The Federal Supreme Court (STF) is expected to begin the trial on the decriminalization of abortion this Friday (22). If approved, abortion will no longer be a crime in the country, which could have positive repercussions on several aspects of public health. This is because the stigmatization and criminalization of abortion in the country has diverse repercussions on the health and lives of women, girls and people who are pregnant. The most visible of these, perhaps, is the high rates of maternal mortality, most of which are due to preventable causes – such as deaths resulting from unsafe abortions.
Elaine Passos, a psychologist specializing in Hospital Psychology, mother and working in the area of Sexual and Reproductive Rights in the Unified Health System (SUS) in Bahia, highlights that deaths resulting from unsafe abortion are more common among the poorest populations, which is why It is even important to treat them as a public health issue.
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Due to lack of financial resources or fear of accessing non-legalized services, most women who wish to terminate a pregnancy end up undergoing unsafe procedures that lead to bleeding and infections. For fear of reprisals, not all of them seek health services even in cases of serious complications.
“In case of hemorrhage, infection, intense pain, they can, after the attempted (abortion), resort to health services. Not only can they but they should seek these health services. There, they do have the right to have humanized abortion care already provided for in technical standards. And they cannot be discriminated against”, highlights Elaine.
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For these women, as well as for any other patient, medical confidentiality is a right guaranteed by Brazilian legislation. Lívia Almeida, member of the Women’s Rights Center at the Public Defender’s Office of Bahia, explains that the medical team cannot report these women, much less can they be arrested during medical care. “Health professionals do not have the duty of judicial police. So, they shouldn’t investigate this woman,” she recalls.
Elaine Passos explains that, regardless of the reason that led to illness, anyone has the right to quality medical care free from violence. “Health is everyone’s right, regardless of the condition in which health was degraded, it needs to be recovered with all the comfort and quality of care that the population deserves”, she states.
Public defender Lívia Almeida also explains that, in cases where the health service calls the police because it suspects that the patient had an abortion, it is the service professionals who commit a crime. “These professionals who engage in this type of conduct may be held criminally liable for breach of confidentiality (based) on the Penal Code,” she says.
She adds that the criminal cases that are being initiated against women based on evidence collected through breach of patient confidentiality have not been brought to justice due to the use of illicit evidence. And anyone who, when seeking health services, suffers a situation like this, should contact the Public Defender’s Office in their city to have adequate defense and ensure that this process does not prosper. “These criminal actions, which may be initiated, have been invalidated by the higher courts”, she explains.
Still, the two professionals point out that, unfortunately, the teams have not adequately served these women. Lívia Almeida highlights that stigma even prevents abortion from being a topic discussed in Medicine and Law faculties, even though it is a social fact and refers to the health and lives of women, girls and people who are pregnant.
“We have been doing this work of rights education, providing women with information about their rights, information about the security they may feel in seeking health services in legal cases. And also providing professionals with the necessary assurance that they are not committing a crime”, adds the public defender.
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Both Lívia Almeida and Elaine Passos point out that the criminalization and stigma of abortion also have consequences for people who have the right to have an abortion in the cases provided for by law – sexual violence, risk of death for pregnant women and fetal anencephaly.
Elaine highlights that it is common for women who have had a legal abortion to arrive at the psychology service in very lonely suffering and also facing the lack of credibility of public bodies and services that should provide early care, especially for victims of sexual violence.
“The vast majority of them do not file a police report, as they believe they will be unwelcome and mistreated in this service; or that this will not result in an investigation, in punishment for those responsible for the violence. It’s a very lonely moment of intense suffering,” she says.
The psychologist adds another serious consequence of this stigmatization: suicidal ideation among women who arrive at the psychology service before legally terminating their pregnancy. “Due to the cultural issue of the criminalization of abortion, the religious discourses that are transmitted to them in the most diverse contexts that abortion is a crime, that it is morally reprehensible, that it generates transcendental punishments, they arrive thinking that they cannot experience that pregnancy, but also they cannot have an abortion and that the only way out is to take their own life”, he says.
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For this reason, Elaine highlights the importance of psychological support provided to these women in the SUS. “It will often be the person’s first opportunity to speak openly in a non-punitive, welcoming context about their experience,” she says. And she explains that this is of fundamental importance for these women to begin to work through this situation and at some point manage to move from being victims to overcoming the widespread damage to their lives caused by this violence.
Lívia Almeida also explains that both the denial of care in cases of legal abortion, and some conduct that services may adopt with people who have had an abortion without legal support, are considered obstetric violence. She cites examples of conduct such as forcing this woman to listen to her heartbeat, showing an ultrasound, trying to convince that person in any way not to perform the procedure, trying in some way to judge or criminalize that woman.
“This is considered obstetric violence, and she can also seek the Public Defender’s Office to also act to hold the professional and the health establishment civilly liable”, he adds.
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The professionals also explain that women, girls and pregnant people who became pregnant as a result of sexual violence do not need to present a police record to have access to the right to a legal abortion. Furthermore, scientific advances in medicine now allow this interruption to be carried out at any gestational age.
“In a situation of sexual violence, the first place this victim should seek is health care. There is a federal law, the Next Minute Law, which determines that every hospital establishment must provide first care in an urgent, priority and welcoming manner to women victims of sexual violence”, Lívia Almeida.
In this care, which should preferably take place within the first 72 hours after the violence, women have the right to receive prophylaxis care to avoid sexually transmitted infections and also emergency contraception to prevent pregnancy.
Victims do not always seek health services during this period for fear of suffering from an unwelcoming approach, as pointed out by Elaine Passos. And they seek the service only when they discover they are pregnant. In this case, she explains that the psychology service is available to patients at all stages of the process, from the first appointment to even after the interruption, if they wish.
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Whether caring for people who are having a legal abortion or who need care after a procedure without legal support, many professionals have argued the right to conscientious objection to not providing care. Conscientious objection is a right provided for in the Code of Medical Ethics according to which the professional can refuse certain care due to internal, individual convictions.
The public defender, Lívia Almeida, however, explains that this is not an absolute right and is also not a right of the healthcare establishment as a whole. “The doctor can do this as long as it does not represent an urgent/emergency situation, that is, it does not represent a risk that poses a risk to the patient’s life and also as long as there is another professional capable of providing this care”, she says.
She also adds that, when informing the patient of her refusal, the doctor cannot embarrass her or try to force her to change her decision, but rather refer her to another professional who provides the reception in a humane way.
*This report was produced with the support of the Future of Care Notice.
Source: BdF Bahia
Editing: Alfredo Portugal