How does the regulation of abortion provision for pregnancies resulting from rape affect its supply in the municipalities?

Abstract

The provision of abortion in pregnancies resulting from rape in Brazil is limited, restricted to a few facilities and concentrated in large urban centers. We aimed to estimate the potential for expansion of this service considering the installed capacity in the country’s municipalities. From the data of June 2021 in the Cadastro Nacional de Estabelecimentos de Saúde (Brazilian National Registry of Health Facilities, CNES), three different scenarios of abortion provision provided by law in pregnancies resulting from rape were elaborated, and the percentage of female population of childbearing age living in the municipalities of each scenario was calculated by region. The first scenario included the municipalities with installed provision; the second, those with potential for provision considering the current regulations; and the third, those with potential for provision considering only the recommendations of the World Health Organization and the Penal Code of Brazil. The scenarios were composed of 55, 662 and 3,741 municipalities, respectively, and were home to 26.7%, 62.1%, and 94.3% of the country’s females between the ages of 10 and 49. In all regions, there was installed capacity to expand provision, both in light of current regulations and international recommendations.

The WHO abortion care guideline: Law and policy—Past, present, and future

“…A 2023 study from Brazil, for example, demonstrates that Ministry of Health ordinances and technical standards on legal abortion narrow access to care as compared to a regulatory scenario based simply on the Penal Code interpreted in accordance with the WHO Guideline. 23 In other words, vague or inconsistent laws are sometimes protective of access to care in their interpretive flexibility, as health workers use diagnostic categories and other tools to subvert restrictive objectives of the law. 24 These examples show that the complexity of law and policy interventions often comes from the shifting and diverse contexts of their use.…”