Country case-study: sexual and reproductive rights in Chile

This research was produced by Paz Peña as part of Privacy International’s global research into data exploitative technologies used to curtail women’s access to reproductive rights. Reproductive Rights and Privacy Project. Read about Privacy International’s Reproductive Rights and Privacy Project here and our research findings here.

1. What are the barriers to access safe and legal abortion?

According to figures from the Ministry of Health, more than 33 thousand clandestine abortions are performed per year, which is equivalent to 90 each day, most with Misoprostol. But the figure is inaccurate because, as it is a penalized practice save for the exceptions provided by the law, there are no records, and data comes from estimates.

The implementation of the current law, however, presents significant hurdles for women, as:

• "Conscientious objectors": The law allows doctors, as well as private hospitals (institutional objectors), to refuse to provide abortions on moral grounds. According to the Human Rights Watch Report on Chile 2019, "nearly 50 percent of all medical providers in Chile object to providing abortions after rape, and some public hospitals lack a single provider willing to perform an abortion in that circumstance".
• No confidentiality: By law, women are entitled to ask for (and expressly authorize) an accompaniment program. It can be provided by hospitals or by the three accredited NGOs (APROFA and Miles Chile and the conservative Chile Unido). According to a CIPER report in 2019, both avenues have serious problems, as, for example, the precarious conditions of their work that do not ensure patient confidentiality as they work with women between corridors and even in gynaecological beds. Moreover, they denounce that the medical teams do not integrate them, that the training is insufficient, and, in some cases, they suffer the hostility of conscientious objectors.

To get an abortion for reasons not included in the law, women must avail themselves of illegal methods clandestinely:

• The black market of Misoprostol. The free purchase of Misoprostol in pharmacies is forbidden since 2009, and the only way to get it is under a medical prescription. Women in Chile have two ways to get help in this context. One way is contacting feminist groups who deliver information to women around abortion (Línea Aborto Libre, Con las Amigas y en la Casa, Miles Chile, etc.). The second way is purchasing Misoprostol in the black market, at a much higher price and with no guarantee of the integrity of the product, which could be extremely dangerous for women. Moreover, "the search for an abortion without the proper legal channels can lead to humiliating, violent and risky situations with abusive people who, because of the law, become victims who are unable to report."
• Illegal abortions. Clinics and doctors can perform unlawful abortions [1]. Upper classes can get abortions in private clinics if they have the resources for that. However, "not all women in Chile who want abortions can find the means to do so. In particular, due to numerous oppressive institutions and social structures, poor, rural, and immigrant women often are left without the resources, whether it be money or connections, to purchase pills or to go to a clinic for an abortion".

2. What are the barriers to access modern contraception? 

According to the Chilean Association for Family Protection (APROFA - Asociación Chilena de Protección de la Familia), although Chile has an entire legal system and a clear national policy regarding access to contraceptive methods for women, barriers remain which are affecting mainly the most vulnerable and youngest population.

One significant barrier is pricing to purchase contraceptive methods in the market. According to the National Consumers Service's data, the prices have climbed an impressive 67 % in just four years. APROFA has highlighted the fact that the public health service in Chile offers free access to eight contraceptive methods and it seems vital to amplify that offer, including contraceptive methods for men, as not everyone knows this service is available.

Gynecologist David Eisen thinks there is a gap between what the regulation says and what it happens on the ground. In his experience, every woman confronts everyday obstacles in health services, mainly because of a lack of information on how to get it, and sometimes because these health care professionals who do not necessarily have the latest knowledge on contraceptive methods.

3. What are the hurdles in accessing non-biased medical reproductive health information?

It is important to address that the main barrier for access to sexual and reproductive rights is cultural; thus, there are historical hurdles to get a non-biased medical reproductive health information. As Lieta Vivaldi describes:

Despite Chile being one of the least religious countries of the region, experiencing an increasing secularisation, it is crucial to notice the strong influence of religious ideas in sexual and reproductive rights policies: through the State and political parties, and working in complicity with think tanks and the civil society.

This conservative influence has deployed its power in many ways. One of the most critical ways is the idea of having as many doctors and private hospitals that declare themselves conscientious objectors for abortion on the three grounds admitted by law. According to a study by Corporación Humanas, this excuse is facilitated to the fullest possible extent by the Ministry of Health as it only requires the completion of a form and refrains from requesting any detailed background information:

The broad refusal of public officials [...] reflects the difficulty that health teams face in respecting the decision of women and girls and incorporating elements other than strictly biomedical in the care of users, as well as the prejudices and stigmatization women and girls face 

Thus, and according to the Ministry of Health, in 2019, 580 of the 1,148 gynecologist-obstetricians of the public health system declared themselves conscientious objectors to practice abortions in cases of rape, 21% declared themselves conscientious objectors in cases of endangerment of the pregnant woman's life (238), and 29% did the same in cases of fetal infeasibility (328). In the case of anesthetists, one in four (26%) prefers not to perform abortions when the girl or woman became pregnant due to rape.

The Centro de Investigación e Información Periodística (CIPER), a non for profit organisation which promotes investigative journalism, has also documented that doctors who are not objectors are pressured by heads of hospitals to change their minds and prevent abortions in their premises.

Moreover, campaigns by conservative groups have been activated online through social media to harass doctors who perform abortions. For example, a photoshopped picture of Gonzalo Rubio, the first doctor who did the procedure under the new legislation, was created and widely shared by a Facebook group called “Cruzada nacional contra el aborto." It is hard to say who is behind this group but it appears to be formed by catholic and evangelicals’ organizations from across Latin America.

The lack of sexual education is another crucial barrier in Chile to get non-biased medical reproductive health information. To date, Chile does not have a comprehensive education policy on sexuality, affectivity, and gender. Chile's indicators show that deficit. For example, between 2008 and 2015, Chile was the country that made the least progress in the prevention of unwanted pregnancies through sex education compared to the other 16 countries that also underwent the study by the International Family Planning Federation (IPPF).

The 2019 Global Annual Report of the Joint United Nations Program on HIV / AIDS revealed that Chile showed the highest rate of new infections annually (34%) in Latin America. Various studies show that the most affected segment of the population is 15 to 25 years old. A specialized commission of the Chilean Congress for this pandemic called for the Ministry of Education to take some responsibility for the increase of infections on account of its failure to design and execute a comprehensive sex education policy. At the time of writing, a bill on comprehensive sex education in educational establishments is being discussed at the Congress, which has also been the target of disinformation campaigns online by conservative groups.

4. What are the concerns regarding the use of technology by anti-abortion organisations?

We have found two ways in which data could be collected and used by conservative organizations to prevent access to information on sexual and reproductive rights in Chile. In all these cases, there are several links (funding, capacity building, networks, etc.) with foreign organizations working locally, regionally, and internationally to erode sexual and reproductive rights. 

Technologies being used in the provision or restriction of reproductive health services

Teen STAR (Sexuality Teaching in the context of Adult Responsibility) is an educational initiative that started in the US which promotes abstinence at the expense of other viable alternatives such as contraception. The group present Teen STAR as a developmental age and gender-appropriate curriculum rooted in moral, psychological, and physiological principles, which uses the Billings method of understanding human fertility patterns. Their curriculum is present in 36 countries. Teen STAR was challenged in Croatia on the basis that it did not provide accurate science-based sexual and reproductive health education. In Chile, however, the Ministry of Education has recommended the program, and it is supported by one of the most prestigious universities in the country, the Pontificia Universidad Católica de Chile.

In a 2018 interview, Suzanne Spence, Western Regional Director at Teen STAR in the U.S., talked about the challenges of women in technology. On that occasion, she said that

for the first time in human history, we have the capacity to collect and store enormous amounts of detailed personal data for our interpretation and application. Fertility charting is exactly that! And it is on the rise among women of all ages. 

Spence also declared to be worried that some fertility apps “may actually be co-opted from serving her individual needs to serving purely market or socio-politically based motives,” referring to apps based in information from Planned Parenthood:

“Teen STAR questions such use of personal protected health information (PHI) and sees a possible breach of the patient-provider relationship, recommending as an alternative the FEMM app as a perfect complement to Teen STAR’s independent philosophy, which allows users to share their data only if and when they choose.”

According to its narrative, “the FEMM app was designed to help women track their health by observing key biomarkers such as cervical fluid, bleeding, physical symptoms like cramps and acne, and emotional symptoms like depression, moodiness, etc. These biomarkers indicate the hormonal interplay that occurs throughout the cycle. The FEMM app can also assist in preventing or achieving pregnancy. Through charting with the FEMM app, women know the average length of their cycle, the quality and length of their bleeding, the point of ovulation at each cycle, their fertility window, and more”.

Teen STAR and the FEMM app have an intersection with Chile. The FEMM app is developed by FEMM Foundation (Fertility Education & Medical Management), which was founded by Ms. Pilar Vigil (she is now the current Medical Director of the Health program). And Ms. Vigil and her husband, Mr. Miguel del Rio, are the founders of Teen STAR Chile. Moreover, Vigil seems to be the second in command of TEEN Star, just after founder Hannah Klaus.

According to FEMM, the project is “grounded in revolutionary, peer-reviewed research in women’s endocrinology, developed through its research institute, the Reproductive Health Research Institute (RHRI), in Santiago, Chile.” The two physicians leading RHRI are the Chileans Pilar Vigil and Patricio Contreras. Teen STAR Chile, and the foundation behind RHRI, the Asociación instituto de investigación en medicina reproductiva, share the same address in Santiago of Chile.

In May 2018, a Guardian investigation into the FEMM app showed that the app promotes concerns about the safety and efficacy of hormonal birth control, asserting that it may be harmful to a woman’s health and that a safer, “natural” way for women to avoid pregnancy is to learn their cycles. Moreover, The Guardian reported that the FEMM Foundation, a not-for-profit which operates the app, receives much of its income from private donors, including the Chiaroscuro Foundation. This is a charity backed almost exclusively by Sean Fieler, a wealthy Catholic hedge-funder based in New York. Fieler also sits on the board of directors for the FEMM Foundation.

Based on the FEMM Foundation’s annual reports, The Guardian noted they received $618,653 in donations in 2017. The same year, Chiaroscuro gave FEMM $445,500, which amount for the majority of its budget. Chiaroscuro gave an additional $350,000 in 2016, and $1 million in 2015. RHRI is also registered in New York City, in the same address as the FEMM Foundation and another anti-abortion organization called the World Youth Alliance. World Youth Alliance gave FEMM $446,042 between 2016 and 2017, and it also received funding from Chiaroscuro Foundation.

According to The Guardian, even while the app collects personal information about sex and menstruation from users, unlike other fertility apps it has not been accused of monetizing confidential data, for sharing data with third parties, and for its lack of privacy protections. In the FEMM privacy fact sheet, they declare that "FEMM never shares or sells data with third parties. FEMM is not funded by drug or big pharma companies, ensuring that we are free from commercial bias in our science and information, as well as from pressures to monetize data and information provided to us by our users".

However, this affirmation is contradictory to their own Privacy Policy [2] which says that that FEMM assigns a random number to the app installed in a mobile device: "We use this random number in a manner similar to our use of Cookies as described in this Privacy Policy." The Privacy Policy also says that they "may use Cookie information to target certain advertisements to your browser or to determine the popularity of certain content or advertisements." Moreover, they say that the random number cannot be used to identify a person "unless you choose to become a registered user of the App." However, there is no opportunity to use the app while unregistered as a user, as the FEMM app requires users to complete data like name, email, and year of born when opening the application to be able to proceed with using the service.