Taking Calls on Abortion, and Risks, in Chile
By Aaron Nelsen
Published: January 3, 2013
Roberto Candia for The New York Times
Volunteers for the Safe Abortion Hot Line in Chile routinely wear masks when showing support in public for the organization in a country where abortion is illegal under any circumstances.
SANTIAGO, Chile – Every time the phone rings, Angela Erpel feels her nerves swell. Sometimes it is a scared teenager on the other end, or a desperate mother of three. There are the angry ones, too, with callers playing the sounds of crying babies or sending text messages with pictures of aborted fetuses.
Then Ms. Erpel, 38, a sociologist who volunteers at Chile’s Safe Abortion Hot Line, gathers herself and settles into a familiar dialogue on the use of misoprostol, a drug that will induce a medical abortion.
“We don’t give them a moral guide or advice; we only provide information,” she said.
Since the hot line began in 2009, volunteers spread across this long, thin country have taken turns answering tense calls from women seeking information about abortion every evening from 7 p.m. to 11 p.m. There have been more than 12,000 calls so far, and they continue rolling in at a steady clip.
In a country where abortion is entirely illegal, even in cases of rape or when a woman’s life is in danger, the hot line is a risky endeavor. Operating in a legal gray area, volunteers face a daunting prison sentence if a conversation veers too far from a lawyer-approved script. The hot line already has had three lawsuits brought against it, though all were eventually dropped.
According to the law, having an abortion carries a penalty of 5 to 10 years in prison, depending on the circumstances, while doctors and others who perform an abortion or assist with one could face up to 15 years, prosecutors say. In practice, however, fewer than 500 cases have been prosecuted over the last several years.
“I think there is a certain sensitivity to the social conditions behind these abortions, such as poverty or rape or teenage pregnancy,” explained Paula Vial, a lawyer and former public defender in Santiago.
Beyond the legal consequences, the 30 hot line volunteers are keenly aware of the social ramifications of taking an active role in such a polarizing issue. They wear masks when promoting the hot line at public gatherings, and are often vague about the details of their volunteer work in their daily lives. Many fear losing their jobs or driving a wedge into personal and family relationships. Indeed, Ms. Erpel was the only volunteer willing to go on the record about her work with the hot line, and even she is usually circumspect about it.
“It’s complicated,” she explained. “I’m open about being in an organization, but not necessarily that I work directly with abortion.”
Abortion was not always a clandestine affair in Chile. The current law that strictly bans it was one of the final acts of the dictatorship. In 1989, shortly before relinquishing power, Gen. Augusto Pinochet ended a tradition of legal abortion dating to 1931, in which a pregnancy that threatened a woman’s life, or a fetus that was not viable outside the womb, could be terminated. Chile’s law now is one of the strictest in the world.
By contrast, Uruguay legalized abortions in the first trimester for any reason last October, joining Guyana and Cuba as Latin American countries with broadly legalized procedures. Abortion is also legal in Mexico City. But Chile has remained a socially conservative country, after 20 years of economic growth and the election in 2006 of a woman as president.
“The hierarchy of the Catholic Church has had a very strong influence in public policy,” said Claudia Dides, a spokeswoman for the Movement for the Legal Interruption of Pregnancy.
In a pivotal case in 2008, Karen Espíndola, then 22, learned in her 12th week of pregnancy that her fetus had holoprosencephaly. Fetuses with the condition have a single-lobed brain, and most die before they are born. It is a common reason for terminating a pregnancy.
Ms. Espíndola sought an abortion, appealing to the president and setting off a national conversation over abortion. In February 2009, Ms. Espíndola gave birth to Osvaldo, who died in 2011.
“In reality he was never conscious he was alive,” she lamented. “He fought to breathe; he was fed through a tube. We all suffered a lot. Nobody here is a winner.”
Chile has witnessed a swell of liberal social movements in recent years, with gay men and lesbians pressing for the country’s first hate-crime legislation, environmentalists stalling dam-building projects in Patagonia, and students pushing for an overhaul of the education system.
Advocates contend that abortion rights sentiment bubbles near the surface as well, but the government has pushed back.
After criticizing the abortion hot line in the news media, the Ministry of Women started a hot line of its own. It is attended by psychologists and social workers who answer calls from men or women looking for information or support when facing what the ministry calls an “abortion situation” or “post-abortion syndrome.”
“Maternity, one of the most satisfactory experiences in the life of a woman, can go through difficult and desperate moments,” Minister Carolina Schmidt said at the time the government hot line began.
Other influential anti-abortion organizations offer to guide women considering abortion away from the procedure.
“If you help that person define what is troubling them and making them think of an abortion, and together you find a solution, in the end the person decides for life and her child,” said Victoria Reyes, director of assistance for Foundation Chile United. “We are convinced the second victim of abortion is the woman; the woman who has an abortion carries that guilt.”
The government reported several hundred adoptions in 2011, but it estimates 120,000 abortions, in a country with a population of about six million women from 15 to 64 years old.
Misoprostol, sold under the brand name Misotrol in Chile, has changed the way many of those abortions are performed. The drug was originally developed as an ulcer medication, and its warning label advised that, in excess, misoprostol would cause a woman to miscarry. Before long, women in countries with little or no access to safe abortions were using the drug to do that very thing.
Misoprostol “is a revolution for women,” said Rebecca Gomperts, founder of the Dutch organization Women on Waves. “Even where abortion is illegal and women don’t have a doctor, or they are poor, they still have a way to do a safe abortion.”
The abortion hot line is Ms. Gomperts’s creation. A medical doctor and former Greenpeace activist, she realized in 1999 that it was possible for a ship sailing under a Dutch flag to take women from countries where abortion is illegal to international waters to administer misoprostol.
Before departing Chile, Women on Waves helped set up the abortion hot line, training volunteers how to discuss misoprostol according to World Health Organization guidelines.
There are now five abortion hot lines in South America: in Argentina, Chile, Ecuador, Peru and Venezuela.
Misoprostol was taken off pharmacy shelves in Chile under Michelle Bachelet, the former president who now runs the United Nations’ agency for women’s advancement, so access to the drug is almost entirely a black market transaction.
Dozens of Web sites offer misoprostol at exorbitant prices, and sometimes of dubious quality.
One 29-year-old lawyer who became pregnant a few months ago said she paid $300 for the necessary 12 pills.
“To meet someone in a clandestine place, hoping they aren’t a police officer, wondering if they are even giving you the right pills, knowing that you could go to prison when all you want to do is exercise your right as a woman is horrifying,” the lawyer said on the condition of anonymity to avoid prosecution.
To its volunteers, the Safe Abortion Hot Line stands as a simple equation – 30 women and a single cellphone that gets passed among them. This month, they expanded: they released an abortion manual on using misoprostol.
Occasionally, women call back the hot line after a successful abortion, but more often the volunteers never know the outcome.
“That’s always the hardest part,” Ms. Erpel said.