Dr. Cinthia Gómez is on a mission to help victims of sexual assault.
It's a major undertaking in Honduras, where domestic violence and murders targeting women occur with impunity – and where half of babies born to girls ages 15 to 19 are the result of rape.
When victims of sexual assault arrive at Tegucigalpa's largest public hospital, where Dr. Gómez's program is based, they are met by both physicians and psychologists. They are tested and given medication to help diminish their chances of contracting HIV or other sexually transmitted diseases.
But ever since 2009, doctors like Gómez have lacked what many global experts say is a vital tool in treating female rape victims: emergency contraception.
The sources of such high rates of sexual abuse across the country and within families remain a complex problem, with officials pointing to factors including increased organized crime and violence, sweeping poverty, low levels of education, blended families due to migration, and cultural taboos on talking about sex.
Even as many here try to raise awareness about reproductive health and sexual assault, however, they must work within a total ban on emergency contraception, which can prevent pregnancy if taken within 72 hours of sex. The six-year-old prohibition is rooted in a powerful religious lobby that views the intervention as a form of abortion, which is banned. Religion is “very important” in Hondurans' lives, and 88 percent oppose abortion in all or most circumstances, according to a 2014 Pew Research report.
But critics say the ban also sends a discouraging message about women's ability – and right – to deal with at least some of the effects of what is acknowledged as a widespread social problem.
“There was a parting of the waters,” says Regina Fonseca, of the NGO Centro de Derechos de Mujeres (CDM), referring to Honduras' 2009 coup that saw economic woes, a sharp uptick in drug trafficking and violence, and setbacks for human rights. “Improvements to women’s rights and gender equality seemed to evaporate overnight.”
A red flag
At the hospital where Gómez and her team from Doctors Without Borders run their clinic, there's another clinic specifically for expectant teen mothers, decorated in shades of violet and bubble-gum pink. Girls with protruding bellies tap on their cellphones as they wait their turn to meet with Ana Raquel Gómez de Ordoñez for a consultation.
Dr. Gómez de Ordoñez asks the same questions of each girl who enters her office: How old are you? When was your last period? Is the father still in the picture?
One 14-year-old patient nails the first two questions; but the last one proves to be more difficult.
She isn’t dating the baby’s father – they only saw each other once, maybe twice. She doesn’t know if he’s in school. She doesn’t know if he works. She doesn’t know his age, and can’t tell the doctor if he is “a lot” older.
With each response, Gómez de Ordoñez sees more red flags.
As levels of violence extend across the country, so too do the stories of gang members “claiming” young girls, or threatening their families if their daughters resist unwanted advances.
There’s a link between the two, says Julio Zuniga, country director for PASMO, a reproductive health NGO. Girls become tools in hurting rival gangs, and as weapons spread in a community, domestic violence grows as well, Mr. Zuniga says.
“A family might report their daughter’s pregnancy as consensual, when in reality they are protecting their safety,” he says
But sexual abuse within the family is all too common as well. An estimated 90 percent of all reported cases of abuse of minors involve sexual abuse by a family member, according to the public ministry. Hundreds of new cases are discovered each year.
This mounting evidence is why Honduras should allow for the use of emergency contraceptive, says Gómez. Some 60 percent of the victims her team treats arrive within the first 72 hours after an assault, which in other countries would be in time to receive emergency contraception. Many come to the hospital specifically seeking emergency contraception, she says.
“They are incredibly vulnerable,” Gómez says. “It’s not just the general risks of unprotected sex like HIV or STDS, but the mental health effects” that come with being victimized, including the possibility that the rape could result in pregnancy.
Many women who become pregnant from an assault tell Gómez they plan to abandon their child after birth, or threaten to commit suicide. They're less likely to get their child vaccinated or attend follow-up medical appointments. This is on top of risks that already exist for teen mothers, such as higher infant and maternal mortality, or the increased likelihood of dropping out of school.
Close to 20 local NGOs, including CDM, have teamed up with Doctors Without Borders to advocate the legalization and sale of emergency contraceptive. They're pressing lawmakers and pursuing legal avenues for survivors of sexual violence, arguing that the ban means the state failing to protect women’s health.
Out of favor
In 2009, when then-President Zelaya was ousted in a coup, he had fallen out of favor with Honduras’ conservative elite by proposing policies seen as in line with the likes of Venezuela’s Hugo Chávez. Among them was his veto of a congressional bill to criminalize emergency contraceptive as a form of abortion.
Soon after he was forcibly removed, the interim government of de facto President Roberto Micheletti issued an administrative ruling that effectively banned the so-called morning-after pill.
For Martha Lorena Alvardo, who was a congresswoman during Zelaya and Micheletti’s governments, that was the right move. She runs Organización Pro-Vida, a pro-life NGO, and says she couldn’t be happier with Honduras’ stance on abortion and emergency contraception.
“When emergency contraceptive was legal it was given out like candy,” Ms. Alvardo asserts. “Honduras has very strong Catholic roots – abortion isn’t acceptable to us,” she says, categorizing emergency contraception as abortion, a view that medical professionals reject.
Alvardo, whose family has run an influential law practice here for generations, acknowledges that Honduras has a crisis of teen pregnancy, sexual assault, and incest. But for her, a 10-year-old-girl who shows up at the hospital after being raped by her stepfather – a case Gómez’s team recently dealt with – isn’t evidence of the need for emergency contraception. Instead, the unborn child “should be seen as the blessing that brought the abuse to light, saving” the young girl’s life.
"You can’t solve personal, social, or economic problems by” not having a baby, says Alvaro.
To an extent, Ms. Fonseca from CDM agrees that preventing a pregnancy through emergency contraception won't solve everything. Though she believes in a woman's right to choose if and when she wants to have a child, the root cause behind sexual abuse is still a burning issue.
"There's no silver bullet to dealing with high rates of sexual assault or teenage pregnancy," Fonseca says. But women have "so little say" over their reproductive health: "Allowing emergency contraception gives them that smallest bit of control."
– Whitney Eulich reported from Honduras as a fellow with the International Reporting Project.