“Abortion is a public health matter,” scientists say. This notion seems a bit abstract – how can a criminalized practice constitute a public health need? The Covid-19 pandemic is a teachable moment. But it is the teaching of horror: according to the World Health Organization, thousands of women visit health services every month to receive care for incomplete abortions. In Argentina, the figure was 3,330 women; in Chile, 1,522; in Colombia, 7,778; and in Mexico, 18,285, in different years. According to the Guttmacher Institute, 760,000 women in Latin America and the Caribbean are treated annually at healthcare services because of complications from unsafe abortions, averaging out to 63,000 beds a month. When a woman goes to a hospital for complications from an unsafe abortion, she might end up needing a bed twice: once, to treat the unsafe abortion and next, to be treated for the Covid-19 she contracted in the hospital.
Abortion has been colonized by patriarchal perceptions: women who have abortions are ‘selfish’ or ‘irresponsible’, according to the moralizers, while women’s own perceptions are ignored by those wielding the power to criminalize bodies. Women have abortions because they need to care for themselves and their families; they have abortions and feel a sense of relief. The image of a hospital bed occupied by a woman recovering from an unsafe abortion might help people with little imagination view abortion rights from a new angle: if abortion were legal and safe, a woman could be prescribed a medication and do the abortion herself, at home. The hospital bed would remain unoccupied, so the moralizer could care for his own mother, father, grandmother, grandfather, or even himself. Generally, there would be no need for any hospitalization and the abortion could be monitored by nurses or nursing assistants through a digital telehealth system. Abortion would be safe and affordable and would not occupy the hospital beds needed for responding to the pandemic emergency.
The criminalization of abortion has exactly the opposite effect. It not only endangers women’s health by subjecting them to unsafe procedures; it also forces them to seek out health services so they won’t die. In Brazil, data from the National Abortion Survey for 2016 showed that about half a million women have abortions every year. Of these, 50% had to go to a hospital to finish an incomplete abortion. In other words, 250,000 women need such health services annually. Doing some rough math, this might mean some 20,000 women a month are occupying hospital beds so they can receive treatment for an unsafe abortion. We do not actually know how the pandemic has impacted clandestine abortions; the figure may have risen, given the precariousness of reproductive health services during the pandemic. What we can safely say is that thousands of women arrive at hospital doors each month.
There is hard evidence that the pandemic presents a heightened risk to reproductive health. Brazil is the epicenter of maternal death from Covid-19. The virus kills some women, but the lack of health care leaves many more of them seriously ill. In Brazil, more than 200 women have already died during pregnancy, childbirth, or postpartum – and one in four had no access to an intensive care unit. “They died in extreme suffering,” said one of the researchers responsible for the study in Brazil. The WHO recently released a document calling on governments to maintain essential sexual and reproductive health services during the pandemic. The Ebola and Zika epidemics demonstrated the harmful impact the interruption of these services can have on women, boosting death rates from unsafe abortions, as well as rates of domestic violence and unintended adolescent pregnancy.
The numbers are frightening: “a modest decline of 10% in service coverage during pregnancy and for newborns could result in an additional 28,000 maternal deaths, 168,000 newborn deaths, and millions of unintended pregnancies as family planning services face disruptions,” said the WHO. What did Brazil, under Jair Bolsonaro’s administration, do when faced with these data? Prohibited the Brazilian Health Ministry from releasing a technical memorandum on access to contraceptives and abortion in cases of sexual violence during the pandemic. More than merely ignoring the centrality of reproductive health, the Brazilian government has begun undermining it with the intensity of authoritarians who turn women’s uteruses into political banners.
These women will end up occupying even more hospital beds because of unsafe abortions, running the vital risk of leaving their children orphaned, while the pregnant women who fall ill from Covid-19 will die in “extreme suffering.” This is not a pandemic that touches our bodies equally: the more fragile the woman and the more dependent she is on an authoritarian regime that rules over life – like many Black and Indigenous women in Latin American and Caribbean countries – the greater her risk of dying simply because she is a woman of reproductive age. Among the consequences of gender inequality, there is no greater outrage than the death of a woman for lack of reproductive health care.
Debora Diniz is a Brazilian anthropologist and researcher at Brown University.
Giselle Carino is an Argentinian political scientist and IPPF/WHR director.