A few days ago, the Constitutional Court issued ruling T-576 of 2023, which studies a case of Sophia, a woman who suffered different situations of violence during the practice of a voluntary interruption of pregnancy in Santa Marta. Two years after ruling C-055 in 2022, which decriminalized abortion in all cases up to week 24, the Court ruled for the first time on the quality problems that persist in accessing this service.
What about health violence?
Violence during abortion is something that is rarely talked about. It is a form of obstetric violence, which is understood as a type of gender-based violence that develops in health services during pregnancy, childbirth or postpartum, and is reproduced in contexts of structural inequality, producing serious physical and psychological effects.
Violence cannot be naturalized in any medical service. This has led to high courts around the world ruling on the matter in recent years. Recently, the Inter-American Court of Human Rights has recalled that States are under an obligation to prevent, punish and refrain from committing acts of obstetric violence which may include, among others, dehumanized and negligent treatment, denial of non-consensual treatments or interventions, violations of the information provided, violations of confidentiality, and other acts that affect the dignity of pregnant persons.
The Sofia case
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In this case, when Sophia She chose to have an abortion and received delays from her EPS to access a health center in her municipality. In this process, the EPS called her father to notify him of the abortion. Once she was referred to a health center, Sofia received questions about her decision from the medical staff, experienced flaws in the information she received, delays in the delivery of medications, lack of medical supervision, ill-treatment of pain management and irregularities with the technique used by health professionals.
Responding to this, the Constitutional Court concluded Sofia suffered “physical and psychological obstetric violence”, thus recognizing that this type of violence also occurs in abortion settings and regardless of whether a pregnancy is carried to term or not. In addition, the Court drew attention to the violation of Sofia's confidentiality, privacy and dignity that occurred in a context of gender stereotypes that dictate that it is “men who must make reproductive decisions for women”.
What this historic decision means
This decision forces us to remember that abortion services are still not spaces free of gender-based violence. As with any other health service, the Colombian health system is obliged to ensure that people access abortion services, in compliance with the requirements of accessibility, quality and acceptability of the right to health. This implies the guarantee of information for decision-making, respect for confidentiality, the monitoring of the technical guidelines of the Ministry of Health and the principles of medical ethics. Ensuring this is not only the responsibility of those who provide the service, but of the EPS who must have options for the provision of this service that are ideal, for which they must carry out the appropriate audits.
It is also up to the National Superintendency of Health and the municipal and departmental Health Secretariats to exercise their legal powers of inspection, surveillance and control, which are not limited to verifying that people access abortion services in any way, but that they do so in a dignified manner and in spaces free of violence.
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