Brazilian Decree Determining Compulsory Registry Of Pregnant Women
Beatriz Galli, from IPAS Latin America, talks about the recent measure edited and signed by Pres. Dilma Roussef regulating the national compulsory registry of pregnant women in Brazil. The language of the text treats fetus as person, and does not apply the reproductive rights terminology.
Beatriz Galli: MP 557 is an absurd measure; instead of protecting pregnant women, it violates their human rights
By Conceição Lemes
Evil deeds have limits. It is that time of the year to perpetrate them, too. After having “destroyed” little by little, throughout the year, the Policy of Women’s Comprehensive Health Care, the Ministry of Health extrapolated during the last week of 2011, to be more exact, on December 26.
Strategically, between Christmas and New Year’s, it authoritatively signed Provisional Measure 557 (known as MP 557), without discussing it with women’s health organizations.
MP 557 instituted the National System of Registration, Tracking and Follow-up of Pregnant and Puerperal Women for the Prevention of Maternal Mortality. Besides Padilha, President Dilma Rousseff and Ministers Guido Mantega (Treasury) and Miriam Belchior (Planning) also signed.
According to MP 557, which took effect on December 27:
That system “aims to ensure better access, coverage and quality of maternal health care, notably for pregnant women at risk.”
It is “constituted by the universal registration of pregnant and puerperal women, so as to enable identifying pregnant and puerperal women at risk, and evaluating and following up on the health care they received during the prenatal stage, childbirth and puerperium.”
Registered pregnant women will have the financial benefit of up to R$50.00, to help with their transfer to SUS healthcare facilities for prenatal follow-up and childbirth assistance.
Public and private healthcare facilities have the obligation to ensure the pregnant woman and unborn child the right to safe and humane prenatal care, childbirth, birth and puerperium.
As soon as that information fell in the hands of social networks, MP was bombarded, even by the courts.
“That MP is really absurd, a fallacy on the part of the federal government, as it does not achieve the purposes for which it was created,” denounced
Beatriz Galli in an interview she granted us. “It demonstrates the lack of commitment to issues to which Brazil already adhered and which are on the agenda of international human right treaties. It still has several legal inconsistencies and even unconstitutional articles.”
Beatriz Galli is an attorney, a member of the Bioethics and Biolaw commissions of Brazil’s Bar Association, Rio de Janeiro chapter (OAB-RJ), and policy advisor in Latin America for Ipas, a non-governmental organization that acts globally in the areas of women’s human rights, and sexual and reproductive rights.
Viomundo – You are a member of networks that defend women’s human rights and of the legal community working on bioethics and sexual and reproductive rights issues. Were these organizations heard by the Ministry of Health before MP 557 was issued?
Beatriz Galli – No. We found out about that MP only after it was launched. It was issued on December 26, 2011, and published in the Union’s Official Newspaper (Diário Oficial da União) on the 27th.
Viomundo – Who is the actual author of that “gift” at the end of the year?
Beatriz Galli – I don’t know yet, but I can assure you that MP 557 does not address the purposes for which it was created. It also has several legal inconsistencies and even unconstitutional articles.
Viomundo – At the beginning of 2011, the Ministry of Health launched the Stork Network, which caused a stir. Now there’s the MP 557. Are they “related”?
Beatriz Galli – Yes. I believe that they are part of the same governmental strategy for the prevention of maternal death, or at least that is the official version that justifies the MP. However, I believe it is not effective for the prevention of maternal death. That MP will not have practical effects in reducing maternal mortality in Brazil.
Viomundo – Why?
Beatriz Galli – Our biggest problem is not women’s access to healthcare services, but rather the quality of health care. And that cannot be altered simply with a provisional measure. Ultimately, the MP will not guarantee, for example, access to tests, timely diagnosis, providers trained in obstetric emergency care, or immediate transfer to a more complex facility.
For that reason, I insist. MP 557 will not have repercussions on the quality of care provided to pregnant women—which is what actually impacts the reduction of maternal mortality—or on the organization of the health system to ensure a vacancy or bed at the time of childbirth. On the contrary, it places on the pregnant woman, who receives R$50 in aid, the responsibility of finding her own transportation to the maternity hospital.
Viomundo – By ensuring R$50 to the pregnant woman who registers, does MP 557 institute an incubation-pension?
Beatriz Galli – With that MP, the woman is seen as a vessel for the development of a new human being. It violates women’s autonomy and dignity, denying them the recognition of freedom of choice. As compensation, it is clearly pro-fetus, as it reduces women to incubators.
There’s more. Straightaway, MP 557 violates the woman’s private life by creating a compulsory register to control and monitor her reproductive life.
That is why it has a discriminatory effect.
Viomundo – What does MP 557 represent for women’s sexual and reproductive rights?
Beatriz Galli – At no point does it mention them.
Viomundo – The MP also does not mention abortion. How can one create a map of maternal mortality in Brazil, ignoring one of its main causes in Brazil? Doesn’t the fact that abortion is not addressed create a bias?
Beatriz Galli – Worse than that. The MP aims to create a register of pregnant women, violating the private life and confidentiality of medical information included in patient’s charts and records at a political time when several clandestine abortion clinics are worsening and being closed in the country.
Moreover, once the Brazilian legislation criminalizes the practice of abortion and is used to close clinics and prosecute hundreds of women, it is at the very least worrisome that the State proposes a register for monitoring and tracking pregnant women.
Viomundo – Considering that there are already policies, laws and decrees to reduce maternal mortality in Brazil, wouldn’t MP 557 be unnecessary?
Beatriz Galli – Totally unnecessary. If the government wanted to address the issue, it would only need to retrieve the CPI’s 2001 Maternal Mortality Report. It includes all recommendations in terms of the policies and laws needed for its reduction.
In addition, MP 557 announces measures and actions already prescribed in public policies and norms. For example, in the Ministry of Health setting, there is Decree No. 1,119, of June 5, 2008, which regulated the tracking of maternal deaths in SUS facilities, executed through a partnership with States, the Federal District, and Municipalities as one of the actions prescribed in the National Pact for the Reduction of Maternal and Neonatal Mortality, of March 8, 2004.
This decree defines the guidelines for investigating the deaths of reproductive-age women; it establishes the special flows and periods for these events; it redefines the role of Health Secretariats in the Municipalities, States and Federal District, as well as the role of the Ministry of Health and Maternal Death Committees with respect to tracking deaths.
Per that decree, within the Ministry of Health’s System of Mortality-Related Information (SIM), they created the Module for Investigating the Deaths of Women of Reproductive Age, enabling the Federal District and municipalities to record actions for investigating and studying each death, which contributes to monitoring this practice. The results produced by that system indicated that more than 70% of deaths of reproductive-age women occurring in 2010 were investigated.
Viomundo – The Chamber of Deputies is considering a bill that aims to pay the pregnant woman who is victim of rape and does not have an abortion a minimum wage until the child reaches 18 years of age. It thus creates a rape-pension. What are the points in common between MP 557, which establishes the incubation-pension, and the rape-pension?
Beatriz Galli – Guarantee of the unborn child’s rights, which is flagrantly against the 1988 Constitution. Thus, it is unconstitutional.
Viomundo – Please expand on that.
Beatriz Galli – The Brazilian Constitution does not adopt the protection of life from conception, that is, protection of the unborn child. Even the Federal Supreme Court (STF) already expressed its opinion on the issue of the unborn child. In May 2008, in a historic ruling of Direct Action of Unconstitutionality (ADI) 3.510, which allowed embryonic stem cell research in Brazil, the Minister-Rapporteur Ayres Brito stated:
The Federal Constitution does not stipulate on the beginning of human life or the exact moment when it begins. It does not turn each and every stadium of human life into an autonomous legal good, but rather from life that is already proper from a concrete person, because nativiva (‘natalist’ theory, countering the ‘conception’ or ‘conditional personality’ theories). And when it refers to ‘the rights of the human being’ and even to ‘individual rights and guarantees’ as an indelible clause, it refers to the rights and guarantees of the individual person, who is the beneficiary of the fundamental rights ‘to life, liberty, equality, safety and property,’ among other rights and guarantees that are equally distinguished with the fundamental stamp (such as the right to health and family planning).
(…) The embryo referred to in the Biosafety Law (in vitro only) is not a life on its way to another virginally new life, as it lacks possibilities to acquire the first nervous endings, without which the human being is not viable as an autonomous and irreplicable life project.
Infra-Constitutional Law protects in diverse ways every stage of a human being’s biological development. The moments in human life preceding birth should be protected by ordinary law. The pre-implanted embryo is a good which should be protected, but not a person in the biographical sense to which the Constitution refers.” (ADI 3.510, Rapporteur Minister Ayres Brito, ruling on 5-29-2008, DJE of 5-28-2010.)
Viomundo – Does MP 557 equate the pregnant woman’s rights to those of the unborn child?
Beatriz Galli – It is an attempt in that sense. It reduces or dilutes the mother’s rights, such as the right to liberty, as her pregnancy will be registered and supervised or monitored to comply with the provisions of the MP.
According to MP 557, the woman will have the legal “obligation” to have all the children she begets, as she will be monitored by the State for this purpose. Thus, it violates the right to equality prescribed in the Federal Constitution, because only women become pregnant and can beget children.
Viomundo – In other words, Brazil is going the wrong way down a one-way street.
Beatriz Galli – Unfortunately, MP 557 is a huge setback to women’s reproductive right policies in Brazil. We are, in fact, going against what the World Health Organization (WHO) advocates.
Conservative sectors, both within and outside the government, are trying to establish a new legal order which does not consider women as subjects of constitutional and human rights.
Brazil was recently condemned by the Committee for the Elimination of Discrimination against Women (CEDAW) due to the case of African-BrazilianAlyne da Silva Pimentel. In 2002, when she was 28 years old and 27 weeks pregnant, she resorted to a private health clinic in Belfort Roxo, in the Baixada Fluminense district, because she was vomiting and had abdominal pain. An ultrasound confirmed the death of the fetus.
The health clinic transferred Alyne to a public hospital in the region, so the fetus could be removed. As she was not accompanied by a document indicating her clinical status, she had to wait for several hours in the hallway to be seen. There, she fell into a coma and died due to lack of appropriate medical care, a death which was perfectly preventable.
Now, in the face of that international condemnation due to the Alyne case, Brazil must implement the recommendations made by CEDAW (an entity that monitors compliance with the Convention for the Elimination of All Forms of Discrimination against Women) to reduce maternal mortality. But it preferred to issue MP 557, which instead of protecting women against preventable maternal death, it violates their human rights.
Viomundo – What were CEDAW’s recommendations to Brazil with respect to the Alyne case?
Beatriz Galli – According to CEDAW, the Brazilian government violated its obligations in relation to access to health care and Justice, as well as its obligation to regulate private providers’ activities. Based on that, it determined adequate compensation to Alyne’s family, including financial compensation. It also made the following general recommendations:
a) Ensure women’s right to safe motherhood and access to appropriate and affordable emergency medical care.
b) Provide adequate professional training to health workers, especially on women’s reproductive health rights, including quality medical treatment during pregnancy and childbirth, as well as appropriate emergency obstetric care.
c) Ensure access to effective measures in cases where women’s right to reproductive health have been violated and provide training to judicial staff and lawmakers.
d) Ensure that appropriate sanctions are imposed on healthcare providers who violate women’s reproductive rights.
e) Reduce preventable maternal deaths through the implementation of the National Agreement for the Reduction of Maternal Mortality at the state and municipal levels, including through the creation of maternal mortality committees in settings where those committees do not yet exist.
However, instead of implementing those measures, the government preferred to issue the unfortunate MP 557, which, I repeat, instead of protecting pregnant women from preventable death, violates their human rights.
Viomundo’s PS: On Friday, when I decided to write this article on MP 557, I requested from the Ministry of Health, through advice from the press, to identify someone in the institution that I could interview on this issue. The two advisors to whom I sent an email were on vacation. Today, the interview was scheduled for Tuesday. It will be conducted with a special advisor to Minister Alexandre Padilha.