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      National Laws and Unsafe Abortion: The Parameters of Change

      Reproductive Health Matters
      Elsevier BV

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          Misoprostol and illegal abortion in Rio de Janeiro, Brazil.

          We report on the determinants and consequences of induced abortion among 803 women admitted to hospital with abortion complications in Rio de Janeiro, Brazil, in 1991. 458 (57%) women reported using misoprostol to induce abortion, 74% in the first 4 months of pregnancy. Doses of 200-16,800 micrograms were reported, with a median of 800 micrograms. 65% of the women took the drug orally, 29% used a combination of oral and vaginal routes, and 6% administered it intravaginally. Vaginal bleeding and uterine cramps were the commonest reasons for seeking hospital care. Only 8% of women reported gastrointestinal side-effects. Misoprostol induced vaginal bleeding within 12 h of administration in 52% of the women, but 16% waited 10 days or more for onset of bleeding. 4% were admitted to hospital with complete abortion. The likelihood of bleeding starting within 12 h increased with duration of gestation and it was greater when the drug was used both orally and intravaginally. A significantly smaller proportion of women taking misoprostol than of those who induced abortion by catheter insertion presented signs of infection or physical injuries or required blood transfusion (< 0.0005). Among 803 women interviewed at delivery as controls, 6% had taken misoprostol but abortion had not ensued. Misoprostol has an important role as an abortifacient among the women studied.
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            Abortion law reform in Nepal: women's right to life and health.

            In Nepal, the effects of the low social status of women and lack of access to health care and family planning have resulted in a maternal mortality ratio that is among the highest in South Asia. By the mid-1990s, the contribution of unsafe abortions to maternal deaths and morbidity was acknowledged by key individuals in the Ministry of Health and Department of Health Services. Advocacy for abortion law reform over several decades culminated in the passage of a new law on abortion in 2002. The parliamentary process took almost four years from the tabling of the bill. Almost two years elapsed between the passage of the bill and approval of the Procedural Order for implementing it This paper describes the development of policy and programme strategies for implementing the new law, led by the government in collaboration with NGOs, donors and other stakeholders. During that time, documents required for implementation were prepared, training of service providers was begun and a model service delivery and training site was established in Kathmandu Maternity Hospital. Simple systems to enable rapid expansion of services and a women-friendly approach were devised, promoting universal availability of affordable services provided by physicians and eventually nurses, the latter particularly in remote and rural areas, where 88% of the population live.
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              With everything exposed: cruelty in post-abortion care in Rosario, Argentina.

              At the suggestion of a social worker who witnessed abusive post-abortion care at a public hospital in Rosario, Argentina, two human rights NGOs collaborated to investigate women's experiences seeking treatment for abortion complications at area public hospitals. During the year-long enquiry, more than 300 women took part. Role play was successfully used to surmount women's initial reluctance to reveal pervasive discriminatory and humiliating mistreatment. Thirty-one women later gave personal testimonies about their experiences, which were contained in the report of the research and later dramatised in a public meeting and video. The report, Con Todo al Aire (With Everything Exposed), was disseminated widely, including to the media, and a formal complaint was made to the local Ombudsman, who called for high-level action to resolve the problems. Initial denial by some health professionals that there was a serious problem was replaced by critical self-assessment within the provincial government, hospitals and medical and nursing schools, who made commitments to reform hospital practices and the medical school curriculum. Women participants also gained an understanding of their right to appropriate and humane health care. The findings from Rosario are not isolated. They are now being shored with activists and researchers in other provinces of Argentina and other countries.
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                Author and article information

                Journal
                Reproductive Health Matters
                Reproductive Health Matters
                Elsevier BV
                0968-8080
                1460-9576
                April 27 2005
                April 27 2005
                : 12
                : sup24
                : 1-8
                Article
                10.1016/S0968-8080(04)24024-1
                1f2fb7ee-cc0a-465d-8e6f-b0cdf81ad7de
                © 2005
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