By Rekha Chandiramani and Ana Teresa Benjamin for Con Las Manos en la Data, TVN and CONNECTAS*

Karelys is twenty years old and she lives in the outskirts of Panama City. Six years ago, when she was fourteen, she became pregnant by an adult man. Back then, she didn’t think about herself as a victim and she didn’t report the situation. There was one thing she knew: she wanted to get an abortion to stay in school and “move on with her life.” 

When she told her mother, she decided to take her to a court with the purpose of getting information on how to access a safe abortion. Things went differently, though. Nobody told her she had the right to request an abortion since she still was in the eight-week time frame  specified by the law in Panama. Instead, Karelys was sent to a shelter. There, she recalls being dissuaded and “blamed” for wanting to have an abortion. She eventually gave birth.  

Abortion is illegal in Panama and it has three exceptions that are typified in Article 144 of the Criminal Code. The first exception states that rape victims can request an abortion, but it can only be done until the eight week of the pregnancy and after a prior claim made in the Public Ministry (MP, in Spanish). Only then, the judge issues a court order to interrupt the pregnancy and the procedure is done in a public hospital. 

The second exception is a therapeutical abortion that takes place when the mother’s life is in danger or when the pregnancy is non-viable. Mothers can access this type of abortion via a request to an interinstitutional commission that sings off on the procedure, bypassing the court. The Criminal Code does not set forth a limit of time to get a therapeutical abortion, but the protocol of the Ministry of Health explains that it can take place until the 22nd week of the pregnancy. 

According to a letter that the General Prosecutor’s Office of the Central American country sent to the Ministry of Foreign Affairs on June 19th, 2020, as a reply to a questionnaire sent to the Panamanian authorities aimed at following-up on the resolutions adopted to “accelerate the efforts to eliminate all forms of violence against women and young girls”, a rape investigation can be launched with an anonymous telephone call, “but it is indispensable to be in contact with the victim in the preliminary stage, its testimony is required.” 

“The person undergoes forensic medical exams, she is referred to the Care Unit for Victims, Witnesses and Other Participants, where a clinical psychologist offers her counseling services for crisis intervention, if required. Her presence and collaboration are critical to apprehend the alleged rapist in a 24-hour period, moreover, for the Attorney General’s Office to request the imposition of provisional detention, the most severe measure.” In the letter, the MP explains that trials can be scheduled one year after the claim was filed. 

The problem with conditioning the access to abortion to a legal process when the pregnancy is the result of rape is that is assumes that the victim will come forward immediately after the crime took place, which is seldom the case with young rape victims due to a series of family and social factors. As Panamanian sociologist and feminist Alibel Pizarro explains, “almost no one reports a rape”, even if a doctor is suspicious after assessing the girl in a health care center and she is with her “partner”, and even if doctors are mandated by law to fill a form to file a suspected abuse. This is confirmed by sociologist Juana Camargo and social worker Yuri Pitti. Beginning a legal process on the grounds of rape seems to be the first setback for victims.

The second setback, as Pitti says, is getting the system to provide accompaniment to rape victims and to offer them the option of a safe and timely abortion. When that fails, as Karelys described, the system itself pushes the victims to get clandestine abortions. 

In fact, local outlets frequently feature stories about fetuses being found in public places. Jose Vicente Pachar, director of the Forensic Medicine and Sciences Institute (IMELCF, for its Spanish acronym) –a branch of the Public Ministry–, describes it as follows: when “human products” arrive to local morgues, it means fetuses have been found in plastic bags, almost due or born alive, who have been dumped in the trash. In 2020, 115 fetuses and neonates were found in those conditions. In 2021, the number rose to 134, and 23 cases had been reported as of June 2022. 

The bodies are examined, preserved and buried in solemn regular ceremonies “because there is no one to charge for the crime”, Pachar stated. “In some cases, it was proved that the child was born alive, survived and then died of starvation”, he added.

According to the International Federation of Gynaecology and Obstetrics (FIGO), vulnerable girls and women are exposed to unsafe abortions the most, they are victimized by disinformation pertaining to the legal framework and technical guidelines of therapeutical abortion among medical staff, users and the population in general; limited times to end the pregnancy as indicated by the law in case of rape; and a stubborn and widespread abortion stigma. Consequently, secrecy and concealment, and risks for women’s health prevail. On top of lack of visibility in terms of the frequency of abortion, backed by a insufficient data and records. 

Indeed, the figures provided by Panamanian institutions involved are scant and are not useful to size the prevalence of teen pregnancy, clandestine abortions and deaths of fetuses and abandoned neonates, nor of mothers dying from unsafe abortions. This outlook makes it difficult to comprehend the magnitude of the problem of forced motherhood in raped young girls.

Nevertheless, figures that are available and have been compiled in context for this investigation, hint at impunity and bureaucracy in the access to abortion by victims of rape: in 2020 the MP filed 2,124 rape claims and 3,010 in 2021. 205 and 259 of these cases –respectively–, were aggravated by the fact that the crime was committed against girls under fourteen or against people that can’t consent for whatever reason. However, in 2020 there were only 441 convictions for statutory rape (barely 20.8% of the annual claims filed).

Data from the National Statistics and Census Institute (INEC, in Spanish) gives an overview of the situation of teen pregnancy in the country: around 75,000 babies are born each year. In 2020, for instance, 69,945 live births were registered, of which 15.87% were by teens whose age limit was 19. In 2019, there were 72,456 births, 16.93% were teen pregnancies. 

This means that almost two of ten births in Panama are by teens, consequently, the country is the third with the highest teen pregnancy rates in the entire region –after Guatemala and Haiti–, and in the world, per the World Health Organization and Unicef. The figures are a source of concern taking into account that the local law regards all pregnancies in girls aged 14 or less to be the result of rape.

In February 2022, the Director of Sexual and Reproductive Health of the Ministry of Health (Minsa, in Spanish), Geneva Gonzalez, made a “peculiar case” public in the TVN news broadcast, the case involved a pregnant eight-year-old girl who had been assaulted by a man in his family circle. The case shook the country to the core not just because of the girl’s age, but because of the contradictory versions reported by the authorities. The girl, as per Gonzalez’ report, was over twenty weeks pregnant when she got to the hospital, thus “nothing could be done from a legal standpoint.” She was admitted on the grounds of a high-risk pregnancy and on her 32nd week she underwent a C-section in the maternity ward of Hospital Santo Tomas.

The case caused human rights activists and feminist lawyers to file a lawsuit in the MP, demanding the definition of specific liabilities and omissions that led to the minor being forced into motherhood. Precisely, the plaintiffs are asking for the “case’s critical roadmap” and for the identification of those liable for “the infringement of the minor’s rights (...) as a consequence of disregarding the enforcement of the law, protocols and agreements that compel the State of Panama to guarantee the minor’s well-being.”

Dayana Bernal, President of the Commission of Women’s Issues at Panama’s Bar Association, and deputy representative Walkiria Chandler are among the plaintiffs, both women question the State’s justification not to give an abortion to the girl. They confirm that the case could have been covered by the first and the second exceptions that allow an interruption of the pregnancy. Aside from the fact that the minor was a rape victim, the subsequent pregnancy endangered her life, as the lawuit states. Bernal also suggested that the Criminal Code does not set limits for therapeutical abortion, contradicting Minsa’s explanation about why it was impossible to give the girl an abortion, because “internal protocols of the Minsa or decrees can not be above the Constitution.” 

Questioned on that subject, Pachar, Director of the IMELCF –which conducts rape victims’ forensic medical exams–, said that the eight-week time frame “is a staitjacket imposed by the law.” And, although he refrained from commenting on the need to extend it, he acknowledged that many cases are referred to the institution way past that time. The doctor exemplifies that in practice:

“Suppose a minor was raped at a party…  She won’t be able to tell that she is pregnant right away, then she’ll tell her family, then she files a claim, then she gets her medical exam… Let’s think about what being raped means: it is a severe crime against a woman or girl’s integrity, it is linked with shame, pain and anger…”.

That is why, as Pachar explains, the girls contact the Forensic Medicine and Sciences Institution “when they are nearly in the limit of the time frame”, referring to the window of opportunity in which they can still request an abortion. Most of the time, however, they are past the eight-week limit. 

For Pitti, this deadline “means a race against time for victims of sexual abuse”. First, they need to file a claim and then go to the forensic medical examiner. “There is no significant legislation in Panama to compel doctors to perform the procedure, to respect women’s rights. The ones in place are very vague… In reality, we live in a State in which officials make decisions based on their religious beliefs, whose answers about women’s rights are erratic, who delay the processes and seem to have no sense of urgency.” 

In that sense, Isabel Lloyd, gynecologist and President of the Panamanian Partnership of Obstetrics and Gynecology (SPOG, for its Spanish acronym), highlighted that health involves an individual’s physical, mental and social well-being , and that it is more than just the “absence of disease.” For instance, she questioned pregnant women’s suicide cases regarded by the State as indirect deaths, to support the need to take into account girls and women’s comprehensive health (mental and emotional, not only physical) and guarantee access to abortion, especially to girls who were abused. 

The MP did not reply to several requests for interviews by this investigation. In its website, it fails to disaggregate rape claims per age group. Nor does it specify if the assault resulted in pregnancy or abortion. This lack of transparency and data by authorities keeps the issue away from public debate, as taboo, despite several officials, physicians and specialists who are aware of the fact that victims are “already late for an abortion” by the time they reach out to the institutions.

Gray Areas

The inquiries conducted by this investigation verified that there is no clear, expedite and consensual protocol or “roadmap” among institutions to guarantee access to abortion following a rape claim. In fact, said information was requested to the MP, but the Ministry’s communication Office had not replied by the time this feature wrapped. The National Bar Association also requested that information in the framework of its lawsuit apropos of the case of the eight-year old. According to the la SPOG, the implementation of a safe abortion protocol co-created by them has just started being applied in public hospitals. 

There are also judicial contradictions. Several documented cases show the hoops that prosecutors, experts and judges jump through, oftentimes delaying the process and closing the two-month window required to get an abortion for a rape victim. In a recently published study, former prosecutor of sexual crimes Maruquel Castroverde questioned the need for a DNA test of the abuser to prove a rape in a case in which the abuser had refused taking with the purpose of delaying the process.

The prosecutors had to raid the rapist’s house, that is how they collected a piece of his underwear from the garbage. They hit the jackpot: the Attorney General’s Office got the judge’s order and proceeded to interrupt the pregnancy one day before the legal deadline expired.

This case reinforces the allegations of the lawsuit filed by the group of lawyers and human rights activists involving the eight-year old girl: “Panama’s grave and profound crisis (…) unveils a blunt negligence by authorities, and an institutional violence imposed upon girls to be forced to give birth without having the physical, psychological and critical capacities; most of the times, girls can’t understand what is happening to them, they have been sexually abused by relatives or people that are close to their families."

In an interview for this investigation, the Director of Sexual and Reproductive Health of the Minsa admitted that there are many faults in the judicial system, as well as legal loopholes in some cases. “Judges or family prosecutors are unaware of the time frame and request the pregnancy to be interrupted when girls are fourteen weeks, for example.” When they are told that they can’t do that –based on the eight-week deadline– “they make the girl go from here to there.” She then said that, indeed, “in terms of abortions for rape victims… the eight-week time frame is very short for the way in which things operate,” alluding to the bureacratic machinery faced by the victim throughout the course of her judicial process. 

Lloyd, of the SPOG, recounts that she has heard about “many” cases of girls for whom this time threshold has closed, and who have had to give birth to the baby. “Eight weeks is not a lot of time. It should be extended a bit,” she added. 

For instance, Karelys went to the court when she was four weeks pregnant, but she was denied her right to request the interruption of the pregnancy. This is how another setback is identified: public servants’ moral bias and religious beliefs.

Pitti, a social worker who frequently works in sexual violence cases, has known women that are exposed to harassment by officials “as soon as they inquire about the exceptions to get an abortion” with the aim of discouraging them to undertke the procedure.

An additional delay may come from the doctor’s refusal to interrupt the pregnancy based on conscientious objections, a right he or she has by law. According to Raul Bravo, gynecologist and former President of the SPOG, doctors are rightfully allowed to exercise their beliefs “whereas women are not entitled to their right to health”. Physicians complain that the abortion debate is polarized mostly by “extreme religious” groups that oppose the discussion of family planning, contraceptives or sexual education.   

The consequences of this issue are not simple nor pleasant. The most common occurrence is that someone stumbles upon a baby by chance while looking in the trash, i.e., cleaning services personnel on their daily tasks who find a plastic bag that makes them go fetch their partner and look again. 

As this feature outlined at the beginning, each year, fetuses found in dumpsters, latrines or even mall bathrooms, indicate the state of despair of women and girls in Panama, who can’t access safe abortion. 

The FIGO estimates that around 25 million unsafe abortions are performed worldwide each year, almost all of them take place in developing countries. Out of those, at least eight million are undertaken in “dangerous conditions of minimum safety”. Moreover, they estimate that unsafe abortions are the leading cause of death of 22,800 women per year in the world, accounting for 8% of all of the deaths. On the other hand, abortion is among the top three causes of maternal mortality in Panama. 

Unlike Karelys, Diana*, got pregnant in her thirties and while in a stable relationship. They had decided not to have the baby, but since their case did not fit in one of the exceptions set forth by the law, she consulted with her gynecologist and bought some misoprostol, an oral abortion-inducing drug, online. Since she was not sure about the dose and the way to proceed, she sought help of a feminist group that champions safe abortions in Panama. 

Diana recalls that she started getting chills and cramps after taking the pills… she vomited several times. “I felt I was going to die,” she recalled.

A Legal Straitjacket That is Hard to Escape From 

Ironically, consensus regarding the need to extend the eight-week deadline to access abortion is as overwhelming as the pesimism deriving from the likelihood of even beginning a discussion on the matter. 

Walkiria Chandler, deputy representative and member of the National Assembly’s Women’s Commission claims that Panama lacks the political maturity to understand the imminence of decriminalization of abortion. “A fundamentalist representative has attempted several times to criminalize abortion, without consensus. There is even an idea to regularize unborn children with the criminalization of spontaneous losses, and with the registration of the baby’s name and last name in a birth certificate issued to an unborn child,” she described.

Chandler is referring to fellow representative Corina Cano, a conservative who is also a member of the National Assembly’s Women’s Commission. She blocked the approval of a long overdue law on sexual and reproductive healts, renamed as Sexual and Affective Health, which was eventually passed. In the opinion of sociologist and feminist Juana Camargo, this new law contains “very conservative guidelines and murky approaches”.

But the executive power has also shown shades of conservatism and taboo when addressing the problem. Background such as President Laurentino Cortizo’s veto to the law of imprescriptibility of sexual crimes –which currently prescribe at the same time as the maximum sentence granted to citizens of age–, or the statement made by the Director of the Secretariat of Childhood, Adolescence and Family, Graciela Mauad, who was asked why she had not given an abortion to the eight-year old who had been raped and declared that “instead of focusing on the interruption of a pregnancy, we must talk about prevention to avoid this situations of violation."  

Lloyd, from the SPOG, admits that not all women request the termination of a pregnancy when they are victims of rape, but she stresses that all of them should be granted the right to choose. “These sexual and reproductive rights are also human rights, just has the right to health and freedom.” 

But in Panama, those rights for a raped girl or woman come down to three options: being subject to a law that is out of tune with their social and emotional reality, which condemns them into forced motherhood; exposing themselves to the risks of an unsafe abortion; or living with the burden of having abandoned the “human product” after it was born. The three options put human rights, comprehensive health, minors' overall well-being and women’s reproductive rights on the backburner. In the meantime, the laws that ought to guarantee these rights become a sword of Damocles that turns against victims instead of their criminals.

* This feature was conducted by Rekha Chandiramaniand Ana Teresa Benjamin for Con Las Manos en la Data, TVN and CONNECTAS, with the support of the International Center for Journalists (ICFJ) in the framework of the Investigative Reporting Initiative in the Americas.