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The woman compares the hills to white elephants several times in the story. Do the hills have a symbolic significance?

Traditionally, a "white elephant" is a possession that, while valuable, is not wanted by its owner. Today, we see in our culture "white elephant" gift exchanges, often between people who are just casual friends and do not want to buy gifts for one another--they are often popular at office parties. The fact that the young woman sees an image of white elephants in the hills is significant because she too is carrying something that is precious but still not wanted--a baby. 

The hills also mimic the woman's growing abdomen and her white skin; her condition mimics the snow-capped mountains over which the train in passing, and of which both the man and woman are largely trying to ignore.  There is also a certain coldness of the mountainous terrain which mimics the icy nature of the relationship between the man and woman. 

The hills can also symbolize the ups and downs that relationships inevitably face. These trials and tribulations are a part of any relationship.