A drama unfolds: Uruguay was about to vote in a groundbreaking law on abortion. It was to be a model for the whole of Latin America. But then things started going wrong ... Hersilia Fonseca and Patricia Pujol report on a battle that may still be won.

FLAVIA was 16 and had a six-month-old baby that she was still breastfeeding at night. Her period was late and she was afraid of being pregnant again. She had no access to sex education or abortion clinics; only an abortion pill that she had put into her vagina. Rosario Echague was the doctor who received her at the hospital an hour after she had used the pill: 'She had a pain in her stomach, abundant diarrhoea and unstoppable vomit. She was pale and trembling, she didn't understand what was happening to her, and she was afraid.'

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Flavia died because of the direct effect of the poison--and furthermore, she was not pregnant. (1)

She is not the only young woman to have died in this way. Abortion is illegal in Uruguay and yet it is the main cause of maternal death. Studies conducted in 2002 estimate that 90 abortions are performed each day--and the actual number is likely to be much higher. (2)

Indeed, the number of women who attempt clandestine self-abortions has risen considerably in the past decades due to Uruguay's severe economic crisis. 'Forty-seven per cent of maternal deaths at the Pereira Rossell Hospital--the main maternity hospital in the country--are due to unsafe abortions,' says Lilian Abracinskas, an expert in sexual and reproductive rights. (3) This compares with 27.7 per cent throughout the country, 24 per cent throughout Latin America, and 13 per cent for rest of the world. (4)

According to leftwing Senator Alberto Couriel: 'For every one of these deaths, another 50 women are left with scar tissue and lesions so dire that they will never be able to give birth again; another 100 women will suffer chronic abdominal and uterine pain, and yet another 1,000 women will suffer some sort of pain or other.'

In many respects Uruguay has been in the forefront of advocating women's rights. Women were allowed to divorce in 1913 and to vote in 1932. But the laws on reproductive health have been much more ambivalent. Abortion is still illegal in most countries in the area with the exception of Cuba, Guyana and Puerto Rico. The current abortion law in Uruguay dates back to 1938 and imposes a penalty of up to six years in prison. There are exceptions, such as rape, or danger of the mother dying during childbirth, or, bizarrely, the 'jeopardy of a man's honour'.

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Today, legal punishments are rarely imposed on women, though from time to time the person in charge of a clinic goes to jail when a woman dies. This antiquated law, however, makes the whole process seem clandestine. It also reinforces 'abortion-as-crime' as an extension of the idea of 'abortion-as-sin'.

In the early 1960s Uruguay had one of the world's highest abortion rates. Then in 1995 contraception was legalized. Now contraceptives are distributed free of charge to women but in insufficient quantities. Nor are education programmes adequate. The current rate of abortion is estimated to be one for every live birth. Evidence in other countries shows that decriminalization reduces the number of abortions. Moreover, fewer women die in the process.

In Uruguay, four separate attempts to decriminalize abortion came up for approval in Parliament between 1995 and 2000. All were turned down, partly because they focused solely on abortion rather than on a wider programme of state education and support for family planning.

In 1998 the big push to get a new law passed began. In December 2002, after a huge amount of lobbying from women's groups, academics, the medical sector and civil society organizations, the House of Representatives finally voted for the bill. There were 47 in favour, 40 against, and 10 absentees. It was an historic victory for the pro-choice movement.

The bill still had to get through the Upper House to become law. Women's organizations claimed that the majority of Senators had pledged their vote in favour. But the victory led to an unprecedented unleashing of anti-choice forces, both nationally and internationally.

First, the Catholic Church published a list of all legislators who voted in favour of the bill and circulated it during Sunday mass. The Archbishop of Montevideo, Nicolas Cotugno, went so far as to qualify abortion as 'homicide', an 'abominable crime', and to compare it with the 11 September terrorist attacks on the US. His condemnation of abortion was so radical and explosive that it provoked dissension within the Catholic Church itself.

Then, at the end of April 2004, six US Republican Senators sent a fax from Washington to Senator Alberto Couriel, saying: 'Abortion methods are violence against children ... As pro-life legislators from a country that 31 years ago legalized the killing of unborn children, we encourage you to vote against this bill and not to leave it up to a referendum.' The Uruguayan Senate voted 17 against, 13 in favour, and one abstention.

But in Uruguayan society as a whole there was a surprising amount of support for the bill. According to a Mori poll in April 2004, 63 per cent of the population were in favour of the bill; a figure that has been growing year by year. Today almost all sectors recognize that abortion is a public health as well as a moral issue. Support came from many different fronts, including medical professionals. Dr Anibal Faundes, professor of Gynaecology and Obstetrics, noted that: 'Social problems can't be resolved with bans. This bill focuses on the causes of abortion ... I believe it has a very good sense of direction.' The prestigious Medical Union of Uruguay announced: 'The current situation is dramatic and inadmissible.'

At the political level, the centrepiece was the work carried out by women MPs of every party. At the grassroots level, young people and rural women's networks developed spokespeople, organized conferences, wrote documents and carried out street publicity in support of the bill.

And the pressure continues to build: on 6 August 2004 the Ministry of Public Health approved a measure which allows doctors to give advice to women who want abortions, with the aim of reducing the number of deaths due to unsafe abortions. Abortion continues to be illegal, but this is another step forward and the first measure of this kind in the region.

Jorge Brovetto, spokesperson for the Frente Amplio party, which backs the bill, said recently that the party: 'will fight ... for sexual and reproductive rights'. With opinion polls all predicting the likely victory of the Frente Amplio at the national elections in October 2004, Uruguay may become the first country in the region to give women the right to choose.

1 Health Senate Commission, 16 August, 2003. 2 Rafael Sansiviero, Centro Internacional de investigacion e informacion para la Paz, Universidad de la Paz de Naciones Unidas (IIIP.UPAZ). Montevideo 2003. 3 Lilian Abracinskas is a feminist, member of Cotidiano Mujer; an expert in sexual and reproductive rights, co-ordinator of MYSU (Women and Health in Uruguay). 4 Unsafe Abortion, WHO, Geneva, 1998; Ministerio de Salud Publica, Montevideo, Uruguay, 2001.

Hersilia Fonseca is a professor of history ([e-mail]) and Patricia Pujol is a journalist ([e-mail]). Both are based in Montevideo, Uruguay.