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High in the Andes: The Ministry of Reproductive Rights

Dr. Pablo Rodriguez reflects on his provision of abortion in an unnamed Latin American country. Introduction by Carole Joffe.

Too often, discussions of abortion are carried out at an abstract level, with no acknowledgment of the context in which abortion occurs. In this short piece, Dr. Pablo Rodriguez, an obstetrician/gynecologist from Providence, Rhode Island, reflects on his provision of abortion in an unnamed Latin American country. Describing his work in a clinic filled with both religious objects and posters of contraceptives, Dr. Rodriguez eloquently contextualizes for the reader what the inability to control their fertility — as well as the lack of adequate health care generally — mean for desperately poor women. He also shows the cruel effects on women in the developing world of U.S. cutbacks in international family planning aid — a move demanded by antiabortion forces in this country, which has had the perverse effect of increasing the search for illegal, often unsafe, abortions. Rodriguez' essay makes very clear that the "pro life" frame that is so widely used by opponents of abortion and contraception, is distorted, indeed Orwellian; as he puts it, the policies supported by "pro life" legislators in the U.S. "represent a death sentence for thousands" in the developing world. The following essay, which originally appeared in the Providence Journal, was written shortly before the 2000 election, but remains highly relevant to the present political moment.

Pablo Rodriguez is the medical director of Planned Parenthood of Rhode Island, and the host of Hablemos ("Let's Talk"), a week radio call in show in Spanish on WELH 88.1, FM, Providence, Rhode Island.

-- Carole Joffe

I never thought that I would be performing an abortion in a room with a picture of Jesus and the Virgin Mary, but there I was, in the middle of the Andes. My brain was loaded with the images of the American abortion war, not knowing if what I was experiencing was a result of the steaming coca tea or if indeed these lay midwives, whom I trained to safely manage the complications of unintended pregnancy, have found a way to publicly view their work as God's work.

Perhaps it is the fact that hunger, extreme poverty and disease are so diabolic and real in their lives that anything that could somehow stem the flow of misery is nothing less than a blessing.

Next to the crude poster of contraceptive methods with condoms and IUDs taped to it were multiple religious icons and passages from the Bible. From what I could tell, these women were as religious as those who protest in front of my clinic in Providence every Thursday and Saturday. Every woman who came in was embraced in her decision to accept or not the promise of a future child.

I met Maria, 53 years very old, after 16 children, the last a set of twins at age 51, who came to see the women of the clinic as her only true advocates in life, after being dismissed at the local hospital for lack of funds during her last pregnancy.

There is little doubt in my mind that for every woman who makes it to this life-saving clinic, three or four risk their lives trying to set a different course for their lives.

My Andean days always ended with a visit to the local Internet Cafe to read the U.S. newspapers and follow the trials and tribulations of local politicians, as they joust to reach the hearts of an electorate that is bored with the empty promises and bloated with the fruits of a good economy. The last poll showed 30 percent of voters were undecided, but that is because the pollster did not include a category for "we haven't even looked at who is running for office."

But, finally, in the last few days of the campaign, the only difference between candidates has begun to emerge: abortion. They all wanted to give you prescription drugs and a patient's bill of rights, but not all of them recognized all of your rights.

While it may be factually true that the House and Senate may not have the opportunity to make abortion illegal, it is quite possible that they could make it a meaningless right through restrictive laws and conditions that would make the procedure less available. In the Senate, the situation is more serious because our senators will be casting votes on the appointment of as many as four Supreme Court justices, who could in time, abandon the promise of abortion as a constitutionally protected right.

It is also a fact that, for women in the Andes and in much of the developing world, the vote taken by the House to restrict funding for international family planning represented a death sentence for thousands who found themselves without contraceptives and facing the uncertainties of unsafe abortion practices. Our Congress voted to eliminate funding to international agencies providing vital reproductive health services if those agencies were involved in or advocated the legalization of abortion in their own countries, even if the funds used for that advocacy came from other sources.

As a result, many clinics ran out of supplies and the Angel of Death fell upon the small villages and towns dependent on the American money. Anyone characterizing this vote as "pro-life" needs a serious dose of reality. Even if you try to soften the edges and say that the vote was against abortion, then you ignore the painful irony of such a vote forcing women to have more abortions and to die trying to obtain them.

I am back in town now, and the religious icons have placed themselves outside the clinic once more. Politicians continue to dance their awkward mambo with both feet firmly planted on both sides of the fence and the sleepy electorate is awakening from its slumber. But inside my heart, the story of the Andean cholitas (native women) spreading the gospel of reproductive rights will forever lift my spirit.

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