El Salvador's Harsh Anti-Abortion Law Fuels New Wave of Women's Criminalization
Women inmates stand at the doors to their cells at the Ilopango Women's Prison in El Salvador, a stark visual representation of the country's severe reproductive justice crisis. Years of hard-won progress that led to the release of 81 women imprisoned under strict reproductive laws is now unraveling dramatically. The suspension of civil rights by President Nayib Bukele is fueling a dangerous new wave of criminalization against women experiencing pregnancy complications.
From Medical Emergency to Criminal Prosecution
The ordeal typically begins with medical distress. Consider the case of a 19-year-old nursing student who experienced severe stomach cramps and sought hospital treatment. After waiting hours in emergency care for what turned out to be an obstetric emergency, she lost her pregnancy. Instead of receiving medical support, doctors alerted police, leading to her immediate arrest and handcuffing.
"She couldn't understand what happened," explains a Salvadoran lawyer speaking anonymously due to fear of political reprisals. "She went to hospital with a stomach ache, not knowing she was pregnant, and had an emergency. Then she was taken to prison, and faced a prosecution asking for a 50-year sentence. She was in complete shock."
El Salvador maintains some of the world's most restrictive reproductive laws. Since 1998, abortion has been completely banned without exceptions for rape, incest, or threats to maternal health. A 1999 constitutional amendment further entrenched protection of life from conception. In practice, women experiencing pregnancy complications often face aggravated homicide charges carrying sentences up to 50 years.
Fragile Progress Unravels Under Emergency Powers
For years, women's rights advocates achieved significant breakthroughs through sustained advocacy and international pressure. Between 2009 and 2023, campaigners secured the release of dozens of women imprisoned for abortion-related charges, miscarriages, stillbirths, and obstetric emergencies.
"By 2023 we had managed to get them all out of prison," says Morena Herrera, a prominent reproductive rights advocate in El Salvador. In total, 81 women were freed from 2009 onward, many having served decades-long sentences for aggravated homicide.
This fragile progress has completely unraveled since March 2022, when President Nayib Bukele assumed emergency powers and suspended civil rights through what he termed the "state of exception." Initially framed as a temporary response to gang violence, this crackdown has produced far-reaching consequences for human rights and justice systems. Due process has been suspended, and approximately one in fifty Salvadoran adults has been imprisoned.
Emergency Powers Expand Into Healthcare Settings
Advocates report that emergency powers have quietly expanded into hospitals, ensnaring women who suffer miscarriages, stillbirths, and other obstetric emergencies. "We are experiencing a new spiral of criminalization against women," states Herrera, former president of Citizens' Group for the Decriminalisation of Abortion.
In a significant development, this organization announced its legal dissolution on Monday, citing a political climate that had become "incompatible" with its work. According to legal teams in El Salvador, at least 29 women have faced investigations since 2022, with several currently imprisoned.
"Women go to hospitals seeking medical help, are identified as suspected of having induced an abortion and prosecuted," Herrera explains. "They are accused of aggravated homicide and face sentences of 30, 40 and 50 years in prison."
Recent cases include a woman prosecuted after her baby died during a breech delivery, and another charged with attempted aggravated homicide after giving birth alone in a toilet, despite the baby surviving.
Legal Protections Erode Under Emergency Framework
Bukele's state of exception has systematically undermined constitutional protections, including access to legal counsel and presumption of innocence. Administrative detention, once limited to 72 hours, now extends up to 15 days before initial hearings. During this period, detainees may have no contact with legal counsel or family members.
Juanita Goebertus, Americas director at Human Rights Watch, notes that after initial hearings, most women are placed in pre-trial detention where they "spend months or years without effective access to legal counsel or contact with their families."
The Salvadoran lawyer describes how Bukele's emergency powers have fundamentally altered legal proceedings. In the case of the 19-year-old nursing student, none of her testimony was heard despite repeated defense requests. Prosecutors sought a 50-year sentence, though the court ultimately handed down a three-year sentence for negligent homicide, later converted to 144 days of community service. Prosecutors have announced plans to appeal.
Healthcare Surveillance and Climate of Fear
Paula Ávila-Guillén, director of the Washington-based Women's Equality Center, explains that before the state of emergency, informal legal networks helped protect women from immediate arrest. "We created a system with lawyers on the ground. Hospitals, instead of immediately calling the police, would call up the legal defenders, to allow us to defend the women properly."
This system, while not changing the law, ensured women could defend themselves and were presumed innocent rather than guilty. "Now it is detention first, investigation later, often without meaningful access to legal defense," Ávila-Guillén states. "These women are not accused of gang activity or organized crime, yet they are prosecuted under emergency rules designed for security threats."
The resulting climate of fear has deterred medical professionals and lawyers from intervening. Healthcare workers face sentences up to 12 years for performing or suspected involvement with abortions. Authorities have reportedly installed cameras throughout hospital facilities, including operating rooms, emergency consultation rooms, and pharmacies.
A Salvadoran healthcare professional who no longer works in the state hospital system claims, "They put cameras inside the ORs, inside the emergency consultation rooms, inside the pharmacies. They are watching you all the time. Imagine that you are a patient and you are without your clothes inside an OR, and there's a camera there."
Broader Regional Context and International Implications
El Salvador's re-criminalization of women occurs amid broader erosion of women's rights across Latin America. Argentina has effectively curtailed abortion access and restricted contraceptive distribution through sweeping funding cuts. Chile's president-elect appointed a vocal abortion opponent as minister for gender equality, while Ecuador's courts have moved to ban the morning-after pill.
Bukele maintains close alliance with Donald Trump, and advocates note limited international political will to address these women's rights abuses. "This government is aligning itself with the most conservative positions of other governments internationally," says Herrera.
"I worry that El Salvador is being held up as an example, as a model for other countries to follow," she adds with concern. "And I worry that this will become the future for women across the continent."
The situation represents a significant regression in human rights protections, with women experiencing pregnancy complications increasingly vulnerable to prosecution under emergency powers originally designed to combat gang violence. As constitutional safeguards erode and healthcare becomes increasingly surveilled, Salvadoran women face unprecedented legal jeopardy for seeking medical assistance during obstetric emergencies.
