When 80 women from the poor Agua Blanca district of Cali got free contraceptive implants last week, they became the first local beneficiaries of one of Latin America's most liberal reproductive rights laws.
Colombia's Congress this fall passed a law guaranteeing all citizens access to free contraceptive drugs and surgical procedures, including vasectomies and tubal ligations.
The benefits are only now filtering down to shanty neighborhoods such as this one in northeast Cali, where birthrates are among the nation's highest, particularly among teenagers, health officials here said.
"The law is a real accomplishment and is already creating a lot of demand," psychologist Maribel Murillo said in her office at the Diamante health clinic, not far from shacks made of boards and plastic sheeting. "It will advance the sexual rights of women of little means, many of whom already have several children."
The law, which had been proposed for years, got a decisive push from new President Juan Manuel Santos, who after taking office in August put it at the top of his legislative agenda.
Activists hail the legislation as a progressive measure for reproductive rights, part of a general liberalizing trend in this largely Roman Catholic nation that has included recent rulings by the constitutional court removing penalties for performing abortions.
But Santos may have had pressing social and economic problems in mind in pushing for the new law.
Colombia's healthcare system is on the verge of collapse because of the constitutional guarantees of universal care, as funding from tax and other government revenue falls short. Because maternity and neonatal care are among the healthcare system's fastest-growing costs, free contraceptive medicine and surgeries could end up saving the government money.
Moreover, Colombia's birthrate, which overall has dropped by nearly two-thirds since 1950, has risen recently among teenagers, said Diva Moreno, an advisor to the Social Protection Ministry in Bogota, the capital. Studies show that adolescent pregnancies feed a vicious cycle of social problems, including poverty, violence and low levels of education.
"Once these girls get pregnant, that's the end of their education," said Murillo, the psychologist.
Recent figures show that 21% of Colombian girls younger than 20 are having babies these days, up from 13% in 1990, Moreno said. In Latin America, Colombia's adolescent birthrate is exceeded only by those of Nicaragua (25%), Venezuela and El Salvador (21.6%) and Honduras (21.5%).
In comparison, recent figures for the United States, tallied in 2006, show about 7% of U.S. teenagers giving birth, according to the Guttmacher Institute, a New York-based reproductive rights think tank.
In Colombia, teenage birthrates tend to be highest in poor neighborhoods such as Agua Blanca, where thousands of displaced families have come to escape drug violence on Colombia's Pacific coast.
The women who came to the Diamante Health Center last week received subcutaneous implants that otherwise might have cost them $75, beyond the reach of women who, in Murillo's words, "have nothing at all; nada."
The implants will keep most from becoming pregnant for up to five years, nurse Blanca Soto said.
Free vasectomies and tubal ligations, which ordinarily would cost $100 to $150, will soon be available to all Colombians who go through the necessary counseling sessions and an eight-day application process, said Moreno of the Social Protection Ministry.
"These wide-ranging rules have few equals in the world, not just Latin America. Now our job is to make sure that Colombians know their sexual and reproductive rights," Moreno said.
To reach adolescent boys and girls with family-planning advice and services, such as free condoms and "morning after" birth-control pills, the Social Protection Ministry has opened 621 offices, called Friendly Health Services for Youths, in hospitals and clinics across Colombia.
"Teenage pregnancies only condemn these youths to more poverty and less education," Murillo said. "We need to reach them so that they know they have options."
Kraul is a special correspondent.