Isabela De Oliveira Dornelas
Content Note: This post discusses abortion, death in childbirth, and sexual violence (including child sexual abuse).
In complicated childbirth scenarios, when the life of the pregnant person and the fetus are in conflict, therapeutic abortion has historically been considered the last resort. But in Brazil, since the nineteenth century, this solution has been replaced by the cesarean operation. This was not based on medical reasons. Cesarean sections, up until the early twentieth century, were rudimentary procedures, almost always fatal to the birthing person. What motivated its adoption in Brazil was based on different logics: religious, legal, and moral. The cesarean became an acceptable alternative to abortion because it allowed the fetus to be born, even if the birthing parent died. The nineteenth-century theological and medical debates that gave rise to this sacrificial logic still shape birth in Brazil. As we saw in the case of the 10-year-old girl who was raped and pregnant in 2020, these ideas continue to resurface today.
August 2020 was a cruel month. Amid the COVID-19 pandemic and the deepening attacks on women’s rights in Brazil, I was writing my dissertation on the historical entanglement between abortion and cesarean section. But nothing in my nineteenth-century sources prepared me to witness this entanglement unfolding so brutally before my eyes.
That month, a 10-year-old girl in Espírito Santo was taken to a hospital after becoming pregnant by her uncle, who had raped her for years. According to Brazilian law, abortion is legal in cases of risk to the life of the pregnant person or pregnancy resulting from rape. Both criteria were present: early pregnancy endangered her life, and the pregnancy was the result of sexual violence. Yet the hospital refused to perform the procedure, claiming the pregnancy had exceeded 12 weeks, a limit that does not, in fact, exist in Brazilian criminal law for these cases.
The girl was exposed to a media frenzy and persecution by fundamentalist religious groups who, violating her right to privacy, made her case public and pressured for the pregnancy to continue. The uproar was so intense that a judge had to issue a court order to guarantee the girl’s right to an abortion. She was then transferred to a hospital in Recife where, accompanied by a social worker and family members, the procedure was finally carried out.
But the violence of the case does not end with the girl’s age. Like so many other rape victims in Brazil, she was poor, living in a peripheral area invisible to the State until her body became the object of national dispute among doctors, judges, ministers, and religious leaders. Her story reveals that the embarrassment surrounding therapeutic abortion is not only moral or religious, but also racial, class-based, and institutional. The Brazilian state, in its many faces–legal, medical, media, and religious–failed to protect this child. Worse, it acted as an active mediator of her suffering.
Days after the abortion, the doctor who performed the procedure recalled in the national and international press that he had already been excommunicated in 2009 by the Diocese of Recife for legally terminating the pregnancy of another girl, aged 9, who was pregnant with twins after being raped by her stepfather. At the time, he was accused of immorality by his peers even though he was acting within the law. The Church reiterated its position: abortion is a sin, even when it saves lives.
But the most shocking moment came from someone who should have defended the rights of the child: then-Minister for Women, Family and Human Rights, Damares Alves. In a TV interview, she stated: “Two more weeks, and a cesarean could have been performed on this girl, take the child out, put it in an incubator. If it survived, it survived. If not, it had a dignified death.”
The religious preference for cesarean section is rooted in a specific Christian theological logic: according to Catholic doctrine, life begins at conception and must be preserved at all costs. Furthermore, birth is necessary for the fetus to be baptized, a condition considered essential, according to the Catholic catechism, for the salvation of the soul. In nineteenth-century Brazil, this belief justified post-mortem cesareans or cesareans on dying pregnant people. Even with no hope for the parent, surgery was advocated to permit baptism.
While cesarean section gradually emerged as an alternative to therapeutic abortion, Brazilian medical writings from the nineteenth century reveal deep anxieties about intervening in pregnancy at all. In an 1870 doctoral dissertation on eclampsia, physician Henrique Thompson asked rhetorically: “By what right would we provoke abortion? By what right annihilate the existence of a being whose life might be precious or even indispensable to society?” Trusting in nature, he concluded, was the only morally acceptable course of action. Earlier still, in 1845, physician José Teixeira da Matta Bacellar acknowledged that cutting instruments were sometimes used “to save the child who cannot pass through the natural ways”, but warned that such interventions often ended in the mother’s death, bringing “sadness and consternation to families.” The tension between technological hope and clinical despair is palpable in a 1922 recollection of a cesarean performed in 1899 on a woman with dwarfism, in a poorly equipped hospital ward. The surgical team prepared for eight days, but the patient died of peritonitis within 24 hours. “I retained no impression, no lesson,” the author, Fernando Magalhães, wrote. “Only the sense of how far behind we still were.” Cesarean birth, in these accounts, was neither triumph nor salvation; it was a desperate and sacrificial act, where preserving the fetus came at the ultimate cost.
From 1869 onward, the Church came to consider abortion as homicide at any stage of pregnancy, morally and spiritually condemning those who performed or assisted it. This position, though anchored in a sacramental doctrine, was later absorbed and reworked by conservative Protestant sectors, not necessarily because they shared the same belief in fetal damnation, but because they converged in their moral and legal condemnation of abortion as a practice. Thus, even with theological differences, Catholic and fundamentalist Evangelical actors found common ground in promoting cesarean as a morally acceptable alternative to abortion. This logic has endured and remains present in contemporary public discourse, as seen in the words of Minister Damares Alves, who is also an Evangelical pastor.
In the nineteenth century, Brazilian doctors began to advocate for cesarean sections as a way to end high-risk pregnancies without incurring the sin of abortion. The practice, even when it resulted in the pregnant person’s death, was accepted because it allowed the fetus to be born — and thus baptized. I call this kind of procedure a sacrificial cesarean: an operation performed in the name of the fetus, even when it meant condemning the pregnant person to death. I use the term “sacrificial” not metaphorically, but to describe a concrete logic in which the suffering — or death — of the pregnant person was deemed acceptable if it ensured the fetus’s birth, even without any chance of survival outside the womb. Over time, Brazilian obstetrical medicine built its moral authority around this logic, grounded in baptism, ideals of motherhood, and deep patriarchal control over women’s bodies.
This is why Minister Damares’s 2020 statement so clearly echoes nineteenth-century debates. Her suggestion that a 10-year-old girl should “wait two more weeks” to deliver by cesarean revives a long-standing sacrificial logic: the prioritization of fetal life over the life, health, and autonomy of the pregnant person, even when that person is a child. This logic did not disappear with medical progress. In 2005, a 19-year-old woman in Goiás, Brazil, discovered she was carrying a fetus with Body Stalk Syndrome, a condition incompatible with life outside the womb. Though her pregnancy posed severe risks to her own health, she was forced to obtain judicial approval to access an abortion — and even after receiving it, a Catholic priest she had never met intervened with a habeas corpus to stop the procedure. The result was a prolonged, painful, and medically dangerous ordeal that led to the death of the fetus and nearly cost the woman her life. She later won a lawsuit for moral damages, but the suffering was irreversible. Both cases — Tatiele’s and the child from Espírito Santo — demonstrate how therapeutic abortion, although legal, is constantly obstructed by religious and moral interference. And in both, cesarean section was framed as the morally acceptable alternative, a way to extract and baptize the fetus, no matter the physical or emotional toll on the person carrying it.
As a historian, I don’t see these episodes as exceptions, but as continuities. Cesarean birth, even with all its technical advances, still carries the weight of its sacrificial origins. And therapeutic abortion remains an unresolved embarrassment, juridically, religiously, politically, and morally, for a state that has never fully guaranteed the reproductive rights of women or other birthing people.
When I returned to my dissertation after that August, I understood more clearly what it was telling me: the dispute between cesarean and abortion is not merely technical. It is ontological. It concerns who is recognized as a subject: the pregnant person who is alive and feeling, or the fetus, which represents an abstract ideal of purity and salvation. The story I tell here is not just about the past or about an exception. It is a warning about the futures we are fabricating, where reproductive rights are still being negotiated at the cost of pregnant people’s, and mostly girls’ and women’s, pain.
NOTCHES: (re)marks on the history of sexuality is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Based on a work at www.notchesblog.com.
For permission to publish any NOTCHES post in whole or in part please contact the editors at NotchesBlog@gmail.com
