How Diplomacy May Have Shaped Uruguay’s Domestic Abortion Policies

A protester holds a pamphlet at a pro-choice in Uruguay rally in May 2012. Currently, the country is the only in South America to legalize abortion. Photo by Mateus S. Figueiredo.

“Everything is legal in Uruguay,” my tour guide said, sniffing the powerful smell of weed drifting from some picnickers in the middle of the park. I was on a free walking tour through Montevideo, Uruguay’s small capital city. “But it’s legal only for the Uruguayans.” He continued, “We are the most liberal country in South America. Gay marriage is legal. Marijuana is legal. Abortion is legal. But you can only buy weed or get an abortion if you are a citizen.”

He wasn’t quite correct about the abortion regulations. You don’t have to be a citizen of Uruguay to get an abortion, but you must have been a legal resident for a minimum of one year before receiving the procedure. In his article The Cost of Abortion, Evan Pheiffer notes that the rule seems directly intended to prevent abortion tourism, the practice where women travel to other nations to obtain abortions. He explains that Uruguay is “mindful of its pioneer status in the region.” Uruguay’s domestic abortion regulations were shaped, Pheiffer implies, by regional diplomatic considerations. 

One of the women in my walking tour asked, “Why can’t you buy weed or get an abortion if you aren’t from Uruguay?”

The tour guide laughed. “We are a liberal country surrounded by conservative countries. We don’t want to piss off our neighbors.” 

Uruguay’s residency requirement for abortion has been rarely considered in academic and policy discussions of international abortion policy. That the law is intended to prevent abortion tourism is obvious, but the reasons for such a vehement reaction to the possibility of transnational abortion travel are less so. Liberal Uruguay’s restriction of abortion access to residents only raises questions about the role of diplomacy and regional concerns in shaping domestic reproductive health policy.

The Most Controversial Tourist Attraction: Legal Abortion

On the international stage, most people looking to travel for an abortion attempt to obtain the procedure as close to home as possible. A study of Polish women who traveled abroad for abortions found that they usually traveled to nearby member states in the E.U., most commonly to neighboring Germany. Until Ireland legalized abortion in 2018, Irish women regularly traveled to the U.K., making up 66.7% of the foreign women who traveled there to receive the procedure in 2014. In total, 5,521 women travelled to the U.K. from other countries to get an abortion that year. 

Providing abortions for internationals proved a British moneymaker, with the operation itself, travel, and accommodation generating millions of pounds each year.  

In the United States, where abortion rights vary from state to state, abortion tourism is a full-fledged, if controversial, industry. In an online advertisement, the Orlando Women’s Center (a for-profit clinic) argues that due to state and national abortion restrictions, abortion tourism is “ever so important” to Florida. It sells Florida as an excellent abortion spot because of good flight and transit connections, world famous beaches and hotels, and “one of the best second trimester and late term abortion clinics.” The promotional article notes that Florida is a destination “especially” for those from “Central America and South America.”

A woman protests for gender equality in Montevideo, Uruguay. Photo by MediaRed UY.

Uruguay Leads the Way

Uruguay legalized abortion in 2012, with moderate regulations. There is twelve-week cut-off for elective abortion (yet no cut-off timeline if there is a threat to the woman’s life) and women are required to have a medical consultation. 

One woman who received an abortion, office worker Mariana Rodriguez, described her experience as “great,” saying, “I felt well supported and never judged. No-one tried to persuade me. The psychologist just asked me if I was sure and I gave my explanation.” 

Still, the system is imperfect and stigmas exist. The law requires residents seeking abortions to wait and reflect for a mandatory five days after the consultation before the procedure can take place, a rule that is widely considered unnecessarily burdensome. In a 2014 study of 207 women seeking abortions at a public hospital in Montevideo, most of the women were satisfied with the services they received, although one quarter reported feeling judged. Despite these limitations, abortions are generally easy to obtain in Uruguay—and this access to safe, clean, generally destigmatized abortion is unique in South America. 

An International Issue

In Latin America and the Caribbean, more than 97% of women of reproductive age live in countries with restrictive abortion laws. Uruguay neighbors two countries with restrictive laws: Brazil, where it is legal only to save the life of the woman, and Argentina, where it is legal for saving life and for preserving physical health. These restrictive laws have tangible health impacts: from 2010-2014, about 60% of abortions in Latin America and the Caribbean were considered less than safe.

Moreover, as my tour guide explained, the citizenship requirement to receive an abortion bars those seeking safer abortions in Latin America from traveling to Uruguay. Article 13 of the relevant law states that “the provisions contained in this law can only be relied upon for natural or legal Uruguayan citizens or foreigners with convincing evidence of habitual residence in the territory of the Republic for a period of no less than one year.” 

This regulation is an anomaly among countries with legal abortion, as most such countries have no residency requirements for abortion recipients.  Those neighboring conservative countries often have some form of abortion tourism: Thailand serves as the destination for Filipinos, Germany for Poles, and South Africa for Malawians. 

That is not to say abortion tourism is popular in the host countries. In his book Medical Tourism, John Connell writes that the practice has “been criticized in destination countries for both the negative connotations of ‘abortion tourism’ for national identity… and the local costs.” Many citizens of countries where abortion is legal feel that abortion tourism is a burden on local health services, causing a cost “to national populations in lost income, or through displacing local people, rather than a boost to the national economy.” The British, for example, felt for much of the 2000s that abortion tourism was a burden on their National Health Service, making legal abortion travel an increasingly unpopular policy among UK nationals.

It may seem that Uruguay would possess such an unusual residency requirement for this exact reason—fear that an influx of women from conservative neighboring countries would overwhelm the country’s currently accessible and affordable health care infrastructure—but it is also likely that diplomatic concerns impacted the decision. As John Connell explains, citizens traveling from conservative nations to other countries for abortions “has been strongly criticized in source countries where it breaches widely held moral positions and national legislation.” 

Uruguay’s most important political and economic partners are neighboring Brazil and Argentina. Both countries’ governments have strictly conservative and deeply negative opinions of abortion, and would look unfavorably upon an abortion provider in their backyards. Regionally, their power far outweighs that of Uruguay. Brazil and Argentina have populations of 209 and 44.9 million, respectively, while Uruguay’s population is only about 3.5 million. And Uruguay’s economy depends on exports to Brazil and Argentina; exports to the two are worth almost $2 billion combined, making up nearly a quarter of all of Uruguay’s exports. 

When Irish women were fleeing to Britain for abortions, they were fleeing to a much larger and economically stronger nation. Britain did not have any particular need to take the Irish government’s desires and regulations into account. And throughout the 20th century, Ireland and Britain’s diplomatic relationship was already strained in the aftermath of the Irish revolution against British rule. England’s government did not take Irish reproductive policies into account, and it had no need to. When making its own policies, Uruguay did not have that luxury. 

Photo by Mateus S. Figueiredo.

But regional opinions on abortion are beginning to shift. Although Brazil remains firmly anti-abortion, in Argentina, this may change. In March, the president signaled his support of legalization, and Argentina’s legislature is set to debate a legal abortion bill. But in 2012, when abortion was legalized in Uruguay, it was still deeply unpopular in the Argentine government. 

In South America, Uruguay has been a leader in reproductive policy, yet it is not the only country to have enacted socially liberal policies. Argentina was the first country to legalize same-sex marriage, and Brazil and Uruguay both followed. But the Uruguayan government’s clear separation of church and state and lower rates of Christianity in the nation have allowed it to move forward with controversial policies, from legalizing marijuana to legalizing abortion, at a quicker pace than its more religious neighbors.

Legal abortion across South America will hopefully follow, if slowly. What is unclear is if Uruguay’s abortion tourism regulation will serves as a model for other states. If Argentina legalizes abortion without a residency restriction, it will significantly open up abortion access in South America (if only for those with the financial resources to travel). That will, most likely, depend on the same regional and local public health issues that may have shaped Uruguay’s policies. The question is if abortion will be made available only to those who reside within the liberalizing countries, or if countries with legal abortion will provide the right to choose to abortion travelers from across South America. Reproductive access is an international issue. For both diplomatic and domestic reasons, Uruguay has attempted to make abortion national; we can only hope Argentina makes a different choice.

Maeve Flaherty is a junior at Columbia College studying English and History. She is a former summer fellow at the Roosevelt Institute and the president of NYC Restrooms4All, a public bathroom advocacy campaign.