Maternity protection vs. maternity rights for working women in Chile: a historical review

Abstract

Maternity leave in Chile has been a social right since 1919, when the International Labour Organization set the first global standards. From its inception, Chile's labour legislation focused on protecting motherhood and the family. The length of maternity leave has been extended several times since then but its main aim remains the protection of infant health. In 1931, Chile's first Labour Code required anyone employing 20 or more women to provide day care services and facilitate childcare and paid breastfeeding time for all mothers of children under one. Labour laws began to play an important role in accommodating the care of infants within working conditions, though not always effectively. In spite of job protection during pregnancy and breastfeeding, women can be dismissed on grounds other than pregnancy. It was only under Salvador Allende and again in the past two decades that Chile has enfranchised women as holders of health rights. However, many unresolved tensions remain. Chile promotes motherhood, but often considers that working women who demand employment protection abuse the system. Motherhood is a magic wand that represents the selflessness of women, but society throws a blanket of mistrust over women who wish to exercise their maternity rights and to determine the number and spacing of their children.

Résumé

Au Chili, le congé maternité est un droit social depuis 1919, quand l'Organisation internationale du Travail a défini les premières normes mondiales. Dès le début, le droit du travail chilien s'est centré sur la protection de la maternité et de la famille. Depuis, la durée du congé maternité a été prolongée plusieurs fois, mais son but principal demeure la protection de la santé du nourrisson. En 1931, le premier code du travail chilien a exigé que tout employeur de 20 femmes ou plus assure des services de crèche, facilite la garde des enfants et accorde des périodes rémunérées d'allaitement à toutes les mères d'enfants de moins d'un an. Les lois sur le travail ont commencé à jouer un rôle important en adaptant les soins des nourrissons aux conditions de travail, quoique pas toujours efficacement. En dépit de la protection de l'emploi pendant la grossesse et l'allaitement, les femmes peuvent être licenciées pour des motifs autres que la grossesse. Ce n'est que sous Salvador Allende et à nouveau ces vingt dernières années que le Chili a reconnu les droits de santé des femmes. Toutefois, beaucoup de tensions demeurent. Le Chili encourage la maternité, mais considère souvent que les travailleuses exigeant une protection de l'emploi abusent du système. La maternité est un mot magique qui représente l'altruisme féminin, mais la société se méfie des femmes qui souhaitent exercer leurs droits à la maternité et déterminer le nombre et l'espacement de leurs enfants.

Resumen

El descanso maternal en Chile ha sido un derecho social desde 1919 concomitante al establecimiento de los primeros estándares de la Organización Internacional del Trabajo. La legislación desde sus orígenes tuvo como principal foco de protección la maternidad y la familia. El descanso maternal ha sido extendido innumerables veces pero su objetivo ha sido la protección de la salud infantil. El Código del Trabajo, promulgado por primera vez en 1931, dispuso que cualquier establecimiento con más de 20 trabajadoras debía proporcionar una sala cuna y pagar las porciones de tiempo para amamantar hasta que el niño cumpliera la edad de un año. De esta manera, la legislación laboral jugó un rol importante en acomodar las necesidades del cuidado de los infantes en contexto del trabajo remunerado de las mujeres, aunque no siempre con éxito. Pese a la protección reforzada de los mujeres durante el embarazo y la lactancia, las trabajadoras pueden ser despedidas bajo causales distintas al embarazo o la maternidad. Fue el gobierno de Salvador Allende y en las últimas dos décadas que ha consagrado a las mujeres como titulares del derecho a la salud. Sin embargo, todavía se mantienen. Se promueve la maternidad, pero con frecuencia es considerada abusiva la demanda de protección a la maternidad. La maternidad es una varita mágica que representa una exaltación de las mujeres en la entrega hacia otros, pero la sociedad mantiene un manto de sospecha cuando ellas ejercitan sus derechos de protección de maternidad y la decisión de decidir el número de hijos y su espaciamiento.

Key Words:

• maternity leave
• infant mortality
• social welfare
• labour law
• Chile

In Chile, maternity leave has been a social right since 1919, when the International Labour Organization's Maternity Protection Convention set the first global standards.¹ Paid leave was introduced amidst global demands for a shorter working week, abolition of child labour, and improved working conditions for women. These concerns were also present in turn-of-the-century Chile, especially among trade unionists and organised working women.

From its inception, Chile's labour legislation focused on working women from the standpoint of protecting motherhood and the family. The main aim of maternity leave was protection of infant and maternal health, and reducing infant mortality.² It has been argued these laws helped to keep women out of the labour market and consolidated a production–reproduction paradigm based on the archetype of men=providers/women=caregivers.³

This article presents information from a larger inter-disciplinary investigation of Chilean law and policies on working women over the past century in relation to public health policy. Three research teams explored legal, health science and psychological perspectives on the benefits of maternity leave for women's mental health, family–work balance, the advantages of breastfeeding for infant health, and women's working conditions. We asked: was maternity leave concerned with the health and working conditions of women or with child morbidity and mortality and welfare?

Three focus groups were conducted with blue collar, retail and professional women workers, in addition to interviews with key informants. This paper reflects a dialogue between two disciplines – medical and legal – based on the literature found through keywords like maternity protection, breastfeeding, women workers, infant mortality and maternal mortality. In addition, it examines Health and Labour Ministry policies from 1910 to 2010, administrative and judicial case law on labour legislation and maternity rights, and legislative debates on labour and maternity rights. Our aim, for Chile's bicentennial, was to use history to inform policy design and implementation in light of public debates on work, gender and health.

Early social security and health policies on day care for small children

Due to poverty and overcrowding, infectious diseases were rampant in early 20th century Chile, resulting in high mortality. The infant mortality rate stood at 250 per 1,000 live births, among the highest in Latin America, and children accounted for over 60% of all deaths.⁴ Health care was not yet a public concern; most health services for the poor were delivered by charitable, church, or non-profit organisations concerned with malnourished children and mothers,⁵ though these suffered from chronic underfunding. One such initiative that operated from 1912 was La gota de leche (A drop of milk), an institution delivering health and social services to deprived infants under two.⁶

Industrialisation was growing; in 1907, women accounted for 80% of Chile's textile and garment workers.⁷ The government encouraged women to join the workforce but without regard to maternity or childcare issues, which were considered a personal matter, not a protected right, even by women's aid societies.⁴ Only one such organisation financially assisted working women themselves for 40 days after childbirth. Other than providing milk and food, the government remained largely unconcerned.⁸

Breastfeeding was strongly encouraged by medical doctors who tried to advance the right of children to mother's milk through educational initiatives and legislative lobbying. The first public health policy and social laws on maternal and infant care grew out of working-class mobilisation against poor working conditions.⁹ By 1917, Chilean law required employers to offer women workers paid day-care services and to set aside two half-hour breastfeeding periods per day for mothers of children under one.¹⁰ While legislative debates showed little concern for the well-being of women, the health benefits of breastfeeding became pivotal to subsequent social law and policy.

The law required workplaces employing 50 or more women aged 18 and up to help facilitate breastfeeding by setting up an adjacent day nursery.³ Employers circumvented this by hiring younger women or fewer than 50 women, to avoid reaching the threshold. In 1931, Chile's first Labour Code required anyone employing 20 or more women to provide day-care services and to facilitate childcare and paid breastfeeding time for all mothers of children under one, regardless of age or marital status.¹¹ Employers again skirted the law by hiring fewer than 20 women, with the attendant impact on reduced job opportunities. Yet, for paediatricians, nurses and social workers providing health care to children, the clash between work schedules and breastfeeding, for example, was obvious. As La gota de leche stated in a report in 1928:

“While much has been done to encourage breastfeeding, sadly we must recognise that it decreases markedly with female employment. This is the main culprit, as it takes mothers away from their homes. But so is the poverty that forces them to work outside the home, resulting in malnutrition and premature depletion of mother's milk.”⁸

In 1929, the Chilean Paediatrics Society printed a childcare booklet for distribution along with marriage certificates: “Breastfeed your baby! Every mother can and should breastfeed for as long as possible…. Children are entitled to their mother's milk and breastfeeding does not harm women.” ⁹ A similar discourse encouraged women to strive for an aristocratic ideal of motherhood and what a good mother should be. Public education campaigns and supervision of women providing childcare also began at this time.²

The notion of a baby's entitlement to breastmilk was enshrined in the Health Code enacted contemporaneously with the Labour Code. It provided that breastmilk was the sole property of the nursing baby. Mothers were required to breastfeed for five months and refrain from nursing other babies unless medically warranted.¹² The latter restriction attempted to prevent women from working as wetnurses for upper class infants so they would have enough breastmilk for their own babies.

Social security system and paid maternity leave

A new social security system, introduced in 1924, profoundly changed the legal and social role of the State, in the face of widespread social conflict. Chile moved to address the health needs of blue-collar workers based on a German model of social insurance, financed jointly by employers and employees through payroll deductions.

Paid maternity leave was among the demands voiced by organised labour during the debate on the social security bill.⁴ As early as 1920, liberal senator Malaquías Concha had argued in the Chilean Congress for a system to protect working women before and after childbirth:

“Since the legislature seeks the reproduction and conservation of the country's population, women should not work four weeks before or four weeks after childbirth.”³

Conservative legislators countered that women were fully capable of returning to work ten days after childbirth and needed no special protection. Others were loath to grant women too many rights, afraid that undercutting employers' interests would drive female employment down.³

Chile ratified the International Labour Organization (ILO) Maternity Protection Convention in 1925 and introduced paid maternity leave of 40 days prior to and 20 days after childbirth, although the Convention called for at least 12 weeks. Employers were required to pay half wages to recipients, who could not be dismissed while on leave.¹³ The 1931 Labour Code extended maternity leave to six weeks before and six weeks after childbirth and reinforced job protection by forbidding dismissal during pregnancy for lower production.¹¹ Dismissal could still take place but the grounds for lawful dismissal could not be based on pregnancy.

The gist of the law was to protect the developing fetus and the newborn baby, not least because of demographic considerations, as a growing consensus had emerged on the need to preserve social peace and promote population and labour force growth. In other words, maternity leave laws came about not at the initiative of women, or of protecting women, but of lawmakers who regarded women as victims of the excesses of capitalism.³

In the 1930s, the early feminist organisation Movimiento Pro-Emancipación de las Mujeres de Chile (Movement for the Emancipation of Chilean Women) was the first to recognise the links between abortion, childbearing, health and working conditions:

“Society cannot force women to bear children if they are not provided with the means to feed them… until there are better conditions and food and shelter for working mothers and their children; as long as motherhood remains a curse for women and society and there is a line-up of small human beings going from womb to graveyard, we will continue to demand abortion reform and support the medical community in its efforts [to provide family planning services].” ¹⁴

In 1939, Health Minister Salvador Allende, a trained physician, also expressed concern about deaths from illegal abortions and the connection between the need to work and abortion as birth control:

“Anxiety about inadequate wages drives hundreds of working mothers to procure an abortion to prevent a new child from shrinking their already meagre resources to naught. Hundreds lose their lives, impelled by the anxieties of financial hardship… Maternal and infant mortality are demographic facts that can be impacted more or less decisively as they depend a great deal on the care that mothers and children receive before, during, and after birth.” ¹⁵

Concerns such as these resulted in isolated community health initiatives to promote fertility regulation but produced no comprehensive policies.¹⁵

The new social security programmes provided preventive medical care, including maternal and child health services designed to ensure normal infant growth and development.³ In 1937, a new Maternal and Child Health Law entitled children under two to free milk supplies,¹⁶ but only the population covered by social security benefited, which represented less than 70% of the total population even in 1952.¹⁵ The social security system is based upon the existence of paid employment, wages and deductions. Women engaged in the informal labour market or working outside the scope of a labour contract were not entitled to these benefits.

Maternal and child health and the new National Health Service

Concern for women's health was a growing issue in Latin America in 1950, when the Pan American Health Organization launched a new maternal and infant health initiative.¹⁵ In 1952, in what became a milestone for maternal and child care, Chile consolidated health policy and service delivery under a new National Health Service (NHS).¹⁷

The creation of the NHS generated the biggest boost to the promotion and protection of maternal and child health in Chile since health care was centralized in a single agency, incorporating free care for the insured's man's wife and children under age 15. At the time, only 52% of deliveries were handled by health professionals (mostly university-trained midwives), and in some parts of the country the rate was 40% or less.¹⁷ The NHS provided professional antenatal, childbirth, family planning, nutrition and vaccination services, and as a result, professionally-assisted births climbed to 74% by 1965 and 81% by 1970.¹⁷ Also in 1952 a programme was launched to provide food supplements to breastfeeding mothers for seven weeks after birth.¹⁸ La ley de la madre y el niño (Mothers' and children's law) became the paradigm by which specialists and policymakers, some until today, would refer to the mother–child dyad, making them indivisible for policy purposes.

Paid maternity leave for working women remained at 12 weeks for over 30 years. In 1963, physician and right-wing Congressman Gustavo Monckeberg sponsored a bill to extend leave for mothers of preterm babies by six weeks. The bill, designed to prolong breastfeeding for the sake of newborns needing special care, was approved on condition that it was medically required. The need for certification of preterm delivery by an attending physician sparked harsh criticism. Right-wing members of Congress thought the medical profession were providing unnecessary certificates. In response, Salvador Allende, then a Senator, said it was an ethical duty to issue certificates when needed. A communist Congresswoman reminded Congress that working class women's deliveries were rarely attended by a physician, but by a midwife, creating barriers as the law required a physician's certificate. On health grounds, Congressman Monckeberg proposed in 1964 that nursery care provided by an employer should be extended until children reach two years of age, not necessarily for breastfeeding but to provide longer nurture and care for toddlers. He was cognizant of the higher costs for employers, but argued they were morally rewarded because of the benefits to society at large. Monckeberg exemplified the discourse of social Catholics which amalgamated medical, social and moral arguments to improve health, labour and living conditions.

Communist congresswomen at the same time proposed greater job protection for pregnant and breastfeeding workers, six months before and after birth. The Executive and right-wing parties argued against, saying that too much protection could keep employers from hiring women. At the time, working women who became pregnant could be dismissed on grounds other than pregnancy,¹¹ and married women faced discriminatory hiring practices because of potential pregnancies. Female trade union representatives gave accounts of job advertisements in factories for single women workers, as if only married women had children. Significantly, legislative debate in the 1960s tended to portray working women as compelled by financial hardship to leave children unattended. Child care was indeed a pervasive problem; women relied on female relatives, older siblings, and female neighbours when there was no employer-funded nursery. Professional women used domestic staff and live-in nannies. By the end of the 1960s, there was debate and policy change on child care in the context of employment. Child care policies called for publicly run facilities when women were not entitled to employer-funded nurseries, especially where employers circumvented the law by hiring less than 20 women. However, women from labour unions reported that 80% of employers did not fulfil their obligations in relation to day care.

Meanwhile, the health of pregnant women, including those with unwanted pregnancies, remained at high risk. In 1965, illegal abortion accounted for over one-third of maternal deaths, then at 279 deaths per 100,000 live births.¹⁷ Against this backdrop, the Cold War drove governments to contain poverty, population growth and social upheaval, which facilitated the introduction of health policies to reduce infant mortality and illegal abortions.¹⁹ In 1965, the joint efforts of the Chilean Association for Family Protection^* and the sitting Christian Democratic government, with wide support from the medical community, paved the way for an innovative family planning programme under the NHS.²⁰ A study published in 1967 showed there was one abortion for every two births, and abortion deaths remained high.^21,22 However, the implementation of the family planning policy was founded on the need to reduce abortions and high multiparity, and increase birth spacing to reduce the number of poor and abandoned children. It was never intended to liberate women from the burden of raising a large number of children so that they could develop as individuals. Then, family planning was not considered a right.²³

Even so, by 1970, the family planning programme had reduced maternal deaths to 168 per 100,000 live births and infant mortality from 120 to 79.3 per 1,000 live births. Total fertility fell from 4.7 in 1960 to 3.3 in 1970. Moreover, skilled delivery care increased from 74.3% in 1965 to 81.1% in 1970.¹⁷

The government of former Health Minister Salvador Allende (1970–1973) introduced reproductive health policies that placed new emphasis on women's rights, encouraged planned, wanted pregnancies, and provided sex education in schools and health care centres.^15–24 Services included family planning, antenatal and post-natal care, and cervical cancer and infertility prevention.¹⁹ For a short time before the 1973 coup d'état, a major hospital in a vulnerable area of Santiago provided menstrual regulation services for patients whose contraceptive method had failed.¹⁹ Access criteria included having several children and not wanting more, being poor, and therapeutic reasons for abortion.²⁵ Women were also encouraged either to enrol in the family planning programme to obtain a reversible contraceptive method or undergo voluntary sterilisation.

The Allende government also bolstered social protection. Paid maternity leave was extended to 18 weeks for all women workers regardless of infant health needs, effectively providing a universal right, no longer governed by medical discretion.

Rollback of reform under the Pinochet dictatorship

Most of Salvador Allende's pioneering health policies and programmes were terminated by the dictatorship of Augusto Pinochet (1973–1990). Many participating health care providers were prosecuted and/or forced into exile. Menstrual regulation and sex education programmes were abruptly halted and labour organisations and rights were significantly weakened.

In 1975, the Health Ministry tightened voluntary sterilisation criteria for low-income women receiving health care at public facilities. New requirements included having three or more living children, being at least 32 years of age, and marital or partner consent,²² effectively introducing a male veto over women's reproductive autonomy.²⁶ The lack of divorce in Chile until 2005 placed even greater barriers. The hospitals required a signed form, but who was to sign: the current common law partner, the husband, the former partner? Women's health advocates in the 1990s conveyed how problematic this was. Yet hospitals were happy to take any male signature to fulfil the requirements, for example, when a widow one of us knew personally was refused the procedure by a Santiago hospital until she presented the form with a male friend's signature.

Although family planning remained an official programme, a policy paper issued in 1978 set population growth as a national goal, noting that Chileans should therefore not “abuse” contraception.²⁶ The document stated that advertisements for birth control should be removed from health care facilities, implying that providing information created demand for family planning services. Health advocates reported anecdotally that in some cases women had their IUDs removed when they went for a check-up. This was corroborated to one of the authors (Casas) when she presented a paper and a listener recalled the instructions from the Ministry of Health. However, Chilean family planning services carried on as usual, though with a low profile, despite government pronouncements, since by then most women were well-informed about birth control.²⁶

While the Pinochet dictatorship continued implementing maternal and child health services and programmes and encouraging motherhood, there was a blatant double standard in matters of labour rights and labour policy and practice. In 1978, the Ministry of Labour issued an official recommendation to employers to ask for a pregnancy test and birth certificates before hiring women in order to assess whether women had maternity protection rights. However, when a major economic crisis hit the country, both women's use of family planning services and their exercise of their labour and maternity rights and protections were deemed abuses of the system.

Finally, in 1989, in the dying months of its tenure, the Pinochet regime struck therapeutic abortion off the books. One of the legal framers of the regime, a constitutional law professor and fervent Catholic, Jaime Guzmán, unsuccessfully attempted in 1974 to introduce a ban on abortion in the proposed new Constitution. The 1980 Constitution did include a general statement on the legal protection of “the unborn” but not a constitutional right to protection. Hence, as was argued in 1974, there was room for exemptions, such as permitting abortion in cases of serious fetal malformation or when pregnancy was a result of rape, a view supported by a minority of constitutional experts even today. The repeal acted as a deterrent of future changes during the democratic transition. The legislative history reveals that a member of the Military Junta feared Chile could follow the same path as Spain, where abortion and divorce were liberalised with the return of democracy.²⁵ Ever since, fierce opposition from moral and political conservatives has thwarted all attempts to reinstate access to abortion, even to save a woman's life.²²

Democratic government and women's health rights

From 1990, democratic renewal opened the way for rights-based policymaking. A milestone came in 1991 with the new National Women's Service, a cabinet-level department concerned with a wide range of women's issues, including health.¹⁵

A new women's health programme made a concerted effort to stop viewing women only in terms of reproductive capacity and the mother–child dyad. The programme picked up from where Allende had left off, notably in his September 1971 Mensaje al Congreso, that he considered legal abortion possible, or at least that the exemption of therapeutic abortion from criminal prosecution was amenable to a more flexible reading, which could include abortion when birth control failed.²⁶ However, the coalition, which included the Christian Democrats, did not permit this reading, and the current administration has not supported change either. The Senate in March and April 2012 debated and voted on three proposals to amend the legislation. The vote to reinstate therapeutic abortion was lost (15 in favour, 18 against), there was less support for cases of serious fetal malformation, even when incompatible with life, and even less for abortion in cases of rape.²⁷ Nevertheless, the opening of legislative debate at all was more promising than previous attempts because it had the support of the Labour Minister, even if that was not enough.

The women's health programme under the new democracy claimed to be concerned with the entire life cycle of women, which means taking care of women from adolescence through reproductive age and afterwards. However, even now it remains focused on reproduction, i.e. pregnancy and breastfeeding. In the mid-1990s, for example, teenage girls were a priority concern only if they were pregnant.¹⁵

Since 1990, health indicators were improving in tandem with social investment. By 1999, for example, maternal mortality was down to 22 per 100,000 live births and infant mortality stood at 10 per 1,000 live births.¹⁷

In 1996, women accounted for one third of the workforce and headed a quarter of all households, but their work remained secondary to men's, as reflected in a sizeable wage gap, tending towards precarious jobs with little stability, short-term or in the informal market, with limited access to leadership positions.²⁸ Trade unions in the 1960s demanded that employers comply with the law, but by 2008 official estimates indicate that less than 9% of employers were obliged to pay for or operate childcare facilities and 36% of employers did not comply with the law.²⁹

The gap between what the law required and what public and private actors did reveals the tensions inherent in protecting the rights of working women, protecting the health of their children, and women's autonomy and health concerns. Our review of case law shows that breastfeeding schedules proved impractical for many women whose babies were not in nearby day nurseries, while a government study showed that many women feared exercising their breastfeeding rights, as it could lead to trouble at work. And this is not to mention that breastfeeding policies have often been at the root of workplace discrimination against women.³⁰ However, the focus group discussions of our larger research revealed how women in three different income brackets attempted to balance the work–family tension and relied on public or employer-funded day care. Certainly, improving access to child care and extending maternity leave lifted some of the burden on women.

During the 2009 presidential campaign, right-wing contender Sebastián Piñera promised to increase maternity leave to 24 weeks if elected. After taking office, Piñera commissioned a blue-chip task force to look into reforms intended to extend breastfeeding and cut down on the use of sick leave for de facto maternity leave. Maternity leave is paid by the government, while sick leave for infant care is covered by private or public health plans. Contrary to what Piñera intended, the law passed by Congress in 2011 did not extend a benefit but created a universal right. The law contemplates a 12-week maternity leave post-birth and 12 weeks of parental leave that can be taken by either mother or father. There is a gradual half-time return-to-work scheme for women after the 12th week if they wish that also allows fathers to share parental leave. In any case, women can remain at home for a full 24 weeks.³¹ This maternal/parental leave is paid with a capped subsidy equivalent to US$ 2,000 per month.

Since November 2011, however, fewer than 3% of women have used the staggered-return scheme and only 23 fathers have taken parental leave.³² There are many explanations, but the most important is the cultural representation of who does child care. Focus group discussions with women workers indicated that blue collar workers were uncomfortable with the idea that men could take care of babies, that men were a nuisance when they did not help and worse in some cases when they did. The retail workers would consider the option but trusted female relatives to give better care than men, while the professional women were open to the change. Initially, the government had added confusion because the proposal established that the subsidy would be calculated from the mother's earnings and not the father's, to reduce social expenditure. But few men or women were interested in this reduction in their family income.

The core intent of these reforms has remained the protection of infants. The most recent example of this is to do with the programme for prevention of mother-to-child transmission of HIV adopted in recent years, which collided with women's own right to HIV treatment. In the late 1990s it took public interest litigation to force the Health Ministry to provide HIV treatment to HIV-positive pregnant women over and above treatment for infants and not to discontinue that treatment after delivery.³³

Conclusion

Although women in Chile have come a long way since the early 1900s, it was only under Salvador Allende and again in the past two decades that Chilean social discourse has truly enfranchised women as holders of health rights. Previously, women received health services and were granted rights provided they conformed to societal notions of the proper role of women and mothers, supervised by the medical community in their role as caregivers, and educated as such.

Female employment was and continues to be perceived as an obstacle to motherhood. A century ago, when women and their children were seen as victims in need of protection from harsh capitalism, social Catholics, conservatives and trades unions reinforced traditional gender roles and medical practitioners concerned about infant health discouraged gainful employment.

A century later, gainfully employed Chilean women continue to pay a high cost if they have children because social and economic policy does not help women to strike a balance between family and employment obligations or relieve the toll on mental health of double duty. The prevailing political discourse extols family well-being but obfuscates the health issues women face. For policy to be effective, it must become more attuned to the real issues women face in their daily lives. If the extension of maternity leave relieves the tension for women of wanting to take care of their babies, the next step is child care. President Bachelet did a tremendous job of expanding the provision of publicly run day care for poor working mothers but the middle classes are trapped because they do not necessarily receive these benefits.

While the medical discourse has carried significant weight over the past century, its central role has waned as considerations of cost-effectiveness pervade the social policy agenda. Rights-based language has become a fixture of policy pronouncements, but at times it seems as if words trump deeds. A recent debate on extended maternity leave in 2011 led to a revival of the rights-based discourse, with women's groups, trades unions and the medical community all joining in, even if not always sharing the same goals. The current administration under President Sebastián Piñera initiated the legislative debate to fulfil a presidential campaign commitment but when it came to formulating the policy, it was framed as a benefit, not a social right. It took many arguments for the administration to realize that if the proposal of co-responsibility between men and women for childcare was to advance, a subsidy based on women's earnings would have the opposite effect. The administration seemed unaware that women earned less, or else the discourse was insincere and they were not willing to provide the necessary finances. Finally, the government had to accept that maternity leave was a social right in the social security system, built 100 years ago.

Chilean policy continues to harbour many unresolved tensions around these issues. Chile promotes motherhood, but often considers that working women who demand employment protection abuse the system. Private health insurance providers, for example, penalise women of reproductive age by charging heavier premiums than for men. Motherhood is a magic wand that represents the selflessness of women, but society throws a blanket of mistrust over women who wish to exercise their maternity rights and to determine the number and spacing of their children.

Notes

* International Planned Parenthood Federation affiliate.