Sexual and reproductive health and rights are at a critical juncture in El Salvador following the February 3 presidential election of center-right Nayib Bukele, on the heels of lawmakers’ failure to amend the total abortion ban last year. While Bukele has repeatedly stated his support for abortion on the grounds of risk to the mother’s life—at a time when popular support of legal abortion is growing—he must contend with his party’s positions. The Grand Alliance for National Unity Party (GANA) is ideologically aligned with the Latin American right, prioritizing religion, ‘family values’ and privatization of social services, including health care. As such, there are concerns that Bukele’s leadership will thwart progress on reproductive rights, including universal access and renewed attempts to decriminalize abortion.

By electing this young, third-party candidate, the Salvadoran electorate voiced its disillusionment with business as usual. As the former mayor of San Salvador, Bukele’s initiatives included youth engagement and infrastructural improvements to reduce vulnerability to violence. Although some see these urban planning projects as physical rather than systemic changes, his approach went beyond the classic iron fist response to violence in the region.

While Bukele has called for increased public sector investments, his political platform does not outline a concrete plan to sustain improvements for key health outcomes, including reductions to maternal mortality and teenage pregnancy. Moreover, he will have to challenge the political power the church wields within his own party and across the legislature if he intends to support any abortion decriminalization proposal.

In this new, complex political environment, civil society actors like Fundación Maquilishuatl (FUMA) find themselves navigating uncertain territory. FUMA, a PAI partner working in El Salvador to improve access to sexual and reproductive health services and support decriminalization of abortion on four grounds (risk to the life of a pregnant woman or girl, risk to her physical or mental health, rape or incest, or if the fetus would be unable to survive outside the womb), as well as other advocates, are now tasked with pushing for continuity of health sector reform under the new leadership when it takes office in June. Specifically, the health sector reform expanded coverage to over 1.8 million people, including free contraception at the community level.

In addition to expanding access through a network of community health workers and facilities, the health reform also increased accountability for Ministry of Health commitments. Citizen monitors—trained as part of the reform—document issues of quality or service availability through systematic evaluations of community facilities and utilize those evaluations to advocate for specific needs from the Ministry of Health. For example, citizen monitoring resulted in the Ministry of Health adding a gynecologist to an Usulután health facility so that women and girls can receive a range of contraceptive options in their community. Civil society and outgoing Ministry of Health representatives alike stress the importance of continuing these citizen monitoring efforts to sustain access and positive health improvements, including decreased maternal mortality.

Although Bukele lacks a clear health platform, he has an opportunity to accelerate positive health trends over the next five years. To do so, his administration must increase public health expenditure to ensure greater financing for key medicines, including contraception; expand coordination with civil society to guarantee health care reaches the most vulnerable populations; foster interinstitutional collaboration across ministries for a longer-term solution to violence; and urge Congress to consider the abortion decriminalization debate. If Bukele and GANA are committed to breaking the traditional mold and creating a better El Salvador, they cannot leave behind the sexual and reproductive health and rights of Salvadoran women and girls.