Image: Nem Presa Nem Morta, or Neither Incarcerated Nor Dead, is an umbrella organization for abortion decriminalization in Brazil.
Abortion stigma stemming from Brazilian law creates misinformation and delays in legal care, and retraumatizes survivors of sexual violence.
On Easter Day in 2023, a woman named Tatiana went to buy Easter eggs for her two daughters. It was something her husband used to do, but he had recently died. So she went herself, after a late shift at a hospital on the outskirts of São Paulo, where she works as a cleaner. As she left the grocery store near her home, a man armed with a gun drove up and grabbed Tatiana. He threw her into his car and raped her, strangling her and leaving bruises all over her body. “He hurt me a lot,” Tatiana said when I met her in March. The man also told Tatiana that he’d been watching her, suggesting that he might repeat the attack.
Tatiana went to the nearest public health clinic. When she told the nurse there she had been raped, the nurse said she needed to file a police report. But Tatiana was afraid to go to the police. If she reported the crime, she was terrified that her attacker would find out, and that he might kill her. She also lives in a close-knit community and knew word would get out. She feared she would be blamed for the assault.
At the clinic, Tatiana asked about emergency contraception, expressing concerns that she could become pregnant or that the man had exposed her to a sexually transmitted infection. The nurse simply told her she needed to wait at least 15 days and then come back for a pregnancy test. By the time Tatiana returned to the clinic, she was pregnant. She spoke with the chief obstetric nurse. “She said, ‘There are so many cases of rape, where women love their children that they have. Think it through,’” Tatiana said. “And I said, ‘Ma’am, how am I going to have the child of someone who I don’t even know? How can I love rape?’”
Tatiana knew Brazilian law allows abortions in the case of rape, but when she asked the nurse about that option, she was again told she’d need a police report to get a legal abortion. This isn’t true: Brazil’s 1940 penal code deems abortion a crime with two exceptions—cases of rape and cases where an abortion is necessary to save a pregnant woman’s life. In 2012, a Supreme Federal Court decision added an exception for cases of fetal anencephaly, a condition where the fetus is missing parts of the brain and skull. Brazilian courts sometimes grant exceptions in other cases where a fetus cannot survive.
And in cases of rape, no evidence is required by law beyond the victim’s statement. But many hospitals “demand a police report,” said Rebeca Mendes, a lawyer and the founder of Projeto Vivas, an organization that helps people access legal abortions in Brazil or travel out of the country when necessary.
This is just one of many abortion myths perpetuated in medical settings across Brazil. The highly restrictive environment creates fear and stigma surrounding abortion, and this in turn produces misinformation and information gaps, leading to a poorer quality of medical care for all pregnant people. For Tatiana, the outlook finally changed when she got in touch with Projeto Vivas. By the time a colleague—who noticed that Tatiana was suffering—referred her to the organization, she was nearly four months pregnant.
Mendes went through her own highly publicized struggle to get an abortion in Brazil, and in the end, had to travel to Colombia for care. Now, she’s dedicated to helping others access abortion. Mendes said that last year, Vivas helped 247 people obtain legal abortions within Brazil and assisted 255 with travel out of the country. The project’s main funding source is Fòs Feminista.
… Vivas connected Tatiana with a hospital that provided her with compassionate care. “The psychologist told me, ‘Your suffering is over from now on,’” she said…
According to a study by Debora Diniz, an anthropologist, law professor, and founder of the reproductive justice organization Anis Institute of Bioethics, rape is the reason behind 94% of legal abortions in Brazil. And in another 2014 paper, Diniz and her colleagues identified a “shared regime of suspicion of the woman’s narrative” across five of the country’s legal abortion facilities.
This suspicion was on full display when I visited Hospital Maternidade Carmela Dutra, on the outskirts of Rio de Janeiro. While the hospital doesn’t require a police report for abortion care, doctors check the story of any woman who says she was raped to make sure the dates match up with the length of her pregnancy, medical director Dr Sidney Rocha said. They don’t necessarily doubt that the woman was raped, he said, but if they don’t believe that the pregnancy was the result of a rape, they don’t approve the abortion. Rocha added that when his staff believes a woman is lying, they will even let other hospitals know, in case she tries to go somewhere else.
This isn’t the case everywhere: One gynaecologist in the Rio de Janeiro public health system, who is remaining anonymous for fear of reprisal, said her definition of sexual violence is more expansive. She encourages women to consider whether violence or coercion of any kind may have led to their pregnancy.
In 2022, nearly 75,000 rapes were reported in Brazil; 88.7% of victims were women, and 56.8%, like Tatiana, were Black. A staggering 61.4% were children ages 13 and younger. The Brazilian Public Security Forum estimates that only 8.5% of rapes are reported to authorities, making these figures a dramatic undercount….
Brazil’s constitution defines health as a fundamental right, and all citizens are guaranteed care in the country’s public health system. Any hospital in that system that offers obstetric and gynaecological services is supposed to provide abortion care. But very few do, largely because of stigma and confusion regarding abortion’s legality among doctors and other hospital staff, and the fact that many health professionals refuse to provide abortion care.
According to a report recently submitted to the United Nations Committee on the Elimination of Discrimination Against Women, in 2019, only 88 out of 1,115 facilities that had the capacity to offer legal abortion in Brazil were actually doing so. Only about a quarter of Brazil’s women of reproductive age live near one of these facilities, and Brazil’s northern region—the most rural and poor part of the country—has the fewest….
There are no reliable data on the number of deaths due to unsafe abortion in Brazil. However, the prohibition is believed to be a leading driver of the high pregnancy-related death rate. One recent study found that 5.2% of all hospitalizations in women of childbearing age between 2008 and 2018 were related to abortion. The most recent National Abortion Survey, a project Diniz helms, found that in 2021, nearly 1 in 7 Brazilian women had an abortion by age 40, and that over half of them had to be hospitalized to safely complete the abortion.
The widespread use of misoprostol — a drug originally approved to treat gastric ulcers — for abortion traces back to Brazil in the late 1980s and early 1990s. At the time, it was sold without a prescription and was mostly used by working-class and poor women to end pregnancies, or as most of them thought of it, to restore their menstrual cycles. [An early study by Anibal Faúndes showed a drop in deaths and morbidity from unsafe abortions within a few years. Editor] In response, the Brazilian government enacted new regulations on misoprostol in 1998 that are so stringent that misoprostol is difficult to obtain, even in some health-care settings.
As a result, illegal misoprostol can be very expensive, and is often fake. Still, said the Rio gynaecologist, women who have used fake misoprostol — which generally just doesn’t work — are usually better off when they arrive at the hospital than those who have turned to less safe means, like drinking toxic chemicals or injuring themselves in an attempt to end the pregnancy.
Beatriz Galli, senior policy and advocacy consultant at Ipas, said: “There’s a lack of social awareness of abortion … And I think this is on purpose. The Ministry of Health could promote public campaigns and disseminate information, but they just don’t do it.”
SOURCE: Excerpts from Rewire, by Garnet Henderson, 9 May 2024
Editor’s Notes: This excellent article continues at length and is a comprehensive picture of the current situation in Brazil, from the views of the head of the Supreme Court to the situation of those who have no access to a safe abortion when they need it.
As I was typing up this text on 23 May 2024, a hearing was taking place at CEDAW in Geneva entitled “Consideration of Brazil”, shown on United Nations Web TV. In it, a delegation from the Brazilian government and women’s rights movements were giving evidence on a range of questions relating to laws and policies on women’s rights issues and the situation of women more broadly, including on abortion. Available to watch for a few days at: https://webtv.un.org/en/asset/k1t/k1tk510nvy.