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Background: In 2019, the World Health Organization identified improving access to safe abortion as an important priority toward improving sexual and reproductive health and rights and achieving Sustainable Development Goals. One strategy for addressing this priority is strengthening access to medicines for medical abortion. All 11 countries in the South-East Asia Region have some indications for legal abortion and permit post-abortion care. Therefore, strengthening access to medical abortion medicines is a reasonable strategy for improving access to safe abortion for the Region. Methodology: We applied an adapted version of an existing World Health Organization landscape assessment protocol for the availability of medical abortion medicines at the country-level in the South-East Asia Region. We collected publicly available data on the existence of national health laws, policies, and standard treatment guidelines; inclusion of medical abortion medicines in the national essential medicines list; and marketing authorization status for medical abortion medicines for each country and verified by Ministries of health. The findings were once more presented, discussed and recommendations were formulated during regional technical consultation workshop. Each country teams participated in the process, and subsequently, the suggestions were validated by representatives from Ministries of Health.. Results: Few countries in the Region currently have national policies and guidelines for comprehensive safe abortion. However, either mifepristone-misoprostol in combination or misoprostol alone (for other indications) is included in national essential medicines lists in all countries except Indonesia and Sri Lanka. Few countries earmark specific public funds for procuring and distributing medical abortion commodities. In countries where abortion is legal, the private sector and NGOs support access to medical abortion information and medicines. Several countries only allow registered medical practitioners or specialists to administer medical abortion. Conclusion: Following this rapid participatory assessment and technical consultation workshop, the World Health Organization South-East Asia Regional Technical Advisory and Sexual and Reproductive Health and Rights technical committee recommended priority actions for policy and advocacy, service delivery, and monitoring and evaluation, and indicated areas for support. [ABSTRACT FROM AUTHOR]

Purpose: Evaluation of the Teens & Toddlers (T&T) positive youth development (PYD) and teenage pregnancy prevention programme suggested that the intervention had minimal effectiveness partly due to its unclear theory of change. The purpose of this paper is to examine the lived experiences of young women participating in the programme to contribute to a clearer understanding of intervention process and potential mechanisms. Design/Methodology/Approach: The authors conducted four focus groups (n = 20), eight paired or triad interviews (n = 12) and 15 interviews with young women participating in an randomized controlled trial of the T&T programme in England, analysing these data using a phenomenological approach. Findings: T&T provided some opportunities to experience the "five Cs" that underpin PYD programme theory: competence, confidence, connection, character and caring. However, the young women did not experience the programme in a way that would consistently develop these characteristics. The lack of opportunities for skill-building and challenge in the activities constrained their ability to build competence and confidence. Some programme facilitators and counsellors were able to achieve connections and caring relationships with the young women, though other adults involved in the programme were sometimes perceived by the participants as overly critical. The character development activities undertaken in the programme addressed attitudes towards sexual risk-taking. Originality/Value: Few studies of the PYD approach examine young people's perspectives. This research suggests that the young women were not consistently provided with opportunities to achieve youth development within the T&T programmes. In refining the programme, more thought is needed regarding how delivery of particular components may facilitate or impede a PYD experience.

Purpose: Evidence from the USA/Australia suggests whole-school interventions designed to increase social inclusion/engagement can reduce substance use. Completeness of implementation varies but contextual determinants have not been fully explored. Informed by previous interventions, the paper aims to examine these topics in an English pilot of the Healthy School Ethos intervention. Design/methodology/approach: This intervention, like previous interventions, balanced standardization of inputs/process (external facilitator, manual, needs-survey and staff-training delivered over one year to enable schools to convene action-teams) with local flexibility regarding actions to improve social inclusion. Evaluation was via a pilot trial comprising: baseline/follow-up surveys with year-7 students in two intervention/comparison schools; semi-structured interviews with staff, students and facilitators; and observations. Findings: The intervention was delivered as intended with components implemented as in the USA/Australian studies. The external facilitator enabled schools to convene an action-team involving staff/students. Inputs were feasible and acceptable and enabled similar actions in both schools. Locally determined actions (e.g. peer-mediators) were generally more feasible/acceptable than pre-set actions (e.g. modified pastoral care). Implementation was facilitated where it built on aspects of schools' baseline ethos (e.g. a focus on engaging all students, formalized student participation in decisions) and where senior staff led actions. Student awareness of the intervention was high. Originality/value: Key factors affecting feasibility were: flexibility to allow local innovation, but structure to ensure consistency; intervention aims resonating with at least some aspects of school baseline ethos; and involvement of staff with the capacity to deliver. The intervention should be refined and its health/educational outcomes evaluated. (Contains 3 tables.)

Objective To examine the effectiveness, safety, and acceptability of nurse provision of early medical abortion compared to physicians at three facilities in Mexico City. Methods We conducted a randomized non-inferiority trial on the provision of medical abortion and contraceptive counselling by physicians or nurses. The participants were pregnant women seeking abortion at a gestational duration of 70 days or less. The medical abortion regimen was 200 mg of oral mifepristone taken on-site followed by 800 µg of misoprostol self-administered buccally at home 24 hours later. Women were instructed to return to the clinic for follow-up 7-15 days later. We did an intention-to-treat analysis for risk differences between physicians' and nurses' provision for completion and the need for surgical intervention. Findings Of 1017 eligible women, 884 women were included in the intention-to-treat analysis, 450 in the physician- provision arm and 434 in the nurse-provision arm. Women who completed medical abortion, without the need for surgical intervention, were 98.4% (443/450) for physicians' provision and 97.9% (425/434) for nurses' provision. The risk difference between the group was 0.5% (95% confidence interval, CI: -1.2% to 2.3%). There were no differences between providers for examined gestational duration or women's contraceptive method uptake. Both types of providers were rated by the women as highly acceptable. Conclusion Nurses' provision of medical abortion is as safe, acceptable and effective as provision by physicians in this setting. Authorizing nurses to provide medical abortion can help to meet the demand for safe abortion services. Objectif Examiner l'efficacite, la securite et l'acceptabilite de l'avortement medical precoce pratique par un(e) infirmier(iere) par rapport au meme acte realise par un medecin dans trois etablissements de la ville de Mexico. Methodes Nous avons mene un essai de non-inferiorite randomise sur l'avortement medical et le conseil en matiere de contraception pratiques par des medecins ou des infirmiers. Les participantes etaient des femmes enceintes souhaitant avorter a un terme de grossesse de 70 jours ou moins. Le protocole de l'avortement medical etait de 200 mg de mifepristone administres sur place par voie orale, suivis de 800 µg de misoprostol auto-administres par voie orale a la maison 24 heures plus tard. Les femmes avaient recu comme consigne de revenir a la clinique pour y etre suivies 7 a 15 jours plus tard. Nous avons effectue une analyse en intention de traiter pour les differences de risque entre l'avortement medical pratique par les medecins et par les infirmiers et le besoin d'une intervention chirurgicale. Resultats Parmi les 1 017 femmes eligibles, 884 femmes etaient incluses dans l'analyse en intention de traiter, 450 dans l'acte d'avortement pratique par un medecin et 434 dans l'acte d'avortement pratique par un(e) infirmier(iere). Les femmes qui ont subi un avortement medical sans avoir eu besoin d'une intervention chirurgicale etaient de 98,4% (443/450) pour l'avortement pratique par un medecin et de 97,9% (425/434) pour l'avortement pratique par un(e) infirmier(iere). La difference de risque entre les groupes etait de 0,5% (intervalle de confiance a 95%: de 1,2% a 2,3%). Il n'y avait pas de difference entre les professionnels de sante pour les termes de la grossesse examines ou la prise de methode contraceptive des femmes. Par ailleurs, les femmes acceptaient completement les deux types de professionnels de sante. Conclusion Dans ce contexte, l'avortement medical pratique par les infirmiers est aussi s-r, acceptable et efficace que celui pratique par les medecins. Autoriser les infirmiers a pratiquer l'avortement medical peut aider a repondre a la demande en matiere de services d'avortement securises. Objetivo Examinar la eficacia, seguridad y aceptabilidad de la actuacion de los enfermeros en los abortos con medicamentos en fases tempranas de la gestacion en tres centros de Ciudad de Mexico en comparacion con la actuacion los medicos. Metodos Se llevo a cabo un ensayo de no inferioridad aleatorio sobre la realizacion de abortos medicos y asesoramiento anticonceptivo por parte de medicos o enfermeros. Las participantes fueron mujeres embarazadas que buscaban interrumpir una gestacion de 70 dias o menos. El regimen para el aborto con medicamentos consistio en 200 mg demifeprlstona por via oral, administrados en el centro, seguidos de 800 µg de misoprostol autoadministrados por via oral en casa 24 horas mas tarde. Se indico a las mujeres que acudieran a la clinica para realizar un seguimiento entre 7y 15 dias mas tarde. Se realizo un analisis por intencion de tratar de las diferencias de riesgo entre la asistencia de los medicos y los enfermeros para el termino y la necesidad de una intervencion quirurgica. Resultados De 1017 mujeres elegibles, se incluyeron 884 en el analisis por intencion de tratar, 450 en el brazo atendido por medicos y 434 en el grupo atendido por enfermeros. De las mujeres que se sometieron al aborto con medicamentos, el 98,4 % (443/450) de las atendidas por medicos y el 97,9 % (425/434) de las atendidas por enfermeras no requirieron ninguna intervencion quirurgica. La diferencia de riesgo entre el grupo fue de 0,5 % (intervalo de confianza del 95 %: -1,2 % al 2,3 %). No hubo diferencias entre los proveedores para la duracion de la gestacion examinada o metodo anticonceptivo de las mujeres. Las mujeres calificaron ambos proveedores como muy aceptables. Conclusion Los enfermeros son tan seguros, aceptables y eficaces como los medicos a la hora de asistir un aborto con medicamentos. Autorizar a las enfermeras a realizar abortos con medicamentos puede ayudar a satisfacer la demanda de servicios para un aborto seguro., Introduction In Mexico City, early elective abortion to terminate pregnancy was legalized in April 2007. (1-3) Up to June 2013,100 000 abortions have been provided by trained physicians in Ministry [...]

This study presents the results of an evaluation of a Story Circles intervention to reduce individual level abortion stigma among women who have experienced abortion in Mexico. Using a mixed-methods approach, the study explored whether participation in the intervention reduced 18 women's experience of stigma one month after having participated. The study used the Individual Level Abortion Stigma Scale (ILAS Scale), qualitative interviews and focus groups to gain an understanding of women's experiences of the intervention and any changes in stigmatising feelings. Findings suggest that the Story Circles offered women a place to talk about their abortion in an affirmative and supportive environment, unlike the context of their daily lives where stigma generated silence and affected their well-being. Participants were able to build trust, share their experiences, create connections and transform their perception of their abortion from a negative experience to one that was empowering and life-affirming. This also led to other significant positive changes in their lives. The paper offers recommendations about programme and intervention design and implementation for practitioners working to reduce individual level stigma among women who have experienced abortion. [ABSTRACT FROM AUTHOR]