Araújo Thália Velho Barreto de, Aquino Estela M L, Menezes Greice M S, Alves Maria Teresa Seabra Soares de Britto E, Almeida Maria-da-Conceição C, Alves Sandra Valongueiro, Coimbra Liberata, Campbell Oona M R
Universidade Federal de Pernambuco, Recife, Brasil.
Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil.
Cad Saude Publica. 2018 Jun 25;34(6):e00168116. doi: 10.1590/0102-311X00168116.
Around 18 million unsafe abortions occur in low and middle-income countries and are associated with numerous adverse consequences to women's health. The time taken by women with complications to reach facilities where they can receive appropriate post-abortion care can influence the risk of death and the extent of further complications. All women aged 18+ admitted for abortion complications to public-sector hospitals in three capital cities in the Northeastern Brazil between August-December 2010 were interviewed; medical records were extracted (N = 2,804). Nearly all women (94%) went straight to a health facility, mainly to a hospital (76.6%); the rest had various care-seeking paths, with a quarter visiting 3+ hospitals. Women waited 10 hours on average before deciding to seek care. 29% reported difficulties in starting to seek care, including facing challenges in organizing childcare, a companion or transport (17%) and fear/stigma (11%); a few did not initially recognize they needed care (0.4%). The median time taken to arrive at the ultimate facility was 36 hours. Over a quarter of women reported experiencing difficulties being admitted to a hospital, including long waits (15%), only being attended after pregnant women (8.9%) and waiting for a bed (7.4%). Almost all women (90%) arrived in good condition, but those with longer delays were more likely to have (mild or severe) complications. In Brazil, where access to induced abortion is restricted, women face numerous difficulties receiving post-abortion care, which contribute to delay and influence the severity of post-abortion complications.
在低收入和中等收入国家，每年约有1800万例不安全堕胎，这对女性健康造成了诸多不良后果。出现并发症的女性前往能够获得适当堕胎后护理的机构所需的时间，会影响死亡风险和进一步并发症的严重程度。对2010年8月至12月期间巴西东北部三个首都城市公立部门医院收治的所有18岁及以上因堕胎并发症入院的女性进行了访谈；提取了医疗记录（N = 2804）。几乎所有女性（94%）直接前往医疗机构，主要是医院（76.6%）；其余女性有各种寻求护理的途径，四分之一的女性去过3家以上医院。女性平均等待10小时后才决定寻求护理。29%的女性表示开始寻求护理存在困难，包括在安排 childcare、陪伴者或交通方面面临挑战（17%）以及恐惧/耻辱感（11%）；少数人最初没有意识到自己需要护理（0.4%）。到达最终医疗机构所需的中位时间为36小时。超过四分之一的女性表示在入院时遇到困难，包括长时间等待（15%）、只能在孕妇之后得到诊治（8.9%）以及等待床位（7.4%）。几乎所有女性（90%）入院时状况良好，但延误时间较长的女性更有可能出现（轻度或重度）并发症。在巴西，人工流产的获取受到限制，女性在接受堕胎后护理方面面临诸多困难，这导致了延误并影响了堕胎后并发症的严重程度。
