Air Date: Week of August 26, 1994

Abortion is one of the most divisive issues in the run-up to this fall’s UN Conference on Population and Development in Cairo. Supporters say safe and legal abortion is essential to reducing high birth rates and improving the status of women . . .while opponents, especially the Vatican, have fought any efforts to ease restrictions on abortion. But behind the debate is the stark reality that 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.

Transcript

CURWOOD: This is Living on Earth. I'm Steve Curwood. Abortion is one of the most divisive issues in the debate over global population growth, and this fall's UN conference on population and development is the latest forum. 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. But conservatives, including a new alliance between the Vatican and the Islamic fundamentalist government of Iran, have fought doggedly against any efforts to ease restrictions on abortion. But behind the increasingly pitched debate, there's a stark reality. Millions of women around the world continue to risk their health, and even their lives, to terminate unwanted pregnancies. 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 a conservative country with a strong Catholic church, which has lowered its birth rate from 7 children per woman to 3 over the past 20 years, while keeping abortion illegal in all but the rarest of cases. Still, abortion is 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 there, and she filed this report. The names of some women in the stories have been changed at their request.

(Office and traffic noises)

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 sounds: pedestrians, a flutist performing)

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 then 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 (through translator): I didn't talk to anyone about this.

HONEY: So it really is like a private secret that you are carrying with you.

MARIA: [Yes. Yes.]

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. Carmen 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.

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.

(Street traffic)

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 2-way mirror in the center. 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. 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.

(A noisy hospital)

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. Dr. 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 women at high risk, but once you cure the high risk and you healed 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. And 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 will cancel. Because for that stupid policy.

HONEY: The Clinton Administration has reversed this policy, and US funding for family planning in Mexico has jumped to $13 million, more than to any other Latin American country. 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 bell ringing; birdsong)

HONEY: Oduna de Arriba is a small village in the rolling hills of Guanajaro. The setting is idyllic, but the health realities are harsh. Guanajaro 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.

(Music 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 to unwanted pregnancies. The heart and soul of the operation are its 50 youthful peer counselors.

(Footfalls and birdsong)

HONEY: In the early afternoon, the three counselors - Angelika, Concepcion, and Rosaria, 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. 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 hospital. After 13 years of work, 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 says that still, many come seeking abortions.

SALAS (through 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 Pro Vida. It walks a tightrope as it tries to safely and humanely meet the needs of women looking for help. Again, Irma Salas.

SALAS (through 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, it's helping women to safely, if not always legally, terminate pregnancies. Today the abortion question is being debated by Mexican politicians, UN conferees, and Clinton Administration and Vatican 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.