Abstract
The article reports on an experience developed by the Rio de Janeiro Municipal Health Department (SMS-RJ) to expand the number of municipal maternity hospitals that provide legal abortion for rape victims. Brazil's legislation allows legal abortions in three cases: risk to the woman's life, rape, and fetal anencephaly. Given the high rate of sexual violence against Brazilian women, health professionals working in the Brazilian Unified National Health System (SUS) need to be trained for such care with abortion as the potential outcome if that is the woman's choice. Despite the legal provisions and guidelines, Brazilian women still experience important barriers when attempting to access this right. One of the main obstacles is health professionals' claim of conscientious objection. The study aims to present an awareness-raising methodology for health professionals to improve the care for victims of sexual violence and expand access to legal abortion in the municipal maternity hospitals. The methodology involved three stages: a workshop, awareness-raising in the maternity hospitals, and monitoring. This experience resulted in an increase in the number of maternity hospitals that perform legal abortion for rape victims, from two hospitals in 2016 to ten in 2019. The experience also strengthened the guidelines for the improvement of care, such as prioritization of cases for reception of patients and risk classification, supply of multidisciplinary care, and safeguards for the presence of an accompanying person during the patient's hospital stay. Factors that favored this work included political determination by the administration of the SMS-RJ, the wager on decentralized activities in permanent education, and the health professionals' direct involvement.
Highlights
Brazil’s legislation allows abortion in three circumstances: risk to the woman’s life, rape 1, and fetal anencephaly 2
Considering this scenario, the current article reports on an experience developed by the Rio de Janeiro Municipal Health Department (SMS-RJ) that aimed to implement an awareness-raising methodology for health professionals and administrators to upgrade care for rape victims and expand access to legal abortion
3 REPORT OF AN EXPERIENCE: ACCESS TO LEGAL ABORTION Methodology The methodology (Figure 1) was elaborated by a Working Group that was coordinated by the Division of Maternity Hospitals of the SMS-RJ and was in charge of mobilizing the awareness-raising activities with the health professionals and administrators
Summary
Brazil’s legislation allows abortion in three circumstances: risk to the woman’s life, rape 1, and fetal anencephaly 2. That same year only 89 legal abortions were performed in the state of Rio de Janeiro This difference may signal difficulties in access to the procedure and women’s lack of information on the right to abortion (under safe conditions and free of cost in the public healthcare system) in cases of rape 12,13. There are potential problems with coding, since there are other codes that end up being used for abortion because of some health professionals’ difficulty in admitting that they perform the procedure Considering this scenario, the current article reports on an experience developed by the Rio de Janeiro Municipal Health Department (SMS-RJ) that aimed to implement an awareness-raising methodology for health professionals and administrators to upgrade care for rape victims and expand access to legal abortion
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