Brazilian President Dilma Rousseff signed a law guaranteeing treatment – including emergency contraception – for rape victims in public hospitals, in spite of strong opposition from religious conservatives who believe it will lead to the decriminalisation of abortion.

“In future when a victim of abuse goes to a hospital, the staff must follow the protocol,” said Health Minister Alexandre Padilha, announcing the president’s ratification of the law Thursday, which will enter into force in 90 days.

The new Law 3/2013 only introduces regulations for authorised procedures for multi-disciplinary care in the public health system for female victims of sexual violence, without actually modifying the country’s law on abortion.

In Brazil, abortion is only legal in exceptional cases: when the mother’s life is at risk; when the foetus has been confirmed by three doctors to be anencephalic (lacking a large part of its brain and skull); or when the pregnancy is the result of rape.

“The novelty is that the law establishes compulsory care in the health services for all cases of sexual violence,” said Beatriz Galli of the Brazilian chapter of Ipas, an international NGO that works for women’s health and reproductive rights, including safe abortions.

“At present, we know that some referral services for the care of victims of sexual violence are not working properly, especially when it comes to guaranteeing access to abortions in cases of sexual violence provided for by law,” she told IPS.

Galli said moral or religious objections by health professionals to practicing abortions were common.

She said there was even resistance in state public prosecutors’ offices, which sometimes request the seizure of records to make sure that the abortions carried out were within the limits of the law.

But the new federal law “will guarantee that health professionals can do their job with the requisite legal backing, putting an end to attempts to backslide on the reproductive rights of women, teenagers and girls who are victims of sexual violence,” Galli said.

Sociologist Angela Freitas of the Provincial Council on Women’s Rights, meanwhile, responded to conservative critics by saying that the law’s goal was not to legalise abortion but to guarantee the rights of women who suffered sexual violence, many of whom were teenagers.

“What bothers critics is that Brazil has begun to create public health services to provide care in cases of legal abortion, which is a victory for women’s movements,” Freitas, who also represents the Articulaçao de Mulheres Brasileiras (AMB – Brazilian Women’s Network) in the organisation’s Rio de Janeiro regional office, told IPS.

“Violence against women, especially sexual abuse, is on the rise, and this bill is important for guaranteeing victims access to healthcare and medical attention. People who are pro-life ought to support it,” said Galli, who added that one million illegal abortions a year are carried out in Brazil, often in conditions that put the mothers’ lives at risk.

Religious resistance

Thursday was the constitutional deadline for ratifying law 3/2013, which was based on a bill presented in 1999 by Iara Bernardi, who at the time was a congresswoman for Sao Paulo from Rousseff’s left-wing Workers’ Party (PT).

But doubts had arisen as to whether it would be signed into law, due to rising pressure surrounding Pope Francis’ Jul. 22-28 visit to Brazil, even though the bill had been unanimously approved in both chambers of Congress.

Three days before the pope’s arrival, representatives of the Brazilian Catholic bishops’ conference and other religious bodies visited Rousseff at the government palace to ask her to partially veto the law.

They were lobbying for the removal of an article referring to “pregnancy prevention” and another requiring “victims to be informed of their legal rights and all the health services available to them” – that is, the right to abort, or to take emergency contraception pills, in cases of rape.

Emergency contraception, also called the “morning-after pill”, delays ovulation or prevents implantation of a fertilised egg up to 72 hours after sex, but does not terminate an already established pregnancy.

But Catholic Church leaders fear these provisions will allow abortions to occur even when sexual abuse has not been proven – in other words, that women may “invent” reports of rape to obtain legal abortions.

“It is despicable to think a priori that women are dishonest liars,” Freitas complained. “And it also shows a lack of respect for the knowledge of the health professionals who talk to and examine patients.”

Freitas pointed out that legal abortions are not easy to obtain in Brazil. “A multi-disciplinary team made up of doctors, nurses, social workers and psychologists decides how to proceed in each case.”

So, “if a woman was inventing her story, she would be found out. But first she must be listened to and not condemned in advance,” she said.

Freitas highlighted that the new law compels the health services to follow regulations in force since 1999, “confronting the legal obstacles that anti-abortion sectors put in the way of rape victims when they decide to terminate a pregnancy and making it possible to penalise health professionals who fail to comply.”

She pointed out that, although emergency contraception and abortions are legal in certain cases, they are frequently not provided.

“There is a general lack of information and of referral services for this kind of care. Brazil is huge and hospitals with this kind of services only exist in the state capitals and other large cities,” Freitas said.

“There are doctors and hospital directors who refuse to talk about the issue and do not provide the service because of conscientious objections,” she said.

Carina Vance: “Our constitution guarantees free access to services, contraceptive methods and family planning visits.” Credit: Courtesy of Health Ministry of Ecuador

By Leisa Sánchez
QUITO, Apr 19 2013 (IPS)

The government of Ecuador is determined to curb the growing number of teen pregnancies, and has begun to knock down barriers that stand in the way of the right to a responsible sexual and reproductive life.

The question of sexual and reproductive health has been a focus of public debate since new regulations were announced on availability and access to birth control methods, including emergency contraception known as the morning-after pill.

Making emergency contraception freely available forms part of the National Multi-Sector Strategy for Family Planning and Teen Pregnancy Prevention (ENIPLA), which has been given a budget of 4.4 million dollars.

Ecuador has the highest teen pregnancy rate in South America: 81 births per 1,000 females between the ages of 15 and 19. Seventeen percent of girls in that age group have at least one child. And the number is on the rise: according to official figures, the number of births to adolescents in that age group rose from 31,053 in 2004 to 45,708 in 2011.

The Catholic Church and other critics claim the morning-after pill is an abortifacient, even though studies show that what the pill actually does is delay ovulation.

The pill has been legally available in Ecuador since 1998, but a prescription was needed. Today it is freely available, without cost, in all public hospitals and health centres in this South American country.

Public Health Minister Carina Vance discussed the ENIPLA strategy, its achievements and challenges with IPS.

Q: Why was the decision reached to make the morning-after pill freely available?

A: We have disturbing statistics with respect to family planning and the spacing of children, in terms of the number of desired children and how many people actually have.

ENIPLA, a joint programme of the ministries of education and economic and social development, has been implemented since 2011 in Ecuador, which has the highest teen pregnancy rate in South America.

Q: Is the controversy over the morning-after pill based more on moral values than on knowledge of rights?

A: We believe there is no real controversy, because there is actually wide acceptance, of ENIPLA and of the fact that the method is freely available.

We have received a favourable response from social organisations and national and international institutions involved in health and women’s rights. The great majority of opinions against (the morning-after pill) are not based on scientific information, but on a mistaken understanding.

They claim that in some cases, emergency contraception is abortive, but there is scientific evidence that it is not. And they also want parental consent in order for an adolescent to have access to birth control methods.

Q: Are young people in Ecuador mature enough to decide on their own?

A: If young people are mature enough to have sexual relations, we have the obligation to respect their right to unlimited access to the pill, without barriers or the approval of third parties. We believe in working with parents to strengthen family communication on sexuality and sexual and reproductive rights.

There are people who because of principles or religious beliefs don’t consider it appropriate to make this kind of contraceptive freely available. We completely respect that position, but we have to integrate public policies in a framework of rights, and understand that the Ecuadorean state is secular.

Q: How many health centres distribute the emergency contraception pill?

A: We have 1,900 units nationwide.

Q: With respect to the promotion of a responsible reproductive and sexual life, what efforts are needed?

A: The Health Ministry has the obligation to provide objective, science-based evidence and provide medication totally free of charge. For example, we have condom dispensers in our health units, but that’s not enough.

Multi-sectoral work is needed, which is why it is so important to work with the Education Ministry. And there is also the shared responsibility of society: conversations on sexuality and rights should not be limited to visits to health centres. We also work with the parents of young people.

We carry out an ongoing effort in prevention, attention and studies on sexually transmissible diseases and the various problems that influence their spread.

We definitely have challenges: high teen pregnancy rates; the fact that 13 percent of maternal deaths occur among adolescents between the ages of 15 and 19; and the fact that six out of 10 women overall have suffered some kind of violence: physical, psychological or sexual.

We also face big challenges in achieving an equitable society free of violence, where sexual and reproductive rights are fully respected.

Q: Does this mark a watershed in sexual and reproductive rights?

A: Use of the emergency contraception pill has been legal since March 1998. With these latest regulations, we are now guaranteeing access to the pill without a prescription, as well as adequate supplies in all public health centres and hospitals, and the exercise of the right to a birth control method without parental or partner consent, a requirement that used to be a barrier for women.

Our constitution guarantees free access to services, contraceptive methods, family planning visits, and the possibility for everyone to lead a healthy life with universal access to health care, with a central focus on primary care.

Q: How does the government plan to move forward in the struggle to consolidate sexual and reproductive rights?

A: I don’t know if I would call it a struggle. A 2011 survey found that 84 percent of respondents agreed with the free provision of birth control methods – in other words, we have a high level of acceptance, and a government that is totally committed to the exercise of rights, including sexual and reproductive ones.

We are going to do everything necessary to implement sustainable policies, to make sure there is no backsliding.

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