Treatment estimates of unsafe pregnancy termination complications: a catalyst for change
Bibliographic record
Abstract
In 2015, complications of unsafe termination of pregnancy remain a preventable public health concern in many countries, notably those with the highest maternal mortality rates. Singh and Maddow-Zimmet, reporting in this issue of the journal, have made a valiant effort to gather the best data available to estimate the number of women with complications of unsafe termination of pregnancy who reached health facilities for treatment in 2012. Their estimates are restricted to 26 countries where they indicate termination of pregnancy was illegal or highly restrictive at the time of their data collection. The methodology uses multiple data sources with well-described limitations. They estimate that rates have increased by about 20% since 2005, based on regional extrapolation, with approximately 7 million women globally reaching facilities for the treatment of complications of termination of pregnancy. Many do not. Women who reach the facility are often not treated respectfully, or according to best practice. Legal risks to providers and women in distinguishing between miscarriage and self-induced termination of pregnancy are problematic in countries where women risk jail or prosecution, and not only stigma. Reviews of facility-based encounters have led to policy change in several countries. Mayi-Tsonga et al. (Reprod Health Matters 2009;17:65–70) determined that women who died from complications of unsafe termination of pregnancy waited almost 24 hours for care to be initiated, compared with other causes of maternal mortality, which had an average wait of 1.2 hours. The review resulted in treatment changes that reduced delays in treating complications of unsafe termination of pregnancy to 1.8 hours, eliminating deaths from this cause at the hospital. As reported by Singh, the differences between Latin America and the Caribbean (LAC), and other regions, are strongly suggestive of a reduction in complications treated at the facility level because of the availability of misoprostol, even in restrictive environments. In LAC, the Dominican Republic, where termination of pregnancy is illegal, has the highest estimated treatment rate, at 10.3, whereas Brazil has the lowest estimated treatment rate, at 2.4. Women's self-use of misoprostol began in Brazil. Briozzo et al. (Int J Gyn Obstet 2006;95:221–6) described a risk-reduction strategy to address high maternal mortality from unsafe termination of pregnancy in Uruguay, where abortion was then illegal. Providing accurate information and counselling to women contemplating termination of pregnancy resulted in the abolition of termination of pregnancy-related deaths. This model of women's self-administration of misoprostol has been replicated in nine countries. Rwanda and Cambodia have experienced a significant scaling up in access to family planning and safe termination of pregnancy services during or since the time of the Singh review, and both countries will meet Millennium Development Goal 5. These examples confirm what is required to decrease the rates of complications from unsafe termination of pregnancy: comprehensive postabortal care, with the integrated provision of free effective contraception, and expanding access to effective contraception and safe medical and surgical termination of pregnancy. The inclusion of a harm-reduction model in countries with restrictive legislation is also an option. Estimate methodology is typically what is available to catalyse and measure change. Women have a right to accurate information. They also have a right to life and health. Full disclosure of interests available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".