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Panel:“Medical abortion pills:  how and where do women get them.”

Panel:“Medical abortion pills:  how and where do women get them.”. Risk and Harm reduction Model. Midwife Ana Labandera Monteblanco Director Iniciativas Sanitarias - Uruguay. Population: 3.3 million Maternal Mortality: 23 / 100.000 live births Abortion penalized by law since 1938.

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Panel:“Medical abortion pills:  how and where do women get them.”

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  1. Panel:“Medical abortion pills:  how and where do women get them.” Risk and HarmreductionModel Midwife Ana Labandera Monteblanco Director Iniciativas Sanitarias - Uruguay

  2. Population: 3.3 million Maternal Mortality: 23 / 100.000 live births Abortion penalized by law since 1938. Exceptions: Preserve life of the woman Rape Extreme poverty Unsafe Abortion was the leading cause of maternal mortality in 2001. Uruguay

  3. Iniciativas Sanitarias – HealthInitiatives In 2001, an NGO, Iniciativas Sanitarias (IS), developed a program to decrease maternal morbidity and mortality from unsafe abortion and the incidence of unsafe abortion This programispart of the Sexual & ReproductiveHealthLaw since 2008

  4. ICPD Paragraph 8.25 and ICPD+5 Paragraph 63i. • “Women who have unwanted pregnancies should have ready access to reliable information and compassionate counselling” OurModel follows this importantrecommendation.

  5. Risk and Harm Reduction Strategy Philosophical education strategy without moral opinion about risk behaviors (Unsafe abortion) Professional Values – medical and health care team values. Vocation – Discipline – Competence – Commitment Bioethics Approach Respect and promote autonomy Beneficence Non maleficence Justice Human Rights approach Right to Health care assistance Right to information of scientific progress Legal Issues and Local Context Professional Secrecy - Confidentiality The framework of the model emphasizes

  6. 1- TO DIMINISH MATERNAL MORBIDITY AND MORTALITY 2- TO DECREASE THE NEED TO HAVE AN ABORTION, AND THUS, THE OVERALL ABORTION RATE 1- THE OBJECTIVE

  7. THE NEW APPROACH OF “Iniciativas Sanitarias” PROGRAM BEFORE AFTER ABORTION ILLEGAL

  8. BEFORE • We speak with the woman, face to face, in a horizontal relationship, taking our time to listen to her instead of censoring her, trying to clarify the reason between the two of us:why she thinks she needs an abortion, and what she really feels, deep in her heart. • It is necessary to align the “thinking and the feeling”, to avoid women feeling guilty or depressed later. • We allow them some time to reflect, and decide with freedom. • This is reinforced with a multidisciplinary consultation with the gynecologist or the midwife, (or either of them) with the psychologist.

  9. Ob-gyn or Midwife + psychologistAppointment • Carrying out a situation diagnosis • Evaluating risk and protection factors • Assessing decision level of the users • Carrying out therapeutic interventions • Identifying the indicators pointing to possible post-abortion mental health increased damages. • Referring the patient, or carrying out a follow up, when necessary.

  10. THE GUIDELINES AFTER POST-ABORTION CARE 1- DamagePrevention 2- Integral rehabilitation 3- Futurecontraception (Diminishingtheabortionrate) BEFORE 1- Counselingregarding alternativestoabortion 2- Informationabout abortionmethods and theirrisks: empowerment. (including Misoprostol) 3- Epidemiological analysis ABORTION ILLEGAL DENIED

  11. IMPLEMENTATION OF HEALTH INITIATIVES RISK-REDUCTION MODEL IN THE MAIN WOMEN THIRD LEVEL HEALTH CENTER OF URUGUAY METHODOLOGY • NUMER OF USERS ASSISTED UNDER THE MODEL: 3215 • PERIOD March/2004 – July/2009 • Project supportedby: • F.I.G.O • IPAS • SAAF • IPPF • OMS • UNFPA

  12. IMPLEMENTATION OF HEALTH INITIATIVES RISK-REDUCTION MODEL METHODOLOGY Data was collected using a pre-designed form for the “before-abortion” and “after-abortion” visit, filled by the professionals and identified with a number PEREIRA ROSSELL HOSPITAL: MAIN WOMEN THIRD LEVEL HEALTH CENTER OF URUGUAY

  13. Age distribution Less than 15 16 to 19 20 to 34 more than 35 No data

  14. “Gestational Age” in patients who required our service. 84,9 % before 13 weeks

  15. “BEFORE” VISITS (n: 2206) CONTRACEPTION AND UNWANTED PREGNANCY

  16. Main reasons given when looking for an abortion

  17. The main fears that women express PRE-ABORTION Access to misoprostol Health Failure of misoprostol No FearsDeath

  18. RESULTS IN RELATION WITH THE USE OF MISOPROSTOL

  19. II Home use of misoprostol to interrupt pregnancy Use of misoprostol in the sample analysed.

  20. II Home use of misoprostol to interrupt pregnancy Self-administration of misoprostol

  21. II Home use of misoprostol to interrupt pregnancy Misoprostol dose used 81,4 % 1 or 2 doses

  22. II Home use of misoprostol to interrupt pregnancy Time between self-administration of misoprostol and expulsion. 66,7 % under 12 hours

  23. II Home use of misoprostol to interrupt pregnancy Post-use Complications of misoprostol 84.6 WITHOUT COMPLICATIONS

  24. Most women come to us after having decided to undergo an abortion Most common reasons for abortion: life PROJECT and economic problems 10% of women did not end up with illegal abortion 55% did engage in abortion but under safer conditions 21% continued with pregnancy Misoprostol (self-administered and in the context of the health program) is very effective and safe. CONCLUSIONS AND PERSPECTIVES

  25. HOW AND WHERE • In the black market. • Some women help others when they have extra pills. • In friendly pharmacies. • Through internet. • Using cell phones in public restrooms at shopping malls. • Very high prices.

  26. HOW AND WHERE • At the professional associations level, we are working for the Ministry of Public Health to enforce Act 18426 of Sexual and Reproductive Health Rights, and for it to regulate the ambulatory use of misoprostol to treat incomplete abortions. • To prescribe or not to prescribe? • Professionals as guarantors of sexual and reproductive rights

  27. Since 2004, Uruguay has been a country that, in spite of a restrictive abortion law, provides comprehensive health care services to women with unwanted pregnancies Maternal mortality has declined in recent years in hospital and throughout the country Patients visit the Service in earlier stages of pregnancy CONCLUSIONS AND PERSPECTIVES

  28. EXPAND THIS SUCCESSFUL MODEL IN URUGUAY SHARE THE MODEL IN LATIN AMERICA AND BEYOND INCREASE PROFESSIONAL COMMITMENT WITH SEXUAL AND REPRODUCTIVE RIGHTS TRANFORM THE PROFESSIONAL – PATIENT RELATIONSHIP TO: EMPOWER WOMEN DEVELOP PROFESSIONAL VALUES 5- PERSPECTIVES AND CHALLENGES

  29. Thank you, Very Much agl@montevideo.com.uy

  30. ADMITED TO THE ICU DUE TO UNSAFE ABORTION COMPLICATIONS

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