So, all abortion is banned in the Dominican Republic?

Yes. Even in instances where a woman or girl is pregnant from rape or incest, if her life is in danger, or if the fetus won’t survive outside the womb. But the ban, in effect since 1884, doesn’t stop abortions — it just forces women to have clandestine abortions.

Women who have money and information can travel abroad or find safe clandestine providers. But if you’re from a rural area, you’re young or poor, or you don’t have information on abortion or people to help, you’re likely to turn to less safe methods.

And women die from unsafe abortions. Around eight percent of maternal deaths in the country are attributed to complications from abortion or miscarriage, but it’s likely higher.

What are these less safe methods?

Clandestine abortion has become safer because there is now medication to induce abortion. A lot of women and girls take misoprostol, which is used to induce labor and treat stomach ulcers. Many still turn to more locally traditional methods to end pregnancy, though – herbs, teas, and beverages that can carry risks and lead to life-threatening complications. Some pregnant women try to harm their health in hopes of causing miscarriage, depriving themselves of rest, water, or food. Some take medication like sleeping pills that are harmful to pregnancy. One woman I spoke with beat her stomach with a concrete block.

What complications arise when women do this?

They can experience heavy bleeding and intense pain. Sometimes the pregnancy ends, but there’s still tissue in the uterus. If the tissue isn’t removed it can lead to severe infections or even death.

Why are women so desperate that they resort to this?

If a woman doesn’t want to continue a pregnancy, it’s for a reason. Most women I spoke with wanted an abortion because of economic difficulties. Maybe they or their partner weren’t working. Some couldn’t afford to care for another child. Some had a violent or abusive partner, or the relationship wasn’t stable. When women or girls become pregnant from rape, when a pregnancy endangers their health, or if the fetus won’t survive outside the womb, being forced to continue a pregnancy can feel like torture.  

I interviewed a health educator at a clinic who, a few days earlier, spoke with an 11-year-old girl who was pregnant because her stepfather raped her. She had no idea what had happened to her, and there was nothing the provider could do but refer her to pre-natal care.

This is what banning abortion looks like.

Dominican Republic: What happens when abortion is totally banned?

The Dominican Republic’s total ban on abortion threatens women's health and lives and violates their rights. Abortion is illegal in the Dominican Republic in all circumstances, even when a pregnancy is life-threatening, unviable, or the result of rape. 

I’m assuming doctors could be imprisoned for performing an abortion?

Yes, up to 20 years for providers who perform abortions and up to 2 years for women who have abortions. That said, the Dominican Republic isn’t like El Salvador, where more than two dozen women alleged to have had abortions are in prison for manslaughter, homicide, or aggravated homicide. Arrests and prosecutions in the Dominican Republic are rare. But the law creates fear and drives the whole process underground, keeping it less safe.

It also stops doctors from acting in the best interest of their patients. Some doctors do perform abortions secretly to help their patients, but at great risk to them and their careers. Imagine looking these women in the eye and saying, “You could die from this pregnancy but I can’t help you.”

Which women that you spoke with stood out to you?

There were so many. One was a young professional. She was educated, lived in a city, had a good income. But her contraception failed. When she learned she was pregnant she thought, “My life is over.” She talked to a friend of a friend who went to a secret abortion clinic, and she went there too. The clinic was filthy, she said, with no running water or sheets on the bed. Afterward the provider told her to get a heavy course of antibiotics and a tetanus shot, which tells you something about the conditions.

Thankfully she didn’t develop any infections. While she has no regrets about her decision, she said, “I could have died.” Today, she’s an activist for making abortion safe and legal.

Many women and girls I interviewed attempted abortion alone or only with one other person. It’s a lonely process. They made a quiet decision, found some pills at a pharmacy, took them with the tea. Then they’d wait. And if the pain or bleeding became too much they planned to seek care at a health center.

How are women treated at health centers?

Some women are so scared of mistreatment, or of being reported to authorities, that they don’t seek treatment. Those who do are often left waiting for a long time, or not given any pain relief if doctors need to remove tissue from their uterus—seemingly as “punishment” for ending a pregnancy. Sometimes, the staff threaten the women, calling them horrible names, like “murderer.” Some who went to health centers after miscarriages said they were treated poorly because staff suspected they had induced an abortion.

I spoke with one woman from a rural area who already had four kids, and knew she couldn’t have another. She drank a tea — a home remedy – and had a lot of pain, but not a lot of bleeding. She knew something had gone wrong, so she went to a health center. The doctor didn’t even examine her, or give her pain medication, just gave her misoprostol to remove tissue from the uterus and sent her away. She felt judged and neglected. So she takes the medication, has intense pain, but doesn’t want to go back, so she suffers through it alone.

Weeks later she’s still in pain, and when she gets checked out is told she has an infection. When I spoke with her, she’d been in pain for months.

What surprised you during your research?

How openly women and girls were willing to speak with me about abortion even though it’s illegal. As one long-time advocate explained, women in the Dominican Republic have always defied the abortion law and ended pregnancies that they couldn’t continue.

Can you easily access birth control in the Dominican Republic?

Everyone we interviewed had at least some information about contraceptives. The public health system offers a range of options which are either free or low cost. But sometimes they’d go for their injection or a refill and the hospital didn’t have it. Some women say birth control makes them sick, or causes their bodies to change, so they stop.

Sometimes, contraception fails. We spoke with one woman who learned she was pregnant at 17, three months before finishing high school, even though she was using injections to prevent pregnancy. She considered an abortion but was scared. When her private school’s director found out, she was kicked out. The director told her she couldn’t be pregnant in school.

Getting kicked out of school is a particular consequence for girls. Are there other ways that girls are affected differently than women?

First, adolescent girls have less access to information about sexual and reproductive health than adults. Girls often find out they are pregnant later because they don’t know the signs. At that point, it’s risky or impossible to have a clandestine abortion. But because having a baby is more likely to derail their plans – they could get kicked out of school or be pressured into marriage – they’re actually more likely to try riskier abortion methods. We found their experiences so compelling that we’re doing a separate report based on their accounts.

What do you want to happen?

The government should decriminalize abortion.

The Dominican Republic has been in the process of reforming its penal code for more than two decades. One of the contentious issues has been the articles dealing with abortion. Some members of Congress and the president support abortion in cases of rape or incest, when the mother’s life is in danger, or when the fetus won’t survive. But Congress hasn’t enacted this. The president twice vetoed versions of the penal code were sent to him without these changes.

There is a really vibrant civil society effort to legalize abortion in these instances. A huge coalition of groups came together and had a big march in July, filling the streets. At the end of October they delivered a petition, signed by 10,000 people, urging Congress to decriminalize abortion. One advocate I spoke with said, “I’m 63 and I’ve been doing this fight for more than 40 years, and I want them to know, I’m not going to give up. I’m not going to back down.” And that’s really inspiring.