Montevideo. August 31, 2022.On 26 August, in the framework of the FLASOG Summit that took place from 25-27 August, a symposium was held regarding the CLAP Network of Sentinel Centers for monitoring the quality of care for women in situations of abortion in Latin America.
Dr. Suzanne Serruya, Director of the Latin American Center for Perinatology - Women's and Reproductive Health (CLAP/WR) of the Pan American Health Organization (PAHO/WHO), was in charge of opening the panel of experts. Dr. Serruya said that this was one of the most important issues to be addressed in relation to sexual and reproductive health and stated that "women in situations of abortion need protection and quality care much more than others" because it has a very strong impact on "the poorest, the youngest, the most unprotected and the most vulnerable". She also said that the CLAP MUSA Network is an important achievement, as it is an "excellent tool that allows us to have evidence for decision-making". Moreover, she recalled that it is a unique experience in the world.
Gynecologist Dr. Laura Gil, spoke about the importance of dealing with unsafe abortion in Latin America, which, according to the data she presented, represents 76% of the abortions that are performed, "leaving the region in a shameful situation in front of the world". In this respect, she said that beyond individual opinions, it is necessary to wonder "what face we want abortion to have" because beyond what each person wants, it is a practice that will continue to exist. She also commented that related studies show that wherever there are more legal restrictions there is a higher rate of abortions.
Dr. Gil said that WHO has already made a pronouncement on safe abortion and that it has updated, evidence-based guidelines that specify how to approach this issue. In this sense, she said that it is not only necessary to focus on access, but also to think that it should be a high-quality service, with an eye on the individual.
Finally, she referred to the harm caused to health personnel, since "it limits freedom of conscience as well as freedom of profession and trade".
Dr. Rodolfo Gómez, Regional Advisor on Sexual and Reproductive Health at CLAP/WR, referred specifically to the CLAP MUSA Network, which emerged as a CLAP initiative and now includes 30 sentinel centers that verify and monitor the quality of care for women in situation of abortion throughout the region. Dr. Gómez said it is "an innovative network that includes different countries that seek to carry out surveillance, operational research and training of human resources, with the goal of improving the health of women and children in the region.
The CLAP advisor stressed that the network uses a common language, which is SIP A or similar systems that "can dialogue in the same language”. This is because a specific form was generated within the Perinatal Information System (SIP), which is already known and used by several countries in the region, to attend specifically to women in situation of abortion. In this regard, he explained that consensus variables have been agreed to analyse assistance to women with incomplete abortions as well as assistance to women with legal abortions.
Dr. Gómez also referred to the importance of data quality and pointed out that the network provides "a large database that enables analysis and advocacy in the region". In this regard, he commented that the quality of the information is evaluated periodically and that the institutions are given feedback so that they can improve data collection.
Finally, he remarked that the network maximizes the qualities of each of the centers and turns them into reference centers in terms of information analysis, research and publications.
The presentation by the coordinator of the CLAP MUSA Network, Dr. Gonzalo Rubio, focused on the concept of Centers of Excellence in the healthcare of women in situation of abortion. In this regard, he explained that "centres of excellence have health programmes whose value offer is based on clinical results and safety levels of patients compared to the best referents. They use the best available scientific evidence and are, at least, national references in the service they offer.
Dr. Rubio stressed that "although it is important to move towards depenalising and decriminalising abortion, this does not prevent countries with highly restrictive laws from improving the quality of care for women".
The network coordinator also referred to the steering role of CLAP/WR, which provides indicators to improve the quality of care as well as the quality of data. In relation to the latter, he noted the importance of "having the minimum percentage of discrepancies and missing data".
Dr. Juan Carlos Vargas commented on the challenges that had arisen, mainly as a result of the quarantines that were established following the COVID 19 pandemic, and the role played by telemedicine. Particularly, he referred to the Profamilia initiative and what became known as "telemedicine abortion" or "tele-abortion", which turned out to be a very important solution for many women, especially for those who are far from large population centers and who are in a more vulnerable situation.
In fact, Dr. Vargas reported that this is a service that continues to be in demand and has been gradually increasing. He said: “This not only demonstrates its acceptance, but also that it is a service that meets an existing need”.
The last presentation of the symposium was given by Dr. Luíz Baccaro, who commented on the impact of the COVID 19 pandemic on the care of women undergoing abortion at the Women's Hospital of the University of Campinas (UNICAMP). In this regard, Dr. Báccaro said that the hospital has been part of the network since 2015 and that participation in the network "has had a very positive influence on clinical practice".
In this regard, he said that the use of SIP A has allowed them to identify chronic problems in healthcare, while enabling research work and the publication of scientific articles.
Especially regarding the impact of the pandemic, the data collected allowed them to evaluate aspects of women's care and, as an example, he mentioned a study showing, among other things, that there was less access to family planning.
All the panellists agreed on the importance of this network and the possibilities it represents to continue advancing towards the practice of safe abortion with a focus on women's rights.
