Providing safe surgical and medical abortion services in low-resource and legally restricted environments: The Latin American Abortion Provide Network
Dee Redwine, MPH, regional Director for Latin America and the Caribbean, Planned Parenthood Federation of America- International, PPFA-I
Heather Blank, associate Regional Director for Latin America and the Caribbean,PPFA-I
In Latin America and the Caribbean, Planned Parenthood Federation of America-International (PPFA-I) focuses on establishing and strengthening safe abortion services through partnerships with women’s organizations that advance sexual and reproductive rights and health services. Many of these agencies in Latin America and the Caribbean suffer from a sense of isolation, as they provide life-saving services under severely restricted legal circumstances, in politically difficult and dangerous situations.
Unsafe abortion in Latin America and the Caribbean can be described as nothing less than a public health crisis. The correlation between access to safe, legal abortion and maternal mortality in the region is shocking: approximately 20 percent of maternal deaths in Latin America and the Caribbean are due to unsafe abortion, a higher proportion than in any other region of the world. In 1995 there were 4.2 million abortions in Latin America and the Caribbean region, 4 million of which were illegal. Except for Eastern Europe, Latin America has the highest global abortion rate (37 abortions per 1,000 women aged 15-44) and abortion ratio (27 abortions per 100 pregnancies) (AGI, 1999).
The average Latin American woman is likely to have at least one abortion in her lifetime, with women in some countries, such as Peru (AGI, 1999), having an average of nearly two abortions. Since the vast majority of these procedures are performed illegally and most likely under unsafe conditions, women are taking enormous risks to prevent unwanted childbearing. This situation results in approximately 800,000 hospitalizations per year in the region.
Access to safe abortion services is critical to preventing maternal mortality and morbidity. In developing countries, regardless of the legal status of abortion, it is poor women in rural areas and poor young women who are most at risk of undergoing unsafe abortion, and most likely to die. However, in various Latin American countries, there are a growing number of health care providers who are committed to combating this trend. In areas where women are most likely to die from an unsafe abortion, client-centered sexual and reproductive clinical services must be provided for poor and marginalized women – the very ones who are most likely to face an unwanted pregnancy, seek out an untrained provider, and most likely to suffer severe consequences.
The reproductive health provider network supported and facilitated by PPFA-International is a forum to link these providers in a mutually constructive and supportive way, in order to regularly exchange ideas and expertise. They represent 8 different Latin American countries.
All of these providers offer life-saving services under extremely difficult circumstances, in both geographic and legal terms. From the rural areas to the rapidly expanding urban slums, these providers offer high-quality health services to those most in need. The network offers a forum in which critical mutual support can be lent to those working in this harsh environment as well as an opportunity for the exchange of information and expertise.
The specific goal of the network is to strengthen and expand sexual and reproductive rights through improved and increased access to services coupled with advocacy efforts in countries where the political and social climate is very restrictive. In order to reach this goal, the network facilitates the professional support needed by local groups working to reduce restrictions on abortion and improves services where they exist, as well as increases the sense of solidarity among service providers in the region.
Furthermore, the group is working to increase access to medical abortion throughout the region through the integration of a misoprostol-only regimen of early first trimester medical abortion. This is being piloted in order to decrease the consequences of unsafe abortion, and create alternative pathways for women to access safe abortion.
Throughout Latin America, misoprostol is cheap, easily accessible, and badly mis-used. From physicians to pharmacists, off-label use of misoprostol for pregnancy termination is increasingly common. Misoprostol has been shown to have a high rate of efficacy for abortion, but it must be used with the correct dosages, within certain gestational age ranges, and with clear instructions for follow up for the woman in order to be successfully used. Even so, given the severe legal restrictions on abortion in the region, a widely disseminated protocol for misoprostol, either for clinic- or home-based use, could radically change not only how abortion is viewed, but also prevent women from resorting to other invasive, highly dangerous forms of abortion.