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Induced Abortion in Chile

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Induced Abortion in Chile In Brief Induced Abortion 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 abortions 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 unsafe abortion.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 misoprostol), 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 abortion law 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.
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