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.

Women’s opinions on the legalisation of abortion in Chile 2009–2013

“…Chile is one of only four countries worldwide where there is no explicit legal exception to prohibitions 1 on abortion, even to save the life of a woman (Shepard and Casas Becerra 2007). These restrictions are a legacy of the 17-year dictatorship headed by Augusto Pinochet, who, shortly before losing power in 1989 amended the country's Health Code to ban abortion in all circumstances.…”

El cambio del perfil epidemiológico de la mortalidad materna en Chile dificultará el cumplimiento del 5° objetivo del Milenio

“…Es necesario destacar un estudio reciente que en base a un modelo epidemiológico, válido y reproducible, estimó que en Chile en 2008, sólo el 10,6% de los egresos por aborto, corresponderían a complicaciones por aborto inducido 29 . Es importante resaltar que en la actualidad el riesgo absoluto de morir por aborto en Chile es de 0,046/100.000 mujeres de 15-49 años (1 en 2.000.000 mujeres de 15-49 años) 30 , como también que la legislación promulgada en 1989 y que prohíbe toda causal de aborto no ha influido en la tendencia de la mortalidad materna por aborto inseguro como ha sido sugerido 31 . La embolia obstétrica fue la cuarta causa de muerte materna en el período 2000-2009, con una RMM (0,9/100.000 nv) similar a lo reportado en Estados Unidos de Norteamérica (1,0/100.000 rev Med chile 2012; 140: 1253-1262 nv) 32 , Canadá (0,5/100.000 nv) 33 y Reino Unido 34 .…”

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

“…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.…”

“…on women's rights, encouraged planned, wanted pregnancies, and provided sex education in schools and health care centres. [15][16][17][18][19][20][21][22][23][24] Services included family planning, antenatal and postnatal 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.…”

“…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.…”