Legal abortion in Brazil: systematic review of the scientific production, 2008-2018

Abstract: Previous reviews on the subject of abortion in Brazil have estimated one million procedures per year but did not address legal abortion. This systematic review sought to update knowledge regarding legal abortion in terms of service and women’s profile, student and doctor knowledge, situations of anencephaly and severe malformations. We searched MEDLINE and LILACS for articles published in all languages between 2008 and 2018. Article quality was assessed using the Joanna Briggs Institute instruments. Search, selection, quality assessment and data extraction were carried out independently by two researchers. We selected 20 articles, 11 on the knowledge and opinion of medical professionals (4 articles) and students (7 articles) revealing a less-than-ideal level of knowledge and a high degree of objection of conscience. Six studies on women who use legal abortion services found that they are young, single and that the main demand was for pregnancy resulting from rape. When women were younger and single and when the aggressor was someone close to them, there were delays in seeking care. Three studies on severe malformation found around 40% of court authorizations. In cases for which no authorization was given, the evolution of pregnancies was complicated and deliveries were done through cesarean sections. Only one article addressed legal abortion services, showing that 37 of the 68 that had been registered were active, lack of services in seven states and concentration in capitals. Knowledge regarding legal abortion is still scarce, the demand for the procedure is repressed and medical training is deficient with regard to this subject.

摘要：既往针对巴西堕胎议题的综述曾估算每年有100万例堕胎手术，但未涉及合法堕胎相关内容。本系统综述旨在针对合法堕胎的服务现状、女性群体特征、医护人员与医学生的认知水平，以及无脑畸形与严重畸形相关场景下的合法堕胎情况，更新现有认知。我们检索了MEDLINE与LILACS数据库，纳入2008年至2018年间发表的所有语言的相关文献。采用乔安娜·布里格斯研究所（Joanna Briggs Institute）制定的文献质量评价工具对纳入文献进行质量评估。检索、文献筛选、质量评估与数据提取工作均由两名研究者独立完成。最终纳入20篇文献：其中11篇聚焦医疗专业人员（4篇）与医学生（7篇）的认知与态度，结果显示其认知水平未达理想标准，且存在较高比例的良心拒诊情况。6项针对使用合法堕胎服务女性的研究表明，该群体多为年轻、未婚女性，最主要的就诊原因为强奸导致的妊娠。当女性年龄更小、未婚且施暴者为其熟人时，其寻求医疗救治的时间会出现延迟。3项针对严重畸形的研究发现，约40%的相关病例获得了法院的许可。未获得许可的病例中，妊娠进程较为复杂，且需通过剖宫产完成分娩。仅有1篇文献涉及合法堕胎服务的供给情况，结果显示登记在册的68家机构中仅37家仍在运营，7个州存在合法堕胎服务空白，且服务资源多集中于各州首府。目前公众对合法堕胎的认知仍较为匮乏，该手术的合法需求受到压抑，且医学培训中关于合法堕胎的内容存在严重不足。