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An Open Secret: the Hidden History of Unwanted Pregnancy and Abortion in Highland Bolivia, 1952-2010

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An Open Secret: the Hidden History of Unwanted Pregnancy and Abortion in Highland Bolivia, 1952-2010 AN OPEN SECRET: THE HIDDEN HISTORY OF UNWANTED PREGNANCY AND ABORTION IN HIGHLAND BOLIVIA, 1952-2010 by Natalie L. Kimball B.A. in Latin American Studies, University of Washington, 2001 M.A. in History, University of Pittsburgh, 2008 Submitted to the Graduate Faculty of the Kenneth P. Dietrich School of Arts and Sciences in partial fulfillment of the requirements for the degree of PhD in History University of Pittsburgh 2013 UNIVERSITY OF PITTSBURGH THE KENNETH P. DIETRICH SCHOOL OF ARTS AND SCIENCES This dissertation was presented by Natalie L. Kimball It was defended on May 7, 2013 and approved by Kathleen Blee, Distinguished Professor and Associate Dean for Graduate Studies and Research, Sociology Alejandro de la Fuente, UCIS Research Professor, History Laura Gotkowitz, Associate Professor, History Lara Putnam, Associate Professor, History Dissertation Advisor: George Reid Andrews, Distinguished Professor and Chair, History ii Copyright © by Natalie L. Kimball 2013 iii AN OPEN SECRET: THE HIDDEN HISTORY OF UNWANTED PREGNANCY AND ABORTION IN HIGHLAND BOLIVIA, 1952-2010 Natalie L. Kimball, PhD University of Pittsburgh, 2013 This dissertation traces the history of unwanted pregnancy and abortion in La Paz and El Alto, Bolivia between 1952 and 2010. Although in Bolivia abortion is illegal, an estimated three in five women terminate at least one pregnancy in their lifetime—making the country’s abortion rate the highest in the region. Based on 113 personal interviews and over 3,000 medical records, the project reconstructs two central aspects of reproductive history. The first centers on the social, political, and medical phenomena of abortion and pregnancy. I outline changing policies and debates on reproduction, the evolution of abortion incidence and provisioning, and the emergence of a stable illegal abortion system in the country. A central argument of the project is that women’s experiences with illegal abortion helped shape both the evolution of reproductive health policy and changes in abortion provisioning in the country. In particular, I find that women’s demand for abortion coalesced with broader processes set in motion by the democratic opening of 1982 to spark the emergence of a stable and efficient system for the provision of illegal abortion in these cities. These improvements in abortion care provided a response to women’s need to control their reproduction while simultaneously slowing efforts to legalize the procedure. The final two chapters of the dissertation chart new territory in the history of reproduction by exploring women’s personal experiences with unwanted pregnancy and abortion. In these ethnographic chapters, I analyze interview testimony to uncover the complex iv range of factors influencing women’s feelings and reactions toward pregnancy and motherhood. I argue that the language of “choice” often employed by reproductive rights movements is too narrow to adequately capture the contours of human experience. Instead, women’s decisions to continue or terminate their pregnancies were often so heavily conditioned by adverse circumstances that most felt they had no choice but to do so. v TABLE OF CONTENTS ACKNOWLEDGEMENTS ........................................................................................................ X 1.0 INTRODUCTION ........................................................................................................ 1 1.1 SEXUALITY, REPRODUCTION, AND NATION-BUILDING IN LATIN AMERICA ............................................................................................................................. 6 1.2 RACE, ETHNICITY, AND GENDER IN ANDEAN BOLIVIA ......................... 10 1.3 THE “PROMISE AND DILEMMA” OF ORAL HISTORY (AND OTHER METHDOLOGICAL QUESTIONS) ............................................................................... 22 1.4 OUTLINE OF PROJECT ....................................................................................... 32 2.0 DOUBLE DISCOURSES: DEBATING AND LEGISLATING UNWANTED PREGNANCY AND ABORTION ............................................................................................ 36 2.1 LEGISLATING WOMEN’S REPRODUCTION: POLICIES ON UNWANTED PREGNANCY AND ABORTION, 1952-2010 ................................................................. 40 2.2 “UN SECRETO A VOCES”: THE DOUBLE DISCOURSE OF ABORTION IN ANDEAN BOLIVIA ........................................................................................................... 68 3.0 MAPPING ABORTION CARE IN THE URBAN ANDES: THE LANDSCAPE OF ABORTION AND UNEXPLAINED MISCARRIAGE .................................................... 84 3.1 ABORTION INCIDENCE AND CONTRACEPTIVE USE IN ANDEAN BOLIVIA, 1952-2010 ......................................................................................................... 88 vi 3.2 THE LANDSCAPE OF ILLEGAL ABORTION IN ANDEAN BOLIVIA, 1952- 2010 .................................................................................................................................. 104 4.0 ABORTION CARE IN THE WAKE OF DEMOCRACY: ABORTION REFERRALS AND PROVISIONING IN HIGHLAND BOLIVIA, 1982-2010 ................. 123 4.1 “EVERY LAW HAS ITS LOOPHOLE”: THE 1982 DEMOCRATIC OPENING AND ITS IMPACT ON ABORTION CARE ............................................. 126 4.2 SYMPATHETIC ALLIES: BOLIVIAN AUTHORITIES AND ABORTION LAW .................................................................................................................................. 138 5.0 NAVIGATING CHOICE AND OBLIGATION: WOMEN’S EXPERIENCES WITH ABORTION AND UNEXPLAINED MISCARRIAGE ............................................ 155 5.1 MEDICAL RECORDS: PARTIAL INSIGHTS INTO ABORTION EXPERIENCES ................................................................................................................ 160 5.2 INTIMATE EXPERIENCES: INTERVIEWS WITH WOMEN WHO HAD ABORTIONS .................................................................................................................... 170 5.3 ABORTION, DECISION-MAKING, AND “CHOICE” .................................... 181 6.0 KEEPING THE CHILD: WOMEN’S EXPERIENCES CONTINUING UNWANTED PREGNANCIES ............................................................................................... 198 6.1 “IT WASN’T THE TYPE OF RELATIONSHIP YOU GET PREGNANT IN”: WOMEN’S FEELINGS TOWARD UNWANTED AND UNEXPECTED PREGNANCIES ............................................................................................................... 202 6.2 “I’LL JUST HAVE IT”: WOMEN’S EXPERIENCES CONTINUING UNWANTED PREGNANCIES ...................................................................................... 221 6.3 CONCLUSION ....................................................................................................... 244 vii APPENDIX A ............................................................................................................................ 249 BIBLIOGRAPHY ..................................................................................................................... 258 viii LIST OF FIGURES Figure 1. Informal medical clinic. ............................................................................................... 110 ix ACKNOWLEDGEMENTS This project was supported by an Andrew Mellon Pre-Doctoral Fellowship, a Lillian B. Lawler Fellowship, and summer funding from the University of Pittsburgh’s Department of History and Center for Latin American Studies. I am very grateful for the opportunities that this funding made possible. I would like to thank, above all, each of the women who shared with me their experiences with pregnancy, abortion, and miscarriage; those who told me of their trials attempting to become pregnant; and those who explained to me their thoughts and attitudes toward pregnancy. En compartir sus historias conmigo ustedes me abrieron el corazón, y por eso les estoy sumamente agradecida. I extend an equally ardent thank you to each of the other individuals I interviewed in La Paz and El Alto, who gave me their time, shared with me their personal and professional insights, and more often than not, directed me to still other individuals to interview. A todos las personas que entrevisté para el proyecto: No sólo hicieron posible esta tesis, sino me influyeron personal- y profesionalmente de una manera profunda. Muchas gracias. This project would have been almost impossible without the assistance of Sayuri Loza, who transcribed all of my interviews and helped me navigate doubts of a linguistic and cultural nature. Sayuri, you have been a gift to this project. Lourdes Peñaranda was also invaluable to the dissertation. Lourdes facilitated my access to dozens of interviewees in La Paz and El Alto, x stretched my thinking on questions of reproductive rights and choice, and kept me company during my various visits to the region. Lulú, eres una amiga de corazón. Thank you also to: - Verónica, María Eugenia, and Yamel of CEPROSI, who introduced me to women at workshops and worked to integrate me into these groups, and to CEPROSI founders and trusted friends Ana María Vargas and Gastón Lobatón. - The many women of CIDEM, who taught me about the history of women’s movements in Bolivia and made my time in La Paz and El Alto both fun and fulfilling. A special thank you to Gladys Achá, Pati Brañez, Ximena Machicao, and Rosario Mamani. - Gabi Kuenzli and Molly Geidel, who read my work and kept me company in La Paz, and the capoeiristas of Cordão de Ouro, who helped me stay sane and active during my field research.
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