BRAZIL – Challenges to the implementation of telemedicine in abortion care for victims of sexual violence

by Beatriz Galli, Jina Dillon
Frontiers in Global Women’s Health
7 December 2022

This article focuses on the recent dynamics resulting from state institutions adding more legal and regulatory barriers to abortion access, particularly against the use of telemedicine for sexual violence victims in Brazil. It presents a case study from a lawsuit targeting a pioneer public health service in the city of Uberlandia to ban telemedicine in abortion care. The case study highlights human rights violations of women’s right to health as well as recent threats to the right to safe, legal abortion care more broadly. It also provides legal arguments − based on scientific evidence and international human rights standards − that support the use of telemedicine for abortion care.

The implementation of telemedicine for abortion care for sexual violence victims was an important step towards improving effectiveness and availability of legal abortion services in Brazil. The initiative was firstly implemented at the Comprehensive Care Center for Victims of Sexual Assault (NUAVIDAS), located at the Federal University of Uberlândia Hospital, Minas Gerais.

In partnership with the Anis Institute, NUAVIDAS health staff developed the Protocol for Legal Abortion via Telehealth in which self-management of misoprostol was allowed at home for pregnancy termination, with remote supervision by health staff at the health facility. The protocol followed international human rights standards and best scientific-based evidence available on telemedicine in abortion care, by which pregnant women exercise the right to informed consent, autonomy in decision-making and right to privacy in abortion care.

Despite positive results and health outcomes, in July 2021, a public civil lawsuit was presented against the Ministry of Health administration asking for the immediate suspension of the NUAVIDAS programme, requesting that the Court declare its illegality nationally, in any medical services and provided in booklets or protocols that promote doing a legal abortion remotely, without follow-up by an in-person physician, and with the use of the drug misoprostol outside the hospital environment”. The case was dismissed without judgment on its merits. Many civil society organisations presented amicus briefs on behalf of NUAVIDAS, evidence-based telemedicine abortion care based on constitutional rights and international human rights law.

In June 2022, the Ministry of Health released the Guide “Technical attention for prevention, assessment and conduct in abortion cases” containing a series of misconceptions and illegalities not based on scientific evidence. This guide also erroneously affirms that unsafe abortion is not among the leading causes of maternal mortality and that the numbers of unsafe abortions are inflated for ideological reasons. It does not adopt a human rights-based approach to every preventable death and ignores the fact that causes of maternal deaths and injuries are under-reported when restrictive laws are in place. It further states that “every abortion is a crime, but when situations of exclusion of illegality are proven after police investigation, it is no longer punished, as termination of pregnancy due to maternal risk”.

VISUAL ; SEE ALSO these four articles published in 2022 in a series on abortion and Covid 19:

– Abortion as an essential health service in Latin America during the Covid-19 pandemic
– Quality of information offered to women by drug sellers providing medical abortion in Nigeria: evidence from providers and their clients
– The impact of Covid-19 on safe abortion access in Africa: an analysis through a framework of reproductive justice and lens of structural violence
– Saving more lives on time: strategic policy implementation and financial inclusion for safe abortion in Indonesia during Covid-19 and beyond