SOARING SEXUAL VIOLENCE ACCOMPANIED BY DECLINING HEALTH CARE: BRAZIL MUST TAKE ACTION
By Naushene Sial
Content Warning: The following story contains mentions of sexual violence and sexual assault.
The absolutely tragic hand of fate dealt to Luana Costa was unfortunately not a shocking headline in Brazil. Luana Costa, an eleven-year-old girl, met her death only days after giving birth to her rapist’s baby in the year 2021. She was subject to continuous rape and sexual abuse from just the tender age of nine. Appalling. Horrifying. Yet, occurrences like these have always been and continue to be almost ‘commonplace’ in Brazil, with an estimated 81.8% of all sexual violence cases in the country being against female adolescents. Childhoods are snatched, lives are ruined, and surviving victims suffer life-long trauma. The following discussion will explore the challenges faced by the Brazilian health sector in its attempts to provide for the drastically large number of female adolescents subject to sexual violence in the country.
Health-wise, the consequences of sexual violence on the life of an adolescent are serious and multiple, especially given the crucial developmental stage adolescence serves to be. Victims typically require a range of health care services, ranging from emergency care to more long-term health care treatment plans. Since 1988, Brazil has operated under a public national health system framework, known as the SUS, whereby free health care financed by the states and federal government is provided to the population. While the private health care sector does exist in Brazil, more than 80% of Brazil’s population is solely reliant on the SUS for their health care needs.
Thus, the SUS is ultimately at the forefront of all health care in Brazil, including health care pertaining to sexual violence cases. However, the efficiency of the SUS itself already faces its own pitfalls with severe shortages of doctors, nurses, and inadequate levels of funding, all of which serve to be a barrier in providing adequate health care to sexual violence victims in Brazil.
The biggest barrier; however, is the fact that sexual violence is neither recognised as a public health problem nor addressed by any public health care policies. For decades women in Brazil fought for a change, and the uproar of the feminist movement in 1984 was accompanied by protests focusing on the implementation of women’s sexual rights, only to be condemned by conservative sectors of Brazil’s society and thus rejected by the State. Despite this setback, ministerial recognition of sexual health as a public health problem was finally accomplished in 2002, and numerous encouraging changes in legal and public health care policies followed. The most prominent directive was the National Policy of Integrated Health Care for Women. This policy focused on the implementation of care services for victims of sexual violence, legalising abortion for rape victims, and the creation of the Violence Notification Form in SUS databases. This form was instrumental in allowing for the collection of data in the field, as well as serving as a basis to formulate policies and operate health services. However, the creation of public health care policies does not necessarily lead to its implementation, and this is what was widely observed in Brazil. Once abortion was legalised for rape victims, the number of hospitals that agreed to carry out legally permitted abortions dramatically declined over the years after which it had been introduced. Moreover, health care professionals carrying out the abortions would confuse their role as a healthcare professional with their religious beliefs, with many workers found to have refused participating in the procedure. Without the healthcare system, victims are forced to turn to methods of unsafe abortion, with the number of women who die as a result of such methods increasing dramatically in Brazil.
Later that decade, advances in the STD/AIDS program were made, and emergency contraception was introduced. However, almost as quickly as emergency contraception was introduced, it was rejected, with almost all batches of emergency contraception dispatched being sent back to the Ministry of Health.
Simply put, Brazil faces two large groups opposed to the provision of effective health care services to sexual violence victims. The first group stems from the observed sexist and patriarchal mindset of the Brazilian culture, to which much of the high incidence rates of sexual violence prevalent in the country can be attributed. While the second group stems from the highly conservative sectors of society, seemingly the most problematic group in the context of allowing for sexual violence victims to receive the health care that they require and are entitled. Professionals urgently require training on their role as health care workers, where personal and religious views are put aside for the wellbeing and health of the patient.
With the number of sexual violence cases in Brazil on the rise, and the quality of health care being provided to victims on the decline, it is crucial that action be taken to separate the health care system from the cultural and conservative sectors of society.