Honduran women demand protocol for survivors of sex abuse
Debate over the morning-after pill has prevented the adoption of crucial guidelines for attending to sex abuse survivors
Tegucigalpa – In Honduras, it is “dangerous to just be a woman”, says Jinna Rosales, a feminist activist and director of human rights organisation Accion Joven Honduras (Youth Action Honduras).
Honduras has one of the highest rates of sexual violence in Latin America. A woman in the country raped every three hours. And for those who report the assault, they’re only “revictimised”, advocates say.
“Rapes in Honduras are systematic,” says Julissa Rivas, a member of feminist organization Yo No Quiero Ser Violada (I Don’t Want to Be Raped). “Every time a woman is raped, they say, ‘Where was she? How was she dressed? What time was it? What was she doing?’ They revictimise her.”
Yo No Quiero Ser Violada’s founding followed the 2018 brutal murder of a 27-year-old medical student who was shot dead when she refused to cooperate with armed assailants who boarded a bus and tried to sexually abuse her and a friend.
Since then, the group and other advocates have worked to raise awareness about the high rates of sexual violence in Honduras, and call for the adoption of a national protocol for victims and survivors of sexual violence.
The country does not currently have a protocol for healthcare professionals who attend to survivors of sexual assault, leading to incomplete care and confusion over what services doctors can legally provide. Some doctors may only run tests for sexually transmitted diseases and pregnancy without providing preventive medication. In other cases, doctors refuse to treat patients because they incorrectly believe that the woman must file a police report against her aggressor before they can offer her medical care.
“Imagine what kind of attention these women are getting?” says Rivas. “Right now, they just give them some tests. Given the circumstances in the country and the high rate of teen pregnancy, it’s unimaginable [that there is no protocol].”
According to health experts, an integral protocol would ensure that sexual assault survivors receive medication to prevent HIV and other STIs, emergency contraception to prevent an unwanted pregnancy and psychological help to deal with the trauma of what they experienced.
Although a protocol has been in the works since 2015, it has recently reached a deadlock over what should and should not be included. Women’s rights organisation, doctors and health experts involved in the process of creating the protocol want to include the morning-after pill (also known as the day-after pill, Plan B or PAE in Spanish), which has been banned in Honduras since 2009. The Health Ministry has indicated it will not approve any protocol that includes the emergency contraception.
“It’s a protocol that all countries should have, but Honduras still doesn’t have it,” Rosales says.
The World Health Organization (WHO) has published its own “guidelines for medico-legal care for victims of sexual assault” and recommends that countries adapt it to their own national context.
The issue of the inclusion of the morning-after pill stems from a ruling by the Honduran Medical College that said the emergency contraception induces abortions. That ruling came despite the WHO’s long-held position, based on scientific studies, that the morning-after pill can prevent pregnancies when effective, but does not cause abortions.
Without a protocol with emergency contraception included, the thousands of Honduran women who are raped each year in the country must endure an unwanted pregnancy or risk prosecution by clandestinely obtaining the morning-after pill or an abortion, which is also banned.
According to a report by Doctors Without Border, more than 80 percent of the women the organisation treated said their pregnancy was a result of rape.
Health experts say that their only option for helping these women is by offering a method called Yuzpe, which includes taking four birth control pills within 72 hours of unprotected sex, and then four more, 12 hours later. Studies of the effectiveness of this method show a rate of between 44 and 87 percent. The morning-after pill is 95 percent effective when it is taken within 24 hours of unprotected sex. The Yuzpe method can also cause unpleasant side effects including nausea and vomiting, which are less severe with the day-after pill because it has a smaller dosage of hormones.
“We use the method Yuzpe, even though it is not as effective, because that’s the method that we have,” said Rafael Contreras, coordinator for Doctors Without Borders in Honduras. The organisation’s international protocol to attend victims of sexual violence includes the morning-after pill, but they do not offer it to Honduran women because the organization follows the laws of the countries where it works.
Attempt to approve a protocol
Doctors Without Borders has been part of a coalition of organisations tasked with preparing a protocol for attention for victims of sexual violence since 2015. The coalition developed what it considered to be a complete and integral protocol two years ago that included pregnancy prevention through the PAE, treatment for prevention of STIs, and mental health services.
In September 2017, the coalition presented a draft of the protocol to the health ministry, which Al Jazeera has reviewed. The protocol states that in cases of rape in which the woman is at risk of pregnancy because she is of childbearing age, is not already pregnant and was not using any birth control method at the time of the rape, she should be offered a dosage of 1.5 mg of levonorgestrel, the dosage in the morning-after pill.
“We understand that there is a national policy and that there is a cultural and religious question,” said Piedad Huerta Arneros, the WHO in-country representative in Honduras. “We respect the autonomy of the country, but in any case, our interest is to present the scientific evidence that the PAE is really an anti-contraceptive pill.”
In January 2018, the general director of normalisation of the Secretary of Health, Elvira Ardon sent a letter to the Interinstitutional Technical Committee, which developed the draft. She requested that the section of the protocol that mentioned emergency contraception be removed because it violates the ministerial decree that bans the morning-after pill. Instead, the health ministry has proposed a different protocol which does not include the PAE. The health ministry declined Al Jazeera’s request for comment on the protocol.
Those involved in developing the protocol say that failing to include the PAE in the protocol would mean that the protocol would fail Honduran women. “If we take out the part about preventing pregnancy, it ceases to be an integral protocol,” Contreras says.
“This section on pregnancy prevention forms part of an integral attention that is given to women who are victims of sexual abuse: access to emergency contraception to prevent a pregnancy, access to all of the mechanisms that can prevent HIV and other STIs, and access to psychological attention,” Rosales says. “It’s urgent that this protocol be complete and that it is not left [without the PAE.] If the protocol doesn’t include the PAE, it will continue to reproduce cycles of violence and discrimination in a state that doesn’t worry about its women. “
This article is part of a multi-part series examining reproductive health in Honduras. Also read:
In Honduras, women fight for access to the morning-after pill
This reporting was also supported by the International Women’s Media Foundation’s Reproductive Health, Rights and Justice in the Americas.