Dr. José David Ortiz Mariscal Mexico New approaches in the holistic treatment of women with rejected pregnancy & incomplete abortion

DECLARATIONS In my practice as Obstetrician & Gynecologist, I am guided by the framework of my Constitution, including treaties, conventions and international declarations signed by my Government, as well as the legal framework that regulates health. In my professional practice, I am guided by scientific evidence, the principles of public health and implementation of human, sexual and reproductive rights of women, in health services.

I have practiced obstetrics and Gynecology for 45 years and I understand that my main goal is to protect and safeguard my patients health, and in general of all women. I am absolutely against women terminating a pregnancy, planned or unplanned, in unsafe conditions because it is unfair and also determines high rates of morbidity and maternal mortality. Declarations

I have no conflict of interests: economic, social, or religious. I am not affiliated with any political party or religious group, therefore I am not obligated to think, feel and act, as these institutions impose it to those who belong to them. I have spent 40 years of my professional life to the prevention of high reproductive and obstetric risk factors, promotion of family planning, responsible sexuality and prevention and comprehensive management of sexual violence against women. DECLARATIONS:

New approaches for Care Of women being treated for:  Unplanned pregnancy  Legal termination of pregnancy  Post abortion period

HUMAN PREGNANCY AND ABORTION DOES NOT EXIST

WHAT REALLY EXIST IS PREGNANT WOMEN!!!! SO WE HAVE TO CENTER OUR APROACHES ON THEM.

WOMEN with an unplanned and rejected pregnancy puts herself in a situation of emotional, physical and social vulnerability. It may cause injury or death to woman and has conceived product, if not detected and duly attended. Dr. José David Ortiz Mariscal 2013 CONSIDERATIONS

CONSIDERATION Women with unplanned or rejected pregnancy derivated of high risk biological or social conditions, should be attended comprehensive and timely by sensitive and well qualified multidisciplinary health staff, because failure to do so will lead a women to terminate her pregnancy in unsafe conditions, with the results that all we know.

CONSIDERATION Every time that a woman has an unplanned pregnancy or arrives at a hospital with signs of having tried to terminate her pregnancy, this means that the family, the health, religious and educational sectors and the whole state has failed. It means that we as a society have failed her.

FIRST APPROACH Women with Unplanned and Rejected Pregnancy, during Legal termination of her Pregnancy or in Post abortion period, must be treated under the umbrella of sexual and reproductive rights.

 They arise from human rights in general, and are an important part of bioethics.  They are applicable to all women. Sexual and reproductive rights

Women Rights The Right to Life: which means among other things that no woman's life should be put at risk by reason of pregnancy. The Right to Liberty and Security of the Person: The Right to Privacy: meaning that all sexual and reproductive health-care services should be confidential and all women have the right to independent reproductive choices.

Women Rights The Right to Freedom of Thought: which includes freedom from the restrictive interpretation of religious texts, beliefs, philosophies and customs as tools used to curtail freedom of thought on sexual and reproductive health care and other issues.

Women Rights The Right to Information and Education: As it relates to sexual and reproductive health for all, including access to full information and free and informed consent. The Right to Health Care and Health Protection: which includes the right of health-care patients to the highest possible quality of care, and freedom from traditional practices which are harmful to health.

Women Rights The Right to the Benefits of Scientific Progress: Includes the right of sexual and reproductive health- service clients to new reproductive-health technologies that are safe, effective and acceptable (MVA, TOP with medicines). The Right to Freedom of Assembly and Political participation: which includes the right of all persons to influence communities and governments to prioritize sexual and reproductive health and rights

Women Rights The Right to be Free from Torture and Ill-Treatment: including the rights of all women, and young people protection from violence, sexual exploitation and abuse. The Right to Equality and to be Free from all Forms of discrimination: including one’s sexual and reproductive life. The Right to Choose whether or not to marry and to find and plan a Family (women are not a reproductive machine). The Right to decide whether or when to have children.

SECOND APPROACH Beneficence (maximize the best health outcomes) Non-maleficence (do no harm) Autonomy (to ensure and respect the rights of individuals to make informed decisions about their own health care) Justice (ensure fairness or fair distribution of costs and benefits) Equity (To ensure that everybody gets what is fair for their needs) Be guided by Principles of Bioethics

The purpose of human rights is to promote human dignity implies the obligation of the States to: Benefit the physical, mental and social health of patient in the course of her treatment (Beneficence) The commitment not to damage or cause unnecessary damage. (Non - maleficence)

Human rights are protected by: laws and treaties national and international Medical ethic is protected by national constitutions, by codes, primarily controlled by the medical profession. Bioethics and human rights are related to sexual and reproductive health

ALL WOMEN Have the right to the highest attainable health standard and the benefits of scientific progress: Form the basis of the professional commitment of Beneficence and Justice.

Human rights: To privacy Freedom of conscience and The freedom and security of person To information Are key elements of autonomy which includes a duty to protect confidentiality in health care.

THIRD APPOACH: Consider the Ethical Obligations of Health Professionals

Professional competence To respect the autonomy of women and the confidentiality

A. Professional competence 1. Achieve and maintain the highest levels of professional competence in relation to the health of woman, using the latest and best medical evidence, in the context of available resources: LTOP with medications(mifepristone and misoprostol and or electrical or manual vacuum aspiration

A. Professional competence 2. Make a respectful professional behavior that promotes the dignity and security of women (not to judge).

A. Professional competence 3. Ensure that the right of the physician to preserve their own moral or religious values does not result in the imposition to women of these personal values. In these circumstances, women should be referred to another health care provider who does not have this problem.

A. Professional competence The conscientious objection to attend women for TOP or PAC does not absolve physicians take steps so that in case of emergency to provide the necessary treatment without delay.

Obligations of the Health Professionals Professional competence Autonomy of women and confidentiality

B. Autonomy of women and confidentiality: 1. Support a process of decision making of women about their sexual and reproductive health, free from prejudice and coercion. Includes: Act only after obtaining the informed consent or disagreement, based on adequate information on the nature, implications of treatment, options and results of the different available alternatives.

B. Autonomy of women and confidentiality: By acting in this way, health professionals respect the right that women consider and assess treatment options in the context of their own circumstances

B. Autonomy of women and confidentiality: 2. Ensure the confidentiality, which does not allow that privileged information and documents, be shared by verbal mode or in any other way, except when required by law or the patient wants it.

My recommendation is to: undertake, adopt and promote these professional responsibilities, based on your commitment to make a reality the inclusion of human rights and bioethical principles in the care of the reproductive health of women and specially for the care of women that has decided to terminate her pregnancy or is in post abortion period. Obligations of Health Professionals

The reproductive and sexual health is a subject of human development, since the women are essential for the social and economic stability and the progress in all the societies. The potential contribution of women frequently is not performed due to limitations in their human rights, including lack of access to information and to a safe and proper care of her health.

Conclusions Women with unplanned pregnancy deserves to be served as all other patients: Under the umbrella of human rights, sexual and reproductive rights and principles of bioethics With humanism, with respect With confidentiality and privacy Taking care of her physical, emotional and social integrity. With counseling With modern and effective techniques(medical or surgical as manual aspiration), for LTOP Contraception post immediate pregnancy termination.

Thank you very much.