Humanizing access to modern contraceptive methods in national hospitals in Guatemala, Central America.

BACKGROUND: The overall situation in Guatemala, Central America, regarding programs caring for women's reproductive health has been lagging behind for some decades. Since the year 2000, 56% of Guatemalan families have lived below the poverty line. Guatemala has one of the highest fertility rates (lifetime births per woman) in Latin America and the Caribbean countries, comparable to those observed in less developed countries in Africa. Considering the lack of sex education, poor access to effective contraceptive methods and issues of unwanted pregnancy, Guatemalan women engage in illegal and unsafe abortions, which often causes harm and sometimes death. A key strategy designed to improve women's health is through free and informed access to contraceptive methods that are effective and accepted by Guatemalan women. STUDY DESIGN: From July 1, 2003, to December 31, 2006, specially hired trained facilitators visited 22 public hospitals for 1 week to train corresponding physician staff in postabortion counseling, enabling them to assist patients to select and use an effective contraceptive method. To monitor the progress achieved, the trained facilitators returned 4 weeks later. The main purpose of the training was to focus in strengthening the understanding and technical capacity of the hospital staff to implement postabortion contraceptive counseling and to enable women to obtain an effective contraceptive method prior to hospital discharge. RESULTS: Out of 22 hospitals, 21 managed to improve their record for counseling patients admitted for postabortion complications, from 31% to 96%. Furthermore, the percentage of women being discharged from the hospital with an effective contraceptive method rose from 20% to 64% from 2003 to 2006. CONCLUSION: The successful results obtained during this study to meet postabortion demands by Guatemalan women point out to the urgent need for the government to expand this initiative within the national health system, including health centers nationwide. This is one of the worldwide recommendations previously made by the World Health Organization.

Acceso humanizado a métodos contraceptivos modernos en hospitales públicos de Guatemala / Access humanized modern contraceptive methods in public hospitals in Guatemala

Guatemala tiene décadas de retraso en la implementación de adecuados programas que protejan la salud reproductiva de las mujeres. Enfrentadas a la terrible pobreza, el 56% de las familias guatemaltecas vivían por debajo de la línea de pobreza en el año 2000, situación que no ha cambiado y que posiblemente haya empeorado. Más aún, el 16% de las familias estaban en pobreza extrema, dicho en otras palabras, no podían ni adquirir una canasta básica de alimentos. Así también, la mujer guatemalteca, tiene una de las tasas más altas de fertilidad (número de hijos por mujer)...

Scaling up post-abortion care in Guatemala: initial successes at national level.

This article describes a programme to scale up post-abortion care services in 22 of the 33 public sector district hospitals in Guatemala from July 2003 to December 2004. The main interventions included strengthening the knowledge and technical capacity of staff, expanding post-abortion care, enhancing related infrastructure, distributing informational materials and instituting an abortion surveillance system. A facilitator supported the work through week-long, monthly visits at each hospital. Attention was also devoted to building institutional consensus in support of post-abortion care at government, district hospital and hospital staff levels. During this period, 13,928 women with incomplete abortions were admitted to the 22 hospitals. Use of manual vacuum aspiration for treatment of incomplete first trimester abortion increased from 38% to 68% of cases (p<0.0001). Provision of family planning counselling also increased, from 31% to 78% of women (p<0.0001), and the proportion of women selecting a contraceptive method before leaving hospital from 20% to 49% (p<0.0001). Infection was associated with 71% of the incomplete abortions, of which 90% were septic. There were nine deaths and 768 women suffered severe complications, the level of which remained unchanged during the study period. Guatemala still has much to do to institutionalise post-abortion care fully and reduce deaths and complications, but our efforts to date will be valuable to others.