Barreras y factores facilitadores para la accesibilidad a lainterrupción legal del embarazo (ILE) en el subsistema privado y de la seguridad social de Argentina: análisis dela situación institucional en el Hospital Italiano de Buenos Aires / Barriers and facilitating factors for accessibility to legal interruption of pregnancy in Argentina's public health and private subsystem: analysis of the institutional situation at Hospital Italiano de Buenos Aires

Hasta diciembre de 2020, en Argentina el aborto era legal ante determinadas causales. Sin embargo, era común que la implementación de esta legislación se viera entorpecida. El objetivo de esta investigación fue identificar las barreras y los factores facilitadores para la accesibilidad a la interrupción legal de embarazo en una institución del subsistema privado y de la seguridad social. Se realizó una investigación con enfoque cualitativo con entrevistas a profesionales del equipo de salud involucrados en el circuito de atención de interrupción legal de embarazo del Hospital Italiano de Buenos Aires. Los resultados se organizan en cinco ejes temáticos que surgieron luego de un proceso de lectura, interpretación y discusión:1) ausencia de una política institucional explícita, 2) los componentes de la práctica (falta de registro en la historia clínica electrónica, desarrollo de circuitos paralelos para acceder a la medicación: misoprostol), 3) el marco jurídico legal y las causales (falta de leyes claras, diversas interpretaciones en lo que respecta al causal salud), 4) la objeción de conciencia y 5) los aspectos contextuales (movimiento feminista, el proyecto de ley desaprobado en el senado en 2018). A pesar de que el equipo de salud contaba con un marco legal claro, implementar una política institucional interna resulta sumamente necesario. (AU)

Up until December 2020, abortion was legal in Argentina on certain grounds. However, it was common for the implementation of this legislation to be hindered. The purpose of this research was to identify the barriers and facilitating factors for the accessibility to legal abortion in both private and public health care institutions. A qualitative research was carried out with interviews with health professionals involved in the health team at Hospital Italiano de Buenos Aires legal interruption of pregnancy care circuit. The results are organized into five thematic axes that emerged after a process of reading, interpreting and discussing: 1) the absence of an explicit institutional policy, 2) the components of the practice (lack of registration in the electronic health records, development of parallel circuits to access medication: misoprostol), 3) the legal framework and grounds (lack of clear laws, different interpretations regarding health grounds), 4) conscientious objection, and 5) contextual aspects (feminist movement, the bill disapproved in the Senate in 2018). Even though the health teamhad a clear legal framework in place, implementing an internal institutional policy is extremely necessary. (AU)

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)

Hangers, Potions, and Pills: Abortion Procedures on American Television, 2008 to 2018.

BACKGROUND: Television portrayals of medical procedures may contribute to patient anxieties and cultural myths. We explored how television depicts abortion procedures, focusing on what these portrayals communicate about abortion access and safety. METHODS: Researchers identified all abortion procedure plotlines on American television from 2008 to 2018 through Internet searches. We viewed plotlines and coded for type of abortion, health outcome, and whether the abortion occurred on or off screen. We used inductive content analysis to identify themes. FINDINGS: We identified 96 television plotlines between 2008 and 2018 in which a character obtains or discloses an abortion. Of these, 39 plotlines (40%) depict some aspect of the abortion procedure. Twenty-three of the 39 abortion portrayals (59%) depict a surgical abortion procedure, of which about one-half were legal abortions and one-half were illegal. Only 7 of the 39 procedure plotlines (18%) portray medication abortions. Five of these plotlines depict illegal abortions; only two depict legal abortions. Four plotlines depict attempted abortions by supernatural means or ingestion of a toxic liquid. CONCLUSION: The majority of abortions on television are surgical, contrasting with the reality of abortion practice in which one-third of U.S. abortions are by medication. Portrayals of surgical abortion often reinforce the misperception that abortion is a surgical intervention requiring hospitalization. The few portrayals of medication abortion also perpetuate inaccuracies, including that it is easily accessible, uncommon, and dangerous. Portrayals of illegal abortions are overrepresented. This misinformation may seed unnecessary fear for patients before an abortion, and may create confusion among the public about abortion access and safety.

Implementation of legal abortion in Nepal: a model for rapid scale-up of high-quality care.

Unsafe abortion's significant contribution to maternal mortality and morbidity was a critical factor leading to liberalization of Nepal's restrictive abortion law in 2002. Careful, comprehensive planning among a range of multisectoral stakeholders, led by Nepal's Ministry of Health and Population, enabled the country subsequently to introduce and scale up safe abortion services in a remarkably short timeframe. This paper examines factors that contributed to rapid, successful implementation of legal abortion in this mountainous republic, including deliberate attention to the key areas of policy, health system capacity, equipment and supplies, and information dissemination. Important elements of this successful model of scaling up safe legal abortion include: the pre-existence of postabortion care services, through which health-care providers were already familiar with the main clinical technique for safe abortion; government leadership in coordinating complementary contributions from a wide range of public- and private-sector actors; reliance on public-health evidence in formulating policies governing abortion provision, which led to the embrace of medical abortion and authorization of midlevel providers as key strategies for decentralizing care; and integration of abortion care into existing Safe Motherhood and the broader health system. While challenges remain in ensuring that all Nepali women can readily exercise their legal right to early pregnancy termination, the national safe abortion program has already yielded strong positive results. Nepal's experience making high-quality abortion care widely accessible in a short period of time offers important lessons for other countries seeking to reduce maternal mortality and morbidity from unsafe abortion and to achieve Millennium Development Goals.

Designs of devices: the vacuum aspirator and American abortion technology.

In 1965, 71% of legal abortions in the United States were performed using the surgical procedure of dilation and curettage. By 1972, a mere seven years later, approximately the same percentage (72.6%) of legal abortions in the United States were performed using a completely new abortion technology: the electrical vacuum aspirator. This article examines why, in less than a decade, electric vacuum suction became American physicians' abortion technology of choice. It focuses on factors such as political and professional feasibility (the technology was able to complement the decriminalization of abortion in the US, and the interests, abilities, commitments, and personal beliefs of physicians); clinical compatibility (it met physician/patient criteria such as safety, simplicity and effectiveness); and economic viability (it was able to adapt to market factors such as production, cost, supply/demand, availability, and distribution).

Physician assistants as providers of surgically induced abortion services.

OBJECTIVES: We compared complication rates after surgical abortions performed by physician assistants with rates after abortions performed by physicians. METHODS: A 2-year prospective cohort study of women undergoing surgically induced abortion was conducted. Ninety-one percent of eligible women (1363) were enrolled. RESULTS: Total complication rates were 22.0 per 1000 procedures (95% confidence interval [CI] = 11.9, 39.2) performed by physician assistants and 23.3 per 1000 procedures (95% CI = 14.5, 36.8) performed by physicians (P =.88). The most common complication that occurred during physician assistant-performed procedures was incomplete abortion; during physician-performed procedures the most common complication was infection not requiring hospitalization. A history of pelvic inflammatory disease was associated with an increased risk of total complications (odds ratio = 2.1; 95% CI = 1.1, 4.1). CONCLUSIONS: Surgical abortion services provided by experienced physician assistants were comparable in safety and efficacy to those provided by physicians.

[Complications of voluntary interruption of pregnancy]. / Les complications des interruptions volontaires de grossesse (IVG).

PIP: Although the legalization of abortion has almost eliminated the risk of mortality, the experience is still psychologically difficult for many women, increasing the need for sympathetic treatment by the staff. Intraoperative complications may result from regurgitation, cardiovascular irregularities, or allergic reaction caused by the general anesthesia usually employed; from uterine perforation by the operative instruments, most commonly among multiparas and women who have undergone cesareans or have a uterine infection; or uterine hemorrhage. Uterine perforation is usually evaluated by celioscopy and may require surgical intervention if bleeding occurs. Infection and peritonitis may result from perforation. Complications of anesthesia may be reduced by using local anesthetic, while complications of uterine perforation may be reduced by careful examination of the patient under general anesthesia before the procedure begins. In the event that no products of conception are recovered, the instruments must be checked for malfunction, evidence of pregnancy should be reexamined, and ectopic pregnancy ruled out through clinical examination and celioscopy. Immediate postoperative complications may include uterine or tubal infection caused by retention of debris or perforation, peritonitis, and septicemia, and can result in secondary sterility. Continuation of the pregnancy is a rare complication. Late complications may include sterility due to cervico-isthmal weakening, uterine synechia, tubal occlusion, or psychological factors.^ieng

[Fatal complications by air embolism in legal interruption of pregnancy]. / Tödliche Komplikationen durch Luftembolie bei legaler Interruptio

PIP: Fatal air embolism as a complication of legal abortion in a 29-year-old woman is reported. After anesthesia had been induced and dilatation accomplished (Hegar 14), the suction tube was introduced into the uterus. The surgeon felt unusually heavy pressure when the pump was started, and heavy bleeding was observed. Aspiration was discontinued, and the abortion was completed by curettage. Irregular breathing and cardiovascular collapse occurred 4 minutes after the start of the operation, and resuscitation attempts were unsuccessful. Autopsy revealed pulmonary edema, pulmonary emphysema, and air bubbles in many areas of the vascular system, which confirmed the clinical diagnosis of air embolism. The hose of the suction cannula was found to have been attached to the exhaust outlet of the suction pump. It is suggested that the exhaust should be clearly differentiated from the intake valve in order to avoid similar accidents in the future.^ieng

Outpatient termination of pregnancy.

Termination of pregnancies ranging from 6 to 10 weeks' gestation is described in 127 women who attended the hospital as outpatients. The technique employed was to aspirate the products of conception through a narrow plastic tube using a high negative pressure. Infiltration of the cervix with local anaesthetic proved so effective that the procedure could be carried out on the fully conscious patient. The short time taken to evacuate the uterus, the small blood loss, and the low incidence of complications in the latter part of the study suggest that the technique is a valuable procedure. Relatively more women can be terminated as outpatients than as inpatients with a corresponding reduction in the demands made on gynaecological beds.