roman Catholic tradition, but it has lowered its birth rate from 7 children per woman to 3 over the past 20 years. Abortion is illegal in all but the rarest of cases, but it's also commonplace. An estimated half million Mexican women have unlawful abortions each year. We sent reporter Martha Honey to Mexico to explore the secret world of abortion. The names of some women in her report have been changed at their request.

(Office sounds)

HONEY: Carmen is a receptionist and sex education teacher. All day long she handles the telephones, typing, and other people's problems. She appears warm, competent, and self-assured. But inside, she's carrying a secret, which until now, she says, she's told no one. When she was just 20 she became pregnant. She and her boyfriend were not planning to get married. They had little money, and Carmen hoped to continue her studies.

CARMEN: (Speaks in Spanish)
TRANSLATOR: One part of me wanted a baby. The other said no, this isn't the moment because of many things. This is a small town and everyone knows one another. We wanted privacy for our problem. So we went to the public library and talked to friends, and they gave us the address of a doctor who could do an abortion.

HONEY: For 2 days Carmen and her boyfriend debated, and finally decided to go ahead.

CARMEN: (Speaks in Spanish)
TRANSLATOR: It was a small clinic; I remember well how it was. When we saw our doctor, she told us that it was against the law, that we shouldn't talk with anyone. She gave us a paper which said something, that I would feel some pain, and that if anything happened it wasn't their responsibility. When I awoke, I was crying. It was something which took me years to get over. I couldn't confide in my friends or my family.

(Street musician amidst crowds)

HONEY: Maria lives in Mexico City. It's the world's largest city, and even Chapultepec Park, where Maria goes to rest on Sunday, is crowded. During the week, Maria works as a domestic servant and is raising 3 daughters on her small salary. Her husband died when she was just 19, and over the years 2 other men walked out on her just after she became pregnant. She says she knew nothing about family planning or contraceptives. About 4 years ago she discovered that once again, she was pregnant. For the first time, she decided to try to have an abortion.

MARIA: (Speaks in Spanish)
TRANSLATOR: I really didn't want to do it. But I realized that given our economic situation I couldn't have any more children. I took some pills, and an injection, but it didn't do anything for me. So I went to another friend who recommended a doctor. And I was so upset when I got there, because I was so afraid of what my daughters would say.

HONEY: And were you able to talk with anybody else about the abortion?

MARIA (via TRANSLATOR): I didn't talk to anyone about this.

HONEY: So it really is like a private secret that you were carrying with you?

MARIA. Yeah. Yeah.

HONEY: For years Carmen and Maria have hidden their secret, and their guilt. They have felt isolated but they are hardly alone. Despite the country's successful family planning campaign, still about two-thirds of Mexican women between the ages of 15 and 44 don't use any contraceptives, making unwanted pregnancies here commonplace. It's estimated that more than a half-million Mexican women have clandestine abortions each year, as many as 4 million in all of Latin America. Carmine and Maria are actually among the lucky ones. They were treated by doctors, and suffered no long-term physical scars. A health educator working in Mexico City says poor women are usually forced to use traditional or crude methods, often with terrible consequences.

HEALTH EDUCATOR: (Speaks in Spanish)
TRANSLATOR: They may take teas made from different herbs. They may insert sticks, wires, or bottles into their vaginas. They may take some medications that could be very dangerous. They'll carry heavy things, fall down stairs, do excess exercise to provoke an abortion. The woman may get infected, suffer hemorrhaging, she could be poisoned, or she could have perforations of the vagina, uterus, intestines, or bladder - lots of complications.

HONEY: Along this street of single-story row houses on the edge of one of Mexico's main cities is a private clinic, with a small sign in the window that says Family Practice. The blinds are shut, the front door is locked. And it has a two-way mirror in the center.

(Street sounds. Fade to office interior and a man speaking in Spanish)

HONEY: Inside, there's a desk, a hospital table, and a doctor. He talks frankly, but he keeps peering through the blinds, checking the street outside.

(Man continues to speak)

HONEY: He says he does abortions for ethical reasons. He's seen women in great need. He estimates he's done over 5,000, for rich and poor women, charging them from about $100 to $1,500. He talks fast, another patient is expected in a few minutes. The doctor says women usually don't ask directly for an abortion. They use code words, such as saying that they want help in starting their periods again. He says the police know about his operation, and they have extorted money and demanded free abortions for their girlfriends in return for leaving him alone.

(Busy hospital noises)

HONEY: But most Mexican women who decide to abort can't afford to go to a private clinic. One way or another they start the process. Then many end up in places like this, a social security maternity hospital. Doctor Neomi Ehrenfeld works in a government hospital in Mexico City. She says that under Mexico's law, doctors must treat women who come with an abortion in progress. That law has helped to keep Mexico's death rate from illegal abortions lower than in most of the rest of Latin America. But beginning an abortion is still a crime. And if a woman comes to the hospital with what appears to be an induced abortion, Ehrenfeld says the doctor is supposed to call the police.

EHRENFELD: Which is absolutely stupid, because not only you have the women at high risk, but once you cure the high risk and you heal all the physical condition, immediately she walks to the jail. Physicians in general don't call the police.

HONEY: Dr. Jose David Ortiz is a gynecologist with Mexico's Health Ministry, in the northern industrial city, Monterrey. Like Dr. Ehrenfeld, he never calls the police, but he otherwise tries to work within the parameters of Mexican law. Dr. Ortiz is part of an international organization which is teaching doctors and nurses to use manual vacuum aspirators to finish abortions started outside the hospital. This is one of the safest, fastest, and most inexpensive methods for completing incomplete abortions.

ORTIZ: So this technique is very good for any of those cases, and if we improve the use of family planning methods, then we break the circle of unwanted pregnancy, no family planning, another unwanted pregnancy, and then again an abortion. So it's one of those times, maybe, the patient will die. So we try to break that cycle.

HONEY: Ortiz acknowledges that the vacuum aspirator technique can easily be used to initiate abortions as well as finish them. He says that for this reason, many hospital administrators don't want their doctors to learn it. Resistance to abortion in Mexico is due in part to the strong Catholic Church, which condemns abortion as murder, and also contraceptives as micro-abortives. Women and doctors involved in abortions risk excommunication. A militant right-wing group, Pro Vida, publicly denounces clinics and doctors suspected of doing abortions, and passes out gruesome photos of dead fetuses. And ordinary Mexicans hold seemingly contradictory views. A recent Gallup poll showed 65% of Mexicans oppose legalization of abortion. Yet over 80% say the decision should ultimately be up to the woman or the couple. Mexico's family planning program has also been influenced by the policies of former US Presidents Reagan and Bush, which cut off all funding to international organizations providing abortion counseling and services. This set back Mexico's population control efforts, and it drove abortions further underground. Dr. Ortiz, for instance, lost funding for a private maternity clinic he was heading.

ORTIZ: We couldn't help many of these patients with an abortion, incomplete or induced or spontaneous, that comes to the hospitals. Which was a terrible mistake, that many of the programs, many things, they just were canceled. Because of that stupid policy.

HONEY: The Clinton Administration has reversed this policy, and US funding for family planning in Mexico has jumped. Despite these cross-currents, no change appears likely in Mexico's abortion law. But that hasn't kept some organizations from trying to make unwanted pregnancies at once less dangerous and less frequent.

(Church bells ringing)

HONEY: Odunia de Arriba is a small village in the rolling hills of Guanajuaro. The setting is idyllic, but the health realities are harsh. Guanajuaro is among Mexico's poorest states. And it ranks near the top in rates of maternal and infant mortality. And women here have on average 6 children, twice the national average.

(Piano playing; a woman speaking)

HONEY: In the darkened room of an adobe house, 3 young women show a video and lead a discussion about the abortion debate. They talk with 2 dozen mothers, grandmothers, teenagers, and children. The trio are peer counselors from a private, nonprofit project called CASA. CASA takes a multidimensional and community-based approach on unwanted pregnancies. The heart and soul of the operation are its 50 youthful peer counselors. In the early afternoon the 3 counselors, Angelika, Concepcion, and Rosario, head down the long dirt road towards another village. Five days a week, they and other CASA counselors fan out, teaching health and sex education to an estimated 50,000 people. During their rounds, the 3 young women explain that just a few years ago they were all unemployed, and 2 were new single mothers. They come from large, very poor families. They were school dropouts with no future. Then they found CASA. There they learned about health, nutrition, family planning, prenatal care, and contraceptives. They began to get control over their own lives. And then they went on to become peer counselors.

SALAS: (Speaks in Spanish)
TRANSLATOR: The peer counselors play a very important role because they provide Casa services throughout the rural areas.

HONEY: Irma Salas is the subdirector of CASA. She says the agency has given its youth counselors expertise, a modest salary, and most importantly, self-esteem and self- confidence.

(Women and children speaking)

HONEY: At CASA's headquarters in the old colonial town of San Miguel de Allende, a dozen people sit on wooden benches waiting to see the doctor. The agency was started in 1981 by a North American woman and her Mexican husband. It receives funding from Mexican and US organizations. It houses doctors, a dentist, social workers, psychologists, midwives, a pharmacy, a library, and a day care center. It's about to open a modern family health center and maternity hosptial. CASA officials say they can measure some of their successes. More men are coming to the clinics and sex education courses. Many of the women CASA reaches are delaying their first pregnancies until they are over 20. And virtually all say they plan to have fewer children than their mothers. But while CASA is trying to help women avoid unwanted pregnancies, Irma Salas say that still, many come seeking abortions.

SALAS: (Speaks in Spanish)
TRANSLATOR: Here in CASA when women solicit abortions, or women arrive with abortions in progress, the doctor receives them. He gives his medical opinion and then channels them to me, and we discuss other areas: their feelings, their emotions. If she still wants an abortion, we look for the most adequate place within her means.

HONEY: CASA fears reprisals from the government, the Church and groups, like ProVida. It walks a tightrope as it tries to safely and humanely meet the needs of women looking for help. Again, Irma Salas.

SALAS: (via TRANSLATOR) CASA is a place where young women feel okay. We don't ask where are you living, who is your father, who is your boyfriend? What's most important is not their past, it's their potential, and what their future can be if given a chance. The only thing we want is to reduce the number of abortions. Of mothers living alone with their children. Of abandoned children. And we don't want them to resolve their doubts in the streets with their friends. That's all that CASA wants.

HONEY: Irma Salas and others at CASA say there is no simple solution to the problems of unwanted pregnancies and clandestine abortions. But they believe that CASA's holistic approach to health care, family planning, and sex education is helping to reduce abortions. And when necessary, is helping women to safely, if not always legally, terminate pregnancies. Today, the abortion question is being debated by Mexican officials. However, it's projects like CASA which are dealing with the abortion reality every day. Perhaps places like this can serve as a model for reproductive health services in Mexico as well as in other developing countries. For Living on Earth, this is Martha Honey in San Miguel de Allende, Mexico.