Solidarity Request: El Salvador
Journal Articles on Abortion Services and Training:
Burkina Faso, South Africa, Indonesia, Turkey, Canada


28 October 2016

EL SALVADOR: Solidarity Request

El Salvador's ruling leftist party, the Farabundo Marti National Liberation Front (FMLN), has presented a bill to the national Congress to allow abortion when the woman's life and health is at risk, in cases of rape or trafficking, unviable fetal anomaly, and in cases of the sexual abuse of a girl who is a minor. Consent of the woman is required in each case, and the consent of the girl and her parents or legal guardian is required in the case of a minor.
The Alianza por la Salud y la Vida de las Mujeres (Alliance for Women's Health and Life) supports this bill, which would add these grounds to Article 133 of the Penal Code as non-punishable grounds for abortion. The clause on girl children is in line with what is already established in Article 18 of the Law for the Comprehensive Protection of Childhood and Adolescence (LEPINA).
With 84 members of parliament, 43 votes in favour are required; the FMLN has 31 seats so they must convince at least 12 other deputies.
In a
PETITION that will be sent to Deputy Lorena Peña, President of the Chamber of Deputies, and 25 other senior decision-makers in the government, the Alianza por la Salud y la Vida de las Mujeres supports the four grounds outlined in the law reform proposal and gives a long list of reasons why.
There are at least 14 women in El Salvador currently in prison who have been sentenced to prison terms of 12 years or more for abortion and about 130 currently facing legal proceedings, according to the Citizens Association for the Decriminalization of Abortion.  


Video by Foro Nacional de Salud El Salvador  

(2) GOOD NEWS: Salvadoran court upholds freedom of Maria Teresa Rivera, who was wrongfully imprisoned after miscarriage
Maria Teresa Rivera, who was wrongfully sentenced to 40 years in prison for aggravated homicide and imprisoned in 2011, when she had only had a miscarriage, was released on appeal on 20 May 2016. However, the court's decision to release her was immediately appealed by the prosecutor in the case, who claimed the judge had made a serious error of logic. On 26 October, the San Salvador Third Criminal Chamber (Cámara Tercera de lo Penal de San Salvador) rejected the prosecutor's appeal, and unconditionally released her.
SOURCE: Center for Reproductive Rights press release, 26 October 2016
Celebrate by supporting law reform so that no one else has to go to prison.




Damien Glez

Estimating the costs for the treatment of abortion complications in two public referral hospitals: a cross-sectional study in Ouagadougou, Burkina Faso 

PG Ilboudo, G Greco, J Sundby, G Torsvik

BMC Health Service Research 2016(7 Oct);16(1):559

Treatment costs of induced abortion complications can consume a substantial amount of hospital resources. This use of hospitals' scarce resources to treat induced abortion complications may affect hospitals' capacities to deliver other health care services. In spite of the importance of studying the burden of the treatment of induced abortion complications, few studies have been conducted to document the costs of treating abortion complications in Burkina Faso. Our objective was to estimate the costs of six abortion complications, including: incomplete abortion, haemorrhage, shock, infection/sepsis, cervix or vagina laceration, and uterus perforation treated in two public referral hospital facilities in Ouagadougou and the cost savings of providing safe abortion care services.

Across six types of abortion complications, the mean cost per patient was USD 45.86. The total cost to these two public referral hospital facilities for treating the complications of abortion was USD 22,472.53 in 2010, equivalent to USD 24,466.21 in 2015. Provision of safe abortion care services to women who suffered from complications of unsafe induced abortion and who received care in these public hospitals would only have cost USD 2,694, giving potential savings of more than USD 19,778.53 in that year...



Clinical outcomes and women's experiences before and after the introduction of mifepristone into second-trimester medical abortion services in South Africa
Deborah Constant, Jane Harries, Thorkozile Malaba, Landon Myer, Malika Patel, Gregory Petro, Daniel Grossman

PLoS One 2016;(1 Sep);11(9):e0161843 DOI: 10.1371/journal.pone.0161843

To document clinical outcomes and women's experiences following the introduction of mifepristone into South African public sector second-trimester medical abortion services, and compare with historic cohorts receiving misoprostol-only.

The 2014 cohort received 200 mg mifepristone, which was self-administered 24-48 hours prior to admission. For all cohorts, following hospital admission, initial misoprostol doses were generally administered vaginally: 800 mcg in the 2014 cohort and 600 mcg in the earlier cohorts. Women received subsequent doses of misoprostol 400 mcg orally every 3-4 hours until fetal expulsion. Thereafter, uterine evacuation of placental tissue was performed as needed. With one exception, all women in all cohorts expelled the fetus. Median time to fetal expulsion was reduced to 8.0 hours from 14.5 hours (p<0.001) in the mifepristone compared to the 2010 misoprostol-only cohort (time of fetal expulsion was not recorded in 2008).
Uterine evacuation of placental tissue using curettage or vacuum aspiration was more often performed (76% vs. 58%, p<0.001) for those receiving mifepristone. Major complication rates were unchanged. Hospitalization duration and extreme pain levels were reduced (p<0.001), but side effects of medication were similar or more common for the mifepristone cohort. Overall satisfaction remained unchanged (95% vs. 91%), while other acceptability measures were higher (p<0.001) for the mifepristone compared to the misoprostol-only cohorts...



Quality of care in a safe abortion hotline in Indonesia: beyond harm reduction
by Caitlin Gerdts, Inna Hudaya

American Journal of Public Health  2016;(Nov)106(11):2071-75  DOI: 10.2105/AJPH.2016.303446
To examine services offered by safe abortion hotlines in contexts in which abortion is legally restricted and to document the experiences of women contacting a safe abortion hotline in Indonesia.
We analyzed 1,829 first-time contacts to a safe abortion hotline in Indonesia as a part of routine service provision between January 1, 2012 and December 31, 2014.
Nearly one third (29.9%) of initial contacts reported their age as between 18 and 24 years, and most (51.2%) reported being unmarried. When asked about their reason for calling the hotline, the majority of initial contacts stated that they were pregnant and not ready to have a child. More than one third reported gestational ages below 12 weeks, and nearly one fifth (18.3%) reported a gestation of 13 weeks or greater...




Abortion rights demonstration, Istanbul, 2012
Legal but not necessarily available: abortion at state hospitals in Turkey
by ML O'Neil, B Aldanmaz, RM Quirant Quiles, RM Resul Kılınç
Kadir Has University Scientific Research Fund, October 2016
A journal article was also published based on this report:
The availability of abortion at state hospitals in Turkey: a national study
by ML O'Neil.

Contraception 12 Sept 2016. DOI: 10.1016/j.contraception.2016.09.009. [Epub ahead of print]
Abortion in Turkey has been legal since 1983 and remains so today. Despite this, in 2012 the Prime Minister declared that, in his opinion, abortion was murder. Since then, there has been growing evidence that abortion access particularly in state hospitals is being restricted, although no new legislation has been offered.

Study design
The study employed a telephone survey in 2015–2016 where 431 state hospitals were contacted and asked a set of questions by a mystery patient. If possible, information was obtained directly from the obstetrics/gynecology department. I removed specialist hospitals from the data set and the remaining data were analyzed for frequency and cross-tabulations were performed.
Only 7.8% of state hospitals provide abortion services without regard to reason which is provided for by the current law, while 78% provide abortions when there is a medical necessity. Of the 58 teaching and research hospitals in Turkey, 9 (15.5%) provide abortion care without restriction to reason, 38 (65.5%) will do the procedure if there is a medical necessity and 11 (11.4%) of these hospitals refuse to provide abortion services under any circumstances. There are two regions, encompassing 1.5 million women of childbearing age, where no state hospital provides for abortion without restriction as to reason...




National Abortion Federation Canada
Assessing abortion coverage in nurse practitioner programs in Canada: a national survey of program directors
by Lindsay Sheinfeld, Grady Arnott, Julie El-Haddad, Angel M Foster

Contraception 2016;(Nov)94(5):483-88  DOI:
Consistent with previous studies, our survey of Canadian Nurse Practitioner (NP) program directors revealed that abortion [training] coverage is uneven and relatively limited. Compared to the coverage of contraception, ectopic pregnancy management and miscarriage management, abortion-related topics receive less coverage. Not surprisingly, clinical inclusion is less robust than didactic inclusion. And consistent with previous studies, our survey findings suggest that the single greatest barrier to inclusion of abortion-related topics is the perception that abortion is not a curricular priority. Given the prevalence of unintended pregnancy and abortion in Canada, this perception is surprising...


Abortion training in Canadian obstetrics and gynecology residency programs

Contraception 2016;(Nov)94(5):478-82  DOI:
J Liauw, B Dineley, K Gerster, N Hill, D Costescu
This study evaluated the current state of abortion training in Canadian Obstetrics and Gynecology residency programs. Surveys were distributed to all Canadian Obstetrics and Gynecology residents and program directors. Data were collected on inclusion of abortion training in the curriculum, structure of the training and expected competency of residents in various abortion procedures.
We distributed and collected surveys between November 2014 and May 2015. In total, 301 residents and 15 program directors responded, giving response rates of 55% and 94%, respectively. Based on responses by program directors, half of the programs had “opt-in” abortion training, and half of the programs had “opt-out” abortion training. Upon completion of residency, 66% of residents expected to be competent in providing first-trimester surgical abortion in an ambulatory setting, and 35% expected to be competent in second-trimester surgical abortion. Overall, 15% of residents reported that they were not aware of or did not have access to abortion training within their program, and 69% desired more abortion training during residency...


“They made me go through like weeks of appointments and everything”: Documenting women's experiences seeking abortion care in Yukon territory, Canada
by Jennifer K Cano, Angel M Foster

Contraception 2016;(Nov)94(5):489-95  DOI:
Research indicates that women still face numerous barriers to accessing care, challenges that are amplified for women living in rural, remote and northern regions in Canada. This qualitative study aimed to document women's experiences seeking and obtaining abortion services while residing in Yukon Territory, identify financial and personal costs and explore avenues through which services could be improved. We conducted 16 in-depth semi-structured phone interviews with women who accessed abortion services on/after January 1, 2005, while residing in the Yukon.
With the Yukon's sole facility offering first trimester abortions twice a month, women experienced difficulty navigating a fragmented process and long wait times. Women found the process of attending multiple pre-procedure appointments at multiple locations with multiple health care providers, all while enduring pregnancy symptoms and handling other life commitments, physically, financially and emotionally taxing...




Entrevista con Lilian Abracinskas, Directora Executiva de Mujer y Salud en Uruguay
–El Ministerio de Salud contabilizó que el 99 por ciento de los abortos son con Misoprostol. ¿Es buena esta uniformidad?
  (The Minister of Health says 99% of abortions are with misoprostol. Is this uniformity a good thing?)
–No tenemos en Uruguay médicos que hagan abortos, sino médicos que prescriben la medicación. El aborto con medicamento hoy es la única vía y no se puede elegir otra forma de intervención como la aspiración manual endouterina (AMEU). Los profesionales de la salud quieren intervenir antes y después, pero no en el aborto. Y las mujeres tienen que poder elegir.
  (In Uruguay, we don't have doctors who do abortions. Abortion with pills is the only way and it isn't possible to choose another method, such as MVA. Health professionals are willing to be involved before and after, but not in the abortion. And women must be able to decide.)

Pagina 12, 11 October 2016 ; PHOTO

Editor: Marge Berer

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