[Abortion in Melilla: barriers to ocean and frontier]. / Aborto en Melilla: barreras de océano y frontera.

OBJECTIVE: To provide insights into the challenges faced by women seeking abortion services in Melilla, Spain. It seeks to describe the journey these women undertake and to identify and analyze the barriers they encounter in accessing abortion care. METHOD: A qualitative research approach was employed, involving a series of eight semi-structured interviews during 2022. Three interviews were conducted with national experts in the field of abortion, while five interviews were conducted with healthcare professionals from the Melilla Health Area who are directly involved in providing abortion services and supporting women throughout the process. The study was guided by a theoretical framework that focuses on barriers to abortion access and sexual and reproductive rights. The collected data was analyzed using content analysis and categorized based on key dimensions of the study. RESULTS: The study identified several significant barriers to abortion care access in Melilla. These include conscientious objection among healthcare providers, the geographical remoteness of Melilla, the legal challenges faced by Moroccan women due to their irregular status, and the requirement of parental consent for minors aged 16 and 17. Consequently, women seeking abortion services are forced to travel to mainland Spain, continue with undesired pregnancies, or resort to unsafe clandestine abortions in Morocco, thereby endangering their lives in the worst cases. CONCLUSIONS: The barriers to abortion access identified in this study represent a violation of women's reproductive rights in Melilla. Urgent action is required to review the current process, ensuring that access is improved and the right to safe abortion is guaranteed for all women residing in Melilla.

Aborto en Melilla: barreras de océano y frontera / Abortion in Melilla: barriers to ocean and frontier

Objetivo: Describir el recorrido que realizan las mujeres para abortar en Melilla, así como identificar y analizar las barreras para su acceso. Método: Investigación cualitativa con un total de ocho entrevistas semiestructuradas realizadas durante 2022 a tres personas referentes en el tema del aborto de ámbito nacional y a cinco profesionales del Área de Salud de Melilla implicadas tanto en la prestación como en el recorrido que hacen las mujeres para poder abortar. El marco teórico que se siguió fueron las barreras de acceso al aborto y los derechos sexuales y reproductivos. Se realizó un análisis temático del contenido y por categorías según las dimensiones del estudio. Resultados: Se han identificado varias barreras de acceso al aborto en Melilla, entre las que destacan la objeción de conciencia, la localización geográfica de Melilla, la situación irregular de las mujeres marroquíes y la necesidad de consentimiento en las menores de 16 y 17 años. Estos obstáculos obligan a las mujeres que quieran abortar a trasladarse a la Península para conseguir el procedimiento, a continuar con un embarazo no deseado o, en el peor de los casos, a someterse a un aborto clandestino en Marruecos poniendo en riesgo su vida. Conclusiones: Las barreras de acceso descritas suponen una vulneración y una violación del derecho al aborto en Melilla. Se debe revisar el recorrido que se ven obligadas a hacer las mujeres de forma que se facilite el acceso y se garantice el derecho a un aborto seguro a todas las mujeres residentes en Melilla.(AU)

Objective: To provide insights into the challenges faced by women seeking abortion services in Melilla, Spain. It seeks to describe the journey these women undertake and to identify and analyze the barriers they encounter in accessing abortion care. Method: A qualitative research approach was employed, involving a series of eight semi-structured interviews during 2022. Three interviews were conducted with national experts in the field of abortion, while five interviews were conducted with healthcare professionals from the Melilla Health Area who are directly involved in providing abortion services and supporting women throughout the process. The study was guided by a theoretical framework that focuses on barriers to abortion access and sexual and reproductive rights. The collected data was analyzed using content analysis and categorized based on key dimensions of the study. Results: The study identified several significant barriers to abortion care access in Melilla. These include conscientious objection among healthcare providers, the geographical remoteness of Melilla, the legal challenges faced by Moroccan women due to their irregular status, and the requirement of parental consent for minors aged 16 and 17. Consequently, women seeking abortion services are forced to travel to mainland Spain, continue with undesired pregnancies, or resort to unsafe clandestine abortions in Morocco, thereby endangering their lives in the worst cases. Conclusions: The barriers to abortion access identified in this study represent a violation of women's reproductive rights in Melilla. Urgent action is required to review the current process, ensuring that access is improved and the right to safe abortion is guaranteed for all women residing in Melilla.(AU)

Depression and associated psychosocial factors following a legal abortion in Mexico

Introduction: Scientific evidence from the United States and European countries shows that women who have had an induced abortion are not more likely to become depressed and several factors may confound this outcome. In contrast, in the case of Latin America, there are practically no studies in this regard due to restrictive legislation prevailing in the region. This paper aims to determine the prevalence of a probable major depressive episode (PMDE) in women who have legally terminated a pregnancy by way of public service in Mexico City and whether there are any psychosocial factors reported by the international literature associated with this outcome. Method: In a cross-sectional study, 274 women aged 15 years or older were interviewed two weeks after undergoing a medical abortion between November 2018 and November 2019. The Center for Epidemiological Studies Depression Scale 35-item version (CES-D-R35) was used to measure the PMDE in a structured interview. Results: The prevalence of a PMDE was 15.8%. Multivariate logistic regression was used for adjusted analysis. Perceived abortion stigma ( OR = 6.74, 95% CI = 3.29-13.82), child sexual abuse (OR = 2.23, 95% CI = 1.01-4.93), and previous childless pregnancies (OR = 6.07, 95% CI = 1.52-24.21) were associated with PMDE. Conclusions: The prevalence of PMDE is similar to or lower than that reported in studies with women who continued a pregnancy; post-abortion counseling and clinical considerations should include the impact that stigma and gender-based violence have on women's mental health.

Introducción: Evidencia científica proveniente de los Estados Unidos y los países europeos indica que las mujeres que han tenido un aborto inducido no tienen más probabilidades de deprimirse y que hay varios factores que pueden intervenir para confundir este resultado. En el caso de América Latina, prácticamente no existen estudios al respecto debido a las legislaciones restrictivas imperantes. El objetivo de este artículo es determinar la prevalencia de un probable episodio depresivo mayor (PEDM) en mujeres que interrumpieron legalmente un embarazo en un servicio público en la Ciudad de México, y si hay algunos factores psicosociales reportados por la literatura internacional asociados con el resultado. Método: En un estudio transversal, se entrevistó a 274 mujeres de 15 años o más dos semanas después de someterse a un aborto médico entre noviembre del 2018 y noviembre del 2019. Se utilizó la versión de 35 reactivos de la Escala de Depresión del Centro para Estudios Epidemiológicos (CES-D-R35) para medir el PEDM en una entrevista estructurada. Resultados: La prevalencia de PEDM fue de 15,8 %. Se utilizó una regresión logística multivariada para el análisis ajustado. El estigma percibido por el aborto (OR = 6.74, IC 95 % = 3.29-13.82), el abuso sexual infantil (OR = 2.23, IC 95 % = 1.01-4.93) y los embarazos previos sin hijos (OR = 6.07, IC 95 % = 1.52-24.21) se asociaron con un PMDE. Conclusiones: La prevalencia de PEDM es similar o menor que la reportada en estudios con mujeres que continuaron un embarazo; el asesoramiento posaborto y las consideraciones clínicas deben incluir el impacto que el estigma y la violencia de género tienen en la salud mental de las mujeres.

Analysis of the impact of COVID-19 pandemic on women ́s care in an abortion situation in Latin America and the Caribbean / Análisis del impacto de la pandemia del COVID-19 en la atención de las mujeres en situación de aborto en América Latina y el Caribe / Análise do impacto da pandemia de COVID-19 sobre a atenção a mulheres em situação de aborto na América Latina e Caribe

Objective: to understand the influence of the COVID-19 pandemic on aspects of quality of care provided to women in abortion situations in sentinel centers of the CLAP MUSA-Network (a multicenter network with international cooperation with the aim of encouraging good practices in Latin America and the Caribbean). Methods: cross-sectional study between January/2017 and December/2021 with women of any age admitted for abortion or miscarriage. We analyzed the total number of cases and the proportion of legal abortions. The dependent variables were complications and use of contraceptives after abortion. The independent variables were COVID-19 pandemic, clinical and sociodemographic data. Statistical analysis was carried out using linear regression, multiple Poisson regression, Cochran-Armitage, chi-square, Mann-Whitney and Cohen tests. Results: we analyzed data from 93689 women assisted in 12 sentinel centers of the CLAP MUSA-Network, 64.55% in the pre-pandemic period (NP) and 35.45% in the pandemic period (PP) (22.73% received post-abortion care and 77.27% legal abortion). We found no differences in the number of cases over the period, regardless of the legal context. We observed a significant increase in the proportion of legal abortions in liberal and moderate contexts. In NP, 46.46% of women underwent medical abortion, while 62.18% of women underwent medical abortion in PP (h-Cohen 0.32). We found no increase in the number of complications during PP. In NP, 79.12% started contraceptives after abortion, while in PP, 70.39% started contraceptives after abortion (h-Cohen 0.20). Conclusion:the COVID-19 pandemic was not associated with a decrease in the number of cases, a decrease in the proportion of legal interruptions, or an increase in complications in sentinel centers of the CLAP MUSA-Network.

Objetivo: compreender a influência da pandemia de COVID-19 nos aspectos da qualidade da assistência prestada às mulheres em situação de abortamento nos centros sentinela da Rede CLAP-MUSA, uma rede multicêntrica com cooperação internacional visando encorajar boas práticas na América Latina e no Caribe. Metodologia: estudo transversal entre janeiro/2017 e dezembro/2021 com mulheres de qualquer idade admitidas por abortamentos espontâneos ou induzidos. Analisamos o número total de casos e a proporção de abortos legais. As variáveis dependentes foram complicações e uso de anticoncepcionais após o aborto. As variáveis independentes foram a pandemia de COVID-19, dados clínicos e sociodemográficos. A análise estatística foi realizada por meio de regressão linear, regressão múltipla de Poisson, testes de Cochran-Armitage, qui-quadrado, Mann-Whitney e Cohen. Resultados: foram analisados dados de 93.689 mulheres, atendidas em 12 centros sentinelas da Rede CLAP-MUSA, 64,55% no período pré-pandêmico (NP) e 35,45% no período pandêmico (PP) (22,73% receberam atendimento pós-aborto e 77,27%,aborto legal). Não encontramos diferenças no número de casos ao longo do período, independentemente do contexto legal. Observamos um aumento significativo na proporção de abortos legais em contextos liberais e moderados. No NP, 46,46% das mulheres realizaram aborto medicamentoso, enquanto 62,18% das mulheres realizaram aborto medicamentoso no PP (h-Cohen 0,32). Não encontramos aumento no número de complicações durante o PP. No NP, 79,12% iniciaram anticoncepcionais após o aborto, enquanto no PP, 70,39% iniciaram anticoncepcionais após o aborto (h-Cohen 0,20). Conclusão: a pandemia de COVID-19 não se associou à diminuição do número de casos, à diminuição da proporção de interrupções legais ou ao aumento de complicações nos centros sentinelas da Rede CLAP-MUSA

Objetivo: comprender la influencia de la pandemia de COVID-19 en aspectos de la calidad de la atención brindada a las mujeres en situación de aborto en los centros centinela de la Red CLAP-MUSA (una red multicéntrica de cooperación internacional con el objetivo de fomentar buenas prácticas en América Latina y el Caribe). Metodología: estudio transversal entre enero/2017 y diciembre/2021 con mujeres de cualquier edad ingresadas para abortos espontáneos o inducidos. Se analizó el número total de casos y la proporción de abortos legales. Las variables dependientes fueron las complicaciones y el uso de anticonceptivos después del aborto. Las variables independientes fueron pandemia de COVID-19, datos clínicos y sociodemográficos. El análisis estadístico se realizó mediante regresión lineal, regresión múltiple de Poisson, pruebas de Cochran-Armitage, chi-cuadrado, Mann-Whitney y Cohen. Resultados: se analizaron datos de 93689 mujeres atendidas en 12 centros centinela de la Red CLAP-MUSA, 64,55% en el período prepandemia (NP) y 35,45% en el período pandemia (PP) (22,73% recibieron atención postaborto y 77,27% aborto legal). No encontramos diferencias en el número de casos durante el período, independientemente del contexto legal. Observamos un aumento significativo en la proporción de abortos legales en contextos liberales y moderados. En NP, el 46,46% de las mujeres se sometieron al aborto con medicamentos, mientras que el 62,18% de las mujeres se sometieron al aborto con medicamentos en PP (h-Cohen 0,32). No encontramos aumento en el número de complicaciones durante el PP. En NP, 79,12% inició anticonceptivos después del aborto, mientras que en PP, 70,39% inició anticonceptivos después del aborto (h-Cohen 0,20). Conclusión:la pandemia de COVID-19 no se asoció con una disminución en el número de casos, una disminución en la proporción de interrupciones legales o un aumento en las complicaciones en los centros centinela de la Red CLAP-MUSA

Acciones para el aborto seguro durante la pandemia: el caso de las prácticas de dos organizaciones de Argentina / Actions for safe abortion during the pandemic: The case of the practices of two organizations in Argentina / Ações para o aborto seguro durante a pandemia: o caso das práticas de duas organizações na Argentina

Objetivo: abordar las acciones de acompañamiento a la interrupción legal y voluntaria del embarazo en el contexto de la pandemia por COVID-19 por parte de las organizaciones Socorristas en Red y la Red de Profesionales de la Salud por el Derecho a Decidir en Argentina. Metodología: se adoptó una metodología de investigación de tipo cualitativa con base en la realización de entrevistas en profundidad, semiestructurada, y cuestionarios de preguntas abiertas on-line orientados a conocer las experiencias de accionar de las integrantes de ambas redes respecto a los desafíos que significó la pandemia para continuar procesos de acompañamientos de abortos seguros. Conclusión: las medidas gubernamentales de Aislamiento Social, Preventivo y Obligatorio (ASPO) llevaron a una profundización de la obstrucción de derechos con relación al aborto que agravó procesos de desigualdades y vulnerabilidades existentes. Sin embargo, la pandemia del COVID-19 obligó a reforzar una red de cuidados feministas orientada a garantizar políticas de atencióny acompañamiento de aborto seguro.

Objective: to examine the initiatives undertakenby the organizations Socorristas en Redand Red de Profesionales de la Salud por el Derecho a Decidirin Argentina concerning the support and facilitation of legal and voluntary termination of pregnancy amidst the COVID-19 pandemic. Methodology:the research employs a qualitative approach, relying on in-depth, semi-structured interviews, and online questionnaires. These methodologies were designed to capture the experiential insights of network members, shedding light on the challenges encountered during the pandemic in sustaining the provision of support for safe abortion procedures. Conclusion:the implementation of Social, Preventive, and Compulsory Isolation (ASPO) measures during the COVID-19 pandemic heightened infringements on abortion-related rights, exacerbating societal inequalities and vulnerabilities. However, the COVID-19 pandemic prompted the reinforcement of a resilient feminist care network dedicated to providing safe abortion services and supportive policies.

Objetivo: abordar as acções de acompanhamento desenvolvidas pelas organizações Socorristas en Red e Red de Profesionales de la Salud por el Derecho a Decidir na Argentina para apoiar a interrupção legal e voluntária da gravidez no contexto da pandemia da COVID-19. Metodologia: foi adoptada uma metodologia de investigação qualitativa baseada em entrevistas aprofundadas e semiestruturadase em questionários on-line, com o objetivo de conhecer as experiências de ação dos membros de ambas as redes no que diz respeito aos desafios colocados pela pandemia para a continuação dos processos de acompanhamento do aborto seguro. Conclusão: as medidas governamentais de Isolamento Social, Preventivo e Compulsório (ASPO) levaram a um aprofundamento da obstrução de direitos em relação ao aborto, o que agravou processos de desigualdade e vulnerabilidade já existentes. No entanto, a pandemia da COVID-19 forçou o fortalecimento de uma rede de atendimento feminista voltada para a garantia de políticas de atenção e acompanhamento ao aborto seguro

¿Necesitás abortar? Estés donde estés te acompañamos: pandemia y acompañamiento de abortos en la ciudad de Neuquén, Argentina, durante 2020 / Do you need to abort? Wherever you are, we accompany you: pandemic and abortions accompaniment in Neuquén, Argentina, during 2020 / Você precisa abortar? Onde quer que você esteja, nós te acompanhamos: pandemia e acompanhamento de abortos em Neuquén, Argentina, durante 2020

Objetivo: describir los cambios que impuso la irrupción de la pandemia por COVID-19 al dispositivo de acompañamientos de abortos durante el año 2020 en la ciudad de Neuquén, Argentina. Metodología: el trabajo tiene un diseño metodológico que combinó aspectos cualitativos y cuantitativos en el análisis. Por un lado, se analizaron documentos elaborados por Socorristasen Redy se realizaron entrevistas semiestructuradas a activistas de La Revuelta. Esto se complementó con análisis de datos estadísticos de los acompañamientos de abortos dentro del sistema de salud entre marzo y diciembre de 2020. Resultados: en el período de estudio, La Revuelta readecuó parte de su dispositivo de acompañamiento y acompañó 270 abortos dentro del sistema de salud. Conclusión: el artículo muestra que la irrupción de la pandemia y la restricción para circular implicaron respuestas rápidas por parte de las activistas de La Revuelta, para continuar acompañando abortos en un momento de gran incertidumbre.

Objective: this article delineates the modifications introduced to the abortion support system in the city of Neuquén, Argentina, during the outbreak of the COVID-19 pandemic in 2020.Methods:the research employs a methodological design incorporating both qualitative and quantitative elements. It involves the analysis of documents prepared by Socorristas en Red, semi-structured interviews with La Revuelta activists, and the examination of statistical data related to abortion accompaniment within the health system from March to December 2020. Results:during the study period, La Revuelta adjusted a segment of its support apparatus and facilitated 270 abortions within the health system. Conclusion: the article illustrates that the pandemic and associated movement restrictions necessitated prompt adaptations by La Revuelta activists to sustain abortion support services amidst a period of considerable uncertainty.

Objetivo: descrever as mudanças que a pandemia de COVID-19 impôs ao sistema de apoio ao aborto durante o ano de 2020 na cidade de Neuquén, Argentina. Metodologia: o trabalho possui um desenho metodológico que combinou aspectos qualitativos e quantitativos na análise. Por um lado, foram analisados documentos elaborados pelos Socorristas en Rede realizadas entrevistas semiestruturadas com ativistas de La Revuelta. Isto foi complementado com a análise de dados estatísticos de acompanhamento do aborto no sistema de saúde entre março e dezembro de 2020. Resultados: no período do estudo, La Revuelta reajustou parte do seu dispositivo de acompanhamento e acompanhou 270 abortos no sistema de saúde. Conclusão: o artigo mostra que a eclosão da pandemia e a restrição de circulação implicaram respostas rápidas por parte dos ativistas de La Revuelta, para continuarem a acompanhar os abortos num momento de grande incerteza

Los derechos sexuales y (no) reproductivos en suspenso en territorios rurales y urbanos de Santiago del Estero, Argentina / Sexual and (non) reproductive rights put on holdin rural and urban territories of Santiago del Estero, Argentina / Direitos sexuais e (não) reprodutivos suspensos nos territórios rurais e urbanos de Santiago del Estero, Argentina

Objetivo: analizar el acceso a derechos sexuales y (no) reproductivos de mujeres y niñas en el contexto de la pandemia por COVID-19; y las políticas implementadas (o no) por los gobiernos de la provincia de Santiago del Estero y nacional. Metodología: desde métodos cualitativos se ha indagado a través de entrevistas no estructuradas y en profundidad por medio de videollamadas por las plataformas disponibles: a funcionarias/os, agentes de salud y referentes de organizaciones sociales. Resultados: el acceso a los derechos sexuales y (no) reproductivos enfrentó graves dificultades entre las que podemos destacar las restricciones a la circulación, sobre todo durante el 2020, y la priorización en los servicios públicos a la atención de los casos de COVID-19. Las respuestas institucionales a las demandas de interrupciones legales de las niñas y mujeres embarazadas han seguido circuitos largos y laberínticos. Conclusión:los diversos obstáculos que enfrentan las mujeres y las niñas para que el Estado garantice sus derechos, deben situarse en la perduración de un contexto histórico y estructural, donde la sexualidad y la reproducción están sometidas a estricto control y el ejercicio de los derechos se enfrenta con morales restrictivas. Las respuestas ofrecidas por el Estado no fueron suficientes y las organizaciones sociales cumplieron un rol sustitutivo. Y allí en donde no hay una red de contención o una organización social, la vida de mujeres y niñas presenta mayor vulnerabilidad.

Objective: this study aims to assess the access to sexual and (non) reproductive rights of women and girls within the context of the COVID-19 pandemic, examining the policies implemented (or not) by the governments of Santiago del Estero province and nationally. Methods: utilizing qualitative approaches, the research conducted unstructured and in-depth interviews via video calls with officials, health agents, and representatives of social organizations.Results: Access to sexual and (non) reproductive rights encountered substantial challenges, notably movement restrictions, particularly in 2020, and the prioritization of public services for COVID-19 cases. Institutional responses to legal interruptions for pregnant girls and women involved complex and protracted procedures.Conclusion: the barriers faced by women and girls in obtaining state-guaranteed rights must be contextualized within a historical and structural framework, characterized by strict control over sexuality and reproduction. State responses proved insufficient, leading social organizations to assume a substitute role. In the absence of a support network or social organization, the vulnerability of women and girls is heightened.

Objetivo: analisar o acesso aos direitos sexuais e (não) reprodutivos de mulheres e meninas no contexto da pandemia da COVID-19 e as políticas implementadas (ou não) pelos governos da província de Santiago del Estero e a nível nacional. Metodologia: utilizando métodos qualitativos, a investigação foi realizada por meio de entrevistas não estruturadas e em profundidade por meio de videochamadas: a autoridades, agentes de saúde e representantes de organizações sociais. Resultados: o acesso aos direitos sexuais e (não) reprodutivos enfrentou sérias dificuldades, entre as quais podemos destacar as restrições à circulação, especialmente durante 2020, e a priorização dos serviços públicos para atendimento aos casos de COVID-19. As respostas institucionais às exigências de interrupções legais por parte de meninas e mulheres grávidas seguiram circuitos longos e labirínticos. Conclusão: os diversos obstáculos que as mulheres e as meninas enfrentam para que o Estado garanta os seus direitos devem ser colocados na continuidade de um contexto histórico e estrutural, onde a sexualidade e a reprodução estão sujeitas a um controle rigoroso e o exercício dos direitos enfrenta morais restritivas. As respostas oferecidas pelo Estado não foram suficientes e as organizações sociais desempenharam um papel substituto. E onde não existe rede de apoio ou organização social, as vidas das mulheres e das meninas são mais vulneráveis.

Reflexões da pandemia de COVID-19: a tomada de decisão médica na abordagem terapêutica pós-aborto em dois hospitais públicos do Distrito Federal / Reflections of the COVID-19 pandemic: medical decision-making in the post-abortion therapeutic approach in two public hospitals in the Federal District, Brazil / Reflexiones de la pandemia de COVID-19: toma de decisiones médicas en el abordaje terapéutico postaborto en dos hospitales públicos del Distrito Federal, Brasil

Objetivo: identificar possíveis alterações da tomada de decisão médica para esvaziamento uterino pós-aborto de primeiro trimestre no cenário da COVID-19em dois hospitais públicos do Distrito Federal. Metodologia: abordagem qualitativa, que usou dois procedimentos metodológicos­documental e entrevistas­,cuja coleta de dados ocorreu entre maio e junho de 2022. No hospital A, coletou-se, em 25 registros consecutivos do livro do centro cirúrgico, a técnica de esvaziamento uterino pós-aborto prevalecente em 2020. No hospital B, coletou-se o mesmo dado em 48 prontuários clínicos, 23 de 2019 e 25 de 2020. As entrevistas semiestruturadas foram realizadas com onze profissionais de saúde: três médicos, quatro enfermeiros e quatro técnicos de enfermagem, lotados na obstetrícia/centro cirúrgico de cada hospital. Resultados: ambos os hospitais, no recorte temporal do estudo de 2019 a 2020, dispuseram de insumos para a eleição por quaisquer das técnicas de esvaziamento uterino. No hospital A, em 2020, a tomada de decisão médica foi 100% pela aspiração manual intrauterina. Em2019, no hospital B, a eleição foi 100% pela dilatação e curetagem; em 2020, período da COVID-19, apesar da dilatação e curetagem manter-se prioritária em 78% dos casos, notabilizou redução em relação a 2019. Evidenciou-se, ainda, no hospital B um maior quantitativo de atendimentos e internações de mulheres em processo de pós-aborto, se comparado como período anterior à COVID-19. Conclusão: o fator determinante para a tomada de decisão médica em ambos os hospitais é a aptidão técnica do médico para a abordagem eleita.

Objective: to discern potential shifts in medical decision-making regarding the selection of uterine evacuation techniques post-abortion in the first trimester within the context of the COVID-19 scenario at two public hospitals in the Federal District. Methods: employing a qualitative approach, the study utilized two methodological procedures - documents and interviews. Data collection occurred between May and June of 2022. At Hospital A, prevalent post-abortion uterine evacuation techniques in 2020 were obtained from 25 consecutive records sourced from the surgical center book. At Hospital B, similar data was collected from 48 clinical records, encompassing 23 from 2019 and 25 from 2020. Semi-structured interviews were conducted with eleven health professionals, including three doctors, four nurses, and four nursing technicians, working in the obstetrics/surgical center of each hospital. Results: during the study period (2019 and 2020), both hospitals maintained supplies for adopting various uterine evacuation techniques. In Hospital A in 2020, medical decision-making predominantly favored manual intrauterine aspiration. Conversely, in 2019 at Hospital B, dilation and curettage were the preferred technique in 100% of cases, and despite remaining a priority in 78% of cases in 2020 during the COVID-19 period, there was a noticeable reduction compared to 2019. Hospital B also witnessed a heightened number of consultations and hospitalizations of women in the post-abortion process during the COVID-19 period compared to the pre-pandemic period. Conclusion: the pivotal factor influencing medical decision-making in both hospitals is the technical proficiency required for executing the chosen uterine evacuation technique.

Objetivo: identificar posibles cambios en la toma de decisiones médicas al elegir la técnica de evacuación endouterina después de un aborto en el primer trimestre en el escenario COVID-19en dos hospitales públicos del Distrito Federal. Metodología:enfoque cualitativo, que utilizó dos procedimientos metodológicos, documentos y entrevistas, cuya recolección de datos se realizó entre mayo y juniode 2022. En el hospital A se recogió la técnica de evacuación endouterina postaborto prevalente en el año 2020 en 25 registros consecutivos del libro del centro quirúrgico, en el hospital B se recogieron los mismos datos en 48 historias clínicas, 23 del 2019 y, 25 del año 2020. Se realizaron entrevistas semiestructuradas a once profesionales de la salud: tres médicos, cuatro enfermeras y cuatro técnicos de enfermería, trabajando en el centro obstetricia/quirúrgico de cada hospital. Resultados:ambos hospitales en el período de estudio, 2019 y 2020, contaron con insumos disponibles para elegir cualquiera de las técnicas de evacuación endouterina. En el hospital A, en 2020, la toma de decisiones médicas se basó en la aspiración intrauterina manual. En 2019, en el hospital B, la elección fue del 100% para dilatación y legrado; En 2020, durante el período COVID-19, a pesar de que la dilatación y el legrado siguieron siendo una prioridad en el 78% de los casos, hubo una reducción notable en relación a 2019. En el hospital B, también hubo un mayor número de consultas y hospitalizaciones de mujeres en proceso postaborto, en comparación con el período anterior al COVID-19. Conclusión: el factor determinante para la toma de decisiones médicas en ambos hospitales es la capacidad técnica para realizar la técnica elegida.

Efficacy, Safety, and Acceptability of Misoprostol in the Treatment of Incomplete Miscarriage: A Systematic Review and Meta-analysis / Eficácia, segurança e aceitabilidade do misoprostol no tratamento do aborto incompleto: Uma revisão sistemática e metanálise

Abstract Objective To assess the efficacy, safety, and acceptability of misoprostol in the treatment of incomplete miscarriage. Data sources The PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Clinical Trials databases (clinicaltrials.gov) were searched for the relevant articles, and search strategies were developed using a combination of thematic Medical Subject Headings terms and text words. The last search was conducted on July 4, 2022. No language restrictions were applied. Selection of studies Randomized clinical trials with patients of gestational age up to 6/7 weeks with a diagnosis of incomplete abortion and who were managed with at least 1 of the 3 types of treatment studied were included. A total of 8,087 studies were screened. Data collection Data were synthesized using the statistical package Review Manager V.5.1 (The Cochrane Collaboration, Oxford, United Kingdom). For dichotomous outcomes, the odds ratio (OR) and 95% confidence interval (CI) were derived for each study. Heterogeneity between the trial results was evaluated using the standard test, I2 statistic. Data synthesis When comparing misoprostol with medical vacuum aspiration (MVA), the rate of complete abortion was higher in the MVA group (OR = 0.16; 95%CI = 0.07-0.36). Hemorrhage or heavy bleeding was more common in the misoprostol group (OR = 3.00; 95%CI = 1.96-4.59), but pain after treatment was more common in patients treated with MVA (OR = 0.65; 95%CI = 0.52-0.80). No statistically significant differences were observed in the general acceptability of the treatments. Conclusion Misoprostol has been determined as a safe option with good acceptance by patients.

Resumo Objetivo Avaliar a eficácia, segurança e aceitabilidade do misoprostol no tratamento do aborto incompleto. Fontes de dados Os bancos de dados PubMed, Scopus, Embase, Web of Science, Cochrane Library e bancos de dados de Ensaios Clínicos (clinicaltrials.gov) foram pesquisados para os artigos relevantes, e estratégias de busca foram desenvolvidas usando uma combinação de termos temáticos de Medical Subject Headings e palavras de texto. A última pesquisa foi realizada em 4 de julho de 2022. Nenhuma restrição de idioma foi aplicada. Seleção dos estudos Foram incluídos ensaios clínicos randomizados com pacientes com idade gestacional até 6/7 semanas com diagnóstico de aborto incompleto e que foram manejadas com pelo menos um dos três tipos de tratamento estudados. Um total de 8.087 estudos foram selecionados. Coleta de dados Os dados foram sintetizados usando o pacote estatístico Review Manager V.5.1 (The Cochrane Collaboration, Oxford, United Kingdom). Para resultados dicotômicos, o odds ratio (OR, na sigla em inglês) e o intervalo de confiança (IC) de 95% foram derivados para cada estudo. A heterogeneidade entre os resultados do ensaio foi avaliada usando o teste padrão, estatística I2. Síntese dos dados Ao comparar misoprostol com aspiração a vácuo médico (MVA, na sigla em inglês), a taxa de aborto completo foi maior no grupo MVA (OR = 0,16; IC95% = 0,07-0,36). Hemorragia ou sangramento intenso foi mais comum no grupo do misoprostol (OR = 3,00; 95%CI = 1,96-4,59), mas a dor após o tratamento foi mais comum em pacientes tratados com MVA (OR = 0,65; 95%CI = 0,52-0,80). Não foram observadas diferenças estatisticamente significativas na aceitabilidade geral dos tratamentos. Conclusão O misoprostol tem se mostrado uma opção segura e com boa aceitação pelos pacientes.

Violência obstétrica no processo do abortamento

Objetivo: Analisar as práticas assistenciais de saúde no processo do abortamento tipificadas como violência obstétrica. Metodologia: Estudo qualitativo e descritivo, realizado em um hospital público no Brasil com 15 profissionais de saúde de nível médio e superior. Os dados foram coletados presencialmente, através de um roteiro de entrevista semiestruturada. O perfil foi analisado pela estatística descritiva simples e as questões abertas pela técnica de conteúdo temática proposta por Bardin. Resultados: Evidenciou-se que as práticas que denotam violência obstétrica relacionam-se a alocação das mulheres em processo de abortamento no mesmo ambiente que gestantes e puérperas e ao emitirem juízos de valor no momento da assistência às mulheres. Conclusão: Há necessidade de educação permanente para que as/os profissionais possam assistir de maneira humanizada e qualificada.

Objetivo: Analizar las prácticas de atención a la salud en el proceso de aborto tipificadas como violencia obstétrica. Metodología: Estudio cualitativo y descriptivo, realizado en un hospital público en Brasil con 15 profesionales de salud de nivel medio y superior. Los datos fueron recogidos presencialmente, a través de un guion de entrevista semiestructurada. El perfil fue analizado por la estadística descriptiva simple y las cuestiones abiertas por la técnica de contenido temática propuesta por Bardin. Resultados: Se evidenció que los profesionales de salud presentaron conocimiento insuficiente sobre violencia obstétrica en el momento en que la restringieron al parto o aborto, a la tipificación física/verbal e identificaron solo a los médicos y enfermeras como los principales perpetradores. Las prácticas que denotan violencia obstétrica se relacionan a la asignación de las mujeres en proceso de aborto en el mismo ambiente que gestantes y puérperas, y al emitir juicios de valor en el momento de la asistencia. Conclusión: Hay necesidad de educación permanente para que los profesionales puedan asistir de manera humanizada y cualificada.

Objective: To analyze health care practices in the abortion process typified as obstetric violence. Methodology: Qualitative and descriptive study, conducted in a public hospital in Brazil with 15 health professionals of medium and higher education. The data were collected in person, through a semi-structured interview script. The profile was analyzed by simple descriptive statistics and the questions opened by the thematic content technique proposed by Bardin. Results: It was evidenced that health professionals had insufficient knowledge about obstetric violence at the time they restricted it to childbirth or abortion, physical/verbal typing and identified only doctors and nurses as the main perpetrators. The practices that denote obstetric violence are related to the allocation of women in the process of abortion in the same environment as pregnant women and puerperal women and when issuing value judgments at the time of care. Conclusion: There is a need for permanent education so that the professionals can assist in a humanized and qualified way.

Impacto psicológico inicial e incidencia de trastorno mental en torno a las interrupciones voluntarias del embarazo (IVE): un estudio piloto en población general / Initial psychological impact and incidence of mental disorders Around voluntary terminations of pregnancy (vtp): a pilot Study in the general population

Introducción/Antecedentes: Existe todavía una insuficiente evidencia científica sobre los efectos psicológicos/psicopatológicos y emocionales de las interrupciones voluntarias del embarazo (IVE), especialmente en nuestro entorno. Los estudios previos sobre el tema se caracterizan por 1) ofrecer resultados dispares, 2) estudiar depresión, ansiedad, trastorno por estrés postraumático y abuso de sustancias, pero al mismo tiempo 3) existen cuestiones metodológicas que limitan la generalización de los resultados. Objetivos: Describir una muestra de mujeres de población general que realizaron una IVE en un servicio público de Atención a la Sexual y Reproductiva (ASSIR) de Catalunya. Métodos: Estudio piloto de pacientes provenientes de población general y atendidas en nuestras consultas de Ginecología del Servicio de Atención a la Salud Sexual y Reproductiva (ASSIR) de Osona a Vic (Barcelona). Las pacientes fueron evaluadas siguiendo escalas estandarizadas, incluyendo la MINI (Mini Psychiatric Interview) y la Escala de Depresión de Hamilton. El seguimiento fue durante cuatro meses. Se realizó una estadística descriptiva. Resultados: Hasta 23 mujeres fueron incluidas en la muestra piloto. La edad media era joven (31.4 años). La mayoría (62.5%) estaban activas laboralmente y tenías estudios equivalentes al bachillerato o superiores (52.2%). El 26.1% habían tenido IVE previas. La IVE actual fue mayoritariamente farmacológica (73.9%). El principal motivo fue su voluntad (86.9%). Tres mujeres puntuaron más de 7 puntos en la Escala de Depresión de Hamilton. La entrevista diagnóstica MINI identificó diez mujeres con criterios para enfermedad mental en ese momento. De estas diez mujeres, seis no tenían antecedentes familiares ni personales de enfermedad mental, mientras que cuatro ya tenían antecedentes personales de alguna patología mental y ya habían consultado anteriormente en alguna ocasión al Servicio de Psiquiatría...(AU)

Introduction/Background: There is still insufficient scientific evidence on the psychological/psychopathological and emotional effects of voluntary terminations of pregnancy (V.T.P.), especially in our setting. Previous studies on the subject are characterized by 1) mixed results, 2) studying depression, anxiety, post-traumatic stress disorder and substance abuse, but at the same time 3) there are methodological issues that limit the generalizability of the results. Objectives: To describe a sample of women from the general population who underwent an abortion in a public center of the Sexual and Reproductive Assistance Network (ASSIR) of Catalonia. Methodology: Pilot study of patients from the general population attended in our Sexual and Reproductive Health outpatient clinics at the ASSIR of Osona (Vic, Barcelona). Patients were assessed using standardized scales, including the MINI (Mini Psychiatric Interview) and the Hamilton Depression Scale. Follow-up was for four months. Descriptive statistics were performed. Results: Up to 23 women were included in the pilot sample. The average age was young (31.4 years). The majority (62.5%) were active in the labour market and had a high school education or higher (52.2%). 26.1% had had a previous VTP. The current abortion was mostly pharmacological (73.9%). The main reason was willingness (86.9%). Three women scored more than 7 points on the Hamilton Depression Scale. The MINI diagnostic interview identified ten women with criteria for mental illness at that time. Of these ten women, six had no family or personal history of mental illness, while four had a personal history of mental illness and had previously consulted the psychiatric service. After the abortion, during the following four months, only one patient consulted the psychology service and was subsequently discharged...(AU)

El aborto eugenésico: entre el diagnóstico prenatal y el consentimiento desinformado / Eugenic abortion: between prenatal diagnosis and uninformed consent

El denominado aborto “eugenésico” tiene un extraordinario matiz diferencial frente a las otras moda lidades de aborto legalmente establecidas, que se concreta en el modo en que llega a formarse la decisión de la mujer, que no es previa, sino consecuencia de una información médica recibida sobre el feto; decisión, además, en la que late una clara componente ‘discriminatoria’, puesto que el aborto se produce exclusiva mente por la discapacidad del feto. Esa singularidad exige prestar atención al contexto en que se plantean las decisiones eugenésicas, porque en ellas inciden tres elementos fundamentales que, según se planteen, pueden conducir o no al aborto: en primer lugar, la oportunidad de realizar determinadas pruebas pre natales sin existir factores de riesgo. En segundo lugar, la enorme responsabilidad de los profesionales sanitarios a la hora de informar a los padres sobre el resultado de una prueba prenatal. En tercer lugar, el punto de vista de los futuros padres, que deberían evitar una concepción eugenésica de la paternidad/ maternidad, siendo conscientes de que lo que se está desarrollando en el útero de la mujer es su hijo o hija, no un embrión genérico afectado por anomalías; y que un hijo o hija es una realidad personal, más allá de sus capacidades. El artículo aborda estas tres cuestiones, que convierten al aborto eugenésico en una práctica discriminatoria y evitable, puesto que no se trata de impedir la decisión abortiva de la mujer, sino de refrendar su decisión primaria de continuar con el embarazo a partir de una visión positiva y no eugenésica de la discapacidad (AU)

The so-called “eugenic” abortion has an extraordinary differential nuance compared to the other le gally established modalities of abortion, which is specified in the way the woman’s decision is formed, which is not prior, but a consequence of medical information received about the foetus; a decision, more over, in which there is a clear “discriminatory” component, since the abortion is produced exclusively because of the disability of the foetus. This uniqueness requires attention to the context in which eugenic decisions are made, because they involve three fundamental elements which, depending on how they are made, may or may not lead to abortion: firstly, the opportunity to carry out certain prenatal tests in the absence of risk factors. Secondly, the enormous responsibility of health professionals in informing parents about the results of a prenatal test. Thirdly, the point of view of future parents, who should avoid a eu genic conception of parenthood, being aware that what is developing in the woman’s womb is their son or daughter, not a generic embryo affected by anomalies; and that a son or daughter is a personal reality, beyond his o her capabilities. The paper addresses these three issues, which make eugenic abortion a dis criminatory and avoidable practice, since the aim is not to prevent the woman’s decision to abort, but to endorse her primary decision to continue with the pregnancy on the basis of a positive, non-eugenic view of disability (AU)

Abortion as a matter of Human Rights

Para garantizar la igualdad real, la autonomía, la libertad y el derecho a la autodeterminación reproductiva, es imperativo que los estados aseguren el derecho a determinar libre y responsablemente el número deseado de hijos. La penalización total del aborto es incompatible con los sistemas jurídicos constitucionales, ya que ignora la garantía de protección de los derechos humanos, imponiendo una carga injusta e indefendible a las mujeres vulnerables. Este artículo examina los elementos que sustentan un enfoque jurídico restrictivo de los derechos reproductivos. Se centra en las nociones cruciales de autonomía reproductiva y autodeterminación y su lugar en el marco de los derechos reproductivos. Estos derechos se consideran derechos humanos y se delimitan las correspondientes responsabilidades de los Estados. (AU)

To ensure genuine equality, autonomy, freedom, and the right to reproductive self-determination, it is imperative for nations to ensure the right to freely and responsibly determine the desired number of children. The complete criminalization of abortion is incompatible with constitutional legal systems as it ignores the assurance of human rights protection, placing an unfair and indefensible burden on vulnerable women. This article examines the elements upholding a legal approach that restricts reproductive rights. It centers on the crucial notions of reproductive autonomy and self-determination and their place in the reproductive rights framework. These rights are regarded as human rights, outlining States’ corresponding responsibilities. (AU)

Vulneración de Derechos Fundamentales por práctica de la interrupción voluntaria del embarazo en una comunidad autónoma distinta a la de residencia: comentario a la Sentencia 78/2023, de 3 de julio de 2023, del Tribunal Constitucional / [Violation of Fundamental Rights due to the practice of voluntary interruption of pregnancy in an autonomous community other than that of residence: comment on Sentence 78/2023, of July 3, 2023, of the Constitutional Court]

El presente trabajo estudia la Sentencia 78/2023, de 3 de julio de 2023, del Tribunal Constitucional, que analiza la práctica de interrupción voluntaria del embarazo en una comunidad autónoma distinta a la de residencia. La cuestión principal radica en apreciar una vulneración a la garantía de interrumpir voluntariamente el embarazo dentro de los supuestos legales, como parte del contenido constitucionalmente protegido del derecho fundamental a la integridad física y moral (art. 15 CE). (AU)

This paper studies Judgement 78/2023, of 3 July 2023, of the Constitutional Court, which analyzes the practice of voluntary termination of pregnancy in an autonomous community other than that of residence. The main question lies in assessing a violation of the guarantee of voluntary termination of pregnancy within the legal circumstances, as part of the constitutionally protected content of the fundamental right to physical and moral integrity (art. 15 CE). (AU)

Proceso de implementación de una iniciativa de atención a mujeres en postaborto en Chile, 2016-2020 / The implementation process of a post-abortion healthcare initiative in Chile, 2016-2020

Objetivo: Analizar el proceso de implementación de una iniciativa de calidad de atención en el postaborto en tres hospitales de Santiago de Chile para su posterior escalamiento al ámbito nacional. Método: Se efectuó un estudio cualitativo, con base en una revisión documental sustentada en documentos normativos emitidos por el Ministerio de Salud y 23 entrevistas semiestructuradas a tomadores de decisiones, profesionales de salud y usuarias. Se realizó un análisis de contenido usando el programa Atlas-ti 8. Resultados: A nivel normativo, se identificaron acciones relacionadas con la implementación de la iniciativa, y a nivel de proceso se identificaron los aciertos, las dificultades y las resistencias que experimentaron los equipos involucrados en el piloto durante su implementación. A pesar de que la implementación de la iniciativa no fue planificada, tuvo efectos positivos para el bienestar de las mujeres y el desempeño de los profesionales de atención implicados en el proceso. Conclusiones: Esta experiencia es un punto de partida para planear la implementación nacional con base en estrategias bien definidas. Los resultados aportan una experiencia documentada para quienes desean desarrollar iniciativas o programas de atención a mujeres en situación de postaborto.

Objective: To analyze the implementation process of a quality post-abortion care initiative in three hospitals in Santiago de Chile for its subsequent scale up at the national level. Method: A qualitative study was carried out, based on a documentary review supported by governmental normative documents issued by the Ministry of Health and 23 semi-structured interviews with decision-makers, health providers and users. Content analysis was performed using the Atlas-ti 8 software. Results: At the regulatory level, actions related to the implementation of the initiative were identified, and at the process level, the success, difficulties and resistance experienced by the teams involved in the pilot during its implementation were identified. Although the implementation of the initiative was not planned, it had positive effects on the well-being of the women and the performance of the care providers involved in the process. Conclusions: This experience is a starting point to plan implementation at the national level with well-defined strategies. Our results provide a documented experience for those who wish to develop post-abortion care initiatives or programs.

Interrupciones voluntarias del embarazo recurrentes. Estudio de prevalencia y exploración de factores asociados. Antioquia, Colombia, 2015 - 2021 / Recurrent voluntary termination of pregnancy. Prevalence study and exploration of associated factors. Antioquia, Colombia, 2015 ­ 2021

Objetivos: Describir la prevalencia de las interrupciones voluntarias del embarazo (IVE) recurrentes y efectuar una exploración de los factores asociados a esta. Materiales y métodos: Estudio de corte trasversal descriptivo, en el que se incluyeron mujeres atendidas entre 2015 y 2021 en cinco sedes, en el Departamento de Antioquia, de una Institución que promueve la atención en salud sexual y reproductiva (SSR) en Colombia. Se midieron variables sociodemográficas, de SSR, así como la realización de IVE recurrente, tipo de procedimiento utilizado en la primera IVE, y método de anticoncepción elegido posterior a esta. Se presenta la prevalencia de período de aborto recurrente global y por año. Se hace exploración de los factores asociados por medio de análisis multivariado. Se obtuvo aval del comité de investigación de la institución. Resultados: Se incluyó un total de 20.423 mujeres. La prevalencia de IVE recurrente fue del 4,07 % (n = 831) en todo el período, y varió del 2,3 al 6 % en los 6 años. El método más utilizado para la IVE recurrente fue inducción farmacológica (48,50 %). Después de la primera IVE, el 69,81 % de las mujeres utilizó métodos anticonceptivos clasificados como "muy efectivos", según la Organización Mundial de la Salud. Se identificaron como factores de riesgo de la IVE recurrente pertenecer al régimen de aseguramiento subsidiado por el Estado (Odds ratio ajustado (ORa) = 1,35; IC 95 %: 1,05-1,72) y haber tenido dos o más gestaciones (ORa = 1,23; IC 95 %: 1,06 - 1,44). Como factores protectores se identificaron: contratación del servicio de IVE bajo modalidad de pago de bolsillo (ORa = 0,71; IC 95 %: 0,61-0,82), el antecedente de IVE tardía (ORa = 0,30; IC 95 %: 0,11-0,81), y la elección del implante subdérmico posterior al primer aborto primer aborto como (ORa =0,64; IC 95 %: 0,49 - 0,83). Conclusiones: La prevalencia de IVE recurrente posiblemente está incrementando. Se requieren estudios prospectivos que evalúen si existe una tendencia al incremento y que verifiquen posibles hipótesis de asociación que surgen de este trabajo.

Objectives: To describe the prevalence of recurrent voluntary termination of pregnancy (VTP) and to explore associated factors. Material and methods: Descriptive, cross-sectional cohort study which included women seen between 2015 and 2021 in five sites of an institution located in the Department of Antioquia which promotes sexual and reproductive health (SRH) care in Colombia. Measured variables included sociodemographics, SRH, recurrent performance of VTP, type of procedure used in the first VTP and contraception method selected afterwards. The prevalence of global and yearly recurrent abortion period is presented. Associated factors were explored using a multivariate analysis. The research committee of the institution approved the study. Results: In total, 20,423 women were included. The prevalence of recurrent VTP was 4.07 % (n = 831) during the entire period, ranging between 2.3 and 6 % over the 7 years. The most commonly used method for recurrent VTP was pharmacological induction (48.50 %). After the first VTP, 69.81 % of women used contraceptive methods classified as "very effective" according to the World Health Organization. The risk factors identified as being associated with recurrent VTP included being part of the state-subsidized health insurance system (adjusted odds ratio [aOR] = 1.35; 95 % CI:1.05-1.72) and having had two or more pregnancies (aOR = 1.23; 95% CI: 1.06 - 1.44). Protective factors were identified and included out-of-pocket payment for VTP service (aOR = 0.71; 95% CI: 0.61-0.82), a history of late VTP (aOR = 0.30; 95% CI: 0.11-0.81), and the selection of a subdermal implant for contraception following the first abortion (sOR = 0.64; 95% CI: 0.49 - 0.83). Conclusions: It is possible that the prevalence of recurrent VTP is increasing. Prospective studies are required in order to determine whether there is a growing trend and to verify potential association hypotheses derived from this work.

Safety and effectiveness of bDMARDs during pregnancy in patients with rheumatic diseases: Real-world data from the BIOBADASER registry.

INTRODUCTION: Inflammatory rheumatic diseases usually affect women of childbearing age treated with biologic drugs. However, there is a lack of literature on the efficacy and toxicity of biologic disease-modifying drugs during pregnancy. The aim of this study was to determine the presence of pregnant patients treated with bDMARDs in a real-world dataset and to examine the impact of pregnancy and lactation on the evolution of rheumatic disease in a registry of Spanish patients. METHOD: This was a multicentre prospective study with a real-world setting. Information was obtained from BIOBADASER registry. Patients included are women who got pregnant until November 2020 from 19 rheumatology units. We conducted proportions, means, and standard deviations (SD) to describe the study population and the use of treatments. T-test and Chi-square test were applied to assess differences between groups. RESULT: Ninety cases of pregnancy were registered (n=68 full-term pregnancies; n=22 spontaneous miscarriages). Most of the cases discontinued bDMARDs during pregnancy (78.9%) but 13 cases continued treatment during pregnancy, mainly using certolizumab pegol. These cases were obtaining better management of rheumatic disease, although the differences were not statistically significant [DAS28-CRP, 2.9 (SD: 1.6) vs. 2.0 (1.2), p=.255; DAS28-ESR, 2.2 (1.0) vs. 1.7 (.5), p=.266]. No serious adverse events were reported during pregnancy and lactation. CONCLUSION: Being pregnant is still an uncommon condition in patients with rheumatic diseases and using bDMARDs. Our results show that rheumatic disease tended to progress better during pregnancy in patients who continued to take bDMARDs.

Aborto e raça no Brasil, Pesquisa Nacional de Aborto 2016 a 2021 / Abortion and race in Brazil, National Abortion Surveys 2016 to 2021

Resumo Examinamos a realização do aborto segundo cor ou raça das mulheres no Brasil usando dados de três edições da PNA, 2016, 2019 e 2021. Comparamos diferenciais raciais aplicando testes de diferenças de médias a dados de levantamentos separados, levantamentos combinados sem reponderação, e levantamentos combinados e reponderados. Na comparação usamos ainda modelos logísticos para a chance de realização de aborto. Os resultados indicam que há diferencial racial consistente nas três edições da PNA, com os percentuais de aborto entre as mulheres negras sendo mais elevados do que entre as mulheres brancas. Nos levantamentos combinados e reponderados, entre as mulheres negras de todas as idades a probabilidade de ter feito um aborto é de 11,03% enquanto entre as mulheres brancas é de 7,55%. Isso significa uma diferença de 3,5 pontos percentuais, que se traduz em uma probabilidade 46% maior para as negras, valores estatisticamente significantes para um intervalo de 5%. Regressões logísticas produzem resultados similares, com probabilidade média predita das mulheres negras de 12,61% e das mulheres brancas de 8,90%, também significantes. As diferenças raciais persistem estatisticamente significantes para várias combinações de edições da PNA. Porém, nos levantamentos isolados os testes de diferenças de média são estatisticamente significantes apenas em 2016.

Abstract We examine racial differentials in abortion among women in Brazil using data from three editions of the Brazilian National Abortion Survey (PNA), 2016, 2019 and 2021. We test the difference in means in data from separate surveys, combined surveys without reweighting, and combined and reweighted surveys. We also use logistic models for the chance of having an abortion. The results indicate that there is a consistent racial differential in the three editions of PNA, with the percentage of abortions among Black women being higher than among white women. In the combined and reweighted surveys, among Black women of all ages the probability of having had an abortion is 11.03% while among white women it is 7.55%. This means a difference of 3.5 percentage points, which translates into a 46% higher probability for Black women, statistically significant values for a 5% interval. Logistic regressions produce similar results, with an average predicted probability of 12.61% for Black women and 8.90% for white women, also significant. Racial differences remain statistically significant for various combinations of PNA editions. However, in the separate surveys, the difference in means tests are only statistically significant in 2016. Black refers to the group formed by Black and Brown women (pretas and pardas). Due to the small sample size, it is not possible to say much about the differences with Asian and Indigenous women.

Safety and effectiveness of bDMARDs during pregnancy in patients with rheumatic diseases: Real-world data from the BIOBADASER registry / Seguridad y efectividad de los FAME biológicos durante el embarazo en pacientes con enfermedades reumáticas: datos del mundo real procedentes del registro BIOBADASER

Introduction: Inflammatory rheumatic diseases usually affect women of childbearing age treated with biologic drugs. However, there is a lack of literature on the efficacy and toxicity of biologic disease-modifying drugs during pregnancy. The aim of this study was to determine the presence of pregnant patients treated with bDMARDs in a real-world dataset and to examine the impact of pregnancy and lactation on the evolution of rheumatic disease in a registry of Spanish patients.Method: This was a multicentre prospective study with a real-world setting. Information was obtained from BIOBADASER registry. Patients included are women who got pregnant until November 2020 from 19 rheumatology units. We conducted proportions, means, and standard deviations (SD) to describe the study population and the use of treatments. T-test and Chi-square test were applied to assess differences between groups.Result: Ninety cases of pregnancy were registered (n=68 full-term pregnancies; n=22 spontaneous miscarriages). Most of the cases discontinued bDMARDs during pregnancy (78.9%) but 13 cases continued treatment during pregnancy, mainly using certolizumab pegol. These cases were obtaining better management of rheumatic disease, although the differences were not statistically significant [DAS28-CRP, 2.9 (SD: 1.6) vs. 2.0 (1.2), p=.255; DAS28-ESR, 2.2 (1.0) vs. 1.7 (.5), p=.266]. No serious adverse events were reported during pregnancy and lactation.Conclusion: Being pregnant is still an uncommon condition in patients with rheumatic diseases and using bDMARDs. Our results show that rheumatic disease tended to progress better during pregnancy in patients who continued to take bDMARDs.(AU)

Introducción: Las enfermedades reumáticas inflamatorias afectan normalmente a mujeres en edad fértil tratadas con fármacos biológicos. Sin embargo, escasea la literatura sobre la eficacia y la toxicidad de los fármacos modificadores de la enfermedad (FAME) biológicos durante el embarazo. El objetivo de este estudio fue determinar la presencia de pacientes embarazadas tratadas con FAME biológicos en un conjunto de datos del mundo real y examinar el impacto del embarazo y la lactancia en la evolución de la enfermedad reumática en un registro de pacientes españoles.Método: Estudio prospectivo multicéntrico en un entorno del mundo real. La información se obtuvo del registro BIOBADASER. Los pacientes fueron mujeres embarazadas hasta el mes de noviembre del 2020, de 19 unidades de Rreumatología. Obtuvimos proporciones, medias y desviaciones estándar (DE) para describir la población de estudio y el uso de tratamientos. Se realizaron las pruebas t y χ2 para evaluar las diferencias entre grupos.Resultado:Se registraron 90 casos de embarazo (n=68 embarazos a término; n=22 abortos espontáneos). La mayoría de los casos suspendieron el tratamiento con FAME biológicos durante el embarazo (78,9%), pero 13 casos prosiguieron el tratamiento durante el embarazo, utilizando principalmente certolizumab pegol. Dichos casos obtuvieron un mejor manejo de la enfermedad reumática, aunque las diferencias no fueron estadísticamente significativas (DAS28-CRP, 2,9 [DE 1,6] vs. 2 [1,2], p=0,255; DAS28-ESR, 2,2 [1] vs. 1,7 [0,5], p=0,266). No se reportaron episodios adversos graves durante el embarazo y la lactancia.Conclusión: La situación de embarazo sigue siendo infrecuente en las pacientes con enfermedades reumáticas que utilizan FAME biológicos. Nuestros resultados reflejan que la enfermedad reumática tendió a progresar mejor durante el embarazo en las mujeres tratadas con FAME biológicos.(AU)

Consideraciones éticas y científicas del inicio de la vida sobre el aborto eugenésico en enfermedades genéticas incapacitantes en Perú

El artículo expone conceptos actuales biológicos, así como algunos planteamientos filosóficos acerca del inicio de la vida, que se examinarán en relación con la necesidad del aborto eugenésico. Se presenta el concepto de "exdurantismo", en el que la combinación del nuevo genoma nuclear y mitocondrial hacen único al individuo; además, se concibe al complejo genómico como "integrador somático" que dirige el desarrollo embrionario, y se muestra la problemática en el caso de las violaciones que provocan embarazos, el aborto eugenésico en enfermedades genéticas incapacitantes o la utilización de embriones posterior a la fertilización in-vitro. Se plantea que la dignidad de la persona comienza desde la concepción. Frente a la detección de una enfermedad genética, grave o letal, se debe ofrecer soporte económico y social, de diagnóstico y tratamiento; además, desde la salud pública, una mayor inversión para plantear estrategias de tamizaje, diagnóstico, manejo e investigación.

The article presents current biological concepts, as well as some philosophical approaches to the beginning of life, which will be examined in relation to the need for eugenic abortion. The concept of "exdurantism" is presented, in which the combination of the new nuclear and mitochondrial genome makes the individual unique; furthermore, the genomic complex is conceived as a "somatic integrator" that directs embryonic development, and the problematic is shown in the case of rape that causes pregnancies, eugenic abortion in incapacitating genetic diseases or the use of embryos after in-vitro fertilization. The dignity of the person begins at conception. When a serious or lethal genetic disease is detected, economic and social support, diagnosis and treatment should be offered; in addition, public health should invest more in screening, diagnosis, management and research strategies.

O artigo apresenta conceitos biológicos atuais, bem como algumas abordagens filosóficas sobre o início da vida, que serão examinados em relação à necessidade do aborto eugênico. É apresentado o conceito de "exdurantismo", no qual a combinação do novo genoma nuclear e mitocondrial torna o indivíduo único; além disso, o complexo genômico é concebido como um "integrador somático" que dirige o desenvolvimento embrionário, e é mostrada a problemática no caso de estupro que resulta em gravidez, aborto eugênico em doenças geneticamente incapacitantes ou o uso de embriões após a fertilização in vitro. Argumenta-se que a dignidade da pessoa começa na concepção. Diante da detecção de uma doença genética, grave ou letal, devem ser oferecidos apoio econômico e social, diagnóstico e tratamento, bem como maior investimento em saúde pública em estratégias de triagem, diagnóstico, gestão e pesquisa.