On Friday, the Inter-American Court of Human Rights found El Salvador responsible for obstetric violence in the case of Beatriz, a woman who suffered from lupus and faced a high-risk pregnancy in which the fetus was diagnosed with anencephaly, a condition incompatible with extrauterine life.
Despite recommendations from El Salvador’s national maternity hospital’s medical committee to terminate the pregnancy, as well as precautionary measures from the Inter-American Commission of Human Rights and provisionary measures from the Court, Beatriz was forced to continue the pregnancy. She had an emergency cesarean-section, and the fetus died five hours later.
The Court determined that lack of legal certainty and clear protocols for managing high-risk pregnancies led to the bureaucratization and judicialization – reliance on the courts – of Beatriz’s case, as medical personnel feared criminal liability. The context of legal uncertainty had a profound negative impact on her physical and mental health, constituting obstetric violence and violating her rights to personal integrity, health, privacy, freedom from violence, and judicial guarantees and protection.
The Court also stated that obstetric violence is a form of gender-based violence prohibited by the Inter-American human rights treaties that includes the denial of treatment and full information on health status and applicable treatments.
Abortion is an essential health service and its safe and legal access a human right, essential for the realization of other human rights including reducing maternal mortality and morbidity and protecting bodily autonomy. However, El Salvador maintains a total ban on abortion, contributing to judicial uncertainty and instilling fear of legal repercussions among medical personnel, which resulted in the violation of Beatriz’s rights. The ban persists despite repeated recommendations by the Inter-American Commission on Human Rights and United Nations bodies. In El Salvador, women have been convicted of homicide after being accused of having abortions, with sentences of up to 50 years of imprisonment. Miscarriage or stillbirth has been used as evidence to convict them – for which the Inter-American Court of Human Rights already deemed El Salvador responsible in 2021, in the case Manuela v. El Salvador.
In its decision, the Court ordered El Salvador to implement “all the regulatory measures necessary to provide directives and guidelines to medical and judicial personnel in situations of pregnancies that put the life and health of women at risk.” This includes establishing protocols and other regulatory measures to ensure legal certainty in such cases, incorporating a gender perspective, and aligning with international human rights standards.
Beatriz passed away in 2017. This ruling is a victory for her family and the Salvadoran feminist movement, which has long highlighted the dire consequences of the absolute criminalization of abortion. This ruling is legally binding on El Salvador and provides an authoritative interpretation for all countries that have ratified the American Convention on Human Rights. Justice will only be achieved through implementing the Court’s ruling, including providing legal certainty so that essential health services, including abortion, are available and accessible for all women, girls and pregnant people.