The Fight for Medical Privacy in Latin America and Its Implications for Abortion Rights

The Green Wave movement has swept through Latin America and has increased the liberalization of abortion law. Still, criminalization, and medical privacy and medical secrecy concerns can impact someone’s access to care or have patients and professionals facing prison sentences. Gloria Orrego-Hoyos, fellow with the Health and Human Rights initiative at Georgetown Law’s O’Neill Institute for National and Global Health Law, sits down to talk with us about the status of criminalization, medical privacy and medical secrecy when it comes to abortion across Latin America.

Some Latin American regions criminalize abortion to the extreme. In El Salvador, abortion carries a charge of “aggravated homicide” and can punished by up to 30 years in prison, while in Nicaragua, those who access an abortion face a sentence of up to two years in prison, with medical professionals facing sentences of up to six years in prison for administering care. Some medical professionals feel pressure to, and do end up, reporting abortions to the police. Many doctors are also afraid to provide care until the most dangerous point, due to the shadow of the criminal system.

Links from this episode

Gloria Orrego-Hoyos on Twitter
Plan C
Abortionfinder.org
Ineedana.com
Repro Legal Helpline
Repro Legal Defense Fund
Digital Defense Fund

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Transcript

Jennie: Welcome to rePROs Fight Back, a podcast on all things related to sexual and reproductive health rights and justice. [music intro]

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Hi RePROs! How's everybody doing? I'm your host Jennie Wetter, and my pronouns are she/her. So y'all, last weekend I did what I talked about going to do. I went to go get apples from an orchard and then I went out to a winery with a friend and it was delightful. But anyway, all that is to say I came back with, like, half a bushel of apples, y'all! So many apples. And now I have to figure out what I'm going to do with all of them. I'm gonna make an apple crisp, for sure. That is, like, my favorite versus like an apple pie. And then I was thinking of making some apple butter, but I feel like I'll still have apples left after all of that. And I don't know, I don't know what else I'm gonna do. So, if anybody has any great ideas, let me know. I'm always happy for suggestions because I really, I don't know, and there are so many, I really got carried away and, like, no regrets because like fresh orchard apples are delightful. But yeah, I don't know, it's one of those things that, like, makes me think of home, too. Like, I remember being little, going to apple orchards back home and going and, like, seeing how they made cider and like all of the fun things. I told you all, I'm such a fall girl. Like it is. I don't know, it just was like a lot of happy childhood memories. So, it is still the thing that makes me really happy. So, that was a lot of fun. And the fun shall continue because I'm thinking of all of the fun things I'm gonna make with my apples. Let's see, what else is going on. I'm enjoying the, like, cooler weather and, you know, I love having my windows open. The kitties love it when I have the windows open. And because it is now cooler, they are just like giant snuggle bugs at night. And I wake up with them, like, curled up against me in various spots. And it makes getting out of bed in the morning very hard because they get real mad when I'm like, "okay, I have to get up now. So y'all have to move." And the look on their faces, like you would think I was being real mean. Such a rough life. They just suffer so much. I kind of think that's it. That's it. Like, now that we're talking weekly, I can keep these a little shorter because there's not as much to update on. Right? But before we get started, I do want to tell you about an incredible new series from The Nocturnists. It's a medical storytelling podcast, and this new series is called “Post-Roe America” and it features the stories and voices of abortion providers from around the country. And they're sharing intimate details about what their lives have been like since the Dobbs decision. And some are grappling with the moral injury of having to turn patients away, who desperately need their care. And others are dealing with the fallout from restricted states and trying to absorb the reproductive health needs of the vast swaths of the country and what kind of choices they're making amid this chaos created by overturning Roe v. Wade. I think listeners of RePROs Fight Back will love this series as much as I do. I've even learned things that I didn't know listening to this podcast. It's so wonderful. So, I hope you listen and subscribe and you can find them wherever you listen to podcasts at The Nocturnists Post-Roe America. So, definitely worth checking out. And then with that let's turn to this week's interview! We're talking to another wonderful advocate from Latin America talking about medical privacy and kind of the challenges they're encountering around that. I'm very excited to have with me today Gloria Orrego-Hoyos to talk all about medical privacy—or medical secrecy, as she often calls it—in Latin America. Hi Gloria! Thank you so much for being here today.

Gloria: Oh, thank you so much for having me and for the interest.

Jennie: So, before we get started, do you want to take a quick second and introduce yourself and include your pronouns?

Gloria: Yeah, I'm Gloria Orrego-Hoyos. I use both my mother and father names, so that's important for me. My pronouns are she/her or ella in Spanish. And I'm originally from Columbia, but I have lived last 20 years in Argentina.

Jennie: So, we've talked about the Green Wave multiple times on the podcast, and I think a lot of the focus on that is like the great decriminalization around abortion that is happening, but that isn't, like, the only barrier that people are encountering trying to access care or causing problems after accessing care. I think one of the things that you have written so lovely about is talking about medical privacy—or medical secrecy, I think you call it in your writing. Do you maybe want to talk a little bit about that and what you're seeing?

Gloria: Yeah, we have—and I say we, because I have worked this issue with two colleagues in Argentina, María Carrera and Natalia Saralegui, and we try to understand: how come abortion wasn't in the police records? We know that there was a lot of abortion happening, insecure abortion, but we wonder how come that is not in the courts and we found that the criminalization keeps doing it, even after the law passed in Argentina, but with different names. So, we found "homicide," aggravated homicide that has life in prison, but when we start talking with people working on that, we think that we have missing a point in was the origin of the report. And we saw in many cases that people from the hospital—doctors, nurses, administrative staff—called the police or the prosecution in order to report these women. And I say women because we haven't had any chance to have gestational people. So, it's like we only work with women for now, and the reports was always from the hospital. So, and in Argentina, for example—that's a difference between Argentina and Peru—for example, the report is a crime. The doctor's report is a crime in criminal code. So, we start digging in and we face the very complicated truth that the reports are made from the hospital, in violation of all professional medical secrecy, in violation of the right to privacy. And we thought at the beginning that was because they were religious or because people feel the woman was doing something wrong. However, our findings are more that they report because of the fear to be prosecuted themselves. And that's very complicated because what we saw also is that the reports were always in certain type of women. So, it was like a combination of discrimination, vulnerability, but also the fact that people are not very comfortable about professional medical secrecy because they're afraid. So, we went to the faculty of medicine and nursing faculty and everything and start asking around that, how come this happened? And some universities don't even teach about professional medical secrecy. It's just a matter of ethics, they say. It's not like a really, really important issue. And we found that that's a big problem, not only in Argentina, but in countries in Latin America where when the report is mandatory, for example, in Peru. And in El Salvador, the Inter-American human rights court they talked about the professional medical secrecy in a case of certain emergency in the case Manuela against El Salvador and was the first time they, the court talks about the importance of receiving good care without the fear that you will be report.

Jennie: I found, I mean, so much to dig through in all of this, but one of the things I found really striking was when you talked about talking to the people at the university and they're like, "oh, we don't talk about it because it's unimportant, not a big deal." And like, all I'm thinking is like the women who have been prosecuted would find it a very big deal. Like, it seems so dismissive.

Gloria: Oh yeah. And we have even a small disagree with a professor and he say, of course we have to report we are...we deal with life. And I say, well, but the criminal code say on contrary. And he was really upset about the question because he was the professor of criminal medicine. It's like forensic.

Jennie: Oh, okay, great.

Gloria: So, the professor of forensics said we don't need to deal with that, we just report because it's our duty to do it." And I talked to him about the Supreme Court ruling supporting the secrecy in 2010, and he was like, "really? I didn't know that's the...we don't use that kind of stuff." And I like, okay. And very interesting to find that in not all the cases, but in some cases was the fear and not the desire to report. And the thing is that in Argentina and mostly everywhere in the world, medicine is not just the books but practicing. So, if you have something in the books, you have, like, 40% of your learning. And when you're practicing, you have this curriculum that people take- told you how to do stuff. Other doctors explain to you the procedures and protocols and everything. So, the vicious way to act from this person, these people are going through next generation and next generation and next generation. So we have this female doctor that was fantastic and she's an activist and she say, "yeah, well I report like 20 years ago an abortion." I say, "how come you're an activist?" And she say, "I was afraid. My boss told me I had to do it. And I was 26." And I say, "wow." So it, but it was good finding because it wasn't something, it was easier to fix when you don't have like, personal beliefs behind the report.

Jennie: Yeah. Definitely seems an easier...in some ways, still to overcome. Like, fear can be also be really hard to overcome.

Gloria: Oh, yeah.

Jennie: So, one of the things that I know you took a lot of time illustrating in your books and I think is really important in this situation is showing, like, the various stories and the various kinds of ways you have seen medical privacy become an issue. Do you maybe want to share a story or two?

Gloria: Oh, yeah. Well, there's a very famous story in Argentina, the case is named Belén and was this woman in her twenties that went to ER because she was very in pain and she thought she was like a flu or something and people help her to arrive to the hospital because she was so much in pain, like stomach pain. And when she was at the hospital, she went to the bathroom because she need to, she, she felt like she had diarrhea or something and she went the bathroom and pass out and then she awake again and leave the bathroom and then a nurse find a small fetus in the bathroom. So, this nurse starts screaming and she was accused to homicide, aggravated homicide, not even abortion. And it was, she was in prison for almost two years and it was a miscarriage. She didn't know she was pregnant. The fetus wasn't ready to have born. She had a miscarriage. And it was, like, a big issue because everybody in the hospital knew what happened and they almost tied her in the bed until police arrived. Like, the hospital has that authority to keep somebody inside. And another one was a case...it was very difficult case, happy ending. But it was Rosalía. She was a mother of four and she became pregnant, and she almost denied the pregnancy because her boss told her: "if you get pregnant again, I will kick you out." And she was like, okay, this is not happening, this is not happening. And she have a very busy job, like 18 hours per day, stuff like that. And she went back to her place and she had the baby in the bathroom, but she passed out because she lost a lot of blood. And her daughter that was seeing counseling because of abuse, sexual abuse, she called her counselor and say, my mom is in the bathroom pass out. And she called the police and she explained what happened, even though this girl was her patient. And so it's like you can't trust anybody in the whole world because they were going to report you, to call the police or to...it's not that the neighbor say something and call the police. It's like the person that had to deal with your intimacy, with your personal matters, call the police and told about it.

Jennie: Yeah. And it really- it breaks down the trust that people have in the health system that you would like to have in your provider, right? You should be able to talk to them about these issues and what is happening. And it just breaks down that relationship.

Gloria: Yeah, absolutely. And it's like you have to choose between life and jail, life and prison. So, I had to go to- for example, there was a very interesting case not related to sexual matters, but apparently in a neighborhood in Buenos Aires, the dealer of the cocaine did something wrong with drugs and it was like adultery and, you know, different and it was toxic. So, more than one hundred people in that neighborhood were ill because of the different approach of the cocaine. And people prefer to stay at home and be almost, you know, in the danger of life because they were afraid that they were reported. And the health ministry went to the TV said, "don't be afraid, come to the hospital." And there was reported 11 deaths because of that. But we don't know how many more because people were afraid to attend the doctor's appointment.

Jennie: That's just terrible, right? Like, you need to be able to trust that you are safe and can go and get the care you need. All of this makes me think of where we're at in the US right now. You know, not that criminalization hadn't happened around pregnancy before the loss of abortion rights, right? Like, we already know that that had already been happening. But thinking through like the things you've said around reporting, but also thinking through where we've heard doctors talking about fear, right? Of, like, you know, abortion is legal if the life of the mother is at risk, but what does that mean? And then doctors being afraid to act until it's the mother's like on death's door and you just see all of these things interacting in ways that is really harmful for pregnant people.

Gloria: Yeah, absolutely. In the United States now after Dobbs, I think we're having, we're facing, like, a shadow all over the medical and healthcare system and a shadow that makes everybody afraid of being reported or going to prison or stuff like that. And it's ironic because we always in Latin America look to the United States as the progressive one, the one that- for example, the Constitutional Court of Colombia quoted Roe v. Wade in the 2022 ruling about abortion. However, I think what it's most- that most worry me in United States is this shadow that tells you are always in danger of being reported. If you drive an Uber, you can be prosecuted because you are accomplice that a woman or a pregnant person. So, I remember in the Inter-American Human Rights Court, Manuela v. El Salvador, they use the term "shadow." That when abortion is a crime, there's a shadow in the providing sexual and reproductive health that allows people to act in ways that are not legal, but that also are not ethical or morally correct, like, reporting. And United States has this case status about medical secrecy. And so, you think you only need to report if it's the possibility of a crime to be committed. But if one person attempt with an abortion, even if it is a crime that's already happened, so you don't need to report. And that's our one thing we need, like, we need to talk about and we need to research more is what kind of people are being reported.

Jennie: Oh, that was going to be absolutely my next follow-up is you talked about that you weren't seeing everybody being reported when you talked about Latin America. Same is true here, right? Like, the people who are already most marginalized are the ones-

Gloria: Mm-hmm.

Jennie: -who Are most likely to be reported. And that is like this whole other layer of problematic on top of a terrible situation.

Gloria: Yeah. It's, like, an intersectional discrimination in between different vulnerabilities. And I remember in one of our cases in Argentina that there was a news...in a newspaper, there was information about the case. And in the comments, people say it's impossible that she didn’t help her baby because even the dogs know how to do it. And I thought- I have two kids and I think wouldn't know how to act during the birth except, you know, calling hot water and towels, like the movies say that. I have no idea how come it helps. But I don't know how to behave in my own birth and I have education and I have support in my family and everything. So, how come that you burden the people with such a big heavy weight of dealing with the birth, like there was no problem. So, the good thing about this is that the last couple of months, maybe a year ago, they start talking about cryptic pregnancy that women that doesn't- they don't recognize that they’re pregnant. And it happens a lot in women that have suffered violence. So, they don't even have the big belly or they keep having the period and everything, but they are pregnant. So, at the moment of the birth, they were absolutely surprised and go to the hospital and there they are reported. And women that also do drugs or women in very poverty are more likely to have a cryptic pregnancy. That's something that is going on in the research, but it's like, well, we have a case in Costa Rica, very similar and eventually they release the woman because they said she just didn't know that she was going through a birth.

Jennie: Yeah, I really do think a lot about the people who are going to be disproportionately harmed by all of this by the lack of access to safe abortion. But then they're also going to be more likely to be reported if they go to the hospital with a complication from a self-managed abortion or something like that. And yeah, it's just again, that intersectional kind of compounding harm that you see and it's just really upsetting.

Gloria: Yeah, definitely. And I'm very angry because the government and the state always abandoned these people except at the moment of criminalization. So, these women didn't have- or these people didn't have sexual education, they didn't have health access. They can't finish high school. So the state was completely outside their lives, never receive any help. However, the criminalization arrives with all the force and violence against them.

Jennie: And then, I just want to be clear, since I talked about a complication with self-managed abortion, that self-managing your abortion with medication is very, very safe. Your risk is much more likely to be around criminalization. Just to not increase any fear or stigma around self-managed abortion.

Gloria: Oh yeah.

Jennie: Right. Like it's, it's very safe. But you do have-

Gloria: Absolutely.

Jennie: -to deal worry about the risk of criminalization.

Gloria: Yeah. The self-managed abortion, sometimes people are afraid because they feel pain, so they go to the hospital because of the pain. And that's okay, you have to deal with it. But you, you have to have, you have the right to have support in those moments. And sometimes people are, because pain's so, like, [indiscernible] sometimes, and yeah, we see the reports here in the United States against African American women and Latina women. And in Europe, Romani people are very in chance to be reported, it's quite common. Jennie: Yeah. And then, I'll just add, if you have questions while you're self-managing abortion, there is a self-managed abortion hotline. So, call to get information so you, before you need decide you need to go to the hospital. And then if you do find yourself on the other side of being criminalized, the Repro Legal Defense Fund is a great resource to call that can help you during that time. And if you have questions around legality, the If/When/How hotline—and we'll include all of the resources in the show notes—is also a great resource to check on legal status.

Gloria: Yeah, absolutely. It's quite important to have the correct information. It's such a shame when you deal with all these situations alone. And there's a lot of people that companion, you know, the self-managed abortion and health. So, I assure you that you'll be in very good hands.

Jennie: Right? And misinformation is like part of all of this, right? Like, the making sure you don't know where to go or getting the information. It is very much a tool of the anti-abortion, anti-gender movement to confuse you, to make you not know if it's legal or where it's safe to access. And all of those things are all tools of that movement to prevent you from exercising your right to bodily autonomy.

Gloria: Yeah, well, that's a big issue in Latin America, too, because there's these groups—usually religious group—that hide themselves and offer to provide help and companion to pregnant person with a non-desired pregnancy or stuff like that. And suddenly they force them, they afraid them about how to do it- about the access to abortion, even in the country that is completely legal like Argentina. Jennie: Okay. So I feel like we're getting to a good point to like wrap up, but I usually like to end with, Like, is there anything our listeners can do? So is there anything our listeners can do around these issues right now?

Gloria: Well, I think one of the best things is to try to have the conversation in your places, in your workplaces in your house about abortion and about access to health. So, it's, like, that will put this traditional way to deal with health, like, in a corner and to have the possibility to build something else, especially with young people. In 2018, was the first time that was debate the access to Argentina and we lost. But the good thing was finally it was a subject in the dinner table. So, I think that even if you're not working in the health system or in access to abortion, it's good talk with your family, with your acquaintances, about the issue and don't have the stigma anymore because the stigma kills people.

Jennie: Absolutely. That is a great place to end. Gloria, thank you so much for being here today. It was wonderful to talk to you. Gloria: Oh, Jennie, it was my pleasure. I'm sorry for my mistakes in English.

Jennie: Oh no, you did great.

Gloria: Okay. Thank you.

Jennie: Okay, y'all, I hope you enjoyed my conversation with Gloria. I had a wonderful time talking to her and seeing some of those connections around medical privacy that they have been dealing with in Latin America and that we are now dealing with in another level now in the US, as well. So with that, I will see you all next week! [music outro] If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@reprosfightback.com or you can find us on social media. We're at @RePROsFightBack on Facebook and Twitter or @reprosfb on Instagram. If you love our podcast and wanna make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you wanna make sure to support the podcast, you can also donate on our website at reprofightback.com. Thanks all!