An Open Secret: The Hidden History of Unwanted Pregnancy and Abortion in Highland Bolivia, 1952-2010

This dissertation traces the history of unwanted pregnancy and abortion in La Paz and El Alto, Bolivia between 1952 and 2010. Although in Bolivia abortion is illegal, an estimated three in five women terminate at least one pregnancy in their lifetime—making the country’s abortion rate the highest in the region. Based on 113 personal interviews and over 3,000 medical records, the project reconstructs two central aspects of reproductive history. The first centers on the social, political, and medical phenomena of abortion and pregnancy. I outline changing policies and debates on reproduction, the evolution of abortion incidence and provisioning, and the emergence of a stable illegal abortion system in the country. A central argument of the project is that women’s experiences with illegal abortion helped shape both the evolution of reproductive health policy and changes in abortion provisioning in the country. In particular, I find that women’s demand for abortion coalesced with broader processes set in motion by the democratic opening of 1982 to spark the emergence of a stable and efficient illegal abortion network in these cities. This illegal network provided a response to women’s need to control their reproduction while simultaneously slowing efforts to legalize the procedure.\ud The final two chapters of the dissertation chart new territory in the history of reproduction by exploring women’s personal experiences with unwanted pregnancy and abortion. In these ethnographic chapters, I analyze interview testimony to uncover the complex range of factors influencing women’s feelings and reactions toward pregnancy and motherhood.\ud I argue that the language of “choice” often employed by reproductive rights movements is too narrow to adequately capture the contours of human experience. Instead, women’s decisions to continue or terminate their pregnancies were often so heavily conditioned by adverse circumstances that most felt they had no choice but to do so