Overall and abortion‐related maternal mortality rates in Uruguay over the past 25 years and their association with policies and actions aimed at protecting women's rights

Access to safe and legal abortion services is a far reach for women and girls in Uganda. Although unsafe abortion rates have fallen from 54 to 39 per 1000 women aged 15-45 years over a decade, absolute figures show a rise from 294 000 in 2003 to 314 000 women having unsafe abortions in 2013. Unfortunately, only 50% of the women who develop abortion complications are able to reach facilities for postabortion care. Despite the clinical evidence and the stories from undocumented cases, debate on access to safer and legal abortion is constricted, moralized, and stigmatized. The harm reduction model has shown evidence of benefit in reducing maternal mortality and morbidity due to unsafe abortion while addressing related stigma and discrimination and advancing women's reproductive health rights. This article presents a case for promoting the model in Uganda.

Section: The Harm Reduction Model: Laws Policies and Ethics For Impmentioning

confidence: 99%

Section: The Harm Reduction Model: Laws Policies and Ethics For Imentioning

confidence: 99%

Access to safe abortion in Uganda: Leveraging opportunities through the harm reduction model

Mulumba

Kiggundu

Nassimbwa

et al. 2017

“…While monitoring and evaluation are standard cornerstones for assessing programmatic efficiency and effectiveness, they proved particularly useful in assuaging fears about these new programs. In countries as different as Ghana and Portugal, data demonstrated the rapid decline in abortion associated death that followed availability of safe procedures . While many complained that data were overly aggregated or problematically coded, precluding fine‐tuned analysis, interviewees also reported that they learned from these data how to constructively modify the program, and had been able to refute incorrect stereotypes about characteristics of those seeking abortion.…”

Section: Facilitationmentioning

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.

“…While abortions remained illegal and could not be obtained within the health system, this approach gave some legitimacy to women's decision to terminate a pregnancy . It also brought women facing unplanned pregnancies closer to the health system, and reduced abortion‐related morbidity and mortality . In 2004, this model was adopted as an official policy of the Ministry of Health, allowing it to be scaled up to other hospitals throughout the country .…”

Section: Contextmentioning

confidence: 99%

“…7 It also brought women facing unplanned pregnancies closer to the health system, and reduced abortion-related morbidity and mortality. 8 In 2004, this model was adopted as an official policy of the Ministry of Health, allowing it to be scaled up to other hospitals throughout the country. 6 Meanwhile, civil society advocacy during the country's first left-wing coalition government led to Parliamentary approval in 2008 of a bill on sexual and reproductive health, including the decriminalization of abortion.…”

Section: Contextmentioning

confidence: 99%

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

Stifani

Couto

Gómez

2018

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.