"I wrote the prescription; the patient did the abortion": Preparation of gynecologists for abortion services in Montevideo before and after 2004 Open Access

EtShalom, Yonah (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/7d278t76x?locale=en
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Abstract

Background: Unsafe abortion causes 13% of all maternal deaths worldwide (WHO, 2011b). In Uruguay, prior to 2001, unsafe abortion caused ~30% of maternal mortality (Briozzo et al., 2004). In 2004-2012, nationwide implementation of a harm reduction model coincided with a steady reduction in abortion-related death. In 2012, 1st-trimester abortion was decriminalized with several restrictions. No data were available on the extent of gynecologist training in the abortion, to help determine the degree to which lack of training is a cause of decreased access to safe abortion under the new law.

Purpose: To determine, 18 months after the decriminalization of abortion, the extent to which gynecologists practicing in Montevideo, Uruguay are trained, willing, and confident about providing abortion services - and which kinds of abortions they are trained to provide. We also sought to measure what proportion of gynecologists have provided abortions, and to capture reasons for denial of abortion services.

Methods: Cross-sectional structured survey using convenience/snowball sampling of 40 gynecologists (37 in-person surveys, 3 via online survey) totaling 42% of gynecologists currently practicing in in the public sector in Montevideo (approx. 90). Montevideo was chosen because, as the capital city of Uruguay, its metro area is home to 51% of the country's population.

Primary Results: Of the respondents, 95% were trained in induced abortion and 97.5% in managing incomplete miscarriage; 97.5% had managed incomplete miscarriage surgically and 95% medically (using misoprostol). Eighty-nine percent of abortion providers reported having denied patients abortions due to gestational age based on legal gestational age restrictions.

Conclusions: Based on the very high prevalence of abortion training amongst respondents, it appears that lack of training is not a major barrier to access. Montevideo gynecologists appear to be trained in both medical and surgical techniques of abortion care, whether through abortion training or miscarriage management training/experience. Because 85% of respondents reported having seen an abortion patient with advanced gestational age, barriers to early access to abortion as well as to contraception should be further researched and extending the gestational limit should be explored.

Table of Contents

Abstract. 4

Acknowledgements. 6

Chapter 1: Introduction. 9

Chapter 2: Background and Literature Review. 14

Chapter 3: Methodology and Results. 35

Chapter 4: Discussion, Conclusion and Recommendations. 65

References.76

Appendices. 81

A. Survey. 81

B. Ley 18.987 (Original Spanish text of law). 86

C. Law 18.987 (Unofficial English translation of law. 92

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