BackgroundOver the last three decades, cesarean section (CS) rates have been rising around the world despite no associated improvement in maternal and perinatal mortality and morbidity. The role of women’s preferences for mode of delivery in contributing to the high CS rate remains controversial; however these preferences are difficult to assess, as they are influenced by culture, knowledge of risk and benefits, and personal and social factors. In this qualitative study, our objective was to understand women’s preferences and motivational factors for mode of delivery. This information will inform the development and design of an assessment aimed at understanding the role of the women’s preferences for mode of delivery.MethodsWe conducted 4 focus group discussions (FGDs) and 12 in-depth interviews with pregnant women in Buenos Aires, Argentina in 4 large non-public and public hospitals. Our sample included 29 nulliparous pregnant women aged 18–35 years old, with single pregnancies over 32 weeks of gestational age, without pregnancies resulting from assisted fertility, without known pre-existing medical illness or diseases diagnosed during pregnancy, without an indication of elective cesarean section, and who are not health professionals. FGDs and interviews followed a pre-designed guide based on the health belief model and social cognitive theory of health decisions and behaviors.ResultsMost of the women preferred vaginal delivery (VD) due to cultural, personal, and social factors. VD was viewed as normal, healthy, and a natural rite of passage from womanhood to motherhood. Pain associated with vaginal delivery was viewed positively. In contrast, women viewed CS as a medical decision and often deferred decisions to medical staff in the presence of medical indication.ConclusionsThese findings converge with quantitative and qualitative studies showing that women prefer towards VD for various cultural, personal and social reasons. Actual CS rates appear to diverge from women’s preferences and reasons are discussed.

Abortion is legally restricted in most of Latin America where 95% of the 4.4 million abortions performed annually are unsafe.Medical abortion (MA) refers to the use of a drug or a combination of drugs to terminate pregnancy. Mifepristone followed by misoprostol is the most effective and recommended regime. In settings where mifepristone is not available, misoprostol alone is used.Medical abortion has radically changed abortion practices worldwide, and particularly in legally restricted contexts. In Latin America women have been using misoprostol for self-induced home abortions for over two decades.This article summarizes the findings of a literature review on women’s experiences with medical abortion in Latin American countries where voluntary abortion is illegal.Women’s personal experiences with medical abortion are diverse and vary according to context, age, reproductive history, social and educational level, knowledge about medical abortion, and the physical, emotional, and social circumstances linked to the pregnancy. But most importantly, experiences are determined by whether or not women have the chance to access: 1) a medically supervised abortion in a clandestine clinic or 2) complete and accurate information on medical abortion. Other key factors are access to economic resources and emotional support.Women value the safety and effectiveness of MA as well as the privacy that it allows and the possibility of having their partner, a friend or a person of their choice nearby during the process. Women perceive MA as less painful, easier, safer, more practical, less expensive, more natural and less traumatic than other abortion methods. The fact that it is self-induced and that it avoids surgery are also pointed out as advantages. Main disadvantages identified by women are that MA is painful and takes time to complete. Other negatively evaluated aspects have to do with side effects, prolonged bleeding, the possibility that it might not be effective, and the fact that some women eventually need to seek medical care at a hospital where they might be sanctioned for having an abortion and even reported to the police.

In Argentina adolescent pregnancy is still regarded as a public health problem or a ''social epidemic'' . However, it is necessary to ask from which perspective and for whom it is a problem, and what type of problem. This article presents the findings of a large quantitative and qualitative study conducted in five Northern provinces and two metropolitan areas of Argentina in [2003][2004]. Based on the results of a survey of adolescent mothers (n=1,645) and ten focus group discussions with adolescent girls and boys, it addresses the connections between school dropout, pregnancy and poverty, and makes recommendations on how to tailor health care and sexuality education to address local realities. The findings indicate a need to develop educational activities to promote safer sex and address gender power relations in programmes working with deprived communities. Sexuality education with a gender and rights perspective, and increasing accessibility to contraceptive methods for adolescent girls and boys is also crucial. Antenatal and post-partum care, as well as post-abortion care, should be improved for young women and viewed as opportunities for contraceptive counselling and provision. Male participation in pregnancy prevention and care also needs to be promoted. A2008 Reproductive Health Matters. All rights reserved.

Resumen Desde hace casi un siglo el código penal argentino incluye situaciones en las que el aborto no está penalizado: riesgo para la salud y embarazo producto de violación. Sin embargo, su implementación ha sido inexistente hasta recientemente. Este estudio cualitativo exploró las experiencias de mujeres que accedieron a un aborto legal con el fin de analizar los recorridos que transitan e identificar los modos en que el estigma se percibe, manifiesta y procesa. Las mujeres parten del supuesto de que el aborto es siempre ilegal y “descubren” la legalidad después de recorrer un laberinto plagado de estigma, riesgo, frustración y desesperación. Las situaciones de mayor angustia no se vinculan a la decisión de interrumpir el embarazo sino al recorrido tortuoso que deben transitar. La “legalidad oculta” es causa y consecuencia del estigma vinculado al aborto.

Resumen Este artículo examina el fenómeno de la objeción de conciencia (OC) a los servicios de aborto legal en Argentina, Uruguay y Colombia. Basado en relatos obtenidos a través de entrevistas, el análisis toma distancia de aquellos enfocados en diferenciar entre OC y barreras al servicio, o en identificar si las razones de objeción son verdaderas o válidas. Partiendo del hecho de que en muy pocos casos las/los objetoras/es están al tanto de las definiciones legales de la OC, se busca entender los significados que las/los entrevistadas/os le atribuyeron, y desde los cuales organizan su práctica médica, y justifican su negación a prestar servicios de aborto. En los tres países las/los entrevistadas/os se oponían principalmente a que fueran las mujeres quienes tomaran la decisión de qué embarazos interrumpir, y cómo y cuándo hacerlo. Los discursos contingentes a través de los cuales las/os médicas/os construyen las racionalidades de su OC están hechos, sobre todo, de un incuestionado apego al control de los cuerpos con capacidad de gestar; y de entendidos médico-sociales de las mujeres como inexorablemente madres, máquinas de reproducción o soportes vitales de fetos.