Realising the right to sexual and reproductive health: access to essential medicines for medical abortion as a core obligation

Perehudoff, Katrina; Pizzarossa, Lucía Berro; Stekelenburg, Jelle

doi:10.1186/s12914-018-0140-z

Cited by 9 publications

(7 citation statements)

References 20 publications

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“…No constitution obliges the State to respect the provision of essential medicines (i.e. Respecting essential medicines could entail the government not interfering with access to specific classes of medicines such as contraception or for medical abortion) [ 54 ]. Full results are reported elsewhere [ 37 ].…”

Section: Resultsmentioning

confidence: 99%

Universal access to essential medicines as part of the right to health: a cross-national comparison of national laws, medicines policies, and health system indicators

Perehudoff

2020

Global Health Action

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Background: Access to essential medicines for the world's poor and vulnerable has made little progress since 2000, except for a few specific medicines such as antiretrovirals for HIV/ AIDS. Human rights principles written into national law can create a supportive environment for universal access to medicines; however, systematic research and policy guidance on this topic is lacking. Objective: To examine how international human rights law and WHO's essential medicines policies are embedded in national law for medicines affordability and financing, and interpreted and implemented in practice to promote universal access to essential medicines. Methods: This thesis consists of (1) a cross-national content analysis of 192 national constitutions, 71 national medicines policies, and legislation for universal health coverage (UHC) from 16 mostly low-and middle-income countries; (2) a case study of medicines litigation in Uruguay, and (3) a follow-up report of eight right to health indicators for access to medicines from 195 countries. Results: Some, but not all, of the 12 principles from human rights law and WHO's policy are embedded in national UHC law and medicines policies (part 1). Even the most rights-compliant legislation for access to medicines is subject to the unique and inconsistent interpretation of domestic courts, which may be inconsistent with the right to health in international law (part 2). Many national health systems for which data were available still fail to meet the official targets for eight indicators of access to medicines (part 3). Conclusions: International human rights law and WHO policy are embedded in national law for essential medicines and practically implemented in national health systems. Law makers can use these findings and the example texts in this thesis as a starting point for writing and monitoring governments' rights-based legal commitments for access to medicines. Future research should study the effect of national law on access to medicines and population health.

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Section: Resultsmentioning

confidence: 99%

Universal access to essential medicines as part of the right to health: a cross-national comparison of national laws, medicines policies, and health system indicators

Perehudoff

2020

Global Health Action

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“…Combining medication uterine evacuation with manual vacuum aspiration within the same curriculum appeared feasible and indeed complementary as misoprostol and mifepristone are increasingly available in countries affected by fragility or crises [ 32 , 33 ]. Additionally, universal access to such medications, which are part of the WHO Model List of Essential Medicines [ 34 ], adhere to contemporary standards on sexual and reproductive health and rights [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Strengthening healthcare providers’ capacity for safe abortion and post-abortion care services in humanitarian settings: lessons learned from the clinical outreach refresher training model (S-CORT) in Uganda, Nigeria, and the Democratic Republic of Congo

et al. 2021

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Background Fragile and crisis-affected countries account for most maternal deaths worldwide, with unsafe abortion being one of its leading causes. This case study aims to describe the Clinical Outreach Refresher Training strategy for sexual and reproductive health (S-CORT) designed to update health providers’ competencies on uterine evacuation using both medications and manual vacuum aspiration. The paper also explores stakeholders’ experiences, recommendations for improvement, and lessons learned. Methods Using mixed methods, we evaluated three training workshops that piloted the uterine evacuation module in 2019 in humanitarian contexts of Uganda, Nigeria, and the Democratic Republic of Congo. Results Results from the workshops converged to suggest that the module contributed to increasing participants’ theoretical knowledge and possibly technical and counseling skills. Equally noteworthy were their confidence building and positive attitudinal changes promoting a rights-based, fearless, non-judgmental, and non-discriminatory approach toward clients. Participants valued the hands-on, humanistic, and competency-based training methodology, although most regretted the short training duration and lack of practice on real clients. Recommendations to improve the capacity development continuum of uterine evacuation included recruiting the appropriate health cadres for the training; sharing printed pre-reading materials to all participants; sustaining the availability of medication and supplies to offer services to clients after the training; and helping staff through supportive supervision visits to accelerate skills transfer from training to clinic settings. Conclusions When the lack of skilled human resources is a barrier to lifesaving uterine evacuation services in humanitarian settings, the S-CORT strategy could offer a rapid hands-on refresher training opportunity for service providers needing an update in knowledge and skills. Such a capacity-building approach could be useful in humanitarian and fragile settings as well as in development settings with limited resources as part of an overall effort to strengthen other building blocks of the health system.

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“…The high frequency of curettage in Latin America had been found in a study of medication provision through telemedicine in the entire world 59 . It is also worth encouraging a reflection regarding the inclusion of mifepristone in the list of medications available in Brazil, considering the greater efficacy and safety of the combined use of this medication with misoprostol in the initial phase of inducing abortions 60 .…”

Section: Discussionmentioning

confidence: 99%

Aborto legal no Brasil: revisão sistemática da produção científica, 2008-2018

et al. 2020

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Resumo: Revisões anteriores sobre o aborto no Brasil estimaram um milhão de procedimentos anuais, porém, não abordaram o aborto legal. O objetivo desta revisão sistemática foi atualizar o conhecimento sobre o aborto legal, quanto ao perfil dos serviços, das mulheres atendidas, conhecimento de estudantes e médicos, situação de anencefalia e malformações graves. A busca de artigos foi via MEDLINE e LILACS, de 2008 a 2018, sem restrição de idiomas. A qualidade dos artigos foi avaliada com instrumentos do Joanna Briggs Institute. Busca, seleção, avaliação de qualidade e extração de dados foram feitas independentemente por duas pesquisadoras. Selecionaram-se 20 artigos, 11 sobre conhecimento e opinião de profissionais médicos (4 artigos) e estudantes de Medicina (7 artigos), revelando conhecimento aquém do ideal sobre o aborto legal e objeção de consciência elevada. Seis estudos sobre as mulheres atendidas identificaram que elas são jovens, solteiras e a principal demanda foi a gravidez decorrente de estupro. A demora em procurar atendimento ocorreu dentre as mais jovens, solteiras e quando o agressor era alguém próximo. Três estudos sobre malformações graves mostraram autorização judicial em torno de 40%. Nos casos sem autorização, a evolução da gravidez foi complicada e o parto foi cesáreo. Apenas um artigo abordou os serviços de aborto legal, apontando 37 dos 68 cadastrados em atividade, inexistência em sete estados e concentração nas capitais. O conhecimento sobre o aborto legal ainda é escasso, a demanda do procedimento é reprimida e a formação médica é deficiente no tema.

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Realising the right to sexual and reproductive health: access to essential medicines for medical abortion as a core obligation

Cited by 9 publications

References 20 publications

Universal access to essential medicines as part of the right to health: a cross-national comparison of national laws, medicines policies, and health system indicators

Universal access to essential medicines as part of the right to health: a cross-national comparison of national laws, medicines policies, and health system indicators

Strengthening healthcare providers’ capacity for safe abortion and post-abortion care services in humanitarian settings: lessons learned from the clinical outreach refresher training model (S-CORT) in Uganda, Nigeria, and the Democratic Republic of Congo

Aborto legal no Brasil: revisão sistemática da produção científica, 2008-2018

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