Recomendação nº 045, de 23 de junho de 2020: recomenda à Câmara dos Deputados o arquivamento do PDL nº 271/2020, que susta a aplicação de Normas Técnicas do Ministério da Saúde referentes à saúde da mulher e dá outras providências / Recommendation No. 045, of June 23, 2020: recommends to the Chamber of Deputies the filing of PDL No. 271/2020, which suspends the application of Technical Norms of the Ministry of Health regarding women's health and other measures

Recomenda à Câmara dos Deputados que arquive o Projeto de Decreto Legislativo nº 271/2020, de autoria do Deputado Filipe Barros, interrompendo sua tramitação, tendo em vista que o referido projeto visa sustar a aplicação de Normas Técnicas expedidas pelo Ministério da Saúde referentes à Saúde da Mulher, o que desrespeita as competências constitucionais do MS. Ao Ministério da Saúde: Que reconsidere a retirada do site e republique a Nota Técnica 016/2020-COSMU/CGCIVI/DAPES/SAPS/MS, reafirmando assim seu compromisso com o direito à saúde e a vida de todas e todos os cidadãos brasileiros.

Association between infrastructure and observed quality of care in 4 healthcare services: A cross-sectional study of 4,300 facilities in 8 countries.

BACKGROUND: It is increasingly apparent that access to healthcare without adequate quality of care is insufficient to improve population health outcomes. We assess whether the most commonly measured attribute of health facilities in low- and middle-income countries (LMICs)-the structural inputs to care-predicts the clinical quality of care provided to patients. METHODS AND FINDINGS: Service Provision Assessments are nationally representative health facility surveys conducted by the Demographic and Health Survey Program with support from the US Agency for International Development. These surveys assess health system capacity in LMICs. We drew data from assessments conducted in 8 countries between 2007 and 2015: Haiti, Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania, and Uganda. The surveys included an audit of facility infrastructure and direct observation of family planning, antenatal care (ANC), sick-child care, and (in 2 countries) labor and delivery. To measure structural inputs, we constructed indices that measured World Health Organization-recommended amenities, equipment, and medications in each service. For clinical quality, we used data from direct observations of care to calculate providers' adherence to evidence-based care guidelines. We assessed the correlation between these metrics and used spline models to test for the presence of a minimum input threshold associated with good clinical quality. Inclusion criteria were met by 32,531 observations of care in 4,354 facilities. Facilities demonstrated moderate levels of infrastructure, ranging from 0.63 of 1 in sick-child care to 0.75 of 1 for family planning on average. Adherence to evidence-based guidelines was low, with an average of 37% adherence in sick-child care, 46% in family planning, 60% in labor and delivery, and 61% in ANC. Correlation between infrastructure and evidence-based care was low (median 0.20, range from -0.03 for family planning in Senegal to 0.40 for ANC in Tanzania). Facilities with similar infrastructure scores delivered care of widely varying quality in each service. We did not detect a minimum level of infrastructure that was reliably associated with higher quality of care delivered in any service. These findings rely on cross-sectional data, preventing assessment of relationships between structural inputs and clinical quality over time; measurement error may attenuate the estimated associations. CONCLUSION: Inputs to care are poorly correlated with provision of evidence-based care in these 4 clinical services. Healthcare workers in well-equipped facilities often provided poor care and vice versa. While it is important to have strong infrastructure, it should not be used as a measure of quality. Insight into health system quality requires measurement of processes and outcomes of care.

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.

Quality of reproductive healthcare for adolescents: A nationally representative survey of providers in Mexico.

OBJECTIVE: Adolescents need sexual and reproductive health services but little is known about quality-of-care in lower- and middle-income countries where most of the world's adolescents reside. Quality-of-care has important implications as lower quality may be linked to higher unplanned pregnancy and sexually transmitted infection rates. This study sought to generate evidence about quality-of-care in public sexual and reproductive health services for adolescents. METHODS: This cross-sectional study had a complex, probabilistic, stratified sampling design, representative at the national, regional and rural/urban level in Mexico, collecting provider questionnaires at 505 primary care units in 2012. A sexual and reproductive quality-of-healthcare index was defined and multinomial logistic regression was utilized in 2015. RESULTS: At the national level 13.9% (95%CI: 6.9-26.0) of healthcare units provide low quality, 68.6% (95%CI: 58.4-77.3) medium quality and 17.5% (95%CI: 11.9-25.0) high quality reproductive healthcare services to adolescents. Urban or metropolitan primary care units were at least 10 times more likely to provide high quality care than those in rural areas. Units with a space specifically for counseling adolescents were at least 8 times more likely to provide high quality care. Ministry of Health clinics provided the lowest quality of service, while those from Social Security for the Underserved provided the best. CONCLUSIONS: The study indicates higher quality sexual and reproductive healthcare services are needed. In Mexico and other middle- to low-income countries where quality-of-care has been shown to be a problem, incorporating adolescent-friendly, gender-equity and rights-based perspectives could contribute to improvement. Setting and disseminating standards for care in guidelines and providing tools such as algorithms could help healthcare personnel provide higher quality care.

Summary indices for monitoring universal coverage in maternal and child health care.

OBJECTIVE: To compare two summary indicators for monitoring universal coverage of reproductive, maternal, newborn and child health care. METHODS: Using our experience of the Countdown to 2015 initiative, we describe the characteristics of the composite coverage index (a weighted average of eight preventive and curative interventions along the continuum of care) and co-coverage index (a cumulative count of eight preventive interventions that should be received by all mothers and children). For in-depth analysis and comparisons, we extracted data from 49 demographic and health surveys. We calculated percentage coverage for the two summary indices, and correlated these with each other and with outcome indicators of mortality and undernutrition. We also stratified the summary indicators by wealth quintiles for a subset of nine countries. FINDINGS: Data on the component indicators in the required age range were less often available for co-coverage than for the composite coverage index. The composite coverage index and co-coverage with 6+ indicators were strongly correlated (Pearson r  = 0.73, P < 0.001). The composite coverage index was more strongly correlated with under-five mortality, neonatal mortality and prevalence of stunting (r =  -0.57, -0.68 and -0.46 respectively) than was co-coverage (r = -0.49, -0.43 and -0.33 respectively). Both summary indices provided useful summaries of the degrees of inequality in the countries' coverage. Adding more indicators did not substantially affect the composite coverage index. CONCLUSION: The composite coverage index, based on the average value of separate coverage indicators, is easy to calculate and could be useful for monitoring progress and inequalities in universal health coverage.

Establishing a quality management system in a fertility center: experience with ISO 9001 / SISTEMA DE GESTÃO DE QUALIDADE NA CLÍNICA DE REPRODUÇÃO HUMANA: EXPERIÊNCIA COM A NORMA ISO 9001

In Fertility Centers, quality should be measured by how well the organization complies with pre-defined requirements, and by how quality policies are implemented and quality objectives achieved. Having a quality management system (QMS) is a mandatory requirement for IVF centers established in most countries with regulatory guidelines, including Brazil. Nevertheless, none of the regulatory directives specify what a QMS must have in detail or how it should be implemented and/or maintained. ISO 9001 is the most important and widespread international requirement for quality management. ISO 9001 standards are generic and applicable to all organizations in any economic sector, including IVF centers. In this review, we discuss how we implemented QMS according to ISO 9001 and what we achieved 5 years later. In brief, with ISO we defined our structure, policies, procedures, processes and resources needed to implement quality management. In addition, we determined the quality orientation of our center and the quality objectives and indicators used to guarantee that a high-quality service is provided. Once measuring progress became part of our daily routine, quantifying and evaluating the organization's success and how much improvement has been achieved was an inevitable result of our well-established QMS. Several lessons were learned throughout our quality journey, but foremost among them was the creation of an internal environment with unity of purpose and direction; this has in fact been the key to achieving the organization's goals.

Na clínica de reprodução humana, a qualidade deve ser medida pela maneira como a organização cumpre os requisitos pré-definidos, e pela forma como as políticas de qualidade são implementadas e os objetivos de qualidade alcançados. Ter um sistema de gestão da qualidade (SGQ) é um requisito obrigatório para centros de fertilização in vitro estabelecidos na maioria dos países com diretrizes regulatórias, incluindo o Brasil. No entanto, nenhuma das diretivas regulamentares especifica o que um SGQ deve ter em detalhe ou como ele deve ser implementado e/ou mantido. A norma ISO 9001 é a exigência internacional mais importante e adotada mundialmente para a gestão da qualidade. Os conceitos da norma ISO 9001 são genéricos e aplicáveis a todas as organizações em qualquer setor económico, incluindo as clínicas de fertilização in vitro (ou bancos de células e tecidos germinativos tipo 2, como denominados no Brasil pela Agência Nacional de Vigilância Sanitária). Neste artigo, discutimos como implementamos um SGQ de acordo com a norma ISO 9001 e o que conseguimos 5 anos mais tarde. Em suma, com a norma ISO definimos nossa estrutura, políticas, procedimentos, processos e recursos necessários para implementar a gestão da qualidade. Além disso, determinamos a orientação da qualidade do nosso centro além dos objetivos de qualidade e indicadores utilizados para garantir que um serviço de alta qualidade seja fornecido para nossos clientes. A partir do momento que a mensuração do progresso tornou-se parte da nossa rotina diária, quantificar e avaliar o sucesso da organização e os resultados atingidos passou a ser uma consequência inevitável de um SGQ bem estabelecido. Várias lições foram aprendidas ao longo de nossa jornada de qualidade, mas o mais importante foi a criação de um ambiente interno com unidade de propósito e direção, que se tornou peça chave para alcançar os objetivos da organização.

Contribution of obstetrics and gynecology societies in South America to the prevention of unsafe abortion in the region.

Unsafe abortion is one of the most serious public health and human rights issues in South America. Rates are among the highest in the world and account for 13% of maternal deaths. Nine out of 10 South American countries have enrolled in the International Federation of Gynecology and Obstetrics (FIGO) Initiative for the Prevention of Unsafe Abortion and its Consequences. Each individual society of obstetrics and gynecology prepared a situational analysis, and an action plan was elaborated with the participation of their respective Ministries of Health, national and international agencies, and other collaborating institutions. Action plans were designed to respond to the problems identified in the situational analyses, with objectives corresponding with all or some of the 4 levels of prevention proposed in the FIGO initiative. This article reports the progress achieved in implementing the action proposed by each country, as well as some activities carried out in addition to those included in the formal plans.

Primary healthcare providers' views on improving sexual and reproductive healthcare for adolescents in Bolivia, Ecuador, and Nicaragua.

OBJECTIVES: To elicit the views of primary healthcare providers from Bolivia, Ecuador, and Nicaragua on how adolescent sexual and reproductive health (ASRH) care in their communities can be improved. METHODS: Overall, 126 healthcare providers (46 from Bolivia, 39 from Ecuador, and 41 from Nicaragua) took part in this qualitative study. During a series of moderated discussions, they provided written opinions about the accessibility and appropriateness of ASRH services and suggestions for its improvement. The data were analyzed by employing a content analysis methodology. RESULTS: Study participants emphasized managerial issues such as the prioritization of adolescents as a patient group and increased healthcare providers' awareness about adolescent-friendly approaches. They noted that such an approach needs to be extended beyond primary healthcare centers. Schools, parents, and the community in general should be encouraged to integrate issues related to ASRH in the everyday life of adolescents and become 'gate-openers' to ASRH services. To ensure the success of such measures, action at the policy level would be required. For example, decision-makers could call for developing clinical guidelines for this population group and coordinate multisectoral efforts. CONCLUSIONS: To improve ASRH services within primary healthcare institutions in three Latin American countries, primary healthcare providers call for focusing on improving the youth-friendliness of health settings. To facilitate this, they suggested engaging with key stakeholders, such as parents, schools, and decision-makers at the policy level.

Termination of pregnancy in Curaçao: need for improvement of sexual and reproductive healthcare.

BACKGROUND: In Curaçao Termination of Pregnancy (TOP) is still forbidden by law, although a policy of tolerance has been stipulated since 1999. This paper is about the prevalence of TOP and about its health complications. These data on TOP are officially unknown but are suspected to be rather high. METHODS: One year registration of illegal performed termination of pregnancy cases by all general physicians (GPs) practicing TOP in Curaçao. The registration included patient characteristics according to the model of the National Abortion Registration in The Netherlands, adjusted to the local Curaçao situation. Socio demographic characteristics, number of previous pregnancies and TOPs, pregnancy duration, contraception methods and reason for failure were registered. The comparative part of the research compares TOP rates of Curaçao with those of Antillean women in the Netherlands. The gynaecologists in the referral hospital registered complications requiring hospital admission after TOP. RESULTS: All GPs performing TOP participated and the majority registered extensively. The total number of registered TOP was 1126. 666 of the 1126 were registered using the local adjusted Abortion Registration Model. With 30.000 women aged between 15 and 45 living in Curaçao, the TOP rate was at least 38 (per 1000 in that age category), comparable to rates for Antillean women in the Netherlands. Mean age was 26.9 years. Nearly half (47%) had one or more TOPs before; the majority (53%) was less than 7 weeks pregnant and two third (67%) had one or more children. Two third of the women did not use contraception (63%). For those using contraception, main reason for failure was inconsistent use (50%). There were 14 hospital admissions due to complications of TOP. CONCLUSION: The number of TOP is high in Curaçao and comparable to (first generation) Antillean women living abroad in the Netherlands. Most unintended pregnancies originated from no or inconsistent use of reliable contraception. Improvement of sex education is necessary in order to bring down the number of TOP, as well as realizing accessible and affordable contraception, including sterilization. The number of complications around TOPs was equal to other countries where TOP is illegal.

Immigrant women's experiences of receiving care in a mobile health clinic.

AIM: This paper is a report of a study of the experiences of Portuguese-speaking immigrant women who used a mobile health clinic for their reproductive health care. BACKGROUND: Upon arrival in Canada, immigrant women often are in better health than their Canadian-born counterparts; however, this health status tends to deteriorate over time. One reason for this change is limited access to services. METHOD: Data collection during 2004 and 2005 involved individual interviews with seven Portuguese-speaking women who received care in a mobile health clinic in Toronto, Canada, and with four clinic care providers. Non-participant observation of the interaction between clients and care providers was also conducted. Interviews conducted in Portuguese were translated into English and transcribed, along with those conducted in English. Interview transcripts were read and re-read in the context of observational notes to develop codes. Emerging codes were grouped together to develop subcategories and categories. FINDINGS: Participants' experiences of accessing and receiving care in the mobile health clinic were shaped by their perceptions of health, which included physical, mental, social and spiritual aspects, and their pre- and postmigration care experiences. As an alternative model of care delivery, the mobile health clinic was perceived by participants to address their care needs and to help overcome postmigration barriers by providing accessible, holistic, and linguistically and culturally appropriate care. CONCLUSION: Mobile health clinics should be considered as an alternative care delivery model for immigrant women who may be at a disadvantage because of their socio-economic, cultural, and racialized statuses.

[Evaluation of the implementation of reproductive health services in Maringá, Paraná State, Brazil]. / Avaliação da implantação de serviços de saúde reprodutiva no Município de Maringá, Paraná, Brasil.

The aim of this study was to develop a tool to evaluate the implementation of a contraceptive program in health services and apply it to the 23 public health services in Maringá, Paraná State, Brazil. A theoretical-logical model was developed, corresponding to a 'target image' for the family planning program. Using the Delphi technique and consensus conference, six experts validated the program's target image, which included three dimensions and 60 evaluation criteria. A data collection instrument was prepared, in addition to a spreadsheet to evaluate the degree of the family planning program's implementation, constituting the Questionnaire for the Evaluation of Reproductive Health Services. The vast majority of the primary health units (91.3%) received an 'intermediate' score on implementation of the family planning program, while 8.7% were classified as 'incipient' and none were scored as 'advanced'. The 'advanced' degree of implementation in the structural dimension contrasted with the organizational and patient care dimensions. The instrument can be useful for evaluating reproductive health programs and is applicable to the health services planning and management processes.

Avaliação da implantação de serviços de saúde reprodutiva no Município de Maringá, Paraná, Brasil / Evaluation of the implementation of reproductive health services in Maringá, Paraná State, Brazil

O objetivo deste estudo foi desenvolver um instrumento para avaliar a implantação da assistência em contracepção em serviços de saúde, bem como aplicá-lo nas 23 unidades básicas de saúde no Município de Maringá, Paraná, Brasil. Elaborou-se o modelo teórico-lógico, correspondente a uma "imagem-objetivo" do programa de planejamento familiar. Por meio da técnica Delphi e conferência de consenso, seis especialistas validaram a imagem-objetivo do programa, que contemplou três dimensões e 60 critérios de avaliação. Elaborou-se um instrumento para coleta de dados e uma planilha para avaliar o grau de implantação do programa de planejamento familiar, que constituíram o Questionário de Avaliação de Serviços de Saúde Reprodutiva (QASAR). A grande maioria das unidades básicas de saúde (91,3 por cento) recebeu a classificação "intermediária" na implantação do programa de planejamento familiar, 8,7 por cento foram categorizadas "incipientes" e nenhuma obteve escore para ser considerada "avançada". O grau de implantação "avançado" na dimensão estrutural contrastou com as dimensões organizacional e assistencial. O instrumento constitui ferramenta para avaliar programas de saúde reprodutiva, aplicável aos processos de planejamento e gestão dos serviços de saúde.

The aim of this study was to develop a tool to evaluate the implementation of a contraceptive program in health services and apply it to the 23 public health services in Maringá, Paraná State, Brazil. A theoretical-logical model was developed, corresponding to a "target image" for the family planning program. Using the Delphi technique and consensus conference, six experts validated the program's target image, which included three dimensions and 60 evaluation criteria. A data collection instrument was prepared, in addition to a spreadsheet to evaluate the degree of the family planning program's implementation, constituting the Questionnaire for the Evaluation of Reproductive Health Services. The vast majority of the primary health units (91.3 percent) received an "intermediate" score on implementation of the family planning program, while 8.7 percent were classified as "incipient" and none were scored as "advanced". The "advanced" degree of implementation in the structural dimension contrasted with the organizational and patient care dimensions. The instrument can be useful for evaluating reproductive health programs and is applicable to the health services planning and management processes.

Propuesta de normas para la consejería en la atención en salud sexual y reproductiva de los y las adolescentes / Standards for the counseling in sexual and reproductive health care for adolescents

En la sociedad chilena contemporánea, la adolescencia constituye un período fundamental en las biografías de las personas. En ellas se aprenden y consolidan muchas de las actuaciones, las competencias, las capacidades y habilidades que modelarán sus proyectos de vida, y que a la vez definirán su ejercicio de la ciudadanía y su construcción como sujeto de derechos.

Perceived quality of reproductive care for girls in a competitive voucher programme. A quasi-experimental intervention study, Managua, Nicaragua.

OBJECTIVE: To determine whether female adolescents from low-income areas in Managua were satisfied with the sexual and reproductive health (SRH) care provided through a competitive voucher programme and to analyse the determinants of their satisfaction. DESIGN: A community-based quasi-experimental intervention study from 2000 to 2002. SETTING: Low-income areas of Managua. INTERVENTION: Distribution of 28,711 vouchers giving adolescents free-access to SRH care in 19 clinics; training and support for health care providers. STUDY PARTICIPANTS: A random sample of 3009 girls from 12 to 20 years completed self-administered questionnaires: 700 respondents had used this care in the last 15 months, 221 with voucher (users-with-voucher) and 479 without voucher (users-without-voucher). MAIN OUTCOME MEASURES: User satisfaction; Satisfaction with clinic reception; Clarity of doctors' explanations. RESULTS: User satisfaction was significantly higher in users-with-voucher compared with users-without-voucher [Adjusted odds-ratio (AOR) = 2.2; 95% confidence interval (95% CI) = 1.2-4.0]. Voucher use was associated with more frequent satisfaction with clinic reception, especially among sexually active girls not yet pregnant or mother (AOR = 6.9; 95% CI = 1.5-31.8). The clarity of doctors' explanations was not perceived differently (AOR = 1.4; 95% CI = 0.9-2.2). User satisfaction was highly correlated to satisfaction with clinic reception and clarity of doctors' explanations (P < 0.001). Longer consultation times, shorter waiting times, older age, and having a female doctor positively influenced user satisfaction. CONCLUSION: Voucher use by teenage girls was associated with a better perceived SRH care. This is an important result, given the crucial role user satisfaction plays in adoption and continued use of health care and contraceptives. Though more research is needed, confidential and guaranteed access appear key factors to voucher success.

[Quality criteria and indicators of women's health care]. / Critérios e indicadores de qualidade da atenção à saúde da mulher.

In this article, quality criteria and indicators of the basic care of the woman's health are presented with emphasis on the sexual and reproductive health that can be used in the management of supervision practices. In its elaboration, formulations regarding the evaluating practice, the managerial work, the full care to the woman's health (sexual and reproductive) are taken into consideration, besides proposals of the Health Ministry for monitoring the attention to this specific group. It focuses mainly on care and vigilance actions as to the women's health and on organizational and managerial aspects of such care.

A strategic assessment of the reproductive health and responsible parenthood programme of Buenos Aires, Argentina.

Since 1991, Argentina has had provincial reproductive health laws, a far-reaching national programme and strong public consensus in support of reproductive health policies. Nevertheless, the challenges of strengthening public services, increasing the number of programme sites and resisting conservative attacks remain. This article describes an assessment of the reproductive health programme of the city of Buenos Aires, passed in 2000, whose objectives are to prevent unwanted pregnancies and sexually transmitted diseases/HIV and to train health personnel. The programme operates in every public hospital and primary health care centre in the city. The assessment was conducted jointly by the Ombudsperson's Office of Buenos Aires and the Centre for the Study of State and Society (CEDES). Hormonal contraceptives, IUDs and male condoms were mostly available, but emergency contraception, female condoms and other barrier methods were not Some health professionals and service users were knowledgeable about the new laws and the reproductive rights recognised under the law. Over 90% were satisfied with quality of care in service delivery but many professionals described excessive workloads, deficient infrastructure, and shortages of supplies and staff. Wanting help to obtain a tubal ligation was the most frequent reason for the claims lodged with the Ombudsperson's Office, followed by HIV, quality of care, and abortion. Information and training for both health care providers and women's and human rights NGOs was carried out.

Refugee women's reproductive health in early resettlement.

OBJECTIVE: To describe reproductive health needs and screening rates for breast and cervical cancer for newly arrived (less than 90 days) refugee women in the United States. DESIGN: A retrospective study of existing medical charts from 1996 to 2000. SETTING: Refugee health screening clinic, central Texas. PATIENTS: Refugee women (n = 283) newly arrived in the United States from Cuba (31.1%), Bosnia (26.1%), Vietnam (24.7%), and other countries (18.0%); age range = 18 to 74 years, mean age = 34.4 years. MAIN OUTCOME MEASURES: Frequency of reproductive health problems and breast and cervical cancer screening rates. RESULTS: Twenty-five percent of women in the sample were pregnant or had a reproductive health problem. A significant percentage older than 40 (86%) had never had a mammogram when compared to American women of the same age (33%). Only 24% reported having had a Pap test within the previous 3 years. CONCLUSIONS: The risk of not receiving adequate reproductive health care is higher among newly arrived refugee women compared to nonrefugee women in the United States. For refugee women to enjoy optimum health, their individual needs and health care system issues must be addressed.

Comparing the quality of three models of postabortion care in public hospitals in Mexico City.

CONTEXT: Each year, an estimated 120,000 women in Mexico seek treatment in public hospitals for abortion-related complications--the country's fourth leading cause of maternal mortality. Models of postabortion care emphasizing counseling and provision of contraceptives have the potential to improve the quality of care these women receive. METHODS: Between April 1997 and August 1998, women treated for abortion complications in six Mexican Institute of Social Security (IMSS) hospitals in the Mexico City metropolitan area were surveyed. Data related to patient-provider interaction, information provision and counseling were analyzed for three models of care: sharp curettage standard care, sharp curettage postabortion care and manual vacuum aspiration postabortion care. RESULTS: Women in the two postabortion care groups rated the quality of services they received more highly than did those receiving sharp curettage standard care. A significantly greater proportion of women treated under the postabortion care models than of those treated under the sharp curettage standard model received information about their health status before treatment, the uterine evacuation procedure, signs of postabortion complications and care at home. In addition, a greater proportion of women treated under the postabortion care models accepted a contraceptive method before leaving the facility (64-78% vs. 40%). CONCLUSIONS: Implementation of a postabortion care model contributes to the delivery of high-quality services to women experiencing abortion complications. The standard IMSS model of postabortion treatment should be modified to emulate those in hospitals that systematically link general counseling and family planning services to the clinical services provided to women with abortion complications.