A review of An Open Secret: The Hidden History of Unwanted Pregnancy and Abortion in Highland Bolivia, 1952-2010, by Natalie Kimball.
In an innovative and engaging dissertation, Natalie Kimball pieces together the story of Bolivian women’s unwanted pregnancies from 1952 to 2010. Using medical records and original interview testimony from doctors, women’s rights and anti-abortion activists, police officers, and Bolivian women who terminated or continued their unwanted pregnancies, Kimball traces the complicated and historically contingent reasons women in the highland cities of La Paz and El Alto sought, failed to seek, or unsuccessfully sought abortion from Bolivia’s 1952 national revolution to 2010, at which point abortion remained illegal despite women’s and reproductive rights provisions in the new constitution of that year (it is still illegal, although currently the courts are considering decriminalization). The connections Kimball makes between women’s decisions about their pregnancies and the broader political and economic context for those decisions constitute one major contribution this dissertation makes to the scholarly conversation about abortion in Bolivia begun by Ann Zulawski, Sandra Aliaga Bruch, and others, but perhaps even more important is its centering of Bolivian women’s testimony, and particularly its attention to women who carry unwanted pregnancies to term.
The dissertation’s title draws attention to several dichotomies that Kimball deconstructs over the course of the project. Drawing on feminist scholarly frameworks from a variety of disciplines, including work by Rosalind Petchesky, Jean Peterman, and Rickie Solinger, Kimball questions the “choice”/”life” binary, arguing that Bolivian women face unwanted pregnancy within a matrix of social, familial, economic, religious, and legal pressures so thick and all-encompassing that the vocabulary of choice becomes woefully inadequate. Kimball also suggests that framing the issue in terms of “life” versus “choice,” particularly given the widespread public suspicion of birth control in Bolivia, has made abortion into an “open secret”: while most Bolivians publicly oppose abortion, 3 in 5 Bolivian women will have abortions in their lifetimes, the police rarely pursue criminal charges related to abortion, and many of the same Bolivians who oppose abortion in theory also say that they support it in particular circumstances and that they would help a family member seeking abortion. Finally, Kimball argues that Bolivian women’s testimony calls into question the very idea of “wantedness”: even as she writes a history of unwanted pregnancy, she demonstrates that Bolivian women have a variety of complex feelings toward their pregnancies; she suggests that there exists “a spectrum of ‘wantedness,’” as well as attitudes, particularly religious ones, that escape the framework of wantedness altogether (p. 26).
The dissertation is organized thematically, moving from a broad historical narrative in the early chapters to an indexing and examination of women’s accounts of their pregnancies in the later ones. Chapter 2 (Chapter 1 is the Introduction) provides an account of the major public debates in Bolivia about women’s rights, indigenous rights, and reproductive health since the 1950s. The chapter begins with Bolivia’s 1952 national revolution, arguing that although the revolutionary MNR government did not give women space to fight for their rights as such, the revolution did enable the political empowerment of some women and the emergence of radical political organizations that provided basic health services. Next Kimball considers the developmentalist population control schemes by the Peace Corps and others in the 1960s, arguing that the backlash against these inchoate programs led to the popular association of birth control with imperialism and eugenics, severely limiting women’s access to birth control as a result. She then details how the right-wing dictatorship of Hugo Banzer Suárez liberalized abortion restrictions, placing Banzer’s efforts in the context of other limited reforms by Latin American dictatorships meant to modernize their nations. In a fascinating section, Kimball discusses Bolivia’s 1982 “democratic opening,” arguing that the country’s return to democracy, coupled with the economic collapse and subsequent decimation of the social safety net, led increasing numbers of women to seek abortions. This increase in abortion spurred the growth of women’s rights NGOs that monitored and provided abortion and put pressure on the government to provide better post-abortion care, to provide contraception, and generally to pay more attention to women’s reproductive health. She concludes with a discussion of reproductive rights under Evo Morales’ government, chronicling women’s rights activists’ struggles to get the government to put into practice the reproductive rights guaranteed by the new constitution. The chapter concludes with a discussion of the public discourse around abortion and contraception, contrasting the ubiquity of contraception and abortion with the widespread public stances against abortion and even birth control. Kimball traces how this public stigma against abortion is taught in schools, churches, and indigenous communities, and how it reflects societal concerns about women abandoning traditional roles and pursuing professional aspirations.
Chapter 3 provides a concrete history of abortion and contraception methods and services. The paramount reasons for the high abortion demand in the post-1952 years, Kimball argues, have been obstacles to women’s use of birth control, either because they did not know it existed, were afraid of negative health effects, or faced opposition from male partners. Kimball reports a recent increase in birth control use, particularly in modern methods, but also reports that induced abortion has remained consistently high. She discusses the herbal and physical methods women use to induce their own abortions, as well as the methods used by clandestine abortion services available to women in La Paz and El Alto, including market-district clinics, the drug Misoprostol, and newer safe and affordable providers, often run and assisted by international NGOs. Kimball argues that the latter providers have made abortion considerably safer for many women in Bolivia, but that the continued illegal nature of abortion means that many women are not aware of their services and consequently use less safe methods.
Chapter 4 considers the increase in women’s rights organizing that occurred in the wake of 1982’s re-democratization, demonstrating how these organizations strengthened clandestine networks of abortion referral and provision in the 1980s and 1990s, allowing more women access to safe, if still illegal, abortion. However, the chapter also argues that this organizing and network fortification, together with the legal system’s tacit acceptance of abortion and the neoliberal privatization of once-public services, have helped defer rather than hasten the legalization of the procedure. Through interviews with abortion providers, feminist organizers, and police officers, Kimball demonstrates both the ambivalence of the state toward abortion providers and networks and the difficulty this ambivalence creates for women seeking to terminate their pregnancies, even in the cases where they are entitled to legal abortions.
In Chapter 5, we get a better sense of Bolivian women’s experiences with abortion. Kimball examines medical records from the 1950s and 1960s as well as her interviews to explore the various reasons women terminated their pregnancies. Kimball skillfully reads the scant evidence the records provide to conclude that women in the 1950s and 1960s had abortions to space their pregnancies, delay motherhood, and limit family sizes, but also that many more women terminated their pregnancies than the official record states. Kimball then moves on to her interviewees, most of whom had abortions in the 1980s and 1990s. These women, she finds, sought abortions for a variety of reasons, the foremost being economic difficulties, trouble with male partners, and the desire to space their pregnancies. Some women experienced more coercive circumstances, either seeking abortion after rape or being pressured by male partners or parents into getting abortions. Many of the women explain that they had no way to evaluate the abortion care they would receive, and others recount receiving substandard care and suffering complications or mistreatment, in one case rape, by providers. A few of the women cast their experiences with substandard and/or coerced abortion as formative, citing their abortion experience as a catalyst in their subsequent work advocating for women. While the illegality of abortion certainly impacted the level of care they received, none of the women cited the law as a factor in their decisions to seek abortion; instead, they often saw themselves as caught between different kinds of economic pressures and social stigmas. This leads Kimball to argue for the inadequacy of the “choice” framework to describe Bolivian women’s situation with regard to reproduction.
In a final chapter, Kimball recounts and contextualizes the testimony of women who continue their unwanted pregnancies. Likewise, the majority of Kimball’s interviewees who experienced unwanted pregnancies ended up carrying to term. These women’s assessments of why and how their pregnancies were unwanted, and how and why they did not terminate them, helps us further understand the cost of the clandestinization of abortion. As with those who successfully sought abortion, this latter group of interviewees who described their pregnancies as unwanted did so for a variety of reasons, the most common being male partners’ unreliability and other relationship difficulties, financial instability, and the desire to pursue further education and space children. Many of the women who experienced unwanted pregnancy recounted their consideration of abortion: some attempted abortion unsuccessfully, while others decided not to seek abortion because of advice or pressure from family members or partners, or doctors. Other women recount deep ambivalence about their pregnancies, often because of opposing economic and financial constraints. Says one woman, “When I got pregnant… part of me wanted to be, because it was a way of escaping from my house, which was a torment…Of course, I also felt really sorry about it because I had just gotten out of high school and didn’t have anything” (p. 218).
Noting that the women who terminated their pregnancies and those who did not used similar language—of obligation, force, and resignation—to describe their actions, why did some women continue their pregnancies while others did not? Kimball finds that the difference “primarily came down to who they knew”: women who had friends or family members who had had abortions before, as well as friends, family members, or partners who could accompany them to the clinic (p. 246). Younger women were less likely to have this social support, and so continued their pregnancies more often.
When published, Kimball’s impressive work of research and advocacy will be an important resource for scholars, students, and policymakers attempting to historicize Latin American women’s continued struggles for rights and equality, and particularly reproductive rights under current liberal/left governments. Her findings on the complicated consequences of the proliferation of NGO-based abortion networks will also contribute to scholarly discussions about neoliberalism and the state in Bolivia, building on accounts by Lesley Gill and Nancy Postero, among others.
Visiting Assistant Professor
Department of History
Biblioteca y Archivo Histórico del Honorable Congreso Nacional (BAHCN)
Hospital de la Mujer (HM), La Paz
Hospital Municipal Boliviano-Holandés (HMBH), El Alto
Patient records from Instituto de Maternidad “Natalio A. Aramayo” (Natalio A. Aramayo Maternity Institute, or INA) and Hospital de la Mujer (Women’s Hospital, or HM), Archivo Histórico La Paz, La Paz, Bolivia
113 personal interviews in La Paz and El Alto, Bolivia
University of Pittsburgh. 2013. 277 pp. Primary Advisor: George Reid Andrews.
Image: Photo by Author.