RESUMEN
OBJECTIVE: To describe utilization of health services for, and case fatality from, abortion in Mexico. METHOD: A historical cohort study using a census of state-level aggregate hospital discharge and primary care clinic data across Mexico's 32 states from January 2000 to December 2016. Abortive events and changes over time in utilization per 1000 women aged 15-44 years, and case fatality per 100 000 abortion-related events were described by year, health sector, and state. Associations of location (Mexico City vs 31 other states) and time (Mexico City implemented legal abortion services in 2007) with outcomes were tested by linear regression, controlling for secular trends. RESULTS: The national abortion utilization rate was 6.7 per 1000 women in 2000, peaked at 7.9 in 2011, and plateaued to 7.0 in 2016. In Mexico City, utilization peaked at 16.7 in 2014 and then plateaued. Nationwide, the case-fatality rate declined over time from 53.7 deaths per 100 000 events in 2000 to 33.0 in 2016. Case fatality declined more rapidly in Mexico City than in the other 31 states to 12.3 in 2015. CONCLUSION: Case fatality from abortive events has decreased across Mexico. Where abortion became legal, utilization increased sharply but plateaued afterward.
Asunto(s)
Aborto Criminal/mortalidad , Aborto Legal/legislación & jurisprudencia , Aborto Legal/mortalidad , Adolescente , Adulto , Estudios de Cohortes , Femenino , Humanos , Modelos Lineales , México/epidemiología , Embarazo , Adulto JovenRESUMEN
OBJECTIVE: To describe the application of the risk and harm reduction model at primary care level to decrease the mortality due to unsafe abortion in the Province of Buenos Aires, Argentina, and evaluate the results. METHODS: The services offered at primary health units to women undergoing abortion are described-first, only risk reduction and later, legal termination of the pregnancy-including their evolution between 2010 and 2015. The changes in abortion-related maternal mortality are also evaluated. The χ2 test was used to evaluate the differences in the percentage of abortion-related deaths out of the total number of maternal deaths. RESULTS: Primary care services increased progressively, both for risk reduction and for legal termination of pregnancy, which was carried out successfully, including manual vacuum aspiration, by general physicians and midwives. The proportion of abortion-related maternal deaths with respect to total maternal deaths fell by two-thirds between 2010 and 2014 (P < 0.001). CONCLUSION: The Uruguayan risk reduction model was successfully applied in primary care in the Province of Buenos Aires.
Asunto(s)
Aborto Legal/legislación & jurisprudencia , Reducción del Daño , Implementación de Plan de Salud , Mortalidad Materna/tendencias , Modelos Teóricos , Política Pública , Aborto Legal/mortalidad , Argentina , Femenino , Humanos , Servicios de Salud Materna , EmbarazoRESUMEN
OBJECTIVE: To describe public policies, social actions, particularly those of obstetricians/gynecologists, and changes in abortion-related legislation in the different historical periods between 1990 and 2015, and to analyze temporal correlations with a reduction in maternal mortality. METHODS: The 1990-2015 period was divided into three different stages to permit evaluation of the legislation, health regulations, healthcare system, and professional practices related to the care provided in cases of unsafe abortion: 1990-2001, characterized by illegality and the healthcare system's denial of abortion; 2001-2012, when the model for reducing the risk and harm of unsafe abortions was developed; and 2012-2015, when abortion was finally decriminalized. RESULTS: Changes in public policies and expansion of the risk reduction model coincided with changes in the social perception of abortion and a decrease in maternal mortality and abortion rates, probably due to a set of public policies that led to the decriminalization of abortion in 2012. CONCLUSION: Changes in public policies and health actions such as the model for reducing the risk and harm of unsafe abortions coincided with a marked reduction in abortion-related maternal mortality. The challenges still to be faced include managing second trimester abortions, ensuring the creation of multidisciplinary teams, and offering postabortion contraception.
Asunto(s)
Aborto Legal/legislación & jurisprudencia , Política de Salud , Modelos Teóricos , Derechos de la Mujer , Aborto Legal/mortalidad , Aborto Legal/estadística & datos numéricos , Femenino , Reducción del Daño , Humanos , Servicios de Salud Materna , Mortalidad Materna/tendencias , Embarazo , UruguayRESUMEN
Hace aproximadamente cinco años, se aprobó por la Asamblea de Representantes del Distrito Federal la despenalización del aborto en el D. F. Esta situación hace reflexionar acerca de la condición moral y ética de los representantes que elegimos para que salvaguardaran nuestros intereses en la Cámara de Diputados. ¿A quién le preguntaron si estábamos de acuerdo con la modificación del Código Penal? ¿Cómo influirá en la práctica de enfermería esta nueva ley que obliga a las enfermeras a participar en actos contrarios a sus creencias y principios? ¿Dónde quedó el respeto al derecho de objeción de conciencia de los profesionales de salud? Son preguntas que quedarán por resolverse. Lo que sí es necesario hacer es un análisis de la situación desde el punto de vista ético-legal, y las implicaciones que acarrea para la práctica profesional. El presente ensayo hace una reflexión sobre los aspectos éticos y morales que se deben de cuestionar las enfermeras cuando les toque enfrentar alguna situación como la que se está tratando; así mismo, se realizará un resumen de las leyes, tanto nacionales como internacionales que protegen al no nacido y que fueron pasadas por alto para aprobar el decreto que despenaliza al aborto en el Distrito Federal.
About five years ago, was approved by the Representatives Assembly of the Federal District, the legalization of abortion in D. F. This situation does reflect on the moral and ethical representatives who chose to have safeguarded our interests in the House of Representatives, because who asked if we agreed with the amendment of the penal code? How to influence nursing practice this new law requiring nurses to participate in acts contrary to their beliefs and principles? What happened to respect the right of conscientious objection by health professionals? This are questions that remain to be resolved. What if you need to do is analyze the situation from the standpoint of legal ethics, and carries implications for professional practice. This paper will make a beginning of reflection on the ethical and moral question that must be nurses when they touch face a situation such as being treated, and it will be a summary of the laws, both national and international protect the unborn and that were overlooked in order to pass the decree decriminalizing abortion in Mexico City.
Asunto(s)
Humanos , Principios Morales , Ética Clínica/educación , Aborto Legal , Aborto Legal/educación , Aborto Legal/efectos adversos , Aborto Legal/enfermería , Aborto Legal/ética , Aborto Legal/legislación & jurisprudencia , Aborto Legal/métodos , Aborto Legal/mortalidad , Aborto Legal/normas , Aborto Legal/psicología , Aborto Legal/tendencias , Aborto LegalAsunto(s)
Humanos , Embarazo , Femenino , Recién Nacido , Uruguay , Esperanza de Vida , Pobreza , Clase Social , Educación , Empleo , Mujeres , Indicadores de Salud , Anticoncepción , VIH , Neoplasias de los Genitales Femeninos , Política de Salud , Parto/métodos , Parto/mortalidad , Parto/economía , Parto/estadística & datos numéricos , Sistemas de Salud , Mortalidad Materna , Amenaza de Aborto , Aborto Criminal/economía , Aborto Criminal/clasificación , Aborto Criminal/legislación & jurisprudencia , Aborto Criminal/prevención & control , Aborto Legal/clasificación , Aborto Legal/economía , Aborto Legal/mortalidad , Aborto Legal/normas , Aborto Legal/tendencias , Legislación como AsuntoAsunto(s)
Humanos , Masculino , Adolescente , Femenino , Niño , Aborto Criminal/estadística & datos numéricos , Aborto Legal/estadística & datos numéricos , Aborto Inducido/estadística & datos numéricos , Aborto Criminal , Aborto Legal/mortalidad , Aborto Inducido/mortalidad , Países en Desarrollo , Países Desarrollados , Argentina , Aborto Inducido , Aborto EspontáneoRESUMEN
Abortion is not only a major cause of obstetric hospitalization in poor countries, but it also represents the failure of the public health system to provide enough information about contraceptive methods and thus prevent pregnancies. In Brazil, the high utilization rates of health facilities due to abortions reflect the ongoing difficulties with family planning and contraception. In addition, mortality resulting from abortions serves as an indicator of the quality of abortion procedures, an important point in a country where the practice is illegal and therefore done clandestinely. In this study, we analyzed the rates of mortality resulting from abortions among women 10 to 54 years old, including women who died from spontaneous and induced abortion, from 1980 to 1995, for the various regions of the country. The information we used came from the mortality data bank of the public health system of the Ministry of Health. Population data were obtained from the Brazilian Institute for Geography and Statistics. We studied 2,602 deaths, 15% of which were due to missed abortion, spontaneous abortion, or legally permitted induced abortion. The other 85% of the deaths were due to illegal induced abortions or to nonspecified abortions. The mortality rates from abortion-related causes have steadily decreased in all the regions of Brazil, but this improvement has been unevenly distributed in the country. The region with the smallest decrease in this rate (38% over 15 years) was the Northeast. The age of women dying from abortions progressively declined over the period studied.