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Lessons for health workers and advocates on how we can harness Argentina’s ‘green wave’ to strengthen access to safe abortion

Argentina’s abortion law is a revolutionary step in eliminating discrimination against women and girls and in combating the scale of unsafe abortion – a public health crisis in Argentina. It is estimated that 500,000 abortions take place each year in Argentina, which represents 40% of all pregnancies. Every year, unsafe abortions represent 18% of pregnancy-related deaths and over 50,000 preventable hospitalizations in Argentina.

The new law represents the culmination of a concerted and multidimensional campaign led by the feminist movement in Argentina and throughout Latin America, supported by health workers and advocates from the political, religious, social, health and social fields. human rights.

The result is a progressive and inclusive law that represents a roadmap for the rest of the region. As Mariela Belski, human rights lawyer and Executive Director of Amnesty International Argentina, explained, “One thing we can learn from Argentina is that finally, people who are pregnant as a result of a rape will not have to document their experience in order to ensure access to safe abortion. When advocating for change, this is a crucial legal element to ensure that all people can access a safe abortion after rape.

On top of that, Belski highlighted the success of having a law that includes gender.

“We are encouraged to see that the law fully includes gender non-conforming and recognizes that transgender men and boys, intersex and non-binary people get pregnant. However, this does mean that additional training should be included on how best to support them. “

According to Dr Analia Messina, Argentine OBGYN and consultant for the National Directorate of Sexual and Reproductive Health and UNFPA, legalizing abortion in Argentina is the start of a long journey to ensure access to abortion secure in Argentina. Many other changes will be necessary to improve the effectiveness of the law on the ground.

In fact, Dr Laura Gil, a Colombian obstetrician-gynecologist and member of the FIGO Safe Abortion Committee, pointed out that beyond the legislative barriers in place due to religious and political objections, there are also regulatory barriers, problems of poor service delivery and a lack of knowledge of existing rights. According to Dr Gil, it is essential that the OBGYN community is aware of the many barriers to accessing safe abortion and finds allies within the legal community to overcome them.

An example of such an obstacle is the fact that “conscientious objection” was immediately exploited by the anti-choice movement in an effort to restrict the application of the new law in Argentina. “Conscientious objection” only applies to physicians performing a medical procedure, and not to the many staff members involved in the overall process of accessing a safe abortion. In addition, under the new law, anyone who is unwilling to perform the procedure must refer the person seeking an abortion to a provider who can provide the service within 10 days.

According to Dr Messina, these provisions have the potential to improve access to abortion and “establish a new basis in law, which creates a judicial and legislative standard”. Yet Dr Gil reported that there is a large amount of misinformation on the subject that continues to be misapplied when it comes to providing abortion care, and therefore education and awareness is essential. the continued provision of a safe abortion.

Dr Analia Messina was at the forefront of the campaign for the legalization of abortion in Argentina. She underlined the importance of a multidisciplinary approach and underlined the role of OBGYNs in providing data on public health and maternal mortality due to unsafe abortion.

“We presented evidence to both legislative chambers that argued for health economics and presented the 88% cost reduction through the use of misoprostol versus the estimated cost of care through the use of misoprostol. [treating] complications of clandestine abortion.

The essential role of healthcare providers in compiling evidence and working in partnership with advocacy networks cannot be underestimated: they can capitalize on their frontline position to gather and present strong clinical evidence. Data provided to legislative chambers underscored the need to view abortion as an essential healthcare procedure and as a necessity to prevent maternal death and disability.

Fundamentally, health care providers need to see themselves as advocates for women’s health. Dr Gil said that through her work with FIGO, she is also able to influence and leverage various formal statements to push for change within national bodies in Colombia, such as the Colombian Federation of Obstetrics and Gynecology (FECOLSOG). She argued that at the center of the discrimination faced by those seeking abortions is “the failure to recognize women’s self-determination” as a human right.

Additionally, FIGO President Dr Carlos Füchtner highlighted the need for obstetricians-gynecologists to recognize their role in working beyond healthcare to implement change and see their role in and within society.

“In a way, corporations, OBGYNs, we can be the problem as well as the solution. We have to learn to be the solution to the problem, and we don’t have to do it as individual societies alone … we can work at all levels to support abortion, not only at the health level, but also social and political level.

According to Dr Atziri Ramirez, OBGYN in Mexico and president of the World Association of Trainees in Obstetrics and Gynecology, it is essential that OBGYNs and other health care providers are trained and empowered to promote full reproductive autonomy.

“Education is changing [people], the need to include comprehensive abortion care in the curriculum is crucial to ensure that these changes can be implemented effectively. We have to work with other health professionals – not only with doctors, but also with nurses, social workers, psychologists. It’s a whole network of support and we have to work as a cohesive system.

As pointed out by Dr Miguel Gutierrez, former president of the Peruvian Society of Obstetrics and Gynecology and coordinator of the FIGO advocacy project for safe abortion, campaigning for changes in the program, both at the national level international, remains one of the clearest methods to advocate for change as a health worker.

“We need to include changes in the health care offer that recognizes sexual education and women’s reproductive autonomy … when we talk about normalizing abortion as a health service, we would remove the stigma, which I think is one of the main obstacles that exist. . “

Dr Gutierrez stressed the importance of a dedicated and persistent approach to de-stigma at different levels of health workers. He also highlighted the holistic approach of FIGO’s ASAP and highlighted the difference between providing information about abortion – a fundamental part of effective health care – and actively promoting abortion. These nuances need to be understood by health workers when tailoring their advocacy to different audiences, in order to bring together different groups of people to support access to abortion as a human right.

In many of the more conservative Catholic societies in Latin America, this distinction is important in building solidarity to provide free and legal access to safe abortion. In fact, Mariela Belski highlighted the importance of legalizing abortion in Pope Francis’ home country, and the influence it has had in the religious region of Latin America.

Overall, FIGO’s discussion of how health workers and advocates can leverage Argentina’s experience to legalize access to safe abortion was broad and engaging. We heard a number of different perspectives, all ultimately aligned to underscore the need for healthcare providers to engage with the campaign and use their privileged positions and access to advocate for women. and the girls.

Abortion is an essential and urgent medical service – a service that should be provided according to the preferences of women and girls, and with safety, privacy and dignity at the forefront. Reproductive autonomy, including access to safe abortion services, is a fundamental and non-negotiable human right.

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