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The New York Times

‘It’s like a dead end’: contraceptive shortages affect women in Venezuela

‘It’s like a dead end’: contraceptive shortages affect women in Venezuela Read in Spanish SAN DIEGO DE LOS ALTOS, Venezuela – When Johanna Guzmán, 25, discovered that she was going to have a sixth baby, she began to cry, dejected by the idea of ​​bringing one more life to a country that is going through such a deep decline. For years, as Venezuela slipped into a downward spiral of economic crisis, she and her husband had tracked down any type of contraceptive that existed in clinics and pharmacies, almost always to no avail. They had a third child. Then a quarter. And a fifth. By then, Guzmán cooked meager dinners on the wood stove, washed clothes without soap, and educated his children without paper. At that moment, she was already haunted by the fear of not being able to feed them all. And now, another creature? “I felt like I was drowning,” he said. Venezuela begins its eighth year of economic crisis and, meanwhile, a deeply personal drama unfolds in the homes: millions of women no longer have enough for contraceptives, forcing them to have unsustainable pregnancies at a time when hard they hardly manage to feed the children they already have. In the capital Caracas, a pack of three condoms costs $ 4.40: triple the minimum wage in Venezuela, which is about 1.50. The birth control pill costs twice that, about $ 11 a month, while an intrauterine device (IUD) can cost $ 40, more than 25 times the minimum wage. And that does not include the fees of the doctor who has to implant it. With the cost of contraception so out of reach, women are increasingly turning to abortion, which is illegal and, in the worst cases, can cost them their lives. This situation contradicts the promise that the Venezuelan government once made to its women and girls. Hugo Chávez, the founder of the country’s socialist-inspired revolution, declared that his government would give women what others did not: full and equitable participation in society. Chavez included women in the instances of power and enshrined in the constitution the right to “freely decide” how many children a partner wanted to have. In a region where abortions are generally forbidden, it only lacked to legalize the procedure. But contraceptives were subsidized and widely available. Chávez and his successor, President Nicolás Maduro, publicly declared to be feminists. But as Maduro’s control turned into an authoritarian regime, Venezuela’s economy has collapsed under the weight of corruption, mismanagement, and US sanctions. The once most prosperous country in Latin America is mired in a crisis that economists rate the worst in decades outside a war context and its people suffer from rampant inflation and widespread hunger. Additionally, Venezuelans grapple with a health system so battered that it can no longer provide basic contraception. Today, contraceptives are almost absent in state clinics and only available in private pharmacies at prohibitive prices. This situation has transformed the lives of women, who carry almost the entire burden of parenting responsibilities just as the crisis exacerbates the challenge of caring for a family. Many women who grew up with the idea that Chavismo would lift them out of poverty, by offering them education and job opportunities, now face the risk of raising four, six, or ten children at a time when the basic products of family care – food , soap, diapers — they come intermittently, or they don’t. Anitza Freitez, a demographer at the Andrés Bello Catholic University in Caracas, said that this dynamic could shape the country for decades by reproducing “a vicious cycle of poverty.” As Venezuela’s maternity wards collapsed, maternal mortality increased 65 percent between 2015 and 2016, according to the country’s Ministry of Health. And then the government stopped publishing data. Fexsibel Bracho was 24 years old and had three children when she sought a clandestine service to terminate her pregnancy in January. The procedure, performed with a hook, pierced her uterus. He died on February 2 from a hemorrhage. “She didn’t have the dollars” to pay for birth control, said her mother, Lucibel Marcano, 51, who took care of Fexsibel in her final moments and watched her daughter’s face color slip away. Representatives from the Ministries of Health and Women did not respond to interview requests sent in letters and emails. When Hugo Chávez was elected president in 1998, he inherited a system in which contraceptive methods were widely available. In her drive to embrace the cause of women’s rights, she offered cash transfers to poor women and transferred women’s ministry to the executive branch. “Without the true liberation of women, the full liberation of peoples would be impossible,” said Chávez in 2009, “and I am convinced that a true socialist must also be a true feminist.” But reproductive health was never a priority, something even its supporters admit. Indhira Libertad Rodríguez, a 45-year-old women’s rights activist and a faithful follower of Chávez, affirms that Chavismo “has not overcome the bias of women as reproducers within the Bolivarian revolution.” For decades, Venezuela’s economy has depended on the country’s vast oil reserves. But starting in 2014, oil prices and poor management caused an economic downturn that severely affected the government’s purchasing power. In 2015, contraceptives that were once free in public hospitals and highly accessible in private pharmacies began to disappear. And women who could previously plan for their futures – thanks to contraception – began to lose control. By 2018, oral contraceptives, implants and patches were almost impossible to find in several major cities, according to a study by the Equivalences in Action rights coalition. Some couples began to abstain or to ration sexual encounters. Others used the rhythm method. But it didn’t always work. And not everyone had a choice. As the crisis deepened, many women say that the abuse has also worsened, making it difficult for them to refuse their partner or end a relationship. Guzmán gave birth to her sixth child, Yorkeinys, in April, when the country was already in the pandemic and her husband, a mechanic, had not worked for weeks. She explains that when she left the hospital and returned home, hungry, she only had lentils in the cupboard, and all of her children were hungry. He fell into depression and spent 20 days in bed. “It’s like a dead end. All dark, ”he said about his worst days. “You turn around here: it’s dark; you turn there and it’s dark ”. The plan she had dreamed of since she was a child – becoming a chemist – has been put on hold indefinitely. As parenting has become increasingly difficult in Venezuela, the number of women seeking abortions has also skyrocketed, according to interviews with health professionals and social workers across the country. Before the economic crisis, some doctors performed abortion procedures in safer facilities. But about 30,000 doctors – half of those in the country – have recently left, according to the Venezuelan Medical Federation, forcing women to go to makeshift clinics. In the shadows, a growing group of women, and a few men, have become a kind of clandestine abortion counselors, mainly with the intention of teaching women how to obtain and use misoprostol, a drug that in other countries use it legally to induce abortion. The idea is that women do not go to unreliable abortion providers who charge high prices in exchange for life-threatening procedures. Faldas-R, an activist group that operates an abortion hotline, reported a 40 percent increase in calls between 2018 and 2019. Women who are detained for terminating their pregnancies, and the people who help them, can get to spend years in prison. At great personal risk, some counselors deliver misoprostol directly to women. But even with counseling, the experience can be an ordeal, often involving a frantic search to get the $ 150 it costs to buy the pills and then find a safe place where they can bleed for a few hours. One night in late 2019, Jessika, a 21-year-old college student, had an abortion in an auto parts shed, accompanied by two friends. Jessika had never been able to buy birth control. She became pregnant after being assaulted by her boyfriend, and she knew that she would not be able to support a child. “In the country we live in,” he said, “a woman cannot have the luxury of bringing one more mouth to feed.” Through his contacts, he got in touch with one of the advisers, who gave him instructions and wished him good luck. At seven weeks pregnant, she bought misoprostol online from a man who called himself “José Vende Todo.” She knew that her mother would not approve of it and that she could not have an abortion at home. So, with a loan from a friend, she went to the shed and settled in a white-walled office with an armchair and a single window, which she left closed so no one would hear her scream. He took two pills at 7 PM and a second dose two hours later. Soon she was doubled over in pain and began to bleed profusely. His legs shook, he groaned, and then passed out. Not all misoprostol abortions are painful or risky. Doctors recommend that women take it along with another drug, mifepristone, which prepares the body for the process and makes the procedure easier. But mifepristone is not readily available in Venezuela, so most women take the hard road. When Jessika came to, her friends begged her to go to the hospital. “You’re not taking me anywhere,” she replied. I was terrified of the police. Then he spent weeks remembering the events of that night. “You always say, ‘Well, this happened, but it could have been worse. Well, it could have been worse. Something else could have happened to me. I could have died in the process. But it didn’t happen and it’s okay, ‘”he said. “But it’s not that, it’s not right!” He continued. “It is not good that I have done it in a shed. It’s not okay that I passed out, it’s not okay that I had depression, it’s not okay how I feel sometimes, ”she said angrily, stumbling over the words. “It is not right that this country is pushing you into such a serious situation. And all it does is close and close doors for you. I am resilient, yes. But we all, at one point, get tired. And I am tired. Very, very much ”. Without other help, a few non-profit organizations have become crucial resources for women, offering low-cost or free contraceptives. Most are supported by international funds. In five clinics operated by one of those organizations, Plafam, the waiting rooms are always full. Sometimes women sleep outside in desperation to be the type to get free birth control implants on the days they are distributed. Fexsibel Bracho, the young woman who died after a poor abortion, never approached Plafam or a counselor. Instead, she went alone to the place where they offered to help her, without telling her mother or sister about her plan. Now her mother struggles to understand her daughter’s decision. “If I could turn back the days,” he said, “I would talk to her so she doesn’t.” And he added: “My daughter was loving and I think even innocent.” But Fexsibel’s sister, Fanix Bracho, 34, said she fully understood his decision. “Being a woman in Venezuela is very difficult,” she said. “I would have done the same.” Julie Turkewitz is the head of the Andes correspondent, which covers Colombia, Venezuela, Bolivia, Ecuador, Peru, Suriname and Guyana. Before moving to South America he was a correspondent in the National section and wrote for the American West. @julieturkewitz This article originally appeared in The New York Times. © 2021 The New York Times Company

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