Multicountry research on comprehensive abortion policy implementation in Latin America: a mixed-methods study protocol.

INTRODUCTION: Access to comprehensive abortion care could prevent the death of between 13 865 and 38 940 women and the associated morbidity of 5 million women worldwide. There have been some important improvements in Latin America in terms of laws and policies on abortion. However, the predominant environment is still restrictive, and many women, adolescents and girls still face multiple barriers to exercise their reproductive rights. This research will systematically assess comprehensive abortion policies in five Latin American countries (Argentina, Colombia, Honduras, Mexico and Uruguay). The aim is to identify barriers, facilitators and strategies to the implementation of abortion policies, looking at four key dimensions-regulatory framework, abortion policy dynamics, abortion service delivery and health system and health outcomes indicators-to draw cross-cutting lessons learnt to improve current implementation and inform future safe abortion policy development. METHODS AND ANALYSIS: A mixed-method design will be used in the five countries to address the four dimensions through the Availability, Accessibility, Acceptability and Quality of Care model. The data collection tools include desk reviews and semi-structured interviews with key actors. Analysis will be performed using thematic analysis and stakeholder analysis. A regional synthesis exercise will be conducted to draw lessons on barriers, facilitators and the strategies. ETHICS AND DISSEMINATION: The project has been approved by the WHO Research Ethics Review Committee (ID: A66023) and by the local research ethics committees. Informed consent will be obtained from participants. Data will be treated with careful attention to protecting privacy and confidentiality. Findings from the study will be disseminated through a multipurpose strategy to target diverse audiences to foster the use of the study findings to inform the public debate agenda and policy implementation at national level. The strategy will include academic, advocacy and policy arenas and actors, including peer-reviewed publication and national and regional dissemination workshops.

Step by Step in Argentina: Putting Abortion Rights into Practice.

In December of 2020, the Argentine Congress legalized abortion through 14 weeks, vastly increasing access to abortion care in the country. The law's passage followed years of advocacy for abortion rights in Argentina - including mass public and civil society mobilization, vocal support from an established pool of abortion providers who offered abortion services under specific legal exceptions prior to the new law, and the growth of community groups such as the Socorristas en Red who provide support for people to self-manage abortions. Aided by ample political will, the number of health facilities offering services increased substantially after the law was passed, and the public visibility around the law has helped assure people seeking abortion that it is their right. Proyecto mirar is an initiative focused on both gathering and using qualitative and quantitative data to inform stakeholders about the progress and obstacles of the law's implementation. In this review, we present an overall summary of the first two years of implementation of the abortion law in Argentina based on proyecto mirar data and contextualized through the historical processes that have contributed to the law's passage and application. While we see increases in abortion services and improved public perception around abortion rights, inequities in access and quality of care persist throughout the country. Specifically, providers in some regions are well trained, while others create obstacles to access, and in some regions health services provide high quality abortion care whereas others provide substandard care. To be sure, the implementation of public policies does not happen overnight; it requires government support and backing to tackle obstacles and solve implementation problems. Our findings suggest that when new abortion laws are passed, they must be supported by civil society and government leaders to ensure that associated policies are well crafted and monitored to ensure successful implementation.

The Shift From Criminalization to Legalization of Abortion in Argentina.

This Viewpoint discusses passage and implementation of Law 27.610, which legalized abortion in Argentina under certain circumstances, and examines the ongoing clinical issues and legal challenges to the law.

Abortion as an Essential Health Service in Latin America During the COVID-19 Pandemic.

Background: The rapid increase in demand for health services as a result of the COVID-19 outbreak has created significant challenges for health systems. National and international health authorities have declared reproductive health services as essential, particularly those related to prevention, care during pregnancy, delivery and postpartum, as well as abortion services. This research was conducted by a regional team in cooperation with nine local organizations that are members of the Latin American Consortium against Unsafe Abortion (Consorcio Latinoamericano Contra el Aborto Inseguro, CLACAI). Objectives: Our research aimed to examine the provision of reproductive healthcare services, with a focus on abortion, in nine countries during the first few months of the pandemic (March to September 2020). Methods: Our research design developed a set of quantitative and qualitative indicators to monitor the availability and accessibility of abortion services during the COVID-19 pandemic. Researchers collected the quantitative data by reviewing regulations and other documents, government and civil society reports, and official statistics; the qualitative data was acquired through interviews with key actors, and non-representative surveys completed by healthcare professional and end users of reproductive services. Results: Although six of the nine countries we researched deemed reproductive health services essential, only two of these six countries considered abortion services to be essential, and all nine countries reported difficulties in accessing abortion services. Restrictive abortion laws remained in place in the majority of countries (seven), and as a result access to abortion services became even more limited than it had been before the pandemic. At the same time, good practices to facilitate access to abortion services in healthcare facilities, updated regulatory frameworks, and collaboration between civil society and government agencies were identified and should continue to be promoted even after the pandemic crisis has subsided. Conclusions: The pandemic catalyzed what was already happening in each country, and as such abortion services have become more accessible in countries like Argentina, where the so-called green wave has been generating social, legal and policy changes, whereas in countries such as Ecuador, where abortion is legally restricted and opposed to by the government, access to safe abortion became even more difficult than it was before the pandemic. However, the general trend has been a lack of adequate adaptation in order to guarantee quality in abortion care. That said, there have also been some interesting and positive service provision initiatives, such as telemedicine, implemented in at least two countries, which, if maintained long-term, could improve access to safe abortion.

Reporte temático 2022. Calidad: el desafío a dos años de la ley de aborto / Thematic report 2022. Quality: The Two-Year Challenge of the Abortion Law

Este nuevo reporte del proyecto mirar aborda la calidad en la provisión de servicios de aborto. Su objetivo es contribuir a poner en agenda una dimensión crítica de la política de abor- to a la luz de los estándares internacionales y de la propia Ley 27.610.1 También este reporte tiene la intención de dar cuenta ­a través de las voces de decisores, abogadas, proveedores y activistas de distintas provincias de Argentina- de la situación actual en materia de calidad de servicios de aborto e identificar tareas pendientes a dos años de sancionada la ley.

Tareas compartidas: una oportunidad para la atención del aborto en Argentina / Shared tasks: an opportunity for abortion care in Argentina

La aprobación de la Ley 27.610 de Acceso a la Interrupción Voluntaria del Embarazo (IVE) y a la Atención Posaborto marca una nueva etapa para la política de salud sexual y reproductiva argentina, que, como suele ocurrir, arrastra y se nutre de lo acumulado, y encuentra nuevos desafíos y respuestas. Bajo ese contexto, este documento introduce las "tareas compartidas", una estrategia de salud que impulsa la formación y habilitación de trabajadores de salud no médicos1 para labores específicas en la atención de IVE/ILE, de manera que puedan desempeñarse en ellas. Es una apuesta para ampliar el elenco del personal involucrado en la garantía y también para enfatizar el trabajo en equipos conformados por distintos profesionales (es decir, multiprofesional) y no jerárquico.

Proyecto MIRAR: el aborto en la prensa argentina 2018, 2020 y 2021 / Proyecto mirar: abortion in the Argentine press 2018, 2020 and 2021

El estudio describe empíricamente las maneras en que los medios escritos abordaron el tema del aborto en 2018, en el 2020 y en el 2021

La objeción de conciencia en las residencias médicas: pautas para la reflexión y acción en la atención del aborto / El aborto en la formación de la salud / Conscientious objection in medical residences: guidelines for reflection and action in abortion care / Abortion in health education

Este documento busca ofrecer alternativas concretas para cuando las creencias personales de residentes entran en conflicto con alguna exigencia del programa de su formación, tomando como ejemplo central el caso de la IVE/ILE. El propósito es ofrecer pistas, ideas y fundamentos para que las residencias en gineco-obstetricia y otras afines, a nivel nacional, provincial, regional o municipal y para instituciones privadas de salud formadoras de residentes puedan desarrollar estrategias de abordaje de las situaciones y resistencias relacionadas con la formación en IVE/ILE. La pregunta guía de este documento es: ¿puede el personal de las residencias de tocoginecología obtener ( o brindar) una capacitación profesional adecuada para ofrecer una atención de calidad en salud reproductiva mientras que, al mismo tiempo, se respetan sus creencias personales ­tanto de residentes como de quienes tienen a cargo esta formación­ cuando éstas conflictúan con sus obligaciones educativas, de entrenamiento y actuación profesional? Y, de ser posible, ¿cómo lograrlo?. Este documento forma parte de la serie "El aborto en la formación del personal de salud" y complementa el documento "Interrupción legal y voluntaria del embarazo: propuesta para la formación de especialistas en ginecología y obstetricia".

Protocolo modelo para la recolección, resguardo, preservación y cadena de custodia de evidencia biológica en casos de abuso sexual contra niñas, niños y adolescentes / Model protocol for the collection, protection, preservation and chain of custody of biological evidence in cases of sexual abuse against girls, boys and adolescents

El abuso sexual contra niñas, niños y adolescentes (NNyA) es una de las vulneraciones más graves de derechos contra la niñez y adolescencia y constituye un problema social, de salud y de justicia La magnitud del problema se ve en los números. La Oficina de Violencia Doméstica (OVD) de la Corte Suprema de Justicia de la Nación señala que las denuncias por violencia sexual representaron un 10% del total de las denuncias recibidas durante el 2019. En los casos de violencia sexual contra NNyA el porcentaje asciende a un 12%. En esta misma línea, del total de los casos que atendió el Programa las Víctimas contra las Violencias del Ministerio de Justicia y Derechos Humanos de la Nación, entre el 1 de octubre de 2019 y el 30 de septiembre de 2020, el 56,82% de los casos eran de NNyA1 (10.043 niñas, niños y adolescentes). Por otro lado, han ocurrido avances no sólo legislativos sino también institucionales y de gestión para mejorar el abordaje en estas situaciones, que incorporen de manera concreta procedimientos para proteger los derechos y la igualdad de género. Se cuenta, en este sentido, con protocolos de salud e intersectoriales, tanto a nivel nacional como provincial, que establecen estándares de atención para casos de abusos contra NNyA. Sin embargo, a partir de nuestra investigación2 constatamos que no existía un protocolo que permita estandarizar la articulación entre la actividad forense y clínico-asistencial, para la recolección, resguardo, preservación y cadena de custodia de evidencia biológica. El presente protocolo busca establecer criterios de trabajo y una metodología consensuada en materia probatoria respecto de los delitos sexuales contra NNyA. Fija estándares adecuados para la recolección, resguardo y preservación de la evidencia biológica, y enfatiza la importancia de que la toma de muestras se haga en forma oportuna en el marco de un abordaje integral de la situación, para así evitar la revictimización. Este protocolo modelo considera distintos escenarios según los recursos humanos y materiales disponibles en el lugar de la evaluación, y describe las condiciones mínimas para garantizar una evaluación adecuada que incluya el resguardo de la evidencia. En este sentido, este protocolo modelo pretende destacar la importancia de la participación del sector salud en articulación con el sector judicial, pues es usual que las víctimas llegan primero al ámbito asistencial sanitario y, por lo tanto, se requiere dar una respuesta estructurada en tres ejes esenciales: eficiencia, evitar la revictimización y el resguardo, cadena de custodia y documentacion de las muestras. De esta forma, se pretende dotar a todo el examen inicial de una visión asistencial que también pueda ser eficiente desde el punto de vista pericial.

Interrupción legal y voluntaria del embarazo: propuesta para la formación de especialistas en ginecología y obstetricia / Legal and voluntary interruption of pregnancy: proposal for the training of specialists in gynecology and obstetrics

Este documento es una propuesta para incorporar la atención del aborto­posaborto, IVE e ILE­ en la formación de especialistas en ginecología y obstetricia. El propósito es que sirva de insumo para los programas de formación en gineco-obstetricia a nivel nacional, provincial, regional o municipal y para instituciones privadas de salud formadoras de residentes; así como insumo para planes de estudios en los posgrados universitarios. Asimismo, mucho del contenido de este documento puede servir para programas formativos de otras profesiones de los equipos, y especialidades médicas y de otras ciencias de la salud. El siguiente trabajo, está dividido en dos secciones, además de la introductoria. La segunda sección describe las características y la regulación de la formación de las especialistas en ginecología y obstetricia en las residencias médicas. En otro apartado de la misma sección, se sugieren formas de contemplar las creencias personales de los médicos, incluso aquellas que parecen conflictuar con la formación y provisión de la ILE e IVE. La tercera sección está dedicada a desarrollar un programa de formación para que residentes de ginecología y obstetricia adquieran las competencias necesarias en materia de aborto.

Regulating Conscientious Objection to Legal Abortion in Argentina: Taking into Consideration Its Uses and Consequences.

Claims of conscientious objection (CO) have expanded in the health care field, particularly in relation to abortion services. In practice, CO is being used in ways beyond those originally imagined by liberalism, creating a number of barriers to abortion access. In Argentina, current CO regulation is lacking and insufficient. This issue was especially evident in the country's 2018 legislative debate on abortion law reform, during which CO took center stage. This paper presents a mixed-method study conducted in Argentina on the uses of CO in health facilities providing legal abortion services, with the goal of proposing specific regulatory language to address CO based not only on legal standards but also on empirical findings regarding CO in everyday reproductive health services. The research includes a review of literature and comparative law, a survey answered by 269 health professionals, and 11 in-depth interviews with stakeholders. The results from our survey and interviews indicate that Argentine health professionals who use CO to deny abortion are motivated by a combination of political, social, and personal factors, including a fear of stigmatization and potential legal issues. Furthermore, we find that the preeminent consequences of CO are delays in abortion services and conflicts within the health care team. The findings of this research allowed us to propose specific regulatory recommendations on CO, including limits and obligations, and suggestions for government and health system leaders.

Constitutional developments in Latin American abortion law.

For most of the 20th Century, restrictive abortion laws were in place in continental Latin America. In recent years, reforms have caused a liberalizing shift, supported by constitutional decisions of the countries' high courts. The present article offers an overview of the turn toward more liberal rules and the resolution of abortion disputes by reference to national constitutions. For such purpose, the main legal changes of abortion laws in the last decade are first surveyed. Landmark decisions of the high courts of Argentina, Bolivia, Colombia, and Mexico are then analyzed. It is shown that courts have accepted the need to balance interests and competing rights to ground less restrictive laws. In doing so, they have articulated limits to protection of fetal interests, and basic ideas of women's dignity, autonomy, and equality. The process of constitutionalization has only just begun. Constitutional judgments are not the last word, but they are important contributions in reinforcing the legality of abortion.

Health care providers' opinions on abortion: a study for the implementation of the legal abortion public policy in the Province of Santa Fe, Argentina.

BACKGROUND: In Argentina, abortion has been decriminalized under certain circumstances since the enactment of the Penal Code in 1922. Nevertheless, access to abortion under this regulatory framework has been extremely limited in spite of some recent changes. This article reports the findings of the first phase of an operations research study conducted in the Province of Santa Fe, Argentina, regarding the implementation of the local legal and safe abortion access policy. METHODS: The project combined research and training to generate a virtuous circle of knowledge production, decision-making, and the fostering of an informed healthcare policy. The project used a pre-post design of three phases: baseline, intervention, and evaluation. It was conducted in two public hospitals. An anonymous self-administered questionnaire (n = 157) and semi-structured interviews (n = 27) were applied to gather information about tacit knowledge about the regulatory framework; personal opinions regarding abortion and its decriminalization; opinions on the requirements needed to carry out legal abortions; and service's responses to women in need of an abortion. RESULTS: Firstly, a fairly high percentage of health care providers lack accurate information on current legal framework. This deficit goes side by side with a restrictive understanding of both health and rape indications. Secondly, while a great majority of health care providers support abortion under the circumstances consider in the Penal Code, most of them are reluctant towards unrestricted access to abortion. Thirdly, health care providers' willingness to perform abortions is noticeably low given that only half of them are ready to perform an abortion when a woman's life is at risk. Willingness is even lower for each of the other current legal indications. CONCLUSIONS: Findings suggest that there are important challenges for the implementation of a legal abortion policy. Results of the study call for specific strategies targeting health care providers in order to better inform about current legal abortion regulations and to sensitize them about abortion social determinants. The interpretation of the current legal framework needs to be broadened in order to reflect a comprehensive view of the health indication, and stereotypes regarding women's sexuality and abortion decisions need to be dismantled.

El acceso al aborto no punible como cuestión de derechos humanos: persistencia de barreras en jurisdicciones con y sin reglamentación del aborto legal / Access to not punishable abortion as a human right issue: persistance of barriers in jurisdictions with and without legal regulation of abortion

INTRODUCCION: Desde 1921, el Código Penal de la Nación (CPN) de Argentina penaliza el aborto pero establece ciertas excepciones en el artículo 86. Sin embargo, el acceso de las mujeres al aborto no punible (ANP) se encuentra seriamente restringido. La ausencia o precariedad de reglas y políticas públicas para facilitar el ejercicio de las permisiones, los debates irresueltos sobre su alcance, los trámites excesivos en los centros sanitarios y la intervención injustificada del sistema de justicia, son sólo algunos de los obstáculos que deben enfrentar las mujeres al requerir un aborto amparándose en los casos contemplados por el mencionado artículo.OBJETIVOS: Contribuir a la remoción de las barreras de acceso de las mujeres al ANP a partir del estudio de los debates jurídicos y los problemas de implementación institucional de las reglas vigentes en la Ciudad Autónoma de Buenos Aires (CABA).METODOS: Se realizó una indagación exhaustiva de los discursos judiciales sobre aborto y ANP y una revisión de los discursos doctrinarios vigentes en el país y el derecho comparado.RESULTADOS: Se realizó una serie de publicaciones que discuten los mecanismos de regulación y distintos argumentos que fundamentan la legalidad del ANP. La investigación permitió reconstruir el recorrido que las mujeres deben realizar para acceder al aborto legal en dos hospitales de la CABA.CONCLUSIONES: El estudio sirvió para realizar un mapeo de algunas de las opiniones de los profesionales de la salud sobre el ANP y las barreras de oferta que identificaron.

INTRODUCTION: Since 1921, the Argentine Criminal Code (ACC) criminalizes abortion but provides some exceptions in Article 86. However, womens access to not punishable abortion (NPA) is severely restricted. The absence or weakness of rules and policies to facilitate the exercise of the permissions, the unresolved legal debates about its scope, the excessive requirements in health centers and the unjustified recourse to the justice system are some of the obstacles faced by women requiring abortion invoking cases covered by the article mentioned above.OBJECTIVE: To contribute to the removal of barriers to womens access to NPA through the study of the legal debates and problems of institutional implementation of the current rules in the Autonomous City of Buenos Aires (ACBA).METHODS: A thorough investigation of judicial discourses on abortion and NPA and a review of current doctrinal discourses in the country and comparative law were made.RESULTS: Several publications have been produced discussing the regulatory mechanisms and arguments that support the legality of NPA. This research describes the different stages required for the access of women to legal abortion in two hospitals of ACBA. CONCLUSIONS: The research was used to perform a mapping of some of the opinions of health professionals about the NPA and the barriers they identified.CONCLUSIONS: The research was used to perform a mapping of some of the opinions of health professional about the NPA and the barriers they identified.

El acceso al aborto no punible como cuestión de derechos humanos: persistencia de barreras en jurisdicciones con y sin reglamentación del aborto legal / Access to not punishable abortion as a human right issue: persistance of barriers in jurisdictions with and without legal regulation of abortion

INTRODUCCION: Desde 1921, el Código Penal de la Nación (CPN) de Argentina penaliza el aborto pero establece ciertas excepciones en el artículo 86. Sin embargo, el acceso de las mujeres al aborto no punible (ANP) se encuentra seriamente restringido. La ausencia o precariedad de reglas y políticas públicas para facilitar el ejercicio de las permisiones, los debates irresueltos sobre su alcance, los trámites excesivos en los centros sanitarios y la intervención injustificada del sistema de justicia, son sólo algunos de los obstáculos que deben enfrentar las mujeres al requerir un aborto amparándose en los casos contemplados por el mencionado artículo.OBJETIVOS: Contribuir a la remoción de las barreras de acceso de las mujeres al ANP a partir del estudio de los debates jurídicos y los problemas de implementación institucional de las reglas vigentes en la Ciudad Autónoma de Buenos Aires (CABA).METODOS: Se realizó una indagación exhaustiva de los discursos judiciales sobre aborto y ANP y una revisión de los discursos doctrinarios vigentes en el país y el derecho comparado.RESULTADOS: Se realizó una serie de publicaciones que discuten los mecanismos de regulación y distintos argumentos que fundamentan la legalidad del ANP. La investigación permitió reconstruir el recorrido que las mujeres deben realizar para acceder al aborto legal en dos hospitales de la CABA.CONCLUSIONES: El estudio sirvió para realizar un mapeo de algunas de las opiniones de los profesionales de la salud sobre el ANP y las barreras de oferta que identificaron.

INTRODUCTION: Since 1921, the Argentine Criminal Code (ACC) criminalizes abortion but provides some exceptions in Article 86. However, women’s access to not punishable abortion (NPA) is severely restricted. The absence or weakness of rules and policies to facilitate the exercise of the permissions, the unresolved legal debates about its scope, the excessive requirements in health centers and the unjustified recourse to the justice system are some of the obstacles faced by women requiring abortion invoking cases covered by the article mentioned above.OBJECTIVE: To contribute to the removal of barriers to women’s access to NPA through the study of the legal debates and problems of institutional implementation of the current rules in the Autonomous City of Buenos Aires (ACBA).METHODS: A thorough investigation of judicial discourses on abortion and NPA and a review of current doctrinal discourses in the country and comparative law were made.RESULTS: Several publications have been produced discussing the regulatory mechanisms and arguments that support the legality of NPA. This research describes the different stages required for the access of women to legal abortion in two hospitals of ACBA. CONCLUSIONS: The research was used to perform a mapping of some of the opinions of health professionals about the NPA and the barriers they identified.CONCLUSIONS: The research was used to perform a mapping of some of the opinions of health professional about the NPA and the barriers they identified.