From harm reduction to legalization: The Uruguayan model for safe abortion

Abstract

Advocacy by feminists and healthcare providers was essential in passing the 2012 bill legalizing abortion in Uruguay, which was primarily framed in terms of a public health imperative. Prior to legalization, a group of influential physicians had established a “harm reduction” approach consisting of pre‐ and postabortion counseling with a focus on safer abortion methods. The existence of a network of providers from this initiative facilitated the implementation of abortion services after legalization. Particularities of the Uruguayan model include a strong focus on medical abortion, and a multidisciplinary approach to patient counseling. The implementation of services was largely successful, and rates of abortion‐related morbidity and mortality have decreased. Remaining concerns include high rates of conscientious objection and insufficient human resources to staff interdisciplinary counseling teams. The focus on medical abortion has led to a lack of method choice. Finally, data collection gaps complicate monitoring and identification of barriers to access.

From stigma to pride: health professionals and abortion policies in the Metropolitan Area of Buenos Aires

“…If the legal context changes but is not followed by change in policies or if there is nobody to deliver the services, the situation could improve, but probably in a limited way. 22 Changes in several of these factors were reflected in our study, allowing shifts in perceptions of stigma.…”

“…The Argentine process has some similarities with the Uruguayan experience 9 , 22 when the focus was on a harm and risk reduction model as a strategy used before the law was changed to allow legal abortions. In Argentina, the law has not changed, but what has changed is the interpretation of the existing Criminal Code from a restrictive interpretation to a permissive one.…”

Desafios e oportunidades para o acesso ao aborto legal e seguro na América Latina a partir dos cenários do Brasil, da Argentina e do Uruguai

“…Despite obvious progress with the new law, there are still obstacles to full access to termination of pregnancy for women in Uruguay 25 . One limitation to access to abortion has been the number of health professionals that refuse to perform the procedure, claiming conscientious objection, considered a barrier and representing 50% of the staff at a primary care service in the capital city, Montevideo 26 .…”

Barreiras para o acesso aos serviços de aborto legal na América Latina e Caribe: uma revisão sistemática qualitativa

“…[47] e um abordou a percepção de adolescentes [48]; dois incluíram as opiniões de profissionais da saúde e mulheres ao mesmo tempo [25]; [37]; dezesseis estudos envolveram apenas profissionais [22]; [24]; [26][27]; [29]; [33]; [30][31][32]; [36]; [39][40]; [42][43]; [45]; [46].…”

“…[44] Por se tratar de uma dimensão cultural e, portanto, estrutural, o estigma também é identificado entre os trabalhadores de serviços de aborto legal. O medo de ser considerado "aborteiro" resulta em menor adesão dos profissionais aos programas desses serviços [39]; [43]; [46] She then said God would punish us." [44].…”