Alberto Pereira Madeiro

Cytotec e aborto: a polícia, os vendedores e as mulheres

This paper analyzes the illegal trade in misoprostol, the medication predominantly used for abortion in Brazil. The study analyzed ten cases that came to the attention of the Public Prosecution Service for the Federal District between 2004 and 2010. The cases were organized into three categories: 1. womens stories; 2. profile of the vendors; 3. maternal mortality cases. The research was reviewed by an ethics committee. The main outcomes were: 1. young women in steady relationships use misoprostol in the home or with the assistance of drug vendors. Of the seven women indicted, three were reported on arrival at the public hospital to finalize abortion; 2. the drug vendors work at the community drugstore and are local agents for the sale of misoprostol. They instruct women on how to use the drug and how to prevent infections, but refuse to provide them with care in case of emergency. Traffickers operate via the internet and have a larger inventory of drugs; 3. there were two cases of maternal mortality due to the combination of high risk methods, such as a vaginal probe and misoprostol. The main causes for maternal mortality are the delay in seeking medical care, as the women fear criminal prosecution, and the combined use of misoprostol with high risk methods.

Sexuality Education in Brazilian Medical Schools

INTRODUCTION Sexuality education has been valued since the 1960s in medical schools worldwide. Although recent studies reaffirm the importance of incorporating sexuality into medical education, there are data gaps concerning how this happens in Brazil. AIM To understand how Brazilian medical school professors teach sexuality in undergraduate courses. METHODS An exploratory, cross-sectional descriptive study was conducted. A total of 207 professors from 110 Brazilian medical schools responded to an online semistructured questionnaire about the characteristics of the sexuality-related topics offered. MAIN OUTCOME MEASURES The main variables assessed were contact hours devoted to sexuality, disciplines in which sexuality topics were taught, sexuality-related course titles, and sexuality-related topics addressed. Questionnaires were tabulated and analyzed using descriptive statistics for frequency distribution. RESULTS The response rate to the questionnaire was 77.2%. Almost all professors (96.3%) addressed sexuality-related topics mainly in the third and fourth years as clinical disciplines, with a 6-hour load per discipline. Gynecology was the discipline in which sexuality-related topics were most often taught (51.5%), followed by urology (18%) and psychiatry (15%). Sexuality-related topics were addressed mainly in classes on sexually transmitted diseases and AIDS (62.4%) and on the anatomy and physiology of the reproductive system (55.4%). About 25% of the professors reported teaching courses with a sexuality-related title. There was emphasis on the impact of diseases and sexual habits (87.9%) and sexual dysfunction (75.9%). Less than 50% of professors addressed nonnormative sexuality or social aspects of sexuality. CONCLUSIONS The teaching of sexuality in Brazilian medical schools occurred in a nonstandardized and fragmented fashion across several disciplines. The topic was incorporated with an organic and pathological bias, with a weak emphasis on the social aspects of sexuality and the variety of human sexual behaviors. The results point to the need for change in the provision of sexuality education in Brazilian medical schools.

Aborto induzido entre prostitutas: um levantamento pela técnica de urna em Teresina - Piauí

This study assesses the prevalence of induced abortion among prostitutes and lists the most common abortion practices. A survey was conducted with 310 prostitutes between 18 and 39 years of age, by sampling age quotas in the 5 territorial areas of Teresina in the state of Piauí. Data collection was conducted through the use of 2 questionnaires: the first, by the ballot-box technique, with questions about abortion; the second, completed by the researcher, with socio-demographic information. The practice of abortion was reported by 163 (52.6%) women. Most prostitutes performed 1 abortion (50.3%), but 16.5% of them reported carrying out 3 or more. Misoprostol was used alone in 68.1% of the reports and associated with tea and/or probes in 9.2%, followed by tea in 13.4%, probes in 3.7%, and uterine curettage in unregulated clinics in 3.7%. There was post-abortion hospitalization in 47.8% of the cases. After adjustment of the multiple logistic regression model, the variable that remained significantly associated with abortion was to have had 3 or more pregnancies. These results revealed that induced abortion is an event of great prevalence among prostitutes in Teresina. Misoprostol is the most common method to abort and hospitalization was necessary in almost half of cases.

Brazilian women avoiding pregnancy during Zika epidemic

Brazil now has confirmed 1845 cases of Congenital Zika syndrome in babies (TORCHZ) in a group of 9091 suspected cases.1 It is estimated that 174 003 Brazilians have been infected with Zika, although the Ministry of Health has not published any updated surveillance data since early July 2016.2 To understand if and how the epidemic has impacted reproductive health practices, we conducted a national survey in June 2016 using mixed methods. We used a face-to-face questionnaire to collect …

Pesquisa Nacional de Aborto 2016

We present the results of the Brazilian National Abortion Survey of 2016 (2016 PNA) and compare them to those obtained in the 2010 PNA as per the profile of women and the magnitude of abortion. The PNA is based on a random sample that combines ballot-box questionnaires with face-to-face interviews with women ages 18 to 39 in urban areas of Brazil. The results show that abortion is a common and persistent occurrence among women of all social classes, racial groups, educational levels, and religions: in 2016, almost 1 in every 5 women had undergone at least one abortion by the age of 40. In 2015, approximately 416,000 women had an abortion. There is, however, heterogeneity among the social groups, with abortions being more frequent among women of lower educational levels, women who are Black, Brown and Indigenous, and women living in the North, Northeastern and Mid-western regions of the country. In line with the 2010 PNA, half of all women took medicine to abort and almost half of them were hospitalized to complete the abortion.

A verdade do estupro nos serviços de aborto legal no Brasil

The truth of the rape at reference abortion services in Brazil This paper analyzes how the truth of the rape is constructed in order to authorize a woman victim of rape to have a legal abortion. We have interviewed 82 health care professionals (physicians, nurses and technicians, social workers and psychologists) at five reference facilities for legal abortion in Brazil. The interviews aimed to understand the procedures and practices imposed on a woman in order to be allowed to have the legal abortion. In spite of the particularities of each facility, we have identified a shared regime of suspicion of the woman’s narrative, which investigates the fact of the violence and the victim’s subjectivity . The truth of the rape for the legal abortion is not a woman’s narrative with a status of veracity, but it is a moral and discursive construction shaped by the victims’ submission to the forensic regimes of the services.This paper analyzes how the truth of the rape is constructed in order to authorize a woman victim of rape to have a legal abortion. We have interviewed 82 health care professionals (physicians, nurses and technicians, social workers and psychologists) at five reference facilities for legal abortion in Brazil. The interviews aimed to understand the procedures and practices imposed on a woman in order to be allowed to have the legal abortion. In spite of the particularities of each facility, we have identified a shared regime of suspicion of the woman’s narrative, which investigates the fact of the violence and the victim’s subjectivity. The truth of the rape for the legal abortion is not a woman’s narrative with a status of veracity, but it is a moral and discursive construction shaped by the victims’ submission to the forensic regimes of the services.

Conscientious Objection, Barriers, and Abortion in the Case of Rape: A Study Among Physicians in Brazil

Abstract In Brazil, to have a legal abortion in the case of rape, the woman’s statement that rape has occurred is considered sufficient to guarantee the right to abortion. The aim of this study was to understand the practice and opinions about providing abortion in the case of rape among obstetricians-gynecologists (OBGYNs) in Brazil. A mixed-method study was conducted from April to July 2012 with 1,690 OBGYNs who responded to a structured, electronic, self-completed questionnaire. In the quantitative phase, 81.6% of the physicians required police reports or judicial authorization to guarantee the care requested. In-depth telephone interviews with 50 of these physicians showed that they frequently tested women’s rape claim by making them repeat their story to several health professionals; 43.5% of these claimed conscientious objection when they were uncertain whether the woman was telling the truth. The moral environment of illegal abortion alters the purpose of listening to a patient — from providing care to passing judgement on her. The data suggest that women’s access to legal abortion is being blocked by these barriers in spite of the law. We recommend that FEBRASGO and the Ministry of Health work together to clarify to physicians that a woman’s statement that rape occurred should allow her to access a legal abortion. Résumé Au Brésil, pour avorter légalement en cas de viol, la déclaration de la femme affirmant que le viol s’est produit est considérée comme suffisante pour garantir le droit à l’avortement. L’objectif de cette étude était de comprendre la pratique et les opinions sur l’avortement en cas de viol parmi les gynécologues-obstétriciens brésiliens. Une étude à méthodologie mixte a été réalisée d’avril à juillet 2012 auprès de 1690 gynécologues-obstétriciens qui ont répondu à un autoquestionnaire électronique structuré. Dans la phase quantitative, 81,6% des médecins exigeaient des rapports de police ou une autorisation judiciaire pour assurer les soins demandés. Des entretiens téléphoniques approfondis avec 50 de ces médecins ont montré qu’ils vérifiaient fréquemment l’affirmation de viol des femmes en les faisant répéter leur histoire à plusieurs professionnels de santé ; 43,5% d’entre eux invoquaient l’objection de conscience quand ils n’étaient pas sûrs de la véracité des dires de la femme. L’environnement moral de l’avortement clandestin modifie le but de l’écoute d’une patiente : ce n’est plus de fournir des soins mais de la juger. Les données suggèrent que l’accès des femmes à l’avortement légal est bloqué par ces obstacles, en dépit de la loi. Nous recommandons que la FEBRASGO et le Ministère de la Santé collaborent pour faire comprendre aux médecins que la déclaration d’une femme affirmant qu’un viol s’est produit devrait lui donner accès à un avortement légal. Resumen En Brasil, para tener un aborto legal en el caso de una violación, la declaración de la mujer de que fue violada es suficiente para garantizar su derecho al aborto. El objetivo de este estudio fue entender la práctica y opiniones de gineco-obstetras en Brasil con relación a la prestación de servicios de aborto en el caso de violación. Desde abril hasta julio de 2012, se realizó un estudio de métodos combinados, con 1690 gineco-obstetras que respondieron a un cuestionario electrónico estructurado. En la fase cuantitativa, el 81.6% de los médicos requerían una denuncia policial o autorización judicial para garantizar los servicios solicitados. Las entrevistas telefónicas a profundidad con 50 de estos médicos mostraron que a menudo verificaban la declaración de violación por parte de las mujeres pidiéndoles que repitieran su historia a varios profesionales de la salud; el 43.5% de estos invocaron objeción de conciencia cuando no estaban seguros de que la mujer estuviera diciendo la verdad. El ambiente moral del aborto ilegal cambia el propósito de escuchar a una paciente: de brindarle atención a juzgarla. Los datos indican que el acceso de las mujeres a los servicios de aborto legal está siendo bloqueado por estas barreras a pesar de la ley. Recomendamos que FEBRASGO y el Ministerio de Salud trabajen conjuntamente para aclararles a los médicos que la declaración de violación por parte de la mujer debe permitirle acceso a un aborto legal.

O Ensino da sexualidade nos cursos médicos: a percepção de estudantes do Piauí

We conducted a descriptive and cross-sectional study with 242 medical undergraduates at two public universities and two private colleges in Teresina, Piaui. A semi-structured questionnaire to understand how human sexuality was taught in medical courses was applied. The questionnaire response rate was 86.3%. The teaching of sexuality was identified by 95.2% of students at some time during the course. Gynecology was the discipline that discussed sexuality the most (91.9%), followed by Psychiatry (55.3%), Medical Psychology (30.6%) and Urology (24.1%). Sexuality was cited as a specific topic in only 8.4% of the reports, but it was reported in classes about other topics such as cancer (70.9%), abortion (67.5%), STD and HIV/AIDS (67%). In class, the teacher emphasized sexual dysfunctions (84.1%), with less emphasis on homosexuality (50%) and sexual and reproductive rights (40.6%). Students indicated that there were positive influences of sexual education in undergraduate study (96.1%). There was great emphasis on the discussion of biological aspects and diseases associated with sexuality, with less emphasis on the social construction of the theme and sexual orientation.

Histórias de aborto provocado entre adolescentes em Teresina, Piauí, Brasil

This paper analyses the methods, techniques and support networks taken by adolescents to perform illegal abortions. It is a descriptive and cross-sectional study involving interviews with 30 adolescents who had been hospitalized for uterine curettage in two public hospitals in Teresina between June and November 2011. Informed consent was given orally, and the interviews were recorded after the confirmation of the induced abortion. The adolescents were between 14 and 17 years old, single, and predominantly lived with their parents in urban areas, had little schooling and recorded a gestational age of 12 weeks. Between 3 and 6 tablets of Cytotec were taken orally and/or vaginally by 28 (94%) adolescents, and they were rushed to the hospital due to severe cramping, vaginal bleeding or both. They either bought Cytotec alone (43%, 13), or with the help of a friend or partner (40%, 12). Cytotec was sold to them in ordinary pharmacies, by the owner (45%, 13) or clerk (55%, 55), who provided instructions for use. They went to the hospital with their mother (40%, 12) or a girl friend (30%, 9). Three (10%) adolescents developed serious complications. The study revealed that Cytotec is the main method used to perform illegal abortions among adolescents.

Induced abortion among Brazilian female sex workers: a qualitative study

Prostitutes are vulnerable to unplanned pregnancies and abortions. In Brazil, abortion is a crime and there is no data about unsafe abortions for this population. The study describes how prostitutes perform illegal abortions and the health consequences thereof. Semi-structured interviews with 39 prostitutes from three cities in Brazil with previous induced abortion experience were conducted. Sixty-six abortions, with between one and eight occurrences per woman, were recorded. The majority of the cases resulted from sexual activity with clients. The inconsistent use of condoms with regular clients and the consumption of alcohol during work were indicated as the main causes of unplanned pregnancies. The main method to perform abortion was the intravaginal and oral use of misoprostol, acquired in pharmacies or on the black market. Invasive measures were less frequently reported, however with more serious health complications. The fear of complaint to the police meant that most women do not inform the health team regarding induced abortion. The majority of prostitutes aborted with the use of illegally-acquired misoprostol, ending abortion in a public hospital with infection and hemorrhagic complications. The data indicate the need for a public policy focusing on the reproductive health of prostitutes.