Three Duke physicians and global health researchers have begun forging collaborations with Argentinean partners in the public and private sectors to explore research opportunities to improve reproductive health and prevent unplanned pregnancies. Given the illegality of abortion in Argentina, many women resort to unsafe procedures that endanger their health and their lives, and as a result, abortion-related complications are a leading cause of maternal mortality.

With pilot funding through DGHI’s International Travel Grant Program, Duke physicians and researchers Viviana Martinez-Bianchi, Jeff Wilkinson and Serina Floyd met with key health care leaders in Rosario, Argentina. According to Martinez-Bianchi, assistant professor of family medicine and an Argentina native, Rosario is a prime location to build partnerships in health since the city is undergoing changes in its health care system and has sought to improve health care training.

“The Municipal government of the City of Rosario has seen progress in access to health care in recent years. The curriculum of the Medical School of the National University of Rosario has been redesigned to better respond to the needs of the population. I also visited their community health centers where the focus is on team care for the population, understanding clinical care in the context of the community, the local and national health system and the role of the doctor as an effector of change,” said Martinez-Bianchi. “This site visit through DGHI made me realize that no dream is too big if enough people are ready to push together for a change in health care access for all.”

Despite some changes in a few provinces, 95 percent of abortions in Argentina are performed under unsafe circumstances and the country still has one of the highest abortions rates in the world – similar to those of sub-Saharan Africa. Women also face numerous barriers trying to access contraception, including lack of supply and providers unwilling to provide contraceptive methods.

After holding productive discussions with Argentinean leadership at the Center for the Study of State and Society (CEDES) and Rosario Center for Perinatal Studies (CREP), goals of the collaboration will be to establish a scalable, model training program in women’s reproductive and maternal health. The training will include post-abortion care, family planning and increased awareness among health care providers of the safe, evidence-based management of incomplete abortions and the complications of unsafe abortion. It will be modeled after the Advanced Life Support in Obstetrics (ALSO) course, which has been taught in 47 countries and employs didactic and hands-on instruction in the management of obstetrics emergencies.

“Duke physicians, including my colleague Jeff Wilkinson, have extensive experience in the administration of ALSO courses in both resource replete and low resource settings including Tanzania, Rwanda, The West Bank, Egypt and Jordan,” said Martinez-Bianchi. “We believe the most successful way to expand access to family planning and effective management of unsafe abortion in Argentina is to integrate these concepts into an emergency obstetrics training curriculum that will be piloted in hospitals in one of the Argentinean provinces with highest maternal mortality and morbidity. “

With mentorship from DGHI faculty member Dennis Clements, Martinez-Bianchi is also developing research and fieldwork exchange programs between institutions for third year medical students, physician’s assistant physical therapy students, undergraduates and Master of Science in Global Health students.

“The DGHI funding was instrumental in allowing us to spend time brainstorming with our colleagues in Argentina, while also planning ways to collaborate on research, education and gender issues related to access to health care,” said Martinez-Bianchi, who is identifying future funding to continue program development. “I returned from this trip energized to look further into helping this area of the world, where there are tremendous health care disparities. I also want to learn how, with a much smaller budget than what we spend in the US, a city of one million people was able to improve access for the most vulnerable populations.”
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