Abortion in Puerto Rico

Abortion in Puerto Rico is legal. Attitudes and laws in Puerto Rico relating to abortion have been significantly impacted by decisions of the federal government of the United States.  Abortion effectively became legal in 1937 after a series of changes in the law by the Puerto Rico legislature based on introduction of Malthusian clinics introduced from US-initiated eugenic policies. During the 1960s and early 1970s, women from the mainland of the United States would travel to the island for legal abortions, with the practice largely ending in 1973 as a result of the US Supreme Court's decision in Roe v. Wade. Women have continued to travel to Puerto Rico from other parts of the Caribbean since the 1990s to obtain abortions illegal in their home countries. The total number of abortion clinics on the island has been in decline since a peak of over a dozen in the 1990s.

Abortion statistics provided by the government have been criticized as unreliable. There were 19,200 abortions in 1991–1992, and 15,600 in 2001. There is an abortion rights community on the island, which is supported by a number of organizations. In 2019, International Women's Day in Puerto Rico revolved around women taking to the streets en masse to support abortion rights. There is also an anti-abortion movement in Puerto Rico, and it is notable for being much less violent than in the mainland United States.

Terminology

Main article: Abortion

The abortion debate most commonly relates to the "induced abortion" of an embryo or fetus at some point in a pregnancy, which is also how the term is used in a legal sense.[note 1] Some also use the term "elective abortion", which is used in relation to a claim to an unrestricted right of a woman to an abortion, whether or not she chooses to have one. The term elective abortion or voluntary abortion describes the interruption of pregnancy before viability at the request of the woman, but not for medical reasons.[1]

Anti-abortion advocates tend to use terms such as "unborn baby", "unborn child", or "pre-born child",[2][3] and see the medical terms "embryo", "zygote", and "fetus" as dehumanizing.[4][5] Both "pro-choice" and "pro-life" are examples of terms labeled as political framing: they are terms which purposely try to define their philosophies in the best possible light, while by definition attempting to describe their opposition in the worst possible light. "Pro-choice" implies that the alternative viewpoint is "anti-choice", while "pro-life" implies the alternative viewpoint is "pro-death" or "anti-life".[6] The Associated Press encourages journalists to use the terms "abortion rights" and "anti-abortion".[7]

Context

Free birth control correlates to teenage girls having a fewer pregnancies and fewer abortions. A 2014 New England Journal of Medicine study found such a link.  At the same time, a 2011 study by Center for Reproductive Rights and Ibis Reproductive Health also found that states with more abortion restrictions have higher rates of maternal death, higher rates of uninsured pregnant women, higher rates of infant and child deaths, higher rates of teen drug and alcohol abuse, and lower rates of cancer screening.[8]

According to a 2017 report from the Center for Reproductive Rights and Ibis Reproductive Health, states that tried to pass additional constraints on a women's ability to access legal abortions had fewer policies supporting women's health, maternal health and children's health.  These states also tended to resist expanding Medicaid, family leave, medical leave, and sex education in public schools.[9] According to Megan Donovan, a senior policy manager at the Guttmacher Institute, states have legislation seeking to protect a woman's right to access abortion services have the lowest rates of infant mortality in the United States.[9]

Hurricane Maria made landfall in Puerto Rico on September 20, 2017 and had a major impact on the overall public health situation on the island that was still being felt years later. Healthcare infrastructure was severely damaged, including hospitals, dialysis centers and HIV support centers.[10] Zika risks were also increased because of an increase in the number of mosquitoes.[10] There was also an increase in demand but a decrease in supply of mental health services.[10]

History

Puerto Rico became a United States territory in 1898.[11] American colonial powers in Puerto Rico had a major impact on the island's relationship with women's reproductive rights and on abortion laws.[12] In 1937, modeled after US-initiated eugenic policies, Puerto Rico adopted more liberal abortion policies which saw the introduction of Malthusian clinics.  Prior to this, abortion in Puerto Rico had been all but illegal.  The changes meant medical doctors effectively became the arbitrators of when it was legal for women to be given an abortion.[12] There was no move by the legislature of Puerto Rico to make change abortion legislation prior to the 1973 Roe v. Wade US Supreme Court ruling.[12] Prior to the Roe v. Wade ruling, it was often a bit cheaper and easier for women to obtain abortions in Puerto Rico than it was for women to obtain abortions in the mainland United States. White women were one of the largest groups of women to travel to the island to get an abortion.[13] The Society for Humane Abortions (SHA) assisted in facilitating women from the mainland traveling to Puerto Rico and other locations like Japan and Mexico for abortions during the 1960s and early 1970s.[14] Research on abortion on the island only began in 1983.[12]

Pregnant women in Puerto Rico in 2016 were at risk of getting the Zika virus, which causes major fetal defects. These defects may lead some women choose to terminate their pregnancy.[15] In 2018 and 2019, the effects of Hurricane Maria hampered women's ability on the island to get access to abortion services.[13]

Legislative history

Abortion effectively became legal in Puerto Rico in 1937 after the territory's legislature repealed existing laws around reproductive care and treatment.  These reforms included allowing interstate transportation of information about contraceptives and birth control methods, legalized contraceptive sterilization, and introduced a therapeutic exemption for abortions to protest the life or health of the woman who was pregnant.[16]

In 1964, there was a legislative effort to try to repeal the 1937 reforms by amending Puerto Rico's penal code, though it was only partially effective in totally criminalizing abortion; one consequence of these efforts though was it resulted in a large drop in the number of abortions performed in Puerto Rico.[16] There was no move by the legislature of Puerto Rico to make abortion legal prior to the 1973 Roe v. Wade US Supreme Court ruling.[12][13]

In 2012, the Puerto Rico Penal Code was revised in Section II, Articles 99 to 101 that relate to abortion.  Changes were made that made having an abortion a felony.  This legislation was largely pushed through by the New Progressive Party who were trying to win votes among conservative voters on the island, even if the legislation could not withstand judicial review.[17]

As of 2016, the law required that women seeking an abortion must have a pelvic exam performed by the doctor providing the abortion at the clinic.  The law also required women have their blood testing for anemia and to determine their RH factor.  The law also required doctors to offer any other exams or tests that may be needed prior to performing the abortion so a woman is fully informed, including a sonogram to determine how far along the pregnancy is.[18] Prior to 2019, minors did not require consent before getting an abortion so long as the doctor had provided the minor woman with adequate information to allow her to make an informed decision.[18]

An evangelical minister Senator named Nayda Venegas put forth a proposed law on March 4, 2019 that would require women under the age of 21 to get parental consent before being allowed to have an abortion. This effort failed.[19] On May 7, 2018, Puerto Rico legislature proposed a series of abortion restrictions that were signed into law by the territory's governor on March 7, 2019.[19] The restrictions included girls under the age of 18 being required to get parental consent before being allowed to get an abortion.  An exception was allowed saying, “the minor can go to court if she insists on having an abortion to present their claims to getting an abortion."[19][11] PS950 was vetoed on the same day, March 7, 2019 by Governor Ricardo Rosselló  who said the legislation imposed “onerous restrictions”  on a woman's ability to access abortion services.  The House then overrrode the veto of PS950.[13] Pre-natal care for women under the age of 18 does not require similar parental consent.[11]

Judicial history

The US Supreme Court's decision in 1973's Roe v. Wade ruling meant the state could no longer regulate abortion in the first trimester.[20] Abortion also became legal in Puerto Rico as a consequence of this decision.[12] The Puerto Rican Supreme Court oversaw the case of the People of Puerto Rico v. Pablo Duarte Mendoza in 1980.  Their ruling was effectively a territory specific answer to a question already answered by the US Supreme Court in the earlier Roe v. Wade.[17] The 1980 cases involved Dr. Pablo Duarte Mendoza being charged in 1973 for allegedly performing an illegal abortion on a 16-year-old girl in violation of Puerto Rico's 1937 abortion laws.  Duarte was given a sentence of two to four years around the time that the 1937 law was being repealed and replaced with a law that provided women with greater access to abortion services. Duarte appealed the sentence to the Puerto Rico Supreme Court, which overturned the sentence given by the Puerto Rico Superior Court, citing the needs of the doctor to be able to consider a woman's health issues in the first trimester, with the women's health being a primary factor in whether or not an abortion should occur.  The Supreme Court said that the issues of the health of the pregnant woman trumped any concern about her age.[17]

Clinic history

During the 1930s when abortion was illegal, Puerto Rican midwives and nurses who had training related to prenatal care and delivering babies would also sometimes perform abortions; Puerto Rican women were willing to pay a premium to use these medical practitioners to have safer abortions.[16] The passage of the 1937 revisions in law did not result in an immediate increase in the number of abortion providers as the new laws were not widely shared.[16]

In the early 1990s, there were over a dozen abortion clinics in Puerto Rico.[11] In 1993, there were thirteen private clinics on the island offering abortion services.[21][12] Women in the 1990s in the Caribbean had few options for where they could get legal abortions, with Puerto Rico and Cuba being two of the places offering women the easiest legal access.[22] This continued into the 2000s and 2010s.[11] Women coming to Puerto Rico in 2016 for abortions included women from the Dominican Republic.[11] In 2016, there were seven abortion clinics in the territory.[18] The type of informed consent materials and documentation that minors were given in 2016 varied from clinic to clinic.  This was because the law did not, by law, require informed consent for minors.[18] In 2016, the price of an abortion at a family planning clinic generally cost around $225 to $325 for a first trimester abortion.[18] In 2019, there were only six abortion clinics left on the island.[11]

Statistics

Reliable statistics about the number of legal abortions in Puerto Rico are difficult to ascertain because the Department of Health has historically failed to use reliable methodologies to attain numbers.[17] 23 out of every 1,000 pregnancies in 1999 were terminated as a result of an abortion.[13][22] In the period between 1991 and 1992, there were an estimated 19,200 legal abortions in the territory, with a rate of 22.7 and a ratio of 23.0 for a total abortion rate of 0.68.[22] These rates were among some of the lowest in the world.[22]

In 2016, 98% of abortions were performed in the first trimester, in the period between 7 and 13 weeks of pregnancy.  Most of these abortions used one of two procedures,  suction or the aspiration method.[18] Only 2% of abortions in 2016 occurred in the second trimester, defined as week 13 to week 22.  All abortions second trimester abortions took place before week 20.  The most commonly used method in Puerto Rico for second trimester abortions is  dilation and extraction.[18]

Number, rate, and ratio of reported abortions, by reporting area of residence and occurrence and by percentage of abortions obtained by out-of-state residents

Location	Residence			Occurrence			% obtained by out-of-state residents	Year	Ref
	No.	Rate	Ratio	No.	Rate	Ratio
Puerto Rico					22			1991	[17]
Puerto Rico				19,200	22.7	23.0		1991–1992	[22]
Puerto Rico				15,600	18			2001	[17]
Puerto Rico				3,622[note 2]				2009–2010	[17]

Public funding

Federal funding through Medicare is available to women in Puerto Rico in cases of rape, incest or risk of health or life to the mother. For women seeking abortions as a result of rape, the Department of Health's Rape Victims’ Assistance Center (CAVV) provides assistance in seeking public funds.[18]

Abortion rights views and activities

Organizations

Clergy Consultation Service was an organization the promoted abortion rights on the island during the 1950s and 1960s. They were an outside organization.[16]

Taller Salud is one of the organizations supporting abortion rights.[13] Amnesty International Puerto Rico also works on abortion rights in Puerto Rico.[11]

Views

Taller Salud's Michel Collado said in 2019, “Over the last few years, we’ve been struggling with a government that has eliminated access to sex education and gender perspective in public schools; they also cut funding to the NGOs [non-government organizations] that work with those issues."[13]

Protests

See also: Fourth-wave feminism and International Women's Day

In 2019, International Women's Day in Puerto Rico revolved around women taking to the streets en masse to support abortion. Their efforts this day on abortion rights were part of broader 8M efforts to combat gender violence.[19] 107 women in Puerto Rico were killed between 2007 and 2011 as a result of partner violence.  Of these 30 were killed in 2011 alone. In 2018, 23 women were murdered by intimate partners with 53 total women killed as a result of domestic violence that year.[19]

Anti-abortion views and activities

Anti-abortion activities in Puerto Rico tend to be more subdued than anti-abortion activities in the mainland United States, and are much less likely to include violence.[17]

Views

Senator Venegas Brown said during the debate around PS950, “I wish this was a bill to ban abortion."  Brown said the only reason Senators were not able to do so was because of Roe v. Wade .[11]

Protests

An anti-abortion rally was held in 1974 in San Juan following revisions in Puerto Rican law earlier that year.[17]

Footnotes

1. According to the Supreme Court's decision in Roe v. Wade:

   (a) For the stage prior to approximately the end of the first trimester, the abortion decision and its effectuation must be left to the medical judgement of the pregnant woman's attending physician. (b) For the stage subsequent to approximately the end of the first trimester, the State, in promoting its interest in the health of the mother, may, if it chooses, regulate the abortion procedure in ways that are reasonably related to maternal health. (c) For the stage subsequent to viability, the State in promoting its interest in the potentiality of human life may, if it chooses, regulate, and even proscribe, abortion except where it is necessary, in appropriate medical judgement, for the preservation of the life or health of the mother.

   Likewise, Black's Law Dictionary defines abortion as "knowing destruction" or "intentional expulsion or removal".
2. This number is from the Department of Health, which uses a methodology that has been described as health academics as questionable.

References

1. Watson, Katie (20 Dec 2019). "Why We Should Stop Using the Term "Elective Abortion"". AMA Journal of Ethics. 20: E1175-1180. doi:10.1001/amajethics.2018.1175. PMID 30585581. Retrieved 17 May 2019.
2. Chamberlain, Pam; Hardisty, Jean (2007). "The Importance of the Political 'Framing' of Abortion". The Public Eye Magazine. 14 (1).
3. "The Roberts Court Takes on Abortion". New York Times. November 5, 2006. Retrieved January 18, 2008.
4. Brennan 'Dehumanizing the vulnerable' 2000
5. Getek, Kathryn; Cunningham, Mark (February 1996). "A Sheep in Wolf's Clothing – Language and the Abortion Debate". Princeton Progressive Review.
6. "Example of "anti-life" terminology" (PDF). Archived from the original (PDF) on 2011-07-27. Retrieved 2011-11-16.
7. Goldstein, Norm, ed. The Associated Press Stylebook. Philadelphia: Basic Books, 2007.
8. Castillo, Stephanie (2014-10-03). "States With More Abortion Restrictions Hurt Women's Health, Increase Risk For Maternal Death". Medical Daily. Retrieved 2019-05-27.
9. "States pushing abortion bans have highest infant mortality rates". NBC News. Retrieved 2019-05-25.
10. 2017 (2017-11-17). "Public Health in Puerto Rico after Hurricane Maria - Issue Brief". The Henry J. Kaiser Family Foundation. Retrieved 2019-06-08.CS1 maint: numeric names: authors list (link)
11. "How Puerto Rico Became The Latest Battleground For Abortion Rights". www.yahoo.com. Retrieved 2019-06-08.
12. Azize-Vargas, Yamila; Avilés, Luis A. (1997). "Abortion in Puerto Rico: The Limits of Colonial Legality". Reproductive Health Matters. 5 (9): 56–65. doi:10.1016/S0968-8080(97)90006-9. ISSN 0968-8080. JSTOR 3775136.
13. Staff, MTV News. "As Activists Rebuild Puerto Rico, Lawmakers Are Trying To Restrict Abortion". MTV News. Retrieved 2019-06-08.
14. "The Forgotten History of Women Traveling Abroad for Abortions". Bitch Media. Retrieved 2019-06-08.
15. Gani, Aisha (2016-01-29). "Zika virus: the options facing pregnant women across Latin America". The Guardian. ISSN 0261-3077. Retrieved 2019-05-29.
16. Marchand-Arias, R. E. (March 1998). "[Legal secrecy: abortion in Puerto Rico from 1937 to 1970]". Puerto Rico Health Sciences Journal. 17 (1): 15–26. ISSN 0738-0658. PMID 9642717.
17. Méndez-Méndez, Serafín; Fernandez, Ronald (2015-07-14). Puerto Rico Past and Present: An Encyclopedia, 2nd Edition: An Encyclopedia. ABC-CLIO. ISBN 9781440828324.
18. "Servicios de Aborto en Puerto Rico". Salud Pro Mujer (in Spanish). Retrieved 2019-06-08.
19. "Puerto Ricans fight against women's rights setbacks on International Women's Day". NBC News. Retrieved 2019-05-23.
20. Buell, Samuel (1991-01-01). "Criminal Abortion Revisited". New York University Law Review. 66: 1774–1831.
21. Azize-Vargas, Yamila; Avilés, Luis A. (1997-05-01). "Abortion in Puerto Rico: The limits of colonial legality". Reproductive Health Matters. 5 (9): 56–65. doi:10.1016/S0968-8080(97)90006-9. ISSN 0968-8080.
22. Henshaw, Stanley K.; Singh, Susheela; Haas, Taylor (1999). "The Incidence of Abortion Worldwide". International Family Planning Perspectives. 25: S30–S38. doi:10.2307/2991869. ISSN 0190-3187. JSTOR 2991869.