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Huertas-Zurriaga A, Palmieri PA, Edwards JE, Cesario SK, Alonso-Fernandez S, Pardell-Dominguez L, Dominguez-Cancino KA, Leyva-Moral JM. Motherhood and decision-making among women living with HIV in developed countries: a systematic review with qualitative research synthesis. Reprod Health 2021; 18:148. [PMID: 34246286 PMCID: PMC8272303 DOI: 10.1186/s12978-021-01197-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/24/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Women living with HIV (WLH) lack evidence-based information about reproductive options while managing pressures from family, clinicians, and communities to give up the idea of having children. As the reproduction intentions of WLH are not well understood, stigmatizing behaviors force them to hide their disease to avoid rejection by their family, partner, and social networks. Compliance with social norms, fear of stigma, and discrimination influence their experience. Current research is individual qualitative studies lacking the synthesis perspective necessary to guide intervention development. The purpose of this study was to synthesize the evidence to explain the reproductive decision-making process for WLH in developed countries. METHODS A systematic review with qualitative research synthesis was conducted through searches in 10 electronic databases (CINAHL, EMBASE, MEDLINE, Scopus, Social Science Citation Index, Web of Science, Google Scholar, Cuidatge, Cuiden Enfispo, and SciELO). Studies published in journals from 1995 to 2019 with qualitative data about reproductive decision-making among WLH in developed countries were eligible for inclusion. Developed country was operationalized by membership in the OECD for comparative conditions of social wellbeing and economic stability. The CASP and JBI checklists for qualitative research were used to assess study quality and methodological integrity. Thematic analysis and qualitative meta-summary techniques were used for the synthesis. RESULTS Twenty studies from 12 developed countries were included in the synthesis. Findings were organized into 3 meta-themes from 15 themes and 45 subthemes, including: (1) Shattered identity, (2) Barriers, inequities, and misinformation, (3) Coping, resiliency, and support. Reproductive decision-making was perceived as a complex process influenced by facilitators and barriers. The facilitators helped WLH cope with their new situation to become more resilient, while the barriers made their situation more difficult to manage. CONCLUSION WLH encounter reproductive decision-making with knowledge deficits and limited social support. An integrated approach to holistic care with comprehensive multidisciplinary counseling is needed to support WLH. Clinicians could benefit from professional development to learn how to be authentically present for WLH, including engaging in conversations, demonstrating compassion, and understanding situations. Evidence-based clinical practice guidelines need to be tailored for the family planning and sexual health needs of WLH.
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Affiliation(s)
- Ariadna Huertas-Zurriaga
- Hospital Universitari Germans Trias I Pujol, Badalona, 08916 Barcelona, Spain
- Grupo de Investigación Enfermera en Vulnerabilidad Y Salud (GRIVIS), Universitat Autònoma de Barcelona, Avda. Can Domènech, Edifici M. Despatx M3/213, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
| | - Patrick A. Palmieri
- South American Center for Qualitative Research, Universidad Norbert Wiener, Av. Arequipa 444, Torre 2, Piso 4, Lima, 15046 Perú
- College of Graduate Health Studies, A. T. Still University, 800 W. Jefferson Street, Kirksville, MO 63501 USA
- Center for Global Nursing, Texas Woman’s University, 6700 Fannin St, Houston, TX 77030 USA
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Suite 402, Lima, 15023 Peru
| | - Joan E. Edwards
- Center for Global Nursing, Texas Woman’s University, 6700 Fannin St, Houston, TX 77030 USA
- Nelda C. Stark College of Nursing, Texas Woman’s University, 6700 Fannin St, Houston, TX 77030 USA
| | - Sandra K. Cesario
- Center for Global Nursing, Texas Woman’s University, 6700 Fannin St, Houston, TX 77030 USA
- Nelda C. Stark College of Nursing, Texas Woman’s University, 6700 Fannin St, Houston, TX 77030 USA
| | - Sergio Alonso-Fernandez
- Recerca i Innovació en Cures Infermeres, Hospital Universitari Germans Trias I Pujol, Badalona, 08916 Barcelona, Spain
| | - Lidia Pardell-Dominguez
- Grupo de Investigación Enfermera en Vulnerabilidad Y Salud (GRIVIS), Universitat Autònoma de Barcelona, Avda. Can Domènech, Edifici M. Despatx M3/213, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Suite 402, Lima, 15023 Peru
- Department D’Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Avda. Can Domènech, Edifici M. Despatx M3/213, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
| | - Karen A. Dominguez-Cancino
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Suite 402, Lima, 15023 Peru
- Escuela de Enfermería, Universidad Científica del Sur, Carr. Panamericana Sur 19, Villa EL Salvador, Lima, 15067 Perú
- Escuela de Salud Pública, Universidad de Chile, Independencia 939, Independencia, 8380453 Santiago de Chile, Chile
| | - Juan M. Leyva-Moral
- Grupo de Investigación Enfermera en Vulnerabilidad Y Salud (GRIVIS), Universitat Autònoma de Barcelona, Avda. Can Domènech, Edifici M. Despatx M3/213, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Suite 402, Lima, 15023 Peru
- Department D’Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Avda. Can Domènech, Edifici M. Despatx M3/213, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
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Mohtashami Z, Esmaili Z, Vakilinezhad MA, Seyedjafari E, Akbari Javar H. Pharmaceutical implants: classification, limitations and therapeutic applications. Pharm Dev Technol 2019; 25:116-132. [DOI: 10.1080/10837450.2019.1682607] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Zahra Mohtashami
- Pharmaceutics Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Esmaili
- Pharmaceutics Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Hamid Akbari Javar
- Pharmaceutics Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Burgner A, Hladunewich MA. Women's Reproductive Health for the Nephrologist. Am J Kidney Dis 2019; 74:675-681. [PMID: 31221529 DOI: 10.1053/j.ajkd.2019.04.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/05/2019] [Indexed: 02/08/2023]
Abstract
Women with chronic kidney disease (CKD) are faced with complex decisions and significant challenges during their reproductive years. Contraceptive choices have a variety of side effects that can disproportionately affect women with CKD, limiting choice. CKD itself and the therapies needed to treat severe disease can affect future fertility. When conception is desired, young women with CKD must plan meticulously because an ill-timed pregnancy can result in disease progression or flare and exposure of an unborn child to potentially teratogenic medications. Among women with CKD, pregnancy risks are substantial, with up to 10-fold higher risk for preeclampsia and 6-fold higher risk for preterm delivery. These pregnancy complications associated with inadequate placentation also increase maternal and newborn risks for cardiovascular morbidity and mortality and progression to kidney failure later in life. As such, it is the obligation of every nephrologist caring for women of reproductive age to provide guidance in the choice of methods to prevent unplanned pregnancies, to choose treatments that preserve fertility, and to participate in shared decision making that optimizes pregnancy timing and outcomes. In this perspective, we review the many challenges associated with reproductive counseling in women with CKD.
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Affiliation(s)
- Anna Burgner
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN
| | - Michelle A Hladunewich
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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Meece FA, Ahmed G, Nair H, Santhamma B, Tekmal RR, Zhao C, Pollok NE, Lara J, Shaked Z, Nickisch K. Esters of levonorgestrel and etonogestrel intended as single, subcutaneous-injection, long-lasting contraceptives. Steroids 2018; 137:47-56. [PMID: 30086356 PMCID: PMC6137153 DOI: 10.1016/j.steroids.2018.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/18/2018] [Accepted: 07/25/2018] [Indexed: 01/01/2023]
Abstract
An effort with the goal of discovering single-dose, long-lasting (>6 months) injectable contraceptives began using levonorgestrel (LNG)-17-β esters linked to a sulfonamide function purposed as human carbonic anhydrase II (hCA 2) ligands. One single analog from this first series showed noticeably superior anti-ovulatory activity in murine models, and a subsequent structure-activity relationship (SAR, the relationship between a compound's molecular structure and its biological activity) study based on this compound identified a LNG-phenoxyacetic acid ester analog exhibiting longer anti-ovulatory properties using the murine model at 2 and 4 mg dose than medroxyprogesterone acetate (MPA). The same ester function linked to etonogestrel (ENG) furnished a compound which inhibited ovulation at 2 mg for 60 days, the longest duration of all compounds tested at these doses. By comparison, MPA at the same dose inhibited ovulation for 32 days.
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Affiliation(s)
- Frederick A Meece
- Evestra, Inc, 6410 Tri County Pkwy, Schertz, TX 78154, United States.
| | - Gulzar Ahmed
- Evestra, Inc, 6410 Tri County Pkwy, Schertz, TX 78154, United States
| | - Hareesh Nair
- Evestra, Inc, 6410 Tri County Pkwy, Schertz, TX 78154, United States
| | - Bindu Santhamma
- Evestra, Inc, 6410 Tri County Pkwy, Schertz, TX 78154, United States
| | - Rajeshwar R Tekmal
- University of Texas Health Science Center San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, United States
| | - Chumang Zhao
- Evestra, Inc, 6410 Tri County Pkwy, Schertz, TX 78154, United States
| | - Nicole E Pollok
- Evestra, Inc, 6410 Tri County Pkwy, Schertz, TX 78154, United States
| | - Julia Lara
- Evestra, Inc, 6410 Tri County Pkwy, Schertz, TX 78154, United States
| | - Ze'ev Shaked
- Evestra, Inc, 6410 Tri County Pkwy, Schertz, TX 78154, United States
| | - Klaus Nickisch
- Evestra, Inc, 6410 Tri County Pkwy, Schertz, TX 78154, United States
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Edelman AB, Cherala G, Li H, Pau F, Blithe DL, Jensen JT. Levonorgestrel butanoate intramuscular injection does not reliably suppress ovulation for 90 days in obese and normal-BMI women: a pilot study. Contraception 2017; 95:55-58. [PMID: 27475035 PMCID: PMC5140699 DOI: 10.1016/j.contraception.2016.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/21/2016] [Accepted: 07/21/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND We performed a pilot evaluation of a new formulation of levonorgestrel butanoate (LB) designed to be a long-acting injectable (6 months) contraceptive to determine pharmacodynamic end points in normal-body mass index (BMI) and obese women. STUDY DESIGN Obese (BMI ≥30 kg/m2) and normal-BMI, otherwise healthy, women received a single intramuscular injection of LB after ovulation was confirmed in a baseline cycle. The primary outcome was return of ovulation in days. RESULTS A total of 14 women enrolled and completed the study [normal BMI n=9, median BMI 22.7kg/m2 (range 19.4-25.8); obese n=5, median BMI 35.7kg/m2 (30.1-39.2)]. The first 6 subjects (normal BMI=4/9, obese BMI=2/5) received 40 mg of LB, and the remaining 8 received 20 mg. All women except one returned to ovulation prior to 6 months. Return to ovulation occurred earlier in the obese group; 3/5 obese and 0/9 normal BMI subjects returned to ovulation within 90 days (p=.03). No serious adverse events were reported during the study. CONCLUSION Return to ovulation was earlier than 6 months in both BMI groups but more so in the obese BMI group. IMPLICATIONS Since return of ovulation was earlier than expected for this LB injectable formulation, additional steps are needed to develop a preparation suitable as a longer-lasting product.
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Affiliation(s)
- Alison B Edelman
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR; Oregon National Primate Research Center, Beaverton, OR.
| | - Ganesh Cherala
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR; CONRAD, Arlington, VA
| | - Hong Li
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR
| | - Francis Pau
- Oregon National Primate Research Center, Beaverton, OR
| | - Diana L Blithe
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | - Jeffrey T Jensen
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR; Oregon National Primate Research Center, Beaverton, OR
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Meczekalski B, Czyzyk A, Kunicki M, Podfigurna-Stopa A, Plociennik L, Jakiel G, Maciejewska-Jeske M, Lukaszuk K. Fertility in women of late reproductive age: the role of serum anti-Müllerian hormone (AMH) levels in its assessment. J Endocrinol Invest 2016; 39:1259-1265. [PMID: 27300031 PMCID: PMC5069312 DOI: 10.1007/s40618-016-0497-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/03/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Fertility is referred to the capability for having offspring and can be evaluated by fertility rate. Women's fertility is strictly dependent on individual's age. The fertility peak occurs in the early 20s, and it starts to decline in the third and fourth decades of life (falling sharply after age 35). AIM The aim of this work is to review the available data concerning fertility in women of late reproductive age, especially the role of serum anti-Müllerian hormone (AMH) levels. RESULTS There are a lot of factors responsible for decrease of fertility in women of late reproductive age. These factors can be classified as oocyte-dependent (decrease in oocyte quantity and quality) and oocyte-independent (reproductive organs [uterus, oviducts] status and general health). Anti-Müllerian hormone (AMH) is a dimeric glycoprotein of the transforming growth factor-β (TGF-β) superfamily produced directly by the ovarian granulosa cells of secondary, preantral, and early antral follicles. It has been used as an ovarian reserve marker since 2002. Anti-Müllerian hormone seems to be the best endocrine marker for assessing the age-related decline of the ovarian pool in healthy women. Evaluation of AMH's predictive value in the naturally aging population is important for counseling women about reproductive planning as well as for treatment planning for women experiencing hormone-sensitive gynecological conditions such as endometriosis and fibroids. CONCLUSIONS AMH can be considered as an indicator of fertility in late reproductive age women and pregnancy outcome in assisted reproductive technology cycles. AMH can strongly predict poor response in the controlled ovarian stimulation.
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Affiliation(s)
- B Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, ul. Polna 33, Poznan, Poland.
| | - A Czyzyk
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, ul. Polna 33, Poznan, Poland
| | - M Kunicki
- INVICTA Fertility and Reproductive Center, Gdańsk, Poland
| | - A Podfigurna-Stopa
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, ul. Polna 33, Poznan, Poland
| | - L Plociennik
- INVICTA Fertility and Reproductive Center, Gdańsk, Poland
| | - G Jakiel
- INVICTA Fertility and Reproductive Center, Warsaw, Poland
- Department of Obstetrics and Gynecology, Center of Postgraduate Education, Warsaw, Poland
| | - M Maciejewska-Jeske
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, ul. Polna 33, Poznan, Poland
| | - K Lukaszuk
- INVICTA Fertility and Reproductive Center, Gdańsk, Poland
- INVICTA Fertility and Reproductive Center, Warsaw, Poland
- Department of Obstetrics and Gynecological Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdańsk, Poland
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Halpern V, Stalter RM, Owen DH, Dorflinger LJ, Lendvay A, Rademacher KH. Towards the development of a longer-acting injectable contraceptive: past research and current trends. Contraception 2015; 92:3-9. [DOI: 10.1016/j.contraception.2015.02.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 02/10/2015] [Accepted: 02/25/2015] [Indexed: 10/23/2022]
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Greenwald SR, Cohen SA. Nonrandom return: lessons from women returning for follow-up results of cervical cancer screening in rural haiti. Gynecol Obstet Invest 2014; 78:255-8. [PMID: 25171063 DOI: 10.1159/000365082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 06/04/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE Few studies have evaluated approaches to improve patient follow-up in screening programs within resource-limited areas. This study investigated the patterns of return among women presenting for results from a cervical cancer screening program implemented in a resource-poor region to highlight areas for future research and potential interventions. METHODS In the development of a cervical cancer screening program in rural Haiti, women aged 18-45 years were recruited from local churches to undergo cervical cancer screening and follow-up for results. A dot plot was used to analyze the distribution of women returning during the results phase compared to the random return rates based on the screening phase. RESULTS Of the 250 women tested, 121 (48%) returned for follow-up. On the 2 result days with the most returnees, 46 and 63% of the women had been tested during only 3 of the 11 testing days which themselves accounted for 41% of the total number of women who returned. The highest volume return days, a Monday and a Friday, gave results to women tested on Monday, Wednesday and Friday, and on Monday, Tuesday and Thursday, respectively. The 2 result days with the lowest return numbers had 80% (8/10) of those who returned coming as the only returnee from their day of testing. CONCLUSION Result days corresponding with the highest return rates had increased clustering of women from the screening phase, and the result days with fewer women returning had less clustering. These findings are among the first to implicate the importance of defining these patterns of return and the potential for recruitment techniques that exploit such groupings, potentially described by social connections, in limited-resource settings to improve follow-up for screening programs.
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Alsibiani SA. Use of misoprostol for self-induced medical abortions among Saudi women: a call for attention. Gynecol Obstet Invest 2014; 78:88-93. [PMID: 24993350 DOI: 10.1159/000363238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 04/24/2014] [Indexed: 11/19/2022]
Abstract
AIMS To investigate misoprostol use as a self-administered medical abortifacient and to explore the knowledge and availability of misoprostol and attitudes towards it among Saudi women. METHODS A questionnaire-based cross-sectional study was conducted in obstetric and gynecological outpatient clinics at private and teaching institutions between January 1 and June 29, 2012. RESULTS Of the 678 respondents, 40% (271/678) were aware of misoprostol use as an abortifacient and 7.4% (50/678) reported personal use of it as an abortifacient. Misoprostol users were more likely to have had previous abortions (96%, 48/50; p < 0.01), had a relative/friend working in the medical field (70%, 35/50; p < 0.01) and known someone else who had used the drug (82%, 41/50; p < 0.01). The majority responded incorrectly that higher misoprostol doses are required with more advanced gestational age (96%, 48/50) and that misoprostol use confers no fetal risks (100%, 50/50). CONCLUSION The proportion that reported personal use of misoprostol in the current study (7.4%) exceeded that in similar samples in Brazil (2.2%) and the USA (5%). One concerning finding was the users' poor knowledge about misoprostol. Increased awareness about the inherent risks associated with unsupervised misoprostol use as an abortifacient is needed.
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Affiliation(s)
- Sharifa A Alsibiani
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Van Look PFA, Cottingham J. The World Health Organization's safe abortion guidance document. Am J Public Health 2013; 103:593-6. [PMID: 23409886 DOI: 10.2105/ajph.2012.301204] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We discuss the history of the World Health Organization's (WHO's) development of guidelines for governments on providing safe abortion services, which WHO published as Safe Abortion: Technical and Policy Guidance for Health Systems in 2003 and updated in 2012. We show how the recognition of the devastating impact of unsafe abortion on women's health and survival, the impetus of the International Conference on Population and Development and its five-year follow-up, and WHO's progressive leadership at the end of the century enabled the organization to elaborate guidance on providing safe abortion services. Guideline formulation involved extensive review of published evidence, an international technical expert meeting to review the draft document, and a protracted in-house review by senior WHO management.
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