1 aborto y salud de la mujer miguel ángel martínez-gonzález @MAM_UNAV ! Debe escucharse en 1er lugar la exposición de estas diapositivas Click Aqui Click Aqui

2 aborto y salud de la mujer sociedad española de epidemiología alicante, 4-9-14 1. ponderación 2. medicina basada en evidencia riesgos beneficios 3. conflicto de interés religioso económico 4. efectos perversos 5. alternativas

3 aborto y salud de la mujer sociedad española de epidemiología alicante, 4-9-14 1. ponderación 2. medicina basada en evidencia riesgos beneficios 3. conflicto de interés religioso económico 4. efectos perversos 5. alternativas

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9 unplanned motherhood (...) represents a threat so great to modern women that it is perceived as equivalent to a "death of self." Abortion: A Failure to Communicate by Paul Swope, First Things 1998

10 unplanned motherhood (...) represents a threat so great to modern women that it is perceived as equivalent to a "death of self." while the woman may rationally understand this is not her own literal death, her emotional, subconscious reaction to carrying the child to term is that her life will be "over."

11 unplanned motherhood (...) represents a threat so great to modern women that it is perceived as equivalent to a "death of self." while the woman may rationally understand this is not her own literal death, her emotional, subconscious reaction to carrying the child to term is that her life will be "over." the sudden intrusion of motherhood is perceived as a complete loss of control over their present and future selves. it shatters their sense of who they are and will become, and thereby paralyzes their ability to think more rationally or realistically

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16 18,4%18,6%19,6%19,9%

17 "mi cuerpo es mío nosotras parimos, nosotras decidimos"

18 Genética XY 23 + 23 alelos del padre Inmunología Proteínas ajenas Fenómeno Rh y otros Expectativa de vida 2 células moribundas  décadas Identidad distinta

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20 the attitude of these women toward abortion is quite surprising. first, all of the scores of women involved in the study (none of whom were pro-life activists and all of whom called themselves "pro-choice") agreed that abortion is killing. second, the women believe that abortion is wrong, an evil, third (...) basically, abortion is considered the least of three evils because it is perceived as offering the greatest hope for a woman to preserve her own sense of self, her own life. Abortion: A Failure to Communicate by Paul Swope, First Things 1998

21 aborto y salud de la mujer sociedad española de epidemiología alicante, 4-9-14 1. ponderación 2. medicina basada en evidencia riesgos beneficios 3. conflicto de interés religioso económico 4. efectos perversos 5. alternativas

22 cáncer de mama

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24 J American Phys Surg2007;12:72

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26 Cancer Causes Control 2014 1.49 (1.23, 1.74)

27 Lancet 2004; 363: 1007–16

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29 Cancer Causes Control 2014 1.49 (1.23, 1.74)

30 aborto y salud de la mujer sociedad española de epidemiología alicante, 4-9-14 1. ponderación 2. medicina basada en evidencia riesgos beneficios 3. conflicto de interés religioso económico 4. efectos perversos 5. alternativas

31 prevención: salud mental materna

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33 (violación 0.02%)

34 es crucial buscar la mejor evidencia sobre si el aborto mejora la salud mental de la mujer en España> 95%

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36 Arch Gen Psychiatry 2000;57:777-784

37  ¿dónde estás odds ratio que no te veo?  ¿donde estás cohorte no expuesta que no te veo?  ¿donde estás medida de efecto (con IC 95%)?  ¿donde estás cálculo de potencia?  ¿donde estás análisis de sensibilidad?  ¿donde estás tratamiento de sesgo selección?  ¿quien publica una cohorte con 100% expuestos y 50% de pérdidas?

38 JAMC 13 may 2003;168:1257-8

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41 2008;193:444

42 aust n z j psychiatry 2013;47:819 metanálisis coleman, 2011. br j psychiatr  amrc (pdf on line), 2011 = there have been extensive criticisms of both Coleman’s study Abel et al., 2011 Coyne, 2011 Howard et al., 2011 Kinney, 2011 Lagro-Janssen et al., 2011 Littell and Coyne, 2011 Polis et al., 2011 Robinson et al., 2011 Thygesen, 2011 and the AMRC report Andrusko, 2011 Christian Medical Fellowship, 2011 Ertelt, 2011

43 aust n z j psychiatry 2013 sep;47:819-27

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49 no review has concluded that abortion has beneficial consequences by mitigating the mental health risks of unwanted pregnancy aust n z j psychiatry 2013 sep;47:819-27

50 aborto y salud de la mujer sociedad española de epidemiología alicante, 4-9-14 1. ponderación 2. medicina basada en evidencia riesgos beneficios 3. conflicto de interés religioso económico 4. efectos perversos 5. alternativas

51 http://www.abc.net.au/7.30/content/2006/s1541543.htm david fergusson it does show, as with any surgical procedure, or any procedure of any form, that there are risks and benefits that need to be taken into account and to be weighed up very carefully. I am not religious. I am an atheist and a rationalist. the findings did surprise me, but the results appear to be very robust because they persist across a series of disorders and a series of ages.

52 falsear estadísticas sobre aborto (100.000  1 millón) mortalidad materna (250  10.000) conspiración católica ni papa ni cristianos lo ideal: obispos un medio anticonceptivo más negocio de 500 millones $/año "I am deeply troubled by my own increasing certainty that I had in fact presided over 60,000 deaths.” N Engl J Med 1974

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55 aborto y salud de la mujer sociedad española de epidemiología alicante, 4-9-14 1. ponderación 2. medicina basada en evidencia riesgos beneficios 3. conflicto de interés religioso económico 4. efectos perversos 5. alternativas

56 In Systematic Reviews WITH stated conflicts of interest In Systematic Reviews WITHOUT stated conflicts of interest big food plos med 2013 dec;10:e1001578

57 lancet feb 22,2014 nejm june 11, 2014 j am coll nutr 2014;33:79–88 big pharma

58 paradigma negocios privados muy rentables % $: marketing social daño conocido ocultación y engaño red multinacional-monopolio selección sector vulnerable  big tobacco  big alcohol  big marihuana  big military  big pharma  big food

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61 aborto y salud de la mujer sociedad española de epidemiología alicante, 4-9-14 1. ponderación 2. medicina basada en evidencia riesgos beneficios 3. conflicto de interés religioso económico 4. efectos perversos 5. alternativas

62 Interpretation Prenatal sex determination followed by is the most plausible explanation for the low sex ratio at birth in India. Women most clearly at risk are those who already have one or two female children. Based on conservative assumptions, the practice accounts for about 0·5 million missing female births yearly, translating over the past 2 decades into the abortion of some 10 M fetuses. lancet 2006;367:211–18 nº niñas por cada 1000 niños

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64 lancet 2011 jun 4;377:1921-8.

65 aborto y salud de la mujer sociedad española de epidemiología alicante, 4-9-14 1. ponderación 2. medicina basada en evidencia riesgos beneficios 3. conflicto de interés religioso económico 4. efectos perversos 5. alternativas

66 am economic j: economic policy 2013;5:160-88 apoyo social a la embarazada apoyo económico @MAM_UNAV

67 [a young woman is jogging through city streets. it is raining. as she runs, her inner thoughts are made audible.] "everyone’s telling me how I should feel.... it’s not like I planned to get pregnant. not now. [referring to angry boyfriend, shown in brief flashback.] telling me how to feel, what to do, then not sticking around when it really counts. so now it’s all up to me. but abortion? not me. I have to live with myself. [pause. she runs into distance, skies clearing.] we’ll make it. yeah, we’ll make it just fine." the ad’s three objectives are to engender admiration for carrying a pregnancy to term to present a woman who serves as a role model and, in a nonconfrontational way, to put abortion in the negative. @MAM_UNAV

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69 the overall rate of decrease for both measures was greater during 2006–2010 than during 2001–2005

70 [email protected] @MAM_UNAV ¡muchas gracias!

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72 www.thelancet.com published online november 1, 2006