Prevalence and management of ectopic and molar pregnancies in 17 countries in Africa and Latin America and the Caribbean: a secondary analysis of the WHO multi-country cross-sectional survey on abortion.

INTRODUCTION: There are limited global data on ectopic pregnancy (EP) and molar pregnancy (MP), making it important to understand their epidemiology and management across different regions. Our study aimed to describe their prevalence for both conditions, severity of their complications and management among women in selected health facilities across 17 countries in Africa and Latin America and the Caribbean (LAC). METHODS: This is a secondary analysis of the WHO multi-country survey on abortion. Data were collected from 280 healthcare facilities across 11 countries in Africa and 6 in LAC. Sociodemographic information, signs and symptoms, management and clinical outcomes were extracted from medical records. Facility-level data on post-abortion care (PAC) capabilities were also collected, and facilities were classified accordingly. χ2 or Fisher's exact tests were used to compare categorical data. RESULTS: The total number of women with EP and MP across both regions was 9.9% (2 415/24 424) where EP accounted for 7.8% (1 904/24 424) and MP for 2.1% (511/24 424). EP presented a higher severity of complications than MP. At admission, 49.8% of EP had signs of peritoneal irritation. The most common surgical management for EP was laparotomy (87.2%) and for MP, uterine evacuation (89.8%). Facilities with higher scores in infrastructure and capability to provide PAC more frequently provided minimal invasive management using methotrexate/other medical treatment (34.9%) and laparoscopy (5.1%). CONCLUSION: In Africa and LAC, EP and MP cause significant maternal morbidity and mortality. The disparity in the provision of good quality care highlights the need to strengthen the implementation of evidence-based recommendations in the clinical and surgical management of EP and MP.

Induced abortion incidence and associated factors in a cohort of women living with HIV in Rio De Janeiro, Brazil, 1996-2016.

BACKGROUND: Abortion is a public health problem in Latin America and is more common among women living with HIV. OBJECTIVE: to verify the incidence and factors associated with induced abortion in a cohort of women living with HIV assisted in a reference service for care for individuals with HIV/AIDS in Rio de Janeiro/Brazil. METHODS: Prospective cohort during the period 1996-2016. We estimated the incidence of induced abortions during follow-up in the cohort by calculating person-time incidence rates [per 100 persons-years (PY)] and investigated the factors associated with the outcome "induced abortion" using a generalized linear mixed model. RESULTS: 753 women and 210 pregnancies were included in the present analysis. We estimated an induced abortion incidence rate of 0.68/100 persons-years (95% confidence interval [CI]: 0.47; 0.94) in the study period, with a significant reduction after 2006. The main factors associated with an induced abortion were currently living with a partner (adjusted OR [AdjOR] 0.32 95% CI: 0.10-0.98), number of children (2 children AdjOR 0.12, 95% CI: 0.02-0.95) and the type of antiretroviral treatment used (regimen without Efavirenz: AdjOR: 0.11, 95% CI 0.02-0.70). CONCLUSIONS: We showed a significant reduction in the incidence of induced abortions in a cohort of women living with HIV in Rio de Janeiro, Brazil, probably due to a decrease in the incidence of pregnancies observed in the same period. The factors associated with a lower occurrence of induced abortion suggest a good integration between the clinical and reproductive assistance offered to those women.

Telemedicine for the provision of medication abortion to pregnant people at up to twelve weeks of pregnancy: a systematic literature review and meta-analysis.

BACKGROUND: Telemedicine represents an important strategy to facilitate access to medication abortion (MAB) procedures, reduces distance barriers and expands coverage to underserved communities. The aim is evaluating the self-managed MAB (provided through telemedicine as the sole intervention or in comparison to in-person care) in pregnant people at up to 12 weeks of pregnancy. METHODS: A literature search was conducted using electronic databases: MEDLINE, Embase, Cochrane (Central Register of Controlled Trials and Database of Systematic Reviews), LILACS, SciELO, and Google Scholar. The search was based on the Population, Intervention, Comparison, Outcome, and Study Design (PICOS) framework, and was not restricted to any years of publication, and studies could be published in English or Spanish. Study screening and selection, risk of bias assessment, and data extraction were performed by peer reviewers. Risk of bias was evaluated with RoB 2.0 and ROBIS-I. A narrative and descriptive synthesis of the results was conducted. Meta-analyses with random-effects models were performed using Review Manager version 5.4 to calculate pooled risk differences, along with their individual 95% confidence intervals. The rate of evidence certainty was based on GRADE recommendations. RESULTS: 21 articles published between 2011 and 2022 met the inclusion criteria. Among them, 20 were observational studies, and 1 was a randomized clinical trial. Regarding the risk of bias, 5 studies had a serious risk, 15 had a moderate risk, and 1 had an undetermined risk. In terms of the type of intervention, 7 compared telemedicine to standard care. The meta-analysis of effectiveness revealed no statistically significant differences between the two modalities of care (RD = 0.01; 95%CI 0.00, 0.02). Our meta-analyses show that there were no significant differences in the occurrence of adverse events or in patient satisfaction when comparing the two methods of healthcare delivery. CONCLUSION: Telemedicine is an effective and viable alternative for MAB, similar to standard care. The occurrence of complications was low in both forms of healthcare delivery. Telemedicine services are an opportunity to expand access to safe abortion services.

Socio-ecological influences on access to abortion care in Costa Rica: a qualitative analysis of key perspectives from clinical and policy stakeholders.

Costa Rica prohibits abortion except under narrow circumstances to save the pregnant person's life. The country boasts historically strong support for social policy and human rights, while also presenting a complex and restrictive abortion access landscape. From September 2021 to March 2022, we conducted 23 interviews with obstetrician-gynecologist (OB/GYN) physicians, OB/GYN medical residents, and policy stakeholders to explore the socio-ecological influences on abortion access in Costa Rica. We sampled clinicians and policy stakeholders from the Universidad de Ciencias Médicas listserv through snowball sampling and conducted semi-structured in-depth interviews in Spanish. We identified limited access to comprehensive sexual health education, lack of support from interpersonal networks, inadequate provider knowledge and training, financial and migratory status, and both provider and community stigma as substantial barriers to abortion access. This study addresses a gap in published research around the social determinants of abortion in Costa Rica and sheds light on the attitudes and opinions of the medical and policy stakeholder communities about abortion access. The results highlight the need for expanded access to comprehensive sexual health education, abortion-related training for healthcare providers, and increased programming efforts, such as funding, outreach, and implementation, to ensure comprehensive reproductive health services are available and accessible, especially for vulnerable populations in Costa Rica.

Intersection between access difficulties and obstetric violence in abortion itineraries. / Intersecção entre dificuldades de acesso e violência obstétrica em itinerários abortivos.

In Brazil, several limitations are imposed upon the access of women undergoing abortion to the healthcare network, primarily caused by the influence of moral and religious values and gender iniquities. In this light, the present study aimed to analyze the experience of women who had an abortion regarding the care provided by healthcare services as part of the abortion itinerary. This is a qualitative study, carried out with 18 women in three cities - one small city, one mid-sized, and one big - in the state of Bahia. Data were produced by face-to-face or online interviews. The empirical material was analyzed using the discourse analysis technique. The results show, in the three municipalities, abortion itineraries under social and gender iniquities, with greater access difficulties for low-income women. Better financial conditions allow access to clandestine private clinics but without guaranteeing humanized care. In the three municipalities, economically disadvantaged women self-induced abortions and delayed seeking services, having faced embarrassing and prejudicial professional attitudes. The results point to the urgency of implementing public policies in which reproductive rights are as effective as human rights.

No Brasil, diversas limitações são impostas ao acesso de mulheres em situação de abortamento à rede de atenção à saúde, sob influência de valores morais, religiosos e iniquidades de gênero. Objetivou-se analisar a experiência de mulheres que realizaram abortamento quanto à atenção pelos serviços de saúde, como parte do itinerário abortivo. Trata-se de pesquisa de abordagem qualitativa, realizada com 18 mulheres em três municípios de pequeno, médio e grande porte, no estado da Bahia. Os dados foram produzidos por meio de entrevista presencial ou virtual. O material empírico foi analisado por meio da técnica de análise de discurso. Os resultados mostram, nos três municípios, itinerários abortivos sob iniquidades sociais e de gênero, com maiores dificuldades de acesso para mulheres de baixa renda. Melhores condições financeiras permitiram acesso a clínicas particulares clandestinas, mas sem garantia de atenção humanizada. Nos três municípios, mulheres desfavorecidas economicamente autoinduziram o aborto e retardaram a busca por serviços, tendo enfrentado atitudes profissionais constrangedoras e preconceituosas. Os resultados apontam a premência de se implementar políticas públicas em que os direitos reprodutivos se efetivem como direitos humanos.

[Association between induced abortion and depression: A systematic review and meta-analysis]. / Asociación entre aborto inducido y depresión: una revisión sistemática y metaanálisis.

This article is a systematic review (SR) and meta-analysis (MA) whose objective was to identify the association between induced abortion and the development of depression, based on the Cochrane guidelines for SRs. A systematic search was carried out in the WoS, PubMed and Scopus databases. Retrospective and prospective cohort studies, carried out until November 2020, that evaluated a population of women in childbearing age (12 to 46 years) with at least 1 induced and/or provoked abortion, including pharma-cological and surgical abortion. Only studies with healthy women at the beginning of the research were included, i.e., with absence of psychiatric pathology prior to induced abor-tion. The quality of the included studies was measured with the Newcastle-Ottawa Scale (NOS), and for the MA random-effects models were specified using the DerSimonian & Laird method, grouping them into follow-up after abortion before and after one year. The results of the SR were measured with relative risk (RR), hazard ratio (HR), odds ratio (OR), and the chi-square test, which assessed the intensity of the statistical relationship between population and exposure. Systematic review demonstrated an OR of 1.38 (95% CI 1.14-1.68) of depression after induced abortion. Meta-analysis demonstrated a statis-tically significant association between depression and induced abortion when the as-sessment after one year was performed OR: 1.37 (95% CI 1.09-1.71). The risks, harms and mental health consequences of induced abortion, such as depression, should be in-vestigated and warned.

El presente artículo es una revisión sistemática (RS) y metaanálisis (MA) cuyo objetivo fue identificar la asociación entre el aborto inducido y el desarrollo de depresión, con base en los lineamientos Cochrane para RS. Se hizo la búsqueda sistemática en las bases de datos WoS, PubMed y Scopus. Se incluyeron estudios de cohorte retrospectivos y prospectivos, hasta noviembre de 2020, que evaluaron una población de mujeres en edad fértil (12 a 46 años) con al menos un aborto inducido o provocado, incluido el aborto farmacológico y el quirúrgico. Solo se incluyeron estudios con mujeres sanas al inicio de la investigación, es decir, con ausencia de patología psiquiátrica previa al aborto inducido. La calidad de los estudios incluidos se midió con la Newcastle-Ottawa Scale (NOS) y para el MA se especificaron modelos de efectos aleatorios con el método de DerSimonian & Laird y se agruparon en seguimiento posterior al aborto antes y después de un año. Los resultados de la RS fueron medidos con riesgo relativo (RR), hazard ratio (HR), odds ratio (OR) y la prueba de chi cuadrado, que valoraron la intensidad de la relación estadística entre la población y la exposición. La RS demostró un OR 1.38 (IC 95% 1.14-1.68) de depresión tras el aborto inducido. El MA demostró una asociación estadísticamente significativa entre la depresión y el aborto inducido cuando se hizo la evaluación posterior a un año OR: 1.37 (IC 95% 1.09-1.71). Se deberían investigar y advertir los riesgos, daños y consecuencias en la salud mental, como la depresión, tras el aborto inducido.

[Women's rescuers network: Community support for self-managed abortion in Argentina]. / Socorristas en red: Soporte comunitario a la autogestión del aborto en Argentina.

The availability of medications to induce abortion, especially in contexts of restricted access, has transformed practices and allowed women and/or their community organizations to assist other women in obtaining abortions, whether or not they interact with the healthcare system. This study recovers the experience of a feminist community organization that, from the province of Neuquén, extends throughout the country, creating a network of community care. An exploratory descriptive study with a qualitative approach was conducted to analyze the experiences of women who facilitate access to permitted abortion in Argentina. Through in-depth interviews with three leaders of the feminist collective La Revuelta and semi-structured interviews with 33 members of the socorrista groups, conducted between November 2019 and December 2020, we describe their history and processes of work and growth; we explore their motivations and feelings and characterize the interactions of these organizations with public and private health systems. The results of this work align with the international conversation and bibliographic production about these organizations and their particularities, and with the need to incorporate these forms of care into institutional health systems.

La disponibilidad de medicamentos para producir un aborto, sobre todo en contextos de acceso restringido, transformó las prácticas y permitió que las propias mujeres y/o sus organizaciones comunitarias ayuden a otras mujeres a abortar, interactuando o no con el sistema de salud. Este estudio recupera la experiencia de una organización feminista de la comunidad que, desde la provincia de Neuquén, se extiende a todo el país, generando una red de cuidados comunitarios. Se realizó un estudio exploratorio descriptivo, con enfoque cualitativo con el propósito de analizar las experiencias de las mujeres que facilitan el acceso al aborto permitido en Argentina. A través de entrevistas en profundidad a tres líderes de la colectiva feminista La Revuelta y de entrevistas semiestructuradas a 33 integrantes de las grupas socorristas, realizadas entre noviembre de 2019 y diciembre de 2020, describimos su historia y los procesos de trabajo y crecimiento; exploramos sus motivaciones y sentimientos y caracterizamos las interacciones de dichas organizaciones con los sistemas de salud público y privado. Los resultados de este trabajo coinciden con la conversación y la producción bibliográfica internacional acerca de estas organizaciones y sus particularidades y con la necesidad de incorporar estos cuidados a los sistemas de salud institucionales.

Effectiveness and safety of medication abortion via telemedicine versus in-person: A cohort of pregnant people in Colombia.

OBJECTIVE: To compare the effectiveness and safety of medication abortion (MAB) via telemedicine versus in-person in pregnant people with less than 12 gestational weeks in Colombia. STUDY DESIGN: A retrospective cohort study was conducted with 23,362 pregnant people who requested MAB service from Profamilia (a Colombian non-governmental organization) in 2021-2022. The outcomes were success and safety of MAB. We performed a descriptive and a multivariate statistical analysis using the binary regression model to obtain an adjusted Odds Ratio (aOR) to identify factors associated with abortion success. RESULTS: In comparison to in-person care (n = 20,289), individuals in telemedicine (n = 3073) were predominantly from urban areas, belonged to a lower socioeconomic stratum, single and did not identify with any ethnic group. In-person users tended to have higher levels of education and accessed the service through private insurance (p < 0,05). There were no differences in the odd of a successful abortion based on the modality of care (aOR 1.18; 95% CI=0.87-1.59). The results were also the same with sensitivity analysis stratified: pregnant people who were nine weeks gestation or less (aOR 0.86; 95% CI=0.63-1.17) or more (aOR 0.87; 95% CI=0.28-2.65). CONCLUSION: Telemedicine is an effective and safe option for MAB, as in-person care. Telemedicine has the potential to increase abortion access by extending the availability of providers and offering people a new option for obtaining care conveniently and privately, especially for women with disadvantaged socioeconomic and educational background. IMPLICATIONS: This study demonstrates that medication abortion (MAB) administered via telemedicine produces outcomes akin to those of in-person care, providing a compelling rationale for its adoption, particularly in underserved regions. This approach can be replicated in other countries in Latin America and the Caribbean.

Motivations for using misoprostol for abortion outside the formal healthcare system in Colombia: a qualitative study of women seeking postabortion care in Bogotá and the Coffee Axis.

BACKGROUND: In 2006, a Constitutional Court ruling partially decriminalized abortion in Colombia, allowing the procedure in cases of rape, risk to the health or life of the woman, and fetal malformations incompatible with life. Despite this less prohibitive law, some women and pregnant people preferred self-managing their abortions outside the formal healthcare system, often without accurate information. In 2018, we undertook a study to understand what motivated women to self-manage using medications that they acquired informally. Colombia has since adopted a progressive law in 2022, permitting abortion on request through the 24th week of pregnancy. However, the implementation of this law is still underway. Examining the reasons why women chose to informally self-manage an abortion after 2006 may not only highlight how barriers to legal services persisted at that time, but also could inform strategies to increase knowledge of the current abortion law and improve access to services going forward. METHODS: In-depth interviews were conducted in 2018 with 47 women aged 18 and older who used misoprostol obtained outside of health facilities to induce an abortion, and who were receiving postabortion care in two private clinics. Interviews explored what women knew about the 2006 abortion law which was then in effect, and the reasons why they preferred informal channels for abortion care over formal healthcare services. RESULTS: Women's motivations to use misoprostol obtained outside the formal healthcare system were influenced by lack of trust in the healthcare system along with incomplete and inaccurate knowledge of the abortion law. Conversely, women considered misoprostol obtained outside the healthcare system to be effective, affordable, and easier to access. CONCLUSIONS: Obtaining misoprostol outside the formal healthcare system offered a more accessible and appealing prospect for some women given fears of legal repercussion and stigma toward abortion. Though this preference will likely continue despite the more liberal abortion law, strategies should be implemented to broaden knowledge of the recent change in law and to combat misinformation and stigma. This would support knowledge of and access to legal abortion for those who wish to avail themselves of these services.

Health care itineraries for women in situations of abortion: methodological aspects of a qualitative study for Birth in Brazil II survey. / Itinerários de cuidado à saúde de mulheres em situações de abortamento: aspectos metodológicos do estudo qualitativo da pesquisa Nascer no Brasil II.

In recent decades, several academic studies on abortion have been produced in Brazil, with different designs, objectives, and methodologies. However, due to the diversity of situations in which Brazilian women experience abortion, the complexity of this topic, and its modulations in different political and sociocultural contexts, it still challenges academicians and the fields of health and reproductive rights. In this article, we present methodological aspects of a qualitative study on health care itineraries of women in situations of abortion, a component of the Birth in Brazil II survey, whose objective is to discuss the effects of gender; race/ethnicity; social class; generational, regional, and territorial inequalities on care itineraries. We discuss the study design development, the construction of the theoretical framework and specific analytical axes, the development of interview instrument, definition of participant selection criteria, strategies to contact participants and conduct the interviews, management of field work and materials produced, analytical procedures, and ethical issues. In total, 120 narrative interviews were conducted in order to include a diversity of women and obtain detailed results from the quantitative analysis under Birth in Brazil II survey. The context of criminalization of abortion has an impact on the production of knowledge on this subject, creating challenges such as difficult access to women, women's anonymity, privacy and data confidentiality, creation of objective and subjective conditions so that they can narrate their experiences in depth. With this article, we seek to contribute to the debate about these challenges in abortion research in Brazil.

Nas últimas décadas, produziu-se um robusto corpus de pesquisas sobre aborto no Brasil, com diferentes desenhos, objetos e metodologias. Contudo, pela diversidade de situações em que as mulheres brasileiras vivenciam o abortamento, pela complexidade do tema e por suas modulações em contextos políticos e socioculturais distintos, o assunto não cessa de desafiar a academia, o campo da saúde e dos direitos reprodutivos. Neste artigo, apresentamos aspectos metodológicos de um estudo qualitativo sobre itinerários de cuidado à saúde de mulheres em situações de abortamento, componente da pesquisa Nascer no Brasil II, que objetiva discutir efeitos das desigualdades de gênero, de raça/etnia, de classe social, geracionais, regionais e territoriais nesses percursos. Discutimos o desenvolvimento do desenho do estudo; a construção do arcabouço teórico e recortes analíticos específicos; a elaboração do instrumento de entrevista; os critérios de seleção das mulheres; as estratégias de abordagem e condução das entrevistas; a gestão do fluxo do campo e dos materiais produzidos; os procedimentos analíticos; e os problemas éticos. Para incluir uma diversidade de mulheres e aprofundar resultados do componente quantitativo do Nascer no Brasil II, serão realizadas 120 entrevistas narrativas. O contexto de criminalização do aborto impacta a produção de conhecimento sobre o tema, impondo desafios como conseguir acesso às mulheres, assegurar o anonimato e sua privacidade, além do sigilo das informações, gerar condições objetivas e subjetivas para que possam narrar em profundidade as suas experiências. Com este artigo, procuramos contribuir para o debate sobre esses desafios das pesquisas sobre aborto no Brasil.

En las últimas décadas, se produjo un robusto corpus de investigaciones sobre el aborto en Brasil, con diferentes diseños, objetos y metodologías. Sin embargo, debido a la diversidad de situaciones en las que las mujeres brasileñas vivencian el abortamiento, la complejidad del tema y sus modulaciones en diferentes contextos políticos y socioculturales, el tema continúa desafiando a la academia, el campo de la salud y los derechos reproductivos. En este artículo, presentamos aspectos metodológicos de un estudio cualitativo sobre los itinerarios de cuidados de la salud de mujeres en situación de abortamiento, componente de la encuesta Nacer en Brasil II, que tiene como objetivo discutir los efectos de las desigualdades de género, raza/etnia, clase social, generacionales, regionales y territoriales en esos recorridos. Discutimos el desarrollo del diseño del estudio, la construcción del marco teórico y los recortes analíticos específicos, la elaboración del instrumento de entrevista, los criterios de selección de las mujeres, las estrategias de abordaje y realización de las entrevistas, el manejo del flujo del campo y de los materiales producidos, los procedimientos analíticos y los problemas éticos. Para abarcar una diversidad de mujeres y profundizar los resultados del componente cuantitativo de Nacer en Brasil II, se realizarán 120 entrevistas narrativas. El contexto de criminalización del aborto impacta la producción de conocimiento sobre el tema, imponiendo desafíos, tales como conseguir acceso a las mujeres, asegurar su anonimato y privacidad y la confidencialidad de la información, generar condiciones objetivas y subjetivas para que puedan narrar en profundidad sus experiencias. Con este artículo buscamos contribuir al debate sobre estos desafíos de las investigaciones sobre el aborto en Brasil.

Protocol of Birth in Brazil II: National Research on Abortion, Labor and Childbirth. / Protocolo do Nascer no Brasil II: Pesquisa Nacional sobre Aborto, Parto e Nascimento.

Brazil has made advances in obstetric care in public and private hospitals; however, weaknesses in this system still require attention. The Brazilian Ministry of Health, aware of this need, funded the second version of the Birth in Brazil survey. This study aimed to evaluate: prenatal, labor and birth, postpartum, and abortion care, comparing the results with those of Birth in Brazil I; and analyze the main determinants of perinatal morbidity and mortality; evaluate the care structure and processes of obstetrics and neonatology services in maternity hospitals; analyze the knowledge, practices, and attitudes of health professionals who provide birth and abortion care; and identify the main barriers and facilitators related to care of this nature in Brazil. With a national scope and a 2-stage probability sample: 1-hospitals and 2-women, stratified into 59 strata, 465 hospitals were selected with a total planned sample of around 24,255 women - 2,205 for abortion reasons and 22,050 for labor reasons. Data collection was conducted using six electronic instruments during hospital admission for labor or abortion, with two follow-up waves, at two and four months. In order to expand the number of cases of severe maternal morbidity, maternal and perinatal mortality, three case control studies were incorporated into Birth in Brazil II. The fieldwork began in November 2021 and is scheduled to end in 2023. It will allow a comparison between current labor and birth care results and those obtained in the first study and will evaluate the advances achieved in 10 years.

Com o passar do tempo, o Brasil vem apresentando avanços na assistência obstétrica em hospitais públicos e privados; no entanto, ainda existem pontos frágeis que necessitam de atenção. O Ministério da Saúde, ciente dessa necessidade, financiou a segunda versão da pesquisa Nascer no Brasil. Os objetivos gerais são: avaliar a assistência pré-natal, ao parto e nascimento, ao puerpério e ao aborto, comparando com os resultados do Nascer no Brasil I, e analisar os principais determinantes da morbimortalidade perinatal; avaliar a estrutura e processos assistenciais dos serviços de obstetrícia e neonatologia das maternidades; analisar os conhecimentos, atitudes e práticas de profissionais de saúde que prestam assistência ao parto e ao aborto; e identificar as principais barreiras e facilitadores para essa assistência no país. Com escopo nacional e amostra probabilística em dois estágios (1-hospitais e 2-mulheres), dividida em 59 estratos, foram selecionados 465 hospitais com total planejado de, aproximadamente, 24.255 mulheres, 2.205 por motivo de aborto e 22.050 por motivo de parto. A coleta de dados, realizada por meio de seis instrumentos eletrônicos, ocorre durante a internação hospitalar para o parto ou aborto, com duas ondas de seguimento, aos dois e quatro meses. Com o intuito de expandir o número de casos de morbidade materna grave, mortalidade materna e perinatal, três estudos caso controle foram incorporados ao Nascer no Brasil II. O trabalho de campo foi iniciado em novembro de 2021 com término previsto para 2023. Os resultados permitirão comparar a atenção atual ao parto e ao nascimento com a retratada no primeiro inquérito e, com isso, avaliar os avanços alcançados no decorrer desses 10 anos.

Aunque Brasil ha presentado avances en la atención obstétrica en hospitales públicos y privados, todavía hay puntos débiles que necesitan atención. El Ministerio de Salud, consciente de esta necesidad, financió la segunda versión de la encuesta Nacer en Brasil. Los objetivos generales son: evaluar la atención prenatal, el parto y el nacimiento, el puerperio y el aborto, comparando con los resultados del Nacer en Brasil I, y analizar los principales determinantes de la morbimortalidad perinatal; evaluar la estructura y los procesos de atención de los servicios de obstetricia y neonatología en las maternidades; analizar los conocimientos, prácticas y actitudes de los profesionales de la salud que brindan atención para el parto y el aborto; e identificar las principales barreras y facilitadores para esta atención en el país. Tiene un alcance nacional y muestra probabilística en dos etapas (1-hospitales y 2-mujeres), la cual se dividió en 59 estratos; y se seleccionaron 465 hospitales con un total planificado de aproximadamente 24.255 mujeres, de las cuales 2.205 tuvieron procedimientos por aborto y 22.050 por parto. Para la recolección de datos se aplicó seis instrumentos electrónicos, que se realizó durante la hospitalización por parto o aborto, con dos rondas de seguimiento, a los dos y cuatro meses. Con el fin de ampliar el número de casos de morbilidad materna grave, mortalidad materna y perinatal, se incorporaron tres estudios de casos y controles en Nacer en Brasil II. El trabajo de campo comenzó en noviembre de 2021 y finalizará en 2023. Los resultados nos permitirán evaluar la atención al parto y al nacimiento actual con lo que se retrató en la primera encuesta, de esta manera se podrá evaluar los avances alcanzados a lo largo de estos 10 años.

Evaluating pregnancy termination decisions for fetal anomalies: a retrospective study in a tertiary referral center.

OBJECTIVE: The aim of this study was to examine the factors that influence pregnancy termination due to fetal anomalies, regardless of gestational age, within the legal framework of Turkey. METHODS: This retrospective study was conducted between January 2021 and July 2023 at a tertiary perinatology center to analyze patients undergoing pregnancy termination. The process involved multidisciplinary evaluations and informed consent, resulting in 326 pregnancy terminations, categorized by gestational timing. RESULTS: Of the 326 patients studied, 219 opted for terminations. Gestational week at diagnosis significantly influenced the decision to terminate, with fetal anomalies being the primary indication. Chromosomal abnormalities accounted for 15.9% of the cases, while structural anomalies and maternal disorders accounted for 84.1% and structural malformations accounted for 84.1% of the cases. Late terminations (≥23 weeks) accounted for 30% of cases and required complex procedures. CONCLUSION: The findings of this study indicate that maternal demographic factors have a limited impact on termination decisions. Early diagnosis of fetal anomalies is crucial for informed decision-making and emotional support, and the psychological consequences of late termination highlight the need for maternal support. Obstetricians play a vital role in facilitating early intervention. This study underscores the complex medical, ethical, and psychological aspects of pregnancy termination due to fetal anomalies. It emphasizes the importance of a holistic approach, considering medical, ethical, and psychological factors and the crucial role of healthcare professionals in supporting families during this challenging process.

"That is when I understood everything": Ideological trajectories of pro-choice female doctors in Mexico.

OBJECTIVES: There is little evidence about how physicians become abortion clinicians or advocates. We describe the ideological trajectories of pro-choice female Mexican doctors and the factors that made them pro-choice. STUDY DESIGN: In this qualitative study, we conducted semistructured interviews with members of the Mexican Network of Female Pro-choice Physicians. Participants came from eight diverse states. We used a feminist epistemology approach and analyzed data using inductive coding as well as a priori categories (becoming pro-choice, trajectories, and training). RESULTS: We included 24 female pro-choice physicians. We identified five intersecting factors that influenced becoming pro-choice: feminism, personal experiences, confrontation with the inequalities and violence that women experience, role models, and routine exposure to abortion care. Participants described three ideological trajectories: being pro-choice before studying medicine, not having a specific opinion, and changing from "pro-life" to "pro-choice." Participants described the absence of abortion training in medical schools, stigmatizing training, and the use of alternative training sources. CONCLUSIONS: In the absence of training on abortion during medical education, a combination of intersecting personal as well as work-related experience may turn doctors into pro-choice abortion clinicians and/or advocates. The findings of this study may be used to develop comprehensive medical curricula as well as strategies directed at doctors who have never received training on abortion care, such as promoting interactions with nonmedical abortion providers, education on inequalities and violence against women, moving beyond public health to a human rights and gender perspective, and exposure to routine safe abortion care. IMPLICATIONS: Mexican female doctors become pro-choice clinicians who provide abortion care and/or advocates in spite of their medical education.

Legal abortion requests and outcomes for women when the law is restrictive - experience from a referral centre in south-eastern Brazil.

METHODS: Retrospective cohort study with review of medical records of women assisted between 2015 and 2020. The variables were socio-demographic and SV characteristics, gestational age, reactions towards pregnancy and outcome. We compared outcome groups using the chi-square test, Fisher's exact test and the Kruskal-Wallis test. The significance level was 5%. RESULTS: We evaluated the medical records of 235 women, of which 153(65%) had undergone to abortion; 17(7.2%) had a spontaneous abortion; 19(8%) remained pregnant; 25(10.6%) had an abortion denied; and 21(8.9%) had been lost to follow-up. Out of the total number of women, 44(18.7%) were adolescents, 152(65.2%) were white and 201(88.5%) had an education ≥9 years. Women who remained pregnant had a known aggressor, disclosed the pregnancy (p < 0.001) and were more ambivalent (p < 0.001) than the other groups. Gestational age was higher in the denied abortion group than in the performed abortion group (p < 0.001). CONCLUSION: Feelings related to decision-making about abortion affected all groups, with differences. It is important to give women space to be heard, so they can make their own decisions.

Abortion care is possible in places with restrictive laws; however, women with more vulnerable characteristics did not seek the service. Legal restrictions interfere with women's decision-making about abortion and can promote inequality in gaining access to health services.

Chilean midwives' experiences while providing induced abortion care after the enactment of a law decriminalising abortion.

INTRODUCTION: The recent change in Chilean legislation towards abortion enabled midwives to include the care of women having an induced abortion within their scope of practice. However, midwives' identity could be strained by induced abortion care provision as it is contrary to midwives' traditional role. Considering this, the aim of the study was to elucidate how Chilean midwives understand and provide abortion care. METHODS: A constructivist grounded theory study was conducted using online semi-structured in-depth interviews. Midwives were purposively sampled considering maximum variation criteria and then theoretical sampling occurred. Saturation was achieved with fifteen interviews. Interviews were conducted in Spanish and then translated into English. Constant comparison analysis generated categories. Data were managed using NVivo 12. All interviewees provided their consent to be part of this study. RESULTS: This article reports on the experiences of nine midwives who had provided lawful induced abortion care in Chile. The experiences of these midwives were grouped into two major categories: 'Defining a position towards abortion' and 'Abortion care is emotional labour'. CONCLUSION: Midwives can successfully provide abortion care despite being challenged by certain areas of it. Considering the high demand for emotional labour in abortion care, efforts should be made to increase midwives' emotional self-regulation skills. Likewise, organisations should strengthen and implement their offer of well-being and emotional self-care support to midwives.

Navigating a maze: Midwives' identity response to the enactment of an abortion law in Chile.

BACKGROUND: Chilean midwives have been identified as essential for successfully implementing an abortion law, a practice which could potentially be understood as contradicting their central mission. Nevertheless, to date, there has been no investigation into how Chilean midwives have incorporated induced abortion care provision into their professional identity. OBJECTIVE: To elucidate how Chilean midwives understand and provide abortion care and how they have (re)defined their professional identity to include induced abortion care. This article reports the findings of the second part of this aim. METHODS: This study was underpinned by a constructivist grounded theory methodology informed by a reproductive justice and feminist perspective. Midwives from Chile who have cared for women undergoing abortion were invited to participate in the study. After purposive and theoretical sampling, fifteen midwives were recruited. FINDINGS: Midwives' identity is woman-centred, with high value placed on their role protecting life. These two aspects of midwives' identity are in contradiction when providing abortion care. Midwives' identity results from and informs midwives' practice. Midwifery regulation influences both practice and identity. The model 'Navigating a maze' explains the interaction of these three elements. CONCLUSION: Midwives' identity response to the enactment of the Chilean abortion law is an example of how professional identity must navigate regulation and practice to make sense of its purpose. In light of this study's findings, the current tension experienced in midwives' identity should be carefully attended to prevent adverse outcomes for midwives and the Chilean population.

Decriminalization of abortion by the Mexican Supreme Court.

In September 2021, the Mexican Supreme Court issued a decision disallowing any federal or local judicial authority to indict someone for the offense of voluntary or consensual abortion. This decision also declared unconstitutional penalties imposed on medical personnel who facilitate or assist such procedures. Furthermore, the Court decided that limiting access to abortion in cases of rape to a specific time frame was disproportionate. Later on, in September 2023, the Supreme Court confirmed that absolute criminalization of abortion was unconstitutional and declared that the rule supporting criminalization in the Federal Penal Code was without effects. Consequently, healthcare providers who work in public federal health institutions cannot be criminalized for guaranteeing the right to abortion. This article reviews the reasons advanced by the Supreme Court to guarantee the right of reproductive self-determination, as well as the effects of both decisions beyond the decriminalization of abortion by Mexican federal and state legislatures. The paper also examines the scope and limitations of these rulings and identifies the remaining challenges regarding voluntary abortion procedures in Mexico.