Although Brazilian law permits abortion only in cases of rape and danger to the woman’s life, an estimated 1.7 million abortions are performed in the country each year. The majority of abortions are performed clandestinely and under unsafe conditions; many are self-induced.

Teens and young women are at particularly high risk for unplanned pregnancy and unsafe abortion: From 1970 to 2000, the pregnancy rate increased from 75 to 89 pregnancies per 1,000 girls aged 15 to 19, and complications from pregnancy and unsafe abortion rank fifth among causes of adolescent mortality.

Since 2003, the Brazilian government has strengthened its commitment to protecting women’s health and rights. Examples of this commitment include the launching of new national norms for abortion care and the revision of norms for care for victims of sexual violence.

As stated by Dr. Humberto Costa, Brazil’s Minister of Health, in December 2004: “The Technical Norms [for abortion care] are an acknowledgment by the Government of Brazil of the fact that abortion in unsafe conditions is an important cause of maternal mortality; that women undergoing an abortion, spontaneous or induced, who seek health services should be supported, cared for and treated with dignity; and delayed care for unsafe abortion and its complications can threaten the life, physical health and mental health of women.”

During the past decade, Ipas Brazil has emerged as a national leader on the issue of abortion in Brazil, specializing in directly training and equipping health systems and providers to carry out high-quality abortion services and postabortion care (PAC). Building on the pioneering work of Brazilian women’s organizations and the obstetrics and gynecology community, Ipas Brazil has also expanded efforts in recent years to address the public-health issue of sexual violence against women, with the goal of increasing access to comprehensive treatment, including abortion for rape victims.

• Increased support and advocacy for abortion law reform in Brazil among health professionals, and worked to prepare the health sector to eliminate barriers to the implementation of a liberalized abortion law.
• Expanded health-care providers’ perspectives on abortion reform through multiple trainings, events and publications.
• Assisted the Ministry of Health in developing the 2005 national norms for abortion care, which cover technical and legal issues as well as ethics, counseling and postabortion contraception.
• Developed innovative strategies for providing training on abortion and PAC with manual vacuum aspiration (MVA) throughout Brazil’s large and decentralized public-health system. By negotiating cost sharing with state and municipal Secretaries of Health, Ipas Brazil has been able to reach a broader range of providers and health facilities while also building local capacity to improve services.
• Partnered with social work, legal and health professionals to expand access to comprehensive care for women and adolescent survivors of sexual violence in the resource-poor north. Based on the results of a needs assessment conducted in two states in the region, Ipas Brazil is establishing networks of care for survivors of sexual violence that link health services with legal and public-safety services and other community-based organizations.
• Expanded access to MVA through standard public- and private-sector channels and facilitated the inclusion of MVA on the Brazilian Medical Association’s list of approved procedures for PAC and endometrial biopsy. The list is used by private health-care companies and insurers to determine the procedures covered and reimbursement rates. Ipas Brazil is also working in the private sector to expand access to MVA as a reimbursable procedure.

• Continue to build support and eliminate barriers by initiating media campaigns, presenting findings from an Ipas study on conscientious objection at the Sexual Violence Forum, and organizing a training workshop on abortion care, human rights and ethics in partnership with feminist groups members of Jornadas and the maternal mortality committee in the state of Pernambuco.
• Widely disseminate Brazil’s new national norms for abortion and care for victims of sexual violence, as well as building on national commitment to improving women’s sexual and reproductive health by training providers, equipping health centers and monitoring the quality of care.
• Continue to improve care for survivors of sexual violence in Brazil, coordinating with ongoing  government initiatives, including those undertaken by the Ministries of Health, Justice, Education, Tourism, Human Rights and Women’s Affairs. This will include strengthening existing programs in three states and expanding the strategy to new states in the northern region.
• Continue to expand and improve national abortion and PAC preservice and inservice training efforts, strengthening existing topic areas and including new ones, such as:
  • The new Ipas MVA Plus® technology
  • Medication abortion
  • Sexual and reproductive rights as human rights
  • Ethics and bioethics

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