Four years ago, a 17-year-old arrived at a hospital in Mexico seeking an abortion. She had been raped and forced to flee to the mountains by an organised crime gang, and was the sole carer for her sister, who lived with mental health conditions.
Under Mexican legislation, the teenager was allowed an abortion, which has been legal in cases of sexual or domestic violence since 2009. But the primary healthcare centres that had previously treated her did not offer a termination, and by the time she reached the hospital, she was at an advanced stage of pregnancy and doctors refused to provide one.
The hospital’s decision reflects a broader problem. Between 85% and 90% of global abortions are estimated to occur before the twelfth week of pregnancy, and there is a widespread assumption that terminations after this point are medically or morally unacceptable. This is a myth with no basis in science – the World Health Organisation says there is no medical reason to restrict abortions as pregnancy progresses – yet it’s enshrined in laws, medical practices, and social narratives, restricting legal and practical access to terminations.
“Abortion time limits are based on political, often arbitrary decisions that do not consider the different needs of pregnant people, nor the specific barriers faced by those in situations of greater vulnerability,” said Valeria Pedraza Benavides, a lawyer and coordinator of legal content and strategies at Ipas Latin America and the Caribbean (Ipas LAC), an organisation that advocates for reproductive freedom.
Across the region, many of those who seek an abortion later in pregnancy have faced specific barriers to accessing one earlier: they live in remote rural areas, are migrants in transit, were previously denied abortion care, or were pressured to continue the pregnancy by partners, family, or others. Other times, they are dealing with health complications or increasingly difficult circumstances, such as a potentially life-threatening condition that develops as the pregnancy progresses, foetal anomalies diagnosed in the second trimester, ‘cryptic’ pregnancies that go undetected until advanced stages, or sexual and gender-based violence.
In the case of the 17-year-old in Mexico, Ipas LAC was concerned by the consequences of allowing the pregnancy to continue. “What would that young girl do with a newborn on a mountain, with no guarantee of food or health?” asked its deputy director of capacity building, Mara Zaragoza, in conversation with openDemocracy.
But the organisation’s offer of medical guidance on how to perform a later-stage termination was “adamantly rejected” by the hospital, she said. “Even though [medical staff and the hospital authorities] found that the adolescent's situation was one of severe marginalisation and combined forms of violence, they lacked the knowledge, experience, and willingness to opt for a ‘late-term’ abortion.”
Eventually, after a long ordeal and with the support of Ipas LAC and other civil organisations, the teenager was able to terminate the pregnancy in Mexico City, which has far greater access to abortion care than the rest of the country. But her case illustrates how legal and medical professionals in Latin America often overlook complex factors when considering an abortion, with stigma superseding the interests of the pregnant person.
Access disparities and taboos
The World Health Organisation recognised abortion as an essential health service and a fundamental human right in 2020 and recommended its full decriminalisation without time limits two years later. But four years on, the reality on the ground in Latin America and the Caribbean remains a complex mosaic, where a woman who is a legal resident in one country could face criminal penalties for having a termination that would be allowed if she were a few miles away across a border.
In El Salvador, Honduras, Nicaragua, the Dominican Republic and Haití, abortion remains illegal in all circumstances, punishable by prison sentences of between two and eight years. At the other end of the spectrum are Argentina and Colombia, which allow abortions up to 14 or 24 weeks, respectively, and permit terminations beyond those time limits in specific instances.
In the middle are the likes of Bolivia, Brazil, Chile, Panamá, Costa Rica, Guatemala, Paraguay, Venezuela, and Perú, where abortion is generally illegal but not punishable in specific circumstances that vary by country, such as when a pregnancy poses a risk to the life or health of a pregnant person, is the result of rape, or the foetus is not viable. While some countries apply no time limits for these exemptions, others enforce 12- or 14-week deadlines. Bolivia makes two additional exceptions – extreme poverty and being a student – but only up to the eighth week of gestation.
Other countries in the region have slightly broader access. In Uruguay, a pregnant person does not need a reason to have an abortion in the first 12 weeks, but must meet certain requirements, including a mandatory five-day reflection period. Where a pregnancy is the result of rape, abortions are legal up to 14 weeks, and there are no time limits where it poses risks to life or health or the foetus is not viable. Similarly, a ministerial decree – not a law – in Cuba allows abortion without restrictions up to week 12 and at medical discretion thereafter.
Even when a country’s legislation permits abortion, women can still struggle to access terminations. This is the case in Mexico, where abortion has been legalised in stages, with some states decriminalising abortion in the years before a 2023 Supreme Court ruling made it mandatory for federal health institutions to provide terminations nationwide. Yet 90% of the country’s terminations still take place in Mexico City, which was the first jurisdiction to legalise abortion 19 years ago.
Despite this supposed legislative protection, the 17-year-old in Mexico struggled to access a termination, coming up against one of the major barriers to reproductive care facing women across Latin America: healthcare workers’ refusal to provide abortions later in pregnancy.
“A large portion of medical staff still holds many taboos,” explains Georgina Díaz Orozco, an obstetrician-gynaecologist with over 20 years of experience, who is a leading authority in late-term abortion in Jalisco, a state in western Mexico, where abortion is legal in the first 12 weeks or without time limits in cases of rape or danger to the health or life of the pregnant person.
Some doctors wrongly cite the impact on a pregnant person’s health. “There is an idea that after week 12, abortion is very risky, regardless of whether you do it with trained staff. That idea is held not only by healthcare personnel, but also by patients; so when they come to us, they have a lot of fear: loss of health, loss of an organ, loss of life,” said Ninde Molre, the director of the pro-choice Abortistas México network of feminist collectives, lawyers, and healthcare professionals.
In reality, terminating a pregnancy is safe at any gestational stage, when recommended methods are used by appropriately trained providers. “The World Health Organisation states that abortion is such a safe process that in the early stages, a person can self-manage their own abortion at home,” said Zaragoza. Abortions at more advanced stages of pregnancy are still safe, but medical support is necessary.
Other times, doctors fear being prosecuted for carrying out abortions after 12 weeks. In Mexico, Díaz Orozco says unfounded legal fears are spread in medical schools – especially those run by the Catholic church. “General practitioners who graduate from there obviously have a total lack of knowledge on the subject,” she said, explaining that they fear being reported for performing or assisting with abortions.
Yet doctors “have all the legislation in our favour to be able to provide the service to our patients with total peace of mind, without the fear of being criminalised,” Díaz Orozco added. Molre, the lawyer and activist from Abortistas México, confirmed: “There is not a single doctor who has had their medical license revoked” for performing abortions in Mexico.
Overcoming stigma
Sources working in reproductive healthcare told openDemocracy that, in Mexico, healthcare staff's awareness of abortion care at advanced stages of pregnancy has improved in recent years. Yet Zaragoza from Ipas LAC warned that women in the country remain at the mercy of local health systems and whether or not they have “medical personnel with the capacity and also the willingness to offer that service”.
One complex obstacle is the misuse of conscientious objection, when doctors and nurses can refuse to perform a medical act if it conflicts with their ethical or religious values. Zaragoza said this has become a tool of inequality in Mexico; when all staff in a public hospital declare themselves conscientious objectors, the service can be denied to entire populations – except those who can afford to pay for private terminations. “This completely distorts conscientious objection, turning it into a selective abortion practice,” she said.
People who require an abortion in an advanced pregnancy also face stigma. “Socially, we label them as insensitive people, lacking a maternal instinct, lacking morality. That makes those who were unable to access care at an early stage feel less confident, with less agency to seek this service,” Zaragoza explained.
This stigma can force a pregnant person to justify their decision, said Molre, who also serves as a companion to those seeking abortions, providing information and guidance on the process. Common defences include, “I didn't realise, I had polycystic ovary syndrome,” or “We used a condom, and it broke”.
Molre said stigma particularly affects people with cryptic pregnancies – who face intense scrutiny and doubts over whether they could not have known they were pregnant – or those who seek an abortion while experiencing gender-based violence, who are subject to victim-blaming questions, such as: “And why were you still with him? And why did you get pregnant?”
In this way, women are expected and encouraged to feel guilty for seeking an abortion – and the choice of language used can reinforce this guilt. It is particularly damaging when people use terms like “baby” or “little child” to refer to a foetus, Zaragoza and Molre explained. “We see it in songs, poems, soap operas. That imposes a significant barrier that equates abortion with the death of a person, which is not the case,” Zaragoza said.
Yet there are also places where stigma and fear are receding. A decade ago, only two of the 47 gynaecologists in Jalisco’s Maternal and Child Hospital were willing to perform abortions. After years of awareness-raising and training, that proportion has been reversed; today there are only two objectors. “It was difficult work; it was a fight against stigma, against pointing fingers, against comments,” doctor Díaz Orozco said. “When they saw that we were helping women and people with the capacity to gestate, they realised that the work was important.”
“Just as those who object on conscientious grounds say ‘my principles do not allow me to perform an abortion,’ that same argument applies to those who perform late-term abortions and say ‘my principles do not allow me to abandon a woman with these needs,’” Zaragoza said. “To me, that seems to be one of the most important lessons that have helped us overcome these barriers.
