Abortion in Brazil: the case for women's rights, lives, and choices

A case study of Brazil could serve to emphasise the negative public health consequences of severely restricting legal abortions and could offer lessons to countries considering restricting abortion rights—as recently seen in the USA.1Jaffe S Legal battles over abortion heat up in the USA.Lancet. 2019; 393: 1923-1924Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar Brazil is the largest and most highly populated country in Latin America and the Caribbean. This region has the most punitive laws for illegal abortion and yet the highest estimated frequency of abortions in the world: 44 per 1000 women compared with lowest frequency of 17 per 1000 women in the USA and Canada.2Sedgh G Bearak J Singh S et al.Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends.Lancet. 2016; 388: 258-267Summary Full Text Full Text PDF PubMed Scopus (382) Google Scholar In Brazil, abortion is only legal in cases of rape, incest, to save a woman's life, and, since 2012, in the case of anencephaly—a fatal condition in which infants are born without parts of the brain or skull. Despite Brazil's severe legislation, 500 000 illegal abortions are esti-mated to occur every year among women aged 18–39 years, which equates to one in five women, with half of these abortions resulting in emergency room visits due to complications.3Diniz D Brito L Ambrogi I Tavares AB Ali M Understanding the sexual and reproductive health needs in Brazil's Zika-affected region: placing women at the center of the discussion.Int J Gynaecol Obstet. 2019; 147: 17Crossref Scopus (6) Google Scholar By contrast, in countries that provide safe and legal abortions, only 2–5% of women require medical care afterwards.2Sedgh G Bearak J Singh S et al.Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends.Lancet. 2016; 388: 258-267Summary Full Text Full Text PDF PubMed Scopus (382) Google Scholar The most women who are admitted to hospital after an illegal abortion are uninsured, representing a government cost of more than US$10 million every year.4Wenham C Arevalo A Coast E et al.Zika, abortion and health emergencies: a review of contemporary debates.Global Health. 2019; 15: 49Crossref PubMed Scopus (27) Google Scholar As a consequence of unsafe abortions, more than 200 women die every year in Brazil. In the past decade, approximately 4000 so-called near-miss events have occurred, when maternal deaths were avoided due to health system intervention.5Valente PK Zika and Reproductive Rights in Brazil: Challenge to the right to health.Am J Public Health. 2017; 107: 1376-1380Crossref PubMed Scopus (15) Google Scholar The prevalence of reproductive complications and other negative health consequences associated with illegal abortion is unknown. Even in the face of the mosquito-borne Zika virus epidemic, which causes severe fetal malformations, the Brazilian Zika emergency protocol did not mention or authorise legal abortions despite WHO recommendations.6Oladapo OT Souza JP De Mucio B de León RG Perea W Gülmezoglu AM WHO interim guidance on pregnancy management in the context of Zika virus infection.Lancet Glob Health. 2016; 4: e510-e511Summary Full Text Full Text PDF PubMed Scopus (17) Google Scholar Between 2015 and 2017, more than 2700 babies were born with congenital Zika syndrome in Brazil.4Wenham C Arevalo A Coast E et al.Zika, abortion and health emergencies: a review of contemporary debates.Global Health. 2019; 15: 49Crossref PubMed Scopus (27) Google Scholar The effect of policies that make abortions illegal include an increase in governmental expenditure related to an increased number of high cost emergency room visits, lifelong child health costs, and potential reproductive health consequences in women. The Brazilian Government also faces heightened cost from the criminal justice system in prosecuting cases and housing women, girls, and abortion providers during their sentences. In Brazil, people who have illegal abortions can serve up to 3 years in prison, while those who conduct abortions can serve up to 4 years.3Diniz D Brito L Ambrogi I Tavares AB Ali M Understanding the sexual and reproductive health needs in Brazil's Zika-affected region: placing women at the center of the discussion.Int J Gynaecol Obstet. 2019; 147: 17Crossref Scopus (6) Google Scholar, 5Valente PK Zika and Reproductive Rights in Brazil: Challenge to the right to health.Am J Public Health. 2017; 107: 1376-1380Crossref PubMed Scopus (15) Google Scholar Abortion laws, whether they are punitive or protective, strongly affect the morbidity and mortality of young women at the most valuable times of their lives. Each year an estimated 55·7 million induced abortions occur globally, 25·1 million (45·1%) of which are unsafe.7Ganatra B Gerdts C Rossier C et al.Global, regional, and subregional classification of abortions by safety, 2010-14: estimates from a Bayesian hierarchical model.Lancet. 2017; 390: 2372-2381Summary Full Text Full Text PDF PubMed Scopus (356) Google Scholar Globally, an estimated 7·9% of maternal deaths are associated with unsafe abortions.8Bearak J Popinchalk A Alkema L Sedgh G Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model.Lancet Glob Health. 2018; 6: e380-e389Summary Full Text Full Text PDF PubMed Scopus (328) Google Scholar Since several USA states are adopting more restrictive abortion legislations, one key lesson from Brazil should be considered: even in countries where abortion is illegal, the practice is highly prevalent, results in substantial health risks to women, and increases government health-care burden. Almost all disability and death from unsafe abortion is preventable, and legislators and governments should work to reduce this burden. We declare no competing interests. Legal battles over abortion heat up in the USAChanges to Title X, several legal challenges, and a change to the Supreme Court composition could mean drastic changes for access to abortion in the USA. Susan Jaffe reports. Full-Text PDF

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