SALVADOR, Brazil -- Abortion is mostly illegal in Brazil, but you would not know it from the numbers.
Every year an estimated 1.4 million Brazilian girls and women take the law into their hands, and often put their health at risk, to terminate their pregnancies. This gives Brazil an abortion rate much higher than that of the United States, even though one country allows the procedure and the other all but bans it.
Illegal abortion has become a fact of life, and not just in Brazil. Across much of Latin America, even as judges, legislators and activists debate whether abortion laws should be tightened or loosened, millions of women are finding clandestine ways to end their unwanted pregnancies.
For Brazilians such as Marta Leiro, the question is not whether to break the law but how.
There are strong teas and herbal mixes designed to cause miscarriage. There are potent prescription medicines, purchased illegally but easily found.
There are private clinics with willing, if expensive, doctors. And then, if absolutely necessary, there is someone around the corner, around some corner in most Brazilian communities, who will put the girl or woman up on a table and end her pregnancy.
"My first choice was a safe abortion, an abortion done in a special clinic," said Leiro, a 38-year-old community activist and mother of two who was jobless when she became pregnant in 2004.
"But I was in no condition to pay," she said. "And so I chose this other method, the one that's used the most. And I did it while terrified of dying."
Leiro lives in Salvador, the biggest city in the poorest region of Brazil and a place believed to have one of the highest abortion rates in the country.
Though no official figures exist, a recent survey indicated that 1 in 5 women under age 20 in Salvador has had an abortion.
Internationally, Brazil's estimated national abortion rate puts it above the United States, which is in the middle of the pack, but below the world leaders in abortion, which are dominated by the countries of the former Soviet Union and their former allies in Eastern Europe.
The vast majority of Brazil's abortions are illegal, as they are almost everywhere in Latin America except Cuba.
Abortion-rights activists are trying to change that, with advertising campaigns, lobbying efforts and court challenges from Mexico City down to Santiago, Chile. They held events marking Latin American and Caribbean Day for the Decriminalization of Abortion on Sept. 28, part of a strategy to focus on abortion as a leading cause of maternal death, especially for young and poor women.
In an article to be released today in the medical journal The Lancet, a group of public health experts and obstetricians estimates that worldwide about eight women die every hour from complications of unsafe abortion.
Abortion-rights activists argue that the laws fail to stop abortion: The United Nations estimates the number of abortions at 4 million a year across Latin America, despite some of the severest restrictions in the world.
The activists have had some success. In May, a top court in Colombia made abortion legal in cases of rape or in other limited circumstances.
But abortion opponents also have scored victories. Last week, Nicaragua's congress voted to strip away all exceptions to the country's abortion law. If signed into law by the president, the measure would make all abortions punishable by prison, even those done to save the woman's life.
"Abortion has always been an issue here. It just hibernates from time to time," said Jacqueline Pitanguy, a Rio de Janeiro sociologist who runs a group called Citizenship Rights, Information and Action.
Pitanguy said certain incidents, such as the arrest of a woman or a court challenge, can re-ignite the debate. But little changes.
"We take two steps ahead and two steps back," Pitanguy said. "We just do not move here."
Religious groups opposed to abortion, from traditional powers such as the Roman Catholic Church to growing forces such as Latin America's evangelical churches, wield considerable influence in the region.
Even nations that have elected leftist politicians, such as Brazil and Bolivia, remain socially conservative. Abortion opponents say the strict laws reflect the wishes and values of the people.
A pregnancy can be terminated legally in Brazil only if it was caused by rape or incest or if it threatens the woman's life.
Despite the strict laws and potential prison terms, hundreds of thousands of women in Brazil end their pregnancies each year, sometimes at great risk.
Catholics for the Right to Choose, a group working to have abortion de-criminalized, estimates that each year in Brazil 250,000 women suffer health complications from secret abortions. Across Latin America, abortion-rights groups attribute 10,000 deaths a year to unsafe abortion.
The favored method in Brazil is to do what Leiro did: take pills.