Latin America encompasses both Central and South America. It is an area that has been marked by frequent social unrest and economic instability. Its population is predominantly Catholic and induced abortion is, for the most part, illegal in the region. Observers of the region have concluded that abortion laws are not likely to be liberalized soon, and that policy makers, social commentators, church officials, and many women oppose legal change. Despite the illegality of abortion, an unknown number of illegal abortions take place in the region. Because abortion is mostly illegal, there are few published studies available. Many of the few available studies are written by those in favor of legalizing abortion and/or reducing the population in the region.
Section I of this article briefly discusses certain cultural aspects of the region which would increase the likelihood of illegal abortion. Section II discusses induced abortion as a violation of beliefs, conscience, or religion of the women. Section III summarizes published studies which discuss characteristics of those who obtain induced abortions, and why women obtain them, as well as some of the abortion techniques used and resulting physical and psychological complications.
The region has been subjected to a vast array of contraceptive programs for purposes of population control. These birth control efforts have resulted in a considerable reduction in the number of children born per woman living in Latin America. For example, the number of births per woman in Brazil in 1980 was 4.5. By 1986 this figure had fallen to 3.8, and by 1991 had fallen to 3.0. In Colombia, the number of births per woman in 1976 was 4.9. By 1986 it had fallen to 3.9, and by 1990 was 3.4. In Mexico, the number of births per woman in 1977 was 6.7. By 1987 it had fallen to 4.6 and by 1992 was only 3.61. However, the development of a contraceptive mentality tends to separate sexual relations from a reasonable possibility of procreation. Thus, induced abortion is increasingly looked upon as a form of birth control providing a necessary secondary back-up for contraceptive failure, or as a primary form of birth control if contraceptives are not used.
Male violence is a social problem in certain Latin American countries. One such country is Colombia where it was reported that 36.8% of all male deaths were due to external causes in 1994 . Females, in contrast, were much more likely to die of degenerative diseases. Nonfatal injuries in Colombia increased 15% between 1995 and 1995 and sexual offenses increased 7.6% during the same period. Men in Peru have been found to be much more likely to die from homicide and intentional injury, injuries due to legal interventions and operations of war, or motor vehicle accidents compared to women. In Ecuador, during 1995 the leading cause of death in men from 45-59 years of age was accidents and violence (23.2% of the total)2. Male violence or abusive behavior, particularly if directed against females, is a potential risk factor for induced abortion. A 1996 U.S. study of urban women who were undergoing abortions at a single facility found that approximately 40% reported prior abuse3.
The WHO has reported that in Paraguay, more than one-fifth of all households were headed by women in 1995. In Colombia, one-third of all households are headed by women. In Ecuador, the WHO reported that families have undergone a major transition in recent decades, characterized by shrinking size, less community participation, less bonding with the extended family, and rising rates of separation and divorce, which have created a high proportion of single parent families. Multiple marriages and tacit separations, even though no divorce is involved, result in many families living in inadequate economic and social conditions4. As the following studies will demonstrate, lack of financial and emotional support from fathers increases the likelihood of abortion if pregnancy occurs.
Various researchers have found that males in Latin America are more likely to engage in premarital sex than females. One study found that 36% of the women living in Guatemala City, and 49% of the women in Paraguay, who were between the ages of 20-24 years, had premarital sexual intercourse. For men between the ages of 20-24, 86% of those living in Mexico City and 87% of those living in Guatemala City had premarital sexual intercourse5. Men also tend to initiate sexual activity at an earlier age than women. In one study among Mexican university students, the average age was 16 years for men and 19 years for women6.
A study was conducted in Lima, Peru between September 1991 and January 1992 of 300 men and 300 women obtaining preemployment or annual health screenings from municipal health centers situated in low income communities. It found that males were much more likely than females to be sexually promiscuous. The mean age of the sample was 25 for men and 26 for women. Overall, 75% of the sample was single and 83% were Catholic although only one-third of the females and one-quarter of the males attended church weekly. Some 53% of the males but only 3% of the females had had at least five (5) sexual partners in their lifetime. Women were more than three times more likely than men to have their first sexual experience with their spouse or with a "beloved or exclusive partner." In contrast, men were more likely to have their first sexual experience with a friend or with a prostitute7. Casual sexual relationships are more likely to result in abortions if pregnancy results compared to married relationships or consensual unions8.
The degree of commitment of the male toward the female is an important factor as to whether a pregnancy results in childbirth or abortion. A study was undertaken in 1974-1975 of women in Cali, Colombia with a total number of 123 pregnancies who had had at least one pregnancy they had described as unwanted. No attempt was made by the women to intervene in the pregnancy outcome in 28 cases, one minor intervention was made in 31 cases, multiple major interventions were made in 22 cases, and induced abortion took place in 42 cases. The women reported that it was the response of the male partner that had a direct bearing on the decision, and that his response was the single most important factor influencing the outcome. In nearly 80% of the cases, where the male partner accepted the pregnancy or was indifferent to its outcome, the woman made no attempt or only one minor attempt toward abortion. If the male partner advised an abortion, in 70% of the cases the woman took major steps or several minor steps toward abortion. Husbands were most likely to suggest an abortion if they were thinking of leaving or had already established other households. Women not in stable relationships tended to seek abortion unless they secured a promise of regular assistance from the father. The authors concluded that, "a sizable proportion of abortion decisions may be understood in terms of the woman's relationship to the economic system. When the relationship's viability was threatened, she sought to obtain an abortion. It was the perception of a threat, rather than the threat per se that was the key to understanding a woman's evaluation of her situation and her timing of the abortion."9
Other Latin American studies have found that whether or not the father of the unborn child offers or provides support is also an important factor as to whether the woman carries a pregnancy to term or has an abortion. For example, a study of women in Argentina found that the key factor in women's decisions for abortion was whether they had emotional and economic support from their partners10. A 1988 study of 357 Chilean women reported that 25% of the women stated as a reason for abortion that she had a relationship problem or that her partner did not want the pregnancy. Some 30% of the Chilean women in this study also stated as a reason for abortion that she could not afford a baby. This may not have been a problem if the partner had provided financial support. Only 5% of the women in this study said they wanted no more children11. A small study of 19 women who had abortions in Honduras during 1992-93 found that 42% of the women stated as a reason for abortion that she had a relationship problem or her partner did not want the pregnancy12.
A study of 156 Mexican women who had abortions in 1980-1988 found that 33% of the women said they were pressured into the abortion by their partner. Other reasons for abortion included women not wishing to marry the partner (21%), and economic reasons (18%). Only 15% of the women said they did not want a baby at this time as a reason for abortion13. In another study of 602 women in Bogota, Colombia who were treated for incomplete abortion in area clinics and hospital in 1990-91, 16.1% of the women reported a relationship problem with her partner or partner does not want the baby as a reason for seeking abortion. In addition, 35.2% of the women said they could not afford the baby. Again, the lack of emotional or financial support appeared to be important reasons for the abortion in up to almost one-half of the cases. Only 6.3% of the women in this study said they had an abortion because they wanted to postpone childbearing14. (See Table 1)
| Primary reasons stated by Latin American women|
for seeking abortion
|Number of Women||156||357||602||19|
|Has relationship problem or|
partner does not want pregnancy
|Cannot afford baby||16%||30%||35%||5.3%|
|Too young or parents or|
others object to pregnancy
|Having a child will disrupt|
education or job
|Risk to maternal health||---||---||8.8%||---|
|Wants to postpone|
|Wants no more children|
or has too many
|Source: Reasons Why Women Have Induced Abortions: Evidence from 27 Countries, A Bankole et al, Int'l Planned Perspectives 24(3):117, Sept 1998|
Some of the specific reasons for abortion identified by researchers in the context of the partner relationship, include a threat to abandon the woman if she gives birth, that the partner or the woman herself refuses to marry to legitimate the birth, that a breakup is imminent for reasons other than the pregnancy, that the pregnancy resulted from an extra-martial relationship, that the husband or partner mistreated the woman because of her pregnancy, or that the husband or partner simply does not want the child. Sometimes the women may combine these reasons with not being able to afford a baby, suggesting the importance of a partner who can offer both emotional and financial support15.
Several studies have also identified the social circumstances and reasons for Brazilian women admitted to the hospital with complications from induced abortion. Many of these women had taken the drug misoprostol in an attempt to induce abortion. In one study of 803 women admitted to a Rio de Janeiro hospital in 1991 with complications of induced abortion, 56% were single, and living alone with little income16. In another study of women admitted to the main obstetric hospital in Fortaleza, Brazil, during 1990-1992 with incomplete abortions induced by misoprostol, 70% were single17. In another study of 102 women in Fortaleza during 1992-1993 with a history of known misoprostol use to induce abortion, 46% were never married and 15% had been married but were not now married. The most frequent reasons stated by these women for abortion were rape, no stable partner, and poor economic conditions18.
The negative or indifferent attitude of the husband or partner toward childbirth and unwillingness to provide emotional or financial support may also be sometimes inferred from the circumstances. In some countries in Latin America and the Caribbean, husbands may not want to know their wives abortion histories although they may take responsibility as to whether or not contraception is used19. If the relationship between the woman and her partner is casual, and economic and social support is lacking for childbirth, then a woman may perceive that the male partner desires an abortion, or simply based upon pragmatic grounds, may procure an abortion once she becomes pregnant. For example, a Cuban study reported that 31.5% of all abortions in that country during 1986 were among women age 15-19 years old. The risk of abortion among students was 10 times higher than that of housewives and almost 7 times higher than that of employed women of the same age. Students in co-educational boarding schools in rural areas were at the highest risk for abortion20.
The beliefs of women about the desirability of abortion frequently conflict with the actions. In-depth interviews were undertaken of 225 women with complications from abortion at two hospitals in Lima, Peru between February-August, 1993. Forty-five percent (45%) were age 24 and below, 27% were between 25-29, 16% were between 30-34, and 12% were age 35 and above; Twenty-six percent (26%) had a primary education, 65% had a secondary education, and 9% had higher education; Fifty-three percent (53%) were not working and 47% were working; Twenty-one percent (21%) were single, 22% were married, and 56% were in union; Twenty-nine percent (29%) never had any children and 71% had at least one child; Eight percent (8%) said they wanted a child as soon as possible, 31% said they wanted a child after two years, 43% said they did not want a child, and 18% were undecided. Forty-eight percent had never used contraceptives. Women using contraceptives had mainly used rhythm and withdrawal methods.
The women were asked under what situations they thought abortion was justified. Among the responses were: if woman is unmarried (16%), if woman is in school (26%), if woman has no money but has many children (40%), the last child is too young (31%), the timing of the pregnancy is wrong (24%), or pregnancy is the result of infidelity (22%). Apparently because of the frequent difference between the stated beliefs and the actions of the women, the authors concluded that abortion is not an acceptable option for the women, even by those who resort to it, and that it is employed as the final option. (emphasis added). The same conclusion was made for postabortion women from Kenya and the Philippines21.
Other research has found that preexisting beliefs about abortion are frequently inadequate to resolve the dilemma. This was confirmed in a study of women in Chile who had abortions which found that, although abortion was regarded as a grave religious sin by the women, a substantial majority of women (76%) who obtained them thought that the distress caused by the pregnancy outweighed the distress of personal conflicts and fears about abortion22.
Stresses which occur shortly before undergoing abortion appear to be very intense. In a recent study of U.S. women in the St. Louis area who were volunteering for a RU-486 (Mifepristone) induced abortion in combination with a prostaglandin (Misoprostol), high preabortion acute stress reactions dominated by high avoidance, intrusion, and anxiety were identified. The researchers stated that "what appears to be happening is that women are trying to control their response to the unwanted pregnancy/abortion situation by avoiding thinking about it23." Other studies have also demonstrated that frequently a woman may undergo a temporary personality change prior to abortion which may be an intense grief reaction, high anxiety and depression, or self-criticism. guilt and hostility similar to those of psychiatric populations24.
Other studies of Latin American postabortion women in Venezuela and Colombia have found that the abortion experience evoked a complex combination of feelings including relief, guilt, depression and confusion. It was concluded that, while women accepted the fact of abortion, the experience left emotional scars that usually heal, but may never wholly disappear25. Also, conflict about the meaning of the abortion and its relationship to deeply held values or beliefs, has been identified as a factor that may result in negative psychological reactions26. Influences of cultural and psychosocial traditions deeply ingrained in many women in Latin America through the socialization process have been identified as a risk factor for negative psychological effects from abortion27.
Other studies have found that abortion may represent a denial or alteration of religious beliefs. A Nigerian study in 1988-89 of primarily Christian women with complications from induced abortion, determined from interviews that the women believed that abortion was immoral and was against the wish of God28. U.S. studies have also found that young women may obtain an induced abortion despite her beliefs about abortion, or that abortion may alter her previously held beliefs about God29. Induced abortion also results in frequent guilt or remorse or regret among postabortion women indicating a violation of the conscience of these women. What may be concluded from these studies is that having an induced abortion frequently will not represent the real aspirations of women. It also violates the right of conscience of many of the women who undergo abortion. This violates the basic rights and human dignity of the woman as set forth in the United Nations Declaration of Human Rights in 1948.
One study involved 156 women who had induced abortions in Mexico between 1980-1988 in Mexico City, Oaxaca, and Acapulco. Women were interviewed by trained psychology students from the National University (UNAM). Out of the 156 women, 119 reported they had their abortion performed by a trained person most often in a hospital or clinic, 32 reported abortions by untrained persons who operated in the woman's home, and 5 could not recall the qualifications.
The ages of the 156 women ranged from 12-56 years, with 14% under age 20, 40% between 20-25, 26% between 26-30, and 20% over age 30. Some 49% were single, 42% were married or living in consensual union, and 8% were separated, divorced or widowed and 61% of the women were nulliparous. Out of the remaining 61 women with children, 31% had one child, 31% had two children,l6% had three children, and 21% had four or more children. The occupations of the women were skilled labor (37%), student (36%), homemaker (19%) and manual worker (8%). Some 32% of the women reported they had previously tried unsuccessfully to self-induce an abortion by resorting to injections (35%), herbs (29%), pills (14%), injections and pills (12%), wires or needles (4%), strenuous exercise (4%), or heavy massage (2%).
Women having abortions by trained persons were more likely to have attended college (39% v 25%), have a professional occupation (19% v 4%), have received contraceptive information (43% v 3%), affirmatively stated they would recommend the abortionist to other women (75% v 25%), and have paid more for their abortion ($88 v $33). Women who had abortions by a trained person were less likely to have had two or more abortions (13% v 22%).
The reported incidence of complications or "troubles" was 22%. Among the women reporting complications (troubles), 44% experienced hemorrhages, 21% reported hemorrhages with infections, 21% reported pain, l2% reported emotional difficulties, and 3% (1 woman) needed a hysterectomy.
Women reporting abortions by trained persons compared to untrained persons were more likely to have undergone a curettage procedure (50% v 13%) or had a suction abortion (20% v 0%), and less likely to have had the abortionist utilize a catheter (3% v 19%) or injection (3% v 25%) or use wire, needles or herbs (0% v 29%) to procure the abortion.
When women were asked the reason for abortion, women reporting abortions by trained persons were much more likely to state partner pressure (39% v 13%) but were less likely to say they had too many children (8% v 16%) or had abortions for economic reasons (15% v 19%). Other reasons stated for having the abortion included not wishing to marry the partner (21%), not wanting a baby at this time (15%), or being too young (9%)30.
Another study evaluated 4371 women admitted to 11 major Bolivian hospitals during a one year period beginning July 1, 1983 with complications associated with pregnancy losses. At admission, medical personnel classified each case as definitely or probably spontaneous or alternatively definitely or probably induced. If the woman said it was induced, then it was considered to be induced. If she said it was spontaneous, and there was clinical evidence to the contrary, such as cervical lacerations, then it was considered to be induced.
| Pregnancy Losses Classified as|
Induced Abortions Compared to Type of Partner Relationship-4371
|Type of Relationship||Percent Classified as Induced Abortion|
|Women in Consensual Union||23.6%|
|Single Women never in union||46.3%|
|Separated, divorced or windowed Women||54.8%|
|Source: PE Bailey et al, A Hospital Study of Illegal Abortion in Bolivia, PAHO Bulletin 22(1):27, 1988|
Overall, 22.7% of the pregnancy losses were classified as induced abortions. Women who were age 14-17 (38.6%) or who were age 18-19 (30.3%) were more likely to have pregnancy losses classified as induced abortions compared to women age 20-29 (24.2%) or women age 30 or higher (18.3%).The quality of the male-female relationship was an important factor as to whether or not pregnancy losses were classified as induced abortions. Women who were never in union (46.3%) or who were divorced, separated or widowed (54.8%) were more likely to have pregnancy losses classified as induced abortions compared with women in consensual union (23.6%) or married women (18.0%). (Table 2) Women with a loss of a first pregnancy were more likely to have been classified as having had an induced abortion (31.3%) compared to women who did not have the loss of a first pregnancy (21.6%). There were no significant differences in the percentages of pregnancy losses attributed to induced abortion with number of living children or level of education.
Some 65% of the abortions were induced by persons with medical training compared to 29.7% by persons without medical training and 5.2% were self-induced. When abortions were induced by persons with medical training 51.3% used curettage and 34.1% inserted a foreign object. When abortions were induced by persons without medical training, 56.5% inserted a foreign object, 11.2% used curettage, and 19.4% administered an oral abortifacient. When women self-induced abortion, oral abortifacients (83.3%) were most often used. Bleeding in any amount was most likely to occur irrespective of the method used. Infection was more likely to occur with curettage (42.9%) or when foreign objects were inserted (40.5%) compared to oral abortifacients (4.3%) or use of injection (10.5%). A fever of 38 degrees centigrade or more was also more likely to occur with curettage (25.9%) or when foreign objects were inserted (37.0%) compared to oral abortifacients (7.1%) or injection (7.9%). Lesions were also more likely to occur following curettage (22.9%) or insertion of foreign objects (38.9%) compared to oral abortifacients (1.4%) or injection (0%).
Women admitted to the hospital with abortions which were classified as induced were more likely to have complications of fever (27.7% v 3.1%), infection (33.2% v 5.7%), or lesions (21.2% v 0%) compared to women who were classified as having spontaneous abortions. Women who were classified as having induced abortions were also more likely to require blood transfusion (11.9% v 6.2%), be hospitalized for 4 or more days (15.7% v 7.6%), and more likely to die compared to women classified as having spontaneous abortions (6 per 1000 case fatality rate v 0.3 per 1000 case fatality rate).
Women admitted with abortions which were classified as induced were also more likely to be using a contraceptive method during the month of conception compared to women with spontaneous abortions (39.8% v 18.6%). However, women admitted with induced abortions were less likely to say the pregnancy was desired (2.3% v 34.9%) compared to women with spontaneous abortions. Women with induced abortions were also more likely to think the use of contraceptives was not necessary (17.4% v 7.8%), and reported less sexual activity following their pregnancy loss (9.4% v 3.6%), but were more likely to express an intent to use contraceptives following their abortion (77% v 49.4%) compared to women whose abortions were classified as spontaneous.
Among the women who stated that they did not intend to use contraceptives in the future, 32.5% of the women with induced abortions compared to 6.0% of women with spontaneous abortions said they intend to discontinue sexual relations. Women with induced abortions were also more likely to cite objections of partner, family or religion as a reason for not using contraceptives compared to women with spontaneous abortions (15.8% v 2.5%)31.