Ipas > Health, human rights and 9-year-old 'Rosa'

Health, human rights and 9-year-old 'Rosa'

January 17, 2007

This self-portrait was drawn by Rosa after her ordeal finally came to an end.

Drawing courtesy of Attie + Goldwater Productions.

Just shy of her ninth birthday, “Rosa,” a young Nicaraguan girl, was raped by a neighbor and became pregnant. At the time, four years ago, she lived in Costa Rica, where her migrant parents had come looking for work.

After thoughtful consideration, Rosa’s parents decided to seek a legal abortion for their daughter. But despite laws in Costa Rica and Nicaragua at that time permitting “therapeutic” abortions — and despite the obvious and compelling health and human-rights arguments for honoring such a decision — Rosa and her parents endured challenges from government and religious leaders in both countries.

Several frustrating weeks passed before human-rights advocates in Nicaragua, adept at navigating the legal and health-care systems, could finally secure a safe abortion for Rosa.

According to Ipas consultant Heathe Luz McNaughton Reyes and colleagues, the obstacles arose because both Costa Rica and Nicaragua had highly restrictive, vaguely worded abortion laws with no formal guidelines for health-care providers on how to interpret them. Together with co-authors Charlotte E. Hord, Ellen M. H. Mitchell and Marta Maria Blandón, all of Ipas, McNaughton Reyes has written an analysis of the case entitled “Invoking health and human rights to ensure access to legal abortion: The case of a 9-year-old girl from Nicaragua.” It appears in the current issue of the journal Health and Human Rights.¹

The authors argue that Rosa’s case underscores how political and ideological considerations imposed by individuals and institutions can trump medical and human-rights considerations in determining whether a given woman or girl can obtain safe, legal abortion services in a country with highly restrictive abortion laws. They note that in such countries, pregnant women and girls who meet eligibility criteria for a legal pregnancy termination (for example, the pregnancy poses a health risk or resulted from rape) often are denied access to abortion services. Particularly vulnerable are the women and girls from poor families like Rosa’s, who cannot afford to access services in the private sector.

Rosa’s obstacles began in Costa Rica, where physicians insisted on hospitalization and bed rest for more than three weeks because her pregnancy was deemed “extremely risky,” yet they never mentioned the possibility of a therapeutic abortion to Rosa’s parents.

When Rosa and her parents returned to Nicaragua, they officially requested a legal therapeutic abortion. Government officials reacted by announcing publicly that an abortion in this case would be “a crime,” claiming that the life of the developing fetus was protected from the moment of conception under Nicaraguan law. Government representatives also attempted to interfere with the establishment of an objective committee of physicians to authorize the therapeutic abortion, a legal requirement in Nicaragua. But their efforts were ultimately blocked by the Nicaraguan Human Rights Ombudsman’s Office.

At 16 weeks’ gestation, shortly before her abortion was safely induced, the physician panel determined that Rosa’s pregnancy was endangering her health and life. They also noted, however, that an abortion at that stage of the pregnancy might also pose risks.

Ultimately, in cases like Rosa’s in a highly restrictive setting, public-health and human-rights approaches to obtaining a safe, legal abortion are of limited utility. For example, although research has established that pregnancy during the preteen and young-adolescent years is associated with an elevated risk for serious complications, physicians cannot know with certainty whether a particular individual will develop a given complication. And without the aid of government-issued guidance for health systems, physicians’ determinations may come down to their own subjective interpretations of the law and their personal judgment regarding the level of risk that’s acceptable for a particular patient to assume.

Similarly, advocates can invoke the internationally recognized rights to life, health and equality, and the right to be free from inhuman and degrading treatment; but because of a lack of explicit wording in some human-rights treaties, opponents of abortion rights typically counter by claiming that the developing fetus has its own right to life under international law. Moreover, even when the documents are worded unambiguously, no enforcement mechanisms exist to compel states to live up to the obligations of the treaties they’ve ratified.

The authors believe that health and human-rights approaches can work together effectively to advance and protect reproductive rights, which, they write, “ought to privilege women’s autonomy and liberty to make informed decisions about their own reproductive health care above all other considerations.” However, they conclude that “the experience of this 9-year-old girl demonstrates how far we still have to go to achieve this goal.”

Reference

1. McNaughton Reyes, Heathe Luz, Charlotte E. Hord, Ellen M. H. Mitchell and Marta Maria Blandón. 2006. Invoking health and human rights to ensure access to legal abortion: The case of a nine-year-old girl from Nicaragua. Health and Human Rights, 9(2):62-86.

For more information, contact:
Kirsten Sherk
Senior Associate, Media Relations
e-mail: sherkk@ipas.org
phone: 919.960.5612
fax: 919.929.0258