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HEALTH-CHILE: ‘Morning After Pill’ for Everyone – for Free

Daniela Estrada

SANTIAGO, Sep 4 2006 (IPS) - The Chilean government decreed that all public health centres must provide birth control, including emergency contraception, to adolescents and women over the age of 14 – a measure that immediately drew the ire of the Catholic Church and the right-wing opposition parties.

“We applaud the decision of the Chilean Health Ministry, because we believe it safeguards the rights of women and gives us a chance to interrupt the cycle of poverty,” Ximena Rojas, assistant director of the non-governmental Centre for the Development of Women (DOMOS), remarked to IPS.

After President Michelle Bachelet, a pediatrician, took office in March, Domos asked the Health Ministry to expand the distribution of emergency contraception.

The measure, announced Saturday by Health Minister Soledad Barría during the fifth Chilean Congress of Pediatric and Adolescent Obstetrics and Gynecology, forms part of the new “national norms on fertility regulation” that will begin to be applied this month in all public hospitals and clinics around the country.

Any teenage girl over the age of 14 will now be able to directly ask her doctor for a prescription for birth control, without authorisation from her parents, and the contraceptives must be provided free of charge by the public health system.

The new decree complies with the sexual and reproductive rights approved at the 1994 United Nations International Conference on Population and Development in Cairo.

The most controversial aspect of the Health Ministry decree is that it not only covers traditional birth control methods, but also emergency contraception, which up to now was only available free of charge in cases of rape, although it was available by prescription in the country’s pharmacies.

Although it is popularly known as “the morning after pill”, emergency contraception can be taken up to five days (120 hours) after unprotected intercourse. The pill works by providing high levels of synthetic hormones, which interfere with ovulation and change the lining of the uterus, significantly reducing the likelihood of pregnancy.

The World Health Organisation (WHO) clarifies that emergency contraception is “not effective once the process of implantation has begun, and will not cause abortion.”

But archbishop of Santiago Francisco Javier Errázuriz said the decision by the centre-left government was a blow to marriage, the birth rate, and the Chilean family.

“I was hoping for good news for Chile at the beginning of the month of the fatherland,” said Errázuriz, referring to the fact that on Sep. 18 and 19, Chile will celebrate 196 years of independence, and will pay homage to the army. “But it is not good news for a country to be obsessed with contraception.”

Several mayors from right-wing opposition parties also rejected the government decree, and threatened not to respect it. (Municipal governments are in charge of administering the public health clinics.)

In response, Barría warned that the new decree was “compulsory.”

Marta Ehlers, mayor of the upscale Santiago district of Lo Barnechea and a member of the right-wing National Renovation party (RN), said she was “indignant” over the news, and announced that she would not permit the distribution of emergency contraception pills, even if it is mandatory.

“If they take strong measures against me, I will accept them or I will fight, but I will not distribute the pills,” she stated.

Socioeconomic, ethical, moral and demographic arguments have all been raised in the heated debate. While the government says the measure is aimed at curbing the rise in unwanted and teen pregnancies and illegal abortions, the Catholic Church and the right-wing parties argue that the role of the family should be strengthened instead, and that (limited) sex education is needed rather than free birth control.

Conservatives also fear that making emergency contraception widely available could further reduce the birth rate. According to Health Ministry figures, the birth rate dropped from 2.5 children per woman in 1983 to 1.9 in 2003 – a 24 percent reduction in 20 years.

“In our view, the morning after pill generates abortion-like situations, which is why it should not be distributed at all – neither to girls under 14 or over 14, with or without parental authorisation, or with medical certification,” Senator Andrés Chadwick of the ultra-conservative Independent Democratic Union (UDI) party said on Sunday.

But Rojas said “The measure is health-related, and should be approached from that angle. This cannot be seen as a values issue. International experience shows that norms of this kind do not lead to an increase in promiscuity.”

The parties making up the centre-left governing coalition are generally in favour of the measure. However, they asked the Ministry for more information on Monday, as they were concerned about how much guidance and information adolescents would receive from their health providers.

Government spokesman Ricardo Lagos Weber said “this is not about handing out contraceptives in bulk,” but about promoting responsible sexuality among young people, by providing comprehensive information and advice.

“Sales of the morning after pill are perfectly legal today, in the eyes of the courts, including the Supreme Court,” but only those who can afford the pill have access to it, said Lagos Weber. “I believe it is fair to give all Chileans access to the entire range of birth control methods,” he added.

“What we cannot do is pretend that these problem don’t exist. In Chile, 14 of every 100 young people are sexually active by the age of 14,” he said.

According to the Health Ministry, the number of adolescent girls and women obtaining birth control from the public health system climbed from 600,374 in 1990 to 1,087,743 in 2004 – an 81 percent rise in 14 years.

In the Americas, emergency contraception is now legally available in Argentina, Bolivia, Brazil, Canada, Chile, Colombia, the Dominican Republic, El Salvador, Jamaica, Mexico, Nicaragua, Paraguay, Peru, Trinidad and Tobago, the United States, Uruguay and Venezuela.

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