Life Under the World’s Strictest Anti-Abortion Law

Santiago Times

A wavy-haired woman with a kind voice speaks into the camera. “I’m going to tell you how to do it.” Behind her, sun shines in Santiago, Chile. Cars honk; big red buses whiz by; men and women amble toward work.

The woman continues her instructions. Leave your house and buy something you normally would, she says: a newspaper, maybe, or bread. Then head to a busy intersection. “You’ll notice how some cars run the traffic lights.” Her face is serious. “Actually, they say that the faster they’re going, the slower their reaction time.”

Pick the car most likely to speed up at a yellow light, she says. Angle yourself so they’ll hit you directly—bumper to belly.

Then cross.

In an instant, tires screech. There’s a sickening crunch. The screen goes black. A beat later, white letters appear: “In Chile an accidental abortion is the only kind of abortion that is not considered a crime.”

This video is one of several in a campaign by Miles Chile, a non-governmental organization based in Santiago that advocates for reproductive and sexual rights. These disturbing mock tutorials garnered coverage by the Associated Press, The BBC, The Daily Beast, The Telegraph and more. With the advent of misoprostol, clandestine abortions in Chile now typically involve much less violent means. Yet for women facing unplanned pregnancies, the fear and desperation illustrated by the videos continues to be the status quo.

Since Chile’s abortion ban was put in place in 1990, 28 legislative efforts have been made to modify or overturn it. Now, in the final months of President Michelle Bachelet’s administration, progressive and center-left lawmakers are giving it another try. A new bill would decriminalize abortion in limited circumstances: in the case of fetal non-viability, to save the life of the pregnant woman and for pregnancies resulting from rape.

The bill, which is currently stalled in Senate committees, has drawn significant international approval, including—during Bachelet’s recent visit to Canada—accolades from Canadian prime minister Justin Trudeau. Yet it remains to be seen whether it will be passed into law before the end of Bachelet’s term.

Chile has never had legalized on-demand abortion. But in the 1930s, Chile began allowing abortions when the pregnant woman’s life was at risk. This loosening of the law—along with a government focus on family planning—helped patients and doctors make reasonable decisions focused on health and well-being, rather than religion or politics.

This all changed in 1990, when, in the twilight days of the military regime, Chilean general and dictator Augusto Pinochet passed a total abortion ban. A nationwide plebiscite had already voted no on eight more years of military rule. Pinochet agreed to step down and let the transition to democracy to begin. Dr. Dominique Truan, a Santiago obstetrician, called the law “the dictatorship’s final gift.”

Still on the books today, the law punishes both women who seek abortions and abortion providers. It makes no exception—not for rape, severe fetal abnormalities or to save the pregnant woman’s life. This stripping of women’s rights seemed brutally fast from the outside. But it had been set in motion decades earlier, in a debate that began shortly after Chile’s 1973 coup d’état.

Jaime Guzmán was a member of the small, all-male military junta that functioned somewhat like a legislative branch in the early days of the dictatorship. He was a close advisor to Pinochet and the founder of the Independent Democratic Union (UDI), which holds significant power in Chile to this day. The UDI staunchly opposes any pro-choice legislation—in a 2016 Senate debate, one UDI senator equated abortion with eugenics and another compared those who would legalize it to Nazis.

Guzmán proposed outlawing therapeutic abortion shortly after Pinochet seized power in 1974. Along with lawyer Alejandro Silva Bascuñán, Guzmán dreamed of solidifying the sacredness of unborn life by crafting it into the dictatorship’s new Constitution. He suggested adding the language “the law protects unborn life”— ensuring that under Chilean law, abortion and murder would be one and the same.

In Guzmán’s view, there were no circumstances that warranted an abortion. “The mother must give birth to her child,” he argued while pushing for his constitutional reform, “even if it will be born abnormal, if she did not plan it, if it was conceived as a result of a rape, and even if giving birth will kill her.”

Guzmán believed that most humans lived their lives in a moral gray zone, doing things that were neither good nor bad, neither evil nor divine. Women faced with a decision—abort or die—were called by Providence to a crucial crossroads to choose between moral failure or martyrdom. And although his views were initially rebuffed as too extreme, even within the right-wing dictatorship, the regime slowly created a society in which a total abortion ban would become feasible.

In the previous government, there had been 15 women amongst the senators and deputies; Pinochet excluded women from his legislative branch. The dictatorship instead fostered a culture in which maternity was the central tenet of womanhood, encouraging women to stay home and have large families. From 1979 to 1985, the government pursued an aggressive pro-natalist policy, campaigning against birth control and making family planning services increasingly difficult to access. Yet abortion was not a major issue or topic of discussion for the military dictatorship until the 1988 plebiscite, and afterward, members of the military junta suddenly faced a ticking clock.

Chilean citizens had voted decisively for a return to democracy. What would they do with their final days in power?

The naval admiral José Toribio Merino, one of the coup’s chief architects and a member of Pinochet’s elite inner circle, decided to take up a very particular cause—banning abortion completely. Contacts at the Vatican urged him along. Hadn’t he seen what happened in Spain, after Franco died? Didn’t he want to tighten up the law before the country began its inevitable march toward liberalization?

Merino consulted with a Polish priest and an economist from the Universidad Adolfo Ibañez’s business school in Valparaíso. This unlikely, non-uterus-having trio drafted a constitutional argument against a woman’s right to terminate a pregnancy threatening her life. Their efforts were almost thwarted again when the junta decided the measure was too extreme, but one of the legislative commissions had a useful suggestion: perhaps the government should investigate the reasons women choose to abort. Another pointed out the law would unfairly burden women with fewer resources.

Merino grew concerned. He saw his opportunity slipping away. In a last-ditch attempt to pass the ban, the 74-year-old man wrote a letter to his colleagues, lamenting a future in which “fundamental values like family, human life and country” would “disintegrate.” He begged God to illuminate the “grave responsibilities” his colleagues bore on their nation’s behalf. Jorge Arturo Medina, a bishop from Rancagua, Chile—now a cardinal at the Vatican—wrote another letter of support.

Three and a half months later, on September 15, 1989, abortion under any circumstance became punishable by law 18.826, which read: “No podrá ejecutarse ninguna acción cuyo fin sea provocar un aborto”—or roughly, “No action meant to cause an abortion can be taken.” With a single sentence, Chile became the only country to have had modern abortion legislation and subsequently revert to complete prohibition.

Ever since, activists, progressive lawmakers and feminist NGOs have been trying to overturn this 1990 law. Now, in the final months of Bachelet’s presidency, there’s still hope that abortion reform—one of her key legislative initiatives—will pass.

Lidia Casas works in an old, pretty building in the center of Santiago. On the corner, men sell bottled sodas to cars idling at stoplights. A security guard lets me through a metal gate. Casas is a legal scholar, professor and researcher at the Universidad Diego Portales who focuses on reproductive justice and violence against women. She lived in Canada during Pinochet’s dictatorship. Returning in 1990 after years abroad, she saw her home country in a different light.

“I realized how bad things were,” she said. “Having lived in Canada made me think about the predicament of women in this country. I come from a working class background, and when we were in Canada, my mom, for the first time, spoke about abortion.” She credits the more liberal Canadian culture with giving her mother space to share stories about abortion, including the experiences of aunts who had sought clandestine abortions in Chile back in the 1970s.

As a law student, Casas began doing research on women criminally charged for having abortions. She was granted access to the Legal Aid files in the women’s prison in Santiago, where many of the women facing charges were held. “It was spooky,” she said. “I was alone, no one around, the bars on the windows. Looking at really old files. At whatever notes people had made.”

This research and other studies on the effects of abortion criminalization in the 1990s began to highlight the injustices built into Chile’s legal system. Just as the government predicted, poor women were much more likely to be criminally charged for terminating pregnancies. This was due at least partially to inequalities in health care: upper-class women could seek out safer abortions in private doctor’s offices or even abroad, while poor women often needed medical attention for clandestine abortions gone wrong. Many of the women facing charges had been reported by staff at public hospitals—a trend that continues today. “The research in the 1990s showed all the injustices the abortion ban has on women,” Casas said, “and how the law impinges upon poor women.”

Yet discussing this injustice continues to be taboo. Helia Molina was Chile’s Minister of Health in 2014 when she gave an interview with newspaper La Segunda and explained that many girls from wealthy, conservative families had sought abortions in fancy Santiago clinics—using a pejorative term for rich, “cuica,” that touched a nerve in class-sensitive Chile. After intense backlash, Molina released a statement clarifying that the comment had been a “personal opinion” and she regretted “stigmatizing certain sectors of the population.” Later, she was forced to resign.

In Casas’s view, legalizing abortion in Chile would not only help fight inequality—it would also help challenge long-established gender norms. “Women are contesting their traditional roles,” Casas said. “Gender, as a political stance, is being contested. The traditional views of women, men’s role in society. And for many people that’s so dangerous. They fear change.”

Marge Berer, the founding editor of Reproductive Health Matters and current coordinator at the International Campaign for Women’s Right to Safe Abortion, agrees with Casas’s assessment. “When I was young,” Berer said in a phone interview, “the way I was taught about abortion was that it was the keystone of women’s liberation. That until a women was able to take a decision whether and when to get pregnant, she wasn’t a free person. And she didn’t have autonomy. Because pregnancy is probably the best way to keep women down that there is. And keep them tied to the kitchen and the cradle.”

In the 1970s, Berer taught English to Chilean exiles who fled to England after the coup d’état. She’s been following the country’s political evolution since she made those connections in the dictatorship’s early years. “In a way, the fact that this issue is on the table at all, is quite extraordinary,” Berer said. “For me, it’s a sign that democracy is really, truly returning to Chile.”

Some of the resistance to Chile’s abortion ban is coming from within the medical establishment itself. Dominique Truan is an obstetric gynecologist specializing in high-risk patients. She has a sizzling energy and a doctor’s penchant for delivering complex facts in clear, succinct terms. We met at a café in Providencia—an old, well-off neighborhood in central Santiago. We chatted in Spanish about how the abortion law has affected her practice and her professional goals.

Truan was not always all that interested in abortion rights. When the Chilean government explored relaxing its stance on therapeutic abortion, Truan became frustrated with the rector at the Universidad Católica, who said he would employ his right to conscientiously object—on behalf of the University’s entire hospital staff. Truan found this appalling, but for a theoretical, rather than practical, reason: it violated her basic sense of what a conscientious objection should be.

“I decided to write a letter,” she said. “I wanted to explain that a conscientious objection was something personal. You can’t object for an entire hospital. It needs to come from the individual.” She approached her colleagues, professors and mentors. She wanted more signatures for her letter and figured her common-sense stance would be uncontroversial. But nearly everyone declined.

“That’s when I realized they see us as incubators,” Truan said. “That’s when I realized how much machismo there really was.” This anger led Truan to pro-choice groups, and eventually to stints in the United States, Canada and Mexico, where she learned from abortion doctors and other OB-GYNs specializing in reproductive health. She was especially impressed by the system in Canada—the privacy and security of the abortion clinics, the respectfulness of the staff.

The more time Truan spent in the pro-choice world, the more she felt at home. “People who work in abortion are interesting, generous,” Truan said. “It’s an active group, generating so much positive change.” She’s also been impressed with the feminist groups in Chile advocating for reproductive rights. “They’re awesome. They’re fighters. They’re consistent, and live out their beliefs.”

In the years since, Truan has explored the arguments for and against abortion, and the many ways people analyze the issue: social, moral, historical. As a physician, she prefers to approach things from a scientific perspective. Because access to safe abortion lowers maternal and adolescent deaths, she said, as a doctor it simply makes sense to support it. “I tell my students,” she said, “what you think, believe—that’s one thing. But you have to leave that at home. When you arrive to work, it’s about science.”

Yet neither Truan nor her students can legally perform an abortion at a patient’s request. The Medical College of Chile only permits it in cases where the pregnant woman’s life is in imminent danger, a directive that technically conflicts with the Chilean Penal Code and is permitted in a kind of legal gray area. But things get even murkier from there. The current rule leaves patients somewhat at the whims of their doctor’s personal beliefs, and vulnerable to long- and even medium-term health threats. A woman with an ectopic pregnancy would qualify for an abortion, for example, but a cancer patient forced to stop her chemotherapy because of an unintended pregnancy would not.

The abortion ban affects other aspects of a Chilean doctor’s medical practice, too. Gynecology residents in Chile learn an outdated procedure for clearing the uterine lining after a miscarriage. Dilation and curettage—often called D&C—involves dilating the cervix and scraping out excess tissue and uterine lining that may be left over. The procedure requires heavy sedation or general anesthesia and, because it carries much higher rates of complications such as uterine perforations, in most of the world it is no longer standard practice. Instead, doctors typically use suction aspiration, which is extremely safe and involves only a local anesthetic applied to the cervix. But because aspiration can be used more easily to perform abortions—and at a much earlier stage in pregnancy—Chilean hospitals have declined to make the necessary devices available.

Unlike most of her colleagues, Truan has access to a device for performing aspirations. And she’s developing a plan to make sure all her residents know how to use it. “In the future,” she said, “when [abortion] is legal, it’s important doctors know how to do this.”

Meanwhile, Truan is growing increasingly frustrated by anti-abortion sentiment and how so-called “pro-life” communities see her. “There’s just no logic, no rationale for not defending the right to abortion,” Truan said. “It’s not like I don’t want people to be born. I’m just aware that this reality exists. The woman who wants to abort will abort. Whether it’s safe, or unsafe, or with the help of her next-door neighbor.”

In December 1983, in Santiago’s Caupolicán Theater, over 10,000 women—centrist and progressive, rich and poor—came together to protest the military dictatorship. It was the largest public gathering since the coup ten years before. “Freedom has a woman’s name,” the crowd chanted. This set the stage for subsequent anti-authoritarian protests, in which Chilean women would march and demand: “Democracy in the country, and at home!”

Reading about this march, I couldn’t help but think of the Women’s March on Washington; of Patrisse Cullors, Opal Tometi and Alicia Garza, founders of Black Lives Matter; of Camila Vallejo, who led the student strikes for education reform in Chile; of the Abuelas de Plaza de Mayo, still searching for children kidnapped during Argentina’s military regime; of the 86 percent of calls to Congress since Trump took office, made by women from Maine to California…

Freedom does have a woman’s name. The fight for freedom certainly has a woman’s name. And as Senate majority leader Mitch McConnell accidentally reminded women in the United States, against the odds, against oppression and violence, against governments that would seek to control our bodies, rob us of our autonomy, our identity—we march and shout and teach and lead. We persist.

Truan believes Chile will eventually have safe, legal abortion even beyond the limited legislation currently in Congress. She’s optimistic about the future of women’s rights in Chile and beyond. “Latin America—yes, it has this machismo,” Truan said. “But there’s also an awakening of women right now, in Latin America, in the whole world. We’re headed the right way. Slowly. But we’re moving.”


Erin Becker writes about literature, politics, and women's rights. She lives in the south of Chile, where she is working on her first novel. You can find her on Twitter @beckererine.