Debora Diniz

Abortion in Brazil: a household survey using the ballot box technique

This study presents the first results of the National Abortion Survey (PNA, Pesquisa Nacional de Aborto), a household random sample survey fielded in 2010 covering urban women in Brazil aged 18 to 39 years. The PNA combined two techniques, interviewer-administered questionnaires and self-administered ballot box questionnaires. The results of PNA show that at the end of their reproductive health one in five women has performed an abortion, with abortions being more frequent in the main reproductive ages, that is, from 18 to 29 years old. No relevant differentiation was observed in the practice of abortion among religious groups, but abortion was found to be more common among people with lower education. The use of medical drugs to induce abortion occurred in half of the abortions, and post-abortion hospitalization was observed among approximately half of the women who aborted. Such results lead to conclude that abortion is a priority in the Brazilian public health agenda.

Itinerários e métodos do aborto ilegal em cinco capitais brasileiras

This paper presents the results of the structured interview phase of the National Abortion Survey (PNA-interviews), describing the itineraries, methods and social and demographic profile of women who had at least one illegal abortion. Structured interviews were conducted during the years 2010 and 2011 in five state capitals (Belem, Brasilia, Porto Alegre, Rio de Janeiro and Salvador) with 122 women aged between 18 and 39 who had abortions. It is a non-probabilistic sample controlled by six parameters in accordance with level of education and age to reflect the social and demographic structure found in the PNA ballot-box questionnaire phase. The majority of women interviewed had had only one abortion, but 1 in every 4 had two abortions and 1 in every 17 had a third one. The majority of abortions are among women under 19 years of age who already had children and a higher incidence is found among black women. The most common test for pregnancy is beta-HCG blood test, the pharmacy urine test and ultrassound. The prevailing method for induction is a combination of teas and misoprostol (called Cytotec in Brazil), followed by hospital assistance after induction. Women are usually helped by a relative or their partners and several women reported helping other women to have abortions.

Aborto e saúde pública no Brasil

Cad. Saúde Pública, Rio de Janeiro, 23(9):1992-1993, set, 2007 For the first time, a Brazilian Minister of Health has taken a stance in favor of changing the country’s legislation on abortion. The recent position by Minister José Gomes Temporão is simple: abortion is a matter of public health. The shift from the moral field to that of public health has led to a redefinition of the terms underlying the Brazilian debate in the last thirty years. A recent search by the University of Brasilia and the State University of Rio de Janeiro retrieved 1,600 printed sources on abortion in Brazil dating from 1987 to 2007, demonstrating how the issue has maintained a constant presence in Brazilian science, with some key characteristics of the debate highlighting the force of the Minister’s statement. There is limited scientific research on the abortion phenomenon in Brazil. A possible explanation for this gap is the context of illegality and immorality surrounding the issue. To identify the women themselves, hear their stories, and care for their physical and psychological needs poses a risk for research participants and researchers: although the two sides may agree to safeguard the data’s secrecy or confidentiality, this does not ensure legal protection against police or court inquiries. The context of moral guerrilla warfare surrounding abortion in Brazil places both researchers and research subjects at jeopardy. In various instances around the world, abortion researchers have been ordered to turn their data over to the courts, and several have already been arrested for refusing to comply. However, there is another way of understanding the abundance of sources but paucity of scientific studies on abortion in Brazil. The debate on abortion represents an arena for confrontation between two previously defined positions: abortion as a serious moral offense and abortion as an exercise of women’s reproductive autonomy. Within this clash between incommensurable positions backed by sparse scientific evidence, the reaffirmation that “abortion is a matter of public health” gains great political force and vitality. In fact, although the available evidence is still limited, the existing results support the contention that illegality has serious consequences for women’s health, that criminalizing abortion fails to prevent it from happening in practice, and that it perpetuates social inequality. In other words, the scientific side of the Brazilian debate on abortion anticipates the Minister’s position. To seriously tackle the abortion phenomenon as a public health issue means to understand it as a health care issue and not as a moral offense committed by frivolous women. This political redefinition can draw on some consistent trends in bedside surveys with Brazilian women who have undergone abortion, namely that the majority are Catholic, young, poor, and already have children. Interestingly, this description fits not only women who have abortions, but also Brazilian women as a whole. Therefore, understanding abortion as a public health issue in a secular state and pluralist society represents a new argumentative approach, in which the field of public health can provide important evidence for the debate. Abortion and public health in Brazil EDITORIAL

Qual deficiência?: perícia médica e assistência social no Brasil

This article examines the concept of disability adopted by the most important cash transfer program targeting the disabled population in Brazil, the Continuous Cash Benefit (Benefício de Prestação Continuada--BPC). The study compares the eligibility criteria established by law and the criteria used by medical examiners in the beneficiary selection process. The data are from a sample survey of 16% of the medical examiners working in the program. The questionnaire aims to assess the instructions, forms, and procedures for selecting disabled beneficiaries. The results show a discrepancy between the formal program criteria and actual practice by the examiners, suggesting an expanded concept of disability aimed at including beneficiaries with genetic, chronic, and severe infectious diseases.

Prevalência do traço e da anemia falciforme em recém-nascidos do Distrito Federal, Brasil, 2004 a 2006

To determine the prevalence of sickle cell trait and sickle cell anemia among newborns in the Federal District, Brazil, a cross-sectional prevalence study covering the years 2004 to 2006 was conducted. Test results reported from the Neonatal Screening Program in the Federal District Health Department from 2004 to 2006 were analyzed, and prevalence rates were calculated. Neonatal blood samples were tested by isoelectric focalization. From January 2004 to December 2006, 116,271 newborns were tested for hemoglobinopathies, corresponding to 85% of all live births from mothers residing in the Federal District. The study identified 3,760 newborns with sickle cell trait (Hb AS) and 109 with sickle cell anemia (Hb SS). The prevalence rates were 323 (Hb AS) and 9 (Hb SS) per 10,000 live births. The high prevalence of sickle cell trait highlights the importance of neonatal screening in the Federal District to support work by health managers and professionals for planning educational measures and reducing the morbidity associated with sickle cell disease.Para determinar a prevalencia da anemia e traco falciforme em recem-nascidos no Distrito Federal, Brasil, no periodo de 2004 a 2006, foi realizado um estudo seccional de prevalencia. Foram utilizados os registros dos resultados de testes realizados de 2004 a 2006 pelo Programa de Triagem Neonatal da Secretaria de Estado de Saude do Distrito Federal, e calculados os coeficientes de prevalencia. As amostras de sangue dos recem-nascidos foram analisadas pela tecnica de focalizacao isoeletrica. No periodo de 1o de janeiro de 2004 a 31 de dezembro de 2006, foram realizados 116.271 testes de triagem neonatal para hemoglobinopatias, correspondendo a 85% do numero de nascidos vivos de maes residentes no Distrito Federal. Foram identificados, nos tres anos, 3.760 recem-nascidos, com traco falciforme (Hb AS) e 109 com anemia falciforme (Hb SS). Os coeficientes de prevalencia foram, respectivamente, 323 (Hb AS) e 9 (Hb SS) por 10 mil nascidos vivos. A elevada prevalencia do traco falciforme evidencia a importância da triagem neonatal no Distrito Federal para atuacao de gestores e profissionais da saude no planejamento de acoes educativas e na reducao da morbidade associada as doencas falciformes.

Bioethics in Brazil

In this article, the authors briefly sketch the nature of Brazilian bioethics. Bioethics emerged in Brazil later than in other Western countries and the 1990s were the most important period for the spread of the discipline in the country. It is in this period that some structural elements of bioethics were established, such as research groups, regulation of Local Research Ethics Committees (Comites Locais de Etica em Pesquisa - CEP), the creation of the National Commission of Ethics in Research with Human Beings (Comissao Nacional de Etica em Pesquisa com Seres Humanos - CONEP) and the Brazilian Bioethics Society (Sociedade Brasileira de Bioetica - SBB). With regard to theoretical work, Brazilian bioethics is clearly an importer of theories from countries central to the studies of bioethics, or, in another words, countries where bioethics first emerged and was established. The most commonly used theory among Brazilian researchers is principlism.

Abortion: 20 years of Brazilian research

The aim of this paper is to discuss the main characteristics of the scientific literature on abortion in Brazil. Data were collected from 88 literature bases, and 2,109 documents from 1987 to 2008 were retrieved. Based on the findings, the field of abortion in Brazil is dominated by female researchers affiliated with public universities and nongovernmental organizations from the Southeast, with training in health sciences. There is no research on abortion in the North, while 14% of the studies were conducted in the Northeast and 4% in the Central-West. Abortion has been a constant theme in the scientific literature in Brazil, increasing in the mid-20th century.

A judicializacao da saude no Distrito Federal, Brasil

This paper seeks to analyze the Judiciarys approach with respect to demands for the judicialization of the right to health by means of a case study of civil lawsuits for access to health care in Brazils Federal District. Judicialization of the right to health signifies the judicialization of various of the health services provided. This is a descriptive and exploratory case study that covers the Federal District and uses mixed techniques to gather and analyze data. This study analyzed 385 lawsuits (87% of the total number of cases of judicialization of health for the period from 2005 to 2010 that reached the Appellate court). The results indicate that the most judicialized service is access to intensive care unit, followed by drugs and health care. Almost all lawsuits are filed by public defenders, with medical prescriptions and recommendations from the public health service. The results of this study challenge some dominant themes in the national debate, particularly the claim that judicialization is a phenomenon of the elites and that the services judicialized are drugs. The study does not seek to make generalizations, but highlights the fact that the phenomenon of judicialization of health has different aspects encompassed under the same concept.

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.

O comércio de medicamentos de gênero na mídia impressa brasileira: misoprostol e mulheres

This article analyzes how the Brazilian news media covers the illegal market for misoprostol, the main drug used to induce abortion. A total of 1,429 news stories were retrieved from 220 print and electronic media channels from 2004 to 2009. The analysis included 524 stories from 62 regional and national newspapers. Misoprostol appeared repeatedly in the news, but was usually approached from a criminal perspective, unlike abortion as a whole, which the Brazilian media routinely covers as a religious, political, and public health issue. Misoprostol is part of the illegal gender-related drug market, along with drugs for weight loss and erectile dysfunction and anabolic steroids. Sixty-four (12%) of the news stories told life histories of women who had aborted with misoprostol. The womens ages ranged from 13 to 46 years, and socioeconomic status was associated with different experiences with abortion. Three characters appeared in the womens abortion itineraries: girlfriends (confidantes), go-betweens, and physicians. Stories of late-stage abortion are confused with the criminal characterization of infanticide and provide the extreme cases in the medias narrative on abortion.