To fight abortion stigma, frame it as healthcare

Two decades ago, when she began advocating for abortion in Guanajuato, one of Mexico’s most anti-choice states, many well-meaning people told Veronica Cruz she was going to get in trouble.

In a state where the right to medically-assisted abortion was extremely limited, she was educating women on using misoprostol (an over-the-counter drug for ulcers) to induce an abortion at any time of pregnancy — before it became a World Health Organization (WHO)-recommended protocol.

Prior to the 12th week of pregnancy, the whole process could be completed at home, without medical supervision. After that point, a doctor’s help was often needed. Surely, showing up at a hospital after a self-induced abortion could land Cruz, if not the woman, in jail.

She didn’t think so. Sharing information wasn’t a crime — nor was seeking medical care. International human rights, as well as the Mexican constitution, protect health. “I said, ‘if they send us to jail it will cause a huge scandal and it will speed up the decriminalization process’,” says Cruz, a founder of Las Libres, an organization supporting women in need of abortion. “Every woman, every person has a right to, and is capable to, make decisions about her health,” she says.

She wasn’t alone in framing abortion as a health issue. “This would change the message so that those who make decisions think about it twice before they take this right away,” says Cruz. Eventually, it was by honing this perspective that Mexican activists were able to achieve federal decriminalization of abortion in 2021, and have been able to legalize it in several states across the country.

That abortion is healthcare is an important message in pro-choice activism in the US, too, but so far it hasn’t been given the same prominence of other elements, such as individual agency, or gender equality. Instead, the now-defunct constitutional right to abortion rested on a different framing. In 1973, Roe v. Wade made it a matter of privacy: The government had no right to interfere with what a woman decided to do with her own body, pregnant or otherwise.

Yet in a post-Roe America, as the movement to build abortion rights looks for new strategies, the Mexican — and more broadly, Latin American — approach could offer a helpful template for what comes next.

When health is a right

Mexico’s focus on abortion as healthcare fit in the broader context of Latin America’s Marea Verde, or Green Wave, a transnational movement that started in Argentina in 2015, moving through the continent and north to Mexico with the goal of securing legal and accessible abortion one country after the other.

Colombia provides a clear example of how focusing on abortion as health can offer more reliable protection than centering access on other rights such as privacy, or gender equality. Earlier this year, the largely Catholic country legalized elective abortion up to 24 weeks. But before then, in 2006, the supreme court of Colombia overturned a total ban on abortion as illegal, allowing the procedure in case of rape, incest, fetal abnormalities incompatible with life, and threat to the mother’s health.

Since the constitution protected a woman’s right to equality and health, the court argued, the exceptions couldn’t be limited to life-threatening conditions for the mother. Instead, conditions such as mental distress could qualify, which allowed a somewhat expanded access even before full decriminalization and legalization of abortion in 2022.

This thinking was central to the decision by the supreme court of Mexico to decriminalize abortion. “It isn’t an affair of public health, a social and healthcare issue,” says Olga Sánchez Cordero, the president of Mexico’s Senate and former supreme court justice.

Framing abortion as a matter of healthcare improved access, too, in Mexico, where available services (according to individual state laws) are provided for free in government hospitals. In Mexico City, where abortion has been legal up to 12 weeks for the past 15 years, free abortion services have been offered not only to residents, but to women and girls traveling from states with more restrictions. About a third of the over 240,000 abortions performed in the state since 2007 have been for non-residents, and an increasing number of foreigners, notably Americans from Texas, are traveling to seek abortions in the city according to official data of the state’s health department.

Not a country for affirmative rights

But there is one problem in shifting the strategy in the US from privacy to health: Unlike the former, the latter isn’t a constitutionally protected right at the federal level, and it simply isn’t going to become one.

The concept of health as a right, which is included in the Universal Declaration of Human Rights (UDHR) and features in many constitutions written or revised in the 20th and 21st century, didn’t enter the American political discourse until long after the US Constitution was signed. In fact, the idea of officially listing healthcare as a citizen’s right was first formally introduced in the US as part of Franklin D Roosevelt’s proposed Second Bill of Rights. Roosevelt was never able to turn his plan into law, but he planted the first seed for the idea that health, education, and housing should be considered human rights.

As a UN member, the US adopted the UDHR in 1948, but the country’s uptake of measures actually protecting health has been notoriously slow. In the only rich nation not to guarantee universal health coverage, it is hard to grant protection for a right that isn’t explicitly enshrined in the constitution. It is also hard to see a path to change that, says Julie von Haefen, a North Carolina state representative. “Realistically, I don’t see that happening in the US — look at what’s been going on with the equal rights amendment,” she says, referring to the century-long battle to  amend the constitution to explicitly grant women equal rights.

“The chances of amending the constitution to protect health are close to zero,” says Cary Franklin, a professor of law at the University of California, Los Angeles, whose work focuses on reproductive rights. “The mainstream view is that the United States Constitution, which is a very old constitution, doesn’t protect affirmative rights — like the right to health, the right to clean water, or shelter — the way more modern constitutions do,” she says.

Yet as abortion once again becomes a matter decided by states, framing it as part of healthcare could be effective at least in some of the 15 states that mention a commitment, duty, or concern related to health in their constitutions. “This is a time to be creative. There are going to be many paths forward and we have to try any and all,” says Andrea Miller, president of the National Institute for Reproductive Health.

Reducing the stigma of abortion

The importance of the framing isn’t just in terms of legalization — it has just as important an effect in reducing cultural stigma. It is something activists in the US can achieve, even in the absence of a constitutional protection of health.

“With time and changes in paradigm, we have been able to accept that abortion saves lives,” says Edith Ruiz Rosales, an ob-gyn at the Centro de Salud México España, a government abortion and reproductive care clinic. “It’s a health decision more than a moral one,” she explains.

This stands in sharp contrast with the way abortion is considered in the US. After all, the very opening line of the supreme court decision overturning Roe v. Wade is, “abortion presents a profound moral issue on which Americans hold sharply conflicting views.”

But the supreme court decision might actually help the broader population understand the impact of lack of abortion on healthcare. “It’s no question that abortion is a matter of health and wellbeing,” says Miller. A large portion of the US is about to experience the grave consequences that a nearly complete lack of access to abortion will have on health, both individual and social. This will raise awareness, allowing for a new momentum in abortion rights protection, as well as a reframing of the principles behind it. “I think in terms of organizing and political messaging there is interest in the health framework,” says Franklin. “And I know a lot of reproductive rights activists in America do talk in those terms.”

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