'Absolutely No Medical Records': How Women Get Back Alley Abortions in Argentina

As it stands today, Argentina's civil code does provide for legal abortion, but only in cases of rape, incest, or endangerment of the mother's health—and the interpretation of that last word is the key issue in Argentina. The Ministry of Health recently published a report stating that mental health risks constitute fair grounds to access safe abortion procedures at any public facility, but the system in the country still allows medical practitioners abstain from performing medical procedures by merely citing "moral grounds".

Stella Manzano thinks that this needs to change. She is a doctor with a professional track record spanning three decades; she is also a member of the national campaign for the legalization of abortion and a proud abortion provider at a public hospital in the province of Chubut. "Doctors have no right to conscientious objection," she told Broadly. "These objectors are typically the ones who attack us for providing abortions, but then they turn around and also perform abortions themselves when the money is right. I think it's simple: If you can't or won't perform abortions, then don't become a gynecologist."

In Camila's case, the mother of her boyfriend fortunately knew of a place that could make it all go away—for a price. Access to illegal abortions performed by medical professionals is a luxury that only middle and upper class women in Argentina can afford, typically through word-of-mouth. Women from low-income neighborhoods have the misfortune of falling prey to local lore—which includes recommendations to chug bleach and parsley-based concoctions—or even worse, unsanitary back-alley abortions.

Argentina's leading cause of maternal death is from complications of unsafe abortions, according to the WHO. And, despite the harsh restrictions, an estimated 500,000 abortions occur in the country per year, meaning that roughly 40 percent of pregnancies end in termination. What should be a simple medical procedure—either performed surgically or orally with the right dose of mifepristone and misoprostol—sends thousands of Argentine women to the ER annually, and thousands more to the morgue. This is an issue that both presidential candidates chose to ignore throughout their campaigns, even during the presidential debate.

Mid-November, a momentous event took place in Argentina: The tight presidential presidential race between two candidates, which could have veered the country towards completely opposite poles of the political spectrum, culminated in a win for conservative, anti-abortion businessman Mauricio Macri. The motto of his campaign was "Let's change." But the approach to women's reproductive choices will likely see no change at all during his term.

The election was a lose-lose situation from the get-go. A win for the other, more liberal candidate would have made no difference at all: Daniel Scioli, the opposing candidate, was also firm about his anti-abortion stance during the race. Pro-choice activists were disheartened throughout the election process, as they had been already during President Cristina Fernandez de Kirchner's terms in office.

Kirchner will step down on December 10 after two consecutive terms in office, having done absolutely nothing to advance women's reproductive healthcare access; according to a 2010 report from Human Rights Watch, Kirchner's leadership "has not improved women's ability to exercise their reproductive and health rights, and even reversed some gains." While the dominant patriarchal mindset that has long dominated Argentina has made concessions for progressive causes spearheaded by white males—for instance, a marriage equality law was passed despite the incumbent Pope being Argentinean—the abortion debate remains stagnant. Equal rights are not for all.

Julieta was another victim of this silence. During her pregnancy, she suffered from severe morning sickness that incapacitated her. "I was sure this pregnancy was going to kill me," she said. She was also sure of what she wanted: to end the pregnancy, to end her suffering and return to her normal life. Although legally her wellbeing was endangered and she had the right to request free access to a safe abortion at a hospital, when she mentioned it to her doctor, he curtly replied, "I don't do that," and turned away, she said. She found some relief when the doctor came back with a handwritten note. "Call this number," he told her, according to her. "This person does what you're looking for." Not once did he utter the word "abortion."

"This is just a result of patriarchal, natalist policies," said Victoria Keller, a member of the Association of Feminist Anthropologists. She explained that the role of women within Argentine society has been typically as that of nurturers and child bearers. Dr. Manzano sees the nation's abortion restrictions as an attack against women. "The medical world is rampant with misogyny and sexism," she said. "Women suffer constant violence at the hands of medical professionals in every sense of the word, both physical and emotional. We doctors should be the guardians of women's rights. It's ridiculous that we have the duty of care to treat a convicted murderer, but not a woman seeking an abortion."

Finding a medical professional that will perform an abortion in Argentina is not hard. What is difficult is finding one that will do it under safe conditions and using the right equipment and techniques. Sonia Rodriguez (an alias), a nurse at several abortion providers' makeshift home clinics, worries about the local overreliance on the curettage technique (D&C). "Many doctors go through med school without ever learning to perform an abortion, because it's assumed it won't be necessary," she said. "Those who do learn it are taught to perform it the old way, via the curettage technique."

As far as first-term abortion techniques go, curettage is the most rudimentary of them all. Although effective, it does carry certain risks: a curette is used to scrape at the uterine lining and remove its contents, which can sometimes lead to uterine perforation and cervical injury. The more modern alternatives are those that are vacuum-based, ranging from electric vacuum aspiration (EVA) to manual vacuum aspiration (MVA). The latter, in particular, is not only quicker but has also been shown to cause less pain. In addition, the risk of assorted perforations and injuries is lower. The problem is that local doctors are not trained in these methods because their professors either don't believe these are worth learning or are staunchly pro-life, according to Sonia. In addition, the vacuum apparatus has to be imported and its parts regularly replaced, which makes it far too expensive for the local market.

After a few calls, Camila ended up at a local gynecologist's practice that doubled as an illegal abortion clinic just one week after discovering she was pregnant. She had collected the 8,000 ARS (about 800 US dollars) she needed for the procedure and made her mother sign off on the anesthesia consent forms by pretending they were for her to get an IUD, which was partly true. "The practice worked partly legally and partly over the table," she recalled. "You see, they processed all your paperwork as if you were there to get an IUD, but you came out of there 8,000 ARS short, with a surgical abortion done and an IUD installed."

Few women are given the most simple option of all: abortion via oral medication, by consuming a dose of mifepristone accompanied by misoprostol. "It's the ideal method," said Dr. Manzano. "It has been vouched by the WHO and it has the least amount of risk associated. And on top of that, it empowers women by allowing them to take control over their own bodies."

Yet access to Misoprostol and Mifepristone really depends on who these women, usually desperate, come in contact with first. Free abortion hotlines and underground pre- and post-abortion counseling centers abound. They guide women through the range of options available to them and even accompany them during the process, no matter which path they choose. The trick is that the contact information for these organizations is typically disseminated online, a means of communication that low-income women do not have easy access to. Another issue is that only misoprostol is available in Argentina, whereas mifepristone isn't. In addition, misoprostol is typically used to treat rheumatic pains in old people, so many pharmacists are reluctant to sell the drug to young women. Even when they do manage to get misoprostol, without mifepristone it is only effective in 60 percent of the cases, according to Dr. German Cardoso, an abortion practitioner who also claims most of the women who come to him for a surgical abortion do so after unsuccessfully attempting the Misoprostol method.

As one of the rare few doctors who openly performs abortions free of charge at the public hospital that employs her, Dr. Manzano estimates that she carries out between 2 and 3 procedures per day on average. Abortions at illegal clinics cost an average of 10,000 ARS (about 1,000 USD), so these doctors are pocketing at least 3,000 USD per day—up to 60,000 USD per month. Even after costs are accounted for and mandatory bribes are paid to the local police station, unwanted pregnancies are still the pink tax of the medical world: They constitute quite a lucrative business, one that would suffer if abortion were legalized and women granted autonomy over their own bodies.

When it comes to bribes, those who refuse to pay suffer persecution. One such example is the aforementioned Dr. Cardoso, a doctor whom the media has dubbed "Dr. Aborto" (Dr. Abortion), vilified by the right-wing press and tacitly endorsed by the left-wingers. He rose to fame after the police raided his clandestine clinic, not once but twice. "I was lucky," he told Broadly. "As long as they don't catch you red-handed, right in the middle of an abortion, there's nothing they can do." Dr. Cardoso has no qualms about admitting he continues with his practice to this day and that his brief stints in jail were just the government's attempt to make an example out of him. His newfound fame after being jailed twice is a double-edged sword. New clients have sought him out, but he has also lost any patients who might be fearful of the stigma of being exposed. He does his best to offer certain guarantees. "I keep absolutely no medical records on any of my patients," he said.

That is a common practice, Dr. Manzano confirms. She went on to explain that few clinics keep records of their abortions, even if the ones performed are completely legal. Abortion remains a taboo topic, and the fear of what people would say if anybody ever found out still weighs heavily upon many women's shoulders. Julieta only shared it with her husband, who still tried to convince her to keep her pregnancy despite the physical pain she was enduring. Out of fear of being stigmatized, she hasn't told anybody else in her immediate circle. Camila, on the other hand, soon after having the procedure, told her mother. "She cried and slut-shamed me," she recalled.

On the 10th of December, Macri is sworn in as president of Argentina. And this is what awaits: four more years of stories full of sexism, violence against women, illicit abortions and hundreds—if not thousands—of deaths. Of nonexistent medical records, underreported numbers, procedures, and even some lives erased. Four more years of a religious-based pro-life movement that kills. Of silence, while ignoring the elephant in the room.