World Report
Costa Rican couples await court-ordered IVF legalisation
A human rights court ordered Costa Rica to legalise in-vitro fertilisation and offer the procedure at
public hospitals. But can officials meet the court’s 1-year deadline? David Boddiger reports.
A 10-year legal battle waged by
18 couples unable to access in-vitro
fertilisation (IVF) services in Costa
Rica ended in late December when the
San José-based Inter-American Court
of Human Rights ordered the country
to legalise the procedure.
A 2000 ruling by Costa Rica’s
Constitutional Chamber of the
Alberto Font
Supreme Court—the country’s highest
judicial body—banned IVF, arguing
that it violated the constitutional
protection of life and various
international human rights con-
ventions.
Justices on the human rights court,
who called the IVF case one of the
most important rulings in the court’s
34-year history, rejected the state’s
argument, ordering Costa Rica to
legalise the procedure and make it
available to couples through its public
health-care system within a year.
Although the ruling comes too
late for the plaintiffs to access IVF
treatment and have children, it
does provide a sense of justice
for them—as well as modest
compensation—and paves the way for
an estimated 15 000 Costa Ricans to
access the procedure, roughly 0·3% of
the country’s 4·7 million citizens.
“There’s a certain level of satis-
faction, because after so much
frustration and powerlessness before
a Catholic-influenced state such
as ours, to win the case based on
scientific arguments is rewarding”, co-
plaintiff Miguel Antonio Yamuni tells
The Lancet. “But we still face an uphill
battle to get this law passed in the best
way possible.”
The court ordered plaintiffs to
monitor the government’s response
and issue a progress report in
6 months. “Future generations will
say we won the most important
human rights case in this country’s
280
history”, says Boris Molina, attorney
for a group of plantiffs.
Costa Rica could have avoided a
costly legal battle. In 2010, the Inter-
American Commission on Human
Rights based in Washington, DC,
ordered the country to adopt laws to
permit IVF. Lawmakers drafted two
IVF bills, but they were never called
to a vote and received little support
from the administration of
President Laura Chinchilla.
“‘...we still face an uphill battle
to get this law passed in the
best way possible.’”
Now, administration officials say
that they will work quickly to bring
Costa Rica—the only country in the
western hemisphere to ban IVF—up
to international legal standards.
Chinchilla has tasked Health Minister
Daisy Corrales to lead the effort.
Corrales did not respond to a list of
questions submitted by The Lancet via
a ministry spokesman.
Officials also will have to decide
whether to push for legalisation
through legislation or via executive
decree. The plaintiffs in the case said
they would not accept anything short
of a new law that establishes the
fundamental human right to access
IVF. “There are private interests who
want this pushed through quickly via
decree, but we’re the victims and we
won’t accept that”, says Yamuni.
Officials at the Social Security
System, the country’s universal
health-care system known as the Caja,
also seem to be scrambling to catch
up with the court ruling. Caja Medical
Director María Eugenia Villalta did not
provide much insight during an early
January press conference, saying only
that Caja officials were undertaking
an analysis of the infrastructure and
personnel required to offer IVF at
public clinics and hospitals. She said
it could take up to 2 years to train Caja
doctors and staff to do the procedure.
Facing bankruptcy just a year ago,
Caja officials have cut spending
by reducing staff and eliminating
services at some hospitals and clinics
throughout the country.
While 14 doctors are registered
as IVF specialists with the country’s
Doctors and Surgeons Association,
none has done the procedure in Costa
Rica in the past decade. Villalta did
not say how many of those doctors
worked at the Caja.
Molina believed Caja officials were
being overly cautious. “You can build
a lab for US$200 000, and we calculate
[the Caja] will need four or five labs”,
he explains. “If Caja officials don’t
want to use their own resources, they
can sub-contract services. They have a
year to figure it out.”
Opposition lawmaker María Eugenia
Venegas, who spearheaded much
of the work on the two previous
IVF bills, says that legislators would
need to make adjustments to the
bills to implement the court ruling,
including regulating gamete and
embryo donation and storage of
genetic material, but that passage of
one of the bills would be a priority in
2013. “The important thing here is that
we managed to get the IVF prohibition
lifted in Costa Rica, and it’s in my
interest, and many other lawmakers
agree, that it’s regulated and orderly in
order to prevent abuses”, says Venegas.
For Yamuni, the ruling is a victory for
future generations. “You can’t violate
someone’s human rights by saying
you’re protecting the rights of others”,
he concludes.
David Boddiger
www.thelancet.com Vol 381 January 26, 2013