Transitar el laberinto: trayectorias de cuidado entre mujeres que deciden abortar en el Ecuador / Traversing the labyrinth: Trajectories of care among women who decide to have an abortion in Ecuador

El acercamiento a las experiencias de mujeres que decidieron abortar en Ecuador, a partir de sus relatos biográficos, nos permitió comprender las trayectorias de cuidado por las que debieron transitar. Se desarrolló una metodología cualitativa, con enfoque biográfico narrativo, con la participación de 19 mujeres mayores de edad, residentes en diferentes provincias del Ecuador, un territorio con medidas restrictivas sancionatorias legales y morales alrededor del aborto. Encontramos que los contextos socio biográficos de las participantes se caracterizaron por la presencia de múltiples formas de violencia; sus decisiones en salud sexual y reproductiva constituyen una carga moral que las responsabiliza y les impone una serie de mandatos sociales en medio de grandes limitaciones y restricciones; sus trayectorias y búsqueda de cuidados se caracterizan por un Estado ausente como garante, lo que las lleva resguardarse en sí mismas o en algunas mujeres que construyen redes de soporte por fuera de la institucionalidad formal de protección, transitando rutas diversas donde el descuido y las violencia vuelven a ser predominantes. Estos hallazgos derivan en una serie de discusiones en torno a la vida de las participantes, como el tránsito por un laberinto donde las violencias que experimentan crean encrucijadas y rodeos difíciles de evadir y superar; por otra parte, la maternidad se presenta como una propuesta que enfrenta a las mujeres a tensiones permanentes, donde la decisión de abortar es una postergación de aquella más que su negación, tensiones como las mutaciones de la religiosidad, que no solo dan soporte del ideal femenino y de su rol básico de la maternidad, sino también un elemento de soporte para la decisión. Se concluye con la propuesta del Cuidado Sororo de la Salud Sexual y Reproductiva (SSR), inspirada en las teorías feministas y en los aportes de las organizaciones sociales que defienden los derechos sexuales y reproductivos de las mujeres. Dicha propuesta se deriva de las narrativas de las mujeres y se centra en su autonomía para reivindicar la importancia del cuidado desde una perspectiva más humanizada, respetuosa, solidaria y empática. (AU)

The approach to the experiences of women who decided to have an abortion in Ecuador allowed us to understand the care trajectories they had to go through, based on their biographical accounts. A qualitative methodology was used with a biographical narrative approach and the participation of 19 women of legal age, residents of different provinces of Ecuador, a territory with restrictive legal and moral sanctioning measures around abortion. We found that the socio-biographical contexts of the participants were characterized by the presence of multiple forms of violence; their sexual and reproductive health decisions constitute a moral burden that makes them responsible and impose a series of social mandates in the midst of great limitations and restrictions; their trajectories and search for care are characterized by an absent State as guarantor, which leads them to take refuge in themselves or in some women who build support networks outside the formal institutionality of protection, going through diverse routes where neglect and violence are once again predominant. These findings lead to a series of discussions about the life of the participants as the transit through a labyrinth, where the violence they experience creates crossroads and detours difficult to avoid and overcome; motherhood as a proposal that confronts women with permanent tensions, where the decision to abort is a postponement of it, rather than its denial and the mutations of religiosity that not only support the feminine ideal and its basic role of motherhood, but also an element of support for the decision. It concludes with the proposal of Sororo Care of Sexual and Reproductive Care (SRH), inspired by feminist theories and the contributions of social organizations that defend women's sexual and reproductive rights. This proposal is derived from women's narratives and focuses on their autonomy, to vindicate the importance of care from a more humanized, respectful, supportive and empathetic perspective. (AU)

Abortion Knowledge Among Advanced Practice Clinicians in Colorado.

INTRODUCTION: Our objective was to quantify abortion law and care knowledge among Colorado advanced practice clinicians. METHODS: We conducted a stratified random survey of advanced practice clinicians, oversampling women's health and rural clinicians. We assessed sample characteristics, positions on abortion legality, and knowledge of abortion law and care. Mean knowledge scores were compared by sample characteristics. Survey responses were compared by provision of pregnancy options counseling and positions on abortion legality. Linear regression models were used to examine knowledge scores. RESULTS: A total of 513 participants completed the survey; the response rate was 21%. Abortion law knowledge questions (mean score, 1.7/7.0) ranged from 12% (physician-only law) to 45% (parental consent law) correct. For five of seven questions, "I don't know" was the most frequently chosen response. Abortion care knowledge questions (mean score, 2.8/8.0) ranged from 19% (abortion prevalence) to 60% (no elevated risk of breast cancer) correct. For four of eight questions, "I don't know" was the most frequently chosen response. Practicing in all other areas (e.g., family practice) was associated with lower abortion law and care knowledge than practicing in women's health. Providing options counseling was positively associated with abortion knowledge (law, ß = 0.44; 95% confidence interval [CI], 0.10-0.78; care, ß = 0.52; 95% CI, 0.08-0.95). Compared with participants who believe abortion should be legal in all circumstances, those who believe abortion should be illegal in all circumstances had similar abortion law knowledge (ß = -0.03; 95% CI, -0.65 to 0.59), but lower abortion care knowledge (ß = -1.85; 95% CI, -2.34 to -1.36). CONCLUSIONS: Abortion knowledge is low among Colorado advanced practice clinicians and education is needed.

Prevalencia y características de objetores de conciencia a la Ley 21. 030 en instituciones públicas / Prevalence and characteristics of conscientious objectors to Law 21. 030 in public institutions

INTRODUCCIÓN: La Ley 21.030 permite la objeción de conciencia al personal de salud al interior del pabellón y a las instituciones privadas. Ha sido considerada conflicto de intereses no monetario, al anteponer los valores personales, afectando el cumplimiento del deber profesional. OBJETIVOS: Establecer la prevalencia de funcionarios/as objetores/as en los hospitales de la red pública del país y caracterizarles según edad, género y nacionalidad. MÉTODO: Estudio cuantitativo, analítico y transversal. Se utilizaron medidas de tendencia central y dispersión. Para medir la asociación entre variables sociodemográficas, profesión y causal objetada, se utilizaron las pruebas de χ2, exacta de Fisher y de Kruskal-Wallis. RESULTADOS: En 57 hospitales, se observa una mayor frecuencia de objetores en causal 3. En 443 objetores, la mediana de edad fue de 43 años, el 64,8% mujeres y el 87,4% de nacionalidad chilena. En las zonas centro y sur del país se concentra la mayor proporción de hospitales con más del 50% de objetores. CONCLUSIONES: La dificultad para obtener información impide conocer cabalmente la magnitud de la objeción de conciencia. Resulta preocupante la alta prevalencia de objetores, específicamente en la causal violación. La objeción no puede operar como barrera que vulnere los derechos y la dignidad de las mujeres.

INTRODUCTION: Law 21.030 incorporates conscientious objection for health personnel inside the surgical ward and allows its invocation by private institutions. It has been considered a conflict of interest, not monetary, by putting personal values first, affecting the fulfillment of professional duty. OBJECTIVE: To establish the prevalence of objectors in the countrys public network hospitals and characterize them according to age, gender, and nationality. METHOD: Quantitative, analytical, and cross-sectional study. Central and dispersion trend measures were used. For measuring the association between sociodemographic variables, profession and causal objected, test χ2, Fisher exact and Kruskal-Wallis test were used. RESULTS: In 57 hospitals, a higher frequency of objectors were observed in the third causal. In 443 objectors, the median age was 43 years, 64.8% are women, and 87.4% are Chilean. The central and southern areas of the country have the highest proportion of hospitals, with more than 50% objectors. CONCLUSIONS: The difficulty for obtaining the information prevents fully knowing the magnitude of conscientious objection in Chile. The high prevalence of objectors, specifically in the causal violation is worrying. The conscientious objection cannot operate as a barrier that violates the rights and dignity of women.

A simple procedure in a complex patient: perioperative takotsubo cardiomyopathy.

Takotsubo cardiomyopathy (TTC) is a rare but life-threatening condition that is still not completely understood. Characterised by rapidly reversible ventricular dysfunction without any prior coronary artery disease, it can imitate a myocardial infarction and lead to death if not managed appropriately. This report examines a case of intraoperative cardiac arrest in a patient with no previous cardiac disease, and discusses the factors that may have precipitated this event, as well as the ways of distinguishing the cause of the arrest based on clinical course and investigations, eventually leading to a diagnosis of TTC.

Concerns of Pregnant Women in "Prenatal Screening/Diagnosis" Practice and Termination of Pregnancy.

OBJECTIVE: To investigate the reasons for decision-making and concerns of patients in the field of prenatal screening, invasive prenatal diagnostic testing (IPDT), and termination of pregnancy (TOP). STUDY DESIGN: This questionnaire-based study consisted of 107 pregnant women who were referred for prenatal screening to the Hacettepe University Hospital. The questionnaire given to patients was prepared from scratch since there is no standard set of questions measuring patients' feelings and concerns regarding prenatal screening/diagnosis, IPDT, and TOP. RESULTS: Our questionnaire results showed that it is possible to classify decision-making factors into 6 groups: psychological, social, fear, religious/faith, support, and trust. The majority of patients were undecided (48.6%) about IPDT if prenatal screening test results were risky. Only 23.4% of patients were willing to accept IPDT. On the other hand, 55.1% of patients were not willing to undergo TOP if the fetal karyotyping results were abnormal. Religious factors seem to be important in refusing IPDT and TOP. CONCLUSION: Physicians should re-evaluate their practice in the field of prenatal screening and diagnosis in light of the high refusal rates of IPDT and TOP. Understanding factors influencing women's decision-making processes provides insight for service providers to help women at high risk of having foetal anomalies to make better-informed choices.

Perinatal grief following neonatal comfort care for lethal fetal condition.

BACKGROUND: The objective of the study was to assess perinatal grief experienced after continuing pregnancy and comfort care in women diagnosed with lethal fetal condition compared with termination of pregnancy for fetal anomaly (TOPFA). METHODS: This was a retrospective observational study which included women who chose to continue their pregnancy after the diagnosis of lethal fetal condition with comfort care support at birth at the Prenatal Diagnosis Center of Rennes Hospital from January 2007 to January 2017. Women were matched with controls who underwent TOPFA for the same type of fetal anomaly, gestational age at diagnosis and year. Women were evaluated by a questionnaire including the Perinatal Grief Scale. RESULTS: There were 28 patients in the continuing pregnancy group matched with 56 patients in the TOPFA group. Interval between fetal loss and completion of questionnaire was 6±3 years. Perinatal grief score was similar at 61±22 vs 58±18 (p = 0.729) in the continuing pregnancy and TOPFA groups, respectively. Women in the TOPFA group expressed more guilt. The cesarean-section rate in the continuing pregnancy group was 25%. CONCLUSION: Perinatal grief experienced by women opting for continuing pregnancy and comfort care after diagnosis of a potentially lethal fetal anomaly is not more severe than for those choosing TOPFA.

Men's and women's roles in decision making about abortion in the context of HIV.

OBJECTIVE: Mother-to-child transmission of HIV is a matter of global concern but is particularly serious in Zimbabwe. A number of strategies have been identified to limit the risk of mother-to-child transmission, including abortion. The aim of the current study was to assess men's and women's roles in decision making about abortion in a setting with a high prevalence of HIV. METHODS: Qualitative research based on eight focus group discussions was conducted among adult men and women in Gokwe North District, Zimbabwe. RESULTS: Both men and women expressed strong, negative attitudes towards abortion. Often, HIV-infected women considered carrying their pregnancy to term so as to fulfil societal and cultural expectations of childbirth after marriage. Termination of pregnancy by HIV-infected women was discouraged due to the availability of highly active antiretroviral drugs. Fear of giving birth to a sick and HIV-infected child, however, remained high. Also, the restricted legal environment appeared to complicate HIV-positive women's decisions to abort. Male involvement in decision making about abortion was relatively limited; if women opted for termination of pregnancy they were likely to do so secretly without obtaining their partner's consent. CONCLUSIONS: In the context of HIV, it is important for prevention programmes to target both men and women in order to reduce the risk of mother-to-child transmission.

Actitudes hacia la interrupción voluntaria del embarazo en jóvenes mexicanos, y su opinión acerca del aborto inseguro como problema de salud pública / Young Mexicans' attitudes towards voluntary interruption of pregnancy and opinions on unsafe abortion as a public health problem / Atitudes perante a interrupção voluntária da gravidez em jovens mexicanos, e a opinião deles sobre o aborto inseguro como um problema de saúde pública

Resumen: El objetivo de este estudio fue explorar las actitudes hacia el aborto inducido en jóvenes mexicanos, y su relación con el hecho de considerar o no al aborto inseguro un problema de salud pública. Los resultados se compararon de acuerdo al sexo, edad, religión y disciplina de los participantes. La muestra estuvo integrada por 411 estudiantes universitarios, quienes contestaron el cuestionario sobre actitudes hacia el aborto y un cuestionario sobre aborto inseguro. Los participantes mostraron actitudes más favorables que condenatorias hacia el aborto inducido. En general, reconocieron que el aborto inseguro constituye un riesgo para la salud, pero no están seguros que su legislación ayude a resolver esta situación. Los hombres y los participantes religiosos (católicos u otra religión derivada del cristianismo) tuvieron actitudes más condenatorias hacia el aborto inducido que sus pares, y fueron los que menos consideran que legalizar el aborto pueda disminuir los problemas de salud que ocasiona el aborto inseguro. No hubo diferencias relacionadas con la edad de los participantes, ni con su disciplina. Un hallazgo preocupante fue el poco interés de los jóvenes en el tema de la legalización del aborto.

Abstract: This study aimed to explore young Mexicans' attitudes towards induced abortion and its relationship to their opinions on unsafe abortion as a public health problem. The results were compared by participants' gender, age, religion, and course major. The sample consisted of 411 university students who answered a questionnaire on their attitudes towards abortion and another questionnaire on unsafe abortion. Participants showed more favorable than unfavorable attitudes towards induced abortion. They generally acknowledged that unsafe abortion poses a health risk, but they were not sure whether legislation would help solve the problem. Male students and those professing a religion (Catholic or another Christian denomination) tended to be more unfavorable to induced abortion and were less likely to feel that legalizing abortion would decrease the health problems caused by unsafe abortion. There were no significant differences according to age or course major. A troublesome finding was the young people's limited interest in the issue of legalizing abortion.

Resumo: O objetivo deste estudo foi explorar as atitudes em face do aborto induzido em jovens mexicanos, e relação deles com o fato de considerar ou não o aborto inseguro um problema de saúde pública. Os resultados foram comparados de acordo ao sexo, idade, religião e disciplina dos participantes. A mostra foi integrada por 411 estudantes universitários, que contestaram o questionário sobre atitudes perante o aborto e um questionário sobre aborto inseguro. Os participantes mostraram atitudes mais favoráveis do que condenatórias perante o aborto induzido. Em geral, reconheceram que o aborto inseguro representa um risco para a saúde, porém não estão seguros que a atual legislação ajude a resolver esta situação. Os homens e os participantes religiosos (católicos ou de outras religiões decorrentes do cristianismo) tiveram atitudes mais condenatórias perante o aborto induzido do que seus pares, e foram os que menos consideram que legalizar o aborto possa diminuir os problemas de saúde que acarreta o aborto inseguro. Não teve diferenças relacionadas com a idade dos participantes, nem com a disciplina deles. Um achado preocupante foi o escasso interesse dos jovens sobre o assunto da legalização do aborto.

"Without any indication": stigma and a hidden curriculum within medical students' discussion of elective abortion.

Pregnancy termination is a common, beneficial medical procedure, but abortion care in the United States is stigmatized. Language, including categorization of some abortions as elective, may both reflect and convey stigma. We present a history of the term "elective" in reference to abortion, followed by data demonstrating its use by a sample of contemporary medical trainees and an analysis of the term's relationship to abortion stigma, medical training, and patient access to abortion care. We analyzed interviews with 41 U.S. medical students who had applied to residency programs in obstetrics and gynecology. Participants discussed experiences with, and attitudes toward, abortion before and during medical school, and plans to perform abortions in future practice. We inductively coded participants' use of "elective" in reference to abortion and analyzed their meanings. Participants did not use "elective" according to its medical definition, which conveys an absence of urgency for surgery. Instead, "elective" identified a subset of abortions that lacked maternal or fetal medical indications. "Elective" negatively marked and isolated some abortions, and participants used the term to convey judgment about patients' social and reproductive histories. Participants saw medical and psychosocial indications as mutually exclusive, and became confused when interrelated factors influenced patients' abortion decisions. They ignored the voluntary nature of abortion in the setting of medical illness, sexual violence, or fetal complications, and accepted discrimination against women seeking abortion for psychosocial indications as normal and ethical. The term "elective" enables the creation and perpetuation of abortion stigma, and contributes to a hidden curriculum for abortion training in medical education that distracts from core content, incorporates social judgment of patients into medical practice, and promotes normative gender concepts. Our findings support calls to improve the language of abortion care to ensure policies and training environments are consistent with professional standards.

Pain Management for First-Trimester Uterine Aspiration.

IMPORTANCE: First-trimester uterine aspiration can easily be performed in the office setting if adequate pain management for the patient is achieved. It is important for clinicians to understand evidence-based approaches for pain control to ensure a safe and efficient procedure. OBJECTIVE: This article reviews the literature regarding pharmacologic and nonpharmacologic pain control options for first-trimester abortion performed in the clinical setting. Preoperative, procedural, and postoperative pain control are all reviewed. EVIDENCE ACQUISITION: Authors searched the online database PubMed for relevant published literature through January 2018. To identify possible publications for review, the key word "abortion" was paired with the following key words: "pain," "pain-control," "pain management," "aspiration," "paracervical block," "sedation, "non-pharmacologic," and "post-operative." RESULTS: Optimizing pain control for first-trimester uterine aspiration may involve interventions before, during, and after the surgery. Evidence shows patients benefit from premedication with nonsteroidal anti-inflammatory drugs, a defined paracervical block technique, and an option to use one of several nonpharmacologic interventions. CONCLUSIONS AND RELEVANCE: Pain management for first-trimester uterine aspiration should be individualized for optimal patient satisfaction. Evidence supports multiple approaches to support this individualization. Targeted interventions before, during, and after the procedure should be offered to improve procedure experience and satisfaction.

Progesterone for preventing pregnancy termination after initiation of medical abortion with mifepristone.

INTRODUCTION: Abortion is often a difficult and traumatic decision for a woman to make. Perhaps greater distress occurs when a woman commences a medical abortion but then changes her mind and wishes to keep the now-threatened pregnancy. One published case series detailed a potential method to counter/reverse the abortifacient effect of mifepristone by administering parenteral progesterone in such situations. OBJECTIVES: The present report details cases of women in similar circumstances who have been treated with progesterone. The aims were to document occurrences of where women have changed their mind after commencing medical abortion, as well as to explore some of the controversies and clinical issues surrounding their circumstances. METHODS: Women who had commenced medical abortion by ingesting mifepristone but who had not taken misoprostol independently contacted a national pregnancy support service the same day. Those meeting criteria for treatment received progesterone pessaries per vaginum for two weeks. RESULTS: Cases: 28-year-old woman, 6 weeks plus 1 day gestation; 35-year-old woman, 8 weeks plus 5 days gestation; and 27-year-old woman, 7 weeks plus 3 days gestation. Outcomes respectively were: healthy male baby delivered at 39 weeks gestation; healthy male baby delivered at term; and completed medical abortion. CONCLUSIONS: Women have changed their mind after commencing medical abortion. Progesterone use in early pregnancy is low risk and its application to counter the effects of mifepristone in such circumstances may be clinically beneficial in preserving her threatened pregnancy. Further research is required, however, to provide definitive evidence.

La objeción de conciencia en el debate sobre la despenalización del aborto por tres causales en Chile / Conscientious objection in the debate on the decriminalization of abortion for three causes in Chile

ANTECEDENTES: en salud la objeción de conciencia del profesional es posible reconocerla globalmente como la negativa individual y privada para el cumplimiento de un deber jurídico considerado injusto que afecta la conciencia moral de quien objeta. En Chile ha cobrado especial relevancia en la actual discusión sobre la despenalización del aborto en tres causales, emergiendo como uno de los temas centrales. OBJETIVO: el presente artículo describe las principales características observadas en el debate público desde los primeros intentos para restablecer el aborto terapéutico hasta el actual proyecto en tramitación que intenta regular la despenalización del aborto en tres causales. La información fue obtenida a partir de la búsqueda en los principales medios de comunicación, identificando los principales actores, las instituciones y el discurso predominante. RESULTADOS: se identificaron 251 piezas de prensa y 215 actores provenientes en mayor proporción de la Cámara de Diputados, de las Universidades y del Ejecutivo. En el discurso prevalece la referencia a la objeción de conciencia individual e institucional, surgiendo la polémica en torno a su legitimidad y posibles consecuencias. DISCUSIÓN: debe evaluarse con mayor profundidad el fundamento basado en el derecho constitucional a la libertad de conciencia considerando los límites establecidos en un Estado de Derecho democrático y las directrices éticas presentes en la relación clínica. Se plantea la necesidad de regular su ejercicio previendo que no se vulneren derechos fundamentales, en especial de quienes detentan un mayor grado de vulnerabilidad.

BACKGROUND: objection on grounds of conscience by health care professionals is generally recognized as a personal, private refusal to perform a legal duty deemed unjust and deleterious to the objector's moral conscience. Conscientious objection has become a central aspect of the debate on the proposed decriminalization of abortion on three grounds currently underway in Chile. METHODS: this article describes the main constituent elements of the associated public debate, covering from the early efforts to restore therapeutic pregnancy termination through to the draft decriminalization legislation now being discussed in Congress. All data comes from a review of leading media outlets; key participants, institutions and prevailing discourses are identified. RESULTS: the said review encompassed 251 media items and 215 key players affiliated mostly with the Chamber of Deputies, universities, and government. Themes prevailing in associated discourses reference conscientious objection by personal and institutional players, as well as the attendant controversy over its legitimacy and possible consequences. DISCUSSION: this article posits that the constitutional right to freedom of conscience should be scrutinized further with due regard to the limits existing in rule-of-law democracies and to the ethical standards governing doctor-patient relationships. The exercise of conscientious objection privilege needs to be regulated in order to prevent infringement of fundamental rights, especially those of particularly vulnerable segments of the population.

Delayed diagnosis and management of second trimester abdominal pregnancy.

Second trimester abdominal ectopic pregnancies are rare and life threatening. Early diagnosis and treatment are paramount in reducing maternal morbidity and mortality. We describe an unusually late diagnosis of abdominal pregnancy despite multiple ultrasounds beginning in early pregnancy. A 28-year-old G2P1001 sought pregnancy termination at 22 weeks' gestation after fetal anomalies were noted on an 18-week ultrasound during evaluation for elevated maternal serum alfa-fetoprotein. Due to abortion restrictions in her home state, she travelled over 500 miles for abortion care. During dilation and evacuation, suspected uterine perforation led to the finding of a previously undiagnosed abdominal pregnancy. At laparotomy, she underwent left salpingo-oophorectomy and removal of abdominal pregnancy and placenta. A multidisciplinary team approach was paramount in optimising the patient's outcome. Abortion restrictions requiring travel away from the patient's home community interrupted her continuity of care and created additional hardships, complicating management of an unexpected, rare and life-threatening condition.

Maus-tratos e discriminação na assistência ao aborto provocado: a percepção das mulheres em Teresina, Piauí, Brasil / Maltreatment and discrimination in induced abortion care: perception of women in Teresina, State of Piauí, Brazil

Resumo O tratamento das complicações do aborto provocado pode ser dificultado por atitudes de discriminação praticadas por profissionais de saúde nos hospitais e serviços de aborto. Este artigo recuperou histórias de violência institucional entre mulheres que provocaram o aborto em condições ilegais e inseguras. Foram entrevistadas 78 mulheres internadas em um hospital público de referência em Teresina por complicações do aborto provocado. Utilizou-se roteiro semiestruturado com perguntas sobre práticas e itinerários de aborto e violência institucional durante a internação. Práticas discriminatórias e de maus-tratos durante a assistência foram relatadas por 26 mulheres, principalmente entre aquelas que confessaram a indução do aborto. Julgamento moral, ameaças de denúncia à polícia, negligência no controle da dor, longa espera pela curetagem uterina e internação conjunta com puérperas foram os principais tipos de violência institucional narrados. As práticas de violência institucional na assistência ao aborto provocado violam o dever de acolhimento do serviço de saúde e impedem que as mulheres tenham suas necessidades de saúde atendidas.

Abstract Treatment of complications resulting from induced abortion may be hampered by discriminatory attitudes manifested by healthcare professionals in hospitals and abortion services. This article retrieved stories of institutional abuse directed at women who had an induced abortion in illegal and unsafe conditions. Seventy-eight women admitted to a public hospital in Teresina for complications after an induced abortion were interviewed. A semi-structured script was used with questions about practices and itineraries of abortion and institutional violence during hospitalization. Discriminatory practices and maltreatment during care were reported by 26 women, especially among those who confessed to induction of the abortion. Moral judgement, threat of filing a complaint to the police, negligence in the control of pain, long wait for uterine curettage, and hospitalization with mothers who have recently given birth were the main types of institutional violence reported by women. Cases of institutional violence in the care of induced abortion violates the duty of the healthcare service and prevents women from receiving the necessary health care.

Meanings of abortion in context: accounts of abortion in the lives of women diagnosed with breast cancer.

BACKGROUND: A breast cancer diagnosis and an abortion can each be pivotal moments in a woman's life. Research on abortion and breast cancer deals predominantly with women diagnosed during pregnancy who might be advised to have an abortion. The other-discredited but persistent-association is that abortions cause breast cancer. The aim here was to understand some of the ways in which women themselves might experience the convergence of abortion and breast cancer. METHODS: Among 50 women recruited from the Australian Breast Cancer Family Study and interviewed in depth about what it meant to have a breast cancer diagnosis before the age of 41, five spontaneously told of having or contemplating an abortion. The transcripts of these five women were analysed to identify what abortion meant in the context of breast cancer, studying each woman's account as an individual "case" and interpreting it within narrative theory. RESULTS: It was evident that each woman understood abortion as playing a different role in her life. One reported an abortion that she did not link to her cancer, the second was relieved not to have to abort a mid-treatment pregnancy, the third represented abortion as saving her life by making her cancer identifiable, the fourth grieved an abortion that had enabled her to begin chemotherapy, and the fifth believed that her cancer was caused by an earlier abortion. CONCLUSIONS: The women's accounts illustrate the different meanings of abortion in women's lives, with concomitant need for diverse support, advice, and information.

Acceptance and Continuation of Contraceptive Methods Immediate Postabortion.

BACKGROUND/AIMS: Providing preabortion contraceptive counseling for the method of contraception may reduce the incidence of repeat abortions. This study aimed to compare the acceptance and continuation rates of intrauterine devices (IUDs), combined oral contraceptives (COCs), and condom use after abortion in women who received preabortion contraceptive counseling. METHODS: Women seeking a first-trimester abortion prospectively received preabortion contraceptive counseling and the choice of method of contraception was based on the counseling and not related to prior methods of birth control. Outcomes included continuation of postabortion contraceptive use and repeat abortions over a 6-month follow-up period. RESULTS: Four hundred and fifty-five women (IUD group: n = 161; COC group: n = 149; condom group: n = 135) completed 6-month follow-up after the abortions. At the sixth month follow-up, patients continued using the IUD, COC, and condoms for contraception were 64.2, 10, and 51.5%, respectively. Higher age, being married, parity ≥1, and previous abortion were factors that were associated with more frequent selection of an IUD, while a higher education level was associated with a more frequent selection of COC and condoms. CONCLUSION: The continued use of COCs after abortion is low even with preabortion contraceptive counseling. The IUD offers reliable birth control with a lower discontinuation rate than COCs or condoms.

Induced abortion - impact on a subsequent pregnancy in first-time mothers: a registry-based study.

BACKGROUND: To date, several studies concerning the effects of induced abortion (IA) on women's later psychosocial well-being and future delivery complications have been published. However, the lack of reports on woman's physical well-being during their first full-term pregnancy occurring after IA is what inspired the current study. Here, we evaluate the physical well-being and use of maternity services of first-time mothers with a history of IA. METHODS: Finnish National Birth Registry data from 2008 to 2010 were linked with the Induced Abortion Registry data from 1983 to 2007. After excluding first-time mothers with a history of miscarriage, ectopic pregnancy or delivery, 57,406 mothers were eligible for the study, with 5,167 (9.0 %) having experienced prior IA. Data from the pregnancy follow-up visits were evaluated and compared between IA mothers and primiparous mothers. RESULTS: Women with IA had higher rates of smoking after the first trimester and were more likely to be overweight (body mass index >25 kg/m2) than the control group mothers. A higher use of maternity health clinic (MHC) services, thrombosis prophylaxis and participation in a second trimester ultrasound and amniotic fluid sample testing were evident in IA mothers, whereas the likelihood of assisted fertilisation procedure(s) was elevated in the control group. A shorter interpregnancy interval (IPI) seemed to contribute to a late first MHC visit and first trimester serum screening test participation, a higher incidence of placenta samples and an increased presence of preeclampsia and maternal care for poor foetal growth. CONCLUSIONS: IA is associated with being overweight before the subsequent pregnancy and with smoking after the first trimester. More frequent pregnancy follow-up visits in the IA group may be due to greater participation in the placenta sample testing and use of thrombosis prophylaxis. No association between IA and preeclampsia, hypertension, gestational diabetes or preterm premature rupture of membranes was evident in the pregnancy parameters. According to our findings, experiencing IA decreased the need for fertilisation procedures before the next pregnancy when compared to primiparous mothers. Among the IA mothers, the short IPI seemed to contribute to the higher risk for preeclampsia and maternal care for poor foetal growth. However, more research is needed around the IPI before establishing its effect on later pregnancy.

Sentimentos de mulheres diante da concretização do aborto provocado / Women's feelings on the occurrence of induced abortion / Sentimientos de mujeres ante el aborto inducido

Objetivo: analisar os sentimentos experienciados por mulheres no processo de concretização da prática abortiva. Método: pesquisa qualitativa realizada com 19 mulheres em situação de abortamento, internadas em uma maternidade pública, localizada em Natal, Rio Grande do Norte, Brasil. Os dados foram coletados entre março/agosto de 2013, por meio de entrevista semiestruturada, e a análise dos depoimentos embasou-se nos referenciais teórico-metodológicos da Teoria Fundamentada nos Dados e Interacionismo Simbólico. O projeto de pesquisa obteve aprovação do Comitê de Ética com CAAE nº 10332312.9.0000.5537. Resultados: as mulheres, ao provocarem o abortamento, interagiram com o feto e profissionais de saúde, e vivenciaram conflitos entre valores morais, os quais as fizeram se sentir transgressoras da moralidade, desencadeando tristeza, medo da morte e do nascimento de filho deficiente. Conclusão: constatou-se a presença de diferentes sentimentos negativos nas mulheres, os quais emergiram do conflito experimentado por elas, principalmente, com valores morais que recriminam a prática abortiva.

Objective: to analyze the feelings experienced by women on the occurrence of abortion. Method: qualitative study of 19 women undergoing abortion, admitted to a public maternity hospital in Natal, Rio Grande do Norte, Brazil. Data were collected between March and August 2013 by semi-structured interview, and analysis of the transcripts was framed theoretically and methodologically by Grounded Theory and Symbolic Interaction. The research project was approved by the Ethics Committee (CAAE 10332312.9.0000.5537). Results: when women underwent abortion, they interacted with fetus and health professionals, and experienced conflicts between moral values, making them feel they were transgressing moral codes, and causing sadness and fear of death and of giving birth to a disabled child. Conclusion: the women were found to have many different negative feelings, which emerged from the conflict they experienced, primarily with moral values that censure the practice of abortion.

Objetivo: analizar los sentimientos que experimentan las mujeres en la realización de la práctica abortiva. Método: investigación cualitativa realizada con 19 mujeres hospitalizadas por aborto en un hospital público en Natal, Rio Grande do Norte, Brasil. Los datos fueron recolectados entre Marzo/Agosto 2013 mediante entrevistas y discursos semiestructuradas analizaron con base en el marco teórico y metodológico de la teoría fundamentada y interacción simbólica. El proyecto de investigación fue aprobado por el Comité de Ética con CAAE 10332312.9.0000.5537. Resultados: cuando las mujeres realizan el aborto, interactuado con ellos mismos, con el feto, los valores morales y profesionales de la salud, lo que les hizo consideran transgredir la moral, provocando dolor, miedo a la muerte y el nacimiento de un hijo con discapacidad. Conclusión: se observó la presencia de muchos sentimientos negativos en las mujeres, que surgieron debido a la interacción que se establece por ellos, especialmente con los valores morales, que reprochan la práctica abortiva.