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Brazil ABORTION POLICY Grounds on which abortion is permitted To save the life of the woman To preserve physical health To preserve mental health Rape or incest Foetal impairment Economic or social reasons Available on request Yes No No Yes No No No Additional requirements An abortion must be performed by a physician. If an abortion is performed in the case of a pregnancy resulting from rape, the consent of the pregnant woman must be obtained or, if she is incompetent, the consent of her legal representative. REPRODUCTIVE HEALTH CONTEXT Government view of fertility level: No official position Government intervention concerning fertility level: No intervention Government policy on contraceptive use: Direct support provided Percentage of currently married women using modern contraception (aged 15-49; 1996): 77 Total fertility rate (1995-2000): 2.3 Age-specific fertility rate (per 1,000 women aged 15-19, 1995-2000): 72 Government has expressed particular concern about: Morbidity and mortality resulting from induced abortion Complications of childbearing and childbirth Yes Yes Maternal mortality ratio (per 100,000 live births; 1990): National South America 220 200 Female life expectancy at birth (1995-2000): 71 Source: The Population Policy Data Bank maintained by the Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat. For additional sources, see list of references. 68 Brazil BACKGROUND The legality of the performance of abortion in Brazil is governed by the Brazilian Penal Code, dating from 1940. Under the Code, a physician may perform an abortion when it is the only means to save the life of the pregnant woman or when the pregnancy is the result of rape. In the latter case, the pregnant woman must consent or, if she is incompetent, her legal representative must consent. The Code replaced legislation dating from 1890 that expressed no exceptions to a general prohibition of abortion, but was understood to allow abortion to save the life of the pregnant woman under the general criminal law principles of necessity. In addition, Article 20 of the Decree Law of 3 October 1941, as amended by Law No. 6734 of 4 December 1979, prohibits the advertising of a process, substance or object designed to cause an abortion or to prevent pregnancy. Illegal abortion in Brazil is punishable by one to four years of imprisonment for the person performing the abortion; the penalty is higher if the pregnant woman’s consent is not obtained, if the woman suffers serious injury or dies, or if the woman is under 14 years of age. Abortion performed by a pregnant woman on herself or performed by another person with her consent is punishable by one to three years’ imprisonment. Efforts to ease restrictions on abortion began in 1975 and to date have been unsuccessful. At present, there are eight legal proposals related to abortion; some of them seek to expand the legal framework and others to protect medical actions related to objections of conscience. Despite the restrictive nature of Brazil’s abortion law, abortions are widely performed. According to most recent estimates, approximately 1 to 4 million women a year obtain abortions in Brazil. The majority of women seeking abortions are married. Prosecution for unlawful abortion is rare. The requirement of legal proof of pregnancy as a precondition for prosecution allows abortion to be performed despite current prohibitions. Moreover, although not authorized to do so by the law, judges in approximately 350 cases in recent years have allowed abortions to be performed in cases of severe foetal defect. Although the public health system has expanded its support of legal abortion services since 1994, increasing from 2 locations to 12, and has improved the quality of post-abortion care, the great majority of abortions are still carried out illegally under unsafe medical conditions. In practice, few women are able to obtain legal abortions owing to the resistance of hospitals. Most hospitals require a legal decision on the cause of pregnancy before they will perform an abortion. Consequently, mortality and morbidity resulting from abortion appear to be high. In the mid-1980s, for example, the percentage of maternal deaths related to abortion in one hospital was estimated to be 44 per cent; in 1997, the state of São Paulo published statistics indicating that between January and September of 1997, 24,000 cases of post-abortion complications were treated in the State’s health care system. A recent legal development relating to abortion in Brazil involves the drug Cytotec, a prostaglandin, that was introduced in Brazil for the treatment of ulcers. In addition to the effect that it produces on ulcers, the drug also causes uterine muscles to contract and is sometimes employed to induce childbirth and abortion. In some countries, in fact, the drug has recently been used in conjunction with mifepristone or RU-486, to terminate early pregnancies. Owing to its abortive properties, Cytotec began to be widely used in Brazil to induce illegal abortions. Such use was particularly easy since the drug was sold without restriction in drugstores and pharmacies. By the end of 1991, almost 600,000 boxes of twenty-eight pills each were being sold each year, with estimates that between 34 and 72 per cent of all women admitted to hospitals in selected cities for complications resulting from abortion had used this drug to induce abortion. Source: The Population Policy Data Bank maintained by the Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat. For additional sources, see list of references. 69 Brazil Near the end of 1991, the Government of Brazil took steps to end the use of Cytotec for the performance of illegal abortions. Acting in part in response to a campaign of a number of groups against the drug, the federal Ministry of Health issued an order placing Cytotec in a category of drugs that could be sold only in authorized drugstores; these drugstores were required to retain a copy of the physician’s prescription for official use. State Governments adopted similar measures. In Rio de Janeiro, use of the drug was limited to hospitals; in Ceará, its sale was completely prohibited; and in São Paulo, sales through drugstores were restricted to use for gastrointestinal purposes and drugstores were required to keep detailed records on the patient, prescribing physician and indications for the use of the drug. Use of Cytotec for gynaecological reasons in hospitals in São Paulo required the permission of health officials. Approval of the regulations has dramatically decreased the sale of Cytotec, although its effect on the number of abortions performed in Brazil is unknown at this time. Source: The Population Policy Data Bank maintained by the Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat. For additional sources, see list of references. 70