Report on the Inter-American Court of Human Rights Decision in Beatriz v. El Salvador and its Implications for the Sustainable Development Goals

Executive Summary

This report analyzes the recent decision by the Inter-American Court of Human Rights in the case of Beatriz v. El Salvador. The analysis is framed through the lens of the United Nations Sustainable Development Goals (SDGs), with a particular focus on SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality), SDG 10 (Reduced Inequalities), and SDG 16 (Peace, Justice and Strong Institutions). The report concludes that the Court’s narrow, proceduralist ruling represents a significant missed opportunity to reinforce international human rights law and advance the 2030 Agenda for Sustainable Development by failing to address the systemic impact of restrictive abortion laws on the achievement of these interconnected goals.

Case Analysis in the Context of Sustainable Development Commitments

Factual Background and El Salvador’s Legal Framework

The case concerned Beatriz, a young woman from an impoverished region of El Salvador, who was living with Lupus. During a second high-risk pregnancy, medical professionals determined the fetus was non-viable and that continuing the pregnancy posed a direct and immediate threat to Beatriz’s life and health. Despite this medical consensus, she was denied a therapeutic abortion due to El Salvador’s absolute ban on the procedure. This legal framework directly contravenes key SDG targets.

• SDG 3 (Good Health and Well-being): El Salvador’s policies, which criminalize abortion without exception, fundamentally undermine Target 3.1 (reduce maternal mortality) and Target 3.7 (ensure universal access to sexual and reproductive health-care services).
• SDG 5 (Gender Equality): The aggressive prosecution of women for obstetric emergencies and suspected abortions constitutes a form of gender-based discrimination and violence, impeding progress on Target 5.1 (end all forms of discrimination against women) and Target 5.6 (ensure universal access to sexual and reproductive health and reproductive rights).

Judicial Findings and their Deficiencies in Upholding the SDGs

Failure to Address Systemic Barriers to SDG 3 and SDG 5

The Court recognized that the State’s actions violated Beatriz’s rights to health, personal integrity, and privacy. It noted that the absence of clear protocols for managing obstetric emergencies led to delays and “judicialization” of medical care, causing Beatriz profound physical and mental suffering. The Court classified this as gender-based, obstetric violence.

However, the decision failed to address the root cause of these violations, thereby weakening its potential impact on advancing SDG 3 and SDG 5. The key shortcomings include:

• The ruling did not explicitly link the harm suffered by Beatriz to the structural violence created by El Salvador’s absolute abortion ban.
• It failed to analyze the “chilling effect” of the law on the health system, a critical barrier to achieving Target 3.8 (universal health coverage).
• By not condemning the ban itself, the Court missed a crucial opportunity to address a discriminatory law that systematically violates women’s rights to health and equality (SDG 5).

Neglect of Intersectionality and SDG 10 (Reduced Inequalities)

The Court’s decision did not adequately apply an intersectional lens, thereby ignoring the disproportionate impact of the abortion ban on marginalized populations, a central concern of SDG 10. Evidence shows that restrictive abortion laws criminalize poverty and vulnerability.

• The majority of women prosecuted under El Salvador’s ban are young, have low socioeconomic status and educational attainment, and reside in rural areas, highlighting a failure to meet Target 10.2 (promote social, economic, and political inclusion of all).
• The punitive use of the public health system, where health workers are compelled to report patients, reproduces and deepens intersectional discrimination against women belonging to multiple disadvantaged groups, contrary to the principle of Target 10.3 (ensure equal opportunity and reduce inequalities of outcome).

Erosion of Precedent and Setback for SDG 16 (Peace, Justice and Strong Institutions)

A central failure of the ruling was its departure from the Court’s own established jurisprudence, undermining the predictability and strength of international law and weakening the institutions meant to uphold it, as envisioned in SDG 16.

The Court neglected to cite critical precedents that provide a framework for balancing rights and ensuring their effective enjoyment:

1. Artavia Murillo v. Costa Rica: This precedent established that the right to life of a fetus is not absolute and must be balanced against the rights of the pregnant person. By ignoring this, the Court eroded a key standard for protecting sexual and reproductive autonomy.
2. I.V. v. Bolivia: This case acknowledged the role of harmful gender stereotypes in creating systemic barriers within health systems. The Beatriz decision failed to extend this analysis, missing an opportunity to address the informal norms that prevent the effective enjoyment of rights.

This retreat from a holistic analysis undermines the development of effective and accountable institutions (Target 16.6) and the promotion of the rule of law and non-discriminatory policies for sustainable development (Targets 16.3 and 16.B).

Conclusion: A Setback for the 2030 Agenda

The Inter-American Court’s decision in Beatriz v. El Salvador, while vindicating the dignity of one individual, failed to address the structural issues at the heart of the case. By avoiding a direct confrontation with El Salvador’s absolute abortion ban, the Court undermined the interconnected and indivisible nature of the Sustainable Development Goals. The ruling represents a significant setback for the advancement of gender equality (SDG 5), good health and well-being (SDG 3), reduced inequalities (SDG 10), and the strengthening of just and effective institutions (SDG 16) across the region.

Analysis of Sustainable Development Goals (SDGs) in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being: The article is fundamentally about health. It discusses a “high-risk pregnancy,” the denial of a “therapeutic abortion” despite “medical consensus,” and the resulting “physical and mental anguish.” It also covers broader issues like “obstetric emergencies,” access to healthcare, and the negative impacts on the “health system.”
• SDG 5: Gender Equality: The article frames the issue as a matter of gender equality and women’s rights. It explicitly mentions “gender-based stereotypes,” “gender-based, obstetric violence,” “structural violence against women,” and the failure to consolidate jurisprudence on “sexual and reproductive health and rights.” The abortion ban is presented as a tool of discrimination against women.
• SDG 10: Reduced Inequalities: The article highlights the disproportionate impact of the abortion ban on marginalized groups. It states that the law affects “impoverished women,” and the “majority of women prosecuted under the ban are young, of low socioeconomic status and educational attainment, and come from rural areas.” This points directly to intersectional discrimination and the widening of inequalities.
• SDG 16: Peace, Justice and Strong Institutions: The article critiques the failure of legal and state institutions. It describes how El Salvador “aggressively prosecutes women,” leading to long prison sentences. It also notes the “lack of regulation and legal uncertainty” and the absence of “protocols” in the health system, forcing doctors to “judicialize” medical decisions. The core argument is a critique of the Inter-American Court’s failure to provide robust justice.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Under SDG 3 (Good Health and Well-being):
   • Target 3.1: By 2030, reduce the global maternal mortality ratio. The case of Beatriz, who faced a “high-risk pregnancy” and was denied care despite “immediate harm,” directly relates to preventing maternal death and severe morbidity.
   • Target 3.7: By 2030, ensure universal access to sexual and reproductive health-care services. The article’s central issue is the denial of access to these services, as El Salvador is one of the countries where “abortion is banned with no exceptions,” preventing access to essential healthcare like therapeutic abortions.
   • Target 3.8: Achieve universal health coverage, including…access to quality essential health-care services. The article points to a failure of UHC, noting that “impoverished women invariably suffer from a lack of access to care and abuses within the public health system.”
2. Under SDG 5 (Gender Equality):
   • Target 5.1: End all forms of discrimination against all women and girls everywhere. The article argues that the abortion ban and its enforcement are based on “gender-based stereotypes” and result in “structural violence against women,” which are severe forms of discrimination.
   • Target 5.2: Eliminate all forms of violence against all women and girls. The court’s ruling explicitly found that Beatriz suffered “gender-based, obstetric violence,” a form of violence this target aims to eliminate.
   • Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights. The article laments the court’s failure to uphold these rights, which are denied by El Salvador’s “draconian abortion restrictions on women.”
3. Under SDG 10 (Reduced Inequalities):
   • Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of…sex…or economic or other status. The article demonstrates the opposite, showing how the law disproportionately prosecutes and excludes women who are “young, of low socioeconomic status and educational attainment, and come from rural areas.”
   • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices. El Salvador’s absolute abortion ban is presented as a prime example of a discriminatory law that creates profoundly unequal outcomes for women based on their health and economic status.
4. Under SDG 16 (Peace, Justice and Strong Institutions):
   • Target 16.3: Promote the rule of law…and ensure equal access to justice for all. The article details a failure of justice, where women are “aggressively prosecute[d]” and medical care is “judicialize[d],” denying individuals like Beatriz timely and just resolutions.
   • Target 16.6: Develop effective, accountable and transparent institutions at all levels. The lack of “protocols to timely address cases of obstetric complications” and the “chilling effect on providers” point to ineffective and non-accountable health and legal institutions.
   • Target 16.b: Promote and enforce non-discriminatory laws and policies for sustainable development. The article is a critique of a discriminatory law (the abortion ban) and the failure of a high court to adequately challenge it, running counter to this target.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Existence of restrictive laws: The article provides a direct indicator by stating that El Salvador is one of “twenty-three in the world, where abortion is banned with no exceptions.” The number of countries with such laws is a measure of progress (or lack thereof).
• Criminalization and penalties: The article specifies the penalties for violating the ban, which serve as indicators of the law’s severity: “prison sentences of thirty to fifty years” for women and “six to twelve years” for providers.
• Socio-economic data of those prosecuted: The article implies a key indicator of inequality by describing the profile of those most affected: “The majority of women prosecuted under the ban are young, of low socioeconomic status and educational attainment, and come from rural areas.” Tracking this demographic data would measure the law’s discriminatory impact.
• Role of the health system in prosecutions: A specific, measurable indicator is provided: “More than 57% of the originating criminal reports against women prosecuted from 2000 to 2011 came from the health workers that treated those women at public hospitals.” This measures the “punitive instrumentalization of the health system.”
• Institutional readiness and protocols: The article implies an indicator of institutional effectiveness by noting the “lack of regulation” and absence of “protocols to timely address cases of obstetric complications.” The existence and implementation of such protocols can be measured.
• Prevalence of specific forms of violence: The identification of “gender-based, obstetric violence” suggests that its prevalence could be tracked as an indicator for violence against women (Target 5.2).

4. Table of SDGs, Targets, and Indicators

Source: opiniojuris.org