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“Why Do They Want to Make Me Suffer Again?” the Impact of Abortion Prosecutions in Ecuador

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HUMAN “Why Do They Want to RIGHTS WATCH Make Me Suffer Again?” The Impact of Abortion Prosecutions in Ecuador “Why Do They Want to Make Me Suffer Again?” The Impact of Abortion Prosecutions in Ecuador Copyright © 2021 Human Rights Watch All rights reserved. Printed in the United States of America ISBN: 978-1-62313-919-3 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, Sydney, Tokyo, Toronto, Tunis, Washington DC, and Zurich. For more information, please visit our website: http://www.hrw.org JULY 2021 ISBN: 978-1-62313-919-3 “Why Do They Want to Make Me Suffer Again?” The Impact of Abortion Prosecutions in Ecuador Summary ........................................................................................................................... 1 Key Recommendations ....................................................................................................... 8 To the Presidency .................................................................................................................... 8 To the National Assembly ........................................................................................................ 8 To the Ministry of Health .......................................................................................................... 8 To the Judiciary Council .......................................................................................................... 10 To the Chief of Police .............................................................................................................. 10 To the Attorney General’s Office .............................................................................................. 10 Methodology ..................................................................................................................... 11 Terminology ..................................................................................................................... 16 I. Background: Abortion in Ecuador ................................................................................... 21 Legal Framework on Abortion .................................................................................................. 22 Confidentiality ................................................................................................................. 27 Conscientious Objection ................................................................................................. 28 Due Process .................................................................................................................... 28 Criminal Code ................................................................................................................. 29 Ecuadorian Constitutional Court Ruling on Access to Abortion in All cases of Rape ............ 30 Human Rights Ombudsperson’s Office on New Abortion Law ............................................ 31 Impact of Covid-19 on Reproductive Rights in Ecuador ............................................................. 33 II. Ecuador’s Criminalization of Abortion ........................................................................... 37 Prosecution of Women and Girls Experiencing Obstetric Emergencies .................................... 49 Prosecution of Survivors of Rape and Other Forms of Gender-Based Violence .......................... 51 Justice Officials Ignoring Gender-Based Violence While Pursuing Abortion Charges ........... 56 Pressure on Health Care Workers and Violations of Medical Confidentiality ............................. 59 Treatment in the Justice System ............................................................................................. 64 Due Process Concerns ..................................................................................................... 64 Gender Stereotypes and Religious Considerations in Treatment of Women Defendants ..... 71 Lack of Comprehensive Sexuality Education ............................................................................ 75 III. Social and Financial Impact of Ecuador’s Criminalization of Abortion ........................... 77 Maternal Mortality and Morbidity ............................................................................................ 77 Cutting Women and Girls Off from Essential Health Care ......................................................... 84 Undermining Efforts to Fight Rape and Other Forms of Gender-Based Violence ....................... 87 Economic Costs of Criminalization ......................................................................................... 88 IV. International Legal Obligations ................................................................................... 90 Right to Life ........................................................................................................................... 96 Right to Health...................................................................................................................... 101 Right to be Free from Cruel, Inhuman, or Degrading Treatment ............................................... 104 Rights to Nondiscrimination and Equality .............................................................................. 106 Right to Privacy ..................................................................................................................... 107 Rights of Persons Deprived of Liberty .................................................................................... 108 Right to Due Process ............................................................................................................. 109 Right to Freedom from Violence ............................................................................................. 111 Adolescents’ and Girls’ Sexual and Reproductive Rights ........................................................ 112 Right to Comprehensive Sexuality Education ......................................................................... 114 Right to Access to Information ............................................................................................... 115 Recommendations ........................................................................................................... 118 To Presidency ....................................................................................................................... 118 To the National Assembly ..................................................................................................... 118 To the Ministry of Health ....................................................................................................... 120 To the Judiciary Council ........................................................................................................ 124 To the Chief of Police ............................................................................................................ 125 To the Attorney General’s Office ............................................................................................ 125 To the Public Defender’s Office ............................................................................................. 125 To the Ministry of Health, Ministry of Education, and the Ministry of Economic and Social Inclusion .............................................................................................................................. 126 To Donors and United Nations Agencies ................................................................................ 126 Acknowledgments ........................................................................................................... 127 Annex 1 .......................................................................................................................... 129 Annex 2 ........................................................................................................................... 141 Summary In 2017, Sara, at age 38 with two children, thought she was too old to get pregnant again. When she started to bleed heavily, she went to a public hospital in Quito. A doctor diagnosed a urinary-tract infection and recorded in her medical chart that the infection had provoked a miscarriage. A new doctor on the following shift took over her care. He began to interrogate Sara about her bleeding, asking her if she had taken any pills or had tried to have an abortion. Sara’s condition was still unstable, and she had a high fever; the doctor called the police. While she was still bleeding from a procedure to remove the remaining tissue from her uterus, Sara, naked but for a hospital gown, and with a few sanitary pads, was taken by police to a detention unit in the middle of the night and charged with an abortion with consent, a crime under Ecuadorian law. By early morning, Sara was assigned a public defender, who advised her to plead guilty in return for a lighter sentence. Within a few hours, the hearing took
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