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Abortion in the Dominican Republic WATCH HUMAN RIGHTS “It’s Your Decision, It’s Your Life” The Total Criminalization of Abortion in the Dominican Republic WATCH “It’s Your Decision, It’s Your Life” The Total Criminalization of Abortion in the Dominican Republic Copyright © 2018 Human Rights Watch All rights reserved. Printed in the United States of America ISBN: 978-1-6231-36758 Cover design by Rafael Jimenez Human Rights Watch defends the rights of people worldwide. We scrupulously investigate abuses, expose the facts widely, and pressure those with power to respect rights and secure justice. Human Rights Watch is an independent, international organization that works as part of a vibrant movement to uphold human dignity and advance the cause of human rights for all. Human Rights Watch is an international organization with staff in more than 40 countries, and offices in Amsterdam, Beirut, Berlin, Brussels, Chicago, Geneva, Goma, Johannesburg, London, Los Angeles, Moscow, Nairobi, New York, Paris, San Francisco, São Paulo, Sydney, Tokyo, Toronto, Tunis, Washington DC, and Zurich. For more information, please visit our website: http://www.hrw.org NOVEMBER 2018 ISBN: 978-1-6231-36758 “It’s Your Decision, It’s Your Life” The Total Criminalization of Abortion in the Dominican Republic Summary ........................................................................................................................... 1 Recommendations .............................................................................................................. 8 To the National Congress ......................................................................................................... 8 To President Danilo Medina ..................................................................................................... 8 To the Supreme Court of the Dominican Republic ..................................................................... 8 To the Ministry of Public Health ................................................................................................ 8 To the Ministry of Education .................................................................................................... 10 To the Ministry of Women ....................................................................................................... 11 To Donors and United Nations Agencies .................................................................................. 11 To the Inter-American Commission on Human Rights ............................................................... 11 Methodology .................................................................................................................... 12 Terminology ........................................................................................................................... 14 I. Background: Abortion in the Dominican Republic ............................................................ 15 Legal Framework ..................................................................................................................... 15 Abortion Incidence and Safety ................................................................................................ 17 Public Opinion on Abortion ..................................................................................................... 21 Proposals for Reform .............................................................................................................. 21 II. Findings: Unplanned Pregnancies and the Impacts of the Total Abortion Ban ................ 24 Unplanned Pregnancies .......................................................................................................... 24 Clandestine and Unsafe Abortions ......................................................................................... 28 Post-Abortion Complications ............................................................................................ 34 Abusive Behavior by Health Care Providers Following Clandestine Abortion ...................... 37 Reluctance to Seek Medical Care ...................................................................................... 42 Failed Abortions ............................................................................................................... 44 Deaths from Unsafe Abortion ............................................................................................ 47 Lack of Access to Legal Abortion Even in Cases of Rape, Incest, and Serious Health Risks ....... 49 Rape and Incest .............................................................................................................. 49 Serious Health Risks ........................................................................................................ 55 Stigma, Isolation, and Emotional Distress ............................................................................... 58 Vulnerability to Undue Pressure, Abuse, and Coercion ............................................................ 61 III. The Dominican Republic’s Human Rights Obligations .................................................. 65 Right to Life ............................................................................................................................ 65 Right to Health....................................................................................................................... 69 Right to be Free from Torture and Other Cruel, Inhuman, or Degrading Treatment ..................... 70 Rights to Nondiscrimination and Equality ................................................................................ 71 Right to Privacy ....................................................................................................................... 72 Right to Information ................................................................................................................ 74 Right to Decide the Number and Spacing of Children ............................................................... 75 Freedom from Gender-Based Violence .................................................................................... 76 Acknowledgments ............................................................................................................ 77 Summary Abortion is illegal in the Dominican Republic in all circumstances, even when the life of the pregnant woman or girl is in danger. The country’s total abortion ban has devastating consequences. Women and girls facing unplanned or unwanted pregnancies—including those resulting from rape or incest, or when the fetus will not survive—are forced to choose between clandestine abortion or continuing their pregnancies, even if they do not want to and even if they face serious health risks, including death. Some women and girls can afford to travel to another country where abortion is legal or find safe providers to help them to end a pregnancy, but many, especially those from poor and rural communities risk their health and lives to have clandestine abortions, often without any guidance from trained providers. Some suffer serious health complications, and even death, from unsafe abortion. Melina, 26, told Human Rights Watch she had an unwanted pregnancy in 2017 when her contraceptive method failed. Already a mother of four young children, she was deeply distressed when she learned she was pregnant. She tried to end the pregnancy by drinking a tea made from herbs and plants—one of many home remedies women use to try to end pregnancies clandestinely. She began bleeding and felt intense pain in her back and abdomen. Melina felt something had gone wrong but delayed seeking medical attention because she feared being reported to authorities, or facing abuse by medical providers, for having an illegal abortion. When the pain became unbearable, she went to a public hospital and explained that she made a tea to try to end a pregnancy. The abortion was incomplete: the pregnancy had ended, but tissue remained in her uterus, putting her at risk of serious complications. The provider prescribed a medication that helps the body expel tissue from the uterus and sent her away without examining her or giving her anything to manage the pain. Melina took the medication, but the pain persisted for ten days, and she developed an infection. “I started thinking I was not going to survive it.” When she spoke with Human Rights Watch, six months later, she still suffered chronic pain and other health effects from the ordeal. “It was really intense. I suffered a lot,” she said. The criminal code in the Dominican Republic imposes prison sentences of up to two years on women and girls who induce abortions and up to 20 years for medical professionals who provide them. Although criminal actions against women and girls who seek abortions, 1 HUMAN RIGHTS WATCH | NOVEMBER 2018 and those who help them, are relatively rare, the law has created pervasive fear that drives women and girls to desperate measures to end unwanted pregnancies, and leaves healthcare providers unable to protect the health and lives of their patients. For more than two decades, legislators in the Dominican Republic have debated a new penal code. President Danilo Medina has urged legislators to decriminalize abortion in three circumstances: when the life of the woman or girl is in danger, when the pregnancy resulted from rape or incest, or when the fetus has serious complications incompatible with life outside of the womb. He twice vetoed penal code reforms that maintained the total abortion ban without exceptions. As of
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