(In)justiça social reprodutiva: um estudo sobre o serviço de aborto legal em uma maternidade de referência no sul do Maranhão

Abstract

This dissertation focuses on analyzing the functioning of the Legal Abortion Service in a referral maternity hospital in southern Maranhão, with emphasis on the perceptions, practices, and resistances of health professionals working in a public maternity unit linked to the Unified Health System (SUS). The topic gains relevance in the current Brazilian context, marked by intense political and moral disputes over reproductive rights, especially regarding legal abortion. Although guaranteed by law in three specific situations — risk to the pregnant woman’s life, pregnancy resulting from rape, and fetal anencephaly — legal abortion remains surrounded by symbolic, institutional, and moral obstacles, which hinder its implementation as a public policy. The central issue of this research lies in the finding that the legal abortion service, despite being a guaranteed right, is often rendered invisible, precarious, and treated as an exception within the hospital structure, raising questions about the role of the State, institutions, and health professionals in ensuring (or denying) this right. Thus, the main objective of the study is to understand how the legal abortion service has been functioning in a referral maternity hospital in southern Maranhão, considering professional practices, ethical conflicts, and institutional barriers that shape its operation. The methodology is qualitative, with socio-anthropological and feminist inspiration, combining direct field observation, field notes, and the application of semi-structured questionnaires to four professional categories: psychologists, social workers, nurses, and a physician. The research site is a macro-regional public referral maternity hospital in southern Maranhão, the only institution in the region authorized to provide the service. Data collection was preceded by a long bureaucratic process of authorization from the Ethics Committee and institutional health bodies, which in itself revealed significant obstacles to conducting research on this subject. Data analysis was based on Bardin’s (1977) thematic content analysis, with interpretative categories developed from professionals’ discourses, also considering silences, refusals, and hesitations as integral parts of the data. The findings show that the service, although officially available, relies more on the individual commitment of ethically engaged professionals than on a solid institutional policy. Social workers emerged as the most aware of their role as guarantors of rights, while psychologists demonstrated sensitivity but with training gaps. Nurses showed a high rate of conscientious objection and lack of knowledge of the legal framework. The only physician who responded revealed technical expertise but also a certain ethical detachment. It is concluded that legal abortion, in the studied context, is far from being consolidated as a fully accessible right, as it is constantly threatened by moral, bureaucratic, and institutional resistances. The research reaffirms the importance of expanding critical listening within the SUS, strengthening professional training policies, and confronting the institutional silencing that characterizes reproductive social justice in Brazil.