Puerto Rico After ‘Roe’: Abortion Clinics on the Frontline

This reporting was made possible by a grant from the International Women’s Media Foundation, part of their Reproductive Health, Rights, and Justice in the Americas initiative, which funds reporting on issues that impact people’s daily lives in the region, including reproductive rights and health.

This is the second in a two-part series, the first of which discussed the historical and political context of the fight over abortion rights in Puerto Rico.

SAN JUAN — Following the U.S. Supreme Court’s reversal of Roe v. Wade in June 2022, the state’s intrusion into a woman’s personal decisions over her body has denied women their humanity and personhood, reducing women to mere reproductive vehicles. Such laws deny women “their right to have rights,” in the words of Hannah Arendt.

Women’s rights begin with access to reproductive health care, and because abortion clinics provide such access, they are on the frontline of the struggle for women’s rights.

In the 1990s, there were 13 private abortion clinics in Puerto Rico. Today, there are only four: Clínica IELLA de Profamilias, Darlington Medical Associates, Women’s Medical Pavilion, and Centro de Planificación Familiar.

As of January 2019, there were seven abortion providers in Puerto Rico, three of whom were over the age of 70. Currently, there are few doctors trained to provide these services, as those practicing age out and younger ones leave the island in search of better pay and a higher standard of living.

The four clinics on the island service at least 630,000 women and gestating people of childbearing age. Of the four, three offer medication abortions as well as in-clinic abortion, also known as surgical abortion.

The cost of a surgical abortion starts at $250, with the price increasing the further into pregnancy a patient waits. Medication abortion is between $300 and $350. About 40.5 percent of Boricuas live below the poverty line —about $30,000 for a family of four with two children— and insurance plans on the island do not cover abortion.

All four clinics are in the San Juan metropolitan area, and getting to them is difficult on an island with poor public transportation. Traveling to the capital from Mayagüez, for example, on the western coast, a patient must take a shuttle bus called “La Sultana,” a two-and-a-half-hour trip each way.

Think of the time off of work, the waiting to save enough money to have the procedure, and the worry that the more you wait, the more expensive it will be. In addition, many patients are mothers, which means they also have to find babysitters for the children they leave at home.

Add to that the lab tests, the gas if they own a car, and the hiding from their families their reason for taking the trip. Abortion remains a taboo subject in many homes on the island.

To have an abortion has never been an easy decision for women to make, nor will it ever be.

That said, no clinic in Puerto Rico has gestational limits, restrictive mandatory waiting periods, minors’ parental consent requirements, or frightening scripts forced on the provider by the government. On the contrary, women walk into a safe space where they find comfort, counseling, and follow-up care.

For more than 16 years, Dr. Yari Vale has been offering abortion services at the Darlington Medical Associates clinic in San Juan’s Río Piedras neighborhood. It is the only clinic on the island performing second-term abortions.

Dr. Vale gave me a tour of the clinic, with its modern equipment and its professional and engaging staff. An effort is made to make patients feel comfortable. There is a recovery area with relaxing music and scented oil diffusers. Such accommodations are impressive considering that abortion clinics in Puerto Rico receive no public funding.

“Many of the laws the Boricua pro-life lobby tries to get approved are a copy-and-paste of what is happening in many of the states in the United States,” she said. “I believe that the religious (pro-life) movement has been gaining a lot more ground since the arrival of Proyecto Dignidad.”

Proyecto Dignidad is the island’s right-wing Christian party founded in 2019, which has two members in the Legislative Assembly: Sen. Joanne Rodríguez Veve and Rep. Lisie J. Burgos Muñiz, both representing at-large districts.

“I have been feeling the pressure since November of last year, when Sen. Joanne Rodríguez Veve and I had an exchange during the public hearings about abortion, and it was published on her social media, on Facebook and Instagram, clips of our exchange,” Dr. Vale said. “Unfortunately, this triggered many people who follow her on social media to start saying harmful things like ‘You should be dead,’ ‘You shouldn’t exist,’ ‘They should have aborted you,’ and ‘You are a murderer.'”

Dr. Vale says she had to delete her social media accounts to escape the online harassment, and no takes added precautions to secure her physical safety.

“You saw that I walked in with a bulletproof vest“, she said. “Those are an additional nine pounds for me every day. I have had to hire a security guard in the office, which I pay out of my own pocket” —to the tune of $1,500 a month— “tinted the windows on my cars. I also change cars and the daily route I take to work.”

I asked Sen. Rodríguez Veve what was gained by signaling out Dr. Vale, forcing a medical professional to adopt extreme measures after being attacked on social media.

“I do not believe nor do I defend those that are attacking the personal character of the doctor,” she said. “Another thing is to attack what she does and her ideas. I wouldn’t have any problem doing a public video with Dr. Vale, the two of us, she and I, to tell the country that even though we have different positions, we both condemn violence.”

Just north of the University of Puerto Rico’s Medical Sciences Campus, at Clinica Iella, Frances Collazo, an abortion access advisor, and Giselle Lanauze, the co-executive director of ProFamilias, discussed the toxicity and stigma around the issue of abortion. Profamilias is the only non-profit organization in Puerto Rico that provides community-based abortion services through its clinic, Iella Clinic, and is one of the leaders in the movement to guarantee safe, affordable, evidence-based pregnancy termination care.

Entering the clinic, also well-equipped, modern, and professional, I spotted what looked like a child’s notebook on a small table in the waiting room. I was told it’s where the women write their stories anonymously, with the promise that they will never be printed. These are the stories of the women we meet at the supermarket, the nail salon, or the office. They are mothers, aunts, daughters, sisters, and friends, and all are grateful for the attention and care provided by the clinic, some calling it a new lease on life and a healing process.

They are the true stories of real women having abortions. As I read their words, I couldn’t help but think that their story was mine too.

“Everything that is being said is that when women are in the last stages of pregnancy, voluntarily and on a whim, they go and decide to murder their child,” Collazo said. “There is no evidence of this.”

In 2021, 4,225 abortions were performed in Puerto Rico’s four clinics. According to the Puerto Rico Department of Health, 96 percent occurred in the first trimester, and 85 percent occurred in the first 10 weeks of gestation.

This debunks the prevailing myth spread by anti-abortion campaigns in Puerto Rico, which present the issue as one-dimensional, arguing that women go out and get pregnant on purpose and simply get rid of “the problem” through abortion, even after 22 weeks.

Conservative and pro-life groups stigmatize women who own their sexuality and have access to abortion, which is made to seem dirty and something women do not have the right to do.

“The ones that have made a lot of noise in the media with their misrepresentations and persuasions have been from Proyecto Dignidad,” Collazo said. “They are trying to make their (anti-abortion) campaign with votes.”

“That is why there is this false crisis —created and invented— that we must regulate what has already been more than regulated in Puerto Rico,” she added. “And it’s a push to make it seem that there are many (who are against abortion), but it’s because they make a lot of noise, though they are not many in numbers.”

The conversation turned to what Collazo believes will happen this year in the legislature.

“They have let it be known that in the next legislative assembly, they have every intention to resume, so I wouldn’t be at all surprised that another project will be introduced, that again they will try to divide, restrict, or reverse the right to an abortion,” she said.

“Officially, since last March, we have been able to find out what would be, for example, the types of projects or negotiations and harassment that we are likely to receive in the next legislative session,” she said. “It will be mostly directed, and surely, according to our calculations, to the abortion clinics directly.”

Abortion clinics, their advisors, and advocates have dedicated themselves more to fighting the legislative battles in recent times and less to grassroots organizations. They had to, as the legislature remains the beachhead in the struggle for abortion rights.

There is little doubt that the pressure they’ve exerted, together with Boricua feminist and pro-abortion organizations —like Proyecto Matria, Aborto Libre, and Las Mingas del Aborto— have ensured that abortion on the island remains legal and unrestricted.

During a chat with Amárilis Pagán, executive director of Proyecto Matria, a community organization dedicated to the economic development of Puerto Rican women, I asked about the way forward. What will happen now after the House killed the five abortion bills, including PC1403, which would have codified abortion?

“We were aware that even if this (PC1403) was to die in the House, it would remain alive in the Senate (the sister bill being PS929),” Pagán said. “Maybe that is why you have not heard us speak about the one that got defeated. That is because we know we have another turn at bat.”

“They may be already drafting a new bill to submit early this year because that is how persistent conservatism is,” she added. “And I am sure that (House Speaker) Tatito Hernández not only looked at what was happening in the United States, but I am also sure he analyzed the votes of 2020.”

I reached out to Hernández for comment on several occasions but received no response.

“Because we have noticed that there is an old conservative guard, both in the (Partido Nuevo Progresista, or PNP) and the (Partido Popular Democrático, or PPD), that continue to think that they depend on the conservative vote to win an election,” Pagán said.

“This issue is so important and has such tragic consequences,” said Dr. Luz Towns-Miranda, a psychologist, psychoanalyst, and former board member of the Planned Parenthood Action Fund who actively advocates reproductive rights and is a donor of Profamilias in Puerto Rico. “I hope that they (the politicians in Puerto Rico) are watching what is happening in the United States.”

“I don’t think it’s an issue (in Puerto Rico) that will go away,” she added “They (the politicians and pro-life groups) are beating a dead horse, but it seems we can’t escape the politics of it all.”

Mayra Díaz-Torres, director of the Colectivo Ilé, an organization at the forefront of anti-racist efforts on the island, put the issue into perspective. Restricting abortion is a method of control —the control of women— and the ones that will be most affected are the women in poorer communities and those with less access to resources.

“Our birthrate is low, but who wants to give birth under these conditions? With what salary? With what quality of life? With what opportunities?” Díaz-Torres said.

“At the end of the day, I am sure that women are the ones holding the island up. Look at who is directing the organizations that are doing what the state refuses to do,” she said. “But the structural, racist, and patriarchal design is to separate people and women.”

With the 2024 elections less than two years away, the island’s two main parties, the PNP and the PPD, are vying for conservative votes any way they can. Abortion will be top on the agenda.

PNP Gov. Pedro Pierlusi, who won by less than 33 percent in 2020, isn’t hedging his bets either. He has sidestepped the abortion issue with platitudes, calling for “balance.”

Yet, in a recent interview, he let slip what many who favor abortion rights consider worrisome language.

“Here we have the rights of women on the one hand, and then there is the life of a fetus at a given moment,” Pierluisi said. “When we are talking about a fetus as ‘viable,’ then there is no doubt that you are dealing with life. We have to find balance, I don’t favor extremes.”

Politics is what it is—the personal becoming political. And politicians do not understand, nor do they care, that abortion will always exist and that restricting it will only cost women their lives. The criminalization and stigmatization of abortion will lead to “a butchering of women,” as Alondra Hernández, spokeswoman for the collective Aborto Libre, said in a phone interview with me.

The reproductive rights organizations, feminist groups, doctors on the frontline, and those that advocate for the rights of Boricua women will continue to fight the good fight. Hopefully, Puerto Rico will remain on the right side of history.

***

Susanne Ramirez de Arellano is the former News Director for Univision Puerto Rico and a writer and journalist living in New York City. Comments can be sent to her email. Twitter: @DurgaOne