The Shift From Criminalization to Legalization of Abortion in Argentina.

This Viewpoint discusses passage and implementation of Law 27.610, which legalized abortion in Argentina under certain circumstances, and examines the ongoing clinical issues and legal challenges to the law.

Indiciamento das mulheres pela prática do abortamento: a (des)continuidade do discurso punitivista / Indictment of women for the practice of abortion: the (dis) continuity of the punitive discourse / Incriminación de mujeres por la práctica del aborto: la (dis)continuidad del discurso punitivo

Resumo O objetivo deste trabalho foi analisar os argumentos empregados na condenação ou absolvição das mulheres acusadas de abortamento, especialmente os processos que foram suspensos. Analisamos sentenças e acórdãos referentes ao autoaborto (art. 124 do Código Penal) dos Tribunais de Justiça dos estados de São Paulo e de Minas Gerais. Como resultado do levantamento, constatamos a reiterada concessão da suspensão condicional do processo ou da pena, o que poderia ser considerado medida despenalizadora, por acarretar a extinção da punibilidade. No entanto, ante a aceitação e devido cumprimento das condições impostas pelo prazo fixado, o conteúdo das decisões de suspensão (de processo e de pena) explicita o caráter moral das sentenças, bem como a discriminação de gênero e a violência institucional. Assim, discute-se os fins da criminalização do abortamento e as consequências para o exercício pleno dos direitos sexuais e reprodutivos das mulheres.

Abstract This article's objective was to analyse the arguments used for the conviction or acquittal of women accused of abortion, especially in processes that were suspended. We analysed judicial decisions from the Justice Courts of São Paulo and Minas Gerais States. As a result of the analysis of these materials, we note the repeated granting of conditional suspension of the process or penalty, which could be considered a decriminalizing measure. However, as it entails the extinction of punishment, once accepted and respected the conditions imposed by a fixed term, the content of the concessive decisions exhibit the explicit moral judgement of the convictions, as well as gender discrimination and institutional violence. Thus, we discuss the overall aim of the criminalisation of abortion and the consequences for the full exercise of women's sexual and reproductive rights.

Resumen El objetivo de este trabajo fue analizar los argumentos utilizados en la condena o absolución de mujeres acusadas de aborto, especialmente los procesos que fueron suspendidos. Analizamos sentencias relacionadas con el aborto autoproducido (art. 124 del Código Penal brasileño) de los Tribunales de Justicia de los estados de São Paulo y Minas Gerais. Como resultado de la investigación, se observa el reiterado otorgamiento de suspensión condicional del proceso o sanción, lo que podría ser considerado una medida despenalizadora, ya que resulta en la extinción de la pena. Sin embargo, ante la aceptación y debido cumplimiento de las condiciones impuestas por el plazo fijado, el contenido de las decisiones de suspensión (de proceso y sentencia) hace explícito el carácter moral de las sentencias, así como la discriminación de género y la violencia institucional. Así, se discute el propósito de criminalizar el aborto y las consecuencias para el pleno ejercicio de los derechos sexuales y reproductivos de las mujeres.

Impact of State-Level Changes on Maternal Mortality: A Population-Based, Quasi-Experimental Study.

INTRODUCTION: Recent increases in maternal mortality and persistent disparities have led to speculation about why the U.S. has higher rates than most high-income countries. The aim was to examine the impact of changes in state-level factors plausibly linked to maternal mortality on overall rates and by race/ethnicity. METHODS: This quasi-experimental, population-based, difference-in-differences study used 2007-2015 National Vital Statistics System microdata mortality files from 38 states and DC. The primary exposures were 5 state-level sexual and reproductive health indicators and 6 health and economic conditions. Maternal mortality rate was defined as number of deaths of women while pregnant or within 42 days of termination of pregnancy per 100,000 live births. A difference-in-differences zero-inflated negative binomial regression model was estimated using the race/ethnicity-age-state-year population as the denominator and adjusting for race/ethnicity, age, state, and year. Data were analyzed in 2017-2018. RESULTS: There were 4,767 deaths among women up to age 44 years, resulting in a maternal mortality rate of 17.9. Reducing the proportion of Planned Parenthood clinics by 20% from the state-year mean increased the maternal mortality rate by 8% (incidence rate ratio, 1.08; 95% CI=1.04, 1.12). States that enacted legislation to restrict abortions based on gestational age increased the maternal mortality rate by 38% (incidence rate ratio, 1.38; 95% CI=1.03, 1.84). Planned Parenthood clinic closures negatively impacted all women, increasing mortality by 6%-15% across racial/ethnic groups, whereas gestational limits primarily increased mortality among white women. CONCLUSIONS: Recent fiscal and legislative changes reducing women's access to family planning and reproductive health services have contributed to rising maternal mortality rates.

La interrupción legal del embarazo en Argentina / The legal termination of pregnancy in Argentina

En el contexto de la publicación por parte del Ministerio de Salud de la Nación de Argentina del Protocolo para la atenciónintegral de las personas con derecho a la interrupción legal del embarazo (ILE), resumido y comentado en este mismonúmero de EVIDENCIA, este comentario editorial ofrece: 1) una perspectiva amplia de lo que significa el aborto, desde lamirada estrictamente biologicista hasta definiciones basadas en el enfoque de género; 2) una descripción de los diferentesmarcos jurídicos respecto del aborto que imperan actualmente en Latinoamérica y Argentina, haciendo especial hincapiéen lo concerniente a las ILE; 3) información epidemiológica sobre la mortalidad materna en Argentina y la asociada alaborto inseguro; 4) estadísticas sobre la realización de ILE en la Ciudad Autónoma de Buenos Aires, Argentina.Dada la situación actual de aislamiento social preventivo obligatorio en el marco de la pandemia de Covid-19, conside-ramos quienes integramos equipos de salud debemos estar más atentos/as que nunca a las situaciones de violenciapotencial que podrían suceder en este contexto, para dar las respuestas pertinentes -entre las que se incluyen las ILE-, alas víctimas de embarazos no deseados consecutivos a situaciones de coerción. (AU)

In the context of the publication by the Argentine Ministry of Health of the Protocol for the comprehensive care of people withthe right to legal termination of pregnancy (LTP), summarized and commented on in this same issue of EVIDENCIA, thiseditorial article offers: 1) a broad perspective of what abortion means, from a strictly biological point of view to definitionsbased on the gender approach; 2) a description of the different legal frameworks regarding abortion that currently prevailin Latin America and Argentina, with special emphasis on LTP; 3) epidemiological information on maternal mortality inArgentina and that associated with unsafe abortion; 4) statistics on the realization of LTP in the Autonomous City ofBuenos Aires, Argentina.Given the current situation of mandatory preventive social isolation in the framework of the Covid-19 pandemic, we considerthat those of us who are part of health teams should be more alert than ever to situations of potential violence that couldoccur in this context, to give the relevant responses - including LTP- to victims of unwanted pregnancies following coercivesituations. (AU)

The Politicization of Abortion and Hippocratic Disobedience in Islamist Sudan.

In Sudan's Islamist state, abortion is politicized through its association with illegal pregnancy. Fornication is a crime against God punishable with 100 lashes, and pregnancy outside a marriage contract constitutes sufficient evidence of a woman's immorality. This enables a strong link between the crime of fornication and the crime of illegal abortion, to the extent that our interviewees often conflate the two in the term "illegal pregnancy." While abortion does not appear in the domestic political debate on women's reproductive and maternal health and is not on the agenda of the national women's movement, it has become politicized in the implementation of the law. A number of bureaucratic barriers, in addition to a strong police presence outside maternity wards in public hospitals, make it difficult for unmarried women to access emergency care after complications of an illegal abortion. These women put themselves at risk of arrest for fornication and illegal abortion. However, many doctors, honoring the Hippocratic oath, disobey state policy and refrain from reporting such crimes to the police to protect unmarried and vulnerable women from prosecution.

Non-marital Pregnancies and Unmarried Women's Search for Illegal Abortion in Morocco.

Abortion in Morocco is illegal except to safeguard a woman's life or health. Morocco has put some sexual and reproductive health policies into motion that are in line with the standards defined by the World Health Organization and the United Nations Population Fund, especially after the 1994 International Conference on Population and Development, but Morocco's Penal Code continues to criminalize the practice. This paper explores how proposed reforms to the abortion law that on the surface seem to legalize abortion in cases of severe health disorders or rape in reality moralize abortion, since vulnerable women should prove these conditions through lengthy bureaucratic procedures. Drawing on ethnographic fieldwork on unplanned pregnancies, I examine the social and health inequalities surrounding illegal abortion. My results show that socioeconomic status, education, geography, and marital status all play a role in delineating which women are willing or able to obtain an abortion and under which conditions the abortion takes place. I use the concept of "reproductive governance" to examine the relevance of rights-based approaches in Morocco, ultimately arguing that the intersection of socioeconomic and political processes in the country normalizes the risk and occurrence of illegal abortion, particularly for unmarried women living in precarious socioeconomic conditions, who are not addressed by sexual and reproductive health policies.1.

Preventing State Harassment of Abortion Providers: The Work of the Legal Support Network in Latin America and East Africa.

Access to safe abortion care is threatened, especially in legally restrictive settings, when providers are harassed or prosecuted on spurious charges. Legal networks have been working with safe abortion providers in Latin America since 2006, and in East Africa since 2010, to short-circuit this intimidation and protect access to quality information and abortion care. Planned Parenthood Global has nurtured these networks, now operating in nine countries. This paper describes this unique, prevention-focused legal strategy, with an eye toward analyzing its effectiveness, sharing the model and lessons learned with an interested audience, and encouraging replication. Prevention-focused legal networks for abortion providers have been effective in reducing police harassment, offering providers the information and skills they need to stand up to intimidation, and keeping safe abortion services available to those who need them. In the few cases of prosecution, providers have access to competent defense counsel through the networks. This model has also enabled better coordination between advocacy efforts on behalf of abortion rights, empowered health care providers, and increased access for women. Providers in other countries might explore whether and how creating local legal networks would offer similar protections.

Criminalisation under scrutiny: how constitutional courts are changing their narrative by using public health evidence in abortion cases.

This article explains how the strategic use of public health evidence, showing that criminalisation of abortion does not result in lower abortion rates, is changing the way judges are confronting constitutional challenges to abortion regulations. The state may have a legitimate interest - and in some legal systems, a duty - to protect prenatal life. Nevertheless, courts are upholding regulations liberalising abortion and declaring criminalisation regimes unconstitutional. This is possible given that lower abortion rates are not achieved through criminalisation, but through preventive policies. In addition, courts uphold liberalisation when the infringement of women's rights resulting from criminalisation outweighs its purported benefits. This new legal narrative has been developed during the last decades by a series of court decisions in Europe and Latin America, and may prove useful for legal advocacy in some countries in Africa. The narrative combines the use of an analytical framework called the proportionality principle with an interpretation of constitutional rights that draws from gender-sensitive international human rights standards and factual evidence about the effects of criminalisation on women's lives and health.

Safe and unsafe abortions: Total monetary costs and health care system costs in Argentina in 2018. / Abortos seguros e inseguros: Costos monetarios totales y costos para el sistema de salud de la Argentina en 2018.

During the first semester of 2018, a profound debate on the legalization of the practice of abortion was initiated in Argentina, which exposed the lack of scientific studies addressing the economic dimension of abortion in this country. This work seeks to move forward in the quantification of the costs of abortion under two scenarios: the current context of illegality and the potential costs if the recommended international protocols were applied in a context of legalization of the practice. The results of the comparison between, on the one hand, the total monetary costs in 2018 (private or out-of-pocket expenditure and costs for the health care system) of the current scenario of illegality and unsafe practice of abortion and, on the other hand, potential scenarios of safe practices, shows that a large amount of resources could be saved if the recommended protocols were implemented. These results proved to be robust after carrying out a series of sensitivity exercises on the main assumptions included in the comparisons.

Durante el primer semestre de 2018, en Argentina se inició un profundo debate sobre la legalización de la práctica del aborto, que puso en evidencia la falta de estudios científicos que aborden la dimensión económica del tema en la Argentina. Este trabajo busca avanzar en la cuantificación de los costos del aborto bajo dos escenarios: el del actual contexto de ilegalidad y los costos potenciales si se aplicaran los protocolos internacionales recomendados, en un contexto de legalización de la práctica. Los resultados de la comparación de los costos monetarios totales en 2018 (privados o de bolsillo y para el sistema de salud) del escenario actual de ilegalidad y práctica insegura del aborto, frente a escenarios potenciales de prácticas seguras, muestran que se podría ahorrar una gran cantidad de recursos si se implementaran los protocolos recomendados. Dichos resultandos, además, se muestran robustos al realizar una serie de ejercicios de sensibilidad sobre los principales supuestos incluidos en las comparaciones.

Abortos seguros e inseguros: Costos monetarios totales y costos para el sistema de salud de la Argentina en 2018 / Safe and unsafe abortions: Total monetary costs and health care system costs in Argentina in 2018

RESUMEN Durante el primer semestre de 2018, en Argentina se inició un profundo debate sobre la legalización de la práctica del aborto, que puso en evidencia la falta de estudios científicos que aborden la dimensión económica del tema en la Argentina. Este trabajo busca avanzar en la cuantificación de los costos del aborto bajo dos escenarios: el del actual contexto de ilegalidad y los costos potenciales si se aplicaran los protocolos internacionales recomendados, en un contexto de legalización de la práctica. Los resultados de la comparación de los costos monetarios totales en 2018 (privados o de bolsillo y para el sistema de salud) del escenario actual de ilegalidad y práctica insegura del aborto, frente a escenarios potenciales de prácticas seguras, muestran que se podría ahorrar una gran cantidad de recursos si se implementaran los protocolos recomendados. Dichos resultandos, además, se muestran robustos al realizar una serie de ejercicios de sensibilidad sobre los principales supuestos incluidos en las comparaciones.

ABSTRACT During the first semester of 2018, a profound debate on the legalization of the practice of abortion was initiated in Argentina, which exposed the lack of scientific studies addressing the economic dimension of abortion in this country. This work seeks to move forward in the quantification of the costs of abortion under two scenarios: the current context of illegality and the potential costs if the recommended international protocols were applied in a context of legalization of the practice. The results of the comparison between, on the one hand, the total monetary costs in 2018 (private or out-of-pocket expenditure and costs for the health care system) of the current scenario of illegality and unsafe practice of abortion and, on the other hand, potential scenarios of safe practices, shows that a large amount of resources could be saved if the recommended protocols were implemented. These results proved to be robust after carrying out a series of sensitivity exercises on the main assumptions included in the comparisons.

The duty to make abortion law transparent: A Malawi case study.

Despite adopting a progressive legal and policy framework informed by internationally recognized human rights norms and values, Malawi has not complied with the obligation to explain its abortion law in accordance with legal and human rights standards. In 1930, the colonial government adopted a Penal Code derived from English criminal law, containing provisions regulating access to abortion, but has not undertaken measures to explain when abortion is lawful. What constitutes legal abortion has never been clarified for health providers and potential clients. Consequently, eligible girls and women fail to access safe and legal abortion. The Malawi Law Commission, following its review of the colonial abortion law, has proposed liberal changes which, if implemented, would expand access to safe abortion. However, the immediate step the government ought to take is to clarify the current abortion law, and not to wait for a new law expected to materialize in the indeterminate future.

A case of suspected illegal abortion: how clinicians may assist the forensic pathologist.

Abortion may be performed in a safe or unsafe manner, the latter being a frequent and dangerous event. It can also be performed in countries where abortion is legally recognised but, for various reasons, may be undertaken in an illegal environment. We present a case of a possible illegal abortion. A woman presented to the hospital with a dead fetus, saying that she was the victim of a car accident. Forensic and gynaecological examination of the woman were carried out, along with an autopsy of the fetus. It was discovered that the woman had performed a clandestine abortion. The differential diagnosis between illegal abortion and miscarriage represents a complicated issue and requires both clinical and forensic support. The gynaecologist may be of assistance to the forensic pathologist in confirming whether an illegal abortion has been performed.

Physicians' challenges under El Salvador's criminal abortion prohibition.

El Salvador's criminal abortion law-one of the few in the world that prohibits all abortions and that is actively enforced against women-harms women's health and undermines the ethical duties of Salvadoran physicians and the standing of the medical profession. Under the criminal abortion regime, physicians are incentivized to disclose their patients' confidential medical information, in violation of their ethical duties, and public healthcare facilities have become sites of criminal investigation. These investigations target women not only for illegal abortions, but also for miscarriages and obstetric emergencies. The ban further prevents physicians from providing medical care that is often necessary to preserve a woman's life or health. Finally, by criminalizing women's pregnancy outcomes, the regime undermines the country's recent public health improvement efforts and compounds the marginalization of women and girls from its most vulnerable communities, in violation of the state's international human rights obligations.