Ipas Bolivia presented to the Inter-American Commission on Human Rights (IACHR) the legal and social obstacles to accessing legal abortion, and called on the Bolivian state to enact a law on sexual and reproductive rights.

On 13 December 2021, a public hearing was held before the Inter-American Commission on Human Rights (IACHR) on the "Situation of Sexual and Reproductive Rights in Bolivia". At the hearing, the petitioner, represented by Ipas Bolivia, pointed out that although SRHR are recognized in the Constitution, this is not in accordance with the absence of a law on SRHR, as well as the failure to comply with Constitutional Ruling 0206/2014, which determines that abortion is legal when the pregnancy is the result of rape, statutory rape or incest, and when the life and health of the woman is in danger, and that it does not require judicial authorization or criminal prosecution. Despite this, several structural obstacles impede this right, and its application is limited and insufficient in the public health system, in addition to the influence of representatives of religious groups that interfere with access to abortion, as seen in the case of the 11-year-old girl from Yapacani [1], in which the State intervened through constitutional protection.

In this regard, it was noted that between 2014 and 2021, 72,376 cases of incomplete abortions and a total of 508 cases of abortion were registered in the country, with the main cause being rape 59.9%; and of the total number of unpunished abortions, (11%) represent girls, (45%) adolescents and (44%) women over 18 years of age [2]. In addition, unsafe abortion accounts for 13% of maternal mortality in Bolivia (direct causes). [3] Linked to this, from 2016 to September 2018, a total of 9,552 girls under 14 years of age were pregnant; and between 2018 and 2020, prenatal care was provided to a total of 7170 pregnant girls under 15 years of age[4].

On the other hand, the Bolivian State, represented by the Attorney General of the State, the Ambassador of Bolivia to the Organization of American States (OAS) and representatives of the Ministry of Justice and Institutional Transparency, affirmed, among other aspects, that the provision of abortion is guaranteed at all three levels of health and reported that based on the reports of the "Monthly Notification for Epidemiological Surveillance - 302, from January to September of this year, 94 abortions were registered. 7. Other data presented was the reduction of cases of unwanted pregnancies to 75.5%; considering that in 2015 there were 82,416 reported cases and in 2020 it decreased to 20,186.

In the same vein, they stated that the recognition of SRHR is a State policy implemented through various regulations and plans, including Ministerial Resolutions No. 0027[5] and No. 1508"[6] that regulate the SCP 0206/2014, in addition to ongoing training for various institutions, especially health providers and professionals on the subject, and that there is a national policy on comprehensive sexuality education that is taught throughout the territory. Regarding conscientious objection, they determined that it is already regulated in Ministerial Resolution No. 0027, and that in 2021 the Ministry of Health in coordination with Ipas Bolivia socialised this regulation in a health centre, when health providers were identified as conscientious objectors.

After hearing the interventions of both parties, the representatives of the IACHR: Flávia Piovesan, Margarette May Macaulay, Julissa Mantilla Falcón and Soledad García Muñoz expressed their concern about the violations in the case of the 11-year-old girl, which prompted the IACHR to issue Communiqué 287/21[7].They also identified the need for civil society and State statistics to coincide and the need to comply with SC 0206 /2014, access to abortion and a DSDR law. In general terms, they recalled that the Bolivian State has the obligation to guarantee compliance with the exercise of SRHR, as well as to guarantee sexual and reproductive rights for the entire population, including comprehensive sexual education and the non-revictimisation of girls and adolescents when accessing abortion services.

Consequently, Ipas Bolivia's main requests to the Plurinational State of Bolivia were:

- Approve and enact a DSDR Law, which guarantees abortion based on international and Inter-American standards; expanding the cause of health in its entirety and others related to socio-economic issues.

- Demand that the Ministry of Health and the Departmental Health Services install processes to guarantee the filling out and implementation of reports of the "Monthly Notification for Epidemiological Surveillance - 302", in relation to the ILE indicator; and urge the Bolivian Police to provide a copy of the report of sexual violence without any obstacle whatsoever.

- Prioritise the enactment of a law that regulates conscientious objection in health facilities; ratifying that it is personal and not institutional; as well as modifying Law No. 1152, incorporating abortion as a health service at all three levels.

- Approve the Protocol for the Care of Pregnancy in Girls under 15 years of age by the Ministry of Health.

- Comply with the recent recommendations of the Committee Against Torture (CAT) and the United Nations Committee on Economic, Social and Cultural Rights in relation to abortion; in addition to adopting measures to comply with the IACHR Report "Violence and discrimination against women, girls and adolescents: Good practices and challenges in Latin America and the Caribbean in relation to forced pregnancies".

In response to the requests, the State representatives stated that they will work on them in the 2022 administration and that they are aware of a draft law on DSDR by the Ombudsman's Office. They also expressed their willingness to broaden the grounds for abortion and to create a specific norm on BGT and rural and indigenous women in DRRD. Finally, they stated that they will take into account the international recommendations mentioned in this space.

At the close of the hearing, both parties were congratulated for being present at the hearing, as it was a historic one for the Inter-American system, and the State and Ipas Bolivia were asked to continue the dialogue on an ongoing basis.

[1]https://www.la-razon.com/voces/2021/10/31/la-nina-de-yapacani/

[2]Ipas. Bolivia. https://www.ipasbolivia.org/

[3] https://www.ipasbolivia.org/

[4] National Health Information System (SNIS) of the Ministry of Health.

[5] Technical Procedure Procedure for the Provision of Health Services in the Framework of the SCP 0206/2014

6] "Modelo de Atención Integral a Víctimas de Violencia Sexual" [Model of Comprehensive Care for Victims of Sexual Violence].

[7] "The IACHR urges the State of Bolivia to comply with its obligation to protect girls and adolescents from sexual violence and to guarantee their sexual and reproductive rights".

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