The strategy is effective in reducing unsafe abortions and their health consequences.

The history of the creation of the risk and harm reduction model applied to unsafe abortion is reviewed, from its initial implementation by a small group of gynecologists at the Pereira Rossell Hospital Center in Uruguay to its spread to the rest of the country. Its ethical rationale, its successful application in the hospital, the decision to disseminate it with the cooperation of the International Federation of Gynecology and Obstetrics (FIGO), and the intervention procedures are explained. It was evaluated from the epidemiological and anthropological viewpoints, from the changes in professionals' and users' perception of the care offered and its impact on complications and maternal deaths. A very favorable change was seen in the number and quality of the services, the providers' attitude, and maternal morbidity and mortality were reduced. It also brought visibility to women with unplanned and unwanted pregnancies and an improved understanding of their problems, which contributed to the legislative changes that were made subsequently.

Objective: To analyze the attitudes and behavior of gynecologists in Uruguay with respect to the right to conscientious objection that is included in the law concerning voluntary termination of pregnancy. Methods: The relevant laws and decrees, academic articles, legal or administrative claims, and the positions published by the institutions representing physicians or by groups of gynecologists were analyzed. Results: In general, the institutions positioned themselves in favor of correct application of conscientious objection and the immense majority of gynecologists followed this conduct. Small groups mounted a strong opposition and in one department (province) all gynecologists declared themselves to be objectors. Conclusion: Most gynecologists, whether or not they are objectors, proved to have a "loyalty to duty," fulfilling their primary obligation to abide by the ethical duty to give treatment to the persons who need it. A small group used conscientious objection to impede the provision of care to the women who needed the service, some group members being genuine objectors and others pseudo-objectors.

Tocolysis and delayed delivery renders better immediate neonatal results than emergency delivery when fetal distress is suspected because of a non-reassuring fetal heart pattern. In addition, it may decrease the need for emergency delivery without increasing maternal and fetal adverse side-effects.

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

Objective: To evaluate the implementation of the law that liberalizes voluntary abortion in Uruguay and enables health services to offer these services to the population. Methods: The legal and regulatory provisions are described and the national data-provided by the Ministry of Public Health's National Information System (SINADI)-on the number of voluntary terminations of pregnancy, the abortion method (medical or surgical), and whether it was performed as an outpatient or inpatient are analyzed. To determine complications, the number of maternal deaths and admissions to intensive care units for pregnant women was used. The study period ran from December 1, 2012, to December 31, 2014. Results: A total of 15 996 abortions were performed during the study period; only 1.2% were surgical and 98.8% were medical. Of the latter, only 3.4% required hospitalization. Less than half of the pregnancies were terminated up to 9 weeks of gestation and 54% were at 10 to 12 weeks in a sample from the Pereira Rossell Hospital. Conclusion: The rapid nationwide rollout of voluntary termination of pregnancy services to all women was possible to a large degree thanks to the availability and broad acceptance of medical abortion, facilitated by the prior experience in applying the risk and harm reduction strategy.

It is feasible to implement the proposed risk-reduction model in a traditional community such as Rivera, not only in Uruguay but in any country irrespective of its abortion laws.

Changes in public policies and health actions such as the model for reducing the risk and harm of unsafe abortions coincided with a marked reduction in abortion-related maternal mortality. The challenges still to be faced include managing second trimester abortions, ensuring the creation of multidisciplinary teams, and offering postabortion contraception.