Breaking the Silence: Violence and the Fight for Dignified Abortion Care in Uruguay

Thirteen years ago, Uruguay marked a pivotal moment in reproductive rights with the legalization of abortion. It was hailed as a significant advancement, a victory for autonomy and health.

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However, behind the veil of this progressive reform lies a troubling reality: obstetric violence that permeates abortion care, leaving many individuals feeling humiliated, judged, and unsupported. The findings from our study lay bare these hidden truths, revealing that legal reform—at least in the model adopted by Uruguay—is insufficient to guarantee respectful and dignified abortion care.

In Uruguay, obstetric violence is legally recognized as a distinct form of gender-based violence, emphasizing the protection of women’s autonomy and rights in reproductive healthcare.

Defined as actions, omissions, or systemic practices by health personnel that interfere with a woman’s ability to make free decisions about her body, it includes coercion, the imposition of invasive procedures without consent, and disregard for informed choice. While Uruguay has a law that explicitly recognizes obstetric violence as a form of gender-based violence, no action has been taken on this matter, and there are very few effective accountability mechanisms to prevent this kind of violence.

Using qualitative interviews with key informants and a quantitative survey conducted between January and February 2023, the research explores individuals’ experiences in accessing abortion services, including interactions with medical professionals, waiting periods, consultations with other professionals, and overall experience.

We show that violence in abortion care in Uruguay is not merely an unintended consequence of poor practices; it is embedded in the very design of the law. The excessive medicalization mandated by the abortion law constitutes a violation of human rights, as it subjects individuals to unnecessary surveillance and control under the guise of healthcare. The law’s requirements for multiple consultations, waiting periods, and mandatory ultrasounds introduce unnecessary hurdles that complicate the abortion process. While these measures do not grant medical providers the ultimate authority to prevent an abortion, they reinforce a framework in which the decision is subjected to medical oversight and institutional approval rather than being fully left to the individual. By placing barriers that treat pregnant people as incapable of autonomy, the law itself perpetuates a form of structural violence. Instead of being a framework built on dignity and respect, it reinforces a system of paternalism and control, undermining the very rights it purports to protect.

A striking insight from the study is the normalization of obstetric violence. Many participants did not initially identify their experiences as violent. This disconnect stems from societal definitions of violence, which often emphasize physical harm while ignoring subtler, systemic abuses. Yet, the emotional and psychological toll—feelings of guilt, shame, and violation—is profound.

Interpersonal Violence: When care becomes control

Our study showed that healthcare providers often become gatekeepers of morality rather than facilitators of care. Accounts of sarcasm, cold attitudes, and outright mockery were disturbingly common. One respondent shared, “I explained the great pain I was in, but the doctor laughed […] what did you expect? That it wouldn’t hurt?’” Another recounted being scolded for having multiple abortions, with a doctor remarking, “You should have thought before you opened your legs.”

Uruguay’s legal framework mandates specific procedures, such as mandatory ultrasounds, but it certainly does not require providers to subject individuals to additional distress by displaying images or describing details. Yet, many respondents in the study recounted being pressured to view the embryo, listen to its heartbeat, or endure verbal descriptions aimed at inducing guilt. One participant described, “[t]he doctor pressured me to hear the heartbeat. I felt so cornered.”

Instead of compassion, many encounter judgment and coercion, reinforcing harmful societal stigmas around abortion. These interactions transcend poor bedside manners; they represent violence—a violation of autonomy and dignity. Such experiences not only exacerbate emotional distress but also deter individuals from seeking healthcare.

Institutional Violence: Barriers in the System

Beyond individual interactions, systemic delays and bureaucratic inefficiencies compound the harm. Respondents described being forced to wait weeks for procedures, often due to unnecessary hurdles like holiday schedules or arbitrary rules. One participant lamented, “I was sure of my decision, but they made me wait until 10 weeks. It felt like punishment for acting too quickly.”

Delays often come with financial burdens, particularly for those in rural areas who must travel long distances or pay out of pocket for private services. As one respondent noted, “I had to go to another city and pay for a private ultrasound because the clinic had no dates available.”

Compounded barriers

About 1 in 6 respondents encountered conscientious objection—the refusal of healthcare providers to offer certain medical services, such as abortion, based on personal, moral, or religious beliefs—and the impact was significant. For some, it meant being referred to distant providers, further delaying care and making access unduly burdensome. Moreover, the limited availability of abortion methods—with a heavy reliance on one method and a troubling use of outdated curettage procedures—raises concerns about the comprehensiveness of care.

For some, these negative experiences deterred future healthcare engagement, with one respondent sharing, “I avoided post-abortion consultations because I couldn’t bear the thought of being treated the same way again.” Such outcomes illustrate the long-term consequences of obstetric violence.

Conclusion: Dignity is Non-Negotiable

Abortion care is a matter of human rights and should never be a site of violence. Uruguay’s legal reform was a milestone, but it is only the beginning. True reproductive justice requires dismantling the systemic and interpersonal barriers that perpetuate harm. It demands a healthcare system where compassion, respect, and dignity are the norm, not the exception. It also requires that individuals be empowered to choose whether they prefer to self-manage their abortions or access them through institutional systems, according to their needs and preferences.

Organizations like Las Lilas are leading the way in creating supportive environments for individuals seeking abortions. Their feminist accompaniment model offers care rooted in empathy and respect, addressing the gaps left by institutional systems. Fostering solidarity and sharing experiences, these networks are not only providing essential support but also working to destigmatize abortion and challenge harmful narratives. Lawyers are also organizing to support victims of obstetric violence through organizations like Gestar Derechos, ensuring that those who experience harm have access to justice and accountability.

Equally inspiring is the resilience of individuals who are resignifying their abortion experiences. Through storytelling and collective reflection, many are transforming what has been a source of stigma into a powerful affirmation of autonomy and agency. These acts of resistance challenge societal norms and highlight the necessity of reframing abortion as a dignified and legitimate aspect of healthcare.

As Uruguay reflects on a decade of legal abortion, it is time to revisit and strengthen the framework to ensure that no one is left behind. Building on the progress made and addressing the shortcomings, let this be a moment not just of reflection but of renewed commitment to reproductive justice.

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About the authors

Dr. Lucía Berro Pizzarossa is a British Academy International Fellow at the University of Birmingham and an Affiliated Researcher of the Global Health and Rights Project at The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School. Her research focuses on reproductive rights, health law, and the intersection of legal and social frameworks affecting access to abortion.

Dr. Carolina Farias is a lecturer and researcher at the Institute of Health Psychology, Faculty of Psychology, at Universidad de la República. Her work explores the psychological dimensions of health, with a particular focus on reproductive and mental health.

Emilia Muller is an undergraduate student at the Faculty of Psychology, Universidad de la República, where she is engaged in research and academic initiatives related to health psychology and reproductive justice.

Oriana França is also an undergraduate student at the Faculty of Psychology, Universidad de la República. Her academic interests include psychological approaches to healthcare and the study of reproductive rights within mental health frameworks.