Tuesday 29 November 2022

Therapeutic abortion: how accessible is it for women in Costa Rica?

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29 November 2022 - At The Banks - BCCR

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QCOSTARICA – In Costa Rica, therapeutic abortion is allowed only when the life or health of the mother is at risk and this is confirmed by three doctors who will determine whether or not to interrupt the pregnancy.

September 28 was established as the International Day of Safe Abortion, promoted in V Latin American and Caribbean Feminist Meetin) held in Argentina

Rape, incest, and affectations to the emotional health of the woman due to an unwanted pregnancy are not considered valid reasons to interrupt the pregnancy and, therefore, are not part of therapeutic abortion.

Despite the fact that clandestine abortions put the life and health of women at risk, in the country there is not much knowledge nor is the legal way simple to access this practice.

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The medication that is usually used to perform an abortion is misoprostol, the main ingredient in Cytotec, which is not made for gynecological use and less for abortions; it was made rather for gastric issues such as ulcers, explained Larissa Arroyo, a feminist lawyer and human rights specialist.

“In Costa Rica, we do not have a registered trademark for this misoprostol product for gynecological use, most likely registration has not been allowed due to the stigma attached to the issue of abortion,” Arroyo said.

Cytotec is a drug that cannot be bought openly in pharmacies, it is much more restricted and can only be purchased with a prescription.

“It is much more restricted, probably because it has this misoprostol component that can be used to perform abortions safely, which is how the World Health Organization (WHO) establishes it,” added the specialist.

If a woman wants to get misoprostol to terminate her pregnancy, she would have to find a doctor to give her the prescription and medical advice for the dose she requires.

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According to the lawyer, the Caja Costarricense de Seguro Social (CCSS or Caja) can provide Cytotec but not for gynecological purposes, but merely for gastrointestinal purposes.

On the other hand, there is no registered organization in the country that provides these medications openly and if they did, they would be outside the context of the law, since they can only be provided under a prescription, the lawyer emphasized.

“Abortion as established in the Penal Code, which is prohibited, that is to say, that it is outside of Article 121 (of the Penal Code) and that corresponds to 118 or 119, all these crimes have to be committed within Costa Rican territory. In other words, if a woman decides to end her pregnancy outside the country, through a foreign organization or support network, that is not considered a crime and therefore she cannot be prosecuted in Costa Rica,” said Arroyo.

If the medication is received by mail, for example, and the abortion is performed on Costa Rican soil, it would be classified as a crime.

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In addition to the woman, the providers and people who assist in the procedure can be sanctioned because it is not a therapeutic abortion.

Other ways to obtain the medication are through the payment of private consultations to medical professionals or through websites that offer the product.

The cost can be as high as ¢350,000 colones (US$540 at the current dollar exchange), although there is also free access through women’s support organizations, with the risk of falling into illegality.

On the other hand, the Caja also establishes within the drugs for this purpose Dinoprostone, a drug that is used to induce contractions in the uterus of women and is part of the Official List of the country, but its use is not as common due to its relationship with the interruption of pregnancy.

With the intention of ensuring women’s health, the WHO has issued a series of guidelines on abortion.

In addition to clinical and service provision recommendations, it is suggested that unnecessary regulatory barriers be removed from a medical point of view, such as penalties, mandatory waiting times, approval by institutions or other persons such as family members or partners, and limits on time of pregnancy when an abortion can be performed

“It is critical that abortion be medically safe, but that alone is not enough. As with any other health service, abortion care must respect the decisions and needs of women and girls and ensure that they are treated with dignity and without being stigmatized or judged. No one should be exposed to abuse or harm such as being reported to the police or imprisoned for seeking or providing abortion care,” said Dr Bela Ganatra, Head of the WHO Unit for the Prevention of Unsafe Abortion.

Since 1990, September 28 was established as the International Safe Abortion Day, promoted in the V Encuentro Feminista Latinoamericano y del Caribe (V Latin American and Caribbean Feminist Meeting) held in Argentina, in which different feminist organizations from the region participated.

One of the goals of the initiative is to prevent complications and deaths from clandestine unsafe abortion.

According to the Caja, between 1997 and 2017, Costa Rica registered more than 97,000 cases of women who came to medical centers due to complications from uncompleted abortions.

In 2017 alone, there were 25 hospitalizations for spontaneous abortions and more than 2,000 for incomplete abortions, according to data from the institution’s Health Statistics Area.

Misoprostol in Costa Rica

In the country there are websites that offer misoprostol for abortion purposes, however, its purchase could violate the legal framework since it is a drug exclusively for sale by prescription.

Inquiries and information are made via Whatsapp and they can ask how many weeks late the interested party is or how many pills she needs, cost, indications, and delivery coordination.

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