In Chile, free morning-after pills to teens

This month, Chile began to combat the problem of high teen-pregnancy rates by distributing free morning-after pills to girls as young as 14 years old.

Government support of emergency contraception is not unusual in Latin America or in Europe. Last month, the US Food and Drug Administration approved the over-the-counter sale of morning-after pills (known as Plan B), for women over 18. Girls age 17 and under must have a doctor's note.

But the Chilean government, by giving away the pills to such young girls, is igniting a storm of opposition from critics who say it undermines parents and is tantamount to abortion.

On Sept. 2, Chile's health minister, Maria Soledad Barria, announced the distribution of morning-after pills in public health clinics as part of a broader set of new regulations on fertility. Since then, the outcry has been building from religious groups, the political right, and even some of the government's own coalition partners in Congress. Many are up in arms about the measure, which they say encourages early sexual activity.

The Roman Catholic Church, long opposed to the use of emergency contraception, calls it a veiled form of abortion. Last week, Chile's Episcopal Conference released a statement in response to the government's new regulations, saying they were "reminiscent of public policies established in totalitarian regimes by which the State aimed to regulate the intimate lives of its citizens." The Chilean constitution forbids "doctrines against the family or those which advocate violence or a concept of society ... of a totalitarian character."

Chile is predominantly Catholic and, until recently, issues related to reproductive and sexual rights have been dominated by the Church, explains Patsili Toledo, a lawyer who represented a Santiago-based women's center in the legal battle to win approval for legalizing the use of emergency contraception. "Unfortunately, the Church has tremendous political power here.... Reproductive rights are an issue with few political dividends."

On Friday, two conservative mayors in Santiago asked Chile's courts to halt the government's program until the courts consider arguments that it violates the constitutional rights of parents to protect "the physical and psychological integrity" of their children.

President Michelle Bachelet responded to the uproar, arguing that the state has a responsibility to prevent unwanted pregnancies. "There are roles that the family undertakes and which no one can replace," Ms. Bachelet said in a national radio interview last Wednesday. "But naturally the state has another role to fulfill, and that is to offer a range of alternatives, which people can choose between – according to their own family values and principles."

Emergency contraception has long been contentious in Chile. In March 2001, while Bachelet was health minister, the use of the morning-after pill by prescription was approved. It was quickly challenged before the courts on the grounds that it was abortive and therefore violated Chile's constitutional protection of "the life of those about to be born." That April, the Santiago Court of Appeals prohibited the distribution and sale of the pharmaceutical Postinal. Chile's Institute of Public Health responded by approving a different pill, Postinor-2, with the same active ingredient (levonogestrel). After repeated attempts to ban that pill, in November 2005, Chile's Supreme Court made a final ruling which legalized the use of the morning-after pill. With the exception of Ecuador earlier this year, similar challenges have been made and lost in other Latin American countries.

Chile's court ruled that, based on scientific studies, the pill is not abortive. Some studies showthat it works to inhibit ovulation and prevent fertilization of the egg. The morning-after pill is a higher dose of a synthetic hormone used in birth- control pills.

Emergency contraception pills have been available in Chilean pharmacies, by prescription, since 2001. But at an average cost of $20, critics say, they have been accessible only to the upper-middle classes.

A movement to provide the morning-after pill in public clinics began. In 2002, the government of President Ricardo Lagos allowed the public distribution of the pill, but only for rape victims. Last year, the government planned to announce its free, universal distribution. But it was shelved after a flurry of public protest – and the onset of a presidential election.

"There was a political decision by Ricardo Lagos not to launch these regulations last year," explains Lidia Casas, a law professor at Santiago's Diego Portales University, who specializes in reproductive-rights cases.

She says Mr. Lagos decided to postpone free distribution of the morning-after pill until after the presidential elections last December and January, for fear it would cause too much division within his own political coalition, and compromise its chances of reelection.

Since the return to democracy in 1990, Chile has been ruled by the Concertacion, a coalition of four left-wing parties. The largest is the Christian Democratic Party, which represents Chile's political center-left, but with a strong Catholic base.

This month's decision to go ahead with distribution of the pill prompted the Christian Democrats to express their dismay for not being consulted, and their concern that the new regulations could encourage premature and irresponsible sexual activity. "More than worrying about the day-after, we need to focus on the day-before," the party said in a communiqué.

But Professor Casas says their position is hypocritical and elitist. Public-health clinics have given out free condoms and birth-control pills to those 15 and older, since 1993.

"So it's only a year difference we're talking about.... This is not something that's new. It's also hypocritical because the same people, mostly from the [political] opposition, who are making a big fuss about the age are also the ones who pushed down the age for kids to be criminally liable," she says.

The government justifies the new age limit, in part, by pointing to recent changes to Chile's laws – including lowering the age of sexual consent to 14, and a new law which reduces the age of criminal responsibility from 16 to 14 years.

The government also justifies the changes in the regulations in light of Chile's statistics on teenage pregnancies. According to the National Institute for Youth, 28 percent of teenage girls in Chile have initiated sexual activity by the age of 14. Bachelet says that almost 14 percent of Chilean women are mothers by the age of 14, and an average 40,000 babies are born to women younger than age 19 every year.

According to Teresa Valdes, with the Santiago-based Center of Women's Development Studies, many of those pregnancies are among girls ages 11 to 15 in Chile, and there are 21,000 teenage mothers studying in high schools. She says the government's new regulations are necessary in order to educate young women to make informed decisions.

Proponents say it's also an issue of ensuring equal access to emergency contraception, since three times more unwanted teenage pregnancies occur in Chile's poorest municipalities than in its richest.

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