Emergency contraception: unresolved clinical, ethical and legal quandaries still linger.

Emergency contraception (EC) has been prescribed for decades, in order to lessen the risk of unplanned and unwanted pregnancy following unprotected intercourse, ordinary contraceptive failure, or rape. EC and the linked aspect of unintended pregnancy undoubtedly constitute highly relevant public health issues, in that they involve women's self-determination, reproductive freedom and family planning. Most European countries regulate EC access quite effectively, with solid information campaigns and supply mechanisms, based on various recommendations from international institutions herein examined. However, there is still disagreement on whether EC drugs should be available without a physician's prescription and on the reimbursement policies that should be implemented. In addition, the rights of health care professionals who object to EC on conscience grounds have been subject to considerable legal and ethical scrutiny, in light of their potential to damage patients who need EC drugs in a timely fashion. Ultimately, reproductive health, freedom and conscience-based refusal on the part of operators are elements that have proven extremely hard to reconcile; hence, it is essential to strike a reasonable balance for the sake of everyone's rights and well-being.

La interrupción legal del embarazo en Argentina / The legal termination of pregnancy in Argentina

En el contexto de la publicación por parte del Ministerio de Salud de la Nación de Argentina del Protocolo para la atenciónintegral de las personas con derecho a la interrupción legal del embarazo (ILE), resumido y comentado en este mismonúmero de EVIDENCIA, este comentario editorial ofrece: 1) una perspectiva amplia de lo que significa el aborto, desde lamirada estrictamente biologicista hasta definiciones basadas en el enfoque de género; 2) una descripción de los diferentesmarcos jurídicos respecto del aborto que imperan actualmente en Latinoamérica y Argentina, haciendo especial hincapiéen lo concerniente a las ILE; 3) información epidemiológica sobre la mortalidad materna en Argentina y la asociada alaborto inseguro; 4) estadísticas sobre la realización de ILE en la Ciudad Autónoma de Buenos Aires, Argentina.Dada la situación actual de aislamiento social preventivo obligatorio en el marco de la pandemia de Covid-19, conside-ramos quienes integramos equipos de salud debemos estar más atentos/as que nunca a las situaciones de violenciapotencial que podrían suceder en este contexto, para dar las respuestas pertinentes -entre las que se incluyen las ILE-, alas víctimas de embarazos no deseados consecutivos a situaciones de coerción. (AU)

In the context of the publication by the Argentine Ministry of Health of the Protocol for the comprehensive care of people withthe right to legal termination of pregnancy (LTP), summarized and commented on in this same issue of EVIDENCIA, thiseditorial article offers: 1) a broad perspective of what abortion means, from a strictly biological point of view to definitionsbased on the gender approach; 2) a description of the different legal frameworks regarding abortion that currently prevailin Latin America and Argentina, with special emphasis on LTP; 3) epidemiological information on maternal mortality inArgentina and that associated with unsafe abortion; 4) statistics on the realization of LTP in the Autonomous City ofBuenos Aires, Argentina.Given the current situation of mandatory preventive social isolation in the framework of the Covid-19 pandemic, we considerthat those of us who are part of health teams should be more alert than ever to situations of potential violence that couldoccur in this context, to give the relevant responses - including LTP- to victims of unwanted pregnancies following coercivesituations. (AU)

Counseling Women on Long Acting Reversible Contraceptive (LARC) Use While Maintaining Reproductive Justice.

[Full article available at http://rimed.org/rimedicaljournal-2017-10.asp].

Bioética, aborto y políticas públicas en América Latina / Bioethics, abortion and public policies in Latin America

La bioética en América Latina está fuertemente influida por creencias religiosas, lo que resulta en la regulación más restrictiva del orbe en salud sexual y reproductiva y, muy señaladamente, en aborto. Los impedimentos legales no disuaden a las mujeres que optan por interrumpir embarazos no deseados; cada año tienen lugar más de 4 millones de abortos ilegales en los que las latinoamericanas más pobres arriesgan su salud y su vida. Este texto recupera el sentido que V. R. Potter -creador del término- dio a la bioética: "una ética basada en el conocimiento científico". Propone el gradualismo -modelo sustentado en la evidencia científica que aportan la embriología, la genética y la neurofisiología- como el idóneo para la regulación del aborto en América Latina. El gradualismo respeta el derecho de toda mujer a decidir sobre su maternidad y es el modelo adoptado por los países con los índices más altos en salud sexual y reproductiva. América Latina está urgida de medidas efectivas para prevenir los embarazos no deseados, que son la causa principal del aborto: educación en salud sexual y reproductiva, acceso a anticonceptivos modernos, y penas severas contra el abuso sexual de mujeres, adolescentes y niñas (AU)

Bioethics in Latin America is strongly influenced by religious beliefs, leading to the most restrictive regulation globally of sexual and reproductive health and, most particularly, of abortion. Legal obstacles do not dissuade women from terminating unwanted pregnancies; each year more than 4 million illegal abortions take place, in which the poorest Latin American women risk their health and lives. This text employs the term bioethics within the meaning given to it by its creator, V. R. Potter: "ethics based on scientific knowledge". It proposes gradualism, sustained on scientific evidence contributed by embryology, genetics, and neurophysiology, as the most appropriate model for the regulation of abortion in Latin America. Gradualism respects every woman'’s right to decide on questions related to maternity and holds sway in countries with the highest levels of sexual and reproductive health. Latin America urgently needs effective measures to prevent unwanted pregnancies, which are the main cause of abortion: education on sexual and reproductive health; access to modern and effective contraceptives; and severe sanctions for sexual abuse of women, adolescents and girls (AU)

Why postnatal abortion throws the baby out with the bath water.

This paper articulates a careful and detailed objection to the moral permissibility of postnatal abortion. Giubilini and Minerva (2012) claim that if being unable to nurture one's newborn child without significant burdens to oneself, family or society, is a proper moral ground for the demand that the life of a fetus be terminated, then 'after-birth abortion should be considered a permissible option for women who would be damaged by [rearing the child or] giving up their newborns for adoption.' It will be shown that the permissibility of postnatal abortion does not follow from the argument's premises, in particular, the premise that the newborn is not a person in the morally relevant sense.

Prenatal diagnosis and abortion for congenital abnormalities: is it ethical to provide one without the other?

This target article considers the ethical implications of providing prenatal diagnosis (PND) and antenatal screening services to detect fetal abnormalities in jurisdictions that prohibit abortion for these conditions. This unusual health policy context is common in the Latin American region. Congenital conditions are often untreated or under-treated in developing countries due to limited health resources, leading many women/couples to prefer termination of affected pregnancies. Three potential harms derive from the provision of PND in the absence of legal and safe abortion for these conditions: psychological distress, unjust distribution of burdens between socio-economic classes, and financial burdens for families and society. We present Iran as a comparative case study where recognition of these ethical issues has led to the liberalization of abortion laws for fetuses with thalassemia. We argue that physicians, geneticists and policymakers have an ethical and professional duty of care to advocate for change in order to ameliorate these harms.

Discrepancies in the laws on identifying foetal sex and terminating a pregnancy in India.

Laws that regulate the identification of a foetus and the termination of a pregnancy in India are shaped by their social context. The Medical Termination of Pregnancy Act, 1971, discriminates against unmarried women by not recognising that unwanted pregnancies in unmarried women could result in at least as much anguish and suffering as that experienced by married women. While the MTP Act permits the abortion of foetuses with disabilities, the Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Act's ban on identifying the foetus's sex prevents the use of sex-detection to identify foetuses at high risk of sex-linked diseases.

Emergency contraception - a human rights issue.

Emergency contraception is the only resource that women can use to avoid becoming pregnant after having sexual intercourse without contraceptive protection. It could be a powerful means to prevent unwanted pregnancies and their devastating consequences for women's health, social wellbeing and life project, and for the unwanted child, if all people had ample access to good quality information, education and services for sexual and reproductive health. In spite of the preventive medicine value of emergency contraception, conservative sectors oppose its availability, appealing to moral values that are not universally shared in pluralistic societies. Excluding the only contraceptive that can be used after intercourse because some consider the mechanism of action to be unacceptable would mean restricting the right of choice of others, and imposing one particular belief or set of values on all members of the community, thus violating the freedom of conscience. Authorities have a moral obligation to protect human rights.