Filmmaker Chronicles Ban on Fertility Treatment

Grethel Artavia and her son Alexey. Photo courtesy of Azul Films.

As the only country in the world to outlaw in vitro fertilization (IVF) treatment, Costa Ricans will be – for the first time in 15 years – presented with the possibility of having fertility treatments, according to an executive decree signed Thursday by the country’s president, Luis Guillermo Solis.

This move comes amidst bitter opposition from the Costa Rican Catholic Church, court battles and hearings that spanned years, increased pressure from human rights organizations and a national debate about reproductive rights that divided much of the country. That struggle is captured by journalist Gabriela Quiros in her timely documentary, Beautiful Sin.

Quiros, a native Costa Rican who now resides in the Bay Area and works as a TV producer at Quest, a science program produced by KQED, dedicated a decade of her life to diving into the realities of three Costa Rican couples coping with infertility in a country where in vitro treatments were outlawed.

Gabriela Quiros

‘Beautiful Sin’ producer and director Gabriela Quirós. Photo by Lenny Gonzalez.

As the film’s producer and narrator, Quiros was first introduced to the issue of the fertility treatment in which embryos are created in a lab through her 1995 coverage of Costa Rica’s first in vitro baby for a Costa Rican newspaper. The treatments were outlawed in 2000.

The 1995 birth, however, became a media sensation in Costa Rica leaving Quiros perplexed as to why it was banned.

In celebration of Latino Heritage Month, Beautiful Sin will air on KQED TV on September 13. Quiros spoke with Mission Local about the political and social issues surrounding fertility treatments and the long road to legalization.

Beautiful Sin explores the complex struggle of religion, politics, and infertility over a 15-year period in Costa Rica. Previous to 2000, in vitro fertilization (IVF) was legal–and practiced. What happened?

In the year 2000, I had moved to the Bay Area to go to the graduate school of journalism at Cal, and was surprised to hear that Costa Rica had become the only country in the world to outlaw IVF.

In the interim, from 1995 until the supreme court banned it in Costa Rica, 15 babies were born. The way IVF was performed in Costa Rica (previous to the ban) was in a very restrictive way, compared to other countries in the world. For example, all of the embryos that were fertilized in the lab had to be placed in the woman — “cryopreservation” (the process of freezing the eggs for later use) was not allowed, which is standard around the world.

In other countries, doctors create as many embryos as they can and then they’ll place a few in the woman depending on her age and health issues and they’ll freeze the rest and try again if she doesn’t get pregnant. The doctors who pioneered IVF in Costa Rica tried to find a way of doing it that was unique to the country — that would be mindful of its cultural Catholic beliefs and traditions.

One of the things they were doing was foregoing cryopreservation — this meant that they were putting all the embryos in the woman and making sure that, as the doctors put it, no one could say that they had caused the demise of any embryos. I remember at the time in ‘95 thinking ‘wow, that’s a very culturally sensitive and smart way of doing it.’

Beautiful_Sin_family cropped and resized

Andrea Bianchi and her husband Alberto Moreno, and their children Camila and Alejandro, are one of the three families the documentary ‘Beautiful Sin’ follows for a decade. Bianchi and Moreno were one of several couples who took the Costa Rican government before an international human rights court to fight that country’s ban on in vitro fertilization (IVF), a fertility treatment in which doctors create embryos in the lab. Costa Rica is the only country in the world that has outlawed IVF. The country lifted its 15-year-old ban on Sept. 10, 2015. Photo courtesy of Azul Films.

How did you find the couples portrayed in the film, and what inspired you to ultimately tell their stories?

IVF was suddenly outlawed in Costa Rica and I wanted to find out why. I wanted to try and understand how that ban had come about — and I also was curious to see its impact on infertile couples and individuals.

I started filming in early 2002 and I found the couples through a husband-and-wife doctor team who had pioneered IVF in Costa Rica. When the ban came down, a number of their patients who had started the process were impacted and had to stop. That’s how I met the three couples featured in the documentary — I ended up following them for almost a decade.

You witnessed these six peoples’ struggles for nearly 10 years — what were some of the hardest moments for you?

The film really shows how the ban on IVF had an impact on these couples and the outcome of their lives. Banning the treatment prompted patients who could afford it to leave the country and seek it elsewhere — in South America for example, in countries like Colombia and Panama.

Two of the couples that I was following did not have the resources to travel outside of the Costa Rica. The films shows how this (limitation) had a profound impact on them as individuals and also on their relationships.

Other Latin American countries that allow IFV also have very strong religious and traditional ideologies. What prompted such a harsh ban in Costa Rica?

What happened in Costa Rica was that a group of pro-life activists brought a complaint in front of the constitutional chamber of the Supreme Court — any citizen can bring a complaint and say ‘this particular law is in violation of the constitution of the country.’

What they did was very novel and unique — because in Costa Rica, no embryos were being disposed of, since the doctors did not practice cryopreservation and all embryos were placed in the uterus. So (this group) said that even though that was the case, the doctors were responsible for the demise of the embryos that were placed in the women’s uterus but never grew into a baby — they set out to protect the embryos that didn’t survive inside the woman.

What I think made Costa Rica different than the rest of Latin America — that is of course also strongly Catholic — was that they found justices in the supreme court who agreed with their interpretation of the constitution’s protection of life. They were lucky — a majority of supreme court justices agreed that embryos are human beings that have legal rights, which is very novel and taking it to the logical extreme.

What does that do the psyche of a person — not being able to decide for themselves what to do with their life in terms of family planning because of laws and limitations set by a government body?

I think the film shows very powerfully that for these couples, not being able to pursue IVF had a huge impact on their ability to make decisions on how they want their lives to unfold. Having a child is probably the most intimate decision you’re ever going to make, and it’s very clear from their outcome that having somebody, in this case the government, come in and ‘say no you can’t pursue this medical treatment,’ had a big impact psychologically, because it comes from the fact that somebody else is thwarting your life plan.

How does Costa Rica’s the IVF debate compare to the abortion debate in the U.S.?

This is the exact opposite of abortion — these are couples that actually want to have children…so in a sense, this story is kind of the flip-side of abortion. The majority of these couples describe themselves as being pro-life — abortion is illegal in Costa Rica in almost every circumstance.

However, that is an argument that has been made in Costa Rica by those who oppose IVF — they portray it as akin to abortion in the sense that it’s causing the destruction of embryos.

But in the way that reproductive rights are constructed, as human rights, it would fall into that (category). The couples featured in my film are part of a group of 10 couples that took the Costa Rican government before the Inter-American Commission on Human Rights (OAS) — a human rights party based in Washington D.C. that takes complaints from around Latin America and gives recommendations to governments to improve human rights situations–in 2001, and they won their case in 2010.

The OAS told the government that they should legalize IVF and that by banning it, was in violation of the couples’ rights to intimacy and to make decisions about their life project.

As you were filming, did you deal with any opposition from the government?

There were no issues while I was filming the bulk of the documentary, but when I did try to go and film after 2010 when the commission came down with its decision, we weren’t given access to film the way we wanted.

It was touchy in congress — where strong opposition to IVF exists to this day.

On September 10, Costa Rica’s president signed an executive order lifting the ban on IVF after 15 years.

This is a big news development in the story. After the OAS came down with its recommendations in 2010, the country did not comply. Unsatisfied with the government’s efforts, OAS took the case in front of the Inter-American Court on Human Rights in 2012, which is based in Costa Rica. Under pressure from this institution… the president signed a decree yesterday.

It will take a couple of years for it to be up and running in public hospitals, which is something that the OAS required the government to do. But from my understanding, IVF will be legal again in the country.

Do you feel that your documentary, which aired in Costa Rica last month, had an impact on this decision?

It definitely joined the international conversation around IVF at a very crucial time. The hearing in front of the court was last week, on September 3, in which the government was called to show what it had done. The documentary aired about 10-15 times in Costa Rica between the end of August and beginning of September of this year.

I think for any journalist doing this type of long term following of a story — what you want is for your film to be in the mix and to join that conversation and to help people think about the issue from different points of view. The channel on which it aired got really moving comments from couples who had done IVF and couples who were hoping to do it in the future.

It was also very gratifying to hear from people of faith, both catholics and evangelicals, who appreciated the documentary. It made them think. To be able to to do that is the best reward for any journalist.

Beautiful Sin airs on KQED 9 this Sunday, September 13, at 6 p.m.

Teaser – Beautiful Sin from Gabriela Quiros on Vimeo.

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