Carla works nights at a beeper answering service. At 29, like most of Peru's young people, she doesn't earn enough money to move out of her mother's home in a lower-income neighborhood of Lima, the capital city. Without post-secondary training, she has few prospects of finding a good job in the future and her boyfriend can't find work, but Carla says life could be much worse - she could be struggling to feed, clothe, and raise a child.
When she was just 19 and pregnant, Carla's mother took her to a doctor who was a friend of the family and known in the community as "safe."
"The girls leave his clinic walking," explains Carla, who nonetheless admits to being afraid before the abortion. "I was so young I didn't know what was happening. I still don't know how it was done ... only that I went into the [private] clinic, was given anesthetic, and woke up alone, fully clothed."
The cost for her family was high, $200 in US dollars (Peru's minimum monthly wage is about $100). But her mother was able to raise the money from relatives and friends, and today Carla says she has no health problems related to the operation.
Considering her scant economic resources, Carla was lucky. Without the emotional support of her family, however, Carla would have lacked psychological guidance, in that the doctor did not provide her with any counseling, advice, or post-operative care other than prescribing contraceptive pills.
Carla says her situation would have been even safer, less expensive, and certainly not as emotionally traumatic if abortion was legal in her country. "But it's not just because of my case that I think abortion should be legalized," she says. "There are people who are much poorer than I am and suffer from having had an abortion."
Like most of Latin America, abortion is illegal in Peru except when necessary to save the expectant mother's life. While many countries (including Brazil, Mexico, and Guatemala) allow abortions under "exceptional" circumstances - if the pregnancy resulted from rape or threatens the mother's life, for example - only Cuba, Guyana, and Barbados have completely decriminalized abortion.
Anti-abortion laws throughout Latin America have created a black market in which women often pay a high price, both economically and health-wise, for the procedure. In Peru, conmadronas are women who perform abortions primarily in middle- and lower-income neighborhoods, often with little or no medical training, using household objects like spoons, knives, and scissors. Carla says she knows women who've gone to conmadronas "and are never right again inside - not all of them are in pain, but many find out later they can't have children."
Abortions in Peru range from about $35-50 US for a conmadrona to $600 or higher for a qualified doctor willing to take the risk. The varying price tags show that abortion is practiced by women from all social classes (though the very rich usually hop a flight to Miami), but the poorest sectors, as always, are more at risk. As a popular local catch-phrase goes, "what's cheap will cost you more in the end." Sadly, the rule also applies to the backroom abortions performed in unsafe conditions that kill about 6000 Latin American women each year - one-quarter of all maternal deaths there, according to World Health Organization (WHO) estimates. The Social Dynamic Research Center of Colombia's Open University reports that at least four million Latin American women risk their lives each year in clandestine abortions, eight times the rate a decade ago.
WHO estimates that between 10 and 50 percent of women who undergo unsafe abortions require some form of post-operative care, highly unlikely in countries where the majority of abortions are unregulated.
WHO officials have argued that legalizing abortion clinics allows for effective regulation and safety standards, but health organizations and activists have not been able to override Latin America's influential Catholic Church. Last year, Brazil's Catholic bishops pushed to keep the abortion debate off the congressional docket. Cardinal Lucas Moreira Neves went so far as to call for "civil disobedience" among doctors if the state loosens control over abortion.
Official statistics estimate that between 200,000 and 850,000 abortions, most of them illegal, are performed each year in Mexico. Feminists and non-governmental organizations say the numbers are much higher - from 500,000 to 1.5 million per year.
To counter church moralists, pro-choice advocates across the region point to studies showing that laws and regulations do not dissuade women with unwanted pregnancies. In Chile, for example, despite laws forbidding abortion under any circumstance, 35 percent of all pregnancies end in abortion, according to the WHO. The organization's statistics also show that 28 percent of the 16.4 million pregnancies in Latin America in 1994 were aborted.
The two sides do agree that the high number of unwanted teenage pregnancies throughout the region is a significant problem. In Peru, Colombia, and El Salvador, approximately 14 percent of all women between 15-19 are already mothers, according to a study published by the New York-based Legal Center for Reproductive Rights.
In a study conducted by the Colombian Profamilia Institute, only four percent of young women surveyed viewed abortion as a "solution" to pregnancy, yet the same study found that of every 1000 pregnancies, 443 are terminated. Last year, a Colombia Open University study came up with even higher numbers: 26 of every 100 female university students, half of them under 20 years old, have had at least one abortion. The report found that 29 percent of women who have abortions suffer complications. The WHO reports pregnant women under 20 are twice as likely to die during childbirth than those above this age, and for 15-year-olds the risk is five times as high.
Beyond the statistics, however, the debate degenerates into seemingly irreconcilable differences with the official church line pushing abstinence as the solution and feminists decrying a lack of effective sex-education programs.
Although Panama and Colombia are the only countries in Latin America without sex education in schools, existing programs throughout the region have been criticized by women's health advocates who say resources and information are usually inadequate.
Carmen Murguia, a youth social worker with the Peruvian Education and Health Institute, a non-governmental organization, says health and social workers there try to warn pregnant young women of the risks associated with unsafe abortions and help them search for alternatives. But she admits there's a lack of services for those who decide to keep their baby but have no financial resources, and after childbirth there are no virtually no support programs to help a woman raise a child.
Whenever possible, Murgia says they encourage young women to confide in a family member or other adult mentor who can help them avoid conmadronas and other unqualified or unhygienic services. "Most youth are afraid of figures of power," she says. "They tell us, ÔMy mother is going to kill me, what can I do?'"
The crushing weight of social taboos, fear, and ignorance in regards to contraception and teenage sexuality have not stopped young people from having sex or abortions. Yet, despite mounting evidence against the effectiveness of anti-abortion laws, many countries are actually tightening existing legislation. A new law in Chile increases prison sentences for anyone convicted of conducting an abortion, while El Salvador last year removed all "exceptional circumstances" under which abortions were previously allowed.
Always eager to jump aboard the puritan bandwagon, conservative forces within the US Congress have so perverted foreign policy that the US, once a major funder of family planning programs, has slashed funding for overseas reproductive health programs in recent years. Claiming such relatively traditional organizations like the UN Population Fund - the world's single largest provider of family planning programs - promote abortion, the pro-life camp has unwittingly become the clandestine abortion practitioner's newest meal ticket.
Nafis Sadik, executive director of the United Nations Population Fund (UNPFA) said the US decision last October to withdraw funding to the organization "will mean the unnecessary death and suffering of women who are deprived of the information.... [The decision] will weaken family planning programs and increase the use of abortion to avoid unwanted births."
In one year alone, according to UNFPA, the withdrawal of US funding will deprive 870,000 women globally of effective modern contraception, resulting in 500,000 unwanted pregnancies and 200,000 abortions.
Women's rights activist and Maryknoll Sister Rose Dominic Trapasso believes that women's access to family planning and sexual education are basic factors in reducing the need for abortions in Latin America. But she also thinks this must be accompanied by a profound elevation of women's social and economic status. She would like to see "services so women can take care of the number of children they already have."
Carla articulates such sentiments when explaining why she is not ashamed of her decision to abort. "I have friends who have had children and do not have anything for them to eat - who go out and leave their babies alone." She tosses her head and says with a touch of quiet pride, "I would never do that."
Stephanie Boyd is the associate editor of Latinamerica Press, a weekly alternative news publication based in Lima, Peru.