Professional societies of obstetrics and gynecology as agents of change in sexual and reproductive health: FIGO's 10-country safe abortion advocacy project in Africa and Latin America.

In 2019, FIGO started implementing its abortion project focusing on advocacy. The Advocacy for Safe Abortion (ASA) Project was conducted in partnership with 10 national professional societies of obstetrics and gynecology in Latin America and Africa. The project aimed to strengthen national societies, support them to be leaders in sexual and reproductive health, and enable them to obtain context-specific advocacy goals that improve access to safe abortion. Innovative monitoring and evaluation methodology enabled tracking of outcomes, consideration of their contribution to success, and cross-country evaluation. The project saw success through some key strategies: institutional capacity strengthening; enhanced work through collaborations; training to increase knowledge and reduce abortion-related stigma with a broad array of stakeholders; and generation and use of evidence to influence decision-makers. This article describes the project and methodology used and provides tangible examples of how societies have been agents of change in their countries and of the need for such important work to continue.

The role of healthcare providers in expanding legal abortion: Qualitative insights from Argentina, Ireland, and South Korea.

Abortion laws are key in creating an enabling environment that facilitates the advancement of people's sexual and reproductive health and rights. Around 50 countries have liberalized their abortion laws in the last decades by adding new grounds allowing abortion. The road toward the expansion of legal abortion is a long, highly sensitive, and difficult process. The specific role of healthcare providers in influencing abortion law reforms has been scarcely studied. With the objective to better understand their (potential) roles, a qualitative study was conducted in 2021 focusing on three countries that had recently liberalized their abortion regulations: Argentina, South Korea, and Ireland. For each country, key informant interviews were conducted with actors in advocacy for legal change, the majority with healthcare providers. The study results indicate that healthcare providers can contribute to the expansion of legal abortion through their influence on public and legal debates. Healthcare providers were found to be scientifically credible and trustworthy. Their voice and argumentation counteracted anti-rights arguments and addressed information gaps, by providing specific clinical experiences and medical information. Healthcare providers amplified women's experiences through their testimonies and had entry points within governmental bodies, which facilitated their advocacy. These healthcare providers often functioned as individual operating obstetrician/gynecologists or general practitioners who were engaged in networks of health professionals or had previous advocacy experience. In a global context of social and political contention around abortion, extending the engagement of healthcare providers in law and policy deliberation on abortion appears to be useful. This requires recognizing the diversity of roles that healthcare providers can take up, creating a safe environment in which they can operate, equipping them with skills that go beyond the medical expert role and facilitating strategic partnerships that seek complementarity between multiple stakeholders, building on the uniqueness of each stakeholder's expertise.

Advocating safe abortion: outcomes of a multi-country needs assessment on the potential role of national societies of obstetrics and gynecology.

In 2019 the International Federation of Gynecology and Obstetrics (FIGO) embarked on an initiative that aims to strengthen the capacity of 10 national societies of obstetrics and gynecology (ObGyn) in advocacy for safe abortion. In 2018 needs assessments that entailed a desk study, interviews, and stakeholder workshops were conducted in Benin, Cameroon, Côte d'Ivoire, Kenya, Mali, Mozambique, Panama, Peru, Uganda, and Zambia. The general aim of the needs assessments was to gain a deeper understanding of the contextual situation and identify the needs of ObGyn societies in relation to safe abortion advocacy. This paper provides a cross-country analysis of the outcomes of the needs assessments and reflects on the capabilities, barriers, and opportunities to strengthen this role of ObGyn societies. Common barriers, such as unavailability of services, lack of technical guidance, unawareness and ambiguity about the legal framework, provider attitudes, and abortion stigma, pose challenges for ObGyn societies to work constructively on safe abortion advocacy. However, ObGyn societies have a strong position due to their strategic networks and technical credibility and can be a facilitator in healthcare providers' advocacy role. Five strategies were developed to strengthen the capacity of ObGyn societies in safe abortion advocacy.

Prevalence of antimicrobial drug resistant bacteria carried by in- and outpatients attending a secondary care hospital in Zambia.

OBJECTIVE: Antimicrobial resistance is an increasing global health problem. Very little data on resistance patterns of pathogenic bacteria in low-income countries exist. The aim of this study was to measure the prevalence of antimicrobial drug resistant bacteria carried by in- and outpatients in the resource constraint setting of a secondary care hospital in Zambia. Nasal and rectal samples from 50 in- and 50 outpatients were collected. Patients were randomly selected and informed consent was obtained. Nasal samples were tested for the presence of methicillin-resistant Staphylococcus aureus (MRSA), and rectal samples for Gram-negative rods (family of Enterobacteriaceae) non-susceptible to gentamicin, ciprofloxacin and ceftriaxone. Additionally, E-tests were performed on ceftriaxone-resistant Enterobacteriaceae to detect extended-spectrum ß-lactamases (ESBLs). RESULTS: 14% of inpatients carried S. aureus, and 18% of outpatients. No MRSA was found. 90% of inpatients and 48% of outpatients carried one or more Enterobacteriaceae strains (75% Escherichia coli and Klebsiella pneumonia) resistant to gentamicin, ciprofloxacin and/or ceftriaxone (p < 0.001). Among inpatients gentamicin resistance was most prevalent (in 78%), whereas among outpatients ciprofloxacin resistance prevailed (in 38%). All ceftriaxone-resistant Enterobacteriaceae were ESBL-positive; these were present in 52% of inpatients versus 12% of outpatients (p < 0.001). We conclude it is feasible to perform basic microbiological procedures in the hospital laboratory in a low-income country and generate data on antimicrobial susceptibility. The high prevalence of antimicrobial drug resistant Enterobacteriaceae carried by in- and outpatients is worrisome. In order to slow down antimicrobial resistance, surveillance data on local susceptibility patterns of bacteria are a prerequisite to generate guidelines for antimicrobial therapy, to guide in individual patient treatment and to support implementation of infection control measures in a hospital.