Brazil: The abortion in numbers

According to documentary revision by AbortionData.org, there is not enough data to know how many abortions are done in Brazil, however, it is possible to have some estimations as that 1 out of 5 Brazilian women who live in urban areas have had an abortion. Studies carried out by scholars reveal how abortion is a common experience in the reproductive life of women and girls, even if this one is restricted. The legal barriers don’t impact the decision of having an abortion, but the data shows how those affect the access of black and indigenous women to legal abortions.

AbortionData.org recognizes that this page presents data about abortion only for women and girls as this was the available information.

The abortion law in Brazil

Induced abortion is still regulated as a crime in the Penal Code since 1940 (Hardy and Rebello, 1996) and it has a minimum of one year of detention according to the Art 124 of the Law N 2.848.

Provocar aborto em si mesma ou consentir que outrem lho provoque: Pena – detenção, de um a três anos.

CP – Decreto Lei n° 2.848 de 07 Dezembro de 1940: Artigo 124

There are only three cases that which a person can get access to abortion services without being punished (art. 124-127).

  • Rape-caused pregnancy – The person does not need to report to the police
  • Imminent danger to the pregnant woman’s life. – A doctor needs to testify this cause
  • Under circumstances of anencephaly – A doctor needs to testify this cause
  • The official data has registered from 2008 to 2015, 1,600 pregnancy interruptions for legal and medical reasons.
  • During the first six month of 2020 the SUS registered 1.042 abortions in legal settings.

Although abortion is legal in three exceptions, information from October 2020 indicates that only 31 cities in Brazil have legal abortion services. As a result, 13 states including the federal district did not have hospitals that covered the abortion services foreseen in the law.

According to Norma Técnica: Atenção humanizada ao abortamento by the SUS it is the State’s duty to keep, in public hospitals, professionals who perform abortions. If a woman needs medical services for cases foreseen in the law.

The demographic data available of women who have requested a legal abortion is from an independent study led by Debora Diniz, who analyzed 1,283 medical records of women who had legal abortions in 5 services in each region of the country during 2013 and 2015. This study offers an estimated landscape of the abortion seekers in the country.

The methodology used for that study relies on the report from public health services. It is crucial to have up-to-date data and a complete register to continue understanding who is seeking and accessing services of legal abortion.

Figure 1: The predominant characteristics of abortion seekers.

This study also provides data disaggregated by self-declared race, educational level, and age.

This is one of the most comprehensive studies of its kind in Brazil, from understanding the kind of services to the demographic characteristics of the abortions seekers.

A key result from this study was that the women who have access to legal abortion services are white. However, according to the information of the Instituto Brasileiro de Geografia e Estatística black women have the double of abortion of white women. The fact that black women are underrepresented in the access to legal abortion is explained by the research Greice Menezes, in the Brazilian magazine Azmina, as the result of the difficulties that black women face to access medical care due to institutional racism (Folego, 2017).

The study also found a relevant number of girls under 14 years old who accessed abortion services. Child sexual violence is an important issue in Brazil, and it is important to highly the right of these girls to access legal services as the need of a responsive action by the state to protect the life of the minors.

  • Abortion with Misoprostol

Misoprostol is a registered medication in Brazil and it is used for legal abortion, for induction of labor with the live fetus, and induction of dead or retained fetus.

  • Manual Vacuum Aspiration

Manual Vacuum Aspiration is available in medical centers for legal interruption of pregnancies until 14 weeks.

  • Electrical vacuum Aspiration

Electrical Vacuum Aspiration is available in some parts of the country. Records state that 3% of legal abortions were performed with this method (Madeiro and Diniz, 2016).

Impact of covid

According to a report by the Brazilian Feminist Magazines Azmina and Gênero e Número, during the 2020 period of the pandemic, only 42 hospitals in the country offered abortion services. Since 45% of the hospitals that offered the service before the pandemic suspended the services due to the sanitary emergency.

Legal abortion by telemedicine

Telemedicine abortion is practiced in cases of sexual violence in Brazil since August of 2020, as a solution to the isolation and lockdown. The program was impulsed by the Núcleo de Atenção Integral a Vítimas de Agressão Sexual (Nuavidas) in the Hospital de Clínicas in Uberlândia.

Until April of 2021, the services reported that 15 women (Acento, 2021) have interrupted the pregnancy using their services. However, this number is pretty low according to the sexual violence reports.

It has been shown that restricting abortion services does not reduce the number of abortions. People are simply forced to seek abortions outside the legal system (Amnesty International). In non-official research done through a household survey was found that 1 out of 5 Brazilian women who live in urban areas have had an abortion in their reproductive period of life (Diniz and Madeiro, 2010).

The information regarding Brazil should be read considering the legal restrictions, and the collective and individual stigma surrounding abortion could lead to underreporting of abortions. It means this number is possibly higher, as people don’t feel comfortable and safe talking about their abortion experiences.

Number of complications of abortions that have been attended

Estimations about abortion usually use the number of complications of abortion that have been attended in the medical health care system to calculate the number of abortions that take place in a population. These estimations have some limitations in countries such as Brazil, where not all people have access to medical health care and where abortion is criminalized. Nevertheless, they can offer information about the limited access to safe abortion methods and the impact for women and for the medical health care systems.

Relationship with legal abortion and number.

In the numbers of complications of abortions and the access to legal abortion services, the striking point is that the number of people who seek medical care for complications of abortions is considerably higher than the number of people that access abortion services. Data collected by news agency G1 shows that the Public Health Care System (SUS) attended 80,9 thousand cases of complications post-abortion during the first semester of 2020. During the same period of time, the SUS registered only 1.024 legal abortions.

The case of Fortaleza

A Study in Fortaleza, Brasil reported that from the 1st of October 1992 to 30st of September 1993, 4.359 patients were attended for abortion-related causes. In this study was revealed that 66% of them used Misoprostol to induce the abortion and most of them were young (Fonseca, Misago, Correia, Parente, and Chagas Oliveira, 1996).

Legal restrictions surrounding abortion create barriers to access to safe abortion methods. In Brazil, people who need an abortion are forced to seek out private clinics that offer the service clandestinely, buy Mifepristone and/or Misoprostol clandestinely, or use traditional folk methods that are not recognized by the WHO.

Misoprostol used vaginally and orally

According to the National Survey of Abortion 2016, 48% of the interviewed women use Misoprostol. The most common method was the use of Cytotec, 4 pills, and ending up the process in the clinic (Madeiros and Diniz, 2012).

Telemedicine and abortion with pills

Telemedicine has shown to be an effective and safe way to have abortions with Misoprostol, and with Mifepristone and Misoprostol (Aiken, Lohr, Lord, Ghosh, and Starling, 2021). Some international organizations offer these services to women that live in restrictive settings, such as Brazil. In 2015, approximately 416,000 women had an abortion 48% of the cases women had abortions with pills, Misoprostol (Diniz et al., 2017 p.256).

Women on Web

The website Women on Web, which offers services of telemedicine worldwide, has published on its website 1.086 do Brasil stories of women who have done a safe abortion with pills.

Travel to access an abortion

The legal restrictions and the lack of health care providers obliged abortion seekers to travel to access the services. The research was done by Azmina and Gênero e Números shows that 13 states don’t have a clinic that offers legal abortions, this situation forced many women to travel to the closest city where they can get access to their rights.

More detailed research is required to understand the experience of traveling for getting abortions. It is necessary to study the logistic barriers, cost, and emotional burden that this experience represents for abortion seekers.

Milhas Pela Vida das Mulheres

Milhas Pela Vidas Mulheres is a non-profit organization that supports women with information and economical support to travel to access legal services of abortion. They work to ensure access to safe abortion for the more vulnerable women, thus, black and peripheric women are privileged to receive their support. Their help could be information and economical fund to travel to another city inside Brazil to access the services or, in some cases, travel abroad the country to access abortion services.

The data that they have collected shows that 70% of the women who need abortions services are not aware that they have the right to access the legal service as their cases are one of the exceptions.

From the 276 requests they received during September of 2021, they found out that:

Their data points out the importance of traveling as an alternative to unsafe abortion methods in Brazil, travel to abortion is not a novelty in the world (Sethna and Davis, 2019) but it is an alternative that involves risk, expenses, emotional burden, stigma, shame, time-consumed, and familiar negotiations (Murray and Khan, 2020) (Jerman et al., 2017) (Gilmartin and White, 2010 that not all people can afford limiting this alternative to a few privileged ones.

What do we not know about abortion in Brazil?

Figure 5: Abortion data gap Brazil

About Brazil

Number of Inhabitants: 210.9 M (Our World in Data 2018)

Hunger and Undernourishment: Low level of hunger, score 5. according to the Global Hunger Index 2016. (Scoring system from 100 to 0, where 0 is no hunger)

Access to safely managed drinking water: 85.77% of the population (Our World in Data 2020)

Human Rights Violations: score 5,6 2014 according to (Scoring system from 0 to 10, where 10 is worst)

Access to clean fuels for cooking: 95.9% (Our World in Data 2016)

Literacy: 90,4% (Our world in Data 2010)

Sources

Acento (2021) El aborto legal por telemedicina se abre paso en Brasil. Acento [Online] https://acento.com.do/actualidad/el-aborto-legal-por-telemedicina-se-abre-paso-en-brasil-8938183.html [Accessed] Jan, 28 2022.

Acayaba and Figueiredo (2020) “SUS fez 80,9 mil procedimentos após abortos malsucedidos e 1.024 interrupções de gravidez previstas em lei no 1º semestre de 2020”. G1 [Online] https://g1.globo.com/sp/sao-paulo/noticia/2020/08/20/sus-fez-809-mil-procedimentos-apos-abortos-malsucedidos-e-1024-interrupcoes-de-gravidez-previstas-em-lei-no-1o-semestre-de-2020.ghtml [Accessed] Jan, 28 2022.

Aiken, A., Lohr, P. A., Lord, J., Ghosh, N., & Starling, J. (2021). Effectiveness, safety and acceptability of no-test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study. BJOG : an international journal of obstetrics and gynaecology128(9), 1464–1474. https://doi.org/10.1111/1471-0528.16668

CLACAI (2017) Mifepristona y misoprostol en seis paises de America Latina.

Departamento de Saúde Comunitária, Universidade Federal do Ceará. Fortaleza, CE – Brasil (W.F., L.L.C.); Maternal and Child Epidemiology Unit. London School of Higiene and Tropical Medicine, UK (C.M.); Hospital Geral César Cals. Fortaleza, CE – Brasil (J.A.M.P.); Maternidade Escola Assis Chateaubriand da Universidade Federal do Ceará. Fortaleza, CE – Brasil.

Diniz, D., Medeiros, M. (2012) Itineraries and methods of illegal abortion in five Brazilian state capitals Ciência & Saúde Coletiva, 17(7):1671-1681.

Diniz, D., Medeiros, M., Madeiro, A., Universidade de Brasília,  Brasil, Universidade de Brasília,  Brasil, Universidade Estadual do Piauí,  Brasil, 2017. Pesquisa Nacional de Aborto 2016. Ciênc. Saúde Coletiva 22, 653–660. https://doi.org/10.1590/1413-81232017222.23812016

Gilmartin, M., White, A. (2011).  ‘Interrogating Medical Tourism: Ireland, Abortion, and Mobility Rights’. Journal of Women in Culture and Society, 36 (2), 275 – 280.

Ferreira and Régia da Silva (2020) “Só 55% dos hospitais que faziam aborto legal seguem atendendo na pandemia” Revista Azmina and Gênero [Online] https://azmina.com.br/reportagens/so-55-dos-hospitais-que-faziam-aborto-legal-seguem-atendendo-na-pandemia [Accessed] Jan, 28 2022.

Freitas, J. E. P. D., 2020. Abortion Is A Fundamental Right—Brazil Is Failing To Fully Recognise It. Human Rights Pulse, 19 Septiembre.

Folego, T. (2017) “Criminalização do aborto mata mais mulheres negras”. Revista Azmina [Online]https://azmina.com.br/reportagens/precisamos-falar-de-aborto-e-como-ele-mata-mulheres-negras/ [Accessed] Jan, 28 2022.

Jerman, J., Frohwirth, L., Kavanaugh, M., Blades, N. (2017). ‘Barriers to Abortion Care and Their Consequences For Patients Traveling for Services: Qualitative Findings from Two States’. Guttmacher Institute, 49(2), 95-102.

Key Facts on Abortion [WWW Document], n.d. . Amnesty Int. URL https://www.amnesty.org/en/what-we-do/sexual-and-reproductive-rights/abortion-facts/ [Accessed] Jan, 28 2022.

Madeiro, A.P., Diniz, D., 2016. Serviços de aborto legal no Brasil – um estudo nacional. Ciênc. Saúde Coletiva 21, 563–572. https://doi.org/10.1590/1413-81232015212.10352015.

Murray, L. and Khan, N. (2020). ‘The im/mobilities of ‘sometimes-migrating’ for abortion: Ireland to Great Britain’. Mobilities, 15(2), 161-172.

Sethna, C. and Davis G. (2019). Abortion Across Borders: Transnational Travel and Access to Abortion Services. Baltimore. Johns Hopkins University Press.