Argentina’s senate during a vote in 2017 | Senado de Argentina. Public domain

While Argentina’s congress struggles to pass a potentially groundbreaking bill to legalise voluntary abortion in the country, further battles loom: in hospitals and in courts, over the implementation and enforcement of the law.

Argentina’s senate is voting this week on the bill, which would loosen long-standing restrictions on abortion in the country, where it is currently legal only in cases of rape or when a woman’s life or health is at risk.

There are three options for the outcome of the vote: that the bill is passed in its entirety; that an amended version is passed; that the bill is rejected – which appears the most likely result at this point.

Meanwhile, even if reforms do pass, either now or when they inevitably return to congress later on, some doctors will likely try to ‘conscientiously object’ and refuse to participate in these procedures.

Last month, 3,072 Argentinian health professionals signed a letter committing to “respect and guarantee the rights of the people who request our services for legal interruptions of pregnancies, within the framework of the law”.

“We do not have the task of judging those who make the decision to have an abortion,” said the letter, which was circulated by the #ContasConmigo (Count on me) campaign of health professionals.

The response “was overwhelming,” said physician Mariana Romero, head of the Center for the Study of State and Society, who led the campaign as a member of the Safe Abortion Access Network.

“In just three weeks we dismantled the argument [that there are] insufficient medical staff to deliver abortions,” said Romero, adding that the signatures collected represent just a fraction of doctors who would agree with the letter.

The Argentinian Medical Society also endorsed the bill, though the conservative National Academy of Medicine has consistently opposed it.

Resistance to legal abortion is powerful and long-standing in Argentina, including at Catholic universities where an army of doctors and other professionals have studied ‘confessional bioethics’ in recent decades.

Course attendees include gynaecologists, nurses, midwives, psychologists and lawyers, trained to penetrate health services and influence judicial rulings and legislative debates, according to sociologist Gabriela Irrazábal.

At the moment, doctors in Argentina can as ‘conscientious objectors’ refuse to participate in sterilisation, contraception and (currently substantially restricted) legal abortion procedures, though there are limits to this.

Some anti-abortion groups “scout hospital wards and break into the rooms where women or girls await an abortion to ‘save the baby,’” added Irrazábal.

Anti-abortion groups ‘scout hospital wards and break into the rooms where women or girls await an abortion to “save the baby”’

In Santa Fe province, where 3.5 million people live, there are 1,000 members of the Network of Health Professionals for Choice, Paula Condrac, part of the National Campaign for Legal, Safe and Free Abortion, told 50.50.

Here, she said, local authorities have also established policies to address unsafe terminations; the public university has a chair focused on abortion; and a local pharmaceutical lab manufactures misoprostol.

But Santa Fe is also home to the Iturraspe hospital – “the grave of 19-year old Ana María Acevedo”, Condrac notes, referring to the young mother of three children who was diagnosed in 2006 with jaw cancer.

Two weeks pregnant at the time of her diagnosis, hospital doctors denied her both an abortion and the chemotherapy she needed to survive, in order to protect the foetus. She died a few months later, after having a stillborn C-section.

Placard against conscientious objectors in Santa Fe, Argentina, 2017 | Churrinche. CC-A-S 4.0

Incomplete implementation of abortion reforms is expected in the province of Córdoba where, Romero says, “anti-rights groups regularly challenge in courts the enforcement of current norms on abortion and sexual and reproductive health,” and “in the northern provinces of Tucumán, Salta, Jujuy and Santiago del Estero where there is a lack of health services”.

Last week, Liliana Herrera, a 22-year-old woman and mother of two young girls, died in hospital in Santiago del Estero after a clandestine abortion.

Herrera is the third life lost this year from unsafe abortions in Santiago del Estero, where Catholic prayers are mandatory in public schools. The province’s three senators have each pledged to vote against the bill.

Last week, Liliana Herrera, a 22-year-old woman and mother of two young girls, died in hospital in Santiago del Estero after a clandestine abortion

Meanwhile, a doctoral thesis to be published later this year tracks how doctors and other professionals have been trained at Catholic universities to influence health services, judicial rulings and legislative debates.

Postgraduate courses on ‘confessional bioethics’ are offered at the Argentinian Catholic University and Austral University, which is inspired and supported by Opus Dei, says Irrazábal, author of the thesis.

These courses, which are also offered at some secular schools, cover topics such as “the foetus as a person and unborn child” and criticisms of allegedly “abortive” intrauterine devices and emergency contraception, she found.

Their “apparent goal,” she wrote in a 2011 paper, “is to train secular professionals to be part of hospitals’ ethical committees”, which play a crucial role in deciding whether to accept or deny requests for abortion services.

‘Confessional bioethicists’ are networked and active at different levels within Argentina’s health facilities, according to Irrazábal. They may include nurses who ring a bell when a woman requesting an abortion arrives as well as members of ethics committees who deny requests for these procedures.

These committees may also delay decisions on abortion requests “until the pregnancy is so advanced that the procedure is riskier and doctors are more reluctant to proceed,” Irrazábal told 50.50.

These committees may also delay decisions on abortion requests ‘until the pregnancy is so advanced that the procedure is riskier and doctors are more reluctant to proceed’

A previous version of the bill currently in the senate would have penalised doctors for refusing to provide legal abortion services. Conservative groups lobbied successfully for some of these provisions to be removed.

In a statement last month, 44 private clinics said that they required “full freedom and rights to refuse delivering abortions […] both for medical staff and private health institutions” when such services are “contrary to their principles, values and ideology” and without “preconditions or limitations”.

The bill’s draft text passed by the house of representatives in June (and currently at the senate) recognises the right of doctors to conscientiously object to providing abortions – but only if they had registered as objectors.

The draft also barred hospitals and clinics from claiming rights as conscientious objectors on institutional levels, based on their ideologies – though this has been removed in the text’s amended version.

Previously, it provided for one-year jail terms for doctors denying or delaying abortion services, and up to three years if this resulted in harm to the patient. These provisions have been relaxed.

Challenging the constitutionality of abortion reforms will be another strategy of their opponents, Alejandra Sardá-Chandiramani, director of programs with the Association for Women’s Rights in Development (AWID) told 50.50.

Austral University law professor Fernando Toller nodded in this direction at a senate hearing last month. “There is not a single constitutional principle to justify the right to abortion,” he said.

Each year in Argentina there are more than 354,000 abortions, 70,200 hospital admissions resulting from unsafe procedures and 37 resultant maternal deaths, minister of health Adolfo Rubinstein told senators.

One thing is clear: regardless of how they vote this week, the battle around abortion rights in this country will escalate and those pushing for reform face opposition at multiple levels, from congress to health clinics.

If congress fails to pass the law “we will cry,” conceded Condrac. “But just for half an hour, and then we will start all over again.”