Preventing unsafe abortion: Achievements and challenges of a global FIGO initiative.

FIGO established a Working Group on the Prevention of Unsafe Abortion in 2007 and a parallel program or "Initiative" with the same name. The initiative involved 46 FIGO member societies from seven regions: South-Southeast Asia, Eastern-Central Europe and Central Asia, North Africa and Eastern Mediterranean, Eastern-Central-Southern Africa, Western-Central Africa, Central America and Caribbean, and South America. Each society working in collaboration with the corresponding Ministry of Health and other agencies conducted a situational analysis and prepared a plan of action based on the findings. Such plans of action are continuously monitored by annual evaluation of the progress in the implementation at regional workshops. A substantial progress has been achieved in providing legal and safe abortion services, replacing curettage for manual vacuum aspiration or misoprostol and introducing and expanding postabortion contraception with emphasis on long-acting methods, such as IUDs and contraceptive implants.

Contribution of obstetrics and gynecology societies in South America to the prevention of unsafe abortion in the region.

Unsafe abortion is one of the most serious public health and human rights issues in South America. Rates are among the highest in the world and account for 13% of maternal deaths. Nine out of 10 South American countries have enrolled in the International Federation of Gynecology and Obstetrics (FIGO) Initiative for the Prevention of Unsafe Abortion and its Consequences. Each individual society of obstetrics and gynecology prepared a situational analysis, and an action plan was elaborated with the participation of their respective Ministries of Health, national and international agencies, and other collaborating institutions. Action plans were designed to respond to the problems identified in the situational analyses, with objectives corresponding with all or some of the 4 levels of prevention proposed in the FIGO initiative. This article reports the progress achieved in implementing the action proposed by each country, as well as some activities carried out in addition to those included in the formal plans.

Módulo de capacitación en hipertensión y embarazo / Training module hypertension and pregnancy

Las causas de mortalidad materna en Latino América y el Caribe estan lideradas por los trastornos hipertensivos del embarazo, en donde una de cada 4 muertes maternas es por esta patología. En términos generales podemos discutir 5 grandes razones para explicar nuestras altas tasas de muerte materna...

The FIGO working group on the prevention of unsafe abortion: mandate and process for achievement.

The Working Group of the International Federation of Gynecology and Obstetrics (FIGO) on the Prevention of Unsafe Abortion and its Consequences received a mandate to contribute to reduce the number of women who have to resort to induced abortion and the maternal mortality and morbidity associated with unsafe abortion by minimizing unintended pregnancies, improving access to safe abortion services, and increasing the quality of and access to post-abortion care, including post-abortion contraception. A project proposal was prepared and approved by an anonymous donor, funding a structure headed by a general coordinator, the Chair of the Working Group, together with 6 regional coordinators and 1 assistant regional coordinator, plus 43 focal points nominated by the participating societies. A situational analysis of induced/unsafe abortion for each country was prepared by the focal points with the technical support of the Guttmacher Institute, and a plan of action based on the findings of the analysis. The situational analysis and plans of action were discussed at 7 regional workshops held between June and August, 2008. Fifty-four member societies nominated a focal point, 48 attended the regional workshops, and 43 had a plan of action approved by their governments and respective societies. The plans of action are currently in the process of implementation, with the collaboration of a number of national and international agencies and organizations.

International organizations and NGOs: an example of international collaboration to improve women's health by preventing unsafe abortion.

International collaboration with organizations and agencies is a basic requirement for the success of the FIGO Initiative for the Prevention of Unsafe Abortion and its Consequences. Many activities being carried out by the organizations form a part of the plans of action of all countries participating in the Initiative. It was, therefore, not difficult to obtain their collaboration in implementing the plans of action. The many ways in which they have collaborated and continue to do so are described in this article. This collaboration has saved time, avoided duplication of effort, and has also satisfied the Accra Agenda of Action by reducing fragmentation of funding. It has already contributed toward preventing unsafe abortion and reducing abortion-related maternal deaths and morbidities, and is expected to contribute even more significantly in the coming months and years.

Emergency contraception under attack in Latin America: response of the medical establishment and civil society.

The concept that it is possible to prevent a pregnancy after coitus is not new, but has gained prominence over the last 10-15 years. It provides a second chance to women who do not want to get pregnant and who, voluntarily or not, have had unprotected intercourse. Emergency contraception has been under strong attack by the Catholic church and anti-choice organisations in Latin America, who claim that the interference with implantation of the fertilised ovum is equivalent to an early abortion. The accumulation of evidence, however, is that the mechanism of action of emergency contraception is to prevent ovulation and that it does not interfere with implantation. This has been ignored by the anti-choice movement. The pattern of opposition to emergency contraception has been the same all over the Latin America region. The medical establishment and civil society, including the International Consortium for Emergency Contraception, have played a key role in defending access to emergency contraception throughout the region. A positive consequence of the public opposition of the Catholic church is that the concept and the method have become better known, and emergency contraception has become widely used. The cases of Peru, Brazil and Chile are described as examples.

Sexual violence.

Gender-based violence is related to the power imbalance between men and women that is present, to a greater or lesser degree, in all societies. It was recognized as a human rights problem by the United Nations relatively recently. It includes emotional, physical and sexual violence. Sexual violence is the extreme form of gender-based violence, usually accompanied by the other types of violence. Its prevalence is difficult to determine, but it is likely to affect at least one-third of women at some time in their life. It has multiple effects on women's physical and gynaecological health, and these depend greatly on the quality of care that women receive immediately after the assault. Unfortunately, most emergency health services, including those in women's hospitals, are not prepared to provide the correct care for these women. Care should be multidisciplinary and should involve crisis treatment, meticulous clinical examination with complementary auxiliary methods, treatment of physical lesions, prevention of pregnancy and transmission of sexually transmitted infections, and follow-up for at least 6 months after the assault.

Legal abortion in Peru: knowledge, attitudes and practices among a group of physician leaders.

OBJECTIVE: We sought to examine knowledge, attitudes and practices regarding legal abortion among a group of Peruvian physicians. METHODS: A pre-conference survey was mailed to Peruvian physicians invited to a workshop on legal abortion. A post-conference survey was distributed following the event. RESULTS: Eighty-six percent of 35 respondents correctly indicated that abortion is legal in Peru when a pregnancy endangers a woman's life while less than 50% knew it is also legal when necessary to protect a woman's health. Knowledge about abortion techniques was lower for induced abortion than for management of incomplete abortions. Dilation and curettage was used more frequently than manual vacuum aspiration and medications. Half of physicians reported having performed a legal abortion. The vast majority of physicians surveyed thought legal indications for abortion should be expanded to include cases of rape or fetal malformations. Most considered their abortion training to be inadequate. They identified lack of training and administrative and professional support as barriers to legal abortion provision. CONCLUSIONS: Physicians surveyed were willing to provide legal abortions but lacked the knowledge, skills, and support to do so. Improved training of health professionals, increasing institutional support, and developing administrative and legal procedures to guide management of women seeking abortions could increase women's access to legal abortion services and diminish the occurrence of unsafe abortion in Peru.