Training of health professionals for the provision of comprehensive care in abortion situations in public Primary Health Care in Brazil: challenges and innovative experiences

Abstract

This essay’s objectives are to reflect on challenges in the training of health professionals for comprehensive care in abortion situations in Primary Health Care (PHC) in the Brazilian National Health System (Sistema Único de Saúde - SUS) and to bring to debate innovative training initiatives organized by social and institutional actresses/actors outside of the traditional training apparatus. In the first part, we dialogue with international literature to explore how training challenges are confronted in countries of the Global North and Latin America, where the practice of abortion has been legalized. Next, we discuss the professional training on abortion in Brazil, focusing on traditional spaces (undergraduate, residencies, and post-graduate). We proceed with the presentation and reflection on some innovative experiences for professional training on comprehensive abortion care, organized by a joint of activist organizations, academic groups, health professionals, professional societies, and the services themselves, mapped from the participation of the authors in forums, organizations, research and activist groups, and selected under the criteria of direct approach to professional training on abortion and/or advocacy actions that have clear or potential repercussion on this training. At the end, we summarize a series of aspects that can strengthen these networks of training for comprehensive care of abortion situations with focus on PHC.

Keywords:
Abortion; Integrality in Health; Professional Training; Primary Health Care; Reproductive Rights.

Resumo

Este artigo, de cunho ensaístico, objetiva refletir sobre desafios da formação profissional para cuidado integral às situações de aborto na Atenção Primária à Saúde (APS) e trazer ao debate algumas iniciativas formativas inovadoras, organizadas por atrizes/atores sociais e institucionais, que não aqueles do tradicional aparelho formador. Na primeira parte, dialogamos com a literatura internacional para explorar como são enfrentados os desafios formativos em países do Norte Global e latino-americanos, onde o aborto foi legalizado. Em seguida, problematizamos a formação profissional em aborto no Brasil, focando espaços formativos tradicionais (graduações, residências e especializações). Prosseguimos com a apresentação e reflexão sobre algumas iniciativas inovadoras de formação profissional para o cuidado integral ao aborto, organizadas por um misto de organizações ativistas, núcleos acadêmicos, profissionais de saúde, sociedades profissionais e os próprios serviços, mapeadas a partir da participação das autoras em fóruns, organizações e grupos de pesquisa e ativismo, e selecionadas pelos critérios de abordar diretamente a formação profissional sobre aborto e/ou realizar incidências que tenham clara ou potencial repercussão sobre essa formação. Ao final, resumimos um conjunto de aspectos que podem fortalecer essas redes de formação para o cuidado integral às situações de aborto com foco na APS.

Palavras-chave:
Aborto; Integralidade em Saúde; Formação Profissional; Atenção Primária À; Saúde; Direitos Reprodutivos.

Introduction

In 2024, Brazil celebrated 30 years of the Family Health Strategy, a priority initiative for the organization of Primary Health Care (PHC), which should serve as the preferred gateway for users into the Unified Health System (SUS) and as the care coordinating body. These years have witnessed a significant expansion of population access to PHC within the SUS. However, challenges remain in consolidating the essential PHC attributes: first-contact access, comprehensive attention to the health needs of individuals and communities, user bondin to the professional team, care continuity over time, and coordination across the several health actions (Lima et al., 2018). To fulfill its role in ensuring the right to health with equity, it is no less important and equally challenging to strengthen PHC’s contribution to addressing social inequalities - deeply structured by gender, race, and class - and promoting human rights and social justice.

The challenges related to the provision of comprehensive care in sexual and reproductive health are emblematic. In recent decades, progress has been made in prenatal care, contraception, cervical and breast cancer control, and sexually transmitted infections. However, other issues, such as infertility and menopause, remain largely silenced. Within this silencing economy is care inadequacy in situations of abortion - whether in cases of unintended pregnancies, induced/legal/spontaneous abortions, post-abortion care, among others (Maia, 2021).

Abortions are commonplace events in the reproductive lives of women and people who can become pregnant (Diniz et al., 2023). From 2008 to 2018, more than two million hospitalizations due to abortion were recorded in Brazil, representing 5% of all hospitalizations among women of reproductive age (Uliana et al., 2022). Even underreported, unsafe abortion has appeared for decades among the leading causes of maternal death in the country (Domingues et al., 2020). As the clearest expression of social and racial inequalities and reproductive injustice, Black women are predominantly represented in the epidemiology of abortion-related morbimortality and the most frequently criminalized for this reason (Goes, 2018; Severi et al., 2022).

Providing care to people experiencing abortion within PHC is a fundamental strategy to increase access to reproductive health (WHO, 2022). However, in the context of a culture of criminalization and stigmatization, as in Brazil, the issue of abortion is surrounded by taboos and prohibitions, with profound repercussions for health policies, technical regulations, professional training, and care practices. People who seek care in induced, legal, or spontaneous abortion situations are frequently victims of mistreatment, threats, punishments, negligence, and other forms of violence in health services (Leite et al., 2024; Madeiro; Rufino, 2017; Aquino et al., 2012). A study with Family and Community doctors showed that professionals feel unprepared to address these situations, often unaware of the legal-regulatory framework regarding abortion and the ethical-political dimensions of reproductive rights; they lack practical skills for dignified, humanized care, which requires attentive listening, respect for autonomy, non-judgment, and non-discrimination; they fear being persecuted by supervisors, peers, or anti-abortion groups, and feel disoriented amidst their own ethical conflicts (Maia, 2024).

Professional training for abortion care has been challenging in Brazil and in different contexts - even in countries with more liberal legislation - due to the scarcity of this subject in undergraduate curricula, residency programs, and continuing education activities (Leitão et al., 2022). The difficulties in integrating abortion into professional curricula are not incidental; instead, they can be attributed to a myriad of factors: the persistent stigma surrounding the topic, the compulsory motherhood norm, the culture of medical control over women’s bodies, institutional racism, a criminalizing perspective to the detriment of Public Health, pressure from conservative groups of several orientations, and the lack of State secularism, among others (Adesse et al., 2016).

The scarce professional training opportunities addressing abortion from an interdisciplinary perspective - founded on humanization, rights, and reproductive justice - across different educational modalities in Brazil was the problem that gave rise to this essay. The development of professional competencies for health care unfolds over training processes that involve the acquisition of theoretical and technical knowledge, practical skills, and values (common sense and ethical principles). Regarding abortion, this is no different. Considering that Brazil has the most extensive Public Health system in the world - the SUS - and a robust PHC structure, sustained and continuous investment in professional training for a praxis of comprehensive abortion care could have a significant impact on sexual and reproductive health indicators, the dignity of people who undergo abortions, and the promotion of reproductive justice - even without changes to the current, highly restrictive legal framework.

This article aims to reflect on the challenges of professional training for comprehensive abortion care within PHC and to bring into the debate some innovative training initiatives organized by social and institutional stakeholders beyond the traditional training apparatus. These initiatives were mapped through the authors’ participation in forums, organizations, and groups dedicated to abortion research and activism. They were selected per the criteria of directly addressing professional training on abortion or engaging in activities with apparent or potential repercussions for abortion training. Although heterogeneous and singular, these initiatives seemingly bring the innovation of building new networks of relations and associations, which, paraphrasing Bruno Latour (2012), are “reassembling the social element” with respect to professional training practices in abortion.

Next, we first engage with the international literature to explore how training challenges are addressed in countries of the Global North and in Latin America, where abortion has been legalized. Then, engaging with Brazilian works, we question professional training on abortion in Brazil, focusing on traditional training environments (undergraduate programs, residencies, and specializations). After that, we present and reflect on some innovative professional training initiatives for comprehensive abortion care, organized by a mix of activist organizations, academic centers, health professionals, professional societies, and health services themselves. Finally, we summarize a set of aspects that may strengthen these care training networks, based on the sociotechnical resources at hand: the constitutional right to health, social stakeholders of public institutions committed to the defense of rights, activists and organizations with expertise in sexual and reproductive rights, SUS principles and guidelines, and, most notably, a robust PHC system.

Abortion training in international experiences

Advances in legal and regulatory frameworks have not eliminated obstacles to providing care for people in abortion situations, even in countries that legalized the procedure decades ago, such as the United States, Canada, France, and England. Training health professionals for this type of care has remained one of the most significant challenges. The international literature amply documents the absence or weakness of the subject in undergraduate and postgraduate curricula, the lack of public policies or regulatory guidelines for professional education on abortion, pressures and difficulties imposed by conservative groups on educational institutions and practice fields, among other issues (Razon et al., 2022; Leitão et al., 2022; Rennison et al., 2022; Myran et al., 2018). In Latin America, countries where abortion rights have recently expanded (Colombia, Mexico, Uruguay, and Argentina) have also faced the abortion care professional training jigsaw (Keogh et al., 2025; Vázquez et al., 2023; Schiavon & Sanhueza, 2021; Fiol, Nozar & Briozzo, 2021; Gil, Marroquin & Vivas, 2021).

Significant gaps in training for abortion care have been observed in the Global North and South, not only among doctors specializing in gynecology and obstetrics, but also among family and community doctors (FCD) and general practitioners, nurses, and midwives. Studies indicate that professionals working primarily in primary care have doubts about their own competence to provide abortion care, feel insecure about the legal implications, fear stigmatization, and consider that administrative and organizational issues are often unfavorable to this practice (Summit & Carvajal, 2023; Razon et al., 2022; Winsor, Gold & Thill, 2021; Gil et al., 2021; Schiavon & Sanhueza, 2021; Myran et al., 2018). At the same time, professionals show interest in and support for including the subject in curricula, with a positive correlation between exposure to information, theoretical knowledge, and practical training and the adequate provision of abortion care in their future clinical practice (Winsor, Gold & Thill, 2021; Schiavon & Sanhueza, 2021; Myran et al., 2018).

In several countries, we can observe the development of educational strategies and professional training programs for abortion care led by organizations and networks beyond the traditional universities or health education and research institutions, and beyond governmental bodies responsible for Health and Education policies. In an effort to overcome political, cultural, or institutional resistance and barriers, training initiatives have been developed by professional and student associations, research centers, health services themselves, civil society organizations - from family planning entities to feminist organizations - international organizations engaged in the sexual and reproductive rights (SRR) agenda, United Nations agencies, among others.

The training situation in France, which legalized abortion in 1975 and made it a constitutional right in 2022, is illustrative. The challenge of training professionals with both technical competence and favorable attitudes toward the right to choose has persisted since the approval of the Weil Law, facing resistance in medical schools and residency programs, widespread conscientious objection, and a shortage of trained professionals for the procedure in some parts of the country (Moysés, 2025). In the history of abortion in France, two organizations stand out for their strong influence on professional training: Planning Familial and the Réseau Entre la Ville et l’Hôpital pour l’Orthogénie (Revho). Founded in the 1960s, Planning Familial has been crucial in disseminating information and promoting debates on SRR for a broad audience, including Health, Education, and Social Service professionals, public managers, activists, journalists, among others.

Revho, in turn, is a network of pro-choice health professionals created in 2004, whose central mission is training health professionals in several pregnancy termination methods, with a focus on providing comprehensive and continuous care for people in abortion situations. With more than 300 people trained annually, Revho has already prepared thousands of professionals, including doctors and sages-femmes - university-trained midwives who, since 2022, have been authorized by the French Health Code to perform both medication and instrumental abortions.

In the Global North, the United States stand out with organizations created more than two decades ago, dedicated to professional training in abortion care, such as Medical Students for Choice (1993), Ryan Residency Training Program in Abortion and Family Planning (1999), Training in Early Abortion for Comprehensive Healthcare (2003), and Reproductive Health Education in Family Medicine (2004). Medical Students for Choice, for instance, has become consolidated, expanded, and today operates in 26 countries, offering training in abortion and sexual and reproductive health in medical schools and residency programs. Other organizations, such as the National Abortion Federation and Planned Parenthood, provide abortion care training for nurses, midwives, and others. However, the direct participation of these professionals in abortion care is limited in the United States and varies according to state laws and regulations.

In Latin America, professional training has also been driven by stakeholders and organizations beyond traditional training institutions and governmental Health and Education policy bodies. The technical and financial participation of North American nonprofit organizations (such as Ipas and Gynuity) and United Nations agencies (such as UNFPA and UNICEF) in sexual and reproductive health and abortion training programs has been significant. Organizations created by health professionals - such as Oriéntame in Colombia and Iniciativas Sanitarias in Uruguay - have also played a prominent role (Schiavon & Sanhueza, 2021; Fiol, Nozar & Briozzo, 2021).

The case of Iniciativas Sanitarias is emblematic. Even before the legalization of abortion in Uruguay in 2012, the organization developed and implemented a successful model for reducing risks and harms associated with unsafe abortion, in partnership with the International Federation of Gynecology and Obstetrics (FIGO), UNFPA, and other partners (Fiol, Nozar & Briozzo, 2021). This experience positively impacted reproductive health indicators, stimulated public debate, and strengthened the network of stakeholders that influenced the abortion legalization process.

Feminist organizations also deserve special attention for their leadership in raising awareness, providing theoretical and technical training, or offering practical training for health professionals on SRR and abortion. Moreover, these organizations monitor and influence training processes, advise, or share responsibilities with other stakeholders in professional training projects. In Colombia, La Mesa por la Vida y la Salud de las Mujeres stands out, with 25 years of legal and political advocacy in the field of SRR, including sensitization and training of health professionals (González-Vélez & Jaramillo, 2017). In Argentina, Socorristas en Red, which since 2012 has provided information and support for self-managed abortion and played an important role in contributing to the high-quality training of health professionals in abortion care (Ramos et al., 2023). In Mexico, the Grupo de Información en Reproducción Elegida and Católicas por el Derecho a Decidir are examples of organizations that have accompanied, supported, and enhanced the training of health professionals.

These international training experiences, briefly revisited here, despite their varied arrangements, timelines, and societal contexts, share certain similarities: they are driven by networks of heterogeneous social, political, and institutional stakeholders who produce and circulate knowledge and expertise and collaborate in creating social practices that combine education, participation, and activism.

Abortion in the training of Brazilian health professionals

In the SUS PHC system, teams are comprised of Medicine, Nursing, Community Health Workers, and Oral Health professionals, supported by multidisciplinary teams (eMulti). They are responsible for a population assigned to a given territory, where they develop health actions guided by cultural dynamics and ways of life (community guidance). They connect with residents through regular family visits (family guidance), ensuring longitudinality, comprehensiveness, coordination of care, and assistance from the first contact. Because of these attributes, PHC is a strategic level for overcoming barriers to access to reproductive health care and providing comprehensive abortion care (Maia, 2021). However, professionals must have comprehensive knowledge of the topic (legal, regulatory, ethical, cultural, technical, and scientific aspects) and be prepared to receive, listen, inform, build bonds, and provide judgment-free and discriminatory care, based on the SRR.

Brazilian studies reveal the abortion care training deficiencies in undergraduate Medicine and Nursing programs (Schroeterl & Pereira, 2019; Darzé & Azevêdo, 2014; Marconsin et al., 2013), with only superficial coverage of clinical and ethical-legal aspects, which does not provide professionals with the confidence needed for future practice, and with no critical training on the subject in light of sexual and reproductive rights (SRR), humanization, and equity of gender, race, and class - contrary to the National Curricular Guidelines for these courses, which establish that professional education must adopt a humanistic, critical, and reflective perspective.

When training environments fail to promote critical reflection, they risk becoming spaces for the reproduction of stigma, discrimination, and ignorance. A study with undergraduate students in Nursing, Medicine, Psychology, and Social Work revealed the lack of preparedness among professors and internship supervisors to guide in abortion-related situations. Students reported that these mentors frequently associated the subject with illegality and approached it with prejudice. The acquisition of broader knowledge about abortion often occurred due to the students’ own interest, motivated by personal experiences. The authors concluded that the absence of the subject in the curriculum is a reflection of society’s broader unwillingness to accept abortion in public debate (Borges, Clemente; Netto, 2020).

Given the incipience of abortion-related content in undergraduate Health courses and the urgent reproductive health needs of the communities served, it would be reasonable to expect that residency programs in the context of PHC - Family and Community Medicine, Family and Community Nursing, and Multidisciplinary Family Health - would fill these gaps, providing training environments sensitive and committed to the issue. However, this is not always the case. As Maia (2024) showed, only half of Family and Community doctors who completed residency programs in the specialty were exposed to discussions on unintended pregnancy and abortion. In most cases, the subject was not part of the programs’ regular theoretical curricula, but rather emerged from the discussion of everyday cases in clinical practice.

Family and Community Medicine residency programs are based on the competency matrix of the National Commission on Medical Residency, which mentions abortion only in the context of obstetric emergencies (Brazil, 2020). The Competency-Based Curriculum of the Brazilian Society of Family and Community Medicine (SBMFC, 2015) likewise does not include content on unintended pregnancy, harm reduction for unsafe abortion, legal abortion, or post-abortion care. As such, comprehensive abortion care in residency training depends on the availability or interest of supervisors and preceptors, who may or may not prioritize it as a subject to be addressed in theoretical-practical discussions. This situation translates into real-world challenges in creating learning environments for handling abortion care in community settings, given its frequent occurrence in service routines.

Abortion training in Nursing residency programs is scarcely documented in the literature. Studies with nurses have identified the influence of personal values on practices related to abortion and concluded that there is a need for critical-reflective training on the subject (Santos et al., 2021; Schroeterl & Pereira, 2019). The Brazilian Association of Family and Community Nursing has publicly defended the right to abortion, as in its statement rejecting Bill N°1904/24, which equates abortion after 22 weeks of gestation with the crime of homicide. However, it has yet to develop a Competency-Based Curriculum for the specialty.

Considering the practice setting as a locus of training is also important in a context where many professionals working in PHC have not completed residency programs. Many have trained in short courses, such as “introductory” programs, or in specializations in Family Health or Family and Community Medicine - the primary training strategy of the Mais Médicos Program - where abortion and SRR topics are rarely addressed. Thus, investing in the role of everyday practice as a formative school becomes even more relevant.

There are many formative stages in the professional trajectory of health workers in which competencies for comprehensive abortion care could be developed. However, in reality, traditional institutions display great inertia regarding this agenda. E pur si muove… through initiatives that gather health professionals, professional societies, professors, researchers, students, activists, nongovernmental organizations, and other social and institutional actors committed to health, rights, and reproductive justice. This is what we will explore next.

Innovative professional training initiatives in Brazil

Despite the weakness of abortion-related content in Brazilian undergraduate and postgraduate curricula, professional training initiatives promoted by networks involving civil society stakeholders and public institutions have advanced the agenda of comprehensive abortion care in PHC. Here, we discuss some of these initiatives, mapped by the authors based on their participation in events and research, training, and activism groups on abortion, and systematized from information available on websites and social media, as well as reports and publicly available informational materials. To date, the reporting of these experiences is unprecedented in the scientific literature.

First, the State Forums on Legal Abortion stand out, as they have played an important role in promoting training initiatives on abortion care. These are heterogeneous groups created to establish actions to make legally authorized abortion care more accessible and improve the quality of services provided to people seeking it. Participants include health professionals, activists, NGOs, social movements, professors/researchers/students, members of social participation bodies, public defenders, and other legal professionals, and stakeholders from the Social Sciences, Humanities, and Communication fields, all committed to ensuring reproductive rights for women and people capable of pregnancy. This diversity brings a particular richness to the forums (Patuzzi et al., 2019; FALRS, 2023).

Currently, the forums are organized in six Brazilian states. The Rio Grande do Sul Forum on Legal Abortion (FALRS) was the first, established in 2016 through the initiative of faculty members at the Federal University of Rio Grande do Sul, and later expanded beyond the university walls. Its actions are structured around two main projects: Colloquia on Legal Abortion and Strengthening Networks. The Colloquia are training events that have gathered hundreds of participants in their six editions, including health professionals from several fields, reference services for legal abortion in the state, managers, researchers, students, NGOs, and activists, among others. They aim to share experiences, practices, challenges, and successful strategies in legal abortion care, strengthen existing teams and services, encourage the expansion of such services to other locations, and foster professional training in abortion. Strengthening Networks aims to facilitate debate on the organization of municipal and regional care networks, identify access bottlenecks, develop proposals to improve legal abortion care, and raise public awareness through the dissemination of informational materials.

FALRS members also operate in academic and education-service spaces, partnering with professors and preceptors to discuss abortion and unintended pregnancy in Medicine, Nursing, and Psychology undergraduate courses, as well as in Family and Community Medicine and multidisciplinary PHC residency programs. FALRS also provides publications and educational materials on its website (FALRS, 2023).

The Pernambuco Forum (FALPE) was launched in 2018 during the First Festival for Women’s Lives, rooted in longstanding reproductive justice organizations such as Curumim and SOS Corpo, active in professional training and service monitoring since the 1990s. FALPE holds annual training meetings to discuss the needs of legal abortion services, everyday challenges, and common barriers, such as conscientious objection. The participation of health professionals, including those in PHC, has grown significantly since 2024.

The Bahia Forum (FALBA) was established in 2021, arising from dialogue circles on SRR promoted by the Women’s Rights Defense Unit (NUDEM) of the Bahia State Public Defender’s Office. With monthly virtual meetings, other institutions, including the Public Prosecutor’s Office, universities, the State Health Secretariat, and the State Public Security Secretariat, have joined. The Public Defender’s Office was crucial in ensuring the right to legal abortion in cases where services denied access due to pregnancies beyond 22 weeks or demanded police reports unnecessarily. Training activities have also targeted Justice system professionals to strengthen support for health teams providing abortion services. In 2022, FALBA organized a seminar and produced an informational booklet on sexual violence and legal abortion, made available on the Bahia Public Defender’s Office website.

The Paraná Forum (FALPR) was formed in 2022 through a leading group from the Advocacy for Women’s Rights Center (NUDEM) of the Paraná Public Defender’s Office and the Human Rights Clinic of the Federal University of Paraná, with support from the Feminist Health Network and the Brazilian Association of Midwives and Nurse-Midwives. Aimed at knowledge exchange and collaboration among abortion care services, FALPR organizes monthly or bimonthly training meetings on topics such as best practices for abortion procedures, conscientious objection, and abortion in advanced gestational stages, often featuring invited experts. The target audience includes professionals from legal abortion services in the state, as well as other health professionals, social movement members, and health secretariat managers.

The Minas Gerais Forum (FALMG) was also created in 2022 as a strategic action to ensure access to legally authorized abortion in the state. Its founding group included the National Feminist Health Network and NUAVIDAS - the Center for Comprehensive Care for Victims of Sexual Violence at the Federal University of Uberlândia’s Clinical Hospital (HC-UFU), among other organizations. FALMG’s actions aim to strengthen dialogue between health professionals, sexual and reproductive health policymakers, and feminist social movements.

The Santa Catarina Forum (FALSC) was formalized in 2024, following five years of activist mobilization around legal abortion and two prior training events on abortion care in cases of sexual violence and guaranteeing this right for minors under 14. With monthly meetings, FALSC functions as a permanent space for dialogue and training, aiming to strengthen legal abortion services in the state. In 2024, it promoted the course “I welcome: PHC Professionals in the Prevention of Unsafe Abortion”, offered by the Feminist Group on Sexuality and Health (2020), and the webinar “PHC: Support and Information in Situations of Legal Pregnancy Termination”, organized with the State Health Secretariat and supported by the Federal University of Santa Catarina. FALSC is spearheaded by activists from the Santa Catarina Front for the Decriminalization and Legalization of Abortion and consistently engages professionals from state legal abortion services and institutions such as NUDEM/Public Defender’s Office, the State Health Secretariat, and the State Women’s Rights Council.

The state forums participate in the Brazilian Forum on Legal Abortion, formerly the Intersectoral Forum of Brazilian Services for Legally Authorized Abortion, a national-level, ongoing arena for discussion and training that holds regular meetings. In ten editions, these meetings have gathered more than 600 participants from across Brazil. This venue emerged from a pioneering experience launched in 1996 with the First Interprofessional Forum on Sexual Violence and Legally Authorized Abortion in Campinas, São Paulo (Giugliani, 2021).

In addition to the forums, notable are other innovative initiatives for professional training in abortion care. The Ampara course (Support for People in Situations of Abortion and Post-Abortion), launched in 2021 by Bloco A - an organization active since 2018 in disseminating information and knowledge on sexual and reproductive health for health professionals - operates through a distance-learning platform. Organized into modules with informative texts, educational videos, and infographics, it is offered broadly and free of charge, often in partnership with municipal and state governments. A partnership with Fiocruz, established in 2024, further expanded its reach, and the course is now also available on the institution’s educational platform. By 2024, Ampara had reached 10,000 registrations from professionals across various fields, not limited to the Health sector.

Another noteworthy initiative is “I welcome: PHC Professionals in the Prevention of Unsafe Abortion”, offered by the Feminist Group on Sexuality and Health (2020). Designed to sensitize and train health professionals to identify cases of unintended pregnancy and provide appropriate guidance - whether by referral to legal abortion services or by ensuring safe provision aligned with a harm reduction strategy - this course is conducted in person, in partnership with local organizations. Its methodology is outlined in a freely available training booklet and is based on five steps (Coletivo Feminista Sexualidade e Saúde, 2020). Training sessions have been held in several cities and states, including Rio de Janeiro (RJ), Brasília (DF), São Paulo (SP), Ribeirão Preto (SP), Recife (PE), Fortaleza (CE), Palmas (TO), Governador Valadares (MG), Belo Horizonte (MG), São João Evangelista (MG), Florianópolis (SC), Rio das Ostras (RJ), and Porto Alegre (RS). Nearly 200 professionals - mostly doctors, nurses, and social workers - have been trained.

NUAVIDAS - the Center for Comprehensive Care for Victims of Sexual Violence at HC-UFU - has played a prominent role in training. In 2023, it launched the extension course NUAVIDAS+, aimed at providing health professionals with knowledge and guidance for the appropriate care of victims of sexual violence. The course includes an online theoretical component with video lectures and a practical component with on-site training. It targets medical residents in Gynecology/Obstetrics and Family and Community Medicine, health professionals working in legal abortion services or interested in implementing them in the SUS, and certified doulas with at least 120 training hours. Among the NUAVIDAS+ competencies developed are reflection on values and beliefs related to legally authorized abortion in Brazil and providing care centered on the needs of girls, women, and other people in situations of legal abortion.

The Program on Legally Authorized Pregnancy Termination (PIGL) at the Dr. Antônio Lisboa Maternal and Child Hospital of Brasília (HMIB) is another reference service leading training initiatives in abortion care. Since 2021, it has offered the Update Course on Care for People Experiencing Sexual Violence, held twice annually in person. It aims to qualify health professionals working in the Federal District Health Secretariat and in the intersectoral care network for people affected by violence, emphasizing pregnancies resulting from sexual violence. The course focuses on strengthening professional skills in reception, reporting, care, referral, and follow-up of people in situations of violence and their support networks. Some 224 health professionals in the Federal District had participated by the end of 2024, and in 2025, the course is expected to expand with an online component for permanent availability.

Within professional associations, the Working Group on Women in Family and Community Medicine has taken a leadership role in the Brazilian Society of Family and Community Medicine (SBMFC) in training for abortion care in PHC. An example is the production of bibliographic materials that have become reference texts for Brazilian Family and Community doctors (Giugliani, 2019; Maia, 2021), as well as the guide Unintended Pregnancy in Primary Health Care: The Questions You Always Had but Could Never Ask (GT Mulheres, 2024), launched nationally at the Tenth Brazilian Congress of Family and Community Medicine in 2021. Now in its second edition, the guide has served as a basis for workshops, seminars, and other training activities across the country, in residency programs, family health teams, universities, and scientific events.

Despite the lack of official health and education policies on professional training for abortion care in PHC, these innovative experiences highlight the training demands and the potential for professional engagement with the issue. They reach a broad audience, not limited to Medicine and Nursing or to PHC professionals. However, they hold great potential to sensitize and develop competencies among PHC professionals for comprehensive abortion care, fostering interdisciplinarity, and enhancing knowledge of epidemiological aspects, clinical-care procedures, and ethical and legal safeguards. The wide range of modalities offered across different initiatives (virtual, in-person, synchronous, or asynchronous) diversifies access, broadens opportunities for participation, and encourages professionals’ involvement in the networks of stakeholders organized around abortion care training.

Final considerations

National and international literature highlights significant gaps in professional training for comprehensive abortion care in more traditional training institutions (undergraduate programs and residency programs). However, in several parts of the world, innovative experiences organized by civil society and diverse social and institutional stakeholders have contributed to this training, despite the lack of or weak regulatory guidelines for this purpose.

In Brazil, we also see innovative and influential training initiatives reaching thousands of healthcare professionals, especially in primary healthcare. These initiatives derive from intense work involving civil society organization and leadership, political mobilization, and inter-institutional coordination, promoting training practices within networks of activism and expertise, where educational processes are conceived as participatory and collaborative construction and knowledge sharing.

This essay maps and describes some of these training initiatives - a topic little explored in the scientific literature - but faces the limits of the essay method for analyzing social processes. This mapping was also not exhaustive, so the lack of other promising training initiatives is also a limitation of the work. The initiatives were selected by convenience, based on the authors’ proximity or participation in many of them. This work aims to give visibility to these experiences and to highlight, as a topic of study, these training processes in networks of activism and expertise, paving the way for research, reflection, and learning that can guide future actions.

It is worth questioning here how much professional training for abortion care - from the perspective of comprehensiveness, rights, and reproductive justice - will actually prosper if it remains confined to the theoretical and methodological canons of an academy built on hierarchies of gender, race, and class. We can conjecture that these networks of associations between multiple social stakeholders and institutions, knowledge from diverse disciplines, sociopolitical expertise, communication and information technologies, and educational techniques that are not subsumed by those of classical educational institutions, do more than merely fill gaps. They can point to more critical and democratic possibilities for professional training, especially if the efforts of the several human and non-human stakeholders involved in these networks - as in the innovative training initiatives we discuss here - manage to move structures and more consistently involve institutional players, such as the Ministry of Health, Ministry of Education, National Council of Education, National Commission for Medical Residency and National Commission for Multiprofessional Residency in Health, state and municipal health secretariats, universities, and other professional training institutions.

Despite the heterogeneity of their composition and experiences, these activism and expertise networks can significantly contribute to institutions in addressing the challenges of professional training for comprehensive abortion care: by developing normative guidelines; including content related to the topic in undergraduate and graduate curricula; developing appropriate practical competencies and skills for this care, with a focus on professionalism, ethical conduct, and person-centered care, without interference from personal values and beliefs; expanding continuing education offers for PHC teams; training for anti-racist and anti-sexist practice and commitment to reproductive justice.

• Funding:
  This work derives from interinstitutional research and was supported by the Oswaldo Cruz Foundation/Vice-Presidency of Research and Biological Collections/Public Policy and Health Care and Management Models Program - Fiocruz/VPPCB/PMA.

Acknowledgments

We are grateful to Melanie Noël Maia for her careful reading and valuable suggestions regarding the manuscript. We are also grateful to Morgani Guzzo (FALSC), Renata Jardim (FALRS), Camila Mafioletti (FALPR), Ana Paula Viana (FALPE), Letícia Ueda Vella (Feminist Sexuality and Health Collective), Patrícia Silveira (Block A), Ligia Maria Carlos Aguiar, and other professionals from the PIGL (HMIB) support team for their solidarity in sharing materials and information to be presented in this article.

Data Availability Statement

The research data are available within the main text of the article.

References

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Edited by

• Editors: Ivia Maksud, Luanda Lima

Publication Dates

• Publication in this collection
  16 Mar 2026
• Date of issue
  2025

History

• Received
  07 May 2025
• Reviewed
  13 June 2025
• Accepted
  13 Aug 2025