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While Chile's partial decriminalization of abortion in 2017 was a long overdue recognition of women's sexual and reproductive rights, nearly four years later the caseload remains well below expectations. This pattern is the product of standing barriers in access to abortion-related health services, especially at the primary care point of entry. This study seeks to identify and describe these barriers. The findings presented here were obtained through a qualitative, exploratory study based on 19 semi-structured interviews with relevant actors identified through non-random sampling and snowballing techniques. Coding was inductive and complemented by semantic content analysis. The authors find that the key barriers in primary care to accessing legal abortion are unfamiliarity with the law, insufficient practitioner training, intersectoral discrimination, and the stigma surrounding abortion. They conclude that the government needs to exercise its constitutional mandate as guarantor of public health and act promptly to safeguard and guarantee the abortion rights of Chilean women.

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El Salvador's criminal abortion law-one of the few in the world that prohibits all abortions and that is actively enforced against women-harms women's health and undermines the ethical duties of Salvadoran physicians and the standing of the medical profession. Under the criminal abortion regime, physicians are incentivized to disclose their patients' confidential medical information, in violation of their ethical duties, and public healthcare facilities have become sites of criminal investigation. These investigations target women not only for illegal abortions, but also for miscarriages and obstetric emergencies. The ban further prevents physicians from providing medical care that is often necessary to preserve a woman's life or health. Finally, by criminalizing women's pregnancy outcomes, the regime undermines the country's recent public health improvement efforts and compounds the marginalization of women and girls from its most vulnerable communities, in violation of the state's international human rights obligations.

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OBJECTIVE: A recent publication [Koch E, Chireau M, Pliego F, Stanford J, Haddad S, Calhoun B, Aracena P, Bravo M, Gatica S, Thorp J. Abortion legislation, maternal healthcare, fertility, female literacy, sanitation, violence against women and maternal deaths: a natural experiment in 32 Mexican states. BMJ Open 2015;5(2):e006013] claimed that Mexican states with more restrictive abortion laws had lower levels of maternal mortality. Our objectives are to replicate the analysis, reanalyze the data and offer a critique of the key flaws of the Koch study. STUDY DESIGN: We used corrected maternal mortality data (2006-2013), live births, and state-level indicators of poverty. We replicate the published analysis. We then reclassified state-level exposure to abortion on demand based on actual availability of abortion (Mexico City versus the other 31 states) and test the association of abortion access and the maternal mortality ratio (MMR) using descriptives over time, pooled chi-square tests and regression models. We included 256 state-year observations. RESULTS: We did not find significant differences in MMR between Mexico City (MMR=49.1) and the 31 states (MMR=44.6; p=.44). Using Koch's classification of states, we replicated published differences of higher MMR where abortion is more available. We found a significant, negative association between MMR and availability of abortion in the same multivariable models as Koch, but using our state classification (beta=-22.49, 95% CI=-38.9; -5.99). State-level poverty remains highly correlated with MMR. CONCLUSION: Koch makes errors in methodology and interpretation, making false causal claims about abortion law and MMR. MMR is falling most rapidly in Mexico City, but our main study limitation is an inability to draw causal inference about abortion law or access and maternal mortality. We need rigorous evidence about the health impacts of increasing access to safe abortion worldwide. IMPLICATIONS: Transparency and integrity in research is crucial, as well as perhaps even more in politically contested topics such as abortion. Rigorous evidence about the health impacts of increasing access to safe abortion worldwide is needed.

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OBJECTIVE: To evaluate the implementation of the law that liberalizes voluntary abortion in Uruguay and enables health services to offer these services to the population. METHODS: The legal and regulatory provisions are described and the national data-provided by the Ministry of Public Health's National Information System (SINADI)-on the number of voluntary terminations of pregnancy, the abortion method (medical or surgical), and whether it was performed as an outpatient or inpatient are analyzed. To determine complications, the number of maternal deaths and admissions to intensive care units for pregnant women was used. The study period ran from December 1, 2012, to December 31, 2014. RESULTS: A total of 15 996 abortions were performed during the study period; only 1.2% were surgical and 98.8% were medical. Of the latter, only 3.4% required hospitalization. Less than half of the pregnancies were terminated up to 9weeks of gestation and 54% were at 10 to 12weeks in a sample from the Pereira Rossell Hospital. CONCLUSION: The rapid nationwide rollout of voluntary termination of pregnancy services to all women was possible to a large degree thanks to the availability and broad acceptance of medical abortion, facilitated by the prior experience in applying the risk and harm reduction strategy.

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OBJECTIVE: To evaluate the implementation of the law that liberalizes voluntary abortion in Uruguay and enables health services to offer these services to the population. METHODS: The legal and regulatory provisions are described and the national data-provided by the Ministry of Public Health's National Information System (SINADI)-on the number of voluntary terminations of pregnancy, the abortion method (medical or surgical), and whether it was performed as an outpatient or inpatient are analyzed. To determine complications, the number of maternal deaths and admissions to intensive care units for pregnant women was used. The study period ran from December 1, 2012, to December 31, 2014. RESULTS: A total of 15 996 abortions were performed during the study period; only 1.2% were surgical and 98.8% were medical. Of the latter, only 3.4% required hospitalization. Less than half of the pregnancies were terminated up to 9 weeks of gestation and 54% were at 10 to 12 weeks in a sample from the Pereira Rossell Hospital. CONCLUSION: The rapid nationwide rollout of voluntary termination of pregnancy services to all women was possible to a large degree thanks to the availability and broad acceptance of medical abortion, facilitated by the prior experience in applying the risk and harm reduction strategy.

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OBJETIVO: Avaliar e comparar o conhecimento, as atitudes e opiniões dos estudantes de Medicina quanto ao aborto no Brasil durante o evoluir do curso. MÉTODOS: Estudo transversal envolvendo 174 estudantes de Medicina. Foi aplicado um questionário cujas variáveis dependentes foram: o grau de informação sobre o aborto, incluindo seus aspectos jurídicos no Brasil, as situações em que concordaria com a ampliação do permissivo legal do aborto, o conhecimento de alguém submetido ao abortamento e o desconforto em realizar o procedimento de forma legal. As variáveis independentes estudadas foram: dados sociodemográficos, religião e situação acadêmica (primeira ou segunda metade do curso). Para análise dos dados foram utilizados os testes do χ2 e exato de Fischer, com nível de significância de 5%. RESULTADOS: Entre os entrevistados, 59,8% foram considerados bem informados acerca do tema. Os estudantes demonstraram conhecimento a respeito das complicações decorrentes do abortamento, sem diferenças com o evoluir do curso. O conhecimento dos aspectos legais do abortamento no Brasil foi demonstrado por 48,9% da amostra, sendo significativamente superior entre os alunos da segunda metade do curso (34,0 e 68,9% respectivamente; p<0,001). A vivência de situações do abortamento clandestino foi significativamente maior entre os alunos da metade final do curso (35,0 e 59,4% respectivamente p<0,001), o mesmo ocorrendo quanto ao conhecimento de alguém que tenha sido submetida ao procedimento de forma ilegal (5,0 e 18,9% respectivamente; p<0,001). A ampliação do permissivo legal do abortamento no Brasil foi concordado por 86,2% da amostra, porém 54,6% dos estudantes relataram que se sentem desconfortáveis em realizar o procedimento mesmo de forma legal, ambos sem significância ...

PURPOSE: To analyze and compare the knowledge, attitudes and opinions of medical students about abortion in Brazil during the progression of the course. METHODS: This was a cross-sectional study involving 174 medical students. A questionnaire was applied whose dependent variables were degree of information about abortion, including its legal aspects in Brazil, situations in which the students would agree with the expansion of permitted legal abortion, knowledge of someone undergoing abortion, and discomfort about performing the procedure legally. The independent variables were sociodemographic data, religion, and academic standing (first or second half of the course). For data analysis it was used χ2 and Fisher's exact tests, with the level of significance set at 5%. RESULTS: Among the interviewees, 59.8 % considered themselves well informed about the topic. Students demonstrated knowledge about the complications of abortion, with no differences with the progression of the course. Knowledge about the legal aspects of abortion in Brazil was shown by 48.9% of the sample, being significantly higher among students in the second half of the course (34.0 and 68.9%, respectively; p<0.001). Experiencing situations of clandestine abortion was significantly higher among students in the final half of the course (3.05 and 59.4%, respectively; p<0.001), the same being observed about knowing someone who underwent the procedure illegally (5.0 and 18.9%, respectively; p<0.001). The expansion of permissive legal abortion in Brazil was agreed about by 86.2% students, although 54.6% of the students reported that they felt uncomfortable about performing the procedure even legally, without statistical significance with the evolution of the course regarding the two situations. CONCLUSIONS: The experiences of abortion and the knowledge of legal aspects were significantly higher among students in the second half of the course, with ...

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