Defending Reproductive Rights: What Uruguay Can Teach Us

By Susan Wood for the International Women’s Health Coalition

As we in the United States prepare ourselves for the forthcoming assault on reproductive rights by the Trump administration, we can learn a lot from the recent gain in Uruguay.

A new study published by the organization Mujer y Salud en Uruguay (MYSU), a longtime IWHC grantee partner, looks at how persistent pressure by the feminist movement resulted in the change of the country’s abortion law in 2012. It now has one of the region’s most liberal laws on abortion. What did feminists do that was so effective?

The study and a related article show that women’s organizations succeeded because they built support across sectors, forging alliances with a range of unions, politicians, student groups, universities, and community organizations. They leveraged public opinion, which was in favor of decriminalization, and showed that the conservative political elite was in the minority.

Feminist activists and their allies did not allow the opposition to set the terms of the debate, but rather were able to frame abortion as a matter of social justice. They upended the established idea that abortion should “naturally” be illegal and instead showed how restricting it was a great injustice. And they maintained visibility and momentum by strategically using slogans and public actions at key moments.

Another critical factor was timing. The party in control of both parliament and the presidency were in favor of reform and the president in office said he would sign the law, in contrast to a previous president of the same party who had vetoed an earlier draft. So women’s rights advocates saw a window of opportunity for changing the law and were determined to use it.

It the final stage of negotiations, however, restrictions on access to abortion services were imposed. The law requires any woman seeking an abortion to meet with a three-person inter-disciplinary team (a gynecologist, social worker, and mental health professional), and then wait five days for reflection. It also dictates that only gynecologists can write the prescription for medical abortion—the most common method—which sharply limits the number of professionals allowed to provide services. This restriction is aggravated by a broad interpretation of conscientious objection, which includes institutions like Catholic hospitals. MYSU estimates that at least 30 percent of doctors refuse to provide the service, and in some provinces it is more than 80 percent.

One of the most surprising findings from the study was that some of the efforts to lower barriers to abortion (e.g. making it available in the public health system, free-of-charge, using medical abortion) may have had unintended consequences and created new, unexpected hurdles for women. Not having to pay for abortion services is a huge win for women, but this results in fewer incentives for doctors, some of whom refuse to provide services because they cannot charge an additional fee.

Regulations put into place after the law was passed call for providing medical abortion, thereby discouraging doctors from offering other procedures, such as aspiration abortion, which some women prefer or need. Most importantly, the law does not decriminalize abortion; it is only legal under the established regulations and terms. A large proportion of women are still having abortions outside the parameters established by the law (for example, outside the public health system or beyond the 12-week limit), leaving them subject to the same legal and health risks they faced before the law changed.

Despite its shortcomings, the change in the law on abortion in Uruguay is a huge gain for women’s rights and social justice. The fact that abortion is allowed by law and is provided by the state has taken it out of the shadows and reduced stigma. Its availability in the public health system, at no cost, makes the service more accessible.

But the opposition is not sitting still. Attacks on abortion began almost the moment the law was approved. The anti-rights forces have utilized new strategies, such as an attempt to call a referendum to overturn the law and use of the courts. Feminist activists and their allies have had to counter these maneuvers every step of the way.

This study is an affirmation of the power of women’s movements, and a call to support them at a time of political changes that threaten women’s rights in many countries around the globe, including the United States. Once again, the movement must step up to defend our rights and speak truth to power.

Originally published at International Women’s Health Coalition.