El Salvador found guilty of 'obstetric violence' in historic abortion ruling

The Inter-American Court of Human Rights on Friday ruled against El Salvador for barring a woman from getting an abortion, despite her life being at risk and her fetus being unviable.

It ordered the Salvadoran government to pay compensation, establish guidelines for medical and judicial personnel, and take legal and other steps to guarantee “legal certainty in regard to similar cases.”

The case goes back to 2013 when the woman – identified publicly as “Beatriz” – was unable to obtain an abortion because El Salvador bans them in all cases, even when a woman’s life is in danger or when pregnancy results from rape.

The Costa Rica-based court found El Salvador responsible for “obstetric violence and violation of the right to health” in Beatriz’s case.

It said the Salvadoran government failed “to comply with its duty of due diligence in guaranteeing the rights of access to effective judicial remedies, personal integrity, health, and privacy of a woman who went through a pregnancy with multiple risks.”

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Beatriz’s mother, identified only as Delmy, told AFP the ruling was “total justice,” saying she hoped the government would comply with the court’s decision in the future.

Organizations in Costa Rica advocating for women’s health also hailed the ruling.

“Justice has triumphed. We are happy. Today… is a day that has gone down in history for reproductive justice for women,” Angelica Rivas, a lawyer for a group called the Colectiva Feminista, told AFP.

The Salvadoran government acknowledged Friday’s ruling and said it would assess its implications.

High-risk pregnancy

Beatriz, who was 22 at the time of the pregnancy, suffered from lupus, lupus-related kidney disease and rheumatoid arthritis.

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She already had a young child from a pregnancy two years previously, during which she had severe preeclampsia, a type of high blood pressure.

Taken together, doctors determined her pregnancy was high-risk, and could kill her – and ultrasounds found the fetus was anencephalic, meaning part of its brain and skull were missing, making it no longer viable.

But while terminating the pregnancy was considered, “no decision was made since… there were no protocols for the care of cases such as Beatriz’s,” the court said.

It noted that El Salvador had admitted there was “a situation of confusion” and that better protocols could have been established for such an unusual set of circumstances.

After Salvadoran authorities heard a contradictory expert opinion that Beatriz’s life was not at risk, the fetus was carried to term and a cesarean section was performed at birth.

The baby died five hours after delivery.

Beatriz survived the birth. But she died in October 2017 after contracting pneumonia while getting treatment for injuries from a traffic accident.

The court said there was no proof of a causal link between the risky pregnancy and her death.

The court also said it was not trying to arbitrate the different medical opinions, nor trying to establish what the best course of treatment would have been for Beatriz.

But it stressed that Beatriz’s underlying medical condition meant the Salvadoran state had “a special duty of protection” to provide her with “diligent and timely medical care.”

But “the lack of legal certainty regarding the approach to Beatriz’s case led to the bureaucratization and judicialization of the required medical care, which generated multiple consequences.”

El Salvador has banned abortion since 1998, with anybody breaking that law facing a potential prison sentence of up to eight years.

More commonly, though, Salvadoran courts apply charges of aggravated homicide in such cases, which carry heavier penalties of up to 50 years behind bars.