NEW YORK (Reuters Health) – A harm-reduction program implemented in Peru, where abortion is legal only to preserve the life and health of the woman, helped reduce abortion risks in women with unwanted pregnancies, researchers say.
“We found that this program, where nurses in Peru provided information to women about how to end an unwanted pregnancy on their own using misoprostol, was very safe and effective,” Dr. Daniel Grossman of the University of California San Francisco, in Oakland, told Reuters Health.
“In Peru, where . . . unsafe abortion is prevalent, this program may help to improve health outcomes and help people achieve their reproductive intentions,” he said by email.
Dr. Grossman and colleagues recruited 500 women seeking harm-reduction services in Peru to assess whether they pursued an abortion after counseling and, if so, what the experience was like.
The harm-reduction consultation included confirmation of pregnancy, assessment of gestational age by ultrasound and counseling about pregnancy options – including the use of misoprostol for women choosing to terminate – and any other needed emotional support.
At the end of the initial consultation, counselors offered in-person and telephone follow-up options. Those who chose telephone follow-up had an assessment that was based on a previous pilot study in the U.S. (http://bit.ly/2mDmPee)
Women who said they had taken misoprostol were asked a series of questions to confirm successful completion of the abortion and to gather information about the woman’s experience. The questions were:
1. Did you have pain and bleeding heavier than a normal period?
2. Did you expel blood clots and/or tissue?
3. Is your bleeding currently less than the heaviest day of your period?
4. Have the symptoms of pregnancy (nausea, swollen breasts) disappeared?
Among women who enrolled, 48% were lost to follow-up. Nine were excluded from the analysis because they did not meet inclusion criteria or answered fewer than 30% of the questions.
Therefore, 253 women (mean age, 26) were included in the analysis reported online January 10 in PLoS One.
Overall, 86% of participants took misoprostol, of whom 89% reported a complete abortion at the time of the survey. Twenty-two percent obtained an aspiration after taking misoprostol and 8% reported adverse events, including hemorrhage without transfusion, infection, or severe pain.
Of the women who took misoprostol, 46% reported receiving follow-up in-person and, in some cases, also by phone; 34% received telephone-only follow-up; and 20% reported receiving no type of follow-up.
Women who had in-person follow-up with a counselor were most likely to report a complete abortion. Satisfaction with both types of follow-up was very high: 81% to 89% said they were very satisfied.
“Liberalization of restrictive abortion laws is associated with improvements in health outcomes, but the process of legal reform is often lengthy,” the authors state.
“In the interim,” they conclude, “giving women information about evidence-based regimens of misoprostol, as well as offering a range of follow-up options to ensure high quality post-abortion care, may reduce the risks associated with unsafe abortion.”
Dr. Grossman said, “I think there are lessons that U.S. physicians could learn from this program and others like it throughout Latin America.”
“As abortion becomes more and more difficult to access in the U.S., I wonder if physicians might be willing to give their patients information about how to use safe medications obtained online, for example,” he suggested. “They could then provide post-abortion care for them to ensure the method was effective and treat any complications.”
Dr. Amitasrigowri Murthy, assistant professor in the Department of Obstetrics and Gynecology at NYU Langone Health in New York City, commented, “Harm reduction using misoprostol is a great option in those places where abortion is illegal or limited.”
“It could be feasible here in the U.S., particularly in those places where abortion is limited due to lack of providers,” she said in an email to Reuters Health. “However, the actual mechanics of care delivery may be complicated and subject to legal issues.”
SOURCE: http://bit.ly/2D5oDDK
PLoS One 2018.
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