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.
A plastic figure depicting a human fetus is seen on display inside a bowl at a Catholic church in Rio de Janeiro. In 2008, Brazil's Catholic Church stepped up its anti-abortion campaign by displaying 600 plastic figures depicting human fetuses during masses in its Rio de Janeiro churches.AP Photo/ Ricardo Moraes
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.
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.”
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?"