This report was written by Coordinator Sonia Ariza Navarrete and Coordination Assistant Carla Zapata, of the Consorcio Latinoamericano Contra el Aborto Inseguro (CLACAI, or Latin American Consortium Against Unsafe Abortion), in collaboration with the Guttmacher Institute. Lisa Remez, Guttmacher Institute, translated the report into English and revised the English version where needed for an international audience. The original Spanish-language report is available on the CLACAI website.
Latin America is currently convulsed by debates over sexual and reproductive rights. Whereas important social movements, principally feminism, are driving progress in the protection of these rights, the entire region and individual countries are also contending with persistent religious and conservative backlash to this progress. Changes in current laws and policies on sexual and reproductive health and rights (SRHR) are crucial to guaranteeing these essential human rights.
In response to this critical moment, the Consorcio Latinoamericano Contra el Aborto Inseguro (CLACAI, or Latin American Consortium Against Unsafe Abortion) launched the initiative La Salud Reproductiva Es Vital (LSRV, or Reproductive Health Is Vital) in 2020. The initiative, first undertaken to address concerns over the impact in the region of COVID-19 on sexual and reproductive health (SRH), involved civil-society monitoring of SRH. It also included studies and advocacy activities on topics such as reproductive health services during the pandemic, maternal mortality during the pandemic, abortion regulations and legislation, and analyses of the estimates of unintended pregnancy and abortion generated by the Guttmacher Institute.
As part of this initiative, a network was born in 2022; its purpose is to bring together key actors in Latin American governments and civil-society organizations. The network, the Red Regional de Tomadoras y Tomadores de Decisiones en Salud Sexual y Reproductiva (Regional Network of Decision-Makers in Sexual and Reproductive Health), was tasked with generating a space for conversations and exchanges that would ultimately improve public policy in the region.
The network is the first at the regional level, and one of very few that exist at all, to bring together government authorities, key individuals with experience developing public policy and civil-society organizations that advocate for sexual and reproductive rights. CLACAI created a space for substantive, collaborative exchanges at both national and international levels. Through opening these channels of communication, the consortium enabled sharing between countries so that they could make advances consolidating the recognition of rights in service provision. The resulting solidarity enabled countries that had successfully reformed restrictive laws to discuss strategies and strengths with countries that had yet to do so.
Both government authorities and members of civil-society organizations involved with SRH policies came together amicably to find solutions and ways to collaborate in this crucial time of legal and social upheaval;1 they circulated best practices in implementation and discussed challenges and aspirations. As an Argentinian member of the network said, “The region is really a single, collective entity in which regional public policy, in many senses, influences national public policy, not only politically but also in the creation and exchange of knowledge and practices.”
This advocacy case study describes the creation of the network and its initial activities, and the potential scope of this unprecedented undertaking. By informing wider audiences, we hope that other regions will be able to adapt this network to their local contexts and gain similar benefits.
For this advocacy case study, the LSRV team interviewed nine members of the regional network. Six were decision-makers from the following five countries: Argentina (two network members), Bolivia, Chile, Colombia and Mexico. The remaining three network members interviewed were activists from each of the following three countries: Argentina, Chile and Ecuador.
First Regional Meeting
The idea for a network grew out of the Primer Encuentro Regional de Tomadoras y Tomadores de Decisiones en Salud Reproductiva (First Regional Meeting of Reproductive Health Decision-Makers), which took place on June 23, 2022, in Lima, Peru. It was organized by CLACAI under the LSRV initiative, with institutional support from the Guttmacher Institute, Ipas and the Center for Reproductive Rights. The meeting was a full day of activities that drew 40 participants from 10 countries,* of which half were decision-makers at local and national levels; the other half were representatives of national-level civil-society organizations.
As one of the regional LSRV coordinators observed about the meeting:
We were thinking of creating a space to go over our similarities and differences. I recall that, at this first meeting, we told ourselves we wanted to learn what our colleagues were doing from a rights perspective, which would serve as inspiration for the entire region.
With the Lima meeting, CLACAI sought to create a space for informed discussions on ideas, experiences and strategies to design and implement mechanisms and policies to: 1) improve access to, and the quality of, safe and legal abortion; 2) share challenges and best practices in implementing the right to abortion in countries throughout the region; and 3) offer an avenue for generating future collaboration between decision-makers and civil-society organizations.
Planning and Structuring the Meeting
In calling the meeting and as part of its careful planning, the LSRV team conferred with the executive director of CLACAI and key regional- and national-level players to identify which countries’ current leadership was favorable to broad access to SRH services, including safe abortion.
The team identified national or provincial officials who would be interested in attending the first in-person regional meeting to share their experiences, challenges and best practices. Once the list was prepared, the LSRV team made informal contact with the listed officials through local CLACAI member-organization intermediaries, who also gauged officials’ willingness to attend. Formal invitations were then issued by CLACAI to officials whose willingness to attend was verified. The strategy proved successful in most cases but not in all.
For example, for Brazil, only provincial government officials attended because the federal government’s anti-abortion position at the time meant that no national official was willing to attend. In contrast, for Argentina, the attendance of both national- and province-level officials was supported by their respective leadership. Thus, Argentina’s national director of sexual and reproductive health attended the Lima conference, as did the directors of sexual and reproductive health for the Buenos Aires and Jujuy Provinces. For Bolivia, both local and national officials initially received authorization to attend, but the national government withdrew its permission at the last minute.
The meeting was structured into four sessions that were facilitated by a lawyer who is also an expert in workshops and human rights. In the first session, participants introduced themselves and their roles in their specific country context. Agreements to uphold confidentiality and mutual respect enabled this opening session to set safe-space boundaries for the entire meeting.
The second session consisted of presentations by researchers from the Guttmacher Institute who were responsible for the study that used statistical models to produce the first region-wide estimates of unintended pregnancy and abortion. These presentations led to a discussion on the gaps in access to safe abortion in Latin America, the importance of producing estimates and the need for designing public policies that are based on evidence—all of which highlight the lack of reliable incidence data throughout the region.
The third session involved presentations by decision-makers from each of the 10 represented countries. Participants then broke out into country groups to discuss points of view from the perspective of their roles as decision-makers, members of civil-society organizations, researchers, etc. Then, all participants regrouped so that each country could present its agreed-on national position, which would be used to construct a larger, panoramic view of the region as a whole.
Finally, the fourth session was devoted to considerations for the future—namely, potential opportunities to collaborate on and establish better standards for quality abortion care. This meant reviewing the lessons learned and the remaining challenges in establishing common agendas and opportunities for further networking. At the end of the meeting, the full group agreed to create the regional network.
Accomplishments of the Lima Meeting
Attendees presented on the pandemic’s impact in their country, focusing on best practices and challenges faced in guaranteeing sexual and reproductive rights, which included their plans for a post-pandemic world. According to findings from an LSRV monitoring effort to track the impact of COVID-19, the pandemic hit investment in and access to reproductive health services especially hard. In nearly all of the 10 countries represented, these services were suspended because of the pandemic and, in many cases, were re-established very slowly and had not yet fully recovered.
On the other hand, the region’s Green Wave and other progressive social movements such as #NiUnaMenos (#NotOneLess, demanding the end of gender-based violence) have had a positive impact on changes in policies on abortion, contraception and sexual violence. These new policies expanded women’s ability to exercise their right to abortion while highlighting the persistent barriers that had prevented them from doing so. Health systems managers were tasked with revamping systems to accommodate these new policies, such as the legalization of on-request abortion (i.e., without restriction as to reason) in Argentina (in 2020) and Colombia (in 2022), and the expansion of the right to abortion in Bolivia (2014), Ecuador (2021) and Mexico (2021).2 Moreover, the legal situation continues to shift constantly: After the Lima meeting, Mexico’s Supreme Court declared the articles in the federal code that restricted the right to abortion unconstitutional in 2023.
It became clear that the experiences of countries farther along on the road to legal abortion—that had accumulated both successes and failures—would be invaluable to countries that were just starting out. The former had much to teach the latter. Lessons learned included the need for focused strategies where opposition to legal abortion is especially entrenched. These include harm-reduction approaches, which are needed where health officials have to combat retrogressive policies, widespread stigma and resistance to abortion rights, and where funding to scale-up services is lacking.
As a Chilean program manager related:
At the meeting, I met a colleague who worked for Profamilia, in Colombia, and she shared her experience with teleabortion. I had not thought about how telemedicine could expand access to safe abortion, and that option suddenly opened up for me. Because Latin America’s strength is that it makes progress without necessarily copying others. Despite our similarities, there is a lot of diversity in our points of view and thus our possibilities; it is important to learn about others’ experiences.
Meeting participants also shared their visions of the future and desires to collaborate on developing better standards of quality abortion care. As an Argentinian program manager asserted:
The meeting’s…strength lies in the fact that we could acknowledge our widely differing roles, and these roles are not fixed. The meeting’s power was in being able to recognize ourselves in many different roles, which are not fixed. There was a broad mix in the make-up of attendees. On the one hand, there were decision-makers with the power to make a difference, since they have the political backing to do so. On the other hand, there were people who were not yet in any official position but may be one day; these hold potential for intergenerational change and bring with them new outlooks and experiences to move things forward.
As a Bolivian decision-maker put it:
The meeting allowed me to not only think about my own experience but to also learn more about the Green Wave, women’s conferences and their combined impact on public policy in Argentina, as well as the experiences of other countries in the region that have legalized abortion, and it showed me the need to conceptualize and systematize experiences using different models and strategies.
Participants judged the diverse make-up of the attendees to be positive. Attendees who worked closely together came from a wide range of backgrounds and had worked in many capacities. This led to an environment open to generating strong bonds of trust, which culminated in the group’s decision to create a formal network that would allow everyone to keep in touch and continue to work together after the meeting ended.
Meeting Highlights
The meeting highlighted several challenges participants faced in governments guaranteeing the right to abortion. Among many, these included: the lack of stable, sufficient funding to ensure adequate personnel and supplies to meet the population’s needs; the need to train medical teams and disseminate information to them about the legal framework and standards of quality care; the inability to widely offer later-term abortions; resistance posed by governments or population groups who are hostile to abortion rights or do not prioritize reproductive health; widespread claims of conscientious objection by health personnel; the impact of organized social conservatives; and ongoing legal restrictions on abortion in many countries.
As a Mexican decision-maker put it:
For those of us who are very operational, it’s important to meet with others who have the same responsibilities and seek out their experiences.… The network enables exchanges not only between public officials but also between program administrators. For us, that was very important, because it meant that after the meeting, we could start collaborating with Colombia and, above all, with Argentina. And we have planned follow-up visits with them! It allowed us to validate some of the issues we were having with implementation, and to better understand that all of this is part of the process of enacting policy itself.
Meeting attendees discussed the following lessons learned and good practices in reproductive health for the region, which require:
-
a feminist-focused implementation approach that is situational, empathic and relational in all aspects, and is wholly centered on the person capable of pregnancy
-
establishment of best practices through collaboration with authorities, professional organizations and civil-society organizations that have experience in service provision
-
service delivery from both a feminist and a human rights perspective
-
a focus on improving accountability mechanisms and content for public information campaigns
-
the need for policies to take an anti-stigma stance to highlight the intrinsic value of abortion services, the medical teams who provide them and the pregnant women who decide to have them
As an Argentinian official further elucidated:
Feminist-focused policy implementation refers to a process that is person-centered and informed by individuals’ preferences and values, always respecting differences. In application, it means meeting the needs of each person with the same dedication that is used to provide services. So, we accompany a patient to their later-term abortion the same way that we work to ensure adequate supplies for services and to generate the data needed to inform society about the progress of implementing the policy.
At the meeting’s close, attendees expressed interest in forming a network, under CLACAI’s auspices, to provide a platform to facilitate discussions, strategic debates and informed advocacy discussions. They agreed that the first step would be creating a WhatsApp channel to organize, build and spread the word about a new network devoted to safe abortion in the region. Attendees also concurred that CLACAI’s years of experience and regional reputation would enhance governments’ willingness to permit their representatives to join the network.
Launching the Regional Network
Communicating through WhatsApp was a terrific way to begin the process of consolidating the network. It enabled exchanges of knowledge and experiences, and the building of trust among members.
As a Colombian official noted:
It felt novel to be one “click” away from colleagues and peers in countries around the region, free from the formality of official diplomatic ties. This space allowed us to interact with other countries’ officials and medical teams in real time.
In chats, members shared country-relevant information; they also consulted one another on technical matters, as well as on new guidelines, progress reports, and doubts and concerns.
As a Bolivian official remarked:
Colleagues consulted one another on issues such as the lack of supplies and shared strategies that had worked to resolve these issues; this gave us ideas and inspired us to seek solutions. Even when, in many cases, countries’ specific circumstances did not allow us to apply the solutions that we would have liked.
The network also provided a space to collaborate on solutions that could be put in place. For example, it enabled a country that had successfully reformed its restrictive abortion law, Argentina, to share what worked with countries that still severely limit the right to abortion, such as Brazil and Chile. Moreover, two other countries that had liberalized their laws, Mexico and Colombia, also provided technical assistance to Brazil and Chile. The above was achieved via members’ sharing information on these crucial issues, even though solving them is still not possible in the presence of barriers such as limited technical capacity, ongoing restrictive legal frameworks and institutional biases.
Important Network Activities
In addition to network members’ ownership in setting up the network themselves, the LSRV team pitched in by establishing further ways for members to exchange information. For example, LSRV hosted virtual meetings in 2022 and 2023 on the importance of evidence-based policies, under the collective title Conversaciones para la incidencia: datos sobre aborto en América Latina (Conversations for advocacy: data on abortion in Latin America). These virtual meetings were designed to share and discuss evidence. They focused on analyzing available data, so attendees could then strategize on how to use them to advocate for legal change and to improve abortion access. Researchers, regional experts in the field, representatives from civil-society organizations and decision-makers from all over Latin America attended the virtual meetings.
The first virtual meeting, Metodología de las estimaciones sobre aborto: Fortalezas y límites de los datos estimativos (Methodologies to estimate abortion. Strengths and limitations of estimates) covered regional estimates of unintended pregnancy and abortion developed by the Guttmacher Institute. It focused on the statistical model used to generate these estimates and the need for better official data to enter into the model; the majority of Latin American countries lack reliable, current and available data on the incidence of abortion.
The second virtual meeting, Incidencia a partir de las estimaciones sobre aborto en Latinoamérica: potencialidades de los datos (Advocacy using abortion estimates in Latin America: maximizing their potential), included discussions on using estimates for national and regional advocacy. Participants discussed issues such as unlocking the estimates’ potential, what they can be expected to accomplish and the limitations of using results from statistical models.
In the words of a Mexican official:
These meetings proved very valuable because they allowed us to invite teams that have expressed doubts about the estimates, and very few spaces allow specific discussions on these topics. For example, this meeting made us think about the possible analyses we could do with the abortion estimates produced by the Guttmacher Institute.
Another major activity was CLACAI’s in-person conference held in Panama City, June 22–23, 2023: VII Conferencia Regional CLACAI 2023—Persistir en el cambio: El aborto es nuestro derecho (CLACAI 2023 Regional Conference—Continue the Change: Abortion Is Our Right). At that conference, LSRV held a session titled Monitoreo y rendición de cuentas en salud reproductiva: Experiencias en la región (Monitoring and Accountability in Reproductive Health: Experiences from the Region). The session attracted representatives from national and regional civil-society monitoring initiatives,† as well as decision-makers looking to improve processes in the following areas: accountability, analyses of data and proposals to advance evidence-based public policies.
Strengthening the Regional Network
The network continues to be active through WhatsApp chats and an email group, which was created so that members could share documents and information and consult one another. Network members continue to demonstrate interest in keeping the exchanges going. Recent legal advances—such as allowing on-request abortions in Colombia and the Mexican Supreme court’s decision that federal abortion law was unconstitutional—have renewed desires to discuss specific policy implementation strategies. The value of the network was commonly expressed, as two examples from Argentinian network members show:
In addition to advances on the legal front, we’ve also made progress on making abortion more available and safer. In Argentina, for example, we have already started public-sector production of misoprostol, and will soon do the same with mifepristone. In-country production will open up opportunities for the region, since it allows us to break pharmaceutical monopolies and sell medication at reasonable prices in every country. The network is a space to think through these strategies and reinforce a common agenda.I think this network can help provide a space for those of us who are too close to the issue to take a step away and get the fuller picture. I want to systematize all of the information collected by those monitoring initiatives on recent and current progress in various countries; but as managers, we often do not have time to closely analyze all of the information from the region, so the network creates a space for us to do that.
The network creates spaces for exchanging common agendas; it also allows for imparting the technical expertise needed to expand safe abortion teams, maintain adequate supplies and extend the availability of later-term abortions. These are just some of the issues that network members identified as being priorities. As two administrators specified:
This network gives us a space to think about tools from an administrative perspective for implementing the law. For example, we can share with other members the problems they’ll have—and some of the possible solutions that have yet to be found, but that we are currently looking for.The urgent need to talk about the production of commodities arose, and another thing that should be talked about is public-sector, in-country production, because we’re spending a fortune on commodities that we can manufacture ourselves.... We need to support one another with technical support on the supply chain, which is an extremely important subject, and I don’t know how the rest of the region handles it, but I’m curious to find out.
In fact, the network plans to promote exchanges with other CLACAI spaces—e.g., the Red Jurídica (Law Network) and the Línea de cuidado de cuidadoras/es (Care for Caregivers’ Helpline)—that produce materials containing legal advice and strategies for safe abortion providers.
Network members even envisioned contributing to a shift in the structural paradigm of health care. As one program manager asserted:
This network allowed us program managers and administrators to hold very specific, targeted conversations. We learned how newly available abortion services could catalyze structural reforms in health care. For the moment, I wouldn’t say in the overall health infrastructure, but yes, for health centers and some hospitals, for which abortion provision has transformed the way they provide care.... For example, these facilities are providing diabetes care differently now based on lessons learned from the benefits of working in interdisciplinary teams; this different and valuable work model expanded quickly.
Conclusions and Recommendations
This advocacy case study demonstrated how the first regional SRHR network within the LSRV initiative, under CLACAI’s auspices, was created and consolidated. The network provides a unique, safe and trustworthy space in the region, enabling those managing health programs and implementing SRH policies to share experiences, consult one another and develop regional strategies of collaboration. As one program administrator noted:
The network has helped me solve real problems, generate professional ties and linkages, find out how things have gone and learn what didn’t work so we could discuss how to make it better.
The network also clearly demonstrated the importance of being in constant contact through email groups, and how WhatsApp enables network members (both decision-makers as well as experts from civil-society organizations) to discuss, debate and offer technical help and collaboration, which has translated into tangible outcomes. Among these outcomes are: the provision of safe abortions in countries that lacked adequate technical capacity or the needed legal framework; the development of implementation or service guidelines that raised standards of care; and the sharing of strategies to think collectively to adapt lessons learned to local contexts.
The need to keep holding in-person meetings in the post-pandemic era emerged as critical. These get-togethers are key to strengthening trust and confidentiality, which are essential to fully address the complexity of implementing and administering services. Virtual meetings can never replace in-person ones. As one program manager remarked:
Everything related to networking is crucial. One thing is knowing that a specific person exists or having sent [name of expert] an email, but it is quite another thing to actually meet that person, so the next time you speak will not be the same. Putting faces to names means that once the meeting is over, you can easily contact each other to ask questions and share documents.
The regional network should continue working on its agenda of program management, service delivery and regulatory frameworks. Among the items covered under the above are: providing abortion at later gestations; maintaining supplies of commodities, including through public production and regional distribution; developing the needed terminology and concepts to clearly write and effectively implement abortion laws and policies; generating and systematizing abortion data and estimates; and building mechanisms of accountability and other administrative tools.
To fulfill these objectives, annual in-person meetings are recommended, in conjunction with virtual gatherings, as is developing materials for policy administrators in the network, which will document the priority areas of group strategizing and discussions.
The greatest challenge to keeping the network up and running is the make-up of its membership. Maintaining current officeholders as active members is extremely difficult in a region where not all governments support or prioritize sexual and reproductive rights. As one program manager commented:
Our countries’ governments are in a state of constant change. Today, the current government is pro-rights, meaning the opposition is doing all it can to make things difficult, but the next government may be right-wing, and opposed to our agenda.
In light of this constant flux and turnover, the network must capitalize on the experiences and expertise of its current membership and work to maintain it even after members leave public office or no longer work for officeholders. In addition, together with local and regional civil-society organizations, the network should annually review current officeholders and staff to keep up to date to invite those in power to join.