Information on trends in abortion methods used in legally restrictive settings is available for just three countries: Colombia and Mexico (between 1992 and 2008), and Pakistan (between 2002 and 2012). Data on misoprostol use were not collected for the earlier years in Colombia and Mexico because its use was considered to be very limited at that time. According to surveys of health professionals, an estimated one-half of all abortions in Colombia in 2008 and nearly one-third in Mexico in 2007 were done using misoprostol alone. At the same time, the proportions of procedures performed by physicians and untrained providers have declined, which suggests that reliance on surgical methods and unsafe traditional methods have both dropped.112 In Pakistan, the proportion of health professionals who responded that misoprostol was commonly used was much higher in 2012 than in 2002, and this change was more evident in urban areas than in rural areas.113
High Quality Ga 141 Form Rajasthan.pdf
Download File: https://urllio.com/2vF3CZ
The abortion-provision picture is mixed for the countries that liberalized their laws within roughly the past two decades (Figure 3.3). One of the first challenges to instituting safe services is communicating that abortion is now legal and where it is available. Informing health professionals and women of a newly granted right is an enormous challenge, especially where rates of illiteracy and poverty are high, and where abortion continues to be strongly stigmatized. The fact that many countries have unclear laws and service provision guidelines that sometimes conflict with the law makes this challenge even more difficult to overcome.
Sometimes, safe services can coexist with clandestine and unsafe ones years after liberalization. In Ethiopia,o for example, only a little over half (53%) of abortions in 2014 were legal procedures about nine years after law reform; nevertheless, that constituted significant progress as the level in 2008 was about half that (27%).125 In Nepal, which enacted more sweeping legal change than any other country since 2000, 63% of health facilities provided legal abortions as of 2014, and 42% of all abortions that year were legal.95 Barriers to safe abortion care that persist in Nepal include women's inadequate knowledge of its legality and of where to obtain services; poor availability, especially in rural areas; long distances to health facilities; and high costs, despite legislation ensuring the contrary.
Women may choose misoprostol because its use mimics the culturally acceptable "bringing on (or down) of menses," a perception that is shared across a broad range of countries, from Argentina20 to Bangladesh21 to Cambodia.22 Its use also allows women to exert control over a highly personal and private process. All women who use misoprostol need accurate information about how to use it correctly and how it works, because without a full understanding, they can unnecessarily experience problems or seek unneeded care. Just as important, women also need to know how to recognize symptoms of an incomplete abortion, which can occur even with correct use.
The heterogeneity in the design of studies assessing the severity of complications, and in the definitions of "mild," "moderate" and "high" severity, is too large to enable comparisons and conclusions from this body of studies.s,181 An alternative approach uses a uniformly defined, acute-severity measure known as "near miss," for which clinically defined life-threatening symptoms signal that the woman would have died if she had not received emergency care in time. A pooled analysis of data from 11 countries in Africa, Asia and Latin America estimates that 240 near-miss events from complicated abortions and miscarriages occur each year per 100,000 live births.29
Access to safe abortion is constrained by many factors: widespread stigma, lack of trained and willing providers, poor-quality and underfunded health services, inadequate supplies of surgical equipment and medication abortion drugs, and legal restrictions on abortion. Even as legality varies widely, so does the extent to which law and safety align. In a few countries with highly restrictive abortion laws, safe services are widely available, whereas in other countries that legally permit abortion without restriction, access to abortion is obstructed by onerous approval and counseling requirements. Complicating matters further is the fact that although the majority of highly restrictive countries allow abortion under at least one legal indication, very few have the regulatory systems in place to ensure that women who legally qualify have access to safe abortion under such indications. 2ff7e9595c
Comments