Welcome to El Salvador

When Maria Teresa Rivera was jailed in El Salvador for 40 years after suffering a miscarriage, the authorities would not allow her to keep a photograph of her son, Oscar. So she would shut her eyes and call up moments from the past, memories that burned bright and deep, and which allowed her to form an image of the youngster in her mind. Being away from Oscar for the five years she eventually served was the most difficult aspect of her incarceration. “Sometimes I would feel sad and desperate,” she told me, a few days after she was released this past spring. “I would go to the church and pray. It helped a lot.” Ms. Rivera, 33, was a victim of what is probably the most draconian legal situation in the world for repro­ductive rights.

There are a handful of nations that do not permit abortions under any circumstance. But activists say that nowhere matches El Salvador, which has a population of just six million, for the relentless vigor with which those laws are enforced. It is estimated that between 1998 and 2013 more than 600 women were jailed after being accused of having had an abortion.

Large numbers of these women, say campaigners, are individuals such as Ms. Rivera, who was prosecuted for suffering a miscarriage. Frequently, women who have rushed to a hospital fearing they might die have found themselves chained to their beds, while the police are called.

Ms. Rivera, who was convicted of “aggravated homicide” of the unborn fetus, was from a poor background, having been abandoned by her family when she was five. Soon after Oscar was born, her husband left, and Ms. Rivera lived with her parents-in-law on the edges of San Salvador, El Salvador’s clogged, overcrowded capital city. She was the only breadwinner in the family, and worked long hours to send her son to school.

“It was horrible in jail, horrible,” she said, as her son sat quietly and listened to what his mother had endured. She said she and other women jailed for the same offense suffered abuse from both the guards and other prisoners.

“There were psychological things. Bad words,” she remembered. “One of my fellow inmates was beaten. It was very crowded, and there was not enough water. There were 250 women in each dormitory; it was only meant for 100.” When she was freed in May after an appeals court ruled on a legal technicality raised by activists working for her release, being reunited with her child was something hard to take in. “It was something I could not believe, holding him in my arms, because before I was released I could not hold him,” she said, occasionally raising her hand to wipe her eyes.

The situation in El Salvador, where an overwhelming majority of the country is Catholic, was not always so drastic. Up until 1998, the law permitted abortions in cases of rape, incest or in which the health of the woman was threatened. But the legislation was changed under pressure from conservatives in the government and with the support of the Catholic church. The then-archbishop, Fernando Sáenz Lacalle, was a member of the ultra-conservative group Opus Dei, and supported the change. At around the same time, the country’s constitution was amended to say that “life began at conception.”

Activists say that these tough laws fall most harshly on the poorest and least educated. Contraception in El Salvador, a staunchly conservative country, is difficult to access for women without private doctors. Teenage pregnancy is rife. Of the 25 women currently in jail on charges of aggravated homicide—until recently there were 17—almost all are from poor backgrounds. The change in their coun­try’s laws has branded them killers.

“These laws are made by men to control women’s bodies,” said Sara Garcia, a campaigner with the Citizens’ Group for the Decriminalization of Abortion (CFDA), which has supported Ms. Rivera, “If the laws were to affect their own bodies, they would not have this kind of law. These laws are a form of violence.” The plight of women such as Ms. Rivera is playing out in a country that is reeling from violence, and agitated by poverty and economic inequality.

Between 1980 and 1992, the country saw a civil war fought between left-wing rebels and the military-controlled, US-supported government that left up to 75,000 dead. Two decades later, the Central American nation is confronting violence from gangs, which had their genesis in US prisons and the war on drugs, that has left El Salvador the deadliest nation per capita outside a recognized war zone. Killings, kidnappings and extortion are a way of life in many neighborhoods, not just in San Salvador but across the country.

The violence is one of the main triggers for a surge in people seeking to leave and move to the US, either legally if they have a relative who can help them secure a visa, or else via the perilous illegal route that takes them through Guatemala.

Adding to the woes is the very pressing threat of the Zika virus. Earlier this year, El Salvador told women to avoid getting pregnant until 2018 to prevent their babies developing birth defects from the mosquito-borne virus that has rampaged through the Americas. “We’d like to suggest to all the women of fertile age that they take steps to plan their pregnancies, and avoid getting pregnant between this year and next,” Deputy Health Minister Eduardo Espinoza announced in January. For a country in which women already face such a challenge in controlling their reproductive health, this piece of advice from the government sounded like little less than lunacy.

“When this arrived, it created a big problem when the health minister said women should not get pregnant for two years,” said Ms. Garcia, the activist. “It was not coherent, because this country does not guarantee sexual education at a broad level. Lots of people are now talking, and groups like ours are establishing themselves. We want to help provide contraception for young women. The government appears to be suggesting abstinence.”

The world was first alerted to the fight women were having for control over their bodies in 2013. A young woman initially identified only by her first name, Beatriz, suffering from lupus and several months pregnant with her second child, was told that the fetus was diagnosed with anencephaly, meaning the baby would be born with no brain or with a significant part of it missing. She was told the child would not survive.

Doctors said her medical condition made carrying the baby to term a threat to the mother’s life. Her case was appealed all the way to the country’s supreme court, which ruled doctors could not terminate her pregnancy. Eventually, as her health became ever more precarious, she was given a caesarean section when the fetus was 27 weeks. The baby lived for five hours.

But while the case of Beatriz made international news, such incidents are not uncommon. Rarely, however, do they receive such attention. Indeed, activists say that doctors are often obligated to wait when they are treating women with ectopic pregnancies who fear they could bleed to death. Under the law, doctors cannot intervene, even to save the mother’s life, until they can ensure the fetus is dead.

One of the ironies of the harsh situation in El Salvador is that the government is now headed by former rebels of the Farabundo Marti National Liberation Front (FMLN), for whom securing human rights was one of their demands.

Mr. Espinoza, the deputy health minister, said he disagreed with the laws, but said there was little likelihood of changing them unless the country’s constitution was altered. He claimed that all women had access to affordable contraception but admitted that comprehensive sex education was insufficient.

Speaking in his government office, he said his ministry had given instructions to doctors that they were not required to inform the police in cases in which they suspected a woman had self-aborted as they were protected by their relationship with their patients. Yet he said there were some doctors whose religious zeal compelled them to contact the authorities if they suspected a woman had an abortion.

He went on to say he could not control everyone. “You get fanatically religious doctors who see that something has hap­pened and immediately call the police or the law ministry,” he said. “This violates the presumption of innocence. Our hands are tied. The doctors get scared.”

In El Salvador, where people are eagerly awaiting the canonization of Oscar Romero, the much-loved Archbishop of San Salvador who was assassinated on the orders of the military in 1980, the church remains hugely influential. Over the years, the staunchly conservative Opus Dei movement has intervened at critical junctures to influence decisions that impact the lives of ordinary people.

Alfredo Vela Cuellar, a spokesman for Opus Dei in the country, said the group supported the total ban on abortion as it believed it helped protect women from attacks and sexual assaults. “If abortion is allowed, they lose their only defense to the oppression,” he argued. He said that those campaigning for exceptions to be reintro­duced were proposing that women who had already suffered violence—such as rape—undergo more “violence” by having an abortion. He also claimed that those looking to change the laws were not indig­enous to El Salvador. “The groups that want to legalize abortion, are financed— economically and ideologically—by people outside the country,” he said.

Among those hoping to change the situation, fighting for what many women in the world consider a fundamental right, is Morena Herrera. For more than a decade, she fought in the jungles as a member of the FMLN; now her goal as head of the Citizen Group for the Decriminalization of Therapeutic, Eth­ical and Eugenic Abortion (CFDA) is reproductive rights and sex education. Quite simply, she said, there were too many teenagers and young girls becoming pregnant. A third of all births in El Salvador are to teenage mothers. Hospitals had also revealed they were dealing with mothers as young as 10.

In addition to the huge number of teenage mothers, another impact of the criminalization of abortion is that a large number of such operations are done ille­gally, with the attendant dangers such a situation creates. Herrera said that the struggle for change was difficult because people were fearful of the reaction from powerful groups, such as the church and the media.

The Guttmacher Institute, a US-based global health organization, has esti­mated there are 35,000 abortions a year in El Salvador. An estimated 11 percent of those result in the death of the woman. Said Morena Herrera, “The problem is the lack of awareness about what reproductive rights are, and because of this, the [impres­sion] for the majority of women is that they are here just to be mothers.”