Constructing Access to Legal Abortion Services in Mexico City

Abstract

Abstract

For the last three decades, government and health institutions have recognised that unsafe abortion is an important social and public health problem in Mexico. Although the Penal Code in every state defines at least one situation in which abortion is legal, access to legal abortion services is restricted for women throughout Mexico. In August 2000, the Mexico City Legislative Assembly reformed the Penal Code to include a wider range of grounds on which abortion is legal and added regulations to ensure access to legal abortion services in cases of rape and forced artificial insemination. The Mexican Supreme Court upheld the constitutionality of the reforms in January 2002. This paper describes a collaborative project between Ipas Mexico and the Mexico City Department of Health to provide legal abortions in cases of rape and to ensure that comprehensive health services for survivors of sexual violence are available and accessible. It describes a model of care being introduced into 15 public general and maternal-child health hospitals in Mexico City through a programme of multi-disciplinary consciousness-raising workshops and training courses on sexual violence and legal abortion. Few health care providers have had prior training in service provision for survivors of sexual violence or abortion service delivery. Workshop participants showed a high level of willingness to participate in legal abortion services for survivors of sexual violence when and if they are receive solid institutional support.

Résumé

Depuis trente ans, le Gouvernement et les institutions sanitaires reconnaissent que l'avortement non médicalisé est un important problème social et de santé publique au Mexique. Bien que dans tous les Etats, le code pénal définisse au moins un cas d'avortement légal, l'accès aux services d'interruption de grossesse est restreint pour les femmes dans tout le pays. En août 2000, l'Assemblée législative de Mexico a réformé le code pénal pour y inclure davantage de cas où l'avortement est légal et l'assortir d'une réglementation garantissant l'accès à des services d'avortement légal en cas de viol ou d'insémination forcée. En janvier 2002, la Cour suprême mexicaine a confirmé la constitutionnalité des réformes. Cet article décrit un projet de collaboration entre Ipas Mexique et le Département de la santéde Mexico pour fournir des avortements légaux en cas de viol et s'assurer que les victimes de violences sexuelles disposent de services complets de santé. Il décrit un modèle de soins introduit dans 15 hôpitaux publics généraux et de santé maternelle et infantile á Mexico grâce à un programme d'ateliers et de cours de sensibilisation multidisciplinaire sur les violences sexuelles et l'avortement légal. Peu de prestataires de soins de santéont suivi une formation préalable sur les services destinés aux victimes de violences sexuelles, ou sur l'avortement. Les participants aux ateliers étaient prêts à participer à des services d'avortement légal pour les victimes de violences sexuelles pour autant qu'ils reçoivent un soutien institutionnel solide.

Resumen

Durante las últimas tres décadas, las instituciones gubernamentales y de salubridad han reconocido que el aborto practicado en condiciones de riesgo es un importante problema social y de salud pública en México. Si bien el Código Penal en cada estado define por lo menos una situación en que el aborto es legal, el acceso a servicios de aborto legal está restringido para las mujeres en todo el país. En agosto 2000, la Asamblea Legislativa de la Ciudad de México adoptóuna reforma al Código Penal que incluyera una gama más amplia de causas por las cuales el aborto es legal, y agregó regulaciones para asegurar el acceso a servicios de aborto legales en casos de violación e inseminación forzada. En enero 2002 la Corte Suprema Mexicana confirmóla constitucionalidad de las reformas. Este artı́culo describe un proyecto de colaboración entre Ipas-México y el Departamento de Salubridad de la Ciudad de México para proveer abortos legales en casos de violación y asegurar la disponibilidad y accesibilidad de servicios integrales de salud para los y las sobrevivientes de violencia sexual. Describe un modelo de atención que se está introduciendo en 15 hospitales públicos generales y de salud materno-infantil en la Ciudad de México mediante un programa de talleres multidisciplinarios de sensibilización y cursos de capacitación en violencia sexual y aborto legal. Pocos proveedores de atención en salud han recibido capacitación anterior en la provisión de servicios para sobrevivientes de violencia sexual o servicios de aborto. Los participantes en los talleres mostraron una alta disposición a participar en los servicios de aborto legal para sobrevivientes de violencia sexual siempre y cuando reciban un sólido apoyo institucional.

Key Words:

• abortion law and policy
• sexual violence and abuse
• reproductive health services
• training of service providers
• Mexico

Acknowledgements

Many thanks to Nadine Gasman, Laura Villa, Ricardo Barreiro, Nancy Martı́nez, Corina Martı́nez, Samuel Salinas and Charlotte Hord for reviewing this paper and for support and guidance throughout the project. We also acknowledge the excellent work of the workshop instructors: Rocı́o Zepeda, Adriana Ortíz Ortega, Verónica Rodrı́guez and Armando Valle Gay.

Notes

1 Abortion is legal in Mexico in cases of rape in all 32 states, accident (imprudencial) on the part of the women in 29 states, 28 when the woman's life is endangered by the pregnancy, 10 for severe fetal malformation, and 9 when the woman's health is endangered by the pregnancy. The state of Yucatán is the only state that allows abortion for economic reasons (i.e. the woman already has at least three children).

2 The CTA, under the authority of the Attorney General's Office of Mexico City (PGJDF), is the only existing public sector centre providing legal and psychological support to victims of sexual crimes and referral for medical care.

3 Cortés and Bissell emphasize the key events upon which the Penal Code reform was based include the Secretary of Health's statement in July 1998 that the issue of abortion should be debated publicly, sparking coverage in the media over the course of several weeks; and the activism of the “Campaign for Access to Justice for Women” (comprised of 40 NGOs with a core group of activists) that presented information to government officials, political party leaders and the media about domestic and sexual violence, the rights of children, young people and victims of violence, the right to freedom from discrimination, and the right to abortion as part of the right to health [22].