RESUMO
OBJECTIVE: Although medication abortion has become more common in high-income countries, the procedure has not yet met early expectations for widening access to abortion. High-quality evidence can serve as a catalyst for changes in policy and practice. To direct research priorities, it is important to understand where quality evidence is concentrated and where gaps remain. High-income countries have developed a body of evidence that may have implications for the future of medication abortion. This literature review assesses the characteristics and quality of published studies on medication abortion conducted in the last 10 years in high-income countries and indicates future areas for research to advance policy and practice, and broaden access. STUDY DESIGN: A structured search for literature resulted in 207 included studies. A framework based upon the World Health Organization definition of sub-tasks for medication abortion was developed to categorize research by recognized stages of the medication abortion process. Using an iterative and inductive approach, additional sub-themes were created under each of these categories. Established quality assessment frameworks were drawn upon to gauge the internal and external validity of the included research. RESULTS: Studies in the US and the UK have dominated research on MA in high-income countries. The political and social contexts of these countries will have shaped of this body of research. The past decade of research has focused largely on clinical aspects of medication abortion. CONCLUSION: Researchers should consider refocusing energies toward testing service delivery approaches demonstrating promise and prioritizing research that has broader generalizability and relevance outside of narrow clinical contexts. Although medication abortion is more commonly available worldwide, it is not being used as often as people thought it would be, particularly in high income countries. In order to encourage changes in policy and practice that would allow greater use, we need good quality evidence. If we can understand where we do not have enough research and where we have good amounts of research, we can determine where to invest energies in further studies. Many high-income countries have produced research on medication abortion that could influence policy and practice in similarly resourced contexts. I conducted a literature review to be able to understand the type and quality of research on medication abortion conducted in high-income countries in the past 10 years. I conducted the review in an organized way to make sure that the papers reviewed discussed studies that I thought would be important for answering this question. The literature review found 207 papers. Each of these papers were reviewed and organized them by theme. I also used existing methods to determinine the quality of each study. Most of the research came from the US and the UK. Furthermore, most of the research conducted in the past 10 years was focused on clinical studies of medication abortion. In future studies, researchers should focus more on new ways of providing medication abortion to women that offers greater access. Also, the studies should be designed so that the results have meaning for a broader group of people or situations beyond where the study was done.
Assuntos
Abortivos/uso terapêutico , Aborto Induzido , Atenção à Saúde , Países Desenvolvidos , Feminino , Humanos , Renda , Gravidez , Garantia da Qualidade dos Cuidados de SaúdeRESUMO
In the aftermath of the introduction of severe restrictions on abortion in several US states, some activists have argued that providing widespread access to an abortive drug, misoprostol, will transform an induced abortion into a fully private act and therefore will empower women. In Brazil, where abortion is criminalized, the majority of women who wish to terminate an unwanted pregnancy already use the illegal, but easily accessible, misoprostol. We examine the history of misoprostol as an abortifacient in Brazil from the late 1980s until today and the professional debates on the teratogenicity of this drug. The effects of a given pharmaceutical compound, we argue, are always articulated, elicited, and informed within dense networks of sociocultural, economic, legal, and political settings. In a conservative and repressive environment, the use of misoprostol for self-induced abortions, even when supported by formal or informal solidarity networks, is far from being a satisfactory solution to the curbing of women's reproductive rights.
Assuntos
Abortivos/uso terapêutico , Aborto Induzido/legislação & jurisprudência , Aborto Induzido/métodos , Empoderamento , Misoprostol/uso terapêutico , Abortivos/administração & dosagem , Abortivos/efeitos adversos , Aborto Induzido/psicologia , Brasil , Características Culturais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Misoprostol/administração & dosagem , Misoprostol/efeitos adversos , Política , Direitos Sexuais e Reprodutivos , Direitos da MulherRESUMO
Ante las evidencias de causalidad entre la infección prenatal de virus ZIKA y el desarrollo de microcefalia y otras anomalías cerebrales fetales, publicadas en el año 2016, en Latinoamérica ha surgido mucha incertidumbre sobre el acceso al aborto en mujeres embarazadas infectadas por el virus. Pese a que existe diversidad regulatoria en la región, hoy existen diferentes instancias que facilitan el aborto farmacológico a las mujeres, incluso en países donde está prohibido. Sin embargo esta realidad no se centra exclusivamente en el brote de virus ZIKA, sino que este hecho ha dejado en evidencia la forma como ONG's internacionales ingresan y facilitan el acceso del aborto farmacológico en diferentes países. Este escenario surgiere la interrogante de cómo enfrenta Chile el desarrollo de esta realidad, ante lo cual se muestra la incidencia de la ONG Women on Web en Chile luego de la alerta epidemiológica emitida por la OPS en noviembre de 2015 por virus ZIKA. Desde Chile se presentaron 442 peticiones de aborto farmacológico en 107 días después de emitida la alerta. Estos datos revelan que en Chile, pese a no estar afectado por virus ZIKA, de hecho se usan las plataformas web que proveen de un "aborto farmacológico por correspondencia". Esta evidencia muestra como hoy en Chile existe acceso al aborto farmacológico, tanto desde ONG's internacionales como la presentada, pero también en el comercio informal, todo promovido desde los alcances de las tecnologías de comunicación.
In lieu of the evidence of causality between prenatal ZIKA virus infection and the development of microcephaly and other fetal cerebral anomalies, published in 2016, there has been a surge of uncertainty in Latin America over the access to abortion in pregnant women infected by the virus. Even though diverse regulation exists in the region, today there are many different instances that facilitate women's to pharmacological abortion, even in countries where it is prohibited. However, this reality doesn't center exclusively in the ZIKA virus outbreak, rather this event has emphasized how international NGOs enter and facilitate access to pharmacological abortion in different countries. This scenario suggests the question of how Chile confronts the development of this reality, in which the marked incidence of the NGO Women on Web is shown in Chile after de epidemiology alert emitted by the PAHO in November of 2015 because of the ZIKA virus. Chile presented 442 petitions for pharmacological abortion in the 107 days following the alert notification. This data reveals that Chile, although unaffected by the ZIKA virus, has use of web platforms that provide a "pharmacological abortion by correspondence". This evidence demonstrates how access to pharmacological abortion exists today in Chile, not only from international NGO like the one mentioned, but even through informal commerce, promoted by the reach of communication technology.
Assuntos
Humanos , Feminino , Gravidez , Aborto Induzido/estatística & dados numéricos , Infecção por Zika virus/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Abortivos/uso terapêutico , Chile/epidemiologiaRESUMO
PURPOSE: The purpose of this study is to verify the use of medicinal plants by pregnant women treated at four Basic Health Units and at a public maternity facility in Brazil's northeast. METHODS: This is a cross-sectional, quantitative study, performed between February and April 2014. The subjects were 178 pregnant women, aged 18 to 42 years. To collect data, a structured questionnaire with dichotomous and multiple choice questions was used. To verify the correlation between the variables, Pearson's chi-square test was used. RESULTS: The study showed that 30.9% of the pregnant women used medicinal plants, and boldo was the most cited (35.4%). All the plants utilized, except lemongrass, have toxic effects in pregnancy, according to Resolution SES/RJ N° 1757. There was no statistically significant correlation between social class and use of medicinal plants. CONCLUSION: The health of the study participants and their unborn children is at risk due to the inappropriate use of medicinal plants.
Assuntos
Abortivos/uso terapêutico , Plantas Medicinais , Teratogênicos , Abortivos/efeitos adversos , Adolescente , Adulto , Brasil , Estudos Transversais , Feminino , Humanos , Gravidez , Inquéritos e Questionários , Adulto JovemRESUMO
Purpose The purpose of this study is to verify the use ofmedicinal plants by pregnant women treated at four Basic Health Units and at a public maternity facility in Brazil s northeast. Methods This is a cross-sectional, quantitative study, performed between February and April 2014. The subjects were 178 pregnant women, aged 18 to 42 years. To collect data, a structured questionnaire with dichotomous and multiple choice questions was used. To verify the correlation between the variables, Pearson s chi-square test was used. Results The study showed that 30.9% of the pregnant women used medicinal plants, and boldo was the most cited (35.4%). All the plants utilized, except lemongrass, have toxic effects in pregnancy, according to Resolution SES/RJ N° 1757. There was no statistically significant correlation between social class and use of medicinal plants. Conclusion The health of the study participants and their unborn children is at risk due to the inappropriate use of medicinal plants.
Objetivo Verificar o perfil de uso de plantas medicinais por gestantes atendidas em quatro Unidades Básicas de Saúde da Família e em uma maternidade pública da cidade de Campina Grande - PB, na região Nordeste do Brasil. Métodos Estudo transversal, quantitativo, desenvolvido no período de Fevereiro a Abril de 2014. Foi incluída uma amostra com 178 gestantes com idade entre 18 e 42 anos. O instrumento de coleta foi um questionário estruturado com perguntas dicotômicas e de múltipla escolha. Para verificar a associação entre as variáveis estudadas, utilizou-se o teste Qui-quadrado de Pearson. Resultados Foi constatado que 30,9% das gestantes utilizavam plantas medicinais, sendo o boldo a mais citada (35,4%). Entre as plantas utilizadas com alta frequência pelas gestantes, todas, com exceção apenas da Erva-Cidreira (Melissa officinalis), apresentavam possíveis efeitos tóxicos para a gestação, segundo a Resolução SES/RJ N° 1757. Ao comparar a classe social e o uso de plantas medicinais, não observou-se relação significante. Conclusões A saúde das grávidas que fazem uso de plantas consideradas medicinais, assim como a de seus filhos, sofrem riscos devido ao uso inadequado destas plantas.
Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto , Adulto Jovem , Abortivos/uso terapêutico , Plantas Medicinais , Teratogênicos , Abortivos/efeitos adversos , Brasil , Estudos Transversais , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To characterize the legal and clinical knowledge of Guatemalan obstetrician-gynecologists (OB/GYNs) regarding medical abortion and to determine factors associated with approval of its use for specific indications. METHODS: A trained interviewer administered a multiple-choice survey to 172 private-practice OB/GYNs across Guatemala. Univariate, bivariate, and multivariate analyses characterized medical abortion opinion and knowledge, and logistic regression identified influential factors. RESULTS: 73% of OB/GYNs knew that abortion is legally permitted when the woman's life is at risk. Although 92% knew that misoprostol can be used to induce abortion, only 35% knew the WHO-recommended dosage. Only 25% knew of mifepristone. Compared with older OB/GYNs, those under 40 years of age were 7 times more likely, and 40-49 year olds were twice as likely to approve of medical abortion for fetal death and severe eclampsia with fetal death, respectively. CONCLUSION: Current indications for abortion under Guatemalan law, as well as OB/GYN practices and beliefs regarding medical abortion, are hindering women's access to safe medical abortion and, therefore, potential reductions in maternal morbidity and mortality. Future research should aim to identify whether and why Guatemalan OB/GYNs are unfamiliar with these drugs, prefer to use other methods, or are completely against abortion.
Assuntos
Aborto Induzido/psicologia , Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Médicos/estatística & dados numéricos , Abortivos/administração & dosagem , Abortivos/uso terapêutico , Aborto Induzido/legislação & jurisprudência , Aborto Induzido/métodos , Adulto , Coleta de Dados , Relação Dose-Resposta a Droga , Feminino , Guatemala , Ginecologia/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Mifepristona/administração & dosagem , Mifepristona/uso terapêutico , Misoprostol/administração & dosagem , Misoprostol/uso terapêutico , Análise Multivariada , Obstetrícia/estatística & dados numéricos , GravidezAssuntos
Feminino , Humanos , Gravidez , Adolescente , Adulto , Abortivos/uso terapêutico , Aborto , Saúde da Mulher , Aborto LegalRESUMO
OBJECTIVE: Several local plant extracts are used in folklore practice as abortifacients. The objectives was to determine the scientific basis, if any, for these claims. METHODS: Aqeous extracts were prepared from 6 plants collected from St.Thomas, Jamaica: Leonotis nepetifolia (LN), Mentha pulegium (MP), Phyllanthus amarus (PA), Stachytarpheta jamaicensis (SJ), Gliricidia sepium (GS) and Wedelia gracilis (WG). The extracts were tested for contractile activity on isolated mouse uteri maintained in de Jalons solution. The effects of indomethacin and atropine on the contractions were used to indicate the possible mechanism of action. RESULTS: Three plant extracts (LN, MP and PA) produced dose-dependent contractions of the non-pregnant and pregnant mouse uteri. No contractions were observed with the other three extracts (SJ, GS, and WG). The contractions produced by MP were significantly reduced by indomethacin (p<0.05) but not by atropine. Contractions produced by LN and MP were blocked by either drug. Pregnant mice given LN litterd with live offspring within 24 hours. CONCLUSIONS: Of the 6 plants evaluated, 3 contracted the uterus in vitro but only one (LN) had a significant action in vivo. The contractile effect of MP may possibly be mediated via prostaglandins. However, this plant extract showed significant toxicity in vivo. (AU)
Assuntos
Camundongos , Técnicas In Vitro , Gravidez , 21003 , Feminino , Extratos Vegetais/toxicidade , Medicina Tradicional , Abortivos/uso terapêutico , Folclore , Estudo de Avaliação , Jamaica/etnologiaRESUMO
Según estudio multicéntrico auspiciado por la OMS, a doble ciegas, se ensayaron 3 dosis diferentes de RU-486 complementado por un análogo deprostaglandina E (ONO-802) por vía vaginal, para inducir aborto en los primeros días del embarazo. Nuestro centro estudió 99 pacientes distribuidas en 3 grupos según los tratamientos, grupo I: 200 mg de RU-486, grupo II: 400 mg de RU-486 y grupo III: 600 mg de RU-486, a todas se les colocó un supositorio vaginal de ONO-802 48 horas después. Se estudiaron aquéllas que reunían los criterios de inclusión. Se evidenció alta efectividad de este régimen para interrumpir el embarazo temprano. La eficacia fue del 93,9 por ciento en el grupo I y del 97,0 por ciento en los grupos I y II, sin diferencia significativa. Los efectos secundarios fueron escasos, sólo se destacó el dolor de bajo vientre. El sangramiento fué algo prolongado y de intensidad, fundamentalmente igual al sanggramiento menstrual, no requirió terapeútica. Se demostró que el uso del RU-486 complementado con ONO-802 es altamente efectivo para interrumpir el embarazo temprano, sin diferencias en el empleo de la dosis