The Legal and Political Battles over the Distribution of Emergency Contraception in Chile under the Presidencies of Ricardo Lagos (2000-2005) and Michelle Bachelet (2006-2010) Carmen G. Sepúlveda Zelaya UCL October 2014 Thesis submitted for the degree of PhD I, Carmen G. Sepúlveda Zelaya confirm that the work presented in this thesis is my own. Where information has been derived from other sources, I confirm that this has been indicated in the thesis. Abstract This thesis analyses the policy process behind the distribution of Emergency Contraception (EC) in Chile during the administrations of Ricardo Lagos (2000-2005) and Michelle Bachelet (2006-2010). For more than ten years, this policy process was marked by a series of political and legal battles at the centre of which were women’s sexual and reproductive rights. The legalisation and distribution of EC had the effect of alerting conservative and religious groups opposing EC for its alleged abortive effect. What could have been considered a minor policy issue by many political analysts became a particularly visible and influential issue, especially once Michelle Bachelet, Chile’s first female president, took power in 2006. Feminists, the Catholic Church, lawyers and doctors became the main players in front of tribunals supporting or opposing the public policy. The main concern of this research is to understand why the EC policy was such a contentious issue in Chile and elucidate which were the main factors affecting the advancement of this progressive social policy and its final gendered outcome. The central research question driving this study is what does the EC policy process tell us about the role of institutions in the advancement of women’s sexual and reproductive rights in Chile? The thesis shows that both formal and informal institutions played a major role in the policy environment in which feminist and sexual and reproductive health and rights advocates had to engage. The role of formal institutions such as the Constitutional Tribunal and the power held by the executive were matched by the power of informal institutions such as the consensus rule, the role of judges and informal lobbying by social actors, as well as the presence of the first female president. Bachelet’s profile as a doctor, feminist and woman mixed with her presidential power provides an important explanation to the positive outcome of the policy process. Acknowledgments My first thanks are extended to my supervisors Maxine Molyneux and Paulo Drinot for their constant support and unlimited patience. Without their encouragement and faith in my work this thesis would not have been possible. A special thank you to Alejandra Serpente, I did not know when I started this PhD research that I would gain such a great colleague, friend and compañera de aventuras who stood by me until the very end. To Juan Ignacio Venegas, Alessandra Mezzadri, Georgina Blanco Mancilla, Marianna Leite, who provided a constant support network through their smiles, humour, friendship and love. To Robert Holloway for your generous time and expertise. Juan Pablo Belair and Emiliano Ruíz Parra, for being the chocolate and coffee every friendship needs, even in the distance. Juan Pablo Belair, Manuel Matta and Lieta Vivaldi for being so generous with their contacts and putting me in touch with key interviewees. This research would not have been possible without the help of many people in Chile who opened doors for me along the way: Tomás Chuaqui for hosting me as a visiting researcher during my fieldwork at Instituto de Ciencia Política, Pontificia Universidad Católica de Chile; Nirvana González and Adriana Gómez Muñoz at RSMLAC for the warm welcome, for sharing information and giving me the key contacts to kickstart my fieldwork; Claudia Dides at FLACSO for her time and opening the door to politicians and sharing her knowledge. To Marion Khamis for the chats, advice and constant optimism. To my family members in Chile for being there for me, always. In particular Mauricio Horta, Patricia Martínez, Gonzalo Martínez, and Eduardo Sepúlveda for being more than cousins, and for welcoming me into your homes. Of course to all the people who kindly accepted to be interviewed, spent time sharing their knowledge and experiences and allowed me to use their contribution in this research. A special mention for my parents who have made so many sacrifices since I was a child to give me all the opportunities I have had; for their unconditional love and support, for simply believing in me, but most importantly, for being the greatest and most selfless grandparents. To my sister Angélica for being my other half, my sunshine, always. Finally, to Maxime, my husband, for being there despite the difficulties, for sharing, loving and caring. For everything: Tout simplement. This thesis is dedicated to Gabriel, my source of energy, my hope and happiness. To Emilia and Joaquín, because I want your world to be a better one. TABLE OF CONTENTS Glossary ......................................................................................................................... i Brief timeline for the EC legal and political process ..................................................... iv Visual timeline and description of the stages of the judicialization process ................... vi CHAPTER 1: Introduction ........................................................................................ 1 Contribution of the thesis .......................................................................................................... 5 The thesis and EC ..................................................................................................................... 5 Emergency contraception in Chile ............................................................................................ 6 Abortion in Chile ...................................................................................................................... 8 The policy and institutional environment defining policy-making in Chile ............................. 9 The policy process, policy-making and the feminist critique of New Institutionalism .......... 12 Outline of the thesis ................................................................................................................ 15 CHAPTER 2: Locating and Contextualising the Research ..................................... 20 Introduction ............................................................................................................................. 20 General overview of the literature .......................................................................................... 21 The legal view on women’s SRHR and the judicialisation of EC .......................................... 26 The EC “saga” in Chile ........................................................................................................... 29 The EC pill and the controversy surrounding it ...................................................................... 34 The Catholic Church’s international mobilisation against SRHR and EC ............................. 35 The Vatican forging international alliances and the resistance of global civil society ........... 36 The Church and SRHR in Chile.............................................................................................. 39 The attack on scientific evidence and evidence-based health policies ................................... 39 The role of the medical establishment .................................................................................... 41 The role of strategic alliances in promoting SRHR ................................................................ 43 Pharmaceutical companies and pharmacists ........................................................................... 45 The politics of sexuality and reproduction in Latin America and Chile ................................. 46 The women’s movement and feminists in Chile ..................................................................... 50 The SRHR agenda in Chile ..................................................................................................... 52 SRHR, the state and institutions ............................................................................................. 54 SERNAM and feminist policy-making ................................................................................... 54 Feminists and the executive v legislative battle ...................................................................... 56 The SRHR Bill ........................................................................................................................ 56 SRHR policy-making: Actors, class, institutions and the state ............................................... 57 Conclusion .............................................................................................................................. 63 CHAPTER 3: Conceptual Framework and Methodology ...................................... 66 Institutionalism: New and Feminist ........................................................................................ 67 New Institutionalism ............................................................................................................... 68 Feminist Institutionalism ........................................................................................................ 69 Women’s agency and Feminist Institutionalism ..................................................................... 71