Abortion in Bolivia: An Open Secret


Abortion in Bolivia is prohibited except in cases of rape, incest, and saving the mother’s life. But even with those allowances, the procedure is rarely greenlighted. Just 126 abortions were legally permitted in Bolivia between 1973 and 2016. 

And yet, abortion in Bolivia is ubiquitous, according to Professor Natalie Kimball (College of Staten Island). While researching a book on the topic, Kimball heard the phrase “secreto a voces”—an open secret—used so often that it became the book’s title: An Open Secret: The History of Unwanted Pregnancy and Abortion in Modern Bolivia

Despite its illegality, abortion is relatively easy to obtain in Bolivia today, Kimball reports. In the cities of La Paz and El Alto, offices advertising pregnancy tests in certain neighborhoods often provide abortions. Abortion is “not widely stigmatized” in indigenous communities (though there are taboos around improper burial of a fetus), so women sometimes turn to traditional healers for abortifacient herbs or teas. Recently, the abortion pill, misoprostol, has made abortions safer, easier, cheaper, and more private. 

But in the past, complications from illegal abortions were not uncommon, including hemorrhages, infections, and even death. The problem was so widespread that the government eventually instituted programs to provide expert, free medical treatment for pregnancy loss. Because it’s difficult to medically distinguish miscarriage from abortion, treatment is provided without asking patients whether a pregnancy ended spontaneously or due to abortion.

Kimball says concepts like “choice” and a woman’s right to bodily autonomy, which dominate abortion rights discussions in the U.S., are “inadequate” to describe Bolivian women’s experiences. In dozens of interviews, women told Kimball that they were “obligated” or “forced” into their decisions. Factors that led them to seek abortions included unstable relationships, poverty, lack of access to contraception, and domestic violence. Women who already had children said they lacked the resources to care for more, while young, unmarried first-time mothers felt ashamed. 

“Recent government programs for the treatment of incomplete abortion and miscarriage belie an official recognition of the frequency with which women confront unwanted pregnancy and abortion,” Kimball wrote. This “does not mean that the state condones abortion,” but it acknowledges “that women will terminate pregnancies regardless of its legal status – and the tacit acceptance of that fact.”

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"Natalie Kimball, " (New Books in Public Policy Podcast)