Every week at the Hospital das Clinicas in Sao Paulo, Brazil’s largest public hospital, women are rushed to the emergency room with severe vaginal bleeding.
Most are in their teens or early 20s and live in the dirt-poor slums that encircle South America’s biggest city. Some say they have no idea what caused the bleeding. Others tell elaborate stories of menstruation gone awry.
But hardly any own up to the truth: Scared of being turned in to the authorities in a country where abortion is illegal, they are reluctant to admit they induced miscarriage by inserting a black-market ulcer medication into their vaginas.
“They try to hide the fact that they were pregnant,” said Pedro Paulo Pereira, a doctor who runs the hospital’s obstetrics ward. “They’re young and afraid.”
Although abortion is outlawed in Brazil except in rare circumstances, the country has one of the highest abortion rates in the developing world. The Health Ministry estimates that 31 percent of all pregnancies end in abortion. That works out to about 1.4 million abortions a year, mostly clandestine.
In the United States, where abortion was legalized in 1973, about 25 percent of all pregnancies end in abortion. In the Netherlands, a country with some of the world’s most liberal abortion laws, the ratio is closer to 10 percent.
Despite its prevalence, abortion largely remains a taboo subject in Brazil, the world’s biggest Roman Catholic country. But that is now changing as civic groups and some medical professionals prompt a public debate on abortion by championing a woman’s right to end an unwanted pregnancy. They want to prevent women from dying in clandestine abortions.
In September, the government sent a bill to Congress to legalize abortion. Supporters of the bill, which will likely be debated for months in the lower house, acknowledge its chances of approval are slim. But they see it as a crucial step in taking abortion out of the realm of religious dogma and turning it into a matter of civic debate.
If approved, the legislation would authorize abortion up to 12 weeks from conception, up to 20 weeks in rape cases and at any time if the woman’s life is at risk or if the fetus is unlikely to survive after birth.
Currently, abortion is only allowed in cases of rape or when the mother’s life is danger. But even then, getting a judge to authorize the procedure can be difficult, and some doctors refuse to perform abortions on religious grounds.
PUBLIC HEALTH VS. WOMEN’S RIGHTS
The abortion battle is also being fought elsewhere in Latin America, where only Cuba and Guyana have fully legalized the procedure. Last month Colombia’s highest court delayed ruling on a lawsuit seeking to loosen the country’s abortion laws.
Argentina’s Congress is debating a handful of bills authorizing abortion in some instances. In Uruguay, a bill legalizing the practice was defeated by just three votes in the Senate in 2004.
In Brazil, activists are trying to frame the debate as a matter of public health. “We’re not advocating abortion as a means of birth control,” said Dulce Xavier, a member of a faith-based group called Catholics for the Right to Choose.
“It has to be recognized that women in Brazil have abortions, and that they are putting their lives at risk.”
Botched abortions are the fourth leading cause of maternal deaths in Brazil. In 2004, some 244,000 women were treated for complications from clandestine abortions in public hospitals, costing the government 35 million reais ($15.2 million).
Brazil’s abortion laws also highlight its gaping social inequalities. Well-to-do women resort to clandestine but safe clinics to end their pregnancies, paying as much as 1,500 reais ($650) - five times the monthly minimum wage - for an abortion.
Most poor women, by contrast, turn to an ulcer drug called misoprostol, better known by the brand name Cytotec. Manufactured by Pfizer, the drug when inserted into the vagina causes the uterus to contract, expelling the embryo or fetus.
Cytotec was never intended for use in abortions, and it has not been widely tested for safety as an abortion technique. It frequently causes hemorrhaging and studies suggest it can cause birth defects when it fails to abort.
“The criminalization of abortion places an undue burden on the poor, both in legal and health terms,” said Dr. Thomaz Gollop, an obstetrician who helped draft the new abortion bill.
Doctors estimate that Cytotec is used in more than 80 percent of all clandestine abortions in Brazil, even though the government banned the drug for all uses in the early 1990s.
GOVERNMENT BACKS OFF
Anti-abortion activists do not dispute that clandestine abortions are a cause for concern. But they say legalization is not the answer, and that the state should not be in the business of sanctioning the termination of human life.
“Taking a life is no way to address an unwanted pregnancy,” said Angela Guadagnin, a congresswoman leading a campaign to block the abortion bill. “We’re not going to let it happen.”
Anti-abortion activists may get their way. After sponsoring the bill, the government has since distanced itself from it, seeking to avoid conflict in Congress as it struggles to recover from a corruption scandal before elections this year.
President Luiz Inacio Lula da Silva, whose Workers’ Party has long championed women’s issues, has also suggested he opposes legalizing abortion.
Still, abortion-rights advocates say momentum is shifting in their favor and that change is inevitable.
“We’ve managed to make this into more than just a woman’s issue,” said Xavier of the Catholics for the Right to Choose group. “This is a battle that is only beginning.”
Revision date: July 5, 2011
Last revised: by Sebastian Scheller, MD, ScD