For every legal abortion, 11 girls are hospitalized for induced or spontaneous interruptions.

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For every legal abortion performed on girls aged 14 and under in Brazil, another 11 needed to be hospitalized as a result of induced or spontaneous pregnancy interruptions in 2021.

The survey was carried out by Sheet with data from hospital records from the SUS (Unified Health System).

Last year, there were 1,556 abortion-related hospitalizations in the 10-14 age group. Only 131 of them (8%) occurred for authorized causes in Brazil: rape, risk to the life of the pregnant woman and anencephaly of the fetus, the latter by decision of the Federal Supreme Court (STF).

The other 1,425 admissions (92%) were due to spontaneous or induced abortions outside hospitals. The frequency was comparable to that of visits for asthma (1,565) or anemia (1,397).

Authorized interventions are in the minority, despite the fact that pregnancy at this age presents a high risk to the health of the pregnant woman and that legal abortion is provided for by law in cases of rape, which automatically includes girls who become pregnant before reaching the age of 14.

Last year, 1,502 curettage or intrauterine aspiration procedures were performed on an urgent basis in patients aged between 10 and 14 years.

Used to remove the remains of incomplete abortions, the two techniques are more frequently associated with unsuccessful attempts to terminate a pregnancy than with natural cases.

Comparison with the number of hospitalizations suggests a high occurrence of complications in abortions performed outside the hospital environment.

According to the Penal Code, any sexual act with children under 14 constitutes rape of a vulnerable person. The same code provides for the possibility of legal abortion when the pregnancy results from rape.

Despite being the minority, legal abortions have increased proportionately in the country.

Interruptions for all causes among pregnant women aged 10 to 14 years have decreased since the past decade —in parallel with a reduction observed also in the occurrence of deliveries — while authorized interventions have become more frequent.

In 2010, the public health system recorded a rate of 352 abortions per million girls in this age group. Last year, the index had already dropped to 217 per million. Legal proceedings, on the other hand, jumped from 4 to 18 per million, respectively.

For experts in the field, statistics indicate that the rights of victims of sexual violence are still far from being addressed.

“The number of legal abortions is even more discrepant with the number of girls becoming mothers. It is also very alarming when we look at the number of victims of sexual violence in this group”, says Nicole Campos, sociologist and strategy manager at the NGO Plan International. .

The Information System on Live Births (Sinasc) shows that 17,500 girls aged 10 to 14 had children in 2020, the latest consolidated official data. On average since 2010, there were 24,000 per year.

The most recent Brazilian Public Security Yearbook, also with information from 2020, indicates that at least 37,600 girls under the age of 14 were raped in the period. Children and adolescents in this age group correspond to 60.6% of victims of crime. Among these, 86.9% are female.

The gynecologist and obstetrician Jefferson Drezett, professor at the School of Public Health at USP, believes that the number of legal abortions is proportionally low in the country due to prejudice and the lack of sufficient public health services.

“Difficult access will not prevent abortion, it will only make the situation even more cruel. And the poorer the woman, the greater the chance of a clandestine abortion performed in an unsafe way”, says Drezett, former coordinator of the Nucleus of Sexual Violence and Legal Abortion at the Pérola Byington Hospital, in São Paulo.

Doctor Marun Cury, from the Paulista Association of Pediatrics, highlights the lack of information for families and even among health professionals.

“When a pregnancy happens at this age, families should be informed about the risk that girls run by keeping it and also about the right to termination. Girls under 14 still do not have their bodies ready for pregnancy”, he says. .

He explains that pregnant women of this age are more likely to have complications such as anemia, hypertension, preeclampsia and premature birth. For the baby, there are greater chances of breathing problems and malformations.

“The girl still doesn’t have, for example, the bone structure of the pelvis ready, because it takes two to three years after the first menstruation to consolidate. Therefore, deliveries are high risk for the mother and the fetus. it’s no wonder that most newborns need to be admitted to ICUs”, notes Cury.

Specialists see a chance of regression after the publication by the federal government of a technical standard that, without having changed the legislation, confuses and can harm medical conduct.

The text says that abortion is not recommended after 22 weeks of pregnancy. This was the argument presented by a team to refuse the procedure in an 11-year-old girl victim of rape in Santa Catarina.

“Without having a scientific justification, the government is imposing its ideological and moralizing bias on this issue. The rule creates an environment of legal uncertainty in hospitals”, says Campos.

The note also guides the teams to “strictly” evaluate cases between 20 and 22 weeks, due to the “possibility of error in estimating the gestational age”. “It is recommended to limit admission to abortion care provided for by law at 20 weeks of gestational age or, when available, with a predicted fetal weight of less than 500 grams”, says the document from the Ministry of Health.

“Abortion has been allowed when there is a risk of death or rape for 82 years. During all these decades, the State has turned its back on this right. Now, the ministry produces a document that makes access even more difficult. Brazil needs”, criticizes Drezett.

In 2020, for every baby given birth by a girl in the South or Southeast, three were born in the North and two in the Northeast. For every 2 hospitalized for abortion in the richest regions last year, 6 and 5 were rescued, respectively, in the poorest.

From a racial perspective, for every abortion of a white girl (25%), there are three among black girls (72%), well above the proportion of brown and black women in the composition of the female population aged 10 to 14 years (56%).

“Early pregnancy is always more recurrent in groups with less access to rights, where there was a lack of access to health, education, social protection. It is the result of systemic inequalities that deepen even more after pregnancy”, analyzes Campos.

The sociologist argues that sex education in schools, which is under attack from political groups in the country, would help prevent early pregnancy and, consequently, the number of abortions.

“All pregnancies up to the age of 14 are presumed violence. Education does not act only to prevent an intentional pregnancy, but is an instrument to prevent violence. It teaches these girls the limits of their bodies, what consent is, whom to turn to in case of abuse”, he defends.

According to her, many girls of that age don’t even know how a pregnancy happens.

“In addition to being victims of violence, they become mothers and lose a series of other rights. They stop studying, lose the opportunity to enter a university, have a career, be socially inserted. We need to understand the gravity of motherhood to these children”, adds Cury.

The WHO (World Health Organization) estimates that 47,000 women die each year as a result of clandestine abortions. It also estimates that 5 million women a year suffer from the sequelae of unsafe procedures.

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