Fernanda Nozar

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

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.

Project ECHO: A Telementoring Program for Cervical Cancer Prevention and Treatment in Low-Resource Settings

Cervical cancer incidence and mortality rates are significantly higher in low- and middle-income countries compared with the United States and other developed countries. This disparity is caused by decreased access to screening, often coupled with low numbers of trained providers offering cancer prevention and treatment services. However, similar disparities are also found in underserved areas of the United States, such as the Texas-Mexico border, where cervical cancer mortality rates are 30% higher than in the rest of Texas. To address these issues, we have adopted the Project ECHO (Extension for Community Healthcare Outcomes) program, a low-cost telementoring model previously proven to be successful in increasing local capacity, improving patient management skills, and ultimately improving patient outcomes in rural and underserved areas. We use the Project ECHO model to educate local providers in the management of cervical dysplasia in a low-resource region of Texas and have adapted it to inform strategies for the management of advanced cervical and breast cancer in Latin America and sub-Saharan Africa. This innovative approach, using ECHO, is part of a larger strategy to enhance clinical skills and develop collaborative projects between academic centers and partners in low-resource regions.

Cervical cancer prevention and treatment in Latin America

Cervical cancer is a preventable disease with a known etiology (human papillomavirus), effective preventive vaccines, excellent screening methods, and a treatable pre‐invasive phase. Surgery is the primary treatment for pre‐invasive and early‐stage disease and can safely be performed in many low‐resource settings. However, cervical cancer rates remain high in many areas of Latin America. This article presents a number of evidence‐based strategies being implemented to improve cervical cancer outcomes in Latin America.

Legal termination of pregnancy as an opportunity for expanding postabortion contraception: Experience at the Pereira Rossell Hospital, Montevideo, Uruguay

To determine to what extent women adopted highly effective contraceptive methods after a legal abortion.OBJECTIVE To determine to what extent women adopted highly effective contraceptive methods after a legal abortion. METHODS The data available during a period before and another period after liberalization of the abortion law were reviewed. The data gathering was incomplete and reliable only during certain periods, which were used in the study. RESULTS There was an increase in the proportion of women who returned for contraception and in the proportion who used any method and long-acting methods; however, no contraception was administered immediately after abortion and only 16% of all women treated started to use a long-acting method during the period after the law was liberalized. CONCLUSION The proposed objective was not being achieved, the recommended guidelines were not being followed, and data gathering was incomplete. Good intentions are not enough and it is always necessary to evaluate the performance of a program. The results indicate that immediate reforms are necessary in postabortion contraception services.