Letter from El Salvador — From the October 2016 issue


Where pregnant women have more to fear than Zika

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Flor Arely Sánchez had been in bed with a fever and pains throughout her body for three days when a July thunderstorm broke over the mountainside. She got nervous when bolts of light flashed in the sky. Lightning strikes the San Julián region of western El Salvador several times a year, and her neighbors fear storms more than they fear the march of diseases — first dengue, then chikungunya, now Zika. Flor worried about a lot of things, since she was pregnant.

Late in the afternoon, when the pains had somewhat eased, Flor thought she might go to a dammed-up bit of the river near her house to bathe. She is thirty-five and has lived in the same place all her life, where wrinkled hills are planted with corn, beans, and fruit trees. She took a towel and soap and walked out into the rain. Halfway to the river, the pains returned and overcame her. The next thing Flor remembers, she was in a room she didn’t recognize, unable to move. As she soon discovered, she was in a hospital, her ankle cuffed to the bed, and she was being investigated for abortion.

The Metropolitan Cathedral in San Salvador. All photographs from El Salvador, May 2016 © Nadia Shira Cohen

The Metropolitan Cathedral in San Salvador. All photographs from El Salvador, May 2016 © Nadia Shira Cohen

There are six countries in the world that prohibit abortion under all circumstances, without exceptions for victims of rape or incest or for cases in which the pregnancy threatens the life of the mother: El Salvador, the Dominican Republic, Chile, Nicaragua, Malta, and Vatican City. In the United States, even the most fervent antiabortion groups maintain that women who have abortions are victims, instead directing their attacks at doctors. Earlier this year, when Donald Trump suggested that if Roe v. Wade were reversed, women who choose to terminate a pregnancy should be subject to “some form of punishment,” he was denounced across the political spectrum.

That scenario already exists in El Salvador, a country of 6.3 million, where an active medical and law-enforcement system finds and tries women who are suspected of having had abortions. Public prosecutors visit hospitals to train gynecologists and obstetricians to detect and report patients who show “symptoms of abortion.” Doctors are legally obligated to be informants for the police.

Salvadoran doctors at public hospitals must rely on after-the-fact evaluations, and women who suffer miscarriages or stillbirths immediately provoke distrust when they seek treatment. At private hospitals, however, patients can pay for discretion. In the capital, San Salvador, residents of the exclusive Colonia Escalón can arrange procedures at clinics for a thousand dollars; some women fly to Miami or Mexico City, if they can afford the ticket. Abortion is a poor woman’s crime.

The sentence is two to eight years in prison. But because El Salvador’s constitution classifies a fertilized egg as a legal person, in many cases prosecutors arbitrarily upgrade the charge to aggravated homicide, which carries a penalty of between thirty and fifty years in jail. (The aggravated-homicide charge is meant to apply to cases in which the fetus is more than twenty-two weeks old, but judges rarely learn the details of a pregnancy.) In July, the conservative party ARENA proposed to the Legislative Assembly that the minimum prison sentence for women convicted of abortion be raised to thirty years.

The day of the thunderstorm, Flor had gone out alone. She has five children, whom she has raised with her mother’s help — the man by whom she had become pregnant had left. Her brother Obidio and her son Mardoqueo Alonso work the fields surrounding their house, clearing the mountain with machetes, planting and harvesting the corn that Flor’s daughters grind and pat into tortillas. When Mardoqueo Alonso returned home, at around six in the evening, he noticed that his mother was missing. Normally he could see up to the river from their house, but the corn had grown high and blocked the view. It was getting dark, so he set out with a flashlight to search for her.

Mardoqueo Alonso found his mother lying on the path, unconscious and bleeding out into the soil. He called for help, and the family, along with a neighbor who works as a nurse, hurried to gather around her body. The neighbor said that Flor had to get to the health center in the nearest town, normally a twenty-minute ride in the flatbed of a truck down a rocky dirt road. No vehicles were available, so they lifted her into a hammock, and Obidio found long sticks to thread through either end. They hoisted it onto the shoulder of one man in front and one man behind, and began the descent. The storm had eased, but it was hard going, and six people had to take turns carrying Flor to town. She left a trail of blood down the mountain.

Women carry a statue of the Virgin Mary during the annual Flower and Palm Festival, in the town of Panchimalco

Women carry a statue of the Virgin Mary during the annual Flower and Palm Festival, in the town of Panchimalco

At the health center, nurses saw that Flor was hemorrhaging and called an ambulance to take her to the public hospital in Sonsonate, the closest city. A blood transfusion saved her life, but she remained in a coma. Doctors surprised her family by saying that Flor had just given birth. Where was the child? When they said they didn’t know, hospital staff called the local prosecutor, who alerted the police.

Obidio was shocked. While he knew that abortions were illegal, he had never heard of a woman being prosecuted for a miscarriage or stillbirth. But for someone accused of inducing an abortion, making those claims is the likeliest defense, he learned, so Flor’s situation was inherently suspicious. Obidio said that when the family gathered in the cornfield to save Flor, “We didn’t hear anything, we didn’t suspect anything. We were only scared of the hemorrhage, all the blood. She was dying.”

The following morning, Flor’s neighbor Reyna Isabel Guzmán heard that her friend was in the hospital. Another neighbor had said she found a tiny premature baby girl out in the cornfield and called the police. They took her to a hospital nearby, where she died several hours later. A police officer said that the fetus matched reports of “suspicious activity” at the Sonsonate hospital. Reyna knew what that meant for Flor. “From the hospital to jail,” she said. “If I had been there, I wouldn’t have let them take her to town, even though she was bleeding to death.”

When I met Reyna, she introduced herself to me as a “human-rights defender.” She is sixty-six, sturdy, and wears T-shirts printed with feminist slogans. Reyna managed to survive El Salvador’s murderous civil war of the Eighties and early Nineties, and when it was over, and a national women’s organization arrived in town, she was the first to join. She invited all her female neighbors, including Flor, to attend meetings at the local branch of the group, Colectiva Feminista. Many would respond, “Let me check with my husband.” Reyna told me with pride that, since she had started running a series of “feminist trainings,” women now attend meetings whether their husbands like it or not, and more have started to use contraception. I asked her how much she is paid for her work. “Nothing, niña,” she answered — Colectiva Feminista covers some of her travel and meals when she is away from home.

On one such trip for the organization, Reyna had heard about a woman a few towns over who had suffered a miscarriage and was then accused of abortion. She sensed that Flor might land in the same trouble. Rumors were burning through the fields where they lived: Flor had tried to abort, people whispered, Flor was a baby killer. Reyna told me, “When one person hears something, the whole town hears it.”

When Flor woke from her coma after several days in the hospital, she protested to the police that she “hadn’t taken anything.” Still, she would be held in detention until the investigation was complete. The police moved Flor from the hospital directly to the Sonsonate bartolina, a concrete jail ringed with barbed wire, to await trial.

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is a doctoral candidate in Latin American and Caribbean history at New York University. Her most recent article for Harper’s Magazine, “Displaced in the D.R.,” appeared in the May 2015 issue.

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