SAN SALVADOR, El Salvador (AP) — Teodora del Carmen Vásquez was nine months pregnant and working at a school cafeteria when she felt extreme pain in her back, like the crack of a hammer. She called 911 seven times before fainting in a bathroom in a pool of blood.

The nightmare that followed is common in El Salvador, a heavily Catholic country where abortion is banned under all circumstances and even women who suffer miscarriages and stillbirths are sometimes accused of killing their babies and sentenced to years or even decades in prison.

When Vásquez regained consciousness, she had lost her nearly full-term fetus. Instead of an ambulance, officers drove her in the bed of a pickup through heavy rain to a police station. There she was arrested on suspicion of violating El Salvador’s abortion law, one of the world’s strictest. Fearing she could die, authorities eventually rushed her to a hospital, where she was chained by her left foot to a gurney. She was prosecuted, convicted and given 30 years in prison for aggravated homicide.

“This is the reality that we have lived, and I am not alone,” said Vásquez, who ended up serving more than 10 years for what she has always said was a stillbirth. “Any woman who arrives to jail accused of having an abortion is seen as the most evil, heartless being.”

“From the moment we get pregnant, we become incubators,” said Vásquez, who was freed in 2018 after her sentence was commuted. “We lose our rights because the only possibility that we have of a life is taking care of the product inside us. It’s violence against us.”

Abortion rights activists say the law has led to widespread human rights violations against Salvadoran women and should serve as a cautionary tale for the United States, where more than 20 states are expected to ban abortion if the Supreme Court overturns the landmark 1973 Roe v. Wade ruling in the coming weeks.

Some states may retain exceptions for cases such as rape or incest, but others are likely to have none save for a threat to a pregnant woman’s life. That would mean some rape victims may be forced to carry unwanted pregnancies to term and obstetric emergencies could be mistaken for intentional abortions, according to Catalina Martínez Coral, Latin America and Caribbean director for the New York-based Center for Reproductive Rights.

“These states are going to live similar situations that women are living in El Salvador,” Martínez Coral said.

Some anti-abortion leaders in the U.S. say they oppose prosecuting women who have abortions, but others think differently. Louisiana legislators unsuccessfully pushed a bill this year that would have allowed such prosecutions, for example, and Tom Ascol, a top contender to become the Southern Baptist Convention’s next president, favors classifying the procedure as homicide.

___

Women used to be able to seek abortions in cases of risk to their life, severe fetal malformations incompatible with life, or rape in El Salvador, a country of 6.5 million people nestled between Guatemala and Honduras along Central America’s Pacific Coast.

But that ended in the late 1990s with a law championed by anti-abortion activists, conservative lawmakers and the Catholic Church, followed by a constitutional amendment defining life as starting at conception.

Today it is one of four countries in the Western Hemisphere with total bans — but it stands out for its aggressive prosecutions. While abortion carries a two- to eight-year prison sentence, dozens of women have, like Vásquez, been convicted of aggravated homicide, punishable by 30 years behind bars.

Overall, El Salvador has prosecuted at least 181 women who experienced obstetric emergencies in the past two decades, according to the Citizen Group for the Decriminalization of Abortion, which has been working to win freedom for such women since 2009. At least 65 imprisoned women have been released with the help of the organization and its allies.

“Everywhere in the world it’s understood that there are pregnancy losses for natural reasons. … Here, that’s punished,” said Morena Herrera, the nonprofit’s director.

El Salvador expects doctors and nurses to report suspected abortions under threat of prosecution, so women who show up at hospitals following miscarriages or botched abortions are sometimes turned over for investigation.

Prosecution and punishment overwhelmingly fall on poor, young women who lack sufficient access to medical services and cannot afford to travel overseas for an abortion or pay for good legal defense if they run afoul of the law. Sometimes they are victims of rape, in a country with a high incidence of that crime.

One such woman, Imelda, was repeatedly raped from age 8 to 18 by her mother’s partner and became pregnant by him. In 2017 she unexpectedly gave birth to the baby in a latrine and then lost consciousness. The child survived, but Imelda was accused of attempted murder due to the circumstances of the birth.

She was freed from prison in 2018 after a court determined that she had not tried to kill her baby.

Imelda firmly believes that a woman should not be forced to carry to term a fetus conceived by rape. Since her release she has been studying to become a nurse and hopes to set an example to medical providers by treating patients in similar situations better than she was.

“What young girl is going to want to be a mother? They’re innocent,” Imelda said. “What they really want is to play, to study. I’ve always wanted to study, not be a mother.”

The Associated Press generally does not identify people who say they have been sexually assaulted; The AP is identifying Imelda only by her first name.

Another woman, Karen, was 21 and pregnant when she fainted alone in her grandmother’s home. She woke up handcuffed to a hospital gurney and lost the pregnancy. A police interrogation led to an aggravated homicide conviction in 2015 and a 30-year prison sentence.

“They told me that I was a murderer and that I was going to pay for what I had done,” she said, “that I was going to rot in jail.”

In prison, other inmates told Karen she didn’t deserve to live. She spent seven years locked up, drawing strength from her son and belief in her innocence, and was released in December.

Like some other women interviewed by AP, Karen shared her story and agreed to be photographed on condition her full name not be disclosed out of concerns over privacy, possible reprisals and societal stigma over abortion.

Today Karen tries to make up for lost time by playing soccer with her 14-year-old son and cooking his favorite meals, refried beans and fried plantains. She holds onto her Catholic faith but has grown disenchanted by some of the church’s positions, including its staunch opposition to abortion.

“If it was up to them, we shouldn’t have been freed,” Karen said. “We should still be paying a sentence for a crime that we committed, according to society and the church.”

___

The Catholic Church and the growing number of evangelical churches have vast influence in the overwhelmingly Christian country, where some lawmakers cited Scripture last year as they voted to uphold the abortion ban.

In his office in El Salvador’s congress, lawmaker Guillermo Gallegos maintains what he calls his altar — a wooden table with an open Bible; images of Jesus that he got on a trip to Russia; a plastic bottle filled with water blessed by Pope Francis during a visit to the Vatican; a statue of the Virgin Mary; and a silver one of Moses holding the Ten Commandments.

In an interview, Gallegos said allowing abortion would countermand deeply held beliefs among a large majority in El Salvador.

“There is no valid reason why abortion can be decriminalized in our country,” Gallegos said. “There are strong movements in the country in favor of abortion for some reasons, but fortunately that has not been able to prosper here in the parliament, where the decision would have to be made.”

“Approving abortion, well, that would go against our faith,” he added.

The Vatican has long been strenuously opposed to abortion, and that hasn’t changed under Francis. The pontiff has repeatedly denounced it as evidence of “throwaway culture,” and in 2019 he asked at a Catholic-sponsored conference, “Is it licit to hire a hitman to resolve a problem?”

After celebrating Mass on a recent morning at St. Francis of Assisi Parish in the Salvadoran capital, San Salvador, Cardinal Gregorio Rosa Chávez praised Francis’ views and echoed his theme of abortion as a violent act.

“We live in a culture of death,” the cardinal told the AP, saying it “leads us to a total disaster.”

Anti-abortion activists say that women sharing their stories did kill their babies and that their arguments are led by abortion-rights nonprofits to try to ease the law. Local anti-abortion groups did not respond to interview requests or declined to talk to the AP.

El Salvador’s health minister declined to comment via a spokesperson for the presidency, who also said no other government officials would be available for interviews.

___

With Roe v. Wade in jeopardy in the United States, Latin American abortion rights activists who once looked to their northern neighbor as a model have shifted their sights elsewhere to countries such as Argentina, Colombia and Mexico, which have loosened restrictions in recent years under pressure from women’s movements pushing the issue through the courts.

The Center for Reproductive Rights was one of several organizations that litigated and lobbied for decriminalizing abortion up to 24 weeks in Colombia. It is now working to preserve Roe.

“We hope that this green wave is also going to inspire our sisters in the United States,” Martínez Coral said, referring to the colorful handkerchiefs worn at demonstrations by supporters of abortion rights in the region. “It needs to be protected everywhere.”

Jocelyn Viterna, a Harvard University sociologist, has reviewed court documents from dozens of cases in which Salvadoran women were convicted of pregnancy-related homicide.

“If this plays out the way it does in El Salvador, in the United States women who have naturally occurring miscarriages may much more frequently be under suspicion for abortion,” Viterna said. “We may be asking, ‘Did they take a pill? Did they drink too much when they shouldn’t? What leads you to lose that child?'”

Herrera, of the Citizen Group, agreed with U.S. activists’ fears that their country may see a disproportionate impact among women of color and low-income women if Roe disappears — similar to the ban’s effect in El Salvador, where it has upended poor families.

Jesús, 22, was 8 years old when his mother was arrested in 2008 after losing her pregnancy. He and his 5-year-old brother were left in the care of their grandparents, subsistence farmers. The boys’ mother, who in court proceedings was identified only as Manuela, succumbed to cancer in 2010 while serving a 30-year sentence.

“Death,” Jesús said. “That’s what the state of El Salvador caused when it sentenced my mom — it killed her and sentenced her children to a bad life.”

Tormented for years by the accusations against his mother, he finally found some closure last November when the Inter-American Court of Human Rights ruled that El Salvador had violated her rights.

The court found that Manuela’s lost pregnancy was due to a complication known as preeclampsia and that health care workers wrongly prioritized reporting her to authorities instead of treating her health situation. It ordered the government to pay damages to her two boys.

Tapping his feet nervously during an interview, Jesús said he decided to tell their story in hopes that other children won’t have to face the same suffering: “My mom’s name is a memory that will never fade.”

___

Vásquez also grew up poor in rural El Salvador, helping her parents farm before moving to the capital as a teen. She entered prison at age 24. Having attended school through just the fourth grade, she earned her high school degree behind bars and became a de facto spokesperson for others serving time.

When she was released in 2018, she vowed to fight to free other women and help them transition to new lives. Today she has become the public face of the abortion rights movement in El Salvador, traveling nationwide to meet with women in similar cases and recruit them to join her group, Mujeres Libres — Spanish for “free women.” Its motto: Don’t let this history repeat itself.

Inside a loaned home that the group helped repair, Mujeres Libres holds theater performances, music lessons for their children and workshops on how to run small businesses. The walls are decorated with a photo of Nelson Mandela and pictures of the women from their time in incarceration.

“The pain of one woman is every woman’s pain,” said Vásquez, who was awarded a human rights and democracy prize by Sweden in 2018. She recently graduated from college with a degree in communications and was featured in a documentary.

The group attracts women like Mariana López, 40, who was also imprisoned after losing a pregnancy in 2000 and served 17 years. Back on the outside, she joined Mujeres Libres and took out a loan to become a baker, a childhood dream.

“Teodora has had the greatest struggle, because she’s the one who has had enough courage to stand up to others,” López said.

Her 7-year-old daughter takes music lessons at the home with other children, and they live off sales of the baguettes that López bakes before dawn in her humble home about two hours from San Salvador.

“Perhaps we could have had the courage, but we needed someone to give us a little push,” López said, adding, “Now we feel a bit better, maybe even happy, because we can share with each other in another stage of life — in freedom.”

Another woman, Cindy, was imprisoned in 2014 after having a stillbirth in a shopping mall bathroom. At the time she had a 4-year-old son, Justin, and was studying tourism and English. Parenting and her education were put on hold, and it was four years before she was able to see Justin again.

“What I reflect on the most is the losses. … The total loss of all family, homes, houses, studies, work, children. Everything is lost,” Cindy said. “What makes you think the most is how are you going to start over? How are you going to recover time with your family?”

Now 30 and out of prison, she has to travel to a judicial office in the capital every month to sign her parole papers. She and Justin live with her parents, and she’s back in school. She makes and sells piñatas to get by, and crafted one for her son’s birthday in the form of a dinosaur — he wants to become a paleontologist.

They dream of traveling abroad together: “To forget everything,” Cindy said, “to start again in a new place.”

Vásquez said she is heartened by the children of the women, who tell her they will carry on her legacy long after she’s gone.

“It gets my hopes up because I really think that these processes must start when we’re young,” Vásquez said. “So the message … especially for mothers worldwide should be: Teach your girls to know their rights now, so that they will be able to defend human rights.

“It’s really important to try to change El Salvador,” she continued, “so our history doesn’t get repeated elsewhere and by future generations.”

___

Associated Press journalists Marcos Aleman in San Salvador and Marko Alvarez in Bogota, Colombia, contributed to this report.

___

Associated Press religion coverage receives support through the AP’s collaboration with The Conversation US, with funding from Lilly Endowment Inc. The AP is solely responsible for this content.

Copyright © The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.