Abortion in Chile has been illegal since General Pinochet’s regime, even if the foetus has died or the mother has been raped. Ellen Jones looks into the chilling world of black-market abortions and wonders whether, finally, the winds might be beginning to change?
Photos by Morten Andersen.
Chile is one of only five countries in the world – including the Vatican City – where abortion is completely illegal under all circumstances. Any woman or doctor inducing an abortion can be charged with homicide and sentenced to three to five years in prison. Even ‘therapeutic’ abortion, performed in order to save a woman’s life or to remove a lifeless foetus, is forbidden. Even if the woman has been raped the law is unbending. Nevertheless, according to the National Institute of Statistics, 160,000 illegal abortions are carried out in Chile every year.
At the age of 24, Ana Luisa was rushed to hospital with a severely swollen, inflamed red belly, the result of an acute uterine infection caused by pushing pills into her own vagina to induce an abortion. Mistrust of doctors led her to avoid seeking medical help until the very last minute, and with good reason; the first thing the gynaecologist did on recognising the signs of a provoked miscarriage was threaten to call the police. This was Ana Luisa’s fourth illegal abortion; her first was when she just 19.
Often unable to rely on a partner or family member to accompany and support them, many young women seek medical abortions online, with very little to tell them whether or not the source can be trusted. Ana Luisa met a complete stranger alone at a metro station: ‘He drove me to his house’, she says, ‘after he’d administered the pills he just left me. He told me to ring him when I started to feel pain’.
The drug Ana Luisa was given is known as Misoprotol, more commonly marketed in Chile as ‘Misotrol’. It is sold throughout the internet with a sign that warns it can cause ‘abortion, premature birth, birth defects, and uterine rupture’ in pregnant women. The pills are desinged for the treatment and prevention of gastric ulcers, to be taken orally, with food. However, thousands of women are inserting them deep into their vaginas, leading to minor contractions that shake an embryo loose from the uterus wall.
Not always, however. Used in a pregnancy of more than two months, Misoprostol is more likely to cause severe damage to the health of both child and mother than to induce an abortion. Even before that point it can be less than effective, as with Ana Luisa: ‘They had to give me a double dose’, she explains, ‘because the contractions hadn’t been strong enough. Even then it didn’t work, and the doctor had to insert a plastic tube into my cervix and suck it out with a syringe’.
With enough money, it is possible to obtain a safe abortion in Chile just like anywhere else in the world, despite it being illegal. If the baby is too far along for a medical abortion, (that is, an abortion using drugs) small, well-regarded private clinics, such as Las Nieves and Las Lilas in Santiago, offer surgical abortions from fully qualified doctors. The patient walks out, bed-rested and healthy after two days, as if she had undergone any other standard surgery. Nobody says a word.
The price is high, however. The incentive for doctors to break the law rarely comes from a belief in the woman’s right to choose, but from the money they can make – up to US$2000 per abortion. With ten clients or more every day, it’s worth risking a prison sentence for. These procedures, as with anywhere else, do of course come with certain risks attached. General anaesthetic can compromise the muscles used for respiration, and there is always a risk of infection if the clinics are not impeccably clean.
However, it is not these expensive surgical abortions that cause so much harm to would-be mothers. According to Sernam, the National Women’s Service in Chile, 10% of maternal deaths are as a result of unsafe abortions. Rudimentary ‘homemade’ recipes are often used in rural areas, where the US$80-100 for Misoprostol is hard to afford. In some regions parsley is inserted into the uterus, causing an infection that loosens the embryo. In the north a herb called borage, or ‘la borraja’, is boiled and drunk in copious quantities, affecting the body’s hormone production, having the same effect. In some cases women even resort to punches to the stomach, deliberate falls or sharp objects such as knitting needles inserted into the vagina to induce an abortion. All these methods, and indeed Misoprostol, can result in acute bleeding and dangerous infections similar to appendicitis, resulting in the need for a hysterectomy. It was this kind of infection that Ana Luisa contracted after her fourth abortion, causing her such pain, as her belly reddened and swelled.
In recent years liberal politicians in Chile have tried to raise the issue of legalising therapeutic abortion with little success. However the winds might be changing. In December 2010 for the first time a member of one of the ruling parties openly showed her support for therapeutic abortion. Evelyn Matthei is a senator of the UDI, the Independent Democratic Union Party, currently forming a right wing coalition called Alliance for Chile with the National Renovation Party. Matthei’s proposal that therapeutic abortion be legalised was co-sponsored by the Secretary General of the Socialist Party and senator for the northern Tarapacá, Arica and Parinacota regions – Dr Fulvio Rossi Ciocca.
‘There is a huge abyss between politicians and the people who are represented by the politicians’, explains Dr Rossi, outlining some of the reasons why therapeutic abortion has remained illegal. ‘The statistics say that 65-70% of the population is in favour of therapeutic abortion. However, politicians do not react, and have never reacted to the reality of public opinion’.
With Matthei’s initiative going against the core beliefs of her own party, she will be hard pressed to maintain the strength of the campaign without losing her position as minister. Leader of the National Renewal Party, Carlos Larraín, has forcefully condemned the initiative, claiming he would leave the party if the coalition publicly gave her its support. He even suggested on local television that therapeutic abortion would lead to full legalisation of abortion, selective abortions and even euthanasia ‘as practiced by the Nazis, the communists and all of the totalitarian regimes’. Such intransigence among respected and influential politicians put Rossi and Matthei’s efforts into some perspective.
What is so remarkable is that despite its continued illegality, a medical abortion is very easy to obtain. To say nothing of common herbs such as parsley or borage, even Misotrol is sold on practically every street corner. ‘I looked it up on the internet, and it was full of adverts, full, full, full, all saying “I sell Misotrol, I sell Misotrol”’, recounts unmarried Gabriela who became pregnant last year. ‘I rang three different people and they all wanted to sell it to me on the spot’. She confesses she had little fear of getting caught: ‘the only thing that scared me was if the abortion didn’t work and I was left with birth defects, with health problems. That scared me – having to live with that responsibility’.
In the five years since Ana Luisa had her first abortion, Misoprostol has become more expensive as demand has increased. They have also become harder to obtain through legitimate doctors. Many women mow buy the pills off the internet, with little idea of how to use them. I myself am given a name, Nicolás, and a number to call. I’m told they will cost me 50,000 Chilean pesos, the equivalent of about US$100, and that I’m to meet him at a busy metro station at rush hour, that I’m not to worry, he is going to make sure I’m OK and tell me exactly how to use them. A thirty-second phone call is all it takes.
Nicolás is a visiting doctor who for five years has been helping women through abortions. He not only sells the pills but often administers them himself if there is no partner, friend or family member who can be relied on. He explains at length how to use the Misotrol and the accompanying pills that dilate the uterus, what to eat and drink and when, what exact position to lie in and when it is safe to take painkillers. He follows up with every client to make sure there have been no complications, recommending they visit a gynaecologist when the ordeal is over. He strives to offer any emotional support he can. Any pregnant woman contacting Nicolás is, I fear, one of the lucky ones.
‘The pills are now banned in Chile’, he remarks, ‘you can’t buy them in pharmacies here anymore. After a fourteen year old girl bought them to try and induce an abortion eight months into her pregnancy they decided they were no longer safe to market’. Nicolás now brings the drugs over from neighbouring Argentina and Bolivia.
Far from being just the frivolous youth that find themselves with unplanned pregnancies, women of all ages are choosing to have terminations, many because they are unable to provide for the baby. In fact, surveys of women hospitalised in Santiago after complications resulting from abortions show that the majority of women who abort a pregnancy are over twenty years old, married and already mothers. This contrasts to the majority of European countries where the majority of women seeking abortions are young, single and childless. Difficult social and economic conditions mean that many families abort a pregnancy because they already have more children than they are able to care for. The number of abortions sought in Chile is vastly higher than, for example, in the UK or Spain, relative to population.
So why do so many women in Chile resort to abortions? ‘We have a Catholic Church and right-wing party that together have a tremendous influence over politics in this sphere’, explains Dr Rossi. ‘For example, there is practically no sexual education in schools’. The Church’s influence in the class room has gone a long way to impeding the development of sexual and reproductive rights in Chile. Santiago’s Universidad Católica, a private institution and arguably the most reputable university in the country, teaches its medical students that abortion and the morning-after pill are immoral.
Whilst condoms and other forms of contraception are readily available, lack of information means that many women remain ignorant of their correct use. Nor do most women understand their body cycles, remaining unaware of when they are most likely to conceive. There is also the stigma to be considered. In a country where using tampons rather than sanitary towels is considered ‘slutty’ because of their invasive nature, it is easy to imagine many women baulking at the idea of having to ask their GP or pharmacist for contraception. Religious pro-life organisations, whose arguments are based on values such as love, fidelity and abstinence, play a powerful part in proliferating this stigma: ‘The evidence shows that the culture of contraception has destructive consequences for society’, argues Salvador Salazar, President of the vocal pro-life group, Muévete Chile. ‘It has caused sexual activity to become a game, a rise in the number of teenage pregnancies, abortions, diseases such as HIV, and divorces’. Some couples, therefore, instead rely on the traditional rhythm and withdrawal methods, which have high rates of failure.
An interesting dichotomy becomes clear when we consider that, whilst an illegal abortion can be obtained with relative ease, the morning-after pill is comparatively difficult to obtain; despite it being legal. The religious right in Chile tend to argue that the morning-after pill, taken up to 72 hours after unprotected sex, is micro-abortive, killing an embryo in the very early stages of life. Many pharmacies, therefore, refuse to sell it because of its moral implications, even though it’s legal. Dr Jean Romagnoli, the doctor in charge of maintaining the health of the 33 trapped Chilean miners last year, condemns this view. He argues that the pill has never been proven to be abortive and that it is an effective way of preventing unsafe abortions: ‘I am totally supportive of it. I think it’s a mature way of confronting this type of problem. A post-rape victim could take it, for example’.
‘Socially it is not cool for people to know you have had an abortion’, Romagnoli continues, ‘the shame and social punishment are almost worse than the legal punishment, than spending five years in prison’. There is a stigma attached to admitting you have had an abortion, a stigma that is propagated by the Church and by pro-life movements that will do all they can to prevent therapeutic abortion from becoming legalised. ‘Therapeutic abortion doesn’t exist’, argues Salvador Salazar, President of Muévete Chile, ‘in no way does abortion constitute a therapy’.
When asked how he felt about Chile being one of only five countries that doesn’t permit therapeutic abortion, he answers ‘We feel enormous pride – an immense pride that we defend the voices of those who have no voice, in the middle of a desert that does not want to listen’. They clamour for an unborn child’s, a foetus’s, even the smallest embryo’s right to life, and strive to defend those who are utterly defenceless.
The reality is that there are many Chilean women who agree with him. ‘Although panic gripped me when I found out, I never thought about aborting’, says Maria, raped repeatedly by her father from the age of fourteen. She fell pregnant at 16, and decided to keep her daughter: ‘I couldn’t go from being a victim to victimising someone else, I couldn’t be worse than the pig that had taken away everything that was most important to me’. Maria’s daughter was born with severe genetic abnormalities that mean she will always be very ill. Nevertheless, Maria maintains: ‘I love all my children equally, regardless of how they came to be in my arms’.
It is, after all, no wonder abortion is so controversial, not just here but around the world. The termination of a pregnancy has a profound emotional impact on a woman, whatever her beliefs or reasons for doing it. Ana Luisa describes her fascination with the foetus she aborted two months into her pregnancy. ‘Rather than just coagulated blood I could see the foetus itself, inside a sack about the size of a lemon’ she describes with difficulty. ‘It had a white body with just two black dots for eyes and a spot where the heart would be. I couldn’t stop looking at it’. Ana Luisa decided to have an abortion because she fell pregnant while she was still studying, and her short-term boyfriend wasn’t ready to be a father. ‘We both cried when we saw it. Me because I had wanted to be a mother. Him because he had to watch me cry’. Their relationship ended only a month later.
Gabriela had the opposite reaction. ‘I didn’t want to look at it. The hardest thing I’ve ever had to do was to flush that toilet. That was the hardest. I had to do it really quickly – done, finished, over. I wouldn’t do it again. I wouldn’t be able to’.
It is easy to imagine the lasting repercussions of such an action, and why it inspires such powerful and conflicting opinions. Salazar, President of Muévete Chile, believes that, in addition to killing an unborn child, an abortion kills a part of the mother at the same time. When we consider the emotional upheaval that goes hand-in-hand with deciding to terminate a pregnancy, this opinion holds some sway.
Quite aside from the fact that the prohibition of abortion in Chile encourages many women to risk damaging their health by having unsafe, clandestine terminations, it also forces some women to continue with a pregnancy under the most traumatic of circumstances. Women who have suffered natural miscarriages do not, as would be the case almost anywhere else in the world, undergo an operation to remove the lifeless foetus, but are forced to carry it to ensure a ‘natural’ birth. A child of 14 who was raped must bear her child despite being far from emotionally mature enough. Situations like these, Dr Romagnoli explains, ‘can lead to depression, stress, mood alterations, suicidal tendencies – a lot of different types of illnesses’.
Whether or not Matthei and Rossi are successful in their campaign for the legalisation of therapeutic abortion, they have at least opened the floodgates for the most open discussion of the issue since its prohibition in 1989, the last year of General Pinochet’s dictatorship. ‘We need to bring the debate to the level of the public, to magazines, television, radio’, declares Dr Rossi. And this is slowly happening. The taboo surrounding abortion is gradually being lifted, with media covering the issue more frankly and objectively than has been seen in years. ‘The solution [to such a high number of unsafe abortions] lies in providing every woman with access to decent health care, to information, and to the morning after pill’, says Dr Rossi. Even if therapeutic abortion does not become legal under the current government, there is at least a movement away from secrecy and shame, from women having to bear the burden of such a monumental decision entirely alone.
Author’s Note: Some of the names of the women in this article have been changed to protect the identities of those who were interviewed.
Ellen Jones is a third year student at St Hugh’s College Oxford studying English and Spanish. She has lived in Buenos Aires, and more recently Santiago de Chile, where she worked as a journalist for media agency AddictVillage. Her work has appeared in Cosmopolitan and Marie Claire, in both Europe and Latin America.