The State, the Church and women's health: collusion and hidden favors.

The relationship between Church and State is an historical concern of women's movements that work for sexual and reproductive rights. What are the implications of this relationship? What are its political contexts? What impact does it have on civil rights? In the following article, Ivana Calle Rivaz, a pro-choice activist with Catolicas por el Derecho a Decidir/Bolivia (Catholics for a Free Choice/Bolivia) suggests some possible answers to these questions and, with uncanny accuracy, forewarns of the civil crisis continuing in Bolivia as this magazine goes to press.

Bolivia is in the midst one of the most serious crises in the last fifty years of its history, a crisis not only of democracy but in terms of the survival of the State itself. Widespread poverty, corruption in almost every public sphere and rising levels of social exclusion are fixtures of everyday Bolivian life that are taking their toll. Widespread feelings of desperation and uncertainty are reflected in demonstrations of civil unrest like those which occurred February 12-13, 2003. Events such as these are signals of social disasters looming on the horizon with consequences that could be even more devastating. (1)

Eighteen years of neoliberal reforms only have compounded poverty and social injustice, revealing the falsity of the arguments used to justify the reforms, the tall tales of modernizing society and improving the standard of living for the population. The Bolivian people are deeply disappointed, not only with reforms but--even more dangerously--with democracy itself. Many people consider democratic government merely to be the privileged arena of the privileged few, a corrupt oligarchic minority.

The Catholic Church and its Social Role

In Bolivia, there is no serious social issue in which the Catholic hierarchy does not intervene. Its justifies this action with the argument of working for the future of the country, bringing peace

and preserving democracy. The Church's most recent proposal made in reaction to the bloody events of February, is called the Reencuentro (Reencounter). In the face of the imminent danger of a downward spiral into total social and political violence, this campaign attempts to bring together the organizations and institutions most representative of the political system to assure peace and preserve democracy. (2)

In its attempt to move the Reencuentro campaign forward, the Catholic Church first initiated a process of consultancy with political parties with the objective of reaching a national agreement to avoid violence and allow economic, political and social affairs to continue. When asked why only political parties were being approached, Monsignor Jeses Juarez explained that civil society should wait for the development of a similar social project after receiving the proposals of the political parties. Furthermore, he stated, "It will be hard for society to proceed without mutual understanding between partisan leaders." (3)

In critical moments such as these, the Catholic Church seems to be the only credible actor able to approach those embroiled in the conflict to strengthen governability and democracy and preserve the peace. It is clear that the Church's role goes beyond religious and spiritual activities. Its influence in political and social life is clearly evident. for example, when it "sponsored" the election of the electoral commission for the recent national elections.

Protected by its supposed moral authority and power, the clergy has assigned itself the role of testifying, sponsoring, calming, protecting and guaranteeing that the actors in the conflict engage in dialogue--generally to no avail--all in the name of overcoming rigid attitudes for the good of democracy and the well-being of the Bolivian people. The Church's role has an almost theatrical quality, complete with the use of sermons, prayers and liturgies.

In the current severe structural crisis which has led to widespread unrest in Bolivia, the attempts by the Catholic Church to increase its influence is like shooting fish in a barrel. Its role as "savior" of democracy, governability and social peace has a significant impact on public opinion, motivating respect and civic appreciation, which in turn has revitalized its role as moral guide of the society.

As confidence in almost all democratic institutions dwindles, the Church's credibility has soared thanks to its self-assumed role as mediator. Its interference in public matters invariably has been permitted and even demanded by the social sectors. Even the most minimal questioning of its teachings or dogmas receives scant attention. As a result, the separation of Church and State has subtly eroded, putting in jeopardy the respect for liberty and diversity and making even more difficult the task of overcoming patriarchal, colonial attitudes.

Other Areas of Action

Politics is not the only area of Catholic Church involvement. It imposes its decisive influence on education and the media, which are fundamental for the reproduction of values and conservative practices.

In Bolivia, the most prestigious and costly private education centers for government, business and intellectual elites are in the hands of the Catholic Church. The Church also promotes a wide range of options affordable to the middle classes. Education financing is also part of its realm of activities. An impressive percentage--almost ten percent of the entire government education budget--is controlled by the Catholic Church.

The Church also operates a significant portion of the country's communications industry through a network of more than one hundred radio and television facilities. It also claims a healthy representation in editorials and articles in magazines, newspapers and other printed materials, particularly through the textbooks used in the school system.

Sexual and Reproductive Health 

During the 1990s, Bolivia approved several important measures favorable to women and girls. Many of these gains are in the area of sexual and reproductive health, for example:

* The Project on Violence against Women and Children (Gender Affairs Department PAHO/WHO) was launched in 1996. The program promotes the incorporation of health services in the treatment of violence.

* National Insurance for Maternity and Childhood (1996-2002) was designed to widen coverage and to eliminate economic barriers to public health services for pregnancy, childbirth and postpartum and care for the most common illnesses occurring in children under five. This service was in place until 1998 when it was absorbed by the Basic Health Insurance program.

* The National Sexual and Reproductive Health Program (1998-2002) set out to increase the awareness and exercise of the sexual and reproductive rights of women, men and adolescents.

* The Ministry of Education's Resolution 457 prohibited the expulsion of pregnant students from the formal education system.

* The Plan for the Prevention, Punishment and Eradication of Violence against Women created programs such as the Brigades for the Protection of the Family, Comprehensive Legal Services, and Childhood and Adolescence Legal Defense.

* Law 1674 Against Domestic and Family Violence specifies sanctions for violence and advocates for changes in socio-cultural values encouraging respect and solidarity among family members.

Despite these advances, the ability to exercise sexual and reproductive rights was profoundly effected when the United States imposed Global Gag Rule which prohibited actions or statements related to abortion (USAID 2000). (5) NGOs working in sexual and reproductive health issues were forced to abandon issues related to abortion for fear of losing funding. In Bolivia, even the topic of emergency contraception was avoided although EC was not mentioned in the Global Gag Rule or the policies of USAID in Washington. (6)

Currently, with the implementation of the program for Seguro Universal de Salud (SUMI, Universal Health Insurance) in January 2003, we are witnessing a backlash and the return to a pronatalist perspective (which we thought we had overcome) and a conception of women as primarily defined by their reproductive function. SUMI only offers services for expecting mothers until six months after childbirth, women who are not pregnant are not covered at all.

While Carlos Romero, a high-ranking official of the Ministry of Health and Social Security, indicates that SUMI does not imply a setback for women, he does acknowledge that it is a small step backwards for women in general in order to provide more comprehensive and universal care for a smaller, higher-risk population: mothers and children under age five.

The SUMI does provide emergency contraception and care for hemorrhaging during the first trimester of pregnancy. Advocacy reports from the women's movement warn of the need for increased vigilance in order to ensure that these services continue to be provided as Sexual and Reproductive Rights. (7)

The Catholic Church and Health Officials

Key health officials assert that the Catholic Church has no influence on sexual and reproductive health in Bolivia. (8) Nonetheless, if this is so, we are left a number of questions: Why does the public not know that contraceptives are free of charge? Why does the State insist on focusing on the supply of contraceptives rather than on encouraging demand? (Here, economic excuses don't hold water since the needed funds exist.) Why have members of Parliament been so resistant even to discuss the bill to amend Article 266 of the Bolivian Penal Code on abortion (9) presented by the September 28 Campaign?

It may be symptomatic, and definitely no mere coincidence, that given the Catholic Church's political pressure, credibility and support of democracy, no politician or health official wants to lose the Church's favor. In other words, no one wants to contradict the Church's historical position. To do so could put one's prestige at risk and might even result in public censure by the Catholic hierarchy.

On the other hand, Bolivia recognizes Catholicism as the official religion. Why then would the State confront the Catholic Church on issues related to women's health, especially when this same Church constantly serves as the mediator for social conflicts? Women involved in health issues through research, advocacy and international cooperation have provided evidence that the Church's stand against explicit mention of modern contraceptive methods, abortion and sexuality has a definite influence on the design of local and national policies. Sociologist Susanna Rance (10) warns that there is a tacit "gentlemen's agreement" to not give priority to certain issues. Bound by such a pact, what government would admit that it is under religious pressure?

According to longtime women's rights activist Ximena Machicao, (11) government authorities carefully watch their step when it comes to issues of sexual and reproductive health in order not to provoke conflict with the Catholic Church. Furthermore, she adds, it is obvious that the Church always has had and continues to have an influence in these matters: the Bolivian people are profoundly Catholic. Because of this, issues like free choice, abortion, condom use, HIV/AIDS and sexual orientation have long been considered part of the Church's hidden agenda projected through the State.

For this reason, the Catholic Church is not interested in taking part in debate and negotiation on the issue of reproductive and sexual health. It abstains because it is omnipotent. The Church knows that any group or individual who stands against it also will be condemned by certain--fundamentally Catholic--sectors of civil society supported by the furtive complicity of local and national government.

Possibly as strong or stronger than Church influence is the influence of USAID. Experts in sexual and reproductive rights in Bolivia are concerned about USAID's reactionary influence, reinforced by the religious posture of the current U.S. President. USAID's efforts and the power of the Catholic Church explain the current resurgence of conservatism.

Defending the Platforms of Cairo and Beijing

The current situation is complex and presents challenges that call for the reappraisal of certain issues, not only the relationship between Church and State but also the conservative politics of the Bush administration. The platforms for action already have been defined and are still valid. We must continue to defend the resolutions established in Cairo and Beijing at the ten-year reviews of these commitments. Given the Bolivian situation, we offer the following recommendations for action:

* Re-forge the links of the women's movement, concentrating on concrete agendas and clear discourses to defend our rights;

* Pay special attention to the subtle processes that chip away at our rights which require new methods of defense through actions of alert and denunciation;

* Revise our methods of research, dialogue and intervention from strategic and pragmatic perspectives;

* Look for other areas of work that allow us to use alternative strategies of action which are not exclusively antagonistic, including the academic realm to influence future health professionals and others;

* Expand our efforts to include technical and practical interventions in order to enrich our ideological position.

Movements committed to the struggle for women's rights based on women's diverse identities will enrich and promote ideas.

Notes

(1.) The government's unfortunate decision to impose a tax on salaries produced a social uprising in the city of La Paz which left some 34 people dead and over 250 wounded (La Razon, February 14, 2003). This was the greatest social upheaval since 1982, the year Bolivia regained democracy. During these tragic events, the government of Gonzalo Sanchez de Lozada was on the brink of collapse. The uprisings have produced a vacuum of political authority that jeopardizes not only democracy and state institutions, but also the well-being of the population. The bloody encounters witnessed in the streets of La Paz created the fear that these violent scenes would spread across the country, obligating authorities to counter with more violence. This further debilitated the functioning of government and increased the possibility of more violence.

(Ed. note: By mid-October 2003, at least 80 Bolivians had lost their lives in the civil unrest. As this issue was going belatedly to press, Sanchez de Lozada had resigned and was replaced by his vice president, Carlos Mesa.)

(2.) The most recent meeting of the Bolivian Episcopal Conference held on May 5, 2003, presented the document Construyamos juntos una Bolivia mejor (Together Let Us Create a Better Bolivia) which states the Church's position: "Based on the current political circumstance and considering our mission as pastors, we reaffirm the agreed upon proposal to support all efforts and initiatives in favor of the national 'reencounter,' establishing a commitment to sincere dialogue among the distinct sectors and the search for concrete solutions that permit us to construct a common project of a just and peaceful society in which all Bolivians can live in dignity as God's children."

(3.) After some disagreements with the Church on this subject, the Permanent Assembly on Human Rights once again undertook an effort to encourage the articulation of civil society on topics of national interest. Sources in the Assembly announced that they hoped for successful collaboration between their project and that being undertaken by the Church (La Prensa, June 4, 2003).

(4.) The Ministry of Education.

(5.) United States Agency for International Development (USAID).

(6.) The Global Gag Rule also has hampered certain opportunities for coordination, articulation and advocacy such as the Grupo de Trabajo de Embarazo no Deseado y Aborto (Working Group on Unwanted Pregnancy and Abortion) and the September 28 Campaign for the Decriminalization of Abortion in Latin America and the Caribbean. These groups found their ability to speak openly and to take action to promote the human rights and health of women significantly reduced.

(7.) The funding for emergency contraception remains in the hands of the international agencies of cooperation. The Bolivian government still is not capable of guaranteeing a sustainable program. Financing for provision of EC is guaranteed until 2004, but it is uncertain if the program will continue in the following years.

(8.) "To tell you the truth, I have not seen any interference. Decision-makers are independent; of course, Catholicism is the official religion, but this does not mean that health policy would be affected. I think health policy is well defined, and it would not be prudent for there to be interference of that kind." (Dr. Carlos Romero. Director of the Unidad de Atencion de las Personas of the Ministry of Health and Social Security).

"It would be really difficult for there to be direct interference of the Church in politics. At least here, in the technical sense, I have felt no pressure. I doubt there would be interference at the much higher levels of government," (Dr. Victor Conde, gynecologist and specialist in public health, National Coordinator of Sexual and Reproductive Health in Unidad Nacional de Atencion a las Personas).

(9.) This Article does not penalize abortion in cases of rape, incest, marital rape or when the life of the mother is in danger. However, regulatory action to make it effective has not followed.

(10.) Ph.D. in Sociology (Trinity College, University of Dublin). Independent Consultant. Instructor, researcher and activist in the areas of gender, health and the rights of persons. General Coordinator of the Working Groups on Unwanted Pregnancy and Abortion, Bolivia, 1994-2001.

(11.) Executive Director of the Centro de Informacion y Desarrollo de la Mujer (CIDEM, Center for Women's Information and Development), with 18 years of activism in the defense of women's rights, human rights and sexual and reproductive rights.

Bibliography

1. Susanna Rance, Actores/as y guionistas nacionales e internacionales en la puesta en escena del aborto en Bolivia (2003).

2. Preliminary report by DAWN, REPEM, CIDEM, Avances y ratroceso en un escenario cambiante: Reforma en Salud, Mortalidad Materna y Aborto en Bolivia. 2000-2002. Maria Dolores Castro, Silvia Salinas, eds. (La Paz, Bolivia, 2003).