The Alyne Pimentel vs. Brazil case is the first instance of the Brazilian state being convicted in the Global Human Rights System involving a complaint about obstetric violence and maternal death.
The Alyne Pimentel vs. Brazil case is the first instance of the Brazilian state being convicted in the Global Human Rights System involving a complaint about obstetric violence and maternal death.
Alyne da Silva Pimentel Teixeira was a 28-year-old Afro-descendant woman living in Belford Roxo, in the state of Rio de Janeiro. On November 11, 2002, Alyne, who was six months pregnant, sought assistance from the public health network due to nausea and severe abdominal pain. [1] During her visit, she was given painkillers and sent home. [2] However, over the next two days, her symptoms worsened, leading her to return to the health facility on November 13. [3]
Upon examination, the death of the fetus was confirmed. Alyne Pimentel then underwent an ultrasound scan and was subsequently informed that she would have an induced labor to remove the deceased fetus. However, the normal delivery was unsuccessful. After a 14-hour wait, Alyne underwent surgery to remove the remnants of the placenta. [1]
On November 15, 2002, Alyne's clinical condition had worsened, leading to the decision to transfer her to a hospital in another municipality. After an eight-hour wait for an ambulance, Alyne was transferred to the General Hospital of Nova Iguaçu, experiencing bleeding and showing signs of coma. At this second hospital, the young woman spent several hours in the corridor due to a lack of available beds in the emergency room. On November 16, she died due to a digestive hemorrhage resulting from the delivery of the deceased fetus. [2] [4] A civil lawsuit was filed in 2003, but it took approximately ten years to be judged at the first instance court. [3]
In 2007, facing the slow progress of justice, the case was brought before the Committee on the Elimination of Discrimination against Women (CEDAW), an entity associated with the UN, by the global organization Center for Reproductive Rights. [3] [4]
In response to the committee, the Brazilian state disputed that Alyne Pimentel's death was due to maternal complications, relying on the findings of the Rio de Janeiro Maternal Mortality Committee, which had investigated the case and identified a digestive hemorrhage as the actual cause of death. Regarding the delays in the judicial process, it argued that all appropriate measures were being taken and that a final decision on the matter was anticipated by July 2008. However, the first sentence was only pronounced in 2013. [1]
In 2011, the CEDAW Committee held the Brazilian state accountable for the death of Alyne Pimentel, due to the failure to provide appropriate services for her condition as a pregnant woman. The committee also found that the young woman faced multiple discrimination on the basis of her Afro-Brazilian identity and economic status, and that the country failed to offer effective judicial protection and adequate legal remedies. [5] In light of this, the Committee recommended that the country compensate the family and take measures against obstetric violence, ensuring that sanctions are applied to health professionals who violate women's reproductive rights. [6] [4]
Maternal death or maternal mortality is defined in slightly different ways by several different health organizations. The World Health Organization (WHO) defines maternal death as the death of a pregnant mother due to complications related to pregnancy, underlying conditions worsened by the pregnancy or management of these conditions. This can occur either while she is pregnant or within six weeks of resolution of the pregnancy. The CDC definition of pregnancy-related deaths extends the period of consideration to include one year from the resolution of the pregnancy. Pregnancy associated death, as defined by the American College of Obstetricians and Gynecologists (ACOG), are all deaths occurring within one year of a pregnancy resolution. Identification of pregnancy associated deaths is important for deciding whether or not the pregnancy was a direct or indirect contributing cause of the death.
A hysterotomy is an incision made in the uterus. This surgical incision is used in several medical procedures, including during termination of pregnancy in the second trimester and delivering the fetus during caesarean section. It is also used to gain access and perform surgery on a fetus during pregnancy to correct birth defects, and it is an option to achieve resuscitation if cardiac arrest occurs during pregnancy and it is necessary to remove the fetus from the uterus.
Abortion in Brazil is a crime, with penalties of one to three years of imprisonment for the recipient of the abortion, and one to four years of imprisonment for the doctor or any other person who performs the abortion on someone else. In three specific situations in Brazil, induced abortion is not punishable by law: in cases of risk to the pregnant person's life; when the pregnancy is the result of rape; and if the fetus is anencephalic. In these cases, the Brazilian government provides the abortion procedure free of charge through the Sistema Único de Saúde. This does not mean that the law regards abortion in these cases as a right, but only that women who receive abortions under these circumstances, and the doctors, will not be punished. The punishment for a woman who performs an abortion on herself or consents to an abortion performed by another outside these legal exceptions is one to three years of detention. The base penalty for a third party that performs an illegal abortion with the consent of the patient, ranges from one to four years of detention, with the possibility of increase by a third if the woman comes to any physical harm, and can be doubled if she dies. Criminal penalties fixed at four years or less can be converted to non-incarceration punishments, such as community service and compulsory donation to charity.
In obstetrics, gestational age is a measure of the age of a pregnancy taken from the beginning of the woman's last menstrual period (LMP), or the corresponding age of the gestation as estimated by a more accurate method, if available. Such methods include adding 14 days to a known duration since fertilization, or by obstetric ultrasonography. The popularity of using this measure of pregnancy is largely due to convenience: menstruation is usually noticed, while there is generally no convenient way to discern when fertilization or implantation occurred.
Sexual and reproductive health (SRH) is a field of research, health care, and social activism that explores the health of an individual's reproductive system and sexual well-being during all stages of their life. Sexual and reproductive health is more commonly defined as sexual and reproductive health and rights, to encompass individual agency to make choices about their sexual and reproductive lives.
Complications of pregnancy are health problems that are related to, or arise during pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal disorders. While some complications improve or are fully resolved after pregnancy, some may lead to lasting effects, morbidity, or in the most severe cases, maternal or fetal mortality.
Uterine atony is the failure of the uterus to contract adequately following delivery. Contraction of the uterine muscles during labor compresses the blood vessels and slows flow, which helps prevent hemorrhage and facilitates coagulation. Therefore, a lack of uterine muscle contraction can lead to an acute hemorrhage, as the vasculature is not being sufficiently compressed. Uterine atony is the most common cause of postpartum hemorrhage, which is an emergency and potential cause of fatality. Across the globe, postpartum hemorrhage is among the top five causes of maternal death. Recognition of the warning signs of uterine atony in the setting of extensive postpartum bleeding should initiate interventions aimed at regaining stable uterine contraction.
Maternal health is the health of women during pregnancy, childbirth, and the postpartum period. In most cases, maternal health encompasses the health care dimensions of family planning, preconception, prenatal, and postnatal care in order to ensure a positive and fulfilling experience. In other cases, maternal health can reduce maternal morbidity and mortality. Maternal health revolves around the health and wellness of pregnant women, particularly when they are pregnant, at the time they give birth, and during child-raising. WHO has indicated that even though motherhood has been considered as a fulfilling natural experience that is emotional to the mother, a high percentage of women develop health problems and sometimes even die. Because of this, there is a need to invest in the health of women. The investment can be achieved in different ways, among the main ones being subsidizing the healthcare cost, education on maternal health, encouraging effective family planning, and ensuring progressive check up on the health of women with children. Maternal morbidity and mortality particularly affects women of color and women living in low and lower-middle income countries.
An amniotic fluid embolism (AFE) is a life-threatening childbirth (obstetric) emergency in which amniotic fluid enters the blood stream of the mother, triggering a serious reaction which results in cardiorespiratory collapse and massive bleeding (coagulopathy). The rate at which it occurs is 1 instance per 20,000 births and it comprises 10% of all maternal deaths.
Abortion is illegal in El Salvador. The law formerly permitted an abortion to be performed under some limited circumstances, but in 1998 all exceptions were removed when a new abortion law went into effect.
Mirror syndrome, triple edema or Ballantyne syndrome is a rare disorder affecting pregnant women. It describes the unusual association of fetal and placental hydrops with maternal preeclampsia.
A vaginal delivery is the birth of offspring in mammals through the vagina. It is the most common method of childbirth worldwide. It is considered the preferred method of delivery, as it is correlated with lower morbidity and mortality than caesarean sections (C-sections), though it is not clear whether this is causal.
The non-pneumatic anti-shock garment (NASG) is a low-technology first-aid device used to treat hypovolemic shock. Its efficacy for reducing maternal deaths due to obstetrical hemorrhage is being researched. Obstetrical hemorrhage is heavy bleeding of a woman during or shortly after a pregnancy. Current estimates suggest over 300,000 women die from obstetrical hemorrhage every year with 99% of cases occurring in developing countries; many of these deaths are preventable. Many women in resource-poor settings deliver far from health-care facilities. Once hemorrhage has been identified, many women die before reaching or receiving adequate treatment. The NASG can be used to keep women alive until they can get the treatment they need.
The Eloá Pimentel hostage crisis, as it is known, refers to the October 2008 incident involving 15-year-old Brazilian girl Eloá Cristina Pimentel, who was kidnapped, taken against her will and held hostage before being murdered by her 22-year-old ex-boyfriend, Lindemberg Alves. Additionally, Pimentel's friend, Nayara da Silva, was shot by Alves.
An obstetric labor complication is a difficulty or abnormality that arises during the process of labor or delivery.
Brazilian hemorrhagic fever (BzHF) is an infectious disease caused by Brazilian mammarenavirus, an arenavirus. Brazilian mammarenavirus is one of the arenaviruses from South America to cause hemorrhagic fever. It shares a common progenitor with Argentinian mammarenavirus, Machupo mammarenavirus, Tacaribe mammarenavirus, and Guanarito mammarenavirus. It is an enveloped RNA virus and is highly infectious and lethal. Very little is known about this disease, but it is thought to be transmitted by the excreta of rodents. This virus has also been implicated as a means for bioterrorism, as it can be spread through aerosols.
Circumvallate placenta is a rare condition affecting about 1-2% of pregnancies, in which the amnion and chorion fetal membranes essentially "double back" on the fetal side around the edges of the placenta. After delivery, a circumvallate placenta has a thick ring of membranes on its fetal surface. Circumvallate placenta is a placental morphological abnormality associated with increased fetal morbidity and mortality due to the restricted availability of nutrients and oxygen to the developing fetus.
Obstetric medicine, similar to maternal medicine, is a sub-specialty of general internal medicine and obstetrics that specializes in process of prevention, diagnosing, and treating medical disorders in with pregnant humans. It is closely related to the specialty of maternal-fetal medicine, although obstetric medicine does not directly care for the fetus. The practice of obstetric medicine, or previously known as "obstetric intervention," primarily consisted of the extraction of the baby during instances of duress, such as obstructed labor or if the baby was positioned in breech.
Maria Filipa de Oliveira is a controversial figure. She is believed to be an Afro-Brazilian independence fighter from island of Itaparica, Bahia, active during the Brazilian War of Independence. The independence struggle against the Portuguese lasted a little over a year, with many battles centered on Itaparica. Maria Filipa is noted as one of three women who participated in the struggle for Bahia's independence in 1823, the others being the military figure Maria Quitéria (1792-1853) and Sister Joana Angélica (1761-1822).