A new bill once again puts abortion at the center of the debate. The proposal, called Listen to Their Heart and presented by six deputies — five of whom belong to far-right parties and one parliamentarian from Chile Vamos — proposes that, before accessing a pregnancy termination allowed by the three grounds law, medical personnel inform the woman about “embryonic or fetal heart activity” and “offer her the opportunity to listen to it.” However, various organizations working on sexual and reproductive rights warn that this measure would function, in practice, as an imposition, since if a woman refuses to listen, the doctor is obliged to refuse to perform the procedure.
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This is not a new idea. It follows a similar line to measures promoted by conservative sectors in countries like Hungary, Spain, and Brazil. It was also “a huge campaign in Colombia, and it is a campaign that is ongoing in Mexico. This is something that follows a rehearsed script to introduce guilt into women’s decisions,” said former Minister of Women, Antonia Orellana, on her social media.
She is not the only one who has raised her voice. The proposal quickly faced rejection among organizations working on sexual and reproductive rights, which have pointed out that it introduces new barriers to accessing a right already recognized by current legislation and qualifies it as a coercive measure aimed at making the application of the three grounds law more difficult. A legislation whose effective access before the presentation of this project already faces significant obstacles, as concluded by the Conscientious Objection Report in Chile 2025.
So, what is really at stake when a project like Listen to Their Heart is discussed? Lawyer and partner at AML Defensa de Mujeres, Francisca Millán Z., says what is at stake is whether Chile will continue eroding the little that already exists, or if we will have the honesty to recognize that the current model has deep flaws.
“Here something very revealing about the limits of the grounds model appears. This project does not need to change the three grounds to restrict access, it only needs to add one more requirement along the way. The discussion stops being whether termination under the grounds should continue to be legal or not. It becomes under what conditions it can be exercised. That shift is not minor; it is exactly what this type of initiative seeks. And in that game, those who lose are always the same: those with fewer resources to overcome an increasing chain of obstacles,” she explains.
Thus, the current discussion does not start with this initiative. It arrives in a context where access to legal abortion continues to face barriers and where even women who meet one of the three grounds find difficulties exercising a right already recognized by law. But the difficulties do not end there.
In addition to the barriers to the real fulfillment of this right, there are currently many other cases, some extreme situations — such as cancer diagnoses, domestic violence, or mental health — that today fall outside the current legal framework of the three grounds. Humanizing the abortion debate through these stories was precisely the goal of the campaign You Could Be You, a joint initiative by Abofem and AML Defensa de Mujeres, presented in March this year, which seeks to show that any of us could go through such a situation.
One of those stories is Daniela’s. She always wanted to be a mother and therefore did not hesitate to start fertility treatment to achieve it. It involved hundreds of injections, doctor visits, and, above all, thousands of sleepless nights. But what she never imagined was that on the same day she received the news of her pregnancy, she would also find out she had cancer. According to medical advice, she could not start chemotherapy while pregnant.
“Chemotherapy had to start immediately for the good prognosis the doctors gave me to be fulfilled. But the laws in Chile forced me to wait. And since my life was not in immediate danger, none of the grounds covered me, so I had to travel to another country to access a legal abortion. Now I am discharged and was able to achieve the dream of being a mother, but I cannot stop thinking about the fate of all those women who do not have the possibility to travel,” she says.
Another case is Constanza’s. She starts by saying, “Do you know how to identify that you are in a violent relationship?” She did not know for a while. It was while she was a student. She lived in fear, anguish, and desperation all the time. She could not tell anyone because her partner threatened to kill her. Until she had the courage to tell her family. With their support, she was able to escape the violence, and it was then that she found out she was pregnant.
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Continuing with that pregnancy meant, she says, staying in that cycle of violence forever. Seeing her like that, her brother helped her find some pills to terminate the pregnancy. “It was not easy. In Chile, to find this type of medication you have to go to the informal market. Now that I am well, I cannot stop wondering what will happen to Chilean women who are forced to live with their abuser forever.”
When access to a health service depends on proving that you belong to an exception, explains lawyer Francisca Millán Z., the system has to decide who qualifies and who does not. “And that decision is not made abstractly by the law: it is made by the on-duty doctor, with their criteria, prejudices, and disposition. The law leaves that margin open, and when there is medical discretion, there is arbitrariness. I think of Daniela, who appears in the campaign. She had cancer. Oncologists recommended terminating the pregnancy to be able to treat her. But since the risk was not “imminent” according to the evaluator, she did not qualify. She traveled abroad. She could afford that. How many cannot?”.
In Chile, nearly six thousand women have accessed legal and safe abortions since the entry into force of Law 21.030 in 2017. However, stories like Daniela’s, Constanza’s, and many others show that the three grounds do not cover all realities. The Guttmacher Institute estimates that between 60,000 and 300,000 clandestine abortions are performed annually in the country. If those figures are contrasted with the procedures carried out under the law, it is concluded that only between 0.36% and 1.76% of abortions are being addressed by the health system. The rest remain in the shadows, with inaccurate and dangerous figures.
Often, when abortion is discussed, the debate is placed on political or moral grounds. However, for Dr. Claudia Santiago, obstetrician-gynecologist, master in Sexual and Reproductive Health, and director of Ginecólogas Chile, the conversation should start from another place: public health.
“It is a health service like any other, and that is how the major institutions that we look to not only to practice medicine but also to build public policies, such as the World Health Organization, FIGO, and EBCOG, see it. In those institutions, abortion has always been viewed as just another health service,” she explains.
From that perspective, she questions the State’s maintenance of this care outside the health system. “How does it look if the State abandons or punishes and leaves untreated a diabetic who binged on sugar and arrived at the emergency room with a severe condition? I am not going to judge them; I will try to save them. And this is exactly the same: abortion is a health service abandoned by the State. As long as it does not have State support, it will continue to be a service where women do put their lives at risk,” she maintains.
Although she recognizes that there are extreme situations like those shown in the You Could Be You campaign testimonies, the specialist believes that focusing the discussion only on those cases ends up diverting the focus. “Women do not have to explain why they want to abort. All those backgrounds are excuses to justify,” she states. And she adds that if abortion were understood as any other health service, no one would have to give additional explanations to access it. “To pick up my hypertension medication at the clinic, I do not have to justify why I have hypertension. I have a prescription from a doctor who validated me. And this is just another health service. If we go around in circles and try to explain the inexplicable, we end up falling into the never-ending game of trying to understand why women abort.”
For the gynecologist, the reasons are as diverse as the women themselves. Some will decide to continue a pregnancy in complex circumstances and others will not. No decision, she says, makes some better or worse than others.
“Behind every human being there is a story that, when one takes the time to listen to it, if one has a bit of humanity, should say: ‘I have no right to judge.’ Because no one has the right to judge another’s life.” Perhaps that is the question this debate leaves us: before listening to a heartbeat, are we capable of listening to the stories of the women who live these experiences?
