As the country grows increasingly religious, strict abortion laws are forcing women to turn to risky, often deadly options to end their pregnancies.
- By Miriam WellsMiriam Wells is a British freelance journalist living in Brazil. She worked for BBC News for five years before moving to Latin America, where she now writes for The Sunday Times, the New York Times, InSight Crime, and the Christian Science Monitor.
RIO DE JANEIRO — As Mariana stepped out of the car, her boyfriend Rafael knew he might never see her again. It was a sunny summer’s morning two years ago in Rio de Janeiro, and the young couple had pulled up outside a small house in a residential northern suburb. The address had been given to them a few days earlier over the telephone by a man who did not identify himself. He told them this address was a place where they could get a certain criminal service: abortion.
Mariana, then 23, was 10 weeks pregnant and desperate. She and Rafael, her boyfriend of six months, were students and had no way to financially support a baby. Making matters worse, Mariana came from a strict evangelical Christian family. “I hadn’t dared buy contraception because if my family found it they would know I was having sex,” she said. “If they found out I was pregnant they would have forced us to get married and would have been angry forever.”
On the day of Mariana’s abortion, Rafael handed over a bag containing 1,600 reais, about $575, to a group of men who approached their car. Then they ordered him to leave. “They would not give us any information about how the procedure would be done or who would perform it,” he said. “I knew she might die or end up with terrible complications. But that was the choice we had.”
Rafael was right to be scared. Hundreds of thousands of women are hospitalized each year following complications from illegal abortions in Brazil, where legal terminations are allowed only in very limited circumstances. Scores of them die.
For decades, Brazilian authorities tolerated underground clinics, but in recent years there has been a major crackdown, coinciding with an increasingly hard-line religious Congress. The result is that far more dangerous procedures are carried out by far more unscrupulous people, according to women’s health experts. “There is nowhere to get a safe abortion,” said Beatriz Galli, policy advisor to the international women’s rights NGO Ipas, and one of Brazil’s leading reproductive rights campaigners. “Closing down clinics is providing even more opportunities for criminal gangs to cash in on a lucrative trade. The situation is extremely bleak.”
The issue was brought sharply into focus last year by the horrific deaths of two women who had undergone procedures at clandestine abortion clinics in suburban Rio, like the one where Mariana was treated.
The burnt body of 27-year-old mother Jandira dos Santos, shot in the head and missing her teeth and limbs, was found in the trunk of a car last September. A car had picked her up at a bus station the day before, along with several other women, to drive them to a place they could get abortions. Her gruesome death hit the headlines, soon followed by that of Elizangela Barbosa, who was dragged into the street, bleeding profusely, after a botched abortion. A passing motorist took her to the hospital, where she died. There, doctors found plastic tubing inside her; her intestines and uterus had also been perforated.
Before seeking surgery, both women reportedly tried unsuccessfully to terminate their pregnancies using misoprostol pills, the most common abortion method in Brazil. The drug induces miscarriage, and, if administered correctly, is a relatively safe and effective way to abort pregnancies of up to 12 weeks. But the drug has always been strictly prohibited, forcing those who need it to turn to drug dealers who sell it alongside crack and cocaine. As with most illegal drugs, it is impossible to know what you are actually buying.
Dos Santos and Barbosa’s deaths made the news. But there are many others that have gone unreported.
Pushing abortion into the shadows
Ana Teresa Derraik is the clinical director of Rio de Janeiro state’s leading public hospital for obstetrics and gynecology. Last fall, she saw four women admitted to intensive care after having corrosive chemicals injected into their uteruses in an attempt to terminate their pregnancies. Two died; both were mothers of young children. Of the two that survived, one, a 25-year-old mother, had to have both feet amputated due to the effects of drugs used to restrict blood flow to her vital areas during emergency surgery. Other women who were reportedly injected with the same substance were admitted to nearby hospitals in the same time period.
Cases of such serious complications from clandestine abortions became very rare in Brazil once misoprostol became widely available on the black market around a decade ago. But the drug has reportedly become much harder to get hold of in recent years, at the same time that clinics have been closed down.
“The situation today for women who need an abortion is exceptionally risky,” said Derraik. “What happened to these patients is so sad. But any investigation into what took place could result in them being prosecuted.”
Brazilian law prohibits abortion except in three circumstances: when the pregnancy is a result of rape, puts the mother’s life at risk, or when the fetus is diagnosed with anencephaly — a fatal condition that causes a baby to be born with part of its brain and skull missing. Women are not permitted to terminate pregnancies in which the fetus is found to have other debilitating conditions, even if the baby will suffer or live only for a few days. Even when a pregnancy does fall into one of the permitted categories, abortions are still not necessarily easy or possible to obtain.
Many women’s rights advocates and medical professionals alike say the law is inhumane and ineffective. And laws prohibiting abortion do not lower abortion rates, they say. In fact, rates tend to be higher in parts of the world with more restrictive laws. What criminalizing abortion does do is increase maternal deaths.
Abortion is illegal almost everywhere in Latin America; in seven countries it is outlawed even in cases where the mother could die from continuing the pregnancy. Yet the region has the highest rate of unsafe abortion in the world. The World Health Organization estimates that about 4.2 million unsafe abortions are carried out each year in Latin America, or about 31 for every 1,000 women. These abortions are a leading cause of maternal death in the region, accounting for at least 12 percent of an estimated 10,000 maternal deaths annually.
In Brazil, between 800,000 and 1.2 million women are estimated to have clandestine abortions each year. A 2010 study by the University of Brasilia found that one in five women had at least one. Until 1994, Brazilian law required doctors to report patients they believed had aborted a pregnancy to the police; since then, it has been the doctors’ choice, though to report a patient does violate medical ethics codes regarding confidentiality. Women who undergo the procedure can face up to three years in jail, while those who carry them out can face up to a 10-year sentence.
In practice, women rarely end up in prison, said Ana Paula Sciammarella, a lawyer who led a study looking at what happened to women and girls who were arrested for having abortions in Rio de Janeiro between 2007 and 2010. Typically, they received suspended sentences with conditions attached, which have included agreeing not to visit certain places in their neighborhoods, such as bars where they were alleged to have behaved “promiscuously.”
Even if the women are not punished criminally, they are often stigmatized socially, said Sciammarella, noting that this can include degrading treatment by police. “We saw one case of a woman handcuffed to her hospital bed with a police officer standing by as if she were a highly dangerous criminal,” she said. Other women, after having to take a day off each month to sign conditional sentence orders at the court, lost their jobs after their employers subsequently discovered their “crime.”
All the women in Sciammarella’s study were poor, non-white women and girls who were reported to the police after ending up in the public health system following complications. Wealthy women, by contrast, have historically had access to safer clandestine abortions. When things do go wrong, their treatment is not carried out at public hospitals but in private clinics where doctors are highly unlikely to report them. “We can only assume — because of course, there are no studies — that women who go to private clinics are in one way or another guaranteed safety from prosecution,” said Sciammarella.
Country of God
Last December, a petition proposing the legalization of abortion of pregnancies up to 12 weeks gained 20,000 signatures, meaning that it will have to be debated in Brazil’s Senate. But it has no chance of progressing in a Congress that “is the most conservative since the dictatorship,” said Ipas’s Galli, pointing to a recent survey.
Brazil and its Congress have always been strongly influenced by the Catholic Church, but in the past two decades there has been a dramatic rise in evangelical Christian churches and an uptick in politicians who share their beliefs. Nearly a quarter of Brazilians now identify as evangelical, up from 5 percent in 1970. Evangelical candidates won 50 percent more seats in the 2010 congressional elections, and 26 percent in those held last October. They now hold 83 out of 574 seats across both houses (14 percent). This month, evangelical congressman and longtime anti-abortion advocate Eduardo Cunha was elected leader of Brazil’s Chamber of Deputies, the lower house. “[Legalization of] abortion … will be passed over my dead body,” he told reporters recently.
In the 2010 presidential election, current President Dilma Rousseff was forced to come out strongly against any change in the abortion law, after being attacked by conservative religious groups for her supposedly ambiguous position. “I am against abortion, which is a [form of] violence against women,” she said. In last year’s election, the three main candidates, including Rousseff, made no mention of abortion in their manifestos.
The climate toward women seeking abortion has become increasingly hostile in the last 10 years, said Galli, pointing to a raid on a clinic in the southern state of Mato Grosso del Sur in 2007 as a watershed moment. In addition to arresting and prosecuting the clinic staff, authorities used decade-old records to pursue thousands of former patients. “Before that, clinics in many parts of the country were informally tolerated,” said Galli. “Since then there has been an increase in raids across the country.”
In Rio, there have been numerous raids and clinic closures over the last few years. When once it was possible to receive safe abortions in private hospitals, experts say even this is now impossible. Jandira dos Santos, whose burnt body was found in a car, paid the equivalent of about $1,900 for her abortion. “She wanted the best treatment,” says Galli. It is now apparent, Galli adds, just how terrible the options are for women.
Last fall, a string of clinics were closed down in what police called the dismantling of Brazil’s “biggest-ever abortion mafia.” Over 70 people were arrested, including doctors and military police who were allegedly acting as security guards. Dos Santos is thought to have been operated on in a clinic run by this clandestine ring. Some of the houses the group operated in were in the same neighborhood where Mariana sought her abortion. “This brought it very close to home,” said Rafael, her boyfriend.
The price of the crackdown isn’t demand, but supply — and safety. The only people now carrying out abortions are criminal gangs or individuals with no real medical training, said Galli. They are only in it for the money, and have little to no regard for women’s safety, she said, recounting the story of a daughter of a family friend who was raped by a man who performed an abortion on her in a dirty living room. “It’s a shadowy world.”
Recalling her abortion ordeal, Mariana describes sitting with some 20 other women in a makeshift waiting room. The woman organizing the patients would not give her any information about what would happen or when. Once finally inside the “surgery room,” she was given an injection. “I woke up in another room, bleeding,” said Mariana. “I asked what happened and a woman just told me everything was okay.”
Back in the car with her boyfriend, she wept. “I’ve killed my child, I kept saying again and again in my head,” she said. Rafael just cried with relief that she was back in one piece. “This is an extremely difficult thing to go through, and the fact that you have to go through this illegal process, where you are totally in the dark, makes it so much worse,” said Mariana. “It’s degrading.”
*Mariana and Rafael’s names were changed to protect their identities.
Portions of this article were previously published in the Dec. 11, 2014, Guardian article “Brazilian Women Resort to Desperate Measures After Abortion Crackdown.”