Motivations for using misoprostol for abortion outside the formal healthcare system in Colombia: a qualitative study of women seeking postabortion care in Bogotá and the Coffee Axis.

BACKGROUND: In 2006, a Constitutional Court ruling partially decriminalized abortion in Colombia, allowing the procedure in cases of rape, risk to the health or life of the woman, and fetal malformations incompatible with life. Despite this less prohibitive law, some women and pregnant people preferred self-managing their abortions outside the formal healthcare system, often without accurate information. In 2018, we undertook a study to understand what motivated women to self-manage using medications that they acquired informally. Colombia has since adopted a progressive law in 2022, permitting abortion on request through the 24th week of pregnancy. However, the implementation of this law is still underway. Examining the reasons why women chose to informally self-manage an abortion after 2006 may not only highlight how barriers to legal services persisted at that time, but also could inform strategies to increase knowledge of the current abortion law and improve access to services going forward. METHODS: In-depth interviews were conducted in 2018 with 47 women aged 18 and older who used misoprostol obtained outside of health facilities to induce an abortion, and who were receiving postabortion care in two private clinics. Interviews explored what women knew about the 2006 abortion law which was then in effect, and the reasons why they preferred informal channels for abortion care over formal healthcare services. RESULTS: Women's motivations to use misoprostol obtained outside the formal healthcare system were influenced by lack of trust in the healthcare system along with incomplete and inaccurate knowledge of the abortion law. Conversely, women considered misoprostol obtained outside the healthcare system to be effective, affordable, and easier to access. CONCLUSIONS: Obtaining misoprostol outside the formal healthcare system offered a more accessible and appealing prospect for some women given fears of legal repercussion and stigma toward abortion. Though this preference will likely continue despite the more liberal abortion law, strategies should be implemented to broaden knowledge of the recent change in law and to combat misinformation and stigma. This would support knowledge of and access to legal abortion for those who wish to avail themselves of these services.

Teamwork skills in higher education: is university training contributing to their mastery?

Teamwork skills are considered essential for personal, academic and professional achievement, so universities are increasingly integrating them into their syllabuses. However, little is known about how some specific features of students and their educational development can affect their acquisition. Accordingly, this study aims to fill this gap and describe higher education students' mastery of teamwork skills and its relation to certain socio-academic variables (gender, academic year and grade point average-GPA). With the aim of determining the level of teamwork skills among university students, an observational, transversal descriptive study was designed with an intentional sample of Spanish university students. The sample is made up of 615 social science degree students. The results suggest significant gender differences, highlighting that female students outdid their male counterparts in most teamwork skills, except leadership. Likewise, students' skills improved as they progressed in their studies, particularly those skills related to adaptability and decision-making. Finally, a positive relationship was observed between teamwork skills and GPA, except for interpersonal development. A regression analysis confirmed the influence of both academic year and GPA for women whilst no effect was detected in the case of men. Based on these results, it is suggested to make changes in university education programmes to compensate for the influence of socio-academic factors and benefit from the most positive features of each gender regarding teamwork to achieve an equal and fair higher education.

Teamwork skills in higher education: is university training contributing to their mastery?

Teamwork skills are considered essential for personal, academic and professional achievement, so universities are increasingly integrating them into their syllabuses. However, little is known about how some specific features of students and their educational development can affect their acquisition. Accordingly, this study aims to fill this gap and describe higher education students' mastery of teamwork skills and its relation to certain socio-academic variables (gender, academic year and grade point average—GPA). With the aim of determining the level of teamwork skills among university students, an observational, transversal descriptive study was designed with an intentional sample of Spanish university students. The sample is made up of 615 social science degree students. The results suggest significant gender differences, highlighting that female students outdid their male counterparts in most teamwork skills, except leadership. Likewise, students' skills improved as they progressed in their studies, particularly those skills related to adaptability and decision-making. Finally, a positive relationship was observed between teamwork skills and GPA, except for interpersonal development. A regression analysis confirmed the influence of both academic year and GPA for women whilst no effect was detected in the case of men. Based on these results, it is suggested to make changes in university education programmes to compensate for the influence of socio-academic factors and benefit from the most positive features of each gender regarding teamwork to achieve an equal and fair higher education. (AU)

The cost of postabortion care and legal abortion in Colombia.

CONTEXT: Although Colombia partially liberalized its abortion law in 2006, many abortions continue to occur outside the law and result in complications. Assessing the costs to the health care system of safe, legal abortions and of treating complications of unsafe, illegal abortions has important policy implications. METHODS: The Post-Abortion Care Costing Methodology was used to produce estimates of direct and indirect costs of postabortion care and direct costs of legal abortions in Colombia. Data on estimated costs were obtained through structured interviews with key informants at a randomly selected sample of facilities that provide abortion-related care, including 25 public and private secondary and tertiary facilities and five primary-level private facilities that provide specialized reproductive health services. RESULTS: The median direct cost of treating a woman with abortion complications ranged from $44 to $141 (in U.S. dollars), representing an annual direct cost to the health system of about $14 million per year. A legal abortion at a secondary or tertiary facility was costly (medians, $213 and $189, respectively), in part because of the use of dilation and curettage, as well as because of administrative barriers. At specialized facilities, where manual vacuum aspiration and medication abortion are used, the median cost of provision was much lower ($45). CONCLUSIONS: Provision of postabortion care and legal abortion services at higher-level facilities results in unnecessarily high health care costs. These costs can be reduced significantly by providing services in a timely fashion at primary-level facilities and by using safe, noninvasive and less costly abortion methods.

Health consequences of unsafe abortion in Colombia, 1989-2008.

The number of Colombian women hospitalized for the treatment of induced abortion complications increased from 57 679 in 1989 to 93 336 in 2008; the hospitalization rate also rose: from 7.2 to 9.1 cases per 1000 women aged 15-44 years. Factors that likely underlie the increase include improved access to postabortion care (although 1 in 5 women still do not obtain the care they need) and the growing role of misoprostol, often used incorrectly and to some extent replacing the use of surgical abortion by doctors. Efforts are evidently needed to improve access to safe abortion and effective contraception.

Induced abortion in Colombia: new estimates and change between 1989 and 2008.

CONTEXT: Although abortion was made legal in Colombia under selected circumstances in 2006, no national studies have examined whether the incidence of the procedure has changed since the previous estimate in 1989. METHODS: Data on the number of women treated for abortion complications were obtained from a nationally representative survey of 300 public and private health facilities, and estimates of the likelihood that women obtaining abortions experience complications and receive treatment at a facility were obtained from a survey of 102 knowledgeable professionals. Indirect estimation techniques were used to calculate national and regional abortion measures for 2008, which were compared with previously published 1989 estimates. Numbers and rates of unintended pregnancy were also calculated. RESULTS: In 2008, an estimated 93,300 women were treated for induced abortion complications in public and private health facilities. An estimated 400,400 induced abortions were performed, which translates to a rate of 39 per 1,000 women aged 15-44, a slight increase from 1989 (36 per 1,000). Rates varied widely across regions, from 66 in Bogotá to 18 in Oriental. Despite the new abortion law, only 322 legal abortions were performed in 2008. Between 1989 and 2008, the proportion of pregnancies ending in induced abortion increased from 22% to 29%, and the proportion of pregnancies that were unintended rose from 52% to 67%. CONCLUSION: Improvements in provision of and access to contraceptive and legal abortion services are needed to meet the increased demand among women and couples to prevent unintended pregnancy and unsafe abortion.

Aborto inducido y embarazo no planeado en Guatemala / Induced abortion and unintended pregnancy in Guatemala

Contexto: aunque la legislación guatemalteca permite el aborto inducido solamente para salvar la vida de la mujer, con frecuencia muchas mujeres obtienen abortos, en condiciones de riesgo y en respuesta a un embarazo no planeado. Estudios recientes indican que el aborto inseguro es un factor clave que contribuye a la morbilidad y mortalidad materna en el país; sin embargo, no existen datos a nivel nacional sobre la incidencia del aborto...

Early childbearing in Honduras: a continuing challenge.

(1) Honduras has the highest adolescent birthrate in Central America, at 137 births for every 1,000 15-19-year-olds. This rate has remained unchanged over the past two decades, despite declines in the birthrate among women in all other age-groups. In absolute numbers, births to adolescents increased by 50% between 1987 and 2001. (2) As of 2001, only one-third of all women aged 20-24 (and only one-seventh of those in rural areas) had completed primary school; less education is associated with a higher likelihood of early childbearing. (3) One-half of 20-24-year-olds give birth by age 20; this proportion is higher among the least-educated women (70%), the poorest women (64%) and those in rural areas (60%). (4) In 2001, 40% of all recent adolescent births were unplanned, and the highest proportion was among those with the most education (48%). Most sexually active 15-19-year-olds (70%) do not want to have a child in the next two years. (5) Despite these reproductive preferences, just one in three sexually active adolescents uses a modern contraceptive method. Overall, 48% of adolescents have an unmet need for effective contraception. (6) High levels of early childbearing coexist with low rates of professional prenatal and delivery care. In 2001, one-third of recent 15-24-year-old mothers did not make a single prenatal care visit. The same proportion gave birth without a medical professional in attendance. (7) Policies and programs that aim to promote adolescents' reproductive health and support their childbearing preferences exist, but they are often not fully implemented and need more official commitment and resources.

Early childbearing in Guatemala: a continuing challenge.

(1) Guatemala has the third highest adolescent birthrate in Central America-114 births for every 1,000 women aged 15-19 each year. (2) Only two-fifths of 20-24-year-old women have completed primary school. The proportion is one in four in rural areas and one in 10 among indigenous women. (3) One-half of young women enter into a union (formal or consensual) before their 20th birthday. Three-quarters of those with no schooling do so, compared with one-quarter of those with a primary education or more. (4) Forty-four percent of 20-24-year-olds were mothers by age 20; the proportion is highest among young women with no education (68%) and among indigenous women (54%). (5) The great majority of 15-19-year-old women in union-83%, with little variation by residence or ethnicity-do not want to have a child in the next two years. However, only 18% are using an effective contraceptive. (6) Although 70% of 15-24-year-olds who recently gave birth made at least one prenatal care visit, roughly half of the least educated and of indigenous women made none. Moreover, only half of 15-24-year-old mothers had professional medical care at their most recent delivery; the proportion is even lower among the least educated and indigenous women (one-quarter).

Early childbearing in Nicaragua: a continuing challenge.

(1) Among Nicaraguan women 20-24 years old, six in 10 had entered a union and almost half had had a child before their 20th birthday. (2) A quarter of all births in Nicaragua--35,000 per year--are to 15-19-year-olds. (3) Rural women, who have less education, on average, than their urban counterparts, are more likely than city dwellers to enter a union and become mothers during adolescence. (4) The proportion of 20-24-year-olds who had a child during adolescence is more than twice as high among the poorest as among those in the highest socioeconomic category. (5) Nearly half--45%--of births to adolescent women are unplanned, a level that varies little by women's urban-rural residence and their educational achievement. (6) Among all sexually active women aged 15-19 (in union and not in union), 86% do not want a child in the next two years, and 36% have an unmet need for effective contraception. Unmet need for family planning is equally high in urban and rural areas. (7) The strong link between low educational attainment and early motherhood suggests that improving educational opportunities for girls is a promising way of reducing high levels of adolescent childbearing in Nicaragua.

Induced abortion and unintended pregnancy in Guatemala.

CONTEXT: Although Guatemalan law permits induced abortion only to save a woman's life, many women obtain abortions, often under unsafe conditions and in response to an unintended pregnancy. Recent studies indicate that unsafe abortion is a key factor contributing to maternal morbidity and mortality in the country, but no national data on the incidence of abortion exist. METHODS: Surveys of all hospitals that treat women for postabortion complications and of 74 professionals who are knowledgeable about the conditions of abortion provision in Guatemala were conducted in 2003. Indirect estimation techniques were used to calculate the number of induced abortions performed annually. Abortion rates and ratios and the level of unintended pregnancy were calculated for the nation and its eight regions. RESULTS: Nearly 65,000 induced abortions are performed annually in Guatemala, and about 21,600 women are hospitalized for treatment of complications. Abortions occur at a rate of 24 per 1,000 women aged 15-49, and there is one abortion for every six births. The abortion rate is higher than average in the Southwest (less developed, mainly indigenous population) and Metropolitan (more developed, mainly nonindigenous population) regions (29-30 per 1,000 women). Over a quarter of all births are unplanned; combining unplanned births with abortions yields estimates that 32% of pregnancies in Guatemala are unintended, with an unintended pregnancy rate of 66 per 1,000 women. CONCLUSIONS: Unsafe abortion has a significant impact on women's health in Guatemala. Comprehensive government programs are needed to address the issues of unintended pregnancy and unsafe abortion, with attention to regional differences.