In Brief

Induced in Chile

Chile is one of a small handful of countries worldwide that Abortion-related deaths and injuries appear to have declined dramatically prohibit induced abortion under any circumstance, including In the 1960s, many Chilean women if a woman’s life is at risk. The longstanding ban, which undergoing unsafe died as a result, or suffered serious short- or long- runs counter to Chile’s stated commitment to international term health complications for which they women’s rights treaties, faces a robust challenge in the did not receive the medical treatment they needed.9 In 1960, there were 294 form of a recent bill proposed by the government of maternal deaths per 100,000 live births,10 and one-third of these deaths were at- President Bachelet that would allow the procedure under tributable to .11 One in limited circumstances. Yet informed debate on the topic is five hospital beds in obstetric depart- ments were occupied by women receiving hindered by the lack of data on the incidence and context of postabortion treatment. clandestine induced abortion. Chile’s maternal mortality ratio fell to 55 deaths per 100,000 live births by In every country, regardless of the legal No data exist on the characteristics of 1990, and to 22 by 2013.12 The precise status of induced abortion, some women women obtaining abortions in Chile, nor contribution of unsafe induced abortion experiencing an unintended pregnancy on their reasons for doing so. As one to overall maternal mortality is unclear, turn to abortion to end it.1 Chile is no researcher points out, “we do not know… but experts agree that far fewer deaths exception to this worldwide pattern. Yet who are the women who practice clandes- result from unsafe induced abortion now data on contraceptive use, unintended tine abortion, from what social back- than was the case 50 years ago. This pregnancy and other determinants of grounds, at what ages, from what regions decrease in abortion-related mortality has abortion in the country are either in- of the country, the sexual or reproduc- been attributed to increasing use of safer complete or nonexistent because large- tive…backgrounds of these women, the abortion methods (primarily ), scale studies like the Demographic and types of interventions they resort to and improvements by Chile’s public health Health Surveys that are available for most how they carry these out.”5(p.52) However, institutions in the management of post- developing countries are not conducted it is widely agreed that Chilean women abortion complications and lower fertility in Chile. who resort to unsafe pregnancy termina- resulting from improved access to family tions, and subsequently seek treatment planning services.13 In addition to this lack of survey data, for complications, tend to come from the the clandestine nature of abortion in Chile National-level hospital discharge data country’s more disadvantaged groups.6,7 It makes all aspects of the procedure dif- provide indirect clues that the frequency is likely that Chilean women’s reasons for ficult to research. The only national study, with which clandestine abortion results seeking abortion are similar to those most conducted in 1990, estimated that women in health complications severe enough commonly given by women around the in Chile had approximately 160,000 to require hospitalization is also declin- world: the desire to delay or stop child- induced abortions annually, for a rate of ing. Cases of morbidity resulting from bearing, fear of disrupting their education 45 per 1,000 women aged 15–49.2 More all pregnancies that were not carried to or employment, lack of economic means recent—but less substantiated— term fell from 56,391 in 196414 to 30,434 to raise a child, lack of support from their estimates cited in the media have ranged in 2012,15 representing a decline in the partner, problems in their relationship from 60,0003 to 300,0004 abortions morbidity rate from 32 to eight hospi- with the father and the perception that each year. talizations per 1,000 Chilean women of they are too young to have a child.8 childbearing age. Because of underreport- ing and likely misdiagnosis, it obstetricians and gynecologists after the first trimester or at are very selective, involv- is difficult to distinguish what for safe procedures. However, the wrong dosage, this method ing most of all…the poorest proportion of these hospital- increased access to misoprostol can result in incomplete abor- women.”16(p.72) izations involve women with outside of formal health care tion, heavy bleeding and other The number of women who are complications from unsafe abor- settings demonstrates that lack complications. Many unscrupu- incarcerated for obtaining an tion attempts as compared with lous online vendors appear to of wealth may no longer be the abortion has dropped dramati- be selling fake pills or supplying those requiring care for compli- insurmountable barrier to a rela- cally in recent years, from 88 in women with incorrect dosages cations related to other reasons tively safe abortion that it once 2003 to five in 2012, and most and charging high prices for pregnancies are not carried to was. A small study from 2013 are now sentenced to proba- them.19 The medication often term (such as ectopic or molar of women charged with break- tion. The length of sentences comes without information on pregnancy, or spontaneous ing Chile’s found for women convicted of obtain- its correct use, even when the pregnancy loss). More research pregnancy terminations using ing or assisting in an abortion correct dosage is supplied. on this topic is needed. misoprostol cost US$75–$215,18 between 2003 and 2012 ranged whereas procedures of varying Aside from the increase in from 1.5 to three years, as Misoprostol is increasingly levels of safety carried out by misoprostol use among those mandated in the penal code.23 available in Chile physicians are said to cost as who can obtain and afford it, Doctors and professional mid- Small-scale studies and anec- much as US$2,000.19 abortion methods in Chile have wives found to have performed dotal evidence suggest that changed very little since the abortions received sentences Although illegal when sold or wealthier Chilean women have 1990s. Those who are unable of 3–5 years; unskilled or access to safe abortions from used to induce abortion, miso- to obtain safe services through untrained providers (including skilled providers, whose most prostol can easily be acquired trained providers still resort traditional birth attendants) commonly used techniques in Chile through the Internet to traditional methods, which received sentences of no more are thought to be dilation and and is also available through are often unsafe, ineffective or than three years. curettage, manual vacuum some providers of clandestine both. These range from drink- aspiration and, increasingly, abortion. When used in the first ing boiled beer or herbal teas Data about contraceptive medication abortion using nine weeks of pregnancy and to inserting knitting needles, use in Chile are lacking misoprostol.16,17 Poorer Chilean at the correct dosage, the drug scissors or rubber catheters into In the absence of survey data women usually cannot afford to successfully ends a pregnancy in the cervix.21,22 on pregnancy intentions and pay the fees charged by private 75–90% of cases.20 When used contraceptive use, it is impos- Poor women bear the sible to estimate the level of brunt of abortion-related unmet need for modern con- Abortion law in Chile prosecution traception. The only available Between 1931 and 1989, Chile’s Sanitary Code permitted induced abortions Each year, Chilean women estimate of contraceptive use to save a woman’s life.1 In 1989, near the end of Augusto Pinochet’s regime, and men are reported to local for Chile is for the combined a total ban on abortion was put in place. Legislators have since made many authorities for having or assist- population of men and women attempts to loosen that ban but, with the support of the highly influential ing in an induced abortion.16,18 aged 15 and older—a non- Catholic Church, members of Congress opposed to changing the law have successfully blocked all such legislative initiatives.2,3 Poor women are thought to be standard measure that does the most likely to use unsafe not permit assessment of the The most recent proposed bill, introduced in January 2015, would amend existing health and penal codes to allow the procedure under three abortion methods and the needs among women of repro- circumstances: when the woman is at such risk that the abortion would most likely to seek postabor- ductive age.24 Unless the vast prevent a danger to her life; when the embryo or fetus has a fatal genetic or tion treatment in public health majority of women who want congenital malformation; and when the pregnancy is the result of rape and facilities, which are the source has reached no more than 12 weeks’ gestation (for girls younger than 14, to avoid pregnancy are using the limit is 14 weeks).4 The draft bill would prioritize patient confidential- of almost all abortion-related effective contraceptive meth- ity above the requirement that doctors denounce women they treat, while denunciations to the criminal ods consistently and correctly, also allowing for conscientious objection on the part of individual doctors justice system. According to both unintended pregnancy and or surgeons unwilling to perform legal abortions on the grounds covered by national police reports, between the proposed bill. Physicians granted this exemption would be required to abortion are likely occurring at ensure that a substitute doctor be assigned. In September 2015, the bill 2003 and 2012, a total of substantial levels.25,26 passed the Health Commission of the lower house of Congress, and as of 3,570 women and 975 men in this writing, it is under review by the Constitutional, Legislative and Justice Chile were sentenced for these Data on adolescents and young Commission; it will need to be approved by the lower and upper houses of adults hint at the particular Congress to become law.5 infractions of the existing penal code.16 The lawyer who analyzed risks and challenges faced by References on page 4. these statistics concludes that young people in Chile. As of cases of “criminal prosecution 2009, the average age at first intercourse was 16 for men and

Induced Abortion in Chile 2 Guttmacher Institute 17 for women, and more than Worldwide, induced abortion— 7. Basadre P and Toro I, Cómo 15. Departamento de Estadísticas nine in 10 young people aged whether legal or clandestine— opera la justicia en los casos e Información de Salud I (DEIS), de aborto: la historia de tres 15–29 had never married, indi- is most often sought in response Ministerio de Salud, Gobierno de condenadas por el “delito de mujeres Chile, Egresos Hospitalarios Según cating than many young people to unintended pregnancy. Most pobres,” The Clinic, 2014, http:// Edad y Causa—Servicios, 2012, no become sexually active well Chilean couples want to have www.theclinic.cl/2014/06/12/ date, http://intradeis.minsal.cl/ before they are likely to want small families, and to achieve como-opera-la-justicia-en-los- egresoshospitalarios/menu_publica_ to have a child.27 Yet school- their desired family size and casos-de-aborto-la-historia-de-tres- nueva/menu_publica_nueva.htm. condenadas-por-el-delito-de-las- 16. Casas Becerra L et al., La based sex education may not be avoid the need for abortion, mujeres-pobres/#commentsSection. meeting adolescents’ needs for they need to use effective penalización del aborto como una 8. Bankole A, Singh S and Haas violación a los derechos humanos comprehensive, evidence-based contraceptive methods cor- T, Reasons why women have de las mujeres, Capítulo 2, in: information: A 2006 assessment rectly and consistently for the induced abortions: evidence from Universidad Diego Portales (UDP), of Chile’s official sex education majority of their reproductive 27 countries, International Family Informe Anual sobre Derechos program concluded that the pro- lives. Research on unintended Planning Perspectives, 1998, Humanos en Chile 2013, , gram did not include instruction pregnancy and unmet need for 24(3):117–127 & 152. Chile: Centro de Derechos Humanos, 2014, pp. 69–120, http://www. 9. Faúndes A and Barzelatto J, The on the negative consequences contraception is needed both to clacaidigital.info:8080/xmlui/ Human Drama of Abortion: A Global of unwanted pregnancy in ado- contextualize women’s recourse handle/123456789/527. Search for Consensus, Nashville, TN, lescence or provide advice that to abortion and to help assess USA: Vanderbilt University Press, 17. Jones E, Chile’s black-market could help students avoid early and improve women’s ability to 2006. abortions, Pulsamerica, 2011, http:// 28 www.pulsamerica.co.uk/2011/04/14/ out-of-wedlock childbearing. plan the timing and number of 10. Molina Cartes R, Perspectiva chile’s-black-market-abortions/. As of 2009, four in 10 sexually their pregnancies. medico-epidemiológica del aborto experienced women aged 15–19 en Chile, in: AFLD, Voces Sobre el 18. Casas Becerra L and Vivaldi L, had had an unintended preg- Aborto, Ciudadanía de las Mujeres, Abortion in Chile: the practice under Cuerpo y Autonomía, Santiago: AFLD, nancy, and 7% of young people a restrictive regime, Reproductive REFERENCES Escuela de Salud Pública, Universidad Health Matters, 2014, 22(44):70–81. aged 15–29 who had experi- de Chile, 2014, Table 1. 1. Singh S et al., Abortion Worldwide: Crellin O, Therapeutic abortion enced an unintended pregnancy 19. A Decade of Uneven Progress, New 11. Ministerio Secretaría General de shot down again in Chilean Congress, reported that it had ended in York: Guttmacher Institute, 2009. la Presidencia, República de Chile, International Consortium for Medical 27 an induced abortion. This low 2. Singh S and Wulf D, Estimated Mensaje 1230–362: Mensaje de S. Abortion, no date, http://www.medi- proportion likely reflects under- levels of induced abortion in E. la Presidenta de la República con calabortionconsortium.org/news/ reporting, however, due to the six Latin American Countries, el que inicia un Proyecto de Ley therapeutic-abortion-shot-down- que regula la despenalización de la again-in-chilean-congress-1598. illegality of the procedure. International Perspectives, 1994, 20(1):4–13. interrupción voluntaria del embarazo html. en tres causales, 2015, http://www. 3. Díaz S, Aspectos médicos del 20. WHO, WHO Reproductive Health Summary minsegpres.gob.cl/wp-content/ aborto, Santiago: Instituto Chileno Library, Medical methods for first The deficit of knowledge on the upLoads/2015/01/1230-362- de Medicina Reproductiva, 2012, trimester abortion, 2004, http:// despenalia-interrupcion-emabrazo-3- prevalence and consequences slide 30. apps.who.int/rhl/ fertility/abortion/ causales-con-ingreso-camara.pdf. of induced abortion in Chile dgguide/en/. 4. Jarroud M, Chile afronta su 12. World Health Organization prevents a fully informed debate deuda con el derecho al aborto de 21. Weisner M et al., Algunos (WHO), Trends in Maternal Mortality: on the impact of clandestine las mujeres, Inter Press Service, resultados de la encuesta sobre 1990 to 2013, 2014, Appendix 2, abortion on Chilean women and 2015, http://www.ipsnoticias. opiniones acerca del aborto http://apps.who.int/iris/bitstr ea net/2014/09/chile-afronta-su-deuda- clandestino realizada por el AGI families. Research is needed to m/10665/112682/2/97892415072 con-el-derecho-al-aborto-de-las- en Brasil, Chile, Colombia, Mexico, fill this gap and provide policy- 26_eng.pdf?ua=1. mujeres/. Peru y Republica Dominicana, makers and health care providers 13. Donoso Siña E, Reducción de paper presented at Encuentro de 5. Palma Manríquez I and Moreno with the information they need la mortalidad materna en Chile de Investigadores sobre Aborto Inducido Standen C, Las paradojas y desafíos 1990 a 2000, Revista Panamericana en América Latina y el Caribe: to devise sound policies and para la investigación social del de Salud Pública, 2004, 15(5):326– Atención Hospitalaria y Costos interventions that best promote aborto inducido en Chile, in: 330, doi: 10.1590/S1020- del Aborto, Santafé de Bogotá, Articulación Feminista por la the nation’s public health. New 49892004000500007. Colombia, Nov. 15–18, 1994. data and policies are particularly Libertad de Decidir (AFLD), Voces Sobre el Aborto, Ciudadanía de 14. Molina Cartes R, Impacto del 22. Lesbianas y Feministas por el important to verify and address las Mujeres, Cuerpo y Autonomía, aborto, in: Dides C, Benavente MC Derecho a la Información, Línea the inequities suggested by Santiago: AFLD, Escuela de Salud and Sáez I, eds., Dinámicas Políticas Aborto Chile: El Manual ¿Cómo the existing data: Poor women Pública, Universidad de Chile, 2014, sobre Aborto en Latinoamérica: las Mujeres Pueden Hacerse un appear to be at an elevated risk pp. 51–59. Estudio de Casos, Santiago: Flacso- Aborto con Pastillas? 2013, http:// Chile, 2010, pp. 17–43. infoabortochile.org/wp-content/ for obtaining unsafe procedures 6. Casas Becerra L, Women uploads/2013/05/manual.pdf. and for being prosecuted as a prosecuted and imprisoned for result. abortion in Chile, Reproductive Health Matters, 1997, 5(9):29–36.

Guttmacher Institute 3 Induced Abortion in Chile 23. Casas Becerra L, Facultad BOX REFERENCES CREDITS de Derecho, Centro de Derechos 1. Casas Becerra L and Vivaldi L, This In Brief was written by Elena Humanos, Universidad Diego Abortion in Chile: the practice under a Prada, independent consultant, and Portales, Santiago, Chile, personal restrictive regime, Reproductive Health Haley Ball, Guttmacher Institute. It communication, Apr. 28, 2015. Matters, 2014, 22(44):70–81. was edited by Lisa Melhado, Gutt- 24. Ministerio de Salud, Gobierno 2. Casas Becerra L et al., La macher Institute. The authors are de Chile, II Encuesta de Calidad de penalización del aborto como una grateful for the suggestions provided Vida y Salud, Chile, 2006, Informe violación a los derechos humanos by Ann Biddlecom and Julia Ferré, de Resultados, Total Nacional, 2006, de las mujeres, Capítulo 2, in: Population Division; http://www.crececontigo.gob.cl/ Universidad Diego Portales, Informe Lidia Casas, University of Diego wp-content/uploads/2013/06/ Anual sobre Derechos Humanos Portales School of Law, Chile; Claudia ENCAVI-2006.pdf. en Chile 2013, Santiago, Chile: Dides, Miles, Chile; Ramiro Molina, School of Public Health, University of 25. DEIS, Tasa global de fecundidad, Centro de Derechos Humanos, Chile; and Cristina Villarreal, Chile, 1992–2011, no date, http:// 2014, pp. 69–120, http://www. Orientame, Colombia. They also www.deis.cl/?page_id=3307. clacaidigital.info:8080/xmlui/ handle/123456789/527. thank the following Guttmacher col- 26. Bongaarts J and Westoff CF, The leagues for their input: Sneha Barot, 3. Maturana-Kesten C, Aborto: potential role of contraception in Isaac Maddow-Zimet, Lisa Remez, derechos humanos de las mujeres reducing abortion, Studies in Family Susheela Singh and Gustavo Suárez. Planning, 2000, 31(1):193–203. frente al parlamento chileno, in: AFLD, Voces Sobre el Aborto, Suggested citation: Prada E and Ball 27. Instituto Nacional de la Ciudadanía de las Mujeres, Cuerpo y H, Induced abortion in Chile, In Juventud, Gobierno de Chile, 6ta Autonomía, Santiago: Articulación Brief, New York: Guttmacher Encuesta Nacional de Juventud 2009, Feminista por la Libertad de Decidir, Institute, 2016. 2010, pp. 256–281, http://www. Escuela de Salud Pública, Universidad injuv.gob.cl/portal/wp-content/files_ de Chile, 2014, pp. 81–90. mf/sextaencuestanacionaldejuventud. pdf. 4. Cámara de Diputados de Chile, Informe de la Comisión de Salud 28. Olavarría J, La Política de recaído en el proyecto que regula la Educación Sexual del Ministerio de despenalización de la interrupción Educación de Chile. Consideraciones voluntaria del embarazo en tres para una Evaluación, 2006, Santiago, causales, 2015, no. 9.895-11, Chile: Seminario Internacional Artículo 119. Equidad de Género en las Reformas 5. Center for , Educativas de América Latina, 2005, Chile’s health commission approves http://www.pasa.cl/wp-content/ abortion bill, press release,2015, uploads/2011/08/La_Politica_ http://www.reproductiverights. de_Educacion_del_Ministerio_de_ org/press-room/chiles-health- Educacion_de_Chile_ Olavarr.doc. commission-approves-abortion-bill.

Advancing sexual and reproductive health worldwide through research, policy analysis and public education

125 Maiden Lane New York, NY 10038 USA Tel: 212.248.1111 [email protected] www.guttmacher.org

January 2016