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NPR has been looking at the way abortion is regulated around the world. Latin America has some of the strictest abortion laws, with some exceptions for cases of rape or to protect the health of the mother. But in El Salvador, abortion is completely banned. A woman accused of terminating a pregnancy can face up to 50 years in prison. NPR's Jason Beaubien reports, these laws have had broad consequences for medical professionals and for pregnant women.
JASON BEAUBIEN, BYLINE: Christina Quintanilla's nightmare with El Salvador's abortion law began on October 26 of 2004. Christina was 17 years old and seven months pregnant with her second child. She was staying at her mother's small apartment in a gang-controlled housing project on the outskirts of San Salvador. It was the middle of the night. She couldn't get comfortable. Her belly was bulging. Her back was aching. Her stomach was upset.
CHRISTINA QUINTANILLA: (Through translator) I felt - I don't know how to describe it - a pain - a terrible pain. And then I felt like I couldn't breathe, like I was drowning. And in that moment, I couldn't call anyone. I couldn't speak. I just remember banging on the bathroom door.
BEAUBIEN: Quintanilla says, she went into labor. And the next thing she remembers, her mom was picking her up from a pool of blood on the bathroom floor. Both Quintanilla and her mother, Carmen, say, the baby was stillborn.
CARMEN: (Foreign language spoken).
BEAUBIEN: The bathroom was a disaster, Christina's mom says, with blood everywhere. Carmen was desperate to get medical help for her daughter.
CARMEN: (Foreign language spoken).
BEAUBIEN: It was 12 midnight, and there weren't any buses or taxis at that time of night, so we called 9-1-1, Carmen says. But no one came. Eventually, one of her neighbors drove Christina to the local public hospital. Christina says, she passed out and woke up in hospital bed. She remembers being confused. The doctors seemed to be wearing white lab coats, instead of the usual blue medical scrubs. But the thing was they weren't doctors. They were actually criminal investigators.
QUINTANILLA: (Through translator) This seems strange to me. And then they said, Christina, as of now, you're under arrest for the murder of your child. I was shocked, and I was confused about what they had told me. I couldn't speak.
BEAUBIEN: El Salvador's abortion law requires doctors, nurses and other medical professionals to report suspected abortions. It turns out that someone at the hospital had denounced Quintanilla to the police. As a result, she was dragged into a court case that lasted almost 12 months and ended with her being sentenced to 30 years in prison. Quintanilla and several of her family members say, they'd been eagerly awaiting the birth of her second child. They'd even had a baby shower for her.
QUINTANILLA: (Foreign language spoken).
BEAUBIEN: Christina states emphatically that she did not kill her baby. The forensic lab report lists the cause of death of her fetus as undetermined. OB/GYNs contacted by NPR say, Christina's account of what happened is consistent with a severe placental abruption, in which the placenta detaches from the uterine wall. The hospital found no evidence that she'd intentionally aborted the pregnancy. Yet, the district attorney pushed forward anyway, arguing that she had terminated the pregnancy because she couldn't afford to support another child. During the trial, Quintanilla says, her public defender was awful and couldn't even remember her name.
QUINTANILLA: (Through translator) At times, she was like, I'm defending - what's your name, honey? And I'd have to reply, my name is - I don't know. It's like her mind was somewhere else or something.
BEAUBIEN: When she was convicted, Christina left her young son, Daniel, with her mother and reported to the women's prison in Ilopango.
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BEAUBIEN: El Salvador is a predominantly Catholic nation, and it's one of several Latin American countries where abortion is completely illegal. The Catholic Church was influential in amending El Salvador's constitution 1999 to state explicitly that life begins at conception. Prior to this, abortion was permitted in some instances, including pregnancies that resulted from violence or incest. But Catholic Bishop Romeo Tovar Astorga says, even if a young girl of 10 or 12 years old is raped, abortion is not the solution.
ROMEO TOVAR ASTORGA: (Through translator) The abortion - the killing of the child - does not solve the problem of being raped - does not solve it.
BEAUBIEN: Prior to 1999, abortions were also permitted on medical grounds in El Salvador. And technically, they still are allowed if a pregnant woman's life is in danger. But last year, a court battle over a woman with lupus transfixed the country.
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UNIDENTIFIED PEOPLE: (Foreign language spoken).
UNIDENTIFIED WOMAN: (Foreign language spoken).
BEAUBIEN: The woman, known publicly as Beatrice, was carrying a fetus with terminal birth defects. And her doctors argued in court and the media that she faced kidney failure if she didn't get an abortion. The Salvadoran Supreme Court, however, refused to grant her permission to terminate her pregnancy. She ultimately had a cesarean section, and the baby died a few hours later.
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UNIDENTIFIED MAN: (Foreign language spoken).
BEAUBIEN: Prominent gynecologists in the country say, the total ban on abortion ties doctors' hands, requires medical staff to betray the confidence of their patients and, at times, is detrimental to women's health. Take, for instance, an ectopic pregnancy. This is when an embryo embeds itself outside of the uterus, usually in one of the fallopian tubes. The growing fetus can cause the fallopian tube to burst and produce massive life-threatening bleeding. In the developed world, such pregnancies are usually terminated, either with medication or surgery, but not in El Salvador.
GEURO ANTONIO ORTIZ AVANDONIO: When we see the heartbeat, we say, well, OK, the fetus is alive. So the law is to protect that fetus, so we cannot do anything.
BEAUBIEN: Dr. Geuro Antonio Ortiz Avandonio (ph) is the head of obstetrics at the National Maternity Hospital in San Salvador. He says, he can't do much for women with ectopic pregnancies. They're admitted to the hospital, and then the doctors simply wait, either for the fetus to die on its own or for the mother's fallopian tube to rupture. Once hemorrhaging starts, then the medical staff rush to save the life of the mother. Avandonio (ph) says, there's no way an ectopic embryo is going to survive, and this major surgery for the mother could be avoided if doctors were allowed to terminate the woman's pregnancy.
AVANDONIO: We could not offer another option that maybe the patient wants. We cannot do it, even if we know that is the best option we can offer, because law is against that option.
BEAUBIEN: Activists who are pushing to liberalize El Salvador's abortion law argue that the total ban is unjust because it only applies to the poor. Women who can afford a plane ticket fly to Mexico City or Miami for an abortion. Middle class women can pay for a black market abortion in a private clinic or get abortion pills.
Dr. Jose Miguel Fortin Magana, the head of the National Forensic Institute, which investigates suspected cases of abortion, says, abortions happen regularly in El Salvador, and poor women get prosecuted because they're most likely to get caught.
JOSE MIGUEL FORTIN MAGANA: (Through translator) In El Salvador, the people in the countryside are very ignorant. They do things that are really repulsive.
BEAUBIEN: He says, they get cases of women who introduced knives or chemicals into their bodies to try to terminate their pregnancies. Magana's staff perform pelvic exams on women accused of abortion. They conduct autopsies on the fetuses. His lab is the key agency that gathers evidence to be used by prosecutors in abortion cases. But Magana says, most abortions are never detected. And he says, feminist activists over-exaggerate the impact of El Salvador's abortion law.
MAGANA: (Through translator) The lie resides in trying to make it appear that all the women who have an abortion are in jail. This is not true.
BEAUBIEN: He says, most of them are at home, and no one ever knows that they had an abortion.
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BEAUBIEN: Christina Quintanilla is also now back in her home. After serving four years of her 30 year prison term, a young lawyer who tumbled across her case managed to get the sentence overturned. He argued successfully no one ever established the cause of her baby's death. Quintanilla now lives near the eastern Salvadoran city of San Miguel with her 11-year-old son, Daniel, and her daughter, Alexandra, who was born after she was released from prison. Christina says, her life post-prison is peaceful.
QUINTANILLA: (Through translator) I look after my children and my family. I help out my relatives. I end up with a little extra money, and so that's the good life I now have.
BEAUBIEN: She says, she still thinks about the baby she lost back in 2004.
QUINTANILLA: (Through translator) When I see another baby, it takes me back. With time, it's gotten better. But sometimes, I think, if he was with me, he'd be eight or nine old, and I think about him. But now I feel like there are some holes that you can't fill. The love I would have given him, I give to my two children.
BEAUBIEN: Christina may have come to grips with losing a baby, but coming to grips with serving four years in prison for a crime, she says, she didn't commit is harder. She blames the hospital for accusing her of abortion and says, that wouldn't have happened if she'd been able to afford a private clinic. The whole experience has made her afraid of doctors and hospitals.
QUINTANILLA: (Through translator) Perhaps if it was something minor, I'd go back to a hospital. But if I was pregnant again, I would be terrified to go.
BEAUBIEN: And she says, if she was bleeding from another possible miscarriage, there's no way she'd go back to the hospital. Jason Beaubien, NPR News.
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