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

The nightmare that came next is common in El Salvador, a heavily Catholic country where abortion is banned under all circumstances and women who suffer miscarriages and stillbirths risk being accused of killing their babies and sentenced to prison.

When Vásquez regained consciousness, officers drove her in the bed of a pickup truck to a police station. There she was arrested on suspicion of violating El Salvador’s abortion law, one of the world’s strictest. She was later convicted of aggravated homicide and sentenced to 30 years in prison.

“This is the reality that we have lived,” said Vásquez, who served more than 10 years for what she maintains 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, whose sentence was commuted in 2018. “We lose our rights.”

Abortion rights activists say the law has led to human rights violations 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 soon overturns the landmark 1973 Roe v. Wade ruling.

Some states may retain exceptions 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, said 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,” she said.

Some anti-abortion leaders in the U.S. oppose prosecuting women who have abortions, but others disagree. Louisiana legislators unsuccessfully pushed a bill this year that would have allowed such prosecutions, and some U.S. clergy favor 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 small Central American country of 6.5 million people.

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.

El Salvador is not the only country in the Western Hemisphere with a total ban but stands out for its aggressive prosecutions.

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. 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.

Prosecution and punishment overwhelmingly fall on poor, young women who lack sufficient access to medical services and cannot afford to travel abroad for an abortion or pay for a good legal defense.

One woman, Karen, was 21 and pregnant when she fainted. She woke up handcuffed to a gurney and lost the pregnancy. She received an aggravated homicide conviction in 2015 and a 30-year prison sentence.

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

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 The Associated Press, Karen shared her story and agreed be photographed on the condition her full name not be disclosed out of concerns over privacy, possible reprisals and societal stigma.

Today Karen tries to make up for lost time with her son. She retains her Catholic faith but is disenchanted with some of the church’s positions, including its opposition to abortion.

“If it was up to them, we shouldn’t have been freed,” Karen said.

The Catholic Church and the growing number of evangelical churches have vast influence in the country.

In El Salvador’s congress, lawmaker Guillermo Gallegos -- whose office is adorned with Catholic imagery -- said allowing abortion would countermand deeply held beliefs among most Salvadorans.

“There is no valid reason why abortion can be decriminalized in our country,” Gallegos said.

The Vatican has long opposed abortion, and that hasn’t changed under Pope Francis.

After celebrating a recent Mass in 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 trying 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, Latin American abortion rights activists who once looked to the U.S. as a model have shifted their sights to countries with loosening restrictions, such as Colombia and Mexico.

In one key case, a Salvadoran woman was arrested in 2008 after losing her pregnancy. Her two young sons were left in the care of their grandparents and the mother, who in court proceedings was identified only as Manuela, died of cancer in 2010 while serving a 30-year sentence.

“Death,” said Jesús, the older son who's now 22. “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.”

Jesús found some closure last November when the?Inter-American Court of Human Rights ruled?that El Salvador had violated Manuela’s rights.

The court found that Manuela’s lost pregnancy was due to a preeclampsia complication. It ordered the government to pay damages to her sons.

Vásquez also grew up poor, helping her parents farm before moving to the capital. She entered prison at 24.

After her 2018 release, she vowed to fight to free others and launched a group, Mujeres Libres — Spanish for “free women.”

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

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