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Uruguay FIGO Project concludes with exceptional success



Since 2006, the SOGC has taken on the role of mentor for FIGO's Saving Mothers and Newborns Initiative in 5 low-resource countries. These projects aim to build and sustain the capacity of ob/gyn and midwife societies in low-resource settings to implement safe motherhood projects in their country. One country project in particular, Uruguay, has achieved remarkable success.

The Uruguay FIGO project entitled, To protect the life and health of Uruguayan women by reducing unsafe abortions, set out to reduce the number of abortions performed under conditions of risk in Uruguay, to reduce maternal morbidity and mortality associated with abortion, and to implement a sustainable model at the national level for reducing the number of abortions performed under conditions of risk. Through FIGO's twinning mechanism, Dr. Lalonde was appointed mentor for this project and provided support to both the Uruguayan Gynecological Society and the Uruguayan Midwives Association.

Dr. Lalonde has been intimately involved with the Uruguay project and team since its initiation. He recently visited Uruguay to attend the closing celebration of the FIGO project, where he shared a panel with the President of Uruguay, José Mujica, along with the Minister of Public Health, Daniel Olesker. The success of the project was celebrated widely, with extensive media coverage resonating the President's message throughout the country: "We need to face the problems head on and take actions to save the lives of more women".

Abortion has remained illegal in Uruguay since the 1938 Uruguayan Constitution was enacted. Under this restriction, health providers were legally obliged to report women who have undergone an abortion to the authorities for punishment by jail sentence. Clearly, this resulted in severe consequences, not only for the women, but for establishing relationships of trust between health care providers and patients. It is a well known fact that women with unwanted pregnancies seek to abort whether safely or not and whether legal or not. As is the case in any country, it is the poorest, less educated women who recur to getting an abortion in unsafe conditions, and risk their lives in so doing.

To address the high rates of deaths secondary to unsafe abortions in Uruguay, a group of concerned Ob/Gyn doctors, midwives, anthropologists, and psychologists formed an NGO called Iniciativas Sanitarias (IS) and designed a new strategy for reducing unsafe abortions based on a human rights approach. Rather than addressing abortion's illegality, the IS group has lobbied for ethical patient treatment and has established a model of care delivery which emphasizes private counseling and women's empowerment to allow each woman to be aware of the consequences of unsafe abortion and to have the necessary information to make an informed decision. Women who were certain of their choice to abort were encouraged to self-administer misoprostol rather than resort to clandestine services.

After testing this model at one hospital over a period of 15 months and obtaining very positive results, the Uruguayan Society of Gynecologists submitted a proposal to FIGO's Saving Mothers and Newborns Initiative to replicate and scale up the IS model to 8 additional health facilities, with the aim of reaching 70% of the Uruguayan population, especially families from low socioeconomic status. Before accepting the project proposal, Dr. Lalonde representing FIGO, insisted on the inclusion of the Uruguayan Midwives' Association as a partner. After negotiating this condition and accepting the collaborative approach, the project was launched in September 2006.

With support from FIGO, the IS model has now been rolled out in a total of 8 health centers in Uruguay. According to Dr. Lalonde, "the project has achieved its goal and is completely sustainable". Indeed, the Uruguay FIGO project has not only achieved its set goal and objectives, but has surpassed expectations and achieved exceptional results. After the project came to an end in August 2010, a consulting firm was hired to evaluate the project outcomes. In the final evaluation document, the consultant stated, "I have worked on improving Post-Abortion services in multiple countries where abortion is illegal but am not aware of any other strategy that can claim this success".

Some achievements of the Uruguay FIGO project include: a change in attitude among health professionals and non professionals towards abortion, following workshops that were designed to address attitudes and prejudice, as well as to encourage mutual trust and confidentiality with patients; adoption of and training on the use of new guidelines and norms of practice; training for delivery of abortion counseling services; improvements to clinic infrastructure to provide complete privacy to patients; delivery of services to 2,717 women, including pre and post-abortion counseling and family planning services; strengthened partnership between the Uruguayan Gynecological Society and Midwives Association; changes to curriculum in national medical, midwives', nursing and psychology schools to include the IS model; and a reduction in deaths secondary to unsafe abortion (since implementation of the project, no deaths attributed to complications of abortion have been reported in any of the project health centers).

Among the most noteworthy results achieved, is the adoption of the IS model by Uruguay's Ministry of Health. Using a train-the-trainer technique, the Ministry of Health is currently scaling up implementation of the IS model throughout the entire country, with abortion counseling services expected to be offered in every health center by 2011. Furthermore, lobbying on behalf of the IS group has resulted in the Uruguayan Government adopting an Ordenanza (less than law but legally binding) in 2004 and subsequently passing Law 18-426 on sexual and reproductive rights in 2008, which states that women with an unwanted pregnancy who are considering abortion must be provided with pre-abortion counseling, as well as post-abortion counseling, and counseling for future pregnancy prevention by use of contraception.

The success of the Uruguay FIGO project exemplifies the need for a paradigm shift in attitudes, as well as implementation of protocols centered on harm reduction, to address the complex issue of abortion. By addressing the harm caused by dangerous abortions as a human rights and health problem rather than addressing the illegality of abortions, it has changed providers' paternalistic, punitive attitudes and behavior towards the women who access services.

Based on the outstanding results of this project, new international efforts are underway to replicate the IS model in other low-resource countries where abortion remains illegal. As Dr. Lalonde explains, "The IS model has the potential of transforming health systems' response to abortions around the world and, more importantly, of influencing the attitudes of health professionals. I think all health providers can learn from Uruguay's experience, even those working in developed countries, like Canada, where abortion laws are less stringent but women's needs are just the same".

Learn more about FIGO's Saving Mothers and Newborns Initiative

Learn more about the Uruguayan Gynecological Society

Learn more about Iniciativas Sanitarias


Or learn more by reading the media articles below:

Proyecto logró disminuir mortalidad materna por aborto inseguro

Experto alabó plan uruguayo de consejería sobre aborto

"Lo más importante es proteger la vida y la salud de las mujeres" dijo Mujica

El médico canadiense André B. Lalonde brinda su punto de vista sobre el aborto  (interview with Dr. Lalonde - available only in Spanish)

 

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