Abortion in Chile
Last week Republican Presidential candidates and their counterparts in Congress launched attacks on the Obama administration’s health care plan, arguing it would fund abortion. The plan requires all hospitals, universities, and religious associations to offer medical plans which include contraception coverage.
Despite similar frequent attacks on abortion at the state level, Roe v. Wade–the court case allowing abortion–remains intact.
Abortion in Latin America
In Latin America abortion laws vary country by country but for the most part it is prohibited. Argentina, Brazil, Bolivia, Mexico (legal in the capital Mexico City, but illegal everywhere else), and Colombia allow abortion only in cases of rape or when the mother’s life is in danger. Venezuela, Peru, and Ecuador allow abortion only in cases where the mother’s life is in danger, but attempt to limit access. Cuba and to some extent Guyana, are the only Latin American countries that allow abortion in all cases. Uruguay, Nicaragua, El Salvador, and Chile are the only countries in the hemisphere where all forms of abortion are criminalized.
Nevertheless, there is a worldwide trend to decriminalize abortion. The last worldwide evaluation of abortion laws shows that since 1998, 16 countries have decriminalized abortion. Another ten countries maintained the same abortion laws, but added measures to increase access.
Several important changes occurred in Latin America. In 2006 Colombia’s Constitutional Court struck down the blanket prohibition of abortion allowing legal access to abortions in cases of rape or when a woman’s life is in danger. In 2007 Mexico City (DF) changed its laws to allow abortion without restrictions in pregnancies up to 12 weeks gestation. In 2008 the Uruguayan senate voted to do the same, but then President Tabare Vasquez vetoed the measure. The Uruguayan senate voted to legalize abortion (up to 12 weeks gestation) again on December 28th 2011, and current President José Mujica is expected to sign the measure into law this year.
That said, not all countries in Latin America are moving towards decriminalization. In 1998 El Salvador created a new penal code that criminalized all forms of abortion, and in 2006 Nicaraguan legislators removed a law that allowed therapeutic abortions thereby criminalizing all forms of the procedure.
In Chile all forms of abortion are considered felonies and punishable with 541 days to ten years in prison as indicated in the penal code. However, as in the case of many countries with strict abortion laws, women still get abortions. In 1994 a Guttmacher Institute survey put the rate of abortions per pregnancy at a startling 35%. Another Guttmacher study estimates that one in twenty Chilean women between the age of 15-45 have had an induced abortion. Today, estimates from various sources put the number of abortions in Chile between 40,000 and 160,000 per year, which make Chile along with Peru the countries in Latin America with the highest abortion rates.
What to make of these Statistics?
Because most abortions in Chile are done clandestinely, the only reliable statistics to estimate the number of abortions come from hospitals that admit women who have attempted abortions, had health complications, and thus need treatment. Therefore the statistics are unreliable, and can only be used as a rough indicator. Nevertheless, some stats show that the number of women receiving abortions may be in decline. According to the Chilean Institute of Reproductive Medicine, the number of women entering hospitals for complications resulting from attempted abortions decreased from 36 to 29 per 100,000 between 1990-2000.
This apparent decline in women entering clinics because of failed abortions in the past decades doesn’t mean less women are getting abortions. According to journalist, Professor at the School of Communication at University of Chile, and author of Aborto en Chile (LOM Ediciones) or Abortion in Chile, Claudia Lagos Lira, there is really only one logical explanation for these statistics, “better and more accessible contraception, or safer clandestine abortions.”
Chile has been slow to adopt many reproductive health measures, but contraception like condoms and birth control are much more accessible now than they ever have been. Still many contraceptive methods like condoms, birth control, and Plan B are too expensive for many people. The ministry of health does offer subsidized contraception upon request, but few people are aware of it. In 2002, the Chilean legislature passed a measure allowing pharmacies to distribute the day-after pill or Plan B as it is called, but many pharmacies still refuse to do so–citing religious or moral reasons. In 2008 a constitutional court struck down attempts to distribute Plan B free of charge, making the drug only available to women able to pay. Condoms and birth control are easier to obtain, but also come at steep prices to the consumer. The average birth control pack (30 pills) costs about 8.500 pesos ($20) per month, and a three pack of condoms costs 2.300 (about five dollars).
Access to abortions is also priced beyond most people’s ability to pay, legal or not. Because all forms of abortion are illegal under the law, women who desire them have limited options: pay for abortions at clinics that practice them clandestinely, pay for a “back-alley” abortion, or travel abroad where laws are less restrictive.
The most Common Methods of Abortion
Medically, the safest option is to go to a clinic or a certified doctor. There appear to be a number of clinics in Santiago that offer abortion procedures, but it’s difficult to know how many due to their desire to stay anonymous. These abortion procedures are considered safe, but they are often expensive, costing patients upwards of $2,000. Furthermore, even “safe” abortions do not come without risk of being caught committing a felony.
For many women, the most practical and accessible options are “back-alley” abortions performed by strangers without medical licenses. The most popular method is through the use of misoprostol. Misoprostol is a drug used to prevent non-steroidal anti-inflamatory drug (NSAID) induced ulcers, as well as induce contractions to start labor. The second use, caused by the loosening or ripening of the cervix, can also cause abortions. (“Ripening” is a process by which the cervix loosens, presumably in preparation for birth.)
Misoprostol is legal in Chile, but many pharmacies no longer carry it because of its reputation as an abortion drug. Still it’s not hard to obtain misoprostol. The drug is readily available on the internet. Sellers meet buyers in discreet locations or mail the drugs with instructions for use. The drug costs anywhere from 30.000 to 60.000 pesos ($60 to $120).
Typically the use of misoprostol involves inserting several pills into the vagina over several hours—though it can also be taken orally. The drug functions to cause an abortion but often with complications to the woman’s health. The national women’s health service SERNAM estimates at least 10% of maternal deaths are caused by complications stemming from attempted abortions. Vomiting, fever, hemorrhaging from the vagina, and infections are not uncommon, and often require visits to the hospital. Health complications often mean legal complications too. There are frequent reports of women who get caught by authorities and risk time in jail, such as this recent case in Vitacura .
The Current State of Legislation
From 1931 to 1989 abortion was officially illegal in Chile, but an article in the health code allowed doctors to perform abortions if the patient’s life was in danger. This allowed doctors to interpret the code as they saw fit. In some instances, such as the case of the Barros Lucos hospital in southern Santiago, doctors interpreted the law openly, and effectively offered abortions. In most cases however, the code allowed doctors to perform “therapeutic abortions” (meaning to protect the mother’s health).
Therapeutic abortions are legal everywhere in the western hemisphere except Chile, Nicaragua, El Salvador, and Uruguay (Uruguay is expected to change their ban on therapeutic abortions this year). In 1989, the final year of the Pinochet government, this article was removed from the health code. It has not been reinstated since.
That said, recent legislative initiatives show some desire to change the law. Last year right-wing UDI minister of labor Evelyn Matthei and PS (Socialist Party) Senator, Professor, and Doctor Fulvio Rossi introduced legislation that would decriminalize therapeutic abortions. However the legislation was met with opposition from left and right, and President Sebastián Piñera promised to veto any law that would decriminalize any portion of the abortion law—though it’s not likely anything will reach his desk.
Despite its unpopularity in the legislature, polling done by Universidad Diego Portales shows that a majority of Chileans (53%) support abortion under two circumstances: when the woman has been raped or when her life is in danger (other polls show numbers closer to 63%). Less, but still a significant number (44% in favor, 49% against), support the woman’s right to abort in cases where the fetus is seriously damaged. A super majority (79%) of Chileans are against the full legalization of abortion. These statistics suggest Chilean legislators are not listening to the opinions of their constituents.
The reason most scholars cite for the impasse on any abortion legislation in Chile is the Catholic Church. Chile is one of the most Catholic countries in South America, and the church is deeply influential in politics and social issues. The church drags its feet on many social issues it considers anti-Catholic, for example, sodomy was only decriminalized in 1994, and divorce was legalized (for the first time ever) in 2005. According to Claudia Lagos Lira, the church commands authority in part because of caché it earned by protecting human rights, and pushing for justice during and after the dictatorship. For instance, Lira says the reason the center-left Concertación has not pushed harder for abortion reform is partly because, “the enormous debt of gratitude that they (Concertación) owe the Catholic Church–who were fundamental in the protection and defense of human rights during the dictatorship, and who were key in condemning those actions. Many politicians from the Concertación owe their lives to these actions of the Church”.
In the case of abortion, the Catholic Church typically argues that aborting is killing a human being, and that killing a human being goes against God’s moral code. Non-Catholics who are opposed to all forms of abortion argue that killing in any form that it comes in, is immoral and should be discouraged. The other side of the argument, typified by groups like Planned Parenthood, often frame the issue in terms of a woman’s right to chose, and as a public health issue.
Terminology: Abortion vs. Therapeutic Abortion
Abortion as defined by the World Health Organization (WHO) is “the interruption of a pregnancy before the viability of the fetus”, which is to say, the termination of a pregnancy before a child can function independently of its mother. Therapeutic abortion, as defined by Professor of Gynecology at Universidad Católica, Enrique Oyarzún is “the interruption of a pregnancy, in search of the death of a fetus by means of external methods, for the health of the mother”.
Both terms are controversial. The former is the metaphysical question “when does life start” that is so commonly discussed in abortion debates. The latter, is the root of disagreement about the only legislation that appears viable in Chile (based on what polls show people want and what legislators are willing to propose): therapeutic abortion.
Those opposed to abortion like Professor of Philosophy at Universidad Católica Valparaiso, Pablo Cerda, argue that both abortion and therapeutic abortion are unethical because, “you should not kill one life to save another, both lives have the same value, and in killing one life to save the other you are arbitrarily assigning more value to one than the other. With what authority?”
Those in favor of therapeutic abortion legislation like President of the Senate Health Committee Fulvio Rossi argue that, “it’s about human rights, dignity, exercise of autonomy and democracy. Under certain international treaties continuing with a pregnancy under certain conditions amounts to torture, a modern form of torture.”
The argument functions in a similar way in the United States. On one side, an often theologically-backed group asserts that abortion is wrong in all cases because it violates an ethical code, while people on the other side assert that the moral code that’s being violated is a woman’s right to chose. The argument is framed as an “either/or” problem, but this reporter wonders if it couldn’t be both.
Indeed it’s undeniable that there is an ethical choice involved in choosing to get an abortion. But it’s also undeniable that there are also certain realities on the ground that put not just women, but people in positions where they have to make difficult decisions. On issues as ethically and publicly complex as abortion, legislative policies like the Chilean leave women in between a rock and a hard place.
According to former Minister of Health Dr. René Castro, the question of whether and how to have an abortion affects lower income women with kids the most. These women lack the resources to effectively confront the problem. They may be uneducated about effective contraceptive methods, or lack the funding to access adequate methods. Their resources are stretched thin, and they are forced to face the realities of bringing an undesired child into this world (that in some instances may threaten their health) or risk aborting it through often dangerous clandestine procedures. Not to mention the psychological threats of having or aborting an unplanned child.
Currently Chile lacks an effective infrastructure to educate and provide people with the resources to be in ethically compromising positions less often, while at the same time, providing legislation that allows for effective administration of these resources. According to the polls people are demanding some change in the abortion status quo, but politicians don’t appear to be listening. According to Claudia Lagos Lira, “a lot of water is going to need to pass under the bridge before this changes in Chile”.