La interrupción legal del embarazo en Argentina / The legal termination of pregnancy in Argentina

En el contexto de la publicación por parte del Ministerio de Salud de la Nación de Argentina del Protocolo para la atenciónintegral de las personas con derecho a la interrupción legal del embarazo (ILE), resumido y comentado en este mismonúmero de EVIDENCIA, este comentario editorial ofrece: 1) una perspectiva amplia de lo que significa el aborto, desde lamirada estrictamente biologicista hasta definiciones basadas en el enfoque de género; 2) una descripción de los diferentesmarcos jurídicos respecto del aborto que imperan actualmente en Latinoamérica y Argentina, haciendo especial hincapiéen lo concerniente a las ILE; 3) información epidemiológica sobre la mortalidad materna en Argentina y la asociada alaborto inseguro; 4) estadísticas sobre la realización de ILE en la Ciudad Autónoma de Buenos Aires, Argentina.Dada la situación actual de aislamiento social preventivo obligatorio en el marco de la pandemia de Covid-19, conside-ramos quienes integramos equipos de salud debemos estar más atentos/as que nunca a las situaciones de violenciapotencial que podrían suceder en este contexto, para dar las respuestas pertinentes -entre las que se incluyen las ILE-, alas víctimas de embarazos no deseados consecutivos a situaciones de coerción. (AU)

In the context of the publication by the Argentine Ministry of Health of the Protocol for the comprehensive care of people withthe right to legal termination of pregnancy (LTP), summarized and commented on in this same issue of EVIDENCIA, thiseditorial article offers: 1) a broad perspective of what abortion means, from a strictly biological point of view to definitionsbased on the gender approach; 2) a description of the different legal frameworks regarding abortion that currently prevailin Latin America and Argentina, with special emphasis on LTP; 3) epidemiological information on maternal mortality inArgentina and that associated with unsafe abortion; 4) statistics on the realization of LTP in the Autonomous City ofBuenos Aires, Argentina.Given the current situation of mandatory preventive social isolation in the framework of the Covid-19 pandemic, we considerthat those of us who are part of health teams should be more alert than ever to situations of potential violence that couldoccur in this context, to give the relevant responses - including LTP- to victims of unwanted pregnancies following coercivesituations. (AU)

Safe and unsafe abortions: Total monetary costs and health care system costs in Argentina in 2018. / Abortos seguros e inseguros: Costos monetarios totales y costos para el sistema de salud de la Argentina en 2018.

During the first semester of 2018, a profound debate on the legalization of the practice of abortion was initiated in Argentina, which exposed the lack of scientific studies addressing the economic dimension of abortion in this country. This work seeks to move forward in the quantification of the costs of abortion under two scenarios: the current context of illegality and the potential costs if the recommended international protocols were applied in a context of legalization of the practice. The results of the comparison between, on the one hand, the total monetary costs in 2018 (private or out-of-pocket expenditure and costs for the health care system) of the current scenario of illegality and unsafe practice of abortion and, on the other hand, potential scenarios of safe practices, shows that a large amount of resources could be saved if the recommended protocols were implemented. These results proved to be robust after carrying out a series of sensitivity exercises on the main assumptions included in the comparisons.

Durante el primer semestre de 2018, en Argentina se inició un profundo debate sobre la legalización de la práctica del aborto, que puso en evidencia la falta de estudios científicos que aborden la dimensión económica del tema en la Argentina. Este trabajo busca avanzar en la cuantificación de los costos del aborto bajo dos escenarios: el del actual contexto de ilegalidad y los costos potenciales si se aplicaran los protocolos internacionales recomendados, en un contexto de legalización de la práctica. Los resultados de la comparación de los costos monetarios totales en 2018 (privados o de bolsillo y para el sistema de salud) del escenario actual de ilegalidad y práctica insegura del aborto, frente a escenarios potenciales de prácticas seguras, muestran que se podría ahorrar una gran cantidad de recursos si se implementaran los protocolos recomendados. Dichos resultandos, además, se muestran robustos al realizar una serie de ejercicios de sensibilidad sobre los principales supuestos incluidos en las comparaciones.

Abortos seguros e inseguros: Costos monetarios totales y costos para el sistema de salud de la Argentina en 2018 / Safe and unsafe abortions: Total monetary costs and health care system costs in Argentina in 2018

RESUMEN Durante el primer semestre de 2018, en Argentina se inició un profundo debate sobre la legalización de la práctica del aborto, que puso en evidencia la falta de estudios científicos que aborden la dimensión económica del tema en la Argentina. Este trabajo busca avanzar en la cuantificación de los costos del aborto bajo dos escenarios: el del actual contexto de ilegalidad y los costos potenciales si se aplicaran los protocolos internacionales recomendados, en un contexto de legalización de la práctica. Los resultados de la comparación de los costos monetarios totales en 2018 (privados o de bolsillo y para el sistema de salud) del escenario actual de ilegalidad y práctica insegura del aborto, frente a escenarios potenciales de prácticas seguras, muestran que se podría ahorrar una gran cantidad de recursos si se implementaran los protocolos recomendados. Dichos resultandos, además, se muestran robustos al realizar una serie de ejercicios de sensibilidad sobre los principales supuestos incluidos en las comparaciones.

ABSTRACT During the first semester of 2018, a profound debate on the legalization of the practice of abortion was initiated in Argentina, which exposed the lack of scientific studies addressing the economic dimension of abortion in this country. This work seeks to move forward in the quantification of the costs of abortion under two scenarios: the current context of illegality and the potential costs if the recommended international protocols were applied in a context of legalization of the practice. The results of the comparison between, on the one hand, the total monetary costs in 2018 (private or out-of-pocket expenditure and costs for the health care system) of the current scenario of illegality and unsafe practice of abortion and, on the other hand, potential scenarios of safe practices, shows that a large amount of resources could be saved if the recommended protocols were implemented. These results proved to be robust after carrying out a series of sensitivity exercises on the main assumptions included in the comparisons.

The National Reproductive Health Programme in Cape Verde: scope, limits and challenges. / O Programa Nacional de Saúde Reprodutiva de Cabo Verde: alcances, limites e desafios.

Cape Verde is an archipelago on the African coast, with 538,535 inhabitants living on nine islands. Since it gained independence in 1975, the country has experienced rapid economic and social growth, with significant gains in education as well as a reduction in maternal and infant mortality deaths. In 2001, following the guidelines of the International Conference on Population and Development (ICPD, Cairo, 1994), the National Reproductive Health Program (PNSR) was launched aiming to provide sexual and reproductive health (SRH) services to adolescents, young people and adult men, in partnership with the education sector and youth centers. However, the continuance of unplanned pregnancies, illegal abortions and HIV infections has indicated that there are gaps in the program`s implementation. Studies conducted in the country point to socio-cultural aspects as well as aspects covering organizations and the services on offer, as some of the reasons for the identified problems. This paper aims to reflect on the scope and limits of the PNSR in Cape Verde with consideration being given to the challenges of implementing health policies that affect cultural practices related to gender and sexuality. Consideration is also given to the specifics of Cape Verde`s demographics, economic and cultural aspects as well as the importance of the SRH services to its development.

Cabo Verde é um arquipélago do continente africano, com cerca de 538.535 habitantes. Desde sua independencia, em 1975, o país tem experimentado um rápido crescimento econômico e social, com ganhos significativos em escolarização, redução dos óbitos maternos e da mortalidade infantil. Em 2001, seguindo as diretrizes da Conferencia Internacional de População e Desenvolvimento (CIPD, Cairo, 1994), foi lançado o Programa Nacional de Saúde Reprodutiva, PNSR, visando incluir ações de saúde sexual e reprodutiva, SSR, para adolescentes, jovens e homens adultos, em parceria com o setor de educação e centros de juventude. Entretanto, a persistência da gravidez não planejada, do aborto clandestino e da infecção pelo HIV indicam lacunas na sua implementação. Estudos realizados no país apontam razões socioculturais e no âmbito da organização e oferta de serviços para os problemas identificados. Este trabalho tem como finalidade refletir sobre os alcance e limites do PNSR de Cabo Verde, considerando os desafios de implementação de políticas de saúde que afetam práticas culturais relativas ao gênero e a sexualidade; as especificidades demográficas, socioeconômicas e culturais de Cabo Verde e ainda a importancia da SSR para o desenvolvimento.

Abortion experience in the media: analysis of abortive paths shared in an online community. / A experiência do aborto na rede: análise de itinerários abortivos compartilhados em uma comunidade online.

This paper aims to analyze the narratives about abortion experiences available in an online community to discuss the methods and strategies to which women resort, facing the legal impossibility of voluntarily interrupting a pregnancy and the effects of the criminalization of induced abortion. The methodology used was virtual ethnography, observing the platform Women on Web, collection and analysis of 18 narratives publicly available without restrictions, selected between November 2016 and January 2017. The narratives report mixed methods to perform an abortion, with widespread use of Cytotec. Some cases include hospitals and medical clinics in the paths, whether to conduct examinations or attend to intercurrences. The internet appears as a popular tool to gather information, negotiate and even purchase abortive drugs, as well as a platform to share experiences. We concluded that the narratives point to insecurities, risks, and violence to which women are submitted in clandestine setting; they show the relevance of debate on decriminalizing abortion in Brazil, and also reinforce the existence of a shared abortion culture, as stated in other studies.

O objetivo deste artigo é analisar narrativas sobre as experiências de abortar disponíveis em uma comunidade online, buscando discutir os métodos e estratégias aos quais as mulheres recorrem frente à impossibilidade legal de interrupção voluntária de gravidez e os efeitos da criminalização do aborto induzido. Como método, utilizou-se a etnografia virtual, com observação da plataforma Women on Web, coleta e análise de 18 narrativas, disponíveis publicamente e sem restrições, selecionadas entre novembro de 2016 e janeiro de 2017. As narrativas informam métodos mesclados para a realização de aborto, com prevalência de utilização do medicamento Cytotec. Em alguns casos, hospitais e consultórios médicos são incluídos nos itinerários, seja para realização de exames ou para atendimento de intercorrências. A internet se revela uma ferramenta de informação, negociação e mesmo aquisição de medicamento abortivo bastante comum, além de uma plataforma de troca de experiências. Conclui-se que as narrativas sinalizam as inseguranças, riscos e violências às quais estão submetidas as mulheres no contexto da clandestinidade, indicam a importância do debate sobre a descriminalização do aborto no Brasil, e também reforçam a existência de uma cultura compartilhada do aborto, já apontada em estudos anteriores.

Abortion as a human right: The struggle to implement the abortion law in Colombia.

In 2006, a Colombian Constitutional Court decision legalized abortion in cases of risk to a woman's physical or mental health, fetal malformation incompatible with life, or rape or incest. This decision resulted from legal action brought by feminist groups, and frames abortion as a human right. Advocates played a key role in implementing the new law by educating providers and the public about its broad interpretations. Healthcare providers and facilities did not have an organized response to the new law. Nonprofit organizations filled this gap, and provide a majority of legal abortions throughout the country. Civil society facilitated implementation of the new law by providing legal accompaniment to women facing barriers to accessing abortions. Despite these efforts, few legal abortions are performed each year, and clandestine, often unsafe abortions continue to prevail. Lack of information about the new law, stigma, and fluctuating political will remain key barriers.

En Argentina, durante 2018 el aborto salió del armario pero no de la clandestinidad / In Argentina, during 2018 abortion came out of the closet but not from hiding

La autora de este artículo hace una síntesis de la evolución histórica y de las diferentes posturas religiosas frente al abor-to, describe su epidemiología mundial y la posición de la Organización Mundial de la Salud frente a esta problemática, resume el desarrollo y el desenlace del recientemente instalado debate sobre la legalización del aborto en Argentina y, finalmente reflexiona sobre lo que nos ha dejado este proceso político. (AU)

The author of this article summarizes the historical evolution and the different religious positions regarding abortion, describes its global epidemiology and the position of the World Health Organization in relation to this problem, summarizes the development and the outcome of the recently installed debate on the legalization of abortion in Argentina and, finally, reflect on what this politi-cal process has left us. (AU)

A experiência do aborto na rede: análise de itinerários abortivos compartilhados em uma comunidade online / Abortion experience in the media: analysis of abortive paths shared in an online community

Resumo O objetivo deste artigo é analisar narrativas sobre as experiências de abortar disponíveis em uma comunidade online, buscando discutir os métodos e estratégias aos quais as mulheres recorrem frente à impossibilidade legal de interrupção voluntária de gravidez e os efeitos da criminalização do aborto induzido. Como método, utilizou-se a etnografia virtual, com observação da plataforma Women on Web, coleta e análise de 18 narrativas, disponíveis publicamente e sem restrições, selecionadas entre novembro de 2016 e janeiro de 2017. As narrativas informam métodos mesclados para a realização de aborto, com prevalência de utilização do medicamento Cytotec. Em alguns casos, hospitais e consultórios médicos são incluídos nos itinerários, seja para realização de exames ou para atendimento de intercorrências. A internet se revela uma ferramenta de informação, negociação e mesmo aquisição de medicamento abortivo bastante comum, além de uma plataforma de troca de experiências. Conclui-se que as narrativas sinalizam as inseguranças, riscos e violências às quais estão submetidas as mulheres no contexto da clandestinidade, indicam a importância do debate sobre a descriminalização do aborto no Brasil, e também reforçam a existência de uma cultura compartilhada do aborto, já apontada em estudos anteriores.

Abstract This paper aims to analyze the narratives about abortion experiences available in an online community to discuss the methods and strategies to which women resort, facing the legal impossibility of voluntarily interrupting a pregnancy and the effects of the criminalization of induced abortion. The methodology used was virtual ethnography, observing the platform Women on Web, collection and analysis of 18 narratives publicly available without restrictions, selected between November 2016 and January 2017. The narratives report mixed methods to perform an abortion, with widespread use of Cytotec. Some cases include hospitals and medical clinics in the paths, whether to conduct examinations or attend to intercurrences. The internet appears as a popular tool to gather information, negotiate and even purchase abortive drugs, as well as a platform to share experiences. We concluded that the narratives point to insecurities, risks, and violence to which women are submitted in clandestine setting; they show the relevance of debate on decriminalizing abortion in Brazil, and also reinforce the existence of a shared abortion culture, as stated in other studies.

O Programa Nacional de Saúde Reprodutiva de Cabo Verde: alcances, limites e desafios / The National Reproductive Health Programme in Cape Verde: scope, limits and challenges

Resumo Cabo Verde é um arquipélago do continente africano, com cerca de 538.535 habitantes. Desde sua independencia, em 1975, o país tem experimentado um rápido crescimento econômico e social, com ganhos significativos em escolarização, redução dos óbitos maternos e da mortalidade infantil. Em 2001, seguindo as diretrizes da Conferencia Internacional de População e Desenvolvimento (CIPD, Cairo, 1994), foi lançado o Programa Nacional de Saúde Reprodutiva, PNSR, visando incluir ações de saúde sexual e reprodutiva, SSR, para adolescentes, jovens e homens adultos, em parceria com o setor de educação e centros de juventude. Entretanto, a persistência da gravidez não planejada, do aborto clandestino e da infecção pelo HIV indicam lacunas na sua implementação. Estudos realizados no país apontam razões socioculturais e no âmbito da organização e oferta de serviços para os problemas identificados. Este trabalho tem como finalidade refletir sobre os alcance e limites do PNSR de Cabo Verde, considerando os desafios de implementação de políticas de saúde que afetam práticas culturais relativas ao gênero e a sexualidade; as especificidades demográficas, socioeconômicas e culturais de Cabo Verde e ainda a importancia da SSR para o desenvolvimento.

Abstract Cape Verde is an archipelago on the African coast, with 538,535 inhabitants living on nine islands. Since it gained independence in 1975, the country has experienced rapid economic and social growth, with significant gains in education as well as a reduction in maternal and infant mortality deaths. In 2001, following the guidelines of the International Conference on Population and Development (ICPD, Cairo, 1994), the National Reproductive Health Program (PNSR) was launched aiming to provide sexual and reproductive health (SRH) services to adolescents, young people and adult men, in partnership with the education sector and youth centers. However, the continuance of unplanned pregnancies, illegal abortions and HIV infections has indicated that there are gaps in the program`s implementation. Studies conducted in the country point to socio-cultural aspects as well as aspects covering organizations and the services on offer, as some of the reasons for the identified problems. This paper aims to reflect on the scope and limits of the PNSR in Cape Verde with consideration being given to the challenges of implementing health policies that affect cultural practices related to gender and sexuality. Consideration is also given to the specifics of Cape Verde`s demographics, economic and cultural aspects as well as the importance of the SRH services to its development.

The responsibility of gynecologists and obstetricians in providing safe abortion services within the limits of the law.

Approximately 47 000 women die each year worldwide as a result of the complications of unsafe abortion, almost exclusively in low- and middle-income countries with restrictive abortion laws. In these countries, very few women who comply with the conditions imposed by the law can access safe abortion services in the public health system. The main obstacle is the unwillingness of gynecologists and obstetricians to provide abortion services by claiming conscientious objection, which is often used to hide their fear of the stigma associated with abortion. This happens because many colleagues are unaware that without access to legal services these women will resort to an unsafe abortion and its consequences. This violates the statement from FIGO's Committee for the Ethical Aspects of Human Reproduction and Women's Health, which asserts that: "The primary conscientious duty of obstetrician-gynecologists is at all times to treat, or provide benefit and prevent harm, to the patients for whose care they are responsible. Any conscientious objection to treating a patient is secondary to this primary duty."

The cost of post-abortion care in developing countries: a comparative analysis of four studies.

Over the last five years, comprehensive national surveys of the cost of post-abortion care (PAC) to national health systems have been undertaken in Ethiopia, Uganda, Rwanda and Colombia using a specially developed costing methodology-the Post-abortion Care Costing Methodology (PACCM). The objective of this study is to expand the research findings of these four studies, making use of their extensive datasets. These studies offer the most complete and consistent estimates of the cost of PAC to date, and comparing their findings not only provides generalizable implications for health policies and programs, but also allows an assessment of the PACCM methodology. We find that the labor cost component varies widely: in Ethiopia and Colombia doctors spend about 30-60% more time with PAC patients than do nurses; in Uganda and Rwanda an opposite pattern is found. Labor costs range from I$42.80 in Uganda to I$301.30 in Colombia. The cost of drugs and supplies does not vary greatly, ranging from I$79 in Colombia to I$115 in Rwanda. Capital and overhead costs are substantial amounting to 52-68% of total PAC costs. Total costs per PAC case vary from I$334 in Rwanda to I$972 in Colombia. The financial burden of PAC is considerable: the expense of treating each PAC case is equivalent to around 35% of annual per capita income in Uganda, 29% in Rwanda and 11% in Colombia. Providing modern methods of contraception to women with an unmet need would cost just a fraction of the average expenditure on PAC: one year of modern contraceptive services and supplies cost only 3-12% of the average cost of treating a PAC patient.

Induced abortion among Brazilian female sex workers: a qualitative study.

Prostitutes are vulnerable to unplanned pregnancies and abortions. In Brazil, abortion is a crime and there is no data about unsafe abortions for this population. The study describes how prostitutes perform illegal abortions and the health consequences thereof. Semi-structured interviews with 39 prostitutes from three cities in Brazil with previous induced abortion experience were conducted. Sixty-six abortions, with between one and eight occurrences per woman, were recorded. The majority of the cases resulted from sexual activity with clients. The inconsistent use of condoms with regular clients and the consumption of alcohol during work were indicated as the main causes of unplanned pregnancies. The main method to perform abortion was the intravaginal and oral use of misoprostol, acquired in pharmacies or on the black market. Invasive measures were less frequently reported, however with more serious health complications. The fear of complaint to the police meant that most women do not inform the health team regarding induced abortion. The majority of prostitutes aborted with the use of illegally-acquired misoprostol, ending abortion in a public hospital with infection and hemorrhagic complications. The data indicate the need for a public policy focusing on the reproductive health of prostitutes.

Induced abortion among Brazilian female sex workers: a qualitative study / Aborto induzido entre prostitutas brasileiras: um estudo qualitativo

Prostitutes are vulnerable to unplanned pregnancies and abortions. In Brazil, abortion is a crime and there is no data about unsafe abortions for this population. The study describes how prostitutes perform illegal abortions and the health consequences thereof. Semi-structured interviews with 39 prostitutes from three cities in Brazil with previous induced abortion experience were conducted. Sixty-six abortions, with between one and eight occurrences per woman, were recorded. The majority of the cases resulted from sexual activity with clients. The inconsistent use of condoms with regular clients and the consumption of alcohol during work were indicated as the main causes of unplanned pregnancies. The main method to perform abortion was the intravaginal and oral use of misoprostol, acquired in pharmacies or on the black market. Invasive measures were less frequently reported, however with more serious health complications. The fear of complaint to the police meant that most women do not inform the health team regarding induced abortion. The majority of prostitutes aborted with the use of illegally-acquired misoprostol, ending abortion in a public hospital with infection and hemorrhagic complications. The data indicate the need for a public policy focusing on the reproductive health of prostitutes.

As prostitutas estão vulneráveis à gravidez não planejada e ao aborto. No Brasil, essa prática é crime e não há dados sobre aborto inseguro entre essa população. O estudo descreve como prostitutas abortam ilegalmente e o impacto à saúde. Foram realizadas entrevistas semiestruturadas com 39 prostitutas de três cidades do Brasil com experiência prévia em aborto induzido. Foram realizados 66 abortos, entre 1 e 8 ocorrências por mulher. A maioria dos casos resultaram de atividades sexuais com os clientes. O uso inconsistente dos condoms e o consumo de álcool na prostituição foram indicadas como as principais causas de gravidez não planejada. O principal método para abortar foi uso intravaginal e oral de misoprostol, adquirido em farmácias ou no mercado clandestino. Métodos invasivos foram menos frequentes, apesar de com mais sérias implicações à saúde. O medo de denúncia à polícia fez com que a maioria das mulheres não informasse à equipe de saúde sobre a indução do aborto. A maioria das prostitutas abortou com uso de misoprostol adquirido ilegalmente, finalizando o aborto em hospital público com quadros de infecção e complicações hemorrágicas. Os dados indicam a necessidade de uma política pública voltada à saúde reprodutiva das prostitutas.

Temporal trends and spatial distribution of unsafe abortion in Brazil, 1996-2012.

OBJECTIVE To analyze temporal trends and distribution patterns of unsafe abortion in Brazil. METHODS Ecological study based on records of hospital admissions of women due to abortion in Brazil between 1996 and 2012, obtained from the Hospital Information System of the Ministry of Health. We estimated the number of unsafe abortions stratified by place of residence, using indirect estimate techniques. The following indicators were calculated: ratio of unsafe abortions/100 live births and rate of unsafe abortion/1,000 women of childbearing age. We analyzed temporal trends through polynomial regression and spatial distribution using municipalities as the unit of analysis. RESULTS In the study period, a total of 4,007,327 hospital admissions due to abortions were recorded in Brazil. We estimated a total of 16,905,911 unsafe abortions in the country, with an annual mean of 994,465 abortions (mean unsafe abortion rate: 17.0 abortions/1,000 women of childbearing age; ratio of unsafe abortions: 33.2/100 live births). Unsafe abortion presented a declining trend at national level (R2: 94.0%, p < 0.001), with unequal patterns between regions. There was a significant reduction of unsafe abortion in the Northeast (R2: 93.0%, p < 0.001), Southeast (R2: 92.0%, p < 0.001) and Central-West regions (R2: 64.0%, p < 0.001), whereas the North (R2: 39.0%, p = 0.030) presented an increase, and the South (R2: 22.0%, p = 0.340) remained stable. Spatial analysis identified the presence of clusters of municipalities with high values for unsafe abortion, located mainly in states of the North, Northeast and Southeast Regions. CONCLUSIONS Unsafe abortion remains a public health problem in Brazil, with marked regional differences, mainly concentrated in the socioeconomically disadvantaged regions of the country. Qualification of attention to women's health, especially to reproductive aspects and attention to pre- and post-abortion processes, are necessary and urgent strategies to be implemented in the country.

Temporal trends and spatial distribution of unsafe abortion in Brazil, 1996-2012 / Tendência temporal e distribuição espacial do aborto inseguro no Brasil, 1996-2012 / Tendência temporal e distribuição espacial do aborto inseguro no Brasil, 1996-2012

OBJECTIVE To analyze temporal trends and distribution patterns of unsafe abortion in Brazil. METHODS Ecological study based on records of hospital admissions of women due to abortion in Brazil between 1996 and 2012, obtained from the Hospital Information System of the Ministry of Health. We estimated the number of unsafe abortions stratified by place of residence, using indirect estimate techniques. The following indicators were calculated: ratio of unsafe abortions/100 live births and rate of unsafe abortion/1,000 women of childbearing age. We analyzed temporal trends through polynomial regression and spatial distribution using municipalities as the unit of analysis. RESULTS In the study period, a total of 4,007,327 hospital admissions due to abortions were recorded in Brazil. We estimated a total of 16,905,911 unsafe abortions in the country, with an annual mean of 994,465 abortions (mean unsafe abortion rate: 17.0 abortions/1,000 women of childbearing age; ratio of unsafe abortions: 33.2/100 live births). Unsafe abortion presented a declining trend at national level (R2: 94.0%, p < 0.001), with unequal patterns between regions. There was a significant reduction of unsafe abortion in the Northeast (R2: 93.0%, p < 0.001), Southeast (R2: 92.0%, p < 0.001) and Central-West regions (R2: 64.0%, p < 0.001), whereas the North (R2: 39.0%, p = 0.030) presented an increase, and the South (R2: 22.0%, p = 0.340) remained stable. Spatial analysis identified the presence of clusters of municipalities with high values for unsafe abortion, located mainly in states of the North, Northeast and Southeast Regions. CONCLUSIONS Unsafe abortion remains a public health problem in Brazil, with marked regional differences, mainly concentrated in the socioeconomically disadvantaged regions of the country. Qualification of attention to women’s health, especially to reproductive aspects and attention to pre- and post-abortion processes, ...

OBJETIVO Analisar tendências temporais e padrões de distribuição espacial do aborto inseguro no Brasil. MÉTODOS Estudo ecológico realizado com base nos registros das internações hospitalares de mulheres por abortamento no Brasil, no período de 1996-2012, obtidos do Sistema de Informações Hospitalares do Ministério da Saúde. Estimou-se o número de abortos inseguros segundo local de residência, utilizando-se técnicas de estimativas indiretas. Foram calculados os indicadores: razão de aborto inseguro por 100 nascidos vivos e coeficiente de aborto inseguro por 1.000 mulheres em idade fértil. As tendências temporais foram analisadas por regressão polinomial e a distribuição espacial utilizando os municípios brasileiros como unidade de análise. RESULTADOS Foram registradas 4.007.327 internações hospitalares por abortamento no Brasil no período. Estimou-se um total de 16.905.911 abortos inseguros, com média anual de 994.465 abortos (coeficiente médio de aborto inseguro de 17,0 abortos/1.000 mulheres em idade fértil e razão de 33,2 abortos inseguros/100 nascidos vivos). O aborto inseguro apresentou tendência de declínio em nível nacional (R2: 94,0%; p < 0,001), com padrões desiguais entre as regiões. As regiões Nordeste (R2: 93,0%; p < 0,001), Sudeste (R2: 92,0%; p < 0,001) e Centro-Oeste (R2: 64,0%; p < 0,001) apresentaram tendência de declínio, enquanto a região Norte (R2: 39,0%; p = 0,030), tendência de aumento, e a região Sul (R2: 22,0%; p = 0,340), de estabilidade. A análise espacial identificou a presença de clusters de municípios com altos valores de abortos inseguros, localizados especialmente em estados das regiões Norte, Nordeste e Sudeste. CONCLUSÕES O aborto inseguro se mantém ...

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.

Histórias de aborto provocado entre adolescentes em Teresina, Piauí, Brasil / Histories of induced abortion among adolescents from Teresina in the State of Piauí, Brazil

Este artigo analisa os métodos, os percursos e as redes de apoio utilizados por adolescentes para o aborto clandestino. O estudo, transversal e descritivo, entrevistou 30 adolescentes internadas após a curetagem uterina por aborto em dois hospitais públicos de Teresina, de junho a novembro de 2011. O consentimento livre e esclarecido foi oral e as entrevistas foram gravadas após a confirmação do aborto induzido. Majoritariamente, as adolescentes tinham entre 14 e 17 anos, eram solteiras, urbanas, moravam com os pais, tinham baixa escolaridade e registravam idade gestacional de 12 semanas. O Cytotec foi usado isoladamente por 28 (94%) adolescentes - de 3 a 6 comprimidos, vaginal e/ou oralmente, que procuraram o hospital após sangramento vaginal e/ou cólicas intensas. Elas compraram o Cytotec sozinhas (43%, 13) ou com ajuda de amigo ou companheiro (40%, 12), em farmácias comuns. O medicamento foi vendido pelo proprietário (45%, 13) ou pelo balconista (55%, 16), que deu as orientações de uso. O apoio para as adolescentes irem ao hospital foi dado pela mãe (40%, 12) ou por amiga (30%, 9). Houve 3 (10%) complicações graves, resultando em internação de até 20 dias. O estudo demonstra a predominância do Cytotec como método abortivo entre adolescentes.

This paper analyses the methods, techniques and support networks taken by adolescents to perform illegal abortions. It is a descriptive and cross-sectional study involving interviews with 30 adolescents who had been hospitalized for uterine curettage in two public hospitals in Teresina between June and November 2011. Informed consent was given orally, and the interviews were recorded after the confirmation of the induced abortion. The adolescents were between 14 and 17 years old, single, and predominantly lived with their parents in urban areas, had little schooling and recorded a gestational age of 12 weeks. Between 3 and 6 tablets of Cytotec were taken orally and/or vaginally by 28 (94%) adolescents, and they were rushed to the hospital due to severe cramping, vaginal bleeding or both. They either bought Cytotec alone (43%, 13), or with the help of a friend or partner (40%, 12). Cytotec was sold to them in ordinary pharmacies, by the owner (45%, 13) or clerk (55%, 55), who provided instructions for use. They went to the hospital with their mother (40%, 12) or a girl friend (30%, 9). Three (10%) adolescents developed serious complications. The study revealed that Cytotec is the main method used to perform illegal abortions among adolescents.