Politics and the morning after pill

SANTIAGO — Opposing sides in Chile's brewing political showdown over women's reproductive rights have fired their latest salvos, spurred by a decision to ban distribution of the morning after pill in the public health system.

The Comptroller General's decision in June was billed as the final word in a long judicial battle pitting the government — which had included the pill in its birth control guidelines — against conservative lawmakers, the Catholic Church and pro-life groups.

But women's rights groups, political leaders and NGOs from around Latin America have been joined in the debate by presidential hopefuls, making contraception a hot-button topic in Chile.

Immediately after the Comptroller General's decision was announced, more than 100 women took to the streets, shouting: “Citizens, on alert! The Comptroller is in your bed!”

Then, a public statement from nearly 120 women’s organizations, political leaders and NGOs from Chile and Latin America called the comptroller’s resolution “another example of the extreme social, moral and institutional conservatism in our country, which certainly doesn’t represent the views of the majority of the population."

More recently, candidates in Chile's presidential election, set for December, have made the issue one of rich versus poor in terms of access to contraception.

The modern chapter in the war here over the morning-after pill traces its roots to 2006, when the Health Ministry included the contraceptive — whose technical name is Levonorgestrel 0.75 — in its reproductive health guidelines, and was set to distribute it for free in the public health system.

The sale and distribution of the pill were approved by the Public Health Institute in 2001, when current President Michelle Bachelet was minister of health. It was already being sold in pharmacies with a prescription.

An indignant Bachelet, herself a doctor, introduced a bill in congress to guarantee “every person, regardless of their economic situation,” free access to the pill.

"The state isn't imposing anything on anyone," Bachelet said. "Each person may decide on her own, but the state must guarantee equal conditions of access to birth control methods."

 

The bill was passed in the lower house and now awaits approval in the senate, dividing the once monolothic conservative rightist opposition. Legislator Marcelo Forni, from the ultra-right party UDI opposing this birth control method, went as far as to say that his party "is not here to legislate in favor of the majority, but for the good of society. Today, promoting natality is good for Chilean society."

Meantime, a group of 36 right-wing lawmakers, many of them members of conservative religious groups, appealed the Public Health Institute ruling on the sale and distribution of the pill to the Constitutional Tribunal. In April, 2008, the court ruled that the morning-after pill could not be part of the ministry’s birth control program, and prohibited its distribution.

Despite the decision, the government decided to provide the pill through municipal health clinics, and through partnerships with NGOs. Some municipalities assumed the cost, and continued to offer the pill for free.

This time, it was the Association of Municipalities that cried out, saying the central government could not impose its reproductive health policies on them, and took the case to the comptroller general. The comptroller’s June 18 decision extended the prohibition to the entire public health system, including municipalities and institutions that work with the health ministry.

“Those opposed to this emergency contraceptive are a group of people that call themselves ‘pro-life,’ who are well organized and have significant power and influence," said Dr. Soledad Diaz, president of the Chilean Institute for Reproductive Medicine (ICMER). "They have a very stubborn doctrinaire position that doesn’t want to recognize the scientific evidence that says the pill is not abortive. It’s an ideological position, there is no other explanation.”

The government has insisted the pill is not a method for abortion, which is illegal in Chile, even when the mother’s life is endangered. Myriad bills to allow abortion under extreme health circumstances — which the military dictatorship prohibited in 1989 — have been opposed by lawmakers and religious leaders, although public opinion overwhelmingly trends in the other direction.

Scientific research has shown that Levonorgestrel 0.75 works by preventing an embryo from embedding in the uterus.

The morning-after pill itself remains legal and any health professional can prescribe it, but the vast majority of Chilean women in the public health system can’t afford it.

The ultra-conservative Congressman Jose Antonio Kast, who spearheaded the campaign against the pill, says that the pill "shouldn’t be allowed to be sold anywhere, not even in pharmacies."

Meanwhile, presidential candidates on the left and right assure their potential electorate that they too support the same rights for rich and poor alike. This included the government candidate, Christian Democrat Eduardo Frei, who just three years ago sided with pro-life organizations and Catholics against the distribution of the pill. Another one to flip is right-wing candidate Sebastian Pinera, whose coalition firmly backs the prohibition.

“If this contraceptive is not made available to all women, we run the risk of having more abortions, but even more serious is that these abortions are not practiced in adequate conditions, especially in the case of low-income women,” said Grace Schmidt, president of the Chilean Association for the Protection of Family (Aprofa), which also announced it would continue to provide the pill at its youth centers.

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