The Therapeutic Exception: Abortion, Sterilization and Medical Necessity in Costa Rica

Abstract

Based on the case of Rosa, a nine-year-old girl who was denied a therapeutic abortion, this article analyzes the role played by the social in medical practice. For that purpose, it compares the different application of two similar pieces of legislation in Costa Rica, where both the practice of abortion and sterilization are restricted to the protection of health and life by the Penal Code. As a concept subject to interpretation, a broad conception of medical necessity could enable an ample use of the therapeutic exception and a liberal use of both surgeries. The practice of therapeutic sterilization has been generalized in Costa Rica and has become the legitimate way to distribute contraceptive sterilization. In contrast, therapeutic abortion is very rarely practiced. The analysis carried out proposes that it is the difference in social acceptance of abortion and sterilization that explains the different use that doctors, as gatekeepers of social morality, make of medical necessity.

Rewriting abortion: Deploying medical records in jurisdictional negotiation over a forbidden practice in Senegal

“…Physicians around the world have exercised authority over abortion through medical gatekeeping practices that both enhance and curtail women’s access to this intervention across a variety of legal contexts (Amir & Biniamin, 1992; Carranza, 2007; Joffe, 1996; McNaughton, Blandón, & Altamirano, 2002; McNaughton et al, 2004; Reagan, 1998). Another boundary work strategy includes the deployment of rhetorical framing devices such as ‘saving women’ or ‘menstrual regulation’ to euphemize abortion in restrictive legal contexts (Amin, 2003; Dixon-Mueller, 1988; Pheterson & Azize, 2005; Rance, 2005).…”

“…In Costa Rica, abortion is only permitted to save a woman’s life or preserve her physical health. Yet, physicians in state hospitals may practice clandestine abortion and record the intervention as the treatment of complications (Carranza, 2007). Irrespective of the legal status of abortion, abortion data can thus be understood as a ‘preferred’ account of procedures related to a practice that can be deeply stigmatizing for patients and providers.…”

“…Scholars of reproduction have traced multiple jurisdictional disputes over abortion between health care professionals, paramedical practitioners, religious authorities, pro-choice and anti-abortion activists, women, and the state (Carranza, 2007; Freedman, 2010; Halfmann, 2011; Joffe, 1996; Luker, 1985; McNaughton, Mitchell, & Blandon, 2004; Mhlanga, 2003; Mohr, 1978; Reagan, 1998). Less attention has been directed to the practice of recordkeeping in maintaining professional jurisdiction over abortion.…”

Reproductive governance in Latin America

“…Less explicit agendas involved the promotion of smaller families as a way to combat the spread of communism, increase consumption of consumer goods, and reduce specific racial populations. Aid agencies, and state administrations, and even occasionally the Catholic Church, engaged in concerted efforts to make modern contraceptive methods available throughout the region (Carranza 2007;Necochea Lo´pez 2008).…”

Men's Narratives of Vasectomy

“…Although the Catholic church has been relatively weak throughout Costa Rica's history as compared to its influence in other Central American states (Wilson ), its influence has been and continues to be felt at legislative, political, and moral levels, because Costa Rica is constitutionally defined as a Roman Catholic nation‐state (Carranza :57; Seiler :126). The church's legislative power is reflected in past penal codes regulating contraceptive technologies, particularly sterilization.…”