How abortion rights advocates cleared the name of Manuela in a landmark case in El Salvador
In recent months, five women in El Salvador serving sentences for abortion-related crimes have been released from prison. This is stunning news in a country where there is a total ban on abortion and more than 180 women have been prosecuted for abortion-related crimes in the past 20 years.
Their release was set in motion by a landmark ruling issued in November 2021 by the Inter-American Court on Human Rights, the highest judicial human rights body in Latin America. The ruling came in the case of Manuela, a woman who had been convicted of an abortion-related crime and died while serving her 30-year sentence. The court held El Salvador responsible for Manuela’s death and said the government must take action to reform its punitive reproductive health and rights policies.
When she was arrested, she was having an obstetric emergency and didn’t get the care she needed. She had done nothing wrong,” says Guillermo Ortiz, Ipas senior medical advisor for quality of care. “But because abortion is so stigmatized in El Salvador, she was suspected of having an abortion.”
Ortiz testified as an expert witness in the case, which was brought on behalf of Manuela’s family by the Center for Reproductive Rights (CRR) and partner organizations Colectiva Feminista para el Desarrollo Local and the Agrupacion Ciudadana por la Despenalizacion del Aborto.
Ortiz, an OB/GYN, practiced medicine for 20 years under El Salvador’s total abortion ban and now is an advocate for repeal of abortion bans there and in other Latin American countries. In his testimony in Manuela’s case, he cited the human rights violations involved in her arrest—including the rights to health, privacy and equality before the law. He also told the court that it is the responsibility of El Salvador and other states to prevent criminal prosecution of women when they are suffering obstetric emergencies.
According to CRR, the ruling in Manuela’s case is “the first time an international court has considered the obstacles women face in accessing reproductive health care in El Salvador…The court recognized that the legal context in El Salvador’s complete criminalization of abortion directly creates discrimination and gender violence, which disproportionately impacts women in vulnerable situations and leads to the criminalization of obstetric emergencies.”
Ipas Central America and Mexico worked with CRR and other partners to develop and prepare evidence for the court hearing and to help raise public awareness and understanding of the issues involved. “We wanted to make sure that the court understood the medical differences between having an abortion and the complications of a pregnancy. The goal was to prove that Manuela had had an obstetric emergency, not an abortion,” says Maria Antonieta Alcalde, director of Ipas Central America and Mexico.
Alcalde notes that the ruling came as the “green wave” of abortion rights activism continues to sweep through the region, beginning with a historic victory in Argentina in 2020 and a recent court ruling in Colombia that decriminalized abortion through 24 weeks of pregnancy. The green wave has been symbolized by images of thousands of women marching in the streets. “Taking to the streets is important,” says Alcalde, “but we are learning that using all of the branches of the political system to advance abortion rights—the courts, the legislative branches, and the ministries of health—is critical, too.”
Ortiz says he felt that the evidence he and others presented had a significant impact on the outcome of the hearing. “We cleared the name of Manuela. The ruling gives some peace for her family—and will give women and girls throughout Latin America and the Caribbeans the opportunity for better access to reproductive health care. The court has made it clear that, regardless of the patient’s situation, health professionals must provide the care that’s needed and must protect doctor-patient confidentiality.”
The court ordered El Salvador to take steps so that a case such as Manuela’s never occurs again, including ensuring that women who need reproductive health care “are not denounced by their medical personnel for allegedly having committed abortion” and that women with obstetric emergencies receive adequate care “free from any forms of gender violence.”