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Buenas prácticas de calidad en servicios de aborto : hoja informativa
No full textEn este documento desglosaremos algunas reflexiones sobre la calidad en la atención y las recomendaciones sobre buenas prácticas para que puedan ser implementadas en la prestación de servicios y así garantizar un aborto de calidad. Nuestro análisis fue desarrollado a partir de la revisión de guías nacionales e internacionales sobre prestación de servicios de aborto y en la experiencia construida a través del dispositivo de atención en salud sexual en un servicio de tocoginecología de un hospital público de tercer nivel
Failure of the Law to Grant Access to Legal Abortion in Chile
No full textFil: Suárez-Baquero, DFM. Department of Child, Family, and Population Health, School of Nursing, University of Washington, Seattle, Washington; USA.Fil: Suárez-Baquero, DFM. Postdoctoral Fellow ACTIONS Program, Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, California; USA.Fil: Dzuba, IG. Gynuity Health Projects, New York, New York; USAFil: Romero, M. National Abortion Federation, Washington, District of Columbia; USAFil: Romero, M. CEDES. Centro de Estudios de Estado y Sociedad; ArgentinaFil: Romero, M. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET); ArgentinaFil: Baba, CF. Advancing New Standards in Reproductive Health, University of California San Francisco, Oakland, California; USAFil: Biggs, MA. Advancing New Standards in Reproductive Health, University of California San Francisco, Oakland, California; USAIntroduction: In 2017, Chile decriminalized abortion on three grounds: (i) if the pregnant person's life is at risk, (ii) fetal nonviability, and (iii) rape or incest. This multicase study explores the experiences of pregnant people legally entitled to but denied access to legal abortion in Chile.
Methods: Through a snowball sampling approach, we recruited adult Chilean residents who sought, were eligible for, and were denied a legal abortion after September 2017. We conducted semistructured interviews with participants to explore their experiences in seeking and being denied legal abortions. We recorded and transcribed the interviews, then coded and analyzed the transcriptions to identify common themes.
Results: We identified four women who met the eligibility criteria. The interviews revealed five common themes in their experiences: (i) disparate levels of social support in accessing abortion, (ii) abundant access barriers, (iii) forced pregnancy, (iv) abortion stigma, and (v) a failure of the law to provide access to abortion.
Discussion and Health Equity Implications: Although the 2017 law expanded legal access to abortion in Chile, significant barriers remain. Compounded with social stigma, and the socioeconomic disparities in abortion access, pregnant people continue to face insurmountable obstacles in obtaining legal abortions, even when their lives are at risk and the pregnancy is not viable. The state must prioritize equity of access to legal abortions. Future studies should continue to explore the challenges people face accessing legal abortion care to inform strategies to ensure people are able to obtain the quality care that they are legally entitled to
Nuevos escenarios requieren herramientas innovadoras: experiencia en el desarrollo de un asistente virtual para equipos de salud que garantizan el acceso a la IVE e ILE en la Argentina – ERA
No full textFil: Romero, M. CEDES. Centro de Estudios de Estado y Sociedad; ArgentinaObjetivo. Compartir la experiencia de diseño, testeo e implementación de una herramienta virtual para equipos de salud que garantizan el acceso a la IVE / ILE en Argentina. Materiales y Métodos. Se trata de un relato de experiencia, que describe el proceso de trabajo en el desarrollo de un asistente virtual destinado a equipos de salud en la Argentina. Resultados. Se presenta el recorrido realizado desde el diseño de la herramienta virtual, hasta la primera evaluación de impacto y actualización, sus desafíos y principales logros. Conclusiones. Contar con información fidedigna, actualizada, basada en las últimas evidencias científicas permite mejorar la calidad de atención de los servicios de aborto y remueve obstáculos o demoras innecesarias en el acceso al aborto
Plan ENIA en riesgo. Razones para sostener una política pública clave para revertir la reproducción intergeneracional de la pobreza
No full textEl Plan Nacional de Prevención del Embarazo No Intencional en la Adolescencia (Plan ENIA) es una política pública interministerial de alcance federal que se creó en el año 2017 con el objetivo de promover el acceso a los derechos vinculados a la salud sexual y reproductiva de adolescentes, así como también la prevención de los embarazos no intencionales en la adolescencia y de los embarazos y maternidades forzadas. Además, al prevenir la maternidad temprana y posibilitar así la continuidad de las trayectorias educativas de niñas y adolescentes, se convierte en una política fundamental para romper el ciclo que perpetúa la pobreza en Argentina. Para dar respuesta a esta problemática que sin dudas impacta en las vidas de las mujeres pero también en el desarrollo económico del país, durante los 6 años de implementación del Plan ENIA el gobierno nacional ocupó un rol rector clave. Desde el gobierno nacional se brindó apoyo técnico, recursos y per- sonal en las provincias con el objetivo de sostener consejerías en salud sexual y reproductiva, activida- des de promoción comunitarias, educación sexual integral y asesorías en las escuelas.
Mediante el trabajo conjunto de los Ministerios nacionales y autoridades provinciales con competen- cias en salud, desarrollo social y educación, el Plan ha facilitado el acceso a métodos anticonceptivos al mismo tiempo que ha fortalecido las políticas para la prevención del abuso y la violencia sexual. Sin embargo, como veremos a continuación, los argumentos centrados en el enfoque de derechos hu- manos, en los beneficios para la salud, en la prevención de las violencias y el abuso sexual infantil así como también la interpelación a hacer un uso más racional de los fondos del Estado, han sido insufi- cientes para torcer la decisión del gobierno nacional de desfinanciar el Plan
Comprehensive Abortion Care
No full textAbortion is a common part of people’s reproductive lives, regardless of where they live in the world.
When using World Health Organization-recommended methods of either surgical or medical abortion, procedures are very safe and effective, and providers do not need a lot of information or testing to provide quality services. Both medical and surgical methods may be used to induce or to treat incomplete abortion. Although both methods are safe and effective, they have different characteristics and acceptability; therefore, clients should be given the choice of method in settings where it is possible.
Service delivery can include provision of surgical and medical abortion services by many cadres of providers, from nurses and midwives to physicians. Most people (generally around 90%) seek induced abortion before 12 weeks’ gestation, during which time medical abortion can be safely provided either through an in-person clinical encounter or through telemedicine, and there is emerging evidence of safe over-the-counter-like use.
Postabortion care includes the timely management of an unsafe or spontaneous abortion (spontaneous loss of pregnancy) that has happened or is in progress; it has been a global strategy to reduce the morbidity and mortality related to less safe abortions. For all people having an abortion, postabortion care includes information and voluntary provision of postabortion contraception or other desired reproductive health services
Análisis de los indicadores para el monitoreo de la salud y los derechos sexuales, reproductivos y no reproductivos en la Argentina
No full textFil: Chaumet, Dolores. Observatorio de Salud Sexual y Reproductiva; Argentina.Fil: Ramos, Silvina. CEDES. Centro de Estudios de Estado y Sociedad. Área de Salud, Economía y Sociedad; Argentina.Fil: Abalos, Edgardo. CEDES. Centro de Estudios de Estado y Sociedad. Área de Salud, Economía y Sociedad; Argentina.Fil: Romero, Mariana. CEDES. Centro de Estudios de Estado y Sociedad. Área de Salud, Economía y Sociedad; Argentina.Para dar cuenta de sus acciones y resultados el programa desarrolló un sistema de monitoreo con 68 indicadores1 para orientar la toma de decisiones en salud sexual y reproductiva, facilitar el acceso a la información y rendir cuentas de la gestión de los recursos públicos. En el año 2017 se crea el Plan ENIA (Plan Nacional de Prevención del Embarazo No Intencional en la Adolescencia), el que a partir de 2020 se integra a la estructura de la Dirección Nacional de Salud Sexual y Reproductiva (DNSSR), a fin de garantizar a las y los adolescentes el ejercicio de sus DSSR. Estos ejemplos son algunos de los claros avances en materia de reconocimiento de derechos, y de compromiso del Estado para resguardarlos y asegurar su goce efectivo. Frente a este escenario, el seguimiento y análisis de los indicadores de salud sexual y reproductiva se torna un imperativo para sostener y consolidar los logros, así como para identificar cuellos de botella, pendientes y desafíos para lograr la cobertura universal en salud sexual y reproductiva.Fondo de Población de las Naciones Unidas (UNFPA Argentina
Usando direitos para aprofundar a democracia: entendendo o caminho para o aborto legal na Argentina
No full textEste artigo situa a aprovação da lei de legalização do aborto de 2020 como um ponto de inflexão na democracia argentina. Percorre os caminhos da aprovação da lei, propõe um estudo de caso sobre como os conceitos de direito podem ser usados para avançar a justiça reprodutiva. Primeiramente, partindo da transição para a democracia na Argentina, o artigo mapeia as transformações das estruturas de oportunidade, incluindo mudanças políticas e institucionais, decisões judiciais importantes, bem como reformas legais; e a construção de relações entre organizações feministas tradicionais, profissionais de saúde e novos atores, inclusive políticos importantes ligados à causa e outros tomadores de decisões. Em seguida, o artigo se volta especificamente aos últimos quinze anos de mobilização legal e social, passando pela evolução das redes de atores engajados no avanço do direito ao aborto e por como essa questão foi inserida em debates públicos dentro e fora das instituições formais do Estado. Em terceiro lugar, o artigo descreve o processo de aprovação da legislação no Congresso argentino e a descriminalização no âmbito social, que foi essencial para a aprovação e implementação da lei. Por fim, apresenta-se uma breve visão do cenário político na Argentina no primeiro ano após a legislação entrar em vigor. O artigo enfatiza que o caso argentino ilustra a natureza construtivista e recursiva do uso de direitos para promover o acesso ao aborto, em que a estrutura dos direitos humanos universais no direito internacional interage dialeticamente com as interpretações e posteriores adaptações a nível nacional
Entrenamiento para la facilitación de talleres en la provisión de servicios de aborto seguro por personal de enfermería
No full textEsta Guía de formación para la facilitación está dirigida a quienes brindan talleres para el personal de enfermería en servicios de salud sexual y reproductiva. La misión principal de este documento es expandir la implementación de la Guía para armar el taller: La enfermería en la interrupción del embarazo
Description of maternal and neonatal adverse events in pregnant people immunised with COVID-19 vaccines during pregnancy in the CLAP NETWORK of sentinel sites. Nested case–control analysis of the immunization-associated risk: A study protocol.
No full textFil: Macías Saint-Gerons, D. Department of Medicine, University of Valencia, INCLIVA Health Research Institute and CIBERSAM, Valencia; SpainIntroduction COVID-19 is associated with higher morbimortality in pregnant people compared with non-pregnant people. At present, the benefits of maternal immunisation are considered to outweigh the risks, and therefore, vaccination is recommended during pregnancy. However, additional information is needed on the safety of the vaccines in this population.
Methods and analysis This a retrospective cohort nested case–control study in pregnant people who attended maternity hospitals from eight Latin American and Caribbean countries. A perinatal electronic clinical history database with neonatal and obstetric information will be used. The proportion of pregnant people immunised with COVID-19 vaccines of the following maternal and neonatal events will be described: preterm infant, small for gestational age, low birth weight, stillbirth, neonatal death, congenital malformations, maternal near miss and maternal death. Moreover, the risk of prematurity, small for gestational age and low birth weight associated with exposure to COVID-19 vaccines will be estimated. Each case will be matched with two groups of three randomly selected controls. Controls will be matched by hospital and mother’s age (±3 years) with an additional matching by delivery date and conception time in the first and second control groups, respectively. The estimated required sample size for the main analysis (exposure to any vaccine) concerning ‘non-use’ is at least 1009 cases (3027 controls) to detect an increased probability of vaccine-associated event risk of 30% and at least 650 cases (1950 controls) to detect 30% protection. Sensitivity and secondary analyses considering country, type of vaccine, exposure windows and completeness of immunisation will be reported.
Ethics The study protocol was reviewed by the Ethical Review Committee on Research of the Pan American Health Organization. Patient informed consent was waived due to the retrospective design and the utilisation of anonymised data (Ref. No: PAHOERC.0546.01). Results will be disseminated in open access journals.
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Incorporating a mobile application to support communication about HPV testing among women and professionals: barriers and facilitators from the perspective of health professionals in a middle- and low-income setting in Argentina
No full textFil: Szwarc L. Centro de Estudios de Estado y Sociedad; Buenos Aires, ArgentinaINTRODUCTION: The delivery of positive Human papillomavirus (HPV) test results
can have a psychosocial impact and act as a barrier for women to continue the
cervical cancer (CC) prevention process. A previous formative research based on a
woman's perspective indicated that a mobile app could be an acceptable and
appropriate tool to help women obtain information and reduce fears related to a
positive result. Based on these findings, we developed an app-based intervention
that would function as a support for professionals who offer the HPV test and
communicate their results. We report data on the perceptions of healthcare
providers regarding the barriers and facilitators to the incorporation, in a low
and middle-income context. METHODS: Qualitative study based on individual
semi-structured interviews with health professionals. All the professionals (n
=13) took HPV and Pap test samples and provided information on HPV testing, in
the public health system of Ituzaingó, Greater Buenos Aires, Argentina. The
themes explored were selected and analysed using domains and constructs of
Consolidated Framework for Implementation Research (CFIR). RESULTS: Practitioners
had a positive assessment of the intervention through most included constructs:
adaptability, compatibility, complexity, relative advantage, belief in the
validity and robustness of the intervention, innovation source and knowledge and
beliefs about the intervention. However, some potential barriers were also
identified including: adaptability, tensions for change, relative priority and
leadership engagement. Practitioners conditioned the intervention's success to
specific adjustments of the app (weight and interface usability), legitimmated
institutions' support, and clear and sustained health authorities' commitment and
directions. CONCLUSION: Health professionals had a positive assessment of
implementing an app to support the HPV test communication and information
provision process, although they conditioned its effectiveness to specific
adjustments. The results allow us to identify and develop recommendations for the
app to be implemented effectively and sustained over time. The findings of this
study have important implications not only for Argentina, but also for other low
and middle-income countries, given that the implementation could be adapted, with
the aim of improving communication between patients and health institutions in
the CC prevention process