O planejamento familiar e a mortalidade materna por aborto / Family planning and maternal mortality for abortion / La planificación familiar y la mortalidad materna por aborto

A mortalidade materna é considerada um excelente indicador de saúde, não apenas da mulher, mas da população como um todo. No Brasil, a morte materna configura-se como um problema de saúde pública. Segundo o Ministério da Saúde, as altas taxas de mortalidade materna compõem um quadro de violação dos direitos humanos de mulheres e de crianças, atingindo desigualmente aquelas das classes sociais com menor ingresso e acesso aos bens sociais nas várias regiões brasileiras. O planejamento familiar, quando oferecido de forma contínua e prolongada, pode contribuir para a redução do número de gestações indesejadas, de abortos ilegais e da mortalidade materna. Trata-se de estudo de revisão sistemática de literatura do tipo exploratória com abordagem qualitativa. Após a leitura seletiva das referências, teve início a fase analítica. Realizou-se o grupamento em duas categorias temáticas, a seguir discriminadas: (1) o homem no planejamento familiar; (2) contracepção pós-abortamento e redes de cuidado. No que tange ao aborto, a participação masculina é de extrema relevância, pois a não aceitação da gravidez ou o abandono do parceiro são alguns dos motivos que levam a mulher ao aborto provocado. O cuidado integral à saúde da mulher em situações de abortamento deve incluir, além do tratamento de emergência, o acesso universal ao planejamento reprodutivo, inclusive orientações para as mulheres que desejam uma nova gestação.

Maternal mortality is considered an excellent indicator of health, not only for women but also for the population as a whole. In Brazil, maternal death is a public health problem. According to the Ministry of Health, the high rates of maternal mortality constitute a framework of violation of human rights for women and children, unequally affecting those of the lower income classes and with less access to social assets in various Brazilian regions. Family planning, when provided on a continuous and protracted basis, can contribute to reducing the number of unwanted pregnancies and illegal abortions as well as maternal mortality rates. This is a systematic review of literature with a qualitative approach and exploratory nature. After selective reading of the references, the analytical phase began. The data were grouped into two thematic categories, as follows: (1) The man in family planning; (2) Post-abortion contraception and care networks. Regarding abortion, male participation is extremely relevant, and non-acceptance of pregnancy as well as partner abandonment were some of the reasons that lead women to abortion. Comprehensive care for women's health in abortion situations should include universal access to reproductive planning and guidelines for women seeking a new pregnancy, in addition to emergency treatment.

La mortalidad materna se considera un excelente indicador de salud no solo de la mujer, sino de la población como un todo. En Brasil, la muerte materna se configura como un problema de salud pública. Según el Ministerio de Salud, las altas tasas de mortalidad materna componen un cuadro de violación a los derechos humanos de mujeres y de niños, alcanzando desigualmente las clases sociales con menor ingresos y acceso a los bienes sociales, en las distintas regiones brasileñas. La planificación familiar, cuando se ofrece de forma continua y prolongada, puede contribuir a la reducción del número de embarazos no deseados y abortos ilegales, y de la mortalidad materna. Se trata de un estudio de revisión sistemática de literatura de tipo exploratorio, con abordaje cualitativo. Después de la lectura selectiva de las referencias, se inició la fase analítica. Se realizó el agrupamiento en dos categorías temáticas: (1) el hombre en la planificación familiar; (2) contracepción postaborto y redes de cuidado. En lo que se refiere al aborto, la participación masculina es de extrema relevancia, pues la no aceptación del embarazo o el abandono del compañero son algunos de los motivos que llevan a la mujer al aborto. El cuidado integral a la salud de la mujer en situaciones de aborto debe incluir, además del tratamiento de emergencia, el acceso universal a la planificación reproductiva, comprendiendo orientaciones para las mujeres que desean una nueva gestación.

Abortion care in Haiti: A secondary analysis of demographic and health data.

BACKGROUND: Abortion-related mortality accounts for 8% of all global maternal deaths and 97% of the estimated 25 million unsafe abortions performed each year occur in low- and middle-income countries. Haiti has the highest rate of maternal mortality in the western hemisphere and to further understand the circumstances of induced abortion in Haiti, the current work uses data from the 2012 Demographic and Health Survey (DHS) to describe the methods of induced abortion in Haiti between 2007-2012 and to identify potential factors associated with use of different abortion methods. METHODS: This is a secondary analysis of nationally representative cross-sectional data from the 2012 Haitian DHS, a two-stage cluster randomized household survey. Analysis included descriptive statistics on participant demographics, methods of abortion, and location of / assistant for the abortion. Multivariate regression was conducted to determine if demographic characteristics were associated with: 1) increased or decreased odds of having an abortion; or 2) increased or decreased odds of reporting an evidence based or non-evidence based method of abortion. RESULTS: Among the 14,287 women of childbearing age who completed the 2012 Haiti DHS survey, 289 women reported having an induced abortion in the previous five years. Recommended methods, manual vacuum aspiration (MVA) or misoprostol alone, were used in 26.6% of the abortions (n = 77). Additionally, 13.8% (n = 40) of abortions used these recommended methods in combination with a non-evidenced based method such as injections, plants or tablets. A total of 92 women had a dilation and curettage (D&C) abortion, either alone (n = 77) or in combination with another method (n = 15) and over a quarter (n = 80) of reported abortions were conducted by non-evidence based methods (n = 80). A majority of abortions using a recommended method were assisted by a relative/friend (n = 28) or were unassisted (n = 34). Most abortions occurred in private homes (n = 174) with hospitals/clinics being the second most common location (n = 84). Women in the middle (OR = 3.3, 95% CI = 2.0-5.6) and highest (OR = 7.4, 95% CI = 4.4-12.3) wealth brackets were more likely to have had an abortion in comparison to women in the lowest wealth bracket. Women who had ever been in a marital union were more likely to have had an abortion than those who had not. The only demographic factor predictive of aborting using a recommended method was living in an urban area, with urban-dwelling women being less likely to use a recommended abortion method (OR = 0.4, 95% CI = 0.2-0.9) in comparison with women living in rural settings. CONCLUSION: In a nationally representative survey in Haiti, 2% of women of childbearing age reported having an abortion in the five years prior to the survey. A large proportion of these abortions were carried out using non-evidence based methods and over half occurred outside of the formal health care system. Understanding women's attitudes, knowledge and barriers around abortion is paramount to improving knowledge and access to evidence-based abortion care in an effort to decrease maternal morbidity and mortality in Haiti.

Embryonic mortality and abortion in goats caused by ingestion of Poincianella pyramidalis / Mortalidade embrionária e aborto em caprinos causados pela ingestão de Poincianella pyramidalis

This study aimed to characterize the embryotoxic, teratogenic and abortifacient effect of Poincianella pyramidalis in goats. Twenty pregnant goats with 18 days of gestation were divided into five groups of four animals each. After collection, the leaves of P. pyramidalis were dried in the shade and crushed. The daily feed provided to the goats was equivalent to 3% of their body weight, being 1% concentrated feed and 2% roughage. In Group 1 (control), the provided roughage was Cynodon dactylon (Tifton) hay; in Groups 2, 3 and 4, 10%, 20% and 80% of the C. dactylon roughage was replaced by dry and ground P. pyramidalis, respectively. In Group 5, all the roughage was replaced by green P. pyramidalis ad libitum, collected daily. Ultrasonographic examination was performed twice a week throughout the pregnancy. Goats in Groups 1, 2 and 3, delivered normal kids. Two goats in Group 4 aborted at 127 and 90 days of gestation. In group 5, three goats showed embryonic death at 25, 30 and 31 days of gestation and the other goat aborted at 39 days of pregnancy. Malformations were not observed. It is suggested that P. pyramidalis, which is very common in the semiarid region of northeastern Brazil, should be considered as an important cause of reproductive losses in this area. Due to its high palatability, it is important to avoid the ingestion of P. pyramidalis by pregnant and mating goats.(AU)

O objetivo deste trabalho foi estudar o potencial embriotóxico, abortivo e teratogênico da Poincianella pyramidalis em caprinos. Para tanto foram utilizadas 20 cabras prenhes com 18 dias de gestação, divididas em cinco grupos de quatro animais. Depois da coleta, as folhas de P. pyramidalis era secas a sombra e trituradas. A alimentação diária fornecida aos caprinos foi proporcional a 3% do seu peso vivo, sendo 1% de alimento concentrado e 2% de volumoso. No Grupo 1 (controle), o volumoso fornecido foi apenas feno de Cynodon dactylon (Tifton). Já nos Grupos 2, 3 e 4, 10%, 20% e 80% do volumoso foi substituído por folhas secas e trituradas de P. pyramidalis, respectivamente. No Grupo 5, todo o volumoso foi constituído por P. pyramidalis verde ad libitum, coletadas diariamente. Para o acompanhamento das gestações, exames ultrassonográficos foram realizados duas vezes por semana, durante toda a gestação. As cabras dos Grupos 1, 2 e 3 pariram cabritos normais. Duas cabras no Grupo 4 abortaram, sendo uma com 127 dias de gestação e outra com 90 dias. No grupo 5, três cabras apresentaram morte embrionária no 25º, 30º e 31º dia de gestação e uma cabra abortou no 39º dia de gestação. No presente estudo não foi observada nenhuma malformação. Com esses resultados e considerando a ampla difusão de P. pyramidalis na região semiárida do nordeste Brasileiro sugere-se que esta planta é uma importante causa de perdas reprodutivas na região. Devido a sua alta palatabilidade, recomenda-se evitar a permanência de cabras prenhes em áreas onde ocorre P. pyramidalis.(AU)

En Argentina, durante 2018 el aborto salió del armario pero no de la clandestinidad / In Argentina, during 2018 abortion came out of the closet but not from hiding

La autora de este artículo hace una síntesis de la evolución histórica y de las diferentes posturas religiosas frente al abor-to, describe su epidemiología mundial y la posición de la Organización Mundial de la Salud frente a esta problemática, resume el desarrollo y el desenlace del recientemente instalado debate sobre la legalización del aborto en Argentina y, finalmente reflexiona sobre lo que nos ha dejado este proceso político. (AU)

The author of this article summarizes the historical evolution and the different religious positions regarding abortion, describes its global epidemiology and the position of the World Health Organization in relation to this problem, summarizes the development and the outcome of the recently installed debate on the legalization of abortion in Argentina and, finally, reflect on what this politi-cal process has left us. (AU)

Embryonic mortality and abortion in goats caused by ingestion of Poincianella pyramidalis / Mortalidade embrionária e aborto em caprinos causados pela ingestão de Poincianella pyramidalis

This study aimed to characterize the embryotoxic, teratogenic and abortifacient effect of Poincianella pyramidalis in goats. Twenty pregnant goats with 18 days of gestation were divided into five groups of four animals each. After collection, the leaves of P. pyramidalis were dried in the shade and crushed. The daily feed provided to the goats was equivalent to 3% of their body weight, being 1% concentrated feed and 2% roughage. In Group 1 (control), the provided roughage was Cynodon dactylon (Tifton) hay; in Groups 2, 3 and 4, 10%, 20% and 80% of the C. dactylon roughage was replaced by dry and ground P. pyramidalis, respectively. In Group 5, all the roughage was replaced by green P. pyramidalis ad libitum, collected daily. Ultrasonographic examination was performed twice a week throughout the pregnancy. Goats in Groups 1, 2 and 3, delivered normal kids. Two goats in Group 4 aborted at 127 and 90 days of gestation. In group 5, three goats showed embryonic death at 25, 30 and 31 days of gestation and the other goat aborted at 39 days of pregnancy. Malformations were not observed. It is suggested that P. pyramidalis, which is very common in the semiarid region of northeastern Brazil, should be considered as an important cause of reproductive losses in this area. Due to its high palatability, it is important to avoid the ingestion of P. pyramidalis by pregnant and mating goats.(AU)

O objetivo deste trabalho foi estudar o potencial embriotóxico, abortivo e teratogênico da Poincianella pyramidalis em caprinos. Para tanto foram utilizadas 20 cabras prenhes com 18 dias de gestação, divididas em cinco grupos de quatro animais. Depois da coleta, as folhas de P. pyramidalis era secas a sombra e trituradas. A alimentação diária fornecida aos caprinos foi proporcional a 3% do seu peso vivo, sendo 1% de alimento concentrado e 2% de volumoso. No Grupo 1 (controle), o volumoso fornecido foi apenas feno de Cynodon dactylon (Tifton). Já nos Grupos 2, 3 e 4, 10%, 20% e 80% do volumoso foi substituído por folhas secas e trituradas de P. pyramidalis, respectivamente. No Grupo 5, todo o volumoso foi constituído por P. pyramidalis verde ad libitum, coletadas diariamente. Para o acompanhamento das gestações, exames ultrassonográficos foram realizados duas vezes por semana, durante toda a gestação. As cabras dos Grupos 1, 2 e 3 pariram cabritos normais. Duas cabras no Grupo 4 abortaram, sendo uma com 127 dias de gestação e outra com 90 dias. No grupo 5, três cabras apresentaram morte embrionária no 25º, 30º e 31º dia de gestação e uma cabra abortou no 39º dia de gestação. No presente estudo não foi observada nenhuma malformação. Com esses resultados e considerando a ampla difusão de P. pyramidalis na região semiárida do nordeste Brasileiro sugere-se que esta planta é uma importante causa de perdas reprodutivas na região. Devido a sua alta palatabilidade, recomenda-se evitar a permanência de cabras prenhes em áreas onde ocorre P. pyramidalis.(AU)

Abortion in the Structure of Causes of Maternal Mortality.

OBJECTIVE: To study the structure of maternal mortality caused by abortion in the Tula region. METHODS: The medical records of deceased pregnant women, childbirth, and postpartum from January 01, 2001, to December 31, 2015, were analyzed. RESULTS: Overall, 204,095 abortion cases were recorded in the Tula region for over 15 years. The frequency of abortion was reduced 4-fold, with 18,200 in 2001 to 4,538 in 2015. The rate of abortions per 1,000 women (age 15-44 years) for 15 years decreased by 40.5%, that is, from 46.53 (2001) to 18.84 (2015), and that of abortions per 100 live births and stillbirths was 29.5%, that is, from 161.7 (2001) to 41.5 (2015). Five women died from abortion complications that began outside of the hospital, which accounted for 0.01% of the total number. In the structure of causes of maternal mortality for 15 years, abortion represented 14.3% of the cases. Lethality mainly occurred in the period from 2001 to 2005 (4 cases). Among the maternal deaths, many women died in rural areas after pregnancy termination at 18 to 20 weeks of gestation (n = 4). In addition, three women died from sepsis and two from bleeding. CONCLUSION: The introduction of modern, effective technologies of family planning has reduced maternal mortality due to abortion.

OBJETIVOS: Estudar a estrutura da mortalidade materna causada pelo aborto na região de Tula. MéTODOS: Os registros médicos de mulheres grávidas falecidas, de parto e de pós-parto, de 01 de janeiro de 2001 a 31 de dezembro de 2015, foram analisados. RESULTADOS: No geral, 204.095 casos de aborto foram registrados na região de Tula, em um período de 15 anos. A frequência de aborto foi reduzida a 1/4, passando de 18.200 abortos em 2001 para 4.538 em 2015. A taxa de abortos a cada 1.000 mulheres (com idades entre 15 e 44 anos) diminuiu 40,5% em 15 anos, isto é, de 46,53 (2001) para 18,84 (2015), e a taxa de abortos a cada 100 nascidos vivos e natimortos foi de 29,5%, isto é, de 161,7 (2001) para 41,5 (2015). Cinco mulheres morreram de complicações do aborto que começaram fora do hospital, o que representou 0,01% do número total. No quadro geral de causas de mortalidade materna neste período de 15 anos, o aborto representou 14,3% dos casos. A letalidade ocorreu, principalmente, no período de 2001 a 2005 (4 casos). Entre as mortes maternas, muitas mulheres morreram em áreas rurais após a interrupção da gravidez, com 18 a 20 semanas de gestação (n= 4). Além disso, três mulheres morreram por sepse, e duas, por sangramento. CONCLUSãO: Com a introdução de tecnologias de planejamento familiar modernas e eficazes, a mortalidade materna devido ao aborto vem sendo reduzida.

Abortion in the structure of causes of maternal mortality / Aborto na estrutura das causas da mortalidade materna

Abstract Objective To study the structure ofmaternalmortality caused by abortion in the Tula region. Methods The medical records of deceased pregnant women, childbirth, and postpartum from January 01, 2001, to December 31, 2015, were analyzed. Results Overall, 204,095 abortion cases were recorded in the Tula region for over 15 years. The frequency of abortion was reduced 4-fold, with 18,200 in 2001 to 4,538 in 2015. The rate of abortions per 1,000 women (age 15-44 years) for 15 years decreased by 40.5%, that is, from 46.53 (2001) to 18.84 (2015), and that of abortions per 100 live births and stillbirths was 29.5%, that is, from 161.7 (2001) to 41.5 (2015). Five women died from abortion complications that began outside of the hospital, which accounted for 0.01% of the total number. In the structure of causes of maternal mortality for 15 years, abortion represented 14.3% of the cases. Lethality mainly occurred in the period from 2001 to 2005 (4 cases). Among thematernal deaths, many women died in rural areas after pregnancy termination at 18 to 20 weeks of gestation (n = 4). In addition, three women died from sepsis and two from bleeding. Conclusion The introduction of modern, effective technologies of family planning has reduced maternal mortality due to abortion.

Resumo Objetivos Estudar a estrutura damortalidadematerna causada pelo aborto na região de Tula. Métodos Os registros médicos de mulheres grávidas falecidas, de parto e de pósparto, de 01 de janeiro de 2001 a 31 de dezembro de 2015, foram analisados. Resultados No geral, 204.095 casos de aborto foram registrados na região de Tula, em um período de 15 anos. A frequência de aborto foi reduzida a 1/4, passando de 18.200 abortos em2001 para 4.538 em 2015. A taxa de abortos a cada 1.000 mulheres (com idades entre 15 e 44 anos) diminuiu 40,5% em 15 anos, isto é, de 46,53 (2001) para 18,84 (2015), e a taxa de abortos a cada 100 nascidos vivos e natimortos foi de 29,5%, isto é, de 161,7 (2001) para 41,5 (2015). Cinco mulheres morreram de complicações do aborto que começaram fora do hospital, o que representou 0,01% do número total. No quadro geral de causas de mortalidade materna neste período de 15 anos, o aborto representou 14,3% dos casos. A letalidade ocorreu, principalmente, no período de 2001 a 2005 (4 casos). Entre as mortes maternas, muitas mulheres morreram em áreas rurais após a interrupção da gravidez, com 18 a 20 semanas de gestação (n= 4). Além disso, três mulheres morreram por sepse, e duas, por sangramento. Conclusão Com a introdução de tecnologias de planejamento familiar modernas e eficazes, a mortalidade materna devido ao aborto vem sendo reduzida.

Mayor mortalidad materna por aborto en Cuba que en Chile, 2000-2015 / Higher maternal mortality from abortion in Cuba than in Chile, 2000-2015

RESUMEN Antecedentes: La muerte materna por aborto inseguro es un severo problema de salud pública, países con leyes de aborto liberales tendrían menor riesgo de aborto inseguro y de mortalidad por aborto. Cuba tiene una legislación que no penaliza el aborto inducido, mientras en Chile es ilegal en todos los casos hasta su reciente despenalización en 3 causales. Objetivo: Se postula que Cuba tendría una menor mortalidad materna por aborto que Chile, por lo que se propone comparar la evolución de la razón de mortalidad materna por aborto entre ambos países, en el período 2000-2015. Material y Método: Los datos crudos de muertes asociadas al aborto y nacidos vivos se obtienen de las bases de datos de estadísticas vitales de ambos países. La oportunidad relativa de muerte se estima según Odds Ratio (OR) con intervalo de confianza del 95% (IC 95%) de las razones de mortalidad materna. Resultados: La razón de muerte materna asociada al aborto fue mayor en Cuba que en Chile (OR: 1,91; IC 95%: 1,331 a 2,739; p=0,0004). Se observa una tendencia al descenso en Cuba y mientras no se observan cambios en Chile. Conclusiones: Contrario a lo postulado basado en las diferentes legislaciones de ambos países, en el período 2000-2015, Cuba presentó mayor razón de mortalidad materna asociada al aborto que Chile. Se comentan posibles condicionantes de la diferencia encontrada.

ABSTRACT Background: Maternal death due to unsafe abortion is a severe public health problem; countries with liberal abortion laws would have a lower risk of unsafe abortion and abortion mortality. Cuba has a legislation that does not penalize induced abortion, while in Chile it is illegal in all cases until its recent decriminalization in 3 grounds. Objective: It is postulated that Cuba would have a lower maternal mortality due to abortion than Chile, for which purpose it is proposed to compare the evolution of the maternal mortality by abortion between both countries, in the period 2000-2015. Material and Method: Raw data on deaths associated with abortion and live births are obtained from the vital statistics databases of both countries. The relative chance of death is estimated according to the Odds Ratio (OR) with a 95% confidence interval (95% CI) of the maternal mortality. Results: The maternal death rate associated with abortion was higher in Cuba than in Chile (OR: 1.91, 95% CI: 1.331 to 2.739; p = 0.0004). A downward trend is observed in Cuba and without changes in Chile. Conclusions: Contrary to the postulate based on the different legislations of both countries, in the period 20002015, Cuba had a higher maternal mortality associated with abortion than Chile. Possible conditioning factors of the difference found are discussed.

Deaths of women hospitalized for childbirth and abortion, and of their concept, in maternity wards of Brazilian public hospitals. / Mortes de mulheres internadas para parto e por aborto e de seus conceptos em maternidades públicas.

The aim of this cross-sectional hospital-based study of 7,845 pregnancies was to analyze deaths of women hospitalized for childbirth and abortion, and fetal and neonatal deaths, in public hospitals in the cities of São Paulo, Rio de Janeiro and Niteroi (RJ), Brazil, in 2011. Outcomes of the pregnancies were: one maternal death, 498 abortions, 65 fetal deaths, 44 neonatal deaths and 7,291 infant survivors. Data were collected through interviews, medical records and the women's pregnancy records, and from the Mortality Information System (SIM). The study population was described and kappa coefficients of causes of death (from the SIM, and certified by research) and mortality health indicators were estimated. The maternal mortality ratio was 13.6 per 100,000 live births (LB), the fetal death rate was 8.8‰ births and the neonatal mortality rate was 6.0‰ LB. The drug most used to induce abortion was Misoprostol. The main causes of fetal and neonatal deaths were respiratory disorders and maternal factors. Congenital syphilis, diabetes and fetal death of unspecified cause were under-reported in the SIM. Kappa coefficients by chapter were 0.70 (neonatal deaths) and 0.54 (stillbirths). Good quality care in reproductive planning, prenatal care, during labor and at birth will result in prevention of deaths.

O objetivo deste estudo foi analisar mortes de mulheres internadas para parto e por aborto, e de seus conceptos ­ fetais e neonatais ­ em maternidades públicas nas cidades de São Paulo, Rio de Janeiro e Niterói (RJ), em 2011. Estudo seccional de base hospitalar. Participaram 7.845 mulheres resultando em um óbito materno, 498 abortos, 65 óbitos fetais, 44 óbitos neonatais e 7.291 sobreviventes infantis. Dados foram obtidos por meio de entrevista, consulta ao prontuário, cartão da gestante e no Sistema de Informações sobre Mortalidade (SIM). Foi descrita a população de estudo e estimados a concordância da causa básica (SIM e certificada pela pesquisa) e os indicadores de mortalidade. A mortalidade materna foi 13,6 por cem mil nascidos vivos (NV), fetal 8,8‰ nascimentos e neonatal 6,0‰ NV. Misoprostol foi o medicamento mais utilizado no aborto provocado. Transtornos respiratórios e fatores maternos foram as principais causas entre óbitos fetais e neonatais. Sífilis congênita, diabetes e causas de morte fetal não especificada foram subdeclaradas no SIM. Os coeficientes kappa por capítulo foram 0,70 (neonatais) e 0,54 (natimortos). A assistência de boa qualidade no planejamento reprodutivo, pré-natal, durante o parto e nascimento resultará na prevenção das mortes.

Mortes de mulheres internadas para parto e por aborto e de seus conceptos em maternidades públicas / Deaths of women hospitalized for childbirth and abortion, and of their concept, in maternity wards of Brazilian public hospitals

Resumo O objetivo deste estudo foi analisar mortes de mulheres internadas para parto e por aborto, e de seus conceptos - fetais e neonatais - em maternidades públicas nas cidades de São Paulo, Rio de Janeiro e Niterói (RJ), em 2011. Estudo seccional de base hospitalar. Participaram 7.845 mulheres resultando em um óbito materno, 498 abortos, 65 óbitos fetais, 44 óbitos neonatais e 7.291 sobreviventes infantis. Dados foram obtidos por meio de entrevista, consulta ao prontuário, cartão da gestante e no Sistema de Informações sobre Mortalidade (SIM). Foi descrita a população de estudo e estimados a concordância da causa básica (SIM e certificada pela pesquisa) e os indicadores de mortalidade. A mortalidade materna foi 13,6 por cem mil nascidos vivos (NV), fetal 8,8‰ nascimentos e neonatal 6,0‰ NV. Misoprostol foi o medicamento mais utilizado no aborto provocado. Transtornos respiratórios e fatores maternos foram as principais causas entre óbitos fetais e neonatais. Sífilis congênita, diabetes e causas de morte fetal não especificada foram subdeclaradas no SIM. Os coeficientes kappa por capítulo foram 0,70 (neonatais) e 0,54 (natimortos). A assistência de boa qualidade no planejamento reprodutivo, pré-natal, durante o parto e nascimento resultará na prevenção das mortes.

Abstract The aim of this cross-sectional hospital-based study of 7,845 pregnancies was to analyze deaths of women hospitalized for childbirth and abortion, and fetal and neonatal deaths, in public hospitals in the cities of São Paulo, Rio de Janeiro and Niteroi (RJ), Brazil, in 2011. Outcomes of the pregnancies were: one maternal death, 498 abortions, 65 fetal deaths, 44 neonatal deaths and 7,291 infant survivors. Data were collected through interviews, medical records and the women's pregnancy records, and from the Mortality Information System (SIM). The study population was described and kappa coefficients of causes of death (from the SIM, and certified by research) and mortality health indicators were estimated. The maternal mortality ratio was 13.6 per 100,000 live births (LB), the fetal death rate was 8.8‰ births and the neonatal mortality rate was 6.0‰ LB. The drug most used to induce abortion was Misoprostol. The main causes of fetal and neonatal deaths were respiratory disorders and maternal factors. Congenital syphilis, diabetes and fetal death of unspecified cause were under-reported in the SIM. Kappa coefficients by chapter were 0.70 (neonatal deaths) and 0.54 (stillbirths). Good quality care in reproductive planning, prenatal care, during labor and at birth will result in prevention of deaths.

[Is abortion a serious public health problem in Chile in the field of maternal-perinatal health?] / Aborto, ¿es un problema de salud pública en Chile en el campo de la salud materno-perinatal?

BACKGROUND: The World Health Organization, by 2014, estimates that approximately 22 million unsafe abortions take place every year in the world, almost all of them in developing countries. The Millennium Goals, as part of the fifth compendium, focused on maternal health by proposing that member states should reduce maternal mortality to 75% by 2015. AIM: To determine, using maternal health indicators, if abortion in Chile is a priority health problem. MATERIAL AND METHODS: Data about maternal mortality and its causes between 1982 and 2014, was obtained from the databases available at the Chilean Ministry of Health. Trend analyzes were carried out using linear autoregressive models. RESULTS: Between 1982 and 2012, maternal mortality rates decreased from 51.8 to 18.3 per 100,000 live births. Complications of pregnancy, childbirth and puerperium were the first three causes and the last one is abortion. The proportion of abortions due to unspecified causes, including induced abortion, decreased from 36.6% to 26.1% between 2001 and 2012. CONCLUSIONS: Abortion is not a public health problem in Chile. To continue reducing maternal mortality, programs for the early detection of risks such as diabetes, obesity and hypertension should be implemented.

Aborto, ¿es un problema de salud pública en Chile en el campo de la salud materno-perinatal? / Is abortion a serious public health problem in Chile in the field of maternal-perinatal health?

Background: The World Health Organization, by 2014, estimates that approximately 22 million unsafe abortions take place every year in the world, almost all of them in developing countries. The Millennium Goals, as part of the fifth compendium, focused on maternal health by proposing that member states should reduce maternal mortality to 75% by 2015. Aim: To determine, using maternal health indicators, if abortion in Chile is a priority health problem. Material and Methods: Data about maternal mortality and its causes between 1982 and 2014, was obtained from the databases available at the Chilean Ministry of Health. Trend analyzes were carried out using linear autoregressive models. Results: Between 1982 and 2012, maternal mortality rates decreased from 51.8 to 18.3 per 100,000 live births. Complications of pregnancy, childbirth and puerperium were the first three causes and the last one is abortion. The proportion of abortions due to unspecified causes, including induced abortion, decreased from 36.6% to 26.1% between 2001 and 2012. Conclusions: Abortion is not a public health problem in Chile. To continue reducing maternal mortality, programs for the early detection of risks such as diabetes, obesity and hypertension should be implemented.

[Multiple causes of maternal mortality related to abortion in Minas Gerais State, Brazil, 2000-2011]. / Causas múltiplas de mortalidade materna relacionada ao aborto no Estado de Minas Gerais, Brasil, 2000-2011.

This study aimed to analyze trends in maternal mortality from abortion in Minas Gerais State, Brazil, from 2000 to 2011, addressing multiple causes of death. The analysis focused on women's social and demographic characteristics, year, location, and underlying and associated causes of death. Maternal mortality ratio (MMR) and abortion-specific ratio were calculated for each year, as well as Spearman's correlation coefficient (p < 0.05), to assess the trend in ratios during the study period. One hundred and eighty-three deaths from abortion were recorded, accounting for 15% of maternal deaths, and MMR remained stable. The ratio between multiple causes and underlying cause of death from abortion was 1.38. Use of the multiple-causes method proved effective for lending greater visibility to abortion. Problems deriving from the illegality of abortion in Brazil favor the appearance of causes that mask maternal deaths, in addition to their underreporting. Inter-sector actions are thus necessary to define strategies for reducing social inequalities and improving the quality of services for women.

Causas múltiplas de mortalidade materna relacionada ao aborto no Estado de Minas Gerais, Brasil, 2000-2011 / Multiple causes of maternal mortality related to abortion in Minas Gerais State, Brazil, 2000-2011 / Causas múltiples de mortalidad materna relacionada con el aborto, en el Estado de Minas Gerais, Brasil, 2000-2011

Resumo: Este estudo objetivou analisar a evolução da mortalidade materna por aborto em Minas Gerais, Brasil, no período de 2000 a 2011, sob o enfoque das causas múltiplas de morte. Estudou-se as características sociodemográficas das mulheres, ano, local e causas básica e associada de óbito. Foi calculada a razão de morte materna (RMM) geral e específica por aborto em cada ano e o coeficiente de correlação de Spearman (p < 0,05), para avaliar a evolução das razões no período. Foram registrados 183 óbitos por aborto, 15% dos óbitos maternos, e a RMM por aborto manteve-se estável. A razão causa múltipla e causa básica de óbito por aborto foi de 1,38. O uso do método de análise de causas múltiplas mostrou-se eficaz para dar maior visibilidade ao aborto. Os problemas oriundos da ilegalidade da prática de abortos favorecem o aparecimento de causas que mascaram mortes maternas e a sua subnotificação. Assim, ações intersetoriais são necessárias para a definição de estratégias, a fim de reduzir as desigualdades sociais e melhorar a qualidade dos serviços de atenção à mulher.

This study aimed to analyze trends in maternal mortality from abortion in Minas Gerais State, Brazil, from 2000 to 2011, addressing multiple causes of death. The analysis focused on women's social and demographic characteristics, year, location, and underlying and associated causes of death. Maternal mortality ratio (MMR) and abortion-specific ratio were calculated for each year, as well as Spearman's correlation coefficient (p < 0.05), to assess the trend in ratios during the study period. One hundred and eighty-three deaths from abortion were recorded, accounting for 15% of maternal deaths, and MMR remained stable. The ratio between multiple causes and underlying cause of death from abortion was 1.38. Use of the multiple-causes method proved effective for lending greater visibility to abortion. Problems deriving from the illegality of abortion in Brazil favor the appearance of causes that mask maternal deaths, in addition to their underreporting. Inter-sector actions are thus necessary to define strategies for reducing social inequalities and improving the quality of services for women.

Resumen: Este estudio tuvo por objetivo analizar la evolución de la mortalidad materna por aborto en Minas Gerais, Brasil, durante el período de 2000 a 2011, desde el enfoque de las causas múltiples de muerte. Se estudiaron las características sociodemográficas de las mujeres, año, lugar y causas básicas y asociadas de óbito. Se calculó la razón de muerte materna (RMM) general y específica por aborto durante cada año y el coeficiente de correlación de Spearman (p < 0,05), para evaluar la evolución de las razones durante el período. Se registraron 183 óbitos por aborto, un 15% de los óbitos maternos, y la RMM por aborto se mantuvo estable. La razón causa múltiple y causa básica de óbito por aborto fue de 1,38. El uso del método de análisis de causas múltiples se mostró eficaz para dar mayor visibilidad al aborto. Los problemas provenientes de la ilegalidad de la práctica de abortos favorecen la aparición de causas que enmascaran muertes maternas y su subnotificación. Por ello, se necesitan acciones intersectoriales para la definición de estrategias, con el fin de reducir las desigualdades sociales y mejorar la calidad de los servicios de atención a la mujer.

Overall and abortion-related maternal mortality rates in Uruguay over the past 25years and their association with policies and actions aimed at protecting women's rights.

OBJECTIVE: To evaluate changes in maternal mortality rates in Uruguay over the past 25years, as well as their distribution by cause, and their temporal relationship with social changes and Human Development Index (HDI) indicators. METHODS: Data on maternal mortality obtained directly from the Uruguayan Ministry of Public Health for the 2001 to 2015 period were analyzed together with data from the United Nations Inter-Agency Group for Child Mortality Estimation for the 1990 to 2015 period. The swiftness of the decrease in maternal mortality per five-year period, the variation in the percentage of abortion-related deaths, and the correlation with HDI indicators were evaluated. RESULTS: Maternal mortality decreased significantly, basically due to a reduction in the number of deaths from unsafe abortion, which was the principal cause of maternal mortality in the 1990s. The reduction in maternal mortality over the past 10years also coincides with a reduction in poverty and an improvement in the HDI. CONCLUSION: A rapid reduction occurred in maternal mortality in Uruguay, particularly in maternal mortality resulting from unsafe abortion. This coincided with the application of a model for reducing the risk and harm of unsafe abortions, which finally led to the decriminalization of abortion.

A replication of the Uruguayan model in the province of Buenos Aires, Argentina, as a public policy for reducing abortion-related maternal mortality.

OBJECTIVE: To describe the application of the risk and harm reduction model at primary care level to decrease the mortality due to unsafe abortion in the Province of Buenos Aires, Argentina, and evaluate the results. METHODS: The services offered at primary health units to women undergoing abortion are described-first, only risk reduction and later, legal termination of the pregnancy-including their evolution between 2010 and 2015. The changes in abortion-related maternal mortality are also evaluated. The χ(2) test was used to evaluate the differences in the percentage of abortion-related deaths out of the total number of maternal deaths. RESULTS: Primary care services increased progressively, both for risk reduction and for legal termination of pregnancy, which was carried out successfully, including manual vacuum aspiration, by general physicians and midwives. The proportion of abortion-related maternal deaths with respect to total maternal deaths fell by two-thirds between 2010 and 2014 (P<0.001). CONCLUSION: The Uruguayan risk reduction model was successfully applied in primary care in the Province of Buenos Aires.

Overall and abortion-related maternal mortality rates in Uruguay over the past 25 years and their association with policies and actions aimed at protecting women's rights.

OBJECTIVE: To evaluate changes in maternal mortality rates in Uruguay over the past 25 years, as well as their distribution by cause, and their temporal relationship with social changes and Human Development Index (HDI) indicators. METHODS: Data on maternal mortality obtained directly from the Uruguayan Ministry of Public Health for the 2001 to 2015 period were analyzed together with data from the United Nations Inter-Agency Group for Child Mortality Estimation for the 1990 to 2015 period. The swiftness of the decrease in maternal mortality per five-year period, the variation in the percentage of abortion-related deaths, and the correlation with HDI indicators were evaluated. RESULTS: Maternal mortality decreased significantly, basically due to a reduction in the number of deaths from unsafe abortion, which was the principal cause of maternal mortality in the 1990s. The reduction in maternal mortality over the past 10 years also coincides with a reduction in poverty and an improvement in the HDI. CONCLUSION: A rapid reduction occurred in maternal mortality in Uruguay, particularly in maternal mortality resulting from unsafe abortion. This coincided with the application of a model for reducing the risk and harm of unsafe abortions, which finally led to the decriminalization of abortion.