Factors associated with the delay in seeking legal abortion for pregnancy resulting from rape

Abstract

Background: About 7% of rape cases in Brazil result in pregnancy.Overall, Brazilian women are unaware of the right to legal interruption of pregnancy after rape, so they delay in applying the procedure to get a legal abortion or at the end they try to abort in a condition that may be unsafe. Objective:To analyse factors associated with the leadtime to have a legal abortion after rape.Methods: This is a cross-sectional study. The data were collected from electronical medical records of 1,270 women who requested legal abortion in a public hospital in São Paulo during the period of 1994 to 2013. The variables age, education, race, marital status, religion, form of intimidation, vulnerable condition, perpetrator of sexual violence, number of perpetrators, and police report were analysed in relation to gestational age, according to multiple multinomial logistic regression models. Results BackgroundSexual crimes particularly affect vulnerable young females and may be associated with physical trauma, mortality, sexual disorders, unwanted pregnancy, and psychological consequences. Damages to reproductive health include increased risk of infertility, anogenital cancer, and sexually transmitted diseases (STDs) [1]. In addition to representing a public health problem in developing countries, the subject of discussing the conflict of interrupting an unwanted pregnancy, as a consequence of a rape or not, requires a well informed decision making proccess, covering the scope of legal, moral, religious, social, and cultural aspects that are linked to it [2].Emerging data on violence against females around the world suggest that in some countries, one in five female suffer rape or attempted rape in their lifetime. Recent research on the behaviour, attitudes, and sexual experiences of young people in areas of Africa, Asia, and Latin America revealed that between 5 and 20% of females' first sexual experience was forced. Regardless of whether they have access to contraception, a forced sexual act is usually unprotected, exposing females not only to unwanted pregnancy but also to STDs, including HIV [3].In Brazil, about 7% of rape cases resulted in pregnancy. Under Brazilian law, the victim of this type of violence has the right to abort. However, 67.4% of females who were pregnant after being raped didn't get the access to legal abortion in a The delay verified in the decision to search for legal termination of pregnancy cannot be attributed to or explained by the cost of abortion in Brazil. The Brazilian Unified Health System (SUS) ensures full and free coverage for abortion in these cases, regardless of the woman has any sort of health insurance. Therefore, the females who have participated in this study did not face any financial barriers to make legal abortion.According to the Allan Guttmacher Institute, the highest rates of abortions were observed between 1995 and 2008 mainly in those regions where laws against abortion are more rigid. In 2008, an average of 28 women per thousand carried out an abortion, indicating a...

Vulnerability in adolescence: a case report of attempted abortion and sexual violence

“…Post-abortion hospital admission rates are high and make abortion unsafe as a public health problem in Brazil 14,15 and it accounts for 13% of maternal mortality worldwide 5,9 . About half of women who had abortions received care in the health system and were hospitalized for complications 16,17 .…”

“…Sexual abuse 11 during adolescence is a traumatic experience that complicates young women's psycho-social development at the threshold of adulthood 2 , resulting in consequences associated with sexually transmitted diseases, pregnancy followed by violence, unwanted pregnancies, psychosocial repercussions 7 and negative sequel e that compromise reproductive health and sexual 1 . The association between violence and unsafe abortion causes a risk of death 2,5 in young women, related to infections, 40% of which reaches the upper genital tract J Hum Growth Dev. 27(1): 117-123.…”

“…In Brazilian public health, this has a negative effect on the economy, which can vary up to 2% of GDP (gross domestic product) 2 , as well as maternal consequences related to the morbidity and mortality of our women [3][4][5] . Unsafe abortion appears as an alternative to unwanted pregnancies 1,6,7 , mainly in cases related to physical violence, sexual violence, usually caused by an intimate or known partner.…”

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

“…Incestual relations can therefore interfere in the outcome of these pregnancies because of the aggressor’s role. According to Blake et al [7], the delayed search for health services is more common when pregnancy results from sexual violence practiced by known or family aggressors. Thus, it would be reasonable to assume that in pregnancies resulting from incest, the proximity of the aggressor might hinder or delay revealing both the violence and the pregnancy, thus affecting the adolescent’s success in obtaining assistance.…”

“…In situations of incest, the close relationship with the aggressor may well be a factor that inhibits the communication of sexual violence to the police, particularly for the need to maintain the “family secret” and avoid the perpetrator accountability. In Brazil, such resistance can affect submission to a legal medical examination, since the procedure is required exclusively by the police and depends, therefore, on the police communication officer [7].…”