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CHILE: Activists Demand Humane Treatment for Women Who Abort

Daniela Estrada

SANTIAGO, Aug 28 2009 (IPS) - Some 30 members of the Chilean Health Ministry’s Consultative Council on Gender and Women’s Health have asked the government to enforce a directive ordering humane and compassionate treatment for women who have had an abortion.

Three representatives of the Consultative Council delivered a letter to Health Minister Álvaro Erazo Wednesday, demanding that he enforce his own instructions, sent Apr. 24 to the heads of every public health service in the country.

“This is a protest against the disclosure of the identities of young women who had abortions and were admitted to public hospitals,” Adriana Gómez, of the Latin American and Caribbean Women’s Health Network, told IPS. She handed over the letter along with Rosa Ferrada, of the Movement for the Emancipation of Chilean Women, and Rosa Yáñez, of the Open Forum on Sexual and Reproductive Health and Rights.

Gómez was referring to two women who were recently admitted to hospitals suffering from complications after abortions induced with misoprostol, a medicine prescribed for gastric ulcers that is effective for terminating pregnancy.

The names and addresses of the women were reported in the media, and they were both prosecuted for the crime of abortion, which carries a three- to five-year prison sentence.

In Chile, abortion is banned without exceptions, even if the mother’s life is at risk. In spite of this, unofficial figures indicate that between 120,000 and 160,000 women voluntarily terminate their pregnancies every year in this country of 16 million people.

On Aug. 19, a 19-year-old woman living in Santiago was admitted to El Pino Hospital in the municipality of San Bernardo with a life-threatening haemorrhage, after taking misoprostol to terminate a four-month pregnancy.

Misoprostol is also known as RU486 or medication abortion.

Five days later, a 21-year-old woman was admitted to the Concepción Hospital, in the southern region of Bío-Bío, with severe abdominal pain. On examination, doctors found the head of a 21-week foetus in the young woman’s uterus; the rest of the foetal remains were found by the police at her home.

While recognising that abortion is legally regarded as a crime, the instructions sent out by the Health Ministry in April call on health service heads not to extract confessions from women seeking treatment for complications arising from abortions, that could later be used to prosecute them.

Extracting declarations under coercion violates article 15 of the Convention against Torture and Other Cruel, Inhuman and Degrading Treatment or Punishment, ratified by Chile in 1988, the guidelines document says.

Making the health care of these patients conditional upon information about the circumstances of their abortions also violates the right to health protection enshrined in the Chilean constitution, and in the International Pact on Economic, Social and Cultural Rights.

The instructions also point out the obligation to preserve doctor-patient confidentiality and professional secrecy.

“It is the view of this Ministry that, while extracting confessions under coercion from women with health complications arising from an abortion is not a common practice in the health sector, it is nevertheless necessary to explicitly state our policy in this area,” concludes the document, which was seen by IPS.

According to Gómez, the Consultative Council was responsible for prompting the creation of the guidelines document, and is now demanding that it be enforced.

The members of the advisory group who signed the letter to the health minister include representatives of networks, forums, observatories, non-governmental women’s organisations and academic centres.

Far from encouraging debate about the decriminalisation of abortion, however, the cases of the two young women who were treated and whose identities were disclosed at the public hospitals prompted concern in various quarters about the ease with which misoprostol can be obtained on the internet, at a price of between 40,000 and 60,000 pesos (between 73 and 109 dollars).

Misoprostol was developed to treat gastric ulcers, but it also induces uterine contractions. It is a derivative of prostaglandin, and is sold under the brand names of Misotrol and Cytotec. A medical prescription is required to buy it at pharmacies.

But write the name of the drug in any internet search engine, and the screen fills up with advertisements like “Misoprostol without prescription”, “Buy Abortion Pill Online”, “Buy Mifepristone Without Prescription Buy Misoprostol Mail Order – Fast worldwide”, or “Buy RU-486”.

On Aug. 21, Carolina Tohá, spokeswoman for the government of socialist President Michelle Bachelet, called on Chileans to report any drug sales over the internet to justice system authorities, as such transactions are illegal in Chile.

The head of the University of Chile’s Centre for Reproductive Medicine and Integral Development of the Adolescent, Ramiro Molina, said the use of Misoprotol to terminate pregnancy in this country is “much, much” more widespread than is generally thought.

“It is being used extraordinarily frequently (as an abortion method) in every country in Latin America, and Chile is no exception,” he said.

In May, the Women’s Health Network of Chile, an umbrella group of about 30 non-governmental organisations, launched a telephone service to provide advice for women who want to terminate their pregnancies safely with misoprostol.

Similar hotlines, supported by the Dutch NGO Women on Waves, were launched in June 2008 in Ecuador, and this month in Argentina.

The information provided by these organisations is the result of studies by the World Health Organisation, which has included misoprostol on its list of essential drugs for gynaecological and obstetric use, and by the Latin American Federation of Gynaecology and Obstetrics Societies.

Ever since 2001, the state maternity Pereira Rossell Hospital in Montevideo, Uruguay, has included advice on using misoprostol in its pre- and post-abortion counselling.

From May to the present, the Women’s Health Network of Chile has received over 1,000 phone calls from people asking about how to use the drug, which is 80 percent effective before the ninth week of gestation, Siomara Molina of the Network told IPS.

Although a judicial investigation was opened against the Network in Concepción, they have had no trouble so far, said Molina, because “we only pass on information that is in the public domain.”

About the Chilean women who had complications after using misoprostol, Molina said it was her impression that “they used the drug in incorrect doses and in the wrong way.”

“Abortion induced with misoprostol carries the same risks as miscarriages,” which have always been faced and dealt with by women and the health services, she said.

“After the ninth week of gestation, the risk of complications increases,” Molina said. Because of this, in countries where abortion is legal, misoprostol is administered in clinics and hospitals after this stage of pregnancy, she said.

“This kind of situation arises because the Chilean state does not provide women with enough information. If they had known that the dose they were using was not correct, one of these women would not have ended up attached to a ventilator,” she complained.

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