New report explores what total abortion ban means in the Dominican Republic

Before her daughter died, Rosa Hernández unsuccessfully pleaded with doctors to give the 16-year-old a therapeutic abortion so she could get needed chemotherapy.

(CNN)A woman spoke of her 16-year-old daughter who died after being denied chemotherapy for leukemia because she was in the early weeks of pregnancy. A nurse described how a woman who was experiencing heavy bleeding after self-inducing an abortion was forced by medical providers to wait for treatment as "punishment" -- only to lose too much blood to be saved. An outreach worker remembered the mentally disabled 14-year-old girl who became pregnant at 12, probably by her father, and received no care.

Stories like these are revealed in a new Human Rights Watch report, released Monday, that focuses on the effect of a total government ban on abortions in the Dominican Republic.
The Caribbean nation is one of just 26 countries around the globe that prohibit -- even criminalize -- the procedure with no exceptions, according to the Guttmacher Institute, a research and policy group focused on reproductive health and rights. And the Dominican Republic is one of six countries in the Caribbean and Latin America to maintain restrictions, no matter the circumstances.
Article 37 in the country's Constitution, which also prohibits the death penalty in all circumstances, reads, "The right to life is inviolable from conception until death."
    But just because abortions are outlawed doesn't mean they don't happen. In fact, Guttmacher has reported that incidence of abortions are no less frequent -- but are less safe -- when they are restricted. And in Latin America and the Caribbean, where 97% of women and girls of reproductive age live in a place with restrictive abortion laws, the rate of abortion has increased, rising 9 percentage points between the early 1990s and 20 years later, Guttmacher found.
    Rosaura Almonte Hernández, known as "Esperancita," died in 2012 after initally being denied chemotherapy because she was pregnant.
    In a nation where the Ministry of Public Health and Social Assistance reports that nearly half of all pregnancies are unplanned or unwanted, the lack of safe and legal options for abortion has real consequences, the report shows.
    "Women and girls in the Dominican Republic have always defied the abortion ban, but they have been forced to put their health and lives on the line to end pregnancies clandestinely," said Margaret Wurth, senior women's rights researcher at Human Rights Watch and the report's author.
    They've tried home remedies, sipped special teas and denied themselves food or water. They've taken prescriptions that aren't supposed to be taken while pregnant, have ingested or inserted other pills to terminate their pregnancies and have tried to harm themselves. One woman reported using a concrete block to beat her belly.

    'Fear that permeates everything'

    Human Rights Watch interviewed 167 people for this report. Included were 50 women and girls who'd experienced unplanned or unwanted pregnancies and dozens of others -- such as health providers, social service professionals and other officials.
    Women with resources who want to terminate their pregnancies may be able to travel outside the country or, with the help of their connections, arrange for abortions through safe clandestine providers. But those who are poor or living in rural parts of the country don't have these options, Wurth said. They are left with two choices: have babies they don't want or fend for themselves to end their pregnancies. Adolescent girls, who often lack access to contraception and information, she said, are especially vulnerable.
    Add to this Article 317 in the Dominican Republic's penal code, which threatens prison sentences when it comes to abortion. Women and girls who self-induce or consent to abortions, and medical providers who provide illegal abortions, face the risk of serving time behind bars.
    In practice, while abortions are against the law even to save the life of a woman or girl, the United Nations reports that "general principles of criminal legislation allow abortions to be performed for this reason on the grounds of necessity."
    But this exception doesn't help every woman or girl who feels she needs an abortion.
    Prosecutions and arrests are rare, but fear of both persists -- often preventing people from seeking or offering help, Wurth explained. Even women who have had miscarriages, she said, admit being afraid to enter hospitals because they might be falsely accused of having induced an abortion.
    "Criminal penalties create fear that permeates everything," the report's author said. It means women and girls believe that "Going to the hospital and saying I had an abortion means I'm going to jail."