Abortion realities

by Washington Castilho

Fábio Grotz

Translation: Sexuality Policy Watch (SPW)

The findings of the first national household survey on the incidence of abortion in Brazil were made public in May. The National Abortion Survey (PNA), by University of Brasilia and Anis, shows that 15 percent of Brazilian women aged 18 to 39 have experienced an induced abortion. This means that one out of seven women has gone through the procedure, a total of 5.3 million Brazilian women. These results contest a number of myths in relation to the profile of women who resort to abortion. It also signals an apparent paradox: if, on the one hand, more than 5 million Brazilian women have had abortions, on the other, according to a public opinion poll by DataFolha in 2008, 68 percent of Brazilians consider that abortion laws should remain as restrictive as they are today. In other words it is quite possible that most of the 5 million women who, as shown by the PNA, have had abortions would share this opinion.

It might be in response to such paradoxical picture that the national newspaper Folha de São Paulo, in a May 25th, 2010 editorial, suggests that the legality or illegality of abortion in Brazil should be decided by referendum. A variety of experts consulted on this matter, however, disagree. In their view, abortion – like other issues in relation to which society will never reach full consensus – cannot be subject to referendum. Such method would inevitably silence the voices of those with a minority stand on the issue, as was the case when Proposition 8 was passed in last years” elections, banning same sex marriages in California. Anthropologist Maria Luiza Heilborn, CLAM co-chair, explains: “Issues that raise deep moral dissent can not be submitted to referendum. A referendum to decide on the adoption of capital punishment is unacceptable; likewise, we oppose the idea of deciding on decriminalization of abortion through a plebiscite. Within the sphere of a State that strictly follows constitutional principles and the rule of law, a minority opinion cannot be disqualified or left unconsidered”.

Sonia Corrêa, co-chair of Sexuality Policy Watch (SPW), is also convinced that a plebiscite should not apply issues in relation to which a full consensus cannot be reached. She stresses the fact that the same paradox Folha de São Paulo is seemingly trying to resolve by referendum exists in all countries where abortion is illegal, where abortion realities remain systematically hidden behind ideological debates. “The reality of abortion, women’s concrete experiences, are shadowed by dominant notions of “sin’ and “crime”, that are used to describe and qualify the practice. Religious and criminal discourses on abortion create a gap between women’s experiences and their ability to publicly express an opinion in favor of legalization. It is very hard to say ‘I have had an abortion and I am for decriminalization”, simply because the procedure and the experience itself is deeply stigmatized."

If for most women it is very difficult to publicly support the legalization of abortion is very difficult, it is even harder to freely talk about having terminated an unwanted pregnancy. One major accomplishment of the PNA was to open the space for women who have had abortion to talk about it. Another breakthrough was to improve the methodology for estimating the magnitude of the phenomenon. Since in Brazil abortion is a crime (except in the cases of rape and risk to the life of the pregnant women), provisions were adopted to protect the interviewees. As a first step, each respondent filled a questionnaire, which was deposited in an urn. Then she went on to respond to another questionnaire, applied by a female interviewer. The methodology was aimed at ensuring confidentiality.

The two questionnaires were codified in a manner that permitted matching responses while preserving interviewees from being individually identified. The question about whether the respondent had had an abortion was asked in the questionnaire that was deposited in the urn. If the answer was yes, the interviewee would then write her age at the time of her last abortion, whether she had used any kind of medicine or drug to induce the abortion, and whether she went to a hospital after the procedure. The study found that 48 percent of women who had abortions had use of some kind of medicine or drug (usually misoprostol), and 55 percent were hospitalized after the procedure.

The total sample was made up of 2,002 women, whose age ranged from 18 to 39, living in State capitals or cities with over 5,000 inhabitants. The proportion of women who have had abortions vary from 6 percent in the 18-19 age range to 22 percent among women between 35 and 39.

Unsafe abortion figures may be higher

The PNA also took on a number of dominant beliefs about abortion, such as the widespread notion that women who have abortions are young and irresponsible, or that abortion is more common among poorer women. The research findings show that clandestine abortions are evenly distributed across social strata. Another myth debunked by this research is the one, spread by religious conservatives, that only women without a structured family unit or a religious community resort to abortion. Contrary to that, the PNA found that women in stable relationships, and belonging to a wide diversity of religious traditions and expressions have terminated unwanted pregnancies.

In reviewing the findings, Dr. Greice Menezes, researcher at the Gender and Health Studies Program of the Collective Health Institute, Federal University of Bahia (MUSA/ISC/UFBA), confirms the relevance of abortion as major public health problem in Brazil, which might be statistically underrepresented:“We must be aware that, even when using a carefully designed methodology, the great sensitivity of the issue is an obstacle to research. Many women may omit a pregnancy that resulted in an abortion, even when knowing that they would not be identified. Therefore, the estimate of 5 million women who have had abortions may in fact be lower than the reality."

According to Menezes, in showing the magnitude of abortion in Brazil and portraying the heterogeneity of women who resort to it, this research touches on the inefficacy of current legal restrictions: "The State”s failure to offer women a comprehensive reproductive health policy is made flagrant. Criminalization does not eradicate abortion. What it actually does is reinforcing social inequalities, leading a significant percentage of women (mostly poor) to unsafe practices.”

In relation to the apparent paradox in abortion”s wide recurrence, while being highly condemned, the specialist recalled the Manichean nature of the debate on the issue: "People, including women who abort, tend, whenever asked, to express a position contrary to decriminalization. As seen in other studies, this has to do with the disapproval of abortion in general. But at the same time it is widely tolerated in particular cases. In fact, all of us are against abortion. What is being debated is whether its practice should be decriminalized. Even those who are totally contrary to abortion may have more flexible positions when faced with concrete situations in which abortion appears as one possible alternative. Many people do not understand that – for religious, moral or personal reasons – somebody can be against abortion in specific circumstances, and at the same time be favorable to decriminalization and accept that the other people who think differently have the right to have an abortion, if needed.”

Dr. Menezes also addressed a concern some people have, that abortion might be trivialized: "This concern must be understood in light of the omission and distortion of facts by groups acting against more flexible legislation. This disinformation feeds the equivocal belief that decriminalizing abortion will stimulate women to resort the procedure in a totally irresponsible manner. What underlies this supposition is the assumption that women are irresponsible, because they engage in unprotected sex relations or simply because they resort to abortion, somehow, at their convenience. This view does not take into account the heterogeneity and multiplicity of situations experienced by the 5 million women that, as estimated by this research, have had abortions in Brazil.” She is convinced that decriminalization will not bring an increase in the number of abortions: “This did not happen in other countries where abortion was legalized. There is no scientific evidence of a sort of post-legalization “abortion epidemic””. In her view, abortion is already trivialized in Brazil, but that is a result of criminalization.

Women who abort: a cross-section of society

To Margareth Arilha, director of the Citizenship and Reproduction Commission (CCR), the PNA has once again revealed that abortion is a reality in women”s lives, and the huge discrepancy that subsists between their real life experiences and existing norms. She commented on a decrease detected in the number of abortions amongst younger women, which she interprets as an effect of higher educational levels of the Brazilian female population. "For decades now, higher educational levels have become a key factor in expanding women’s choices. We live in a context where information and contraception have become more accessible, quite different of what it was two decades ago. The younger female generation is in many ways more privileged than we were".

She noted, however, that "this reasoning could lead us to the conclusion that the Brazilian elite, who is highly educated, would be favorable to the legalization of abortion. But that is not the case. For example: a lot of people wrongly think that, in Brazil, abortion is allowed in the case of anencephaly, which is not the case. This means that the public debate on abortion should expand and go much deeper.”

Another key aspect of the PNA, according to the CCR director, is that it demystifies a dominant dichotomous assumption about women who abort. "Those who abort are demoniac, those who do not abort are saints. This simplified categorization must be overcome. The research findings shows a plethora of configurations, as in the case of a working woman who has children, is married, but does not want to have another kid.”

Arilha, who was a director at the United Nations Population Fund”s office for Latin America and the Caribbean, also highlights that that since the abortion reform took place in Mexico”s Federal District, in April 2007, the road towards expanding access to abortion has not been easy: "There have been hard legal debates at each Mexican state legislature. There are still judicial clashes going on. Medical doctors claim conscious objection to avoid providing the procedure, and the state has to contract doctors who do not object. The Mexican experience also signals the key role played by the feminist movement, which framed the issue in ways that strengthened and enhanced the abortion debate in Mexican society. This is the quite opposite of what we are witnessing in Brazil in relation to reproductive rights. We live in a “developing country” where the scenario for women is still quite perverse. A country full of contradictions."

The rights of the unborn

The depth and extension of these debates was made evident right after the PNA findings were made public, when the Family and Social Security Commission (CSSF) of the House of Representatives approved, on Wednesday 19 May, a bill titled the "Statute of the Unborn”, which under the category “unborn” includes both in uterus and in vitro embryos. The bill”s approval would imply the juridical assumption that human life begins at conception, automatically eliminating the two cases in which abortion is now permitted under the Penal Code.

The text approved substituted other versions submitted by Congresswoman Solange Almeida (PMDB – Brazilian Democratic Movement Party) of Bill number. 478/2007, originally drafted by Representatives Luiz Bassuma (PV – Green Party) and Miguel Martini (PHS – Solidarity Humanistic Party). The text of that bill, in fact, already states that human life begins at conception: "To affirm that the unborn is a human person is only possible from a specific moral point of view, from a very specific belief. The bill imposes a specific conception that can hardly be shared by other subjects of rights, therefore violating fundamental principles, rights and guarantees such as freedom of belief and expression in the country”, argued Kauara Rodrigues, adviser on health and sexual rights for the Feminist Center for Studies and Counsel (CFEMEA).

However, the members of the Commission had the bill”s rapporteur elaborate a complementary vote, stating that, if approved, the bill will not change Article 128 of the Penal Code, that authorizes abortions in cases of rape and life risk to the pregnant woman. Still, this compromise does not resolve the many ethical and juridical problems raised by the bills. For instance, doubts are raised regarding Art. 12, which states that "neither the State nor private individuals may cause any injury to the unborn by reason of acts performed by any of the parents.”

Additionally, the bill includes an article that ensures state "incentives" for women who have become pregnant as a result of rape, as a means to persuade them not to terminate the pregnancy. If approved, it will guarantee prenatal assistance and psychological support; the possibility to offer the baby for adoption – if the mother agrees –; the obligation for the father of the unborn, when identified, to provide alimony; and, if the rapist is not identified, alimony to be provided by the State.

Rodrigues sees this particular content as totally absurd: "It will make the State accomplice of a hideous crime and, legitimating sexual violence; not to mention its disregard for the physical and psychological effects of rape. In order to justify the torture implied in forcing or inducing women to take a pregnancy resulting from rape to term, it is said that “The child cannot pay for his/her parents mistakes”! -What is the mistake of a woman who has been raped? What about the woman whose life is threatened by a pregnancy? In our view this bill can be equated to torture. Moreover, it entitles the violator with parental rights”.

The bill will now be reviewed by the Finances and Tax Commission, where the budgetary and financial effects of a proposed legislation are reviewed. As mentioned, if approved, it will imply the provision of a so-called "rape aid fund” whose costs must be evaluated. Then it will to the Commission on Constitution, Justice and Citizenship, where its constitutionality will be critically assessed, to then be finally taken to vote by the House.

Sociologist Maria José Rosado, professor of Sociology of Religion at Catholic University of São Paulo and coordinator of the Catholics for Choice (CDD) Brazil, agrees with Kauara Rodrigues: "The Statute, in a way, provides state consent to the crime of rape, which on the other hand is still addressed by the Penal Code, making this proposition absurd. We are not reproductive animals. We are human beings. To make a pregnancy be taken to term and then have the child given away an outrageous. Even more absurd is to propose that the state should finance the outcome of rape.”

Balancing rights

In the case of a disabled unborn, the bill states that "all existing therapeutic and prophylactic means to redress or minimize the disability” is to be ensured, “independently of the potential or expected extra-uterine survival". This is also aimed at curtailing the possibility of abortion in the case anencephaly, while politically targeting a pending Supreme Court ruling on the matter, even when a broad consensus exists today in society that abortion should be decriminalized in these cases.

Sonia Corrêa considers that the Statute of the Unborn is not accidental. "The approval of this text by the Family and Social Security Commission is part of a longer backlash process. It is a consequence of the Government retreat in relation to the 3rd National Human Rights Plan (PNDH3). The Plan, launched in December 2009, provoked an outcry of conservative forces, due mainly to its support to the decriminalization of abortion in Brazil. In the end, the Plan was rewritten and this initiative was left out. We have witnessed the same pattern since 2003: each institutional retreat in relation to abortion is followed by a proactive action on the part of anti-abortionist forces. When the Executive back stepped in relation to the draft bill for the legalization of abortion introduced by the Tripartite Commission, that was immediately followed by the Pro-Life Parliamentary Front. Each time the government retreats, the adversary moves one step forward. This is the politics of abortion, here and everywhere.”

Another factor to take into account, according to SPW”s co-chair, is that the Brazilian feminist movement did not establish a systematic and sustained dialogue with society at large as to clarify a core argument for legalizing abortion. This, in her view, is necessarily based on the balancing of rights: "While we haven”t invested enough on the dialogue, conservative sectors have. We have kept focusing on institutions, specially Congress. A small investment was made on media debates, but that was not enough to countervail the capillarity of the conservative discourses on abortion, which are based on the defense of life. Our main gain over the past twenty years was to achieve a social consensus around the idea that the law should go further down the path of restriction. This is not much, but considering the losses we had over the past ten years, it is not be seen as a gain. Even that is now under threat!”

The Statute of the Unborn makes it clear that anti abortion groups are now concentrating their energy in further restricting the law. In Margareth Arilha’s view, the bill is also connected with a climate in which concerns with state and public security are on the rise. “A notion of cleansing, eliminating the clandestine, the underground, underlies these various legal and policy initiatives. A recent example was the spectacular closure of an abortion clinic in Campo Grande (Mato Grosso do Sul), in 2008. At least four health professionals were charged with conspiracy”.

All experts interviewed agree that the feminist movement should invest further in the discussion about the balancing of rights between women’s and the life potential accorded to the embryo, since today, in 2010, the argument of women’s autonomy and the motto "our bodies belong to us” is still hardly sustainable.