Excerpts from: Business as Usual for Quinacrine Sterilization in Chile

Author(s): Lezak Shallat
Date Published: July 17, 2006
Source: (Reprinted with permission from Reproductive Health Matters No.6, November, 1995)

Quinacrine sterilization has been part of the national contraceptive research landscape since the early 1970s, when it was first developed as a sterilization method by Chilean scientist Jaime Zipper. Some 1,500 women have undergone quinacrine sterilization to date in trials supervised by him in three public hospitals.

But it was not until last year-when Health Ministry plans to participate in expanded trials came to light-the facts about quinacrine use erupted into public controversy. The uproar began when women's health activists received copies of a September 1994 memo from the US-based Center for Research on Population and Security, which stated (erroneously, as it turned out) that the Chilean Health Ministry was replacing surgical sterilization with quinacrine in the nation's two most populous regions. The memo presented this possibility as an already-decided policy, saying that Chile's support of quinacrine in the face of the World Health Organization's 'ridiculous position' against its clinical use until more is known about its safety and efficacy, was a landmark event that would pave the way for quinacrine sterilization to be taken up throughout the region.

These bombastic assertions turned out to be false. But probing by activists determined that the Chilean Health Ministry was, in fact, studying plans to join the Zipper team in providing quinacrine sterilization to up to 1,000 women in central and southern Chile.

With women's health activists sounding the alarm over quinacrine safety and the spectre of experimentation on poor women, the Chilean Health Ministry withdrew its support for quinacrine research and in December 1994, the Minister of Health called for suspension of its use. More than a ban, however, this proved to be a short hiatus in which the three public hospitals providing the method were asked to review their internal ethical procedures.

In response, the Sotero del Rio Hospital - Dr. Zipper's research base and home to the country's largest maternity ward - stopped doing quinacrine sterilizations for three months. The hospital has since re-instated its programme, however, and is conducting a privately-financed trial with up to 700 women. As of October 1995, the quinacrine sterilization programmes in the two other hospitals were still under internal review.

Leading the public scrutiny of quinacrine use in Chile is the Santiago-based Foro Abierto de Salud y Derechos Reproductivos (Open Forum for Reproductive Health and Rights), a coalition of activist groups.

One possibility the Foro has discussed is to enlist the support of the Pan American Health Organization's Latin American and Caribbean Regional Program on BioEthics, created in 1994 and headquartered in Santiago. The Program's head, Dr. Julio Montt, a former Chilean Health Minister, has already expressed reservations about the unresolved issues of quinacrine safety and informed consent to the national health authorities. However, the Program views its role as educational, not activist, in monitoring ethical issues concerning reproductive rights in Chile.

Thus, it would appear that the Foro must assume the activist role in addressing the ethical issues surrounding the use of quinacrine, one way or the other, nearly 30 years after its first appearance in Chile.