Unsafe abortion in Brazil: a systematic review

Abstract

Background In Brazil, abortion is legally allowed in cases of risk to the woman's life, pregnancy resulting from rape and cases of fetal anencephaly. Despite the restrictive legislation, studies estimated that around 1 million abortions took place in the country in 2005. Abortions occurred regardless of womeńs socioeconomic position, race, age and religion, but unsafe practices were more common among young women, with low educational levels, single, students or domestic workers. This study sought to update knowledge on unsafe abortion in Brazil. Methods We carried out a systematic review with study search on Medline and LILACS, with no language restriction, from 2008 to 2018. We evaluated article quality using the Joanna Briggs Institute instruments. We evaluated 50 articles. Results There was a decrease in the ratio of induced abortions by 1,000 women of reproductive age reaching 16 per 1,000 in 2013. However, direct estimates do not indicate a decrease in the prevalence of induced abortion, estimated to be 13% in 2016. Higher prevalences were observed in more socially vulnerable populations. Half of all women reported using medications for terminating pregnancies and the number of hospital admissions due to complications from abortion decreased from 1992 to 2009. Maternal morbimortality from abortion had a reduced frequency but it is likely that maternal deaths from abortion are under-reported. Conclusions Abortion is frequently used in Brazil, especially in less-developed regions and by more socially-vulnerable women. Access to safer methods probably contributed to the reduction of complications, hospitalizations and morbimortality from abortion. However, half of all women still used other unsafe methods and the number of admissions due to complications from abortion is still high. The small scientific production and lack of methodological adequacy led to the development of a special issue on Abortion in Brazil in the jornal Reports in Public Health. Key messages Restrictive legislation does not prevent abortion, but limits access to safe abortion and makes it diffiult to prevent morbidity and mortaliity from abortion. Restrictive legislation and the stigma associated with abortion make studies difficult to estimate the rates, complications and factors associated with abortion.

Promoting evidence-based clinical practice for women in abortion situations after the implementation of a surveillance network: a situational analysis in a Brazilian university hospital

“…For comparison and contextualization purposes, in the United States, uterine evacuation performed exclusively with medications was used in approximately 40% of all abortions in 2018, with most patients being up to 9 weeks pregnant [35]. In Brazil, misoprostol is used for uterine emptying in hospitalized patients [4]. In comparison to surgical procedures, MA takes longer to complete [8], leading to a longer hospital stay; thus, it may not be the rst choice for women or doctors.…”

“…Our hospital has been a sentinel institution of the MUSA Network since July 2017. The hospital follows the laws of Brazil regarding the legal termination of pregnancy, in which abortion is allowed only in cases of risk of maternal death, sexual violence, and fetal anencephaly [4].…”

“…Among these, 22 million unsafe abortions are performed annually, leading to 47,000 maternal deaths due to complications [2]. In Brazil, where the law ensures the right to terminate a pregnancy only in cases of sexual violence, risk of maternal death, and fetuses with anencephaly, the avoidable morbidity and mortality persists [4]. It is estimated that one in ve women up to 40 years of age has had an illegal abortion, with almost half of them having been hospitalized for complications.…”

“…When an abortion is performed by a professional trained in providing adequate technical or ethical assistance, the procedure is very safe [4]. Choosing a method of uterine evacuation is essential for the safe management of abortion conditions [13].…”

“…Choosing a method of uterine evacuation is essential for the safe management of abortion conditions [13]. Dilatation and curettage should be avoided whenever possible and replaced by other methods [8,4]. The aim of this study was to evaluate the frequency of use of MVA and exclusively MA, and investigate the associated factors after the installation of a surveillance network of good practices in a university hospital in the southeastern region of Brazil.…”