MEXICO CITY -- It's been years since Dr. Rosa Luz Castro treated the 23-year-old woman she calls Josefina. But her memory of the experience is a vivid reminder of an abiding condition in Latin America.
Josefina staggered into the emergency room of Mexico City's women's hospital late one December night. "She was screaming: 'I'm dying. I had an abortion. Help me,' " Dr. Castro recalled. She was soaked with blood.
In examining the woman, the doctor found a thin plastic rod, shaped almost like a knitting needle. Josefina's uterus was so badly perforated that the doctors decided to perform a hysterectomy. For two weeks, Josefina lay unconscious in intensive care. When she came to, Dr. Castro visited her room.
"I asked her to tell me about her abortion," Dr. Castro said. "She got very nervous and said she had lied, that she hadn't had an abortion and only said that so we would help her immediately.
"The next day, she sneaked out of the hospital. It's probably still a secret she hasn't shared with anyone."
But Josefina's secret is shared by thousands of women throughout Latin America. For while abortion is illegal in every Latin American country except Cuba, a recent study by the Alan Guttmacher Institute in New York indicates that clandestine abortion has become one of the leading methods of birth control in the region.
Contraceptive methods such as birth control pills or intrauterine devices are not widely used, mostly because family planning education is still neither widely available nor widely sought. Young Mexicans, for example, are not taught about sexual relationships until high school. But most Mexicans attend school only through the sixth grade.
"Parents don't want us to talk about sex because they don't want their kids coming home with questions," said Efren Ortiz Villasenor, director of health education in Mexico's Department of Education. "They also think if we talk about sex, we are telling their kids to have sex."
Having an abortion is as easy as a walk to a herb market, where vendors sell "zoapatle," which causes violent uterine contractions. The names of midwives and paramedics who use even cruder methods of abortion are well-known. And, in the process, botched procedures have become a leading cause of maternal deaths.
In Mexico, population experts estimate that between 1 million and 2 million abortions are performed every year and cause the deaths of 25,000 to 30,000 women.
High abortion rates
The study by the Guttmacher Institute, a non-profit organization that analyzes public policy, found that in Brazil, with 150 million people, the region's most populated country, between 1.4 million and 2.4 million abortions are performed each year -- a rate higher than in the United States, where abortion is legal. About 400,000 are admitted to hospitals with complications from bungled procedures, and about half of those women die, say women's rights groups, such as CIDHAL, Communication, Interchange and Human Development in Latin America .
For every 10 women who give birth, three to four in Colombia and two in Peru have abortions, according to the Guttmacher Institute.
"It's become a big business for doctors and police officers," said Patricia Ruiz, a representative of Mexico City in Mexico's Chamber of Deputies.
Women's groups say that abortions can range from a $30 visit to a herbalist to a $200 visit to a midwife, to up to $400 for an abortion in the office of a doctor who is seeking to supplement his income. Most women in Latin America can afford only the first two options.
"These back-street abortions are making a lot of doctors rich," Ms. Ruiz said. "Then they pay off police officers not to raid their clinics."
"Meanwhile," she added, "lots of women are dying or being seriously hurt."
Abortions are allowed in cases of rape or if doctors determine that carrying a child to term poses serious risk to the life of the mother. But even in those circumstances, a court must approve the abortion, and the courts generally take months to handle the cases. Because of this bureaucracy, as well as extreme shame, most rape victims prefer clandestine abortions.
One of those was 43-year-old Yolanda, who shared her story with a CIDHAL women's support group in Mexico City this month.
As a mother of two in her mid-20s, she divorced her husband and was forced to return to the house of her abusive father. One night, she said, her father got drunk and raped her.
A friend told Yolanda about a woman who would "resolve the problem" for about $50. She was instructed to take a liter of alcohol, some towels and the money.
"The doctor laid me on a table -- you could say a dining table," said Yolanda, a small-framed woman, with her long hair pulled back in one thick braid. "He inserted a tube and told me that when I started to bleed and to have a lot of pain, I had to take out the tube and throw it in the trash, where no one would see it."
The 10 hours that followed were almost more painful than the procedure. "I kept thinking I was going to bleed to death and go to hell," she said.
At 2 a.m., she suddenly felt as if a razor were being slipped up and down her body. Then came the blood -- gushes and gushes of blood.
"I didn't want to call my father," she said. "But I was desperate.
"I told him: 'Look, papa, help me. Later, you can criticize me, insult me, mistreat me. But take me to the hospital, or I am going to die.'"
Until this meeting -- at which no one asked for last names, occupations or addresses -- Yolanda has never shared her memory of her abortion experience with anyone except her father. And therein lies the main reason why women's groups have been unable to muster the power they need to force Latin American governments to legalize abortions.
No sustained protests
Campaigns to change abortion laws have been mounted and then faded many times over the last 20 years. Catholic doctrine ** is influential on the issue, and so is the traditional treatment of women in Mexican society.
Marta Lamas, a longtime activist in Mexico's feminist movement, said that in general Mexicans are conditioned to avoid confrontation, especially against government authority. They tend to accept what rights the government grants them and ask for nothing more.
"Women especially are taught never to speak out," said Ms. Lamas, an American who has lived in Mexico for about 20 years and publishes a magazine called Feminist Debate. Most Mexican women, she adds, handle their family problems very personally, without seeking help from friends or relatives.
And, because they are typically more religious than men, Mexican women feel ashamed to talk about abusive relationships, sex and abortions. In fact, while many of them have abortions, they consider their actions sinful and do not necessarily support legalization.
At the same time, women's rights workers in Mexico can remember hardly anyone being arrested for having had an abortion -- technically, a crime punishable by at least a year in jail.
L This leaves little urgency to the fight for abortion rights.
"Women in this country do have abortions," Ms. Lamas said. "But it is one thing to go somewhere and secretly have an abortion, and another thing entirely to fight for the right to have an abortion."
"Although it is a sin, women have abortions," said Ms. Ruiz, of the Chamber of Deputies. "But they believe that if they ask for forgiveness, the Virgin of Guadalupe will forgive and protect them."
In an unusual crackdown this year in Brazil, a Brasilia jury convicted a woman of having an abortion (she had been 'D admitted to the hospital to stop hemorrhaging from a piece of wire left in her uterus), and Sao Paulo police raided a succession of underground abortion clinics.
Last week, in Mexico City, the anti-abortion group Pro-Vida (Pro-Life) released a list of doctors who it said regularly perform abortions, and it launched a campaign to toughen laws against such doctors.
"They are assassins and should be treated like assassins," said Jorge Serrano Limon, head of Pro-Vida. The law, he said, requires that abortionists spend between six months and two years in jail. But, he added, most of those who are convicted receive little more than a citation.
"The government must do more to protect all of its citizens," Mr. Serrano said, holding a plastic figure of a fetus in the womb. "Especially its unborn children."
Demands from Pro-Vida have become more urgent over the years, as women's rights groups have made significant strides.
Last year, for example, in Mexico's southern state of Chiapas, legislators surprised the nation by legalizing abortion under any circumstances in the first three months of pregnancy.
Pro-Vida and Catholic groups launched an intensive counterstrike. They showed graphic films of abortions to high school and elementary school students. Catholic priests declared vehemently in churches that women who have abortions commit unforgivable sins.
Within months, the Chiapas legislature suspended the new laws indefinitely.
"This is a country with value-based laws," said Efren Ortiz Villasenor, head of health curriculums in Mexico's Department of Education. "And thank God it is, because extremely liberal societies sometimes induce undesirable behaviors."
"The government thinks that if abortions are legal, everyone will have them," said Dr. Juan Luis Alvarez. "But what they refuse to admit is that women are having them anyway."
ABORTION IN MEXICO
A survey of 100 women who went to Mexico City's General Hospital for treatment after bungled abortions revealed the following statistics:
Divorced, widow, etc. 29%
One to six 53%