By Adaeze Okeke, WHP Coordinator, PSI and Emma Halper, LAC Assistant, PSI
Marya is a passionate OB/GYN who lives in San Salvador, the capital of El Salvador. An avid traveler and painter, her clinic is beautifully decorated with paintings and warmly glowing candles.
“A lot of my patients are young, from age 13 to 22,” Marya explains. “I want them to feel like this is a positive space where they won’t be judged.”
In contrast to Marya’s welcoming clinic, most Salvadoran women face a conservative and often judgmental environment in many aspects of their healthcare. As a result, women and girls have difficulty accessing contraception, and unsafe abortion is prevalent. Both take a heavy toll on Marya’s work.
In El Salvador, abortion is illegal under all circumstances, including when a woman is raped or if her life is at risk. Women who have abortions, miscarry or deliver a stillborn fetus can face up to eight years in prison for “aggravated homicide,” and their healthcare providers may face up to 12 years in prison for providing an abortion. Between 2005 and 2008, there were 19,290 abortions in El Salvador; more than a quarter by girls under the age of 18.
Because of this total abortion ban, access to contraception is especially important for women in El Salvador.
However, poor, rural and unmarried women and girls still face many barriers when seeking contraception due to religious and sociocultural attitudes, stigma around seeking contraception and harmful gender norms. Marya has many clients who have confronted these barriers before coming to her clinic.
“A young woman, Silvia*, came here who had previously consulted a different healthcare clinic to get an IUD. She was a university student who did not want to get pregnant,” Marya says. “However, the healthcare provider at the other clinic told her that she could not get an IUD as it ‘attracted lightning bolts’ during storms.”
Marya relates to patients like Silvia. She also encountered barriers in pursuing her dream to become a surgeon. Her dream was stalled by the head of the surgery department at the national hospital, who prohibited women from becoming surgeons. Determined to pursue medicine, Marya instead became an OB/GYN, so she could perform small surgeries and provide healthcare to women in her community.
As part of her work, Marya is a member of the Alianza de Profesionales por la Salud, a reproductive health provider network supported by PSI’s Women’s Health Project since 2010. Through PASMO S.A., the Pan American Social Marketing Organization Sociedad Anonima, Marya and other providers in the network receive training and continuous support in order to strengthen quality and ensure that clients like Silvia receive confidential and non-judgmental care.
“Silvia came into our clinic for an ultrasound, where it became clear that she had experienced a miscarriage,” Marya recalls. “She received a manual vacuum aspiration service to expel the remains. After the service, she had an IUD inserted and was provided with counseling.”
Marya’s clinic provides post-abortion care and offers counseling and contraceptive methods to women who have suffered unsafe abortions. Her clinic also provides optional psychological support for young women who have had an abortion, giving them a space to talk through their emotions. Patients can come back weeks, months, even years after for further counseling.
“Giving women the resources to plan and take control of their lives has made a huge impact on the community here,” Marya shares.
That’s why she’s committed to helping women like Silvia, providing the professional and confidential sexual and reproductive health services they deserve.
*This name has been changed to protect the client’s identity.