Knowledge and Attitude towards Sexual and Reproductive Health and Rights
A Study of First- and Final-Year Healthcare Students of the University of Buenos Aires, Argentina.
Belén Provenzano Castro
Dissertation for the degree Philosophiae Doctor (PhD) Institute of Clinical Medicine
Faculty of Medicine, University of Oslo October 2018
© Belén Provenzano-Castro, 2019
Series of dissertations submitted to the Faculty of Medicine, University of Oslo
ISBN 978-82-8377-403-0
All rights reserved. No part of this publication may be
reproduced or transmitted, in any form or by any means, without permission.
Cover: Hanne Baadsgaard Utigard.
Print production: Reprosentralen, University of Oslo.
3
To my Dad, who will always live in my heart.
To Prof. Babill Stray-Pedersen, whose light and generosity inspire all those around her.
Acknowledgements
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Contents
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6.1.1 First-year students
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List of publications
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Paper I.Future healthcare professionals' knowledge about the Argentinean abortion law.
Belén Provenzano-Castro6LOYLD2L]HURYLFK%DELOO6WUD\3HGHUVHQ ,QW-0HG(GXF
Paper II.LNG- Emergency Contraceptive Pills: What do Argentinean healthcare students know?
Belén Provenzano-Castro6LOYLD2L]HURYLFK%DELOO6WUD\3HGHUVHQ 6H[5HSURG+HDOWK±
Paper III.Healthcare students at an Argentinean school of medicine: are they well prepared to provide quality sexual and reproductive health services?
Belén Provenzano-Castro6LOYLD2L]HURYLFK%DELOO6WUD\3HGHUVHQ (XU-&RQWUDFHSW5HSURG+HDOWK&DUH
Summary
Introduction and Objective
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Conclusion
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1 Introduction
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2 Background
2.1 General information about Argentina
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Figure 1. Argentina. Maps of the Americas
Table 1. Argentinean statistics
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2.2 Sexual and reproductive health and rights in Argentina
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%XHQRV $LUHV LPSOHPHQWHG WKH ILUVW 5HSURGXFWLYH +HDOWK 3URJUDPPH LQ DQG VRPH DGRSWHG ODZV WKH SURYLQFHRI/D3DPSDZDVWKHILUVWWRSDVVDODZWKDWLPSOHPHQWHGWKH3URJUDPPHRI5HVSRQVLEOH3URFUHDWLRQ LQLWZDVQRWXQWLOLQWKHFRQWH[WRIDVRFLDODQGHFRQRPLFFULVLVWKDWVWUHVVHGWKHQHHGIRUEHWWHU DQVZHUV IRU DQ LQFUHDVLQJO\ YXOQHUDEOH SRSXODWLRQ WKDW WKH National Sexual Health and Responsible ProcreationODZZDVSDVVHG7DEOH>@7KLVODZHQDEOHGWKH0LQLVWU\RI+HDOWKWRLPSOHPHQWWKH National Program of Sexual Health and Responsible ProcreationDQGHVWDEOLVKHGLWVPDLQREMHFWLYHVWRRIIHU WKHSRSXODWLRQWKHKLJKHVWOHYHORIVH[XDOKHDOWKDQGUHVSRQVLEOHSURFUHDWLRQVHUYLFHVVRWKDWLQGLYLGXDOVFDQ WDNH GHFLVLRQV IUHH RI GLVFULPLQDWLRQ FRHUFLRQ RU YLROHQFH WR UHGXFH PDWHUQDO DQG LQIDQW PRUELGLW\ DQG PRUWDOLW\ WR SUHYHQW XQZDQWHG SUHJQDQFLHV WR SURPRWH DGROHVFHQWV¶ VH[XDO KHDOWK WR FRQWULEXWH WR WKH SUHYHQWLRQDQGHDUO\GHWHFWLRQRIVH[XDOO\WUDQVPLWWHGGLVHDVHV+,9$,'6DQGJHQLWDODQGEUHDVWGLVHDVHVWR JXDUDQWHH WKH HQWLUH SRSXODWLRQ DFFHVV WR LQIRUPDWLRQ FRXQVHOOLQJ PHWKRGV DQG VHUYLFHV UHODWHG WR VH[XDO KHDOWKDQGUHVSRQVLEOHSURFUHDWLRQWRHQKDQFHZRPHQVSDUWLFLSDWLRQLQGHFLVLRQPDNLQJUHJDUGLQJWKHLUVH[XDO KHDOWKDQGUHVSRQVLEOHSURFUHDWLRQ
,WWRRNDOPRVWWHQ\HDUVRISROLWLFDOVWUXJJOHDQGVRFLDOGHEDWHDLPHGWRHQDFWDQDWLRQDOODZWRJXDUDQWHHVH[XDO DQGUHSURGXFWLYHULJKWVWRFUHDWHWKHNational Program of Sexual Health and Responsible ParenthoodDQGWR GLVWULEXWHIUHHFRQWUDFHSWLYHPHWKRGVLQDOOWKHSURYLQFHVIRUWKHILUVWWLPH>@
,WLVLPSRUWDQWWRPHQWLRQWKHLPSRUWDQWUROHSOD\HGE\1*2VDQGZRPHQ¶VPRYHPHQWVGHQRXQFLQJEUHDFKHV DQGJDSVDQGUDLVLQJDZDUHQHVVRIWKHUHFRPPHQGDWLRQVRIWKHFRPPLWWHHVWKDWPRQLWRUWKHLPSOHPHQWDWLRQRI WKH6WDWH¶VLQWHUQDWLRQDOFRPPLWPHQWV>@
)RU WKH ODVW \HDUV VHYHUDO ODZV WKDW IRFXV RQ JXDUDQWHHLQJ VH[XDO ULJKWV 7DEOH KDYH EHHQ HQDFWHG WR HQVXUHWKHHIIHFWLYHLPSOHPHQWDWLRQRIVH[XDODQGUHSURGXFWLYHULJKWV7KHNational Sexual Health and Responsible Procreation law ZDV QRW DQ LVRODWHG ODZ HQDFWHG E\ &RQJUHVVEXW D SDUDGLJP VKLIW IURP WKDW QRWLRQRIELUWKFRQWUROLQIDYRXURISURQDWDOSROLFLHVWRWKHZDUUDQW\RIULJKWV7DEOH>@
Table 2. Argentinean national laws related to sexual and reproductive rights.
Year Law Nº Name
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6H[XDO +HDOWK DQG 5HVSRQVLEOH 3DUHQWKRRG
,PSOHPHQWDWLRQ RI WKH 1DWLRQDO 3URJUDP RI 6H[XDO +HDOWK DQG 5HVSRQVLEOH3URFUHDWLRQ2EMHFWLYHV
3URKLELWLRQRIDQ\DFWLRQWKDW LPSHGHVWKHLQLWLDWLRQRU FRQWLQXDWLRQRIWKHVFKRRO\HDU WRSUHJQDQWVWXGHQWV
,WDOVRDXWKRUL]HVDEVHQFHVWKDWDUHQHFHVVDU\WRHQVXUHWKHLUKHDOWK
3UHJQDQWZRPDQ+,9WHVW $OOSUHJQDQWZRPHQVKRXOGEHRIIHUHGWKH+,9WHVWGXULQJSUHJQDQF\
+XPDQL]HG%LUWK 3DUHQWVDQGFKLOGUHQULJKWVGXULQJWKHELUWKSURFHVV
+HDOWKFDUH GXULQJ SUHJQDQF\ DQG SXHUSHULXP DUH WR EH IXOO\ FRYHUHG E\VRFLDOVHFXULW\DQGSULYDWHKHDOWKFDUHLQVXUDQFH
&RPSUHKHQVLYH3URWHFWLRQRIWKH 5LJKWV RI &KLOGUHQ DQG
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(TXDO6H[0DUULDJH 0DUULDJH ZLOO KDYH WKH VDPH UHTXLUHPHQWV DQG HIIHFWV UHJDUGOHVV RI ZKHWKHUWKHSDUWQHUVDUHWKHVDPHRUGLIIHUHQWVH[
*HQGHU,GHQWLW\ 5LJKW WR WKHLU VHOISHUFHLYHG JHQGHU LGHQWLW\ IUHH GHYHORSPHQW DQG WUHDWPHQW DFFRUGLQJ WR WKHLU JHQGHU LGHQWLW\ DQG LGHQWLILFDWLRQ E\ WKH LQVWUXPHQWVWKDWSURYHWKHLULGHQWLW\
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2.3 Argentinean sexual and reproductive health statistics
7RGDWHWKHUHLVDEURDGSROLF\IUDPHZRUNWKDWSURWHFWVVH[XDODQGUHSURGXFWLYHULJKWVLQ$UJHQWLQD+RZHYHU WKH H[LVWHQFH RI WKHVH ODZV GRHV QRW JXDUDQWHH WKDW SHRSOH ZLOO KDYH DFWXDO DFFHVV WR WKHLU ULJKWV 7KH LPSOHPHQWDWLRQ RI WKHVH QDWLRQDO SROLFLHV KDV EHHQ DIIHFWHG E\ WKH HFRQRPLF HWKQLF FXOWXUDO DQG SROLWLFDO GLIIHUHQFHVDPRQJWKHSURYLQFHVDQGWKHFRPSOH[FRRUGLQDWLRQUHTXLUHGDWGLIIHUHQWOHYHOVRIJRYHUQPHQW>@
7KHKLVWRULFDOEDFNJURXQGDOVRGHWHUPLQHGWKHH[LVWHQFHRIKHDOWKFDUHSURYLGHUVZLWKVFDUFHH[SHULHQFHLQWKH SURYLVLRQRIVH[XDODQGUHSURGXFWLYHKHDOWKVHUYLFHV
'HVSLWHWKHSURJUHVVDFKLHYHGLQPDQ\DUHDVRI65+LQWKHSDVWGHFDGHLQ$UJHQWLQDLQGLFDWRUVKDYHVKRZQD VFDUFHLPSURYHPHQW7DEOH
Table 3. Vital statistics, Argentina.
Indicator* 2011 2016
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0DWHUQDOPRUWDOLW\KDVUHPDLQHGDOPRVWXQFKDQJHGLQWKHODVWGHFDGH)LJXUHDQG,QLWUHDFKHG SHUOLYHERUQV7DEOHZLWKLPSRUWDQWGLIIHUHQFHVDPRQJWKHSURYLQFHVWKHJDSUDQJHGIURPUDWHV OHVVWKDQLQ%XHQRV$LUHV&LW\WRLQ)RUPRVDLQWKHQRUWKRIWKHFRXQWU\)LJXUH7KLUW\VL[RIWKH WRWDOPDWHUQDOGHDWKVZHUHWHHQDJHPRWKHUV
Figure 2. Maternal mortality rate per 100 000 liveborn. Argentina, 2000-2016
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35
43 46 44
40 39
48 44 40
55
44 40
35 32 37 39 34
0 10 20 30 40 50 60
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 MM Rate
Figure 3. Maternal mortality rate per province. Argentina, 2011
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40
0 20 40 60 80 100 120 140
Provincies 1
Figure 4. Total number of maternal deaths and maternal deaths due to abortion. Argentina, 2000-2016
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Figure 5. Teenage pregnancies. Argentina, 2001-2016
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245
297 320 304
295 279
333 306 296 410
331 302
258 245 290 298 245
72 92 100
83 94 79 93
74 62 87
68 73
33 50 43 55 43 0
50 100 150 200 250 300 350 400 450
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Maternal Deaths
Year
Maternal Deaths Maternal deaths due to abortion
14,5%
15,0%
15,3% 15,6% 15,5% 15,8%
15,5% 15,7%
15,5% 15,6%
15,1%
14,5%
13,8%
12,5%
13,0%
13,5%
14,0%
14,5%
15,0%
15,5%
16,0%
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
% Teenage pregnancy
Table 4. Public hospitals providing SRH services (2010) SRH services/practices provided by
hospitals:
Public hospitals that provide the practice/service
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2.4 Voluntary interruption of pregnancy (VIP) and unsafe abortion
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2.4.1 VIP in Argentina
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2.5 Contraception
In this section, general information about contraception is presented. Then, a more specific description about contraception in Argentina is provided, with a special focus on regulation and accessibility.
Only emergency contraception, and among the different emergency methods, the LNG-ECP, is described and discussed in more detail since it is still one of the most controversial methods, there are several myths about its mechanism of action, use, etc., and healthcare professionals tend to present the greatest barriers to provide it, even though it should be accessible to all people.
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2.5.1 Contraceptive prevalence and unmet need for family planning
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2.5.2 Contraception in Argentina Regulations
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Distribution of contraceptives methods by the National Program of Sexual Health and Responsible Procreation
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Table 5. Contraceptive methods distributed by the National Program of Reproductive Health and Responsible Procreation
Contraceptive method 2011 2016
Combined oral contraceptive&2&
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Emergency contraceptive pill(&3
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Condom
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Current use of contraceptive methods/ contraceptive prevalence and unmet need
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Table 6. Contraceptive methods used by the population.
Contraceptive method used: Women Men
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Contraceptive method free of charge
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