When Manuela, a 33-year-old mother of two from rural El Salvador, had a miscarriage in 2008, she did what most women would do: she went to hospital. There she was handcuffed to her hospital bed, accused of having an abortion, and charged with aggravated homicide. The authorities said Manuela – whose full name has never been made public in El Salvador – must have been guilty of killing her baby as the child was conceived outside marriage. They did not allow her to speak with a lawyer while she was being interrogated. Manuela was sentenced to 30 years in prison. Around the same time she was diagnosed with lymphatic cancer. Two years later, she died of her illness in prison. On Wednesday, the Inter-American Court of Human Rights heard arguments in Manuela v El Salvador, a landmark case that could shape policy and debate on abortion across Latin America. As well as seeking reparations for Manuela’s family, the plaintiffs – a group of reproductive rights groups including the Center for Reproductive Rights and the Feminist Collective for Local Development – are also asking the court to mandate that the state take responsibility for failing to guarantee Manuela’s rights to health and life. It is the first time that an international court has had the opportunity to challenge the staunchly religious Central American country’s aggressive prosecutorial approach to abortion. “I remember my mum, she gave us advice and never left us alone. It is painful to grow up without a mother because that love is incomparable,” said Santos de Jesús, Manuela’s eldest son, in a statement to the media before the hearing. “I ask the state not to do these things because they left us abandoned without a mother.” Manuela’s treatment is not unique. El Salvador has some of the world’s most draconian abortion laws, with the procedure outlawed. Unlike in many other Latin American countries, El Salvador does not permit abortion in cases where the child is conceived by rape or incest, or where the health of the mother or child is at risk. The penalties for women are often enforced. Over the past two decades, about 181 women who experienced obstetric emergencies were prosecuted for abortion or aggravated homicide, according to rights groups. “We know that Manuela’s case is not isolated and that many other women are in the same situation,” said Catalina Martínez Coral, regional director for Latin America and the Caribbean at the Center for Reproductive Rights. “When Manuela went to hospital the doctors and the authorities immediately presumed guilt, going against all the guarantees of due process.” The court’s decision, expected later this year, could have a sweeping effect throughout the region, as most Latin American countries respect the tribunal’s jurisprudence. “This case will establish a standard not only in El Salvador but across the whole region on how we protect the reproductive rights a woman has when she arrives at a hospital,” Martínez Coral said. “A good decision will be a win for reproductive rights.” Rights groups say Manuela’s ordeal was typical in El Salvador not only for its cruelty, but due to her status as a poor rural woman. “What we are also seeing in El Salvador is the criminalisation of women who live in poverty,” said Paula Avila-Guillen, executive director of the Women’s Equality Center in New York, in reference to at least 25 other women who are in Salvadoran jails after obstetric emergencies. “I am certain that if these women had had proper attorneys at the hospital, if they had had the agency to tell their story, if they had had the guidance of what to do in their situation, then none of them would be in prison,” she said. Avila-Guillen added that this week’s hearing could apply pressure on Salvadoran courts to treat another woman who is in Manuela’s situation more leniently. The woman, called Sara, also had a miscarriage and will be sentenced in El Salvador on Monday. “We don’t need more women dying in prison,” Avila-Guillen said. “And that’s what we’re hoping will come out of today [the court case].”