Experiencia vivida frente al aborto inducido en un grupo de mujeres en Bogotá, Colombia / Lived Experience with Induced Abortion of a Group of Women in Bogotá, Colombia / Experiência com o aborto provocado em um grupo de mulheres em Bogotá, Colômbia

Introducción: frente al aborto inducido se han establecido diferentes posturas que muchas veces se basan en perspectivas morales, filosóficas y religiosas, cuando deberían estar centradas en lo que implica esta situación de salud en la vida de las mujeres Metodología: se desarrolló una investigación fenomenológica para establecer los diálogos desde la perspectiva de las propias protagonistas sobre el aborto inducido con una participación de siete mujeres, mayores de 18 años en Bogotá. Resultados: las experiencias de las mujeres son variadas, pero se identificaron algunos aspectos similares o comunes. Sin embargo, cada vivencia es particular y tiene como marco el contexto en el que cada una habitaba en el momento del aborto. Se identificaron las siguientes categorías de análisis: aborto como consecuencia de un embarazo no deseado, aborto como experiencia frente a una decisión autónoma, aborto, culpa y pecado, cambios asociados a la experiencia, maternidad, materialización del deseo y aborto no debe ser considerado como un delito. Conclusiones: la vivencia del aborto no puede ser generalizable, y para su entendimiento debe tenerse en cuenta aspectos que solo atañen a la mujer como experta en su vida y en su situación. El aporte de la presente investigación fue recuperar la vivencia de las mujeres sobre el aborto para contribuir al cuidado de la salud en la población femenina

Introdução: sobre o aborto provocado têm-se estabelecido diferentes posturas, muitas vezes baseadas em perspectivas morais, filosóficas e religiosas, quando deveriam estar focadas no que implica essa situação de saúde na vida das mulheres. Metodologia: desenvolveu-se uma pesquisa fenomenológica para estabelecer os diálogos na perspectiva das próprias protagonistas sobre o aborto provocado com a participação de sete mulheres, maiores de 18 anos, em Bogotá. Resultados: as experiências das mulheres são variadas, mas alguns aspectos semelhantes ou comuns foram identificados. Porém, cada experiência é particular e se enquadra no contexto em que cada uma permanecia no momento do aborto. Foram identificadas as seguintes categorias de análise: aborto como consequência de uma gravidez indesejada, aborto como experiência diante de uma decisão autônoma, aborto, culpa e pecado, mudanças associadas à experiência, maternidade, materialização do desejo e aborto não deve ser considerado como um crime. Conclusões: a experiência do aborto não pode ser generalizável e, para sua compreensão, devem ser considerados aspectos que dizem respeito apenas à mulher como especialista em sua vida e em sua situação. A contribuição desta pesquisa foi resgatar as vivências de mulheres sobre o aborto para contribuir com a atenção à saúde da população feminina.

Introduction: Regarding induced abortion, different positions have been adopted, often based on moral, philosophical, and religious perspectives, when they should be focused on what this health situation implies for women's lives. Method: A phenomenological research was conducted to establish dialogues from the own protagonists' perspective of induced abortion, where seven women over 18 years of age in Bogotá participated. Results: Women's experiences are varied, but some similar or common aspects were identified. However, each experience is specific and is framed within the context where each woman lived at the time of the abortion. The following categories of analysis were identified: Abortion as a consequence of unwanted pregnancy, abortion as an experience versus an autonomous decision, abortion, guilt and sin, changes associated with the experience, maternity, desire materialization, and abortion should not be considered a crime. Conclusions: Abortion experience cannot be generalized, and for its understanding, aspects that only concern women as the experts on their lives and situations must be taken into account. This research contribution was to restore women's abortion experiences to advance female population health care

Mayor mortalidad materna por aborto en Cuba que en Chile, 2000-2015 / Higher maternal mortality from abortion in Cuba than in Chile, 2000-2015

RESUMEN Antecedentes: La muerte materna por aborto inseguro es un severo problema de salud pública, países con leyes de aborto liberales tendrían menor riesgo de aborto inseguro y de mortalidad por aborto. Cuba tiene una legislación que no penaliza el aborto inducido, mientras en Chile es ilegal en todos los casos hasta su reciente despenalización en 3 causales. Objetivo: Se postula que Cuba tendría una menor mortalidad materna por aborto que Chile, por lo que se propone comparar la evolución de la razón de mortalidad materna por aborto entre ambos países, en el período 2000-2015. Material y Método: Los datos crudos de muertes asociadas al aborto y nacidos vivos se obtienen de las bases de datos de estadísticas vitales de ambos países. La oportunidad relativa de muerte se estima según Odds Ratio (OR) con intervalo de confianza del 95% (IC 95%) de las razones de mortalidad materna. Resultados: La razón de muerte materna asociada al aborto fue mayor en Cuba que en Chile (OR: 1,91; IC 95%: 1,331 a 2,739; p=0,0004). Se observa una tendencia al descenso en Cuba y mientras no se observan cambios en Chile. Conclusiones: Contrario a lo postulado basado en las diferentes legislaciones de ambos países, en el período 2000-2015, Cuba presentó mayor razón de mortalidad materna asociada al aborto que Chile. Se comentan posibles condicionantes de la diferencia encontrada.

ABSTRACT Background: Maternal death due to unsafe abortion is a severe public health problem; countries with liberal abortion laws would have a lower risk of unsafe abortion and abortion mortality. Cuba has a legislation that does not penalize induced abortion, while in Chile it is illegal in all cases until its recent decriminalization in 3 grounds. Objective: It is postulated that Cuba would have a lower maternal mortality due to abortion than Chile, for which purpose it is proposed to compare the evolution of the maternal mortality by abortion between both countries, in the period 2000-2015. Material and Method: Raw data on deaths associated with abortion and live births are obtained from the vital statistics databases of both countries. The relative chance of death is estimated according to the Odds Ratio (OR) with a 95% confidence interval (95% CI) of the maternal mortality. Results: The maternal death rate associated with abortion was higher in Cuba than in Chile (OR: 1.91, 95% CI: 1.331 to 2.739; p = 0.0004). A downward trend is observed in Cuba and without changes in Chile. Conclusions: Contrary to the postulate based on the different legislations of both countries, in the period 20002015, Cuba had a higher maternal mortality associated with abortion than Chile. Possible conditioning factors of the difference found are discussed.

Abortion: a look from the perspectives of public health, rights and social justice / El aborto: una mirada desde la salud pública, los derechos y la justicia social

ABSTRACT Unsafe abortion is a problem of public health, rights and social justice, particularly so for women living in developing countries. Consequently, public health is called upon to protect dignity, promote the exercise of rights and create the right conditions to ensure that women can have control over their own reproductive autonomy. The article analyses three schools of distributive justice, examines their strengths and contradictions, and concludes that capability building, with its resulting social justice, that derives from these, would be the ideal approach to the issue of abortion in medium and low income countries; and that, for a public health system intent of achieving the highest degree of health and wellbeing, it secures the basic material conditions required for capabilities to flourish becoming the best alternative for greater participation in the construction of individual life projects; it would consider the reality of the people in their sociocultural environments and would allow to pull the female world out of the private realm to allow a public debate on these matters and prevent them from being considered as "natural" unchangeable aspects of human relations. This would ensure greater relevance in terms of meeting the needs of each population. The article also highlights that the social justice that characterises this approach will not come from the top, from the State, but requires collective participation, where movements that oppose hegemony play a very important role and are active in building their own capabilities.

RESUMEN El aborto inseguro se considera un problema de salud pública, de derechos y de justicia social. Esto es particularmente certero para las mujeres que viven en países en vías de desarrollo, por lo que se requiere de una salud pública que defienda la dignidad, fomente el ejercicio de los derechos y genere las condiciones necesarias para que las mujeres sean dueñas de su autonomía reproductiva. El artículo tiene como objetivo analizar tres corrientes de justicia distributiva, examina sus fortalezas y contradicciones, y concluye que el desarrollo de capacidades y la justicia social que de este se derivan sería ideal para afrontar de mejor manera el tema del aborto en los países de medianos y bajos ingresos, y, para una salud pública que pretende el mayor grado de salud y bienestar posibles, asegura la satisfacción de todas las condiciones materiales básicas para el florecimiento de las capacidades y, por ende, sería la mejor alternativa para una mayor participación en la construcción de vidas propias; tendría presente la realidad que viven las personas en sus entornos socioculturales, y posibilitaría sacar del espacio privado el mundo femenino, permitir el debate público sobre dichas cuestiones e impedir que sigan siendo consideradas como cuestiones "naturales" e inmutables de las relaciones humanas, lo que garantizaría una mayor pertinencia en la satisfacción de las necesidades de cada población. También recalca que la justicia social que caracteriza a este enfoque no llegará de arriba, del Estado, sino que requiere de una construcción colectiva, donde los movimientos contrahegemónicos juegan un papel muy importante y hacen parte de la propia construcción de capacidades.

Caracterización de adolescentes con aborto inducido en el Hospital Municipal de Libolo, Kwansa Sul, Angola / Characterisation of adoslescents with induced abortion in the Municipal Hospital of Libolo, Kwansa Sul, Angola

Se realizó un estudio descriptivo, observacional, de corte transversal, con el objetivo de caracterizar a las adolescentes con aborto inducido, que fueron ingresadas en la sala de maternidad del Hospital Municipal de Libolo, Kwansa Sul, en la República de Angola, desde noviembre de 2015 a diciembre de 2016. El universo de estudio estuvo constituido por las 103 adolescentes a las cuales se les realizó el diagnóstico de la patología antes mencionada. Las variables investigadas fueron edad, estado civil y complicaciones, como: sepsis, hemorragias, aborto incompleto y perforaciones. El grupo de edad más afectado fue el de 15 a 19 años. Las solteras tuvieron mayor predominio y la complicación más frecuente fue la sepsis. El aborto inducido en la adolescencia constituyó un problema de salud(AU)

A transversal observational descriptive study was carried out to characterise adoslcents with induced abortion that were hospitalized in the room of motherhood of the Municipal Hospital of Libolo, Kwansa Sul, in the Republic of Angola, from November 2015 to December 2016. The universe of study was of 103 adolescents positive to the diagnostic of the above-mentioned pathology. The variables investigated were age, civil state and complications as: sepsis, bleedings, incomplete abortion and perforation. The group of age more affected was the one of 15 to 19 years. The singles had greater predominance and the most frequent complications was the sepsis. The induced abortion in the adolescence is a problem of health(AU)

Unsafe Abortion: a serious public health issue in a poverty stricken population / Aborto Inseguro: um sério problema de saúde pública em uma população em situação de pobreza

Eighteen years after ICPD (Cairo, 1994), unsafe abortion (UA), contemplated thereby as a serious Public Health issue, persists in Brazil. This research, conducted in a slum in the outskirts of São Paulo by means of a cross-sectional study, intended estimating the prevalence of women who have had unsafe abortions, identifying the socio-demographic characteristics (SDC) related thereto, and their morbidity. This article refers to the SDC, the variables of which remained in the final model of the Multiple Multinomial Logistic Regression analysis carried out therefor - age at 1st sexual intercourse, number of partners, schooling, ethnicity/color, marital status and abortion acceptance driven by low-income conditions-with an approach intended for the social determinants of health and for the health inequities generated thereby in the case of UA, in an impoverished population. In conclusion, the UA and SDC are influenced by the SDH, creating health inequities in that population. The greatest proportion of women that induced unsafe abortion within this population was represented by black women, with lower income, with less than 4 years of school attendance and single, which indicates health inequalities and inequities.

Após 18 anos da CIPD, Cairo, 1994, a situação do Aborto Inseguro (AI), nela contemplado como um grave problema de Saúde Pública, permanece a mesma no Brasil. Esta pesquisa, um estudo transversal, realizada em uma favela da periferia de São Paulo, teve como objetivos estimar a prevalência de mulheres com aborto inseguro, identificar as características sociodemográficas (CSD) a ele associadas, e sua morbidade. São discutidas neste artigo as CSD cujas variáveis permaneceram no modelo final da análise de Regressão Logística Multinomial Múltipla efetuada com essa finalidade - idade da 1a relação sexual, número de parceiros, escolaridade, etnia/cor, estado civil e aceitação do aborto por falta de condições econômicas - com uma abordagem voltada aos determinantes sociais e às iniquidades em saúde por esses geradas na ocorrência do AI,em uma população em situação de pobreza. A maior proporção de mulheres que provocaram aborto inseguro nesta população foi a de mulheres de cor preta, com renda mais baixa, menos de 4 anos de estudo e solteiras, o que demonstra a presença de desigualdades e iniquidades em saúde.

Prevalência e características de mulheres com aborto provocado - Favela México 70, São Vicente - São Paulo / Prevalence and characteristics of women with induced abortion - Favela México 70, São Vicente - São Paulo

No Brasil, o aborto está entre as principais causas de mortalidade materna. Pesquisas mostram que o aborto é praticado clandestinamente por mulheres de todas as classes sociais; no entanto, tem consequências desiguais, dependendo da inserção social, produzindo riscos à vida de mulheres pobres. Embora o tema venha sendo amplamente explorado nos últimos 20 anos, observou-se escassez de dados sobre mulheres de baixa renda. Desta forma, o presente estudo tem por objetivo estimar a prevalência de mulheres com aborto provocado. Arrolaram-se mulheres por inquérito domiciliar de base populacional em setores de baixa renda de São Vicente, São Paulo. Eram elegíveis as mulheres em idade fértil de 15 a 49 anos. A avaliação das razões de prevalência de mulheres com aborto provocado foi realizada por meio de modelos lineares generalizados, usando-se a regressão de Poisson com função de ligação logarítmica e variância robusta para aproximar a binomial. As variáveis que demonstraram ter maior influência no relato de aborto foram: "aceitar sempre esta prática" (IC95 por cento 2,98 - 11,02), seguida de "não ter filho nascido vivo" (IC95 por cento 1,35 - 19,78), ter de "dois a cinco nascidos vivos" (IC95 por cento 1,42 - 14,40) e ter de "seis ou mais nascidos vivos" (IC 95 por cento 1,35 - 19,78), "idade no momento da entrevista" (IC 95 por cento 1,01 - 1,07) e "renda" < R$ 484,97 (IC 95 por cento 1,04 - 2,96). É necessário campanha de grande abrangência sobre a prática do aborto, que consiga sensibilizar para esta causa todas as mulheres, sobretudo as de baixa renda, evitando assim mortes desnecessárias.

In Brazil, abortion is among the leading causes of maternal mortality. Research has shown that abortion is practiced clandestinely by women of all social classes, but has unequal consequences depending on social inclusion, producing risks to poor women. Although the issue has been widely explored in the past 20 years, there is a lack of data about low-income women. Thus, the present study aims to estimate the prevalence of women with induced abortion. Women from a population-based household survey in low-income sectors of São Vicente, São Paulo were recruited. Women of childbearing age from 15 to 49 years were eligible. The evaluation of the prevalence ratios for women with induced abortion was performed by using generalized linear models, with Poisson log-link function and robust variance to approximate the binomial. The most frequent variables that influenced reporting of abortion were: "always accept this practice" (95 percent CI 2.98 - 11.02), followed by "not having a child born alive" (95 percent CI 1.35 - 19.78), having "two to five live births" (95 percent CI 1.42 - 14.40 ), "having 'six or more live births" (95 percent CI 1.35 - 19.78), "age at interview" (95 percent CI 1.01 - 1.07) and "income" < R$ 484.97' (95 percent CI 1.04 - 2.96). A widespread campaign about the practice of abortion, which can raise awareness among women in favor of the cause, especially among those in low-income strata is necessary to prevent unnecessary deaths.

Sociodemographic determinants of complicated unsafe abortions in a semi-urban Nigerian town: a four-year review / Determinantes sociodemográficas de abortos inseguros complicados en un poblado semiurbano de Nigeria: una revisión de cuatro anos

BACKGROUND: Abortions performed by persons lacking the requisite skills or in environments lacking minimal medical standards or both are considered unsafe. It is estimated that over 20 million unsafe abortions are performed annually and about 70 000 women die globally as a result, with the majority occurring in the developing world. This study aims to determine the sociodemographic factors involved in complicated unsafe abortions. SUBJECTS AND METHODS: The study is a four-year retrospective evaluation of all cases of complicated unsafe abortions managed at the Niger Delta University Teaching Hospital, Okolobiri, Bayelsa state, Nigeria between January 1, 2007 and December 31, 2010. RESULTS: The incidence of unsafe complicated abortions over the study period was 4.10% of total deliveries and contributed 14.0% of gynaecological admissions: 34.92% occurred in adolescents less than 20 years of age, of which the majority (55.55%) were secondary school students. There were 55.45% of patients who were nulliparae, 60.32% were unemployed and 69.80% were unmarried. A total of 87.30% had never used any form of contraceptive. Abortion mortality rate was 256/100 000 deliveries and the case fatality was 4.76%. It constituted 30.0% of all gynaecological deaths and 17.64% of maternal deaths during the study period. The commonest cause of death was septicaemia (66.66%). CONCLUSION: Unfavourable sociodemographic factors are major determinants of the high incidence of unsafe abortion in the Niger Delta despite strict abortion laws. Concrete measures must be put in place to address these, as unsafe abortion and its complications are a major cause ofmaternal morbidity and mortality in the environment.

ANTECEDENTES: Los abortos realizados por personas que no poseen las habilidades requeridas o en circunstancias en las quefaltan las normas médicas mínimas, o ambas, son considerados inseguros. Se estima que se realizan encima de 20 millones de abortos inseguros anualmente y aproximadamente 70 000 mujeres mueren globalmente como resultado, presentándose la mayoría de estos casos en el mundo en vías de desarrollo. Este estudio se propone determinar los factores sociodemográficos involucrados en los abortos inseguros complicados. SUJETOS Y MÉTODOS: El estudio es una evaluación retrospectiva de cuatro anos de todos los casos de abortos inseguros complicados tratados en el Hospital Docente Universitario de Niger Delta, Okolobiri, estado de Bayelsa, Nigeria, entre el 1ero de enero de 2007y el 31 de diciembre de 2010. RESULTADOS: La incidencia a lo largo del periodo de estudio fue 4.10% y contribuyó el 14.0% de los ingresos ginecológicos: 34.92% ocurrieron en los adolescentes de menos de 20 anos de edad, de los cuales la mayor parte (55.55%) eran estudiantes de escuela secundaria. Hubo 55.45% pacientes nulí-paras, 60.32% desempleadas y 69.80% solteras. Un total de 87.30% nunca había usado contraceptivo alguno. La mortalidad por aborto fue 256/100 000 partos, y la fatalidad de casos fue 4.76%. Ello constituyó el 30.0% de todas las muertes ginecológicas. La causa más común de las muertefue la septicemia (66.66%). CONCLUSIÓN: Los factores sociodemográficos desventajosos constituyen determinantes principales de la alta incidencia del aborto inseguro en Niger Delta, a pesar de sus estrictas leyes en contra del aborto. Deben tomarse medidas concretas para abordarlos, ya que el aborto inseguro y sus complicaciones constituyen una de las mayores causas de morbosidad maternal y mortalidad en el ambiente.

Costos de la atención postaborto en hospital es de Lima, Perú

Objetivos: Determinar el costo de atención de los abortos incompletos en los hospitales públicos y de abortos electivos en una institución privada. Diseño: Investigación prospectiva. Participantes: Mujeres con aborto incompleto. Metodología: En 120 mujeres con aborto incompleto complicado o no complicado en cuatro hospitales públicos de Lima y 40 mujeres en una clínica privada, se estableció el tiempo que demandó la atención, costo de personal, medicamentos, insumos, equipos y funcionamiento del hospital; igualmente el costo de bolsillo, transporte, cuidado de los niños y del hogar y el ingreso dejado de percibir. Todas firmaron un consentimiento informado. Principales medidas de resultados: Costos de atención. Resultados: La permanencia en tres hospitales, hasta el alta, por aborto incompleto no complicado fue alrededor de 6 horas, siendo mayor en uno de ellos por la normativa interna. En los cuatro hospitales, las complicaciones del aborto ameritaron una permanencia mayor. Las mujeres de aborto electivo requirieron la mitad del tiempo de aquellas con aborto incompleto no complicado en los hospitales. El costo total para la atención de abortos incompletos no complicados fue similar en los cuatro hospitales, entre US$ 110 y US$ 150; y para abortos complicados varió entre US$ 376 y US$ 858. El costo total de atención de los abortos electivos fue similar a la atención del aborto no complicado en los hospitales. Conclusiones: La permanencia de las mujeres con aborto no complicado fue relativamente corta en los hospitales. El costo de atención de los abortos complicados y no complicados demandó un monto importante para los hospitales y las propias mujeres. Los costos del aborto electivo estuvieron al alcance de las mujeres y ninguno de ellos evidenció complicación alguna.

Objectives: To determine care costs of incomplete abortions at public hospitals and elective abortions at a private institution. Design: Prospective study. Participants: Women with incomplete abortion. Methods: In 120 women with either complicated or non-complicated incomplete abortion in four public hospitals and 40 women in a private hospital, time for attention, cost of personal, drugs, materials, equipments and hospital functioning were determined; also pocket cost, transportation, children and home care and non-perceived income. All women signed informed consent. Main outcome measures: Care costs. Results: Hospital stay at three hospitals for non-complicated incomplete abortion until discharge was about 6 hours, more in one hospital because of internal norms. Abortion complications at the four hospitals required longer stay. Women with elective abortion required half the time of those with non-complicated incomplete abortion at hospitals. Total cost for non-complicated incomplete abortions care was similar at the four hospitals, between US$ 110 and US$ 150, and for complicated abortions between US$ 376 and US$ 858. Elective abortions care total cost was similar to that of non-complicated abortions care at hospitals. Conclusions: Non-complicated abortion stay of women was relatively short at hospitals. Complicated and non-complicated abortions care demanded an important cost for hospitals and women themselves. Elective abortion costs were accesible to every woman and none had complications.

Estrategia FIGO para la prevención del aborto inseguro: experiencia en Colombia / Experience in Colombia regarding the FIGO strategy for preventing unsafe abortion

Objetivo: analizar la situación del aborto inseguro en Colombia para establecer: consecuencias, factores determinantes y calidad de la atención e identificar los puntos susceptibles de intervención, para elaborar un plan de acción tendiente a reducir los embarazos no deseados, abortos provocados y sus consecuencias. Materiales y métodos: estudio cualitativo con un componente de revisión de material bibliográfico y otro de consenso de expertos. Se llevó a cabo en dos fases. En la fase 1, de análisis situacional, se recolectó información mediante el formato elaborado por el grupo de trabajo de FIGO (Federación Internacional de Ginecología y Obstetricia). En la fase 2, de elaboración del plan de acción utilizando un marco lógico, se reunieron los representantes de OPS (Organización Panamericana de la Salud), UNFPA (Fondo de Población de las Naciones Unidas), filiales de IPPF (Federación Internacional de Planificación Familiar), ONG locales y agencias del gobierno. Resultados: el análisis situacional se resume en tres ejes: embarazo no deseado, intervenciones para su prevención y aborto. En el plan de acción se definieron cuatro objetivos específicos: mejorar el acceso a los servicios de salud sexual y reproductiva; facilitar el acceso a la interrupción voluntaria del embarazo acorde con la Sentencia C-355 de 2006; promover el acceso al misoprostol para usos ginecoobstétricos; y mejorar la información sobre tasas y complicaciones asociadas al aborto inseguro. Conclusión: a pesar del avance en Colombia con la Sentencia C-355 de 2006, aún persisten grandes retos, tales como reglamentar opciones de fácil acceso al servicio de interrupción voluntaria del embarazo para mujeres víctimas del conflicto armado, protocolos de investigación al interior de los tribunales de ética médica para los asuntos relacionados con objeción de conciencia, clarificar la autonomía y capacidad de menores de catorce años.

Objective: analyzing the situation regarding unsafe abortion in Colombia for establishing its consequences, determinant factors and the quality of attention as well as identifying susceptible intervention points for preparing a action plan aimed at reducing unwanted pregnancies, provoked abortions and their consequences. Materials and methods: this was a qualitative study, having a bibliographic material review component and another regarding expert consensus. It was carried out in two phases: 1. A situational analysis: information was compiled by using a form drawn up by the International Federation of Gynecology and Obstetrics (FIGO) working group; and 2. Preparing an action plan using a logical framework. A meeting was held with representatives from the Pan-American Health Organization (PAHO), the United Nations Population Fund (UNFPA), International Planned Parenthood Federation (IPPF) affiliates, local NGOs and government agencies. Results: the situational analysis revealed three areas of interest: unwanted pregnancy, prevention interventions and abortion. Four specific objectives were defined in the action plan: a) Improving access to sexual and reproductive health services; b) Facilitating access to voluntary interruption of pregnancy according to ruling C-355/2006; c) Promoting access to misoprostol for gynecobstetric use; and d) Improving information about unsafe abortion associated rates and complications. Conclusion: in spite of advances having been made in Colombia via ruling C-355/2006, there are still great challenges to be faced, such as establishing regulations for female victims of armed conflict, options for gaining easy access to the voluntary interruption of pregnancy service, research protocols within medical ethics’ tribunals for matters related to conscientious objection, clarifying the autonomy and ability of minors aged less than fourteen.