Savita Halappanavar, Ireland
Savita Halappanavar was 31 years old when she died of blood poisoning nearly a week after she arrived at University Hospital Galway (UHG) in Ireland complaining of intense back pain.
Halappanavar, a dentist from Karnataka, in south-west India, was 17 weeks pregnant with her first child and went to hospital with her husband, Praveen, on Sunday 21 October 2012. Within hours, doctors said a miscarriage was inevitable, even though a foetal heartbeat could be heard. By this point, Halappanavar was in “unbearable” pain and “very upset”, according to healthcare staff. The plan was, she was told, to “wait and see” if she would miscarry naturally.
At the time, Irish law stated that abortions were permitted only if there was a “real and substantive” threat to a woman’s life. By Tuesday, there had been no miscarriage. The couple asked whether one could be induced but were told by the doctor: “Under Irish law, if there’s no evidence of risk to the life of the mother, our hands are tied so long as there’s a foetal heart[beat].”
Halappanavar developed a high fever. On the Wednesday morning, the medical team diagnosed infection and, later, septic shock. Her condition was deteriorating rapidly.
A plan was made, but not enacted, to give Halappanavar a drug to induce abortion. According to the Health Service Executive inquiry, by this point, the death of the foetus was certain and the appropriate treatment was to terminate the pregnancy because of the risk to Halappanavar’s life.
Halappanavar spontaneously miscarried mid-afternoon on Wednesday and was admitted to intensive care. She was now critically ill with severe sepsis and multiple organ failure. She suffered a cardiac arrest and died in the early hours of Sunday 28 October, almost a week after being admitted.
The case sparked outrage in Ireland and highlighted how the law put women with life-threatening medical conditions at risk in Irish hospitals. In media interviews, Halappanavar’s husband revealed that he and his wife had repeatedly asked for the pregnancy to be terminated but had been refused and told: “This is a Catholic country.”
Protesters took to the streets, calling for accountability and change, accusing the Irish state of failing to protect its citizens. An Amnesty International report in 2015 said her “entirely preventable death was a consequence of Ireland’s restrictive abortion law”.
Anti-abortion campaigners said the case was being exploited by those with an agenda to liberalise Ireland’s laws, and the Catholic church declared that a woman had no more right to life than the foetus.
The government, under intense public scrutiny, carried out multiple inquiries into Halappanavar’s death. In the HSE’s final report, the investigation team stated that a termination of pregnancy was medically indicated and would have been performed in “other jurisdictions”.
In May 2018, Ireland voted by a landslide to repeal its near-total ban on abortion. The referendum – in which 66.4% voted Yes, a majority of 706,349 – drew the highest turnout for a ballot on social issues.
Olga Reyes, Nicaragua
Olga Reyes, 22, waited in pain for hours at the hospital ward in 2006. She had already been turned away from one hospital but arrived at the next one with the proof that she needed urgent care: an ultrasound scan from a private clinic that showed an ectopic pregnancy was rupturing her fallopian tube.
The fertilised egg had implanted itself outside her womb and the embryo, at about six weeks old, could not survive but was threatening her life: Reyes was bleeding to death. Doctors delayed treatment, fearful of the repercussions of the ban on therapeutic abortions that had been introduced only months earlier, in November 2006. By the time they took Reyes for surgery it was too late.
The 22-year-old law student, who had celebrated her wedding only two months earlier, suffered repeated heart attacks during the operation and died from cerebral arrest due to haemorrhaging.
In a report published the same year on the banning of therapeutic abortions in Nicaragua, the rights organisation Human Rights Watch said she should have been treated immediately under government rules on ectopic pregnancies, but the contradictory new ban on therapeutic abortions meant doctors feared intervening.
Only days after the law was changed, another young woman, the same age as Reyes, spent days asking for treatment from a local hospital without success. When she was transferred to another hospital it was, again, too late. She died of a cardiac arrest.
The penal code Nicaragua introduced to enforce its ban included prison sentences for anyone performing abortions, as well as the women seeking them, regardless of whether their lives were in danger. It was because of this, her husband told the media, that Reyes was left bent double in agony in the hospital ward.
The young women’s deaths did not alter the course of Nicaraguan law. After the ban on therapeutic abortions in 2006, more amendments brought a blanket ban by 2008, with no exceptions for saving the woman’s life.
The morning before her death, Izabela* texted her mother from the hospital. “The child weighs 485g. For now, because of the abortion law, I have to stay in bed and they can’t do anything,” she wrote. “They will wait for the baby to die or for something to start happening. If it doesn’t then great, I can expect sepsis.”
Izabela, 30, owned a hair salon in Pszczyna, a small town in Silesia. On her Instagram account Pani Iza, as she was known to customers, would regularly post photos of her influencer-worthy wedding coiffures and hair transformation. Her clients did not spare compliments. “The best hairdresser in the world, you can see that she loves her job,” reads one of the last online reviews dated June 2021, a month before Izabela died. “Thanks to her, I went from black to blonde and my hair survived!”
When her waters broke at 22 weeks, Izabela thought it was stress. She had spent the day at hospital with her nine-year-old daughter, who had fallen from her scooter. Izabela was taken to hospital the next day, though no treatment was undertaken until the next morning.
“They can’t do anything, because then it’ll look like they did it on purpose,” she texted her mother, to explain why doctors were not inducing the birth hours after the waters broke.
“They have to wait for it to happen on its own. And if it doesn’t, then we’re waiting for the heart to stop beating,” she wrote. “The woman is like an incubator. And the baby is suffering too – it has nothing to breathe with.”
According to a Polish law introduced in 2021, abortion is legal to save the health or life of the mother and in cases where the pregnancy is a result of rape. Previously, the procedure could also be legally carried out in cases of severe foetal abnormalities.
Although the doctors could have legally aborted, they chose not to until it was too late. The law that would have allowed them to do this was “difficult to apply in practice”, says Jolanta Budzowska, the lawyer representing Izabela’s family in a court case against the hospital. “If they carry out an abortion too early and the prosecutors then decide that there was no danger to the mother [at that point] they can face up to three years in prison. Consequently, doctors are more cautious in their decisions.”
As doctors waited for the foetal heartbeat to stop, women on Izabela’s ward recall her pleading with the staff. “She felt that something was not right. But they kept telling her that the heart is beating, and that as long as the heart is beating this is the way it must be,” one woman told Polish media.
“I can still hear her words to this day: that she wants to live, she doesn’t want to die, that she has people to live for,” the woman said.
After nationwide protests, the hospital where Izabela died was fined 650,000złoty (£120,000) by the Polish health service. The court case against the doctor responsible for Izabela during her stay at the hospital is ongoing. The hospital’s director resigned in March.
‘Manuela’, El Salvador
Manuela*, a mother of two from El Salvador, did what most people would do when she fell ill while pregnant in 2008: she went to hospital. Tragically, she miscarried, but instead of medical and social support, she was handcuffed to her hospital bed and interrogated by police.
Manuela, 33, whose full name has never been made public, was charged with aggravated homicide under El Salvador’s draconian anti-abortion laws, and sentenced to 30 years in prison. She died of cancer two years later – a disease that activists say was ignored and left untreated during her incarceration.
“The stories of women in El Salvador who have been unjustly criminalised for experiencing obstetric emergencies, as happened to Manuela, should also serve as a global example of the terrible consequences of criminal restrictions on access to a service such as abortion,” says Carmen Martínez, an associate director in Latin America for the Center For Reproductive Rights, a US-based human rights organisation.
Last November, the Inter-American Court of Human Rights (IACHR) ruled that the state was responsible for Manuela’s death, having violated her rights to life, health, judicial protections and guarantees, freedom from discrimination and gender violence. The court ordered El Salvador to pay reparations to the young woman’s family and to reform its strict abortion laws and healthcare policies.
“There is no doubt that Manuela suffered an obstetric emergency,” stated the landmark ruling. “Such situations, as they are medical conditions, cannot lead to a criminal sanction.”
El Salvador has some of the world’s most restrictive abortion laws. Since 1998, the procedure has been banned without exception, including in cases of rape and incest. Over the past 20 years, more than 180 women have been jailed for murder for having an abortion after suffering obstetric emergencies, according to rights groups.
“I remember my mum, she gave us advice and never left us alone. It is painful to grow up without a mother because that love is incomparable,” Santos de Jesús, Manuela’s eldest son, said in a statement before the hearing in March last year. “I ask the state not to do these things because they left us abandoned without a mother.”
At the time of the ruling, many women’s rights activists believed that the Americas could be on the path to further liberalisation of abortion laws – and decriminalisation gains in Colombia and Argentina fuelled those hopes.
However, the leak of the US supreme court’s draft opinion to overturn Roe v Wade has many rights groups worried that progressive policies may remain out of reach.
“The threats to abortion rights in the US matter to all of us because it is a terrible precedent at the international level,” Martinez, one of the lawyers who argued Manuela’s case before the IACHR, says. “This does not mean that what happens in a court like the one in that country can affect the achievements we have made in El Salvador and throughout Latin America, and for which we will continue to work with more enthusiasm.
“Roe v Wade must be protected as well as all laws that have advanced in the decriminalisation of abortion in the world. The fight for our rights has no borders.”
Mildred* was a 15-year-old girl from Manyani estate in the Kenyan city of Nakuru. She was admitted at the Nakuru Level 5 hospital last summer with acute abdominal pains and uncontrollable vomiting. She died writhing in pain, 20 weeks into a pregnancy she had tried and failed to end using herbs and salt.
Her anguished father, David, explained that the family did not know about her pregnancy. Mildred had travelled to the family’s rural home in Bungoma, where, her family believe, she tried to end the pregnancy with the help of an older woman she knew there.
“I did not know that my daughter attempted to terminate her pregnancy using a mixture of herbs, concentrated drinks and salt, a secret she kept close to her heart,” her father says.
“I wish my daughter had accessed a safer abortion … terminating the pregnancy was a better option to her happiness than trading her life with herbs that caused her infection and painful death,” he says.
At the same hospital, two years ago, Betty* died after trying to use detergent to end her pregnancy. The pain of the loss is still raw for her mother, from Racecourse estate, in Nakuru. “I thought my daughter was suffering from malaria. She was vomiting and complained of a severe headache,” she says.
Betty died on 19 May 2020 in agony. “It is sad that my daughter suffered in silence. I would have supported and walked with her in her pregnancy journey, and guaranteed her a safe delivery,” says her mother. “It pains me that she died such a painful death, yet I could have helped raise the baby as she continued with her studies.”
Her mother claims Betty was encouraged to take the detergent by her peers for fear of being forced to drop out of school and the stigma that comes with a teenage pregnancy. Kenyan society views teenage mothers as failures, with a number being denied education and forced into early marriages, often with abusive men.
“I wish there was a way of stopping my daughter from dying,” says her mother. “I trusted she would save me from poverty.”
In Kenya, abortion is outlawed under the constitution, with the exception of pregnancy from rape, pushing women and girls into crude methods of abortions, risking their health and their lives. According to the most recent Demographic Health Survey, 35% of maternal deaths in 2014 were as a result of unsafe abortions.
Dr Susan Gitau, chair of the Department of Counselling Psychology at Africa Nazarene University, says many of those who survive such unsafe procedures suffer lasting trauma. “Psychological counselling is key, counselling that should be done within 48 hours,” she says, “because abortion is illegal, girls do not access this.”
* Names have been changed to protect identities.