Acceptability and continuation of use of the subdermal contraceptive implant among adolescents and young women in Argentina: a retrospective cohort study.

A new public policy was instituted in Argentina for free distribution of subdermal contraceptive implants to women aged 15-24 years old in the public healthcare system. The objective of this study is to determine the extent to which this population adhered to the implant, as well as predictors of continuation. The retrospective cohort study was based on a telephone survey of a random sample of 1101 Ministry of Health-registered implant users concerning the continuation of use, satisfaction with the method and side-effects, and reasons for removal. Descriptive statistics and multivariate regression analysis were used to explore the association between adherence and having received contraceptive counselling, satisfaction, and side effects. We found high levels of adherence (87%) and satisfaction (94%). Common reported side effects were amenorrhoea or infrequent bleeding, perceived weight gain, increased menstrual bleeding and headaches. Multivariate regression analysis indicates that, among adolescents, having received contraceptive counselling increased comfort, while frequent bleeding at six months hindered trust. Participants who had a history of a prior delivery or who had themselves primarily chosen the method were less likely to request the removal of the implant. Our results support the public policy of free implant distribution in the public health sector. This is a sustainable public policy that contributes to equity and access to effective contraception. It is appropriate for adolescents and young women and will also reduce unintended pregnancies. Our results suggest that counselling patients is key prior to insertion of the implant, as it improves acceptability and continuation.

Protocolo para la atención integral de las personas con derecho a la interrupción legal del embarazo / Protocol for the comprehensive care of people entitled to legal termination of pregnancy

Los derechos sexuales y los derechos reproductivos están garantizados en nuestro país por un amplio marco legal que tiene como base la Constitución Nacional, el Código Civil y Comercial y el Código Penal, como pilares fundamentales sobre los que se apoyan las leyes nacionales y provinciales. Por otro lado, a partir de la reforma constitucional de 1994 se incorporan en nuestra Constitución Nacional los pactos y tratados internacionales que nos someten a Tribunales y Comités a los que nuestro país debe responder para garantizar los derechos que dichos acuerdos internacionales establecen. En ese marco, uno de los ejes prioritarios de trabajo de la Dirección de Salud Sexual y Reproductiva de la Secretaría de Gobierno de Salud de la Nación es la política pública diseñada y sostenida para garantizar el acceso a la interrupción legal del embarazo en todos los casos contemplados por el Código Penal y refrendados por el Fallo F., A. L. de la Corte Suprema de Justicia de la Nación. La publicación de este Protocolo para la Atención Integral de las Personas con Derecho a la Interrupción Legal del Embarazo es parte de esa política pública ya que responde a la necesidad de actualizar la normativa adaptándola al Código Civil y Comercial de 2015 y la Resolución 65/2015 del Ministerio de Salud de la Nación, actualizar, también, las recomendaciones internacionales acerca de los procedimientos para la interrupción legal del embarazo - dosis de medicamentos y aspiración manual endouterina (AMEU) - y reforzar la importancia del acceso rápido a la atención integral y a la práctica, haciendo hincapié en la atención en primer nivel y los tratamientos con medicamentos.

The use of long-acting reversible contraceptives in Latin America and the Caribbean: current landscape and recommendations.

STUDY QUESTION: Can the high rate and associated burden of unintended pregnancy (UP) and adolescent pregnancy in Latin America and the Caribbean (LAC) be reduced through wider access to and use of long-acting reversible contraceptive (LARC) methods? SUMMARY ANSWER: Studies show that impoved access to and use of LARC methods is an effective tool for reducing the high rates of UP, unsafe abortion and abortion-related complications, and maternal deaths (as well as reducing their social and financial burden), and we have provided recommendations to help achieve this in LAC. WHAT IS KNOWN ALREADY: LAC comprises 46 countries with 650 million inhabitants, and shows large disparities in socioeconomic development, access to health services and attention to sexual and reproductive health rights. The exercise of these rights and universal access to sexual and reproductive health (SRH) programmes is a key strategy for improving maternal health by reducing the number of UPs, the rate of women's and child mortality and morbidity, and the number of unsafe abortions. The implementation of SRH programmes in the region has contributed to a decrease in pregnancy rates of more than 50% over 40 years. However, despite this progress, the numbers of UP and adolescent pregnancies are still among the highest worldwide, which can be attributed in large part to the low prevalence of use of LARC methods. STUDY DESIGN SIZE DURATION: This is a position paper with the objective of reviewing the magnitude and burden of UP in LAC, as well as available LARC methods and barriers to their access, with the goal of increasing knowledge and awareness among healthcare professionals (HCP), policymakers and the general public about the potential to reduce UP rates through the increased use of LARC. PARTICIPANTS/MATERIALS SETTING METHOD: We searched the electronic databases of PubMed and EMBASE to identify studies published up to May 2017. We also searched for websites regarding LAC, LARC methods, and UP including, for example, those from the United Nations, the World Health Organization, Pan American Health Organization, the Alan Guttmacher Institute and the United States Agency for International Development. Studies were included if they investigated mainly UP and their consequences as well as the use of LARC methods in the region. During 3 days of meetings, the importance of the studies identified and the appropriateness of inclusion were discussed. MAIN RESULTS AND THE ROLE OF CHANCE: LAC is not one unit and shows great ethnic diversity as well as economic and cultural differences among the various countries. These differences must be taken into account when developing policies related to disseminating information and combatting misinformation regarding the use of LARC among different audiences, such as adolescents and young women, nulligravidas, indigenous populations and women with disabilities. Furthermore, only some governments have made efforts to increase accessibility to LARC methods, and there is a need to implement training programmes for HCPs, launch education campaigns for the general public, increase access and review the cost-benefit analyses specific to LARC, which have already demonstrated that the upfront cost of LARC is less than the cummulative expense of short-term contraceptives. Recommendations to achieve these goals are presented. LIMITATIONS REASONS FOR CAUTION: Knowledge and awareness of the contraceptive method itself and of the mix of individual countries in the region is essential to the development of specific strategies and actions, tailored to each particular country situation, aimed at increasing access to modern contraceptive methods, especially LARC. WIDER IMPLICATIONS OF THE FINDINGS: Healthcare systems in LAC should consider LARC as a primary option for decreasing UP and adolescent pregnancy. Disseminating information, increasing awareness of their efficacy, removing barriers and improving access to LARC methods are the urgent actions recommended for government, academia, professional organizations, insurance companies and policymakers in order to address this major public health problem in LAC. STUDY FUNDING/COMPETING INTERESTS: This manuscript was supported by a grant from the Americas Health Foundation (AHF), a 501(c)3 nonprofit organization dedicated to improving healthcare throughout the Latin American Region. LB and IM received additional support from the São Paulo Research Foundation (FAPESP) award # 2015/20504-9. The authors declare no conflict of interest.

Health care students at an Argentinean school of medicine: are they well prepared to provide quality sexual and reproductive health services?

OBJECTIVES: The aim of our study was to assess what students of the University of Buenos Aires School of Medicine learn about sexual and reproductive health (SRH) and rights, focusing particularly on their knowledge of accessibility to contraception and abortion legislation. METHODS: In this cross-sectional study, self-administered, anonymous questionnaires were administered to 760 first year students and to 695 final year students from different fields of study (medicine, midwifery, nursing, radiology, nutrition, speech therapy and physiotherapy) between 2011 and 2013. Students' knowledge of SRH was measured according to six variables: contraceptive methods, accessibility to contraception, emergency contraception, legislation on surgical contraception, legislation on voluntary interruption of pregnancy, and HIV transmission and prevention. Their level of knowledge was categorised as low, basic, medium or high, according to their responses. RESULTS: We observed higher levels of knowledge in final year students compared with first year students. Those with basic level knowledge or higher were doubled in most of the variables. However, when analysed in detail per field of study, the differences were not so marked. It is important that medical, midwifery and nursing students receive formal education in SRH topics. CONCLUSIONS: Our investigation revealed important deficiencies in knowledge in core topics of SRH care among soon-to-be health care providers that could represent serious barriers to health and rights for the Argentinean population in the near future. Thus, there is an urgent need to improve the teaching of SRH care.

Future healthcare professionals' knowledge about the Argentinean abortion law.

OBJECTIVE: We assessed healthcare students' knowledge and opinions on Argentinian abortion law and identified differences between first- and final-year healthcare students. METHODS: In this cross-sectional study, self-administered anonymous questionnaires were administered to 760 first- and 695 final-year students from different fields of study (medicine, midwifery, nursing, radiology, nutrition, speech therapy, and physiotherapy) of the School of Medicine at the University of Buenos Aires, in 2011-2013. RESULTS: Compared to first-year students, a higher percentage of final-year students knew that abortion is legally restricted in Argentina (p < 0.001). A significantly higher percentage of final-year students could correctly identify the circumstances in which abortion is legal: woman's life risk (87.4% last vs. 79.1% first year), rape of a woman with developmental disability (66.2% first vs. 85.4% last-year; p < 0.001). More final-year students chose severe foetal malformations (37.3% first year vs. 57.3% final year) despite its being illegal. CONCLUSIONS: Although most final-year students knew that abortion is legally restricted in Argentina, misconceptions regarding circumstances of legal abortion were observed; this may be due to the fact that abortion is inadequately covered in the medical curricula. Medical schools should ensure that sexual and reproductive health topics are an integral part of their curricula. Healthcare providers who are aware of the legality of abortion are more likely to provide the public with sound information and ensure abortions are appropriately performed.

Healthcare students' knowledge and opinions about the Argentinean abortion law.

OBJECTIVE: Abortion is legally restricted in Argentina. Although this law is almost 100 years old, most women who meet the criteria for legal abortion are not informed of or offered this possibility within the healthcare system. Healthcare students' knowledge and opinions on abortion may influence their future practice. They may deny a woman with an unwanted pregnancy a practice to which she is legally entitled, resulting in an unsafe abortion. This study assessed knowledge and personal opinions on the abortion law among first year healthcare students in order to design adequate educational strategies. STUDY DESIGN: In this descriptive, analytical, cross-sectional study, structured self-administered questionnaires were administered to 781 first year medical, nursing, midwifery, and other healthcare students from the Faculty of Medicine, University of Buenos Aires from 2011 to 2013. Data were recorded anonymously in SPSS 20. Student samples were adjusted for gender and fields of study using the University statistics. RESULTS: Of the students, 48.8% did not know the current regulations. Most of the students thought abortion was legally restricted and failed to recognize the circumstances in which it is allowed. Over 75% of the students were pro-abortion, especially those with sexual experience. CONCLUSION: Students lack sound knowledge on the abortion law that may affect their personal lives and influence their future professional practice. It is crucial that medical schools include sexual and reproductive health issues in their curricula in order to ensure better quality healthcare services in the future. IMPLICATIONS: In Argentina, approximately 400,000 abortions are performed every year, many under unsafe conditions, resulting in one third of the maternal deaths for the past decade. High quality sexual and reproductive healthcare services are a key strategy to improve adolescents' and women's health, thereby lowering maternal mortality.

Mitos y realidades en anticoncepción de emergencia / Miths and realities in emergency contraception

El término anticoncepción hormonal de emergencia (AHE) se usa para descibir un método que cuando se toma durante los primeros días después de una relación sexual no protegida, puede prevenir un embarazo no buscado. Es sabido que sobre anticoncepción de emergencia mucho se dice y poco realmente se conoce. El desconocimiento del mecanismo de acción por parte de los médicos y la información errónea que reciben los pacientes, ya sea de ámbitos científicos, como de los medios de comunicación, han generado creencias y mitos en torno a los mismos, que no permiten que se utilicen correctamente. Se ha dicho sobre la AHE: que es abortiva; que trae importantes efectos adversos; que las pacientes van a dejar de utilizar otros métodos anticonceptivos; que aumenta el contagio de infecciones de transmisión sexual, etc. Hemos revisado la bibliografía existente hasta el momento sobre AHE, y podemos decir y justificar que ninguno de estos mitos son correctos y que aumentando los conocimientos acerca de la misma, y transmitiendo información correcta a nuestras pacientes, podremos brindar mejores opciones anticonceptivas para aquellas personas que no han utilizado correctamente un método, ha fracasado el mismo o ha sido víctima de una violación.

Mitos y realidades en anticoncepción de emergencia / Miths and realities in emergency contraception

El término anticoncepción hormonal de emergencia (AHE) se usa para descibir un método que cuando se toma durante los primeros días después de una relación sexual no protegida, puede prevenir un embarazo no buscado. Es sabido que sobre anticoncepción de emergencia mucho se dice y poco realmente se conoce. El desconocimiento del mecanismo de acción por parte de los médicos y la información errónea que reciben los pacientes, ya sea de ámbitos científicos, como de los medios de comunicación, han generado creencias y mitos en torno a los mismos, que no permiten que se utilicen correctamente. Se ha dicho sobre la AHE: que es abortiva; que trae importantes efectos adversos; que las pacientes van a dejar de utilizar otros métodos anticonceptivos; que aumenta el contagio de infecciones de transmisión sexual, etc. Hemos revisado la bibliografía existente hasta el momento sobre AHE, y podemos decir y justificar que ninguno de estos mitos son correctos y que aumentando los conocimientos acerca de la misma, y transmitiendo información correcta a nuestras pacientes, podremos brindar mejores opciones anticonceptivas para aquellas personas que no han utilizado correctamente un método, ha fracasado el mismo o ha sido víctima de una violación. (AU)

Síndrome de ovario poliquístico en la adolescencia: ¿Qué criterios diagnósticos utilizar? / Polycystic ovary syndrome in adolescence: what diagnostic criteria used?

A los efectos de comprender los criterios diagnósticos de Síndrome de Ovario Poliquístico vigentes y su posible aplicación en la adolescencia, se realiza una revisión de los cambios ocurridos desde 1990 hasta la fecha. Se reconoce la trascendencia que ha tenido cada una de las instancias de consenso, la importancia de las características claves que definen la disfunción ovárica y el hiperandrogenismo, así como los diferentes fenotipos resultantes con posibilidad de pasaje de uno a otro. No obstante, se concluye que los criterios vigentes no son herramientas suficientes para poder establecer el diagnóstico en adolescentes, ya que se confunden con el proceso normal de esta etapa. Mientras no surjan nuevas evidencias, se recomienda utilizar estos criterios cuando la edad ginecológica sea superior a dos años con reclasificación a los dos años siguientes.

Anticoncepción quirúrgica varones / Male surgical contraception

El Programa Nacional de Salud Sexual y Procreación Responsable tiene comopropósitos promover la igualdad de derechos, la equidad y la justicia social. Coneste fin el Programa se ha propuesto mejorar el acceso a servicios integrales desalud sexual y reproductiva en un marco de respeto de los derechos sexuales yreproductivos y con perspectiva de género.La Ley Nacional 26.130 establece el derecho de todas las personas a acceder a lasprácticas quirúrgicas denominadas ôligadura de trompas de Falopioö y ôligadurade conductos deferentes o vasectomíaö.Esta norma nacional entró en vigencia en el mes de septiembre de 2006 (BoletínOficial 30978). La nueva ley prevé que las prácticas deben realizarse en hospitalesy clínicas del país, sean públicos o privados.Con esta norma, todas las personas capaces y mayores de 21 años tienen derechoa realizarse una ligadura de trompas de Falopio o vasectomía.La ley no requiere adhesión provincial. No es necesario que las provincias adhierana la norma nacional para que las mujeres y varones que decidan acceder ala anticoncepción quirúrgica puedan hacerlo. Las provincias tiene la obligaciónde garantizar el acceso a la anticoncepción quirúrgica desde el momento mismode la entrada en vigor de la ley nacional, ya que deben garantizar el acceso a losderechos constitucionales en juego: los derechos a la salud y derechos sexualesy reproductivos. Concretamente, esto significa que todos los hospitales provincialesque cuenten con la complejidad requerida deben realizar las prácticas enlos términos establecidos por la ley nacional. La entrada en vigencia de la ley tampocoestá supeditada a su reglamentación. Además, ninguna jurisdicción puededictar normativa legal o reglamentaria que establezca más requisitos o mayorescondiciones que las establecidas en la ley nacional.