Patricia Gonzales-Huaman1, Ala Khalid2, Ivana Di Salvo3
1. Universidad Peruana de Ciencias Aplicadas, Lima, Perú
2. University Of Gezira, Faculty of Medicine, Sudan
3. Swiss Tropical and Public Health Institute, University Hospital of Basel
SAFE ABORTION: A GLOBAL HEALTH AND GLOBAL SURGERY INITIATIVE
Safe Abortion is defined as the termination of pregnancy in the case of unintended and unwanted pregnancies done by a skilled person (physician, nurse, midwife, or doula) either medically or as a surgical procedure.1 Surgical procedures, including surgical repairs of tears and perforations of the genital tract, laparotomy for sepsis management, and hysterectomy are also performed to manage the complications of abortions performed under unsafe conditions.
Safe Abortion is a global mandate achieved with health policy that protects the reproductive autonomy of gestating persons (defined as a person with a uterus) through access to timely and sensitive care, skilled providers on safe abortion protocols, telemedicine, and updated surgical practices such as the Manual Vacuum Aspiration (MVA).2 In low resource settings, surgical workforce and access to surgical and anaesthesia are limited, therefore surgical methods are often not provided.3 Moreover, limited training of healthcare providers may affect the quality of the care.
One barrier to safe abortion is the lack of trained providers who can offer education, resources, support, and services to people. Around the world caring and providing access for Safe Abortion and Abortion complications has relied in Obgyn surgeons. Many countries face an increase in the number of Conscientious Objections, emphasizing a call for more care providers trained in Safe Abortion.
IMPACT OF THE SUSTAINABLE DEVELOPMENT GOALS ON ABORTION
The United Nations Sustainable Development Goals (SDGs) arose in 2015 as modifications to the Millennium Development Goals which were a universal call to action to end poverty and ensure prosperity and health for all.4 However, the SDGs like SDG 3 address the essential missing components in sexual and reproductive health aimed to reduce maternal mortality, achieve universal access to sexual and reproductive health education, establish reproductive rights, achieve gender equality, and provide access to legal and safe abortion. Nevertheless, the fact that different countries vary widely in the access, availability, and quality of abortion care means there is a lot of work to achieve the SDGs; governments frequently refuse to acknowledge access to safe and legal abortion as the fundamental health and human right that it is, and private donors refuse to fund safe abortion-related care.
Access to safe and legal abortion services is very important for achieving the target of SDGs to reduce the global maternal mortality ratio to less than 70 per 100 000 live births by 2030.4
Nevertheless, there’s dysfunctionality in implementing this within global health systems and communities where abortion rights are still overlooked, especially for certain marginalized and minority groups: women with mental and physical disabilities, transgender and non-gender conforming people, and those with financial problems in accessing abortion rights.5
HOW COVID-19 PANDEMIC AFFECTED ACCESS TO ABORTION
In the past two years, the Covid-19 pandemic prevented women from accessing crucial sexual and reproductive health services, such as their first gynecology visit and timely abortion care.6,7 In fact, the United Kingdom was the only country to fully introduce remote medical abortion.8 In a 2020 publication, Aiken et al show that 3,915 people made requests for self-managed abortion to Women on Web between January 1st, 2019 and June 1st, 2020, ranging from 28% in Northern Ireland to 139% in Portugal.9
ABORTION AMONGST SURGEONS
Among female physicians, heavy workload and maternity leave policies affect the decision to have children and one’s ability to carry or continue a pregnancy. Female surgeons are particularly affected, as found in a survey of 692 female surgeons conducted at the Brigham and Women’s Hospital.10 In this study, researchers found 48% experienced pregnancy complications while 42% had a pregnancy loss. This might be explained by work overload and physical stress during pregnancy, as 57% of the female surgeons surveyed said they worked over 60 hours per week while pregnant and 37% took more than six overnight calls. These practices may be a consequence of gender bias in surgical culture that prohibits women from seeking help or showing vulnerability. Limited research exists on the attitudes, willingness, and prior experiences of gestating persons working as surgeons in obtaining abortion care. To our knowledge, the only existing study refers of 223 orthopaedic surgeons, amongst whom 2.7% underwent abortion (three of them due congenital abnormalities related to the maternal age).11
CONCLUSION
● Safe abortion is a procedure by which pregnancy termination occurs under clean and secure conditions with help from a skilled professional with proper training.
● Safe abortion is a basic health and human right that must be accessible and attainable for all.
● Covid-19 has impeded individuals from getting access to abortion.
● Gestating persons who are surgeons had reported high incidence of spontaneous abortions due to workload and physical stress, though the prevalence of and attitudes toward voluntary abortions among surgeons remains largely unknown.
● Global initiatives are moving towards raising awareness about the significance and importance of access to safe abortion, as well as demolishing societal stigmas and legal restrictions limited access to safe abortion care.
REFERENCES
1. Safe abortion: technical and policy guidance for health systems Second edition technical and policy guidance for health systems. Accessed October 6, 2021. www.who.int/reproductivehealth
2. Clinical Practice Handbook for Safe Abortion. Clin Pract Handb Safe Abort. Published online 2014. Accessed September 27, 2021. https://www.ncbi.nlm.nih.gov/books/NBK190095/
3. Lancet T. Abortion: access and safety worldwide. Lancet. 2018;391(10126):1121. doi:10.1016/S0140-6736(18)30624-X
4. Take Action for the Sustainable Development Goals – United Nations Sustainable Development. Accessed October 9, 2021. https://www.un.org/sustainabledevelopment/sustainable-development-goals/
5. Bringing Abortion Back to the Advocacy Table - Erasure and Silencing in the Sustainable Development Goals | OutRight Action International. Accessed October 9, 2021. https://outrightinternational.org/content/bringing-abortion-back-advocacy-table-erasure-and-silencing-sustainable-development-goals
6. N J, G S, O G, et al. Lockdown with a Price: The impact of the COVID-19 Pandemic on Prenatal Care and Perinatal Outcomes in a Tertiary Care Center. Isr Med Assoc J. 2020;22(9):533-537. Accessed October 9, 2021. https://europepmc.org/article/med/33236549
7. Rimmer M, Wattar B Al. Provision of obstetrics and gynaecology services during the COVID-19 pandemic: a survey of junior doctors in the UK National Health Service. BJOG An Int J Obstet Gynaecol. 2020;127(9):1123-1128. doi:10.1111/1471-0528.16313
8. Aiken A, Lohr P, Lord J, Ghosh N, Starling J. Effectiveness, safety and acceptability of no-test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study. BJOG An Int J Obstet Gynaecol. 2021;128(9):1464-1474. doi:10.1111/1471-0528.16668
9. Aiken ARA, Starling JE, Gomperts R, Scott JG, Aiken CE. Demand for self-managed online telemedicine abortion in eight European countries during the COVID-19 pandemic: a regression discontinuity analysis. BMJ Sex Reprod Heal. 2021;0:1-8. doi:10.1136/BMJSRH-2020-200880
10. Rangel EL, Castillo-Angeles M, Easter SR, et al. Incidence of Infertility and Pregnancy Complications in US Female Surgeons. JAMA Surg. Published online 2021. doi:10.1001/JAMASURG.2021.3301
11. AR H, MD T, JA B, LB L. Childbearing and pregnancy characteristics of female orthopaedic surgeons. J Bone Joint Surg Am. 2012;94(11). doi:10.2106/JBJS.K.00707