A Legal Victory for Abortion, but Out of Reach for Indigenous Women in Oaxaca

On September 26, 2019, Oaxaca decriminalized abortion on all grounds, making it the second state in Mexico to affirm the legal right to abortion. This legislative action is an important step toward ensuring universal access to sexual and reproductive health (SRH), especially in Latin America and the Caribbean, where few abortion movements have succeeded in recent years. However, indigenous women and girls in the region already face obstacles receiving public sector SRH services. Without reducing these existing disparities in access, Ministry of Health efforts to provide medical and surgical abortions will fall short. Ensuring access to safe abortion in Oaxaca requires broader health systems strengthening. Local civil society organizations already vested in the process—like PAI partner the Observatorio de Mortalidad Materna (Maternal Mortality Observatory, OMM)—can play a critical role in driving the Ministry to expand geographic coverage, strengthen cultural and technical competencies and include mifepristone and misoprostol within the reproductive health supply chain.

In Oaxaca, where nearly 65% of the population lives in poverty and 45% are deprived of their basic needs, indigenous women and girls are disproportionately impacted by limited access to health services. OMM Technical Secretariat Dr. Hilda Argüello underscores, “We have large indigenous populations that are dispersed, isolated, and ensuring geographic availability has been a major barrier for the health system itself.” While unmet need for contraception is 17.7% for women of reproductive age, that rate nearly doubles among indigenous women and girls ages 15 to 49. Moreover, in remote indigenous communities with low human development levels, a woman is nine times more likely to die during pregnancy or childbirth than in less isolated communities. Geographic isolation is compounded by a lack of qualified medical staff who not only speak the local languages, but also are willing to work in rural communities.

PAI and OMM are working throughout southern Mexico to eliminate the detrimental impacts of inequitable SRH access on indigenous women and girls by advocating for the Ministry of Health and National Women’s Institute to implement high-quality, culturally relevant information and services in underserved areas. To date, this advocacy includes supporting the Ministry in developing culturally competent guidelines and increasing public sector service provider adherence to the Mexican Official Standard for health care for adolescents and youth ages 10 to 19 (NOM-047), as well as positioning local community members to be interlocutors between indigenous populations and the public health sector.

These efforts elevate and seek to address the unique SRH needs of indigenous youth, including the effect of critical contraceptive supply chain bottlenecks in indigenous communities—and the pathway to guaranteeing access to safe abortion will be no different. Specifically, CSOs will need to hold the Ministry accountable to its legal commitments by advocating and the development of protocols for:

• Timely mifepristone and misoprostol distribution within the existing contraceptive supply chain;
• Provider competencies to provide counseling in terminology that is understandable to the diverse population;
• Technical skills for the provision of medical and surgical services at the community level; and
• Clear guidelines for service provider follow-up in rural areas and a civil society monitoring mechanism to guarantee Ministry compliance with these protocols.

PAI works with OMM and local citizens, monitoring contraceptive stock and SRH services in public health facilities monthly. Establishing a broader monitoring mechanism that also gauges the availability of safe abortion services—including mifepristone and misoprostol for medical abortions—in high-risk indigenous communities is an easy next step. Building the capacity of the Oaxacan Ministry of Health to provide safe and widely accessible abortion services is not.

In a resource-constrained environment like Oaxaca, guaranteeing access to safe abortion within SRH services will not only take time, but also require a broader transformation within the existing public health infrastructure to fully close the gap in access and respond to the needs of indigenous women and girls. While civil society has made advances in driving this public health sector transformation, there is still a long road ahead to make legal abortion a reality for indigenous women and girls so they can exercise their sexual and reproductive rights.