1. Bioethics in Latin America and the Caribbean Sexual and Reproductive Health Ruth Macklin Albert Einstein College of Medicine

2. Trends in past 10 years • Dual picture • Laws and policies have become more restrictive • Power and influence of Catholic church • Conservative legislatures • Unsafe abortion a leading cause of maternal mortality • Several countries have passed laws prohibiting abortion altogether, without exception • Chile and El Salvador

3. Trends in past 10 years • Dual picture • Some countries have passed laws increasing access to abortion services • Barbados and Guyana • Peru apologizes for past sterilizations • Public awareness of reproductive rights heightened • Empowerment of women • Greater public discussion

4. Definition of ‘reproductive health’ • Reproductive health [means] that people have the ability to reproduce, to regulate their fertility; and that women are able to go safely through pregnancy and childbirth; and that reproduction is carried to a successful outcome through infant and child survival and well-being. To this may be added that people are able to enjoy and are safe in having sex.

5. Definition adopted in UN programmes • Programme of Action for the 1994 Cairo International Conference on Population and Development (ICPD) • 1995 International Conference on Women in Beijing • But the definition adopted stipulated that actions in pursuit of reproductive health not be against the law

6. Reproductive rights as human rights • Violations of reproductive rights • Programme in Peru that forcibly sterilized indigenous women • Law in Argentina that prohibits voluntary sterilization and makes it punishable • Upholding women’s rights • 1994 Constitutional reform in Argentina • Included CEDAW and other human rights treaties in the constitution

7. Catholic church and reproductive rights • Influence of the church on matters relating to abortion, contraception, and HIV/AIDS • “Day of the unborn child” • Judges in Argentina interpret the constitution as protecting the “right to life” of the fetus • Judges use theological arguments in favor of supremacy of the fetus

8. Views of women and physicians • Survey in Argentina revealed a majority of women in favor of decriminalization of abortion • Physicians refuse to perform abortions sanctioned by law even when ordered by a judge • Some local laws require physicians to report women with suspected induced abortions to the police

9. The Church and HIV/AIDS • Church hierarchy in Brazil opposed prevention plan that promoted the use of condoms • Bishops in Guatemala opposed plan to reduce maternal-infant mortality and combat the spread of AIDS • However, priests and nuns at grass roots level counsel people to use condoms

10. Emergency Contraception • Not legally prohibited in Latin American countries • Church-sanctioned opposition to this method • False claims that EC is abortifacient • Multicenter study in three countries showed widespread support of education about and use of the method

11. Some good news • Success in Mexico of program for education about and promotion of emergency contraception • Transition taking place in Argentina • Passage in legislature of bill on responsible procreation • Public debates about reproductive and sexual rights

12. Need for ongoing actions • Reproductive and sexual rights continue to be violated with impunity • Rape of adolescent in Mexico • Girl’s request for legally permitted abortion denied • Petition signed by 70 Latin American women’s groups, sent to Interamerican Commission for Human Rights

13. Hopes for the future • Mechanisms in place in the Federal District (Mexico City) do provide legal assistance and recourse for women and adolescents in such cases • Hopes for the future in Latin America lie in efforts by women’s groups and networks, and human rights organizations