In the light of a recent breakthrough ruling of the Constitutional Court of Colombia regarding abortion, Marta Jiménez from the People’s Health Movement thematic group on Gender Justice and Health spoke to Ana Cristina Gonzalez Velez, public health expert and co-founder of the Roundtable for Life and Health of Women. The Roundtable for Life and Health of Women is one of the platforms which initiated the creation of the movement Just Cause for Abortion, which has played a key role in women’s mobilization for reproductive rights in Colombia in the past decades.
People’s Health Dispatch (PHD): Let’s start off with the broader picture – can you tell us a bit more about the context in which the recent ruling of the Constitutional Court happened, and the lead-up to that moment?
Ana Gonzalez Velez (AG): The first thing we have to clarify is that there was no legislative change in Colombia in February. We did not take any bill to the legislature. What happened was a decision of the Colombian Constitutional Court. And this is important, because it is not as people say that it is already law. Abortion was totally prohibited in Colombia until 2006, when a first constitutional amendment was introduced following a lawsuit presented by Women’s Link. At that moment, the Court basically said it is not constitutional to totally criminalize abortion, and it allowed three circumstances in which it could take place: in case where there is a risk to the woman’s life, in case there is a malformation of the fetus, and in cases of rape.
Since then, the Roundtable for Life and Health of Women, the organization of which I am a co-founder of, has been working to implement that ruling in practice. We had been working on issues regarding access to abortion even before that, since 1998 when we were formed, but since 2006 a particular focus was put on the implementation of the Court ruling.
More or less 4 years ago, we helped launch the Just Cause movement, because we saw that even after all this time of following, of advancing, the implementation of the ruling and of accompanying women through the process, they still experience barriers to access. In practice, abortion was still mostly illegal. It largely took part outside the health system, meaning that there still was criminalization, access was unequal, and that the grounds struck by the Court were insufficient in relation to actual needs. That was why we decided to go back to our original objective of creating a strategy to eliminate the crime of abortion from the Penal Code, that is to say, to decriminalize it completely. We saw that as a just cause, and that was what we called the initiative. That initiative soon became a movement, because from the very beginning many organizations were drawn to it. So today, Just Cause is made up of more than 115 organizations, and hundreds of more people, including opinion leaders in public policies and activists.
Our starting point was that criminal law should not be used for the administration of a health service. And our strategy to achieve that is made up of many things: social mobilization, network mobilization, media work, production of arguments, research, collective work. There is also a legal component to it, we wanted to open the conversation first and then see what conditions there were either for a bill or for an unconstitutionality lawsuit. Two years ago we saw a situation that seemed favorable to us, and five organizations from the Just Causes movement led an unconstitutionality lawsuit in the Court.
PHD: What exactly did you ask the Court to do at this point?
AG: Well, basically we were asking the Court to stop treating abortion as a crime and to regulate it outside the criminal sphere. This was more than 500 days of struggle, mind you, of waiting for the constitutional decision and at the same time, presenting investigations to the public, coming up with more than 90 arguments to support our file. We had a strategy of mobilization in the streets, in the networks, and finally, the court ruled. I would like to stress here that this movement did not come out of nowhere, it was the result of much accumulated political experience. The feminist movement in abortion struggles does not just wake up one day and have an idea that changes everything. It is the result of political accumulation. It arises in a specific context.
The time when we filed the lawsuit was very different from the context in which the ruling came out, which was a pre-election context. And once the ruling came out, the presidential candidates, especially those from the right, took it as an opportunity to go against the lawsuit, of course, misinterpreting the scope of the lawsuit in a context, to link it with the signing of the peace agreement, where we have also said that women’s freedom is fundamental for their full citizenship and for a peaceful society. The misogyny that accompanied the ruling pushed even more young women on the streets to fight for their rights on March 8.
But let’s go back to what the Court actually did. It eliminated the crime of abortion until the 24th week of gestation. That means that up to that point women can have an abortion of their own free will, without having to give a justification. And after that period, the three circumstances struck in 2006 apply. Another important thing is that the Court also urged Congress and the Government to formulate a comprehensive policy so that abortion services are provided within the framework of a comprehensive policy of sex education, access to contraception, and abortion services.
Why would they opt for the 24-week limit? Well, because they take that point in time as a marking of what we can call foetal viability. It is clear that 24-week fetuses hardly survive outside the womb, unless there is a very advanced state-of-the-art technology at hand, which is not the case in Colombia, at least not in all cities of the country. But also, the Court’s decision reflects the understanding that a shorter time limit will negatively influence the most vulnerable women. A vast majority of women are going to have an early abortion, but there is a small percentage of women, the most vulnerable women, who will require a termination beyond the 20th week, and this ruling tries to protect their need. But of course, the right wing sticks to saying that what the Court did is a horror.
PHD: You mentioned that Just Cause is made of more than 100 organizations and individuals. What kind of organizations are they, how do you work together?
AG: [Just Cause] is made up of really diverse organizations, with a lot of different people at the table. For example, there are feminist human rights organizations from more than 20 cities in Colombia. Some are national networks, others are academic organizations, others again are legal aid organizations, or activist networks.
But while many organizations have joined Just Cause and help carry its ideas forward, I’d say that 5 of the organizations share a more organic joint past and experience of legal work on health issues. Those would be Women’s Link, the Center for Reproductive Rights, Catholics for the Right to Decide, the medical group from the Right to Decide, and the Roundtable for Life and Health of Women. We have always believed that big struggles need big movements, both to achieve them and to sustain them, so we came together to file the lawsuit and continue the pressures, and that led to the Court accepting four counts from our lawsuit.
The Court basically recognized that the classification of abortion as crime violates the right to equality of women in the most vulnerable groups. It also recognized the freedom of conscience of individuals and said that the state cannot impose a decision as transcendental as motherhood on any woman, because women have their own conscience and can make decisions based on that conscience.
It recognized that criminalization of abortion violates the right to health, because if reproductive health is not protected and abortion is part of reproductive health, then we do not have the right to health. The last one was a more technical charge, I wouldn’t want to get lost in the details of that here.
After the Court made this decision, there was quite a debate on whether it could rule on abortion since it already did so in 2006, it’s a thing called res judicata. And interestingly, the Court said that this does not apply here, because a lot has changed since 2006, and we have seen how the model worked in practice, how insufficient it was, what kind of barriers it created, etc.
PHD: It’s interesting to hear that physicians are involved in groups dedicated to the right to abortion. In Spain where I’m located, for example, many medical associations oppose this. Do you see it as an important point, bringing different profiles of people together and seeing them work on the topic of abortion? What kind of difference does this make in practice?
AG: Don’t worry, there are also many doctors here who are against it. In fact, this week a spokesperson for an association of one of the medical guilds of a major city came out to campaign against the decision. And he’s a plastic surgeon, he doesn’t even have anything to do with this field! But you are right, this kind of background – who backs what in times of need – is very important.
I have been working for many years, more than 15 years, at the intersection between health and law, and I believe that by now those who make legal and judicial decisions should try to have a much better understanding of the effects their work can have on the field of health. It’s equally important that those of us who work in the health field understand the scope of the law and the international human rights framework.
In the 2006 ruling, one of the indications for women to be able to have an abortion was if their health or life was at risk. And so the question was, what does it mean to say that your health is at risk? How are professionals going to interpret it? And then we made a big effort with people from law, health, bioethics, to make sure that providers could have easy access to an interpretative framework which they could apply in this case, in a way that was coherent with human rights and in a broad manner.
At least for now, the interaction of all these disciplines represented in the initiative has been very very productive work. It has been a lot of work to learn and to learn from the experience, it has been a job of mutual learning, and I think it has been very enriching for all sides. But above all, it has led to good results, to a decision which we saw two weeks ago, which is essentially a health decision, but marked by the legal, juridical and even criminal fields. And our work is still not done, we are going to continue working so that one day abortion will stop cease existing as a crime and it will be understood that one can have a regulation of abortion outside the criminal sphere without punishing women.
PHD: And of course, it’s only been a short while since the ruling came out. Was there already a chance to see how it will be implemented in the health system in Colombia, which is quite complex on its own?
Yes, to be fair, the public health system is quite complicated. We’ll need some time to see how this will be put into practice. But you have to note several important things here. First of all, abortions have been performed in Colombia since 2006. Opponents of the decision would have make you believe that we are only now starting to have abortions. And in the framework of the three conditions struck in the 2006 ruling, there are no gestational limits.
Therefore, there have been second and third trimester abortions here since 2006. Few, with many difficulties and many barriers, but there have been some. So the service exists, in the sense that there are the preconditions to perform an abortion, whether it is medicines or equipment for manual vacuum aspiration of the uterus. These preconditions are incorporated into the benefits plan of the General Social Security Health System in Colombia, and that applies to both contributors and non-contributors, that is, contributory and subsidized. All women who are affiliated to the health system, which is the vast majority of Colombians, have the right to this form of healthcare, because the benefits are already there in the system.
On the other hand, there are regulations, technical guidelines, and technical routes that now need to be updated in light of the new decision. So we will surely have to go to Congress or the health authority to achieve regulation that guarantees and incorporates all the human rights standards that the Constitutional Court has been setting over the years in relation to abortion.
I believe that the most important challenges are in three directions in terms of the provision of services. First, professionals will need to understand – and you know how complicated this can be in practice – that if abortion services are available, they have to be respectful and of good quality. 90% of women will have an abortion in the first trimester of pregnancy if that’s the case. So what we need to do, instead of opposing regulation, is to open up services and provide them in a timely manner. But this will also mean opening up more training and education on abortion, because now we no longer have the three grounds, the woman’s will alone is enough.
So we are going to have to work on training health professionals and giving information to women, so that they can demand and demand this right in a timely manner and not be the object of barriers to the provision of services.
Then there’s the issue of the protection of the decision, because it is being attacked by fundamentalist right-wing sectors that are not only attacking the decision, but also the judges. Last week there was a very serious death threat letter to the judges who had voted in favor of the abortion ruling. So here again it is not only about defending the abortion decision, but also about defending democratic institutions and defending what a Constitutional Court does.
And finally, there’s a lot of pedagogical work, let’s call it that, for everyone to understand that the Court’s decision is the most peaceful decision that could have been taken, because it does not force any woman to have an abortion, but neither does it force any woman to be a mother.
PHD: And have the March 8 protests indicated that this is something that moves women, that inspires them to take action?
AG: I would say so, yes. There was a huge mobilization on March 8. Of course it wasn’t all about abortion, it was International Women’s Day and there was a strong focus on working women’s issues as well. However, there was a stop during the march, called the Libertad stop, and there were all these signs saying: We women are responding to misogyny and the attempts of the fundamentalist right to go backwards by taking to the streets and fighting for our rights with joy, with strength. That’s how it is, and we’ll continue pursuing that path.
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