Stapff Cecilia, Garbero Lucía Gómez, Ponce de León Rodolfo Gómez, Briozzo Leonel, Lavelanet Antonella, Narasimhan Manjulaa
Iniciativas Sanitarias, Pereira Rossell Hospital Centre, Women's Hospital, Montevideo, Uruguay.
Latin American Center of Perinatology, Women and Reproductive Health, Pan-American Health Organization - World Health Organization (CLAP/PAHO-WHO), Montevideo, Uruguay.
Lancet Reg Health Am. 2025 Jan 10;42:100981. doi: 10.1016/j.lana.2024.100981. eCollection 2025 Feb.
In the 1990s, almost 40% of maternal deaths in Uruguay were caused by unsafe abortions.
A harm reduction model implemented in Uruguay, which addressed the risks associated with unsafe abortion practices by promoting and supporting the self-management of medical abortions by women in their homes, encouraged women's autonomy.
Since 2005, an accelerated decrease in maternal mortality has been recorded in Uruguay, coinciding with the implementation of two major actions: a harm reduction approach with active promotion of self-care through self-management of medical abortions; and in 2012, a change in legislation, which made abortion legal within sexual and reproductive health facilities when requested by women up to 12 weeks of pregnancy or later for specific indications.
This example demonstrates that progress in public policies is possible through the combined efforts of civil society, healthcare professionals and policy makers. The initiative expanded the entry points to the healthcare system while strengthening women's autonomy.
Increased access to self-care interventions for SRH contributed to advancing achievement of universal health coverage and the highest, most attainable standards of health.
The authors have no financial relationships relevant to this article to disclose.
在20世纪90年代，乌拉圭近40%的孕产妇死亡是由不安全堕胎造成的。
乌拉圭实施了一种减少伤害模式，通过促进和支持妇女在家中自行管理药物流产来应对与不安全堕胎行为相关的风险，鼓励了妇女的自主权。
自2005年以来，乌拉圭孕产妇死亡率加速下降，这与两项主要行动的实施相吻合：一种减少伤害的方法，通过药物流产的自我管理积极促进自我护理；以及在2012年，立法发生了变化，当怀孕12周或更晚的妇女因特定指征提出要求时，在性健康和生殖健康设施内堕胎合法化。
这个例子表明，通过民间社会、医疗保健专业人员和政策制定者的共同努力，公共政策取得进展是可能的。该倡议扩大了进入医疗保健系统的切入点，同时增强了妇女的自主权。
增加获得性健康和生殖健康自我护理干预措施的机会有助于推动实现全民健康覆盖以及最高、最可实现的健康标准。
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