Introduction Excerpt for Lawful Sins

INTRODUCTION

AT FIRST, I DIDN’T THINK MUCH about the sonogram images on the screens of Mexico City’s public abortion clinics. The scans measured the gestational ages of women’s pregnancies to ensure that they qualified for a legal abortion, which in the Mexican capital is available only up to twelve weeks. Since most women arrived early in their pregnancies, the images were blurry and opaque. I could only ever make out a pixelated gray or black blot. Dr. Rios, the medical director of Santa Marta Clinic, told me early on that women sometimes asked to see their scans. “It’s morbid,” she had said, taking me by surprise, “when they are coming here to interrupt the pregnancy.” Teresa’s scan showed that she was six weeks pregnant when she first visited Santa Marta in the fall of 2014, meaning she qualified for a medical abortion that would be induced pharmacologically. Dr. Rios gave her a dose of mifepristone at the clinic and sent her home with another dose of misoprostol to produce contractions and provoke an abortion.

On the day we met, Teresa had returned to the clinic for a second scan to ensure that the process was complete. No embryonic tissue remained in her uterus but she spoke of a baby that haunted her dreams, tormenting her with hazy visions of blood and flesh. “I worry that come tomorrow I will feel very guilty,” she confided to me from a private room in the back of the clinic. Teresa knew that first-trimester abortion was legal and available on demand in the Mexican capital even before she went online to research options after learning she was pregnant. Disputes had captivated the entire country years earlier when proposals to legalize the procedure were introduced to the Mexico City Legislative Assembly. Back then, she recalled, everyone had an opinion on the matter. In her high school classroom she had once defended the issue in a staged debate. “It’s ironic,” she reflected, “to have ended up here.”

As I listened to her talk, it was clear that the classroom exercise hardly captured the complicated moral calculus facing her now. That abstract question suddenly had new weight and consequence, bearing directly on the shape of her future. At twenty-three years old, she had been trying to finish the high school degree she had abandoned after the birth of her son five years earlier. The second pregnancy was an accident. As a single mother she couldn’t afford a second child on the wages she earned as a cosmetics clerk in the Zócalo, Mexico City’s historic square. Like many Mexican urbanites, Teresa had been raised in a Catholic family, but she rarely went to mass. Though her faith did not conform to religious rules, she had reservations about the abortion. “I did this because I couldn’t have another baby at this moment in my life,” she told me, “but I still believe that as human beings, what grows inside of us is also human.”

I didn’t know how to respond, but it felt wrong to sit there silently as my tape recorder memorized her dilemma. So I told her what I thought I would want to hear: that many women had made similar decisions and that abortion was her right. “That’s the problem,” she replied, resisting my clumsy attempt at comfort. “Like the social workers here at the clinic said, there are many women in Mexico who come for an abortion not once, but two, three times. They use it like a contraceptive method. I think it should be legal, but not for people who are so irresponsible.”

After that day at Santa Marta I never saw Teresa again. Along with about a dozen other women who had crowded into the small hilltop clinic that morning, she disappeared back into the vast city, anonymous in its multitudes. I was left with a snapshot of her life, like the ultrasound scans, a moment with no before or after. In some ways, reflecting on our conversation later felt like looking at the same hazy images I tried to decipher on the screen; even the details of her face and hair had blurred in my memory. But there was something important there. I had thought that emphasizing the prevalence and legality of abortion might ease her concerns in some small way. Yet abortion, she seemed to suggest, was not a procedure that should be ordinary. And its redefinition as a juridical right and a free health service in the Mexican capital, she had implied, was having precisely that effect: women were beginning to devalue their procreative potential. Perhaps that was what Dr. Rios had meant when she questioned her patients’ “morbid” desires to see the pregnancies they intended to interrupt.

I had not anticipated these kinds of responses when I moved to Mexico City to research abortion politics early in graduate school. As a student of anthropology, I wanted to understand the aftermath of a landmark 2007 reform that legalized voluntary abortion in the national capital, making it the only place in the country where the procedure was permitted on an elective basis. When I arrived for long-term fieldwork, the reform was seven years old. Tens of thousands of women had visited one of the public and private abortion clinics that opened throughout the city as a result. Everyone knew someone—an aunt or sister, a daughter or friend—who had obtained a legal abortion, but many people still talked about it in hushed voices, on the edges of conversations.

When the reform passed, people around the world noticed. Latin America has long been hostile to reproductive rights and is home to some of the world’s strictest abortion laws. Across the region the procedure provokes bitter controversy, even though it is widely practiced. The 2007 reform made Mexico City one of just three places in Latin America where voluntary abortion was allowed at the time, in addition to Cuba and Guyana. For the first time in Mexican history women were afforded the right to interrupt their pregnancies up to twelve weeks—for any reason—without legal repercussions. Even more striking, they could now access the procedure for free through a new program provided by the Mexico City Ministry of Health (MOH) called “the ILE program” for its Spanish name interrupción legal del embarazo (legal interruption of pregnancy).¹ The reform had resounding implications. Beyond guaranteeing abortion rights, it promised to make the procedure widely accessible, even to the poorest sectors of the population who had long been unable to purchase illegal private abortion care available to wealthier women.²

Wherever one stood on the question of abortion, the reform was a watershed. Many Mexicans celebrated a landmark victory for women’s rights and citizenship, hailing passage of the law as evidence of a consolidation of democratic processes in the country. At the same time, critics assailed the conferral of abortion rights as a threat to the Mexican family and religious notions of sacred life. The backlash was organized and immediate. Even after the Mexican Supreme Court defended the law against challenges levied by the National Human Rights Commission and the Attorney General’s Office, resistance followed.³ Within two years, sixteen of thirty-two states had modified their constitutions to redefine “life” as beginning from conception to preclude replication of the reform elsewhere across the country.

Despite strident resistance from all directions, women flocked to the ILE program to obtain safe and subsidized abortion care. Most, like Teresa, were residents of Mexico City, but some arrived from far-flung states, desperate for an affordable way to interrupt pregnancies that for a variety of reasons they could not bear to term. Within the first year alone thousands of women had obtained an ILE procedure through one of the public clinics, and demand on the ILE program would only grow in the years to come.

I didn’t have such a clear picture of this landscape when I met Teresa at Santa Marta Clinic back in 2014. I had moved to Mexico City to understand how people thought about legal abortion in a country that is home to the second-largest Catholic population in the world. I wanted to know if women and health care providers saw abortion as a right, or in some other way, and how they reconciled its legalization with Catholic proscriptions and their own moral misgivings. Even though I had read everything I could about abortion in preparation for the research, being there—embedded in the whirlwind of clinical life in a country that was not my own—was overwhelming. At first, I could make sense of what I saw only through frameworks I had developed elsewhere.

Much of what I knew about abortion at the time was rooted in the American Midwest, where I had worked part-time as an abortion counselor while developing this study as a graduate student at Washington University in St. Louis. Back then, I spent my time outside class driving my Honda across the Mississippi to a lonely industrial city on the western edge of Illinois. Granite City is home to Hope Clinic, which opened one year after the Supreme Court decision in Roe v. Wade legalized first-trimester abortion across the United States in 1973. A few times a week I stayed with the director of counseling well into the evening to learn what things had been like in the aftermath of Roe.

At the time, she said, it was impossible not to have a position on abortion. Protesters assembled outside the clinic every week, squeezing their bodies together to block women and staff from entering. She and her coworkers rehearsed drills to prepare for acid spills, arson, kidnapping, and other forms of political violence visited upon abortion clinics across the country. Going to work every day meant exposing oneself to tremendous danger. The most alarming attack came in 1982. The leaves were just starting to dry up that year when a firebomb exploded at the clinic. Only a ghost of the building was left; ash and char dusted the vacant lot. A few months later the clinic owner and his wife were kidnapped at gunpoint by a group that called themselves “the Army of God.” The couple spent a week as captives in an army bunker somewhere in the Midwest. “We didn’t know if they were going to be found dead or alive,” the director of counseling told me, “or whether they would be sent to us in a box piece by piece. We didn’t know if we’d be picked off one by one from our homes at night.” A decade later police dug up the Army of God manual in the backyard of a woman who had attempted to murder Dr. George Tiller, the celebrated Kansan abortion provider who was eventually assassinated by a different antiabortion protester in 2009.⁴

By the time I started training as a counselor at Hope Clinic in 2012, the violence had died down and the building had been entirely reconstructed with cinder blocks and ballistic windows, like a midcentury fallout shelter. But the attacks haunted it. Old-timers recounted the stories in meticulous detail. Protesters still stalked the entrance each morning, though by then they had abandoned their firebombs and acid. Most waved gory images of dismembered fetuses and heckled women and clinic staff as they entered. For the midwestern providers I came to know, the protesters and their evocative images redoubled their commitments. While I was a newer recruit, they had been at this for years. Most saw themselves on the front lines of an enduring political struggle for women’s rights and equality. It didn’t take more than a few weeks in their company for me to start referring to the protesters as “the antis.” Their terms became mine.

In Mexico’s public abortion clinics the lines weren’t as clean. At first, I expected the ILE providers and me to share a common vocabulary grounded in “prochoice” politics and a mutual understanding of the boundary between “us” and “the antis.” When protesters convened once a week outside the clinic to stage a communal prayer, I assumed the providers would see them as antagonists. But before long it was clear that the Mexican clinicians did not generally think of themselves as a feminist vanguard. To my surprise, much of their work in the clinic entailed discouraging women from seeking subsequent abortions. Women need to protect themselves, the clinicians insisted; they have to take responsibility; abortion is not a game. Some providers agreed with the protesters that God is the moral arbiter of life and death, even as they facilitated abortions day after day. “I consider it a life,” a clinical social worker called Carolina once told me candidly. “But I can’t interfere in other people’s decisions. I have to be neutral, professional.” Unlike my midwestern coworkers, few of the ILE providers had been abortion advocates prior to the Mexico City reform. Even afterwards they rarely spoke about their work in political terms unless I pressed them. Embedding myself in the ILE clinics meant balancing my understandings against the realities of a new and very different context. Intellectually, I struggled to accommodate these differences. Early on in my research the Mexican clinics could seem a world apart from those in the US Midwest.

At the same time, the history of abortion in Mexico is intimately connected to the history of abortion in the United States. Mexico was an indispensable resource for American women seeking abortion services that were largely unavailable at home before Roe vs. Wade. In the middle of the twentieth century hundreds of thousands of American women traveled south to procure abortions from underground Mexican providers.⁵ After Roe the direction of travel reversed and Mexican women who could afford it began to head north for the procedure, evading restrictive laws and avoiding the underground clinics back home.⁶ Today, more than four decades after Roe, abortion politics have reached a “crisis point” in the United States.⁷ In recent years more than half of US states have passed laws to restrict abortion access, and now, with the conservative majority on the Supreme Court, abortion rights are even more precarious. As more and more US clinics succumb to regulatory and funding constraints, women have once again begun flowing into Mexico to obtain abortions. Recent media reports document the passage of Texan women into northern Mexico to acquire the abortifacient drug misoprostol.⁸ The drug, whose official use is for gastric ulcers, is regulated in the United States but can be purchased over the counter in Mexico.⁹ Circular patterns of abortion travel between the two countries were an indication for me of some of the connections across these apparently disparate spheres.

Lawful Sins is an account of how recent transformations in Mexican reproductive governance bear on the ways that women experience their bodies and their relationship to the Mexican state and its public health institutions. The book follows the experiences of women seeking to interrupt their pregnancies, public health personnel charged with delivering a stigmatized service in the context of overwhelming demand and limited state resources, and the activist networks that have mobilized to expand abortion access beyond existing legal and geographic constraints. The chapters ahead show how a picture of contemporary debates on abortion is incomplete without Mexico, tracing aspects of reproductive politics and care that unsettle prevailing liberal frameworks developed in the Global North.

While this book tells the story of the aftermath of abortion legalization in Mexico City, it gestures to global questions about gender and citizenship, divine versus individual control of the body, and the politics of health care. Teresa’s abortion was one of around fifty-six million that are induced across the world each year, making the procedure a common aspect of women’s reproductive lives.¹⁰ Although Teresa struggled with ambivalence, research shows that most women do not regret ending their pregnancies.¹¹ A mixture of feelings ranging from relief and hope to sadness can accompany abortion, depending on the circumstances, and in some parts of the world the procedure is considered unremarkable.¹² At the same time, perhaps because it taps into ethical quandaries about when life begins and ends and who is authorized to draw these boundaries, abortion can raise hard individual and communal questions, such as who has ownership over the body, what makes a person, and who bears responsibility for nascent life.¹³ The disavowal of a pregnancy is imagined in many parts of the world to cut against women’s biological and cultural imperative to propagate persons and societies, to help us continue anew as humans. Contests over abortion, write anthropologists Elise Andaya and Joanna Mishtal, “trigger wider social debates about gender roles and expectations of the (female) life course, shifting ideas of moral personhood, and contested economic, cultural, and political futures.”¹⁴

Despite its global prevalence, abortion is arguably the single most controversial medical procedure that exists, representing what Joan Caivano and Jane Marcus-Delgado have described as “one of the most loudly contested public struggles in the contemporary global arena.”¹⁵ This is especially true in Latin America, where the Catholic Church wields tremendous political and popular power.¹⁶ An astonishing 97 percent of women throughout the region live in countries with restrictive abortion laws, and the procedure is banned entirely in six Latin American countries.¹⁷ It is no secret that criminalization does not stop women from terminating pregnancies they cannot bear to term. Harsh laws push women to obtain illicit and often dangerous procedures, driving up associated morbidity and mortality. In fact, Latin America has the highest rates of abortion in the world, with as many as 6.5 million abortions induced there annually.¹⁸ Even though abortion is remarkably safe when performed in suitable conditions, around 760,000 women across the region suffer entirely preventable abortion-related injuries each year, amounting to what some scholars have called a “clandestine epidemic.”¹⁹

As a Catholic-majority country, Mexico is considered a “strategic point” for global antiabortion activism.²⁰ The procedure has been banned there since the late nineteenth century, when the first penal codes established after national independence defined it as a crime.²¹ Despite the secular values enshrined in the national Constitution of 1917, voluntary abortion remained illegal across the country throughout the twentieth century.²² Today, rape is the only legal exception for abortion that applies in every state, though many states have additional exemptions, permitting the procedure when necessary to save a woman’s life, in the case of fetal anomaly, and, less commonly, for economic reasons.²³ Before a string of reforms loosened constraints on the procedure in the capital beginning in the year 2000, Mexico City’s abortion laws had not been revised since 1931.²⁴ This punitive legal environment has made unsafe abortion the fourth cause of women’s death nationally.²⁵ But the deadly burden is borne most by the poor, racialized, and young. Abortion in Mexico is what Adriana Petryna and Karolina Follis have called “a fault line of survival.”²⁶ This fault cuts across the country in such a way that “the poorest, least educated, and/or indigenous women are nine times more likely to undergo an unsafe abortion” than their wealthier, more educated, and nonindigenous counterparts.²⁷

As these figures make plain, there is a good deal at stake in the Mexican abortion debate. Abortion distills long-standing contests over the role of women in society and the place of the Catholic Church in public and political life. Women’s bodies have been transformed, in the past few decades, into a “political battlefield” for powerful actors and institutions interested in advancing contrasting moral visions for the future of Mexican society.²⁸ Feminist activists and women’s health advocates place abortion rights at the center of ongoing struggles to secure women’s status as citizens afforded equal rights in a secular democracy.²⁹ The Catholic hierarchy and its political allies in Mexico’s right-wing National Action Party (PAN) see abortion as the destruction of “innocent human life.” The extension of abortion rights, for these groups, represents an assault on religious visions of family, femininity, and the nation itself. The contested cultural values wrapped up in this simple medical procedure amount to a contemporary “culture war.”³⁰ At the heart of this fierce dispute is the very definition of Mexico and what it means to be Mexican today.

Societal clashes came to a head in April of 2007 with the transformation of voluntary first-trimester abortion from a punishable crime to a protected right of women in Mexico City and a new element of public health care services available there. The reform represented the culmination of over four decades of feminist activism to strengthen gender equity as part of a broader national movement for democratic governance. Advocates declared the law change a historic victory for women’s health and equality, and an important step in the ongoing struggle to strengthen democratic processes more generally.³¹ For supporters, passage of the law reconfigured women’s relationship to the Mexican state, signaling a new era for the production of women’s citizenship.³² Yet little is known about how women make sense of their new reproductive freedoms or how configurations of care across the public ILE clinics shape the materialization of abortion rights.³³ What happened after the law was implemented? And what might be lost in the gap between abortion rights and experience?

For Teresa, a resident of one of Mexico City’s working-class boroughs, seeking an abortion raised serious questions about her social and moral responsibilities as a woman, a mother, a person raised in the Catholic faith, and a member of Mexican society. Even after the procedure became legal in the capital, the idea that abortion existed as a transcendent right did not hold up for her, though she herself had sought the procedure. Nor did the legal status of abortion resolve the moral qualms she had about parting with her pregnancy. She knew she could not make ends meet with another child, but she did not know how to face her existing son, or herself, after disavowing her second pregnancy. How, she wondered that day at the clinic, would she answer to God after rejecting a child he had sent? What separated her from the “irresponsible” women whose abortion decisions she, and the ILE clinicians, condemned? For the public health workers staffing the ILE clinics too, the introduction of abortion services posed a number of thorny questions. How many abortions can a woman seek? What happens if she does not arrive in time to meet the twelve-week gestational limit on ILE care? When is the interruption of a pregnancy justified, and when is it indefensible? And what obligations, if any, do women who avail themselves of a publicly funded abortion acquire upon accessing these services?

The extension of abortion rights in the Mexican capital has afforded new reproductive possibilities for hundreds of thousands of women and averted immeasurable suffering. It is hard to overstate the significance of these outcomes. At the same time, the transformation of abortion into a juridical right and a new aspect of public health care services has instigated a process of moral negotiation that women, health workers, and ordinary people must navigate with little scaffolding. This book works to reorient prevailing scholarly and advocacy perspectives that approach abortion rights as a central pillar of women’s citizenship in liberal societies. The following chapters cohere around one central claim: while women in Mexico today have new reproductive options not available to them just over a decade ago, they are also subject to the expanded reach of the Mexican state and the Catholic Church over their bodies and reproductive lives. In the pages to come, I place law, religion, and biomedicine as moral orders within the same analytic frame to consider how people grapple with the moral and practical dimensions of pregnancy disruption in ways that rights concepts may not fully resolve.

The panorama of Mexican abortion law has continued to transform since I finished the research behind this book. The southern state of Oaxaca became the second place to legalize elective first-trimester abortion in the fall of 2019, followed by the states of Hidalgo and Veracruz in the summer of 2021. While I was putting the final touches on this manuscript, moreover, the Mexican Supreme Court determined in a watershed vote that the imposition of criminal penalties for abortion is unconstitutional, a historic move that will undoubtedly transform the legal landscape in the years to come. At the time that Teresa sought the procedure, Mexico City was the only place in the country where voluntary abortion was permitted. She is one of roughly 235,000 women from across the country who has accessed an abortion through the public sector ILE program at the time of this writing. Her experience, and the broader story I tell here, capture the aftermath of a historic reform that has transformed the national landscape with reverberations across the region and around the world.

Notes

1. When I refer to the ILE program and its clinics throughout this book, I am referencing the public health sector unless I specify otherwise.

2. Kulczycki 2003.

3. Pou Jiménez 2009.

4. Mason 1999.

5. Murillo 2016; Reagan 1997.

6. Ojeda 2006.

7. Andaya and Mishtal 2016, 54.

8. Mccammon 2019.

9. Misoprostol, sold under the generic name Cytotec, is useful in contexts with restrictive abortion laws and in low-resource settings where abortion services may be legal but prohibitively costly.

10. Barot 2018.

11. Rocca et al. 2020.

12. Andaya 2014; Gammeltoft 2002; Kimport 2012.

13. Ginsburg 1989; Mishtal 2015; Morgan 2009; Rapp 1999.

14. Andaya and Mishtal 2016, 42.

15. Caivano and Marcus-Delgado 2012, 6.

16. Kulczycki 2003.

17. This figure is drawn from the Guttmacher Institute (2018). While Latin American abortion laws are extremely strict, a few notable exceptions include Cuba, where abortion up to ten weeks has been legal and available through the public health system since 1965; Uruguay, which legalized abortion up to twelve weeks in 2012; and Argentina, which legal ized abortion up to fourteen weeks in 2020.

18. Guttmacher Institute 2018.

19. Paxman et al. 1993.

20. Kulczycki 2007, 62.

21. Jaffary 2016; Ortiz-Millán and Kissling 2020.

22. All of Mexico’s thirty-two federal entities (the capital plus thirty-one states) have their own penal codes, and abortion laws vary by state.

23. Abortion is permitted in twenty-four Mexican states when necessary to save a woman’s life; in sixteen states when the pregnancy poses a grave danger to women’s health; in sixteen states in cases of fetal anomaly; and in two states for economic reasons (Ortiz-Millán and Kissing 2020).

24. Sánchez-Fuentes et al. 2008.

25. Sousa, Lozano, and Gakidou 2010.

26. Petryna and Karolina Follis 2015.

27. Paine, Noriega, and Beltrán y Puga 2014, 63.

28. Amuchástegui et al. 2010, 989.

29. Lamas 1997.

30. Maier 2012.

31. Lamas 1997, 2014.

32. Amuchástegui and Flores 2013.

33. Amuchástegui and Flores 2013; E. Singer 2016.