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In Colombia, abortion is no longer a crime. But rural women will still find it hard to get one.

Women in rural areas already have a hard time getting ordinary health care

Abortion rights activists celebrate in Bogotá on Feb. 21 after Colombia’s Constitutional Court approved the decriminalization of abortion, lifting all limitations on the procedure until the 24th week of pregnancy. (Fernando Vergara/AP)
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In late February, Colombia’s highest court ruled that having an abortion would no longer be a criminal offense. Previously, women in Colombia could have abortions only under certain conditions.

Women can no longer be imprisoned for medical abortions, and health-care providers cannot legally deny abortions to women who request them or are at least required to refer women to providers who offer them.

However, women in rural areas may still find it difficult to get equal access to abortion — because they don’t have equal access to health care more generally. Outside urban centers, our research finds, Colombians’ general health needs are often unmet.

How we did our research

In November and December, one of us, Sarah Moore, worked with fellow political scientist Ana Arjona to survey 1,517 people from towns across Colombia that had been affected by Colombia’s long-standing conflict with various armed groups. The survey was fielded in-person by local enumerators from Cifras y Conceptos among a random sample of individuals in towns representative of various regions in the country. The goal was to gather data on local conflict dynamics and conditions since the Colombian government signed a 2016 peace agreement with the Revolutionary Armed Forces of Colombia (FARC), the guerrilla group that has since demobilized. The survey asked about a number of things, including what services the government now offers in these areas that had either been under the control of an armed group, like the FARC or the National Liberation Army (ELN), or contested.

In the same towns from the survey, we also conducted about 70 in-depth, in-person interviews with knowledgeable community members, asking about their greatest needs and which services they wished the state would provide. After the abortion ruling, Kiran Stallone also conducted phone-based interviews about abortion access with six legal activists and female leaders living and working in other rural areas in Colombia. These interviews were what social scientists call “open-ended,” meaning there was no survey with set responses, but a list of questions guided our conversations.

Data from these sources all lead to a similar conclusion: Although the ruling is a significant achievement, rural women are not likely to have equal access to safe abortions.

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The Colombian government’s limited capacity to provide health care

Colombia’s regions and towns offer very different levels of health care. As political scientist Silvia Otero-Bahamón showed, Colombia’s national, one-size-fits-all approach to providing health care leads to poorer outcomes across rural areas, where at least 16 percent of Colombia’s population lives.

In our interviews, Valeria Pedraza, a lawyer at Women’s Link who drafted and signed the abortion decriminalization petition, told us that regional disparities will complicate efforts to deliver abortion safely and equally to everyone. “If the ruling is properly implemented,” she told us in Spanish (our translation), “the barriers and inequalities surrounding access to abortion should decrease. … This will undoubtedly be a challenge. Colombia is still a country with very unequal access to health and many complexities.”

When we visited rural towns and asked interviewees about the quality of local state services, many related frustrations about health facilities. For example, in Boyacá, a central Colombian territory that has historically been fought over by various armed groups, respondents said they wished for more than their local drop-in clinic, calling for a local hospital that would provide a greater array of procedures.

Yirley Velazco, a social leader from El Carmen de Bolivar, a mountain town near Colombia’s northern coast, told us in Spanish (our translation), “I don’t think things will change much. … One thing is what the court says from over there and another thing is what the local entities actually want to do.”

Diana Marcela Torres, a social leader who works with rural women in the Magdalena Medio region, similarly predicts access won’t be the same for rural women, given “the historical situation in Colombia, which is a complete neglect of rural areas.”

Our survey respondents echo this. When asked, “At some point, have you ever felt abandoned by the state?,” 63 percent of those living in rural areas answered yes.

“Other rights that have already been achieved or recognized, such as education or health, do not reach those territories,” Torres continued. She expects that the right to abortion will be among “those rights that will not reach the majority of rural women.”

Mobility also challenges health-care access

Interviewees in the Caribbean state of Sucre told us that some of the difficulties with health-care access have nothing to do with health care itself. Abysmal roadways between town centers where health services are located and the outlying rural communities stymie access.

Less than half of our survey respondents reported that they lived in a household that owned a car, bicycle or motorcycle. When transportation is available, travel between some outlying communities to basic health clinics can take anywhere from two to 12 hours, may only be available on certain days and can be very costly. In Magdalena Medio, Torres explained, these trips can end up costing 10 times as much as a person living closer to an urban area would pay.

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Despite barriers, activists say the ruling is still a monumental achievement for women’s rights

Despite the limited reach of government health services, Colombians still say they rely on those state services. When we asked respondents whether they felt that the government should be the primary provider of education and health care, 88 percent of respondents either agreed completely or somewhat.

Challenges notwithstanding, the female activists interviewed for this project repeatedly emphasized that the decision is a landmark moment.

“For me, decriminalizing abortion is a huge step, a tremendous achievement for this entire movement. It is an opportunity to decide about our bodies; it is an opportunity to be able to make a choice about motherhood,” said Velazco.

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Sarah Moore (@sarahmoreorless), a PhD candidate in political science and an MS candidate in statistics at Northwestern University, was a pre-doctoral fellow with CESED at Universidad de los Andes-Bogotá from 2019 to 2021. Her research focuses on social science methods among hard-to-reach populations and the effects of conflict on civilian political behavior.

Kiran Stallone (@kiranstallone) is a PhD candidate in sociology at the University of California at Berkeley and currently based in Colombia. Her research examines civilian responses to war and conflict violence from a gender perspective.

Support for this research was provided by the Global Challenges Research Fund (GCRF) project “Drugs & (dis)order: building peacetime economies in the aftermath of war” (ES/P011543/1), the Buffett Institute for Global Affairs at Northwestern University, Folke Bernadotte Academy in Sweden, and the Center for the Study of Security and Drugs (CESED) at Los Andes University in Bogotá, Colombia.

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