| Madeiro & Diniz 1414. Madeiro AP, Diniz D. Legal abortion services in Brazil-a national study. Ciênc Saúde Colet 2016; 21:563-72.
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Hospital census, Brazil (2013-2015). |
Survey. Self-administered online questionnaire. |
Census stage. Active services (37) of the 68 registered with the Ministry of Health. |
Structure of legal abortion services. |
No description of hospital characteristics. |
37 active services were identified, providing abortion in cases of: rape (37/37), risk to the woman’s life (27/37) and anencephaly (30/37). 35 also provided care for sexual violence, distributed in the regions North (5), Northeast (11), Central (3), Southeast (12) and South (6), concentrated in the capitals. Seven states have no services. Different documents demanded for abortions. Multi-professional/non-specific team. Available methods: Curettage (89%), medication (97%), aspiration (86%). Care provision: 5,057 demands vs. 2,422 procedures. |
| Women’s characteristics |
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| Madeiro & Diniz 1414. Madeiro AP, Diniz D. Legal abortion services in Brazil-a national study. Ciênc Saúde Colet 2016; 21:563-72.
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Brazil (year not informed). |
Case series. Chart evaluation. |
Sample stage: data from charts of 1,283 women, in 5 selected services. |
Profile of women who underwent a legal abortion and abortion characteristics. |
Convenience sample: (available charts). Non-consecutive cases. |
Age 15-29 years, (62%); white (51%) and brown (26%); single (71%); Catholic (43%) and Evangelical (26%); educational level ≤ 8 years (41%), secondary education (37%) and higher education (14%); GA ≤ 14weeks (68%). Rape 94%. Method: aspiration (45%) and misoprostol (32%). |
| Drezett et al. 1717. Drezett J, Pedroso D, Gebrim LH, Matias ML, Macedo Jr. H, Abreu LC. Motivos para interromper legalmente a gravidez decorrente de estupro e efeitos do abortamento nos relacionamentos cotidianos das mulheres. Reprod Clim 2011; 26:85-91.
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São Paulo (2000-2007). |
Case series. Phone interviews. |
43 of 53 women admitted to a reference center for legal abortion following rape. |
Women’s profile, aggressor, characteristics of the violence, reasons for the abortion, personal conflict. |
19% loss (refusal or no contact) Interview conducted a long time after the abortion. Only a descriptive analysis of cases. |
Age: 19-44 years (mean 28.9); white (58%), black (27.9%) and brown (13.9%); single (65%), Catholic (46.5%) and Evangelical (25.6%); educational level ≤ 8 years(18,8%), secondary education (53,3%) and higher education (27,9%). Unknown perpetrator (65%); when known, former partner (60%). Sharing decision with family members in around 60% of cases. Reasons for abortion: rejection of pregnancy and connection with violence in around 90%; violation of the right to choose 77%. No participant regretted the abortion. |
| Drezett et al. 1818. Drezett J, Pedroso D, Vertamatti MA, Macedo-Júnior H, Blake MT, Gebrim LH, et al. Pregnancy resulting from sexual abuse: reasons alleged by Brazilian women for carrying out the abortion - pregnancy and violence. Health Med 2012; 6:819-25.
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São Paulo (2000-2007). |
Case series. Phone interviews. |
43 of 53 women admitted to a reference center for legal abortion due to rape. |
Profile of women and of the violence, information regarding rights. |
19% loss (refusal or no contact) Interview conducted a long time after the abortion. Only a descriptive analysis of cases. |
Violence occurred on the way to work (35%) during leisure time (32.5%), at home (12%). Information regarding the right to an abortion: police unit (44%), health unit (23%). |
| Blake et al. 1919. Blake MT, Drezett J, Machi GS, Pereira VX, Raimundo RD, Oliveira FR, et al. Factors associated with the delay in seeking legal abortion. Int Arch Med 2015; 8:1-14.
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São Paulo (1994-2013). |
Cross-sectional. Analysis of database based on charts. |
1,270 women admitted to a reference center for legal abortion due to rape. |
Association between sociodemographic factors and GA at time of abortion. |
Exclusion of incomplete charts. |
Age: 10-46 years (adolescents, 42%); white (58%), black (13.2%) and brown (26.1%); single (70%), Catholic (50.6%) and Evangelical (24.42%); educational level ≤ 8 years (49.4%); secondary education (45.9%) and higher education (4.7%). Unknown perpetrator (62%). Reasons for seeking abortion at a late GA (≥ 23 weeks): being a minor (OR = 1.8), being single (OR = 8.7), perpetrator was a family member (OR = 1.99), police report (OR = 1.95). |
| Santos et al. 2020. Santos J, Drezett J, Alves AL. Características sociodemográficas de migrantes bolivianas com gestação decorrente de violência sexual atendidas em serviço público de referência para abortamento legal, São Paulo, Brasil, 2002 - 2014. Reprod Clim 2015; 17:25-32.
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São Paulo (2002-2014). |
Case series. Analysis of database based on charts. |
38 Bolivian women who requested a legal abortion after rape at a reference center. |
Women’s profile, aggressor, characteristics of the violence, |
No definition of consecutive cases or completeness. Only descriptive analysis of cases. |
Age: 13-44 years (mean 24.0); single (23%); Catholic (55.3%) and Evangelical (13.2%); educational level ≤ 8 years (52.7%), secondary education (44.7%) and higher education (2.6%). Violence occurred at home (26.3%), during leisure time (23.7%), on the way to work (13.7%). Unknown perpetrator (63%); referral from a health unit (39.5%) and from a police unit (31.6%). |
| Mutta & Yela 2121. Mutta DS, Yela DA. Sociodemographic characteristics of women in a public hospital in Campinas who underwent legal abortion due to sexual violence: cross-sectional study. São Paulo Med J 2017; 135:363-8.
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Campinas, São Paulo State (1994-2014). |
Case series. |
131 women admitted for legal abortion following sexual violence. Data extraction from charts (UH). |
Physical and psychological characteristics of women, the violent act and type of care offered. |
No limitations. |
Age 70% < 29 years, 36.6% adolescents. Single (72%); none with higher education, 45% ≤ 8 years of schooling; Low income (76.4%); 30% with no previous sexual activity; Almost 70% with no habitual CC use and 99% with no emergency CC use. Characteristics of the violent act: unknown aggressor (62%). Presented a police report (92%). Characteristics of abortion: GA < 12 weeks (63%); Method: misoprostol and curettage; Complications (2.3%); cervical laceration and uterine perforation. All wanted to terminate the pregnancy, only 35% with no psychological conflict. Adolescents were students, not previously sexually active, with no CC use, with known aggressor and more advanced GA. Adults were workers, sexually active, unknown aggressor, GA ≤ 12 weeks and low CC use (45.6%). |
| Awareness/behavior of doctors/medical students |
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| Benute et al. 2222. Benute GR, Nonnenmacher D, Nomura RM, Lucia MCS, Zugab M. Influência da percepção dos profissionais quanto ao aborto provocado na atenção à saúde da mulher. Rev Bras Ginecol Obstet 2012; 34:69-73.
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São Paulo (year not informed, prior to 2012). |
Survey. Self-administered questionnaire. |
119 of 149 Obstetrics professionals of a UH and public hospital in the São Paulo periphery. |
Knowledge of Brazilian legislation. |
No detailed description of participants. Total response rate of 80%, with no description by category. Limited statistical analysis. |
Participants: 48.7% doctors, 33.6% nurses and 17.6% from other areas. Correct knowledge of the legislation (abortion permitted in cases of rape and risk to woman’s life, at the time of the study): 67.2% of doctors, 2.5% of nurses, 4.5% of others. Favorable opinion to increasing legal cases: for fetal malformation, 62.0% of doctors, 20% of nurses and 23.8% of others; for unwanted pregnancies, doctors (53.4%), nurses (85%), others (33.3%). |
| Diniz et al. 1616. Diniz D, Madeiro A, Rosas C. Conscientious objection, barriers, and abortion in the case of rape: a study among physicians in Brazil. Reprod Health Matters 2014; 22:141-8.
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Brazil (2012). |
Survey. Self-administered online questionnaire. |
1,690 of 15,000 OBGYN members of FEBRASGO. |
Doctors’ behavior with regard to legal abortion following rape: knowledge of conditions for requesting an abortion and objection of conscience. |
No definition of sample size. No detailed description of results according to participants. Response rate of 11.3%, no description of loss. |
Participants: 53.5% women, age group < 50 years (58.5%); over 20 years of medical practice (50.9%); 50% Catholic; 13% Spiritist; 7% Evangelical and 27% with no religion; 57% from the Southeast Region; 43% with experience providing care to rape victims. Only 13.7% trusted the information provided by the woman; almost half required a document (court authorization, police report); 37% required 2 documents. In total, 81.6% required some document, creating barriers to care. Almost half would refuse to perform the procedure for non-specified reasons (only 5% for religious reasons); 21% would perform it and 18% only with a document. |
| Ribeiro & Fonseca 2323. Ribeiro DR, Fonseca CT. Atenção humanizada ao aborto legal em um hospital público de Belém - PA. Rev Para Med 2015; 29:13-20.
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Belém, Pará State (2013). |
Survey. Face to face interviews. |
33 of 58 professionals of the Legal Abortion Service of a SUS hospital. |
Knowledge of the Ministry of Health’s Technical Norm (Atenção Humanizada ao Abortamento). |
No definition of strategy or sample size. Convenience sample. No detailed description of participants or results. Very limited statistical analysis. No description of losses. |
Little over half of the interviewed professionals knew the Technical Norm (52%). Among those who did not know it, there were 5 nurses and 10 doctors. |
| Rocha et al. 2424. Rocha WB, Silva AC, Leite SML, Cunha T. Percepção de profissionais da saúde sobre abortamento legal. Rev Bioét 2015; 23:387-99.
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Brasília, Federal District (2014). |
Survey. Self-administered questionnaire. |
177 professionals (35 doctors) of a SUS reference center for legal abortion, however, not directly connected to the service. |
Health professionals’ perception of legal abortion. |
No definition of the calculation of sample size or sampling strategy. No description of results according to category. No tables. No description of losses. Limited statistical analysis. |
Participants: female sex (89.8%); age: 25-35 years (38.9%) and 36-50 (42.4%); Catholic (54.2%), Protestant or Evangelical (27.1%); Spiritist (10.2%); no religion (4.5%); 32 OBGYN (18.1%), 3 clinicians, 5 social workers (2.8%), 9 psychologists (5.1%), 8 pharmacists/biochemists (4.5%), 68 nurses (38.4%) and 52 nursing technicians (29.4%); no lato or stricto sensu post-graduate degree (37.9%). Lack of knowledge regarding the necessary documentation (> 90%). Only 27.1% agreed with the right to termination in any situation. Of those who partially agreed, 45.8% Catholic, 41.7% Protestant and 38.9% of Spiritists are favorable to termination only in the cases established by law. As for convincing women to carry their pregnancy to term, 25% of Catholics and around 40% of Evangelicals and Spiritists would adopt a strategy of persuading women to carry a post-rape pregnancy to term. |
| Almeida et al. 2525. Almeida MAS, Amorim FHR, Barbosa IAF, Dias A, Morita I. Brazilian abortion law: knowledge in medical education. Rev Bras Educ Méd 2012; 36:243-8.
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Mid-sized city in São Paulo (2008). |
Survey. Self-administered questionnaire. |
151 of 180 medical students in the first (74/90) and sixth years (77/90) at a public university. |
Knowledge regarding Brazilian legislation on abortion. |
No detailed description of participants. No description of results according to category. Response rate of 79.5%. No description of losses. Limited statistical analysis. |
Participants: women (60%), from smaller cities in São Paulo (> 50%); Catholic majority. Knowledge of situations for legal abortion (at the time: rape, risk to the woman’s life) considered to be median (48% of correct answers) in all years of the course. Disciplines which addressed the subject: 49.3% Embryology; 29.9% Genetics, 47.8% Public Health, 68.7% Gynecology/obstetrics, and 44.8% medical ethics. High ignorance (> 90%) of non-requirement of documents such as police reports. |
| Medeiros et al. 2626. Medeiros RD, Azevedo GD, Oliveira EA, Araújo FA, Cavalcanti FJ, Araújo GL, et al. Opinion of medical and law students of Federal University of Rio Grande do Norte about abortion in Brazil. Rev Bras Ginecol Obstet 2012; 34:16-21.
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Rio Grande do Norte State (2010). |
Survey. Self-administered questionnaire. |
52 + 73 (125) medical and law students (seniors) at a federal university. |
Knowledge regarding legal abortion (permitted situations at the time) and opinion regarding expanding legal situations. |
Convenience sample. No information on sample size. No detailed description of participants. Response rate of 56.5%. No description of losses. Limited statistical analysis. |
Participants: male sex (62.4%); high income (> 70%). Knowledge of the situations permitted by law higher among medical students (p < 0.05); 100 and 87.5% for rape; 94.2 and 87.5% for risk to woman’s life. Opinion on increasing legally permitted situations: Higher for cases of anencephaly (73%), for any severe malformation (34.6%); harm to the pregnant woman’s physical health (40.4%); for other situations (< 10%). For unrestricted increase of legal abortion: 17.3%. |
| Faúndes et al. 2727. Faúndes A, Duarte GA, de Sousa MH, Soares Camargo RP, Pacagnella RC. Brazilians have different views/abortion should be legal, but most do not agree with imprisoning women for abortion. Reprod Health Matt 2013; 21:165-73.
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Campinas, São Paulo State (2011). |
Survey. Self-administered questionnaire. |
874 medical students from 3 universities. |
Opinion regarding conditions for legal abortion and regarding the criminalization of abortion. |
No information on sample size. No description of results according to characteristics. Response rate of 69.5%. No detailed description of losses. Limited statistical analysis. |
Participants: 82% < 24 years, 59% women, 96.3% single, 71.8% follow some religion. Only 15% of students agree with legal abortion in all circumstances, but 85% oppose imprisonment of women who have had abortions. |
| Darzé & Azevêdo 2828. Darzé OISP, Azevêdo BKG. Competências adquiridas durante a formação médica e as opiniões e atitudes sobre o aborto. Rev Bras Ginecol Obstet 2014; 36:5-9.
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Bahia State (2012). |
Survey. Self-administered questionnaire. |
174 students from several phases of the School of Medicine and Public Health of Bahia medical course. |
Knowledge of and opinion on abortion . |
Convenience sample; Inadequate sample strategy and size. No description of participants. No quantitative or qualitative description of losses. Limited statistical analysis. |
Participants: women (63%), single (93.7%), follow some religion (73.6%). Knowledge of legislation: 48.9% (higher among students in the second half of the course, p < 0.001). Discomfort in conducting the procedure: 54.6%. Favorable opinion to increasing legal abortion cases: 86.5%, especially for cases of lethal malformations. For terminations due to personal reasons: 29.9%. |
| Madeiro et al. 2929. Madeiro A, Rufino A, Santos P, Bandeira G, Freitas I. Objeção de consciência e aborto legal: atitudes de estudantes de Medicina. Rev Bras Educ Méd 2016; 40:86-92.
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Piauí State (2012). |
Survey. Self-administered questionnaire. |
1.174 students of all medical schools in Piauí. |
Objection of conscience in the permitted situations for legal abortion and ethical responsibility associated with the objection. |
Response rate of 67%. No qualitative description of losses. Limited statistical analysis. |
Participants: 21-25 years (68%); men (52%); 1/3 in each period of the course (1st/2nd , 3rd/4th, 5th /6th years). Percentage of objection of conscience according to legal reason: - Rape: 50.8% with no differences according to age, sex and year; religious (55%) vs. non-religious (32.6%) - p = 0.000. - Anencephaly: 31.6%, no differences according to age, sex and year; religious (36.4%) vs. non-religious (10.8%) - p = 0.000. - Risk of death to the pregnant woman: 13.2%, no differences according to age, sex and year; religious (15.4%) vs. non-religious (4.1%) - p = 0.000. Ethical responsibility (justifying, explaining, referring): - Would not justify the refusal - only 4.9%. - Would not explain options - 38.8% (72.5% for rape) - Would not refer - 28% (54% rape). No differences according to age, sex and year. For the non-religious, percentages of non-ethical responsibilization were lower (p < 0.05). |
| Motoki et al. 3030. Motoki MS, Cabar FR, Francisco RP. Mother's freedom of choice and the rights of an unborn child: a comparison between the views of freshmen and senior medical school students. Clinics 2016; 71:570-4.
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São Paulo (Year not informed, after 2012). |
Survey. Self-administered questionnaire. |
201/±350 students in the first (100) and sixth years (101) of the São Paulo University, School of Medicine. |
Respect to pregnant women’s choices and need to protect the fetus in other situations. |
No information on sample size. No description of results in tables. No description of losses. Limited statistical analysis. |
Participants: 1st year (mean 19.5 years; 56.4% men; 76% white; 11% Asian; 11% brown; 2% black); 6th year (mean 26 years, 58% men, 73% white; 16% Asian; 8% brown; 3% black). Position regarding the legalization of abortion: no differences according to course year. Around 40% approve legalization in any circumstances, 4% would ban it in all circumstances and the remaining would approve in some situations. Current rules of legal abortion: Knowledge: 80.2% among first year students vs. 94% in sixth year students. Agreement: 64% among 6th year students vs. 48% among 1st year students; non-significant difference (p = 0.08). |
| Darzé & Barroso Júnior 3131. Darzé OISP, Barroso Júnior U. Prevalence, attitudes, and factors motivating conscientious objection toward reproductive health among medical students. Rev Bras Ginecol Obstet 2018; 40:599-605.
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Bahia State (2016-2017). |
Survey. Self-administered questionnaire. |
120 students in the ninth semester at the Bahia School of Medicine |
Objection of conscience. |
Undefined sampling strategy. Limited statistical analysis. |
Participants: mean age 24.35 years; women (75%); white (62%); some religion (80%). The more religious, the higher the objection (reaching 71%). Knowledge regarding ethical principles of objection varied between 74.2 and 85%. |
| Malformations and legal abortion |
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| Diniz et al. 1515. Diniz D, Penalva J, Faúndes A, Rosas C. A magnitude do aborto por anencefalia: um estudo com médicos. Ciênc Saúde Colet 2009; 14 Suppl 1:1619-24.
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Brazil (2008). |
Survey. Self-administered questionnaire. |
1,814 OBGYNs (of a total of 15,000). |
Medical care to women pregnant with anencephalic fetuses. |
No description of participants. Response rate of 12%. No description of losses. Limited statistical analysis. |
Of responding doctors, 83.3% followed at least one woman pregnant with an anencephalic fetus. Of these, 84.8% wanted to terminate their pregnancies and it is estimated that 43.7% were able to obtain a court authorization. |
| Nomura et al. 3232. Nomura RM, Brizot ML, Liao AW, Hernandez WR, Zugaib M. Conjoined twins and legal authorization for abortion. Rev Assoc Med Bras 2011; 57:205-10.
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Reference Hospital, São Paulo (1998-2010). |
Case series. Data extraction from charts. |
Thirty cases of conjoined twins without post-natal viability. |
Court authorization for abortions. |
No limitations. |
Twin profile: thoracopagus (> 70%) and cardiac malformations (100%). Mean GA at diagnosis: late (24 weeks). Cases of abortion requests (63%) with lower GA (p < 0.001). 5/19 cases did not receive authorization. Of these, four NB died < 24h and one died after 28 days. |
| Westphal et al. 3333. Westphal F, Araujo Júnior E, Fustinoni SM, Abrahão AR. Maternal risks and predictor factors for the termination of pregnancy in fetuses with severe congenital anomaly: experience from a single reference center in Brazil. J Matern Fetal Neonatal Med 2016; 29:3762-7.
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Reference center in São Paulo (2010-2013). |
Retrospective cohort. Data extraction from charts. |
Initial N = 166. N = 94 pregnant women and fetuses with lethal malformations. Hospital (HU). |
Factors associated with the request for court authorization. Complications from pregnancy, abortion and delivery. |
No limitations. |
Mean age 27 years; white (52%); high school (54%); Catholic (62%); single (62%). Court requests: 43.6%; Associated factors: CNS malformation (OR = 18.6) or thoracoabdominal malformation (OR = 16) and living children (OR = 0.45). Women who did not terminate their pregnancies had complications (86%) and all had cesarean sections. |
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