Beyond personal choices: Abortion as a matter of public health and social justice

I finally finished my draft for the 2nd assignment! I am looking forward to reading your suggestions. I am aware it deals with a very controversial topic. Please let me know if there is anything I said that can be seen as offensive, for whatever reason. Also, feel free to share your views! Curious to know what you think about that!

It was a regular weekday, that Wednesday in March, 2009. I came back from the university at noon and I was having lunch with my brothers while watching the local news on TV. I was not paying much attention to it until I was struck by that familiar name: Olimpio Barbosa de Moraes Filho – my father. My brothers and I instantly looked towards the TV to check what was actually being said.
It took a while for us to finally understand what was going on. The archebishop of our city was publicly excommunicating my father – who is a doctor - and the whole medical team for performing an abortion. But that was not a common case of abortion. In the contrary, it was a very shocking and polemical case.
A 9 year-old girl from the interior of my state, Pernambuco, got pregnant of twins due to sexual abuse by her step father. Carrying on the pregnancy represented an enormous risk of death to the girl, as she was not yet physically prepared for such transformations in her young body.
Under Brazilian Law, abortion is a crime. However, there are a few exceptional cases in which it is legal for a doctor to perform an abortion. These cases are: 1. If there is no other way to save the pregnant woman’s life or 2. If the pregnancy is the result of rape. Both of these circumstances were present in the 9 year-old girl’s case. Therefore, my father and his team were not doing anything illegal.
The archebishop argued, however, that the law of God was superior to the law of men and that abortion resulted necessarily in excommunication from the Catholic church. When asked about the girl’s step father who had raped her, the archebishop affirmed that rape was a dreadful sin, but abortion was even worse. This statement led to an astonishing amount of attention from the media and generated wide public debate, not only in my state and in my country, but also internationally, being published even in newspapers such as the New York Times.
The population was compelled to debate, as the condemning position of the archaebishop was highly controversial. How could he claim to be protecting life when presenting some tolerance to the rape of an innocent child, while harshly condemning the doctors who were acting with the support of the law and trying to save the child’s life? The case raised all sorts of questions about theology, morality, the blurry line between right and wrong, the value of life, the role of religion in a laic state, gender-based and domestic violence, criminality in poor rural areas of Brazil, among various other important topics. But most and foremost, it finally made people – young and old, progressive and conservative, religious and atheists, men and women - discuss about abortion.

Brazil, a laic country - Brazilians, a Catholic people

Positioning yourself politically with regards to abortion implies dealing with very delicate and often intimate experiences and beliefs. As science currently does not offer a satisfactory answer to the question about the beginning of life, and as we still have to answer this question to regulate our conduct both morally and legally, the most accepted answer is very often the one given by religion. That is very much the case in my country.
Brazil is legally a secular state since 1890. That means it has been 120 years since the state and the Catholic church have been legally separated. However, in practice, the Catholic religion has always shaped much of the public opinion. That makes sense when you consider that by the latter half of the 20th century, Brazil became the largest Catholic country in the world. According to the national census from 2000, nearly 74% of the country’s population is Catholic.
This strong influence has been considered harmful by many organizations that advocate women’s rights. The condemnation by the Catholic church of the use of condoms and anticonceptionals go in the very opposite direction of what women’s rights movements defend. In the case of abortion, that is also the case, and both topics are directly related to each other.

Abortion in Brazil: a matter of public health and social justice

A research led by the NGO Ipas Brasil, in 2007, in partnership with the Institute of Social Medicine of the University of the State of Rio de Janeiro (UERJ), showed that approximately 1.054.243 abortions are performed in Brazil each year. Unsafe abortion is among the top 3 causes of avoidable death among women in my country. The same research showed the magnitude of unsafe abortions according to race/ethnicity, age and geographical location.
The result is shocking, and yet, it unfortunately makes complete sense. With regards to race/ethnicity, the population of black women is three times more vulnerable to death due to unsafe abortion than the population of white women. With regards to geographical location, the annual rates of unsafe abortion are visibly higher in states from the Northern and Northeastern regions, and it becomes even more so when the adolescent population (from 10-19 years old) is the group taken into consideration.
These numbers are far from being random. They lead to the very consistent conclusion that unsafe abortion victimizes mainly the social groups who are more vulnerable, excluded and less economically privileged. In Brazil, black people have been discriminated since the beginning of our national history. At first, Africans were brought to Brazil as slaves for the Portuguese colonizers. Although slavery was abolished in 1888, there were no inclusive policies put into place to make sure the ex-slaves would become participative citizens with equal access to opportunities. In practice, racism and social exclusion remained, although much progress has been done. But until the current times, a high percentage of the poor people in Brazil are black. Similarly, the Northern and Northeastern regions in Brazil are the poorest in the whole country. They present the higher rates of illiteracy, unemployment as well as the lower income rates.
Taking this context into consideration, it becomes clear that the issue of abortion, far from being a topic that should be kept exclusively in the intimacy of households, is a serious matter of public health and social justice, and should therefore be widely debated.

The criminalization of abortion in Brazil: does it solve the problem?

The main argument that supports the criminalization of abortion in Brazil is that criminalizing it is a way of discouraging and repressing such a practice. However, the women’s rights movement alleges that such a measure is ineffective in avoiding women with unwanted pregnancies to have an abortion. If they do not have the economic, social and psychological conditions to carry on that pregnancy, they usually find a way to have an abortion, even if it puts their own life in risk. The Committee on Elimination of Discrimination Against Women (CEDAW) by the United Nations supported this argument in its 39th edition, in 2007.
“What in fact happens is that the abortion is performed anyways. The difference is that wealthy women can afford a safe abortion in clean clinics – legally or not, whereas poor women, who are the majority of the feminine population in Brazil, have to perform abortions in places with little or no hygiene and with no adequate medical care, resulting in serious damage for their health.” This statement, given by Benita Spinelli, the coordinator of the sector of women’s health in the municipality of Recife, my city, indicates the evident injustice in this situation.
Another argument that stands against the present abortion legislation in Brazil is the fact that it punishes only the woman. Although the man is necessarily involved in making the woman pregnant, if the pregnancy is unwanted or unfeasible, the woman is supposed to be punished, but her partner does not have any legal responsibility and is considered completely innocent. The Brazilian Criminal Code has many outdated points, as its text dates back to 1940 and the role of women in society was very different than it is today by then.
Besides, the criminalization of abortion creates a threatening and psychologically violent atmosphere that makes many women present symptoms of anxiety, depression, regret and insomnia after they made the choice interrupting the pregnancy. Leila Adesse, the founder of the NGO Ipas Brasil, affirms that the penalization, stigmatization and prejudice against women in such a situation does not minimize the problem nor does it reduce the serious consequences for the health of women. “Instead of being discriminated and put in jail, these women need psychological support, medical care and a more efficient coverage of anticonceptional methods”, says Leila.

The way(s) out – my own solution-oriented perspective

The most efficient way to reduce the rates of unsafe abortions is, of course, reducing the rates of unwanted pregnancies. For that to happen, women have to be able to negotiate with their partners and engage in family planning. That demands a leveled field among men and women, an environment in which women have a voice to express their wills and their needs.

As a matter of public health and human rights, it also demands a proactive attitude from the government. The situation urges for public policies aimed at promoting education on sexual and reproductive health, human reproductive rights and contraceptive methods. Besides, it is necessary to make condoms and other contraceptive options available and accessible to the population, as much as possible. These programs should prioritize the poor, the less educated and the people living in violent and at risk communities, but should also go beyond that. It should also make sure to involve both women and men, as gender equality cannot be built by women alone.
Another interesting measure that works very efficiently in some countries – but definitely not in Brazil, is the creation of orphanages that are well equipped to offer the proper conditions to the children. This way, women who do not have financial or psychological conditions to raise a kid properly would not feel compelled to interrupt their pregnancy, as their kids could be adopted by a family who could offer a much better life to them.
But even in countries where all these policies were put in place effectively, they were not enough to solve the problem of unwanted pregnancy and unsafe abortion. Therefore, I believe amplifying the possibility of legal abortions (for example, stipulating it as legal until the third month of pregnancy) would eliminate many barriers to a healthy life for women, mainly those women who are socially excluded and discriminated.

Unanswered questions, difficult decisions and the importance of debate

The fact is that abortion is a contentious topic. It deals with the most serious issue of all – life. The problem is that one can be against the legalization of abortion in order to protect life. And curiously one can also be in favor of the legalization of abortion for the exact same reason. The difference, in many cases, lies in whose life you are considering the most important. And to consider some lives more important than others is undoubtedly a problematic assumption to make.
The issue is made even more complex due to the lack of a precise, well accepted and universal definition about when does life really start. This unanswered question poses all sorts of challenges to the consideration of the matter. If you consider that life begins with the conception – as does the Catholic church, having an abortion would always correspond to murdering a baby – no matter what. However, if you apply more flexible criteria – for example, that life starts with the formation of the fetus’neurological system, which happens by the third month of pregnancy – as it is in the legislation of most countries in Europe, having an abortion at very early stages of the fetus’ development would not configure such a reproachable action and the lives of many women could be saved.
Despite of all these doubts, questions and the frustrating lack of convincing answers, there is one thing I am certain about: unsafe abortion is a reality in Brazil. And thus, no matter how controversial this subject is, debate should not be avoided, but insistently encouraged. I remember my father saying that even though he was excommunicated, he was glad this had happened because it brought attention to the topic and it fostered debate. “I just hope all this debate will be constructive”, he completed.
I believe I fully realized the importance of such a widespread debate when I caught myself talking to my grandmother about abortion. From this unlikely dialog between a strongly Catholic 70 year-old woman and an agnostic 17 year old girl, we did not reach any definitive conclusions, but we realized that we both had our reasons, who were legitimate and made sense, however different our beliefs were.