RECIFE, Brazil (WOMENSENEWS)--Brazil is on track to meet targets to improve maternal health, goal No. 5 of the Millennium Development Goals, U.N. targets that countries worldwide have pledged to achieve by 2015.
Maternal deaths are supposed to decline by two-thirds from 1990, when they were 220 per 100,000 live births. By 2005, that figure in Brazil had already declined by half, to 110 per 100,000.
But one of the country's biggest maternal health impediments is abortion, which is illegal in most cases and often unsafe.
Women undergo an estimated 1 million abortions in Brazil each year, with the majority considered unsafe, according to Ipas Brazil, part of a global nongovernmental organization that promotes reproductive rights and gender equality.
While that number represents a decline from 1.1 million in 2005, unsafe abortion is among the top three causes of avoidable death among women in Brazil and the fourth-leading cause of maternal death here.
Under Brazilian law, abortion is only legal if there is no other way to save the pregnant woman's life or if the pregnancy is the result of rape. The punishment for violating this law varies, depending on the circumstances, between one and 10 years in jail.
Dr. Carlos Reinaldo Marques is a gynecologist at the Amaury de Medeiros Integrated Health Center, a public hospital in this port city in northeastern Brazil. He blames the high incidence of unsafe abortion in part on a shortage of information about contraception.
The pregnant woman's family also plays a role in the decision, he says.
"There are also cases in which the woman does not feel support from her partner or any family members," he says.
Marques says a lack of sexual and reproductive health services also plays a role.
"On top of that, there is a clear insufficiency in the public health services, which in turn fail to deal with abortion as a public health matter," he says.
Unsafe Legal Abortions
Even some legal abortions are unsafe because of a lack of public services in many cities in Brazil, Marques says.
He says that unsafe abortions, whether legal or illegal, carry various risks, such as infections, hemorrhages, uterine perforations and uterine adhesions. All of these conditions can affect women's sexual and reproductive health in the future and even lead to death, he adds.
Because of the risks involved, Marques says that health workers must be careful about the influence they can have on women's decisions regarding abortion.
"The team of health workers must not, in any way, try to influence the patient with their personal beliefs," he says. "The team should inform the woman about all alternatives, motivating her to reflect on her health and reproductive rights for a more [conscientious] and informed decision."
Benita Spinelli, coordinator of the women's division of the Recife Health Department, says that abortion safety has more to do with socioeconomics than legality.
"The difference," she says, "is that wealthy women can afford a safe abortion in clean clinics – legally or not – whereas poor women, who are the majority of the female population in Brazil, undergo abortions in places with no adequate medical care, resulting in serious damage to their health."
Research by Ipas Brazil backs her claims. It found high maternal mortality rates from unsafe abortions in northern and northeastern Brazil, the country's poorer regions.
Black women in Brazil are also three times more vulnerable to death from unsafe abortion than white women, which the report attributes to socioeconomic inequalities.
Garnering Public Support
Paula Viana is a coordinator for the Curumim Group, a leading reproductive rights advocacy organization in Recife. After identifying a push by Recife lawmakers to criminalize women who have abortions, the group created a public petition and has garnered support from citizens to pressure politicians to change their position toward abortion laws.
The Curumim Group also runs a program called Humanization of Comprehensive Care to Women's Health, which aims to prepare health workers for the treatment and referral of pregnant women, including for legal abortion services. The program has already trained more than 3,000 professionals in the state of Pernambuco and nationwide, including 30 percent of the health workers in Recife.
Viana says that the feminist movement has fought since 1940 for policies that enable pregnant women who were raped or whose pregnancy could endanger their lives or their babies' lives to have abortions, as the Brazilian Penal Code allows. She says her organization aims to extend these rights to all women.
"We fight for this reality to be expanded to all women, which should avoid not only the negligence with which many women are treated at hospitals when they need to have an abortion, but mainly the stigma that surrounds abortion itself, which many times transform health professionals in[to] inhumane and even cruel individuals," she says.
Leila Adesse, one of the founders of Ipas Brazil, agrees.
"Instead of being discriminated against and put in jail, the women who have abortions need psychological support, medical care and a more efficient coverage of contraceptive methods," she says in an e-mail interview.
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Thais Moraes reports for Global Press Institute's Brazil News Desk. Based in Recife, Brazil, she focuses on human rights issues.