Beatriz spends her days in a hospital room, anxiously watching her belly grow.
Her doctors say she is inching along a high-risk pregnancy that could ultimately kill her, fraught with risks caused by lupus and other complications. The fetus itself has such a severe birth defect that it has almost no chance of surviving, they say, urging an end to the pregnancy to protect Beatriz’s health before it gets worse. But in El Salvador, where she lives, abortion is illegal under any circumstances.
Now she is waiting for the Salvadoran Supreme Court to rule on her case, which has quickly become a focal point in a broad battle over abortion in Latin America, a largely conservative region where the Roman Catholic Church holds considerable sway.
Long home to some of the world’s most stringent abortion laws, the region has begun experiencing a shift in recent years, with some nations loosening restrictions or even legalizing the procedure. Now Beatriz’s case is testing the limits of El Salvador’s law, one of the more ironclad bans the region still has, by challenging whether abortion should remain off limits even when the mother is at risk and the baby has little hope of survival.
“I don’t want to die,” Beatriz, 22, said in a telephone interview, explaining her reason for seeking an abortion. “I want to be with my boy, taking care of him.”
Advocates have adopted her cause to intensify a regional push to change abortion laws, arguing that her rights under international law are being violated: the fetus is not viable, the danger of serious illness or death is increasing as her pregnancy progresses, and she already has an infant child to care for. A group of United Nations human rights experts called on El Salvador’s government to grant “exceptions to its general prohibition, especially in cases of therapeutic abortion.”
The Salvadoran church, by contrast, has argued that the baby’s malformation should not be met with a death sentence.
“This case should not be used to legislate against human life,” read a statement from the Episcopal Conference of El Salvador.
Several Latin American nations have softened their stances against abortion in recent years. Uruguay’s Senate approved a bill last year allowing women to have abortions during the first trimester for any reason, after an earlier move to legalize the procedure in Mexico City. Courts in Colombia, Brazil and Argentina have also loosened restrictions on some abortions, allowing them in certain cases like rape or when the fetus is expected to die.
But a total ban on the procedure remains in El Salvador, Chile and Nicaragua. Doctors who perform abortions and mothers who request them can be sentenced to long prison terms. Under Salvadoran law, Beatriz, who asked that her last name be withheld to protect her identity, and her doctors could face up to eight years in prison if one is performed.
A group of doctors at the National Maternity Hospital, where she is being treated, determined that Beatriz’s risk of serious illness or death increased as the pregnancy continued, and that the fetus would die. They suggested terminating the pregnancy. “We agree in what proceeds,” the doctors wrote in a report, “but we are all subject to the laws of this country.”
In a letter addressed to the Supreme Court last month, Health Minister María Isabel Rodríguez described Beatriz’s situation as “grave maternal illness with a high probability of deterioration or maternal death.” Given the fatal prognosis of the fetus, “it is necessary to undertake a medical-legal approach urgently,” Ms. Rodríguez wrote.
But the case has its medical detractors as well. José Miguel Fortín Magaña, director of the Institute of Legal Medicine, which evaluates medical issues for the Supreme Court, acknowledged Beatriz’s medical problems but said that her health was currently under control and that she was not in danger at the moment.
“If someone has appendicitis, we have to remove the appendix, but we can’t say, ‘We’ll remove it now because maybe in the future there’ll be a problem,’ ” he said, arguing that when a mother was in more immediate peril, doctors would be allowed to induce a premature birth, possibly saving both the woman and the baby.
Other nations have wrestled with the question of whether to prioritize the health of the mother or the fetus. In 2010, the Inter-American Commission on Human Rights ordered chemotherapy or radiation to protect the life of a Nicaraguan woman with metastatic cancer who was being denied treatment because she was pregnant.
Last year in the Dominican Republic, a pregnant 16-year-old with cancer was denied chemotherapy for several weeks while doctors deliberated whether the drugs amounted to an induced abortion. The girl lost the baby and died herself after beginning treatment.
Last month, the inter-American commission told the Salvadoran government to protect Beatriz’s life by following the doctor’s recommendations for an abortion, but the government has been waiting for the Supreme Court to weigh in on the matter.
Beatriz is well aware that there is an international frenzy swirling around her, but it seems far from her mind — an abstraction compared with the palpable yearning to touch the young son she left behind in her rural village, three hours away.
She says she believes abortions are almost always wrong, acceptable only when the mother is at risk.
Her first pregnancy, in 2012, was fraught with complications, especially after the sixth month. Pre-existing lupus, an autoimmune disease, coupled with severe preeclampsia, a serious condition that leads to high blood pressure, forced her doctors to perform a premature Caesarean section. The baby remained in the hospital for over a month.
Medical records show that, following her doctor’s advice, Beatriz had a sterilization procedure scheduled shortly after the birth. She did not show up.
Then Beatriz found out she was pregnant again. Doctors told her the fetus had anencephaly, a birth defect in which the baby is born without parts of the brain and skull. According to the Centers for Disease Control and Prevention, almost all anencephalic babies die soon after birth.
Beatriz testified at a two-day oral Supreme Court hearing two weeks ago, the first of its kind in the country’s history. During a cross-examination, Víctor Hugo Mata, Beatriz’s lawyer, asked her to remove her shawl. Standing in front of the judges, she uncovered her arms, chest and back to reveal lupus-related sores. Her lupus is under control now.
Overwhelmed, she had to leave the chamber. The judges announced they would make a decision within 15 business days.
Mr. Mata said that no matter what the Supreme Court ruled, doctors would probably have to remove the fetus as Beatriz enters her third — and riskiest — trimester. Several American hospitals have offered to perform an abortion, but Mr. Mata said this was an opportunity for El Salvador to modify its law.
In a video posted on Vimeo this month, Beatriz asks that her doctors not be imprisoned “for what they may do to me.” The camera remains closed in on her small, spotted hands fidgeting on her thighs. Her burgeoning belly is covered with a red shirt.
The New York Times | By KARLA ZABLUDOVSKY