An Abortion by Any Other Name: Beatriz and the Global Anti-Choice Spin Machine

See all our coverage of Beatriz here.

Yesterday in El Salvador, Beatriz (a pseudonym) had an abortion. The Catholic Church and the international anti-choice movement are desperate to deny this reality, so the anti-choice spin machine is in high gear, engaging in linguistic gymnastics to suggest otherwise.

And much of the media is taking the bait.

Beatriz had a hysterotomy, a form of abortion carried out through c-section, and a procedure of such high risk compared to other forms of abortion, and of such last resort, according to medical experts, it is practically never performed in the United States. What is known beyond a doubt is that having forced Beatriz into a situation of having a late abortion, the government of El Salvador, Catholic Bishops, and anti-choice groups in the country (and those supporting them from the outside) unquestionably privileged a non-viable fetus over the life and long-term health of the primary patient, a woman who wanted to—in fact begged to—live.

In parroting what anti-choicers and the government of El Salvador are saying, many media outlets are glossing over and ignoring what actually happened in El Salvador. As a result, otherwise highly regarded media sources such as the New York Times, Salon, the Associated Press, The Guardian, and Reuters are helping to perpetuate lies that defy both medical evidence and public health data and that support dangerous policies under women all over the world continue to lose their lives.

The New York Times, for instance stated that the “ill Salvadoran woman … delivered her 27-week-old fetus” and quoted El Salvador’s Minister of Health, María Isabel Rodríguez as saying, “At this point, the interruption of the pregnancy is no longer an abortion. It is an induced birth.” Rodríguez elaborated that it could be “either an abdominal or vaginal birth.” Meanwhile, Reuters uncritically reported that the c-section permitted El Salvador to avoid having to allow Beatriz an abortion.

Actually, the only thing El Salvador—and apparently the media—avoids by denying that a hysterotomy is an abortion is reality.

Beatriz’s pregnancy was complicated from the start. As Anibal Faundes, an OB-GYN and international leader on public health and human rights, wrote for RH Reality Check last week:

Beatriz is a 22-year-old woman from a poor, rural area of El Salvador who has the misfortune of suffering systemic lupus erythematosus (lupus), an autoimmune disease. Pregnancy often exacerbates lupus, with adverse effects on kidney function, potentially leading to accelerated progression to end-stage renal disease. In addition, pregnancies in women with lupus are at high risk for spontaneous abortion and premature delivery, intrauterine growth retardation, and a maternal complication called superimposed pre-eclampsia.

Beatriz’s doctors knew ten weeks into her pregnancy that she needed an abortion to save her life, and even in El Salvador, a country in which doctors go to jail for performing abortions, her physicians began petitioning the government for an exception to the law. Doctors also knew something else: Beatriz was carrying a fetus with no brain, and therefore it could not survive outside the womb under any circumstance. They also knew that the longer the delay in providing Beatriz with an abortion, the much higher the risks to Beatriz’s life and health.

While the Ministry of Health agreed the abortion was warranted (again, a profoundly unusual circumstance in El Salvador), the Catholic Bishops, anti-choice groups, and the attorney general would not budge, threatening to put both doctors and patient in jail. At one point, colleagues in El Salvador contended that the country’s bishops were quite willing to just let her die and put it down to “god’s will” so as to hold the hard line on their contention that “abortion is never necessary,” even to save a woman’s life.

The turning point came when an international campaign was launched, and every relevant court and human rights body was petitioned. Yet despite pressure from human rights bodies in the region and internationally, El Salvador’s Supreme Court refused to budge, and Beatriz was denied an uncomplicated early abortion and subsequently also a less complicated second trimester procedure. She was therefore pushed into the third trimester, with her health failing to “save” a fetus that could not be saved. Finally, in the face of mounting international opprobrium, she was given a hysterotomy, which anti-choicers are spinning as though it were a normal c-section.

Thankfully, Beatriz has survived the late abortion and is doing well, though according to colleagues in El Salvador, she lost substantial amounts of blood and as yet faces unknown health consequences from lack of an early abortion that complicated her lupus, compromised her kidneys, and racked up unnecessary medical bills. The key difference is that, at death’s door, Beatriz was an international cause célèbre. As a poor, rural woman who may now face lifelong health and medical complications gravely exacerbated by the delay in her treatment, she will almost certainly become a forgotten statistic, a woman who may need ongoing medical care she will almost certainly not be able to afford.

In what seems to be at best an afterthought of the media these days, I asked actual medical professionals about Beatriz’s condition. Dr. Faundes, as noted above, wrote about her condition extensively. But what about the decision to provide a “c-section”? Here is what doctors told me. In response to Beatriz’s case, Dr. Valencia Stephens, an OB-GYN and clinical consultant on safe abortion care, said that when she heard about the decision to give Beatriz a c-section, she was aghast. As she wrote via email:

A Cesarean section involves much more [risk] for even a healthy woman. The only reasons I would do a section for a 26 week pregnancy would be to prevent head entrapment if the fetus is breech (NOT an issue in her case since the fetus has anencephaly), if the fetus is transverse and cannot be verted, or if she had a prior section and was not a candidate for VBAC [vaginal birth after c-section] because of the MATERNAL risks involved.

Another OB-GYN, who asked that their name be withheld, wrote the following:

At 26 weeks gestation, the usual options for terminating a pregnancy are:

1. Dilation and Evacuation (D&E)
2. Induction of Labor (IOL)

In situations where neither of these can be done (and the reasons for this are usually because the cervix will not – or cannot – dilate adequately and one needs to get the uterus evacuated urgently) then a cesarian section is entertained. (Actually, we use the word, “hysterotomy” in these situations in an attempt to differentiate it from a delivery of a viable fetus). It is generally a last resort, and to give you some perspective on how uncommon it is, they are many a practitioner who have done both IOLs and D&Es for decades and have not ever had to do an hysterotomy.

What we do know for quite some time now, and this has been corroborated by recent data, is that abdominal surgery (in this case, c-section) carries a greater risk to the patient than a vaginal delivery (such as IOL) or D&E. In fact, these risks are not insignificant and may be as much as 10 to 100 fold times greater. So to answer your question, yes, they are opting for the more dangerous route.

“It may be more palatable in the public eye that Beatriz undergoes a c-section,” the doctor continued. “However this is certainly not the preferred method [in the case of a] fetus that is anencephalic (absence of higher-function brain tissue) and therefore incompatible with life. It is not the preferred method because doing so unjustifiably increases the patient’s risk (especially in someone like Beatriz who has an underlying medical issue like lupus and what you want most for her is to minimize any risks!).” (Emphasis added.)

What happened here is unethical and immoral, and the media is responsible for perpetuating conditions under which this scenario is almost certainly going to play out again and again. A woman was brought to death’s door for the sake of ideology made only somewhat more grotesque by the fact that the fetus she was carrying could never have survived in the first place. Abortion is part of health care. Sometimes it is required to save a woman’s life or health. Women’s lives are real, and we deserve medical care, not the fanatical ideology of a small group of men. It is time for the media to start doing its job in reporting on these issues, and stop providing the anti-choice movement with an uncritical platform for its misogyny.

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  • HeilMary1

    If Beatriz needs a kidney transplant because of the murderous interference by fetal idolaters, then I hope those fetal idolaters are forced to donate a kidney to her. Start with El Salvador’s pedophile priest-protecting RCC bishops.

    • Lolly

      The fetal idolaters lie, talking out of their mouths and their asses, quite a feat. They “claim” to support abortion when it’s to save the life of the mother. Oh, can’t you see how “merciful” they are?!! They’re not ghouls! They aren’t demanding that other women pay the price for their own “moral righteousness”. They are so caring! Right? But in the next sentence they proclaim that pregnancy NEVER EVER affects the life of the mother. They are hypocrites who want only to kill women with a free conscience.

      Then they look the other way when the rich women, and the “pro life” politicians wives and mistresses who go discreetly seek out the delicately named “D&C’s” in NYC. Abortion is always moral for the wealthy and well connected.

      • HeilMary1

        And they never complain about priests arrested at hooker hotels! One just got beaten up at a San Antonio dive and cops noticed “baby killing” condoms in the room! I’ll bet “Father” Rafael Padilla blasts women who use contraception in his next Sunday sermon!

  • Apple Blossom

    Brilliant, rational article. Another nail in the coffin for the narrow-minded, unbelievably evil people who would willfully deny a woman the right to her own life.

    Sick to my stomach that this is happening in the 21st century.

  • Maryanna Price

    I’m so glad you’re posting this. I’ve been hanging my head against the wall all week arguing with people about how this is not a “victory” for Beatriz, but merely a consolation prize.

  • Maude22

    What pleases religious conservatives more is that the pregnant woman “paid” and fulfilled her expected “selfless martyr” role as a mother by suffering more – she underwent major surgery, which could have and should have been avoided with a simpler late-term abortion technique. (Though I read that she also requested a tubal ligation which was performed at the same time, so it’s possible she would have undergone surgery in any case.) She paid for the sex and the pregnancy by being cut open. It is a disgusting violation of her bodily rights.

    • phatkhat

      I’m very glad she got the tubal! I had one, myself, and it was microsurgery, even in the early 80s. One tiny incision in the navel, and another a little further down. Getting over the effects of the anesthesia was the hardest part – the surgery itself was never painful after.

  • Margaret

    I congratulate you on this story; you’re absolutely right. I just read an e-mail from a “progressive” source that did not truthfully address Beatriz medical condition or the resulting insult to her general health and did not have the word abortion in it. WHICH IS STUPID. We are letting the right control the conversation. With Lupus with an anacephalic fetus! Of course she needs an abortion!

  • Edohiguma

    Amusing. The argumentation is just as retarded as that as of most “pro-life” morons.

    The best solution is this: purge all pro-choicers AND pro-lifers. Too many lunatics adhering to ridiculous ideology and primitive superstition rather than fact on both sides.

    Then base everything else on scientific facts, not the over-hyped “truth”. You know, facts like the “fetus” being a homo sapiens sapiens with untapped potential. Potential that abortion denies in the ridiculous strawman argument of “women’s rights”.

    If it’s a woman’s right to butcher her unborn child, then it’s my gods damn right to kill any human I run into. In both cases homo sapiens sapiens die. There is no difference.

    In fact, I should be allowed to do that anyway. Too many lunatics around as it is. Purge it, clean the gene pool, for the greater good of mankind.

    • Jennifer Starr

      Yes, dear, we are aware that the fetus (you do actually call it a fetus, you know) is human. That’s kind of obvious, and also a ridiculous strawman argument. Another ridiculous argument is the ‘untapped potential’ thing. “OMG! You might have killed the person who cures cancer!” Or you might have killed the next John Wayne Gacy or Jeffrey Dahmer–who knows? As I said ridiculous. But the point is this–the one person who should be able to make a decision about a pregnancy is the woman who’s actually pregnant. It’s inside her body, her choice. Not too radical a concept for you, I hope.

    • canaduck

      Ho ho ho, I’m so glad you find this “amusing”.

  • Natalie

    First of all, a hysterotomy is just an incision in the uterus, nothing more, nothing less. It is actually a fairly common procedure since it is part of each and every c-section. Fortunately it is almost never done for a termination procedure.
    Second, the terminology people are using is deliberately vague and confusing. This fetus was greater than 24 weeks, regardless of whether or not it was viable, this would be called an indicated preterm birth in the US where I practice.
    Thirdly – D&Es are not the simple procedure you all seem to want to believe they are. They get more and more dangerous the further along you are in a pregnancy and require a skilled provider to do them. Given the political and religious environment in Beatriz’s country, I doubt such a provider was available.
    Finally, I can think of several reasons why a c-section was done instead of attempting a vaginal delivery.
    1 – Her condition deteriorated to the point that they could not risk a prolonged induction of labor
    2 – She had a c-section for her first delivery and was not a candidate for a trial of labor
    3- It was the only way they could get permission to do her tubal
    4 – She requested the procedure and her providers honored her request

    All this aside, this is a prime example of the atrocious medical care that is provided when religion and politics collide in the exam room. I am sure Beatriz’s providers were as upset as I would be if this happened to one of my patients. The church and the politicians need to lose their obsession with pubic issues and start focusing on alleviating poverty and working for social justice.

    • cjvg

      -A hysterectomy is removal of the uterus, not an incision!

      -A D&E is not the same as a vaginal delivery, and it most certainly is not major abdominal surgery like a C-section is!

      -she did not request this procedure, she was informed it was the only option she had, she requested an abortion!

      You completely reversed the actual recommendations taught to further doctors by those teaching obstetric care in any civilized country!

      If the mothers health is of concern at all, and had a previous C-section as well as a severely compromised health status, she is neither a good candidate for an induced labor or a C-section!
      A D&E or D&X is the preferred method to preserve the live of the mother.

      A C-section is major abdominal surgery with a recovery time of weeks not days.
      -A C-section will increase her risk for infection, (especially with her health status)
      -She will need systemic pain medication for at least a few weeks,
      -She will have to be put on stool softeners since she can not strain,
      -She is at increased risk of pneumonia and she will have trouble clearing her lungs since deep breathing and coughing will cause pain and stress on the incision.
      -She will also be at increased risk of a blood cloth, just to name a few very common complications even for women who are in perfect health!

      I certainly hope your patients are not relying on your medical expertise to survive!

      You seem to lack in anatomical as well as surgical, obstetric and practical biological knowledge.

      • Natalie

        Oh dear, I was afraid if this. If you read the article, it clearly states that she had a hysterotomy, not a hysterectomy. At no point did I say that her care was optimal or even acceptable. I merely pointed out that, given the circumstances and the resources available to them, her providers may have been left with no other choices. At no point did I trivialize c- sections, their risks or sequela, I listed a few circumstances that might have led her providers to choose this option. Since I was not privy to the discussions that led to the event, I do not know the thought process that led to this final decision. A D&E needs to be done by a trained provider, in a country that does not allow abortions, that provider may not have been available. I hope I have addressed all of the issues you have taken with my reply.

        • cjvg

          My apologies, I did miss the hysterotomy part.

          Even so she was 27 weeks pregnant at the time, in general this is a procedure not recommended after 24 weeks gestation!

          it is also a procedure done under general anesthesia which in itself carries greater risks and is not advisable with her health status.

          Another very troubling fact is that this method has the greatest risk of complications out of all the abortion procedures, so it is most definitely not the safest choice for her.
          In fact it is not even legal to perform this procedure outside of a hospital in most countries that offer abortions, due to the elevated risks to the life of the woman.

          A D&E needs to be done by a trained provider, I would hope you are not suggesting that a hysterotomy does not have to be done by a trained provider, this is a dishonest and misleading assumption.
          The difficulty of finding a provider who has done a hysteroctomy in an anti-abortion country would be the same as finding one who can do a D&E
          So yes I stand by the accuracy of the rest of my statement, this was not an appropriate choice!

          • Natalie

            I fully agree that this was not the best option. Any trained OB/GYN and a few Family Practitioners are trained to c-sections and hysterotomies, which are a part if doing a c-section. Most OB/gyns are not trained to do late second trimester abortions. The American College of OB/GYN recommends D&E be the first choice option under these circumstances provided a highly trained provider is available to do the procedure. If a highly trained provider is not available the procedure becomes too risky and other options must be entertained. We have to remember that she lives in a resource poor country – if providers are not even getting basic abortion training, the possibility of finding someone to do a D&E is pretty remote. While we may never know why her providers opted to choose the riskier option, I will never fault a physician who opts not to perform a procedure that is outside of his or her comfort level and skill set.

          • cjvg

            A D&E was not allowed that is why it as not done!
            The courts and the government clearly and loudly said to her doctors that she could not have an abortion.
            They informed her doctors that they would be prosecuted and would face significant jail time if they did provide her with one!

            After the international outcry ( as well as several countries and the WHO organization making noises about severe civil right violations)that followed after they made this decision known, the government and the courts magnanimously decided that she could have an early delivery instead!

            Nobody claims D&E is a simple procedure, but it is by far the safest procedure available in a situation like hers!
            You were the one who dishonestly claimed that a c-section or a hysterotomy was the best out come in this case, that is what I took severe exception too!

            Plenty of doctors are trained in the US or other countries that allowed full reproductive care, before they move back home to practice.

            I have no doubt that they could find one, and lets not forget that it was her doctors that appealed to the courts to allow an abortion, I doubt they would do that if they had no clue what to do after they got permission.

  • Jonathan Kuperberg

    I have seen numerous definitions of “abortion” which specifically do not include post-viable/. third trimester, and the news media you refer to are liberal/mainstream. This is one big conspiracy: why exactly would the NYT, Guardian or Salon, all firmly pro-choice, take part in an “anti-choice” deception regarding whether a procedure is an abortion or not?