Leonel Briozzo

A risk reduction strategy to prevent maternal deaths associated with unsafe abortion

Introduction: Worldwide, 13% of maternal deaths are caused by complications of spontaneous or induced abortion, 29% in Uruguay and nearly half (48%) in the Pereira Rossell Hospital.

Unsafe abortion in Uruguay

We conducted a retrospective study of induced abortion as a cause of death in Uruguay for the period 1997–2001. Results show that although the maternal mortality rates of Uruguay are similar to those of developed countries death from unsafe abortion is the main single contributor to that rate and one of the highest in the world. For the lowest-income women the absolute frequency of deaths due to this cause is considerably higher than for the rest of the nation’s population. Maternal mortality is the most dramatic consequence of pregnancy-related complications. It is also the health indicator the most clearly related to inequity in the distribution of obstetric care. (excerpt)

Right to protection from unsafe abortion and postabortion care.

The International Congress on Population and Development (ICPD) Programme of Action urged governments and intergovernmental and nongovernmental organizations to reduce womens recourse to abortion through improved family planning services; reliable information and counseling should be readily accessible to women who have unwanted pregnancies; where abortion is legal, it should be safe; and in all cases, quality services for management of abortion complications should be accessible. Review of the extent to which these recommendations have been implemented over the last 15 years shows that, with few exceptions, little attention has been given to this serious problem. Because of its political and religious implications, abortion is mostly ignored. Those with the power to promote change have an obligation to raise the issue of abortion from the darkness in which it is currently hidden, and bring it into the public light as a human drama and a health problem that is not difficult to solve if the ICPD recommendations are taken seriously.

The medical profession and the defense and promotion of sexual and reproductive rights

The values of the medical profession and other healthcare providers allow assessment of the relationship between physicians, healthcare teams, patients, and healthcare networks regarding the defense and promotion of sexual and reproductive health and rights. This paper questions the traditional model of the relationship between healthcare professionals and patients, based on the classic paternalistic role of the physician. It describes the tools available to the medical profession and healthcare teams for the promotion of sexual and reproductive rights, and proposes specific actions that would lead to improvements for women and communities.

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

The history of the creation of the risk and harm reduction model applied to unsafe abortion is reviewed, from its initial implementation by a small group of gynecologists at the Pereira Rossell Hospital Center in Uruguay to its spread to the rest of the country. Its ethical rationale, its successful application in the hospital, the decision to disseminate it with the cooperation of the International Federation of Gynecology and Obstetrics (FIGO), and the intervention procedures are explained. It was evaluated from the epidemiological and anthropological viewpoints, from the changes in professionals’ and users’ perception of the care offered and its impact on complications and maternal deaths. A very favorable change was seen in the number and quality of the services, the providers’ attitude, and maternal morbidity and mortality were reduced. It also brought visibility to women with unplanned and unwanted pregnancies and an improved understanding of their problems, which contributed to the legislative changes that were made subsequently.

Improving care of women at risk of unsafe abortion: Implementing a risk-reduction model at the Uruguayan-Brazilian border

To describe the initial stages of the implementation of a risk‐reduction model designed by Iniciativas Sanitarias to shield women from unsafe abortion in a traditional community on the Uruguay‐Brazil border.

Tocolysis and delayed delivery versus emergency delivery in cases of non‐reassuring fetal status during labor

Aim:  To determine whether fetal intrauterine resuscitation using tocolysis and delayed delivery is better for the fetus than emergency delivery when fetal hypoxia is suspected because of a non‐reassuring fetal heart‐rate (FHR) pattern using conventional heart rate monitoring.

From risk and harm reduction to decriminalizing abortion: The Uruguayan model for women’s rights

To describe public policies, social actions, particularly those of obstetricians/gynecologists, and changes in abortion‐related legislation in the different historical periods between 1990 and 2015, and to analyze temporal correlations with a reduction in maternal mortality.OBJECTIVE To describe public policies, social actions, particularly those of obstetricians/gynecologists, and changes in abortion-related legislation in the different historical periods between 1990 and 2015, and to analyze temporal correlations with a reduction in maternal mortality. METHODS The 1990-2015 period was divided into three different stages to permit evaluation of the legislation, health regulations, healthcare system, and professional practices related to the care provided in cases of unsafe abortion: 1990-2001, characterized by illegality and the healthcare systems denial of abortion; 2001-2012, when the model for reducing the risk and harm of unsafe abortions was developed; and 2012-2015, when abortion was finally decriminalized. RESULTS Changes in public policies and expansion of the risk reduction model coincided with changes in the social perception of abortion and a decrease in maternal mortality and abortion rates, probably due to a set of public policies that led to the decriminalization of abortion in 2012. CONCLUSION Changes in public policies and health actions such as the model for reducing the risk and harm of unsafe abortions coincided with a marked reduction in abortion-related maternal mortality. The challenges still to be faced include managing second trimester abortions, ensuring the creation of multidisciplinary teams, and offering postabortion contraception.

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

To evaluate the implementation of the law that liberalizes voluntary abortion in Uruguay and enables health services to offer these services to the population.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 Healths 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.

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

To evaluate changes in maternal mortality rates in Uruguay over the past 25 years, as well as their distribution by cause, and their temporal relationship with social changes and Human Development Index (HDI) indicators.