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RECIFE, Brazil — When her home pregnancy test came back positive last August, Juliana panicked.
“I saw all of my dreams being destroyed,” she recalled in Portuguese. “And I saw my family pointing at me and saying that I was a failure.”
The 20-year-old college student — who asked not to be identified by her real name — was confused. She and her boyfriend of five months had always used condoms, she said; the pregnancy was an accident.
At 15, Juliana had been diagnosed with depression. A year later, at a party, someone she knew put something in her drink. Juliana passed out and was raped. Years later, she never really talked about it, but the flashbacks were a constant reminder. And at age 18, she attempted suicide. In these circumstances, she knew she didn’t want to have or raise a child.
An estimated 5 million Brazilian women under the age of 40 have had at least one abortion, according to a groundbreaking survey published in 2010 through the University of Brasilia. Because abortion is only allowed legally if the pregnancy threatens a woman’s life, if the fetus has a congenital brain disorder or if the pregnancy is the result of a rape, an overwhelming majority of these women terminate their pregnancies illegally — risking prison, serious health consequences, social stigma and even death.
But in a desperate attempt to get a safe abortion, Juliana did something different: She falsely reported rape.
Her chilling saga may be uncommon, but it’s a window into some of the difficult choices Brazilian women are forced to make — and their unequal odds of survival — when trying to end a pregnancy in the country with the largest Roman Catholic population in the world.
Juliana knew she couldn’t tell her parents her secret. She lived with her mother, a staunch Catholic for whom abortion — under any circumstance — would be unforgivable. And she feared that if she told her father, he would tell her mother.
Instead, she confided in her boyfriend and friends and scoured the Internet for advice.
Online, she found blogs and message boards where women shared their experiences about what had and hadn’t worked for them.
“I found a thousand medicines on the Internet,” she recalls, “and my worst fear about taking them was that the abortion would not work and I would have a baby with problems.”
She placed more trust in her friends, although their advice led her on one wild goose chase after another. One of them told her to look for small drug stores and ask for an illegal medicine that would induce abortion.
“I wasn’t brave enough to do it, so my boyfriend did it for me,” Juliana explained. “He went into many different drug stores and talked to a lot of people, but he couldn’t find anything at all.”
One friend’s sister was a nutritionist and recommended foods to avoid if she wanted to keep the baby, so Juliana ate those foods — to no avail. She drank losna, or wormwood tea, on the advice of one of her boyfriend’s friends, who was nurse. That didn’t work either. Neither did the cinnamon tea, pure-wheat-leaf tea or an anti-inflammatory medicine she tried.
With every failed effort, her desperation grew, and so did the sickness she was feeling. One day, she passed out.
“I felt as sick as a human being could feel,” she remembered. “I stayed in bed for a month, barely eating.”
Even so, Juliana was lucky.
Every year, more than 200,000 Brazilian women are hospitalized after botched or incomplete abortions, according to the Ministry of Health. Seeking treatment for complications like infection, hemorrhaging and hypertension, they can face neglect or abuse by hospital staff because of the cultural stigma associated with the procedure.
“Some hospitals won’t use proper anesthesia on these women,” explained Simon Diniz, a professor of maternal health at the University of Sao Paulo. Though they are not required to, hospital staff will sometimes report these women to the police, who may arrest them. In Brazil, women who get illegal abortions can be sentenced to one to three years in prison.
Fear of mistreatment or arrest, Diniz warned, sometimes keeps women from seeking treatment, exacerbating their medical condition. Many of the women who don’t get medical attention in time end up paying the ultimate price. Abortions are the fifth-leading cause of death for women in the country, according to the Ministry of Health.
And even though Brazil’s infant mortality rate and standard of living have improved significantly over the last 15 years, the country’s maternal mortality rate has stagnated over the same period — a discrepancy many health experts say is linked to the criminalization of abortion.
The typical profile of a woman (who) has complications from abortions and survives is aged 22 to 29, black, poor, Catholic and in a committed relationship.
The rural northeast — the country's poorest and least-developed region — is home to 27 percent of Brazil’s population. And it is where two-thirds of the deaths resulting from unsafe abortions occur, a 2011 study of five states found. In contrast, only 1 percent of those deaths occur in the wealthier, industry-driven south.
“The typical profile of a woman (who) has complications from abortions and survives is aged 22 to 29, black, poor, Catholic and in a committed relationship,” explained one of the authors of the 2011 study, Paula Viana, coordinator for reproductive-health rights NGO Grupo Curumim, based in the northeastern state of Pernambuco. “The women who die from abortions are also mostly black, poor and Catholic, but [differ in that] they have a very basic education — can barely read and write — and are single.”
Roughly half of Brazil’s 1 million illegal abortions each year are induced with drugs. The most popular one used is Misoprostol. Better known by its trade name, Cytotec, the drug was developed to prevent ulcers. But as women discovered that it could also cause contractions in the womb that could result in abortions, its demand surged in the 1990s and the Brazilian government soon cracked down, restricting its availability.
She found that like Juliana, most women first ask their female friends or family members, and then their boyfriends or husbands, to find the drug or someone who would know how to get it. When that doesn’t work, some seek out drug dealers who also sell harder drugs like cocaine and marijuana.
“These women usually submit themselves to revictimization by the sellers, usually men, who may abuse them or treat them like prostitutes,” Diniz said, explaining that dealers sometimes press for sexual favors in return.
Brazilian pharmacies no longer carry Misoprostol, but drug traffickers peddle it on the black market at inflated prices: a single pill whose market value is ordinarily $4 elsewhere can sell for up to $60 a pop in Brazil. And with 12 pills recommended for a procedure, the total dosage needed can cost almost $720.
Some women find the drug at better prices online, but that isn’t necessarily a safe solution either. They may be tampered with, underdosed or placebos. Even when the real medicine is obtained safely, there are more risks. “Cytotec is one of the safest ways to have an abortion,” Diniz explained. “But these women may not know how to take it.”
Of course, there are safe ways to get abortions. But they are primarily available to those who can afford a short flight to nearby Mexico City, French Guiana or Cuba or to visit one of the private underground clinics still operating in urban areas. Though precise costs are difficult to determine, these procedures can cost in the thousands of dollars.
For women who can’t afford those options, there are the other, illegal clinics. Juliana had heard about them.
“Illegal abortion, going to a clinic that is not allowed — that sounds like something dark,” she said. “It sounds like I’m not coming back if I go there.”
Juliana decided she would do the one thing she knew would ensure a safe abortion. She worked up her courage and walked into a police station.
Juliana and her boyfriend entered a busy police station in one of Brazil’s biggest cities. It was teeming with people.
“I was really quiet because I was embarrassed,” she said. “But the officer couldn’t hear me, so I spoke louder, and then everyone heard. They were shocked.”
The officer sent for the station chief. And with her boyfriend waiting outside, Juliana began telling a story she had borrowed from a friend, who had been raped two weeks earlier.
As she told the story, tears fell down Juliana’s cheeks. She had stopped taking her anti-depressants, so she found it easy to cry.
“The chief was really concerned about me, and I could see in his face that he was shocked by the story,” she explained. "I felt really guilty to have to lie to such a kind person."
He summoned Juliana’s boyfriend and advised him to be patient with her. She was in pain, the chief said, and they would need to be strong together.
Then he gave her a letter to take to a nearby hospital that performs abortions, one of the best in the country. It noted her parents’ names, her birthday, place of birth and marital status. Under “Education,” the chief had written “Superior, Full.”
Juliana suspected that part made a difference.
“I was studying in university. I was kind of cute and tidy and arrived and made that scene,” she said. “But I can’t imagine what it’s like for a poorer woman who may already have some problems in the community. Maybe she will have less credibility because of this prejudice within the police.”
The station chief’s letter may have helped, but Juliana’s police report was unnecessary. In 2005, the Ministry of Health lifted the requirement that pregnant rape victims present a police report at the hospital. The Catholic Church vehemently opposed this reform, with some of its most fierce critics charging that women would file false rape claims in order to get abortions.
But maternal-health and reproductive-rights experts pointed out that even when a woman meets the criteria for and wants a legal abortion, significant barriers remain. The process involves doctors, nurses, social workers and psychologists, who have input into how a case proceeds. All that red tape, coupled with the deep social stigma associated with both rape and abortion, they say, is a deterrent for both patients and doctors.
A 9-year-old girl became pregnant with twins and accused her stepfather of raping her. Weighing only 80 pounds 15 weeks into her pregnancy, she was given an abortion that doctors said would save her life. A local archbishop excommunicated her mother and all the doctors involved in the procedure.
In March 2009, an abortion in the eastern city of Alagoinhas tested attitudes and revealed just how deeply the stigma permeates and divides Brazilian society.
There, a 9-year-old girl became pregnant with twins and accused her stepfather of raping her. Weighing only 80 pounds 15 weeks into her pregnancy, she was given an abortion that doctors said would save her life.
A local archbishop excommunicated her mother and all the doctors involved in the procedure, but not the girl’s stepfather.
“He did a terrible crime, but one with no ground for excommunication,” the priest, Jose Cardoso Sobrinho, declared. “There are many other serious sins…but even graver than that, I tell you, is abortion.”
Though there isn’t precise data for women who became pregnant as a result of rape, the total is estimated to be significantly more than the 1,376 legal abortions performed last year in the 65 facilities across the country that are permitted to perform them.
Most of these facilities are in bustling urban centers and can be hard to reach for women who live in rural areas. The girl from Alagoinhas had to travel 140 miles to the city of Recife to have her abortion because there were no closer options.
In Piaui state in the northeast, one of the poorest parts of the country, there is only one legal abortion facility. And illegal abortion was the leading cause of maternal death there for the last three years. Maria das Dores Sousa Nunes is an obstetrician and gynecologist in the Piaui and studies teenagers who get abortions. Almost all such procedures, she said, are performed illegally.
“We have a legal abortion service in Piaui, but it’s very precarious,” she explained. “There are still so many objections from the reviewing commission here that considers abortion requests. They require unnecessary documentation for the woman to have the abortion, like demanding a police document. Often, it eventually upsets the woman enough that she gives up.”
Nunes said there was not a single legal abortion on account of rape in Piaui last year.
The NGO Ipas has documented cases in which doctors treating victims of sexual violence didn’t tell their patients about the legal abortion options available to them.
A 2005 survey of obstetrician-gynecologists in the country found that just 48 percent had accurate knowledge about abortion law and that nearly 70 percent had never received training in abortion procedures.
Still, 77 percent of the physicians surveyed said the law should allow for legal abortions under more circumstances — significantly higher than the 16 percent of Brazilians who expressed that view in a 2007 poll.
I was really afraid of being arrested, more than I was of having a baby.
At the hospital she had been referred to, Juliana was examined in a cold room. They took photos of her body to see if she had been injured or if she required any other medical attention. On her way out, she noticed the five others waiting for their exams.
“That made me feel terrible,” she remembered. “When I got home, I quit. I decided that I wouldn’t do anything at all. I would have the baby.”
A week later, she changed her mind again, returning to meet with the social assistant who by law would guide Juliana through the process.
She told Juliana that she had three options: have the baby and raise it, have the baby and give it up for adoption or have an abortion. She suggested Juliana have an ultrasound before making the decision. But when the results came back, Juliana was stunned: She was further along in her pregnancy than she had thought.
“I realized I told the police officers the wrong date of the rape,” she said. “I was really afraid of being arrested, more than I was of having a baby.”
So when she returned to meet with the social assistant after the ultrasound, Juliana told her a second story. She said that a few weeks before the assault she had described earlier, she had also been raped by a friend while drinking at a party -- which is what happened to her when she was 16.
The social assistant responded by asking questions that upset Juliana.
"The social assistant wasn’t a cold person, but I was expecting someone a bit more sensitive," Juliana said. "She made unnecessary comments, like, 'Why didn’t you take the morning-after pill?'"
Still, the social assistant believed her and set up meetings with a psychologist and with a doctor. When Juliana met with the doctor the next week, he asked if she was sure about her decision. She said she was, and one final appointment was set up.
When Juliana checked in for the procedure, scheduled for the following day, she was alone. Her boyfriend was working in another city, and her best friend had gone out of town. That evening, the doctor came into the room and gave Juliana some medicine, which she took by inserting into her vagina.
“The nurse told me some girls abort with only the medicine,” she said. “I think it was two doses of Cytotec, but I am not sure.”
When I saw the fetus, it was one of the hardest moments of my life. I thought it was a crime, that I was a killer.
She felt sick afterward but managed to sleep through the night. The next morning, as she brushed her teeth, Juliana felt something slide down her legs.
“When I looked, it was lots of water and a little bit of blood,” she said.
The nurse assured her that it was normal and told her not to make so much noise because other patients would realize why Juliana was there and complain about the abortion taking place.
As she showered, Juliana felt something else. At first it looked to her like a normal period. Then something heavier came out.
“When I saw the fetus, it was one of the hardest moments of my life. I thought it was a crime, that I was a killer, because the fetus had the shape of a tiny baby,” she said. “I couldn’t talk to the nurses, who were trying to calm me down because I was in shock.”
Another woman waiting to have an abortion told her that she was jealous that Juliana didn’t have to go to the surgical room.
“I told her not to be jealous,” Juliana said, “because I would have the baby right now if I could after seeing [the fetus].’”
For the next few weeks, Juliana veered between regret and happiness. Now, close to the date she was expected to deliver a child, Juliana says she is sure about her decision.
"I can say I have no guilt. I don’t have the financial or psychological support to have a baby right now," she explained. "I had people who helped me, but can you imagine someone who doesn’t have anyone to help them? Who doesn’t have any kind of financial support?...What is she going to do?"
In Brazil, the idea of legalizing abortion is so taboo that no major political candidate raised the issue in the last presidential election. Legalization is politically untouchable in this country. Instead, the government’s approach has been to increase access to contraception, raising contraceptive spending almost 10-fold since 2003. Brazil has one of the highest rates of condom distribution in the world, with free contraceptives available in every single one of the country’s 5,565 municipalities. And it’s one of only two countries that distributes free female condoms.
But it’s not enough. The rate of illegal abortions in the country — 1 million per year, according to the Health Ministry— has remained steady in spite of the increased access to contraception, revealing a curious, but entrenched contradiction in this Catholic country: Though a significant majority of the Brazilian population doesn't approve of abortion, millions of Brazilian women will do whatever it takes to continue to seek them out illegally.
In January, Juliana and her boyfriend broke up. After the abortion, they fought a lot, she said. When it became too much, she asked him what had happened.
“He said he couldn’t see me with the same eyes he saw me with before,” she said. “That he couldn’t erase that image of me letting someone kill a life inside of me.”
Today, Juliana volunteers with nonprofit organizations. She still gets depressed sometimes, but she wants to start her own organization to help people who are thinking of committing suicide. And she says her experience taught her just how unfair the system is.
Not long after Juliana’s abortion, a form letter and questionnaire from the Ministry of Health arrived at her home.
“The Ministry of Health sends this letter to see if you or your family were well attended during treatment and hospitalization,” the letter begins. It notes that the services Juliana received were free of charge but had cost the state less than the equivalent of $75.
She was struck by how illegal clinics, facing such desperate demand, charge 5 to 10 times that amount, even if their services are generally subpar.
“By keeping abortion illegal, the government is maintaining these illegal clinics that make lots of money,” she said.
When asked what advice she would give to other young women with pregnancies they want to end, Juliana said she would recommend that they too file a false rape claim.
“The system is corrupt,” she explained. “I think it’s crazier to take the medicines on the Internet than go to a legal hospital with real doctors. … If we can lie, then we should do it, because it’s the safest way.”