Every week of late, more than 20 women with unwanted pregnancies come to Dr. Miranda Ruiz, one of the few physicians who perform free abortions in northern Argentina’s Salta province — many under a year-old law that legalized elective abortion to the 14th week of gestation.
Yet activists say that abortion services in socially conservative parts of the country such as Salta remain restricted and under threat, leaving poor women the choice of a clandestine abortion or having an unwanted child.
Ruiz, who works at a public hospital, faces charges of performing an abortion without a patient’s consent and was jailed for several hours in August.
Feminist medical and human rights groups say the prosecution is part of efforts by anti-abortion forces to intimidate doctors to stop performing abortions.
The Voluntary Interruption of Pregnancy Law adopted on Dec. 30, 2020, gives women the right to abort until the 14th week of gestation — and past that point if a pregnancy results from rape or if the life or health of a woman is in danger.
Elective abortion also is legal in the Latin American nations of Cuba, Guyana, French Guiana, Uruguay and parts of Mexico. Some countries, such as Chile allow abortions due to rape, when a fetus is malformed or for danger to a woman's life. Total bans are in place in Nicaragua, Honduras, El Salvador and the Dominican Republic.
Since the beginning of the year, 32,758 pregnancies have been terminated at the 1,243 medical centers across Argentina willing to perform abortions, according to Ministry of Health figures.
But ease of access often depends on the cooperation of local officials.
In some jurisdictions, such as around the capital of Buenos Aires abortion is easily obtainable. In other areas, few medical centers offer abortions, either because doctors have conscientious objections or because staffers are not trained.
Women also often face bureaucratic obstacles to abortion and lack information about how to apply for one, activists say.
"There are spaces where abortion is guaranteed," but in others women have little support, said Ruth Zurbriggen, a member of the Network of Rescuers, an activist group that even before the law passed helped women seeking abortions.
Valeria Isla, national director for sexual and reproductive health at the Ministry of Health, agreed the law is not being applied evenly, but said there have been advances since it was adopted. She said challenges include expanding the number of public health centers and doctors performing the procedure.
Salta is one of the places where few professionals are available to perform the procedure, according to doctors consulted by The Associated Press, and Ruiz said the case against her could aggravate that.
"I cover more than 90% of the demand (for abortions in her region), so my detention would make it impossible to comply with the law where I work," Ruiz said.
She has a small office at the Juan Domingo Perón public hospital in Tartagal, a town of mostly low-income people about 1,200 kilometers (745 miles) north of Buenos Aires. She said patients, who also come from neighboring provinces, seek her out because word has spread that she will perform abortions.
Ruiz’s legal troubles stem from an abortion on a woman in her 22nd week of pregnancy. The prosecutor initially accused Ruiz of failing to justify that the pregnancy threatened the woman’s health, but in a modified claim, he alleged she performed the abortion without the woman’s consent. Conviction could bring up to 10 years in prison.
"At one point, I felt that if I had been in the Middle Ages I would have been burned," Ruiz said, recalling her detention at the hospital and jailing for several hours.
Ruiz said the woman had been evaluated by a psychologist and social worker as well as herself, and that the abortion “was endorsed by the (hospital) management, the head of the gynecology service and the supervisor of sexual and reproductive health of Salta. That's all written in the medical record."
Ruiz speculated the accusation was intended to dissuade other physicians from performing abortions, but said the effect was the opposite.
"As it gained public notice, not only did the number of patients who come to see me expand, information is circulating," she said.
The prosecutor, Gonzalo Vega, denied seeking to "silence" health professionals. He said the accusation against Ruiz arose from a complaint filed by an uncle of the patient who charged that his niece has tried to stop the abortion.
The prosecutor said the woman has stated that she wanted to leave the hospital but was prevented from doing so.
Vega also alleged "that the express consent required for performing the termination of the pregnancy” was not signed by Ruiz until after the abortion. Ruiz denies that.
The identity of the complainant has not been made public.
In neighboring Santiago del Estero province, only two hospitals perform abortions and women there can’t seek the procedure directly: They must call a confidential telephone line at the national Ministry of Health to start a process of being put in touch with doctors who do abortions.
"Along with the bureaucracy, there is the stigma, the abuse, making them wait," said Dr. Teresa Santillán, who performs abortions in a private practice and works in a primary public care unit in Santiago del Estero.
"Women have ultrasounds in the same place where they are pregnant for prenatal care, and in the (waiting) corridor they ask, 'Who has come for abortion?'" Santillán said. "There is no closed place that preserves confidentiality."
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