How US-Style Abortion Protests Are Now Threatening Women's Health in Colombia

"Breathe in through your nose, hold it, out through your mouth. In through your nose…"

Estefania is 24 and unemployed. Omar, her boyfriend and her son's father, drives a bus from four in the afternoon until midnight. He was with her at the clinic in the morning but had to leave before her abortion procedure to make his shift. She wanted an earlier appointment so he could be there, but there are other women alone in the waiting room, some of whom came with no company at all, so she wasn't out of place when he left. She wears a silver band on her ring finger even though they're not married.

"Having my son is beautiful, but another baby–" She doesn't want more children and fears she couldn't care for another, especially now that she's been let go from her convenience store job.

Estefania's case is an uncommon one: For many women in Colombia, getting a safe and legal abortion is a complete impossibility. If the country's newly galvanized pro-life movement can help it, however, stories like hers will only get rarer.

At the Orientame (Spanish for "guide me") clinic in Bogota, where Estefania got her procedure, around two dozen protesters gathered outside daily through February and March, kneeling on the sidewalk under banners that read "I love you Mom" in Spanish. It wasn't always like this: The protesters used to only turn up at the clinic every other Saturday, marching from a nearby park to stand outside and say a few prayers.

40 Days for Life, a US-based protest movement which hosts round-the-clock rallies, held its first Colombian vigil in October of last year; it took place outside the church across the street from Orientame. The group then held another cycle of vigils during Lent and has expanded its protests to abortion clinics in nine other Colombian cities.

"Many people are motivated by the fear that our country wants to liberalize abortion in any case," a representative for 40 Days for Life Colombia told Broadly over email.

Late last year, the country's attorney general said he would push Congress for abortion to be made legal before twelve weeks without any conditions, though the proposal died before getting close to a vote. Health minister Alejandro Gaviria has said the country will need to expand abortion access within a few years.

"It's the law of the pendulum: The more we win, the harder they attack," says doctor Cristina Villarreal, who heads Orientame.

On paper, Colombia's abortion laws are liberal relative to those of its neighbors. The public health system is required to provide timely abortions to any woman who qualifies under the three exceptions, and medical institutions must have staff willing and able to perform the procedure.

But in practice, Colombian women face sometimes-insurmountable obstacles to obtain legal abortion care. Some hospitals demand proof of rape beyond a police report or say that, in cases of threat to the mother's health, a panel of specialists must consider whether the procedure is truly necessary, wasting precious time. Clinics in rural areas often lack equipment or training, forcing women to travel to larger cities and begin the request process over again. Catholic hospitals, which are sometimes the only medical facilities available to women, often declare themselves exempt from providing the procedure at all.

Officials acknowledge access is difficult. Health minister Gaviria told a conference late last year that doctors often misinterpret the health exception, unaware that potential damage to a woman's mental and emotional health count as reasons to approve an abortion. Because of those hurdles, Colombian women who find themselves unexpectedly and unhappily pregnant are often forced to turn to back alley providers and black market packets of misoprostol abortion pills, delivered by motorbike messenger for the equivalent of $30.

Clandestine procedures will increase if women are scared away from legal providers by protesters, pro-choice advocates say, and illegal clinics will benefit. "It's not just that women could be intimidated when they're trying to enter the clinic and so opt to get a clandestine service, which would be bad enough, but that the message they get is that abortion is a sin and a crime," says Silvia Plana, the head of legal aid organization La Mesa por la Vida y la Salud de las Mujeres, which represents women fighting to get abortions within the public health system.

Forty vigil participants, praying from their white plastic chairs, doubly outnumbered pro-choice advocates at recent counter-protest outside Orientame. The group said an average of 25 people per day participated in its Lent round of vigils. "40 Days is a peaceful prayer vigil that has undoubtedly breathed new life into the movement," says Danelia Cardona, a psychiatrist who heads the Colombia Episcopal Conference's Department for the Promotion and Defense of Life.

However, the refreshed pro-life movement could spawn aggressive and even violent factions, like the ones that carry out attacks against abortion clinics in the United States, pro-choice campaigners say. "I know the history of the United States over the last forty years. I know that's where we're headed, bit by bit," says Villarreal, whose father founded Orientame in 1977.

"There's always the fear this will be the seed for something bigger," says Juan Carlos Vargas, the head of research for Profamilia, another charity clinic feeling the pressure of the 40 Days protests. Demonstrators first gathered outside during the October vigil, and the Lent protests expanded to Profamilia clinics in several other cities.

Violence is a possibility pro-choice advocates can't rule out, given the US precedent, says La Mesa's Plana. "What scares us the most is that the protests will be accompanied by an increase in aggressive messages, in aggressive behavior."

Orientame staff, from receptionists to surgeons, say they've never seen protests like these and that more patients are coming in shaken, sometimes clutching rosaries handed to them outside. Several employees have taken to changing out of their uniforms before heading out of the white stucco wall that surrounds the clinic to avoid being identified.

"It's a new era," says one Orientame staff member. "We aren't used to having people outside. During the 40 Days protest in October, you could hear them praying from the recovery room."

"I wanted to ask," Monica pauses, fidgeting. "They said at reception it would cost me 210,000 pesos, since I don't have my insurance anymore. If it could maybe be a little lower, I could make it, but at 210,000…"

"Don't worry," the psychologist, a bright round-faced woman, says. "I'll speak to administration and see what we can do."

Orientame charges women only what they can pay. Patients in dire circumstances pay nothing at all, while others are charged up to 740,000 pesos—roughly equivalent to $245 and just over a minimum monthly salary.

Twenty-three-year-old Monica needs whatever savings she can get. She's unemployed, renting a small bedroom in a boarding house outside of Bogota. Her five-year-old daughter lives elsewhere with her father. A childhood rape survivor who has no relationship with her family, she worries this unwanted pregnancy will harm her mental health.

Monica's abortion takes place in the afternoon, one of 18 procedures on this particular Monday. She leaves the operating room shaky, shuffling along in her socks. It costs her 170,000 pesos, less than $60.

Because of a lack of recent academic study and shaky government tracking, reliable figures on how many abortions—legal or otherwise—take place in Colombia remain difficult to come by. Orientame's Villarreal says she reported to officials that her organization performed nearly 9,000 abortions in 2013, only to later see a health ministry report that claimed there were a total of 2,000 legal abortions in the country during that same year.

In 2015, Profamilia performed around 7,000 abortions, while Orientame tallied nearly 8,900. The most recent estimate, from a 2011 study by the Guttmacher Institute, shows there are just under 400,000 illegal abortions in Colombia each year. A 2008 study estimated 99 percent of abortions were illegal, though pro-choice campaigners say that number has likely decreased.

"Prompt care is the exception, not the rule," the Guttmacher study says. "Colombian women who attempt to exercise their right to have a legal abortion often must overcome significant administrative barriers before obtaining one."

In part because of bureaucratic hurdles, the cost of abortions at hospitals could be anywhere from four to five times as expensive as at private clinics like Orientame, the study found. And the neediest women often bear the heaviest burden because of delays, says Guttmacher's Elena Prada. "A rich woman will never, never ever ask for an abortion in public hospital. She would never go there," Prada says. "The ones who always suffer are the poorest women."

"[At public hospitals], they tell women, 'Oh, there's no appointments, the calendar is full, come back next week, the doctor didn't come, a panel has to study your case,'" says Profamilia's Vargas. "All these barriers that the ruling specifically forbids." Women are legally entitled to an answer from the public system within five working days after they request an abortion, he adds. "That's not what's happening."

She smiles, looking up at the nurse bending over to hand her a plastic cup of water.

"Thank you. Thank you so much."