Report of an experience to expand access to legal abortion for rape victims in the city of Rio de Janeiro, Brazil

The article reports on an experience developed by the Rio de Janeiro Municipal Health Department (SMS-RJ) to expand the number of municipal maternity hospitals that provide legal abortion for rape victims. Brazil's legislation allows legal abortions in three cases: risk to the woman's life, rape, and fetal anencephaly. Given the high rate of sexual violence against Brazilian women, health professionals working in the Brazilian Unified National Health System (SUS) need to be trained for such care with abortion as the potential outcome if that is the woman's choice. Despite the legal provisions and guidelines, Brazilian women still experience important barriers when attempting to access this right. One of the main obstacles is health professionals' claim of conscientious objection. The study aims to present an awareness-raising methodology for health professionals to improve the care for victims of sexual violence and expand access to legal abortion in the municipal maternity hospitals. The methodology involved three stages: a workshop, awareness-raising in the maternity hospitals, and monitoring. This experience resulted in an increase in the number of maternity hospitals that perform legal abortion for rape victims, from two hospitals in 2016 to ten in 2019. The experience also strengthened the guidelines for the improvement of care, such as prioritization of cases for reception of patients and risk classification, supply of multidisciplinary care, and safeguards for the presence of an accompanying person during the patient's hospital stay. Factors that favored this work included political determination by the administration of the SMS-RJ, the wager on decentralized activities in permanent education, and the health professionals' direct involvement.