ABSTRACT

OBJECTIVE

Explore the use of two abortion care models in Argentina over the period 2016–2019: pro-rights private medical service providers and abortion accompaniment (via self-management and via health institutions); and compare the profile of who accesses these models and when.

METHODS

We used data from accompaniment collectives in the Socorristas en Red and private service providers. We estimated annual abortion rates via these service models and compared the profile of the populations by type of service and gestational age (2019) using descriptive statistics and chi-square tests.

RESULTS

In 2016, 37 people per 100,000 women of reproductive age obtained accompanied self-managed abortions, and the number increased to 111 per 100,000 in 2019, a threefold increase. The rate of abortions via care providers was 18 per 100,000 in 2016 and 33 in 2019. Higher proportions of those who obtained abortion via care providers were 30 years or older. A higher proportion of those accompanied were 19 years or younger; 11% of those who obtained accompanied self-managed abortions were more than 12 weeks gestation compared with 7% among those who had accompanied abortions via health institutions and 0.2% among those who had abortions with private providers. A higher proportion of those who accessed accompanied abortions after 12 weeks gestation had lower educational levels, did not work or have social security coverage, had more past pregnancies, and attempted to terminate their pregnancies prior to contacting the Socorristas compared to those who had accompanied abortions at 12 weeks or earlier.

CONCLUSIONS

In Argentina, prior to Law 27.610 models of care guaranteed access to safe abortion. It is important to continue making visible and legitimizing these models of care so that all those who decide to have an abortion, whether inside or outside health institutions, have safe and positive experiences.

Abortion, Induced; Healthcare Models; Self-Managed Abortion; Argentina

INTRODUCTION

In 2021, Law 27.610 went into effect in Argentina, which regulates voluntary termination of pregnancy (IVE) and post-abortion care. Currently, people have the right to an abortion in health institutions up to and including the fourteenth week of gestation. Those who exceed this limit may access a legal abortion (ILE) when the pregnancy puts their life or health at risk, or if the pregnancy is the result of rape¹1. Ley 27610, 30 dez 2020. Acceso a la interrupción voluntaria del embarazo. Boletín Oficial de la República Argentina, 15 ene 2021 [cited 2022 Aug 5]. Available from: https://www.boletinoficial.gob.ar/detalleAviso/primera/239807/20210115
https://www.boletinoficial.gob.ar/detall... . Before 2021, an abortion could only be accessed under these conditions. This regulatory advance is largely the result of years of resistance by the feminist movement for abortion rights, known as the “Marea Verde” [Green Tide], whose most visible feature is the use of a green headscarf in mass mobilizations and demonstrations in support of the movement.²2. Alonso D, Brussino S. Abortion legalization and social representations of feminism in Argentina. Papers Social Representations. 2021;30(2):3.1-23. The use of the green scarf was a hallmark of the National Campaign for the Right to Safe and Free Legal Abortion in Argentina launched in 2005 and, due to its extension throughout the region, is today a feminist symbol in Latin America³3. Elizalde S, Mateo N. Las jóvenes: entre la “marea verde” y la decisión de abortar. Salud Colect. 2018;14(3):433-46. https://doi.org/10.18294/sc.2018.2026
https://doi.org/10.18294/sc.2018.2026... .

In Argentina, the institutional health system is made up of three sectors: the social health insurance sector, which covers salaried employees and their families, as well as retired persons; the public sector, which provides free coverage to anyone who requests it, but mainly to those who do not have social health insurance or access to private establishments; and the private sector, which operates by covering the population benefited by some social health insurance programs and/or those who have private insurance, or under individual demand. It is a complex system with little integration between sectors and high fragmentation. As such, the system’s main challenge is to promote equitable access to health care⁴4. Belló M, Becerril-Montekio VM. Sistema de salud de Argentina. Salud Publica Mex. 2011;53 Suppl 2:s96-108. https://doi.org/10.1590/S0036-36342011000800006
https://doi.org/10.1590/S0036-3634201100... .

In Argentina there were several models that guaranteed access to safe abortion inside or outside health institutions prior to 2021. For more than two decades, activists and allied organizations implemented strategies to guarantee abortions in this restrictive context through different models of abortion care.

One of these models was developed within health institutions⁵5. McReynolds-Pérez J. Abortion as empowerment: reproductive rights activism in a legally restricted context. BMC Pregnancy Childbirth. 2017 Nov;17(Suppl 2):350. https://doi.org/10.1186/s12884-017-1498-y
https://doi.org/10.1186/s12884-017-1498-... , ⁶6. Fernández Vázquez SS, Brown J. From stigma to pride: health professionals and abortion policies in the Metropolitan Area of Buenos Aires. Sex Reprod Health Matters. 2019 Nov;27(3):1691898. https://doi.org/10.1080/26410397.2019.1691898
https://doi.org/10.1080/26410397.2019.16... with the support of medical professionals from feminist-allied organizations⁷7. Ruibal A, Fernandez Anderson C. Legal obstacles and social change: strategies of the abortion rights movement in Argentina. Polit Groups Identities. 2020;8(4):698-713. https://doi.org/10.1080/21565503.2018.1541418
https://doi.org/10.1080/21565503.2018.15... . Under this model, health care providers guaranteed abortion services to people according to the legal exemptions and within the framework of risks to the woman’s life or health. Health was defined using the World Health Organization’s (WHO) definition: “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”⁸8. Organización Mundial de la Salud. Gobernanza. Documentos básicos. 49ª edición: con las modificaciones adoptadas hasta el 31 de mayo de 2019. Ginebra: Organización Mundial de la Salud; 2020 [cited 2022 Aug 5]. Available from: https://apps.who.int/gb/bd/s/index.html
https://apps.who.int/gb/bd/s/index.html... . Providers could then consider biological as well as social and psychological elements of health, allowing more people to exercise their right to choose⁷7. Ruibal A, Fernandez Anderson C. Legal obstacles and social change: strategies of the abortion rights movement in Argentina. Polit Groups Identities. 2020;8(4):698-713. https://doi.org/10.1080/21565503.2018.1541418
https://doi.org/10.1080/21565503.2018.15... , ⁵5. McReynolds-Pérez J. Abortion as empowerment: reproductive rights activism in a legally restricted context. BMC Pregnancy Childbirth. 2017 Nov;17(Suppl 2):350. https://doi.org/10.1186/s12884-017-1498-y
https://doi.org/10.1186/s12884-017-1498-... , ⁹9. González Vélez AC. “The health exception”: a means of expanding access to legal abortion. Reprod Health Matters. 2012 Dec;20(40):22-9. https://doi.org/10.1016/S0968-8080(12)40668-1
https://doi.org/10.1016/S0968-8080(12)40... .

Another important aspect of activism in Argentina has been to ensure access to a safe abortion for people who decide to have an abortion⁷7. Ruibal A, Fernandez Anderson C. Legal obstacles and social change: strategies of the abortion rights movement in Argentina. Polit Groups Identities. 2020;8(4):698-713. https://doi.org/10.1080/21565503.2018.1541418
https://doi.org/10.1080/21565503.2018.15... , ¹⁰10. McReynolds-Pérez J. No doctors required: lay activist expertise and pharmaceutical abortion in Argentina. Signs. 2017;42(2):349-75. https://doi.org/10.1086/688183
https://doi.org/10.1086/688183... . A fundamental model in ensuring such access has been el Socorrismo , which was consolidated with the creation of Socorristas en Red – Feministas que abortamos ( SenRed ), a national feminist initiative made up of collectives from different regions of the country¹¹11. Socorristas en Red (feministas y transfeministas que abortamos). Quiénes somos. 2022 [cited 2022 Aug 5]. Available from: https://socorristasenred.org/quienes-somos/
https://socorristasenred.org/quienes-som... . These collectives offer accompaniment, in which activists share WHO recommendations on medication abortion, information on laws and rights, and support during and after the abortion via self-management or via health institutions according to the decision of the individuals¹²12. Moseson H, Jayaweera R, Raifman S, Keefe-Oates B, Filippa S, Motana R, et al. Self-managed medication abortion outcomes: results from a prospective pilot study. Reprod Health. 2020 Oct;17(1):164. https://doi.org/10.1186/s12978-020-01016-4
https://doi.org/10.1186/s12978-020-01016... .

Although Law 27.610 exists today, these models will continue to be fundamental because people will decide to have an abortion outside of health institutions and because the existence of alternative models will make it possible to address old and new challenges¹³13. Ramos S, Romero M, Ramón Michel A. Health care providers’ opinions on abortion: a study for the implementation of the legal abortion public policy in the District of Santa Fe, Argentina. Reprod Health. 2014 Sep;11(1):72. https://doi.org/10.1186/1742-4755-11-72
https://doi.org/10.1186/1742-4755-11-72... . For example, before 2021, documented practices delayed or denied access to legal abortions and violated the rights of people seeking abortion under non-punishable conditions ¹⁴14. Cascardo F, Robaina I, Testoni E, Trebotic G. Violencias en el acceso al aborto. Un acercamiento desde la red de profesionales por el derecho a decidir en la regionales Zona Oeste PBA y Mendoza. Buenos Aires: Observatorio de Géneros y Políticas Públicas; 2021 [cited 2022 Aug 5]. Available from: http://redsaluddecidir.org/2021/12/29/informe-violencias-en-acceso-al-aborto/
http://redsaluddecidir.org/2021/12/29/in... . Health personnel, mainly in the public sector, stigmatized people seeking abortion care through blaming or punitive attitudes¹⁰10. McReynolds-Pérez J. No doctors required: lay activist expertise and pharmaceutical abortion in Argentina. Signs. 2017;42(2):349-75. https://doi.org/10.1086/688183
https://doi.org/10.1086/688183... , ¹⁵15. Szulik D, Zamberlin N. La legalidad oculta: Percepciones de estigma en los recorridos de mujeres que descubren y acceden a la interrupción legal del embarazo por causal salud. Sex, Salud Soc (Rio J). 2020;(34):46-67. https://doi.org/10.1590/1984-6487.sess.2020.34.04.a
https://doi.org/10.1590/1984-6487.sess.2... , ¹⁷17. Szulik DE, Zamberlin N. Trayectorias profesionales de médicos y médicas proveedores de interrupción legal del embarazo en Argentina [FLASOG]. Bol Feder Latinoam Soc Obstet Ginecol. 2017;5(3):6-14. . It is essential, therefore, that under the new law, comprehensive, quality services that are free of prejudice and focused on the needs of those seeking abortion care are offered¹⁸18. Vacarezza, Nayla Luz. 2022. Saberes y perspectivas activistas para la implementación de la ley de acceso a la interrupción voluntaria del embarazo. Jornadas de Investigación Instituto de Investigaciones Políticas/ Escuela de Política y Gobierno UNSAM, 19-21 abril 2022, Buenos Aires. San Martín: Unsam; 2022. . There is a risk that the barriers that existed before the law will continue to be reproduced. Because of the 14 week gestational age limit, these barriers may more frequently affect those who exceed 14 weeks of gestation¹⁹19. Romero M, Ramos S, Ramón Michel A, Keefe-Oates B, Rizzalli E. Proyecto mirar: a un año de la ley de aborto en Argentina. Buenos Aires: CEDES/Ibis Reproductive Health; 2021 [cited 2022 Aug 5]. Available from: https://proyectomirar.org.ar/reporte/PROYECTO_MIRAR_reporte_aniversario_ley_VF.pdf
https://proyectomirar.org.ar/reporte/PRO... . This is an important challenge, as the evidence indicates that people who have abortions after the first trimester experience greater vulnerability²⁰20. Baum S, DePiñeres T, Grossman D. Delays and barriers to care in Colombia among women obtaining legal first- and second-trimester abortion. Int J Gynaecol Obstet. 2015 Dec;131(3):285-8. https://doi.org/10.1016/j.ijgo.2015.06.036
https://doi.org/10.1016/j.ijgo.2015.06.0... . In addition, there are wide geographic gaps in the provision of abortion services, and some more conservative provinces are known to offer only limited abortion services¹⁹19. Romero M, Ramos S, Ramón Michel A, Keefe-Oates B, Rizzalli E. Proyecto mirar: a un año de la ley de aborto en Argentina. Buenos Aires: CEDES/Ibis Reproductive Health; 2021 [cited 2022 Aug 5]. Available from: https://proyectomirar.org.ar/reporte/PROYECTO_MIRAR_reporte_aniversario_ley_VF.pdf
https://proyectomirar.org.ar/reporte/PRO... .

Therefore, it is necessary to monitor how these challenges are being addressed, despite the fact that in Argentina abortion statistics are scarce. Recent data indicate that the national rate of ILE and IVE during the first six months after the approval of Law 27.610 is 3.2 per 1,000 women of reproductive age¹⁹19. Romero M, Ramos S, Ramón Michel A, Keefe-Oates B, Rizzalli E. Proyecto mirar: a un año de la ley de aborto en Argentina. Buenos Aires: CEDES/Ibis Reproductive Health; 2021 [cited 2022 Aug 5]. Available from: https://proyectomirar.org.ar/reporte/PROYECTO_MIRAR_reporte_aniversario_ley_VF.pdf
https://proyectomirar.org.ar/reporte/PRO... . However, this calculation excludes people who accessed care through private establishments and community-based models. In 2009, a publication estimated between 49 and 65 abortions per 1,000 women between 15 and 49 years of age, the most recent national estimates²⁴24. Mario S, Pantelides EA. Estimación de la magnitud del aborto inducido en la Argentina. Notas Población. 2009;35(87):95-120. [cited 2022 Aug 5]. Available from: https://repositorio.cepal.org/handle/11362/12842
https://repositorio.cepal.org/handle/113... .

In this study, we explore access to abortion under two models of care (pro-rights health care providers and accompaniment) pre-Law 27.610. We analyzed the use of three services offered under these models: 1) abortions with private service care providers; 2) abortion accompaniment via self-management; and 3) abortion accompaniment via health institutions. This analysis assesses how these models meet the needs of different populations and establishes a benchmark for a region where abortion data are scarce.

The specific objectives are:

1. Analyze trends (2016–2019) in the utilization of three abortion services in Argentina offered by pro-rights health professionals and the Socorristas.

2. Compare the sociodemographic profile of people who had abortions via the three services.

3. Compare the sociodemographic profile of individuals who had abortions via the Accompaniment model who were 12 weeks pregnant or less to those who were more than 12 weeks pregnant.

METHODS

This is a secondary analysis of data from individuals who had abortions between 2016 and 2019 from two sources: a) systematizations of Socorristas en Red accompaniment collectives; and b) systematizations of health care providers in private establishments. We did not seek approval of an Ethics Committee according to the Guidelines for Research in Human Health of the Ministry of Health, given that the data was already available, stored, and deidentified.

Data from Accompaniment Collectives

SenRed’s accompaniment model includes a standardized protocol in which collectives capture sociodemographic information on the people who contact them and receive support²⁵25. Burton J. Números activistas: acerca de la producción de datos del activismo feminista que acompaña a mujeres que abortan con medicación. En: Panel 35 Feminismo y Políticas de Género. 8º Conferencia Latinoamericana y Caribeña de Ciencias Sociales: las luchas por la igualdad, la justicia social y la democracia em un mundo turbulento; Primer Foro Mundial del Pensamiento Crítico. 17-18 nov 2018 [cited 2022 Aug 5]; Buenos Aires, Argentina. Available from: https://www.clacso.org.ar/conferencia2018/presentacion_ponencia.php?ponencia=2018411135838-8446-pi
https://www.clacso.org.ar/conferencia201... . In 2019, people from all regions of the country were accompanied by SenRed. We used anonymized information from people accompanied between 2016 and 2019. We analyzed data from people who received: a) accompaniment in their self-managed abortions; or b) abortion accompaniment via health care institutions. We excluded information from those who: continued their pregnancy; lost communication with SenRed after the first contact; were referred for medical support; or had a miscarriage.

Data From Private Health Care Providers

We used data collected by an anonymous organization in which private sector health care providers in 12 provinces participate. Members of this organization practice a model of comprehensive sexual health care with a pro-rights approach, including safe, quality and humanized abortion care. Information from individuals who accessed their services to obtain a medication or surgical abortion are collected in a standard format. For this study, we used anonymized data from individuals who had abortions between 2016 and 2019. We refer to this model here as “care providers”.

Data Management

From each database, we extracted variables of interest and matched response categories between SenRed and care provider variables. The information we obtained from both sources was: age, gestational age in weeks (in the case of SenRed it is at the moment of contacting the collective and in the case of care providers it is at the moment of abortion), the means through which they found out about the accompaniment collective or the care providers’ service and the province in which the service was accessed. We also extracted projections of the female population²⁶26. Instituto Nacional de Estadísticas y Censos (INDEC). Proyecciones de población por sexo y grupo de edad 2010-2040, para cada provincia. Buenos Aires: Instituto Nacional de Estadísticas y Censos; 2013 [citado 10 jun 2021]. Disponible en: https://www.indec.gob.ar/indec/web/Nivel4-Tema-2-24-85
https://www.indec.gob.ar/indec/web/Nivel... by year, province and at the national level in Argentina from 2016 to 2019. For SenRed we obtained the following additional information: level of education, student status, religious beliefs, employment, social health insurance coverage, experience of gender-based violence, previous knowledge of abortion with pills, previous pregnancies and abortions, previous contact with the accompaniment group, and previous attempts to interrupt the current pregnancy. Data management and statistical analysis were performed using Stata 15.0 software.

Data Analysis

Regarding trends in utilization of the three abortion services (2016–2019), we estimated annual crude rates per 100,000 women of reproductive age for each service. We calculated the number of self-managed accompanied abortions, accompanied abortions via health institutions and abortions with pro-rights care providers relative to the female population aged 15-49 per year for the provinces where people accessed abortion. We calculated the rates separately for each of the three services. We do not present standardized rates because the variable “age” was not available in SenRed data for 2017. However, we calculated standardized rates (direct method) for the remaining years to confirm that the trends observed with crude rates were not due to differences in the age structure of our populations.

To describe the sociodemographic profile of people who used the three services, we compared the characteristics of the population that accessed the services using descriptive statistics and chi-square tests. We analyzed only data from 2019, given that the characteristics of the populations over the years were relatively homogeneous.

We used descriptive statistics and chi-square tests to compare the characteristics of people who were accompanied (via self-management and via health institutions) in 2019 by gestational age: those who were 12 weeks gestation or less at the time of contact compared to those who were more than 12 weeks. We used these categories according to the classifications captured by SenRed (8 weeks or less, 9 to 12 weeks, 13 weeks or more)^aaAlthough the gestational age limit for elective abortions in the new law is 14 weeks, we used the best approximation of this range from the available data. . Few individuals who consulted with care providers were more than 12 weeks pregnant, so we only used SenRed data for this objective.

It is important to clarify that we do not know the gender identity of the people who had abortions via care providers or accompaniment groups. Recognizing that not all people who have abortions identify as women and that people with other gender identities may also become pregnant and have abortions, we use the term “people/individuals” in the text to refer to those who have abortions. However, we use the term “women” when referring to rates because the denominator used for their construction refers to the female population. We use projections of women, as they are the best available approximation of the population that might need abortion services.

RESULTS

Trends in Access to Abortion in Argentina

Between 2016 and 2019, 29,857 people in Argentina accessed abortions with accompaniment from SenRed, of whom 28,454 self-managed their abortion and 1,403 obtained abortions via health institutions. In the same period, 8,868 people had abortions via care providers.

In this period, the number of people who obtained accompanied self-managed abortions increased from 3,797 in 18 provinces to 12,575 in all provinces in 2019. That is, in 2016, 37 individuals obtained accompanied self-managed abortions per 100,000 women aged 15-49 years, while by 2019 this number increased to 111 per 100,000 women. Self-managed accompanied abortions increased particularly between 2018 and 2019, increasing by 163% (shown in Figure 1 ). On the other hand, 153 people obtained accompanied abortions via health institutions in 2016, representing 1 person per women of reproductive age. In 2019, the total number of people with accompanied abortions via health institutions was 802; that is, 7 people per 100,000. In 2016, 1,359 individuals obtained abortions through private providers, corresponding to 18 individuals per 100,000 women of reproductive age; this number increased to 3,047 in 2019, equivalent to 33 individuals per 100,000 women ( Figure 1 )^bbStandardized rates were similar to crude rates (data not shown). .

The majority of those who accessed an abortion between 2016 and 2019 were 8 weeks or less pregnant ( Figure 2 ). This population increased in the period analyzed among those who received accompaniment in health care institutions (58% versus 79%) (p ≤ 0.05). The majority of people who had abortion through all three services were between 20 and 29 years of age ( Figure 3 ). Over time, the proportion of people 19 years old and younger who went to care providers declined from 15% in 2016 to 8% in 2019. Similarly, the percentage of those under 20 who were accompanied in health care institutions dropped from 22% to 15%^ccSpecific rates by age group show that in those under 20 years old, the use of abortion services in health facilities through providers and SenRed remained stable between 2016 and 2019. However, accompaniments to abortion via self-management increased in this group. (p ≤ 0.05).

Comparing the Profile of Individuals Accessing Three Abortion Services in 2019

In 2019, the majority of those who used all three services were 20–29 years old (> 50%), but a higher proportion of those who consulted with care providers were 30 years old or older (38% versus 28% and 29%), while a higher proportion of those who obtained accompanied self-managed abortions and accompanied abortions via health institutions were 19 years old or younger (15% versus 8%) (p ≤ 0.05). The majority had a gestational age of 8 weeks or less, both among those who had abortions via care providers (69%) and among those who obtained self-managed abortions (66%), and particularly among those who were accompanied in health institutions (79%). Among those who obtained accompaniment, 11% of those who had abortions via self-management and 7% of those who had abortions via institutions had pregnancies of more than 12 weeks; 0.2% of people who went to care providers had this gestational age (p ≤ 0.05) ( Table 1 ).

The main source of referral to the service reported by individuals who obtained abortions from care providers was a referral figure, including activists, or pharmacy personnel (30%), and also ex-users of the service (29%). By comparison, 10% of those who obtained accompanied self-managed abortions were referred to SenRed by health personnel and 10% by people previously accompanied by SenRed; among people accompanied in health institutions these sources were reported by 6% and 7%, respectively. The main source of referral to SenRed was friends (33% of those who obtained accompanied self-managed abortions and 30% of those who had accompanied abortions in health institutions) and the media/internet (reported by 21% and 35% of these groups, respectively) ( Table 1 ).

Individuals Who Access Abortions According to Gestational Age

Among those who were accompanied in their abortion inside or outside health institutions, a higher proportion of those with gestational age greater than 12 weeks were referred to SenRed by health personnel (22% versus 8%); were 19 years old or younger (19% versus 14%), had a secondary education or less (63% versus 47%), had no paid work (50% versus 40%), no social health insurance coverage (68% vs. 53%) and were not currently students (66% versus 61%), compared to those who were 12 weeks or less (p ≤ 0.05). In addition, a higher proportion of those over 12 weeks had had at least one previous full-term pregnancy (63% versus 58%) and had attempted to terminate the current pregnancy before contacting SenRed (23% versus 13%); (p ≤ 0.05) ( Table 2 ).

DISCUSSION

In this study, we explore trends in the utilization of three abortion services in Argentina in the period 2016–2019: i) abortions via private health care providers; ii) abortion accompaniment via self-managed abortions; and iii) abortion accompaniment via health care institutions. We observed an increase in the use of these services before Law 27.610, particularly in accompanied self-managed abortions, which tripled, with a large increase starting in 2018. This increase may be related to the consolidation of SenRed collectives across the country; the debates around the legalization of abortion in 2018 in Argentina; and to a greater visibility of accompaniment because of the Marea Verde (Green Tide).

Most people had abortions at eight weeks gestation or less, both inside and outside health institutions, and this early access was more noticeable over the years, suggesting that availability of information, sources of support, and access to safe abortions improved over time. Nevertheless, some gaps were identified. In the new legal regime, the most vulnerable individuals may be those at later gestational ages, who may experience the most barriers to accessing abortion in health institutions. This conclusion comes from the finding that people accompanied who were more than 12 weeks pregnant had lower educational levels, were younger, were less likely to have paid work or social health insurance coverage, and had tried to terminate their pregnancies before contacting SenRed. Evidence suggests that this population may experience greater obstacles, first in recognizing their pregnancy, and subsequently in accessing services²⁰20. Baum S, DePiñeres T, Grossman D. Delays and barriers to care in Colombia among women obtaining legal first- and second-trimester abortion. Int J Gynaecol Obstet. 2015 Dec;131(3):285-8. https://doi.org/10.1016/j.ijgo.2015.06.036
https://doi.org/10.1016/j.ijgo.2015.06.0... , ²²22. Jones RK, Finer LB. Who has second-trimester abortions in the United States? Contraception. 2012 Jun;85(6):544-51. https://doi.org/10.1016/j.contraception.2011.10.012
https://doi.org/10.1016/j.contraception.... ; that is, barriers to accessing abortion are reproduced throughout the pregnancy and abortion seeking process²⁷27. Becker D, Diaz-Olavarrieta C, Juarez C, Garcia SG, Sanhueza Smith P, Harper CC. Sociodemographic factors associated with obstacles to abortion care: findings from a survey of abortion patients in Mexico City. Womens Health Issues. 2011;21(3 Suppl):S16-20. https://doi.org/10.1016/j.whi.2011.02.009
https://doi.org/10.1016/j.whi.2011.02.00... . It may also be that some people are denied care by providers or have attempted to terminate the pregnancy themselves without access to resources, resulting in a higher gestational age at the time of abortion. The feminist model of accompaniment guarantees access to abortions beyond the first trimester, especially in legal restrictive contexts.²³23. Zurbriggen R, Keefe-Oates B, Gerdts C. Accompaniment of second-trimester abortions: the model of the feminist Socorrista network of Argentina. Contraception. 2018 Feb;97(2):108-15. https://doi.org/10.1016/j.contraception.2017.07.170
https://doi.org/10.1016/j.contraception.... , ²⁸28. Bercu C, Moseson H, McReynolds-Pérez J, Wilkinson Salamea E, Grosso B, Trpin M, et al. In-person later abortion accompaniment: a feminist collective-facilitated self-care practice in Latin America. Sex Reprod Health Matters. 2021;29(3):2009103. https://doi.org/10.1080/26410397.2021.2009103
https://doi.org/10.1080/26410397.2021.20...

On the other hand, our results suggest a possible link between Accompaniment Collectives and pro-rights providers. People over 12 weeks gestation were referred to SenRed by health personnel and three of every 10 people who accessed abortions through providers were referred, including by activists. It is possible that this population of providers are referring individuals past the first trimester to other abortion models such as Socorrismo . In addition, we now know that pro-rights health care providers also engage in activism and collaborate with feminist organizations⁶6. Fernández Vázquez SS, Brown J. From stigma to pride: health professionals and abortion policies in the Metropolitan Area of Buenos Aires. Sex Reprod Health Matters. 2019 Nov;27(3):1691898. https://doi.org/10.1080/26410397.2019.1691898
https://doi.org/10.1080/26410397.2019.16... and that many people who have abortions are referred to health care facilities by feminist organizations¹⁴14. Cascardo F, Robaina I, Testoni E, Trebotic G. Violencias en el acceso al aborto. Un acercamiento desde la red de profesionales por el derecho a decidir en la regionales Zona Oeste PBA y Mendoza. Buenos Aires: Observatorio de Géneros y Políticas Públicas; 2021 [cited 2022 Aug 5]. Available from: http://redsaluddecidir.org/2021/12/29/informe-violencias-en-acceso-al-aborto/
http://redsaluddecidir.org/2021/12/29/in... . For example, during the first half of 2021, 22% of the people who contacted SenRed decided to request an abortion in a health institution, 86% of whom accessed it in the public system²⁹29. Socorristas en Red (feministas y transfeministas que abortamos). Acompañamientos a abortar realizados por SenRed durante el 1º semestre del 2021. Buenos Aires: Socorristas em Red; 2021 [cited 2022 Aug 5]. Parte 3. Sobre acompañamientos a abortar en el sistema de salud. Socorristas en Red. Available from: https://socorristasenred.org/primer-semestre-2021/
https://socorristasenred.org/primer-seme... . Our analysis confirms that in a pre-decriminalization context, the different lines of collective action for the right to abortion coincide and promote safe abortion care⁷7. Ruibal A, Fernandez Anderson C. Legal obstacles and social change: strategies of the abortion rights movement in Argentina. Polit Groups Identities. 2020;8(4):698-713. https://doi.org/10.1080/21565503.2018.1541418
https://doi.org/10.1080/21565503.2018.15... , ³⁰30. Fernandez SS, Szwarc L. Aborto medicamentoso: transferencias militantes y transnacionalización de saberes en Argentina y América Latina. Reviise. 2018;12(12):163-77. .

Our data also suggest that the coexistence of these models facilitates reaching different populations. The results suggest that the accompaniment model reaches younger people. Under the new law, it will be important to guarantee the coexistence and linkage of these models in order to reach all people who decide to have an abortion, because people will continue to have abortions in health institutions, at home, or with the support of accompaniers, ³²32. Yanow S, Pizzarossa LB, Jelinska K. Self-managed abortion: exploring synergies between institutional medical systems and autonomous health movements. Contraception. 2021 Sep;104(3):219-21. https://doi.org/10.1016/j.contraception.2021.06.006
https://doi.org/10.1016/j.contraception.... . In addition, studies have shown barriers to accessing services in contexts with progressive laws such as delayed access by some populations such as those with low socioeconomic status²⁰20. Baum S, DePiñeres T, Grossman D. Delays and barriers to care in Colombia among women obtaining legal first- and second-trimester abortion. Int J Gynaecol Obstet. 2015 Dec;131(3):285-8. https://doi.org/10.1016/j.ijgo.2015.06.036
https://doi.org/10.1016/j.ijgo.2015.06.0... , ²⁷27. Becker D, Diaz-Olavarrieta C, Juarez C, Garcia SG, Sanhueza Smith P, Harper CC. Sociodemographic factors associated with obstacles to abortion care: findings from a survey of abortion patients in Mexico City. Womens Health Issues. 2011;21(3 Suppl):S16-20. https://doi.org/10.1016/j.whi.2011.02.009
https://doi.org/10.1016/j.whi.2011.02.00... , ³³33. Díaz Olavarrieta C, Bonifaz Alfonzo L, Sanhueza-Smith P, Fajardo Dolci GE, Guevara-Guzmán R, Aburto-Arciniega MB, et al. Twelve years after abortion decriminalization in Mexico City: can we still remain an island of liberties? Best Pract Res Clin Obstet Gynaecol. 2020 Jan;62:63-78. https://doi.org/10.1016/j.bpobgyn.2019.07.009
https://doi.org/10.1016/j.bpobgyn.2019.0... , logistical barriers delaying procedures²⁰20. Baum S, DePiñeres T, Grossman D. Delays and barriers to care in Colombia among women obtaining legal first- and second-trimester abortion. Int J Gynaecol Obstet. 2015 Dec;131(3):285-8. https://doi.org/10.1016/j.ijgo.2015.06.036
https://doi.org/10.1016/j.ijgo.2015.06.0... and conscientious objection or refusal and, therefore, lack of service providers³⁵35. Cárdenas R, Labandera A, Baum SE, Chiribao F, Leus I, Avondet S, et al. “It’s something that marks you”: abortion stigma after decriminalization in Uruguay. Reprod Health. 2018 Sep;15(1):150. https://doi.org/10.1186/s12978-018-0597-1
https://doi.org/10.1186/s12978-018-0597-... , ³⁶36. Ramón Michel A, Ariza Navarrete S. Objeción de conciencia y aborto: la libertad consciente. En: Ramos S, comp. Investigación sobre aborto en América Latina y El Caribe: una agenda renovada para informar políticas públicas e incidencia. Buenos Aires: Centro de Estudios de Estado y Sociedad-CEDES; 2015. p. 17. . Thus, accompaniers and health professionals will be essential to ensure equitable access.

Below we point out some limitations. This analysis considers only the population that accesses these models and does not represent all people who have abortions in Argentina. The number of comparable variables across models was limited; in addition, we did not make a comparison of the population accessing each abortion model/service according to their gestational age because few people obtained abortions beyond 12 weeks via care providers and because before 2020 few people were accompanied via health institutions, reducing our power to make comparisons. We can only compare the profile of those who accessed accompanied abortions using 12 weeks of gestation as the cut-off point and not the 14 weeks as written in the current law. Finally, we refer to the construction of rates, but use of this term is questionable as it assumes the same level of exposure of all individuals to the event of interest (abortion) in the observed period.

In conclusion, it is important to guarantee access to those who decide to have an abortion in health institutions and at the same time continue to make visible the accompaniment model so that those who decide to have an abortion outside health institutions, because by law they cannot or because they experience greater barriers to care, have safe options. It is imperative to promote immediate access to abortion and to redouble efforts to prevent reproducing a cycle of marginalization of the already socially disadvantaged. Linkages between medical providers and activists can reduce gaps in access, and the implementation of the new law presents an opportunity to strengthen these linkages, especially in regions where few abortion services are available. Research is needed to understand who lacks access to abortion care; what factors are important to people in deciding where to have an abortion; and what the abortion experience is like in the new legislative context.

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