Abortion in Costa Rica

Therapeutic abortion refers to the termination of a pregnancy for medical reasons aimed at protecting the health or life of the pregnant person. This type of abortion is performed when continuing the pregnancy poses a significant risk to the physical or mental well-being of the pregnant individual.

According to the Center for Reproductive Rights (translated from Spanish), therapeutic abortion is legal according to Article 121 of the Penal Code. Although it might be technically allowed, public hospitals, where the majority of Costa Ricans seek medical treatment, generally decline to provide the procedure unless a woman's life is on the line, such as in the situation of an ectopic pregnancy.[6]

Adequate measures have not been taken to guarantee this right. Specifically, there are no specialised protocols or guides that tell health care workers how to proceed with an abortion if the life or physical or mental health of the woman is at risk. There are also no effective judicial or administrative mechanisms through which this procedure can be demanded to be performed."[7]

On December 12th 2019, Costa Rica's President Carlos Alvarado issued a technical decree that allowed for therapeutic abortions in the Central American nation, despite opposition from religious and conservative political groups.[8] The measure outlined clearer requirements for medical professionals and enabled the first therapeutic abortions to be performed within six months at public hospitals.[8] Private clinics were also allowed to perform the procedure.[8]

Health Minister Daniel Salas said in a statement therapeutic abortions can be performed if three requirements are met:[8]

1) If there is no other medical alternative;

2) If the woman gives consent;

3) After mandatory evaluation by three medical professionals.

Fourteen days prior to this, Costa Rica witnessed a gathering of thousands, marching in support of "Yes to Life!" These demonstrators urged Carlos Alvarado not to bypass the legislative chambers, where lawmakers advocating pro-life positions had the potential to obstruct a new abortion legislation.[9]

Fabricio Alvarado, leader of the opposition, actively participated in the protest and accused the government of attempting to enforce "unlimited abortion" in defiance of the majority's wishes.[9]

Ricardo Salazar, Pastor of the Abundant Life evangelical church, asserted, "Costa Rica is a nation that values life, a country built on the belief in life. Suddenly, through deceitful means, there's an attempt to supplant a law that truly reflects the sentiments of Costa Ricans with an unnecessary one that could legalize abortion."[9]

Bishop José Manuel Garita Herrera of Ciudad Quesada spoke out against the decree and urged respect for both lives- that of the mother and of the child in her womb.[10]

"To doctors, my call is also that, faithful to the principle and vocation to which they have consecrated themselves, allow them to place their gifts at the service of the mother and her son," Bishop Herrera said, as reported by CNA's Spanish-language news partner ACI Prensa.[10]

Rodrigo Chaves Robles is Costa Rica's current President and has played a pivotal role in shaping the country's approach to therapeutic abortion.

In 2022 President Rodrigo Chaves Robles took part in a significant meeting with members of the Catholic Episcopal Conference.[11] The discussions centred around the topic of abortion, particularly the therapeutic interruption of pregnancy[11].This commission, composed of subject experts, representatives from the Ministry of Health, the Costa Rican Social Security Fund (CCSS), medical professionals, and other stakeholders, concluded its assessment on June 20, 2022.[12]

Following the meeting, the newly appointed Minister of Health, Joselyn Chacón, announced a forthcoming review of the technical standard concerning therapeutic abortion.[11] Chacón emphasised that this review, scheduled for June 2022, aimed to ensure that the regulations accurately reflect the government's commitment to prioritising the life of the mother.[11]

Chacón stated that the revision process would involve a commission and comprehensive studies on the subject.[11] She emphasised the alignment of this initiative with the requests made by the bishops during the meeting with President Chaves Robles.[11] Chacón reiterated that the government's stance is not in favour of pro-abortion policies but is steadfast in safeguarding the mother's life.[11]

President Chaves Robles articulated his position on the revision of the technical standard.[11] He highlighted that the primary objective of this review is to eliminate any potential loopholes that might arise.[11] He reiterated his unwavering commitment to ensuring that the standard serves the explicit purpose of regulating situations where a pregnancy jeopardizes the life of the mother.[11]

Chaves Robles acknowledged his limited expertise on the matter but emphasised that any deviations from the core objective of protecting the mother's life would warrant careful examination.[11]

The technical standard, initially signed in December 2019 by then-President Carlos Alvarado, holds paramount importance in the landscape of abortion regulations in Costa Rica.[8] It establishes the framework for the application of therapeutic abortion within the country, outlining the necessary regulations and procedures.[8]

Griselda Ugalde, former president of the College of Nurses and a participant in the commission's work, conveyed that the commission found no need for changes to the document.[12] However, any further progress or action regarding the technical standard is contingent upon the decision of Joselyn Chacón, the Minister of Health.[12]

Griselda Ugalde highlighted the persistence of patriarchal, homophobic, and misogynistic attitudes in Costa Rican society. She acknowledged that despite progress, there may be limited support for therapeutic abortion.[12]

The lack of implementation of the existing norm posed questions about the necessity of the review process.[13] The challenges surrounding personnel training and evaluation processes were noted as factors contributing to the limited application of the standard.[14]

The consensus reached by the commission was that modifications to the technical standard were unnecessary given its evaluation.[13] Larissa Arroyo, a representative for individuals who were compelled to carry unviable pregnancies to term, pointed out that while the technical norm might not be ideal according to international standards, it represents progress within Costa Rica's legal framework.[13]

The possibility of a review process raised concerns about resource allocation and accountability.[13]

Following a comprehensive 10-day visit to Costa Rica, UN Special Rapporteur on health rights, Tlaleng Mofokeng, has emphasised the country's potential to overcome challenges and achieve truly universal healthcare.[17] During her visit, Mofokeng engaged with a range of stakeholders, including government officials, civil society, healthcare professionals, and marginalised groups.

She underscored the need for a holistic approach to healthcare, focusing not only on access but also on addressing underlying determinants.[17] Mofokeng called for the full recognition of the right to health in Costa Rica's constitution and expressed concerns about the criminalization of abortion, which she deemed to be in violation of human rights standards and medical protocols.[17]

Mofokeng's recommendations include the decriminalisation of abortion, highlighting that such laws restrict autonomy, hinder the patient-doctor relationship, and perpetuate gender discrimination.[17] She proposed a moratorium on enforcing abortion laws and commended Costa Rica for its effective COVID-19 strategies, urging ongoing stakeholder involvement in health policymaking.[17]

Additionally, Mofokeng addressed issues of racism and xenophobia, identifying them as significant obstacles to health rights, as marginalised communities often face systemic violence.[17] While acknowledging Costa Rica's progress, Mofokeng's visit underscored the importance of comprehensive healthcare reform that ensures equitable access for all individuals, especially marginalised groups.[17]

Her report, scheduled for presentation to the UN Human Rights Council in June 2024, will provide comprehensive recommendations to further advance healthcare access and human rights in the country.[17] In response to the call by Tlaleng Mofokeng, the Catholic Church in Costa Rica has voiced its strong opposition.

The Church emphasised the sanctity of human life and rejected the assertion that the restriction of abortion contributes to obstetric violence.[18] The Church questioned the claim that deaths related to obstetrics would have been prevented through total decriminalisation of abortion, and stated that intentionally taking the life of a foetus is the worst form of discrimination a human being can experience.[18]

The Church invoked various norms, including the Political Constitution and agreements safeguarding children's rights, to support their stance. The Foreign Ministry of Costa Rica also responded, highlighting that the prohibition of abortion is deeply rooted in the country's legal principles and constitution.[18] The government expressed disagreement with the UN observations, asserting that the right to life is a fundamental human right enshrined in the country's legal framework.[18]

Tlaleng Mofokeng's visit to Costa Rica revealed various health-related concerns. She noted challenges in the Costa Rican health system, including long wait times for consultations and care, particularly in the Costa Rican Social Security Fund.[18] Mofokeng identified vulnerabilities in specific groups such as people with disabilities, the LGBT population, adolescents, migrants, and indigenous and Afro-descendant peoples.[18]

The drug commonly utilised for abortions, misoprostol, is primarily known by its trade name Cytotec. However, it was initially developed for gastric issues like ulcers, rather than gynecological purposes.[19] Notably, Costa Rica lacks a registered trademark for misoprostol for gynecological use, possibly due to the associated stigma around abortion. Cytotec is not available for over-the-counter purchase and is strictly controlled, requiring a prescription.[19]

The restricted availability of Cytotec stems from its key component, misoprostol, which the World Health Organization (WHO) recognizes as a safe element for performing abortions. However, its dual-use nature prompts stringent regulations. The medication can only be provided under a prescription and is available within the Caja Costarricense de Seguro Social (CCSS) for gastrointestinal issues, not for gynecological purposes.[19]

In Costa Rica, there is no officially registered organisation offering misoprostol openly, and any such provision would be unlawful without a prescription. Abortion remains prohibited by the Penal Code (Articles 118 and 119), with the exception of therapeutic abortion under Article 121.[19] Additionally, the law is specific to abortions within Costa Rican territory, and performing an abortion abroad doesn't constitute a crime under Costa Rican jurisdiction.[19]

If a woman receives the medication through mail and performs the abortion within the country, it can be considered a crime. Providers and individuals assisting in the procedure may also face sanctions.[19] Alternative methods to obtain the medication include private consultations with medical professionals or purchasing from websites. The cost can be significant, potentially leading individuals to women's support organizations that offer free access but may involve legal risks.[19]

To promote women's health, the World Health Organization (WHO) advocates for removing regulatory barriers to safe abortion. WHO's guidelines emphasise the importance of dignified, non-stigmatising care that respects women's autonomy and decisions.[19] Ensuring safe abortion care extends beyond medical safety; it involves addressing societal stigmatization and the potential legal repercussions that women may face.[19]

International Safe Abortion Day on September 28 aims to prevent complications and deaths from unsafe clandestine abortions. In Costa Rica, the period from 1997 to 2017 saw over 97,000 cases of women seeking medical care due to complications from incomplete abortions.[19] In 2017 alone, the Caja reported 25 hospitalisations for spontaneous abortions and more than 2,000 for incomplete abortions.[19]

Websites offering misoprostol for abortion-related purposes have emerged in Costa Rica. However, acquiring misoprostol through such channels could potentially breach legal frameworks as it's a prescription-only medication.[19] These online platforms facilitate communication through WhatsApp, inquiring about factors like gestational age and delivery coordination, but purchasing from them can carry legal and safety risks.[19]

The landscape surrounding abortion access in Costa Rica reflects both medical complexities and legal considerations, emphasizing the need for comprehensive and compassionate approaches that prioritize women's health and autonomy.[19]