June 15, 2005

I. Summary

Decisions about contraception and abortion are difficult, deeply personal, and sometimes wrenching.In Argentina, women are routinely prevented from making such decisions.Despite important advances in the area of women's political participation and economic independence, doctors and spouses continue to exercise control over women's reproductive health through laws and policies that subject female decision-making to arbitrary extraneous interference.Historically, successive governments have legislated on matters related to contraception and abortion as if women were instruments of reproduction and not equal human beings, contributing to an underlying sense among service providers and policy makers that birth control and reproductive health care are somehow illegitimate, immoral, or even illegal.The consequences for women's health and lives are serious, sometimes literally fatal.

While Argentina's current government is making important strides toward addressing a number of the abuses exposed in this report, its efforts to date continue at times to be undermined by public health officials who are opposed to reform, or who fear retribution if they implement the needed reforms.

As detailed in this report, women who want to use contraceptives face a series of imposing, sometimes insurmountable restrictions and obstacles. These barriers include domestic and sexual violence at the hands of intimate partners which authorities are not moving aggressively enough to prevent and remedy. Another obstacle is blatantly inaccurate or misleading information, too often propagated by health care workers themselves. A third is that many poor women simply cannot afford contraceptives and government promises of assistance are often not reaching those who need it most.

Some women told us that their abusive partners or husbands deliberately sabotaged their access to contraceptives."He always told me: 'I am going to fill you up with children so that you can't leave my side,'" said Gladis Morello, a thirty-two-year-old mother-of-eight from Buenos AiresProvince.Others said that public health officials themselves at times provided inaccurate information or did too little to combat misinformation spread by opponents of contraception and abortion.Paola Mndez, a thirty-five-year-old mother-of-ten from Buenos AiresProvince said: "I wanted to get an IUD, but [t]he doctor himself explained to me that the majority [of newborns of women who have used IUDs]are born with the IUD in their heads."This warning is not supported by medical evidence and experience.

Women's access to the contraceptive method of their choice is also subject to legal restrictions.Under Argentine law, voluntary access to one of the most effective forms of contraception-sterilization-is severely limited.Many public hospitals require that women obtain their husband's consent for the operation, have at least three children, and be older than thirty-five to be eligible for the surgery.These regulations are in violation of international human rights standards on privacy, nondiscrimination, and health.Some physicians and hospitals, moreover, require women to seek judicial authorization for sterilization even when they fulfill all of the requirements.

When women are unable or unwilling to carry an unwanted pregnancy to term, the only option for many is an illegal and therefore unsafe abortion. The toll on women's health and lives is immense: unsafe abortion is the leading cause of maternal mortality in Argentina today.

"You get overwhelmed by desperation," said Paola Mndez, "You seek all the ways out, pills, anything.But if there is no way out, then you take a knife or a knitting needle."In Argentina, more than 40 percent of all pregnancies end in illegal abortions, indicating women's lack of opportunity to control their fertility and health.

Human Rights Watch also found that women in Argentina received inhumane and sometimes grossly inadequate treatment when they sought medical assistance for incomplete abortions or infections due to unsafe abortions.A social worker from Santa FeProvince told us: "A woman [we work with] went to the [public] hospital in a very bad state with an abortion and she was infected and hemorrhaging.A doctor started to examine her, and when he started to see her and realized, he threw down his instruments on the floor.He said: 'This is an abortion, you go ahead and die!'"

In 2003, the government began implementing a much-needed national program on reproductive health.This program is intended in particular to address poor women's economic obstacles to accessing contraceptives by distributing certain contraceptive methods for free in the public health sector.It is also meant to address regional differences in access to contraceptives, in that the national government, through the program, commits to providing all needed and publicly approved contraceptive devices to those provinces who wish to take part in the program.

After continued pressure from civil society and previous promises from the government, in April 2005 the national health ministry launched an information campaign to inform the general public about the reproductive health services available through the national program, including characterizing access to contraceptives and counseling as a legal right.Previously, in October 2004, the health ministries from all the Argentine provinces had committed to reduce maternal mortality in the country, inter alia through the provision of humane, fast, and effective post-abortion care, and through guaranteeing access to safe abortions where they are not penalized by law.As this report went to press, in late May 2005, the national government was planning to publish a guide on how to provide humane post-abortion care and distribute it to heads of maternity wards in public hospitals.

The government's demonstrated resolve to realize women's right to make independent decisions about their reproduction and health, however, has so far failed to reach the women who most need assistance.This has happened for a number of reasons. First, authorities have not devoted sufficient attention to the barriers to accessing contraceptives faced by women who want to use them, such as for example domestic violence. Second, critical laws and policies are not being implemented.Public health officials continue to charge for contraceptive methods that, according to the law, should be free, and women have severely limited access to those abortion procedures that are not subject to criminal penalties: where the life or health of the pregnant woman is in danger, and where the pregnancy is the result of the rape of a mentally disabled woman.Third, current laws continue to arbitrarily limit women's control of their fertility and discourage necessary health care, including by restricting access to voluntary tubal ligation and abortion, and by requiring medical doctors to report to national authorities when women seek life-saving post-abortion care.While effective implementation of existing laws, policies, and programs could go a long way toward addressing the concrete harms described in this report, legal reform is essential in the long run.

Opponents of contraceptives and abortion in Argentina sometimes argue that international human rights law as integrated into Argentina's constitution protects the "right to life" of the fetus and therefore requires the criminalization of abortion.The law does no such thing. International human rights legal instruments ratified by Argentina guarantee women's rights to life, physical integrity, health, nondiscrimination, privacy, information, freedom of religion and conscience, equal protection under the law, and the right to make independent decisions about the number and spacing of children.Taken together, this body of law, including directly relevant interpretations of this law by authoritative U.N. expert bodies, compels the conclusion that women have a right to decide in matters relating to abortion. The only regional human rights instrument that explicitly contemplates the application of the right to life from the moment of conception-the American Convention on Human Rights-contains qualifying language specifically intended by the founders of the convention, including Argentina, to allow for non-restrictive domestic abortion legislation.

Safe and legal abortion is essential to women's health and autonomy and would be the most direct way to stop the loss of life and other preventable health effects of illegal, unregulated abortion in Argentina today.Even those who favor Argentina's restrictive legal regime on abortion, however, should be given pause by the cases described in this report.Given the extent of the harm and the number of women whose health and lives are destroyed as a result of current laws and practices, Human Rights Watch believes it is incumbent on all parties concerned, whatever their position on abortion, to give priority to ensuring women's independent control of their own fertility through the provision of accurate contraceptive information and full range of contraceptive methods.Priority should also be given to make sure that all women, including those suffering health consequences after an illegal abortion, receive humane and adequate health care.

In Argentina as in many other countries, the public debate on abortion and even contraceptives and sex education has sometimes included arguments and accusations that are unworthy of a democratic society.Decisions related to contraceptives and abortion are complicated and socially contested.They are, however, also a question of human rights.It is almost twenty years since Argentina joined the international community of democratic states after a painful military dictatorship and on that occasion ratified some of the most important international human rights treaties.It is more than ten years since these treaties gained constitutional force in Argentina.It is time to have a debate about contraceptives and abortion, and to have it in a civilized manner.Human Rights Watch intends this report to further such debate.

As this report was being finalized, in late May 2005, important reforms-such as the distribution and implementation of new guidelines on humane post-abortion care-were about to commence.This report illustrates the urgent need for these reforms, and the essential nature of further government action in the area of reproductive rights.

This report is based on field research in Argentina in September and October 2004, as well as prior and subsequent research.A Human Rights Watch staff member conducted in-depth interviews with more than forty women and one girl who had experienced problems in accessing contraceptives or who had undergone illegal and unsafe abortions.These interviews took place in the provinces of Buenos Aires, Tucumn, and Santa Fe.All names and identifying information of the women interviewed have been changed to protect their privacy.

These persons were identified largely with the assistance of Argentine NGOs and grassroots organizations providing services and support to low income women, women affected by domestic or sexual violence, and women living with HIV/AIDS.

Human Rights Watch also interviewed more than seventy representatives of government agencies, the United Nations, and NGOs specializing in women's rights or reproductive health; academics; religious officials; and public healthcare workers and hospital administrators.Certain identifying information has been withheld for some respondents for privacy reasons.All documents cited in this report are either publicly available or on file with Human Rights Watch, as noted.