Abstract

Abortion laws are subject to frequent change with wide-ranging impacts on fertility and health. Understanding how such legal changes translate into practice is crucial in determining how de jure abortion laws map to de facto access and use. This study examines the rollout of Chile’s 2017 decriminalization of abortion under three specific grounds–life-threatening risk to the woman, fetal unviability, and rape– and its effects on legal access and key usage patterns. We analyze data from administrative records on legal abortion occurring in Chile from January 2018 (shortly following decriminalization) until December 2024, to conduct descriptive analyses examining correlates of usage at the individual and territorial (regional) levels. Our findings show strong correlations between age and the grounds for abortion: the average age is highest for life-threatening risk to the woman, and lowest for rape–with a considerable proportion of adolescents. Geographical disparities are evident: regions with higher rates of sexual crimes also show high requests for abortion due to rape. However, access to abortion is uneven, partly due to geographic variation in conscientious objectors among medical professionals. Despite the increasing access to abortion on the decriminalized grounds over time, various challenges persist that could potentially limit the impact of abortion decriminalization, such as a significant proportion of conscientious objectors, both at the individual and institutional level, and binding gestational age limits in the case of rape. © The Author(s), under exclusive licence to Springer Nature Switzerland AG 2025.