Translated and edited by Walter Lippmann for CubaNews.
Those two dashes, indicating a positive test, confirmed that morning her doubts, but also the fear that had been keeping her on edge for days. Camila was in her second year of psychology, and carrying a pregnancy to term was not part of the “plan”; for her, it was simply not the right time, nor did she feel ready to take on the responsibility of being a mother.
She admits that the decision was always clear to her, even when her parents asked her to think it over, that they would help her with the child’s upbringing. “But I knew what I wanted, and I was in time to have a menstrual regulation; today I have no regrets.”
Talking about abortion in Cuba is not a taboo subject; however, it sometimes raises conflicting opinions in society. What is clear is that sexual and reproductive health is a right in our country and includes, among other elements, women’s access to voluntary interruption of pregnancy, which is supported by a medical-legal, free and safe procedure.
The Island was, in fact, the first country in Latin America and the Caribbean to decriminalize abortion, and since 1965 the legal basis was created so that it could be performed within the framework of the national health system.
This basis is based on three fundamental principles: the woman is the one who decides about her body and whether she will carry her pregnancy to term; the voluntary termination of pregnancy will be performed in controlled health environments and by specialized personnel, and it will be performed completely free of charge, recently explained Dr. José Angel Portal Miranda, Minister of Public Health (Minsap).
For more than 50 years, Cuban women have had access to this right and, legally and in terms of implementation, abortion is guaranteed for any woman over 18 years of age or with the authorization of the legal guardian for adolescents.
The current practice – Portal Miranda pointed out – is that up to 12 weeks of gestational age, abortion is allowed by voluntary decision of the woman, with no restrictions as to the reason, and up to 26 weeks, for fetal malformations incompatible with life, in authorized health care institutions.
It also established the use of informed consent for the performance of all cases of legal interruption by the woman or her representative, in case she is a minor or is not in physical or mental condition, because she is in serious danger to her life, it said.
WHAT DO CUBAN LAWS SAY ABOUT REPRODUCTIVE RIGHTS?
The Constitution of the Republic leaves little doubt on the subject. Article 43 states that the State promotes the integral development of women and their full social participation. It also ensures the exercise of their sexual and reproductive rights, protects them from gender violence in any of its manifestations and spaces, and creates institutional and legal mechanisms for this purpose.
This postulate reinforces the legal nature of abortion in Cuba and its attention as a health issue in Minsap institutions, even when the procedure is not registered, as such, in a law.
However, the Penal Code establishes that abortion becomes a crime when it is performed for profit, without the woman’s consent or in conditions that may threaten her life and health.
In this regard, the head of Public Health has stated that reproductive rights include equality, non-discrimination, health, reproductive autonomy, information and integrity; issues that should be included in the next Health Law, which should be approved by the end of this year.
We hope that the new legislation will further protect the right to voluntary termination of pregnancy in the face of the advance of conservatism and fundamentalism that jeopardize, in the world and in the region, a fundamental conquest for women.
This is undoubtedly a need that must be reinforced by the legal framework, but also by more effective protocols and procedures that prevent the so-called “naturalization of the procedure” from taking patients away from the center of attention, since the interest is, and will always be, to safeguard the integral health of women, both physical and psychological.
DEFENDING BODILY AUTONOMY, LIFE, AND WOMEN’S HEALTH
About 56 million abortions are performed every year in the world, of which approximately 45% are performed in an unsafe manner, the Minister of Public Health detailed at that press conference.
Portal Miranda clarified that the maternal mortality related to this unsafe practice is also generally high, where abortion is severely restricted.
She explained that our country defends a public policy of family planning that allows a conscious decision on the number of children one wants to have and at what time. It advocates implementing a process of accompanying women in their right to decide about their bodies and abortion is left as a last resort in the face of an unwanted pregnancy. “In this way a legal, safe, free and feminist abortion can be achieved,” she stressed.
The institutions that perform voluntary interruption of pregnancy are defined in the national health system. They are maternity hospitals; maternal-children’s hospitals; general hospitals with gynecology-obstetrics services and, in addition, certain polyclinics are accredited to perform medical abortion, which is used in patients with a menstrual delay of up to 45 days, counting from the first day of the last period, she pointed out.
She added that Cuba has 167 menstrual extraction services; and the accuracy of the statistics for abortion as an event of any kind, including spontaneous abortions, is recognized by international organizations.
She stated that voluntary interruption of pregnancy has not been a main determinant in the current fertility decline, while there is a discreet trend towards a decrease in abortion and menstrual regulation events. For example, in 1985 the rate was 55.0; in 1990, 45.6; in 2015, 30; and in 2020, 22.1 per 1,000 women aged 12 to 45 years.
In her opinion, this decrease is based on educational programs, both general and sexual education, and on the availability of varied, efficient and effective contraceptive methods and means, both of which can be improved. “The limited availability of contraceptives in this pandemic period is no secret”.
The volume of voluntary abortions is considered to be high because the main purpose of Family Planning policies, to reduce this practice to the indispensable minimum, has not been achieved, she pointed out. For this goal, she said, there is a national strategy to decrease the rates of surgical abortions, including medical abortions.
“This objective will become a reality when non-invasive techniques for the voluntary interruption of pregnancy are extended, mainly medical abortion with Misoprostol, a protocol that proposes to perform 80% of all voluntary abortions with this method, without abandoning the development of all abortion services, mainly aimed at increasing their safety, resolution and efficacy”.
From the Health system, said the Minister, we insist on the prevention of unwanted pregnancies and on using this right only in the face of the failure of contraceptive methods. “It is not a contraceptive method in itself or a family planning method, since its indiscriminate use can put women’s sexual and reproductive health at risk,” she said.
She insisted on the need to continue working towards providing information on these services, even in our country, where it is a conquered right, and for people to know how to access them and the support of the health system for women’s bodily autonomy, life and health.