Implementation of the risk and harm reduction strategy against unsafe abortion in Uruguay: From a university hospital to the entire country

Abstract

The history of the creation of the risk and harm reduction model applied to unsafe abortion is reviewed, from its initial implementation by a small group of gynecologists at the Pereira Rossell Hospital Center in Uruguay to its spread to the rest of the country. Its ethical rationale, its successful application in the hospital, the decision to disseminate it with the cooperation of the International Federation of Gynecology and Obstetrics (FIGO), and the intervention procedures are explained. It was evaluated from the epidemiological and anthropological viewpoints, from the changes in professionals' and users' perception of the care offered and its impact on complications and maternal deaths. A very favorable change was seen in the number and quality of the services, the providers' attitude, and maternal morbidity and mortality were reduced. It also brought visibility to women with unplanned and unwanted pregnancies and an improved understanding of their problems, which contributed to the legislative changes that were made subsequently.

Keywords: Maternal morbidity; Maternal mortality; Professional ethics; Risk reduction; Unsafe abortion; Uruguay.