Abortion withdrawal of sexual violence pregnancy: the role of the sex offender
Keywords:Sex offenses, Domestic violence, Abused women, Legal abortion, Induced abortion
Introduction: Unwanted pregnancy is a serious consequence for women who experience sexual violence. Although deciding on abortion is frequent in these cases, there is not much information on women who give up abortion in this circumstance.
Objective: To analyse the associated factors in abortion withdrawal of sexual violence pregnancy.
Methods: A cross-sectional epidemiological study with a convenience sample of adolescents and women with pregnancy due to sexual violence and requesting legal abortion between August 1994 and December 2012, at Hospital Pérola Byington, São Paulo, Brazil. Pregnant women who gave up abortion after receiving the procedure approval were included and, in another group, pregnant women who completed the abortion. The variables were selected from a digitized database and analyzed using SPSS 15.0 software. The outcome was abortion withdrawal. The study variables were age; low education level; gestational age; color/black ethnicity; not being united; declare religion; serious threat from the aggressor; known offender; and residence of the aggressor. Odds ratios with 95% confidence intervals were calculated. The analysis used Wald's chi-square test (?2W) and logistic regression with variable of interest defined as the known aggressor. The research was approved by the Research Ethics Committee of the Federal University of São Paulo, Opinion No. 6767.
Results: The study included 941 women, 849 (90.2%) who had an abortion and 92 (9.8%) who gave up after being approved. Age ranged from 10-46 years, mean 23.2 ± 7.9 years, gestational age 4-22 weeks, average 11.9 ± 4.5 weeks. Among those who gave up abortion, 12.0% were <14 years old; 50.0% had gestational age ? 13 weeks; 50.0% had low education; 14.2% were black; 90.2% single; 85.9% declared to have religion; 50.0% were threatened; 12.0% of the cases occurred at the perpetrator's residence and 53.3% of the victims were raped by known perpetrators. In logistic regression, the only significant variable was the known perpetrator, increasing the victim's chance of giving up abortion twice.
Conclusion: The known sex offender has influenced the woman or adolescent's decision to give up legal abortion.
2. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Atenção às mulheres com gestação de anencéfalos: norma técnica. Brasília: Ministério da Saúde; 2014. 52p.
3. World Health Organization. Department of Reproductive Health and Research. Safe abortion: technical and policy guidance for health systems. 2nd ed. Uruguay: World Health Organization; 2012; 134p.
4. Souza CM, Adesse L. Violência sexual no Brasil: perspectivas e desafios. Brasília: Secretaria Especial de Políticas para Mulheres; 2005. 188p.
5. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Prevention and treatment of damages resulting from sexual violence against women and adolescents: technical standard. 3th ed. Brasília: Ministério da Saúde; 2012. 124p.
6. Madeiro AP, Rufino AC. Maus-tratos e discriminação na assistência ao aborto provocado: a percepção das mulheres em Teresina, Piauí, Brasil. Cienc Saude Coletiva. 2017,22(8):2771-80. http://dx.doi.org/10.1590/1413-81232017228.04252016.
7. Menezes G, Aquino EML. Pesquisa sobre o abortamento no Brasil: avanços e desa?os para o campo da saúde coletiva. Cad Saude Publica. 2009:25(sup 2):S193-S204. http://dx.doi.org/10.1590/S0102-311X2009001400002
8. Pedroso D. Estudo de fatores relacionados ao abortamento previsto em lei em situação de violência sexual. [dissertação]. São Paulo: Universidade de Santo Amaro; 2010.
9. Blake MT, Drezett J, Machi GS, Pereira VX, Raimundo RD, Oliveira FR, et al.,. Factors associated with the delay in seeking legal abortion for pregnancy resulting from rape. Int Arch Med. 2015;8(29). DOI: http://dx.doi.org/10.3823/1628
10. Costa RG, Hardy E, Osis MJ, Faundes A. Decisão de abortar: processo e sentimentos envolvidos. Cad Saude Publica. 1995;11(1):97-105. http://dx.doi.org/10.1590/S0102-311X1995000100016
11. Drezett J, Pedroso D, Vertamatti MA, Macedo-Junior H, Blake MT, Gebrim LH, et al.,. Pregnancy resulting from sexual abuse: reasons alleged by Brazilian women for carrying out the abortion pregnancy and violence. Health MED. 2012;6(3):819-25.
12. Mutta DS, Yela DA. Sociodemographic characteristics of women in a public hospital in Campinas who underwent legal abortion due to sexual violence: cross-sectional study. Sao Paulo Med J. 2017;135(4):363-8.
13. Bessa MM, Drezett J, Adami F, Araújo SDT, Bezerra IMP, Abreu LC. Characterization of adolescent pregnancy and legal abortion in situations involving incest or sexual violence by an unknown aggressor. Medicina. 2019;55(474):1-11. doi: 10.3390/medicina55080474
14. Schraiber LB, D'Oliveira AFPL, França-Junior I, Diniz S, Portella AP, Ludermir AB, et al. Prevalence of intimate partner violence against women in regions of Brazil. Rev Saude Publica. 2007;41(5):1-10. http://dx.doi.org/10.1590/S0034-89102007000500014
15. Ellsberg M, Jansen HA, Heise L, Watts CH, Garcia-Moreno C. Intimate partner violence and women’s physical and mental health in the WHO multi-country study on women’s health and domestic violence: an observational study. Lancet. 2008;371(9619):1165-72. doi: 10.1016/S0140-6736(08)60522-X
16. Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R. World report on violence and health. Geneva: World Health Organization; 2002. 346p.
17. Lathrope A. Pregnancy resulting from rape. J Obstet Gynecol Neonatal Nurs.1998;27(1):25-31. doi: https://doi.org/10.1111/j.1552-6909.1998.tb02587.x
18. Holmes MM, Resnick HS, Kilpatrick DG, Best CL. Rape-related pregnancy: estimates and descriptive characteristics from a national sample of women. Am J Obstet Gynecol. 1996;175(2):320-4. doi: https://doi.org/10.1016/S0002-9378(96)70141-2
19. Blake MT, Drezett J, Vertamatti MA, Adami F, Valenti VE, Paiva AC, et al. Characteristics of sexual violence against adolescent girls and adult women. BMC Womens Health. 2014; 22(14):15. Doi: 10.1186/1472-6874-14-15
20. Zambon MP, Jacintho ACA, Medeiros MM, Guglielminetti R, Marmo DB. Domestic violence against children and adolescents: a challenge. Rev Assoc Med Bras. 2012;58(4):465-71. doi: org/10.1590/S0104-42302012000400018
21. Madeiro A, Diniz D. Legal abortion services in Brazil – a national study. Ciênc Saúde Coletiva. 2016;21(2):563-72. doi: 10.1590/1413-81232015212.10352015
22. Sodipo OO, Adedokun A, Adejumo AO, Olibamoyo O. The pattern and characteristics of sexual assault perpetrators and survivors managed at a sexual assault referral centre in Lagos. Afr J Prim Health Care Fam Med. 2018;10(1):e1-e5. doi: 10.4102/phcfm.v10i1.1727
23. Jewkes R. Intimate partner violence: causes and prevention. Lancet. 2002;359(9315):1423-9. doi: 10.1016/S0140-6736(02)08357-5
24. Oshikata CT, Bedone AJ, Papa MSF, Santos GB, Pinheiro CD, Kalies AH. Características das mulehres violentadas sexualmente e da adesão ao seguimento ambulatorial: tendências observadas ao longo dos anos em serviço de referência em campinas, São Paulo, Brasil. Cad Saude Publica. 2011;27(4):701-13. doi: http://dx.doi.org/10.1590/S0102-311X2011000400009
25. Souto RQ, Leite CCS, França ISX, Cavalcanti AL. Violência sexual contra mulheres portadoras de necessidades especiais: perfil da vítima e do agressor. Cogitare Enferm. 2012;17(1):72-7. doi: http://dx.doi.org/10.5380/ce.v17i1.26377
26. Instituto Brasileiro de Geografia e Estatística (IBGE). Ministério do Planejamento, Desenvolvimento e Gestão. Síntese de indicadores sociais: uma análise das condições de vida da população brasileira 2016. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2016. 141p.
27. Machado CL, Fernandes MAS, Osis MJD, Makuch MY. Gravidez após violência sexual: vivências de mulheres em busca da interrupção legal. Cad Saúde Pública. 2015;31(2):345-53. doi: http://dx.doi.org/10.1590/0102-311X00051714
28. Jewkes R, Dunkle K, Koss MP, Levin JB, Nduna M, Jama N, et al. Rape perpetration by young, rural South African men: prevalence, patterns and riskfactors. Soc Sci Med. 2006;63(11):2949-61.
29. Vadysinghe AN, Dassanayaka PB, Sivasubramanium M, Senasinghe DPP, Samaranayake AN, Wickramasinghe WMMHP. A study on sexual violence inflicted on individuals with intellectual developmental disorder. Disabil Health J. 2017;10(3):451-4. doi: 10.1016/j.dhjo.2016.12.010
30. Ramos CRA, Medicci VPG, Puccia MIR. Sexually abused women – social and demographic profile and health care procedure analysis at a referral center. Rev Inst Ciênc Saúde. 2009;27(1):22-7.
31. Atkeson BM, Calhoun KS, Morris KT. Victim resistance to rape: the relationship of previous victimization, demographics, and situational factors. Arch Sex Behav. 1989;18(6):497-507.
32. Reis JN, Martin CCS, Ferriani MGC. Female victims of sexual abuse: coercive methods and non-genital injuries. Cad Saude Publica. 2004;20(2):465-73. http://dx.doi.org/10.1590/S0102-311X2004000200014
33. Lamichhane P, Puri M, Tamang J, Dulal B. Women's status and violence against young married women in rural Nepal. BMC Womens Health. 2011;11:19. doi: 10.1186/1472-6874-11-19.
34. Vertamatti MAF, Strufaldi R, Evans DP, Drezett J, Barbosa CP, Abreu LC. Factors associated with reporting delays and severity of childhood sexual abuse in São Paulo, Brazil. Psychology Health Med. 2018;1-10. doi: 10.1080/13548506.2018.1556397
35. Chasweka R, Chimwaza A, Maluwa A. Isn't pregnancy supposed to be a joyful time? A cross-sectional study on the types of domestic violence women experience during pregnancy in Malawi. Malawi Med J. 2018;30(3):191-6. doi: 10.4314/mmj.v30i3.11
36. Ensslen K, Beauregard E, Pedneault A. An Examination of the home-intruder sex offender. Int J Offender Ther Comp Criminol. 2018;62(14):4694-713. doi: 10.1177/0306624X18778450
37. Wegner R, Abbey A, Pierce J, Pegram SE, Woerner J. Sexual assault perpetrators' justifications for their actions: relationships to rape supportive attitudes, incident characteristics, and future perpetration. Violence Against Women. 2015;21(8):1018-37. doi: 10.1177/1077801215589380
38. Erickson KA, Jonnson M, Langille JI, Walsh Z. Victim gender, rater attitudes, and rater violence history influence perceptions of intimate partner violence. Violence Vict. 2017;1;32(3):533-44. doi: 10.1891/0886-6708.VV-D-15-00086
39. Yildirim A, Ozer E, Bozkurt H, Ozsoy S, Enginyurt O, Evcuman D, et al. Evaluation of social and demographic characteristics of incest cases in a university hospital in Turkey. Med Sci Monit. 2014;20:693-7. doi: 10.12659/MSM.890361
40. Martin SL, Ray N, Sotres-Alvarez D, Kupper LL, Moracco KE, Dickens PA, et al. Physical and sexual assault of women with disabilities. Violence Against Women. 2006;12(9):823-37. doi: https://doi.org/10.1177/1077801206292672
41. The PLOS Medicine Editors. Observational studies: Getting clear about transparency. PLoS Med. 2014;11(8):e1001711. https://doi.org/10.1371/journal.pmed.1001711