Historical Contexts of Fertility Regulation and the Roots of Family Planning Programs

Family planning in Chile, defined as a history of official programs that helped women and couples plan the numbers and spacing of their children through birth control, begins in the middle of the 20th century but is rooted in prior debates about human reproduction and about who should, and could, prevent pregnancies. Since the early 19th century, in response to Englishman Reverend Thomas Malthus’s Essay on the Principle of Population (London: J. Johnson, 1798), politicians and reformers often linked family planning to concerns about population size and to fears of overpopulation. Malthus warned of what he saw as the dangerous consequences of uncontrolled population growth, when exponential growth of the human population would surpass resource and food production and lead to their depletion. We cannot document how many individuals and couples felt obliged to limit pregnancies due to Malthus’s dire predicament, but we know that the task of preventing conception was daunting and unreliable at best and that new medical technologies offered possibilities of effective and reliable contraception only in the 20th century. We also have evidence that proves that many women, all over the world, have for centuries resorted to self-induced abortions as one of the few method available to them to limit births.

Prior to the 1950s, Chilean couples, much like those in other parts of the world, used such technologies as condoms, coitus interruptus, sexual abstinence, and self-induced abortions to prevent or end pregnancies. Medical doctors recognized the problem of induced, unsafe abortions in the 1930s; in the same decade, members of the newly founded Movimiento Pro-Emancipación de la Mujer Chilena (Movement for the Emancipation of Chilean Women, MEMCh) demanded that women be granted access to birth control and legal abortions.¹ While MEMCh activists successfully pushed for some changes in women’s lives, including female suffrage, their campaigns for women’s liberation from “compulsory motherhood,” did not lead to new policies regarding fertility regulation.² The illegal nature of abortion was an obstacle to any wide-ranging public discussion about the problems of women who had had abortions and who could have testified to the need for access to family planning devices. Self-induced abortion was declared a criminal offence under the Chilean Penal Code of 1874, and even when therapeutic abortion was legalized in Chile in 1931, few women had the means or connections to seek official legal and medical support. The Chilean moral and cultural codes, which defined the “admissible” subjects for public debate, imposed a silence on sexuality and procreation and prevented public initiatives in response to the private problems of women who died as a result of botched abortions. The Chilean “double discourse system” maintained a public silence on subjects of sexuality and reproduction and limited women’s access to information and medical advice.³

The public silence on the subject of abortion was at times interrupted through such exceptional events as the 1936 Medical Convention, in the port city of Valparaiso, where some public health doctors forcefully defended not only the legalization of abortion, but also the distribution of contraceptive technologies with the goal of ending the problem of criminal backstreet abortions and maternal mortality. They added justifications that revealed neo-Malthusian and eugenic bends, arguing that fewer children would not only alleviate the lives of working class mothers and families, but also would have positive consequences for the development of the Chilean population. Their quests for change caused outrage and confirmed the deep social conservatism that shushed public contemplations on voluntary motherhood or women’s need for birth control. Many members of the medical establishment—including groups of health professionals such as midwives—judged all deliberations about abortions as immoral, and as direct attacks on the family and the nation.⁴ Doctors found new spaces to address their concerns about maternal mortality only after World War II, when new community health services brought social medicine practitioners into the homes of their patients, and when post-war fears of population growth, as well as Cold War competitions, added authority to neo-Malthusian arguments.

In the 1950s, medical doctors set out to re-examine health problems in urban communities and gathered statistical evidence about abortion and maternal mortality. They found that women desperately wanted contraceptive services to limit their pregnancies; they also documented that those same contraceptive services could help solve the health crises of induced abortion and maternal mortality. Physicians showed the correlation between the numbers of women’s pregnancies and the numbers of abortions: those patients who had many successive pregnancies, at times twenty in a row, also had histories of multiple abortions.⁵ Epidemiologists, such as Hernán Romero, Tegulda Monreal, Rolando Armijo, Mariano Requena, and Benjamín Viel, engaged in field research projects that included interviews in people’s homes and visits to local communities, inquiring about the causes of abortions and the measures needed to prevent abortions. Women affirmed that economic pressures, anxiety about moral condemnations of children born out of wedlock, sexual abuse, and their inability to limit pregnancies and control family size, were key reasons for backstreet abortions that often took place under unsanitary conditions.⁶ The data also confirmed that poverty alone did not explain the high abortion rates; middle and high-income sectors were among the high-risk group of women who sought abortions to limit family size. Women’s testimonial accounts, as well as the sheer number of induced abortions and maternal deaths at the time, spoke volumes about women’s need for birth control. Women terminated about one third of all pregnancies. In 1961, four thousand interviews of women between twenty and forty-nine years of age showed that one out of every four women admitted to having had between one and thirty-five induced abortions.⁷ Hospital statistics confirmed that complications as a result of induced abortions accounted for 8.1 percent of all hospital admissions in Chile. Post-abortion patients made up close to one third of all admissions in obstetrical services.⁸ Cases admitted to the hospital for complications following an abortion accounted for 35 percent of surgeries in obstetric services and 26.7 percent of the blood used in all emergency services.⁹ Indeed, women expressed their need to prevent pregnancies by inducing abortions under life-threatening circumstances. Illegal abortions had reached epidemic proportions.

New Family Planning Technologies: Chilean IUDs and the Contraceptive Pill

Jaime Zipper, one of the many Chilean doctors employed in public hospitals, witnessed first hand that women sought to limit pregnancies; on his own independent initiative, he opened the first Contraceptive Clinic in the Barros Luco Hospital in Santiago. Zipper engaged in clinical work in the obstetrical and gynecological service of the hospital, was a researcher at the Institute of Physiology of the University of Chile, and explored contraceptive technologies in that capacity. In 1959, he expanded Gräfenberg’s experiments with tailless intra-uterine devices (IUDs), seeking to improve the device by making it easier to remove. Zipper used nylon thread to construct a ring whose loose end could be used as a tail for removal. With the “Zipper ring,” he opened his Contraceptive Clinic and initiated a new stage of family planning services; about 3,000 women found their way to his office between October 1959 and June 1963, and all were fitted with the ring. While this first experiment raised questions about the legitimacy of using female patients in medical research without their consent, the number of women who reached Zipper’s Clinic through word of mouth confirmed their dire need for family planning services and contraceptive technologies.¹⁰

Other technological developments, such as the contraceptive pill, contributed to changes in the global debates on fertility regulation and increased women’s choices about family planning. Indeed, the first tests with contraceptive pills in Puerto Rico and the United States in the 1950s, and the international distribution of the pill in the 1960s, foretold of a contraceptive revolution. The understanding that pregnancy could be prevented by scientific means stimulated debates on fertility control and family planning among scholars, physicians, politicians, and clergy, as well as women. For some, it implied increased control over population size in global settings and nation-states; for others, the contraceptive pill offered a new degree of control and new choices women could make about pregnancy and family size. In 1968, Chilean women, married or single, could, for the first time, purchase the contraceptive pill in a local pharmacy. In short, in the 1960s, a new range of contraceptive technologies provided increased choices for women and couples to plan the number and spacing of their children. But the unequal access to these technologies, the limited information available to some women, and the political dimension of fertility regulation in the Cold War reveal that we cannot equate reproductive technologies with women’s rights, nor can we see the histories of family planning and reproductive rights as histories of technology, or as histories left untouched by larger, global discussions about the meanings of population and fertility regulation. Post-World War II fears of population growth, as well as the tensions of the Cold War, added new dynamics to subjects of family planning, with multiple results: on the one hand, they provided a new discourse that helped justify family planning programs in the name of population control; on the other hand, some population planners sought to manage women’s individual choices about contraceptives when they linked family planning to population control.

Official Family Planning Programs: National Developments and International Support

In Chile, we can document the rise of a new public consensus about the acceptability of family planning programs when physicians linked two parallel discourses: the need to prevent maternal mortality and self-induced abortions, and the need to stimulate modernization and development by controlling family size. Chilean health officials often supported the neo-Malthusian paradigm that began to shape population debates during the Cold War. Concerns over population dynamics, especially in the developing world, brought together representatives from private foundations, population researchers from universities, and officials from international agencies who set out to assist developing countries in attempts to curb population growth. Individuals and institutions in the United States played a leading role in global population initiatives that coincided with Chile’s first family planning initiatives. In 1965, U.S. President Lyndon Johnson’s public statement on population control illustrated the pervasive link many policymakers made between underdevelopment and alleged overpopulation: “less than five dollars invested in population control is worth a hundred dollars invested in economic growth.”¹¹ Public campaigns and private foundations contributed a range of ideological incentives that helped justify growing population initiatives; these were tied to the political tensions of the Cold War and to assumed threats that the poverty of developing nations might pose to their developed counterparts.

In the United States, those who dreaded overpopulation and population explosions often framed their fears in the context of the Cold War. Physicians, scientists, and political leaders agreed that rapid population growth would increase underdevelopment and provoke political unrest and violent revolutions. Some feared a world soon swarming with “people dominated by Communism.” Some of the leaders of population control initiatives, like Hugh Moore, entrepreneur and sponsor of multiple population campaigns, argued that the threat of communism was key to all birth control initiatives. Moore explained that “we are not primarily interested in the sociological or humanitarian aspects of birth control,” but are, instead, “interested in the use which Communists make of hungry people in their drive to conquer the earth.”¹²

When overpopulation became a “population threat,” the common goal of stabilizing population growth moved such institutions as the Population Council, the Milbank Memorial Fund, and the Ford Foundation to multiply their initiatives.¹³ In 1964, John D. Rockefeller III, founder of the Population Council, emphasized the urgent need for political leaders in the West to address population problems that had become a threat of the Cold War: “Until recently, I believed an even greater problem [than population growth] was the control of nuclear weapons. However, there is a justifiable hope that the use of these weapons can be prevented; but there is no hope that we can escape a tremendous growth in world population. Therefore it becomes a central task of our time to stabilize this growth soon enough to avoid its smothering consequences.”¹⁴ To protect international security and peace, Rockefeller lobbied political leaders from around the world to support the “Statement on Population” that he presented to the U.N. secretary general in 1966. Heads of states should recognize the need to curb the dangers of overpopulation “as a principal element in long-range national planning,” not only to advance goals of economic development, but also to help secure peace.¹⁵

Population initiatives ranged from large-scale funding commitments for family planning programs, to the production and international distribution of information on the population threat, to research projects, and to individual campaigns aimed at increasing the demographic effectiveness of family planning programs. Rockefeller maintained that couples should be able to decide the number and spacing of their children, and others, such as Kingsley Davis, supplied pioneering research results that exposed possible cultural inhibitions that might prevent poor populations from accepting family planning programs. Population planners in the United States agreed that conditions conducive to fertility decline had to be created by all means necessary.¹⁶ By 1968, the United States Agency for International Development (USAID) had become the largest single resource to support population control and family planning action in developing countries.¹⁷ In Latin America, physicians and politicians contributed population studies and program initiatives of their own, and often adopted neo-Malthusian demographic discourses to their specific national trajectories.

Chilean medical doctors, frequently with close ties to the international medical establishment as grant recipients from the Rockefeller and Ford Foundations, and as practicing physicians trained in their home countries and in the United States, contributed demographic studies and used the neo-Malthusian enthusiasm for fertility regulation to promote family planning programs of their own and independent design. Population initiatives by Chilean doctors reveal that they did not merely respond to global demographic paradigms, but they actively participated in their construction. Chilean physician and family planning pioneer, Dr. Benjamin Viel, for example, published a series of much-acclaimed studies on what he called the “demographic explosion” in Latin America. He also made a case for family planning in his native Chile and emphasized that the population had more than doubled between 1920 and 1965. Santiago, the capital city, had increased five-fold in the same period as a result of a decrease in mortality rates and a concomitant increase in urban migration.¹⁸ For Viel, the key to Chile’s development lay in family planning. He advocated voluntary motherhood and envisioned state policies as well as education campaigns that addressed women. In his view, the answers to women’s individual, familial, and national problems could be found in family planning education and in ready access to a wide selection of contraceptive technologies.

The pioneering role of Dr. Benjamin Viel in the history of family planning in Chile demonstrates that Chileans developed health and family programs not as a result of pressures by the United States, but in the context of his collaborative and professional relationship with U.S. institutions and individuals. The Rockefeller Foundation’s International Health Division awarded a first fellowship to Benjamín Viel in 1939. Subsequently, in the 1940s, he encouraged the Foundation to broaden its activities in Chile.¹⁹ Viel earned degrees in public health from Harvard and Johns Hopkins University in the United States. He traveled internationally and used his experiences in the United States, England, and the Soviet Union to contribute to the foundation of the Chilean Public Health System in 1952, and the first Family Planning Office in Santiago in 1963. In short, Viel received ample training, funding, and institutional support from universities and foundations in the United States, but in Chile, he implemented family planning programs and health campaigns of his own design.

Chilean doctors, like Viel, used their understanding of specific domestic problems in conjunction with global connections to garner official government support for family planning programs. First, in 1962, an advisory council of professionals from the medical schools of Santiago’s major universities prepared research results to demonstrate the links between abortion, maternal mortality, and fertility regulation. They then transformed the council into the Comité Chileno de Protección de la Familia (the Chilean Committee for the Protection of the Family), an independent, private organization with corporate status under the chairmanship of a medical doctor. By 1965, seven family planning projects operated in Santiago, most directly connected to earlier fieldwork efforts to control abortion and decrease maternal mortality rates. Chilean doctors had secured ongoing financial and technical support from the Rockefeller and Ford foundations as well as from the U.S. Population Council. The committee also negotiated an official affiliation with the International Planned Parenthood Federation (IPPF/WHR), the Western Hemisphere Region of the IPPF. Material support, including IPPF subsidies and ongoing funding by private institutions in the United States, helped to equip clinics and expand family planning programs.²⁰

Family Planning and the Church

In the 1960s, the availability of the contraceptive pill brought new concerns about religious opposition to family planning. Population planners, including Viel, feared that the Catholic Church, as well as the religious beliefs of individual women or couples, would prevent the widespread acceptance of family planning programs. In Chile, a crucial juncture of developments opened up unprecedented spaces in defense of voluntary motherhood and helped promote family planning programs. The newly elected Christian Democratic government gained prominence for its reformist character and for the spirit of a “revolution in liberty,” enhanced not only by U.S. support of the Alliance for Progress, but also by Christian social doctrine. President Eduardo Frei Montalva (1964–1970) prepared to right the wrong of human inequalities, to address such pressing problems as land reform, and to encourage the participation of all citizens, men and women, in Chilean development. Public policies also sought to strengthen the community involvement of women; in Mothers Centers, for example, women explored unprecedented spaces to gather, exchange information, and increase the weight of their political activism. Family planning programs, and information campaigns by APROFA to promote family planning as a way to protect the wellbeing of the family, fit well into the political platform of the Christian Democrats. Public health representatives encouraged women to use APROFA services as well as those of Chile’s National Health Service (NHS), which worked in partnership with APROFA. We find proof of the successful outcome of this collaboration in numbers: by 1966, 102 family planning centers addressed women’s needs nationwide, and more than 58,000 women received contraceptives free of charge. By 1967, in the third year of Christian Democratic rule, the government increased the funds allocated for family planning services to cover an additional one hundred thousand women.²¹

In the 1960s, we also find a remarkable openness to the subject of family planning by Church officials. The Chilean Episcopate considered humanitarian and health concerns as well as problems of overpopulation. Bishops addressed, in public, the threat of demographic explosion and related the subject of population size to poverty and underdevelopment. In a 1967 “Declaration of the Chilean Episcopate about Family Planning,” the authors also expressed the Church’s willingness to help find realistic solutions to alleviate such problems.²² In the spirit of the Second Vatican Council, Chilean bishops recognized that solving the problem of rapid population growth should include initiatives on global, national, and family levels. Chilean bishops greatly emphasized the need to prevent maternal mortality, articulating that contraceptive technologies could be justified as a means to prevent abortion. In the words of Cardinal Raúl Silva Henríquez of Santiago, the Church should not defend a position of pro-natalism at all costs, but should promote “responsible parenthood.”²³

Lastly, a crucial factor that helps explain why the Catholic Church did not represent an obstacle to family planning in the 1960s is that the Humanae Vitae, Paul VI’s 1968 papal encyclical that rejected all artificial methods of fertility regulation, actually followed the founding and promotion of nation-wide family planning programs in Chile. It was issued at a time when the awareness of the need for family planning was so pronounced that the pope’s verdict actually surprised some Church officials, who did not expect that the Church would uphold its rigid conservative position in light of the problems of unwanted pregnancies. Similarly, not every practicing Catholic was prepared to accept that all marriage acts had to remain open to the transmission of life, as stipulated by the Encyclical. Chilean couples, more often than not, continued to rely on birth control technologies—and demographic research on women’s contraceptive practice in Chile confirmed that the stance of Catholic women on birth control was not distinct from that of other women at the time.²⁴ Indeed, religion remained an insignificant factor not only in a couple’s decision to practice birth control, but also in the choice of method.²⁵

With the election of socialist President Salvador Allende in 1970, the interpretation of birth control as a “weapon of imperialism” by sectors of the Latin American left once again linked the subject of family planning to the Cold War. Chilean communists, for example, took on the issue of family planning as early as the 1970 election campaign, accusing family planners of selling out to foreign imperialists for the sake of controlling and limiting Latin American populations. In August 1970, the communist newspaper El Siglo went to great lengths to accuse Chilean health officials in general, and family planning pioneer Dr. Benjamin Viel, in particular, of “heading a campaign of North American origin to pressure working class and peasant women into limiting births.”²⁶

For Allende, however, the key socialist governance was class equality, including equal access for all Chileans to all health services, including, but not prioritizing, family planning services. In an effort to control the impact of foreign funding for family planning programs on health care delivery, the National Health Service officially integrated birth control programs into its Program of Women’s Health, addressing contraception as only one among the many needs of women and mothers.²⁷ The newly integrated program of maternal childcare featured a health team of doctors, midwives, nurses, and social workers who could address all the needs of every patient. Health officials were instructed to teach women about birth control as well as provide such services as prenatal care, delivery, and postpartum care. Some family planners, such as physicians like Benjamin Viel, deeply rejected the move and argued that financial and technical assistance from the IPPF did not represent a threat to Chile’s independence. Others, in support of Allende’s policy change, agreed that both IPPF support and APROFA’s family planning programs forced Chilean doctors to unduly prioritize family planning and to limit their care of patients who sought help in other matters.²⁸ In 1970, the National Health Service stipulated that birth control had to be offered as part of the state-controlled program directed by the Maternal and Child Department.²⁹ These re-arrangements caused some tension among health officials with different political views, but few women and couples noticed an interruption of family planning services during Allende’s short-lived presidential term.

Women and couples relied on family planning services under the Christian Democratic government of President Frei and benefited from health and family planning programs under the subsequent government of President Salvador Allende’s Popular Unity coalition party (1970–1973). A military coup in 1973 brought unparalleled violations of human rights and changed perspectives on family planning. The period of military rule (1973-1989), as well as the cumbersome path to re-democratization in the 1990s, provides ample evidence that negotiations over reproductive rights and family planning remained deeply political. The human rights abuses, the dictatorship’s failure to adhere to the rule of law, and the re-writing of the Constitution in 1980, reveal that women bore the brunt of human rights violations and suffered the ill effects of the violation of their reproductive rights.

The developments under the Chilean dictatorship confirm that the histories of family planning and reproductive rights in Chile are hardly stories of linear progress and gradual improvements of possibilities and rights. Instead, we find setbacks, protests, and new mobilizations for rights in the years between 1973 and the 1990s.

Parallel to the temporary defeat of democracy in Chile, we see the rise of new international paradigms of human rights, women’s rights, and reproductive rights, confirmed at international gatherings sponsored by such organizations as the United Nations (U.N.) and the World Health Organization (WHO). The U.N. supported reproductive rights first at the Conference on Human Rights Tehran, Republic of Iran, in 1968, confirming that “couples have a basic human right to decide freely and responsibly on the number and spacing of their children and a right to adequate education and information in this respect.”³⁰ In 1979, the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) set an unequivocal standard for women’s rights and sought to pressure governments to adhere to the norms of gender equity. National leaders could choose to ratify CEDAW or to support a modified version of the original document. In 1993, the Declaration and Program of Action of the 1993 World Conference on Human Rights in Vienna officially defined “women’s rights are human rights.”³¹ Women’s rights remained key to subsequent definitions of reproductive rights, which included references to reproductive health and sexual health, specifying that “reproductive health . . . implies that people are able to have a satisfying sex life and that they have the capability to reproduce and the freedom to decide if, when, and how often to do so.”³²

In 1994, at the U.N. World Conference on Population and Development in Cairo, governments adopted a radically new perspective on population and development, prioritizing women’s perspectives on reproductive and sexual health and rights. Acknowledging that women required comprehensive sexual and reproductive health services, maternity care, and access to contraception as well as safe abortions, the Cairo Declaration also asserted that “all attempts should be made to eliminate the need for abortion.”³³ The latter gained new relevance in the debates about reproductive rights in Chile under dictatorship, re-democratization, and the politics of health and rights in the 21st century.

Struggles over Family Planning, Health, and Rights under Dictatorship: Top-Down Policy Changes and Grassroots Resistance

The everyday violence under dictatorship evidenced a new reality of human rights violations that also influenced family planning and reproductive rights. The military junta, headed by General Augusto Pinochet, instigated radical economic and political restructuring, implemented censorship, and used violence to eradicate the opposition. Random arrests and incarcerations were the most visible signs of violence that could affect any citizen, any time. While leftists and former supporters of the Allende governments were the initial targets, the subsequent indiscriminate nature of government arrests and incarcerations caused widespread fear and helped control the population. Less visible human rights abuses often followed arrests, and alleged dissidents were often tortured, or “disappeared.” The regime outlawed political parties, implemented a neoliberal economic system, and cut government spending for social services, including public health.

From the perspective of the regime, attention to gender roles, to women’s maternal responsibilities, and to healthy families proved critical in the consolidation and maintenance of authoritarianism. Through the media, and in a public discourse reinforced by spokespeople that included the First Lady, Lucía Hiriart de Pinochet, military leaders constructed and promoted a model of supposed natural, trans-historical characteristics of family life in service to the nation and placed public rhetoric regarding the family and women’s maternal responsibilities center stage. In this process, military policies employed a discourse on motherhood derived from religious and moral arguments that aimed to solidify women’s identities as mothers and link their sexuality to motherhood. The military promoted an idealized “sexuality-maternity”³⁴ and thereby a religious and moral positioning of female sexuality that saw marriage as the only suitable manifestation of sexual relations. Wives could then redeem the earthly character of sexual desires through procreation, abnegation, and self-sacrifice for their children.³⁵ In this logic, both family planning and abortion became deviant acts. In 1974, Jaime Guzmán, lawyer and key ideologue of the regime, pushed for constitutional reforms that eliminated therapeutic abortion and set the direction for new restrictions on abortions that became a legal reality: “The mother must give birth to her child, even if it will be born abnormal, if she did not plan it, if it was conceived as a result of a rape, and even if giving birth will kill her . . .”³⁶

Military policies gradually implemented the criminalization of abortion, first by actively prosecuting self-induced abortions, and next through legislature that made abortion a criminal offence under all circumstances. The number of women prosecuted for abortions skyrocketed in the 1980s; over one thousand court cases involving abortion were reported annually during the decade. Chilean attorney Lidia Casas documented that multiple individuals were often tried together in one single case, as prosecutors cited not only the women who had abortions, but also providers and suspected accomplices.³⁷ These procedures increased the climate of mistrust and suspicion among women and doctors, since the latter could report patients for criminal violations. Even if doctors honored the confidentiality of doctor-patient relationships, hospital staff at times breached the privacy of medical records to report patients. Some women began to avoid hospitals, afraid of the type of attention they would receive. Meanwhile, the number of patients in dire need of medical care for complications following spontaneous or self-induced abortions skyrocketed due to the new restrictions placed on family planning services offered by medical doctors.

Institutional changes evident in the restructuring of public health services not only helped to reinforce the culture of a sacred maternity for the nation, but also made women’s access to family planning services increasingly difficult. Economic doctrines defined by neoliberal technocrats led to a radical decline of public spending on health services, promoted the privatization of the health sector, and thereby limited patients’ access to health-care practitioners. These changes disproportionally affected women who sought help obtaining birth control measures. Family planning services took the brunt as new regulations concerning the order of attendance in health-care centers gave priority care to patients needing emergency care, followed by pregnant women and maternal-child assistance, and then ultimately to preventive care, including family planning, at the bottom of the hierarchy. With reduced health-care personnel available to attend patients, and because of the way state health care providers ranked services, women who sought family planning often waited in vain and left local health centers without receiving attention to their needs.

The military also applied geopolitical arguments to yoke human reproduction to the interests of the regime and link population size to national security concerns. The Office of Government Planning (ODEPLAN) issued the Population Policy of the Chilean Government and declared that “a significant increase of our population is desirable” to keep pace with the rapidly growing birth rates in neighboring countries that could supersede population size in Chile.”³⁸ Between 1979 and 1985, an aggressive pro-natalist population policy triggered campaigns against birth control. The ODEPLAN decree demanded that the government be notified before doctors published their research, be it nationally or internationally, on family planning in Chile.³⁹ This not only obstructed doctors’ delivery of family planning services, but also led some women to believe that physicians could remove family planning devices such as IUDs even against the will of their patients. While some histories of forceful removals of IUDs may have been urban legends rather than real events, women did find family planning services increasingly hard to obtain. Doctors in private practice, at times, ended services they had once offered to patients. Others continued silently without advertising the service of birth control. APROFA services, still linked to the international family planning network of the IPPF, remained reliable and continued to provide information and contraceptive devices to women. In 1985, the military changed course and began tolerating family planning under the motto of “responsible parenthood.” In the midst of these changes, many women began to protest the violence of the military and to critique the patriarchal foundations of the regime and demand reproductive rights.

At the same time that audiences and participants at international conferences worldwide were working to define universal women’s rights, women in Chile were fighting at the national level against military violence, against the regime, and for a new range of citizenship rights for Chileans. Individual women activists from different backgrounds and women who considered themselves feminists created or joined self-help, human rights, and feminist organizations and condemned the patriarchal characteristics of the regime. Some women began to discuss sexuality and reproduction, subjects that most people still considered deeply private and personal in nature. Initially, middle-class feminists used the support and protective umbrella of the Church to invite women from all walks of life to meetings where specific problems of women in Chilean society could be addressed. In 1979, they founded a pioneering Círculo de Estudios de la Condición de la Mujer, Women’s Studies Circle, which gathered regularly under the official guise of a reading circle and self-help group and, initially, counting on Church support. In meetings, and through publications, women began to deal with questions of human rights and women’s rights. They also found innovative answers to address questions about human rights, paying new attention to women’s rights, voluntary motherhood, and birth control. Círculo participants also concluded that a recognition of women’s right to equal citizenship with men required that their choices regarding birth control be legally and culturally respected.⁴⁰

In the early 1980s, Chilean women became a key force that drove the “protestas,” the wave of public protests that interrupted the silence imposed by the authoritarian regime and, eventually, forced the military out of power. In December 1983, for example, over ten thousand women of different political and class backgrounds came together at the Caupolicán Theatre in Santiago to participate in what was the largest gathering since the military coup. They proclaimed that “freedom has a woman’s name.”⁴¹ In subsequent public marches, protesters called for “Democracia en el país y en la casa”—democracy in the country and at home.⁴² Their activism had its roots in the struggle against human rights abuses, and in the defense of social justice and democracy. Women, organized labor, students, human rights protesters, and, eventually, the majority of Chilean citizens joined public demonstrations against the regime, most visibly by supporting the NO Campaign in preparation for the 1988 plebiscite proposed by General Pinochet. With the intention of securing the longevity of his regime, Pinochet asked Chileans to vote NO or YES to ongoing support for the military regime. In 1988, Augusto Pinochet lost the national plebiscite when citizens said NO to the regime and voted in favor of democratic elections. In 1989, voters showed their overwhelming support for the new Concertación coalition and its candidate, Christian Democrat Patricio Aylwin. President Aylwin presided over the process of re-democratization and promised to be the president of all Chileans.

New Threats to Reproductive Rights in the 1990s and in the 21st Century

In 1991, Chilean women helped promote the establishment of the National Office for Women’s Affairs (Servicio Nacional de la Mujer, SERNAM), aimed at addressing the most pressing violations of women’s citizenship rights, including reproductive rights. SERNAM’s formal status as a state-led institution has, at times, limited the range of subjects it could address. But SERNAM has also increased the national awareness to gender-based inequalities, and represents the government’s official commitment to incorporate a gender perspective into the making of public policies. Nonetheless, neither policy makers nor SERNAM officials could easily overcome the barriers to equal citizenship rights, rights that were often stalled by the legacies of the dictatorship.

During the first years of re-democratization, the defense of reproductive rights in general, and women’s rights in particular, proved a difficult task because of two final, and deeply contradictory, changes in national law implemented by the Pinochet dictatorship: the abolition of therapeutic abortion and the signing of the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW).⁴³ Induced abortion posed a continuing threat to many lives, and legal specialists and transnational feminist activists concurred that the termination of therapeutic abortion in Chile violated the principle that “safe and dignified healthcare is a major human right.”⁴⁴ The termination of therapeutic abortions violated the very principles defined by CEDAW, but only the former, and not the latter, had legally binding consequences in Chile.

In the years since re-democratization, it has become clear that poor women, as well as adolescents, are more likely to suffer the consequences of the declining health care system, of inadequate sexual education, and of the lack of access to legal, therapeutic abortion. In the 1960s, Chilean health officials supplied pioneering studies of an abortion epidemic and led the way in American health campaigns as they opened family planning clinics nation-wide. In the 1990s, and in the new millennium, female patients have had to confront the long-term consequences of military policy and have had to find ways to survive health challenges reminiscent of the early 20th century.⁴⁵ Maternal mortality and complications as a result of illegal abortions have remained the most rampant public health crises in the nation.⁴⁶

Gender- and class-based disadvantages have increased the vulnerability of young women of poor backgrounds in the realms of health and reproductive rights. Their lack of access to sex education and reliable contraceptives are contributing causes of teenage pregnancies and to self-induced abortions. In a medical study completed in 2000, public school students showed less knowledge about sexuality than students at private schools, reflecting ongoing divisions along class lines.⁴⁷ Adolescents with more access to education do not necessarily know more about sex, but they tend to be more conservative about having sex—thereby reducing the risk of unplanned pregnancies. Health officials document that unwanted pregnancies, illegal, unsafe abortions, and sexually transmitted diseases disproportionally affect poor youths.⁴⁸

In 2006, health activists effectively linked the problem of teenage pregnancy to women’s rights to health and reproductive freedom; they successfully lobbied for the legalization of “emergency contraception,” a pill that women could use if other birth control measures had failed.⁴⁹ In 2010 an emergency contraception law legalized the distribution of the “morning-after pill” through the public health system. Women above the age of fourteen can now get emergency contraception free of charge in public health centers, without parental consent. Given that the new policy mandates access to free emergency contraception, it may help reduce the risk of unwanted pregnancy across class and age lines.

While health officials and reproductive rights activists have scored some successes in Chile, sexual and reproductive rights remain at the core of an ideological and material struggle in the 21st century. Violations of reproductive rights remain among the most haunting legacies of the dictatorship’s anti-abortion legislation, now reinforced by segments of a newly conservative Catholic Church and by the growing influence that Opus Dei wields in politics. Today, Chile’s abortion legislation is among the most restrictive in the world and poses the largest challenge to women’s reproductive rights and health. Once again doctors find that illegal abortions account for about one-third of maternal deaths. Even though opinion polls show that the majority of Chileans are opposed to the current rigidity of abortion legislation, and even though women’s groups and politicians forcefully demand legal reforms and the de-criminalization of abortion, legal change is slow. Most recently, President Michelle Bachelet has introduced new legislation that permits therapeutic abortions when the mother’s life is in danger, when the fetus shows signs of malformation, and in cases of rape, but the bill remains stalled in congress. For Chileans, September 28, the designated “Day of Decriminalization of Abortion in Latin America and the Caribbean,” is a reminder that Chile is, along with the Dominican Republic, El Salvador, Haiti, Honduras, and Nicaragua, among a group of nations in which abortion is illegal under all circumstances and high numbers of women become victims of illegal backstreet abortions under unsafe and insanitary conditions.

Discussion of the Literature

Medical doctors, human rights experts, and scholars with an expertise in women’s rights and gender equity have contributed to the multifaceted scholarship on family planning and reproductive rights. They have traced historical developments that range from the advances in contraceptive technologies to changes in human and women’s rights paradigms, and have presented historical evidence of the ill-effects that patriarchal systems have had on the choices women could make about pregnancies.

Historically grounded studies by physicians who worked in the Chilean public health system during, and since, the 1960s have explored the bio-medical, cultural-religious, and socio-political contexts that often made women’s health and reproductive rights hard to defend. Some authors have shared epidemiological and biological insights into histories of sexuality, reproduction, and abortions. Obstetricians Aníbal Faúndes and José Barzelatto, for example, present a study that may well serve as a primer of all aspects of abortion. Their study is both intensely political and deeply personal, as it presents details on why women are compelled to seek abortions. Uncovering some of the power relations that prevent women from controlling their sexual encounters—from a lack of power in their intimate relationships, to a lack of understanding of biological processes—the authors present a convincing case that health services and education as well as legal changes, such as the de-criminalization of abortions that could save women’s lives, are necessary.⁵⁰

Other scholars have stressed the need to examine the specific legal, political, and cultural contexts that contribute to developments in family planning and reproductive rights. Lidia Casas, for example, has documented that the termination of therapeutic abortion disproportionally harms the poor, and that poor women are more likely to be persecuted for having had an abortion and to serve prison terms as a result.⁵¹ In the midst of these visible violations of reproductive rights, scholars have also effectively addressed the political contexts that continue to make struggles for reproductive rights hard to win in Chile. Alejandra Brito Peña, Beatriz E. Cid Aguayo, and Carla Donoso Orellana, for example, document the complex negotiations among women activists and outspoken feminists, on the one hand, and deeply conservative political interest groups, on the other. Many of the latter have affiliations with a newly conservative Catholic Church and have received support from Opus Dei, an organization that has significantly increased its political weight in Chile over the past two decades.⁵²

Other histories reveal that family planning and reproductive rights have remained highly politicized subjects through the long 20th century. In my own work on the politics of motherhood in Chile, I show that we can draw conclusions about how women’s rights and reproductive rights have changed over time by examining the changing social constructions of motherhood and the political uses to which motherhood has been put. After all, motherhood has been the most important signifier of womanhood in Latin America; it has sat at the heart of gender systems, and has helped define women’s responsibilities in the nation. Governments and health officials often addressed women in their capacity as mothers, and even women activists often have justified their quest for increased citizenship rights in the context of their maternal responsibility. The lens of motherhood also offers a useful perspective on women’s activism in defense of family planning and reproductive rights. Chilean women, some of them committed feminists, first spoke of reproductive rights and evoked voluntary motherhood as a concept in order to promote the notion of choice and rights.

Primary Sources

In the United States, the Rockefeller Archive Center (RAF) holds the most relevant collection on subjects of family planning programs, debates on population control, and the Rockefeller’s own initiatives related to health and population. Its archival materials include information about the relationship between foundation officers and international doctors, for example, and help explain the international dimension of program building. RAF holdings also include the records of the Population Council as well new acquisitions of the Ford Foundation archives. Most recently, RAF has begun to make thousands of newly digitized documents available online.

In Chile, the Centro Latinoamericano de Demografía (CELADE) has published numerous series on the subject of population and family planning and provides documentation on demographic data and population research. Its collections permit comparisons between family planning developments in different regions and countries. International conference files on the subject of family planning and program building are highly valuable sources from which to document the impact of competing political positions on the content of policies.

FLACSO Chile has recently shifted its emphasis away from gender-related research and has reduced the number of publications that are available in its on-site documentation center. FLACSO research of the past still contributes an invaluable range of publications related to human rights, health, reproductive rights, and questions of gender equity. Selected documents and research publications have been digitized and are available online.

Chile’s La Morada, or Casa Morada, has long been an important site of research and publications on histories of women’s activism, as well as a place to trace the condition of gender equity and women’s rights in Chile and the Americas. Like La Morada, the Instituto de La Mujer and Fempress were founded in the early 1980s, to provide research and publication venues as well as press services for women. Both continue to publish internationally.

Links to Digital Materials

Multiple Chilean blogs address the subject of abortion and reproductive rights from a perspective of human rights and health and provide updated information: