It was first published in August 1927 in the literary magazine transition, then later that year in the short story collection Men Without Women.

In 2002, the story was adapted into a 38-minute short film starring Greg Wise, Emma Griffiths Malin and Benedict Cumberbatch.

Setting the piece in Spain "dramatizes the peripatetic subject" and allows the man to discuss abortion outside the "restraints from the behavioral prescriptions of his place of origin."

Critics like Stanley Renner assert that the details in the story imply that the woman decides to keep the baby: "The logic of the story's design enjoins the conclusion that she smiles brightly at the waitress's announcement of the train because she is no longer headed in the direction of having the abortion that she has contemplated only with intense distress".

The description of the valley of Ebro, in the opening paragraph, is often seen as having deeper meanings: "It has long been recognized that the two sides of the valley of the Ebro represent two ways of life, one a sterile perpetuation of the aimless hedonism the couple have been pursuing, the other a participation in life in its full natural sense.

"[3] Critics also point to the various positions of the characters, with relation to the train tracks and the valley, to show a wide variety of possible symbolic interpretations.

"[4] Lanier asserts that every detail in "Hills Like White Elephants" is intentionally placed by Hemingway, and that the absinthe could have several possible connotations.

[4] This interpretation assumes the couple have the abortion and end their relationship, as well as that the young woman wants to continue the pregnancy; none of these are certain, due to the ambiguity of the story.

It's a sale put together through the donation of unwanted gifts, making the reader believe that this may be correlating with the act of getting an abortion.

"Elephant in the room" is a term used mainly by couples having a relationship crisis or difficulty including break-ups, divorce, cheating, marriage, adoption, or abortion.

The child is seen "as simply a white elephant to the man" to be rid of, whereas the woman only sees it as this due to the father's views.

[7] The final reference to the hills is when the girl contemplates her decision of getting an abortion through the following line, "it will be nice again if I say things are like white elephants, and you'll like it?"

In contrast, Gary Elliott writes that the beaded curtain and its similarity to a rosary lends insight to the girl’s reluctance to go through with the abortion and is almost certainly indicative of her Catholic background.

Some critics have written that the dialogue is a distillation of the contrasts between stereotypical male and female relationship roles: in the excerpt above, for instance, the woman draws the comparison with white elephants, but the hyper-rational male immediately denies it, dissolving the bit of poetry into objective realism with "I've never seen one."

The anti-feminist perspective emphasizes the notion that the man dominates the woman in the story, and she ultimately succumbs to his will by getting the abortion.

[3] Stanley Renner claims that "Hills Like White Elephants" is primarily empathetic towards the female character: "So firmly does the story's sympathy side with the girl and her values, so strong is her repugnance toward the idea of abortion, and so critical is the story of the male's self-serving reluctance to shoulder the responsibility of the child he has begotten that the reading I have proposed seems the most logical resolution to its conflict.