Prevention of unsafe abortion in Brazil
1
Health and Society, Faculty of Public Health University of São Paulo, São Paulo, Brazil
2
Department of Preventive Medicine, Medical School of the University of São Paulo, São Paulo, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A2296
ABSTRACT
INTRODUCTION:
Although abortion is legally permitted and regulated in Brazil, access remains limited and largely concentrated in state capitals.¹,²,⁷ This restricted availability contributes to preventable maternal deaths.³–⁵ Continued pregnancies among girls under 14 years of age persist, despite legal permissibility in cases of rape.⁶ Unsafe clandestine abortion practices also remain prevalent, posing serious risks to women’s health.³,⁸
METHODS:
This mixed-methods study involved health professionals from Primary Health Care (PHC) services and Referral Services for the Legal Interruption of Pregnancy. The study analysed professionals’ knowledge, opinions, and practices about unwanted pregnancy, harm reduction counselling, and referral for legal abortion. It aimed to identify institutional, technical, and knowledge-based barriers to access.
RESULTS:
Of the 110 eligible PHC professionals in a medium-sized Brazilian city, 83 participated, including nursing technicians, nurses, and physicians. While most respondents recognised abortion as a leading cause of maternal mortality, substantial gaps were identified in epidemiological knowledge and clinical management. Most professionals were unaware of the correct misoprostol dosage for abortion before 12 weeks, despite recognising key signs of unsafe abortion. In the qualitative component carried out in São Paulo city, physicians reported insufficient undergraduate training on abortion and identified residency as a critical space for discussing gender, sexuality, and patient-centred care. Although committed to harm reduction, they faced stigma, fear, and institutional pressure, often providing care informally. In service provision studied among the most prominent referral centres in the country (75), the misoprostol was widely used, but outdated practices such as curettage remained common. Access to anaesthesia, telemedicine, and dilation and evacuation was limited.
CONCLUSIONS:
Persistent gaps between technical guidelines and everyday practice hinder the role of Primary Health Care in preventing unsafe abortion. These findings highlight structural inequalities and underscore the urgent need for investments in infrastructure, professional training, and strengthened referral services for legal abortion.
Although abortion is legally permitted and regulated in Brazil, access remains limited and largely concentrated in state capitals.¹,²,⁷ This restricted availability contributes to preventable maternal deaths.³–⁵ Continued pregnancies among girls under 14 years of age persist, despite legal permissibility in cases of rape.⁶ Unsafe clandestine abortion practices also remain prevalent, posing serious risks to women’s health.³,⁸
METHODS:
This mixed-methods study involved health professionals from Primary Health Care (PHC) services and Referral Services for the Legal Interruption of Pregnancy. The study analysed professionals’ knowledge, opinions, and practices about unwanted pregnancy, harm reduction counselling, and referral for legal abortion. It aimed to identify institutional, technical, and knowledge-based barriers to access.
RESULTS:
Of the 110 eligible PHC professionals in a medium-sized Brazilian city, 83 participated, including nursing technicians, nurses, and physicians. While most respondents recognised abortion as a leading cause of maternal mortality, substantial gaps were identified in epidemiological knowledge and clinical management. Most professionals were unaware of the correct misoprostol dosage for abortion before 12 weeks, despite recognising key signs of unsafe abortion. In the qualitative component carried out in São Paulo city, physicians reported insufficient undergraduate training on abortion and identified residency as a critical space for discussing gender, sexuality, and patient-centred care. Although committed to harm reduction, they faced stigma, fear, and institutional pressure, often providing care informally. In service provision studied among the most prominent referral centres in the country (75), the misoprostol was widely used, but outdated practices such as curettage remained common. Access to anaesthesia, telemedicine, and dilation and evacuation was limited.
CONCLUSIONS:
Persistent gaps between technical guidelines and everyday practice hinder the role of Primary Health Care in preventing unsafe abortion. These findings highlight structural inequalities and underscore the urgent need for investments in infrastructure, professional training, and strengthened referral services for legal abortion.
| eISSN: | 2654-1459 |
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