Greetings from Montevideo, Uruguay! This summer my practicum is with the Pan American Health Organization (PAHO), more specifically their Center for Latin American Perinatology and Women’s Reproductive Health (or in its more efficient Spanish acronym, CLAP/SMR). While PAHO is headquartered in Washington DC, the CLAP/SMR office is home to the region’s MUSA data base (the Spanish acronym for “women in situations of abortion”), which compiles data from 40 sentinel health centers across 13 countries in Latin America. (You can check out a quick video about MUSA here: https://www.youtube.com/watch?v=wxqt01BTQ6E).
PAHO’s Perinatal Information System (SIP) maintains a wealth of data regarding maternal and neonatal health outcomes, including a specific database, SIP-A, that is dedicated to clinical information about abortion, miscarriage management, and post-abortion care. Unsafe abortion, while completely preventable, is one of the leading causes of maternal mortality globally, and contributes to 13% of maternal deaths in Latin American and the Caribbean. At the 40 sentinel health centers across the region, whether a person is accessing a legal abortion, seeking medical treatment following an unsafe abortion, or experiencing a miscarriage, their clinical and sociodemographic data will be collected in SIP-A. These data include the presence of any complications, a near miss or maternal death, as well as whether or not a pregnancy was planned, whether the pregnancy was a result of a contraceptive method failure, and whether the person begins a contraceptive method as part of their post-abortion care. My practicum this summer is focused on analyzing data from SIP-A.
office with Dr. Suzanne Serruya, director of CLAP/SMR.
Thus far, I’ve had the chance to sit in on a meeting with the Uruguayan Ministry of Public Health and CLAP/SMR staff in order to see how SIP-A works with the Uruguayan health system’s protocols around abortion and miscarriage. As one of the only countries in the region where abortion is legally available without restriction as to reason (the other two are Cuba and Guyana), Uruguay provides a unique context both for my practicum and for working with the data in SIP-A. Using this regional database, I’ve been analyzing contraceptive counseling and service provision as a part of post-abortion care. This includes looking at what type of contraceptive method patients request, as well what methods doctors provide. Depending on the context, these contraceptive methods may include long-acting reversible contraceptives (LARCs), or other methods, such as pills, injectables, or sterilization.
As I wrap up my time in Montevideo, it is now clearer to me than ever before how important accurate data is in making informed public health decisions. Working alongside experts in reproductive health, research, epidemiology, and medicine over the past few weeks has been an incredible way to see how bringing together a wealth of perspectives and approaches can be used to improve health at every level, whether it is a patient-provider interaction or a region-wide policy change.
-Mallory