Implementation of the risk and harm reduction strategy against unsafe abortion in Uruguay: From a university hospital to the entire country

Self Cite

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.

Section: Discussionmentioning

confidence: 99%

“…They sought on one hand to liberalize the law, and to find alternative solutions without waiting for changes in the legislation on the other hand. This solution, which proved to be very effective, was the so‐called “risk and harm reduction” strategy, which is described in detail in this Supplement [2].…”

Section: Introductionmentioning

confidence: 99%

Conscientious objection as a barrier for implementing voluntary termination of pregnancy in Uruguay: Gynecologists’ attitudes and behavior

Coppola

Briozzo

Nozar

et al. 2016

Self Cite

“…The fact that it is a small country is without doubt a facilitating factor, but it is not sufficient in itself to account for the extremely rapid deployment of VTP services. In an attempt to analyze the factors that may be behind this startling success in implementation of the law, we would draw attention to the risk and harm reduction strategy applied prior to the law and described in other articles in this supplement [12,13]. The political will of the executive arm and the efficiency of the Ministry of Public Health's senior officials also played a significant role.…”

Section: Discussionmentioning

confidence: 99%

The role of medical abortion in the implementation of the law on voluntary termination of pregnancy in Uruguay

Fiol

Rieppi

Aguirre

et al. 2016

Self Cite

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.

“…We identified two main frameworks used to advocate for legal change and effectively position abortion services within the healthcare system. One was to focus on the public health necessity of reducing maternal death and morbidity—a tactic utilized in all our case countries . In South Africa, proponents of the new law used both women's rights and equity arguments as well as those surrounding maternal health .…”

Section: Innovationmentioning

confidence: 99%

“…For the most part, physicians and their professional associations were supportive and played significant roles. In Portugal and Uruguay the obstetricians/gynecologists had been important advocates in the period leading up to legal change and were poised to provide the care, obviating the need for much additional training or certification . The professional medical societies collaborated in creating clinical protocols and designing training and certification in five of these.…”

Section: Recipientsmentioning

confidence: 99%

Implementing and expanding safe abortion care: An international comparative case study of six countries

Chavkin

Stifani

Bridgman-Packer

et al. 2018

We conducted a comparative case study‐based investigation of health sector strategies that were useful in expanding or establishing new abortion services. We selected geographically diverse countries from across the human development index if they had implemented new abortion laws, or changed interpretations of existing laws or policies, within the past 15 years (Colombia, Ethiopia, Ghana, Portugal, South Africa, and Uruguay). Factors facilitating the expansion of services include use of a public health frame, situating abortion as one component of a comprehensive reproductive health package, and including country‐based health and women's rights organizations, medical and other professional societies, and international agencies and nongovernment organizations in the design and rollout of services. Task sharing and the use of techniques that do not require much infrastructure, such as manual vacuum aspiration and medical abortion, are important for rapid establishment of services, especially in low‐resource settings. Political will emerged as the key factor in establishing or expanding access to safe abortion services.