Melanie Riffo, 20, and her boyfriend Cristobal Cabezas, 22, learned they were expecting a child while she took birth control pills that were later recalled. Photo / Tomas Munita, The New York Times
The public health system delivered, and then quietly recalled, 276,890 potentially flawed packets of birth control pills. At least 140 women believe they got pregnant because of the error.
There had to be a mistake, Melanie Riffo thought, staring in disbelief at the result of her pregnancy test: positive.
She had been taking her birth control pills without fail, Riffo said. She and her boyfriend were careful. He'd even been told by doctors that a childhood ailment could have left him infertile.
"I couldn't make sense of it," said Riffo, 20, of the test she took in September. "We had been taking all the precautions."
Across Chile, scores of women like Riffo say they became pregnant last year after taking one of the 276,890 packets of oral contraceptives that were provided by the public health care system — and later quietly recalled over defects that made them potentially ineffective.
The Chilean government's failure to assertively warn women about the flaws in the pill packs was a stunning dereliction that resulted in at least 140 unintended pregnancies, reproductive rights activists say.
"We've never seen such a systemic failure, that lasted as long as the case in Chile, with such severe consequences," said Paula Ávila-Guillén, executive director of Women's Equality Center, which monitors reproductive rights in Latin America.
Riffo, a cashier at a sushi restaurant in the city of Chillán, had heard nothing about the faulty pills. She lives with her mother, who has cancer; she had been with her partner for only six months. The thought of bringing a child into her life left her in a panic.
"I don't have a career, I don't have anything stable, I don't have a home where he can be safe," she said of the baby. But without a legal option — abortion is allowed in Chile in limited cases including rape or a danger to the mother's life — she will have the child, she said.
The case of the flawed pill packs, exacerbated by the Chilean government's perfunctory response, has brought the debate about women's reproductive rights and access to abortion into sharp focus in a politically decisive year, when Chile will overhaul its political establishment.
Voters will select in April the members of an assembly that will draft a new constitution, and in November, they will vote in a new Congress and a president, replacing the conservative, and unpopular, Sebastián Piñera.
"There's one entity that's primarily responsible for distributing defective birth control pills through the public health care system and that's the Chilean state," said Claudia Mix, an opposition lawmaker. "The government cannot wash its hands of this."
After Argentina legalised abortion in January, becoming the largest country in Latin America to do so, female legislators in Chile introduced a bill to decriminalise the procedure. Lawmakers supporting that bill intend to push for greater access to abortions after a new president is elected in November.
Birth control has become increasingly available in Latin America, and countries with quality public health care systems like Chile provide them as part of routine care.
The first inklings of a problem with the birth control pills emerged soon after Chile imposed in March of last year one of the world's strictest coronavirus lockdown measures. Representatives from Miles, a reproductive rights organization in Santiago, the capital, began calling public health care workers across the country to determine whether quarantine measures and global supply chain snags were affecting the availability of contraceptives.
They heard a rumour: That the birth control pills being distributed by the government were defective, said Javiera Canales, executive director of Miles, or "thousands" in Spanish.
After Miles submitted a formal inquiry to government officials, the health ministry on Aug. 24 issued a recall for 139,160 packets of birth control pills sold under the name Anulette CD, which are produced by Silesia and Andrómaco, two Chilean companies that belong to German pharmaceutical company Grünenthal.
The problem, according to the health ministry and Silesia, was not the pills, but the packaging. Like many other oral birth control pills, packets of Anulette CD include 21 active pills, which are yellow, and seven blue placebo pills, which are intended to be taken during the time the user is menstruating.
An undetermined number of packets included placebo pills in the active slots and vice versa, according to the alert. A week after the initial recall, the health ministry issued a second one withdrawing an additional 137,730 Anulette CD packets. The second alert said some of the packets had missing or crushed pills.
The recalls, issued amid a severe coronavirus outbreak and on a government website that the public generally does not consult, generated relatively little news coverage. The government did not hold a news conference or develop a plan to directly warn the women who got the recalled contraceptives.
Marlisett Guisel Rain Rain, 37, a mother of three, was taking the pills when she learned she was pregnant. The news came at a challenging time: She was splitting up with her husband and starting the third year of a college degree in public administration.
"It was very hard to come to terms with the pregnancy," Rain Rain said. "I was studying and didn't have a stable place to live."
Rain Rain said she never contemplated having an abortion. "Maybe it's fear," she said. But the unplanned pregnancy was a blow.
"I don't think people grasp how hard it is to be a mother for a woman who is not ready," she said. "You have to rebuild yourself completely."
The manufacturer said in an emailed statement that the contraceptives it produced last year were effective, but a production glitch caused some pills "to move during the sealing process," which resulted in empty cavities and misplaced tablets.
It also said the health care workers distributing the pills could "visually identify any anomaly before handing over" the packets to the user.
The manufacturer said it "had not received any pregnancy reports" linked to the recalled contraceptives and that modern contraceptives are not foolproof: "It is statistically expected that 3 out of every 1,000 women who take a combined oral contraceptive — even under ideal circumstances — become pregnant."
The Chilean government announced it had imposed a fine of about $92,000 on the manufacturer over "quality problems" identified in the contraceptives. The companies continue to be the government's main provider of birth control pills.
Mix, the opposition lawmaker, said she and a handful of colleagues had demanded a report from the government on what exactly went wrong. They have yet to hear back.
Miles, the reproductive rights group that identified the 140 women who believe they got pregnant while taking the faulty contraceptives, is planning to sue the government and the companies that makes the pills in the coming weeks.
"This definitely violated the right that women have to decide when they want to have a child," Canales said.
Reproductive rights activists hope the case will galvanize the movement to broaden abortion access in Chile, which had an outright ban on terminating pregnancies until 2017.
Regardless of how that debate unfolds, Riffo said the government has a responsibility to help her and other pregnant women who were receiving contraceptives at government centers.
"At least they should help us with the education of the child, which is super expensive," she said.
As her belly has grown in recent weeks, Riffo said she has battled depression and anxiety severe enough that she has been prescribed medication and took a leave from her job. The hardest part, she said, is dreading a moment that many expecting mothers dream about.
"I'm not looking forward to his birth like I would have liked to," she said. "And that makes me feel terrible."
Written by: Ernesto Londoño
Photographs by: Tomas Munita
© 2021 THE NEW YORK TIMES
Simone White, 28, is the fifth tourist to have died after becoming ill last week.