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    • As long as developing world health systems are

    2019-05-20

    As long as developing-world health systems are ill prepared to offer safe anaesthesia and intensive care to patients in need of surgery, surgically treatable conditions will remain leading causes of death, the world will lose trillions of dollars in gross domestic product, and we in the global health Ponceau S Staining Solution will fail those in greatest need of our support. Through efforts like World Health Assembly Resolution 68/15; the Global Alliance for Surgery, Obstetric, Trauma, and Anaesthesia Care (the G4 Alliance); \'s Commission on Global Surgery; and the World Congress of Anaesthesiologists, global attention is increasingly focused on anaesthesia and surgical care. The opportunity exists to build on this momentum through prioritisation of anaesthesia and intensive-care capacity in LMICs.
    Sex has regularly proven to be a polarising issue for the UN Member States, and the 2016 High-Level Meeting on Ending AIDS on June 8–10 was no exception. The Political Declaration adopted at the meeting addresses the sexual health needs of young people (15–24 years), including adolescents (11–19 years). 2000 new HIV infections occur among young people every day. HIV is the leading cause of death among adolescents in Africa, and the second-highest cause of death worldwide in this . HIV is not their only sexual health concern—globally, 17 million adolescent girls give birth every year, 1 million of them younger than 15 years, and a further 3 million will have an unsafe abortion.
    Inaccessible sexual and reproductive health care continues to be a major obstacle to women\'s health and a violation of their rights. Access to comprehensive abortion care—comprising induced abortion and post-abortion care, including contraceptive services—is fundamental to avert preventable maternal mortality and morbidity. In east Africa, abortion rates have not declined since 1990 and about 2·7 million abortions are estimated to occur annually in this region. The vast majority of these abortions are unsafe, making them a major cause of maternal mortality and morbidity. A workshop was organised in Kampala, Uganda, in March, 2016, to address the challenges of implementation and expansion of access to comprehensive abortion care in east Africa. Workshop participants included researchers from teaching institutions and health-care providers from Kenya, Uganda, and Sweden, members of the Uganda Ministry of Health, WHO, the International Federation of Gynecology and Obstetrics working group on the prevention of unsafe abortion, representatives of non-governmental organisations and aid organisations, and journalists. Although the workshop focused on Uganda and Kenya, delegates also presented research from Tanzania and Rwanda. Here we summarise key action points needed to speed up implementation and expand access to comprehensive abortion care in east Africa, as identified by the workshop delegates. Kenya and Uganda have restrictive abortion laws dating from the time of British rule. In both countries the constitution and penal code are not harmonised, leaving room for ambiguous interpretation of the legal environment. Standards and guidelines on reduction of morbidity and mortality due to unsafe abortion were developed by the respective ministries of health in Kenya in 2012, and in Uganda in 2015. These standards and guidelines were an expansion of existing national policies and standards and the 2012 WHO Technical Guidance on Safe Abortion, supported by the constitutions. However, the standards and guidelines were withdrawn in Kenya in December, 2013, and in Uganda in January, 2016, because of disagreements between stakeholders regarding their content. Absence of clear standards and guidelines specific to comprehensive abortion care leaves vital questions on health-care access and provision—such as roles, eligibility, and responsibility—unanswered. At the time of the workshop, discussions between the Ugandan Ministry of Health and stakeholders were ongoing, including efforts to bring religious leaders who opposed the standards and guidelines to the table. Meanwhile, in Kenya, the withdrawal of the standards and guidelines was being petitioned in court by civil societies.