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Abortion Access and Post-Abortal Care

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Abortion Access and Post-Abortal Care ! Case 1: Abortion Access and Post-Abortal Care Case 1: SJ’s Journey SJ, an 18-year old mother of two, travels by bike from her village to an urban hospital in Kenya. She is 10 weeks from her last period and has felt the familiar signs of nausea and breast tenderness of early pregnancy. She sees Dr. D in the outpatient surgical clinic to obtain a vacuum aspiration. SJ was nervous about the procedure, and was even more horrified at the lack of pain control she was given, despite her screams of pain and requests for pain relief. Dr. D has mentioned to colleagues in the past that far too many women are having abortions. She believes that providing pain relief only encourages women to have more abortions. Although Dr. D professes that she supports legal and safe abortion, she believes that current laws make it too easy for women to terminate pregnancies. Dr. D considers that a little pain during the procedure discourages women from having unprotected sex. Almost a week post-procedure, SJ develops severe cramping and vaginal bleeding. She reluctantly visits a local clinic where a nurse performs a vaginal examination. The nurse finds what appear to be some retained products of conception. The nurse records SJ’s history and physical examination in a hand-written note. She hands SJ an envelope with the note, and then calls for an ambulance to transfer her to the district hospital. After waiting approximately three hours, the ambulance arrives to take SJ to the district hospital 300 kilometers away. Upon arrival, the doctor reviews the nurse’s notes, and asks her “Why did you murder your baby?” He conducts a cursory examination and adds to her medical record. Despite her profuse vaginal bleeding and rapid pulse, the doctor calls for an ambulance to take her to another hospital, which is two hours away. SJ continued to bleed throughout the long ambulance journey and was pronounced dead on arrival at the provincial hospital. Questions for Discussion 1.! What are the healthcare problems in this case? 2.! Using the Integrated Human Rights and Women’s Health Checklist, which human rights are protected or infringed in this case? 3.! What are some contributing factors to abortion stigma? What are the consequences of abortion stigma? 4.! What are the primary and secondary prevention strategies addressing unsafe abortions? 5.! What standards of practice are in place in your healthcare system to prevent similar outcomes to those of SJ? 6.! What are the consequences of abortion? Unsafe abortion? a.! 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