Manuela, a mother of two in rural El Salvador, couldn't even walk to the hospital.
In February 2008, her relatives had to wrap her in a hammock and transport her as best they could to the health center two hours away, after a pregnant Manuela suffered severe pelvic pain, started hemorrhaging, expelled her fetus and passed out.
A day later, still bleeding, she was interrogated by a doctor at the hospital who came to the conclusion that Manuela did not have an obstetric emergency, but instead had an abortion. Manuela, who had a visible mass on her neck, was shackled for days, then arrested and charged with aggravated homicide, accused of killing her fetus. The masses in her body turned out to be cancer, but she did not get timely and appropriate chemotherapy in jail where she was serving a 30-year sentence. She died in April 2010.
Manuela's story, described in detail in a report from the Center for Reproductive Rights, was argued last week at the Inter-American Court of Human Rights. The group and the Feminist Collective for Local Development are calling for "the Court to issue a ruling on behalf of Manuela’s family, so the Salvadoran State can take public responsibility for not guaranteeing her right to life and health and to compensate her family for their loss and suffering."
Manuela's last name has been withheld by the human rights organizations for privacy reasons as they are doing about other women in El Salvador with similar cases.
El Salvador has a total ban on abortion — one of the world's most restrictive — and sentences can run up to 50 years in prison. It is estimated that between 2000 and 2019, 181 women suffered obstetric emergencies but were criminalized for alleged abortions or charged with aggravated homicides.
The Inter-American Court began an investigation of the case in 2012 after Manuela's relatives could not get justice from El Salvador's courts, the groups say.
“Her case reached the Inter-American Court because there was no justice in El Salvador. It is not recognized that she died in a prison without receiving the medical attention she needed," Paula Avila-Guillen, executive director of the New York City-based Women's Equality Center, said in an interview with Noticias Telemundo.
The 2019 report about Manuela's case listed the multiple abuses that were committed, from her illegal detention to violations of her fundamental rights, such as the presumption of innocence, judicial protection and health, among others.
"I can't understand when it goes from being a medical emergency, as is Manuela's case, to a crime. I can't connect it,” said Dr. Guillermo Ortiz, an OB-GYN who testified at the IACHR hearing. “How can you establish a crime link in a woman who was very, very ill — and even faints?”
Attorney Laura Clérico said Manuela’s sentence “reaches the degree of torture given that it was intentional, motivated by her gender.”
Advocating for a woman still in jail
The human rights groups are also calling attention to the case of Sara, who has been sentenced to 30 years in prison for aggravated homicide after suffering a miscarriage when she slipped and hurt herself while washing clothes. She was home alone and lost a lot of blood before getting help.
A hearing was supposed to be held March 15 in a Salvadoran court in Cojutepeque to determine if new evidence was enough to find her innocent and release her. But her hearing was postponed indefinitely, and groups are urging the court to announce a new hearing date.
"Manuela's story may be Sara's if we don't do something to try to get her out of jail — it's the same story as the rest of the women still in jail. She has been imprisoned for nine years, and the last time we saw her, she was not in the best physical, emotional or health condition," Avila-Guillen said. "Her sad case shows us why we have to continue fighting for the women who are in jail, and it can serve as a call to El Salvador to do the right thing."
Criminalization amounts to “gender violence”
Catalina Martínez Coral, the executive director of the Center for Reproductive Rights, which is based in New York, said she hopes the IACHR highlights that the “absolute criminalization of abortion constitutes a form of discrimination, of gender violence, which has a disproportionate impact on women who are vulnerable and that it facilitates the criminalization or judicialization of reproductive processes, including obstetric emergencies.”
Representatives for the Salvadoran government have said that Manuela’s rights were respected and that the simple fact she received medical treatment is a sign that there was no negligence in her case.
The Salvadoran Institute for the Advancement of Women, an arm of the government, did not respond to Noticias Telemundo’s requests for comment.
An opportunity “to repair the damage”
During the IACHR hearing, Santos de Jesús, Manuela's eldest son, said in a video statement: “It is painful to grow up without a mother because that love is unequaled. I ask the state not to do these things because they left us abandoned without a mother.”
The court is expected to issue a ruling in Manuela’s case in the next month or two.
Martínez Coral said she’s optimistic ahead of the ruling and believes the court should take this opportunity to point out El Salvador's responsibility. This would set a valuable regional precedent since the Inter-American Human Rights System is recognized by at least 25 countries.
"The states must prevent the criminal prosecution of women who suffer obstetric emergencies and work to repair the damage to those who have been detained, and arbitrarily sentenced for suffering such complications," she said.
From prison to human rights crusader
Teodora del Carmen Vásquez, a Salvadoran woman who suffered a stillbirth in the last month of her pregnancy, was also sentenced to 30 years in prison. But her highly publicized story had a different outcome.
Vásquez managed to be released in 2018 after spending almost 11 years in prison, and has now dedicated herself to fighting for women's rights and to help their social reintegration after being released from prison.
“They don't give us work because of our criminal record, it's very difficult,” she said about life after being released. “In addition, there are health complications and psychological problems because many times, family members think that when you get out of jail, all the problems are over, but really at that moment other important things begin.”
At 37, Vásquez said she feels "reborn." She is studying for a degree in communication and advertising and is an activist for Mujeres Libres El Salvador, an organization that works to free women who have been imprisoned after being criminally convicted of abortions. The group has helped in the release of 44 women; there are still 20 in the system.
During her long stay in prison, Vásquez met Manuela. "Like every woman who comes to jail, she had the hope of being freed,” Vasquez said. “She always showed love and affection for her children. Unfortunately, she died but she has become a symbol for us.”
On March 7, more than 5,000 women marched in San Salvador, the country’s capital, in honor of International Women's Day. According to 2020 statistics from nongovernmental organizations and news reports, the country registered at least 130 femicides and 541 missing women. It’s estimated that every 18 hours, a woman disappears in El Salvador.
"My dream is that through our struggle, we will achieve a change in legislation and that women are no longer penalized for abortions. We are sure that we have sown a seed and, although it is not seen now, future generations will reap it at another time. And for me, that's the most important thing," Vásquez said.
Avila-Guillen said the “way to keep Manuela's story from happening again” is to release women who have been criminalized for obstetric emergencies, adding that United Nations committees have determined these are “arbitrary detentions.”
She also called on El Salvador’s president to drive the necessary changes.
"Nayib Bukele has no excuses for El Salvador to not move forward. On May 1, the president will have a qualified majority in Congress, so if the will of his party is to protect the lives and health of women, he has all the tools in his hands to allow at least some [abortion] exceptions in El Salvador and to stop criminalizing women suffering obstetric emergencies,” Avila-Guillen said. “Unlike other past moments or in other contexts, it's just up to him —he can politically coordinate his party.”