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The case of a nine-year-old girl who was raped and impregnated by her stepfather has revived the debate in Brazil on sexual violence, the need to reform the abortion law, and the shortcomings of the health system when it comes to dealing with the few cases in which abortion is legal. The little girl from Alagoinhas, a town in the northeastern state of Pernambuco, underwent an abortion when she was 15 weeks pregnant, at one of the centres authorised by the Health Ministry to interrupt pregnancies under the few circumstances in which abortion is legal in Brazil: in cases of rape or when the mother’s life is at risk. The girl, who weighs just 36 kilos and is 1.33 metres tall, was carrying twins. "She’s very small. Her uterus does not have the capacity to hold one baby, let alone two," said Fatima Maia, director of the teaching hospital where the therapeutic abortion was performed. As a result of her pregnancy, it came out that the girl had been sexually abused by her stepfather since she was six years old. He had also repeatedly raped her mentally disabled sister, now 14. But the compelling legal and moral arguments of the case did not keep the Catholic Church from launching an all-out offensive. The archbishop of Olinda and Recife, Jose Cardoso, excommunicated the mother and the members of the medical team who carried out the abortion. "God’s law is above any human law," said Cardoso, the highest Church authority in Pernambuco. The archbishop said the "crime" of committing the abortion was even more serious than the years of sexual abuse by the stepfather, and successfully kept the procedure from being carried out in another health centre authorised to perform legal abortions. But human rights groups helped the mother bring her daughter in to another hospital, where the abortion was practiced in early March. Lessons to be learned "This case is extremely important, because it once again brings to the forefront the debate on the importance of having a state that acts in a truly secular fashion," Carla Batista, with Recife SOS Corpo, a local women’s group that has closely followed the case, told IPS. Batista also said another "lesson" to be learned from the case has to do with a long-time demand by Brazil’s women’s movement: the urgent need to expand and improve public health services to women who have suffered sexual violence. To illustrate the shortcomings of these health services, she pointed out that the mother was forced to travel all the way to the state capital in order to apply for an abortion for her daughter, and to have it performed. "If a rape victim had immediate access to such services, she would be able to receive emergency contraception, like the ‘morning after pill’, as well as prophylaxis against AIDS and other sexually transmitted diseases, not only to prevent pregnancy but also to prevent illness," said Batista. That kind of service acts as "prevention against legal abortion," said the SOS Corpo activist. There are no reliable statistics on sexual violence against minors in Brazil. But Batista pointed out that the Health Secretariat of Pernambuco alone is currently handling 270 cases of rape of under-age girls. Most of the victims come from low-income families, although the phenomenon is also seen in middle and upper income families, "who are able, however, to hide the cases," she said. Official figures show that of the half a million cases of domestic violence reported annually in Brazil, 29 per cent involve sexual abuse. SOS Corpo and other organisations that advocate women’s rights, like the Feminist Centre for Studies and Advisory Services (CFEMEA), have highlighted studies on the issue since the scandal broke out over the nine-year-old girl in Alagoinhas. For example, a report by the special juvenile police unit indicated that 1,114 children examined by forensic medical examiners in 2005 were victims of sexual abuse. In 28 percent of the cases, the children were under 14, and in 20 percent the perpetrators were family members. Batista also cited a study she helped draw up two years ago, based on interviews with girls who received legal abortion services: "In no case did we find that the women regretted the decision to abort, and they were generally fully aware of what they wanted when they requested an abortion." Batista said that in rape cases involving minors, the support of the victim’s mother is very important, as it was in the case of the girl in Alagoinhas, who was poor and illiterate. "Sometimes the mother knows what is going on at home, in other cases the minor has been threatened by the rapist, or the parents demand that she keep things secret, and there is always a sense of guilt on the part of the girls," she said. In the Alagoinhas case, the mother had been the victim of abuse at the hands of her first husband, but trusted her new partner and said she "believed he was a good man, because he treated her daughters with affection." The case "is emblematic because it was successful," in the sense that the little girl was able to obtain an abortion, despite the fact that it occurred in a region where there is little access to legal abortion services, said Beatriz Galli, with IPAS, an international organisation that works around the world to increase women's ability to exercise their sexual and reproductive rights, and to reduce abortion-related deaths and injuries. But, she told IPS, "that is not the rule." According to Health Ministry statistics, 3,050 legal abortions were performed in Brazil in 2008 – "a small number compared to the magnitude of the problem," said Galli. Alliance between Church and conservatives Galli, Batista and Natalia Mori, one of the directors of CFEMEA, all expressed concern over the growing influence of "conservative sectors" that are attempting to further limit the practice of abortion. "The Church’s attitude was to be expected, because it does not pay the slightest attention to women, never considers the underlying drama behind each case, and clings to dogma," said Batista. "It defends ‘life’ as a matter of dogma, but does not take into account the real lives of people." A CFEMEA study found that of 50 initiatives addressing the question of abortion that are currently under study in Congress, at least 40 are aimed at making the already restrictive abortion law even tighter. The draft laws range from an initiative that would declare abortion an appalling crime, to others that would require home pregnancy tests to carry warnings like "abortion is a crime" or "the penalty for abortion is between one and three years in prison." There are only around 10 bills in favour of expanding access to legal abortion, including one that would make it legal in the case of anencephalic fetuses (which do not have a complete brain). Under current legislation, abortions in such cases must be approved by the courts on a case by case basis. In 2008, a draft law for the decriminalisation of abortion was voted down in three different congressional committees. The government of Luiz Inácio Lula da Silva introduced its first bill on abortion in 2005, but failed to win strong support in the leftwing governing Workers’ Party (PT) or allied parties, said Mori. The CFEMEA director said positive stances have been taken by Lula, a Catholic, and by Health Minister Jose Gomes Temporão, both of whom vehemently condemned the position taken by the Church in the case of the girl who was raped by her stepfather. "It is positive that this government has addressed the issue publicly, and we can consider the Health Ministry and the Special Secretariat on Women as allies," said Mori. "But because of our culture and our political system, there is an alliance between the government and the Catholic Church and other churches, to keep themselves in power," she said. It is these alliances, she said, that throw hurdles in the way of compelling action to produce a modern, up-do-date law that would decriminalise abortion. Hard-hitting figures The Health Ministry estimates that one million illegal abortions a year are practiced in Brazil, based on the records from public hospitals, which assist 250,000 women a year for complications arising from back alley abortions. The Ministry reports that illegal abortions are the fourth case of maternal mortality in Brazil, and a study carried out in 2008 by women’s groups in cities in the impoverished northeastern states of Bahía and Pernambuco shows that it is the top cause of maternal death there. The Ministry estimates that there is one abortion for every three births in Brazil. Girls and adolescents are especially vulnerable to risks associated with early pregnancy and abortion. Statistics from the health system show that 192,445 girls between the ages of 10 and 14 gave birth from 2000 to 2006, while 105 girls under 14 died as a result of complications caused by pregnancy, birth or abortions. Further information