Abortion Policies and Practices in Chile: Ambiguities and Dilemmas

Abstract

Abortion is not legal in Chile even to save the woman’s life or health. This situation creates serious dilemmas and vulnerabilities for both women and medical practitioners. Abortion incidence has probably decreased since 1990, when data were last studied, due to increased use of contraception and lower fertility, and deaths and complication rates have fallen as well. Misoprostol is available, but Chilean hospitals are still using D&C for incomplete abortions. Although Chilean medical professionals should by law report illegal abortions to the authorities, less than 1% of women in hospital with abortion complications are reported. There are two loopholes, one legal, one clinical. “Interruption of pregnancy” after 22 weeks of pregnancy is legal for medical reasons; this may save some women’s lives but can also force prolongation of health-threatening pregnancies. Catholic clinical guidelines define interventions solely aimed at saving the woman’s life, even if the fetus dies, not as abortion but “indirect abortion” and permissible. Since 1989, three bills to liberalise the law on therapeutic grounds have been unsuccessful. The political climate is not favourable to changing the law. Conservatives have also not succeeded in making the law more punitive, while the governing centre–left coalition is divided and the associated political risks are considerable.

Résumé

L’avortement n’est pas légal au Chili, même pour sauver la vie ou la santé de la femme. Cette situation crée de graves dilemmes pour les femmes et les praticiens, et les rend vulnérables. L’incidence de l’avortement a probablement diminué depuis 1990, date de la dernière analyse des données, avec l’utilisation accrue de la contraception et la baisse de la fécondité; le nombre de décès et de complications a aussi reculé. Le misoprostol est disponible, mais les hôpitaux chiliens utilisent encore la dilatation et le curetage pour les avortements incomplets. Les soignants sont tenus de notifier les avortements illégaux, mais moins de 1% des femmes hospitalisées pour des complications sont signalées. Il existe deux lacunes, l’une juridique et l’autre clinique. « L’interruption de la grossesse » après 22 semaines de gestation est légale pour raisons médicales; elle peut sauver la vie de certaines femmes, mais oblige aussi à prolonger les grossesses à risque. Les directives cliniques catholiques définissent les interventions destinées uniquement à sauver la vie de la femme, même si le fłtus meurt, non comme un avortement, mais comme un « avortement indirect » autorisé. Depuis 1989, trois projets de libéralisation de la loi pour motifs thérapeutiques ont été refusés. Le climat politique n’est pas favorable à un amendement légal. Les conservateurs n’ont pas non plus réussi à rendre la législation plus punitive, alors que la coalition de centre-gauche au pouvoir est divisée et les risques politiques d’un assouplissement des lois restrictives sont considérables.

Resumen

En Chile, el aborto no es legal, ni tan siquiera para salvar la vida o salud de la mujer. Esta situación crea graves dilemas y vulnerabilidades tanto para las mujeres como para los profesionales médicos. La incidencia del aborto probablemente ha disminuido desde 1990, último año en que se estudiaron los datos, debido al aumento en el uso de anticonceptivos y al descenso en fertilidad; además, las tasas de muertes y complicaciones también han disminuido. Misoprostol está disponible, pero en los hospitales chilenos aún se utiliza el legrado uterino instrumental (LUI) para el aborto incompleto. Aunque la ley exige que los profesionales médicos chilenos denuncien abortos ilegales a las autoridades, menos del 1% de las mujeres en hospitales con complicaciones son reportadas. Existen dos lagunas: una jurídica y una clínica. La “interrupción del embarazo” después de 22 semanas de gestación es legal para indicaciones médicas, lo cual puede salvar la vida de las mujeres pero también forzar la prolongación de embarazos que ponen en riesgo su salud. Las directrices clínicas católicas definen las intervenciones cuyo objetivo exclusivo es salvar la vida de la mujer, aun si el feto muere, no como aborto sino como “aborto indirecto” y permisible. Desde 1989, los tres proyectos de ley para liberalizar la ley por motivos terapéuticos fueron infructuosos. El clima político no es favorable para cambiar la ley. Los conservadores tampoco han logrado hacer la ley más punitiva, mientras que la coalición gobernante de centro–izquierda está dividida y existen considerables riesgos políticos en abogar por leyes menos restrictivas.

Key Words:

• unsafe and clandestine abortion
• abortion law and policy
• Catholic church
• Chile

Acknowledgements

The authors would like to acknowledge the support of the Ford Foundation for the study by Bonnie Shepard. The authors also wish to thank Claudia Dides of FLACSO, Chile, for her valuable input into the earlier study and this article.

Notes

* Rosita is a recent documentary dramatising Nicaraguan authorities’ opposition to access to a legal abortion for a nine-year-old girl whose pregnancy resulted from rape.

* To protect both women and hospital staff from prosecution, hospital patient data reported to the Ministry of Health do not differentiate between spontaneous and induced abortion.

† While many assume that the use of misoprostol would reduce the rate of serious abortion complications as measured by hospital-based abortion statistics, the effect is not straightforward. Anecdotal reports and research in other countries such as Brazil suggest that some women using misoprostol without medical supervision end up in hospital either because of incomplete abortion or because they are uninformed about normal side effects such as bleeding. It is also likely that more women feel able to seek post-abortion care than in the past.

* These statistics are incomplete, since at the end 2000 a new criminal justice system was gradually implemented with parallel registries.

† This information corresponds to six regions where the new justice criminal system was implemented.

* These figures correspond to FONASA, which allows free choice of doctor in the public health system. Assuming that the same rates apply in all other establishments, there may be more than 1,800 cases of ectopic pregnancy per year, since the free choice of doctor system accounts for 36% of care.

* Decreto 216/03 Ministry of Health, Official Gazette, 17 December 2003, which modified the Reglamento General de Cementerios 357, June 1970.

* These distortions in the democratic legislative process, alongside manipulation of information, have characterised the political process on several issues recently.³⁵ Sex education books and clinical guidelines have been censored when the Catholic church or its allies pressured Ministers to prevent the circulation of information deemed contrary to the teachings of the church. For example, a publication for parents as part of the sex education programme in 2005, A Y ahora, qué digo?, was shelved because it contained content on masturbation.