"Even if you have the right, it won't be an easy path": Challenges and potentials of primary health care for legal abortion care in Brazil - a qualitative study.

Abstract

Access to legally permitted abortion depends not only on the legal framework, but also on policy implementation, health system organisation, and professional practices. In Brazil, abortion is legally permitted in specific circumstances, but access remains highly limited. This qualitative study aimed to understand how Primary Health Care (PHC) professionals in São Paulo deal with cases eligible for abortion in everyday practice, focusing on conditions that constrain or enable the realisation of reproductive rights. Thirteen semi-structured interviews were conducted with professionals engaged with reproductive rights. Data were analysed through a hermeneutic-dialectical approach, organised around three stages of care: identification of legal eligibility, communication of rights, and referral to specialised services. Findings show that care is shaped by macro-political conditions, service organisation, and interpersonal relations. Eligibility is identified under high workloads, limited privacy, and routines that privilege prenatal care and constrain disclosure of legal grounds for abortion. Communicating rights is affected by stigma, territorial bonding, and power asymmetries. Referral pathways are marked by institutional opacity and weak accountability. Attentive listening, feminist identification, supportive colleagues, exchange of experiences, alternative networks, and professionals' moral courage enable care. Transforming abortion care requires acting upon conditions of professional practice, not only legal frameworks or individual training.