Abortion Legal Reform and Neonatal Mortality in Mozambique.

INTRODUCTION: Abortion law reforms have been hypothesized to influence reproductive, maternal, and neonatal health services and health outcomes, as well as social inequalities in health. In 2014, Mozambique legalized abortion in specific circumstances. However, due to challenges implementing the law, there is concern that it may have negatively influenced neonatal outcomes. METHODS: Using a difference-in-differences design, we used birth history data collected via the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) between 2004 and 2018 to assemble a panel of 476 939 live births across 17 countries including Mozambique. We estimated the effect of the abortion reform on neonatal mortality by comparing Mozambique to a series of control countries that did not change their abortion policies. We also conducted stratified analyses to examine heterogeneity in effect estimates by household wealth, educational attainment, and rural/urban residence. RESULTS: The reform was associated with an additional 5.6 (95% CI = 1.3, 9.9) neonatal deaths per 1,000 live birth. There was evidence of a differential effect of the reform, with a negative effect of the reform on neonatal outcomes for socially disadvantaged women, including those with no schooling, in poorer households, and living in rural areas. DISCUSSION: Given the delay in implementation, our analyses suggest that abortion reform in Mozambique was associated with an initial increase in neonatal mortality particularly among socially disadvantaged women. This may be due to the delay in effective implementation, including the dissemination of clear guidelines and expansion of safe abortion services. Longer-term follow-up is needed to assess the impact of the reform after 2018, when services were expanded. Abortion legal reform without adequate implementation and enforcement is unlikely to be sufficient to improve abortion access and health outcomes.

Reconsidering post 20-week abortion in Aotearoa New Zealand.

The Abortion Legislation Act 2020 established comprehensive grounds for approving abortions after 20 weeks. These grounds are less restrictive than before law reform. They give qualified health practitioners (QHP) the scope to approve any abortion anyone wants and might reasonably request, if the QHP believes the abortion is clinically justified in the circumstances, having considered all the factors required by law. Because patients hold QHPs accountable under the Health and Disability Commission and legal processes, it is unlikely a QHP will need to justify approving an abortion, although they may well be called upon to justify refusing one.

[Voluntary interruption of pregnancy and sexual and reproductive health in migrant women in BarranquillaInterrupção voluntária da gravidez e saúde sexual e reprodutiva em mulheres migrantes em Barranquilla]. / Interrupción voluntaria del embarazo y salud sexual y reproductiva en mujeres migrantes en Barranquilla.

Objective: Identify knowledge about and barriers to effective access to voluntary interruption of pregnancy (VIP), and to sexual and reproductive health (SRH) services in general, among women from Venezuela (Venezuelan migrants and Colombian returnees). Methods: Qualitative study of 20 semi-structured interviews with women from Venezuela who are residents of Barranquilla and who carry out leadership activities in communities or who participate in or benefit from those activities. The interviews included opinions and experiences related to access to VIP, and to SRH in general, as well as suggestions for improving access for migrant women. The relationship between access to these services and the migration process was explored, as well as the role of social organizations. Results: A lack of information on SRH-related rights was identified as the main access barrier to VIP. Other identified barriers were: attitude towards VIP, excessive steps involved in accessing medical care, difficulties in admission to the social security system, lack of training and care in SRH, and xenophobia in hospitals. The interviewees said they did not understand the legal framework in Colombia and did not know the channels for safe abortion care. Conclusions: Despite the efforts of institutions and international cooperation, Venezuelan migrant women in Barranquilla are in a situation of vulnerability due to their lack of access to sexual and reproductive health, including voluntary interruption of pregnancy. Implementing strategies for comprehensive care for migrants will improve current health conditions and the effective enjoyment of SRH-related rights.

Objetivo: Identificar os conhecimentos e as barreiras para o acesso efetivo das mulheres provenientes da Venezuela (migrantes venezuelanas e retornadas colombianas) à interrupção voluntária da gravidez (IVG) e aos serviços de saúde sexual e reprodutiva (SSR) em geral. Métodos: Estudo qualitativo de 20 entrevistas semiestruturadas com mulheres provenientes da Venezuela, residentes em Barranquilla, que atuam na liderança comunitária ou que participam (ou se beneficiam) das atividades. As entrevistas compreenderam as dimensões de opiniões e experiências relacionadas ao acesso à IVG e aos serviços de SSR em geral, e sugestões para melhorar o acesso das mulheres migrantes. Explorou-se a relação do acesso a esses serviços com o processo migratório e o papel das organizações sociais. Resultados: Identificou-se a falta de informações sobre direitos em SSR como a principal barreira para o acesso à IVG. Outras barreiras identificadas foram: atitude em relação à IVG, excesso de burocracia para obter atenção médica, dificuldades para inclusão no sistema de seguridade social, falta de capacitação e atenção em SSR e xenofobia nos hospitais. As entrevistadas declararam desconhecer o enquadramento jurídico na Colômbia e os trâmites para obter atenção ao aborto seguro. Conclusões: Apesar dos esforços institucionais e de cooperação internacional, as mulheres migrantes venezuelanas em Barranquilla estão em situação de vulnerabilidade por falta de acesso aos serviços de SSR, incluindo a IVG. A implementação de estratégias para atenção integral a migrantes possibilitará a melhoria das condições atuais de saúde e a efetiva fruição dos direitos em SSR.

Impact of legislative change on waiting time for women accessing surgical abortion services in a rural hospital in the Northern Territory.

BACKGROUND: Women face challenges when accessing abortion, including varied legislation and reduced access to services in rural and remote settings. There are limited clinical guidelines in Australia and little information regarding the patient journey, particularly the timeframe between referral to abortion procedure. Legislation reform in the Northern Territory (NT) legalised early medical abortion (EMA) in primary health care, providing an opportunity to review service provision of elective surgical abortion prior to and after these changes. AIMS: To review the waiting time to access abortion, percentage eligible for EMA based on ultrasound gestation alone, percentage of Indigenous women accessing abortion in the NT and the effects of the legislation change. MATERIALS AND METHODS: Retrospective audit-analysed surgical abortion data from 354 patient files who underwent suction curettage of uterus between 2012-2017 in one NT public hospital. RESULTS: Mean wait-time ranged from 20 to 22 days in 2012-2016 and dropped to 15 days in 2017 following the law reform. Sixty-two percent of women waited longer than that in the recommended clinical guidelines. Indigenous women represented approximately 25% of patients accessing surgical abortion services. Average gestation at surgical abortion procedure increased following reform. Prior to reform up to 95% of patients accessing surgical abortion would have been eligible for EMA at time of referral. CONCLUSIONS: Results demonstrate potential for changes in service provision of abortion in the NT with increased choice, patient-centred care and reduced waiting times. This audit demonstrated the possibility to move the majority of abortion services into primary health care leading to cost savings.

Women's reasons for choosing abortion method: A systematic literature review.

AIMS: We aim to describe and classify reasons behind women's choice between medical and surgical abortion. METHODS: A systematic literature review was conducted in PubMed and PsycINFO in October 2015. The subjects were women in early pregnancy opting for abortion at clinics or hospitals in high-income countries. We extracted women's reasons for choice of abortion method and analysed these qualitatively, looking at main reasons for choosing either medical or surgical abortion. RESULTS: Reasons for choice of method were classified to five main groups: technical nature of the intervention, fear of complications, fear of surgery or anaesthesia, timing and sedation. Reasons for selecting medical abortion were often based on the perception of the method being 'more natural' and the wish to have abortion in one's home in addition to fear of complications. Women who opted for surgical abortion appreciated the quicker process, viewed it as the safer option, and wished to avoid pain and excess bleeding. Reasons were often based on emotional reactions, previous experiences and a lack of knowledge about the procedures. Some topics such as pain or excess bleeding received little attention. Overall the quality of the studies was low, most studies were published more than 10 years ago, and the generalisability of the findings was poor. CONCLUSION: Women did not base their choice of abortion method only on rational information from professionals but also on emotions and especially fears. Support techniques for a more informed choice are needed. Recent high-quality studies in this area are lacking.

Global Abortion Policies Database: a descriptive analysis of the legal categories of lawful abortion.

BACKGROUND: Texts and interpretations on the lawfulness of abortion and associated administrative requirements can be vague and confusing. It can also be difficult for a woman or provider to know exactly where to look for and how to interpret laws on abortion. To increase transparency, the Global Abortion Policies Database (GAPD), launched in 2017, facilitates the strengthening of knowledge and understanding of the complexities and nuances around lawful abortion as explicitly stated in laws and policies. METHODS: We report on data available in the GAPD as of May 2018. We reviewed the content and wording of laws, policies, standards and guidelines, judgments and other official statements for all countries where data is available in the GAPD. We analyzed data for 158 countries, where abortion is lawful on the woman's request with no requirement for justification and/or for at least one legal ground, including additional indications that are nonequivalent to a single common legal ground. We classified laws on the basis of the explicit wording of the text. The GAPD treats legal categories as the circumstances under which abortion is lawful, that is, allowed or not contrary to law, or explicitly permitted or specified by law. RESULTS: 32% of countries allow or permit abortion at the woman's request with no requirement for justification. Approximately 82% of countries allow or permit abortion to save the woman's life. 64% of countries specify health, physical health and/or mental (or psychological) health. 51% allow or permit abortion based on a fetal condition, 46% of countries allow or permit abortion where the pregnancy is the result of rape, and 10% specify an economic or social ground. Laws may also specify several additional indications that are nonequivalent to a single legal ground. CONCLUSIONS: The GAPD reflects details that exist within countries' laws and highlights the nuance within legal categories of abortion; no assumptions are made as to how laws are interpreted or applied in practice. By examining the text of the law, additional complexities related to the legal categories of abortion become more apparent.

Diagnosis and management of a ruptured 20-week anencephalic cornual ectopic pregnancy undergoing termination: implications of interstate travel due to restrictive abortion law.

In the changing legal environment of obstetric care in the USA, with laws in many states banning termination at all stages of pregnancy with narrow exemptions, healthcare providers are encountering cases in which risk to maternal safety is increased. This report presents a case of a 28-year-old primigravida with an anencephalic fetus who was legally unable to pursue termination in her home state. She traveled to another state in order to pursue safe and legal abortion of a non-viable fetus. Due to an unrecognized cornual ectopic gestation, the delivery resulted in uterine rupture, the need for hysterectomy, and significant morbidity in a patient with a strong desire for future fertility.

Profile of female survivors of sexual violence in the first 6 months of the COVID-19 quarantine in the city of Campinas, Brazil: A cross-sectional retrospective study.

OBJECTIVES: Describe the characteristics and changes in the profile of women who sought care after experiencing sexual violence (SV) during the first six months of the COVID-19 pandemic in a Brazilian city. METHODS: This is a cross-sectional retrospective study. Data from emergency care and legal abortion requests of women assisted at the Women's Health Care Center Hospital (School of Medical Sciences, University of Campinas, Brazil) due to SV experienced between March 23 and August 23, 2020 (Quarantine Group, QG), were collected and compared with data from the same period of the previous biennium (Comparison Group, CG). χ2 and Fisher's exact tests were used to compare groups; the significance level was 5%. RESULTS: Data for 236 women were analyzed; 70 women were included in the QG and 166 in the CG. In the QG, there was a restriction in the area of origin of women, with a higher proportion of women who lived in Campinas (P = 0.0007) and a higher frequency of chronic SV (P = 0,035). There were no rapes associated with the use of social media or apps in the QG, but 9.8% of women in the CG experienced rape associated with the use of social media or apps. There were higher rates of domestic violence (P = 0.022) and intimidation through physical force (P = 0.011) in the first two months. CONCLUSION: The COVID-19 quarantine affected the profile of women who sought care after experiencing SV. The quarantine resulted in changes in the area of origin of patients, hindering access to health services and leading to higher rates of chronic and domestic SV, particularly in the first 2 months of the pandemic.

Using a Call Center to Reduce Harm From Self-Administration of Reproductive Health Medicines in Bangladesh: Interrupted Time-Series.

BACKGROUND: Annually, there are approximately 25 million unsafe abortions, and this remains a leading cause of maternal morbidity and mortality. In settings where abortion is restricted, women are increasingly able to self-manage abortions by purchasing abortion medications such as misoprostol and mifepristone (RU-486) from pharmacies or other drug sellers. Better availability of these drugs has been shown to be associated with reductions in complications from unsafe abortions. In Bangladesh, abortion is restricted; however, menstrual regulation (MR) was introduced in the 1970s as an interim method of preventing pregnancy. Pharmacy provision of medications for MR is widespread, but customers purchasing these drugs from pharmacies often do not have access to quality information on dosage and potential complications. OBJECTIVE: This study aimed to describe a call center intervention in Bangladesh, and assess call center use over time and how this changed when a new MR product (combined mifepristone-misoprostol) was introduced into the market. METHODS: In 2010, Marie Stopes Bangladesh established a care provider-assisted call center to reduce potential harm from self-administration of MR medications. The call center number was advertised widely in pharmacies and on MR product packaging. We conducted a secondary analysis of routine data collected by call center workers between July 2012 and August 2016. We investigated the reported types of callers, the reason for call, and reported usage of MR products before and after November 2014. We used an interrupted time series (ITS) analysis to formally assess levels of change in caller characteristics and reasons for calling. RESULTS: Over the 4-year period, 287,095 calls about MR were received and the number of users steadily increased over time. The most common callers (of 287,042 callers) were MR users (67,438, 23.49%), their husbands (65,999, 22.99%), pharmacy workers (65,828, 22.93%), and village doctors (56,036, 19.52%). Most MR calls were about misoprostol, but after November 2014, a growing proportion of calls were about the mifepristone-misoprostol regimen. The most common reasons (of 287,042 reasons) for calling were to obtain information about the regimen (208,605, 72.66%), to obtain information about side effects (208,267, 72.54%), or to report side effects (49,930, 17.39%). The ITS analyses showed that after November 2014, an increasing number of calls were from MR users who had taken the complete regimen (P=.02 and who were calling to discuss reported side effects (P=.01) and pain medication (P=.01), and there were fewer calls asking about dosages (P<.001). CONCLUSIONS: The high call volume suggests that this call center intervention addressed an unmet demand for information about MR medications from both MR users and health care providers. Call center interventions may improve the quality of information available by providing information directly to MR users and drug sellers, and thus reducing the potential harm from self-management of MR medications.

Caracterización de la interrupción voluntaria del embarazo en pacientes mayores de 19 años

Introducción: Se conoce como interrupción voluntaria del embarazo a la muerte biológica del embrión o feto para su posterior eliminación, con o sin asistencia médica y en cualquier circunstancia social o legal. Objetivo: Caracterizar la interrupción voluntaria del embarazo en pacientes mayores de 19 años en los municipios de la región del Guacanayabo perteneciente a la provincia Granma en el año 2022. Métodos: Se realizó un estudio descriptivo, retrospectivo y de corte transversal sobre la interrupción voluntaria del embarazo en pacientes mayores de 19 años pertenecientes a los siete municipios a la región del Guacanayabo, provincia Granma en el periodo de enero a diciembre del 2022. El universo estuvo constituido por 579 gestantes, para lo cual se seleccionó una muestra de 572 mediante muestreo no probabilístico intencional. Resultados: El municipio de Manzanillo fue el que mayor casos aportó (53,1 %). Prevalecieron las edades de 20 a 24 años (34,3 %). Predominaron las mujeres con un nivel de escolaridad de preuniversitario/técnico medio (56,9 %), 71,9 % estaban casadas, el 53,2 % trabajaban, el 54,9 % eran de procedencia urbana y 76,4 % de las mujeres tenían antecedentes obstétricos. El método de interrupción más utilizado fue el de dilatación y curetaje (98,6 %). Conclusiones: El municipio Manzanillo aportó el mayor número de casos de interrupciones de embarazos al año. Las mujeres de procedencia urbana se someten con mayor frecuencia a interrupciones de embarazos, siendo el procedimiento de dilatación y curetaje el método de interrupción más empleado.

Introduction: It is known as voluntary interruption of pregnancy to the biological death of the embryo or fetus for its subsequent elimination, with or without medical assistance, and in any social or legal circumstance. Objective: To characterize the voluntary interruption of pregnancy in patients over 19 years of age in the municipalities of the Guacanayabo region belonging to Granma province in 2022. Methods: A descriptive, retrospective and cross-sectional study was conducted on voluntary termination of pregnancy in patients over 19 years of age from the seven municipalities of the Guacanayabo region, Granma province, from January to December 2022. The universe consisted of 579 pregnant women, for which a sample of 572 was selected by intentional non-probabilistic sampling. Results: The municipality of Manzanillo was the one with the highest number of cases (53, 1 %). The prevalence was between 20 and 24 years of age. Women with a pre-university/intermediate technical education predominated. (56, 9 per cent), 71, 9 per cent were married, 53, 2 per cent worked, 54.9 per cent were of urban origin and 76.4 per cent of women had an obstetric history. The most commonly used method of interruption was dilatation and curettage (98,6 %). Conclusions: The municipality of Manzanillo contributes the highest number of cases of terminations of pregnancies per year. Urban women are more likely to undergo abortions, with dilatation and curettage being the most widely used method of termination.

Playing it Safe: Legal and Clandestine Abortions Among Adolescents in Ethiopia.

PURPOSE: The 2005 expansion of the Ethiopian abortion law provided minors access to legal abortions, yet little is known about abortion among adolescents. This paper estimates the incidence of legal and clandestine abortions and the severity of abortion-related complications among adolescent and nonadolescent women in Ethiopia in 2014. METHODS: This paper uses data from three surveys: a Health Facility Survey (n = 822) to collect data on legal abortions and postabortion complications, a Health Professionals Survey (n = 82) to estimate the share of clandestine abortions that resulted in treated complications, and a Prospective Data Survey (n = 5,604) to collect data on abortion care clients. An age-specific variant of the Abortion Incidence Complications Method was used to estimate abortions by age-group. RESULTS: Adolescents have the lowest abortion rate among all women below age 35 (19.6 per 1,000 women). After adjusting for lower levels of sexual activity among adolescents however, we find that adolescents have the highest abortion rate among all age-groups. Adolescents also have the highest proportion (64%) of legal abortions compared with other age-groups. We find no differences in the severity of abortion-related complications between adolescent and nonadolescent women. CONCLUSIONS: We find no evidence that adolescents are more likely than older women to have clandestine abortions. However, the higher abortion and pregnancy rates among sexually active adolescents suggest that they face barriers in access to and use of contraceptive services. Further work is needed to address the persistence of clandestine abortions among adolescents in a context where safe and legal abortion is available.

Estudo observacional dos casos de violência contra mulher notificados em um hospital fluminense em 2020 / Case study observational of violence against women reported in a Rio de Janeiro hospital in 2020

RESUMO Este estudo analisou o perfil das mulheres em situação de violência atendidas no serviço de acolhimento de um hospital na região metropolitana I do Rio de Janeiro, bem como a presença de alguns determinantes sociais que podem se relacionar à ocorrência da violência e atuar sobre as condições de acesso a estes serviços. Foram analisados os dados das notificações de violência, considerando a violência sexual e outras violências, em 2020. Casos de HIV e sífilis compuseram os grupos de comparação. Realizou-se o mapeamento e o levantamento dos perfis de mulheres. O total de residentes fora da área metropolitana I foi maior entre casos de violência sexual do que entre outras violências, HIV e sífilis. Dentre as mulheres brancas, estas foram mais frequentes entre casos de violência sexual e as negras entre as atendidas por outras violências. Os casos de violência sexual relataram maior escolaridade e frequência de emprego. A maioria das mulheres em todos os grupos analisados eram negras, enquanto a maioria das que acessaram o aborto legal eram brancas. O estudo sugere que fatores sociais e econômicos afetam o acesso ao serviço de atendimento às mulheres em situação de violência, sendo necessária uma reorganização deste para garantir o pleno acesso das mulheres.

ABSTRACT This study analyzed the profile of women in situations of violence who accessed care service of a hospital in the metropolitan region I of Rio de Janeiro, as well as the presence of some social determinants that may be related to the occurrence of violence and act on the conditions of access to these services. Data of the violence notification form were analyzed, considering cases of sexual violence and other violence, in 2020. Cases of HIV and syphilis were used as comparison groups. The mapping and survey of the profiles of women were carried out. The total number of residents outside first metropolitan area was higher among cases of sexual violence than among other violence, HIV, and syphilis. White women were more frequent among cases of sexual violence and black women among those cared for other violence. Cases of sexual violence had higher education and reported being employed more often. Most women in all groups were black, while most of those who accessed legal abortion were white. The study suggests that social and economic factors affect access to the care service for women in situations of violence, requiring its reorganization to guarantee women's full access to health care.

Interrupción voluntaria del embarazo y salud sexual y reproductiva en mujeres migrantes en Barranquilla / Voluntary interruption of pregnancy and sexual and reproductive health in migrant women in Barranquilla / Interrupção voluntária da gravidez e saúde sexual e reprodutiva em mulheres migrantes em Barranquilla

RESUMEN Objetivo. Identificar el conocimiento y las barreras para acceder efectivamente a la interrupción voluntaria del embarazo (IVE), y en general a los servicios sexuales y reproductivos (SSR), entre mujeres provenientes de Venezuela (migrantes venezolanas y colombianas retornadas). Métodos. Estudio cualitativo de 20 entrevistas semiestructuradas en mujeres provenientes de Venezuela, residentes en Barranquilla que ejecutan acciones de liderazgo en comunidades o que participan (o se benefician) de las actividades. Las entrevistas comprendieron dimensiones sobre opiniones y experiencias relacionadas con el acceso a IVE, y en general a SSR, y sugerencias para mejorar el acceso para las mujeres migrantes. Se exploró la relación del acceso a estos servicios con el proceso migratorio y el papel de las organizaciones sociales. Resultados. Se identificó la falta de información sobre derechos en SSR como principal barrera para acceso a la IVE. Otras barreras identificadas fueron: actitud hacia la IVE, exceso de trámites para atención médica, dificultades para la inclusión al sistema de seguridad social, falta de capacitación y atención en SSR y xenofobia en hospitales. Las entrevistadas manifestaron desconocer el marco legal en Colombia y las rutas para la atención de un aborto seguro. Conclusiones. Pese a los esfuerzos institucionales y de cooperación internacional, las mujeres migrantes venezolanas en Barranquilla se encuentran en una situación de vulnerabilidad debido a la falta de acceso a los SSR incluida la IVE. Implementar estrategias para atención integral a migrantes, permitirá mejorar condiciones de salud actual y el goce efectivo de los derechos en SSR.

ABSTRACT Objective. Identify knowledge about and barriers to effective access to voluntary interruption of pregnancy (VIP), and to sexual and reproductive health (SRH) services in general, among women from Venezuela (Venezuelan migrants and Colombian returnees). Methods. Qualitative study of 20 semi-structured interviews with women from Venezuela who are residents of Barranquilla and who carry out leadership activities in communities or who participate in or benefit from those activities. The interviews included opinions and experiences related to access to VIP, and to SRH in general, as well as suggestions for improving access for migrant women. The relationship between access to these services and the migration process was explored, as well as the role of social organizations. Results. A lack of information on SRH-related rights was identified as the main access barrier to VIP. Other identified barriers were: attitude towards VIP, excessive steps involved in accessing medical care, difficulties in admission to the social security system, lack of training and care in SRH, and xenophobia in hospitals. The interviewees said they did not understand the legal framework in Colombia and did not know the channels for safe abortion care. Conclusions. Despite the efforts of institutions and international cooperation, Venezuelan migrant women in Barranquilla are in a situation of vulnerability due to their lack of access to sexual and reproductive health, including voluntary interruption of pregnancy. Implementing strategies for comprehensive care for migrants will improve current health conditions and the effective enjoyment of SRH-related rights.

RESUMO Objetivo. Identificar os conhecimentos e as barreiras para o acesso efetivo das mulheres provenientes da Venezuela (migrantes venezuelanas e retornadas colombianas) à interrupção voluntária da gravidez (IVG) e aos serviços de saúde sexual e reprodutiva (SSR) em geral. Métodos. Estudo qualitativo de 20 entrevistas semiestruturadas com mulheres provenientes da Venezuela, residentes em Barranquilla, que atuam na liderança comunitária ou que participam (ou se beneficiam) das atividades. As entrevistas compreenderam as dimensões de opiniões e experiências relacionadas ao acesso à IVG e aos serviços de SSR em geral, e sugestões para melhorar o acesso das mulheres migrantes. Explorou-se a relação do acesso a esses serviços com o processo migratório e o papel das organizações sociais. Resultados. Identificou-se a falta de informações sobre direitos em SSR como a principal barreira para o acesso à IVG. Outras barreiras identificadas foram: atitude em relação à IVG, excesso de burocracia para obter atenção médica, dificuldades para inclusão no sistema de seguridade social, falta de capacitação e atenção em SSR e xenofobia nos hospitais. As entrevistadas declararam desconhecer o enquadramento jurídico na Colômbia e os trâmites para obter atenção ao aborto seguro. Conclusões. Apesar dos esforços institucionais e de cooperação internacional, as mulheres migrantes venezuelanas em Barranquilla estão em situação de vulnerabilidade por falta de acesso aos serviços de SSR, incluindo a IVG. A implementação de estratégias para atenção integral a migrantes possibilitará a melhoria das condições atuais de saúde e a efetiva fruição dos direitos em SSR.

Análise do desejo de manter ou interromper gravidezes decorrentes de violência sexual / Analysis of the desire to maintain or interrupt pregnancies resulting from sexual assault

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.

Conocimientos y actitudes sobre interrupción voluntaria del embarazo en estudiantes de una Universidad de Cartagena (Colombia) / Knowledge and attitudes regarding interruption of pregnancy in students of a University in Cartagena (Colombia)

Introducción: La interrupción voluntaria del embarazo es un asunto político que polariza las opiniones y genera controversias entre el sector salud, social, económico y cultural. Objetivo: Determinar el nivel de conocimiento y actitudes sobre la interrupción voluntaria del embarazo en estudiantes de dos programas de Ciencias de la Salud de Cartagena. Materiales y métodos: Estudio descriptivo transversal, se aplicó el cuestionario adaptado por Marceliano y Medrano a 231 estudiantes de Enfermería y Medicina, los datos se analizaron obteniendo frecuencias relativas y absolutas. Resultados: El nivel de conocimiento de los estudiantes fue alto con 92,20% (213). Sin embargo, el 37,2% (86) no sabía cuáles eran las tres causales para que el aborto no se considere un delito. El 56,7% asume actitudes negativas hacia firmar una petición para legalizar el aborto y el 18,8% considera que si una mujer se realiza un aborto debe ir a la cárcel. Conclusión: El nivel de conocimiento de los estudiantes de medicina y enfermería es alto, sin embargo, los patrones muestran desconocimiento sobre las causales de legalización del aborto de acuerdo con la norma vigente y una variabilidad de actitudes positivas y negativas ante la interrupción voluntaria del embarazo.

Introduction: Voluntary interruption of pregnancy is a political issue that polarizes opinions and generates controversy within the health, social, economic, and cultural sectors. Objective: To determine the level of knowledge and attitudes regarding voluntary interruption of pregnancy in university students from two Health Sciences programs of Cartagena. Materials and methods: A descriptive cross-sectional study; the questionnaire adapted by Marceliano and Medrano was given to 231 students within the Nursing and Medical programs; the data was analyzed through relative and absolute frequencies. Results: The level of knowledge of the students was high with a 92.20% (213). Yet, a 37.2% (86) did not know the three reasons why abortion is not considered a crime. 56.7% have negative attitudes regarding signing a petition to legalize abortion and an 18.8% believe that a woman who has an abortion should go to jail. Conclusion: The level of knowledge in medical and nursing students is high, yet the patterns show lack of knowledge of the reasons for legalization of abortion according to the current laws and a variety of positive and negative attitudes regarding the voluntary interruption of pregnancy.

Objeção de consciência e aborto: opiniões e conhecimentos dos estudantes de enfermagem / Objeción de conciencia y aborto: opiniones y conocimientos de los estudiantes de enfermería / Conscientious objection and abortion: opinions and knowledge of nursing students

RESUMO Objetivo: analisar as concepções dos acadêmicos de enfermagem de uma universidade do Centro Oeste do Brasil acerca do conceito e utilização da ferramenta objeção de consciência em situações de abortamento. Métodos: estudo qualitativo do tipo exploratório-descritivo, realizado entre os meses de março a abril de 2016. Participaram do estudo 46 acadêmicos do 7º ao 10º semestre do curso de graduação em Enfermagem. A coleta de dados ocorreu por meio da aplicação de questionário eletrônico enviado por e-mail individualmente aos estudantes. Utilizou-se a análise categorial; os relatos dos participantes foram fragmentados em unidades de significados. Resultados: emergiram duas categorias para cada questão do questionário eletrônico: (1) Meus preceitos morais e crenças vão contra o aborto e não sei se teria condições emocionais e psicológicas; (2) Não me lembro e Ferramenta Legal; (3) Discriminação e comprometimento do serviço e Liberdade de pensamento; (4) Mais consciência sobre nosso papel como profissionais de saúde e ampliar a visão dos estudantes sobre os aspectos éticos e humanitários. Considerações finais: a partir das concepções dos estudantes, percebeu-se que a objeção de consciência é de suma importância quando se trabalha com a temática do aborto e poderia ser mais amplamente abordada no processo de formação acadêmica.

RESUMEN Objetivo: analizar las concepciones de los académicos de enfermería de una universidad del Centro Oeste de Brasil acerca del concepto y la utilización de la herramienta objeción de conciencia en situaciones de aborto. Métodos: estudio cualitativo del tipo exploratorio-descriptivo, realizado entre los meses de marzo a abril de 2016. Participaron del estudio 46 académicos del 7º al 10º semestre del curso de graduación en Enfermería. La recolección de datos ocurrió mediante la aplicación de un cuestionario electrónico enviado por correo electrónico individualmente a los estudiantes. Se utilizó el análisis categorial; los relatos de los participantes fueron fragmentados en unidades de significados. Resultados: surgieron dos categorías para cada pregunta del cuestionario electrónico: (1) Mis preceptos morales y creencias van contra el aborto y No sé si tendría condiciones emocionales y psicológicas; (2) No me acuerdo y Herramienta Legal; (3) Discriminación y compromiso del servicio y Libertad de pensamiento; (4) Más conciencia sobre nuestro papel como profesionales de salud y Ampliar la visión de los estudiantes sobre los aspectos éticos y humanitarios. Consideraciones finales: a partir de las concepciones de los estudiantes, se percibió que la objeción de conciencia es de suma importancia cuando se trabaja con la temática del aborto y podría ser más ampliamente tratada en el proceso de formación académica.

ABSTRACT Objective: to analyze the conceptions of nursing students of a university in the Midwest of Brazil about the concept and use of the conscientious objection tool in abortion situations. Methods: a qualitative exploratory-descriptive study, conducted between March and April 2016. The study included 46 students from the 7th to the 10th semester of the Nursing graduate course. Data collection occurred through the application of an electronic questionnaire sent by email individually to the students. Categorical analysis was used; participants' reports were fragmented into units of meaning. Results: two categories emerged for each question of the electronic questionnaire: (1) My moral precepts and beliefs go against abortion and I don't know if I would have emotional and psychological conditions; (2) I don't remember and Legal Tool; (3) Discrimination and Commitment to Service and Freedom of Thought; (4) More awareness about our role as health professionals and Broaden students' view of ethical and humanitarian aspects. Final thoughts: from the conceptions of students, it was realized that conscientious objection is of paramount importance when working with the theme of abortion and could be more widely addressed in the process of academic training.

Legal abortion in childhood: the official discourse and the reality of a Brazilian case / Aborto legal en la infancia: el discurso oficial y la realidad de un caso brasileño / Aborto legal na infância: o discurso oficial e a realidade de um caso brasileiro

ABSTRACT Objective: to identify the ideological perspectives of official discourses in relation to sexual violence, childhood pregnancy and access to legal abortion based on a Brazilian case. Methods: a qualitative documentary study. Data collection was carried out in documents published on official Brazilian websites, between August and December 2020. The analytical categories of gender and generation supported data analysis. Results: a total of 39 documents were selected and three empirical categories were identified: Protection against violence in the legislation and the (re)production of injuries in reality; Facing sexual violence against children by the Brazilian State; Being a Brazilian girl: gender and generational oppressions. Final considerations: the ideological perspectives of official discourses in relation to the case showed a lack of compliance with advances in Brazilian legislation on issues related to child violence and adult-centric authoritarianism, with the imposition of gender and generation subalternity.

RESUMEN Objetivo: identificar las perspectivas ideológicas de los discursos oficiales en relación a la violencia sexual, el embarazo infantil y el acceso al aborto legal a partir de un caso brasileño. Métodos: estudio documental cualitativo. La recolección de datos se realizó en documentos publicados en sitios web oficiales brasileños, entre agosto y diciembre de 2020. Las categorías analíticas de género y generación apoyaron el análisis de datos. Resultados: se seleccionaron 39 documentos y se identificaron tres categorías empíricas: Protección contra la violencia en la legislación y la (re)producción de lesiones en la realidad; Enfrentando la violencia sexual contra los niños por parte del Estado brasileño; Ser niña brasileña: opresiones generacionales y de género. Consideraciones finales: las perspectivas ideológicas de los discursos oficiales en relación al caso mostraron una falta de adhesión a los avances de la legislación brasileña en temas relacionados con la violencia infantil y el autoritarismo adultocéntrico, con la imposición de la subalternidad de género y generacional.

RESUMO Objetivo: identificar as perspectivas ideológicas dos discursos oficiais em relação à violência sexual, à gravidez na infância e ao acesso ao aborto legal a partir de um caso brasileiro. Métodos: estudo documental qualitativo. A coleta de dados foi realizada em documentos publicados em sites oficiais brasileiros, entre agosto e dezembro de 2020. As categorias analíticas de gênero e geração deram suporte à análise dos dados. Resultados: foram selecionados 39 documentos e identificadas três categorias empíricas: A proteção contra a violência na legislação e a (re)produção dos agravos na realidade; O enfrentamento da violência sexual contra a criança pelo Estado brasileiro; Ser menina brasileira: opressões de gênero e geração. Considerações finais: as perspectivas ideológicas dos discursos oficiais em relação ao caso mostraram falta de adesão aos avanços na legislação brasileira nos temas relativos à violência infantil e autoritarismo adultocêntrico, com imposição de subalternidade de gênero e geração.

Dilemas clínicos en la constitución de la tercera causal de la interrupción voluntaria del embarazo / Clinical dilemmas derived from the need to certify rape for voluntary pregnancy interruption

Since 2017, women in Chile are allowed to interrupt voluntarily a pregnancy on three grounds: 1) When a woman's life is at risk due to the pregnancy, 2) When there are fetal anomalies incompatible with life, or 3) When pregnancy is result of rape. Women who qualify for any of these three pregnancy interruption requirements are entitled to a psychosocial accompaniment program to promote an integrative approach. In this article we will discuss the role of the psychosocial team in cases of rape resulting pregnancy. Specifically, the clinical and ethical dilemmas posed by the need to certify the rape in a general hospital such as difficulties in assessment of the story's plausibility, clinician's dual role and the limits to confidentiality, are discussed.

Conhecimento e percepção de estudantes de medicina sobre abortamento legal / Knowledge and perception of medical students on legal abortion / Conocimiento y percepción de estudiantes de medicina sobre el aborto legal

Resumo O abortamento é prática frequente no Brasil e importante causa de mortalidade materna. Mesmo em condições legais, as mulheres enfrentam diversas barreiras para acessar o procedimento, muitas vezes em decorrência do desconhecimento de médicos acerca dos marcos regulatórios. Este artigo objetiva avaliar o conhecimento de estudantes da Faculdade de Medicina da Bahia da Universidade Federal da Bahia sobre as leis que permitem o aborto no Brasil, bem como a percepção desses estudantes sobre o tema. Trata-se de estudo de corte transversal com análise qualitativa de dados obtidos pela aplicação de questionário a 237 estudantes. Apesar de os participantes demonstrarem conhecimento teórico adequado dos aspectos legais, houve incongruências e erros quando questionados sobre aplicação das leis em situações práticas de atendimento ao aborto legal. Os resultados demonstram a necessidade de fortalecer a abordagem do tema durante a graduação, de modo multidisciplinar e transversal. Vale ressaltar, por fim, que se observou entre os participantes inclinação favorável à descriminalização do aborto.

Abstract Abortion is a frequent practice in Brazil and a major cause of maternal mortality. Even under legal conditions, women face many barriers to access the procedure, often related to physicians' unfamiliarity with the legislation. This article assess the knowledge of medical students from Faculdade de Medicina da Bahia of Universidade Federal da Bahia about the laws that regulate abortion in Brazil and their perception on the topic. This qualitative cross-sectional study analyzed data collected from a questionnaire answered by 237 students. Although the participants showed adequate theoretical knowledge of legal aspects, discrepant and incorrect answers were observed when asked about law enforcement in situations of legal abortion care, showing that education focused on the topic is required using multidisciplinary and transversal discussions during the medical course. Finally, we observed that participants tended to favor decriminalization of abortion.

Resumen El aborto es una práctica frecuente en Brasil y una importante causa de mortalidad materna. Incluso cuando cumplen con las condiciones legales, las mujeres enfrentan varias barreras para acceder al procedimiento, a menudo debido a la falta de conocimiento de los médicos sobre los marcos regulatorios. Este artículo tiene como objetivo evaluar el conocimiento de los estudiantes de la Facultad de Medicina de la Universidad Federal de Bahía sobre las leyes que permiten el aborto en Brasil, así como la percepción de estos estudiantes sobre el tema. Se trata de un estudio transversal con análisis cualitativo de datos obtenidos mediante la aplicación de un cuestionario a 237 alumnos. Si bien los participantes demostraron un conocimiento teórico adecuado de los aspectos legales, hubo inconsistencias y errores cuando se les preguntó sobre la aplicación de las leyes en situaciones prácticas de atención al aborto legal. Los resultados demuestran la necesidad de fortalecer la enseñanza de la temática durante la graduación, de manera multidisciplinar y transversal. Finalmente, cabe mencionar que los participantes mostraron una inclinación favorable hacia la despenalización del aborto.