How Puerto Rico Became The Latest Battleground For Abortion Rights

Ana* says she always dreamed of being a mother. But, when she got pregnant at 21 while still in college, she knew it was not the right time to become a parent. “I simply didn’t want to bring a child into the world without me being ready to offer them everything they deserve,” Ana, now 25, told Refinery29.

Immediately after discovering she was pregnant, she went to her health provider in the metro area of Puerto Rico to ask for an abortion. They scheduled her appointment for two weeks later and at about seven weeks pregnant, she had a surgical abortion. “They explained everything about the procedure,” she said, “and I still decided.”

Though Ana had a relatively easy time obtaining an abortion four years ago, for young women on the island in similar situations, it may not be that simple going forward.

The Puerto Rico House of Representatives voted Thursday to pass the first major anti-abortion legislation in decades. Proyecto del Senado 950, known for its acronym PS950, passed in the Senate last week and now goes to the desk of Gov. Ricardo Rosselló. The measure has alarmed pro-choice advocates and health providers since it was first introduced in mid-2018. While the bill slaps a list of onerous regulations on clinics, the sticking point that has worried advocates the most is that PS950 requires pregnant people under the age of 18 to receive consent from their parents or legal guardians before obtaining abortion care. (The legislation originally applied the requirement to people under the age of 21, but it was amended.)

“There are other laws in Puerto Rico that don’t require minors to obtain parental consent for healthcare services such as prenatal care, due to a 1993 law, or STI treatment. In other terms, you can become a mother without having your parents’ consent, but you can’t terminate your pregnancy,” Dr. Yari Vale Moreno, a clinic administrator and obstetrician who is one of the few abortion providers in Puerto Rico, told Refinery29. “It’s concerning. Minors are a vulnerable population, because they usually wait longer to disclose they are pregnant. They would be the most impacted.”

Puerto Rico’s local laws ban abortion, but after the U.S. Supreme Court's decision on Roe v. Wade in 1973, those became unenforceable. (Puerto Rico has been a territory of the United States since 1898 and decisions such as Roe, which legalized abortion in the U.S., apply to the island even if it’s not a state.) As of now, the Puerto Rican government allows abortions at any point of the pregnancy as long as they’re offered by one of the few licensed providers in the island. PS950 aimed to change that. The legislation was authored by Sen. Nayda Venegas Brown, a pro-statehood lawmaker and evangelical minister. The original bill introduced a series of restrictions including a 48-hour waiting period, a ban on abortions after 20 weeks of gestation, and a sentence of up to 15 years of prison for providers who violated the law — in line with the wave of anti-abortion legislation that has swept states in recent years.

The most recent version of the bill, which pro-choice advocates have denounced was amended without input from constituents, tones down the restrictions on patients. Instead, PS950 focuses on requiring providers to offer informed consent in writing, be inspected annually by the Puerto Rico Health Department, and posting signs informing patients they can’t be coerced into either having an abortion or continuing their pregnancies. The legislation adds that providers who fail to comply with their regulations would face fines of up to $10,000, and, in a move that has raised eyebrows, those funds would be allocated for health education campaigns focusing on alternatives such as adoption. Sen. Venegas Brown told local outlet Primera Hora that she was satisfied with the changes, calling PS950 a “beautiful piece of legislation.” She didn’t respond to questions about the imposition of parental consent on women under the age of 21 in the bill prior to the Senate's amendment, just answering that her legislation is focused on underaged pregnant people. When Primera Hora pointed out that the age of consent on the island is 16, or that women 18 and older can drink and vote, Venegas Brown sidestepped the question. (Her office didn’t respond to Refinery29’s multiple requests for comment.)

While the bill that passed does away with many of the original restrictions, Dr. Vale Moreno said she’s concerned the effort is just the beginning of the fight over reproductive rights in Puerto Rico. “The measure amending the Civil Code says that a fetus has the same rights as a person,” she said in reference to legislation that passed the Senate on Wednesday. “That’s the foundation for new legislation and legal challenges [related to abortion] under the presumption that it would violate the new Civil Code.” Her fears were confirmed by Venegas Brown, who during debate of PS950 told the Senate chamber: “I wish this was a bill to ban abortion,” before adding that’s not possible due to Roe. She concluded her turn implying this will be the first of other anti-choice measures.

The idea of making abortion harder to access in Puerto Rico has rattled some of the women who’ve terminated their pregnancies in the island. Karla* was not ready to be a mother — far from it. When she found herself pregnant three years ago at the age of 27, she was in a tumultuous relationship, without health insurance, and not in a financially stable position. “I wasn’t ready for a kid,” she told Refinery29. “[Becoming a parent] ] was not viable. It was never an option.” She was around eight weeks along when she terminated her pregnancy and the process was pretty much seamless. “I just Googled it and found a clinic. I made an appointment and two weeks later, it was over,” she said. She was terrified of facing anti-abortion protesters outside the clinic, but that didn’t materialize. Once she got to the clinic the day of her appointment, she was out in 30 minutes. Her dilation and evacuation — a type of surgical abortion — cost her around $300.

Karla said that the fact her abortion was viewed as a healthcare and that it was accessible, lifted some of the weight of being put in a stressful situation. She recognized that living in the metro area of the island certainly made her life easier, while low-income women or those who live in rural areas might have a harder time traveling to clinics. “I didn’t feel like bureaucracy was getting in the way. If I had not had such easy access, including how it was economically accessible [was to get my termination], my life would be very different — probably not for the better,” she said. “Restrictions would just impact women with less resources than me. I was an adult woman and I can’t imagine what a young woman at 16 or 17 in my same situation not having the freedom to say ‘This isn’t the life I want.’”

The most recent research on abortion rates in Puerto Rico dates back to 1999. At the time, researchers said that about 23 out of every 1,000 pregnancies were terminated in Puerto Rico — which means the island’s abortion rates were lower than other places in the world with similar non-restrictive laws, which were estimated to be 35 out of every 1,000. One of the reasons is the how conservative and religious society is in the territory: “In Puerto Rico, abortion and the concept of choice are not part of our culture,” Alexandra-Marie Figueroa Miranda, campaign and activism coordinator with Amnesty International Puerto Rico, told Refinery29. Amnesty have strongly opposed PS950 alongside other major groups such ACLU Puerto Rico and International Planned Parenthood Federation, the feminist organization Colectiva Feminista en Construcción, the women’s healthcare group Taller Salud, and many more. Organizers also denounced that Thursday’s hearing and vote were closed off to the public, in direct violation of Article 3, Section 11 of the Commonwealth of Puerto Rico’s Constitution.

Figueroa Miranda said advocates have been alarmed by the secrecy surrounding the amendments process, which they still view as severely curbing access to abortion in Puerto Rico. “This makes it almost impossible to certain pregnant people to get an abortion,” she said, explaining no one has been able to outline how the legislation would impact women under the age of 21 if it passes. She blasted the measure as yet another attempt by the religious right in Puerto Rico to influence legislation. “This bill wasn’t not created because we have a legislative vacuum [when it comes to reproductive healthcare] — we already have those rights,” she said. “This is a violent response by conservative and fundamentalist people in Puerto Rico against the feminist movement and other equality fights in the last few years, which has sought out the empowerment and autonomy [of society’s most marginalized.]”

A major concern for reproductive rights advocates is the diminishing number of abortion providers on the island. Vale Moreno said that back in the 1990s, Puerto Rico had over a dozen of clinics. Now there are only six clinics — and half of them are managed by providers who are over 70-years-old. (Overall, there’s a crisis over the access to healthcare services on the island: According to a 2016 report by the Health Resources and Services Administration, more than 19,000 Puerto Ricans live “healthcare provider shortage areas.”) Puerto Rico has also served as sort-of an abortion haven for other Caribbean women, Vale Moreno said. Some of her patients have traveled from the nearby islands of St. Thomas and St. Croix for abortion care, because there are no clinics that offer services after the first trimester. Vale Moreno and other providers have also attended patients from the neighboring Dominican Republic, where abortion remains illegal. The implementation of anti-abortion legislation on Puerto Rico would impact these women too.

For women who’ve received abortion care in the island like Ana, the efforts led by Venegas Brown are a gross overreach. “I find these regulations ridiculous. It’s so hypocritical,” she said, adding that the idea of parental consent especially irked her. “I bet that most of the men and women in the Puerto Rican Legislature were having sex before they were 21. And if they had found themselves pregnant and wanted to terminate, they would not have wanted to tell their parents and instead would want to make the decision that was best for them on their own.”

Today, Ana is a young professional and the mother of a toddler. She is also still with the same partner she was at 21. The debate over abortion rights in Puerto Rico has angered her, especially in the context of the island’s debt crisis and the recovery of Hurricane Maria. “Lawmakers should use their creativity to solve other crises in the island, instead of focusing on this bullshit,” Ana said. “I want to be clear: I don’t regret my abortion, because now I’m able to be the best mother for my child, who I adore. Women deserve that chance.”