Although in Bolivia abortion is permitted in three cases, just six women have had access to legal abortion in this country, says Ipas. The reasons: judicial barriers as well as doctors who oppose abortion.

In fact, according to Bolivia’s current Penal Code, which was adopted in 1973, abortion is permitted only when the life or health of the woman is in danger, or when pregnancy is a result of rape or incest. The legislation also allows abortion in the case of abduction not followed by marriage.

However, a judicial order has to be issued before a physician may terminate a pregnancy. Such authorization has been denied or delayed by many judges. This is expected to change as a result of the recent order issued by the Supreme Court of Justice of Bolivia.

According to Ipas, “one reason women have been unable to access safe and legal abortion care is because of delays in the judicial authorization process. This includes delays by district attorney offices, by the ways in which rape cases are characterized, and by the sentences or judgments made. Staff may know the existing standards and legal frameworks but do not observe these and public servants often do not oppose violations of human rights but rather tend to negotiate and seek compromises in these cases.”

This “historic event” – as it is called by Ipas – comes just ten month after the CEDAW Committee expressed its concerns about access to abortion in Bolivia, stating, “The Committee urges the State party to adopt implementing regulations for existing laws on Bolivian women’s right to therapeutic abortion. The Committee also urges the State party to afford women access to high-quality services for the treatment of complications resulting from unsafe abortions with a view to reducing maternal mortality.”

In addition to judicial permissions, Bolivian women and girls face barriers legal and safe abortion, since many doctors are opposed to abortion – even in the legal cases – and claiming “conscientious objection” refuse to provide the medical service. In other countries, including in Colombia, the medical center or hospital has to find another physician to provide the medical service. In Bolivia, referral is not required.

In this context, unsafe abortion is a common practice. Raúl Hevia, director of the Hospital de la Mujer (Santa Cruz, Bolivia), told the Bolivian daily El Deber that 99.5% of the cases of abortions received in this hospital are induced abortions.

Many women obtain abortions in a clandestine manner, often in septic conditions, which ended in serious health complications, including death. Bolivia has one of the highest maternal mortality rates in Latin America (230 deaths per 100,000 births, while the average in the region is 190), and complications from unsafe abortions account for approximately one-third of maternal deaths.

According to Elizabeth Salguero of the Bolivian Human Rights Commission of the Lower Chamber, 30,000 to 40,000 clandestine abortions occurred annually. “This is a matter of public health because of the considerable number of abortions, and a matter of social justice since poor women account the most of the mortal victims resulting from abortions,” she says. Salguero also called for the legalization of the abortion. And she is not the only one.

Since 1996, the Campaña 28 de Septiembre (28th of September Campaign) has been fighting for the decriminalization of abortion in Bolivia. In 2006, this movement submitted to the Asamblea Constituyente (a group in charge of reforming the Constitution) a proposition regarding women’s rights, particularly the right to make decisions about their bodies and to determine the number of children they want to have.

Moreover, in 2005, Movimiento al Socialismo, the political party of the current President Evo Morales, submitted a bill to legalize abortion, which soon after was rejected.

However, the Bolivian government has succeeded in including postabortion care (PAC) as a basic service within its Universal Health Insurance package. Nevertheless, “although PAC is routinely part of emergency obstetric services, many Bolivian women delay going to the hospital after an unsafe abortion because they fear poor treatment from healthcare professionals,” Ipas says.

The Court undertook this new measure as part of a judicial sector commitment made during a March 2008 national symposium on sexual violence.

For Ipas, “it is remarkable that the Supreme Court has intervened to mandate that the entire judicial system is responsible for guaranteeing an aspect of women’s human rights. And it is notable that in their letter to the lower courts the Supreme Court specifically cited the state’s responsibility to uphold international human rights treaties ratified by the Bolivian government.”

Although the order from the Court is an important step, it has to be followed by an appropriate information strategy within the judicial structure. Ipas announced a monitoring process to ensure that all lower courts receive relevant information, so they can implement the law. Bolivian NGOs can apply experiences from other Latin American countries, where women’s organizations have contributed to such information not only to judges but also to medical health staff.