Women’s reproductive autonomy matters for global progress toward gender equality, but how countries successfully liberalize abortion access continues to pose a puzzle. Laws legalizing abortion are difficult to pass and to implement, particularly in the Global South. They trigger considerable opposition from conservative actors, including center-right and right parties, religious or pro-life organizations, and doctors (Blofield Reference Blofield2006; Htun Reference Htun2003; Htun and Weldon Reference Htun and Weldon2018; Tribe Reference Tribe1992). When conservative actors hold congressional majorities, they block progressives’ attempts at reform (Blofield Reference Blofield2006; Reference Blofield2008; Blofield and Ewig Reference Blofield and Ewig2017; Fernández Anderson Reference Fernández Anderson2017; Reference Fernández Anderson2020; Reference Fernández Anderson2022; Htun Reference Htun2003; Htun and Weldon Reference Htun and Weldon2018). Even when left-wing parties hold congressional majorities, abortion liberalization does not automatically follow: legislative abortion reform occurs only when feminist coalitions count on sufficient support to both pass the measures and avoid executive vetoes. Consequently, feminist proponents often must negotiate with moderate or conservative elites, resulting in laws that are more restrictive than the versions initially proposed by proponents. Opponents thus attain small victories, so even as abortion liberalizes, conservatives are not utterly defeated, capitalizing upon these victories during implementation to further widen restrictions. Legal changes thus do not end the battle over access; they merely open up new forms of resistance (Pérez Bentancur and Rocha-Carpiuc Reference Pérez Bentancur and Rocha-Carpiuc2020; Piscopo and Walsh Reference Piscopo and Walsh2020; Wilson Reference Wilson2016). Indeed, the very strategies proponents and opponents deploy to respectively facilitate or impede implementation often originate with progressive actors’ decisions during the adoption phase.
This linkage notwithstanding, most of the literature analyzing legislative abortion reform has analyzed the adoption and implementation stages separately. Scholars have assessed how legalizing efforts succeed (Blofield Reference Blofield2006; Reference Blofield2008; Blofield, Ewig, and Piscopo Reference Blofield, Ewig and Piscopo2017; Fernández Anderson Reference Fernández Anderson2017; Reference Fernández Anderson2020; Reference Fernández Anderson2022; Htun Reference Htun2003; Htun and Weldon Reference Htun and Weldon2018) and examined conservatives’ mobilization to obstruct implementation (Biroli and Caminotti Reference Biroli and Caminotti2020; Corredor Reference Corredor2019; Pérez Bentancur and Rocha-Carpiuc Reference Pérez Bentancur and Rocha-Carpiuc2020; Piscopo and Walsh Reference Piscopo and Walsh2020). In this paper, we analyze events during the adoption and implementation stages together, arguing that (1) feminists make two different kinds of decisions about abortion barriers during adoption and (2) that these different decisions have different, yet patterned, effects on feminists’ and conservatives’ postreform strategies. In this way, we offer an analytic framework showing a predictable interaction between feminist and conservative actors. These linkages allow scholars and policy makers to better understand—and even anticipate—how and why feminists and conservatives react as they do once the law passes.
Our focus is therefore the pro- and antiabortion coalition leaders, the decisions they make, and the strategies they pursue. Proponents are the legislators, ministers, lawyers, and movement and nongovernmental organization (NGO) leaders who write and introduce the bills and later defend their implementation. Opponents are prominent politicians and other figures (e.g., religious leaders) who coordinate to extract concessions during legislative negotiations and erect barriers during implementation. Both sets of actors are elites who enjoy rarified access to political networks and influence. We call the former “feminists” and the latter “conservatives” because, while the rank-and-file legislators and bureaucrats who support or oppose abortion liberalization may not see themselves in these ideological terms, the pro- and antiabortion coalition leaders certainly do. These elites act in ways consistent with broadly accepted definitions of feminism (namely, its commitment to women’s bodily autonomy and reproductive rights) or conservatism (namely, its opposition to abortion and support for traditional gender roles and family structures).
Drawing on case studies that combine elite interview data and documentary evidence, we propose an analytic framework for legislative abortion reform that links these actors’ behavior in the adoption and implementation stages. First, we distinguish between two kinds of decisions that feminists make in the quest for legislative abortion reform: (1) “acceptable conditions,” in which feminists ex ante include limitations they believe are inconsequential or even important, failing to anticipate how these measures can and will be exploited by conservatives; and (2) “strategic sacrifices,” in which feminists agree to restrictions that were not in their original proposal, but which eventually become necessary to secure the support of moderate or conservative legislators.
Second, we argue that this difference between acceptable conditions and strategic sacrifices shapes implementation. While both acceptable conditions and strategic sacrifices weaken abortion laws by introducing barriers to abortion access, they do not generate the same behavioral response. When feminists introduce an acceptable condition at the outset, they do so because they agree in principle. This ex ante agreement means they largely fail to anticipate how conservative actors can leverage this condition into a significant obstacle. This failure means feminists play defense: they are caught off guard by the limitation’s implications and must scramble to protect access. By contrast, when feminists make a strategic sacrifice, they concede to a restriction they disagree with in principle (hence why they had not included this restriction in the first place). They can anticipate how this restriction will be leveraged by conservatives to limit access, which allows them to play offense: since they understand the consequences, they can proactively take steps—such as writing administrative rules—that attempt to mitigate the restriction’s reach during implementation. Thus, the type of decisions feminists make during adoption patterns how they defend the law and ensure its implementation.
We build this argument using the cases of Chile and Uruguay, two instances where feminists achieved legislative abortion reform in Global South democracies. Our data include 36 interviews with legislators, ministers, and high-ranking ministry officials, as well as a systematic analysis of legislative and government documents and media reports. The cases differ in their scope of legalization (Uruguay fully legalized abortion whereas Chile legalized abortion in instances of rape, fetal inviolability, and danger to the woman’s life), but both political processes were similar. The reforms involved tough negotiations between feminists and conservatives during the adoption phase, in which feminists included acceptable conditions and made strategic sacrifices, both of which allowed conservative actors to restrict abortion access during implementation. We then illustrate how our framework travels to other Latin American and Global South cases.
By tying adoption decisions and implementation strategies together and by bringing feminists back into analyses of the latter, we offer a new analytic framework for understanding feminists’ and conservatives’ behavior during processes of legislative abortion reform. We show that barriers to abortion access introduced during adoption are not idiosyncratic outcomes of legislative negotiations, but the results of decisions that are clearly typed in two different ways. This difference, in turn, generates predictable behaviors from proponents and opponents during implementation. By providing new empirical insights into conservatives’ victories during adoption and feminists’ offensive or defensive strategies during implementation, we follow scholars’ calls to analyze abortion liberalization “beyond success and failure” (Zaremberg and Almeida Reference Zaremberg and de Almeida2022). We identify patterns that can help scholars and policy makers alike to anticipate how legislative bargaining shapes actors’ efforts to facilitate or obstruct a law’s implementation.
The Politics of Abortion Liberalization
Reproductive rights policies are distinctive issues within the broader women’s rights agenda (Fernández Anderson Reference Fernández Anderson2020; Htun and Weldon Reference Htun and Weldon2010). Abortion access in particular invokes doctrinal beliefs, challenging widespread religious principles and provoking confrontations among mobilized coalitions of feminists and pro-choice activists on the one side, and conservative and pro-life activists on the other (Htun and Weldon Reference Htun and Weldon2018). Due to the contentious nature of reproductive rights policies, political elites will not univocally defend them (Htun and Weldon Reference Htun and Weldon2018; Tribe Reference Tribe1992). Moreover, global experiences show that laws promoting women’s reproductive autonomy are “never safe,” as they face backlash and setbacks after passage (Bergallo, Jaramillo Sierra, and Vaggione Reference Bergallo, Sierra and Vaggione2018; Biroli and Caminotti Reference Biroli and Caminotti2020; Pérez Bentancur and Rocha-Carpiuc Reference Pérez Bentancur and Rocha-Carpiuc2020; Sutton and Vacarezza Reference Sutton and Vacarezza2021; Undurraga Valdés Reference Undurraga Valdés, Becerra and Vargas2019; Wilson Reference Wilson2016).
Abortion rights have been particularly difficult to achieve in the Global South (Hall, Daire, and Hendrie Reference Hall, Daire and Hendrie2023). Most Global South countries maintain restrictive legislation, forcing women with unwanted pregnancies to resort to illegal procedures—paths that are especially risky for or even inaccessible to marginalized women (Casas and Vivaldi Reference Casas and Vivaldi2014; Sedgh et al. Reference Sedgh, Bearak, Singh, Bankole, Popinchalk, Ganatra and Rossier2016). Against this backdrop, Latin America has drawn considerable scholarly attention thanks to a recent liberalization wave occurring via two parallel channels: the courts and legislatures. Liberalization via the latter channel occurred in Uruguay in 2012, Chile in 2017, and Argentina in 2020. When feminists cannot secure congressional majorities, they have utilized strategic litigation, with recent court rulings expanding abortion access in Colombia and Mexico (Blofield Reference Blofield2008; Blofield and Ewig Reference Blofield and Ewig2017; Díez Reference Díez2025; Díez and Ruibal Reference Díez and Ruibal2025; Haas Reference Haas2010; Htun Reference Htun2003; Ruibal Reference Ruibal2021; Reference Ruibal, Botero, Brinks and Gonzalez-Ocantos2022).
One line of research explains Latin America’s legislative successes. Studies consistently identify the joint importance of feminist mobilization inside and outside legislatures and the activists’ and legislators’ ability to build cross-party coalitions (Blofield Reference Blofield2006; Reference Blofield2008; Blofield, Ewig, and Piscopo Reference Blofield, Ewig and Piscopo2017; Cherif Reference Cherif2015; Daby and Moseley Reference Daby and Moseley2022; Fernández Anderson Reference Fernández Anderson2020; Friedman Reference Friedman2019; Htun Reference Htun2003; Htun and Weldon Reference Htun and Weldon2018; Lopreite Reference Lopreite2023; Reuterswärd Reference Reuterswärd2022). Essentially, the political opportunity structures of women’s movements improve as leftist and/or secular parties gain congressional majorities and count on chief executives who will, at the very least, not veto the laws, and, at the very best, aid feminists’ negotiations (Blofield and Ewig Reference Blofield and Ewig2017; Fernández Anderson Reference Fernández Anderson2020; Friedman Reference Friedman2019; Htun and Weldon Reference Htun and Weldon2010). Feminist movements’ influence over public opinion also matters. Despite the region’s reputation for religiosity, voters in most Latin American countries support abortion in at least some circumstances, with feminist mobilization further increasing public support (Daby and Moseley Reference Daby and Moseley2022; Hall, Daire, and Hendrie Reference Hall, Daire and Hendrie2023; Sutton and Vacarezza Reference Sutton and Vacarezza2021).
Access to abortion rights depends not only on the legislative framework, but also on implementation. Thus, a second line of research focuses on struggles over implementation. This literature emphasizes conservative actors’ efforts to inhibit implementation or to repeal the laws (Corrales Reference Corrales2015; Haider-Markel and Taylor Reference Haider-Markel, Taylor and Ball2016; Lamas Reference Lamas2017; Undurraga Valdés Reference Undurraga Valdés, Becerra and Vargas2019). Antiabortion coalitions pursue institutional strategies, such as obtaining legal injunctions, seeking repeal referenda, and passing executive decrees that more narrowly interpret the law. They also pursue noninstitutional strategies, such as leading protests outside hospitals and organizing campaigns to persuade healthcare providers to declare themselves conscientious objectors (Bergallo, Jaramillo Sierra, and Vaggione Reference Bergallo, Sierra and Vaggione2018; Lamas Reference Lamas2017; Pérez Bentancur and Rocha-Carpiuc Reference Pérez Bentancur and Rocha-Carpiuc2020; Undurraga Valdés Reference Undurraga Valdés, Becerra and Vargas2019). Many scholars situate these strategies within the broader phenomenon of a global backlash against women’s rights (Biroli and Caminotti Reference Biroli and Caminotti2020; Mayka and Smith Reference Mayka and Smith2021; O’Brien and Walsh Reference O’Brien and Walsh2020; Pérez Bentancur and Rocha-Carpiuc Reference Pérez Bentancur and Rocha-Carpiuc2020; Piscopo and Walsh Reference Piscopo and Walsh2020). Conservative actors thus gain new prominence and influence once the law is approved (Johnson, Rodríguez Gustá, and Sempol Reference Johnson, Gustá, Sempol and Friedman2019; Lamas Reference Lamas2017; Pérez Bentancur and Rocha-Carpiuc Reference Pérez Bentancur and Rocha-Carpiuc2020; Undurraga Valdés Reference Undurraga Valdés, Becerra and Vargas2019).
These complementary literatures on adoption and implementation have seldom dialoged. Most works have considered adoption and implementation as separate political processes, analyzing feminists as protagonists in the first phase and conservatives as protagonists in the second. Yet this literature on conservative countermobilization or backlash largely overlooks feminists’ actions during implementation—with some exceptions. Scholars have analyzed, for example, how activists offer accompaniment services to women seeking abortions (Sutton and Vacarezza Reference Sutton and Vacarezza2021) and how feminist elites in the executive and judicial branches mobilize to block conservative efforts to reinterpret or overturn the law (Zaremberg and Almeida Reference Zaremberg and de Almeida2022). This work underscores the importance of going “beyond failure and success” when analyzing legislative abortion reform, instead examining the ongoing interaction between feminists and conservatives, wherein victory by one sparks a response from the other (Zaremberg and Almeida Reference Zaremberg and de Almeida2022). We build on this scholarship, offering an analytic framework that conceptualizes how feminists’ different decisions during adoption affect conservatives’ and feminists’ different responses during implementation.
Linking Adoption and Implementation
All laws require negotiations between proponents and opponents (Tsebelis Reference Tsebelis2002). The relative bargaining strength of the “for” and “against” camps affects which party will make the most concessions. In the case of abortion liberalization, feminist elites—legislators and other policy leaders—represent the “for” camp and open the negotiations. They belong to the larger feminist coalition seeking reform and they channel feminist organizations’ demands for reproductive autonomy (Htun and Weldon Reference Htun and Weldon2018; Johnson, Rocha, and Schenck Reference Johnson, Rocha and Schenck2015). At the same time, the coalition’s preferences for voluntary abortion access with few restrictions may exceed what feminist elites can achieve. Feminists’ initial proposals will reflect their preferred version of the law, but to craft majorities for passage, feminist elites may be forced to make concessions that deviate from their ideal version.
Our analytic framework envisions that, once the window for legislative abortion reform opens, feminist elites and conservative actors engage in a two-stage process. We conceptualize two different decisions that feminists make in the adoption stage, and we map these decisions to different forms of conservative resistance and feminist response in the implementation stage. The adoption stage refers to the legislature’s decision to legalize or decriminalize abortion, meaning the law shifts from prohibitive to more permissive. Figure 1 shows how actors’ different decisions map onto their different implementation responses.
Figure 1 A Two-Stage Process for Legislative Abortion Reform: Linking Adoption and Implementation
The process begins when feminists put forward their ideal version of the bill. We expect feminists to prefer laws with fewer restrictions on abortion access, consistent with feminists’ commitments to women’s reproductive autonomy. In the negotiations, however, feminists may agree to additional restrictions, to secure support from legislators who hold less progressive positions but are willing to compromise (Fernández Anderson Reference Fernández Anderson2020). Feminists concede these restrictions as they cannot craft majorities from progressive legislators alone. Thus, legislators with less permissive views become veto players (Tsebelis Reference Tsebelis2002) who prevent feminists from realizing their full preferences. When feminists agree to restrictions that were not part of their preferred proposal, they are fully aware of how these barriers will limit abortion access—after all, that is why their original version did not include them. Still, feminists will view the more restrictive bill as preferable to no bill at all, because “the compromise is worth it” (Reuterswärd Reference Reuterswärd2022, 1152).
While scholars have documented these concessions as part of the legislative negotiations (Collins Reference Collins2016; Fernández Anderson Reference Fernández Anderson2020; Maira, Casas, and Vivaldi Reference Maira, Casas and Vivaldi2019; Reuterswärd Reference Reuterswärd2022), we argue that negotiated concessions are not only the avenue through which the adoption stage plants the seeds for postreform challenges to abortion access. We distinguish between restrictions that feminists include ex ante—which they do not mind or even prefer, but later come to regret—and restrictions that feminists are forced to concede once the chamber negotiations are underway.
First, we conceptualize acceptable conditions: these are limitations identified as part of feminists’ original, preferred version of the bill. For the bill’s feminist authors, these limitations appear inconsequential or harmless, or even desirable. Feminists accept or even welcome these limitations, as they believe they will not overly hinder implementation. These limitations are often consistent with feminists’ own principles. For instance, feminists might ex ante agree that women seeking abortion should receive emotional support, that healthcare providers who express conscientious objection should not be forced to deliver abortions, or that having only licensed hospitals perform abortions ensures quality healthcare (Dickens Reference Dickens, Cook, Erdman and Dickens2014; Maira, Casas, and Vivaldi Reference Maira, Casas and Vivaldi2019). Yet despite their theoretically innocuous or even beneficial effects, acceptable conditions establish limitations on abortion access that conservative actors exploit during implementation, such as using judicial activism to expand conscientious objection clauses to greater numbers of providers. Since feminists accepted the limitation in the first place, they do not necessarily anticipate conservatives’ reactions.
Second, we conceptualize strategic sacrifices: these are deliberate decisions wherein feminists knowingly move the bill away from their ideal point. Strategic sacrifices are identified because they are absent from feminists’ original, preferred version, but later appear during the negotiations. Since feminists did not want these restrictions in the first place, they are aware of their negative consequences. In this instance, they can anticipate how conservative actors will leverage this small victory into access barriers, and they can plan their postreform steps accordingly. For example, feminists understand that women may face challenges navigating the procedures necessary to obtain legal abortions, and proactively plan mitigation strategies like creating accompaniment programs wherein volunteers support abortion seekers in navigating legal and medical bureaucracies (Sutton and Vacarezza Reference Sutton and Vacarezza2021).
The distinction between acceptable conditions and strategic sacrifices during adoption therefore shapes two different feminist responses during implementation. Acceptable conditions lead to feminists playing defense during implementation. By failing to anticipate how acceptable conditions can limit access, feminists do not plan a response in advance, and so they must react to—rather than seek to preempt—conservatives’ maneuvers. Playing defense means being reactive rather than proactive and thus playing from behind. In this way, acceptable conditions lead to unintended consequences, results that occur when policies operate in unexpected ways. During the legislative process, individuals have incomplete information: they can neither identify all available policy alternatives nor calculate all possible outcomes during implementation (Lindblom Reference Lindblom1959). Proponents are especially limited, as their focus on getting laws passed may mean they concentrate more on policies’ broad aspects than on their specific details. As a result, proponents may overlook gray areas or neglect details they perceive as less relevant (Moe and Howell Reference Moe and Howell1999). Our use of the term “acceptable conditions” thus captures a distinctive way feminists’ ex ante preferences lead to unintended consequences. In our case, feminist policy makers understood the limitation, but they calculated its impact incorrectly: they viewed this limitation as innocuous or even beneficial. Consequently, they must play defense to ensure abortion access in the implementation stage. By contrast, strategic sacrifices during adoption lead feminists to play offense during implementation. Feminists can anticipate how their concessions will affect abortion access during implementation. Being able to anticipate means acting proactively and thus planning ahead. In doing so, feminists can recoup their losses during the adoption phase, highlighting what policy scholars long have identified as protagonists’ postadoption efforts to bring implementation back to their initial preferences (Moe and Howell Reference Moe and Howell1999).
In linking acceptable conditions to playing defense and strategic sacrifices to playing offense, our framework conceptualizes how different decisions during the adoption phase map onto resultant strategies during the implementation phase. These distinctions emphasize the decision type and the offensive or defensive response, rather than the magnitude of the access barriers themselves or the ultimate landscape of abortion access. Access barriers resulting from acceptable conditions may be perceived as more severe because they appear unexpectedly, but on-the-ground limitations resulting from acceptable conditions are not necessarily larger or smaller than restrictions resulting from strategic sacrifices. Many other national and local variables outside our framework affect the realization of abortion rights, from health infrastructure to cultural norms around sexuality (Elverdin Reference Elverdin2025). Said another way, our framework is neither predicting nor measuring the scale of each decision’s actual effect on abortion access. Rather, our framework is conceptualizing the interaction between feminists and conservative actors across a two-stage adoption and implementation process, capturing how different types of decisions during adoption lead to different types of reactions during implementation.
Method, Data, and Case Selection
We build our framework using an in-depth case analysis of Uruguay and Chile, two Global South countries that liberalized abortion via statutory reform, and the first two within Latin America to do so. These reforms marked a significant advance for women’s lives, though the extent of the reform varied. Chile liberalized access on three grounds while Uruguay allowed voluntary abortion within the first 12 weeks of gestation. Yet our focus is not on the scope of liberalization, but on actors’ decisions, strategies, and responses: important for our purposes, then, is that the reform processes were similar. We analyzed the legislative negotiations, observing how feminists introduced acceptable conditions they considered harmless or even important, while also making strategic sacrifices to gain necessary votes. Additionally, we traced how feminists’ decisions about strategic sacrifices and acceptable conditions shaped their respective defensive and offensive responses during implementation. Such similarities lend confidence to our descriptive inferences, as the two processes—making strategic sacrifices and then playing offense, on the one hand, and introducing acceptable conditions and then playing defense, on the other—repeat across the cases.
Process Tracing as a Method
We completed a within-case analysis using systematic process tracing to capture the processes specified in the theory (Beach and Pedersen Reference Beach and Pedersen2016; George and Bennett Reference George and Bennett2005; Goertz Reference Goertz2017). We map the pieces of evidence (Collier Reference Collier2011) for feminists’ decisions about strategic sacrifices and acceptable conditions, and for feminists’ defensive and offensive strategies deployed during implementation. We show how the latter are conditioned by the former. Overall, we offer a conceptual framework that orders the decisions and reactions of feminists and conservative actors. Importantly, conservatives pursue multiple avenues to obstruct the implementation of abortion laws. Their efforts are not limited to only those avenues intentionally or unintentionally opened by feminists’ decisions during adoption, though these are the strategies we analyze here.
Our evidence comes from three types of sources: (1) a systematic review of the media coverage, (2) a systematic analysis of parliamentary records, and (3) 36 in-depth interviews with feminist activists, legislators, and ministry officials close to or directly involved in the bills’ negotiation and implementation (19 in Uruguay and 17 in Chile). We use the interviews to trace strategic sacrifices and acceptable conditions and to obtain information about the laws’ negotiations and implementation. All interviewees spoke on the record and are cited with permission. The interviews were conducted in Spanish, and quotations from them and other Spanish-language sources have been translated into English by the authors.
To enhance data validity, we triangulate by cross-referencing these three sources. Triangulation ensures a higher level of inferential confidence and is particularly useful when two or more sources have low probative value (Bennett and Checkel Reference Bennett, Checkel, Bennett and Checkel2015). We proceeded as follows: First, we reviewed the legislative documents to identify the bill’s original version and its modifications as it traversed the legislative process. Comparing the original bill’s content to its modifications enables us to objectively identify acceptable conditions (limitations present in the original version) compared to strategic sacrifices (restrictions not present initially but added later). Second, using our three data sources, we bolstered our identification of acceptable conditions, strategic sacrifices, playing defense, and playing offense through quotes and comments in actors’ accounts and media reports. Evidence of acceptable conditions included quotes or comments in which feminist actors expressed ideas such as “This clause seemed fine to us, as we did not realize it would be misused,” or “We agreed with that idea, then realized we were naïve.” Evidence of strategic sacrifices appeared in sentiments such as “If we hadn’t accepted that clause, the bill would have failed,” or “We had to compromise on this issue.” To pinpoint feminists’ behavior during implementation, we considered that feminists play defense when they described the unanticipated problems arising from acceptable conditions, forcing them to seek contingent solutions. Conversely, we categorized offensive play as when feminists described planning actions to mitigate the potential damage caused by a strategic sacrifice.
The main text includes key quotes or comments, and the online appendix contains all supporting quotes and comments. We explain how each quote or comment lends supporting value for the inferences on acceptable conditions, strategics sacrifices, defensive play, or offensive play. To assess the latter, we use process-tracing tests (Beach and Pedersen Reference Beach and Pedersen2016; Collier Reference Collier2011; Fairfield Reference Fairfield2013), where it is not the amount of evidence that is important, but its probative value.Footnote 1 Following recent recommendations about transparency in qualitative research (Kapiszewski and Karcher Reference Kapiszewski, Karcher, Elman, Gerring and Mahoney2020; Reference Kapiszewski and Karcher2021), our online appendix lists each piece of evidence and its probative value relative to the inference. We use the presentation format for reporting process-tracing evidence established by Fairfield (Reference Fairfield2013), making adjustments so the notation corresponds to our argument: a “UY” or a “CH” code refers to an observation from Uruguay or Chile, respectively; “AC” indicates an acceptable condition; “SS” refers to evidence of strategic sacrifice; “PD” refers to defensive actions; and “PO” designates offensive behavior.
Abortion Reform in Uruguay and Chile
Uruguay legalized abortion in 2012, via Law 18,987. Various attempts had been made since the 1985 democratic transition. One bill passed the Chamber of Representatives in 2002 but later failed in the Senate. Another passed both chambers in 2008, when leftist legislators from the Frente Amplio (Broad Front, FA) enjoyed the majority, but was subsequently vetoed by FA president Tabaré Vázquez, opposing his own caucus (Blofield, Ewig, and Piscopo Reference Blofield, Ewig and Piscopo2017; Correa and Pecheny Reference Correa and Pecheny2016; Fernández Anderson Reference Fernández Anderson2020; Johnson, Rocha, and Schenck Reference Johnson, Rocha and Schenck2015). The third attempt succeeded in 2012, during the FA’s second administration, under the presidency of José Mujica (Correa and Pecheny Reference Correa and Pecheny2016; Fernández Anderson Reference Fernández Anderson2017; Reference Fernández Anderson2020; Johnson, Rocha, and Schenck Reference Johnson, Rocha and Schenck2015; Johnson, Rodríguez Gustá, and Sempol Reference Johnson, Gustá, Sempol and Friedman2019; Reuterswärd Reference Reuterswärd2022).
Before 2012, abortion was legal only in limited circumstances: to save the honor of the wife or a close relative, in case of rape or risk to the woman’s life, or for economic necessity. All reasons except rape required judicial authorization, severely limiting access (Carril Berro and López Gómez Reference Carril Berro and Gómez2008). The 2012 reform introduced voluntary abortion within 12 weeks. However, women must first receive information about the procedure and its alternatives via consultation with a multidisciplinary healthcare team. Then, women must take five days for reflection. If they decide to continue, the national healthcare system provides the abortion at no cost.
Chile liberalized abortion in 2017, via Law 21,030. This law moved Chile from a complete prohibition of abortion to allowing it under three circumstances: danger to the woman’s life, fetal malformation incompatible with extrauterine life, and rape. The previous ban had been among General Augusto Pinochet’s last actions during his dictatorship (1973–90), when he modified the Health Code to eliminate “therapeutic abortion” (interpreted as voluntary interruptions of pregnancies when women’s lives or health were in danger). Pinochet’s ban placed Chile among the few countries wholly prohibiting abortion (Casas and Vivaldi Reference Casas and Vivaldi2014; Haas Reference Haas2010; Ríos Tobar, Godoy, and Guerrero Caviedes Reference Ríos Tobar, Godoy and Caviedes2003).
Following democracy’s return in 1990, feminists made multiple attempts to reestablish abortion rights, but faced a difficult conservative context (Baldez Reference Baldez2002; Fernández Anderson Reference Fernández Anderson2020; Haas Reference Haas2010). Legalization generated significant controversy, even among leftist politicians who generally supported abortion. Legislators feared conflict with the Catholic Church, whose role protecting left activists during the dictatorship gave the institution significant moral authority in the initial posttransition years (Guzmán, Seibert, and Staab Reference Guzmán, Seibert and Staab2010; Haas Reference Haas2010). Eventually, the Church’s alignment with right-wing parties and the scandal of priests’ sexual abuse eroded this authority. Still, the main coalition partner of the left-wing parties, the Partido Demócrata Cristiano (Christian Democratic Party, PDC), opposed any form of legalization. For a long period, Chilean feminists struggled to find political support (Fernández Anderson Reference Fernández Anderson2020; Haas Reference Haas2010; Pérez Bentancur Reference Pérez Bentancur2022).
The abortion bills faced multiple challenges in both countries. Feminists in the legislature (Uruguay) and in the executive (Chile) promoted the reforms during left-wing governments. In Uruguay, feminist activists united behind the original bill (Fernández Anderson Reference Fernández Anderson2017; Johnson, Rocha, and Schenck Reference Johnson, Rocha and Schenck2015). In Chile, the bill provoked disagreement within the feminist movement, with many activists considering the initial proposal too moderate. Yet many feminist elites, especially leaders from the nonprofit and policy sectors, recognized the bill as the only realistic path and lent their explicit support (Fernández Anderson Reference Fernández Anderson2020; Maira, Casas, and Vivaldi Reference Maira, Casas and Vivaldi2019; Maira Vargas and Carrera Ferrer Reference Maira Vargas, Ferrer, Becerra and Vargas2019; Pérez Bentancur Reference Pérez Bentancur2022).
In both countries, the left-wing coalition—the FA in Uruguay and the Nueva Mayoría (New Majority, NM) in Chile—did not have enough votes to secure a congressional majority on its own. Feminists thus had to negotiate with legislators from moderate or conservative parties who were willing to compromise. Consequently, feminists’ original bills were diminished in their scope and both laws passed with narrow margins (Correa and Pecheny Reference Correa and Pecheny2016; Fernández Anderson Reference Fernández Anderson2017; Reference Fernández Anderson2020; Johnson, Rocha, and Schenck Reference Johnson, Rocha and Schenck2015; Johnson, Rodríguez Gustá, and Sempol Reference Johnson, Gustá, Sempol and Friedman2019; Maira, Casas, and Vivaldi Reference Maira, Casas and Vivaldi2019; Pérez Bentancur Reference Pérez Bentancur2022; Reuterswärd Reference Reuterswärd2022).
During the first years of the laws’ implementation, both Chilean and Uruguayan women faced numerous hurdles to accessing abortion, from excessively bureaucratic procedures to widespread conscientious objection by healthcare providers and Catholic hospitals. Below, we describe how decisions that feminists made about limitations during adoption affected conservatives’ and feminists’ efforts to respectively inhibit and ensure abortion access during implementation.
Case Study: Uruguay
Feminist organizations and FA elites led the Uruguay coalition seeking abortion legalization. Feminist FA legislators with strong linkages to women’s organizations headed the negotiation. At the time, the Uruguayan Congress was composed of three major parties. The FA held majorities in both chambers and most—but not all—of its legislators supported abortion reform. The other two major parties, the Partido Nacional (National Party, PN) and the Partido Colorado (Red Party, PC), were on the center-right, had close connections with religious and pro-life organizations, and mainly advocated for the protection of life since conception (Correa and Pecheny Reference Correa and Pecheny2016; Johnson, Rocha, and Schenck Reference Johnson, Rocha and Schenck2015). Furthermore, two out of the three legislators of the Partido Independiente (Independent Party, PI), a small centrist party, were opponents. Only the third PI representative, Ivan Posada, was open to negotiations.
Adoption: Acceptable Conditions and Strategic Sacrifices
FA legislators introduced the bill in the Senate, where they counted on sufficient votes and passed it easily. The bill’s first version contained an exception for individual conscientious objection, marking individual conscientious objection an acceptable condition for feminists. Interviews reveal that FA drafters accepted individual conscientious objection for principled (rather than tactical) reasons. As the bill’s author explained, she supported this limitation in theory and did not see a reason for concern:
I advocate for the existence of conscientious objection for individuals … but with limits. It is not possible for someone to oversee a service and object to the very service they provide. It is not possible to pursue a career in certain fields when you are diametrically opposed to an existing law. So, I believe we were naïve, we didn’t foresee that step.Footnote 2
The bill’s initial version remained untouched until it reached the Chamber of Representatives, where the FA held 50 of the 99 seats. There, the bill faced major hurdles, as two FA legislators refused to support feminists’ original proposal, holding strong positions against it (Johnson, Rocha, and Schenck Reference Johnson, Rocha and Schenck2015). Under this scenario, Senator Mónica Xavier, who drafted the proposal, stated, “In the current situation, it is impossible for the Chamber of Representatives to approve the bill” (Molnar Reference Molnar2012). To get the law passed, feminists had to seek votes outside the FA, giving Posada an advantage. These negotiations led feminists to make two strategic sacrifices, introducing restrictions not contained in their original version.
First, Posada agreed to support legalization if the law stipulated that women had to first consult with a multidisciplinary team comprised of a doctor, a social worker, and a psychologist. Posada also wanted one team member to be a conscientious objector and to require that a five-day reflection period must elapse following the consultation. Feminist legislators managed to convince Posada to remove the requirement about the objector, and to specify that the team would only provide information about the procedure and its alternatives. However, they had to accept the consultation with the multidisciplinary team and the reflection period. Two feminist legislators described the necessity of sacrificing the perfect bill to obtain a good one:
There is an opportunity to advance in decriminalization. We do not have the votes to approve a text with the degree of maturity and depth [from the original version]. [But] I cannot remain rigidly loyal to the original bill while criminalization and women putting their lives at risk continue. I can either raise that flag and die with it in my hands, or I can be more flexible and get a big obstacle out of the way. (Representative Juan Carlos Souza [FA], quoted in Johnson, Rocha, Schenck Reference Johnson, Rocha and Schenck2015, 97)
In politics, you always reach the same point: either everything stays as it is, or we move forward. For some, moving forward was a lot; for others, it was a betrayal of fundamental principles. Politically, there were some protagonists, among them … Mónica [Xavier], who were willing to negotiate. … Now I have moral freedom to say well, between nothing, and this, I prefer this. That dilemma is permanent, there is a trade-off between the ethics of conviction and the ethics of responsibility, and nobody can solve it.Footnote 3
Second, whereas the original bill only allowed individual conscientious objection, feminists had to accept Posada’s introduction of institutional objection. This restriction covered two specific religious hospitals, the Evangelical and the Catholic Circle hospitals. These institutions had lobbied the Chamber of Representatives for exemptions, claiming they could not perform abortions because their statutes required them to protect life. As a result, Posada introduced the following clause:
Healthcare institutions, which prior to the enactment of this law, had religious objections to voluntary termination of pregnancy, may agree with the Ministry of Health on the way their patients will have access [to abortion].Footnote 4
Feminists claimed that recognizing institutional conscientious objection “was the only possible thing” they could do.Footnote 5 They also affirmed that although they “would have preferred not to include” this element, they supported it “following the agreement … reached in the process of drafting [the] bill.”Footnote 6 Thus, according to our theory, this clause also represents a strategic sacrifice (see observations UY4SS–UY6SS in the online appendix). Feminists agreed to institutional conscientious objection for tactical reasons to pass the law.
Bolstering the distinction between individual conscientious objection as an acceptable condition and institutional conscientious objection as a strategic sacrifice, an FA legislator explained that feminists focused on the consequences of institutional objection while disregarding the implications of individual objection. She commented,
The discussion surrounding conscientious objection was not about incorporating it into the bill, but rather about collective [institutional] conscientious objection. … So, all the efforts were made to prevent collective conscientious objection, having individual conscientious objection instead. I was so concerned about getting the bill passed, so concerned … that the only thing we were concerned about regarding conscientious objection was collective conscientious objection, not individual.Footnote 7
Implementation: Feminist Paying Offense and Defense
After the law passed, its opponents (members of the PN, PC, and PI in alliance with pro-life groups and the Catholic Church) unsuccessfully attempted to call a repealing referendum (Correa and Pecheny Reference Correa and Pecheny2016; Johnson, Rodríguez Gustá, and Sempol Reference Johnson, Gustá, Sempol and Friedman2019). Meanwhile, feminists in the Ministry of Health played offense relative to the strategic sacrifice they perceived as most consequential: the multidisciplinary team requirement. Leonel Briozzo, the then vice-minister of health and a prestigious gynecologist committed to reproductive rights, led the offensive strategy. Briozzo considered that if he “regulated the law as it came, the law would fail.”Footnote 8 Therefore, Briozzo acted proactively, drafting a regulatory decree that would mitigate how the “Posada clause” would negatively affect abortion access.
Specifically, Briozzo attempted to prevent the multidisciplinary teams’ ability to stall or inhibit women’s abortion access. In some areas of the country, establishing such a team would be virtually impossible in the short term because many hospitals lacked social workers and psychologists. Briozzo anticipated that conservatives would use the absence of the team to insist that no abortion services could be offered. As a countermove, his decree facilitated the formation and work of multidisciplinary teams by stating that the consultation could take place with one member at a time rather than with the entire team simultaneously. During our interview he explained,
It was a very complex law. It had to be regulated extensively to leave nothing to chance. … At that time, it was crucial that the consultation with the multidisciplinary team could be done successively, with the doctor, the social worker, and the psychologist. … It was impossible at that time to have all three together. … It was a political interpretation of what to do because I had interpreted that it was impossible to do it simultaneously … and that we had to do it successively.Footnote 9
Briozzo further hoped that allowing for one-by-one consultations would buy time for each hospital to establish teams.Footnote 10 Official data show that over 90% of women who consulted with the multidisciplinary team still chose to interrupt their pregnancy, suggesting that the multidisciplinary-team requirement did not deter women from seeking abortions, but did make the process more bureaucratic (Stapff, Briozzo, and Van Velthoven Reference Stapff, Briozzo and Van Velthoven2023; MYSU 2017). However, Briozzo’s offensive play meant that the teams’ inability to convene would not prevent women from moving forward when they wished.
Feminists could not act offensively on the matter of conscientious objection, however. During implementation, a significant hurdle emerged as many doctors declared themselves conscientious objectors, creating significant access barriers, particularly in regions outside the capital city (Montevideo) with limited healthcare providers. In some areas, such as the Salto region (approximately 500 kilometers from Montevideo), all doctors in private and public hospitals declared themselves objectors (MYSU 2017). In others, such as Cerro Largo (400 kilometers from Montevideo), many doctors became “pseudo-objectors,” refusing to perform abortions not necessarily because of their personal beliefs but because they received pressure from pro-life supervisors and/or feared censure from pro-life colleagues and friends (Cárdenas et al. Reference Cárdenas, Labandera, Baum, Chiribao, Leus, Avondet and Friedman2018; MYSU 2017).Footnote 11 Consequently, women often had to travel far from their homes to access abortions. In the first years of implementation, between 30% and 40% of doctors across Uruguay identified themselves as objectors (MYSU 2017).
Feminists initially supported individual conscientious objection, but did not anticipate conservatives’ strategies of persuading so many providers to become objectors. They thus had to play defense. While the Left was still in government, feminists in the Health Ministry attempted to respond, but were limited in their ability to do so. For example, they reassigned nonobjecting doctors to regions that lacked willing providers, and they assisted women in traveling to cities where abortion services were available. Additionally, still playing defense, they drafted a bill that would have placed guardrails on conscientious objection, such as stipulating that objecting doctors could not hold leadership positions in sexual and reproductive health services. Yet they lost their chance to pass this bill once the right-wing coalition won the 2019 election (see observations UY1PD–UY3PD in the online appendix). As Senator Constanza Moreira reflected several years after the reform, “I would never have given it legal status, considering what happened then.”Footnote 12
Consequently, conscientious objection continues to pose a barrier for women living outside metropolitan areas. For instance, in 2021, in three major cities, all doctors in public hospitals had declared themselves as objectors and 32% of the country’s public hospitals reported that at least half of their doctors were objectors (MYSU 2021). Moreover, another NGO surveyed doctors providing legal abortion services and found that doctors listed individual conscientious objection as the second-most common obstacle to abortion access, after long waiting periods (Stapff, Briozzo, and Van Velthoven Reference Stapff, Briozzo and Van Velthoven2023).
Case Study: Chile
In Chile, the opportunity to liberalize abortion emerged during the second term of President Michelle Bachelet (2014–18). Feminists from parties comprising Bachelet’s center-left coalition (NM) led the lobbying effort, ensuring that liberalization on the three grounds appeared in Bachelet’s 2014 electoral platform. Once in office, Bachelet—herself committed to the women’s rights agenda—tasked her cabinet to draft this bill. The Ministry of Women and Gender Equality led the process, without consulting the women’s movement (Fernández Anderson Reference Fernández Anderson2020; Maira Vargas and Carrera Ferrer Reference Maira Vargas, Ferrer, Becerra and Vargas2019; Pérez Bentancur Reference Pérez Bentancur2022). The authors justified making the bill “top secret” because they already faced intricate negotiations within Bachelet’s legislative coalition.
We generated the agreements [to introduce the bill in Congress] without anyone knowing about them, we did not filter anything in the press … and we had to work as an Executive very carefully because we knew we had detractors even within the government. … [I]t was a bill that unfortunately could not be discussed with the social organizations during the pre-legislative negotiations because we knew we had an internal problem as a government.Footnote 13
From the perspective of feminist elites within Bachelet’s NM coalition, legalization on three grounds was the best possible reform that could be achieved. The two major center-right parties, Renovación Nacional (National Renewal, RN) and Unión Demócrata Independiente (Independent Democratic Union, UDI), held strong positions against any form of liberalization, as they believed abortion violated the “legal status” of life (Pérez Bentancur Reference Pérez Bentancur2022). As the minister for women and gender equality stated, “they were closed to any type of negotiation.”Footnote 14 Bachelet’s bill would need the support of all NM legislators, but also faced opposition from within the NM, particularly from the first minority party and Bachelet’s main governing partner, the PDC.
Adoption Phase: Strategic Sacrifices and Acceptable Conditions
The first amendments took place in the Chamber of Representatives, where feminists made several strategic sacrifices that moved the bill away from the Bachelet’s original version. Although the NM’s electoral platform included abortion liberalization on the three grounds, several PDC legislators considered the government’s bill too permissive. They demanded that the grounds for abortion due to fetal malformation should be better specified, attempted to restrict interruptions to pregnancy in cases of rape, and sought to establish a procedure wherein a healthcare team would have to accompany women throughout the entire process.
To win PDC votes, feminists conceded to three modifications to their original proposal. The first strategic sacrifice established that fetal malformation should be considered as “malformation of a lethal nature.” The second stated that hospitals had to report the rapes. Finally, where the original bill only stated that women should receive written information about the abortion procedure, the third strategic sacrifice introduced an accompaniment program to help women in their “discernment process [and] after the decision was made” (Congreso Nacional de Chile 2017, 27–28; see also observations CH1SS–CH3SS in the online appendix).
Another strategic sacrifice took place in the Health Committee, where the PDC’s representatives moved to reduce the time limit in cases involving the rape of minors (defined as girls under the age of 14) from up to 18 weeks to just 14 weeks (Congreso Nacional de Chile 2017, 58). Feminists understood that this modification would significantly reduce access: adolescent rape often occurs within violent family relationships, meaning that resultant pregnancies are generally detected at an advanced stage. As one feminist explained, “[e]ighty percent of rapes and pregnancies involve girls and adolescents, and these pregnancies are discovered after the first trimester. That’s not my opinion; all the evidence supports it.”Footnote 15 However, feminists also stated that shortening the time frame became something they eventually “had to compromise on”Footnote 16 because they were unsuccessful in securing representatives’ votes for the original draft (see observations CH4SS–CH6SS in the online appendix). As another feminist explained, the 14-week provision was never in their preferred version:
The original bill established 18 weeks for children under 14 [to have an abortion]. We did not change the 14 weeks. That was an initiative of members of the Health Committee. … We requested representatives to vote for our draft, but we lost. And then, their proposal was voted.Footnote 17
Yet as in the Uruguayan case, the question of individual conscientious objection for doctors entered as an acceptable condition rather than a strategic sacrifice, as bill drafters agreed with this principle at the outset. Protecting doctors’ religious beliefs was fundamental for feminist proponents. In their words, it was “a way to be equanimous” and of not “forcing anyone.”Footnote 18 As another drafting-team member explained, individual conscientious objection for doctors was “part of the bill from day one”:
We know it is critical. We know there are people who effectively intervene in a termination of pregnancy, which can be something that honestly conflicts with their deepest values. So, we shared the idea of the objection, but with the safeguards that it should be limited … exceptional, and … ensure healthcare provision to women.Footnote 19
Thus, feminists’ decision to ex ante include individual conscientious objection for doctors constitutes an acceptable condition (see observations CH1AC–CH3AC in the online appendix). The opposition, however, did not find this provision acceptable enough. In the Senate Health Committee, PDC legislators conditioned their support on extending conscientious objection to the whole health team, not just doctors. Feminists were forced to compromise, accepting the PDC requirement because, once again, they could not advance the bill through the committee with just their own votes.Footnote 20 Here, the decision to move from the conscientious objection of individual doctors to the conscientious objection of the whole health team became a strategic sacrifice, as this modification moved the bill away from feminists’ ideal point. Had feminists not conceded, however, they might have lost even more ground, as some PDC senators were discussing an even more dramatic alternative: an amendment promoted by right-wing legislators that would establish institutional conscientious objection, allowing entire healthcare centers to refuse abortion provision (see observations CH7SS–CH8SS in the online appendix).
Unforeseen Developments
Amid the Health Committee’s vigorous debate about the extent of conscientious objection, NM senators Felipe Arboe and Alfonso de Urresti endeavored to play offense early. To prohibit the institutional conscientious objection floated by their right-wing colleagues, they attempted to refine the bill by adding language clarifying that conscientious objection is a personal prerogative that cannot apply to institutions. To the final version of the bill, they added, “[C]onscientious objection has an individual nature and in no case can it be invoked by an institution” (Congreso Nacional de Chile 2017, 1221, indications 86, 88). The Arboe and de Urresti clause entered into the version Congress passed, yet their offensive maneuver—the attempt to preempt institutional conscientious objection—backfired.
In August 2017, center-right legislators launched a new challenge. This time, they appealed to the Tribunal Constitucional (Constitutional Tribunal, TC), an independent body that judges the constitutionality of Chilean laws. The conservatives argued the law violated two rights: an individual’s right to life, and the prerogatives of health institutions to exercise their values (Congreso Nacional de Chile 2017, 1836). Their petition argued the bill should not force these institutions since the state itself guarantees “the statutory right to ascribe to a certain ideology, religious or not” (Congreso Nacional de Chile 2017, 1923–24).
In response, the TC took a very unusual step relative to Arboe and de Urresti’s clause (Undurraga Valdés Reference Undurraga Valdés, Becerra and Vargas2019). The TC is empowered to review and decide on laws in their entirety, but in this case, the TC ruled that the law was constitutional, but that a particular sentence was not. They determined that the Chilean Constitution assures conscientious objection as a “manifestation of freedom of conscience” and that there was no reason to restrict this freedom to individuals. Thus, only a phrase in the law was declared unconstitutional—precisely the phrase that Arboe and de Urresti had added stipulating that conscientious objection could “in no case” be invoked by institutions. The TC thus contradicted the Congress’s will (Congreso Nacional de Chile 2017, 1923–24). This decision widened the scope of conscientious objection (Undurraga Valdés Reference Undurraga Valdés, Becerra and Vargas2019), a victory for the Right, but one that could not have been foreseen by feminists or by Arboe and de Urresti. A member of the drafting team noted that the senators had tried to do the right thing—but guessed wrong:
They incorporated it to reaffirm it [that conscientious objection was only individual]. … But it was a double-edged sword, because that was what allowed them to cross out the word “never” or “will not be,” it was a negative. … I think they did it in good faith, to reaffirm their opposition to institutional conscientious objection. But in fact, the effect was the opposite, because the Constitutional Tribunal changed it.Footnote 21
Implementation: Feminists Playing Offense and Defense
As in Uruguay, feminists in Chile responded to strategic sacrifices by playing offense during implementation, attempting to safeguard the law’s contents and prevent distortions. Correctly anticipating that the Right would win the December 2017 elections, Bachelet’s government understood that the future right-wing administration would restrict abortion access as much as possible. Before leaving office, Health Ministry feminists aspired to leave clear guidelines for appropriate implementation. For example, as feminists had to concede to provisions mandating that women seeking abortions were accompanied in the procedure, the ministry guidelines included training plans to ensure healthcare teams provided medically appropriate information and support (see observations CH1PD–CH2PD in the online appendix).
Bachelet’s government also responded to the unanticipated ruling of the TC. In the law’s original version, feminists had included doctors’ individual conscientious objection as an acceptable condition but failed to anticipate the twists this clause would take, culminating in the TC’s unusual ruling that transformed an individual principle into an institutional one. Thus, in October 2018, attempting to mitigate the damage, Bachelet issued an executive rule establishing that institutional conscientious objection could not apply to private hospitals receiving state funds (Ministerio del Interior y Seguridad Pública 2018). In terms of our framework, this action could be read as defensive, as an effort to contain unexpected consequences. While feminists knew that conservatives preferred institutional constitutional objection, they thought the Arboe and de Urresti amendment, by excluding institutions, had settled the matter. When the TC decided otherwise, feminists—in this case, Bachelet—did what they could to revert to their preferences, by excluding hospitals funded wholly or partially by the state. However, this defensive move could not fully eliminate the application of institutional conscientious objection (see observations CH1PD–CH2PD in the online appendix).
When the new center-right government took office, President Sebastián Piñera did not repeal the law, but further limited access. At the beginning of his term, and in response to a complaint from the Catholic University of Chile, Piñera issued a new executive rule allowing institutional conscientious objection for any private hospital, regardless of whether it received state funds. Feminists thus failed to block the logical outcome of the conservative victory in the TC, and institutional conscientious objection entered into force. Their acceptable condition of individual conscientious objection, initially motivated by a principled belief in doctors’ rights, opened a can of worms that ultimately could not be contained.
As in Uruguay, during the first years of the law’s implementation in Chile, numerous hurdles to abortion services appeared. These ranged from excessively bureaucratic procedures to widespread conscientious objection (Fondo Alquimia and Mesa Acción por el Aborto en Chile 2019; Humanas 2022; Maira, Casas, and Vivaldi Reference Maira, Casas and Vivaldi2019; Sarmiento et al., Reference Sarmiento, Carrasco, Carrasco and Monteron.d.). According to Ministry of Health data, 3,826 legal abortions were performed between 2018 and 2022 (Ministerio de Salud 2024), while previous estimations had expected an annual average of three thousand.Footnote 22 Yet these numbers are not representative of the overall abortion landscape in Chile. Since the three causes do not cover all circumstances in which women seek abortions, many abortions continue to be performed clandestinely.
Also as in Uruguay, conscientious objection became widespread. Several private clinics declared themselves institutional objectors. Conscientious objection also appeared in public hospitals, with about 42% of doctors declaring themselves objectors in cases of rape as of 2022. This figure climbs to 100% for public hospitals in Santa Cruz (O’Higgins region), Cauquenes and Constitución (Maule region), Victoria (La Araucanía region), and Puerto Aysén (Aysén region) (Humanas 2023). Moreover, the Maule, Arica and Parinacota, and La Araucanía regions have the highest percentage of objectors for each cause (Corporación Miles 2021). In general, conscientious objection rates have remained practically unchanged since 2018, suggesting that it constitutes a stable reality hindering abortion access (Humanas 2023). Only during implementation did feminists realize the extensive limitations this principle, included in their original bill, would generate. As an activist explained,
I think we were so consumed by the urgency to approve this bill that it happened to me too, or it’s happening to me now, as if I look back and say, “But what happened that we never had a reflection?” … So, the truth is that we never anticipated how brutally obstructive conscientious objection would be to the implementation of the law.Footnote 23
Applying the Framework beyond Uruguay and Chile
We derive our analytic framework by leveraging similarities in the Uruguayan and Chilean cases, uncovering and organizing the patterned ways that feminists’ decisions during adoption inform their strategies during implementation. The framework’s underlying logic emerges from two democratic elements. First is the concept of legislative bargaining itself. Feminists rarely enjoy legislative majorities (Htun and Weldon Reference Htun and Weldon2018): even when left-wing governments hold congressional majorities, these majorities do not proactively initiate women’s rights reforms, especially not in doctrinal issue areas (Blofield, Ewig, and Piscopo Reference Blofield, Ewig and Piscopo2017). Thus, we expect to see strategic sacrifices when feminist politicians cannot command legislative majorities and must negotiate with legislators from more moderate or even conservative parties, adding restrictions that move their proposals away from their ideal points. Moreover, feminists—like members of any coalition focused on winning—often attend to the big picture rather than the details, and so may ex ante include conditions that they view as harmless but generate unexpected consequences (Moe and Howell Reference Moe and Howell1999). Second is the existence of multiple policy-making channels. Battles over implementation unfold as feminists and conservatives seek to leverage institutional checks and balances to their advantage. Since democracies count on different policy-making arenas, feminists try to use executive decrees to guarantee or expand access, and conservatives try to use courts and decrees to prevent the bill’s implementation.
Consequently, our framework should also explain patterns of legislative abortion reform in other democratic or democratizing countries where legislative bargaining takes place and multiple channels of policy making exist. Different political, cultural, and historical factors may explain when and why feminists succeed in placing abortion liberalization on their countries’ legislative agendas, but our framework explains not why the window of reform opens, but rather the decisions and strategies that take place once the reform process begins. These dynamics should be similar even when countries’ reasons for initiating the reform diverge.
To explore this possibility, we identified all cases of legislative abortion reform since 1994 (see table A in the online appendix). In this year, the landmark United Nations International Conference on Population and Development (the Cairo Conference) formally endorsed women’s right to decide the number, timing, and spacing of their children.Footnote 24 The conference’s proximity to the equally important 1995 UN Fourth World Conference on Women in Beijing—which called for unsafe abortions to end and endorsed women’s reproductive rights—makes 1994 a pivotal moment for feminists seeking abortion reform.
Using data from the Center for Reproductive Rights (2023), we counted a total of 44 legislative reforms: 14 countries made abortion voluntary up to a certain number of weeks (including Uruguay) and 30 countries expanded access for certain reasons, like rape or incest (including Chile). We then focused just on the Global South democracies, compiling and reading a bibliography of secondary sources related to each country’s reform. Importantly, not all countries have generated the same amount of research interest and the authors of the scholarly or policy accounts that do exist were not writing with our framework in mind. Primary research using our process-tracing method would thus better determine how many democratic cases match our framework. Still, we found “proof of concept” for our framework’s applicability in several instances, three of which we discuss here: Argentina, Guyana, and South Africa. Like Chile and Uruguay, all are Global South democracies where feminists succeeded in introducing and passing legislation liberalizing abortion access. In doing so, feminists made decisions about abortion limitations during adoption that influenced their strategies during implementation.
Argentina
To date, Argentina remains the only other Latin American country to liberalize abortion via legislative reform. Argentina took this step in 2020, allowing voluntary abortion up to 14 weeks. As in Argentina’s South American neighbors, the women’s movement had long sought abortion reform. The National Campaign for the Right to Legal, Safe, and Free Abortion introduced the first voluntary abortion bill in 2007, with support from a multiparty group of women lawmakers. The bill remained undiscussed and was introduced again in 2008, 2010, 2012, 2014, 2016, and 2018 (Bellucci Reference Bellucci2014; Di Marco Reference Di Marco2011; Fernández Anderson Reference Fernández Anderson2020; Reference Fernández Anderson2022). During this period, the campaign undertook extensive lobbying and media outreach. The campaign strengthened its grassroots mobilization, gained widespread attention, and ultimately grew considerably (Daby and Moseley Reference Daby and Moseley2022; Fernández Anderson Reference Fernández Anderson2022).
During the 2019 presidential campaign, left-wing candidate Alberto Fernández, representing the incumbent branch of the Peronist party, promised abortion reform. After his inauguration, Fernández appointed a drafting commission that included high-profile feminist elites, many of whom held current or previous positions in Congress or the executive. These leaders included his chief of staff and former senator, Vilma Ibarra, and movement leader icon Dora Barrancos. The 2020 version of their bill resembled the campaign’s earlier versions, but also introduced new elements—including individual conscientious objection (Clause 10). As both Ibarra and Barrancos explained, they viewed individual conscientious objection as an important principle and thus an acceptable condition, and Ibarra further did not anticipate an issue:
IBARRA: Since 2012, it’s been recognized by the Supreme Court, which is why we have included it in the bill, and I don’t believe we’ll have any inconvenience with the implementation of the law. (Vilma Ibarra, quoted in La Nación 2020)
BARRANCOS: What I believe is this [conscientious objection] is preserved in most legal abortion legislation in Europe, especially in some countries. So, in the end, it had to be accepted. The important thing about the Executive’s bill is that it doesn’t endorse institutional conscientious objection. (Barrancos Reference Barrancos2020)
The 2020 bill thus went to Congress with an exception for individual conscientious objection. However, feminist legislators—like their counterparts in Uruguay—were forced to include a form of institutional conscientious objection during the negotiations. This strategic sacrifice accommodated legislators concerned with religious health institutions, who otherwise would not support the bill (Argento Reference Argento2020; Giménez Reference Giménez2020). Feminists thus introduced an amendment that allowed healthcare institutions to refrain from performing abortions, but would still require women to be referred to alternative healthcare providers (Clause 11). Therefore, our framework identifies the two different decisions made by feminists: individual conscientious objection as an acceptable condition, and the healthcare institutions’ opt-out as a strategic sacrifice.
In line with our framework, feminist politicians understood the consequences of their strategic sacrifice. They knew that allowing healthcare institutions to opt out would limit access, creating service gaps. They thus took proactive actions during implementation, working through the Ministry of Health’s National Division of Sexual and Reproductive Health to develop an implementation strategy that included alternative access routes, such as the large-scale distribution of abortion pills (Ramos et al. Reference Ramos, Ábalos, Gerdts, Keefe-Oates, Krause, Michel and Romero2022). They also published clear protocols for health services not opting out and provided extensive training for healthcare professionals (Reference Ramos, Keefe-Oates, Romero, Michel, Krause, Gerdts and Yamin2023, 1007–8).
Individual conscientious objection has created unforeseen challenges, mirroring the scenario in Uruguay and Chile. The number of abortion providers remains limited outside the capital of Buenos Aires, especially in the provinces of Chaco, Mendoza, Santiago del Estero, Tierra del Fuego, and Córdoba (Amnistía Internacional Argentina 2023; Ramos et al. Reference Ramos, Keefe-Oates, Romero, Michel, Krause, Gerdts and Yamin2023). In response, feminist providers and activists have designed contingency strategies—for instance, helping women to travel to another city for their abortions (Ramos et al. Reference Ramos, Keefe-Oates, Romero, Michel, Krause, Gerdts and Yamin2023). Yet these defensive maneuvers had limited impact, and further challenges emerged with the election of conservative Javier Milei, who has slashed public health budgets and blustered about repealing the law. Still, as of writing, Argentina’s reform remains, marking a significant advance for women’s rights.
Guyana
Abortion remains widely restricted in the Caribbean, with only Guyana and St. Lucia liberalizing access since 1994. In Guyana, a self-described Pro-Reform Group, consisting of women’s rights activists alongside medical practitioners and other abortion advocates, successfully steered a legislative abortion reform through Parliament, securing votes across party lines (Nunes and Delph Reference Nunes and Delph1995). The 1995 Medical Termination of Pregnancy Act allows voluntary abortion up to eight weeks and then adds constraining conditions for abortions between eight and 16 weeks and even more restrictive conditions after 16 weeks.
Feminists included several acceptable conditions in their original bill, clauses which they initially viewed as normatively and practically important. First, feminists agreed that legal abortion should not become a substitute for birth control, given very limited access to contraception. Two protagonists recount, “[T]here was genuine concern, even among liberal reformers, for safeguards against the misuses of the Medical Termination of Pregnancy Act … proponents of reform did not want to appear to be giving pregnant women an unrestricted license” (Nunes and Delph Reference Nunes and Delph1995, 21). The bill’s initial version therefore contained provisions for pre- and postabortion counseling and tougher qualification thresholds after eight weeks. Second, feminists knew that many Guyanese health facilities did not offer high-quality care and did not want women to suffer botched procedures. Their initial version included a provision requiring that doctors and institutions performing abortions be preapproved by the Ministry of Health, which was “considered appropriate because of poor medical standards” (Nunes Reference Nunes, Klugman and Budlender2001, 114).
Following our conceptualization of acceptable conditions, feminists included these limitations at the outset—and did not anticipate their large, negative effects. Since the implementing regulations were written as part of the parliamentary negotiations, feminists were lulled into a false sense of security regarding the Ministry of Health’s ability to ensure access. Yet after the law passed, the ministry failed to issue the regulations and senior staff showed little commitment to legal abortion, effectively stalling implementation (Nunes Reference Nunes, Klugman and Budlender2001; Reference Nunes2012; Nunes and Delph Reference Nunes and Delph1995). Without regulations, no doctors or institutions were licensed, no procedures for authorization could be established, and no counseling could move forward. Clauses that Guyanese feminists initially viewed as important for protecting women’s health and safety, like restricting provision to licensed hospitals, instead became used to prevent abortions from happening. Feminists were forced into a defensive position from which they could not recover: while they launched public information campaigns to make women aware of their rights, they could not reach Ministry of Health officials, who refused meetings (Nunes Reference Nunes, Klugman and Budlender2001; Reference Nunes2012; Nunes and Delph Reference Nunes and Delph1995). The Guyana case underscores how acceptable conditions are determined by the limitations feminists (mistakenly) prefer ex ante, not the nature or extent of the restriction itself. In Argentina, Chile, and Uruguay, acceptable conditions arose from feminists’ principled commitment to individual conscientious objection, but in Guyana, acceptable conditions stemmed from feminists’ focus on women’s health and safety.
South Africa
South Africa’s landmark 1996 Choice on Termination of Pregnancy Act (CTOPA), which allows voluntary abortion up to 12 weeks and with further restrictions thereafter, formed part of the country’s democratic transition. In December 1994, women’s organizations convened a Women’s Health Conference that would articulate a legislative agenda for the newly elected African National Congress party (ANC) (Klugman and Varkey Reference Klugman, Varkey, Klugman and Budlender2001). Delegates from women’s groups, health professionals, trade unions, and the ANC proposed a new abortion law that included two pillars: women’s right to choose an early termination of pregnancy according to their own beliefs, and health workers’ rights to refuse participation, according to their own beliefs (Reference Klugman, Varkey, Klugman and Budlender2001, 257). The ANC government drafted the abortion law in 1995, including both pillars. Specifically, the draft recognized conscientious objection as an individual right, but stated that objecting healthcare workers must refer women to alternative providers and that this right could not be invoked when a woman’s life was in danger (Ngwena Reference Ngwena2004). The bill thus preserved feminists’ goals of balancing abortion access against individual religious beliefs (Klugman and Varkey Reference Klugman, Varkey, Klugman and Budlender2001, 257), including regulated conscientious objection as an acceptable condition.
Yet conservatives disliked regulated conscientious objection, rejecting the exception for danger to the women’s life and the referral mandate (Koekemoer Reference Koekemoer2022; Ngwena Reference Ngwena2004). Whereas conservatives in other countries wished to introduce conscientious objection in any form, conservatives in South Africa decided they preferred to remove conscientious objection entirely. The 1994 Constitution, already in place, guaranteed freedom of conscience. Consequently, conservatives determined that adopting an abortion bill that was silent on conscientious objection would provide more favorable circumstances during implementation, as appealing to the constitution would allow objection in more forms and instances than the government bill proposed (Ngwena Reference Ngwena2004).
Feminists’ acceptable condition was thus not acceptable enough. As the bill moved through Parliament, abortion opponents within the ANC began lobbying party leaders to allow a conscience vote. Such a decision put feminists’ vote tally at risk, given the number of ANC members opposed to abortion (Klugman and Varkey Reference Klugman, Varkey, Klugman and Budlender2001). In exchange for the ANC enforcing a party-line “yes” vote, the conscientious objection provision was eliminated (Reference Klugman, Varkey, Klugman and Budlender2001, 264). The issue, one feminist advocate stated succinctly, “was conservatism” (265). For feminists, dropping the original bill’s regulated conscientious objection became a strategic sacrifice, traded to ensure the party-line vote necessary for passage.
Since eliminating guardrails for conscientious objection constituted a strategic sacrifice, feminists engaged in playing offense. The National Abortion Advisory Committee—comprised of provincial Mother, Child, and Women’s Health service directors, university researchers, and NGOs—organized workshops to train healthcare workers in implementation (Klugman and Varkey Reference Klugman, Varkey, Klugman and Budlender2001, 266). They offered “Values Clarification Workshops” which, despite their neutral-sounding name, were designed to eliminate healthcare workers’ negative attitudes toward abortion and guide them away from conscientious objection (Koekemoer Reference Koekemoer2022; Vincent Reference Vincent2011). An estimated four thousand health workers attended Values Clarification Workshops in the initial postreform years, and they were widely touted as among the CTOPA’s more successful outcomes (Vincent Reference Vincent2011, 267). These offensive maneuvers notwithstanding, the CTOPA’s failure to regulate conscientious objection led to its widespread exercise, and conscientious objection is today considered South Africa’s largest barrier to abortion provision (Bertolè Reference Bertolè2021; Favier, Greenberg, and Stevens Reference Favier, Jamie and Stevens2018; Harries et al. Reference Harries, Cooper, Strebel and Colvin2014).
Conclusions
This paper offers a conceptual framework linking adoption and implementation in cases of legislative abortion reform. Our two-stage process connects feminists’ decisions about abortion limitations during adoption to the strategies of conservative and feminist actors to respectively inhibit or ensure access during implementation. Laws that liberalize abortion are rarely passed without any clauses that condition access, as even their proponents might ex ante view some limitations as harmless or even important. Still, feminists generally want a minimally restrictive law, and conservatives a maximally restrictive one. Conservative elites will thus seek to extract concessions in the legislative phase. After the law passes, conservatives will continue resisting, looking to repeal the law or to expand restrictions. While scholars have tended to study the adoption and implementation phases separately, our framework links both phases and brings feminists back into the analysis of implementation, highlighting their maneuvers to preserve access.
Drawing on primary research from Uruguay and Chile, we have shown that the types of decisions feminists make during adoption directly affect which strategies they pursue during implementation. We distinguish between two kinds of decisions. First, acceptable conditions are limitations feminists themselves introduce at the outset, not because they want access barriers, but because they view the limitation as harmless or even normatively or practically important. Since feminists fail to anticipate the condition’s far-reaching implications, they must play defense in implementation, inventing strategies post hoc. Second, strategic sacrifices are modifications to feminists’ original, preferred version of the abortion bill. These are restrictions feminists never sought in the first place—because they knew the restriction would hinder access—but which they concede to pass the bills. Yet armed with this knowledge, they can play offense and attempt to protect access in implementation. By distinguishing acceptable conditions from strategic sacrifices, we highlight how feminists (like any other set of political actors) cannot fully control the reform process once it begins.
We further postulated that our conceptual framework applies to legislative abortion reforms in other democracies, given the underpinning democratic elements of legislative bargaining during adoption and multiple policy-making channels during implementation. Our framework matches processes of legislative abortion reform in Argentina, Guyana, and South Africa. This extension provides further insight into the framework’s operation and benefits. First, acceptable conditions and strategic sacrifices need not occur together: only acceptable conditions appear in Guyana, but they link to playing defense, as predicted. An acceptable condition may also become a strategic sacrifice, as in Chile and South Africa, when a form of conscientious objection began as an acceptable condition but ended as a strategic sacrifice.
Second, the cases underscore how it is not only the content of feminists’ decisions that shapes access to abortion rights, but whether the consequences of this decision are known or unknown. In Uruguay and Chile, individual conscientious objection constituted the acceptable condition that posed widespread barriers following the reform, but in Guyana, it was limiting abortion procedures to certified doctors and hospitals. In both cases, the failure to anticipate how extensive this limitation would become constrained feminists’ responses during implementation. By contrast, strategic sacrifices—whether related to the multidisciplinary team in Uruguay or removing regulated conscientious objection in South Africa—allowed feminists to anticipate conservatives’ maneuvers and go on the offense to attempt to protect rights.
Our schema of acceptable conditions leading feminists to play defense, and strategic sacrifices leading them to play offense, offers some lessons for future cases of legislative abortion reform. The case studies suggest that acceptable conditions cannot be entirely avoided: in some cases, feminists have good reason to include a limitation ex ante, because they view this limitation as practically necessary or normatively important. Agreeing on acceptable conditions may well be necessary to open legislative negotiations in the first place. Still, acceptable conditions need to be well thought out: in an environment where opponents will exploit any advantage, seemingly harmless limitations can transform into significant access barriers. Feminists need to avoid being blindsided by the unanticipated consequences of acceptable conditions.
Indeed, our framework shows that strategic sacrifices lead to better planning on the part of feminists. This insight applies to other instances of women’s rights reform, where we posit our framework also applies. Take gender quota laws. Women have long fought within political parties to secure more nominations, understanding that party leaders publicly profess their commitments to gender equality while simultaneously continuing to nominate mostly men. Consequently, feminists have sought binding gender quota laws—but to pass the laws, they need male legislators’ votes. They have thus made strategic sacrifices, like lowering proposed thresholds, weakening binding language, and agreeing to sunset clauses. Once these requirements were sacrificed, feminists have acted offensively, working with electoral management bodies to reintroduce the rules (Piscopo Reference Piscopo2016; Piscopo and Vázquez Correa Reference Piscopo and Correa2024). In this way, our framework might also explain the patterned interactions between proponents and opponents in policy areas beyond women’s rights—perhaps whenever legislative reforms seek to expand the benefits or protections accorded to marginalized groups. As group rights expand, antagonists will seek to preserve the most exclusionary status quo possible, opening an interaction between reformers and resisters. Future work could use our framework to analyze reforms expanding group rights more generally.
Overall, our emphasis on decisions and strategies that limit implementation should not obscure that winning legislative abortion reform (or other women’s rights reforms) constitutes a significant feminist victory. Women in Uruguay and Chile still face hurdles in accessing legal abortions, but such difficulties characterize nearly all places where abortion is at least partly legal. Feminists’ acceptable conditions and strategic sacrifices hinder access to abortion rights but should not undermine the fact that securing legal abortion on paper is a necessary first step toward providing any legal abortions at all. As feminist legislators ultimately chose, securing imperfect laws that would save at least some women’s lives seems a better prospect than no law at all.
Supplementary material
To view supplementary material for this article, please visit http://doi.org/10.1017/S1537592725102284.
Acknowledgments
An earlier version of this paper was presented at the 2023 World Congress of the International Political Science Association. We thank Gisela Zaremberg and Conny Roggeband for their insightful feedback, as well as four anonymous reviewers for their thorough and constructive comments. We also acknowledge the valuable assistance of Agustín Daguerre, whose support was crucial in the development of this paper. Funding for original data collection comes from the Agencia Nacional de Investigación e Innovación (ANII, Uruguay) project “The Politics of Legal Abortion. Institutions, Actors and Processes” (project no. FCE_3_2020_1_162436).
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