Forty years ago as a teenager in New York I had occasion to go to a clinic to get a pregnancy test.  I assumed that this encounter was within a circle of confidentiality. That was why I went–no one but me would have access to my pregnancy test result.

For the last 30 years, I have been living and working in Mexico. In July a young woman, barely out of her teens, visited the clinic I helped found in the state of Guanajuato. She asked for a pregnancy test and assumed there would be confidentiality.  She was wrong.  The local justice ministry demanded that the clinic provide the results of her test to them, as she was under investigation for illegal abortion after seeking medical attention at a public hospital for vaginal bleeding and pain.  

In early October this same young woman was advised that her case was officially dropped due to insufficient evidence. Her nightmare, which started in an emergency room with a brutal interrogation and included inappropriate questioning about her personal sex life by the General Attorney’s Office, is seemingly over. Both this young woman and the clinic personnel, including me and my husband, faced the real possibility of incarceration – in our case because we did not hand over the confidential information of our patient.

In 1997 abortion in the first trimester was legalized in Mexico City, but laws throughout the rest of the country are extremely harsh and confusing.  Furthermore Mexico is not alone when it comes to doctors in public health facilities being joined on site by prosecutors and others. Similar laws and practices, in the name of “protection of the right to life,’ can be found in many countries in Latin America and elsewhere. The goal seems to be to punish, coerce, and even frighten women away from needed medical care.

In late September, the New York Times published an article that shared the history of seven women from Guanajuato incarcerated, some for eight years, for the crime of “homicide in reason of parentage” — loosely defined as homicide between family members, including mother and newborn.  On September 7^th following considerable pressure from the press and the general public, these women were released.  They and others maintain they are innocent of any crime and that they did not receive due process in being accused of a crime.

Prior to and since the passing of the 2007 law that made abortion a crime punishable as a homicide,  abortion has been illegal in Guanajuato except in cases of rape. Also in 2007 the State Congress in Guanajuato passed a constitutional amendment establishing conception as the official start of the right to life, apparently with the aim of  ensuring beyond doubt that no woman in Guanajuato will ever have the right to interrupt an unwanted pregnancy.  All of these laws are seemingly designed and being used to punish women who are suspected of inducing abortion, and have been applied even to women who have miscarriages.

As a woman and a public health and human rights activist I am incensed by what is happening in my adopted country. And I am baffled and saddened about what is happening in the United States, my motherland, afraid for my daughter and for my sons, and for all U.S. residents. Soon after the time I first went to the clinic in New York 40 years ago, the landmark 1973 Roe v Wade decision secured my right as a woman to have access to abortion services on demand. Over many decades I felt secure and protected.  Not anymore… especially when I see men and women running in U.S. senate races with a platform that includes overriding Roe v Wade.  It is more than disturbing to see Attorneys General in the United States dedicating themselves to rewriting hospital regulations with the purported mission of increased safety for women while in fact they are dismantling the already insufficient supply of abortion providers in their states.

I am also disappointed that the international public health world and others that have made significant progress in bringing attention to unacceptable high maternal mortality rates is still not speaking plainly and with the needed frequency about the need for safe, free family planning and abortion services. It is an undisputed fact that in countries where abortion is illegal or access is curtailed, abortions still take place.   In Mexico, according to national and international public health sources, 800,000 women a year abort illegally.  Moreover, Mexico like other countries, including the United States is experiencing rising maternal mortality rates. Lack of access to safe abortion is a well-documented killer of women.

In Guanajuato, where I live, the Mexican human rights group Las Libres maintains that 165 women are currently being arraigned for the crime of abortion and that the majority went to public health facilities for medical assistance only to have the physicians who attended them abandon patient-doctor confidentiality and act as agents of the state.  This not only violates medical ethics on patient privacy, it compromises respectful, confidential doctor-patient relationship necessary for high quality diagnosis and treatment.  Obviously if a patient believes that a physician will report her to authorities, she will be fearful of telling the doctor the truth.  Indeed, some women will be too scared to go for treatment at all.

The current law in Guanajuato, and the barrage of restrictions being enacted against women throughout Mexico and in the United States and elsewhere poses a test first and foremost for the medical community:  Do health care providers serve their patients?  Or are they supposed to ignore medical ethics, good science and human need to serve as informants for state prosecutors and others?  How the medical community performs on this test, and how policy makers and the public support them, will have implications for the lives and well-being of countless women around the world.  I, for one, hope we all pass this test; that we will vote for people who will also pass this test and that women will get the confidential care we all have a right to.