“A Grateful Subject”: Legal Abortion, Clientelism, and Health Rights in Mexico City

The construction of subjective notions of rights related to sexuality and/or reproduction is a relevant and timely field of research in contemporary Mexico. From the perspective of Latin American social psychology, I am interested in the analysis of processes that impinge on people recognizing themselves as subjects of “sexual” and/or “reproductive” rights, and the social and political practices linked to such recognition.

Such processes, however, not only depend on cultural and subjective factors, like historical constructions of gendered sexuality and reproduction, but also on the material and institutional bases where these rights can be exercised: laws, public policies, judicial systems, health services, etc.

In Mexico, a relevant case of a society struggling for democratization, rights related to sexuality and reproduction have never before been so protected—and subsequently publicly debated—than in the last decade. For instance, in 2004, emergency contraception was included in Official Family Planning Norms by the Federal Ministry of Health, and in 2007, the Supreme Court asserted the labor and health rights of military men who had been expelled from the army for living with HIV. Later on, in 2009, the Federal District Legislative Assembly approved both so-called “egalitarian marriage” and the Gender Identity Law, which prohibits discrimination based on “gender expression”, and protects people’s rights to change their birth certificate in order to facilitate “sex-gender conformity.”

Within this wave of legal and institutional changes, abortion within 12 weeks of pregnancy was legalized in Mexico City in 2007. Since then, more than 75,000 procedures have been carried out. This legal provision included the obligation of the city’s public clinics to provide free services to every woman who applied. In total contrast with the rest of the country, where 16 state congresses subsequently reformed their constitutions in order to “protect life from the moment of conception,” in the capital city abortion is now a universal right.

This has been happening along with the advance of the health sector reform, initiated in 1994, when structural-adjustment policies were implemented through partial privatization and decentralization of health services, transferring part of the costs to users themselves. Although protested, drastic reductions of federal health budgets (from 13.2 USD in 1981 to 2.3 USD in 1983) have affected social security schemes.¹ Ironically enough, not long after the “right to the protection of health” was raised to a constitutional level, health itself became a commodity.²

In this contradictory context, how are people negotiating their notions of rights regarding sexual and reproductive health? My qualitative research on women’s experiences with legal abortion in Mexico City may offer some guidance. Mainly, I have been looking at the ways in which the recently legal status of abortion may have potential effects for the production of citizenship; that is, whether it fosters women’s recognition of themselves as subjects of rights. How do women interpret state provision of abortion services? Do they consider legal abortion as their right?

So far, our analysis shows that interpretations of newly acquired abortion rights are mediated by women’s historical relationship to state services, including health services, and by certain trends in Mexican political culture: clientelism, authoritarianism, and assistentialism. In their narratives, women’s interpretations of abortion rights are expressed as three discursive positions: legal abortion as: (a) a concession from the government, (b) excessive tolerance by the state, and (c) an individual right to be protected and guaranteed. Within the scope of this article, I will only mention some issues regarding legal abortion as concession: in the interviews, notions of “support”, “help”, or “aid” suggest that legal abortion is interpreted as a gift from the government, the recipient of which would not be a citizen with rights, but a “grateful subject.” Consequently, although women make use of a public service; they do not exercise it, in symbolic terms, as a right.

Narratives also suggest that participants’ understandings of the right to legal termination of pregnancy are marked by the ways in which Mexican health systems have historically structured their relationship to the population, and especially to women. Although, as discussed above, the right to the “protection of health” is formally granted by article four of the federal constitution, access to the public health system has been deeply unequal. Social security and health coverage have been tied to formal employment, leaving the remainder of the population forced either to pay for private services or to go to the Ministry of Health, where employment is not required and thus is where the poorest people are treated, if they are treated at all.

According to Assies, the Mexican version of the welfare state was characterized by:

1) The initial appearance of a system of social security (…) for specific sectors of the population; 2) the inclusion of trade unions in a context marked by the absence of union freedom; and 3) mechanisms of social assistance that became props for political clientelism. The outcome was the formation of “social enclaves”, discretionally provided with some social “rights”, in exchange for a restriction of civil and political ones.³

This is why Valencia writes that there is a “deficit of citizenship” in Mexico: those included in social security have been treated “as political clients, and not as citizens that have exigible social rights.” Therefore, “social services have been considered more as a decision and a gift from the State than as a citizenship claim.”⁴ In this sense, rights to health care have not been implemented as universal citizenship rights.⁵ Furthermore, in the case of legal abortion, the service is only provided by the Mexico City governmental health clinics, not by federal social security. This means that it is precisely the poorest women who can benefit from the legal provision.

However, even though the social practices and subjectivities that have historically produced the “grateful subject” described above have not been entirely transformed by the legal reform, the mere existence of legal abortion as a universal right in the capital city—and the fact that any woman can make use of it— directly contradicts the traditional clientelist practices so dominant in Mexican political culture.

This is just an example of a possible analysis of subjectification processes produced by the contradictions between the effects of neoliberal policies related to the dismantling of rights, in this case related to health; to poverty reduction programs; and to the increasing legitimacy of modern notions of citizenship and democracy—and how such processes may, in fact, be gendered.

1. V. Brachet, “Salud y seguridad social, 1917-2008: ¿Quién decide?,” Los grandes problemas de México, XIII, Políticas Públicas, ed. J.L. Méndez (México: El Colegio de México, 2010). [↩]
2. V. Ríos Cortázar, A. Gasca García, and M. Franco Martínez, “Crisis y salud. Una compleja relación de derechos negados,” Salud Urbana 6.9 (2009): 103-110. [↩]
3. W. Assies, M.A. Calderón, and T. Salman, eds., Citizenship, political culture and state transformation in Latin America, (Amsterdam: Dutch U P and El Colegio de Michoacán, 2005) 101. [↩]
4. L. E. Valencia, “Políticas sociales y estrategia de combate a la pobreza en México. Hacia una agenda de investigación. Notas para la discusión,” Estudios Sociológicos 21.1 (2003): 115. [↩]
5. L. Mills, “Citizenship, reproductive rigths, and maternal health in Mexico,” Canadian Journal of Development Studies/Revue canadienne d’etudes du développement, 31.3-4 (2010): 417-438. [↩]