En 2020, el aborto en Argentina salió de la clandestinidad / In 2020, abortion in Argentina came out of hiding

El aborto voluntario es legal en Argentina a partir de la sanción y promulgación de la ley 27.610, enmarcada en el artículo 75 de la Constitución Nacional y de aplicación obligatoria en todo el territorio de la República Argentina, que tiene como objeto regular el acceso a la interrupción voluntaria del embarazo y a la atención post-aborto. En este artículo, las autoras sintetizan los aspectos más destacados de esta ley y plantean los desafíos a tener en cuenta para su exitosa implementación. (AU)

Voluntary abortion is legal in Argentina since the sanction and promulgation of Law 27,610, which is framed in Article 75 of the National Constitution and mandatory throughout the territory of the Argentine Republic. It aims to regulate access tothe voluntary termination of pregnancy and post-abortion care. In this article, the authors summarize the most importantaspects of this law and pose the challenges to be considered for its successful implementation. (AU)

The effects of a community-based intervention on women's knowledge and attitudes about safe abortion in intervention and comparison towns in Oromia, Ethiopia.

The aim of this post-intervention assessment was to measure the effects of community intervention on the knowledge and attitudes of women regarding safe abortion in Ethiopia. In 2014, following implementation of an educational intervention on sexual and reproductive health from December 2012 to December 2013, 800 women were interviewed about their knowledge, attitudes, and practices regarding abortion. Multivariate regression analyses of respondents' demographics, sources of abortion information, knowledge, and attitudes about safe abortion were conducted. More women in the intervention community knew safe abortion was available in the community (76 percent vs. 57 percent; p < 0.001). Women in the intervention community had greater odds of feeling that women should have access to safe abortion services (adjusted odds ratio [aOR]: 1.55, 95 percent confidence interval [CI]: 1.06, 2.28) after adjusting for socio-demographic characteristics. They had significantly greater odds of feeling comfortable and confident talking to a healthcare provider (aOR: 2.44, 95 percent CI: 1.55, 3.84) and/or her partner (aOR: 2.47, 95 percent CI: 1.58, 3.85) about abortion. Increased mobilization of community networks in disseminating sexual health and abortion information was followed by increased knowledge of abortion services in the intervention community and improved reproductive choices for women.

Knowledge on legislation of abortion and experience of abortion among female youth in Nepal: A cross sectional study.

BACKGROUND: Abortion has been legal in Nepal since 2002 and the country has made striking progress in rolling out induced abortion services. It led to well-known changes in reproductive behavior, however knowledge about legislation and abortion experience by female youth has been least investigated. This paper is an attempt to examine knowledge about legislation of abortion and abortion experiences among female youth in Nepal. METHODS: This paper uses data from the Nepal Demographic and Health Survey (NDHS 2011). The analysis is confined to female youth aged 15-24 (n = 5050). Both bivariate and multivariate analyses have been performed to describe the knowledge about law and experience of abortion. The bivariate analysis (chi-square test) was applied to examine the association between dependent variables and female youth's demographic, socioeconomic, and cultural characteristics. Besides bivariate analysis, the net effect of each independent variable on the dependent variable after controlling for the effect of other predictors has also been measured through multivariate analysis (logistic regression). RESULTS: Only two-fifth (41%) female youth was aware of abortion legislation in the country. Knowledge on at least one condition of abortion law is even lower (21%). Less than two percent (1.5%) female youth reported that they ever had an abortion. The multivariate analysis found that the knowledge and experience of abortion varied with different settings. Youth aged 20-24 [adjusted odds ratio (aOR) = 1.3; 95% CI 1.7-5.0)], who have higher education (primary aOR = 1.89, ; 95% CI 1.5-2.5 secondary aOR = 4.6; 95% CI 3.7-5.9), who were from rich households (aOR = 1.5; 95% CI 1.2-1.7), who had high autonomy (aOR = 1.29; 95% CI 1.02-1.64) were more likely to be aware compared to their counterparts about legislation of abortion. In the other hand, female from Dalit (aOR = 0.55; 95% CI 0.5-0.7 and Janajati aOR = 0.72; 95% CI 0.6-0.8) caste, who were married (aOR = 0.80; 95% CI 0.7-0.9), who were from Muslim (aOR = 0.54; 95% CI 0.3-0.9) and who resided in Hill (aOR = 0.63 ; 95% CI 0.5-0.8) and Terai/plain area (aOR = 0.74; 95% CI 0.6-0.9) were less likely to be aware about the law. Similarly, female youth who have knowledge on abortion law (aOR = 2.8; ; 95% CI 1.6-4.8), who have primary (aOR = 5.2; 95% CI 1.6-16.9) and secondary education (aOR = 3.8; 95% CI 1.2-12.8), married (aOR = 7.7; 95% CI 3.8-12.9), who had higher number of children ever born [1-2 children aOR = 1.9; 95% CI 1.1-3.6 and 3 or more children aOR = 3.4; 95% CI 1.1-10.9), who were from rich households (aOR = 2.62 ;95% CI 1.3-5.4), who have high autonomy (aOR = 3.0; 95% CI 1.6-5.8), who had experienced sexual violence (aOR = 1.91; 95% CI 1.1-8.7) were more likely to undergone abortion compared to their counterparts. CONCLUSION: Knowledge about legislation of abortion and conditions of abortion law is low among female youth. Awareness program should target these youth as they are more likely to be sexually active. There is a need of comprehensive education about abortion to these youth which can help eventually reduce unsafe abortion that take a large toll on women's life.

Knowledge of Abortion Legislation Towards Induced Abortion Among Female Preparatory School Students in Dabat District, Ethiopia.

More than 32% of maternal mortality reported in Ethiopia is due to unsafe abortions. Women's knowledge of abortion legislation is a key determinant of the utilization of safe abortion services. The objective of this study was to determine knowledge of abortion legislation and associated factors among female students of Dabat Preparatory School. A quantitative school-based cross-sectional study was conducted from May 25-June 7/2014. Data were collected from 234 randomly selected female students using structured and pre-tested questionnaire. Majority of the participants, 147 (62.8%) know that the law in Ethiopia allows safe and legal abortion under certain circumstances. Ninety-seven (41.5%) of them have poor knowledge towards the legality of induced abortion in Ethiopia. Higher family income (OR=2.63, 95% CI=1.22-5.63), knowing the place where safely induced abortion can be performed (2.51, 95%CI=1.31-4.81) and current use of contraceptive (OR=2.3, 95% CI, 1.1-4.81) are significantly associated with knowledge of the abortion legislation. Student's knowledge of the legal status of abortion is still low. School-based health education about abortion legislation and where it can be safely performed is essential.

Doctors or mid-level providers for abortion.

BACKGROUND: The World Health Organization recommends that abortion can be provided at the lowest level of the healthcare system. Training mid-level providers, such as midwives, nurses and other non-physician providers, to conduct first trimester aspiration abortions and manage medical abortions has been proposed as a way to increase women's access to safe abortion procedures. OBJECTIVES: To assess the safety and effectiveness of abortion procedures administered by mid-level providers compared to doctors. SEARCH METHODS: We searched the CENTRAL Issue 7, MEDLINE and POPLINE databases for comparative studies of doctor and mid-level providers of abortion services. We searched for studies published in any language from January 1980 until 15 August 2014. SELECTION CRITERIA: Randomised controlled trials (RCTs) (clustered or not clustered), prospective cohort studies or observational studies that compared the safety or effectiveness (or both) of any type of first trimester abortion procedure, administered by any type of mid-level provider or doctors, were eligible for inclusion in the review. DATA COLLECTION AND ANALYSIS: Two independent review authors screened abstracts for eligibility and double-extracted data from the included studies using a pre-tested form. We meta-analysed primary outcome data using both fixed-effect and random-effects models to obtain pooled risk ratios (RR) with 95% confidence intervals (CIs). We carried out separate analyses by study design (RCT or cohort) and type of abortion procedure (medical versus surgical). MAIN RESULTS: Eight studies involving 22,018 participants met our eligibility criteria. Five studies (n = 18,962) assessed the safety and effectiveness of surgical abortion procedures administered by mid-level providers compared to doctors. Three studies (n = 3056) assessed the safety and effectiveness of medical abortion procedures. The surgical abortion studies (one RCT and four cohort studies) were carried out in the United States, India, South Africa and Vietnam. The medical abortion studies (two RCTs and one cohort study) were carried out in India, Sweden and Nepal. The studies included women with gestational ages up to 14 weeks for surgical abortion and nine weeks for medical abortion.Risk of selection bias was considered to be low in the three RCTs, unclear in four observational studies and high in one observational study. Concealment bias was considered to be low in the three RCTs and high in all five observational studies. Although none of the eight studies performed blinding of the participants to the provider type, we considered the performance bias to be low as this is part of the intervention. Detection bias was considered to be high in all eight studies as none of the eight studies preformed blinding of the outcome assessment. Attrition bias was low in seven studies and high in one, with over 20% attrition. We considered six studies to have unclear risk of selective reporting bias as their protocols had not been published. The remaining two studies had published their protocols. Few other sources of bias were found.Based on an analysis of three cohort studies, the risk of surgical abortion failure was significantly higher when provided by mid-level providers than when procedures were administered by doctors (RR 2.25, 95% CI 1.38 to 3.68), however the quality of evidence for this outcome was deemed to be very low. For surgical abortion procedures, we found no significant differences in the risk of complications between mid-level providers and doctors (RR 0.99, 95% CI 0.17 to 5.70 from RCTs; RR 1.38, 95% CI 0.70 to 2.72 from observational studies). When we combined the data for failure and complications for surgical abortion we found no significant differences between mid-level providers and doctors in both the observational study analysis (RR 1.36, 95% CI 0.86 to 2.14) and the RCT analysis (RR 3.07, 95% CI 0.16 to 59.08). The quality of evidence of the outcome for RCT studies was considered to be low and for observational studies very low. For medical abortion procedures the risk of failure was not different for mid-level providers or doctors (RR 0.81, 95% CI 0.48 to 1.36 from RCTs; RR 1.09, 95% CI 0.63 to 1.88 from observational studies). The quality of evidence of this outcome for the RCT analysis was considered to be high, although the quality of evidence of the observational studies was considered to be very low. There were no complications reported in the three medical abortion studies. AUTHORS' CONCLUSIONS: There was no statistically significant difference in the risk of failure for medical abortions performed by mid-level providers compared with doctors. Observational data indicate that there may be a higher risk of abortion failure for surgical abortion procedures administered by mid-level providers, but the number of studies is small and more robust data from controlled trials are needed. There were no statistically significant differences in the risk of complications for first trimester surgical abortions performed by mid-level providers compared with doctors.

[Knowledge and attitudes of medical students on decriminalized induced abortion]. / Conocimientos y actitudes de estudiantes de medicina ante el aborto inducido despenalizado.

Objective To explore if the academic exposure to legal abortion affects the knowledge and attitudes of medical students. Method To asses this relationship, both qualitative and quantitative approaches were performed. We analyzed a medical student cohort enrolled in gynecology and obstetrics at two accredited universities in Bucaramanga, Colombia during the second half of 2011. Students were invited to participate in two anonymous surveys. One survey was conducted in the first three weeks of the semester, and the second was done in the last three weeks. A quantitative approach was taken by a group interview of two random groups of participants. One group was composed of medical students of gynecology and obstetrics (fourth year of medicine), and the other group was composed of medical students in their last year (internal medical students). Results The items pregnancy with risk to the mother´s life, or affected by a non-viable fetal malformation, or result of rape were recognized and accepted. 46% of the participants changed their attitude about legal abortion at the end of the semester. Three out of every four participants changed their attitude to accept the decriminalized conditions, while one out of every four people had the opposite change of opinion. Medical student´s don´t believe that general practitioners are trained to advice patients in these cases. Conclusions Educating and training general practitioners in issues related to legal abortion may decrease the risk of inadequate medical assessment in cases of legal abortion.

Medical students' attitudes and perceptions on abortion: a cross-sectional survey among medical interns in Maharastra, India.

INTRODUCTION: Although abortion care has been an established routine since decades in India, 8% of maternal mortality is attributed to unsafe abortion. Increased knowledge and improved attitudes among health care providers have a potential to reduce barriers to safe abortion care by reducing stigma and reluctance to provide abortion. Previous research has shown that medical students' attitudes can predict whether they will perform abortions. The objective of our study was to explore attitudes toward abortion among medical interns in Maharastra, India. STUDY DESIGN: A cross-sectional survey was carried out among 1996 medical interns in Maharastra, India. Descriptive and analytical statistics were used to interpret the study instrument. RESULTS: Almost one quarter of the respondents considered abortion to be morally wrong, one fifth did not find abortions for unmarried women acceptable and one quarter falsely believed that a woman needs her partner or spouse's approval to have an abortion. Most participants agreed that unsafe abortion is a serious health problem in India. A majority of the respondents rated their knowledge of sexual and reproductive health as good, but only 13% had any clinical practice in abortion care services. CONCLUSION: Disallowing attitudes toward abortion and misconceptions about the legal regulations were common among the surveyed medical students. Knowledge and attitudes toward abortion among future physicians could be improved by amendments to the medical education, potentially increasing the number of future providers delivering safe and legal abortion services. IMPLICATION PARAGRAPH: Abortion is legal in India since decades, but maternal mortality due to unsafe abortions remains high. This survey of attitudes toward abortion among medical interns in Maharastra indicates that disallowing views prevail. Improved knowledge and clinical training can increase numbers of potential abortion providers, thus limit unsafe abortion.

Aborto no punible: cuestiones filosóficas de un debate que nos trasciende / Non-punishable abortion: philosophical questions of a debate that transcends us

El avance de las sociedades postula desafíos y problemas que complejizan la vida comunitaria. Los cambios son vertiginosos. A veces, las acciones avanzan más rápido que las ideas o las propuestas destinadas a resolver los problemas que suscitan. El aborto ocupa un lugar destacado dentro del debate público. Implica aspectos fundamentales entre los que se cuentan: la vida, la muerte, la salud, la religión, la ética, la moral y sus límites, la capacidad de decidir por uno mismo y la potestad para decidir por alguien más. El aborto es una problemática socio-sanitaria que trasciende a sí misma y nos arrolla con su complejidad.

Unintended consequences: abortion training in the years after Roe v Wade.

The US Supreme Court's 1973 Roe v Wade decision had clear implications for American women's reproductive rights and physician ability to carry out patient choices. Its effect on physician abortion training was less apparent. In an effort to increase patient access to abortions after Roe, provision shifted from hospitals to nonhospital clinics. However, these procedures and patients were taken out of the medical education realm, and physicians became vulnerable to intimidation. The consequent provider shortage created an unexpected barrier to abortion access. Medical Students for Choice was founded in 1993 to increase abortion-training opportunities for medical students and residents. Its mission ensures that motivated medical students will learn and a growing number of physicians will commit to comprehensive abortion provision.

Knowledge and attitudes of Swedish politicians concerning induced abortion.

OBJECTIVE: Induced abortion is more frequent in Sweden than in many other Western countries. We wanted to investigate attitudes and knowledge about induced abortion among politicians responsible for healthcare in three Swedish counties. METHOD: A study-specific questionnaire was sent to all 375 elected politicians in three counties; 192 (51%) responded. RESULTS: The politicians stated that they were knowledgeable about the Swedish abortion law. More than half did not consider themselves, in their capacity as politicians, sufficiently informed about abortion-related matters. Most politicians (72%) considered induced abortion to be primarily a 'women's rights issue' rather than an ethical one, and 54% considered 12 weeks' gestational age an adequate upper limit for induced abortion. Only about a third of the respondents were correctly informed about the number of induced abortions annually carried out in Sweden. CONCLUSION: Information and knowledge on induced abortion among Swedish county politicians seem not to be optimal. Changes aimed at reducing the current high abortion rates will probably not be easy to achieve as politicians seem to be reluctant to commit themselves on ethical issues and consider induced abortion mainly a women's rights issue.

Reflexiones sobre la despenalización del aborto en México / Reflections on the decriminalization of abortion in Mexico

Hace aproximadamente cinco años, se aprobó por la Asamblea de Representantes del Distrito Federal la despenalización del aborto en el D. F. Esta situación hace reflexionar acerca de la condición moral y ética de los representantes que elegimos para que salvaguardaran nuestros intereses en la Cámara de Diputados. ¿A quién le preguntaron si estábamos de acuerdo con la modificación del Código Penal? ¿Cómo influirá en la práctica de enfermería esta nueva ley que obliga a las enfermeras a participar en actos contrarios a sus creencias y principios? ¿Dónde quedó el respeto al derecho de objeción de conciencia de los profesionales de salud? Son preguntas que quedarán por resolverse. Lo que sí es necesario hacer es un análisis de la situación desde el punto de vista ético-legal, y las implicaciones que acarrea para la práctica profesional. El presente ensayo hace una reflexión sobre los aspectos éticos y morales que se deben de cuestionar las enfermeras cuando les toque enfrentar alguna situación como la que se está tratando; así mismo, se realizará un resumen de las leyes, tanto nacionales como internacionales que protegen al no nacido y que fueron pasadas por alto para aprobar el decreto que despenaliza al aborto en el Distrito Federal.

About five years ago, was approved by the Representatives Assembly of the Federal District, the legalization of abortion in D. F. This situation does reflect on the moral and ethical representatives who chose to have safeguarded our interests in the House of Representatives, because who asked if we agreed with the amendment of the penal code? How to influence nursing practice this new law requiring nurses to participate in acts contrary to their beliefs and principles? What happened to respect the right of conscientious objection by health professionals? This are questions that remain to be resolved. What if you need to do is analyze the situation from the standpoint of legal ethics, and carries implications for professional practice. This paper will make a beginning of reflection on the ethical and moral question that must be nurses when they touch face a situation such as being treated, and it will be a summary of the laws, both national and international protect the unborn and that were overlooked in order to pass the decree decriminalizing abortion in Mexico City.

"Lonely, tragic, but legally necessary pilgrimages": transnational abortion travel in the 1970s.

This article explores the work of the Calgary Birth Control Association with a particular focus on their referral service to help Albertan women obtain abortions in Seattle. The fact that Canadian women were travelling to the United States for abortions highlights the shortcomings of the Canadian health-care system and the legal changes in the 1969 omnibus bill. Cross-border travel is also compelling evidence for the argument that reproductive rights are an international issue. More particularly, this study demonstrates the tensions that reproductive-rights activists faced in addressing the needs of individual women vs the long-term objective of changing the laws and improving accessibility.

The effect of patient-centered contraceptive counseling in women who undergo a voluntary termination of pregnancy.

OBJECTIVE: The aim of the study was to evaluate, by means of a randomized controlled trial, whether a patient-centered contraceptive counseling intervention increased the use of contraception, and the knowledge and positive attitudes towards contraception, in women who undergo a termination of pregnancy (TOP). METHODS: The study was carried out at the San Paolo Hospital of Milan between the 1st of February and the 31st of May 2004. Participants (41 women; ages 20-44 years) were randomly divided into two groups: an experimental group (n = 20), who received patient-centered contraceptive counseling, and a control group (n = 21), who received the routine treatment in use at the San Paolo Hospital and were referred to the community health centers after the TOP. Both groups were administered a questionnaire at two points in time (before the counseling and 1 month later) which evaluated participants' knowledge, attitudes and use of contraception (the latter was also followed up 3 months later). The counseling intervention lasted 30 min and was carried out by a psychologist and a gynaecologist. RESULTS: It was found that knowledge, favorable attitudes and use of effective contraception increased significantly for the experimental group, whereas there was no significant change for the control group. CONCLUSION: The counseling intervention was therefore found to be efficacious in improving understanding and use of contraception in women who have undergone a TOP. The hope is that this will contribute to increased use of effective contraception in the future. PRACTICE IMPLICATIONS: Following the principles of patient-centered medicine, this study provides evidence for the importance of exploring woman's feelings, beliefs, wishes and expectations regarding contraception within a contraceptive counseling intervention.

Exploration of the views of traditional healers regarding the termination of pregnancy (TOP) law.

The North-West Province is predominantly a rural area, and traditional healers remain the most important and influential members of the rural communities. A qualitative, explorative, descriptive and contextual research design was used. In-depth, individual focused and interactive interviews were held with eight traditional healers from the rural areas of Mmabatho-Mafikeng. In addition, field notes and observations were utilised. The objective of this article is to explore the views of the traditional healers regarding termination of pregnancy (TOP) law. The results reflected the following themes: termination of pregnancy is killing; a child is a precious gift from God and the ancestors; there are alternatives to TOP; people who had any type of abortion should be cleansed with "dipitsa" or herbs; TOP may be allowed only in case of rape and incest, rape and incest offenders should be severely punished; and the traditional healers were not consulted during formulation of the TOP Law. It is therefore recommended that traditional should be involved in TOP workshops and educational programmes to enable them to provide counselling before and after abortion.