Where Policy Does Not Fully Address Reality – Abortion in Brazil

Therese Kuester – The Brazil Institute, 07/21/2016

Politicians promote, or at least have on their agendas, policies that better the conditions of their own kind. This is often the rationale for people’s assumption that a female president looks to improve the condition of women in her country, especially on issues concerning reproductive choices, access to education, political representation and sexual assault. Brazil is one of a handful of nations that boasts, at least for now, a female president. As President Dilma Rousseff undergoes her impeachment trial, which is most likely to end in August with her removal from office  and with a recent Zika outbreak highlighting reproductive concerns, it seems to be appropriate to ask what this female president has done for her fellow women, with abortion being a central issue.

In what Brazilian news network, O Globo, referred to as Dilma Rousseff’s first public  stance on abortion, they paint the female President as a strong advocate for providing abortion in government operated clinics of the “Sistema Unico de Saude” (SUS) in the case of rape. Indeed, in 2013 President Rousseff supported the approval of a bill (Lei 12.845) that ensures that women who have been raped or assaulted receive immediate care and permission for abortion through state care. According to the President’s press secretary at the time, during the Worker’s party’s thirteen year tenure there was a reduction in deaths due to botched abortions thanks to an expansion of public health services for women. This information was published in a report by the government think tank IPEA (Instituto de Pesquisa Economica Aplicada) report using the national Health Ministry’s data from their Sistema de Informacoes sobre Mortalidade (SIM) which Globo compares with other statistics, showing that there was not as drastic of a drop in the maternal mortality as Rousseff seems to focus on.  Even so, while Rousseff claims that there has been a 54% decline in maternal deaths in 22 years, 1.5 thousand Brazilian women still die each year due to improperly performed abortions. Dilma’s support of the bill contradicts a 2010 campaign promise she made to religious lobbyists, promising she would not seek to alter abortion legislation.

While O Globo examines Rousseff’s accomplishments, they do not provide general statistics on abortions or an explanation of current  legislation. Abortion, as in many countries in Latin America except for Uruguay and Cuba, has been illegal in Brazil since the development of the 1940 penal code (WSJ 2016). There are only three exceptions: a threat to the mother’s life,  evidence that the baby has anencephaly (absence of brain development) and in the case of rape. If a woman seeks an abortion, and is not included in these exceptions, she can be imprisoned for one to three years. Furthermore, if the woman is harmed by the abortion provider, the prison sentence given to the person who performed the abortion can be up to four years and to six if the woman dies. In an article published in March of 2016, Reuters describes how these punishments are enforced and often result in the raid of abortion clinics and the arrest of doctors.

Anti-abortion legislation is strongly defended by religious lobbies, which also advocate for complete criminalization of abortion. Since 1940, when the Brazilian penal code was enacted, the Catholic Church has been very vocal against any type of legalization of abortion. In recent years,  Evangelical Churches have often taken the lead on anti-abortion campaigns . Almost two thirds of Brazilians identify as Catholic, and while this percentage has been in decline in recent years, millions of Brazilians have become members of the Evangelical Church. Several senior politicians, such as Congressman Eduardo Cunha, the former speaker of the Chamber of Deputies, have been vocal about the need to get rid of the exceptions, and want to pave the way to completely criminalize abortions. In the past 70 years 53 abortion-related bills have been tabled by religiously-minded politicians and public support for current abortion laws remains high at almost 82%. Out of the plethora of political parties, Dilma’s Worker’s Party and the Communist Party are the only two to have spoken about legislation of abortion as a matter of public health.

Despite these strict rules and religious views, women have not been stopped from seeking abortions. Over half (56%) of unwanted pregnancies end with abortion. This adds up to around one million abortions being performed in Brazil each year. Many of these abortions are performed in clandestine conditions or are self-induced, with the Guttmacher Institute reporting that at least 10% of pregnancy-related deaths were because of such unsafe abortions, and 760,000 women are hospitalized each year for treatment from complications. According to the Guttmacher report, 26% of all abortions are self-induced, with 26% of respondents reporting self-administering drugs, compared to the 18% who use the mainstream medication called Misoprostol. Many women responded that they chose this method because physicians and drugs are expensive and hard to come by.

Ato em defesa da descriminalização do aborto

Véspera do Dia Nacional de Redução da Mortalidade Materna, feministas em ato na Praça XV, defendem a descriminalização do aborto e destaca o alto índice de mortes em abortos clandestinos (Fernando Frazão/Agência Brasil)

While O Globo says that President Dilma Rousseff takes credit for an increase in access to safer abortions, the data could suggest that there needs to be an expansion on access to abortions beyond those who qualify under the three exceptions. With over one million abortions each year, and a probable increase in the demand with the threat of microcephaly due to Zika, many woman could take extreme measures to terminate a pregnancy which could turn into a public health crisis.

Therese is a staff intern at the Brazil Institute

 

Brazil says there is ‘almost zero’ risk of Zika during Olympics. Really?

Dom Phillips – The Washington Post, 07/06/2016

A small but growing number of athletes, from golfer Rory McIlroy to cyclist Tejay van Garderen, have canceled their trips to the Summer Olympics in Rio due to fears about the Zika epidemic.

But what are the chances that visitors and athletes could become infected?

“Almost zero,” Brazil’s new health minister, Ricardo Barros, said recently. He and other officials note there are far fewer mosquitoes active in August, when the Games are being held, because it’s winter in the Southern Hemisphere. Already, reports of new cases have plunged in Rio state — from 3,000 to 3,500 a week earlier in the year to just 30 cases a week in June, officials say. Meanwhile, 80 percent of the city’s buildings have been inspected for mosquito breeding sites, authorities maintain.

Read More…

 

Abortion Requests ‘Double’ in Brazil due to Zika Concerns: Study

Conor Gaffey – Newsweek, 06/23/2016

Requests for abortions have doubled in Brazil and Ecuador due to fears about the Zika virus, according to a study.

Researchers found that demand for terminations also increased in other Latin American countries affected by the virus, which has been strongly linked to microcephaly—a condition where children are born with underdeveloped brains and small heads.

A Zika outbreak in Brazil in 2015 has infected around 40,000 people, with estimates of unconfirmed cases rising to almost 150,000. The virus, which originated in 1947 in the Zika forest in Uganda, has spread to a total of 39 countries and territories, most of which are in Latin America, where abortion remains illegal in many countries.

Read More…

 

Rio’s Forgotten Health Crisis

Anne Vigna – Americas Quarterly, 06/16/2016

As Rio de Janeiro prepares to receive hundreds of thousands of tourists and athletes from over 200 countries for the Olympic Games, health authorities are working overtime to combat the spread of the Zika virus. But beyond Zika, the city hides shockingly high rates of tuberculosis, especially in its favelas.

The infectious lung disease, not common in Europe since the 18th and 19th centuries, killed a total of 840 people in Rio de Janeiro state in 2014, including 440 in the city itself.

That’s the highest number in any of the country’s 27 state capital cities, amounting to 6.9 deaths per 100,000 people in 2014.

Read More…

 

Eradication of Zika-Spreading Mosquito in Brazil Unlikely

Peter Prengaman, Mauricio Savarese – AP, 04/19/2016

In the 1940s and 1950s, Brazilian authorities made such a ferocious assault on Aedes aegypti – the mosquito that spreads the Zika virus – that it was eradicated from Latin America’s largest country by 1958.

But Aedes aegypti returned, and now Brazil has launched another offensive against the pest, employing hundreds of thousands of troops to fumigate and educate people about how to eliminate its habitats. The assault is part of President Dilma Rousseff’s “war” on the Zika virus, which the Centers for Disease Control and Prevention says can cause devastating birth defects.

But eradication experts say there is little chance Brazil can come anywhere near stamping out the pest like it did a half century ago. The world is different, with globalization bringing more travelers and trade across borders. And Brazil is different; its resources are limited as the country suffers through its worst recession in decades and its president is focused on battling impeachment for allegedly breaking fiscal rules in managing government funds.

Read more..

Interfarma, 04/14/2016

A controversial decision by the Brazilian government authorizing the use of untested and unproven cancer drug for human clinical has been strongly criticized by local pharmaceutical industry association, Interfarma. The  decision was approved by embattled president Dilma Rousseff, who faces impeachment proceedings in Congress, and seen as a politically calculated move to help prevent her ousting.

The drug, phosphoesthanolamine, has not properly been vetted by Brazil’s health agency AVISA, and sets a new precedent for fast tracking and releasing to the market drugs without proper approval.

In a public statement, Interfarma chastised the release of the drug and argued that it is a political stunt to divert attention away from the embattled president and will put patients at risk and noted it “has no proof of efficacy or the inexistence of side effects.” US press outlets have also lashed out at the decision, noting its lack of clinical trials and providing a false sense of hope to patients in need of cancer drugs.

Read Portuguese press release here…

How A Town In Brazil Reportedly Rid Itself Of The Zika Mosquito

Ana Beatriz Rosa, Anna Almendrala – The Huffington Post, 02/29/2016

Brazil has recently ramped up its fight against the Aedes aegypti mosquito, which spreads dengue, Chikungunya and Zika, the latter a virus that has been linked to birth defects. Brazil’s health minister Marcelo Castro announced in January that the country would send 200,000 members of the armed forces to help in mosquito eradication, and cities across the country have intensified strategies to combat the pest.

But a few communities in Brazil are already leading the way when it comes to eliminating the disease-carrying mosquito from their neighborhoods. One of these is the small town of Água Branca, home to 16,000 people in the state of Piauí.

Compared to other similarly sized rural towns in Brazil, Água Branca should have a mosquito problem. But in 2013, when Zika virus wasn’t even an issue, the town launched a community initiative to address rising dengue fever rates. The partnership between municipal health authorities and residents focused on eliminating mosquito hotspots, and as a result, Água Branca has reportedly been mosquito-free for three years.

Read more…

Zika exposes class differences in Brazil, where most victims are poor

Alex Cuadros – The Washington Post, 02/24/2016

Watching kids skate around an ice rink inside the 1-million-square-foot Ribeirao Shopping center, you would hardly guess that this city is one of the hardest hit by the Zika epidemic.

Young women in dresses buy lattes at a Starbucks by the rink. Men in shorts and T-shirts take selfies with their cellphones next to a stand selling exercise machines. If they look unconcerned, it’s because, in this air-conditioned space, the mosquito that carries Zika can’t survive.

Although 230 miles from the southeastern coast, Ribeirao Preto is sometimes called the California of Brazil. The nickname traces back to the 1980s, when a boom in sugar and ethanol production raised living standards for many residents. But the boom left many others behind.

Read more…

Logistics cause delays on first day of Brazil Zika study

Associated Press – New York Times, 02/23/2016

JOAO PESSOA, Brazil — U.S. and Brazilian health workers seeking to determine if the Zika virus is causing a surge in birth defects ran into the chaotic reality of northeastern Brazil on their study’s first day Tuesday. Traffic and logistical problems shredded their schedule, delaying or preventing meetings with mothers and babies.

The plan conceived in the air-conditioned halls of Brazil’s Health Ministry and the Atlanta headquarters of the Centers for Disease Control and Prevention had seemed simple:

Eight teams of “disease detectives” are looking to enroll about 100 mothers of babies with microcephaly, a rare defect that causes newborns to have unusually small heads and damaged brains. They also want to sign up two to three times as many mothers of babies without the birth defect, born in the same area at around the same time.

Read More…

Why Zika is not the new Ebola

Michael Edelstein – World Economic Forum, 02/05/2016

A rise in birth defects in the Americas is increasingly linked to Zika virus, previously undetected in that part of the world. Regardless of the underlying cause for these congenital abnormalities, the key to success lies in strong global health leadership. While some lessons from the Ebola outbreak can be applied, this new threat presents a different challenge and needs a different response.

 

In December 2015, the journal Nature asked infectious disease experts to predict which pathogens would trigger the next global crisis. None suggested Zika virus, a mosquito-borne disease first identified 70 years ago in Africa. Yet, a month later, the World Health Organization (WHO) is ‘deeply concerned’ and predicts up to four million cases in the Americas over the next year, including in the United States.

 

Zika virus infection causes mild, flu-like symptoms in most cases. What prompted concern was not the infection, but Brazil’s live birth information system (a system not readily available in less-developed countries) detecting a 30-fold increase in the number of babies born with microcephaly, a congenital defect limiting brain development. If the spreading virus is associated with microcephaly, as evidence increasingly suggests, the global social-economic repercussions could be severe. A large increase in the number of children born with profound learning disabilities worldwide would have severe human as well as socio-economic repercussions globally, causing productivity loss and high associated healthcare costs.

Read More…