Reform of abortion law in Uruguay: context, process and lessons learned

Abstract

In October 2012, a new law was approved in Uruguay that allows abortion on demand during the first 12 weeks of pregnancy, 14 weeks in the case of rape, and without a time limit when the woman's health is at risk or in the case of foetal anomalies. This paper analyses this legal reform. It is based on 27 individual and group interviews with key informants, and on review of primary documents and the literature. The factors explaining the reform include: secular values in society, favourable public opinion, a persistent feminist movement, effective coalition building, particular party politics, and a vocal public health sector. The content of the new law reflects the tensions between a feminist perspective of women's rights and public health arguments that stop short of fully recognizing women's autonomy. The Uruguayan reform shows that, even in Latin America, abortion can be addressed politically without electoral cost to the parties that promote it. On the other hand, the prevailing public health rationale and conditionalities built into the law during the negotiation process resulted in a law that cannot be interpreted as a full recognition of women's rights, but rather as a modified protectionist approach that circumscribes women's autonomy.

Implementing and expanding safe abortion care: An international comparative case study of six countries

“…Indeed, in many places, National Health Service responsibility for service provision continues to be partially achieved by contracting out to NGOs, with Colombia and South Africa relying significantly on provision by national and international NGOs, respectively . Uruguay is the only one of these countries that limits abortion to facilities that belong to the integrated national health system; there is significant private provision alongside public sector provision in all the other countries …”

“…Women seeking care are of course the ultimate recipients of these programs. Aside from Portugal and Uruguay, interviewees reported that many women were inadequately informed about safe legal care options and therefore continued to resort to illegal and often unsafe procedures …”

“…Although many respondents supported the integration of counseling regarding the abortion decision and subsequent contraceptive use, some expressed concern if the requirement for counseling was structured so as to delay the abortion. All of the mandated consultations and approvals can deter women from seeking legally available care or impose delays . Procedures later in pregnancy are not only riskier, but often fall outside the boundaries of what is legally permissible.…”

“…The cost of private provision remains a barrier. Moreover, the lack of understanding of the legal grounds for abortion that prevails among many women and clinicians leads some women to expensive private or uncertified providers, some of whom may offer dangerous alternatives …”

“…Some articles have described the context and the actors involved in abortion reform in specific countries, including Uruguay, Colombia, and Nepal . Some studies employed in‐depth interviews to identify successes and problems in specific country contexts . However, these studies were not designed to inform the development of a practice‐based guide for the implementation of health services.…”