This publication presents the results of the first compilation of bibliographical and documentary research on induced abortion in Latin America and the Caribbean. It includes a base of bibliographical references published between 1990 and 2005, as well as a thematic analysis divided into nine chapters, corresponding to various aspects of the practice of abortion in the region. Although this issue has increasingly attracted the attention of Latin American researchers, it is still not sufficiently examined. The issue is made more difficult to study in the region by laws restricting abortion in most of Latin America countries, which leads to clandestine abortions and therefore the underreporting of voluntary terminations of pregnancy. It is also due to the fact that in the region, the prevailing social, cultural, political, ideological and religious atmosphere is opposed to abortion, the practice of which is regarded as taboo among broad sectors of the population. For this reason, it is a polemical issue that creates complex tensions and intense debate. These circumstances hamper the production of information on the issue, thereby affecting its quality and reliability.
This compilation forms part of one of the thematic area of study defined by the program of activities of the Center for Population and Development Studies (CEPED, Paris), called “Abortion: International Comparisons,” coordinated by Agnès Guillaume. An earlier publication by the same program included an analysis of the literature and a reference base on abortion in Africa, updated for the period between 1990 and 2005, available for consultation at: http://www.ceped.org/article.php3?id_article=28. One of the aims of CEPED’s activities is to regularly update the bibliographical base on the issue, as well as to continue expanding the state of knowledge on the practice of abortion.
This study deals exclusively with the issue of induced abortion, defined as the deliberate action by a woman or another person to terminate an unwanted, unforeseen or unplanned pregnancy. It is important to bear this definition in mind, since one of the main problems of studies on abortion, particularly those undertaken by health professionals, is the frequent lack of distinction between miscarriages and abortion, whose causes and consequences are very different, as are the characteristics of the women that experience them.
In the literature on the subject, various types of abortion are identified, depending on the conditions in which they are practiced or authorized. The World Health Organization defines risky or unsafe abortion as the kind performed in inadequate or insufficient health and safety conditions, using dangerous techniques, in unhygienic areas and usually performed by unqualified medical staff. This leads to a high incidence of complications that threaten women’s health and which lead to a variety of adverse consequences in various spheres of their lives.
Abortion may be illegal or legal, depending on the legal framework in force in each country. It may also be the result of an intentional or unintentional act. In the latter case, it occurs as a result of an accident, carelessness on the part of the woman or risky conditions linked to her everyday or work activities. An abortion may also be therapeutic or medical, as when it is performed in response to a threat to the woman’s life or health. These definitions, among others (see Annex 1 in Chapter 1) are important insofar as they are used in legislation to impose sanctions on women that seek or perform abortions. Sanctions vary from country to country and are applied according to the circumstances under which a pregnancy is interrupted. At the same time, however, these definitions are often used indistinctly to prevent these sanctions. This publication will only deal with the various types of induced abortion, simply using the term “abortion.”
The bibliographical material considered in this study is mainly drawn from the bibliographical reference bases of the field of social sciences and, to a lesser extent, of medical sciences. Research published in books or as journal articles was also consulted. Other types of documents, known as “gray literature”, were also incorporated, such as multi-graphic reports, dissertations, working reports, unpublished materials given at symposia, colloquia or meetings, or texts available only in electronic form. The results of this compilation show that the subject of abortion has been approached from various analytical and disciplinary perspectives in Latin American and Caribbean countries. As a result, there is an extremely vast and varied body of documentary information on the subject. Although the research data base included here contains over 2,800 bibliographical references, it is by no means exhaustive.
The bibliographical references recorded in the base were included either because the title refers to abortion or because they are texts in which abortion was linked to topics such as contraception, maternal mortality, reproductive health, health policies and programs, reproductive rights or gender inequality, among others.
Likewise, some references are not limited to the Latin American or Caribbean sphere, since they provide important general information and reflections on legislation, debate and health programs, as well as to methodological and analytical strategies. Knowledge of these aspects of current research are important data that may help achieve a better understanding of the issue and above all, the difficulties that occur when abortion practices are analyzed.
The thematic analysis undertaken here does not attempt to be exhaustive or to be either explanatory or interpretive. The aim of this material is more modest, and is restricted to providing some of the main arguments and empirical evidence on the various manifestations and issues regarded as crucial for having a general overview of abortion in the region. The text is the result of a selective review of the abundant existing literature, limited to the materials published in the region to which the authors had access.
The thematic selections in this publication are based on the structure defined in the aforementioned research on Africa. Other issues and sub-issues were included and examined on the basis of the specificity of the context of the Latin American and Caribbean region, the theoretical and methodological development achieved, and the use of certain dimensions and analytical axes. These include the chapter on the debate over abortion and two others focusing on the practice of abortion among adolescents and on the role of males in such practice.
The preliminary version of this book, drafted in 2005, was delivered at a parallel session of the “XXV International Population Congress”, organized by the International Union for the Scientific Study of Population, held in Tours, France, in July of that year. It was also delivered at the “II Research Meeting on Unwanted, Unsafe Pregnancy”, organized by the Population Council, held in Mexico City in August of the same year. Both events were attended by researchers from various academic centers, as well as reproductive health professionals, members of international organizations and representatives of civil society that undertake various activities related to abortion issues in Latin America and the Caribbean. As a result of their critical comments, specific proposals and additional texts that they sent us from their respective countries, we have expanded and completed the bibliographical reference base and the documentary analysis of the current publication.
The thematic analysis includes nine chapters. The first, “Legal Framework of Abortion” describes the legislations in force in the various countries in the region in different moments, their origin, the legal sanctions imposed and some of the requirements for authorizing the termination of a pregnancy. It also includes a section on women’s rights related directly or indirectly to abortion, recognized at various international conferences and conventions. Moreover, it documents some of the barriers faced by women seeking abortion in the cases permitted by law. As this chapter indicates, this is a key issue that largely influences the conditions of access to abortion, the specific practices involved, the consequences linked to this act, and the opinions, perceptions and attitudes of various sectors of the population towards this phenomenon. These also determine information-gathering methods and therefore the estimates of the occurrence of abortion and the characteristics of the women that resort to this practice.
The second chapter, “The Debate on Abortion: Positions, Opinions, Perceptions and Arguments,” reviews the literature on the discussion of abortion in the region. It includes a brief description of the main actors or participants in this debate and some of their positions, opinions, perceptions and arguments. Emphasis is placed on the perspectives of progressive and feminist groups, as well as that of the Catholic hierarchy, whose influence continues to be strong in most Latin American countries. Likewise, the findings of certain opinion surveys applied among various sectors of the population, particularly health professionals, were also included. The results reflect the different perceptions of abortion, as well as the conditions under which performing one is regarded as acceptable. Finally, some of the consequences of the debate on the legislative and medical spheres, particularly reproductive health services, are included by way of illustration. The abundant literature on the topic confirms the importance of this debate in Latin America in contrast to Africa, where the issue has generated less interest.
The aim of the remaining chapters is to present, mainly, the diverse available empirical evidence on various key aspects of the practice of abortion. The third chapter, “Estimates of Abortion: Difficulties and Limitations,” is oriented towards showing the diversity of methods used to estimate the scope of the phenomenon. It also includes a brief description of the various sources of information and their varying degrees of reliability, as well as the different methodologies and research techniques used to gather information on abortion. This chapter stresses the fact that it continues to be a practice that tends to be under-declared, unregistered, or erroneously classified. This situation is due as much to the attitude of the women themselves as of the health professionals that treat them, who, in many cases, fail to declare abortions for fear of legal, social or moral sanctions. For all those reasons, the reader is warned that the indicators used to measure abortion, as regard both its frequency and trends, should be considered with reservations, since they only correspond to an extremely limited part of reality. These estimates therefore only constitute an approximation of the minimum level of abortion in each country, or rather within the specific contexts or populations that are the object of study. Echoing what Llovet and Ramos point out (2001), some tolerance is required towards the ambiguity and imprecision of the information on the subject. This makes it necessary to improve the research methods and sources that contribute to obtaining more precise and rigorous knowledge on this phenomenon in the region.
Abortion is a widespread practice in all countries. Women resort to the interruption of pregnancy in both rural and urban societies, in different social and ethnic groups, in different generations and regions within the countries. This practice also varies according to social, economic or cultural factors. These factors are explained in the fourth chapter, “Socio-demographic Profile and Reasons: Why Women Resort to Abortion”, which also describes the circumstances that lead to the termination of unforeseen or unwanted pregnancies. Despite the scant bibliography on the issue, the findings presented show the wide variety of profiles and situations faced by women that abort. At the same time, they shed light on their common characteristics, particularly regarding the reasons why they choose to interrupt their pregnancies.
The fifth chapter, “Adolescent Abortion” focuses on one of the population sectors whose practice of abortion attracts particular attention in the region. As the studies described in the chapter point out, this is due to the high incidence of abortions observed among teenagers, as well as the lower likelihood of their being able to undergo a safe abortion in appropriate conditions. It also provides empirical evidence of the implications of early pregnancy and abortion among younger women, in addition to the factors that intervene in this practice. These aspects are preceded by a brief description of the arguments given by various authors about the meaning and connotation of teenage pregnancy as a problem, which shows the importance of having a broader perspective on the issue. Reference is also made to the reproductive rights of this population group and to the barriers to the exercise of those rights.
Chapter 6, “The Diversity of Abortion Methods” provides a broad overview of the range of procedures used by women in the region to interrupt their pregnancy, from traditional to modern and medicalized methods. It also mentions the factors and conditions underlying the choice of abortion methods, as well as the often incorrect use of some of them. Finally, it documents some of the examples of the participation of different health service providers and organizations in civil society in the dissemination of the use of abortion methods and advice on it.
Other aspect of the problem of abortion that has created enormous concern is the one dealt with in Chapter 7, “The Health and Social Consequences of Abortion.” This chapter refers to the implications of abortion for women, their families and society as a whole. It also documents the evidence on maternal morbi-mortality resulting from unsafe abortions. It discusses the conditions of access to public health services and the so-called parallel or clandestine abortion market, to which millions of Latin American and Caribbean women resort every year due to the legal restrictions in force and the penalization of this practice. This chapter also deals with the economic impact of abortion on health systems, women and their families, in addition to the social and psychological effects of the practice of abortion. The last section summarizes some of the arguments described in the literature on the consequences of laws that restrict women’s rights to abortion, as well as the availability of information.
Chapter 8, “Abortion and Contraception,” illustrates the various circumstances associated with the lack or inadequacy of contraceptive practice that contributes to the increase in the number of unwanted pregnancies that end in abortion. It also deals with failures in the use of contraceptive methods, difficulties in access to the latter, and the importance of including family planning programs in post-abortion care, in order to prevent women from resorting to the interruption of pregnancy in the future. It also includes some considerations of the possible impact of abortion on the fertility levels of countries in the region that have begun their demographic transition.
Finally, Chapter 9, “Males and the Practice of Abortion” documents some of the academic reflections on ways of dealing with the problem of abortion from a male perspective. Discussed at various international conferences, the issue has been the subject of intense reflection in feminist studies. Male domination, common in everyday life, is even more important in the sphere of sexual and reproductive life, and understanding of the consequences of this domination on unwanted pregnancies is still insufficient. This chapter also presents some empirical evidence on the role played by males in the experience of abortion, from the point of view of both women and their partners. A review of the literature on this issue in particular yielded two analytical dimensions that are highly relevant in exploring males’ responsibility in abortions. The first refers to the influence of the links between emotional relationship and living arrangement within the couple. The second refers to the role and responsibility acknowledged and assumed by males in the decisions concerning the contraceptive practice of both their partners and themselves.
Since the end of each chapter includes conclusions on each of the topics dealt with, the last section, “Final Conclusions” merely highlights some of the initial reflections and recommendations. These focus largely on those aspects of abortion that require further research and which are derived from the thematic analysis. This chapter also includes some reflections to be considered in the field of public intervention. In our opinion, this last is a pending task that should form part of a collective discussion by specialists on the topic in the region.
It is important to make two observations about the review included here. The first is that in some cases, empirical evidence is included without sufficiently defining the social and cultural context to which it belongs. This is due, on the one hand, to the lack of information in some of the materials consulted (such as the methodology and sources of information used or the date when the study was carried out) and on the other, to the impossibility of describing the extensive bibliography considered in greater detail. The second observation is that in some chapters, the evidence and arguments presented by the authors consulted are repeated. This is due to an attempt to keep each chapter self-contained as much as possible; in other words, to ensure that it provides the broadest possible overview of a given topic, which in many cases can be inter-related to the other topics included in other chapters.
This study, available on CEPED’s website http://www.ceped.org/avortement is published in Spanish, English and French on a CD-Rom. It has two main sections, the first of which includes the text with the nine chapters on the aforementioned topics. The bibliographical references cited in this text include the author’s name, year of publication and a link that will enable readers to consult the reference in the bibliographical base.
The second section contains the base of bibliographical references classified by author (or publication, if the author has not been identified), year of publication and country where the work was published. These references include other data such as the title of the text, and the type of publication in which it appears, in addition, and in most cases, to a précis of the text in either one or several languages (Spanish, English, French or Portuguese) drawn from the data bases or the summaries of the texts consulted. Likewise, each bibliographical reference has corresponding key words indexed by theme, country and geographical zone that can be located by readers and are available in Spanish, French and English.
This bibliographical base has over 2,800 titles, most of which correspond to Mexico, where the study was conducted and where it was easier to compile the material than in other countries. The aim is to regularly update the bibliographical base and to complement the state of knowledge on this topic, with thematic analyses of more reflection, rigor and depth.
The bibliographical references and information presented in this document were obtained from various reference bases, summaries of the content of the latter by various authors and institutions as well as a number of articles consulted. Several of the references were obtained from databases to which the Daniel Cosío Villegas Library at El Colegio de México subscribes or from clusters of other bases done by certain providers.
The databases catalogs of the following documentation centers were consulted:
The following are journals that were systematically reviewed and web resources that were consulted for select articles:
Sources cited in the bibliography and analyzed in the text may be consulted at the following websites: