Gender and Health Justice in Brazil

The GHJP has worked for a number of years with a core group of partners in Brazil to carry out a series of research and advocacy activities to address health and human rights issues related to gender, including reproductive health concerns for women impacted by the Zika epidemic, and the implications for human rights and health professional ethics of police reporting requirements in the context of abortion.

In collaboration with the Center for Reproductive Rights (CRR), the GHJP developed a Technical Note setting out the human rights and ethical obligations put at risk by legal provisions in Brazil requiring health professionals to provide information to law enforcement authorities when patients seek legal abortion following rape. The Technical Note concludes that the risks these police reporting requirements pose to human rights and ethics can be resolved only by ensuring that such requirements do not apply to cases of abortion, or only in very exceptional cases. Human rights and ethical standards underscore the particular risk of involving the criminal legal system in abortion care, even ostensibly to support survivors. Ultimately, removing all preconditions, legal or otherwise, including authorization processes, and instead focusing on providing material support and good-quality, unbiased care, is essential to ensuring real access to legal abortion.

The GHJP and CRR also developed a shorter Ethics Brief, exploring in more detail the professional ethics obligations put at risk for physicians, nurses, social workers, and psychologists who are involved in the authorization process for legal abortion in cases of rape, and therefore exposed to ‘dual loyalty’ conflicts through their simultaneous ethical duties to patients and legal obligations to report to police. The Brief provides recommendations for action for health professionals, professional organizations and collectives, health facilities and hospitals, and Brazil’s Ministry of Health, in order to ensure ethical practice.

The GHJP's approach in supporting the advocacy goals of our Brazilian partners in work related to Zika is focused on a rights-based response: to stress the relationship between overall rights enjoyment and the impacts of Zika, and, as a result, we foreground the obligations of the state toward the most marginalized women who bear the brunt of the epidemic’s reproductive health outcomes.

Our collaborative work includes the joint submission, in 2021, with the Center for Reproductive Rights, Instituto Anis, and the Center for Justice and International Law (CEJIL), of a hearing request to the Inter-American Commission on Human Rights (IACHR) on the human rights situation of women and girls in Brazil in the context of COVID-19, in particular women affected by the Zika virus, and their children. GHJP Practicum students also prepared a “parecer” or expert's statement on gaps in the Ministry of Health’s Zika guidelines for reproductive health care providers, as part of a petition submitted by GHJP partner Instituto Anis, and the Brazilian National Association of Public Defenders (ANADEP) to the Brazilian Supreme Court to ensure expanded reproductive health services for women affected by Zika (including the option to terminate a pregnancy) and increased social services and support for families with children affected by Zika.

GHJP faculty and partners carried out a qualitative research study in 2016 with adult women and men in in Brazil on perceptions, experiences, and concerns related to reproductive health in Zika-affected areas. In 2017, in collaboration with the Center for Reproductive Rights, GHJP students also carried out public health, law and human rights-based analyses of policy responses to the Zika virus outbreak in Brazil and El Salvador, paralleling CRR-led investigations on the responses in Colombia and globally. The methodology included desk-based research and in-country interviews with affected women and their families, as well as with civil society and government stakeholders engaged in surveillance, prevention, health and social supports, and legal advocacy. The final reports were released by CRR in a series called “Unheard Voices,” which includes in-depth analyses of the responses in Brazil, El Salvador, and Colombia, as well as a broader examination of the response from the international community, including key intergovernmental actors.

In 2016, GHJP co-sponsored the international release of a documentary about women in Northeast Brazil who have been impacted by the Zika epidemic. The documentary was directed by Debora Diniz, co-founder of partner Instituto Anis, and provides a powerful glimpse into the concerns and challenges facing women who were infected with Zika during their pregnancy. GHJP faculty and students provided input during the final editing stages for the documentary and support in the preparation of English subtitles.

All of GHJP's research and advocacy work for this project has been made possible by the Gruber Program for Global Justice and Women's Rights.

Publications

The Impact of Police Reporting on Sexual and Reproductive Health and Rights, and Professional Ethics

Center for Reproductive Rights, Yale Global Health Justice Partnership, The Negative Impact of Police Reporting Requirements
on Health Professional Ethics in Brazil (2024).

Center for Reproductive Rights, Yale Global Health Justice Partnership, First, Do No Harm: How Police Reporting Requirements
for Health Professionals Endanger Brazil’s Obligations to Support Sexual and Reproductive Health and Rights (2024).

Ensuring a rights-based response to Zika

Hearing request to the Inter-American Commission on Human Rights on the human rights situation of women and girls in Brazil in the context of COVID-19 (Available in English and Portuguese).

Petition to the Brazilian Supreme Court to ensure expanded reproductive health services for women affected by Zika and increased social services and support for families with children affected by Zika (Available in English, Portuguese. Read the press release here).

Miller, A. et al. “Zika before the Brazilian Supreme Court: From a delay in hearing to denial of rights?” in JOTA, May 21, 2019 (Available in English and Portuguese).

Center for Reproductive Rights, Yale Global Health Justice Partnership, and Women and Health Initiative at the Harvard T. H. Chan School of Public Health, “Unheard Voices: Women's Experiences with Zika” (September 2018).

Brazil Report: Available in English and Portuguese
El Salvador Report: Available in English
Colombia Report: Available in English
The Global Response: Available in English

Baum, P. et. al., Ensuring a rights-based health sector response to women affected by Zika, in Cadernos de Saúde Pública (June 2016). (Available in English and Portuguese).

Galli, B. and Ricardo, C., Using a human rights accountability framework to respond to Zika” in Health and Human Rights (May 2016).