Abortion

Chile: The Long Struggle for Access to Emergency Contraception

In Chile, a conservative country in which women's rights are contested on many levels, there is an ongoing struggle to make emergency contraception more accessible to women at every level of income.

In Chile, women’s rights are perhaps even more contested than in other countries in Latin America. It is the only country in the region where the law grants men the right to “manage the patrimony” of their marriage. It was the last country in the region to legalize divorce. And it is one of the few countries in the world where therapeutic abortion is criminalized.

On April 4th 2008, the Constitutional Court of Chile banned free distribution of the emergency contraceptive (EC) pill in the public health system. The judicial ruling came after a debate on the reform of the National Norms on Fertility Regulation (2006), which had resulted in introduction and free distribution of EC by public health care centers to all women from 14 years of age, without their parents’ consent.  Opponents of birth control objected to the reform, so Chilean President Michelle Bachelet secured access to EC by virtue of an executive order. However, the judicial ruling annulled the reform and the Bachelet’s order, deciding that the distribution of EC was unconstitutional because, according to the justices, the hormone levonorgestrel, contained in the EC pills, is “abortive”, and therefore against the right to life.

As a result of the court decision, EC was partially removed from pharmacies, whereas other pills containing levonorgestrel continued to be sold, but for a price that not all women can afford.

In Chile, a high number of illegal abortions and teen pregnancies present serious challenges to a government which has made reducing both abortion and unintended pregnancy a focal point of its reproductive health policy. So even despite the Court ruling on EC, Bachelet’s Administration continued to seek new legal mechanisms to ensure access for all women—poor and rich alike—to emergency contraception.

The government introduced a bill to regulate information and distribution of contraception methods. Last July the Lower House of the Parliament of Chile passed the bill, which allows—among other measures—the free distribution of EC in the public health system.

The bill aimed to guarantee “every person, regardless of their economic situation” free access to the pill.

“The state isn’t imposing anything on anyone,” Bachelet said. “Each person may decide on her own, but the state must guarantee equal conditions of access to birth control methods.”

A vast majority of the legislators voted in favor of the bill–73 votes for, 34 against, and 2 lawmakers abstained from voting. All the votes against the bill were from members of the party Unión Demócrata Independiente, which has linkages with the Opus Dei organization. The feminist organizations celebrated the results while the Catholic Church denounced it.

Now the bill awaits Senate approval. Meanwhile, Chile is in the midst of an electoral campaign, a circumstance which certainly will have an influence in the votes at the Senate, with presidential candidates on the left and right seeking to assure their potential supporters of their own position on this and other issues. Candidates include Christian Democrat Eduardo Frei, who just three years ago sided with “pro-life” organizations and Catholics against the distribution of the pill. On the other hand is the right-wing candidate Sebastian Piñera, whose coalition also firmly backs the prohibition.

As if the debate was not already hot enough, this October the Ministerio de Salud Pública (Ministry of Health) of Chile authorized the sale of the EC pill “Escapel-1” in pharmacies. Conservative members of Parliament reacted against the decision, insisting that Escapel-1 has levonorgestrel, the hormone they declare to be “abortive”. The conservative movement “Red por la Vida y la Familia” (Network for Life and Family), through its lawyer Jorge Reyes, stated that this announcement shows that the health authorities of the government are acting in opposition to the current legal situation, where the public distribution of EC pills is banned.

At the same time, scientists and reproductive health advocates have expressed strong support for expanded access to EC in Chile. “Those opposed to this emergency contraceptive are a group of people that call themselves ‘pro-life,’ who are well organized and have significant power and influence,” said Dr. Soledad Diaz, president of the Chilean Institute for Reproductive Medicine (ICMER). “They have a very stubborn doctrinaire position that doesn’t want to recognize the scientific evidence that says the pill is not abortive. It’s an ideological position, there is no other explanation.”

Research and medical opinion back them up. The World Health Organization states, for example that “levonorgestrel emergency contraceptive pills (Epps) have been shown to prevent ovulation and [do not] have any detectable effect on the endometrium (uterine lining) or progesterone levels when given after ovulation. ECPs are not effective once the process of implantation has begun, and will not cause abortion.”