Characterization of Adolescent Pregnancy and Legal Abortion in Situations Involving Incest or Sexual Violence by an Unknown Aggressor

Abstract

Background and Objectives: In pregnancies resulting from incest, the adolescent maintains close family and emotional relations with the aggressor, different from what occurs when pregnancy results from sexual violence by strangers. Evidence indicates that this type of relationship with the aggressor may interfere in the dynamics of such violence and the adolescent’s access to health services. Materials and Methods: The objective of this research was to describe and correlate aspects associated with pregnancy when resulting from rape of adolescents in situations of incest; rape when perpetrated by an unknown aggressor and an abortion as allowed by law was sought. Method: A cross-sectional, epidemiological study of adolescents treated at the Pérola Byington Hospital, São Paulo, Brazil, bringing an allegation of pregnancy, resulting from sexual violence and a request for abortion as allowed by law. A total of 311 adolescents, being 134 in the “pregnancy from incest group”, and 174 in the group “pregnancies resulting from rape by a stranger” were considered under the study variables; relationships were investigated using the chi-squared test and Poisson regression with robust variance. Results: The study included 137 cases (44.1%) of pregnancy resulting from incest, and 174 cases (55.9%) of pregnancy from rape by a stranger. In cases of incest, a declaration of religion (92.0%) was significantly more frequent, and the adolescents were approached in spaces considered safe or private (92.7%); the aggressor taking advantage of the adolescent’s legal condition of vulnerability as a function of age (83.3%). Cases of incest presented a lower median adolescent age and greater gestational development, with gestations being ≥ 13 weeks prevailing. Conclusion: Cases of pregnancy by incest presented indicators suggesting both proximity and relationship with the aggressor, and pregnancy at a very early age, which postponed the adolescent’s procurement of health service, and interfered negatively with abortion assistance as allowed by law.

Sexual and reproductive health communication between parents and high school adolescents in Vientiane Prefecture, Lao PDR

“…The reasons for this in this study are not clear but are likely to include embarrassment, lack of confidence or socio-cultural norms that make sexual activity a taboo topic [22,29]. This is of concern as adolescents are more likely to make informed, less risky decisions about their sexual health when they have access to appropriate and timely advice, with parents being an influential source of information for their adolescent children [30][31][32].…”

Sexually Transmitted Infections Among Adolescent and Adult Women Victims of Sexual Violence in the Metropolitan Region of São Paulo, Brazil

“…14,15 Women who suffer sexual violence at the hands of strangers in urban centres are usually constrained by serious threat, and the common use of cold weapons or firearms. 16 In those circumstances, the threat of death can inhibit women's resistance, leading to the occurrence of physical damage. 17 Yet genital damage may disrupt the integrity of the genital tissues, causing the inoculation of STIs.…”

“…15 Under those conditions, prophylaxis and diagnosis of STIs are postponed, exposing the different injuries and damages to reproductive health. 16 In Seattle, USA, research with adult women and adolescents who were treated within 72 hours of sexual violence compared cervicovaginal samples collected at baseline and after two weeks. Controlling the cases considered prior to violence found 4.2% of positive tests for gonococcus and chlamydia and 1.5% to 12.3% for trichomonas.…”

“…Infections of two or more concurrent STIs were observed in 18.1% of adolescents and 41.6% of adult women in this study, an average of 1.2 STIs among adolescents and 1.4 STIs among adult women, as also noted by Estreich et al 18 In recent years there has been an increase in the number of victims of sexual violence who use urban health services early and maintain adherence to follow-up, enabling the prevention, investigation and proper treatment of STIs. 16,38 These protective actions for women, although evident, still depend on public policies that effectively change old inadequate practices in health services. In Brussels, Belgium, a recent review of emergency services showed that only 20% of women have received adequate care after suffering sexual crimes.…”

Abortion withdrawal of sexual violence pregnancy: the role of the sex offender

“…Despite this perceived violation of their human rights, some Brazilian women still cannot obtain a legal abortion due to technical impediments, even when accessing the few specialised services available 8,9,12,13 . Among these impediments, it is worth considering the role played by the sexual aggressor.…”