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2.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334739

RESUMO

Takotsubo cardiomyopathy (TTC) is a rare but life-threatening condition that is still not completely understood. Characterised by rapidly reversible ventricular dysfunction without any prior coronary artery disease, it can imitate a myocardial infarction and lead to death if not managed appropriately. This report examines a case of intraoperative cardiac arrest in a patient with no previous cardiac disease, and discusses the factors that may have precipitated this event, as well as the ways of distinguishing the cause of the arrest based on clinical course and investigations, eventually leading to a diagnosis of TTC.


Assuntos
Aborto Induzido/efeitos adversos , Parada Cardíaca/etiologia , Complicações Intraoperatórias/diagnóstico , Estresse Psicológico/etiologia , Cardiomiopatia de Takotsubo/diagnóstico , Aborto Induzido/psicologia , Adulto , Cardiotônicos/administração & dosagem , Catecolaminas/sangue , Ecocardiografia , Eletrocardiografia , Feminino , Parada Cardíaca/sangue , Parada Cardíaca/tratamento farmacológico , Humanos , Infusões Intravenosas , Complicações Intraoperatórias/sangue , Complicações Intraoperatórias/tratamento farmacológico , Complicações Intraoperatórias/etiologia , Gravidez , Simendana/administração & dosagem , Estresse Psicológico/sangue , Estresse Psicológico/psicologia , Cardiomiopatia de Takotsubo/sangue , Cardiomiopatia de Takotsubo/tratamento farmacológico , Cardiomiopatia de Takotsubo/etiologia
3.
Int Perspect Sex Reprod Health ; 46(Suppl 1): 83-89, 2020 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-33326403

RESUMO

COVID-19 has compromised and disrupted sexual and reproductive health (SRH) across multiple dimensions: individual-level access, health systems functioning, and at the policy and governance levels. Disruptions to supply chains, lockdown measures and travel restrictions, and overburdened health systems have particularly affected abortion access and service provision. The pandemic, rather than causing new issues, has heightened and exposed existing fractures and fissures within abortion access and provision. In this viewpoint, we draw on the concept of "structural violence" to make visible the contributing causes of these ruptures and their inequitable impact among different groups.


Assuntos
Aborto Induzido/psicologia , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Racismo/psicologia , Serviços de Saúde Reprodutiva , Feminino , Humanos , Pandemias , Política , Gravidez , Determinantes Sociais da Saúde , Violência
4.
PLoS One ; 15(10): e0239894, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33035246

RESUMO

INTRODUCTION: Worldwide, 25 million unsafe abortions (45% of all abortions) occurred every year between 2010 and 2014 and 97%, occurred in low-and-middle income countries. Abortion among adolescent girls and young women (15-24 years) is a major public health issue, especially in low-and middle-income countries, including Ghana. Using data from the 2017 Maternal Health Survey, we sought to examine the association between mass media exposure and adolescent girls and young women's self-efficacy in abortion decision making. MATERIALS AND METHODS: A sample of 5,664 adolescent girls and young women in Ghana was considered in this study. Both descriptive and inferential analytical approaches were employed to analyse the data. The descriptive analytical approach involved the use of proportions to illustrate the proportion of adolescent girls and young women who had self-efficacy in abortion decision-making. Self-efficacy in abortion decision-making was derived from the question 'Could you decide on your own to get an abortion?' Respondents who answered "Yes" to this question were considered as having self-efficacy in abortion decision making. At the inferential level, a chi-square test and bivariate and multivariable logistic regression models were employed with statistical significance pegged at p-value <0.05. The results of the bivariate and multivariable logistic regression analyses were presented using crude and adjusted odds ratios respectively. RESULTS: Less than a quarter of adolescent girls and young women (24%) in Ghana had self-efficacy in abortion decision-making. We further found that adolescent girls and young women who were exposed to mass media had higher odds in self-efficacy in abortion decision-making compared to those who were not exposed to the mass media [AOR = 1.55, CI = 1.14-2.11]. It was also found that adolescent girls and young women aged 20-24 [AOR = 1.45, CI = 1.25-1.68], those who were cohabiting [AOR = 1.40, CI = 1.02-1.93], and those from the Ashanti region [AOR = 2.39, CI = 1.85-3.07] had higher odds on self-efficacy in abortion decision-making. On the other hand, adolescent girls and young women from the Eastern Region [AOR = 0.52, CI = 0.36-0.73] and those belonging to the Ga-Adangbe ethnic group [AOR = 0.70, CI = 0.50-0.99] had lower odds in self-efficacy in abortion decision-making. CONCLUSION: Less than a quarter of adolescent girls and young women in Ghana have self-efficacy in abortion decision-making which can affect adolescent girls and young women's future abortion seeking behaviours. Exposure to mass media was strongly associated with self-efficacy in abortion decision making. We recommend that policy makers should promote mass media campaigns scheduled on regular intervals in order to inform the target audience about safe abortions in Ghana. This could go a long way to ensure that cases of unsafe abortions are reduced to the starkest minimum.


Assuntos
Aborto Induzido/psicologia , Tomada de Decisões , Meios de Comunicação de Massa/estatística & dados numéricos , Autoeficácia , Aborto Induzido/estatística & dados numéricos , Adolescente , Feminino , Gana , Inquéritos Epidemiológicos , Humanos , Saúde da Mulher/estatística & dados numéricos , Adulto Jovem
5.
Womens Health (Lond) ; 16: 1745506520953353, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32853055

RESUMO

OBJECTIVES: Abortions are difficult to measure; yet, accurate estimates are critical in developing health programs. We implemented and tested the validity of a list experiment of lifetime abortion prevalence in Istanbul, Turkey. We complemented our findings by understanding community perspectives using in-depth interviews with key informants. METHODS: We conducted a household survey between March and June 2018. In a random sample of 4040 married women aged 16-44 years, we implemented a double list experiment. We averaged difference in mean values calculations between the average counts for each list to provide an estimated lifetime abortion prevalence. We conducted in-depth interviews with 16 key informants to provide insights into possible explanations for the quantitative results. RESULTS: The abortion prevalence estimate from the list experiment was close to that of the direct question (3.25% vs 2.97%). Key informant narratives suggest that differing definitions of abortion, inaccessibility, provider bias, lack of knowledge of abortion laws and safety, and religious norms could contribute to under-reporting. Results from the qualitative study suggest that abortion is largely inaccessible and highly stigmatized. CONCLUSION: Measuring experiences of abortion is critical to understanding women's needs and informing harm-reduction strategies; however, in highly stigmatized settings, researchers may face unique challenges in obtaining accurate reports.


Assuntos
Aborto Induzido/estatística & dados numéricos , Coleta de Dados/métodos , Aborto Induzido/psicologia , Adolescente , Adulto , Feminino , Humanos , Gravidez , Prevalência , Pesquisa Qualitativa , Estigma Social , Inquéritos e Questionários , Turquia/epidemiologia , Adulto Jovem
6.
PLoS One ; 15(7): e0236670, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32722708

RESUMO

Intimate partner violence (IPV) is a social problem in Bangladesh with adverse effects on maternal healthcare. This study analyzed the sociodemographic factors responsible for intimate partner violence and its overall association with reproductive healthcare-specifically miscarriages, stillbirths and induced abortions (MSA)-using Bangladesh Demographic Health Survey 2007, which contains the latest available intimate partner violence data till date, with the hypothesis that intimate partner violence is associated with miscarriages, stillbirths and induced abortions. The generalized linear regression model was fitted to 3,920 women adjusting survey weights and cluster/strata variations. The study concluded that 1 out of every 4 women who reported experiencing intimate partner violence also reported having one or more of miscarriages, stillbirths and induced abortions. The results revealed that intimate partner violence and miscarriages, stillbirths and induced abortions were significantly associated with the age of the women, residence, age of the women at their first birth, sex of household head and the household's financial condition. Furthermore, the odds of having one or more miscarriages, stillbirths and abortions was increased by 35% for women who were victims to intimate partner violence, establishing a significant association between miscarriages, stillbirths and abortions and intimate partner violence. There appeared to be a need to address the issue in both paradigms, particularly for the poor rural women in Bangladeshi patriarchal society. These findings demand a combined intervention effort in the vulnerable cohorts, especially if Bangladesh intends to attain the goals 3.1 and 5.2 of the Sustainable Development Goals (SDG) by 2030.


Assuntos
Aborto Induzido/estatística & dados numéricos , Aborto Espontâneo , Violência por Parceiro Íntimo/estatística & dados numéricos , Natimorto , Aborto Induzido/psicologia , Aborto Espontâneo/psicologia , Adulto , Bangladesh , Feminino , Humanos , Modelos Lineares , Masculino
7.
Womens Health Issues ; 30(5): 353-358, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32669243

RESUMO

BACKGROUND: Abortion is a common medical procedure, integral to women's health, and a core educational topic for medical students. Medical schools often rely on brief clinical exposure to abortion during the obstetrics and gynecology clerkship to provide this learning. Abortion is also a highly politicized and stigmatized procedure. Given this potential conflict, we examine medical student reactions to their observation of abortion care. STUDY DESIGN: Medical students in their second and third years at an academic medical center who observed in a first trimester abortion clinic completed open-ended, written questionnaires. Questionnaires explored student reactions to participating in the abortion clinic. We used applied thematic analysis to code and qualitatively analyze 78 questionnaires. RESULTS: We identified the following five themes: (1) students found participating in abortion care deeply worthwhile, (2) some were challenged by their reactions, particularly when reactions conflicted with prior beliefs, (3) some demonstrated empathy for the patient, but (4) some expressed judgment of both the patient and the abortion provider, and (5) students reported a desire for curricular change around abortion education, requesting more time for reflection, and some felt that their abortion observation might better prepare them to serve future patients. CONCLUSIONS: Observing in an abortion clinic is a valued experience that allows students to challenge their existing beliefs and may build empathy. Educators should provide students with adequate time for preparation and reflection around this topic and address areas of misunderstanding that may perpetuate abortion stigma. These findings may inform medical student curriculum changes around abortion.


Assuntos
Aborto Induzido/psicologia , Estudantes de Medicina/psicologia , Aborto Induzido/educação , Adulto , Instituições de Assistência Ambulatorial , Currículo , Feminino , Ginecologia/educação , Humanos , Masculino , Obstetrícia/educação , Gravidez , Primeiro Trimestre da Gravidez , Inquéritos e Questionários , Estados Unidos
8.
PLoS One ; 15(7): e0235971, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32678861

RESUMO

OBJECTIVE: The purpose of this study is to explore Protestant religious leaders' attitudes towards abortion and their strategies for pastoral care in Georgia, USA. Religious leaders may play an important role in providing sexual and reproductive health pastoral care given a long history of supporting healing and health promotion. METHODS: We conducted 20 in-depth interviews with Mainline and Black Protestant religious leaders on their attitudes toward abortion and how they provide pastoral care for abortion. The study was conducted in a county with relatively higher rates of abortion, lower access to sexual and reproductive health services, higher religiosity, and greater denominational diversity compared to other counties in the state. Interviews were audio-recorded, transcribed verbatim, and analyzed by thematic analysis. RESULTS: Religious leaders' attitudes towards abortion fell on a spectrum from "pro-life" to "pro-choice". However, most participants expressed attitudes in the middle of this spectrum and described more nuanced, complex, and sometimes contradictory views. Differences in abortion attitudes stemmed from varying beliefs on when life begins and circumstances in which abortion may be morally acceptable. Religious leaders described their pastoral care on abortion as "journeying with" congregants by advising them to make well-informed decisions irrespective of the religious leader's own attitudes. However, many religious leaders described a lack of preparation and training to have these conversations. Leaders emphasized not condoning abortion, yet being willing to emotionally support women because spiritual leaders are compelled to love and provide pastoral care. Paradoxically, all leaders emphasized the importance of empathy and compassion for people who have unplanned pregnancies, yet only leaders whose attitudes were "pro-choice" or in the middle of the spectrum expressed an obligation to confront stigmatizing attitudes and behaviors towards people who experience abortion. Additionally, many leaders offer misinformation about abortion when offering pastoral care. CONCLUSION: These findings contribute to limited empirical evidence on pastoral care for abortion. We found religious leaders hold diverse attitudes and beliefs about abortion, rooted in Christian scripture and doctrine that inform advice and recommendations to congregants. While religious leaders may have formal training on pastoral care in general or theological education on the ethical issues related to abortion, they struggle to integrate their knowledge and training across these two areas. Still, leaders could be potentially important resources for empathy, compassion, and affirmation of agency in abortion decision-making, particularly in the Southern United States.


Assuntos
Aborto Induzido/psicologia , Atitude Frente a Saúde , Cristianismo/psicologia , Liderança , Princípios Morais , Assistência Religiosa/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Georgia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
9.
PLoS One ; 15(7): e0235329, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32702035

RESUMO

INTRODUCTION: Pregnancy termination is one of the key issues that require urgent attention in achieving the third Sustainable Development Goal (SDG) of ensuring healthy lives and promoting well-being for all at all ages. The reproductive health decision-making (RHDM) capacity of women plays a key role in their reproductive health outcomes, including pregnancy termination. Based on this premise, we examined RHDM capacity and pregnancy termination among women of reproductive age in sub-Saharan Africa (SSA). MATERIALS AND METHODS: We pooled data from the women's files of the most recent Demographic and Health Surveys (DHS) of 27 countries in SSA, which are part of the DHS programme. The total sample was 240,489 women aged 15 to 49. We calculated the overall prevalence of pregnancy termination in the 27 countries as well as the prevalence in each individual country. We also examined the association between RHDM capacity, socio-demographic characteristics and pregnancy termination. RHDM was generated from two variables: decision-making on sexual intercourse and decision-making on condom use. Binary logistic regression analysis was conducted and presented as Crude Odds Ratios (COR) and Adjusted Odds Ratios (AOR) with their corresponding 95% confidence intervals (CI). Statistical significance was declared p<0.05. RESULTS: The prevalence of pregnancy termination ranged from 7.5% in Benin to 39.5% in Gabon with an average of 16.5%. Women who were capable of taking reproductive health decisions had higher odds of terminating a pregnancy than those who were incapable (AOR = 1.20, 95% CI = 1.17-1.24). We also found that women aged 45-49 (AOR = 5.54, 95% CI = 5.11-6.01), women with primary level of education (AOR = 1.14, 95% CI = 1.20-1.17), those cohabiting (AOR = 1.08, 95% CI = 1.04-1.11), those in the richest wealth quintile (AOR = 1.06, 95% CI = 1.02-1.11) and women employed in the services sector (AOR = 1.35, 95% CI = 1.27-1.44) were more likely to terminate pregnancies. Relatedly, women who did not intend to use contraceptive (AOR = 1.47, 95% CI = 1.39-1.56), those who knew only folkloric contraceptive method (AOR = 1.25, 95% CI = 1.18-1.32), women who watched television almost every day (AOR = 1.16, 95% CI = 1.20-1.24) and those who listened to radio almost every day (AOR = 1.11, 95% CI = 1.04-1.18) had higher odds of terminating a pregnancy. However, women with four or more children had the lowest odds (AOR = 0.5, 95% CI = 0.54-0.60) of terminating a pregnancy. CONCLUSION: We found that women who are capable of taking reproductive health decisions are more likely to terminate pregnancies. Our findings also suggest that age, level of education, contraceptive use and intention, place of residence, and parity are associated with pregnancy termination. Our findings call for the implementation of policies or the strengthening of existing ones to empower women about RHDM capacity. Such empowerment could have a positive impact on their uptake of safe abortions. Achieving this will not only accelerate progress towards the achievement of maternal health-related SDGs but would also immensely reduce the number of women who die as a result of pregnancy termination in SSA.


Assuntos
Aborto Induzido/psicologia , Saúde Reprodutiva/tendências , Saúde da Mulher/tendências , Adolescente , Adulto , África ao Sul do Saara , Benin/epidemiologia , Tomada de Decisão Clínica , Comportamento Contraceptivo/psicologia , Anticoncepcionais/uso terapêutico , Feminino , Gabão/epidemiologia , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Gravidez , Saúde da Mulher/estatística & dados numéricos , Adulto Jovem
10.
BMC Womens Health ; 20(1): 90, 2020 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-32366245

RESUMO

BACKGROUND: Medical crowdfunding is the process of using a crowdfunding platform to raise funds for medical treatment and associated expenses, such as missing work or transportation costs to access care. This type of crowdfunding has become increasingly popular, and is an effective tool to raise financing for medical treatment in the absence of insurance. However, it is accompanied by questions of which diseases or treatments are viewed as worthy to fund and which do not fit the criteria of worthiness. In the context of an abortion, a legitimate and important medical procedure, there is a lack of research that determines if campaigners can successfully utilize GoFundMe to pay for abortions and abortion related services and costs given the social stigma around this procedure. Here, we explore the outcomes of crowdfunding campaigns for stigmatized needs and conditions by examining campaigns related to abortion. METHODS: A total of 211 campaigns that utilized the term "abortion" were retrieved on the medical-section of the GoFundMe crowdfunding platform. These results were thematically analyzed by each author and two distinctive categories were identified to group the campaigns. RESULTS: The categories of campaigns using the term "abortion" were: campaigns seeking funds to access abortion related services (n = 84) and campaigns using the choice not to terminate pregnancy or the harms of abortion as a reason to give (n = 127). The number of donors, number of Facebook shares, campaign location, funding requested, funding pledged, campaign creation date, relation between the recipient and campaigner, and proposed use for the funds were recorded for each included campaign. CONCLUSIONS: This study suggests that certain conditions or diseases may be less successful in medical crowdfunding based on perceived features of worthiness, such as in the case of abortion. In the categories we identified, campaigns seeking funds to access abortion-related services were less successful than campaigns using choosing not to terminate a pregnancy or the harms of abortion as a reason to give. This is an area of concern in medical crowdfunding - that certain medical needs will not be funded equitably.


Assuntos
Aborto Induzido/economia , Crowdsourcing , Obtenção de Fundos/estatística & dados numéricos , Acesso aos Serviços de Saúde/economia , Estigma Social , Aborto Induzido/psicologia , Feminino , Financiamento da Assistência à Saúde , Humanos , Gravidez
11.
BMC Public Health ; 20(1): 493, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32295574

RESUMO

BACKGROUND: In Kenya, unsafe abortion is the leading cause of maternal deaths in adolescent girls aged 15-19 years, and a majority did not use a modern contraceptive before becoming pregnant. The aim of this study was to explore attitudes related to abortion and contraceptive use among secondary school teachers and student peer-counsellors in a low-resource setting in western Kenya. METHODS: A mixed methods design, combining a questionnaire-survey and focus group discussions (FGDs), was utilised to explore attitudes to abortion and contraceptive use among teachers (n = 15) and student peer-counsellors (n = 21) at a secondary school in Kisumu, Kenya. First, two Likert scale questionnaires were used: a modified version of the Stigmatising Attitudes, Beliefs and Actions (SABA) scale and the Contraceptive Use Stigma (CUS) scale. Secondly, four FGDs were conducted. Descriptive statistics and Abductive Thematic Network Analysis (ATNA) were used to analyse the data. RESULTS: Overall, Social judgments on abortion and contraceptive use were found among teachers and student peer-counsellors, with similar patterns between sexes. Christian and cultural values; A majority, 28/36 considered abortion a sin, and chastity and purity before marriage were highly valued feminine ideals. Discrimination and isolation; 18/36 believed that a girl who has had an abortion might be a bad influence on other girls, and 13/35 stated that an adolescent girl cannot decide for herself if to use a contraceptive method. Conflicting views on abortion and contraceptives; A third (11/34) believed that contraceptives may cause infertility, and its use was related to promiscuity. Girls associated with abortion and contraceptive use were considered immoral, lacking parental guidance, and were used to represent bad examples in school. Although conflicting views were present, sexuality was considered a taboo topic, which left adolescents ignorant on contraceptive use. CONCLUSIONS: Adolescent girls associated with abortion and contraceptive use are at risk for social judgements and discrimination, by both peers and teachers. Sexual and reproductive health training needs to be implemented in teacher education to increase knowledge on adolescent sexuality, abortion and contraceptive use to improve adolescents' sexual health and decrease the stigma. TRIAL REGISTRATION: This was a prestudy nested in a cluster randomised intervention study, registered on February 28, 2017, at ClinicalTrials.gov (NCT03065842).


Assuntos
Aborto Induzido/psicologia , Comportamento Contraceptivo/psicologia , Julgamento , Grupo Associado , Professores Escolares/psicologia , Estigma Social , Estudantes/psicologia , Adolescente , Adulto , Idoso , Feminino , Grupos Focais , Humanos , Quênia , Masculino , Pessoa de Meia-Idade , Áreas de Pobreza , Gravidez , Gravidez na Adolescência , Professores Escolares/estatística & dados numéricos , Instituições Acadêmicas , Estudantes/estatística & dados numéricos , Adulto Jovem
12.
Int J Public Health ; 65(4): 477-486, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32270237

RESUMO

OBJECTIVES: This study explores abortion decision-making trajectories in Ouagadougou, Burkina Faso, examining the spaces for decision making that young people manage to create for themselves within restrictive policy, gender norms and other constraints. METHODS: The study presents data collected from observations in three referral health facilities in Ouagadougou and interviews (with 31 young women (aged 17-25) who had sought abortions and five men (aged 20-25) whose partners had done so). Using inductive content analysis, we capture the different streams, actors and rationales in the decision-making process, as well as the pattern of negotiation. RESULTS: Abortion decision-making trajectories are complex and affected by a range of factors including fertility desires, relationship stability and financial stability. The process can include intense periods of negotiation between intimate partners when their rationales are discordant. Constraints on women's decision making include restrictive policy environment, coercion from partners (threats, emotional blackmail and even physical force) and pressure from people in and out of their social network. CONCLUSIONS: In a context where legal abortion is highly restricted and women's decision-making power is constrained, the abortion decision making appears as collective, operates in an uncertain time frame, an unofficial social environment and has an unpredictable collaborative mechanism.


Assuntos
Aborto Induzido/psicologia , Tomada de Decisões , Adolescente , Adulto , Burkina Faso , Feminino , Humanos , Masculino , Gravidez , Encaminhamento e Consulta , Fatores Sexuais , Adulto Jovem
15.
Z Geburtshilfe Neonatol ; 224(3): 136-142, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32157675

RESUMO

OBJECTIVE: To investigate the reasons for decision-making and concerns of patients in the field of prenatal screening, invasive prenatal diagnostic testing (IPDT), and termination of pregnancy (TOP). STUDY DESIGN: This questionnaire-based study consisted of 107 pregnant women who were referred for prenatal screening to the Hacettepe University Hospital. The questionnaire given to patients was prepared from scratch since there is no standard set of questions measuring patients' feelings and concerns regarding prenatal screening/diagnosis, IPDT, and TOP. RESULTS: Our questionnaire results showed that it is possible to classify decision-making factors into 6 groups: psychological, social, fear, religious/faith, support, and trust. The majority of patients were undecided (48.6%) about IPDT if prenatal screening test results were risky. Only 23.4% of patients were willing to accept IPDT. On the other hand, 55.1% of patients were not willing to undergo TOP if the fetal karyotyping results were abnormal. Religious factors seem to be important in refusing IPDT and TOP. CONCLUSION: Physicians should re-evaluate their practice in the field of prenatal screening and diagnosis in light of the high refusal rates of IPDT and TOP. Understanding factors influencing women's decision-making processes provides insight for service providers to help women at high risk of having foetal anomalies to make better-informed choices.


Assuntos
Aborto Induzido/psicologia , Aborto Terapêutico/psicologia , Gestantes/psicologia , Diagnóstico Pré-Natal/métodos , Comportamento de Escolha , Tomada de Decisões , Feminino , Humanos , Programas de Rastreamento , Gravidez , Cuidado Pré-Natal , Diagnóstico Pré-Natal/psicologia
16.
Sex Reprod Health Matters ; 28(1): 1730122, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32188353

RESUMO

Abortion providers' approaches to patient-centred pregnancy tissue viewing (PCV) - when a patient requests to see their products of conception - is understudied in abortion care. This mixed-method study aimed to identify: (1) if, when, and how PCV is facilitated at US independent abortion clinics; (2) how staff are trained to offer viewing; and (3) provider experiences facilitating PCV. We surveyed administrators from 22 independent abortion clinics affiliated with the Abortion Care Network about their PCV practices and then completed in-depth semi-structured interviews with 25 providers to better understand their experiences facilitating PCV. Results indicate that most of the clinics that provide PCV do so by patient request. A variety of providers facilitate viewing, including counsellors, educators, physicians, nurses, and medical assistants. Timing, viewing location, and staff training vary by facility. Benefits of and barriers to PCV emerged through three themes: (1) patient-centred care; (2) misinformation about fetal tissue; and (3) personal navigations as providers. Providers and administrators report PCV aligns with their patient-centred clinic missions and offers patients opportunities for choice, closure, and access to information. Yet, anti-abortion misinformation about fetal tissue impacts the ways providers must navigate complex conversations about PCV professionally and personally. Clinic resources and concern about adverse patient reactions to identifiable fetal parts present barriers to offering viewing. Understanding providers' experiences and approaches to PCV is an important first step to developing quality practices that can be shared across clinics. The findings of this study support the need for more research and training on PCV in abortion care.


Assuntos
Feto Abortado , Aborto Induzido/psicologia , Instituições de Assistência Ambulatorial , Pessoal de Saúde/psicologia , Assistência Centrada no Paciente , Gestantes/psicologia , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Gravidez , Pesquisa Qualitativa , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
17.
Am J Public Health ; 110(5): 677-684, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32191521

RESUMO

In the aftermath of the introduction of severe restrictions on abortion in several US states, some activists have argued that providing widespread access to an abortive drug, misoprostol, will transform an induced abortion into a fully private act and therefore will empower women. In Brazil, where abortion is criminalized, the majority of women who wish to terminate an unwanted pregnancy already use the illegal, but easily accessible, misoprostol. We examine the history of misoprostol as an abortifacient in Brazil from the late 1980s until today and the professional debates on the teratogenicity of this drug. The effects of a given pharmaceutical compound, we argue, are always articulated, elicited, and informed within dense networks of sociocultural, economic, legal, and political settings. In a conservative and repressive environment, the use of misoprostol for self-induced abortions, even when supported by formal or informal solidarity networks, is far from being a satisfactory solution to the curbing of women's reproductive rights.


Assuntos
Abortivos/uso terapêutico , Aborto Induzido/legislação & jurisprudência , Aborto Induzido/métodos , Empoderamento , Misoprostol/uso terapêutico , Abortivos/administração & dosagem , Abortivos/efeitos adversos , Aborto Induzido/psicologia , Brasil , Características Culturais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Misoprostol/administração & dosagem , Misoprostol/efeitos adversos , Política , Direitos Sexuais e Reprodutivos , Direitos da Mulher
19.
Int J Gynaecol Obstet ; 149(2): 197-202, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32077092

RESUMO

OBJECTIVE: To evaluate residents' knowledge about the evolution of abortion rates in countries where abortion has been legalized, and to assess whether such knowledge correlates with residents' sociodemographic characteristics and experience in abortion care. METHODS: A multicenter, cross-sectional study was conducted in 21 Brazilian hospitals with 404 medical residents in obstetrics and gynecology. Data collection occurred during February 2015 through January 2016. Data were collected through a self-administered, anonymous questionnaire. The χ2 test, Fisher exact test, and multiple logistic regression analysis were performed. RESULTS: Of residents, 60% believed that the abortion rate would increase after legalization; 82% had been involved in the care of women with incomplete abortion and 71% in the care of women admitted for legal abortion. Associations were found between knowledge of the evolution of the abortion rate after legalization and region of birth, region of medical school, and importance attached to religion. Multiple regression confirmed that studying medicine in the south/southeast of Brazil and attaching little importance to religion were associated with knowing that legalization does not lead to an increase in abortion rate. CONCLUSION: Information relating to abortion in medical schools and during residency is very limited and should be improved.


Assuntos
Aborto Induzido/psicologia , Aborto Legal/legislação & jurisprudência , Atitude do Pessoal de Saúde , Aborto Induzido/estatística & dados numéricos , Adulto , Brasil , Estudos Transversais , Feminino , Ginecologia/educação , Humanos , Internato e Residência/estatística & dados numéricos , Obstetrícia/educação , Gravidez , Inquéritos e Questionários , Adulto Jovem
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