Charters for Choice: Abortion Travel, Abortion Referral Networks and Spanish Women's Transnational Reproductive Agency, 1975–1985
2020; Wiley; Volume: 32; Issue: 2 Linguagem: Inglês
10.1111/1468-0424.12463
ISSN1468-0424
AutoresAgata Ignaciuk, Christabelle Sethna,
Tópico(s)French Historical and Cultural Studies
ResumoThe last decade has witnessed the blossoming of abortion referral networks assisting women who live in healthcare jurisdictions that limit their access to abortion services. The Abortion Support Network has facilitated abortion travel to Britain for women from Ireland, Northern Ireland and the Isle of Man. In 2019, it expanded to support women from Malta and Gibraltar.1 Ciocia Basia, Kumpela and Abortion Network Amsterdam aid women from Poland, where abortion access is severely restricted, in travelling to Berlin, Leipzig and Amsterdam, respectively. In December 2019, the aforementioned organisations teamed up with Abortion Dream Team, a Polish informal activist group, to establish an ‘Abortion Without Borders’ initiative, which further supports Polish women's abortion travel by liaising with foreign clinics and providing information and access to abortion funds.2 This paper historicises similar types of abortion travel by analysing abortion referral networks for Spanish women. We focus on the period between 1975 – signifying the beginning of Spain's transition to democracy from a militaristic, right-wing, authoritarian regime, triggered that year by the death of dictator Francisco Franco – and 1985, the year in which abortion was partially decriminalised in Spain. Although this partial decriminalisation did not completely end Spanish women's abortion travel, it did curtail abortion travel as a mass phenomenon, with thousands of Spanish women annually boarding charter flights to Britain, taking ferries to Morocco or crossing borders to Portugal or France in search of abortion services.3 Abortion referral networks assisting Spanish women were knit together by antifascist and feminist individuals and groups. They created broad or narrow, longstanding or temporary alliances among friends, acquaintances, medical professionals, left-wing political parties, trade unions, travel agencies, abortion referral agencies, abortion clinics and family planning centres. The sizeable numbers of Spanish women who travelled for abortion services, combined with the widespread existence of formal and informal abortion referral networks, led to the recognition of abortion as a major public health issue, the mainstreaming of abortion rights and the transmission of ideas about socialism, feminism and social justice. Moreover, they enhanced the exercise of what we call ‘transnational reproductive agency’. Possibly because of a rise in the use of reproductive technologies and the many ethical controversies generated, reproductive agency is currently associated most closely with cross-border travel for fertility services.4 However, women's reproductive agency should be studied more expansively as the capacity to realise one's reproductive desires.5 These can vary widely. Reproductive agency may be circumscribed on several grounds including state scrutiny, coercion or indifference, restrictive laws and policies, religious dictates, gender inequality, socioeconomic status, racial or ethnic group affiliation, cultural norms, intimate partner violence and familial relationships.6 Similar to research on fertility services, research on abortion services shows that limitations on women's reproductive agency are compounded by physical distance to a provider of these services and that women organise, mobilise and strategise to circumvent those limitations by travelling locally and transnationally.7 From the 1960s onward, abortion travel grew in the Western world to become a commonplace transnational occurrence as the result of the liberalisation of abortion laws in Britain and parts of Western Europe and North America, and the availability of more cost-effective, long-range transportation and hospitality services connected to the tourist industry.8 The emergence of abortion referral networks is another crucial, yet somewhat overlooked, factor that had a powerful impact on the exercise of women's transnational reproductive agency with regard to abortion. Through these networks, women were able to overcome legal, geographical and logistical obstacles to access abortion services often far outside their own healthcare jurisdictions. Leslie J. Reagan's important research on the California-based Association to Repeal Abortion Laws, which helped American women find abortion providers in Mexico, provides one of the first accounts of an abortion referral network. It served as a ‘feminist public health agency’, building a list of vetted Mexican abortion providers.9 Another well-known network, the Clergy Consultation Service, operated out of both New York and Chicago to provide women with the names and addresses of reliable abortion providers across the United States and Canada.10 Some scholars point to the involvement of Canadian feminist groups and family planning organisations that sent women to Montreal, overseas to London and southward to the United States.11 Others explore the Abortion Birth Control Referral Service, established by the University of Washington's YWCA, and its cross-border efforts to assist Canadian women for abortion services.12 A recent volume coedited by Christabelle Sethna and Gayle Davis places abortion travel, past and present, at the intersection of reproductive healthcare, mobility and globalisation. Several contributors to this volume examine the vital role abortion referral networks played in providing essential support services to women of diverse nationalities alongside abortion services.13 The existing literature on abortion travel routes and abortion referral networks most often encompasses the Republic of Ireland, Northern Ireland and Britain and, to a lesser extent, the United States, Canada and France. Consequently, with the exception of Agata Ignaciuk's contribution on Spain in the aforementioned coedited volume, this analysis of Spanish abortion referral networks enters almost uncharted territory.14 Spanish women's abortion travel has been examined almost exclusively from social sciences and public health perspectives, and historical scholarhip on abortion has concentrated on earlier periods, such as the liberalisation of abortion law in the Catalonia region during the civil war and Spain's ban in 1941 of abortion.15 Many sociological and legal scholars of abortion law reform during Spain's democratic transition emphasise that abortion travel was invoked as an argument to liberalise the abortion ban.16 Epidemiologists, on the other hand, have quantified Spanish women's abortion travel, demonstrating that it was a regular occurance.17 The present analysis builds upon these contributions in dialogue with scholarship on the cultural history of Spain's transition to democracy and on the historiography of Spanish family planning which, like abortion, was banned in 1941.18 The analysis is based on a several sources, such as relevant archival collections of the Instituto de la Mujer, a public equality institution founded in Madrid in 1983, and popular print media coverage of abortion travel in the daily liberal newspaper El País, the conservative magazine Blanco y Negro and the feminist magazine Vindicación Feminista.19 Selected oral history interviews from three major research projects were also used. Between 2010 and 2016, Teresa Ortiz-Gómez led two research projects that focused on the history of family planning in Spain in the 1960s–1970s.20 Interviews with Spanish physicians and family planning activists were conducted by Ortiz-Gómez, Ignaciuk and Eugenia Gil García and are archived at the University of Granada. Between 2013 and 2019, Ignaciuk conducted a total of twenty-nine personal, telephone and Skype interviews with twenty-seven women and two men involved in abortion referral networks as providers, assistants or clients. The more recent interviews are part of the third and ongoing major research project, led by Sethna, on transnational abortion travel from the 1960s to the 1990s. Honouring the wishes of the interview participants, their identities were either revealed, disguised or anonymised. Ignaciuk translated relevant interview data from Spanish into English. Interview participants were contacted through personal and professional networks including RedCAPs, an online network of women health professionals working in Spain. Special caution was taken especially in the case of interviews with women who recounted their own experiences of abortion travel; Skype and telephone interviews have proven very useful insofar as offering them a safe space in which to speak and withdraw if necessary.21 We use the interview data to highlight the entangled personal, professional and activist experiences of the interview participants, paying special attention to motivations for enhancing the exercise of women's transnational reproductive agency. The 1941 ban on abortion and the simultaneous legal prohibition of the sale and advertisement of contraceptives were examples of the close ideological alliance between Franco's Spain and the Catholic Church, later labelled ‘National-Catholicism’.22 Subsequent legislation penalised abortion providers and women who induced their own terminations with fines and imprisonment.23 The illegality of abortion subjected women to the risk of injury and death, but this risk was stratified across class, region and political affiliation. Several interview participants had vivid recollections of the time ‘when abortion was a crime’, recalling an acquaintance who died after trying to induce her own miscarriage; a woman who, bleeding badly after an illegal abortion, was admitted to hospital while the police waited outside to imprison her; and a patient dying of a botched abortion in a hospital ward.24 For healthcare professionals, performing or even helping to arrange abortions carried the additional risk of professional disqualification for up to twenty years.25 They were obliged to report a woman suspected of attempting an abortion to the police or local prosecutor, although many chose to complete the abortion without notifying the authorities.26 This practice became more common – or was more commonly acknowledged – after Franco's death. The text of the 1941 law and the country's Penal Code did not explicitly criminalise indirect assistance, such as accompanying a woman to an abortion provider or paying for the abortion. However, it was condemned in numerous Supreme Court decisions during the 1960s and 1970s.27 Terminations performed outside Spain did not entirely remove the possibility of prosecution for a woman who had an abortion and those who aided her. Several such cases were reported in the late 1970s and early 1980s, as abortion referral networks multiplied during a peak period of public discussions about decriminalising abortion.28 Despite what amounted to a total ban on abortion, scholars agree that the procedure remained a routine birth control measure for thousands of Spanish women. Using legal records, Inmaculada Blasco Herranz and Clive Beadman contend that in the 1940s, at the height of political repression and economic precarity, women networked informally with female family members, friends and neighbours to induce their own miscarriages or locate an abortion provider.29 These informal abortion networks, which also existed in other Catholic countries with repressive abortion laws, date back even earlier to the 1930s.30 Indeed, the staying power of abortion as a birth control measure is often interpreted as a sign of the superficiality of the Francoist regime's rigid gender norms that associated women with fertility, maternity and family. Challenging these norms openly was one of the most emblematic aspects of the democratic transition that occurred after Franco's death.31 Public discussions about the abortion ban as ineffective began in Spain even before Franco's death.32 These discussions occurred in the context of deepening fractures between the Catholic Church and the state, a moderate relaxation of press censorship and the increasingly visible circumvention of the 1941 legal prohibition of the sale and advertisement of contraceptives. This was particularly evident in case of the birth control pill, which was widely debated in the popular press and advertised in medical journals as a treatment for irregular menstruation.33 Post-1975 Spain was characterised by an explosive socio-political mobilisation fuelled by the emergence of a feminist movement and also by the reappearance of left-wing political parties and class-based trade unions. These had been outlawed by the Francoist regime and pushed underground, but then legalised gradually between 1975 and 1977. The era also coincided with a liberalisation of sexual attitudes, extensive coverage of sexual matters in the popular media (el destape) and the flourishing of family planning centres offering advice on birth control and sexuality, some functioning semi-clandestinely even before the death of Franco.34 All these factors culminated in December 1978 with the decriminalisation of the sale and advertisement of contraceptives.35 Abortion remained, however, illegal and polarised along political and ideological lines, and considered a contentious issue even within the left. A conservative coalition that would form the political party Alianza Popular was against any reform of the abortion law and so too was the Spanish Episcopate.36 The Spanish Communist Party generally supported abortion on demand in early pregnancy. The main socialist party, Partido Socialista Obrero Español (PSOE), was divided between supporters of a broad liberalisation of abortion legislation and a narrow reform,37 with leaders leaning more towards the latter. The logic behind their strategy was to position this particular party as moderate in its policies and capable of governing.38 The PSOE used the narrow reform strategy in its 1982 electoral programme, won a substantial victory over the conservative coalition and pursued it after coming to power.39 The new law, accepted by parliament in October 1983 at the height of Spain's accession negotiations with the European Union, maintained abortion in the Criminal Code but defined three exceptions when a pregnancy could be terminated legally: if it threatened a woman's life or health, resulted from rape, or foetal abnormalities were detected.40 According to polls conducted by the public research institute Centro de Investigaciones Sociológicas, the law had the support of fifty-seven per cent of the Spanish population.41 Nevertheless, many feminist groups criticised the law because it did not recognise a woman's right to choose.42 Conservative political parties and the Catholic Church opposed the law as immoral for not providing the foetus with legal protection. Upon the initiative of Alianza Popular, which opposed decriminalising abortion, the 1983 law was immediately brought before the Constitutional Court in the hope it would be struck down, but it eventually came into force in 1985. It soon became clear that many healthcare professionals were reluctant to perform abortions in public sector hospitals. Some physicians declared themselves as conscientious objectors, a right granted to them by the Spanish Constitution. Those who practised abortion came under fierce attack.43 Moving abortion into the private healthcare sector was a handy solution to this problem. In late 1986, a decree authorised licensed private healthcare sector clinics to provide ‘low-risk’ abortion services, meaning those performed relatively easily, during the first trimester of pregnancy.44 While these clinics served clients for payment, many of them also signed specific licensing agreements with regional healthcare administrations that enabled women having abortions under the three exceptions defined in the 1985 law to be reimbursed for the cost of the abortion.45 In actuality, most of these clinics functioned in what could be called ‘tolerated illegality’, insofar as they offered abortion on demand and sheltered within the World Health Organisation's (WHO) broad understanding of ‘health’ as holistic.46 In fact, clinic staff psychiatrists could certify that pregnant women would face depression or emotional distress if their abortion requests were denied. The concentration of abortion services in the private healthcare sector – with specifications as to which regional healthcare administration would cover the cost of the abortion – endured even after the passage of the 2010 law on sexual and reproductive health. This law removed abortion from the Spanish Penal Code and legalised it on demand up to fourteen weeks of pregnancy. Yet, the concentration of services in the private sector persists. By 2017, almost eighty-eight per cent of all terminations in Spain were carried out in private clinics.47 By authorising terminations in the private healthcare sector, the 1986 decree put an end to large-scale Spanish women's abortion travel abroad. Available statistics indicate that, before 1984, 160,000 Spanish women's abortions were registered in Britain alone.48 The British Abortion Act (1967) carried no residency requirements.49 After it came into effect a year later, London became the top destination hub for abortion services for non-resident women from several countries.50 In Spain, London was so widely discussed in this context in conservative and liberal media that, between 1975 and 1985, a charter flight to the British capital became a popular symbol of legal abortion services in the Spanish imagination.51 The economy of scale attained by alliances made between travel agencies and local Spanish intermediaries were joined by abortion referral agencies that were commercial, charitable or some mixture of the two. Commercial abortion referral agencies could reap financial profits from the services they provided women and were regarded suspiciously. They usually directed non-resident women to private healthcare sector physicians in Britain for abortions. Charitable abortion referral agencies were more likely to be grassroots in origin, non-profit and sometimes staffed by healthcare professionals and feminist activists dedicated to safeguarding the quality of abortion services, protecting clients from financial or sexual exploitation from unscrupulous physicians, and providing counselling for their emotional needs. In Britain these included Pregnancy Advisory Services and Birmingham (later British) Pregnancy Advisory Services.52 These two agencies served resident women who were unable to access public healthcare sector abortion services via the National Health Service in their home communities.53 However, they also assisted non-resident women. Spanish women were directed most often to London, ‘the destination par excellence’, according to interview participant Reyes Cordero, a social worker in a Spanish family planning centre, Instituto de Medicina Social (IMS), that engaged in intense abortion referral from the late 1970s onwards.54 Moreover, many London clinics, both private and charitable, hired Spanish-speaking staff, which made abortion services more accessible to Spanish women who did not speak English. For Spanish women living near international airports in Madrid or Barcelona, the total cost of travelling to London for an abortion was considerably cheaper than an illegal clandestine procedure performed by a local physician, making a London abortion an affordable alternative for many middle- and even some working-class women.55 Going to Amsterdam or The Hague in the Netherlands was a more expensive prospect, since affordable package deals were less common for these travel itineraries. At the same time, Dutch clinics advertised themselves in Spanish.56 Dutch clinics, according to interview participants NN, BG and DN, were viewed as highly specialised, with personalised services available, as opposed to their allegedly overcrowded and callous British counterparts, a perception that several Spanish clients of London abortion clinics deny.57 Other pathways led women to France, Portugal and Morocco, countries that had the important advantage of sharing with Spain an easily traversable border. However, there were also disadvantages to border crossing; local abortion legislation could exclude non-residents, as in France, or ban abortion on demand, authorising abortion only for therapeutic reasons. Spanish women travelling to these countries were, therefore, in a situation that public health scholar Rosa E. Marchant has termed ‘legal clandestinity’.58 She uses this term in reference to Puerto Rico, which received American women travelling for abortion services in the 1960s and 1970s despite restrictive local laws. In effect, Spanish women travelling to France had ‘clandestine abortions in legal clinics’, a point made by NCP, an interview participant and physician from Zaragoza, who crossed the northern Spanish border to have an abortion in 1983.59 One of the noteworthy aspects of abortion referral networks assisting Spanish women was how they functioned in a society speeding toward democratisation. Individuals became involved in abortion referral networks on different levels for personal and political reasons. Sporadic support – from offering the address of an abortion provider or accompanying women in their abortion travels, to driving them to an abortion clinic near the Spanish border – was prevalent in progressive segments during the early years of the democratic transition. Medical students, trade unions and left-wing political parties were among the central individual and institutional actors in this process. Interview participant Laura Campos, a medical student with communist sympathies, was motivated by her antifascist consciousness and personal relationships with women who needed help arranging abortions. In Zaragoza in 1974, Campos learned that two of her pregnant friends had appointments in an abortion clinic in Toulouse, France. She accompanied them, assuming she would be useful because she spoke French and had previous experience travelling abroad. Two years later, she borrowed a car to drive another pregnant friend to a Spanish-speaking physician in the small village of Urdos, located on the Spanish–French border, for an abortion. Campos, who subsequently passed along this physician's address, stressed: ‘we [she and others who assisted women seeking abortions] were in state of pure solidarity’. She perceived complications accessing contraceptives and abortion as characteristic of the repressive Francoist regime. To her, facilitating abortion travel was a type of antifascist resistance she could practice.60 Accompanying a pregnant woman abroad influenced the professional future of another interview participant, Enrique Lebrero. As a fifth-year medical student at the Autonomous University of Madrid who gave talks about sexuality and contraception in high schools, Lebrero was once approached by a teenager. She told him she was pregnant and wanted an abortion desperately. Lebrero accompanied her to a London abortion clinic. The journey became more ‘exciting’, as he put it, when the girl used her sister's passport to enter Britain because she did not have one of her own. Later, he travelled with a friend to the same clinic. After obtaining his degree, Lebrero specialised in gynaecology and became involved with the Acuario clinic in Valencia. Founded in 1976, it remains one of Spain's most important private healthcare sector woman-centred medical facilities.61 The responsibilities of individuals in abortion referral networks also involved paying for women's travel, accommodation and the abortion itself. Fundraising was a popular activity. Interview participant NN, who went from Granada to London for an abortion in 1976, collected the necessary sum thanks to donations from friends from the University of Granada. One of them, who had travelled earlier to the British capital for her own abortion, escorted NN in turn. NN then herself became involved in escorting women to Lisbon and Amsterdam, paying the good deed forward.62 For many left-wing political organisations, trade unions and feminist groups that flourished from the mid-1970s onward, involvement with abortion referral became a regular part of their informal activities.63 Interview participant Consuelo Catalá, a nurse, feminist and member of the Communist Revolutionary League, a Trotskyist-influenced political party, travelled to France for an abortion in 1977. A party comrade took Catalá to Paris by car. The abortion was performed by a Spanish-speaking physician and paid for by money the party had solicited.64 Informal individual abortion networking was carried out by many Spanish physicians, particularly those with socialist or communist leanings. Reluctant to risk performing illegal abortions themselves, they communicated with clinics in Britain, France, Portugal and Morocco on behalf of their Spanish patients. In Seville and Zaragoza during the early 1980s, several gynaecologists working in the private healthcare sector referred women to abortion clinics abroad, selecting them to suit the women's preferred travel itineraries.65 Some offered their patients a post-abortion check-up, recognising it as a vital healthcare service because of the difficulty women had contacting or returning to the original abortion provider, especially in the event of medical complications.66 For some physicians, pre- and post-abortion care, and the referral itself, could serve as an income source without excessive legal risk-taking. Opportunities for cross-border cooperation arose as British commercial abortion referral agencies approached Spanish physicians, offering them cash payments for each woman they referred to British clinics, and enticing them with the likelihood of money to be made from post-abortion check-ups conducted in Spain. Confirmation of such activities was reported in 1977 by the conservative magazine Blanco y Negro. It printed in full letters that two British commercial abortion referral agencies, Inga and N. P. A. Services, had used to solicit the cooperation of Spanish physicians, at least since 1972. The letters, apparently the cause of ‘diplomatic protest upon the initiative of [Spanish] medical associations’,67 included contact details of British commercial abortion referral agencies that, ironically, Spanish magazine readers seeking abortion services may have welcomed. While the magazine ignored the reactions of individual Spanish physicians to these potential revenue streams, it is fair to speculate that some of them would have taken part in commercial abortion referral to attend to the pressing needs of their patients and/or benefit economically. Financial agreements likely struck between British commercial abortion referral agencies and overseas physicians reinforced public distrust of what amounted to a transnational trade in abortion services.68 By comparison, in low-priced private healthcare sector family planning centres that flourished in Spain after the decriminalisation of the sale and advertisement of contraceptives in 1978, abortion referral was one of the key, albeit unofficial, healthcare services offered, often provided by nurses or social workers rather than by physicians. This type of abortion provision was perhaps intended to protect the integrity of patients and healthcare professionals in a clinic space that was new and explicitly transgressive.69 The ad-hoc manner in which women could tap into abortion referral networks coexisted with more organised endeavours meant to help Spanish women access safe abortions abroad on a much wider scale. Names and addresses of recommended abortion clinics were usually circulated by word of mouth and information about commercial and charitable abortion referral agencies that sometimes included the names and addresses of abortion providers, typically in Britain, surfaced sporadically in the print media.70 More comprehensive information about international abortion clinics was disseminated by feminist publications and groups, meeting two intersecting aims: helping individual women access abortion services and addressing the feminist struggle for abortion law reform.71 Frequently, lists with contact information for abortion clinics were supplemented by annotations about price, type of medical facility and presence of Spanish-speaking staff. This information allowed women to make more informed choices about their transnational abortion journeys while partially overcoming language barriers. It was also a powerful reminder of the ineffectiveness of an abortion ban that could not prevent Spanish women from having abortions abroad and of the urgent need for domestic abortion law reform. One of the earliest examples of such an annotated list appeared in Leonor Taboada's Cuaderno Feminista (1978). The author was inspired by the American feminist self-help health text Our Bodies, Ourselves (1969).72 An Argentinian-born feminist, journalist and one of the primary disseminators of the ideas of the American women's health movement in early democratic Spain, Taboada highlighted those clinics in Britain, France and the Netherlands that had Spanish-speaking staff, were recommended by Spanish physicians and which cost the least.73 She added information about the Mouvement pour la Libération de l'Avortement et la contraception, a militant French organisation that, was involved in abortion provision and referral.74 Soon feminist groups in different parts of Spain began to publish and update their own lists and even feature up-to-date costs of abortion procedures at different stages of gestation. With this information, Spanish women could better prepare for their trip abroad and attend the most reliable abortion clinic they could afford, thereby rendering women's abortion travel choices more intelligible.75 Some feminist groups went a step further by gathering women together to receive first-hand feedback about their abortion experiences abroad. This was one of the g
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