A dark reality

November 2014

Vivian Mannheimer | Blog HCS-Manguinhos

Last October, two tragic cases in Rio de Janeiro shed light on a dark reality that was largely ignored in the most recent presidential campaign. Hundreds of thousands of women die regularly from illegal abortion procedures, as abortion is only legal in Brazil in cases of rape, anencephaly, or if the mother’s life is at risk. One of the recent cases was that of Jandira dos Santos Cruz, a 27-year-old mother of two. Her ex-husband stated that a woman took Jandira to a clinic and she never came back. Police believe she died during the abortion and her body was mutilated to avoid identification.

The other case was of Elizangela Barbosa, 32, who also died after going to an illegal abortion clinic. These shocking cases have drawn attention to the huge risks Brazilian women take in order to get abortions. While the legalization of abortion is absent from legislative debates, Brazilian authorities have intensified the raid against illegal abortion networks. More than 47 people have been arrested in Rio de Janeiro since these two cases.

In order to understand this reality and its earlier historical antecedents, HCSM  spoke to Cassia Roth, a PhD Candidate in History at the University of California, Los Angeles. Her research discusses fertility control (abortion and infanticide) and reproductive health (in particular pregnancy and delivery) in Rio de Janeiro between 1890 and 1940. In this interview, Cassia explains the connection between state policies towards reproduction in early-twentieth-century Brazil and the current state of women’s reproductive health.

What is the connection between state policies towards reproduction in the early-twentieth century and the current situation of women’s reproductive health (for example the high mortality rate for women who undergo illegal abortive procedures)?

Under the 1890 Penal Code, the woman who sought out or self-induced an abortion was criminalized for the first time. This change in legal precedence did not lead to the prosecution of women who had abortions, however. Rather, the state targeted abortion providers, including both licensed and unlicensed midwives and doctors. Other historians have demonstrated that this trend continued throughout the twentieth century. This persecution prevented the medical profession from helping women who presented with post-abortion complications. For example, doctors in the 1920s and 1930s refused to attend women with post-abortion infections or hemorrhaging until they first reported the abortion to the police, as doctors did not want to be investigated or charged with the crime. I believe that the current high mortality rate for women who undergo illegal abortive procedures is a result of the Brazilian state’s past history of prosecuting healthcare professionals. This trend barred medical professionals willing to provide abortions or even post-abortion care from doing so, pushing abortion into the shadows. Women have to resort to illegal methods and unqualified and often unscrupulous providers.

How did reproductive health services develop during Brazil’s early-twentieth-century modernization projects?  

Reproductive health services—for example prenatal and post-natal care, maternity hospitals, and gynecological healthcare—did not expand to meet the needs of Rio de Janeiro’s growing population in the early-twentieth century. The majority of women could not afford professional medical services, and the state did not provide the needed state assistance for Rio de Janeiro’s size. One example of this was the city’s high stillbirth rate. As the graph below demonstrates, these numbers remained unchanged throughout the fifty years of the 1890 Penal Code, and they even increased after Getúlio Vargas began implementing child and family welfare services in the 1930s. Government action lagged behind the population’s needs in terms of prenatal care, and the state was unable to reduce stillbirth rates.

Some chapters of your research rely on a set of 160 investigations and court cases involving fertility control under 1890 penal code. Can you tell us a bit more about some of those cases? 

I researched 131 police investigations (inquéritos policiais) of reproductive-related events (including infanticide, abortion, miscarriage, maternal death, and stillbirth) and 29 court cases (processos criminais) dealing with abortion and infanticide. One interesting point is that infanticide and abortion cases reveal two different classes of women that historiography has lumped together. Infanticide remained the recourse of the very destitute, while abortion was only available to the working and middle classes. In fact, I argue that infanticide cases tell the story of people who are often left out of traditional working-class histories, as they provide one of the only times these women make it into the “official record.” For example, a 1903 infanticide case in Rio de Janeiro demonstrates the precarious lives of female domestic servants at the turn-of-the-twentieth century. After Emilia Faustina gave birth alone in the backyard of her employer’s home, she buried the child alive, causing its death. Emilia’s life as a domestic servant had not been an easy one. Emilia’s parents had sent her at the age of seven to the city of Rio de Janeiro from her hometown in the interior to begin her work as domestic servant. She remained in this first home for three to four years, roughly until the age of eleven after which she began working in the home of another family. In this second home, she stayed for six years, until her employer raped her. Several months later, and after being continually mistreated by the dona da casa, Emilia ran away, leaving her clothes and few possessions behind. From there she went to work as a domestic servant for another family, but as the family did not pay her wages (8$000 milreis per month) she left after a few months and started working in the home where she eventually committed infanticide. Emilia’s employment was dangerous, unstable, and underpaid. She had been alone in a large city since the age of seven. Yet, she faced more danger within the home than on the streets. Emilia was raped by her employer and mistreated by his wife. She continually did not receive her wages, which were low to begin with. Her economic circumstances were not much different from an urban slave’s fifteen years earlier. This stands in contrast to abortion cases where women, while struggling financially, were able to pay around 20$000 milreis in 1920 for an abortion.

A common explanation for the Brazilian conservative view regarding abortion is religion/morality. Did you identify these elements in your research? 

Early-twentieth-century condemnations of abortion and infanticide had strong Catholic undercurrents. Yet Catholicism was often not mentioned explicitly. For example, a 1926 complaint against the midwife Bertha Vieira was one of the only times Christianity was specifically discussed in these judicial documents. One disgruntled husband accused Vieira of performing an abortion on his estranged wife, causing the mental problems that resulted in the couple’s separation. The husband’s lawyer argued that abortion was one of “the most repugnant crimes…a grave affront to Christian teachings” (delicto dos mais repugnantes…uma grave inpericia aos proprios ensinamentos christãos…). Additionally, the medical profession did not frequently and overtly evoke Catholicism. Doctors more often referred to public morality and women’s proper gender roles as wives and mothers. I argue that Catholic views on traditional gender roles, women’s honor—based on their virginity outside of marriage and fidelity within it—and women’s “natural” roles as mothers permeated Brazilian legal, medical, and popular discourse at a much more subtle level. It became an integral part of the condemnation of fertility control, and it shaped public and private discourses, yet it hardly ever was mentioned explicitly.

Is there any relation between the current understanding of reproductive health in Brazil and the high rates of cesarean sections? Or are these high rates a mere economic phenomenon? 

While I cannot speak to the specific economic trends behind cesarean sections in Brazil, I can discuss the larger culture that surrounds reproduction. In one part of my research, I argue that the Rio de Janeiro civil police criminally investigated stillbirths and miscarriages at a time when both were common. The police force and judicial system did not connect the medical realities of poor birthing conditions, especially in the lower and working classes, to their investigations of these unfortunate but frequent reproductive events. Leading from this de facto criminalization of common practices, I conclude that much larger processes of official suspicion and control were at play. The police acted upon preconceived notions of women who engaged in fertility control based on patriarchal notions of female honor and sexuality complicated by a racial hierarchy that was the consequence of an ex-slave society. Gender and racial inequalities were built into the foundation of the modern Brazilian state. Legal and medical practices cemented in early-twentieth-century Rio de Janeiro continue to structure the state’s response to women’s reproduction today. In particular, I want to emphasize that this de facto criminalization went beyond actual fertility control like abortion to encompass all aspects of women’s reproductive lives. I often refer to the April 2014 case in Rio Grande do Sul in which the judicial system forced a woman to have a cesarean section against her will. The medical profession and judicial system worked together to essentially criminalize the woman’s own decision and exert state control over her body. I believe this trend became institutionalized in the early-twentieth century.

For related articles in Portuguese and Spanish, please see:

Drovetta, Raquel Irene. “Morbimortalidad femenina en la Puna jujeña: potencialidad de la técnica autopsia verbal.” Hist. cienc. saude-Manguinhos, 2008, vol.15, p.257-268.

SILVA, Marinete dos Santos. Reproduction, sexuality and power: the struggles and disputes over abortion and contraception in Rio de Janeiro, 1890-1930. Hist. cienc. saude-Manguinhos [online]. 2012, vol.19, n.4, pp. 1241-1254.  Epub Nov 27, 2012. ISSN 0104-5970.

VARGAS, Eliane Portes. “Pregnant belly showing”: the vicissitudes and valorization of the reproductive body in the construction of images of pregnancy.“ Hist. cienc. saude-Manguinhos [online]. 2012, vol.19, n.1, pp. 237-258. ISSN 0104-5970.

Leite, Ana Cristina da Nóbrega Marinho Torres and Paes, Neir Antunes. “Direitos femininos no Brasil: um enfoque na saúde materna.” Hist. cienc. saude-Manguinhos, Set 2009, vol.16, no.3, p.705-714.