title: Conscientious objection, barriers, and abortion in the case of rape: a study among physicians in Brazil.
abstract: In Brazil, to have a legal abortion in the case of rape, the woman's statement that rape has occurred is considered sufficient to guarantee the right to abortion. The aim of this study was to understand the practice and opinions about providing abortion in the case of rape among obstetricians-gynecologists (OBGYNs) in Brazil. A mixed-method study was conducted from April to July 2012 with 1,690 OBGYNs who responded to a structured, electronic, self-completed questionnaire. In the quantitative phase, 81.6% of the physicians required police reports or judicial authorization to guarantee the care requested. In-depth telephone interviews with 50 of these physicians showed that they frequently tested women's rape claim by making them repeat their story to several health professionals; 43.5% of these claimed conscientious objection when they were uncertain whether the woman was telling the truth. The moral environment of illegal abortion alters the purpose of listening to a patient - from providing care to passing judgement on her. The data suggest that women's access to legal abortion is being blocked by these barriers in spite of the law. We recommend that FEBRASGO and the Ministry of Health work together to clarify to physicians that a woman's statement that rape occurred should allow her to access a legal abortion.
authors.affiliation: Professor, Graduate Program in Social Policy, University of Brasilia (UnB)/Anis, Institute of Bioethics, Human Rights, and Gender, Brasilia, Brazil. Electronic address: anis@anis.org.br.
authors.forename: Debora
authors.initials: D
authors.lastname: Diniz
authors.affiliation: Professor, Research Center and Extension Program in Women's Health, Piauí State University (Uespi), Teresina, Brazil/Anis, Institute of Bioethics, Human Rights, and Gender, Brasilia, Brazil.
authors.forename: Alberto
authors.initials: A
authors.lastname: Madeiro
authors.affiliation: Physician, Sexual Violence Commission, Brazilian Federation of Obstetrics and Gynaecology (FEBRASGO), São Paulo, Brazil.
authors.forename: Cristião
authors.initials: C
authors.lastname: Rosas
mesh_terms: D000028:Abortion, Induced / Q000941:ethics / Q000523:psychology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001938:Brazil; D003657:Decision Making; D005260:Female; D006176:Gynecology; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009774:Obstetrics; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D011902:Rape / Q000523:psychology*; D012068:Religion and Medicine; D011795:Surveys and Questionnaires
keywords: Brazil; abortion law and policy; barriers to abortion; conscientious objection; provider-patient relations; rape; sexual violence