Artículo de revisión

Published on 26 de noviembre de 2025 | http://doi.org/10.5867/medwave.2025.10.3139

Emergency contraception in Chile: Analysis of public policy according to Walt and Gilson

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Elements of Walt and Gilson’s policy triangle in the time periods that characterized the political process of emergency contraception in Chile.
ElementStage 1Stage 2Stage 3Stage 4
 Political actorsIt was evident in the power and influence of individuals and organizations [13] during the initial stages of the policy on access to the emergency contraceptive pill. From 1995 to 2001, ideas played a key role as a strategy to articulate the concerns of the leading actors; opponents framed the policy’s implementation using both internal and external lenses, highlighting the vulnerabilities of emergency contraception among the general public, including leaders who controlled resources [13] and other external actors [16]. Numerous socio-political actors across the conservative–liberal spectrum emerged as these public policies were rolled out: the general public, the WHO, health, justice, and SERNAM authorities, medical professionals and technical experts in the emergency contraception method, journalists, and lawyers advocating for emergency contraception. All of them were necessary to address the second identified stage.In 2001, the first emergency contraceptive pill—Postinal—was registered [14]. The Supreme Court granted a writ of amparo, prohibiting its sale due to uncertainty about its mechanism of action and possible abortifacient effect. A second drug, Postinor, was later registered, without the restriction being extended to it. In 2002, lawsuits were brought by business associations. APROFA, ICMER, the Corporación de Salud y Políticas Sociales, and women’s NGOs attempted to join the proceedings but were not admitted. Other “technical” NGOs advised the Ministry of Health. From 2003 onward, several scientific publications showed that emergency contraception’s mechanism of action was safe [14] and that its use was appropriate regardless of age, weight, or breastfeeding status [19].Supply problems revealed a disconnect between policy and practice. Evidence showed that although 100% of health providers endorsed the use of emergency contraception, only 49% were aware of the available options [20]. Given that refusal to provide the emergency contraceptive pill is associated with worsening reproductive health outcomes, this became a critical issue [18].In 2007, 36 deputies from the conservative bloc filed a claim of unconstitutionality against the Fertility Regulation Norm before the Constitutional Court (TC). Forty-six members of parliament, NGOs, ICMER, APROFA, the University of Chile, and women’s groups joined as parties in the defense of emergency contraception. Various national and international organizations sent letters supporting the judicial process. That same year, the Movement for the Defense of Contraception was created. Among the public, two politically significant actors emerged in the debate: groups of citizens who opposed allowing services to provide the emergency contraceptive pill, and others who demanded its availability. There were also mayors who, through legal actions, challenged the requirement that municipal health services provide it [16].In 2009, the General Comptroller interpreted the Constitutional Court’s decision as prohibiting the provision of emergency contraception in institutions of the National Health System. This not only created unmet needs among all women who sought to prevent an unintended pregnancy, thereby limiting the exercise of rights in a pluralistic society, but also reflected the power of the Catholic Church and conservative politicians. In 2010, President Bachelet sent to Congress, with suma urgencia (fast-track) status, a bill seeking to reinstate the provision of emergency contraception in the public health sector [21].
 ContentThe elements of these public policies began to be mapped out based on the strategy designed by the authorities of the time to introduce emergency contraception. The drafting of a protocol for the use of emergency contraception in women who were victims of rape (1998) established the need to provide emergency contraception in cases of sexual assault [2]. The distribution of this protocol targeted authorities at the Ministries of Health and Justice, as well as SERNAM. Training on the medical and technical aspects of the emergency contraception method focused on journalists and lawyers advocating for emergency contraception.During this period, the protocol remained in force. As it was disseminated to the Ministries of Health and Justice and to SERNAM, it was kept without major changes. However, external advisers to the Ministry of Health and the academic community incorporated recommendations stemming from new scientific publications. These clarified the drug’s mechanism of action, confirming its safety [14].In 2008, the Constitutional Court (CC) declared it unconstitutional to include emergency contraception in the Fertility Regulation Norm. Thirty-six members of parliament filed the petition. It specifically referred to the use of the emergency contraceptive pill, as well as counseling for minors under 14 without parental consent. The Court decided to prohibit the distribution of the emergency contraceptive pill in central-level health services, but left municipal clinics and health posts to decide on its availability according to each municipality. This created a scenario of uncertainty regarding effective, free access and the circumstances under which emergency contraception would be provided. Monitoring of distribution began. In 2009, 50.5% of municipalities dispensed the emergency contraceptive pill, while 41.4% did not dispense it regardless of the circumstances [22].In 2010, the bill was introduced and comprised five articles concerning information and the provision of services related to fertility regulation. The bill established: the right of every person to receive information and counseling on fertility regulation and emotional and sexual life; the right to freely choose methods of fertility regulation; the right to confidentiality; the State’s duty to make authorized contraceptive methods, including emergency contraception, available to the population; and, where sexual violence is suspected, the duty of the competent authority to make the relevant records available [21].
 ContextThe Catholic Church and actors from the conservative bloc opposed emergency contraception since the first drug registered in the country for this purpose (Postinal) was introduced. In addition, an intense campaign across various media outlets fostered public prejudice against the drug.During this period, sociopolitical tensions escalated between the public and social organizations that sought to participate in official debates but were denied the opportunity to do so. In the civil lawsuit brought by business associations against the laboratory and the PHI, organizations such as APROFA, ICMER, the Corporación de Salud y Políticas Sociales, and women’s NGOs attempted to join the case but were not admitted. The public debate continued, with extensive media coverage. Within the government, the Undersecretary of Health was dismissed after announcing emergency contraception for all women (2005). In addition, the new authorities planned other health processes regarding its distribution [16].During 2009, opinion polls showed that most Chileans supported emergency contraception. In light of this, emergency contraception became a topic in the presidential campaign, and all the candidates supported it.At this stage, Chilean public opinion favored emergency contraception. In response, deputies and senators signaled their support for legislating on emergency contraception. To that end, it was necessary to implement effective education systems, since knowledge of emergency contraception is the main predictor of its use [12]. A thorough understanding of how it works is crucial for individuals to make informed decisions [23]. Misperceptions about its mechanism of action generate resistance to its implementation among the population and among health professionals [19,24].
 Political processAccording to the literature, the involvement of numerous sociopolitical actors in the process of formulating public policies for access to the emergency contraceptive pill revealed a scenario of ongoing ideological tensions, with arguments that continually strengthened and weakened the initial policy-making process. This was resolved 10 years later with the promulgation of Law 20.418, which strengthened the reproductive rights of Chilean women.In 2004, emergency contraception was included in the Ministry of Health’s standards for care in cases of sexual violence [25], as part of the protocol proposed by ICMER for the prevention of pregnancy and STIs, thereby strengthening the policy initiative. However, there was a setback in implementation: following the dismissal of the Undersecretary of Health, the new appointee announced that emergency contraception would not be discussed until March 2006. In the meantime, the Court of Appeals and the Supreme Court upheld the PHI’s decision to approve emergency contraception in the case in which ICMER and APROFA participated. The issue remained in the public debate and became part of the presidential campaign, with all candidates in favor. Emergency contraception was added to the Ministry of Health’s essential medicines list, further strengthening the nascent public policy. This period culminated in 2006 with the inclusion of emergency contraception in the Ministry of Health’s National Fertility Regulation Norms [26].In 2009, the Comptroller General (CGR) interpreted the Constitutional Court’s (CC) decision from the previous year as prohibiting the delivery of emergency contraception in institutions of the National Health System. This represented a significant setback for the policy proposal. Nevertheless, the Executive introduced a bill to regulate family planning services that included emergency contraception. The bill passed the initial stage and was approved by a vast majority in the Chamber of Deputies [22].The bill became a reality with the promulgation of Law 20.418. A series of milestones followed to advance the implementation of these public policies. In 2010, 50 000 doses of emergency contraception were procured to improve nationwide availability; however, numerous NGOs reported shortages of the emergency contraceptive pill. A new study by FLACSO showed that 50% of municipalities were not dispensing emergency contraception. In addition, some Regional Ministerial Secretariats and pharmacies rejected prescriptions issued by midwives. In 2011, the need arose to amend the Health Code so that midwives could prescribe the emergency contraceptive pill; this was achieved with Law 20.533. In 2015, a decree allowed the emergency contraceptive pill to be sold in pharmacies without a medical prescription [27]. In 2018, the updated National Fertility Regulation Norms were published. In 2021, the Ministry of Health published a protocol for the provision of emergency contraception [28–31].

Stage 3, litigation concerning national fertility regulation standards (2001 to 2006). Stage 4, promulgation of Law No. 20.418 "Standards on information, guidance and services regarding fertility regulation" and subsequent regulatory advances (2010 to 2023). WHO, World Health Organization. SERNAM, National Women´s Service. NGOs, Non-Governmental Organizations. APROFA, Chilean Association for the Protection of the Family. ICMER, Chilean Institute of Reproductive Medicine. CGR, Office of the Comptroller General of the Republic. CC, Constitutional Court. PHI, Public Health Institute. FLACSO, Latin American Faculty of Social Sciences. STIs, Sexually Transmitted Infections. Stage 2, harassment and supply shortages campaign (2001 to 2006). Stage 1, manifestations of the conservative-liberal axis (1995 to 2000).

Elements refer to the time periods that characterized the political process to secure access to the emergency contraceptive pill in Chile. .

Source: Prepared by the authors, based on a literature review.