Safety and effectiveness of bDMARDs during pregnancy in patients with rheumatic diseases: Real-world data from the BIOBADASER registry / Seguridad y efectividad de los FAME biológicos durante el embarazo en pacientes con enfermedades reumáticas: datos del mundo real procedentes del registro BIOBADASER

Introduction: Inflammatory rheumatic diseases usually affect women of childbearing age treated with biologic drugs. However, there is a lack of literature on the efficacy and toxicity of biologic disease-modifying drugs during pregnancy. The aim of this study was to determine the presence of pregnant patients treated with bDMARDs in a real-world dataset and to examine the impact of pregnancy and lactation on the evolution of rheumatic disease in a registry of Spanish patients.Method: This was a multicentre prospective study with a real-world setting. Information was obtained from BIOBADASER registry. Patients included are women who got pregnant until November 2020 from 19 rheumatology units. We conducted proportions, means, and standard deviations (SD) to describe the study population and the use of treatments. T-test and Chi-square test were applied to assess differences between groups.Result: Ninety cases of pregnancy were registered (n=68 full-term pregnancies; n=22 spontaneous miscarriages). Most of the cases discontinued bDMARDs during pregnancy (78.9%) but 13 cases continued treatment during pregnancy, mainly using certolizumab pegol. These cases were obtaining better management of rheumatic disease, although the differences were not statistically significant [DAS28-CRP, 2.9 (SD: 1.6) vs. 2.0 (1.2), p=.255; DAS28-ESR, 2.2 (1.0) vs. 1.7 (.5), p=.266]. No serious adverse events were reported during pregnancy and lactation.Conclusion: Being pregnant is still an uncommon condition in patients with rheumatic diseases and using bDMARDs. Our results show that rheumatic disease tended to progress better during pregnancy in patients who continued to take bDMARDs.(AU)

Introducción: Las enfermedades reumáticas inflamatorias afectan normalmente a mujeres en edad fértil tratadas con fármacos biológicos. Sin embargo, escasea la literatura sobre la eficacia y la toxicidad de los fármacos modificadores de la enfermedad (FAME) biológicos durante el embarazo. El objetivo de este estudio fue determinar la presencia de pacientes embarazadas tratadas con FAME biológicos en un conjunto de datos del mundo real y examinar el impacto del embarazo y la lactancia en la evolución de la enfermedad reumática en un registro de pacientes españoles.Método: Estudio prospectivo multicéntrico en un entorno del mundo real. La información se obtuvo del registro BIOBADASER. Los pacientes fueron mujeres embarazadas hasta el mes de noviembre del 2020, de 19 unidades de Rreumatología. Obtuvimos proporciones, medias y desviaciones estándar (DE) para describir la población de estudio y el uso de tratamientos. Se realizaron las pruebas t y χ2 para evaluar las diferencias entre grupos.Resultado:Se registraron 90 casos de embarazo (n=68 embarazos a término; n=22 abortos espontáneos). La mayoría de los casos suspendieron el tratamiento con FAME biológicos durante el embarazo (78,9%), pero 13 casos prosiguieron el tratamiento durante el embarazo, utilizando principalmente certolizumab pegol. Dichos casos obtuvieron un mejor manejo de la enfermedad reumática, aunque las diferencias no fueron estadísticamente significativas (DAS28-CRP, 2,9 [DE 1,6] vs. 2 [1,2], p=0,255; DAS28-ESR, 2,2 [1] vs. 1,7 [0,5], p=0,266). No se reportaron episodios adversos graves durante el embarazo y la lactancia.Conclusión: La situación de embarazo sigue siendo infrecuente en las pacientes con enfermedades reumáticas que utilizan FAME biológicos. Nuestros resultados reflejan que la enfermedad reumática tendió a progresar mejor durante el embarazo en las mujeres tratadas con FAME biológicos.(AU)

Derechos y deberes de información: el rol de la atención primaria de salud en la implementación de la ley que despenaliza la interrupción voluntaria del embarazo en tres causales en Chile / Drets i deures d'informació: el rol de l'atenció primària de salut en la implementació de la llei que despenalitza la interrupció voluntària de l'embaràs en tres causals a Xile / The right to information: The role of Primary Health Care in theimplementation of the Abortion Law in Chile

Este artículo presenta los resultados de una investigación cualitativa que indagasobre la implementación de la ley de interrupción del embarazo que despenalizó elaborto en tres causales específicas en Chile en 2017 (Ley 21.030) y el rol que laatención primaria de salud (APS) en la Región Metropolitana de Chile. Serealizaron 19 entrevistas a personal de la salud de la APS y del nivel secundariode atención en la Región Metropolitana además de dos personas del Ministerio deSalud.El cambio de régimen de penalización total a uno de despenalización por causalesexige capacitación a los equipos de salud e información a la población. Loshallazgos revelan que la falta de información y capacitación formal al personalsanitario constituye un obstáculo para el ejercicio de los derechos de las mujeresque otorga la ley, produciéndose un efecto cascada, en que las mujeres nocuentan con la información suficiente para ejercer sus derechos. A ello se suma,una disposición en la ley que produce confusión entre profesionales sobrepublicidad e información sobre los servicios. Se analizan los resultados a partir deestándares normativos nacionales e internacionales respecto a la obligación deinformar, y el derecho a ser informado en contexto de prestaciones sanitarias relativas al aborto.(AU)

Es va realitzar un estudi exploratori a través d'una enquesta a Comitès d'Ètica a països d'Amèrica Llatina i el Carib de parla hispana, per rellevar la seva situació davant d'emergències sanitàriesi consultar els dilemes ètics enfrontats a les investigacions per a COVID-19. S'obtingueren respostes de 106 comitès, pertanyents a 14 països. Només el 24% va respondre que existia una xarxa de comunicació eficient i efectiva entre comitès, prèvia a la pandèmia. El 45% va respondre que no existien a la seva regió comitès específics per avaluar projectes vinculats a emergències sanitàries amb anterioritat a la pandèmia. El percentatge de CEI que disposava de procediments previs per avaluar investigacions ensituacions d'emergències sanitàries va ser només de 7%, si bé el 52% estava en procés d'elaboració arran de la pandèmia. El percentatge de CEI que va considerar raonable un temps inferior a 5 dies per a l'avaluació de projectes de recerca va variar en virtut del disseny: 32% per als estudis observacionals i 12% per als assaigs clínics amb drogues o amb vacunes.Els tres problemes ètics principals identificats als estudis per a COVID van estar relacionats amb el consentiment informat, els aspectes metodològics i la poca informació prèvia o manca d'evidència per als productes de recerca. Considerem que cal reformular la manera de pensar els problemes ètics de les emergències cap a un abordatge global, amb un enfocament preventiu, on les xarxes de col·laboració entre els CEI haurien de convertir-se en regla.(AU)

This article presents the results of a qualitative research that inquiriesabout theimplementation of the law on termination of pregnancy that decriminalized abortionon three specific grounds in Chile in 2017 (Law 21.030) and the role of primaryhealth care (PHC) in the Metropolitan Region of Chile. Nineteen interviews wereconducted with PHC and secondary level of care health professionals in addition totwo officials from the Ministry of Health. The change from a regime of totalcriminalization to one of decriminalization by cause requires training for healthteams and information for the population.The findings reveal that the lack ofinformation and formal training for health personnel constitutes an obstacle to theexercise of women's rights under the law, producing a cascade effect in whichwomen do not have sufficient information to exercise their rights. In addition, thereis a provision in the law that causes confusion among professionals aboutadvertising and information on services.The results are analyzed on the basis ofnational and international normative standards regarding the obligation to informand the right to be informed in the context of health services related to abortion.(AU)

Dilemas de la objeción de conciencia en la interrupción voluntaria del embarazo: revisión integrativa de literatura / Dilemmas of conscientious objection in the voluntary interruption of pregnancy: integrative literature review

Introducción: La objeción de conciencia (OC) puede generar un conflicto para los profesionales de la salud en temas como la interrupción voluntaria del embarazo (IVE).Objetivo: Analizar los argumentos contenidos en la evidencia científica para la OC en el contexto de IVE. Método: Revisión integrativa literaria en seis etapas, obtenidos en las bases de datos MEDLINE/PUBMED, ISI Web of Science, LILACS y SciELO publicados entre 2018-2022 en idiomas inglés, portugués y español, ajustada a los requerimientos PRISMA. Los datos fueron resumidos mediante análisis temático. Resultados: A partir de 55 textos, 25 fueron analizados. Un 32% de las publicaciones se realizó en 2020, el 36% son análisis crítico de la literatura, 24% realizadas en Chile y un 32% se obtuvieron de PUBMED. Se obtienen tres categorías de trabajo: 1. Características de la OC. ¿Cómo afecta la OC a la salud pública? 2. La conveniencia de proceder a una regulación del ejercicio de la OC.3. Desafíos en materia de OC. Conclusiones: Se problematiza acerca de los aspectos que sostienen las actitudes profesionales, insistiendo en que, si bien la ley reconoce el ejercicio de OC en el ámbito de la salud, es necesario articular una protección bidireccional, de esta manera la OC se legitima y adquiere coherencia, velando por el derecho a la salud de las mujeres. Así, su argumento reside en el entendiendo que el principal compromiso de los equipos de salud es el bienestar de la salud sexual y reproductiva de las mujeres en todos los contextos. (AU)

Introduction: Conscientious objection (CO) can generate a conflict for health professionals on issues such as voluntary interruption of pregnancy (IVE). Objective: To analyze the arguments in the scientific evidence for CO in IVE. Method: Integrative literary review in six stages, obtained from the MEDLINE/PUBMED, ISI Web of Science, LILACS, and SciELO databases published between 2018-2022 in English, Portuguese, and Spanish, adjusted to PRISMA requirements. Data were summarized using thematic analysis.Results: From 55 texts, 25 were analyzed. 32% of the publications were made in 2020, 36% are critical analyses of the literature, 24% were made in Chile, and 32% were obtained from PUBMED. Three categories of work are accepted: 1. Characteristics of the CO. How does CO affect public health? 2. The advisability of proceeding to a regulation of the exercise of the CO.3. CO challenges. Conclusions: The aspects that support professional attitudes are problematized, insisting that, although the law recognizes the exercise of CO in the health field, it is necessary to articulate bidirectional protection; in this way, CO is legitimized and acquires coherence, ensuring the right to health of women. Thus, his argument resides in the understanding that the main commitment of health teams is the well-being of women's sexual and reproductive health in all contexts. (AU)

The Impact of the COVID-19 Pandemic on the Care of Women Experiencing Abortion in a University Hospital in Brazil / O Impacto da pandemia de COVID-19 no atendimento de mulheres que vivenciam o aborto em um hospital universitário no Brasil

Abstract Objective To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with miscarriage and legal termination of pregnancy in a university hospital in Brazil. Methods A cross-sectional study of women admitted for abortion due to any cause at Hospital da Mulher Prof. Dr. J. A. Pinotti of Universidade Estadual de Campinas (UNICAMP), Brazil, between July 2017 and September 2021. Dependent variables were abortion-related complications and legal interruption of pregnancy. Independent variables were prepandemic period (until February 2020) and pandemic period (from March 2020). The Cochran-Armitage test, Chi-squared test, Mann-Whitney test, and multiple logistic regression were used for statistical analysis. Results Five-hundred sixty-one women were included, 376 during the prepandemic period and 185 in the pandemic period. Most patients during pandemic were single, without comorbidities, had unplanned pregnancy, and chose to initiate contraceptive method after hospital discharge. There was no significant tendency toward changes in the number of legal interruptions or complications. Complications were associated to failure of the contraceptive method (odds ratio [OR] 2.44; 95% confidence interval [CI] 1.23-4.84), gestational age (OR 1.126; 95% CI 1.039-1.219), and preparation of the uterine cervix with misoprostol (OR 1.99; 95% CI 1.01-3.96). Conclusion There were no significant differences in duration of symptoms, transportation to the hospital, or tendency of reducing the number of legal abortions and increasing complications. The patients' profile probably reflects the impact of the pandemic on family planning.

Resumo Objetivo Avaliar o impacto da pandemia de coronavirus disease 2019 (Covid-19) no atendimento de pacientes com aborto espontâneo e interrupção legal da gravidez em um hospital universitário no Brasil. Métodos Estudo transversal com mulheres admitidas por aborto por qualquer causa no Hospital da Mulher Prof. Dr. J. A. Pinotti da Universidade de Campinas (UNICAMP), Brasil, entre julho de 2017 e setembro de 2021. As variáveis dependentes foram complicações relacionadas ao aborto e interrupção legal da gravidez. As variáveis independentes foram período pré-pandemia (até fevereiro de 2020) e período pandêmico (a partir de março de 2020). O teste de Cochran-Armitage, teste do qui-quadrado, teste de Mann-Whitney e regressão logística múltipla foram utilizados para análise estatística. Resultados Foram incluídas 561 mulheres, 376 no período pré-pandemia e 185 no período pandêmico. A maioria das pacientes durante a pandemia era solteira, sem comorbidades, teve gravidez não planejada e optou por iniciar método anticoncepcional após a alta hospitalar. Não houve tendência significativa para mudanças no número de interrupções legais ou complicações. As complicações foram associadas a: falha do método contraceptivo (razão de chances [RC] 2,44; intervalo de confiança [IC] 95% 1,23-4,84), idade gestacional (RC 1,126; IC 95% 1,039-1,219) e preparo do colo uterino com misoprostol (RC 1,99; IC 95% 1,01-3,96). Conclusão Não houve diferenças significativas na duração dos sintomas, transporte ao hospital ou tendência de redução do número de abortos legais e aumento de complicações. O perfil das pacientes provavelmente reflete o impacto da pandemia no planejamento familiar.

Contracepção pós-parto e pós-abortamento: um compilado das evidências atuais / Postpartum and post-abortion contraception: a compilation of current evidences

Idealmente, a contracepção deve ser iniciada o mais precocemente possível após o parto ou após o abortamento, permitindo que as mulheres sejam protegidas contra uma gravidez não programada subsequente. O objetivo desta revisão é discutir a contracepção no pós-parto e pós-aborto, por meio da análise de ensaios clínicos e metanálises, além das principais diretrizes internacionais, com ênfase nas indicações e contraindicações, tempo de início do uso dos métodos contraceptivos e possíveis complicações. Nesta revisão não sistemática, são discutidos os principais métodos contraceptivos: dispositivos intrauterinos, métodos somente de progestagênios, métodos hormonais combinados, métodos de barreira, método de amenorreia lactacional e esterilização. O aconselhamento contraceptivo pós-parto deve começar durante o pré-natal e, em pacientes após abortamento, durante a internação hospitalar. Todas as mulheres devem ter acesso a informações claras sobre cada método contraceptivo, e o processo de tomada de decisão deve ser compartilhado com o médico assistente. Idealmente, métodos de contracepção reversíveis de longa duração devem ser priorizados em relação aos outros. Em conjunto, todas as evidências demonstram que o melhor método para cada paciente é aquele que combine altas taxas de segurança com o desejo da paciente de iniciá-lo e mantê-lo pelo tempo que desejar.

Contraception should ideally be started as early as possible after childbirth or abortion to allow women to be protected against a subsequent unplanned pregnancy. The aim of this review is to discuss postpartum and postabortion contraception, through the analysis of clinical trials and meta-analyses, in addition to the main international guidelines, with emphasis on indications and contraindications, time to start contraceptive method and possible complications. In this review, the main contraceptive methods are discussed: intrauterine devices, progestin-only methods, combined hormonal methods, barrier methods, lactational amenorrhea method and sterilization. Postpartum contraceptive counseling should start during prenatal care and during hospital stay in post-abortion patients. All women should have access to clear information about each contraceptive method and the decision-making process must be shared. Ideally, long acting reversible contraception methods should be prioritized over others. Taken together, all the evidence shows that the best method for each patient is the one that combines high safety rates with the patient's desire to start and maintain it for as long as she wants.

Percepção sobre o cuidado à perda gestacional: estudo qualitativo com casais brasileiros / Perceptions on pregnancy loss care: a qualitative study with brazilian couples / Percepción sobre la atención a la pérdida del embarazo: estudio cualitativo con parejas brasileñas

Este artigo analisou a percepção e os sentimentos de casais sobre o atendimento recebido nos serviços de saúde acessados em função de perda gestacional (óbito fetal ante e intraparto). O convite para a pesquisa foi divulgado em mídias sociais (Instagram e Facebook). Dos 66 casais que contataram a equipe, 12 participaram do estudo, cuja coleta de dados ocorreu em 2018. Os casais responderam conjuntamente a uma ficha de dados sociodemográficos e uma entrevista semiestruturada, realizada presencialmente (n=4) ou por videochamada (n=8). Os dados foram gravados em áudio e posteriormente transcritos. A Análise Temática indutiva das entrevistas identificou cinco temas: sentimento de impotência, iatrogenia vivida nos serviços, falta de cuidado em saúde mental, não reconhecimento da perda como evento com consequências emocionais negativas, e características do bom atendimento. Os achados demonstraram situações de violência, comunicação deficitária, desvalorização das perdas precoces, falta de suporte para contato com o bebê falecido e rotinas pouco humanizadas, especialmente durante a internação após a perda. Para aprimorar a assistência às famílias enlutadas, sugere-se qualificação profissional, ampliação da visibilidade do tema entre diferentes atores e reorganização dos serviços, considerando uma diretriz clínica para atenção ao luto perinatal, com destaque para o fortalecimento da inserção de equipes de saúde mental no contexto hospitalar.(AU)

This study analyzed couples' perceptions and feelings about pregnancy loss care (ante and intrapartum fetal death). A research invitation was published on social media (Instagram and Facebook) and data collection took place in 2018. Of the 66 couples who contacted the research team, 12 participated in the study by filling a sociodemographic questionnaire and answering a semi-structured interview in person (n=04) or by video call (n=08). All interviews were audio recorded, transcribed, and examined by Inductive Thematic Analysis, which identified five themes: feelings of impotence, iatrogenic experiences in health services, lack of mental health care, not recognizing pregnancy loss as an emotionally overwhelming event, and aspects of good healthcare. Analysis showed experiences of violence, poor communication, devaluation of early losses, lack of support for contact with the deceased baby, and dehumanizing routines, especially during hospitalization after loss. Professional qualification, extended pregnancy loss visibility among different stakeholders, and reorganization of health services are needed to improve the care offered to grieving families, considering a clinical guideline for perinatal grief care with emphasis on strengthening the insertion of mental health teams in the hospital context.(AU)

Este estudio analizó las percepciones y sentimientos de parejas sobre la atención recibida en los servicios de salud a los que accedieron debido a la pérdida del embarazo (muerte fetal ante e intraparto). La invitación al estudio se publicó en las redes sociales (Instagram y Facebook). De las 66 parejas que se contactaron con el equipo, 12 participaron en el estudio, cuya recolección de datos se realizó en 2018. Las parejas respondieron un formulario de datos sociodemográficos y realizaron una entrevista semiestructurada presencialmente (n=4) o por videollamada (n=08). Los datos se grabaron en audio para su posterior transcripción. El análisis temático inductivo identificó cinco temas: Sentimiento de impotencia, experiencias iatrogénicas en los servicios, falta de atención a la salud mental, falta de reconocimiento de la pérdida como un evento con consecuencias emocionales negativas y características de buena atención. Los hallazgos evidenciaron situaciones de violencia, comunicación deficiente, desvalorización de las pérdidas tempranas, falta de apoyo para el contacto con el bebé fallecido y rutinas poco humanizadas, especialmente durante la hospitalización tras la pérdida. Para mejorar la atención a las familias en duelo, se sugiere capacitación profesional, ampliación de la visibilidad del tema entre los diferentes actores y reorganización de los servicios, teniendo en cuenta una guía clínica para la atención del duelo perinatal, enfocada en fortalecer la inserción de los equipos de salud mental en el contexto hospitalario.(AU)

Aborto, o direito maldito: uma análise sócio-histórica a partir da ADPF 442 / Abortion, the damn right: a socio-historical analysis from ADPF 442

Esta tese investiga os discursos hegemônicos em torno da "questão do aborto" no Brasil contemporâneo, a partir das 50 exposições realizadas na audiência pública sobre a Arguição de Descumprimento de Preceito Fundamental (ADPF) 442. Tal ação, ajuizada pelo Partido Socialismo e Liberdade em março de 2017, propõe a descriminalização do aborto induzido pela própria gestante ou com o seu consentimento, até a 12ª. semana de gravidez. A ADPF 442 deflagrou a convocação, pelo Supremo Tribunal Federal (STF), da referida audiência pública, realizada em agosto de 2018 e acompanhada presencialmente pela pesquisadora. O objetivo da pesquisa consiste em examinar a atual configuração das disputas travadas em torno da "questão do aborto" no Brasil, em uma perspectiva socio-histórica. Na primeira parte da tese, reconstituímos as dinâmicas de reprodução social e as políticas reprodutivas (inclusive, mas não apenas, aquelas relativas ao aborto) vigentes desde o período colonial até a democracia liberal contemporânea, através de um extenso levantamento historiográfico sobre o tema. Na segunda parte da tese, nos debruçamos sobre o conteúdo das exposições realizadas na audiência pública, utilizando o método da análise documental. O material empírico da pesquisa é composto pelo registro audiovisual e pela transcrição das exposições - ambos disponibilizados pelo STF. Dentre as 50 exposições, 33 foram favoráveis à ADPF, e 17, contrárias, havendo uma variação significativa na distribuição destas posições entre os quatro campos de enunciação e argumentação identificados, quais sejam: o da saúde, o do direito, o das religiões e o das organizações não governamentais, institutos e associações. Ao longo do processo analítico-interpretativo, buscamos apreender os sentidos e significados (patentes ou ocultos) dos discursos proferidos, nos quais a problemática do aborto aparece imbricada a questões atinentes às esferas da sexualidade, da contracepção, da maternidade, da família, da violência, dos valores morais, dos direitos, entre outras. Organizamos os resultados da análise documental em dois eixos. No primeiro, discutimos as diferentes maneiras como os atores políticos em cena enquadram a sua posição em relação à descriminalização do aborto em termos de uma batalha pela vida e contra a morte. Enquanto no campo favorável à ADPF esse embate entre morte e vida focaliza as condições concretas e desiguais sob as quais diferentes grupos de mulheres vivenciam a sexualidade e a reprodução, no campo contrário à ADPF a defesa da "inviolabilidade da vida desde a concepção" se dá de forma abstrata, como uma verdade autoevidente, incontestável e universal, completamente alheia aos percursos que levam a uma gravidez imprevista e aos dilemas enfrentados pelas mulheres que se deparam com tal situação. O segundo eixo analítico aborda as distintas noções - unitárias ou plurais - (re)produzidas na audiência a respeito da(s) mulher(es), família(s) e (não) maternidade(s). Nesta seara, os atores favoráveis à ADPF defendem a descriminalização do aborto como um dos elementos necessários à promoção da justiça social, indissociável de um conjunto de políticas públicas integrais, equânimes e universais, ao passo que os atores contrários à ação tendem a manifestar expectativas, preconceitos, prescrições e interdições centrais a uma agenda de restauração moral exacerbada no atual cenário político brasileiro.

This thesis investigates the hegemonic discourses around the "abortion issue" in contemporary Brazil, based on the 50 exhibitions held at the public hearing on the Fundamental Precept Noncompliance Claim (ADPF) 442. This action, filed by the Socialism and Freedom Party in March 2017, proposes the decriminalization of abortion induced by the pregnant woman herself or with her consent, until the 12th. week of pregnancy. ADPF 442 triggered the convening, by the Supreme Court (STF), of the aforementioned public hearing, held in August 2018 and accompanied in person by the researcher. The objective of the research is to examine the current configuration of disputes around the "issue of abortion" in Brazil, from a socio-historical perspective. In the first part of the thesis, we reconstruct the dynamics of social reproduction and the reproductive policies (including, but not limited to, those related to abortion) in force from the colonial period to contemporary liberal democracy, through an extensive historiographical survey on the subject. In the second part of the thesis, we focus on the content of the exhibitions held at the public hearing, using the method of document analysis. The empirical material of the research consists of the audiovisual record and the transcript of the exhibitions - both made available by the STF. Among the 50 expositions, 33 were in favor of ADPF, and 17 were against it, with a significant variation in the distribution of these positions among the four identified fields of enunciation and argumentation, namely: health, law, religions and non-governmental organizations, institutes and associations. Throughout the analytical-interpretative process, we seeked to apprehend the senses and meanings (patent or hidden) of the speeches, in which the issue of abortion appears intertwined with issues related to the spheres of sexuality, contraception, motherhood, family, violence , moral values, rights, among others. We organized the results of the document analysis into two axes. In the first one, we discuss the different ways in which political actors on the scene frame their position on the decriminalization of abortion in terms of a battle for life and against death. While in the field favorable to ADPF this clash between death and life focuses on the concrete and unequal conditions under which different groups of women experience sexuality and reproduction, in the field contrary to ADPF the defense of the "inviolability of life from conception" takes place abstractly, as a self-evident, indisputable and universal truth, completely alien to the paths that lead to an unforeseen pregnancy and to the dilemmas faced by women who are faced with such a situation. The second analytical axis addresses the different notions - unitary or plural - (re)produced in the audience regarding women, family(ies) and (non)maternity(ies). In this field, the actors in favor of ADPF defend the decriminalization of abortion as one of the necessary elements to promote social justice, inseparable from a set of integral, equitable and universal public policies, while the actors opposed to the action tend to express expectations, prejudices, prescriptions and interdictions central to an agenda of moral restoration exacerbated in the current Brazilian political scenario.

Conocimientos y actitudes sobre interrupción voluntaria del embarazo en estudiantes de una Universidad de Cartagena (Colombia) / Knowledge and attitudes regarding interruption of pregnancy in students of a University in Cartagena (Colombia)

Introducción: La interrupción voluntaria del embarazo es un asunto político que polariza las opiniones y genera controversias entre el sector salud, social, económico y cultural. Objetivo: Determinar el nivel de conocimiento y actitudes sobre la interrupción voluntaria del embarazo en estudiantes de dos programas de Ciencias de la Salud de Cartagena. Materiales y métodos: Estudio descriptivo transversal, se aplicó el cuestionario adaptado por Marceliano y Medrano a 231 estudiantes de Enfermería y Medicina, los datos se analizaron obteniendo frecuencias relativas y absolutas. Resultados: El nivel de conocimiento de los estudiantes fue alto con 92,20% (213). Sin embargo, el 37,2% (86) no sabía cuáles eran las tres causales para que el aborto no se considere un delito. El 56,7% asume actitudes negativas hacia firmar una petición para legalizar el aborto y el 18,8% considera que si una mujer se realiza un aborto debe ir a la cárcel. Conclusión: El nivel de conocimiento de los estudiantes de medicina y enfermería es alto, sin embargo, los patrones muestran desconocimiento sobre las causales de legalización del aborto de acuerdo con la norma vigente y una variabilidad de actitudes positivas y negativas ante la interrupción voluntaria del embarazo.

Introduction: Voluntary interruption of pregnancy is a political issue that polarizes opinions and generates controversy within the health, social, economic, and cultural sectors. Objective: To determine the level of knowledge and attitudes regarding voluntary interruption of pregnancy in university students from two Health Sciences programs of Cartagena. Materials and methods: A descriptive cross-sectional study; the questionnaire adapted by Marceliano and Medrano was given to 231 students within the Nursing and Medical programs; the data was analyzed through relative and absolute frequencies. Results: The level of knowledge of the students was high with a 92.20% (213). Yet, a 37.2% (86) did not know the three reasons why abortion is not considered a crime. 56.7% have negative attitudes regarding signing a petition to legalize abortion and an 18.8% believe that a woman who has an abortion should go to jail. Conclusion: The level of knowledge in medical and nursing students is high, yet the patterns show lack of knowledge of the reasons for legalization of abortion according to the current laws and a variety of positive and negative attitudes regarding the voluntary interruption of pregnancy.

Pesar no óbito fetal: luto sem voz / Grief after fetal death: a voiceless mourning / Pesar por la muerte fetal: duelo sin voz

Resumo O Ministério da Saúde orienta que a declaração de óbito não seja emitida em casos de óbito fetal com gestação inferior a 20 semanas ou feto com peso inferior a 500 g ou estatura menor que 25 cm, acrescentando que a legislação permite a emissão da declaração em casos em que a família deseje fazer o sepultamento do feto. Nesse contexto, são poucos os casos de aborto em que a declaração é feita. Este artigo realizou revisão integrativa que responde à pergunta: os rituais de fechamento, particularmente o sepultamento (possibilitado pela emissão da declaração de óbito) em caso de morte fetal inferior a 20 semanas de idade gestacional, ajudariam no processo de luto dos pais? A literatura consultada trouxe informações favoráveis à emissão da declaração de óbito e possibilitou discussão médica, jurídica e antropológica do tema.

Abstract The Ministry of Health advises that death certificates should not be issued in cases of fetal death for a pregnancy of less than 20 weeks or fetus weighing less than 500 g or shorter than 25 cm in height; however, the legislation allows the issuance of the certificate in cases where the family wishes to bury the fetus. Given this context, abortion cases in which the certificate is issued are few. This article presents an integrative review that answers the question: would the death ceremonies, particularly the burial (made possible by the issuance of the death certificate), in case of fetal death under 20 weeks of gestational age help in the parents' mourning process? The literature consulted presented favorable information for the issuance of the death certificate and enabled a medical, legal and anthropological discussion of the theme.

Resumen El Ministerio de Salud brasileño recomienda que no se debe emitir el certificado de defunción en los casos de muerte fetal de menos de 20 semanas de gestación, feto con peso inferior a 500 g o estatura inferior a 25 cm, pero agrega que se puede permitirlo cuando la familia opta por el entierro del feto. En este contexto, el certificado se emite en pocos casos de aborto. Este artículo realizó una revisión integradora a partir de la pregunta: ¿Ayudarían en el proceso de duelo de los padres los rituales de inhumación, sobre todo el entierro (habilitado mediante la emisión de un certificado de defunción) en caso de muerte fetal con menos de 20 semanas de edad gestacional? La literatura consultada aportó con informaciones favorables a la emisión del certificado de defunción y permitió fomentar la discusión médica, jurídica y antropológica del tema.

Alteraciones citogenéticas en pacientes con diagnóstico de infertilidad en Lima, Perú / Cytogenetic abnormalities in patients with infertility diagnosis in Lima, Peru

INTRODUCCIÓN: La infertilidad es una enfermedad multicausal y el componente genético representa uno de sus principales eventos. Si bien la distribución de la infertilidad puede variar entre poblaciones, las parejas de los países con bajos y medianos ingresos pueden verse más afectadas por la infertilidad, con una proporción de alteraciones citogenéticas aún no esclarecidas. OBJETIVO: Evaluar la frecuencia de alteraciones citogenéticas y su correlación con el número de abortos en pacientes peruanas con diagnóstico de infertilidad. MÉTODO: Se realizó un estudio de corte transversal en 400 pacientes de 18 a 60 años, de ambos sexos, con diagnóstico de infertilidad. Se registraron las características clínicas disponibles durante el examen genético y el análisis citogenético convencional fue con bandeo GTG en muestras de sangre periférica. El análisis de correlación se realizó con la prueba de Spearman. RESULTADOS: Del total, 389 pacientes cumplieron los criterios de inclusión, y de estos, 169 (43,44%) tuvieron reportes de abortos (promedio: 2,25, rango: 1-7). Hallamos una correlación significativa ente el número de abortos y las alteraciones citogenéticas (p < 0,000). Reportamos 25/289 (6,43%) alteraciones cromosómicas, de las que 11/25 (44%) fueron heterocromatinas constitutivas y 6/25 (24%) fueron translocaciones reciprocas. Las alteraciones citogenéticas más frecuentes fueron 16qh+ y 9qh+ (ambas con un 16%), y afectaron a 17 (68%) varones. CONCLUSIONES: Existe una moderada frecuencia de alteraciones citogenéticas en pacientes peruanos con diagnóstico de infertilidad, y las alteraciones más frecuentes fueron heterocromatina constitutivas. Además, evidenciamos una correlación significativa ente el número de abortos y las alteraciones citogenéticas.

INTRODUCTION: Infertility is a multicausal disease and the genetic component represents one of its main events. Although the distribution of infertility may vary between populations, couples in low-and-middle-income countries may be more affected by infertility with a proportion of cytogenetic alterations still unclear. OBJECTIVE: To evaluate the frequency of cytogenetic alterations and their correlation with the number of abortions in Peruvian patients with a diagnosis of infertility. METHOD: A cross-sectional study was carried out in 400 patients between 18 and 60 years-old, of both genders with a diagnosis of infertility. The clinical characteristics available during the genetic examination were recorded and the conventional cytogenetic analysis was with GTG banding in peripheral blood samples. The correlation analysis was performed with the Spearman test. RESULTS: Of the total 389 patients who met the inclusion criteria, of these 169 (43.44%) patients had reports of abortions (mean: 2.25, range: 1-7). We found a significant correlation between the number of abortions and cytogenetic alterations (p < 0.000). We report 25/289 (6.43%) chromosomal alterations, where 11/25 (44%) were constitutive heterochromatin, and 6/25 (24%) were reciprocal translocations. The most frequent cytogenetic alterations were 16qh + and 9qh + (both 16%), and affected 17 (68%) men. CONCLUSIONS: There is a moderate frequency of cytogenetic alterations in Peruvian patients diagnosed with infertility, where the most frequent alterations were constitutive heterochromatin. Furthermore, we evidenced a significant correlation between the number of abortions and cytogenetic alterations.

Abordagem psicossocial às perdas gestacionais na Atenção Primária à Saúde / Psychosocial approach to pregnancy loss in primary health care / Abordaje psicosocial de las pérdidas gestacionales en Atención Primaria de Salud

Introdução: Perdas gestacionais são eventos comuns na vida reprodutiva. Tendo em vista a dificuldade individual e profissional de lidar com o sofrimento mental que ocasionam, indaga-se sobre a escolha da técnica, a periodicidade e o modo de execução das abordagens que melhor se adequariam ao enfrentamento dessa situação. Sendo assim, esta revisão clínica tem como objetivo avaliar a literatura recente acerca do tema e buscar as melhores evidências científicas em relação à abordagem psicossocial a essas perdas. Métodos: Foram utilizadas palavras-chave determinadas pelo Medical Subject Headings (MeSH) para selecionar títulos de estudos nas bases de dados: PubMed, ACCESSSS, British Medical Journal (BMJ), DYNAMED, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Os critérios de inclusão foram: ano de publicação entre 2010 e 2020; tipo de estudo (metanálise, revisão sistemática, ensaio clínico randomizado, ensaio clínico não randomizado, coorte ou caso controle); não abordar abortamento induzido; estar em inglês, português ou espanhol; ser passível de ser encontrado na íntegra. Resultados: Foram encontrados 28 artigos, que tiveram seus resumos avaliados; 14 foram excluídos e 14 lidos na íntegra. No fim, nove estudos foram incluídos nesta revisão. Foi possível observar que sintomas psicológicos são frequentemente apresentados após perdas gestacionais, que há diversas maneiras de acessar esses dados e que não há consenso sobre qual a melhor intervenção a ser feita. Além disso, em homens e casais homossexuais, há maior chance de invisibilidade do sofrimento e menor abordagem de luto por profissionais de saúde. Conclusão: Na falta de consenso sobre quais intervenções apresentam melhores resultados, recomenda-se o rastreamento de sofrimento mental e o compartilhamento da decisão com as partes envolvidas.

Introduction: Pregnancy losses are common events in reproductive life. In view of the individual and professional difficulty of dealing with the mental suffering that they cause, we question the choice of technique, the regularity and the way of carrying out approaches that would be better suited to cope with this situation. Therefore, this clinical review aimed to assess the recent literature and seek the best scientific evidence about the psychosocial approach to these losses. Methods: Keywords determined by MeSH were used to select study titles in the databases PUBMED, ACCESSSS, BMJ, DYNAMED, EBM and LILACS. The inclusion criteria were: year of publication between 2010-2020; study type (meta-analysis, systematic review, randomized clinical trial, non-randomized clinical trial and cohort or control case); induced abortion not addressed; written in English, Portuguese or Spanish; and found in full text. Results: Twenty-eight articles were found and their abstracts were evaluated, where 14 were excluded and 14 were read in full. In the end, 9 studies were included in this review. It was observed that psychological symptoms are frequently presented after pregnancy losses, that there are several ways to access these data and that there is no consensus on the best intervention. In addition, in men and homosexual couples, there is a greater chance of making suffering invisible and a lesser mourning approach by health professionals. Conclusion: In the absence of consensus on which interventions have the best results, it is recommended to screen for mental suffering and share the decision with the parties involved.

Introducción: Las pérdidas de embarazos son eventos comunes en la vida reproductiva. Ante la dificultad individual y profesional de afrontar el sufrimiento mental provocado, nos cuestionamos la técnica, la periodicidad y la forma de los mejores abordajes a afrontar esta situación. Por lo tanto, esta revisión clínica tiene como objetivo evaluar la literatura reciente y buscar la mejor evidencia científica sobre el abordaje psicosocial de estas pérdidas. Métodos: Se utilizaron palabras clave determinadas por MeSH para seleccionar los títulos de los estudios en las bases de datos: PUBMED, ACCESSSS, BMJ, DYNAMED, EBM, LILACS. Criterios de inclusión fueron: año de publicación entre 2010-2020; tipo de estudio (metaanálisis, revisión sistemática, ensayo clínico aleatorizado, ensayo clínico no aleatorizado, cohorte o caso de control); no abordar el aborto inducido; estar en inglés, portugués o español; posible encontrar en su totalidad. Resultados: Se encontraron 28 artículos, se evaluaron sus resúmenes, se excluyeron 14 y se leyeron 14 completamente. Al final, se incluyeron 9 estudios. Se pudo observar que los síntomas psicológicos se presentan con frecuencia después de las pérdidas del embarazo, que existen varias formas de acceder a estos datos y que no existe consenso sobre la mejor intervención. Además, en los hombres y las parejas homosexuales existe una mayor posibilidad de invisibilizar el sufrimiento y un menor enfoque de duelo por parte de los profesionales. Conclusión: En ausencia de consenso sobre qué intervenciones tienen los mejores resultados, se recomienda realizar un seguimiento del sufrimiento mental y compartir la decisión con las partes involucradas.

Seguridad de la Interrupción Voluntaria del Embarazo (IVE) en dos Instituciones Prestadoras de Salud en Medellín, Colombia, en 2019. Cohorte histórica / Safety of voluntary interruption of pregnancy (VIP) in two healthcare institutions in Medellín, Colombia, in 2019. Historical cohort

RESUMEN Objetivos: caracterizar una cohorte de mujeres con interrupción voluntaria del embarazo (IVE) y describir las complicaciones intraoperatorias según la técnica aplicada. Materiales y métodos: estudio descriptivo, de cohorte histórica en mujeres intervenidas a IVE en dos Instituciones Prestadoras de Salud-IPS en Medellín, Colombia, en el 2019. Se excluyeron aquellas mujeres con infección pélvica, e infecciones de transmisión sexual (ITS). Se realizó un muestreo consecutivo, se evaluaron variables sociodemográficas, de salud sexual y reproductiva, características clínicas del embarazo, causa legal de la IVE, características de la atención y las complicaciones hasta los 7 días posteriores al procedimiento de las técnicas de IVE. Finalmente, se hace análisis descriptivo. Resultados: durante el periodo de estudio hubo 1.520 mujeres elegibles de las cuales 46 fueron intervenidas en otras instituciones por lo que quedaron 1.474 candidatas a ingresar al estudio, de estas se excluyeron 30 por presentar infecciones pélvicas o de transmisión sexual, por lo que, finalmente, se analizaron 1.444 mujeres gestantes. Los riesgos para la salud de la mujer fueron la causa legal más frecuente con un 94,3%. El 99% de las mujeres tenían asesoría previa, y el 78,4% aceptó algún método anticonceptivo post-IVE. El 95,6% de las mujeres fueron intervenidas por la técnica de aspiración manual endouterina (AMEU) y al 4,4% se la practicó la técnica de dilatación y curetaje (D&C). En un 17,56% de las pacientes intervenidas con D&C se presentaron complicaciones hasta el séptimo día posoperatorio, no hubo complicaciones en el grupo sometido a AMEU, el 80% de las mujeres asistieron a control el séptimo día post-IVE. Conclusiones: la AMEU es un procedimiento seguro que no generó complicaciones intraoperatorias en el procedimiento, mientras la D&C se acompañó de complicaciones en una de cada seis pacientes. Se requieren estudios prospectivos que evalúen la seguridad y costos de las diferentes alternativas de IVE.

ABSTRACT Objectives: To characterize a cohort of women with voluntary interruption of pregnancy (VIP) and to describe intraoperative complications according to the technique used. Materials and methods: Descriptive study in a historical cohort of women undergoing VIP in two healthcare institutions in Medellín, Colombia, in 2019. Women with pelvic infection and Sexually Transmitted Infections (STIs) were included. Consecutive sampling was used. Sociodemographic, sexual and reproductive health, clinical characteristics of the pregnancy, legal cause of the VIP, characteristics of the care process and complications of the VIP techniques up to postprocedural day 7 were the measured variables. A descriptive analysis was carried out. Results: Overall, 1,520 women were identified as eligible during the study period. Of them, 46 were intervened in other institutions, leaving 1,474 candidates to enter the study. Of them, 30 were excluded because of pelvic or sexually transmitted infections. Ultimately, 1,444 pregnant women were included in the analysis. Risk to the mother's health was the most frequent legal cause in 94.3% of cases. Ninety-nine percent of women received pre-procedural counseling, and 78.4% agreed to use some form of contraception after VIP. Manual vacuum aspiration (MVA) was used in 95.6% of women and dilation and curettage (D&C) in 4.4%. Complications up to postoperative day 7 occurred in 17.56%, and there were no complications in the MVA group; 80% of women attended the follow-up visit on post-VIP day 7. Conclusions: MVA is a safe procedure which was not associated with intraperatory comoplications. D&C was associated to complications in one of each six patients. Prospective studies to assess the safety and cost of the different VIP options are required.

A enfermagem na assistência às mulheres em situação de perda fetal e aborto: revisão integrativa / Nursing care for women with fetal loss and abortion: integrative review / Cuidados de enfermería a mujeres en situación de pérdida fetal y aborto: revisión integradora

Objetivo: Analisar a inserção da enfermagem na assistência às mulheres em situação de perda fetal e aborto nos diferentes níveis de atenção à saúde. Método: Revisão integrativa da literatura publicada entre 2015 e 2020 por meio de busca nas bases de dados Pubmed, Medline, CINAHL, LILACS, BVS, Embase e Web of Science e com descritores estabelecidos pelos MeSH e DeCS. Resultados: Foram selecionados 13 artigos de origem nacional (15,3%) e internacional (84,7%) nos idiomas português e inglês. Os principais resultados reportam que o cuidado integral e humanizado em situações de perda fetal envolve as seguintes etapas: o acolhimento; as orientações; e o esclarecimento de possíveis dúvidas. Afirma-se que o impacto emocional decorrente da perda afeta a mãe, familiares e o profissional de enfermagem. Conclusão: A revisão evidencia que a prática assistencial da enfermagem em situações de perda fetal e aborto representa uma experiência complexa, contudo, gratificante por oportunizar um espaço de humanização do cuidado com ênfase no sofrimento psíquico da mulher e companheiro. Apontam-se como eixos fortalecedores da qualidade desta assistência a capacitação profissional, o desenvolvimento de estudos e diretrizes sobre a prática assistencial.(AU)

Objective: To analyze the insertion of nursing in the assistance to women in situations of fetal loss and abortion in the different levels of health care. Método: Integrative review of literature published between 2015 and 2020 by searching Pubmed, Medline, CINAHL, LILACS, BVS, Embase and Web of Science databases and with descriptors established by MeSH and DeCS. Resultados: Thirteen articles were selected from national (15.3%) and international (84.7%) origins in Portuguese and English. The main results reported that integral and humanized care in situations of fetal loss involves the following stages: welcoming, guidance, and clarification of possible doubts. It is stated that the emotional impact resulting from the loss affects the mother, family members and the nursing professional. Conclusion: The review shows that the practice of nursing care in situations of fetal loss and abortion represents a complex experience, however, rewarding for providing an opportunity for humanization of care with emphasis on the psychological suffering of the woman and her companion. Professional training, the development of studies and guidelines on care practice are pointed out as strengthening axes for the quality of this assistance. Descriptors: Fetal Death; Abortion; Women´s Health; Obstetric Nursing; Nursing Care.(AU)

Objetivo: Analizar la inserción de la enfermería en la asistencia a las mujeres en situación de pérdida fetal y aborto en los diferentes niveles de atención sanitaria. Método: Revisión integradora de la literatura publicada entre 2015 y 2020 mediante búsqueda en las bases de datos Pubmed, Medline, CINAHL, LILACS, BVS, Embase y Web of Science y con los descriptores establecidos por MeSH y DeCS. Resultados: Se seleccionaron 13 artículos de origen nacional (15,3%) e internacional (84,7%) en portugués e inglés. Los principales resultados indican que el cuidado integral y humanizado en las situaciones de pérdida fetal incluye las siguientes etapas: el acolchado, las orientaciones y la aclaración de las posibles dudas. Se afirma que el impacto emocional resultante de la pérdida afecta a la madre, a los familiares y a los profesionales de la enfermería. Conclusión: La revisión evidencia que la práctica asistencial de la enfermería en situaciones de perdición fetal y aborto representa una experiencia compleja, sin embargo, gratificante por oportunizar un espacio de humanización del cuidado con énfasis en el sufrimiento psíquico de la mujer y el acompañante. La formación profesional, el desarrollo de estudios y directrices sobre la práctica asistencial se señalan como ejes de refuerzo para la calidad de esta asistencia.(AU)

Dolor fetal y sus consideraciones bioéticas / Fetal pain and its bioethical considerations

Los avances médicos y científicos han hecho posible la realización cada vez más temprana de procedimientos que involucran la vida humana dentro del vientre materno. A partir de lo anterior, ha surgido eldilema entorno a la percepción o experiencia del dolor fetal y sus implicaciones en diversos campos como:el diagnóstico prenatal, la cirugía fetal y en especial en torno al aborto. El presente documento buscarealizar una aproximación al desarrollo embriológico de las vías del dolor y sus componentes, evaluar lapertinencia de la definición actual de dolor en este contexto, y las implicaciones bioéticas a las distintasintervenciones que se realizan en el feto. Consideramos que a pesar de que hace falta evidencia científicaen este campo, el conocimiento disponible indica que si es posible experimentar dolor en el vientre materno en especial desde el segundo trimestre por lo que es importante la reflexión sobre el dolor fetal yla necesidad de tomar consciencia de esto, antes de realizar cualquier intervención que involucre al fetocomo paciente.

Medical and scientific advances have made it possible to carry out more and more early proceduresinvolving human life within the mother’s womb. Based on the above, the dilemma surrounding the perception or experience of fetal pain has emerged and its implications in various fields such as: prenataldiagnosis, fetal surgery and especially around abortion. This document seeks to carry out an approach tothe embryological development of pain pathways and their components, to assess the relevance of thecurrent definition of pain in this context, and the bioethical implications of the different interventions carried out on the fetus. We consider that despite the need for scientific evidence in this field, the availableknowledge indicates that it is possible to experience pain in the mother’s womb especially since the 20thweek of gestation, so it is important to reflect on fetal pain and the need to become aware of this, beforeperforming any intervention involving the fetus as a patient

"When America Sneezes, the World Catches a Cold" What does overturning Roe v. Wade mean for women's reproductive health in Africa?

Communities and countries and ultimately the world are only as strong as the health of their women." - Michelle Obama, 2016 On 24 June 2022, the Supreme Court of the United States (SCOTUS) decided on Dobbs v Jackson Women's Health Center, overturning the historic Roe v. Wade decision that has, since 1973, confirmed and enshrined the constitutional right of a woman to seek an abortion1 . Restrictions to legal, safe abortions are known to have serious repercussions for maternal and infant health. Evidence shows that restricting access to abortion does not reduce the number of abortions; it only makes abortion less safe and more likely to lead to preventable complications, including maternal death. Conversely, expanding access to safe, legal abortion­a common medical procedure that carries very little risk when performed by a trained provider in an appropriate environment­is associated with improved maternal health outcomes. Further, illegal abortion results in negative societal outcomes, including chronic morbidity for the individual woman; economic burdens to women and their communities when they cannot work or finish school; and added stress to families, communities, and already over-stretched public health systems.

Roe vs. Wade: US prevarication poses threat to sub-Saharan Africa

Roe vs. Wade is a well-publicized decision of the US Supreme Court in January 1973 in which the court ruled 7-2 that the US constitution protects the liberty of a pregnant woman to choose to have an abortion without excessive government restriction1. Since then, various governments and States in the United States have applied this decision rather inconsistently, and indeed, abortion has become one of the most controversial issues in US political history2. In early May 2022, this prevarication reached its zenith when a leaked document showed that the US Supreme Court might be contemplating reversing itself on its former decision, and thereby limit women's rights to safe abortion3. If this happens, it would mean that abortion could instantly become illegal in 26 out of the 50 US States. This possibility could be reached as early as June or early July 2022. The implications of restrictive abortion law in 26 American States would not be difficult to contemplate. It would mean a major reversal of the gains in women's health and social well-being that have been achieved over the past decades, something that should be unthinkable for a major developed and exemplary country like the US. In truth, restrictive abortion laws have never been known to reduce women's desire to seek induced abortion, anywhere. It only makes the procedure more difficult to access and therefore more dangerous and unsafe for women. What the change in the law therefore means is that women requiring pregnancy termination would have to travel to other States in the US or possibly outside the country to seek safe abortion care, resulting in untold hardships. It would re-enact the case of another developed country like Romania that witnessed severe hardships and increased mortality of women after abortion became legally restricted in 1967 under President Nicolae Ceausescu4. The situation changed from 1990 when the restriction on abortion was lifted following the Romania revolution.

Strengthening access to long-acting reversible contraception within postabortion care in Tanzania: A pre-post evaluation

Postabortion care services provide lifesaving treatment for abortion-related complications and addresses women's needs by offering family planning (FP) counseling and voluntary access to contraception. Between 2016 and 2020, the Government of Tanzania sought to strengthen its PAC program by enhancing FP counseling and clients' access to a wide range of contraceptive options.The project team conducted a pre-post evaluation in 17 public sector healthcare facilities in mainland Tanzania and 8 in Zanzibar. It comprised structured client exit interviews (CEIs), completed first in 2016 (n=412) and again in 2020 (n=484). These data complemented an evaluation that used routine service statistics to demonstrate the intervention's effects on client-reported outcomes. Primary outcomes of the CEIs reflected client experience and satisfaction with services, and researchers compared prepost differences using chi-square tests. There were improvements in numerous indicators, including client waiting times, recall of emergency procedure counseling, contraceptive uptake, and satisfaction with the quality of overall counseling and FP information and services; however, triangulation of CEI data with service statistics indicated that some outcomes, though still improved since baseline, attenuated. Strengthening the FP component of PAC is feasible in Tanzania and Zanzibar, but strategies to sustain quality improvements over time are needed. (Afr J Reprod Health 2022; 26[5]: 28-40)

Application of a modified Poisson model in identifying factors associated with prevalence of pregnancy termination among women aged 15 ­ 49 years in Uganda

Background: Abortion in Uganda is illegal, only permitted when it places the pregnant mother at risk. This study aimed to apply the modified Poisson model in identifying factors associated with the prevalence of pregnancy termination among women of reproductive age in Uganda. Methods: The 2016 Uganda Demographic Health Survey (UDHS) data were used in this study. More than 18,000 women of the age of 15 ­ 49 years participated in this study. A modified Poisson model that incorporated sampling weights was used to establish the factors associated with pregnancy termination. Results: In Uganda, 18,506 (18.1%) had ever had a pregnancy terminated. The results revealed that, the woman's age [APR = 3.15, 95% CI: 2.72-3.63], being married [APR = 1.55, 95% CI: 1.40-1.71], mass media exposure [APR = 1.18, 95% CI: 1.08-1.29], working status [APR = 1.21, 95% CI: 1.09-1.35], and having visited a health facility [APR = 1.20, 95% CI: 1.10-1.31] were positively significantly associated with likelihood of pregnancy termination. Conclusion: There exists a significant proportion of women who have had their pregnancies terminated in Uganda. It is observed that woman's age, marital status, mass media exposure, having visited a health facility in the last 12 months and working status were main predictors. Based on these results, researchers concluded that the emphasis should be put on improving access to post-abortion care, contraceptive use and media exposure

Barreras y factores facilitadores para la accesibilidad a lainterrupción legal del embarazo (ILE) en el subsistema privado y de la seguridad social de Argentina: análisis dela situación institucional en el Hospital Italiano de Buenos Aires / Barriers and facilitating factors for accessibility to legal interruption of pregnancy in Argentina's public health and private subsystem: analysis of the institutional situation at Hospital Italiano de Buenos Aires

Hasta diciembre de 2020, en Argentina el aborto era legal ante determinadas causales. Sin embargo, era común que la implementación de esta legislación se viera entorpecida. El objetivo de esta investigación fue identificar las barreras y los factores facilitadores para la accesibilidad a la interrupción legal de embarazo en una institución del subsistema privado y de la seguridad social. Se realizó una investigación con enfoque cualitativo con entrevistas a profesionales del equipo de salud involucrados en el circuito de atención de interrupción legal de embarazo del Hospital Italiano de Buenos Aires. Los resultados se organizan en cinco ejes temáticos que surgieron luego de un proceso de lectura, interpretación y discusión:1) ausencia de una política institucional explícita, 2) los componentes de la práctica (falta de registro en la historia clínica electrónica, desarrollo de circuitos paralelos para acceder a la medicación: misoprostol), 3) el marco jurídico legal y las causales (falta de leyes claras, diversas interpretaciones en lo que respecta al causal salud), 4) la objeción de conciencia y 5) los aspectos contextuales (movimiento feminista, el proyecto de ley desaprobado en el senado en 2018). A pesar de que el equipo de salud contaba con un marco legal claro, implementar una política institucional interna resulta sumamente necesario. (AU)

Up until December 2020, abortion was legal in Argentina on certain grounds. However, it was common for the implementation of this legislation to be hindered. The purpose of this research was to identify the barriers and facilitating factors for the accessibility to legal abortion in both private and public health care institutions. A qualitative research was carried out with interviews with health professionals involved in the health team at Hospital Italiano de Buenos Aires legal interruption of pregnancy care circuit. The results are organized into five thematic axes that emerged after a process of reading, interpreting and discussing: 1) the absence of an explicit institutional policy, 2) the components of the practice (lack of registration in the electronic health records, development of parallel circuits to access medication: misoprostol), 3) the legal framework and grounds (lack of clear laws, different interpretations regarding health grounds), 4) conscientious objection, and 5) contextual aspects (feminist movement, the bill disapproved in the Senate in 2018). Even though the health teamhad a clear legal framework in place, implementing an internal institutional policy is extremely necessary. (AU)