Keogh Sarah C, Binstock Georgina, Tort Mailén Pérez, Singh Susheela
Guttmacher Institute, New York, New York, United States of America.
Centro de Estudios de Población, Buenos Aires, Argentina.
PLOS Glob Public Health. 2025 Feb 25;5(2):e0003526. doi: 10.1371/journal.pgph.0003526. eCollection 2025.
Argentina's 2021 abortion law grants the right to abortion on-request up to 14 weeks' gestation, as well as continuing to allow abortion after 14 weeks on specific grounds. The early years after law reform provide a unique opportunity to assess progress and identify barriers, to both inform program improvements and guide other countries undergoing reform. This study assesses the first two years of law implementation. We surveyed a purposive sample of 45 key informants about implementation successes and barriers. In addition, we surveyed 223 public health facilities (selected through stratified systematic random sampling) in three provinces: Buenos Aires, Chaco and La Rioja. We collected information on abortion services, resources, personnel, training, and obstacles to provision. We present weighted results on characteristics of abortion provision by facilities, representative of each province, complemented by key informant perspectives. Two years into law reform, abortions under 14 weeks were offered in a large number of facilities at all levels, while later abortions were offered mainly in hospitals. Facilities adhered to protocols, had adequate supplies, and kept comprehensive records. Over 90% of abortions were performed using misoprostol, with MVA accounting for most of the remainder. Major barriers to provision included insufficient personnel, exacerbated by high levels of conscientious objection (over 60% of hospitals had at least 2 objecting doctors), and inadequate training in methods other than misoprostol, particularly among health centers. Argentina has made impressive advances in the short time since law reform. Implementation could be improved by increasing personnel (through incentives, task-shifting, and enforcement of conscientious objection regulations), strengthening training on different abortion techniques, and expanding public information campaigns about abortion rights and services available. In the face of diminished support for abortion under the new government, measures to strengthen abortion services and reduce stigma are critical, if reproductive rights are to be upheld.
阿根廷2021年的堕胎法赋予女性在怀孕14周内按需堕胎的权利，并继续允许在14周后基于特定理由进行堕胎。法律改革后的最初几年提供了一个独特的机会，来评估进展情况并找出障碍，以便为项目改进提供信息，并指导其他正在进行改革的国家。本研究评估了法律实施的头两年。我们对45名关键信息提供者进行了有目的抽样调查，询问了实施过程中的成功之处和障碍。此外，我们还对布宜诺斯艾利斯、查科和拉里奥哈三个省份的223家公共卫生机构（通过分层系统随机抽样选取）进行了调查。我们收集了有关堕胎服务、资源、人员、培训以及提供服务的障碍等方面的信息。我们展示了各省份代表性设施提供堕胎服务的加权结果，并辅以关键信息提供者的观点。法律改革两年后，各级大量机构都提供14周内的堕胎服务，而后期堕胎主要在医院提供。各机构遵守规程， supplies充足，并保留了全面的记录。超过90%的堕胎手术使用米索前列醇，其余大部分是通过手动真空吸引术进行的。提供堕胎服务的主要障碍包括人员不足，因大量出于良心拒服兵役的情况而加剧（超过60%的医院至少有2名拒服兵役的医生），以及除米索前列醇之外的其他方法培训不足，尤其是在卫生中心。自法律改革以来，阿根廷在短时间内取得了令人瞩目的进展。可以通过增加人员（通过激励措施、任务转移以及执行良心拒服兵役规定）、加强不同堕胎技术的培训以及扩大关于堕胎权利和可用服务的公共宣传活动来改进实施情况。在新政府对堕胎支持减少的情况下，若要维护生殖权利，加强堕胎服务和减少污名化的措施至关重要。
