RESUMO
METHODS: Retrospective cohort study with review of medical records of women assisted between 2015 and 2020. The variables were socio-demographic and SV characteristics, gestational age, reactions towards pregnancy and outcome. We compared outcome groups using the chi-square test, Fisher's exact test and the Kruskal-Wallis test. The significance level was 5%. RESULTS: We evaluated the medical records of 235 women, of which 153(65%) had undergone to abortion; 17(7.2%) had a spontaneous abortion; 19(8%) remained pregnant; 25(10.6%) had an abortion denied; and 21(8.9%) had been lost to follow-up. Out of the total number of women, 44(18.7%) were adolescents, 152(65.2%) were white and 201(88.5%) had an education ≥9 years. Women who remained pregnant had a known aggressor, disclosed the pregnancy (p < 0.001) and were more ambivalent (p < 0.001) than the other groups. Gestational age was higher in the denied abortion group than in the performed abortion group (p < 0.001). CONCLUSION: Feelings related to decision-making about abortion affected all groups, with differences. It is important to give women space to be heard, so they can make their own decisions.
Abortion care is possible in places with restrictive laws; however, women with more vulnerable characteristics did not seek the service. Legal restrictions interfere with women's decision-making about abortion and can promote inequality in gaining access to health services.
Assuntos
Aborto Legal , Humanos , Feminino , Gravidez , Estudos Retrospectivos , Brasil , Adulto , Aborto Legal/legislação & jurisprudência , Aborto Legal/estatística & dados numéricos , Aborto Legal/psicologia , Adulto Jovem , Adolescente , Aborto Induzido/legislação & jurisprudência , Aborto Induzido/psicologia , Aborto Induzido/estatística & dados numéricos , Idade Gestacional , Resultado da Gravidez , Aborto Espontâneo/psicologia , Aborto Espontâneo/epidemiologiaRESUMO
Objetivo: el objetivo de este estudio es conocer el estado de situación de los procesos de las usuarias que asistieron a la policlínica de interrupción voluntaria del embarazo en el Hospital de Clínicas en un período de agosto de 2019 a agosto de 2020. Metodología y materiales: estudio descriptivo y retrospectivo, a partir de la entrevista clínica de salud mental y una ficha de uso interno utilizada para relevar el proceso de toma de decisión. En muestra de 78 usuarias se analizan variables sociodemográficas, ginecoobstétricas y asociadas al proceso de interrupción, antecedentes psicológicos y/o psiquiátricos y motivos de interrupción. Resultados: el promedio de edad es de 25 años, la mayoría en pareja y ciclo básico educativo finalizado. El promedio de edad gestacional fue de 7,36 semanas. El 81% de las mujeres no había realizado un IVE. Un 65.4% de las mujeres no tienen antecedentes psicológicos y/o psiquiátricos. No existe relación significativa entre haber realizado un IVE previamente y tener antecedentes psicológicos y/o psiquiátricos.Utilizaban anticonceptivos 78.2%. Conclusiones: la interrupción del embarazo supone una situación vital estresante para quienes la transitan, se encuentran atravesadas por múltiples motivos que inciden en la toma de decisión de interrumpir. Se infiere que la realización de uno o más procedimientos de IVE no necesariamente está relacionada con tener un antecedente psicopatológico o cursar una psicopatología al realizar el proceso. Es pertinente promover la atención focalizada en las pacientes, integrando la perspectiva de género y derechos humanos, mejorar los procesos de atención, asesoramiento en salud mental, sexual y reproductiva de las usuarias y sus acompañantes.
Objective: The objective of this study is to know the status of the processes of the users who attended the polyclinic for voluntary termination of pregnancy at the Hospital de Clínicas in a period from August 2019 to August 2020. Methodology and materials: The study used descriptive and retrospective methods based on interviews with mental health professionals and a form that was used to ask about how people make decisions. In a sample of 78 users, sociodemographic, obstetric and gynecological variables associated with the discontinuation process, psychological and/or psychiatric history and reasons for discontinuation were analyzed. Results: The average age is 25 years, most people are married and have finished their elementary education. The average gestational age was 7.36 weeks. 81% of the women had not undergone an IVE. 65.4% of women have no psychological and/or psychiatric history. There is no significant relationship between having previously performed an IVE and having a psychological and/or psychiatric history. 78.2% used contraceptives. Conclusions: The interruption of pregnancy is a stressful life situation for those who go through it; they are faced with multiple reasons that influence the decision to terminate. It is inferred that carrying out one or more IVE procedures is not necessarily related to having a psychopathological history or experiencing psychopathology when carrying out the process. It is pertinent to promote patient-focused care, integrating the gender and human rights perspective, improve care processes, and provide advice on mental, sexual, and reproductive health of users and their companions.
Objetivo: O objetivo deste estudo é conhecer a situação dos processos das usuárias que compareceram à policlínica de interrupção voluntária da gravidez do Hospital de Clínicas no período de agosto de 2019 a agosto de 2020. Metodologia e materiais: estudo descritivo e retrospectivo, baseado na entrevista clínica de saúde mental e em formulário de uso interno utilizado para levantamento do processo de tomada de decisão. Numa amostra de 78 usuárias foram analisadas variáveis ââsociodemográficas, obstétricas e ginecológicas associadas ao processo de descontinuação, histórico psicológico e/ou psiquiátrico e motivos de descontinuação. Resultados: a idade média é de 25 anos, a maioria vive em casal e completou o ciclo educativo básico. A idade gestacional média foi de 7,36 semanas. 81% das mulheres não realizaram IVE. 65,4% das mulheres não têm antecedentes psicológicos e/ou psiquiátricos. Não há relação significativa entre ter realizado EIV anteriormente e ter antecedentes psicológicos e/ou psiquiátricos, 78,2% faziam uso de anticoncepcional. Conclusões: a interrupção da gravidez é uma situação estressante de vida para quem passa por ela, pois se deparam com múltiplos motivos que influenciam na decisão de interrompê-la. Infere-se que a realização de um ou mais procedimentos de IVE não está necessariamente relacionada a ter histórico psicopatológico, ou vivenciar psicopatologia na realização do processo. É pertinente promover cuidados centrados no paciente, integrando a perspectiva de gênero e direitos humanos, melhorar os processos de cuidados e aconselhamento sobre saúde mental, sexual e reprodutiva dos utentes e dos seus acompanhantes.
Assuntos
Humanos , Feminino , Gravidez , Aspirantes a Aborto/estatística & dados numéricos , Aborto Legal/estatística & dados numéricos , Uruguai/epidemiologia , Aspirantes a Aborto/psicologia , Estudos Retrospectivos , Distribuição por Idade , Fatores SociodemográficosRESUMO
Objetivo: Avaliar o desejo de gestantes, vítimas de violência sexual, em manter ou interromper a gravidez. Métodos: Estudo transversal retrospectivo que avaliou o desejo da gestante vítima de violência sexual pela manutenção ou interrupção da gravidez, no Programa de Atendimento às Vítimas de Violência Sexual, no período de janeiro de 2019 a setembro de 2022. Resultados: Foram acolhidas 67 gestantes vítimas de violência sexual que procuraram atendimento com vistas a orientação, manutenção ou interrupção da gestação. Entre elas, 56 (83,6%) pacientes solici- taram a interrupção da gestação e para 32 (57,2%) a solicitação foi aceita; 9 (16%) não tiveram a solicitação de interrupção autorizada por equipe multidisciplinar e mantiveram a gestação; 11 (16,4%) não solicitaram a interrupção e também optaram pela manutenção da gestação. A média das idades foi de 26 anos. Em sua maio- ria, eram solteiras, brancas e procedentes de munícipios do entorno de Caxias do Sul. O agressor era quase sempre desconhecido, e a agressão teria ocorrido pre- dominantemente na residência da vítima ou do agressor. Conclusão: No período estudado, foram avaliadas 67 gestações decorrentes de violência sexual. Dessas, 56 pacientes solicitaram a interrupção da gestação e 32 tiveram a solicitação aceita; nove não tiveram a solicitação de interrupção autorizada e mantiveram a gestação; 11 não solicitaram a interrupção e também optaram pela manutenção da gestação. Não cabe ao médico julgar a decisão da vítima, mas, sim, acolher e ofertar o seu direito de escolha.
Objective: To evaluate the desire of pregnant women, victims of sexual violence, to maintain or terminate pregnancy. Methods: Retrospective cross-sectional study that evaluated the desire of pregnant women victims of sexual violence for the mainte- nance or interruption of pregnancy in Program to Assist Victims of Sexual Assault, from January 2019 to September 2022. Results: Sixty-seven pregnant women who were victim of sexual assault and who sought care for maintenance or interruption of pregnancy were received. Among these, 56 (83.6%) patients requested the interruption of pregnancy and in 32 (57.2%) cases the request was accepted; 9 (16%) didn't have the interruption request authorized by the multidisciplinary team and have kept the pregnancy; 11 (16.4%) didn't request the interruption and have chosen to keep the pregnancy. The average age was 26 years. They were single, white, and mostly from cities around Caxias do Sul. The aggressor was almost always unknown, and the assault occurred mostly at the victim's or aggressor's home. Conclusion: Sixty-seven pregnancies resulting from sexual assault were evaluated during the period of the study. Fifty-sixth patients of those have requested pregnancy termination and 32 had their request accepted; nine didn't have their request for termination authorized and have kept their pregnancy; eleven didn't request termination and have chosen to keep their pregnancy. It isn't up to the physician to judge the victim's decision, but to welcome and offer her the right to choose.
Assuntos
Humanos , Feminino , Gravidez , Manutenção da Gravidez , Estupro , Aborto Legal/estatística & dados numéricos , Gestantes/psicologia , Gravidez/estatística & dados numéricos , Estudos Transversais/métodos , Aborto Induzido/estatística & dados numéricos , Violência contra a MulherRESUMO
En 2021 entró en vigencia en Argentina la Ley N.º 27.610. El objetivo es describir características de afiliadas a OSEP que solicitaron interrupción del embarazo (SIE).Trabajo observacional descriptivo. Se analizaron las variables del 0800 del Ministerio de Salud de la Nación de todas las personas que SIE con OSEP, entre el 24/01 y 31/12/2021. Los datos fueron analizados con SPSS Statistics. Se utilizaron moda, mediana, porcentaje, tasa y el chi2. Se recibieron 427 SIE, se concretaron 330 (77,3%). Solicitaron ive: media 28,59 años. Modo 19 y 33 años. Concretaron ive: modo 22 años. 84,5% se realizó ambulatorio con misoprostol. De las SIE, 50,4% eran solteras, 43,4% trabajaba, 59,1% tenía secundario completo. Se desconoce 32,8%. De las SIE, 52,7% refirió haber estado utilizando MAC (54,2% preservativo; 37,4% anticonceptivos orales; 2,8% métodos "naturales"; 2,2% DIU). La mayor cantidad fue de zonas urbanas del Gran Mendoza. Sin embargo, se observan tasas elevadas en zonas rurales respecto de algunas zonas urbanas y más pobladas. Se observó progresión de SIE a lo largo del año. Un 11% después de SIE decidió continuar con el embarazo. Aparentemente ninguna de las variables tuvo relación con esa decisión. El MAC utilizado fue mayormente preservativo y anticonceptivos orales. Esto podría indicar falta de educación y poco acceso a métodos de larga duración. La problemática de interrupción es transversal. En base a los resultados de este trabajo, las personas sin pareja conviviente, ante un embarazo no planificado serían las que SIE. Ninguna otra variable parece actuar como determinante. Tampoco del paso de la solicitud a la interrupción efectiva o a la continuación del embarazo. Hay que aumentar la accesibilidad a MAC en zonas rurales (AU)
In 2021, Law No. 27610 entered into force in Argentina. The objective is to describe characteristics of people with OSEP who requested termination of pregnancy (PWRTP). Descriptive observational work. The variables of the 0800 of the Ministry of Health of Argentina of all the PWRTP with OSEP, between 01/24 and 12/31/2021, were analyzed. Data were analyzed with SPSS Statistics. Mode, median, percentage, rate and chi2 were used. PWRTP: 427 requests were received, 330 (77.3%) were completed. PWRTP: mean 28.59 years. Mode 19 and 33 years. People who had an abortion: mode 22 years. 84.5% were performed on an outpatient basis with misoprostol. 50.4% of the PWRTP were single, 43.4% worked, 59.1% had completed high school, 32.8% unknown, 52.7% reported having been using contraceptive methods (CM): 54.2% condoms; 37.4% oral contraceptives; 2.8% "natural" methods; 2.2% IUDs. The largest amount was from urban areas of Mendoza. However, high rates are observed in rural areas. A progression of the amount of PWRTP was observed throughout the year. 11% after requesting an abortion decided to continue with the pregnancy. Apparently none of the variables was related to that decision. The CM used were mostly condoms and oral contraceptives. This may indicate a lack of education and poor access to long-acting CM. The problem of interruption is transversal. People without a cohabiting partner, faced with an unplanned pregnancy, are the ones who RTP. No other variable seems to act as a determinant. Nor from the transition from the request to the effective interruption or continuation of the pregnancy. We must increase the accessibility to CM in rural areas (AU)
Assuntos
Humanos , Feminino , Gravidez , Adulto , Gravidez não Desejada , Aborto Legal/estatística & dados numéricos , Anticoncepção/estatística & dados numéricos , Gravidez não Planejada , Manutenção da Gravidez , Gravidez/estatística & dados numéricos , Zona RuralRESUMO
Abstract Objectives: to analyze abortions provided by law (APL) carried out in Brazil between 2010 and 2019 regarding the need for travel of users, as well as the expenditure of time and money on these trips. Methods: descriptive study of records of outpatient care and hospitalizations for APL between 2010 and 2019. The municipal provision and the inter-municipal flows for the realization of the APL, the availability of public transportation for this travel, as well as its cost and time, were identified. Results: 2.6% of Brazilian municipalities had a sustained provision of APL between 2010 and 2019. Of the 15,889 APL performed, 14.8% occurred in municipalities other than those where the user lived. The smaller the population size of the municipality of residence, the higher the percentage of the need for travel. Of these inter-municipal trips, 16.0% had regular round-trip links by public transport. The total travel time ranged from 26 minutes to 4 and a half days, and the cost from R$2.70 to R$1,218.06; the highest medians were among residents of the Midwest region. Conclusions: the concentration of services, the deficiency of inter-municipal public transport, and the expenditure on travel to access the APL are barriers to users that need the health service, demanding public policies to overcome them.
Resumo Objetivos: analisar as restrições aos abortos previstos em lei (APL) realizados no Brasil entre 2010 e 2019 quanto à necessidade de deslocamento das usuárias, bem como quanto ao dispêndio de tempo e dinheiro nessas viagens. Métodos: estudo descritivo dos registros de atendimentos ambulatoriais e internações para APL entre 2010 e 2019. Foram identificados a oferta municipal e os fluxos intermunicipais para realização dos APL, a disponibilidade de transporte coletivo para esse deslocamento, bem como seu custo e tempo. Resultados: 2,6% dos municípios brasileiros tiveram oferta sustentada de APL entre 2010 e 2019. Dos 15.889 APL realizados, 14,8% se deram em municípios diferentes daqueles de residência da usuária. Quanto menor o porte populacional do município de residência, maior o percentual com necessidade de viajar. Desses deslocamentos intermunicipais, 16,0% tinham ligações regulares de ida e retorno em transporte público. O tempo de viagem total variou de 26 minutos a quatro dias e meio, e o custo de R$ 2,70 a R$ 1.218,06; as maiores medianas estiveram entre as residentes da região Centro-Oeste. Conclusões: a concentração de serviços, a deficiência de transporte público intermunicipal, bem como o dispêndio com a viagem para acesso ao APL são barreiras às usuárias que precisam do serviço de saúde, demandando políticas públicas para sua superação.
Assuntos
Humanos , Feminino , Gravidez , Transporte de Pacientes/economia , Transporte de Pacientes/estatística & dados numéricos , Aborto Legal/estatística & dados numéricos , Equidade no Acesso aos Serviços de Saúde , Acessibilidade aos Serviços de Saúde , Hospitalização , Brasil , Estudos Transversais , Serviços de Saúde ReprodutivaRESUMO
Anencephaly is a malformation characterized by the total or partial absence of the brain, and Brazil records the fourth largest number of births of anencephalic fetuses in the world. Fetal anencephaly is associated with a more significant number of maternal complications. As of 2012, women with anencephalic gestation were empowered with the right to carry the pregnancy to term or terminate it, if they so desired, without any judicial authorization. Objectives: to understand the experiences of women with fetal anencephaly and to identify the determinant factors for interrupting the gestation or not. This is a qualitative study using the Life Narratives method with 12 women over 18 years old diagnosed with an anencephalic fetus, who interrupted gestation or delivery in a public maternity hospital in Rio de Janeiro. Data were collected between June and November 2016, and the process was finalized when the narrative patterns reached progressive saturation from the recurrences. The statements that emerged following floating and in-depth reading were articulated in Narrative Nuclei, and data comparative and comprehensive analysis was performed. The reports brought to light the intense experiences of these women, as well as the weaknesses existing concerning care and the pregnancy termination issue.
A anencefalia é uma malformação caracterizada pela ausência total ou parcial do encéfalo e o Brasil é o quarto colocado em número de nascimentos de fetos anencéfalos no mundo. Existe associação entre anencefalia fetal e maior número de complicações maternas. A partir de 2012 a mulher com gestação de anencéfalo poderá manter ou interromper a gestação, se assim o desejar, sem necessidade de autorização judicial. Objetivos: compreender as vivências das mulheres de fetos com anencefalia e identificar os fatores determinantes para a escolha de interromper ou não interromper a gestação. Estudo qualitativo e método das narrativas de vida, com 12 mulheres, maiores de 18 anos e com diagnóstico de feto anencéfalo, que realizaram a interrupção da gestação ou o parto em uma maternidade pública do Rio de Janeiro. A coleta dos dados foi entre junho e novembro de 2016 e encerrada quando os padrões narrativos alcançaram a saturação progressiva, a partir das recorrências. Os enunciados emergidos após leitura flutuante e aprofundada foram articulados em Núcleos Narrativos e realizada análise comparativa e compreensiva dos dados. Os relatos trouxeram à tona as vivências intensas dessas mulheres, como também as fragilidades existentes em relação ao cuidado e a problemática da interrupção da gestação.
Assuntos
Aborto Eugênico/estatística & dados numéricos , Anencefalia , Aborto Eugênico/legislação & jurisprudência , Aborto Eugênico/psicologia , Aborto Legal/psicologia , Aborto Legal/estatística & dados numéricos , Adulto , Brasil , Feminino , Humanos , Gravidez , Adulto JovemRESUMO
The Argentine Penal Code in its article 86 specifies the grounds for the legal interruption of pregnancy. In the Programmatic Area of the Piñero Hospital, city of Buenos Aires, a protocol to perform them was established. Since the implementation it had not been evaluated. The objective was to describe the characteristics of these interventions in 2017. A descriptive study was conducted, as a source of information a form completed by the teams after care for the women was used. There were 503 cases, the average gestational age at the first consultation was 8.5 weeks; 93.8% were resolved in the first level, 94.5% of them in the first trimester of pregnancy. The causal integral health was the main one addressed in the health centers, while in the hospital it was rape. The resolution period for the interruptions was 5.7 days in the health centers and 1.3 days in the hospital. The resolution was with medications in 80.9% of the cases in the health centers. The complication rate was 8 per 1000 interruptions. The subsequent contraceptive method coverage was 16.7 per 100 interruptions. In compliance with the sentence F.A.L. (Supreme Court of Justice), access to legal interruptions of pregnancy and women's care implies an increase in effective access to sexual and reproductive rights and a decrease in the number of those who will be exposed to unsafe practices that increase the risk of morbidity and mortality.
El Código Penal Argentino en su artículo 86 especifica las causales para las interrupciones legales del embarazo. En el área Programática del Hospital Piñero de la Ciudad Autónoma de Buenos Aires se estableció un protocolo para realizarlas. Desde la implementación no se ha evaluado. El objetivo fue describir las características de dichas intervenciones en 2017. Se realizó un estudio descriptivo, como fuente de información se utilizó una planilla completada por los equipos luego de atender a las mujeres. Hubo 503 casos, la edad gestacional promedio de la primera consulta fue de 8.5 semanas. El 93.8% se resolvió en el primer nivel, el 94.5% de ellas en el primer trimestre de gestación. La causal salud integral fue la principalmente tenida en cuenta en los centros de salud, la causal violación lo fue en el hospital. El plazo de resolución de las interrupciones fue de 5.7 días en los centros de salud y de 1.3 días en hospital. La resolución fue medicamentosa en el 80.9% de los casos en los centros de salud. La tasa de complicaciones fue 8 cada 1000 interrupciones. La cobertura de método anticonceptivo posterior fue 16.7 cada 100 interrupciones. En cumplimiento del fallo F.A.L. (Suprema Corte de Justicia de la Nación), el acceso a las interrupciones legales del embarazo y la atención de las mujeres, implica un aumento en el acceso efectivo de los derechos sexuales y reproductivos y una disminución del número de las que se verán expuestas a prácticas inseguras que aumentan su riesgo de morbimortalidad en situación de embarazo.
Assuntos
Aborto Legal/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Argentina , Criança , Feminino , Idade Gestacional , Humanos , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Fatores de Tempo , Adulto JovemRESUMO
Resumo A anencefalia é uma malformação caracterizada pela ausência total ou parcial do encéfalo e o Brasil é o quarto colocado em número de nascimentos de fetos anencéfalos no mundo. Existe associação entre anencefalia fetal e maior número de complicações maternas. A partir de 2012 a mulher com gestação de anencéfalo poderá manter ou interromper a gestação, se assim o desejar, sem necessidade de autorização judicial. Objetivos: compreender as vivências das mulheres de fetos com anencefalia e identificar os fatores determinantes para a escolha de interromper ou não interromper a gestação. Estudo qualitativo e método das narrativas de vida, com 12 mulheres, maiores de 18 anos e com diagnóstico de feto anencéfalo, que realizaram a interrupção da gestação ou o parto em uma maternidade pública do Rio de Janeiro. A coleta dos dados foi entre junho e novembro de 2016 e encerrada quando os padrões narrativos alcançaram a saturação progressiva, a partir das recorrências. Os enunciados emergidos após leitura flutuante e aprofundada foram articulados em Núcleos Narrativos e realizada análise comparativa e compreensiva dos dados. Os relatos trouxeram à tona as vivências intensas dessas mulheres, como também as fragilidades existentes em relação ao cuidado e a problemática da interrupção da gestação.
Abstract Anencephaly is a malformation characterized by the total or partial absence of the brain, and Brazil records the fourth largest number of births of anencephalic fetuses in the world. Fetal anencephaly is associated with a more significant number of maternal complications. As of 2012, women with anencephalic gestation were empowered with the right to carry the pregnancy to term or terminate it, if they so desired, without any judicial authorization. Objectives: to understand the experiences of women with fetal anencephaly and to identify the determinant factors for interrupting the gestation or not. This is a qualitative study using the Life Narratives method with 12 women over 18 years old diagnosed with an anencephalic fetus, who interrupted gestation or delivery in a public maternity hospital in Rio de Janeiro. Data were collected between June and November 2016, and the process was finalized when the narrative patterns reached progressive saturation from the recurrences. The statements that emerged following floating and in-depth reading were articulated in Narrative Nuclei, and data comparative and comprehensive analysis was performed. The reports brought to light the intense experiences of these women, as well as the weaknesses existing concerning care and the pregnancy termination issue.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Adulto Jovem , Aborto Eugênico/estatística & dados numéricos , Anencefalia , Brasil , Aborto Eugênico/legislação & jurisprudência , Aborto Eugênico/psicologia , Aborto Legal/psicologia , Aborto Legal/estatística & dados numéricosRESUMO
El Código Penal Argentino en su artículo 86 especifica las causales para las interrupciones legales del embarazo. En el Área Programática del Hospital Piñero de la Ciudad Autónoma de Buenos Aires se estableció un protocolo para realizarlas. Desde la implementación no se ha evaluado. El objetivo fue describir las características de dichas intervenciones en 2017. Se realizó un estudio descriptivo, como fuente de información se utilizó una planilla completada por los equipos luego de atender a las mujeres. Hubo 503 casos, la edad gestacional promedio de la primera consulta fue de 8.5 semanas. El 93.8% se resolvió en el primer nivel, el 94.5% de ellas en el primer trimestre de gestación. La causal salud integral fue la principalmente tenida en cuenta en los centros de salud, la causal violación lo fue en el hospital. El plazo de resolución de las interrupciones fue de 5.7 días en los centros de salud y de 1.3 días en hospital. La resolución fue medicamentosa en el 80.9% de los casos en los centros de salud. La tasa de complicaciones fue 8 cada 1000 interrupciones. La cobertura de método anticonceptivo posterior fue 16.7 cada 100 interrupciones. En cumplimiento del fallo F.A.L. (Suprema Corte de Justicia de la Nación), el acceso a las interrupciones legales del embarazo y la atención de las mujeres, implica un aumento en el acceso efectivo de los derechos sexuales y reproductivos y una disminución del número de las que se verán expuestas a prácticas inseguras que aumentan su riesgo de morbimortalidad en situación de embarazo.
The Argentine Penal Code in its article 86 specifies the grounds for the legal interruption of pregnancy. In the Programmatic Area of the Piñero Hospital, city of Buenos Aires, a protocol to perform them was established. Since the implementation it had not been evaluated. The objective was to describe the characteristics of these interventions in 2017. A descriptive study was conducted, as a source of information a form completed by the teams after care for the women was used. There were 503 cases, the average gestational age at the first consultation was 8.5 weeks; 93.8% were resolved in the first level, 94.5% of them in the first trimester of pregnancy. The causal integral health was the main one addressed in the health centers, while in the hospital it was rape. The resolution period for the interruptions was 5.7 days in the health centers and 1.3 days in the hospital. The resolution was with medications in 80.9% of the cases in the health centers. The complication rate was 8 per 1000 interruptions. The subsequent contraceptive method coverage was 16.7 per 100 interruptions. In compliance with the sentence F.A.L. (Supreme Court of Justice), access to legal interruptions of pregnancy and women's care implies an increase in effective access to sexual and reproductive rights and a decrease in the number of those who will be exposed to unsafe practices that increase the risk of morbidity and mortality.
Assuntos
Humanos , Feminino , Gravidez , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Aborto Legal/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Argentina , Fatores de Tempo , Estudos Retrospectivos , Idade Gestacional , Distribuição por IdadeRESUMO
En el contexto de la publicación por parte del Ministerio de Salud de la Nación de Argentina del Protocolo para la atenciónintegral de las personas con derecho a la interrupción legal del embarazo (ILE), resumido y comentado en este mismonúmero de EVIDENCIA, este comentario editorial ofrece: 1) una perspectiva amplia de lo que significa el aborto, desde lamirada estrictamente biologicista hasta definiciones basadas en el enfoque de género; 2) una descripción de los diferentesmarcos jurídicos respecto del aborto que imperan actualmente en Latinoamérica y Argentina, haciendo especial hincapiéen lo concerniente a las ILE; 3) información epidemiológica sobre la mortalidad materna en Argentina y la asociada alaborto inseguro; 4) estadísticas sobre la realización de ILE en la Ciudad Autónoma de Buenos Aires, Argentina.Dada la situación actual de aislamiento social preventivo obligatorio en el marco de la pandemia de Covid-19, conside-ramos quienes integramos equipos de salud debemos estar más atentos/as que nunca a las situaciones de violenciapotencial que podrían suceder en este contexto, para dar las respuestas pertinentes -entre las que se incluyen las ILE-, alas víctimas de embarazos no deseados consecutivos a situaciones de coerción. (AU)
In the context of the publication by the Argentine Ministry of Health of the Protocol for the comprehensive care of people withthe right to legal termination of pregnancy (LTP), summarized and commented on in this same issue of EVIDENCIA, thiseditorial article offers: 1) a broad perspective of what abortion means, from a strictly biological point of view to definitionsbased on the gender approach; 2) a description of the different legal frameworks regarding abortion that currently prevailin Latin America and Argentina, with special emphasis on LTP; 3) epidemiological information on maternal mortality inArgentina and that associated with unsafe abortion; 4) statistics on the realization of LTP in the Autonomous City ofBuenos Aires, Argentina.Given the current situation of mandatory preventive social isolation in the framework of the Covid-19 pandemic, we considerthat those of us who are part of health teams should be more alert than ever to situations of potential violence that couldoccur in this context, to give the relevant responses - including LTP- to victims of unwanted pregnancies following coercivesituations. (AU)
Assuntos
Humanos , Feminino , Gravidez , Criança , Adolescente , Adulto , Adulto Jovem , Isolamento Social , Aborto Criminoso/legislação & jurisprudência , Aborto Legal/legislação & jurisprudência , Violência de Gênero/legislação & jurisprudência , Argentina , Gravidez não Desejada/ética , Estupro/legislação & jurisprudência , Aborto Criminoso/estatística & dados numéricos , Aborto Criminoso/ética , Mortalidade Materna , Infecções por Coronavirus , Aborto Legal/estatística & dados numéricos , Aborto Legal/ética , Feminismo , Aborto , Saúde de Gênero/ética , Perspectiva de Gênero , Políticas Inclusivas de GêneroRESUMO
Objetivos: Evaluar los datos clínicos obtenido en la policlínica de Salud Sexual y Reproductiva del Hospital Universitario a los 6 años de la implementación de la ley de interrupción voluntaria del embarazo (IVE). Métodos: revisión de historias clínicas de diciembre de 2012 a diciembre de 2018. Resultados: de 448 pacientes, 361 completaron el proceso IVE, 63 requirieron una segunda dosis de Misoprostol. Cuarenta pacientes decidieron continuar sus embarazos y siguieron con el control en el servicio y 32 no volvieron tras su primera entrevista. Conclusiones: basado en los resultados de la investigación, el procedimiento médico de IVE es efectivo en todos los casos, solo en 33 pacientes se requirió procedimientos quirúrgicos adicionales. La ley IVE representa un progreso considerable en la salud reproductiva de la mujer uruguaya. La IVE ha asegurado asistencia médica, salud y el respeto a los derechos reproductivos sexuales y humanos, incluyendo oportunidad, continuidad y humanización de la interrupción del embarazo. La existencia de la ley de por sí no garantiza que las mujeres opten por abortar.
Aims: To evaluate clinical data from the Sexual and Reproductive Health Clinic of the University Hospital six years after the implementation of the voluntary interruption of pregnancy law (VIP). Methods: revision of clinical records from December 2012 to December 2018. Results: Out of 448 patients, 361 interrupted their pregnancies. 63 patients required a second dose of Misoprostol, 30 patients required additional medical interventions, 49 patients decided to continue their pregnancies and were provided assistance, and 32 did not return following their first interview. Conclusions: Based on the research findings, the medical procedure of VIP is effective in all the cases, just 33 needs surgical additional process. The VIP law represents a considerable progress in the reproductive health of Uruguayan women. As a result, there is a higher rate of abortions in the country. VIP has ensured medical assistance, healthcare and respect for sexual and human reproductive rights, including opportunity, continuity, and humanization of pregnancy interruption. The existence of the law per se does not ensure that women will opt for abortion.
Objetivos: Avaliar os dados clínicos obtidos na Policlínica de Saúde Sexual e Reprodutiva do Hospital Universitário 6 anos após a implementação da lei da interrupção voluntária da gravidez (IVE). Métodos: revisão de historias de dezembro de 2012 a dezembro de 2018. Resultados: Dos 448 pacientes, 361 completaram o processo IVE, 63 necessitaram de uma segunda dose de Misoprostol. Quarenta y nove pacientes decidiram continuar suas gestações e continuei o controle no serviço e 32 não retornaram após a primeira entrevista. Conclusões: Com base nos resultados da investigação, o procedimento médico do IVE é eficaz em todos os casos, apenas em 33 pacientes foram necessários procedimentos cirúrgicos adicionais. A lei do IVE representa um progresso considerável na saúde reprodutiva das mulheres uruguaias. O IVE assegurou cuidados médicos, saúde e respeito pelos direitos sexuais e reprodutivos humanos, incluindo oportunidades, continuidade e humanização da interrupção de gravidez a existência da lei em si não garante que as mulheres a optar por abortar.
Assuntos
Humanos , Feminino , Adolescente , Adulto , Aborto Legal/legislação & jurisprudência , Aborto Legal/estatística & dados numéricos , Uruguai , Epidemiologia Descritiva , Estudos Retrospectivos , Aborto Legal/métodos , Avaliação do Impacto na SaúdeRESUMO
Background and Objectives: In pregnancies resulting from incest, the adolescent maintains close family and emotional relations with the aggressor, different from what occurs when pregnancy results from sexual violence by strangers. Evidence indicates that this type of relationship with the aggressor may interfere in the dynamics of such violence and the adolescent's access to health services. Materials and Methods: The objective of this research was to describe and correlate aspects associated with pregnancy when resulting from rape of adolescents in situations of incest; rape when perpetrated by an unknown aggressor and an abortion as allowed by law was sought. Method: A cross-sectional, epidemiological study of adolescents treated at the Pérola Byington Hospital, São Paulo, Brazil, bringing an allegation of pregnancy, resulting from sexual violence and a request for abortion as allowed by law. A total of 311 adolescents, being 134 in the "pregnancy from incest group", and 174 in the group "pregnancies resulting from rape by a stranger" were considered under the study variables; relationships were investigated using the chi-squared test and Poisson regression with robust variance. Results: The study included 137 cases (44.1%) of pregnancy resulting from incest, and 174 cases (55.9%) of pregnancy from rape by a stranger. In cases of incest, a declaration of religion (92.0%) was significantly more frequent, and the adolescents were approached in spaces considered safe or private (92.7%); the aggressor taking advantage of the adolescent's legal condition of vulnerability as a function of age (83.3%). Cases of incest presented a lower median adolescent age and greater gestational development, with gestations being ≥ 13 weeks prevailing. Conclusion: Cases of pregnancy by incest presented indicators suggesting both proximity and relationship with the aggressor, and pregnancy at a very early age, which postponed the adolescent's procurement of health service, and interfered negatively with abortion assistance as allowed by law.
Assuntos
Aborto Legal/estatística & dados numéricos , Incesto/psicologia , Gravidez na Adolescência/estatística & dados numéricos , Delitos Sexuais/estatística & dados numéricos , Adolescente , Brasil , Estudos Transversais , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , GravidezRESUMO
During the first semester of 2018, a profound debate on the legalization of the practice of abortion was initiated in Argentina, which exposed the lack of scientific studies addressing the economic dimension of abortion in this country. This work seeks to move forward in the quantification of the costs of abortion under two scenarios: the current context of illegality and the potential costs if the recommended international protocols were applied in a context of legalization of the practice. The results of the comparison between, on the one hand, the total monetary costs in 2018 (private or out-of-pocket expenditure and costs for the health care system) of the current scenario of illegality and unsafe practice of abortion and, on the other hand, potential scenarios of safe practices, shows that a large amount of resources could be saved if the recommended protocols were implemented. These results proved to be robust after carrying out a series of sensitivity exercises on the main assumptions included in the comparisons.
Durante el primer semestre de 2018, en Argentina se inició un profundo debate sobre la legalización de la práctica del aborto, que puso en evidencia la falta de estudios científicos que aborden la dimensión económica del tema en la Argentina. Este trabajo busca avanzar en la cuantificación de los costos del aborto bajo dos escenarios: el del actual contexto de ilegalidad y los costos potenciales si se aplicaran los protocolos internacionales recomendados, en un contexto de legalización de la práctica. Los resultados de la comparación de los costos monetarios totales en 2018 (privados o de bolsillo y para el sistema de salud) del escenario actual de ilegalidad y práctica insegura del aborto, frente a escenarios potenciales de prácticas seguras, muestran que se podría ahorrar una gran cantidad de recursos si se implementaran los protocolos recomendados. Dichos resultandos, además, se muestran robustos al realizar una serie de ejercicios de sensibilidad sobre los principales supuestos incluidos en las comparaciones.
Assuntos
Aborto Criminoso/economia , Aborto Legal/economia , Custos de Cuidados de Saúde , Aborto Criminoso/efeitos adversos , Aborto Criminoso/legislação & jurisprudência , Aborto Criminoso/estatística & dados numéricos , Aborto Legal/efeitos adversos , Aborto Legal/legislação & jurisprudência , Aborto Legal/estatística & dados numéricos , Argentina , Redução de Custos/economia , Feminino , Gastos em Saúde , Humanos , Complicações Pós-Operatórias/economia , GravidezRESUMO
OBJECTIVES: In the Mexico City Metropolitan Area, only women in the city center have local access to legal first-trimester abortion. We quantify how this legislative discrepancy affects access to legal, public-sector abortion across the metropolitan area. STUDY DESIGN: In this observational study, we used a dataset representing 67.2% of all abortions occurring between 2010 and 2012 in Mexico City's public abortion program and census population data. We calculate utilization rates for 75 municipalities in the metropolitan area for 2010-2012. We compare utilization between municipalities with and without local legal access, adjusting for differences in sociodemographic drivers of abortion demand. We explore the effects of local abortion legality, travel time and socioeconomic status (SES). RESULTS: Women who had to travel into the city center for legal abortions used services at only 18.6% (95% CI 13.3%-33.0%) of the expected rate if they had local access, adjusting for sociodemographic factors. After controlling for travel time and SES, women who lived where abortion is illegal had a 58.6% (95% CI 21.5%-78.1%) reduction in access, and each additional 15â¯min of travel further reduced access by 33.7% (95% CI 18.2%-46.3%). Women who travel to seek legal abortions are more likely to have completed secondary education compared to other reproductive age women in their municipality (pâ¯=â¯<.00001). CONCLUSIONS: We find that, in the Mexico City Metropolitan Area, both living where abortion is illegal and having to travel further to access services substantially reduce access to legal, public-sector abortion. These burdens disproportionately affect women of lower SES. IMPLICATIONS: Both local legality and proximate access are key to ensuring equity in access to public-sector abortion. Legalization of abortion services across the greater Mexico City Metropolitan Area has the potential to increase equity in utilization and meet unmet demand for legal abortion.
Assuntos
Aspirantes a Aborto , Aborto Legal/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Setor Público/legislação & jurisprudência , Adulto , Cidades , Feminino , Humanos , Prontuários Médicos , México , Gravidez , Análise de Regressão , Classe Social , Viagem , Adulto JovemRESUMO
RESUMEN Durante el primer semestre de 2018, en Argentina se inició un profundo debate sobre la legalización de la práctica del aborto, que puso en evidencia la falta de estudios científicos que aborden la dimensión económica del tema en la Argentina. Este trabajo busca avanzar en la cuantificación de los costos del aborto bajo dos escenarios: el del actual contexto de ilegalidad y los costos potenciales si se aplicaran los protocolos internacionales recomendados, en un contexto de legalización de la práctica. Los resultados de la comparación de los costos monetarios totales en 2018 (privados o de bolsillo y para el sistema de salud) del escenario actual de ilegalidad y práctica insegura del aborto, frente a escenarios potenciales de prácticas seguras, muestran que se podría ahorrar una gran cantidad de recursos si se implementaran los protocolos recomendados. Dichos resultandos, además, se muestran robustos al realizar una serie de ejercicios de sensibilidad sobre los principales supuestos incluidos en las comparaciones.
ABSTRACT During the first semester of 2018, a profound debate on the legalization of the practice of abortion was initiated in Argentina, which exposed the lack of scientific studies addressing the economic dimension of abortion in this country. This work seeks to move forward in the quantification of the costs of abortion under two scenarios: the current context of illegality and the potential costs if the recommended international protocols were applied in a context of legalization of the practice. The results of the comparison between, on the one hand, the total monetary costs in 2018 (private or out-of-pocket expenditure and costs for the health care system) of the current scenario of illegality and unsafe practice of abortion and, on the other hand, potential scenarios of safe practices, shows that a large amount of resources could be saved if the recommended protocols were implemented. These results proved to be robust after carrying out a series of sensitivity exercises on the main assumptions included in the comparisons.
Assuntos
Humanos , Feminino , Gravidez , Aborto Criminoso/economia , Custos de Cuidados de Saúde , Aborto Legal/economia , Argentina , Complicações Pós-Operatórias/economia , Aborto Criminoso/efeitos adversos , Aborto Criminoso/legislação & jurisprudência , Aborto Criminoso/estatística & dados numéricos , Redução de Custos/economia , Gastos em Saúde , Aborto Legal/efeitos adversos , Aborto Legal/legislação & jurisprudência , Aborto Legal/estatística & dados numéricosRESUMO
CONTEXT: Although abortion is illegal in most of Mexico, it was decriminalized in Mexico City in 2007, creating an island of legal abortion in a sea of restricted access. The characteristics of women seeking abortions in Mexico City-notably their socioeconomic status and place of residence-have not been well documented. METHODS: Medical records from 22,732 women who sought abortions at one of four primary-level clinics in Mexico City in 2013-2015 were used to examine characteristics of women seeking legal abortion. Linear regression analyses were used to explore differences between women from Mexico City and those from elsewhere in Mexico, using education as a proxy for socioeconomic status. Because of geographic differences in population structure, women's education level was normalized in some models. RESULTS: Most abortion seekers came from Mexico City (66%) or its surrounding metropolitan area (22%), while the remainder came from bordering states (7%) or the rest of Mexico (5%). Abortion seekers from the rest of Mexico had, on average, 1.4 more years of education than did those from Mexico City. In regression models that normalized education levels, the difference in educational attainment between women from the rest of Mexico and those from Mexico City was 4.9 years (unadjusted model) and 3.2 years (adjusted model). CONCLUSIONS: These findings, in conjunction with the literature on unsafe abortion in Mexico, suggest that women from outside Mexico City who have low levels of education may be less likely than their more educated peers to benefit from the safe abortion services provided in the city.
RESUMEN Contexto: Aunque el aborto es ilegal en la mayor parte de México, en 2007 fue despenalizado en la Ciudad de México, creando una isla de aborto legal en un mar de acceso restringido. Las características de las mujeres que buscan servicios de aborto en la Ciudad de México en particular su condición socioeconómica y lugar de residencia, no han sido bien documentadas. Métodos: Se usaron los registros médicos de 22,732 mujeres que buscaron servicios de aborto en una de las cuatro clínicas de nivel primario en la Ciudad de México entre 2013 y 2015 para examinar las características de las mujeres que buscan un aborto legal. Se aplicaron análisis de regresión lineal para explorar las diferencias entre las mujeres de la Ciudad de México y las de otros lugares de México, utilizando la escolaridad como un indicador de la condición socioeconómica. Debido a las diferencias geográficas en la estructura de la población, el nivel de escolaridad de las mujeres se normalizó en algunos modelos. Resultados: La mayoría de las solicitantes de aborto provinieron de la Ciudad de México (66%) o del área metropolitana circundante (22%), mientras que el resto provino de estados fronterizos cercanos (7%) o del resto de México (5%). Las mujeres del resto de México que buscaron servicios de aborto tuvieron, en promedio, 1.4 años más de escolaridad que las de la Ciudad de México. En los modelos de regresión que normalizaron los niveles de escolaridad, la diferencia en el logro educativo entre las mujeres de la Ciudad de México y las del resto de México fue de 4.9 años (modelo no ajustado) y 3.2 años (modelo ajustado). Conclusiones: Estos hallazgos, junto con la bibliografía sobre el aborto inseguro en México, sugieren que las mujeres que provienen de fuera de la Ciudad de México y que tienen bajos niveles de escolaridad podrían tener menos probabilidades que sus pares con mayor escolaridad de beneficiarse de los servicios de aborto seguro que se brindan en la ciudad.
RÉSUMÉ Contexte: Bien qu'illégal presque partout au Mexique, l'avortement est décriminalisé depuis 2007 dans la ville de Mexico, ainsi devenue îlot d'accès légal dans un océan sinon sujet à restriction. Les caractéristiques des femmes qui viennent se faire avorter à Mexico notamment leur situation socioéconomique et leur lieu de résidence ne sont pas bien documentées. Méthodes: Les dossiers médicaux de 22 732 femmes venues se faire avorter dans l'une de quatre cliniques de niveau 1 de la ville de Mexico en 20132015 ont servi à examiner les caractéristiques des clientes de l'avortement légal. Les différences entre les résidentes de Mexico et celles venues d'autres régions du Mexique ont été étudiées par analyses de régression linéaire, avec l'éducation comme indicateur de situation socioéconomique. Pour parer aux différences géographiques de structure démographique, le niveau d'éducation des femmes a été normalisé dans certains modèles. Résultats: La plupart des femmes venues se faire avorter étaient originaires de la ville de Mexico (66%) ou de sa périphérie (22%); les autres venaient des États voisins proches (7%) ou du reste du Mexique (5%). Celles en provenance du reste du Mexique avaient, en moyenne, 1,4 année d'éducation de plus que leurs homologues originaires de la ville de Mexico. Dans les modèles de régression à niveaux d'éducation normalisés, la différence de durée de scolarité entre les femmes de Mexico et celles du reste du Mexique est de 4,9 années (modèle non corrigé) et de 3,2 années (modèle corrigé). Conclusions: Ces observations, unies à celles de la documentation sur l'avortement non médicalisé au Mexique, laissent entendre que les femmes qui ne vivent pas à Mexico et dont le niveau d'éducation est faible sont peut-être moins susceptibles que leurs homologues davantage instruites de bénéficier des services d'avortement médicalisé assurés dans la ville.
Assuntos
Aspirantes a Aborto , Aborto Legal , Escolaridade , Características de Residência , Aborto Legal/estatística & dados numéricos , Adulto , Feminino , Humanos , Modelos Lineares , Prontuários Médicos , México , Gravidez , Classe Social , Adulto JovemRESUMO
La autora de este artículo hace una síntesis de la evolución histórica y de las diferentes posturas religiosas frente al abor-to, describe su epidemiología mundial y la posición de la Organización Mundial de la Salud frente a esta problemática, resume el desarrollo y el desenlace del recientemente instalado debate sobre la legalización del aborto en Argentina y, finalmente reflexiona sobre lo que nos ha dejado este proceso político. (AU)
The author of this article summarizes the historical evolution and the different religious positions regarding abortion, describes its global epidemiology and the position of the World Health Organization in relation to this problem, summarizes the development and the outcome of the recently installed debate on the legalization of abortion in Argentina and, finally, reflect on what this politi-cal process has left us. (AU)
Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto , Adulto Jovem , Aborto Criminoso/história , Aborto Criminoso/legislação & jurisprudência , Aborto Induzido/legislação & jurisprudência , Aborto Legal/ética , Aborto , Argentina/epidemiologia , Religião e Medicina , Filosofias Religiosas , Educação Sexual/organização & administração , Classe Social , Aborto Criminoso/mortalidade , Aborto Criminoso/estatística & dados numéricos , Saúde Pública/legislação & jurisprudência , Fatores de Risco , Misoprostol/provisão & distribuição , Aborto Induzido/mortalidade , Aborto Induzido/estatística & dados numéricos , Aborto Legal/história , Aborto Legal/legislação & jurisprudência , Aborto Legal/estatística & dados numéricosRESUMO
BACKGROUND: Despite Britain, Colombia, and some Mexican states sharing a health exception within their abortion laws, access to abortion under the health exception varies widely. This study examines factors that result in heterogeneous application of similar health exception laws and consequences for access to legal abortion. Our research adds to previous literature by comparing implementation of similar abortion laws across countries to identify strategies for full implementation of the health exception. METHODS: We conducted a cross-country comparative descriptive study synthesizing data from document and literature review, official abortion statistics, and interviews with key informants. We gathered information on the use and interpretation of the health exception in the three countries from peer-reviewed literature, court documents, and grey literature. We next extracted public and private abortion statistics to understand the application of the law in each setting. We used a matrix to synthesize information and identify key factors in the use of the law. We conducted in-depth interviews with doctors and experts familiar with the health exception laws in each country and analyzed the qualitative data based on the previously identified factors. RESULTS: The health exception is used broadly in Britain, somewhat in Colombia, and very rarely in Mexican states. We identified five factors as particularly salient to application of the health exception in each setting: 1) comprehensiveness of the law including explicit mention of mental health, 2) a strong public health sector that funds abortion, 3) knowledge of and attitudes toward the health exception law, including guidelines for physicians in providing abortion, 4) dissemination of information about the health exception law, and 5) a history of court cases that protect women and clarify the health exception law. CONCLUSIONS: The health exception is a valuable tool for expanding access to legal abortion. Differences in the use of the health exception as an indication for legal abortion result in wide access for women in Britain to nearly no access in Mexican states. Our findings highlight the difference between theoretical and real access to legal abortion. The interpretation and application of the health exception law are pivotal to expanding real access to abortion.
Assuntos
Aborto Induzido/legislação & jurisprudência , Aborto Legal/legislação & jurisprudência , Comparação Transcultural , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Direitos Humanos , Aborto Induzido/estatística & dados numéricos , Aborto Legal/estatística & dados numéricos , Colômbia , Inglaterra , Feminino , Política de Saúde , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Direitos Humanos/legislação & jurisprudência , Humanos , Serviços de Saúde Materna , México , Gravidez , Reino UnidoRESUMO
OBJECTIVE: To analyze the strategies developed by the health centers to implement the law of legal abortion (LA) in public services of the primary care in Montevideo, Uruguay. MATERIALS AND METHODS: A qualitative research was conducted combining techniques of document analysis, self-administered questionnaires to key informants, and in-depth interviews with directors of health centers. A simple summative index of accessibility to abortion services was built. RESULTS: The law approved in Uruguay in 2012 demanded the development of a strategy to promote women's accessibility to LA in the public primary care system. The services failed to fully implement the strategy, due to institutional barriers. CONCLUSION: Despite the wide availability of LA services in primary care and that they are an integral part of sexual and reproductive health benefits, there is an important barrier to their use in the number of gynecologists that appeal to conscientious objection.
OBJETIVO: Analizar las estrategias desarrolladas por los centros de salud para implementar la ley de interrupción voluntaria del embarazo (IVE) en los servicios públicos del primer nivel de atención en Montevideo, Uruguay. MATERIAL Y MÉTODOS: Investigación cualitativa, que combinó técnicas de análisis documental y cuestionarios autoadministrados a informantes clave y entrevistas semidirigidas a directores de centros de salud. Se construyó un índice sumatorio simple de accesibilidad a las prestaciones de IVE en el centro de salud. RESULTADOS: La ley aprobada en Uruguay en 2012 exigió el desarrollo de una estrategia para favorecer la accesibilidad de las mujeres a la IVE en el primer nivel de atención público. Los servicios no lograron implementar cabalmente la estrategia por dificultades institucionales. CONCLUSIÓN: Pese a la amplia disponibilidad de servicios públicos de IVE en el primer nivel de atención y a que forman parte de las prestaciones en salud sexual y reproductiva, lo que favorece integralidad en la atención, persiste una barrera importante en el alto porcentaje de ginecólogos objetores de conciencia.