An Open Secret

The History of Unwanted Pregnancy and Abortion in Modern Bolivia

Natalie L. Kimball

• Publisher: Rutgers University Press
• Year: 2020
• ISBN:
  9780813590752
• Topic: History
• Subtopic: World History
• Index: History

Many women throughout the world face the challenge of confronting an unexpected or an unwanted pregnancy, yet these experiences are often shrouded in silence. An Open Secret draws on personal interviews and medical records to uncover the history of women's experiences with unwanted pregnancy and abortion in the South American country of Bolivia. This Andean nation is home to a diverse population of indigenous and mixed-race individuals who practice a range of medical traditions. Centering on the cities of La Paz and El Alto, the book explores how women decided whether to continue or terminate their pregnancies and the medical practices to which women recurred in their search for reproductive health care between the early 1950s and 2010. It demonstrates that, far from constituting private events with little impact on the public sphere, women's intimate experiences with pregnancy contributed to changing policies and services in reproductive health in Bolivia.

CHAPTER 1

Legislating Unwanted Pregnancy and Abortion in Bolivia

Abortion is like an iceberg, where we only see the tip.… It is something that is done with or without laws and that is practiced in the entire country. When I ask women who come to medical consults, it is rare that they say they never had an abortion.… It’s something so hidden, this mountain beneath the water. Whether or not permission is given by the state to do it, abortions will continue to be performed.

—Dolores Ticahuanca, a physician who performed abortions in El Alto in 2009

When asked to describe abortion in Bolivia, individuals in La Paz and El Alto draw on a variety of metaphors. Whether characterizing abortion as an iceberg—a significant, and perhaps menacing, reality obscured by the waters of social convention—or as an open secret, rarely discussed but widely acknowledged, these metaphors about abortion point to the same truth. Abortion in Bolivia, although prohibited in most circumstances since 1973, occurs frequently and is spoken of sparingly. While abortion has remained illegal due to the strength of those political and religious forces that oppose it, recent government programs for the treatment of incomplete abortion and miscarriage belie an official recognition of the frequency with which women confront unwanted pregnancy and abortion in the country. This recognition does not mean that the state condones abortion, or even necessarily empathizes with the women who need it; however, it reveals an acknowledgment that women will terminate pregnancies regardless of its legal status—and a tacit acceptance of that fact. In leaving intact prohibitions against abortion, policy makers pass on to women the consequences of unsafe abortion and social stigma associated with the procedure in the urban Andes.

This chapter illuminates the conflictive history of reproductive policy in Bolivia, which is marked by significant rates of unwanted pregnancy and abortion alongside restrictive laws on these phenomena. Reproductive policies after the revolution were deeply embedded in longer-standing, elite anxieties concerning indigenous people and the place they occupied in the Bolivian nation. For this reason, the first section of the chapter considers the perspectives of politicians, medical doctors, and other professionals in regard to women and men of different sociocultural and racial groups in the late nineteenth and early twentieth centuries. The second section of the chapter draws on interviews, political documents, newspaper articles, and medical and demographic policy reports to explore how evolving historical attitudes about race and gender shaped the development of reproductive policies across the revolutionary, military, and democratic periods.

This chapter finds that shifts in public policies on reproduction were deeply intertwined with broader social, political, and economic trends at the local, national, and global levels. Issues surrounding women and their reproduction—and particularly that of indigenous women—were, in the minds of creole and mestizo elites, central to Bolivia’s progress as a nation. Policy makers, intellectuals, and other dominant sectors measured the value of women and their health primarily in terms of their role as mothers. Through the 1950s, domestic elites were primarily concerned with what they perceived as Bolivia’s underpopulation vis-à-vis other Latin American countries, and voiced concerns that indigenous women, who they saw as dirty and culturally backward, were ill-equipped to produce a healthy population of citizens and laborers. Reforms during the period attempted to solve this “problem” by improving public health and by westernizing indigenous women’s mothering practices (and the indigenous family more broadly). In the 1960s and 1970s, in the context of the Cold War, international observers became concerned with the supposed overpopulation of poor people of color in a variety of locations worldwide, including the indigenous residents of Bolivia. Foreign officials from organizations such as USAID alleged that high birth rates threatened Bolivia’s economic and political progress and made the country susceptible to political unrest. Yet the efforts undertaken by foreign and domestic policy makers to implement family planning programs during the period were largely unsuccessful, partly because they were confronted by pushback from a variety of social sectors concerned with the projects’ eugenicist and imperialist aims. Instead, it was women’s persistent efforts to negotiate their reproductive lives, mobilization on the part of women’s groups and health activists, and broader international trends that spurred the Bolivian state to implement programs in western-derived contraceptive methods and for the clinical treatment of incomplete abortion and miscarriage, largely after the mid-1990s.

The policy developments that took place during these years—changes that ultimately made abortion safer while ensuring that it remained both ubiquitous and illegal—suggest that most biomedical doctors and government officials conceived of abortion and unexplained miscarriage primarily as issues of public health, rather than of women’s or human rights. At the same time, the persistence of legal restrictions against abortion reveal urban society’s continuing ambivalence toward those aspects of women’s lives that fell outside of their role as mothers, such as their engagement in sex for pleasure or companionship, and their efforts to limit pregnancies in order to pursue social or economic mobility. The stories of some of these women, most of whom are also mothers, are explored in the remainder of this book.

REPRODUCTION AND INDIGENOUS “DIFFERENCE” AT THE TURN OF THE TWENTIETH CENTURY

Following independence, Bolivia’s population was primarily rural, and the status of indigenous Bolivians within the political, economic, and social order hinged in large part on the varied nature of land tenure claimed by individuals, families, and kinship groups.¹ Up to 1880, ayllus (independent kin-based communities) held half of the land and comprised half of the country’s total population; the rest of the rural indigenous either labored as colonos (servile tenants) on private haciendas or worked as freeholders. While, in theory, all indigenous people were required to pay a tax (or tribute) to the state, in practice the majority of tributaries were members of ayllus; landless peasants often succeeded in avoiding these obligations. While the relationship that Bolivia’s peasantry shared with state bureaucracies varied according to land tenure, however, these differences did not necessarily determine variations in the perspectives of creole and mestizo elites toward individuals of indigenous ancestry.² While elites’ perspectives on rural-dwelling indigenous people often emphasized their natural submissiveness and thus their suitability to agricultural labor, the upper classes tended to feel greater ambivalence toward the racially mixed, who were deemed more threatening to the socioracial order. At the same time, the contours of elite perspectives on indigenous women and men shifted in response to national political and economic patterns—and particularly, to the specter of political mobilization by indigenous populations.³

The last third of the nineteenth century saw a rising tide of economic and political liberalism that placed the political mobilization of indigenous women and men, and elite anxieties about it, at the center of the national stage.⁴ The country’s liberal reformers, as those elsewhere in the Andes and in Mexico in the nineteenth century, sought to dismantle the status of the rural indigenous community in order to consolidate land into large latifundios (privately owned estates) for the development of export-oriented agriculture and the construction of railroads. The reforms were further designed to convert indigenous peasants into modern, yeoman farmers (and thus prevent their migration to the cities) and to force indigenous Bolivians to adopt western lifeways, which were seen as necessary for national progress.⁵ Liberal policies were often thwarted by resistance and rebellion, which peasants unleashed via paper campaigns filed in bureaucratic offices and courts, as well as through direct action in the countryside.⁶

Undergirding the liberal reforms were discriminatory and racist attitudes toward both rural- and urban-dwelling indigenous people, which were widely expressed in the late nineteenth and early twentieth centuries in a range of literary, photographic, and artistic forms throughout the Andean region.⁷ Among these was indigenismo, “a reformist movement led by mestizo and Creole intellectuals and artists who sought to defend a marginalized Indian population and vindicate its cultural past or future potential.”⁸ While not as consolidated in Bolivia as in other Andean contexts, Bolivian indigenismo, which seized upon the historical significance of the Aymara archaeological site at Tiwanaku, emphasized the latent value of the country’s indigenous populations for the modernizing projects that would eventually be pursued during the 1952 revolution.⁹ The rise of indigenismo in the Andes and of scientific racism in Latin America more broadly in the early twentieth century had particular implications for women and families. As nations in the region pursued modernization, “state policies … fastened onto gender as both a precept and a tool in their attempts to subordinate popular households to the interests of national development, social order and patriarchal power.”¹⁰ In Bolivia, this process was facilitated by an extraordinary rural education movement that swept through the countryside in the first decades of the twentieth century. As described by Brooke Larson, “Gender difference became the device through which rural schools might accomplish their dual ends: the stabilization of the rural peasant class (whose station in life would be narrowly confined to agriculture) and the incremental incorporation of normative values and hygienic routines into the peasant family.… To mold the campesino into Bolivia’s modern (albeit still landless) farm producer was one aim; to fold the campesina into universal womanhood was its essential complement.”¹¹

Key to the rural education movement were broader concerns about the “inability” of indigenous families, and particularly women, to reproduce a robust and healthy population of future laborers. Ethnographic texts from the early twentieth century depicted the indigenous family as fragile, unhealthy, and unstable, haunting elites concerned with populating the Bolivian nation with strong and modern yeoman farmers.¹² Reformers seized upon indigenous women and their bodies as crucial sites in which “improvements” to the indigenous family might take place. Through educational courses in “home economics,” modern campesinas would adopt the trappings of bourgeois femininity, including western nutritional habits, practices of infant care, and beauty products, and thus be converted into housewives safely subordinated to their husbands’ (and the nation’s) patriarchal authority.¹³

Dominant notions of womanhood such as those espoused as part of the rural educational reforms were also at work in cities, where they confronted pushback by both white and mestiza liberal feminist and Aymara anarchist groups of women in La Paz across the first half of the twentieth century.¹⁴ Legal records from the period articulated socioeconomic and racial distinctions between upper-class creole señoras, pollera-clad indigenous mujeres, and rural-dwelling indígenas.¹⁵ Each of these hierarchically ordered groups referenced a different relationship with the racialized female and maternal body, which in turn worked to “ ‘[naturalize] social differences,’ ” particularly, the exclusion of women from the public realm—an exclusion that only upper-class women could readily accommodate.¹⁶ Working-class cholas (urban-dwelling women of indigenous ancestry) who labored in La Paz as merchants, domestic servants, laundresses, and cooks, “profoundly unsettled the dominant ideology of womanhood by powerfully disrupting gendered categories of the ‘natural.’ ”¹⁷ They did so, in part, by organizing for labor rights, and thus thrusting into public debate the domestic spheres of the elite women for whom they labored, which until then had been safely protected from politics. In so doing, urban cholas refuted broader ideologies of womanhood that linked biological notions of the female body to an apolitical sphere centered in the home.¹⁸

By the 1930s, militant groups of working-class women organized unions representing cooks, flower sellers, and other professions, coming together under the Federación Obrera Femenina (Federation of Female Workers, or FOF), which itself formed part of a broader anarchist labor federation. Members of the unions, “raised issues related to their professions, but also made gender-based demands that later governments would be pleased to take credit for implementing, such as child care facilit...