Natanael Barbosa and his aunt, Maria Aparecida Barbosa, talking about Natanael’s sister Ingriane Barbosa Carvalho, who died from a clandestine abortion.CreditLianne Milton for The New York Times

PETRÓPOLIS, Brazil — For three days after she had an illegal abortion, Ingriane Barbosa Carvalho hemorrhaged in silence. Even as she writhed in pain, and an infection caused by the botched procedure spread, Ms. Carvalho insisted to relatives she was just nursing a stomach bug.

By the time she sought medical help, it was too late. Ms. Carvalho, a 31-year-old mother of three, died seven days later.

Her death on May 16 illustrates the high stakes of the fight over reproductive rights that is playing out before Brazil’s Supreme Court during a rare two-day public hearing that started Friday.

The court will consider whether Brazil’s abortion laws — which forbid terminating pregnancies with few exceptions, including cases of rape and instances in which the mother’s life is in peril — are at odds with constitutional protections.

The hearing, which will continue Monday, is unlikely to lead to the imminent legalization of abortion. But women’s rights activists hope the public hearing will set off a high-profile debate on the issue, draw attention to the risks hundreds of thousands of women take each year as they resort to clandestine abortions and ultimately pave the way to overhauling the existing law.

During the first day of arguments, a majority of the 26 speakers argued for decriminalizing abortion.

Though the Ministry of Health did not take an official position on the issue, Maria de Fátima Marinho, who represented the ministry before the court, made clear that unsafe abortions created public health challenges, leading to overcrowding of facilities as well as preventable illness and death.

The death of Ms. Carvalho, a 31-year-old mother of three, illustrates the high stakes of the abortion debate playing out before Brazil’s Supreme Court.CreditLianne Milton for The New York Times

Ms. Marinho said that she hoped the hearing would “give a voice to those who hide the act, who are ashamed, and, because of that, take too long to ask for help, face complications, and die.”

The hearing is being held as Brazilian lawmakers take steps to adopt even more restrictive laws and abortion rights groups across the region face a strong backlash after attaining victories.

“This hearing comes at a historic moment in Brazil and in Latin America, where we have seen a rise in recent years in the opposition to sexual and reproductive health and rights,” said Beatriz Galli, a Brazilian human rights lawyer. “Brazil exemplifies the regional paradox: There has been massive mobilization in civil society for expanded rights, contrasting with a very conservative Congress.”

Brazil’s top court has ruled narrowly on abortion cases in recent years, signaling an inclination to expand access, but it has refrained from making sweeping legal changes related to the politically fraught issue.

In March 2017, the leftist Socialism and Liberty Party and Anis, a women’s rights group, filed a petition asking the court to rule that terminating a pregnancy within the first 12 weeks of gestation should not subject the pregnant woman or the abortion provider to prosecution.

They argue that abortion laws written in 1940 violate protections conferred by the 1988 Constitution, including the right to dignity, equal protection and access to health care.

Taking up their petition, Justice Rosa Weber, one of two women on the 11-member court, took the relatively rare step of seeking input from legal analysts in Brazil and abroad and convened a hearing.


Doctors found a piece of mamona, a plant used to induce abortions, inside Ingraine Barbosa Carvalho’s uterus.CreditLianne Milton for The New York Times

In a March statement she called abortion rights one of the “most sensitive and delicate” legal issues, “since it involves matters of ethics, morality, religion, public health and fundamental rights.” Since then the court has received legal briefs from 38 groups, a record number.ADVERTISEMENT

While Ms. Carvalho’s case is not before the court, abortion rights activists say her death, which received extensive press coverage, starkly shows how the current abortion laws disproportionately affect poor women.

After a long struggle to make ends meet, Ms. Carvalho landed a good job as a nanny early this year. It paid twice the minimum wage and put her dream of buying a home within reach. The unexpected pregnancy threatened to derail that progress, according to an account of her final weeks drawn from police reports and interviews with relatives.

The man who got her pregnant made clear he had no interest in being a father. When Ms. Carvalho told him in a text message that she intended to have an abortion, he didn’t respond.

Ms. Carvalho seemed to know her relatives would try to talk her out of her decision. Her brother, Natanael Barbosa, an evangelical preacher, said he would have been adamantly opposed to an abortion.

“I wish she had told me,” Mr. Barbosa said during a recent interview at his small church in a hillside neighborhood. “I would have said, Give me one of your kids, I’ll raise it.”

A protest demanding the legalization of abortion in Rio de Janeiro in June.CreditSilvia Izquierdo/Associated Press

Ms. Carvalho first attempted to terminate the pregnancy by swallowing an entire pack of hypertension pills. When that didn’t work, she stuck a knitting needle in her uterus. By early May, when she was nearly four months pregnant, she sought the services of an underground abortion provider, who inserted a stalk of castor-oil plant into Ms. Carvalho’s uterus, according to the police report, which included an affidavit from the woman who administered the procedure.

Ms. Carvalho was instructed to remove the plant by pulling on a thread attached to it. But the thread came undone and the stalk remained inside her. As an infection took hold, she lay in a tiny bedroom in an aunt’s home. By the third night, when the aunt, Maria Aparecida Barbosa, went into the room to give her niece a blanket, the young woman’s lips were purple.

“I think I’m dying,” she told her aunt.

By the time Ms. Carvalho arrived at the hospital, the infection had entered her bloodstream.

Estimates of the number of abortions performed in Brazil each year range from 500,000 to 1.2 million. Each year, more than 250,000 women are hospitalized as a result of complications from abortions, according to the Brazilian Health Ministry. In 2016, the last year for which official figures were available, 203 women died as a result of botched abortions. Providing medical care for them has cost the government more than $130 million over the past decade.

Wealthy and middle-class women can have safer abortions by traveling abroad or resorting to medical professionals willing to perform them. Poor women, many of whom are black, make up a disproportionate number of those who die, become ill or get prosecuted as a result of the procedure, according to researchers, activists and public defenders.

Lívia Casseres, a public defender in Rio de Janeiro who is among those who will argue before the court, said that Brazil’s overwhelmingly male, and increasingly conservative, politicians had shown little interest in women’s reproductive rights.

“It makes our democracy weak,” Ms. Casseres said, noting that 11 percent of Brazil’s lawmakers are women, one of the lowest rates in the world.


Natanael Barbosa visits the grave of his sister.CreditLianne Milton for The New York Times

Since 2000, 28 countries and regions have expanded abortion rights. Last year, lawmakers in Chile lifted the country’s total prohibition on abortion, and next week the Senate in Argentina will vote on a bill that could legalize abortion there.

In Brazil, where Congress has become more conservative in recent years as the political power of evangelicals has grown, lawmakers have introduced bills that would ban abortion under any circumstances. Few women in politics publicly champion legalizing abortion. The activists who do are often threatened and ostracized.

Debora Diniz, an anthropologist at the University of Brasília who helped write the petition before the court, recently decided to leave the capital after receiving death threats. In an interview, she said she was hopeful the hearing would lead to a vigorous debate on the issue ahead of Brazil’s presidential election in October.

“This hearing has the potential to shape the political debate,” she said.

Even as the political establishment has become more conservative, a growing number of Brazilian women have spoken out about their decision to have abortions. Last year, Rebeca Mendes, a mother of two, unsuccessfully sought to get permission from the Supreme Court to have an abortion. She ultimately traveled to Colombia, where the rules are less strict, to undergo the procedure.

The Supreme Court hearing prompted Ladyane Souza, a lawyer in Brasília, to publicly disclose that she had an abortion two years ago, even though doing so means she could be prosecuted.

“It’s very cruel to submit women to dealing with this all alone, underground,” Ms. Souza, 22, said. “During that time, I wanted very much to talk to my mother, because I felt it would have been easier if my mother knew, if my friends knew, but I was afraid of being prosecuted.”

Prosecutors and religious organizations intend to rebut the arguments of advocates by telling the court that legalizing abortion would put an unreasonable burden on the public health care system.

José Paulo Leão Veloso, a lawyer who will represent the northeastern state of Sergipe before the court and argue against decriminalizing abortion, said that the penal code was the prerogative of the legislature and that the current law should stand.

“Of all the obligations of the state, the most important is to protect life,” he said.

Ms. Carvalho’s relatives opted to bury her in a cemetery several miles from her hometown after local residents reacted with outrage and scorn to details of her death. They held a low-key ceremony as her remains were deposited in an unmarked grave in a small hillside cemetery.

“I wish she had survived, so she could have been arrested and learned to be responsible,” Ms. Barbosa, her aunt, said.