Catalyst for change: Lessons learned from overcoming barriers to providing safe abortion care in Médecins Sans Frontières projects.

Autor: Kumar M; Médecins Sans Frontières, Operational Centre Amsterdam, Amsterdam, Netherlands., Schulte-Hillen C; Médecins Sans Frontières, International Office, Geneva, Switzerland., De Plecker E; Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium., Van Haver A; Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium., Marques SG; Médecins Sans Frontières, Operational Centre Barcelona, Barcelona, Spain., Daly M; Médecins Sans Frontières, Operational Centre Amsterdam, Amsterdam, Netherlands., Vochten H; Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium., Merzaghi L; Médecins Sans Frontières, Operational Centre Geneva, Geneva, Switzerland., de le Vingne B; Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium., Saint-Sauveur JF; Médecins Sans Frontières, Operational Centre Barcelona, Barcelona, Spain.
Jazyk: angličtina
Zdroj: Perspectives on sexual and reproductive health [Perspect Sex Reprod Health] 2024 Mar; Vol. 56 (1), pp. 60-71. Date of Electronic Publication: 2022 Oct 23.
DOI: 10.1363/psrh.12209
Abstrakt: Context: Despite instituting a policy in 2004, Médecins Sans Frontières (MSF) continuously struggled to routinely provide safe abortion care (SAC). In 2016, the organization launched an initiative aimed at increasing availability of SAC in MSF projects and increasing understanding of abortion-related dynamics in humanitarian settings.
Methodology: From March 2017 to April 2018, MSF staff conducted support visits to 10 projects in a country in sub-Saharan Africa. Each visit followed a systematic approach with six key components and related tools that were later shared with teams worldwide. Data regarding women seeking abortion services and related outcomes were collected and analyzed retrospectively.
Results: From Q1 2017 through Q4 2019, SAC provision increased significantly in all 10 projects, rising from three to 759 safe abortions per quarter. Teams received 3831 patients seeking SAC and provided 3640 first and second trimester abortions, over 99% via medication methods. The overall complication rate was 4.29% and 0.3% for severe, life-threatening complications. No major security incidents were reported. MSF provision of SAC worldwide increased from 781 in 2016 (the year before this initiative began) to 21,546 in 2019.
Conclusion: Implementation of SAC in humanitarian settings-even those with significant legal restrictions-is possible and necessary. Both first and second trimester medication abortion can be safely and effectively provided through both home- and facility-based models of care. Programmatic data provide valuable insights into abortion-related dynamics which must shape operational decision-making. Addressing internal barriers and providing direct field support were key to stimulating organizational cultural change.
(© 2022 The Authors. Perspectives on Sexual and Reproductive Health published by Wiley Periodicals LLC on behalf of University of Ottawa.)
Databáze: MEDLINE
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