In a decision that gladdened the heart of the country's Catholic hierarchy, the Supreme Court of Chile recently issued a ban on emergency contraception in that sometimes-modern, sometimes-medieval nation. Chile remains the only country on the planet that bans both divorce and abortion without exception. If the Vatican ever had to go into exile again, rather than Avignon, my bet would be on Santiago.

In Chile, there are no legal grounds for divorce; there is no exception for spousal abuse, no exception for adultery, no exception for anything, although annulments are technically possible. The same with abortion--no exceptions for saving the woman's life, for rape or for any other reason. The result? A huge number of illegal abortions, officially estimated at 400,000 per year in a country with a population of 15 million people, compared to 1.2 million abortions in the United States with a population of 275 million--or a rate six times that of the United States. Maternal mortality and morbidity from illegal abortion are high.

One would think the government would encourage any health measure to reduce the clandestine abortion rate, and, in fact, earlier this year the Chilean government through the Ministry of Health and its Institute of Public Health approved one brand of emergency contraception (EC), Postinal, which is also approved for use in many other countries in Latin America and around the world. Anti-abortion organizations, urged on by the Catholic Church, immediately filed suit claiming that Postinal was the equivalent of abortion and hence should be illegal under Chilean law.

EC is generally a large dose of ordinary birth control pills taken within 72 hours of unprotected sexual intercourse (there is some evidence that it is effective if taken within 120 hours of unprotected intercourse). It is 75 percent effective in reducing the risk of pregnancy. Another method of EC is the insertion of an IUD within five days after unprotected intercourse. There are side effects with taking the pills, mostly nausea, but there is no absolute contraindication to a woman taking EC. A doctor's examination is not necessary, and, in some states in the United States, EC is available directly from a drug store without a visit to the doctor. It must be emphasized that EC does not prevent sexually transmitted diseases, such as HIV, and is therefore not to be used as a substitute for regular contraception by both the man and the woman. EC is often called, mistakenly, the "morning after pill."

The Chilean government maintained that emergency contraception was the same as other contraception, the only difference being that it was taken after intercourse (of course, so are some other methods of contraception like douching). The U.S. Food and Drug Administration, when it approved EC for use in the United States, stated that the drug worked in one of three ways: (1) it inhibited ovulation, (2) it inhibited fertilization, or (3) it inhibited implantation. The exact mechanism is unknown, but it may depend on the time during the woman's cycle when it is taken.

Mechanism no. 3, inhibiting implantation, was what caused the Chilean high court to pause. Wasn't preventing implantation of a fertilized egg the same as abortion? No, say most medical authorities, because a pregnancy begins when the egg implants, not before, and thus a pregnancy cannot be terminated (aborted) before then. Anti-abortion groups, on the other hand, define pregnancy beginning at fertilization and any interference with implantation to be abortion. This reasoning flies in the face of biology, since estimates are that as many as 40 percent of fertilized eggs never implant and are therefore, under this definition, aborted by Mother Nature or God.

Nevertheless, the Chilean Supreme Court bought the argument and banned EC under Chile's abortion law. If this reasoning were followed through to its illogical conclusion, other methods of birth control would be banned since they possibly worked in the same manner--the Pill and the IUD to name just two.

The ink was not dry on the Chilean Supreme Court decision when the Chilean Health Ministry stated that it had approved yet another brand of EC for distribution in Chile. Where do things stand now? A constitutional crisis between the elected government and the Supreme Court, with women as the pawn.

As in the United States, the fight over emergency contraception is not about health, or pregnancy prevention or abortion prevention. It is about society's view of women and sex. Traditionalists believe EC leads to nonprocreative sex, sex outside of marriage, and a loosening of morals. In order to preserve their worldview, women's health is sacrificed on an altar of religious purity. Studies indicate that EC, properly distributed, could prevent up to half the abortions in the United States and elsewhere. In the calculus of the Chilean church, this notion is left out of the equation.

Cardinal Francisco Javier Errázuriz, Archbishop of Santiago and the top leader of Chile's Catholic Church, threw himself into the fray by likening the use of emergency contraception to the human rights violations committed by the 1973-90 dictatorship of General Augusto Pinochet.

"Señor cardenal: si usted no la mete, no se meta" (roughly "Mr. Cardinal: If you don't put it in, stay out of it") reads a graffiti along one of the main thoroughfares in the Chilean capital, causing giggles as well as indignation, and graphically highlighting the controversy unleashed by the Catholic Church's opposition to emergency contraception.

Elsewhere in Latin America, EC has been approved in countries like Mexico, Colombia and Brazil. The women of Chile wait.

Alex Sanger
9/21/01