The Legislative Assembly of Goiás, Brazil, sanctioned Law n. 22,537/2024¹1. Estado de Goiás. Lei nº 22.537, de 11 de janeiro de 2024. Institui a Campanha de Conscientização contra o Aborto para as Mulheres no Estado de Goiás. Diário Oficial do Estado de Goiás 2024; 11 jan. on January 11, 2024, which institutes the “Awareness Campaign Against Abortion for Women in the state of Goiás”. Proposed by then-state deputy Fred Rodrigues, it provides for measures to combat abortion in the state of Goiás. However, the document makes no mention of the legal allowances for abortion in Brazil: (i) risk to the life of the pregnant woman; (ii) pregnancy resulting from rape; and (iii) fetal anencephaly. Although the target of a Direct Action of Unconstitutionality (ADI 7,597) in the Brazilian Supreme Court, the law remains in force.

In line with the main strategies recently adopted by groups against abortion ²2. Luna N, Porto R. Aborto, valores religiosos e políticas públicas: a controvérsia sobre a interrupção voluntária da gravidez na audiência pública da ADPF 442 no Supremo Tribunal Federal. Religião & Sociedade 2023; 43:151-80. and other Bills that are being processed or have recently been processed in the Brazilian National Congress ³3. Brasil. Projeto de Lei nº 478, de 2007. Dispõe sobre o Estatuto do Nascituro e dá outras providências. https://www.camara.leg.br/propostas-legislativas/345103 (accessed on 13/Jan/2024).
https://www.camara.leg.br/propostas-legi... ^,44. Brasil. Projeto de Lei nº 5.435, de 2020. Dispõe sobre o Estatuto da Gestante. https://www25.senado.leg.br/web/atividade/materias/-/materia/145760 (accessed on 13/Jan/2024).
https://www25.senado.leg.br/web/atividad... ^,55. Brasil. Projeto de Lei nº 4.281, de 2023. Institui o Dia Nacional do Nascituro a ser comemorado, anualmente, em 8 de outubro e a Semana de Defesa e Promoção da Vida, na semana que o antecede. https://www.camara.leg.br/proposicoesWeb/fichadetramitacao?idProposicao=2392991 (accessed on 13/Jan/2024).
https://www.camara.leg.br/proposicoesWeb... , the central argument of the Goiás’ document revolves around protecting the life of the “unborn”. Attributing subjectivity to the unborn fetus aims to produce a false conflict of rights between the pregnant woman and her fetus ⁶6. Rybka LN, Cabral CS. Morte e vida no debate sobre aborto: uma análise a partir da audiência pública sobre a ADPF 442. Saúde Soc 2023; 32:e220527pt., clearly violating the reproductive rights of pregnant persons.

In paragraph 1 of Art. 3, the document provides for the development of lectures aimed at children and adolescents on the supposed “risks” of abortion, without distinguishing between clandestine (which are largely unsafe) and legal abortions. The recent scientific literature warns of the risks of unsafe abortion, especially in countries with more restrictive laws, such as Brazil ⁷7. Pilecco FB, McCallum CA, Almeida MCC, Alves FJO, Rocha AS, Ortelan N, et al. Abortion and the COVID-19 pandemic: insights for Latin America. Cad Saúde Pública 2021; 37:e00322320.. The efficacy and safety of legal abortion ⁸8. Raymond EG, Grimes DA. The comparative safety of legal induced abortion and childbirth in the United States. Obstet Gynecol 2012; 119(2 Pt 1):215-9. is ensured under the most recommended methods ⁹9. World Health Organization. Abortion care guideline. Geneva: World Health Organization; 2022..

However, this proposal draws attention by focusing on children and adolescents, who are the main victims of sexual violence in Brazil. The most affected by this problem are girls (88.7%) aged from 10 to 13 years (33.2%) ¹⁰10. Fórum Brasileiro de Segurança Pública. 17º Anuário Brasileiro de Segurança Pública. https://forumseguranca.org.br/wp-content/uploads/2023/07/anuario-2023.pdf (accessed on 13/Jan/2024).
https://forumseguranca.org.br/wp-content... . The law approved in Goiás intends to misinform children and adolescents who are possibly victims of sexual assault and, therefore, have the right to legal abortion. It is worth mentioning that pregnancy in children aged under 14 years configures statutory rape. Therefore, the pregnant woman has had the right to abortion provided by law since 1940.

Another guideline, in paragraph 2 of Art. 3, provides for information to the population about contraceptive methods to prevent unplanned pregnancies. While expanding access to information about contraceptive methods is a positive action based on a public health perspective, including this topic in an anti-abortion law suggests that unwanted pregnancies primarily stem from a lack of access to information. However, the effective use of contraception goes beyond access to knowledge on the subject as it involves a complex network of social relations, such as social markers of difference (social class, race, gender, structuring of services, etc.), inequalities in affective-sexual relationships, and individual history ¹¹11. Cabral CS. Articulações entre contracepção, sexualidade e relações de gênero. Saúde Soc 2017; 26:1093-104.. Thus, the immediate association between contraception and lack of information reinforces a narrative that blames only women for pregnancy, exempts men, and disregards the complexities of contraception. The aforementioned law includes yet another mistake, reinforcing the stigma of unforeseen pregnancy as women’s failure to regulate their fertility ¹²12. Brandão ER, Cabral CS. Vidas precárias: tecnologias de governo e modos de gestão da fecundidade de mulheres "vulneráveis". Horizontes Antropológicos 2021; 27:47-84..

The topic with the greatest repercussion of the approval of the text was the “compulsory provision” of ultrasound for pregnant women, who are now obliged to listen to the heartbeat of the fetus (Art. 3, § 6). In addition to constituting obstetric institutional violence, this measure aims to precisely curb the intention of those who refuse to continue the pregnancy. As observed in another study ¹³13. Lima MRP, McCallum CA, Menezes GMS. A cena da ultrassonografia na atenção ao aborto: práticas e significados em uma maternidade pública em Salvador, Bahia, Brasil. Cad Saúde Pública 2020; 36 Suppl 1:e00035618., the use of ultrasound in abortion care confers “attributes of a social subject” to the fetus, favoring the moral condemnation of the woman who chooses abortion and putting her at risk of being denounced.

Finally, the text proposes “to stimulate the private sector and NGOs in the promotion of means to welcome, guide, and provide psychological and social assistance to pregnant women who wish to have an abortion, always prioritizing the maintenance of the life of the unborn child” (Art. 3, § 5). The prioritization of the life of the fetus prevails over the pregnant woman’s right to legal abortion, which induces the maintenance of an unwanted pregnancy, even if the right to interruption is protected by law. Thus, it configures a way of producing moral, psychological, and institutional impediments for those who need to interrupt their pregnancy, increasing the immense number of current barriers for access to abortion provided for by law.

Barriers and difficulties in accessing safe abortion can damage the health and living conditions of the involved persons. Maintaining pregnancies by refusing abortions can lead to psychological, social, economic, and relational consequences, among other outcomes ¹⁴14. Foster DG, Biggs MA, Ralph L, Gerdts C, Roberts S, Glymour MM. Socioeconomic outcomes of women who receive and women who are denied wanted abortions in the United States. Am J Public Health 2022; 112:1290-6.. In health, the denial of abortion can lead to higher risks of conditions such as eclampsia and postpartum hemorrhage, and may even increase the risk of maternal death ¹⁵15. Gerdts C, Dobkin L, Foster DG, Schwarz EB. Side effects, physical health consequences, and mortality associated with abortion and birth after an unwanted pregnancy. Womens Health Issues 2016; 26:55-9., in addition to being associated with higher rates of postpartum depression ¹⁶16. Brito CNO, Alves SV, Ludermir AB, Araújo TVB. Postpartum depression among women with unintended pregnancy. Rev Saúde Pública 2015; 49:33.. Moreover, proposals that restrict access to legal and safe abortion contradict the most recent recommendations of the World Health Organization ⁸8. Raymond EG, Grimes DA. The comparative safety of legal induced abortion and childbirth in the United States. Obstet Gynecol 2012; 119(2 Pt 1):215-9., which considers that less restrictive abortion laws are an important step toward promoting sexual and reproductive health and rights of women and men.

Therefore, the approval of Law n. 22,537/2024 aims to prevent access to legal abortion and to impose pregnancy in cases of rape, violating the Brazilian Penal Code, which confers the right to abortion in these cases. Although state laws are unable to change federal law, the proposal imposes unnecessary psychological suffering on pregnant women by forcing the maintenance of pregnancies resulting from rape and worsens the existing barriers to access related to medical conscientious objection, gestational time limit, service distribution ¹⁷17. Diniz D. Objeção de consciência e aborto: direitos e deveres dos médicos na saúde pública. Rev Saúde Pública 2011; 45:981-5.^,1818. Grupo Curumim; IPAS Brasil; Universidade Federal da Bahia. Barreiras de acesso ao aborto legal na Bahia no período da pandemia da COVID-19: 2020 e 2021. https://www.isc.ufba.br/wp-content/uploads/2023/04/Barreiras-de-acesso-ao-aborto-legal-na-Bahia-RESUMO-EXECUTIVO.pdf (accessed on 24/Jan/2024).
https://www.isc.ufba.br/wp-content/uploa... ^,1919. Jacobs MG, Boing AC. Como a normatização sobre o serviço de aborto em gravidez decorrente de estupro afeta sua oferta nos municípios? Ciênc Saúde Colet 2022; 27:3689-700., among others.

Although the change will only directly impact the state of Goiás, its approval contributes to strengthening similar bills in other states of Brazil. These changes in legislation are strong institutional mechanisms that interfere with reproductive autonomy and management (not only of people who become pregnant), and contribute to producing moral regimes ²⁰20. Morgan LM, Roberts EFS. Reproductive governance in Latin America. Anthropol Med 2012; 19:241-54.^,2121. Fonseca C, Marre D, Rifiotis F. Governança reprodutiva: um assunto de suma relevância política. Horizontes Antropológicos 2021; 27:7-46.^,2222. Fassin D. Another politics of life is possible. Theory Cult Soc 2009; 26:44-60. that act coercively on subjects, defining their ways of living. Currently, several bills in Brazil are in line with a neoconservative and anti-abortion agenda, proposed by representatives of the municipal, state, or federal executive branch. Added to this are other recent attacks on sexual and reproductive rights, which manifest themselves, for example, in the closure of referral services for legal abortion care, such as the Vila Nova Cachoeirinha Hospital, in the municipality of São Paulo. Considered one of the only hospitals to offer the procedure after 22 weeks of gestation, the mayor of the municipality ordered the interruption of the legal abortion service in December 2023, alleging that it prioritizes other procedures and surgeries ²³23. Cetrone C. Prefeitura de SP fecha serviço de aborto legal em hospital referência no procedimento. Marie Claire 2023; 20 dec. https://revistamarieclaire.globo.com/direitos-reprodutivos/noticia/2023/12/prefeitura-de-sp-fecha-servico-de-aborto-legal-em-hospital-referencia-ha-30-anos-no-procedimento.ghtml.
https://revistamarieclaire.globo.com/dir... . There followed the dismissal of the unit director and the appointment of a physician who opposes abortion (in view of her public opinion on social media).

In addition to being part of a set of actions aimed at preventing the exercise of sexual and reproductive rights, these initiatives increase the moralization and condemnation of abortion in public debates, worsening the existing inequities in access to legal and safe abortion and in health care in cases of complications due to unsafe abortions. This whole context exemplifies one of the central arguments that make up the theoretical framework on reproductive governance. As Briggs warns ²⁴24. Briggs L. How all politics became reproductive politics: from welfare reform to foreclosure to Trump. Oakland: University of California Press; 2017., “all policies are reproductive policies” since the development needs of the capitalist State are intimately related to the management of reproductive work, which includes reproduction itself, the work of caring for and feeding children and older adults, and all that makes possible the maintenance of human life. Thus, gestating bodies remain as preferential targets of State control and intervention strategies. An alliance between academia, social movements, and sectors at different levels and government levels is urgently needed to enforce the rights guaranteed by law and to defend a secular State with rights.

Acknowledgments

To the Brazilian Coordination for the Improvement of Higher Education Personnel (CAPES; 88887.663682/2022-00) and the Brazilian National Research Council (CNPq; 308568/2022-2) for their financial support.

References

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