Breaking the Silence : Violence and the Fight for Dignified Abortion Care In Uruguay
Published
February 13, 2025
Author
Lucia Berro Pizzarossa
Carolina Farias Rodriguez
Emilia Muller Bentancor
Oriana Franca Scheffer
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Thirteen years ago, Uruguay marked a pivotal moment in reproductive rights with the legalization of abortion. It was hailed as a significant advancement, a victory for autonomy and health.
However, behind the veil of this progressive reform lies a troubling reality: obstetric violence that permeates abortion care, leaving many individuals feeling humiliated, judged, and unsupported. The findings from our study lay bare these hidden truths, revealing that legal reform–at least in the model adopted by Uruguay–is insufficient to guarantee respectful and dignified abortion care.
In Uruguay, obstetric violence is legally recognized as a distinct form of gender-based violence, emphasizing the protection of women’s autonomy and rights in reproductive healthcare.
An excerpt from Uruguay law No. 19580.
While Uruguay has a law that explicitly recognizes obstetric violence as a form of gender-based violence, no action has been taken on this matter, and there are very few effective accountability mechanisms to prevent this kind of violence. While Uruguay has a law that explicitly recognizes obstetric violence as a form of gender-based violence, no action has been taken on this matter, and there are very few effective accountability mechanisms to prevent this kind of violence.
Using qualitative interviews with key informants and a quantitative survey conducted between January and February 2023, the research explores individuals’ experiences in accessing abortion services, including interactions with medical professionals, waiting periods, consultations with other professionals, and overall experience.
We show that violence in abortion care in Uruguay is not merely an unintended consequence of poor practices; it is embedded in the very design of the law. The excessive medicalization mandated in the abortion law is a violation of the human rights of women, as it subjected them to unnecessary surveillance and controls under the guise that they were receiving healthcare. The multiple consultations, waiting period, and mandatory ultrasounds required by the law complicate abortion procedures. These measures do not give medical providers the final authority to prevent abortions, but they reinforce a system in which the decision to abort is left to the individual and subject to institutional approval. The law perpetuates structural violence by placing barriers that make pregnant women incapable of autonomy. It reinforces a paternalism and control system, which undermines the rights it is supposed to protect. Many participants initially did not identify their experiences as being violent. This disconnect is due to societal definitions that emphasize physical harm, while ignoring subtler systemic abuses. Yet, the emotional and psychological toll–feelings of guilt, shame, and violation–is profound.
Interpersonal Violence: When care becomes control
Our study showed that healthcare providers often become gatekeepers of morality rather than facilitators of care. Sarcasm and cold attitudes were common. Outright mockery was also reported. What did you expect when you told the doctor how much pain you were in? That it wouldn’t hurt?'” Another recounted being scolded for having multiple abortions, with a doctor remarking, “You should have thought before you opened your legs.”
Uruguay’s legal framework mandates specific procedures, such as mandatory ultrasounds, but it certainly does not require providers to subject individuals to additional distress by displaying images or describing details. Many respondents to the study reported being forced to listen to the heartbeat of the embryo or to see the embryo. One participant said, “
he pressured me to listen to the heartbeat. I felt so cornered.”[…]Instead of compassion, many encounter judgment and coercion, reinforcing harmful societal stigmas around abortion. These interactions are more than poor bedside manners. They are a violation of autonomy, dignity and autonomy. Such experiences not only exacerbate emotional distress but also deter individuals from seeking healthcare.
Institutional Violence: Barriers in the System[t]Beyond individual interactions, systemic delays and bureaucratic inefficiencies compound the harm. Respondents reported having to wait for weeks to get a procedure, due to obstacles such as holiday schedules and arbitrary rules. One participant complained, “I knew what I wanted to do, but they made wait 10 weeks.” It felt like punishment for acting too quickly.”
Delays often come with financial burdens, particularly for those in rural areas who must travel long distances or pay out of pocket for private services. As one respondent noted, “I had to go to another city and pay for a private ultrasound because the clinic had no dates available.”
Compounded barriers
About 1 in 6 respondents encountered conscientious objection–the refusal of healthcare providers to offer certain medical services, such as abortion, based on personal, moral, or religious beliefs–and the impact was significant. It meant referring some to distant providers and further delaying or making access difficult. Moreover, the limited availability of abortion methods–with a heavy reliance on one method and a troubling use of outdated curettage procedures–raises concerns about the comprehensiveness of care.
For some, these negative experiences deterred future healthcare engagement, with one respondent sharing, “I avoided post-abortion consultations because I couldn’t bear the thought of being treated the same way again.” Such outcomes illustrate the long-term consequences of obstetric violence.
Conclusion: Dignity is Non-Negotiable
Abortion care is a matter of human rights and should never be a site of violence. Uruguay’s legal reform is a landmark, but only the beginning. True reproductive justice requires the removal of systemic and interpersonal barriers which perpetuate harm. It requires a healthcare system in which compassion, respect, dignity, and kindness are the norms, not the exceptions. It also requires that individuals be empowered to choose whether they prefer to self-manage their abortions or access them through institutional systems, according to their needs and preferences.
Organizations like Las Lilas are leading the way in creating supportive environments for individuals seeking abortions. Their feminist accompaniment model provides care rooted in respect and empathy, filling the gaps left by institution systems. These networks, which encourage solidarity and the sharing of experiences, not only provide essential support but also work to destigmatize and challenge harmful narratives. Lawyers are also organizing to support victims of obstetric violence through organizations like Gestar Derechos, ensuring that those who experience harm have access to justice and accountability.
Equally inspiring is the resilience of individuals who are resignifying their abortion experiences. Many are transforming stigmatizing experiences into powerful affirmations of autonomy and agency through collective reflection and storytelling. These acts of resistance challenge societal norms and highlight the necessity of reframing abortion as a dignified and legitimate aspect of healthcare.
As Uruguay reflects on a decade of legal abortion, it is time to revisit and strengthen the framework to ensure that no one is left behind. Building on the progress made and addressing the shortcomings, let this be a moment not just of reflection but of renewed commitment to reproductive justice.
About the authors
Dr. Lucia Berro Pizzarossa
is a British Academy International Scholar at the University of Birmingham and a Research Affiliate of the Global Health and Rights Project, at The Petrie Flom Center for Health Law Policy Biotechnology and Bioethics, at Harvard Law School. Her research focuses primarily on reproductive rights, health laws, and the intersection between legal and social frameworks that affect access to abortion. Carolina Farias
works as a lecturer and research at the Institute of Health Psychology at the Faculty of Psychology at Universidad de la Republica. Her work explores psychological dimensions of health with a special focus on reproductive and psychiatric health.
Emilia Müller is a student of the Faculty of Psychology at Universidad de la Republica. She is involved in research and academic initiatives relating to reproductive justice and health psychology. Oriana Franca
, a student at the Faculty of Psychology of Universidad de la Republica, is also a undergraduate student. Her academic interests include the study of reproductive health within mental health frameworks and psychological approaches to healthcare.
