Cross-posted with permission from The Women’s News Network (WNN).

At 11 years of age, Nina was raped by her stepfather. Traumatized and pregnant, she sought an abortion. But every doctor she met claimed conscientious objection and refused. She was forced to travel 35 miles to another city, where she eventually tracked down an obstetrician willing to help.

She was one of the lucky ones.

Despite a landmark ruling five years ago – when Colombia’s Constitutional Court decriminalized abortion in cases of rape, fetal abnormality or to save the mother’s life – less than 0.5 percent of procedures are carried out legally each year. Many doctors simply turn girls like Nina away.

There is endemic confusion about the status of the law, especially the rules for conscientious objection, coupled with a widespread reluctance to obey it. Unsafe abortion remains the third leading cause of maternal deaths in a country where, according to government figures, over 300,000 take place each year.

Upon its inception the law has been the target of an aggressive anti-choice campaign, led by conservative political forces and supported by the Catholic Church. These forces are now threatening to unravel the little progress made.

Since coming into office in 2009, the Procurador-General, Alejandro Ordonez – the official appointed to protect the constitution and promote human rights – has led a vociferous campaign to dismantle the legislation.

“He hasn’t hidden his intent to overturn the law,” says Monica Roa, the human rights lawyer and Program Director at Women’s Link Worldwide, who led the campaign to reverse the abortion ban. “He has been filing requests to nullify the decisions of the Constitutional Court, including the legal framework for conscientious objection.”

Two years ago he announced that the State Council – another judicial body – had suspended the decree overseeing the provision of abortions. The result has been a legal vacuum.

“Although the Court said no regulation was needed for women to be able to access legal abortion services, the suspension of the decree leaves health care providers and other authorities with no specific guidelines to provide the service, or to oversee the fulfillment of the decision,” explains Arango.

The law explicates that all hospitals must employ doctors willing to perform the procedure or provide a direct referral to someone who is. Institutions, judicial representatives or public officials cannot practice conscientious objection. But without any guidelines in place the law is difficult to implement.

Ordonez has publicly backed the position of the Catholic Church, who immediately after the 2006 decision instructed all hospitals, doctors and judges to ignore the ruling and threatened to excommunicate those who didn’t.

“This is particularly problematic because the health system is administered to a great deal by the church,” adds Arango. “Many of the hospitals in rural areas and even in big cities are run by them.”

Earlier this year, Ordonez petitioned the Ministry of Health in an attempt to exclude the abortion-inducing drug misoprostol from the public health plan. He falsely claimed that the World Organization considered it dangerous. “They were so shamelessly manipulating the information, and because they have this public profile everything they say is very much publicised,” says Roa.

Now he has formed an alliance with the Conservative Party and the Church in a bid to challenge the 2006 decision through Congress. On August 3, 2011, the leader of the Conservative Party, José Darío Salazar, proposed a 14-word amendment to the Constitution that affirms the right of life from the point of conception. If approved, a total abortion ban will be reinforced.

Salazar claims to have broad political support, as well as the backing of over 5 million signatures collected over several months. As part of this process, Colombia’s archbishop sent letters to all churches ordering them to collect signatures during holy week, a time when the vast majority of Colombians attend church.

In the next few months the proposal will be debated in Congress, where opinion is split and it is unclear if anyone is willing to take a public stance to defend abortion rights. But campaigners are hopeful that the reform bill will not go through. It is possible that the issue will be sidelined by mainstream concerns – including terrorism and security – in the run-up to elections in October.

But even if Colombia does not go down the same route as Nicaragua – which reinstated its blanket ban on abortion in 2005 – implications for abortion access could be dire.

“It will send the message that they have a lot of support,” warns Roa.

“It will probably make doctors more concerned and likely to raise conscientious objection,” says Monica Arango, Latin America Director at the Center for Reproductive Rights. “It will make it a lot more difficult for women who are in rural areas to access provisions that are currently in place. They are trying to reshape the conversation and put it further away from the real issue here, which is not religion, but public health.

Nor is Ordonez likely to be silenced. Despite repeated reprimands by the Constitutional Court for misusing his powers and over thirty disciplinary complaints filed to the Supreme Court, no action has been taken against him.

It was only in late July that he reluctantly conceded to the Court’s ruling that his office must implement awareness-raising campaigns about existing abortion provisions. But he has insisted that the right to conscientious objection remains paramount and appointed Ilva Myriam Hoyos – a prominent anti-choice campaigner and close political ally – to coordinate the campaigns.

Access to safe, legal abortion remains severely restricted. According to figures released by the Procurador’s office only 649 legal abortions were carried out between 2006 and 2009. Although these statistics are likely to be undercooked, it highlights a harrowing gap in provision.

In the absence of political will, it falls largely on women’s groups, like Women’s Links Worldwide and the Center for Reproductive Rights, to push for change.

Women’s Link Worldwide provides legal services to women and girls, who are deprived of their right to abortion. In 2009, they successfully challenged the Colombian government before the Inter-American Commission of Human Rights on their failure to help a 13-year old who was made pregnant through rape.

They are also active in the public debate. “It is very important to have Catholic women understand that the position from their religion is one thing, but they still have the right to make a separate decision,” says Roa.

She is positive that change can be felt on the ground. “People have made the abortion debate their own. It has been on the agenda these five past years continuously.” In many ways the drastic actions of the Procurador is a response to the advances that have been achieved, she adds.

Arango agrees. “Since 2006, there has been a complete change of view on abortion. The process that Monica Roa pushed has made it less of a taboo. I have not heard anyone [in the mainstream media] say that if an underage girl is raped, she should not be allowed to have an abortion.”

But without vocal political support and effective public policy implementation, women’s reproductive rights will continue to be in serious danger. The next few months will serve as a crucial test of just how far Colombia has come.

(Some names in this story have been changed to protect identities.)