San Salvador, El Salvador - Beatriz, a 22-year-old woman known to the world only by a single name, has a simple request.
“I want to live,” she says.
Her life hangs by a thread while the El Salvador’s Supreme Court decides whether her right to life should be protected, or whether the rights of her unborn foetus should prevail.
Beatriz is almost 23 weeks pregnant. She has lupus, an auto-immune disease which causes the body’s immune system to attack its own tissue. Her condition is deteriorating and her doctors say she is at “high risk of death” if the pregnancy continues.
Medics have recommended an abortion in order to save her life, but cannot proceed amid fear of prosecution.
El Salvador is one of three Latin American countries where abortion is illegal in all circumstances – punishable with up to 30 years in prison.
Yet in this case, the foetus is unviable. Several scans have revealed that it is anencephalic – missing a large part of the brain and skull. Almost all babies with anencephaly die before birth, or within a few hours or days after birth. It has no chance of surviving into infancy, experts say.
Beatriz, from the east of this tiny Central American country, has a 14-month-old son who also suffers various health problems – caused by serious complications she suffered during pregnancy.
At that time, Beatriz suffered an exacerbation of her lupus, but also anaemia, pneumonia, and high blood pressure which led to severe pre-eclampsia. Her son was delivered early using an emergency caesarean section, and spent more than a month in hospital with digestive and respiratory problems.
“I want to live to protect and raise my son,” Beatriz said through her lawyers.
She is currently in hospital suffering from early-stage kidney failure, caused by her lupus. With every day that passes the risk to Beatriz’s life increases, her doctors say.
But the country’s powerful religious campaigners are adamant that there be no exceptions - that the life of the foetus must be protected from the moment of conception. Public opinion is divided.
Her medical team made an application to El Salvadorian legal authorities at the end of March, seeking permission to proceed with a therapeutic abortion in order to safeguard Beatriz’s health. They asked for a guarantee that they would not be prosecuted.
Under Article 133 of the country’s penal code, anyone who provides – or tries to access – abortion services can face lengthy prison sentences. Women and doctors can be charged with aggravated homicide.
The authorities have yet to respond to her doctors’ request.
The attorney general could use his powers to give the doctors and Beatriz protection from prosecution. He has so far refused to do so.
The country’s highest court was therefore presented with the case in mid-April. Lawyers acting for Beatriz asked the Supreme Court to guarantee legal protection for Beatriz and her doctors.
Several international bodies have also intervened.
The Inter-American Commission on Human Rights took the unprecedented step of ordering the El Salvadorian government to take “precautionary measures” and implement the treatment recommended by the Specialised National Maternity Hospital.
On April 29, the commission gave the government 72 hours to comply with the precautionary measures in order “to safeguard life, personal integrity and health”. It was an attempt by the commission to ensure the case was expedited by the Supreme Court.
Despite that ruling, no decision has yet been made.
“The delays are unconscionable,” Amnesty International’s Esther Major told Al Jazeera.
Last week the Constitutional Chamber of the Supreme Court ordered a range of psychological and physical tests to be carried out on Beatriz by the Institute of Legal Medicine (ILM).
To the shock of campaigners, the ILM opinion contradicted all previous assessments and recommended Beatriz continue with the pregnancy – a “wait and see” approach.
“The opinion was completely biased,” said Sara Garcia from the Citizens’ Group for the Decriminalisation of Therapeutic, Ethical and Eugenic Abortion. ”Four of the doctors that participated had already expressed an opinion against Beatriz being allowed a therapeutic abortion.”
The ILM has publicly rejected accusations of bias, stating that its opinion was supported by various national medical organisations – including the Association of Bioethics, the Association of Rheumatology and the Association of Nephrology and Arterial Hypertension.
In what appears to be Beatriz’s last chance, her lawyers submitted an application to the Supreme Court on May 8, urging them to reject the ILM opinion on the grounds of “bias and flawed process”.
“This is the end, the legal possibilities have been exhausted,” said Victor Hugo, Beatriz’s lawyer.
The case has re-ignited national and international debates about access to abortion and a woman’s right to life.
Abortion was criminalised in El Salvador in 1997 by the then-governing Nationalist Republican Alliance party. Before then, abortion in cases such as Beatriz’s would have been permitted.
Marta Maria Blandon is the regional director of the international abortion rights organisation IPAS. “It was a political manoeuvre in an electoral context, trying to secure votes from conservative groups by showing unconditional support for the Catholic Church,” she told Al Jazeera.
“The reform to the penal code was done in secret without any public consultation.”
Since then, around 600 women have been criminally investigated. Almost 30 have been imprisoned for 30 years, many convicted of infanticide. Six women have subsequently been freed following campaigns by the Citizens’ Group for the Decriminalisation of Therapeutic, Ethical and Eugenic Abortion.
Activists, rights groups, academics and clinicians – including the United Nations representative in El Salvador and UN experts on the rights to health, torture, violence and discrimination against women – are among those urging authorities to grant Beatriz the right to a termination in order to save her life. Amnesty International has launched an online appeal for people to write to Luiz Martinez, the country’s attorney general.
They argue that the failure of the state to act amounts to cruel, inhumane and degrading treatment.
El Salvador’s Minister of Health, Maria Isabel Rodriguez, and her legal adviser have also written to the Supreme Court supporting the medical and constitutional basis of Beatriz’s case.
Rodriguez is the only government minister so far to speak out in support of Beatriz’s right to life – and has also criticised the IML medical opinion as flawed.
In contrast, the “Sí a la Vida” ["Yes to Life"] Foundation, an anti-abortion religious group, says feminist groups are exploiting and manipulating Beatriz in order to legalise abortion.
In a recent statement of support for anti-abortion groups, El Salvador’s Conference of Catholic Bishops said protecting the unborn child “does not constitute a violation” of Beatriz’s constitutional rights.
A global issue
Parallels are being drawn between this case and the death of Savita Halappanavar in Ireland in October 2012.
Halappanavar, an Indian dentist working in Ireland, was denied a potentially life-saving emergency abortion despite the fact she had suffered a miscarriage – because the foetus’ heart was still faintly beating.
In Ireland, the Catholic Church is vehemently opposing a new parliamentary bill to relax the strict laws and allow abortion to save a mother’s life.
Around 25 per cent of the world’s population live in countries which prohibit or punish women and health professionals for abortion.
World Health Organisation figures suggest almost 70,000 women die annually as a result of unsafe “illegal” abortions – accounting for 13 per cent of all maternal deaths.
Latin America hosts some of the world’s most restrictive abortion laws. In many countries, abortion is permitted only to save the woman’s life, but in Nicaragua, El Salvador and Chile, abortion is prohibited under all circumstances.
Yet the region also has some of the world’s highest rates of abortion, due to the significant unmet need for contraceptives which causes high rates of unplanned pregnancies, according to IPAS.
“We are horrified that government officials in El Salvador are standing by, watching Beatriz suffer pain and anguish, and maybe even die. It is utterly inexcusable of them to deny her life-saving treatment,” said Esther Major, Amnesty International’s El Salvadorian expert.
“Each official and judge who does not do what they can to save her, or prevent her suffering severe health damage, risks having blood on their hands. It is a human rights scandal, and one which has discrimination at its heart. Beatriz is poor, and needs treatment only women and girls need.”
Beatriz’s identity has been hidden amid enormous stigma and strong, divided opinions about her case. But on Sunday May 5, she recorded a plea to the country’s president.
“President Mauricio Funes Cartagena, help me please,” she said.
“This baby inside me cannot survive. I am ill. I want to live… I want to live for my son.”