September 10, 2012
RECIFE, BRAZIL – Luisa, 20, was 18 when she had an abortion in a clandestine clinic. She says she didn’t want to but felt as if she didn’t have any other choice.
Luisa, who declined to give her full name for privacy reasons, is the eldest of three daughters in a lower-middle-class family in Recife, a port city in northeastern Brazil. Her father worked in a factory and earned a decent wage, which was enough to provide the whole family with everything they needed.
Still, Luisa wanted to earn some money of her own to become more independent from her parents. So she quit her studies a year before the abortion and got a day job at a clothing store in a shopping mall. When the store hired her, though, she went back to school in the evenings with the support of her employer.
At this store, Luisa met Carlos, whose last name she declined to give for privacy reasons. He was looking for Christmas gifts that day, but came back many times after that to talk to her and eventually invited her on a date.
Carlos was 21 and the only son of a wealthy couple. With time, they fell in love. When they started to have sexual relations, Luisa says she realized she had to protect herself from a possible pregnancy so she began taking birth control pills.
But she soon started having strong headaches, so she went to see a doctor at the town’s family planning clinic. The doctor suggested that she change her contraceptive method to the diaphragm. She learned how to use it properly, and the headaches disappeared.
Three months later, however, she noticed her period was late. Luisa waited for another two weeks, then returned to the clinic. After some testing, they gave her the news: She was pregnant.
“I didn’t know what to do,” Luisa says. “I felt divided between fear and happiness, for being pregnant of the man I loved so much. Maybe I even wanted this to happen on the back of my mind.”
Luisa figured she had her savings and could continue working until she had the baby. From then on, her main focus in life would be Carlos and their child.
The following Saturday, she told the news to Carlos. His reaction, however, was not what she thought it would be. She says he was, for the first time ever, angry with her and could not stop yelling.
He told her he did not want the baby. Luisa says that Carlos’ unexpected reaction made her feel lonely and depressed.
After some hesitation, Luisa told her mother about the situation. Her mother tried to be supportive, but was against the pregnancy. She told Luisa that her father would also be disappointed because Luisa would not be able to invest in herself professionally, as he had always hoped.
“She told me she knew a place where we could go to have an abortion and that she would get me the money,” Luisa says.
Luisa says she didn’t want to have an abortion so she turned to her last resort: her boss at the store. She says her boss was a young and liberal woman, who had already supported Luisa in other times of need.
But, to Luisa’s surprise, she was faced with another disappointment. Her boss made herself clear that she would not support any pregnant employees and even mentioned the possibility of firing her if she continued with the pregnancy.
Feeling isolated, Luisa resisted the abortion idea for a while, but soon gave in. She says she realized she would not be able to raise her child by herself without a job.
Then, she went to the clandestine clinic her mother knew of and had an illegal abortion. She says there weren’t any complications because she got the procedure during the first six weeks of her pregnancy.
Luisa’s story is but one of millions throughout Brazil of women who seek unsafe abortions.
Doctors here say that the lack of contraceptive awareness, family support and public health services are among the reasons why Brazilian women seek abortions. In clandestine clinics throughout the country, abortions are many times performed unsafely, which some attribute to narrow abortion laws, while others cite socio-economics. The government and civil society organizations have been working together to improve maternal health and sexual and reproductive health services, but diverge when it comes to the criminalization of abortion.
Women procure an estimated 1 million abortions in Brazil each year, with the majority considered unsafe, according to Ipas Brazil, part of a global nongovernmental organization that promotes reproductive rights and gender equality in Brazil. There was a reduction in the estimation of unsafe abortions from nearly 1.5 million in 1992 to 1.1 million in 2005, according to a 2007 study by Ipas Brazil in partnership with the Institute of Social Medicine, part of the University of the State of Rio de Janeiro. Still, unsafe abortion is among the top three causes of avoidable death among women in Brazil and the fourth-leading cause of maternal death here.
Dr. Carlos Reinaldo Marques, a gynecologist at the Amaury de Medeiros Integrated Health Center, a public hospital in Recife, says that there are various reasons for unsafe abortions in Brazil.
“Lack of information about contraceptive methods is one of the main motives,” he says.
He says that the pregnant woman’s family also plays a role in the decision.
“There are also cases in which the woman does not feel support from her partner or any family members,” he says.
Marques says that sexual and reproductive health services are also lacking here.
“On top of that, there is a clear insufficiency in the public health services, which in turn fail to deal with abortion as a public health matter,” he says.
Under Brazilian law, abortion is a crime. Abortion is only legal if there is no other way to save the pregnant woman’s life or if the pregnancy is the result of rape. The punishment for violating this law varies, depending on the circumstances, between one and 10 years in jail.
Many say that this law forces women who don’t fall into either category to seek illegal abortions, which can pose serious risks to women’s health.
But Marques says that in some cases, even legal abortions are done under unsafe conditions because of a lack of public services to ensure safe abortions in many cities in Brazil.
Marques says that unsafe abortions – whether legal or illegal – carry various risks, such as infections, hemorrhages, uterine perforations and uterine adhesions. He says that these can all affect women’s sexual and reproductive health in the future and can even lead to death.
Because of the risks involved with abortion, Marques says that health workers must be careful about the influence they can have on women’s decisions.
“The team of health workers must not, in any way, try to influence the patient with their personal beliefs,” he says. “The team should inform the woman about all alternatives, motivating her to reflect on her health and reproductive rights for a more [conscientious] and informed decision.”
Benita Spinelli, coordinator of the women’s division of the Recife Health Department, says that abortion safety has more to do with socio-economics than legality.
“The difference is that wealthy women can afford a safe abortion in clean clinics – legally or not – whereas poor women, who are the majority of the feminine population in Brazil, have to perform abortions in places with no adequate medical care, resulting in serious damage for their health,” she says.
Research by Ipas Brazil identified a strong link between socio-economics and abortion safety. For example, maternal mortality rates from unsafe abortions are high in northern and northeastern Brazil, the country’s poorer regions. Black women in Brazil are also three times more vulnerable to death from unsafe abortion than White women, which the report attributes to socio-economic inequalities.
Brazil is on track to meet targets to improve maternal health, goal five of the Millennium Development Goals, MDGs, a U.N. initiative that countries worldwide have pledged to achieve by 2015, according to the MDG Monitor. Maternal deaths per 100,000 live births have declined by half – from 220 in 1990 to 110 in 2005.
The government and civil society organizations have been working together to meet this goal.
Spinelli says that reproductive health, delivery and abortion make up two-thirds of the areas addressed by the women’s division of the Recife Health Department. She says the division also partners with the Department for Women on a range of initiatives, such as ensuring women the right to accompaniment during the delivery or abortion, preparing health professionals to deal with high-risk prenatal procedures, acquiring material to further educate the population about family planning and reproductive rights and improving the infrastructure of municipal maternity hospitals.
Spinelli says that it’s important to adopt an interinstitutional approach to solve this problem. She says the department strives to be open to Recife’s many strong feminist organizations, which have been advocating for reproductive rights for decades.
Among these organizations is Catholics for a Free Choice, which promotes debate about abortion, interfaith dialogue and social justice. Since 1994, when it was founded in Brazil, Catholics for a Free Choice has been actively advocating for reproductive rights for women, despite a strong reaction by more conservative segments of the Catholic Church.
Another organization, the Curumim Group, has also been a strong voice in reproductive rights activism. After identifying the trend in Recife’s municipal legislative chamber to criminalize women who have abortions, the group created a public petition and has garnered support from citizens to pressure the politicians to change their position toward abortion laws.
The Curumim Group also runs a program called Humanization of Comprehensive Care to Women’s Health, which aims to prepare health workers for the treatment and referral of pregnant women, including for legal abortion services. The program has already trained more than 3,000 professionals in the state of Pernambuco and nationwide, including 30 percent of the health workers in Recife.
Paula Viana, the coordinator of the Curumim Group, says the group is also active in politics and the media.
“We actively participate in the media, doing our best to inform people about sexual and reproductive health, as well as to amplify the debate on abortion,” she says. “We also try to participate in politics by pressuring our government leaders through advocacy in favor of the decriminalization of abortion in Brazil.”
She adds that the group also organizes conferences to foster debate about public policies regarding abortion.
Viana says that the feminist movement has fought since 1940 for policies that ensure the abortion rights that the Brazilian Penal Code establishes for pregnant women who were raped or who could endanger themselves by carrying or delivering the baby. She says her organization aims to extend these rights to all women.
“Furthermore, we fight for this reality to be expanded to all women, which should avoid not only the negligence with which many women are treated at hospitals when they need to have an abortion, but mainly the stigma that surrounds abortion itself, which many times transform health professionals in[to] inhumane and even cruel individuals,” she says.
Leila Adesse, one of the founders of Ipas Brazil, agrees.
“Instead of being discriminated against and put in jail, the women who have abortions need psychological support, medical care and a more efficient coverage of contraceptive methods,” she writes in an e-mail.
Viana says abortion is a taboo subject and faces much resistance, mainly from conservative legislators, but that there has been a gradual openness to discussing the topic since 1998.
“However, there is still a lot to be done,” she says. “For example, there needs to be a[n] increase in the number and quality of services of legal abortion, and the population needs to be informed about it.”