Though abortion is permitted in Bolivia after rape and when judicial approval is given for the procedure, several judges denied an abortion to a 10-year-old rape victim. During this highly polarized case, in which Catholic Church officials threatened to excommunicate anyone who performed an abortion on the minor, physicians and attorneys, respectively, refused to examine the girl or report on her condition to a juvenile judge. Despite the public and the fact that the penal code clearly allows abortions in cases of rape and public outcry, the judges refused to authorize the abortion.

In the landlocked Andean nation of Bolivia, the combination of poverty and poor health care can have tragic consequences for women of reproductive age.

Bolivia has South America’s lowest earned income for women (US$ 1,615 in 2003) and also one of the highest maternal mortality rates (MMRs) in Latin America and the Caribbean region. According to national demographic surveys, between 390 urban and 420 rural women per 100,000 live births die each year. Many of those deaths are attributable to unsafe abortion.

Article 266 of Bolivia’s penal code prohibits abortion except in cases of rape and incest, when the woman’s life or health is endangered or, in a condition unique to Bolivian law, in cases of abduction not followed by marriage; even in such circumstances, the abortion must be performed by a physician with the woman’s consent and judicial authorization. In practice, it is nearly impossible for women to obtain an authorized abortion without fear or punishment due to the narrowness of the law, biases in the health-care and legal sectors, cultural beliefs and bureaucratic hurdles.

Isolated from urban centers where medical care is more readily available, rural and indigenous women are particularly likely to risk unsafe abortions and suffer complications that threaten their lives. They also are less likely to receive the contraceptives and counseling that are key to preventing unwanted pregnancy.

In response to the number of women perishing from unsafe abortion, Ipas Bolivia, the government and health officials have mobilized to address the alarming maternal mortality rate. Postabortion complications are common, and the Bolivian government has included postabortion care (PAC) as a basic service within its Universal Health Insurance package. Though PAC is covered by this insurance plan and is a routine part of emergency obstetric services, many Bolivian women still delay going to the hospital after unsafe abortions due to anticipated maltreatment from health-care professionals. In addition to its training program, Ipas Bolivia works to reduce stigma among the medical providers who are most likely to treat women who have attempted unsafe abortions.  

Violence against women is a significant factor in unplanned pregnancies; though few studies specifically focus on gender-based violence, some evidence suggests that more than a third of Bolivian women have been forced to have sex with a partner and many more have suffered physical or mental abuse. Given the prevalence of violence against women in the South American nation, Ipas Bolivia developed a comprehensive and multidisciplinary approach to ensure sexual violence victims have access to abortion and other health services, as well as to law enforcement and judicial processes.

In collaboration with the Vice Ministry of Women’s Affairs, Ipas Bolivia played an integral part in the creation and release of national norms and health-care protocols outlining comprehensive care for survivors of sexual abuse, guaranteeing that rape victims can get a range of services, including safe, legal abortion and psychological counseling.

The norms also mandate protocols for collecting evidence and documenting rape and/or pregnancy resulting from rape. Ipas Bolivia and partners have created a special evidence-collection box that includes gloves and other materials for collecting evidence that could substantiate rape claims in the courts and ensuring that evidence is not tampered with or altered.

• Institutionalize PAC training with manual vacuum aspiration (MVA) in nursing and medical schools, particularly for future obstetrician-gynecologists;
• Expand knowledge about medication abortion and protect access to misoprostol by promoting its use for all accepted obstetric-gynecological indications;
• Implement the comprehensive model of care for women survivors of sexual violence;
• Contribute to women’s and adolescents’ ability to recognize and exercise their human, sexual and reproductive rights, including the right to live free from violence;
• Advocate for inclusion of reproductive rights in the new constitution being drafted by the Constituent Assembly and acknowledgement of public-health problems;
• Work with the law enforcement, legal and health sectors (including medical examiners, forensics professionals and police) to improve access to legal abortions.