Legalidade e ética entre obstetras do serviço de aborto legal em Alagoas no atendimento às vítimas de estupro / Legality and ethics among obstetricians of the legal abortion service in Alagoas during the care for rape victims

Objetivo: Determinar o perfil ético profissional dos obstetras do serviço de aborto legal no estado de Alagoas (Brasil) e delinear um protocolo e fluxograma para auxiliar no atendimento de mulheres estupradas. Métodos: Realizamos um estudo observacional-transversal, prospectivo e descritivo, incluindo todos os 26 obstetras do serviço de aborto legal. Na fase 1, investigaram-se o conhecimento legal e a posição ética, enquanto na fase 2 foram construídos um protocolo e um fluxograma para guiar o serviço nos casos de aborto legal. Resultados: Na fase 1, identificamos que a maioria dos obstetras não conhecia os aspectos legais sobre o aborto, não se sentiam confortáveis em estar no serviço e apontaram várias limitações no funcionamento dele. Na fase 2, foram desenvolvidos um protocolo e um fluxograma aplicados aos casos em que uma mulher estuprada deseja abortar por métodos legais. Conclusão: O perfil dos obstetras do serviço de aborto legal é insuficiente para lidar com a complexidade do aborto no estado. O protocolo e o fluxograma delineados tiveram o propósito de ajudar o serviço de aborto legal do estado a lidar com esse problema público/social.(AU)

Objective: To determine the professional ethical profile of obstetricians from the legal abortion service in Alagoas state (Brazil) and to design a protocol and flowchart to help the attendance of raped woman. Methods: We performed an observational- -sectional, prospective and descriptive study including all 26 obstetricians from the legal abortion service. Phase 1 investigated the legal knowledge and ethical position, while phase 2 was the construction of a protocol and flowchart to guide the service in cases of legal abortion. Results: In the phase 1 we identified that most obstetrician did not know the legal aspects about abortion; did not few comfortable to be in the service and they pointed out several limitations of how service works. Phase 2 of the study was the development of a protocol and flowchart applied to the cases which a raped woman wants to abort by legal methods. Conclusion: The profile of obstetrician from the legal abortion service is insufficient to deal with the complexity of abort in the state. The protocol designed have the purpose to help the state legal abortion service to deal with this public/social problem.(AU)

Resgate histórico do primeiro programa público de interrupção da gestação por estupro no Brasil / Historical rescue of the first public rape pregnancy program in Brazil

Os autores apresentam a evolução histórica dos caminhos percorridos até a criação do primeiro programa público de interrupção legal da gestação no Brasil. Mencionam o atendimento antes desse programa, que era realizado por poucos, de maneira dissimulada e sem publicidade nem publicações para a preservação das equipes. Mencionam como o Hospital Municipal Dr. Arthur Ribeiro de Saboya foi escolhido para esse desafio. Resgatam a luta das mulheres e dos movimentos feministas, e a criação da portaria que determinava a obrigatoriedade do atendimento para a realização do abortamento legal nos casos de antijuricidade, pela Prefeitura Municipal de São Paulo. Mencionam os difíceis caminhos até a constituição das equipes de atendimento e o desenrolar de uma sequência de fatos históricos, passando pelo início do atendimento imediato às vítimas no sentido de realizar as profilaxias pertinentes, a utilização de aspiração manual intrauterina (AMIU) como técnica principal para atendimento ao abortamento em todas as suas situações, os Fóruns Nacionais de Aborto Legal realizados pelo Cemicamp, Ministério da Saúde e Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo), entre outros, que culminaram com tudo o que temos hoje em termos de atendimento integral à saúde da mulher, mormente no que tange aos direitos sexuais e reprodutivos, à violência sexual e à interrupção legal da gestação.(AU)

The authors present the historical evolution of the paths traveled until the creation of the First Public Program for Legal Interruption of Pregnancy in Brazil. They mention the care before this program that was carried out by a few, in a covert way and without advertisements or publications for the preservation of the team. Mention as the Municipal Hospital Dr. Arthur Ribeiro de Saboya was chosen for this challenge. They rescued the struggle of women and feminist movements, the creation of the ordinance that determined the mandatory care for the performance of legal abortion in cases of anti-juristy, by the city of São Paulo. They mention the difficult paths to the constitution of care teams and the development of a sequence of historical facts, through the beginning of immediate care to victims in order to perform the relevant prophylaxis, in the use of the AMIU as the main technique for abortion care in all its situations, the National Legal Abortion Forums held by Cemicamp, Ministry of Health and Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo), among others, which culminated in all that we have today in terms of comprehensive care for women's health, especially with regard to sexual and reproductive rights, sexual violence and legal interruption of pregnancy.(AU)

La interrupción legal del embarazo en Argentina / The legal termination of pregnancy in Argentina

En el contexto de la publicación por parte del Ministerio de Salud de la Nación de Argentina del Protocolo para la atenciónintegral de las personas con derecho a la interrupción legal del embarazo (ILE), resumido y comentado en este mismonúmero de EVIDENCIA, este comentario editorial ofrece: 1) una perspectiva amplia de lo que significa el aborto, desde lamirada estrictamente biologicista hasta definiciones basadas en el enfoque de género; 2) una descripción de los diferentesmarcos jurídicos respecto del aborto que imperan actualmente en Latinoamérica y Argentina, haciendo especial hincapiéen lo concerniente a las ILE; 3) información epidemiológica sobre la mortalidad materna en Argentina y la asociada alaborto inseguro; 4) estadísticas sobre la realización de ILE en la Ciudad Autónoma de Buenos Aires, Argentina.Dada la situación actual de aislamiento social preventivo obligatorio en el marco de la pandemia de Covid-19, conside-ramos quienes integramos equipos de salud debemos estar más atentos/as que nunca a las situaciones de violenciapotencial que podrían suceder en este contexto, para dar las respuestas pertinentes -entre las que se incluyen las ILE-, alas víctimas de embarazos no deseados consecutivos a situaciones de coerción. (AU)

In the context of the publication by the Argentine Ministry of Health of the Protocol for the comprehensive care of people withthe right to legal termination of pregnancy (LTP), summarized and commented on in this same issue of EVIDENCIA, thiseditorial article offers: 1) a broad perspective of what abortion means, from a strictly biological point of view to definitionsbased on the gender approach; 2) a description of the different legal frameworks regarding abortion that currently prevailin Latin America and Argentina, with special emphasis on LTP; 3) epidemiological information on maternal mortality inArgentina and that associated with unsafe abortion; 4) statistics on the realization of LTP in the Autonomous City ofBuenos Aires, Argentina.Given the current situation of mandatory preventive social isolation in the framework of the Covid-19 pandemic, we considerthat those of us who are part of health teams should be more alert than ever to situations of potential violence that couldoccur in this context, to give the relevant responses - including LTP- to victims of unwanted pregnancies following coercivesituations. (AU)

Sexualidade infantojuvenil e judicialização / Children and adolescent sexuality and judicialization / Sexualidad infanto-juvenil y judicialización

Este artigo visa mostrar modos de judicialização da sexualidade infantojuvenil, principalmente através da negação desta sexualidade como um direito, restringindo-a apenas à contravenção e suas punições. Também, discute o chamado abuso sexual e um novo dispositivo de controle da sexualidade chamado estupro de vulnerável. Mostra como a biopolítica vai ampliando a governamentalidade da conduta sexual de crianças e adolescentes, usando como estratégia a punição das relações sexuais com menores de 14 anos. (AU)

This article seeks to show ways in which children and adolescent's sexuality becomes a justiciable issue by exploring the dichotomy of denial of children an adolescent's sexuality as a right at the same time that it is taken for granted in cases of transgression and punishment. In addition it discusses the so called sexual abuse and a new sexuality control apparatus called rape of the vulnerable. It shows how biopolitics is expanding the governmentality of sexual conduct of children and teens, using the strategy of punishment of below 14 years old sexual relations. (AU)

Este artículo se propone a presentar modos de judicialización de la sexualidad infanto-juvenil, principalmente a través de la negación de esta sexualidad como un derecho, retringiéndo la apenas a la contravención y a los castigos. También discute el denominado abuso sexual y un nuevo dispositivo de control de la sexualidad denominado violación de vulnerable. Muestra como la biopolítica amplía poco a poco la gubernamentalidad de la conducta sexual de niños y adolescentes, usando como estrategia el castigo de las relaciones sexuales con menores de 14 años. (AU)

Medico-legal documentation of rape or sexual assault: are community-service doctors equipped for the task?

Background: Following upon two-year internship, community-service doctors make mistakes when they deal with evidence of medico-legal examinations in various settings. These mistakes result in alleged perpetrators being released by courts. This study investigated undergraduate clinical forensic medicine training, based on experiences and opinions of community-service doctors. This article focuses on incidents of alleged rape cases only.Methods: The study was a quantitative retrospective cohort study that made use of a questionnaire with an adapted Likert scale. An electronic survey tool was employed to target 150 community-service doctors throughout South Africa. Percentages are used to display results.Results: A response rate of 59.3% was achieved. Although 80% of the participants reported that they had undergraduate training on how to manage alleged rape or sexual assault cases, only 11.4% of the participants had hands-on exposure to an alleged rape case during their undergraduate training. In addition, the majority of the participants (77.1%) never had undergraduate training on how to complete the J88 form. These findings indicate that clinical forensic training in the undergraduate medical programme does not adequately prepare community-service doctors to meet the challenges of clinical forensic practice. The current curriculum should be adapted to address these shortcomings.Conclusions: Perpetrators cannot be convicted if evidence collected cannot stand up in court. Proper training of undergraduate medical students prior to their community-service posting will ensure that medico-legal documentation is completed correctly, leading to the presentation of credible evidence in a court of law in order to ensure successful conviction of alleged perpetrators

Opinión de estudiantes de medicina sobre la legalización del aborto en casos de violación, y sus factores asociados, Perú, 2015 / Opinion of medical students about the legalization of abortion after rape, and its associated factors. Peru, 2015

Objetivo: describir la opinión de estudiantes de medicina de Perú sobre la legalización del aborto por violación y evaluar sus factores asociados. Material y Métodos: estudio observacional, transversal y analítico, en estudiantes de Medicina Humana que asistieron a alguna de las dos asambleas estudiantiles nacionales realizadas en la ciudad de Trujillo durante el 2015. Se aplicó una encuesta de 25 preguntas que recolectó variables sociodemográficas e información sobre la opinión de los estudiantes sobre la legalización del aborto. Los factores asociados a estar a favor de la legalización del aborto en casos de violación se evaluaron mediante la regresión de Poisson con varianza robusta, obteniendo razones de prevalencia (RP) y sus intervalos de confianza al 95% (IC95%). Resultados: se encuestó a 142 estudiantes de Medicina Humana. El 53,5% fueron mujeres, el 62,7% se encontraban estudiando en universidades fuera de Lima y el 44,0% se encontraban entre quinto y octavo semestre. El 57,5% estuvieron de acuerdo con la legalización del aborto en casos de violación, lo cual estuvo asociado a mayor compromiso religioso (RP=0,50; IC95%=0,30-0,84) y a la aprobación familiar de la legalización del aborto (RP=1,39, IC95%=1,08-1,80). Conclusiones: aproximadamente la mitad de los encuestados estuvo de acuerdo con la legalización del aborto en casos de violación. Esto estuvo asociado a tener un menor compromiso religioso y a que su familia apruebe la legalización del aborto, lo cual resalta la importancia del entorno familiar y religioso en este tema.

Objective: to describe the opinion of Peruvian medical students about the legalization of abortion in cases of rape, and to address its associated factors. Material and Methods: an observational, cross-sectional and analytical study was performed in medical students who attended any of the two national student assemblies that took place in the city of Trujillo during 2015. A 25-question survey was administered, which included socio-demographic variables and information regarding the students’ opinion about abortion legalization. Factors associated with favoring abortion legalization in cases of rape were assessed using Poisson regression with robust variance, obtaining prevalence ratios (PR) and 95% confidence intervals (CI). Results: we surveyed 142 medical students. Fifty-three and a half per cent were women, 62.7% were studying in universities outside Lima and 44.0 % were between fifth and eighth semester. Fifty-seven and a half percent of the students agreed with legalizing abortion in cases of rape, which was associated with religious commitment (PR = 0.50, 95% CI = 0.30-0.84) and with the approval of such legalization by their relatives (PR = 1.39, 95% CI = 1.08 to 1.80). Conclusions: Half of the participants agreed that abortion should be legalized in cases of rape. This was associated with having a more relaxed religious commitment and with the approval of abortion legalization by their relatives, which highlights the importance of the family and religious environment in this issue.

Examining an Accused of Sexual Assault - Some Practical Aspects.

Rape or Sexual Assault victim examination is one important medicolegal procedure, but examining an accused of sexual assault - is not any less important task and it is one of the commonest responsibilities a medico encounters generally when posted at any Government Hospital. But it has been observed that this type of case has always been a headache for them because of mainly two reasons – firstly - how to conduct the cases with clear-cut concept, and secondly - for a fear to face the court. It has also been seen that at so called standard books, views on minute practical problems during conduction of such cases they are lacking at several aspects which are really necessary. This discussion is with the motto of highlighting those specific portions as much as possible to enable an easier proceeding of such medicolegal works.

Gender bending, gender testing: reflections on the Pinki Pramanik case.

The arrest and subsequent humiliation of Indian athlete and international medal winner Pinki Pramanik has violated her right to privacy, bodily integrity, and basic human dignity.It has also raised important and often sidelined questions about gender, sports and the way the world is organised.Twenty-six-year-old Pramanik was accused by her live-in partner of repeated rape and torture, and of being a man. She was arrested on June 14, 2012. She was not granted bail for 26 days, which she spent in a male cell in a West Bengal jail, and she had to undergo three gender determination tests at different state hospitals, because the necessary facilities were not available at a single hospital.

Rape, sodomy and murder of a minor girl.

In this short case of article on typical sexual assault, a 14 year old minor girl was killed and found in a ditch of a jungle nearby her house. The minor girl has died as a consequence of barbarous act of sexual assault, sustained bruises on labia, recent hymnal tears, and tears around anus with signs of ligature strangulation besides the generalized signs of asphyxia. The wearing garments were found torn at places with the presence of stains of mad and sand particles. The laboratory findings confirm presence of spermatozoa. The presence of marks of violence on the genitals of the child, when an early examination is made is the strong evidence that the sexual assault has been committed. The psychiatric analysis of all the accused of this kind of cases should be made mandatory for better assessment of the cases besides an active legislative and judicial actions, comprehensive quick approaches of investigative officers and healthcare providers.

Estado actual de la población víctima de desplazamiento forzado en cuanto al enfoque diferencial de su atención, el derecho a la integridad, la subsistencia mínima y al ingreso económico / Current status of the population victim of forced displacement as for its differential approach of its attention, the right to integrity, the minimum sustenance and the economic income

El siguiente artículo recoge algunos aspectos de la investigación que sobre el Goce Efectivo de Derechos (Informe GED) elaborara el Observatorio Departamental de Desplazamiento Forzado de Antioquia en 2011. En esta entrega, la tercera de una serie de cuatro, se recogen algunos contenidos, metodologías de la medición, diseño de indicadores y resultados que arrojara el informe GED. En particular, en este aparte se exponen aspectos relativos a la atención de la población víctima del desplazamiento en términos del respeto a su integridad y las garantías para obtener un tratamiento acorde al enfoque diferencial. Así mismo, se tratan los diseños y resultados de la medición de los indicadores sociales sobre garantías de subsistencia mínima y alcance de la cobertura de ingresos económicos y educación en la población de estudio.

The following article contains some aspects of the research that about the effective enjoyment of rights (EER report) developed by the State Observatory of Forced Displacement in Antioquia in 2011. In this installment, the third in a series of four, the measurement methodologies, the design of indicators, and the results which the EER report will produce, are included. In particular, in this supplement, aspects relating to the care of the victims of displacement in terms of respect for their integrity and guarantees to obtain a treatment according to the differential approach. It also shows the design and the results of the measurement of the social indicators about the warranty of minimum sustenance and the scope of the coverage of the economic income and education, in the population under study.

Analysis of bite mark evidence.

Bite mark analysis casework strives to connect a biter to the teeth pattern present on an object linked in some way to a crime or event. The general public and some law enforcement may consider any “bite mark” case they develop to be a certainty in the quest to identify the biter. The ability of skin to register sufficient detail of a biter’s teeth is highly variable. Bite mark casework indicates that many bite marks are not well defined in detail and posses distortion due to the physical nature of skin itself. The current opinion is that bite mark can be useful in including or excluding possible suspects and ability to identify only one person as the biter. In mortal combat situations, such as the violence associated with life and death struggles between assailants and victims, the teeth are often used as a weapon. It is well known that assailants in sexual attacks, including sexual homicide, rape and child sexual abuse, often bite their victims as an expression of dominance, rage and animalistic behaviour. The teeth are a significant component of our natural arsenal.

Need for enhanced punishment for outraging the modesty of woman U/S 354 IPC.

Crime against women are rising in India especially in State of Uttar Pradesh, Madhya Pradesh and Delhi and there is a need felt in every corner of India to enhance punishment to deter these crimes. India is signatories to various International treaties including related to protection of human rights of woman and children. Hon’ble Supreme Court of India and various High Courts has taken cognizance of situation on many occasions and recommended to Union of India and state Governments to amend the law to protect the faith of common man especially vulnerable groups like woman and children. A Critical review of decisions of courts has been done for highlighting the legal situation on the issue of meaning and scope of applicability of section 354 IPC. Data base collected and compiled from the National Crime Record Bureau website to understand the rising trend of crime. This paper discusses various reasons for less punishment for molestation and need for enhanced punishment and making it non-bailable to make sense in preventing rising crimes against woman.

Legal changes towards justice for sexual assault victims.

The crime of rape is a major problem in India, evident from the reports in the press as well as official statistics. The accused has often gone free, because the victim did not file a complaint, or because of poor evidence gathering and well as lacunae in the law. This paper presents an overview of the laws applicable to sexual assault cases and amendments in these laws, specifically in terms of the roles and responsibilities of healthcare providers to bridge the gap in providing medical evidence to the courts.

Rape : Its medicolegal and social aspect.

A retrospective study of medicolegal and social aspect of victims of rape was conducted at the Upgraded Department of Forensic and State Medicine, Medical College, Kolkata for a period 2005-2007 . 37% of the victim girls were found to be 16-20 yrs of age, 77% were from poor family, 45% were found to be illiterate, 72.5% showed recent tear of hymen.

Módulo de la A a la Z en derechos sexuales y reproductivos para funcionarios y funcionarias con énfasis en violencia intrafamiliar y violencia sexual / Sexual and reproductive rights module from A to Z for employees with emphasis on domestic and sexual violence

El desplazamiento forzado de la población en Colombia a causa del conflicto armado constituye una crisis humanitaria, por tanto el Estado ha venido desarrollando políticas, normas e interpretaciones jurisprudenciales que permiten el restablecimiento de sus derechos...

The responsibility on the shoulders of courts and doctors to provide proper legal protection to rape victim.

Rape is not only a crime against the person of a woman; it is a crime against the entire society. It destroys, as noted by the Supreme Court [1], the entire psychology of a woman and pushes her into deep emotional crisis. It is a crime against basic human rights, and is also violative of the victim's most cherished of the Fundamental Rights, namely, the Right to Life contained in Article 21 of the Constitution of India, 1950. The low rate of convictions in cases of rape raises serious questions about the workings of the law. The amendments seem to have had little effect and merit closer examination. There is reluctant recognition of the amendments and its swamping under pre-conceived notions. After more than two decades since legal reforms gave rape victims more leverage in the courtroom; we need to change society’s attitude towards rape.