Authors by program from Edinburgh 2012

Marijke Alblas

Speeches:

Syed Mustafa Ali

Speeches:

Jean-Jacques Amy

Speeches:

Elisabeth Aubény

Speeches:

R. Baig

Speeches:

  • close

    Situation analysis of family health hospitals of
    Rahnuma-FPAP about the preparedness to provide
    effective post-termination of pregnancy care
    services
    Baig, R
    Rahnuma-Family Planning Association of Pakistan (FPAP), MA of
    IPPF London, UK
    This study is a situation analysis of 10 family health hospitals of
    FPAP regarding their preparedness to provide effective PAC
    services. There were 14 service providers in 10 hospitals in the
    study. The most common procedure used for treating women
    coming with miscarriage or incomplete termination of pregnancy
    (TOP) was manual vacuum aspiration (MVA) (71.4%), followed
    by D&C (64.3%). The most common procedures followed for
    women coming with complications of induced TOP done
    elsewhere were MVA (85.7%) and D&C (57.1%). In 71.4% cases,
    surgical procedures for incomplete TOP were performed on the
    same day. The three most common complications were infection
    (92.9%), haemorrhage (78.6%) and pelvic inflammatory disease
    (78.6%). Length of gestation up to which surgical procedures for
    incomplete TOP was performed, was up to 4 weeks (14.3%), up
    to 12 weeks (42.6%), followed by 13–20 weeks (21.4), more than
    20 weeks (14.3%). A majority of the providers used analgesia,
    anxiolytic/sedation/tranquilizers for conducting surgical
    procedures for incomplete TOP of <8 weeks (64.3%), 9–13 weeks
    (57.1%), 13–20 weeks (21.3%) and >20 weeks (14.2%). The
    aborted fetus/products of conception were incinerated (35.5%),
    burnt (14.2%), thrown in open pit or garbage (14.2%), burnt and
    covered (21.3%) and others (14.2%). Three main reasons of
    choosing the hospital were doctors/staff being well behaved
    (52.8%), good reputation/better care (40%) and less waiting time
    (16.7%). In the present study, 51.4% clients were very satisfied
    and 22.2% were satisfied, while 20.8% classified the services as
    average. Only 4.2% were dissatisfied or highly dissatisfied.

David Baird

Speeches:

Natalie Bajos

Speeches:

Rob Beerthuizen

Speeches:

Marge Berer

Speeches:

Johannes Bitzer

Speeches:

F. Bloomer

Speeches:

  • close

    Termination of pregnancy rights in Northern
    Ireland – the role of pro-choice activists
    Bloomer, F
    University of Ulster, UK
    This paper considers the protests and activism led by the Alliance
    for Choice movement, an organisation that campaigns for the
    extension of the 1967 Abortion Act to Northern Ireland. The role
    of women in the movement is considered with particular focus on
    its most recent period of activism which began in the months
    preceding a proposed debate in Westminster in 2008 where a
    tabled amendment to the Human Fertilisation and Embryology
    Bill by Diane Abbot MP sought an extension of the 1967
    Abortion Act to NI. In response to this a series of events and
    activities were held to raise awareness amongst MP’s, trade unions
    and the wider public. The Alliance for Choice campaign took a
    strong pro-choice approach, focusing on the issue of equality with
    women in the rest of the UK. Despite the withdrawal of the
    amendment to the Bill in late 2008 the movement has continued
    on with its campaign, including preparation of a submission to
    the United Nations Convention on the Elimination of all forms of
    Discrimination Against Women (CEDAW).
    This paper will review the actions of the Alliance for Choice
    movement, considering the motivations for participation in the
    movement and reflect on the impact of the movement in
    achieving its goal of termination of pregnancy legislation
    extending to Northern Ireland.

Teresa Bombas

Speeches:

  • close

    Going ForwardThe prevalence of contraceptive use and the
    abortion rate are very different among countries.
    We know that the abortion rate is high in
    countries where the prevalence of use a modern
    contraceptive method is low. Combined hormonal
    contraceptives (COC) are one of the most popular
    methods of birth control. This is a reliable form
    of contraception, having a theoretical failure
    rate of 0.1% and, due to problems related with
    compliance an actual failure rate of 2-3%. The
    pill use is very different among countries. It will
    be important to try to understand why these
    differences exist. Despite the safety of current
    COCs, fears of adverse metabolic and vascular
    effects and possible oncological effects remain.
    Misperceptions and concerns about side effects,
    especially those affecting menstrual cycle, fertility
    and body weight increase, are often reasons for
    discontinuation. Making contraception available
    is not enough to prevent abortion: women should
    be able to choose a contraception method that
    suits their personal expectations - only then
    will unwanted pregnancies be successfully
    avoided and the abortion rate will decrease. For
    contraceptive efficacy, a woman’s/couple’s free
    and informed choice is required.

  • close

    Medical termination of pregnancy up to the 10th
    week: an experience of two obstetric centres in
    Portugal
    Ce´u Almeida, M; Bombas, T; Silva, I; Ribeiro, S;
    Monteiro, J; Fernandes, T; Moura, P
    Maternidade Bissaya Barreto – CHUC, Portugal
    Since 2007, termination of pregnancy (TOP) on request is legal in
    Portugal up to the 10th week of gestation and we perform mainly
    medical TOP.
    This study investigated the efficacy and the safety of medical
    TOP up to the 10th week of gestation in the two major obstetric
    services in central Portugal, over 16 months.
    A retrospective study was performed of the clinical outcome of
    women requesting a TOP, over the previous 16 months. We
    considered three groups regarding gestational age: Group 1:
    £49 days; Group 2: 50–62 days; Group 3: ‡63 days and studied
    the efficacy and the safety.
    We included 1276 women who had had a medical TOP. Group
    1: 41.5% (529), Group 2: 41.5% (530) and Group 3: 17% (217).
    The mean age was 51 days. The global efficacy was 99%. In three
    groups, the efficacy of medical TOP was 99.6%, 99.2% and 96.8%
    (P < 0.01) in groups 1, 2 and 3. We performed an aspiration per
    failed TOP or incomplete TOP in 1.1%, 3.3% and 6.1%
    (P < 0.01) of group 1, 2 and 3, respectively. The global rate of
    complications was 5.4%. Group 1: 4.2%; Group 2: 5.4% and
    Group 3: 8.3% (p=NS), mainly related with an uncompleted TOP
    (4.5%), haemorrhagic complications (0.6%) and infection (0.3%).
    Medical TOP is a safe method up to the 10th week of gestation
    with a low incidence of complications, most of them (80%) due
    to incomplete TOP. In the group with a gestational age of 63 days
    or more, the efficacy was lower but similar to the efficacy
    specified on the labelling.

Vivian Brache

Speeches:

G. Brady

Speeches:

  • close

    Young women’s experiences of termination of
    pregnancy and miscarriage
    Brady, G
    University of Coventry, UK
    In Britain, the politics and policy of teenage pregnancy places the
    emphasis on ‘prevention’ of teenage pregnancy, positioning
    parenthood for young people as a negative choice; this dominant
    discourse is likely to influence young people’s reproductive
    decisions and experiences. With this in mind, this paper focuses
    on a key finding from a multidisciplinary empirical research
    study, conducted in a city in the West Midlands of England, UK,
    which considered and explored young people’s experience of
    support before and following termination and miscarriage. Data
    were collected via indepth interviews with professionals and
    practitioners, young mothers and one young father. Although
    termination and miscarriage are generally perceived as distinct
    and different issues, the data suggest that the issues become more
    blurred where younger women are concerned. The experiences of
    young, ‘inappropriately pregnant teenagers’ often remain
    unacknowledged and devalued. This paper highlights the social
    and political context in which young women experience
    termination and miscarriage, and suggests that termination and
    miscarriage should be acknowledged as significant medical, social
    and emotional events in the lives of young people.

Raïna Brethouwer

Speeches:

Marie Laure Brival

Speeches:

Audrey Brown

Speeches:

  • close

    Continuation rate of contraceptive implant fitted
    on the day of a termination of pregnancy
    Brown, A; Nixon, H
    NHS Greater Glasgow and Clyde, UK
    Sandyford is an integrated sexual health service with over 100 000
    visits annually. Our termination of pregnancy (TOP) service sees
    over 1500 women annually. Around 30% of TOPs are in women
    who have previously had at least one TOP. As a strategy to reduce
    repeat TOP, we encourage uptake of long-acting reversible
    contraception on the day of a TOP. Anecdotally, clinic staff were
    reporting that many women having a contraceptive implant on

    the day of abortion were returning in a short time to have it
    removed.
    Aim: To assess: uptake of contraceptive implant on the day of the
    TOP; and continuation rate at one year after the TOP.
    Methods: Records of women attending from May to October
    2010 were accessed to record: method of contraception provided
    on day of the TOP; rate of removal at one year after the TOP;
    and reason for removal.
    Results: During the 6 month period, 707 women had a TOP.
    One hundred and fifty-two women (21%) had a contraceptive
    implant fitted on the day of the TOP.
    During the first year, 27 women had the implant removed for
    reasons including bleeding (20), mood problems (2), weight gain
    (2), planned pregnancy (2) and not sexually active (1).
    One hundred and twenty-five women (82%) continued with
    the implant for at least 1 year after insertion.
    Discussion: Published series demonstrate implant continuation
    rates of around 75% at 1 year. Implants are cost-effective at one
    year of use. In our audit, women having an implant fitted on the
    day of the TOP do not have a higher removal rate than standard
    implant users.

  • close

    Uptake of independent counselling in addition to
    termination of pregnancy consultation
    Nixon, H; Brown, A
    Sandyford, NHS Greater Glasgow and Clyde, UK
    Sandyford is an integrated sexual health service with over 100 000
    visits annually. Our termination of pregnancy and referral
    (TOPAR) service sees over 1500 women annually and offers
    information, assessment and admission for medical and surgical
    termination of pregnancy (TOP). There is access to a trained
    counsellor if wished.
    Recently in the UK, there have been demands to make
    additional counselling or a ‘cooling off’ period compulsory.
    Aim: To assess: uptake of counselling in addition to the TOPAR
    consultation; and relationship between time to TOP and eventual
    decision.
    Methods: Records of women attending from September to
    November 2011 were accessed to record:
    (i) certainty of decision at first visit.
    (ii) uptake of additional counselling.
    (iii) waiting time to TOP date and final outcome to proceed to
    TOP or continue the pregnancy.
    Results: Of 384 women with confirmed pregnancies at
    consultation:
    (i) Twenty-six decided to continue the pregnancy.
    (ii) Three hundred and forty-one wanted a TOP and this was
    arranged.
    (iii) Twenty-eight subsequently did not attend for a TOP and
    continued the pregnancy.
    (iv) Seventeen women wished more time to consider their
    decision and were offered an appointment with a trained
    counsellor – two women accepted.
    (v) Sixof the undecided women continued thepregnancy,
    including the two women who attended for counselling and 11 had
    aTOP.
    (vi) Neither time to the TOP or gestation influenced the
    decision to abort or continue the pregnancy.
    Our results suggest that the vast majority of women do not
    wish or need additional counselling and that introducing a
    ‘cooling off’ period or delay would not alter the decision.

    Post Abortion Family Planning (PAFP) is a key part of any
    comprehensive TOP service as this is a vital opportunity in which
    to provide family planning, to avoid future unwanted pregnancies.
    In order to understand the factors that may impact on the
    uptake of PAFP, MSI undertook a baseline survey of all clients
    accessing services in four of the MSI country programmes. The
    data was collected for 1 month, September 2011.
    In total 4081 clients availed themselves of TOP services across
    MSI centres in Ethiopia (1974), Nepal (1160), Vietnam (888), and
    Zambia (59).
    The average age of clients was 27–29 years. Ethiopia was the
    only programme with a lower than average age of 22 years.
    Eighty-three percent of TOP were performed at under 9 weeks
    of gestation. Medical TOP was chosen by an average of 61% of
    women: Zambia (90%), Vietnam (76%), Ethiopia (62%), Nepal
    (16%).
    Sixty-eight percent of women had not been using any
    contraception when they became pregnant. Thirteen percent were
    using male condom, 9% the oral contraceptive pill, 4% injection,
    1% emergency contraception, and 1% traditional methods. No
    one had been using implants, IUDs, male or female sterilisation as
    a method of contraception when they became pregnant.
    This review reflects the baseline factors of MSI clients,
    including the low use of contraception in women seeking TOP,
    and highlights variables to consider when providing PAFP and
    informing the ongoing MSI PAFP project that focuses on
    increasing levels of PAFP uptake.

Marc Bygdeman

Speeches:

Lucy Caird

Speeches:

Sharon Cameron

Speeches:

  • close

    Outcomes of very early medical termination of
    pregnancy at ££6 weeks of gestation
    Heller, R; Cameron, S
    NHS Lothian, UK
    Background and methods: In 2010 the termination of pregnancy
    (TOP) service at The Royal Infirmary of Edinburgh, Scotland, UK
    introduced a protocol that allowed women at very early gestation
    without ultrasonic evidence of an ongoing intrauterine pregnancy,
    but who fulfilled certain criteria (£6 weeks of gestation by dates,
    eccentric placed intrauterine gestational sac of £3 mm, decidual
    reaction, no risk factors for ectopic) to proceed directly
    with medical TOP, without the need for further investigations
    or ultrasound scans. Follow up consisted of routine
    telephone follow up with home low sensitivity urine pregnancy
    (LSUP) test.
    A retrospective audit of the management of this group of
    women attending in 2011 was conducted. Hospital computerised
    records and case notes were used to determine the number of
    visits made, investigations performed and outcome of the
    pregnancy.
    Results: Five hundred and eighty women attended over the audit
    period requesting a TOP at £6 weeks of gestation. Of these
    women 3.7% (n = 21) had a serum hCG performed prior to TOP,
    and 2% of women (n = 12) had more than one ultrasound before
    TOP. Seventy-three percent of women (n = 414) had routine
    follow up (telephone follow-up with LSUP) only, 24.4% (n = 138)
    had one post-TOP ultrasound, and 1.5%, (n = 9) returned for
    more than one post-TOP ultrasound. At follow up ultrasound,
    two women were found to have ongoing pregnancies (0.3%).
    There were no ectopic pregnancies.
    Discussion and conclusions: Most women at early gestation
    (£6 weeks) without definite evidence of a viable intrauterine
    pregnancy can proceed to medical TOP without the need for
    additional pre-TOP or post-TOP ultrasonography

  • close

    Self-assessment of success of early medical
    termination of pregnancy: a service evaluation
    Cameron, S1,2; Glasier, A1,2; Dewart, H1,2;
    Johnstone, A1,2; Burnside, A1,2; Paterson, B1,2;
    Hunt, L1,2; Rahimi-Rizi, J1,2
    1 NHS Lothian, UK; 2 University of Edinburgh, UK
    Introduction: In a recent study, we demonstrated that telephone
    follow- up with a self-performed low sensitivity urine pregnancy
    (LSUP) test was effective to determine the success of early medical
    TOP (<9 weeks of gestation). In the latter study, one half of
    women surveyed stated that they would have chosen self
    assessment (without a telephone call), if available. We
    subsequently introduced self-assessment with a self-performed
    LSUP test to our hospital TOP service in Edinburgh, Scotland.
    Women choosing this option were given detailed information on
    symptoms that may indicate an ongoing pregnancy and advised to
    contact the service if symptoms or LSUP suggested ongoing
    pregnancy.
    Methods: Ongoing service evaluation of self assessment with
    LSUP test as a method of follow up after early medical TOP,
    consisting of review of the proportion of women choosing this
    follow-up, contacting the service, and the efficacy for detecting
    ongoing pregnancies.
    Results: To date, out of a total of 89 women having early medical
    TOP, 66 have opted for self-assessment (74%), 18 for telephone
    follow-up (20%) and four for a clinic follow up with ultrasound
    (4%). Only three of the first 66 women (4.5%) choosing self
    assessment have contacted the service, because of pain/bleeding
    (n = 1), discharge (n = 1) and a positive LSUP (n = 1). To date
    there have been no known ongoing pregnancies in the self
    assessment group. 

    Conclusion: Initial findings suggest that self-assessment with a
    LSUP test is a popular choice for women. Few women contact the
    service, suggesting that women are confident in managing follow-
    up in this way.

Roch Cantwell

Speeches:

Laura Castelmann

Speeches:

W. Chatchawet

Speeches:

  • close

    Level of male participation when unwanted
    pregnancy is terminated from the perspective of
    Thai healthcare providers
    Chatchawet, W; Sompron, J; Kritcharoen, S
    Prince of Songkla University, Thailand
    When unwanted pregnancy occurs and ends with termination,
    women usually take responsibility for the consequences due to
    such unsafe termination of pregnancy (TOP) but men typically do
    not have to participate in taking care of women. This qualitative
    study aims to understand the perspective of healthcare providers
    from the viewpoint of male participation when an unwanted
    pregnancy is terminated. The thirteen participants consisted of ten
    professional nurses, two physicians and one social worker with
    exerience in taking care of women who were undergoing
    unwanted pregnancy termination. Individual interviews were
    conducted. Data analysis was carried out through content analysis.
    Member checking was conducted to establish the rigour of the
    study

    The level of male participation when unwanted pregnancy is
    terminated from the perspective of healthcare providers was found
    to be ‘taking care together’ because of mutual sex, men conduct,
    or women hurt and ‘women taking care of themselves’ due to
    male privilege or female surrender. ‘Different aspects on
    termination of unwanted pregnancy’ such as understanding the
    woman’s reason or prejudice from not listening to a woman’s
    voice, affect the level of male participation.
    The findings of the study help to improve the understanding
    about male participation that is influenced by gender bias.
    Encouraging men to participate in taking care of women without
    gender bias will enhance reproductive health care to transform a
    women-only framework to gender equity among women and men.

Linan Cheng

Speeches:

Rosemary Cochrane

Speeches:

  • close

    Termination of pregnancy in Lothian: a health
    needs assessment
    Cochrane, R; Milne, D; Cameron, S
    NHS Lothian, UK
    Introduction: The rate of termination of pregnancy (TOP) in
    Scotland remains high, with 12 681 TOPs performed in Scotland
    in 2010.
    Most TOPs are hospital procedures or early medical
    termination. In 2011 a new centre for SRH (Chalmers) opened in
    Edinburgh; most provision of early medical termination will be
    delivered from here in the future. Some TOPs will continue to be
    performed within hospitals.
    Whilst much research has concentrated on the efficacy and
    acceptability of TOP, little has been written about women’s
    experience and the patient pathway.
    How the current service is viewed by users and providers, and
    the impact of future change to the service, was uncertain.
    This health needs assessment aims to:
    (i) describe population accessing TOP services in Lothian
    (ii) describe current service
    (iii) identify areas of delay in service provision
    (iv) identify areas of unnecessary complexity in patient’s
    journey
    (v) elicit stakeholders views
    (vi) consider evidence of and recommend effective intervention
    to improve termination services
    (vii) support planning for change from 2011.
    Methods: Women attending TOP services were interviewed and
    then telephoned approximately two weeks after TOP and
    questioned about their views of the TOP service.
    Staff members within the TOP service including management
    were interviewed.
    Results and conclusions: Seventeen women and 17 staff members
    were interviewed. Difficulty with patient recruitment and follow-
    up is discussed.
    Patients overall were happy with the service; several pertinent
    negative points were raised.
    Staff have mixed feelings about the service, and useful ideas for
    improvement were garnered, and form part of an action plan as
    part of the Lothian Sexual Health and HIV Strategy.

Kate Cockrill

Speeches:

Rodica Comendant

Speeches:

Rebecca Cook

Speeches:

Kelly Culwell

Speeches:

Bernard Dickens

Speeches:

  • close

    Conscientious commitment
    Freedom of conscience is a human right
    recognised in the Universal Declaration of Human
    Rights of 1948. Accordingly, the U.N. International
    Covenant on Civil and Political Rights provides
    that “Everyone shall have the right to freedom
    of thought, conscience and religion” (Art.18(1)).
    Conscience is thereby expressed as separate
    from religion. Individuals may, of course, base
    their conscience on their religious beliefs, but
    the Covenant establishes that religion has
    no monopoly on conscience. A common
    invocation of conscience regarding abortion is in
    conscientious objection to participation, which is 

    often based on religious convictions.
    Conscientious commitment is the reverse of
    conscientious objection. It arises when healthcare
    providers feel conscientiously committed to
    offer patients advice and services to which
    administrators of their healthcare facilities such
    as hospitals are opposed in principle, for religious
    or comparable reasons. Institutions such as
    hospital corporations cannot claim human rights
    such as conscientious objection. Health facility
    administrators must accommodate service
    providers’ rights of conscience, such as to
    recommend and offer services the providers
    conscientiously consider to be in their patients’ best
    interests, and, with patients’ consent, to provide,
    or refer patients for, such services, including lawful
    abortion, without discrimination, in the same way
    that facility administrators must accommodate
    providers’ rights of conscientious objection.

Thoai D Ngo

Speeches:

  • close

    Risk factors for repeat termination of pregnancy:
    implications for addressing unintended pregnancy
    in Vietnam
    Ngo, T1; Keogh, S1; Nguyen, T1; Le, H2; Kiet, P2;
    Nguyen, Y2
    1 Marie Stopes International; 2 Hanoi Medical University, Vietnam
    Objective: Vietnam has one of the highest pregnancy termination
    rates in the world; 26 terminations of pregnancy (TOPs) per 1000
    women. We explored factors associated with having repeat TOPs
    in three provinces in Vietnam.
    Methods: A cross-sectional survey was conducted from September
    to December 2011 among abortion clients at 61 health facilities in
    Hanoi, Khanh Hoa and Ho Chi Minh City. After their procedure,
    women participated in an exit interview asking about socio-
    demographic factors, contraceptive use, and knowledge and
    experience of TOP services. The primary outcome was repeat TOP
    (‡2 TOPs).
    Results: A total of 1233 women were interviewed. The median
    age was 28 years; 92.5% had secondary education; 77.8% were
    married; and 31.9% had no children. Half the respondents were
    not using contraception prior to their recent pregnancy. The
    prevalence of repeat TOP was 32.9%. A significantly higher
    proportion of repeat TOP compared to first time TOP clients
    intended to adopt long-acting contraceptive methods, particularly
    the IUD (35% vs. 23%, P £ 0.001), in future. In a multivariate
    model, individuals living in Hanoi, older women, and those with
    two (vs. fewer) children were more likely to have a repeat TOP
    (P < 0.001). While women with ‡2 daughters (vs. 1) were more
    likely to have a repeat TOP (P = 0.03), women with no sons
    (vs. 1) were less likely to have one (P = 0.03).
    Conclusions: Repeat TOP remains high in Vietnam. Strengthening
    post-TOP family planning interventions is critical to reduce the
    high number of repeat unintended pregnancy in Vietnam.

C. Dufey-Liengme

Speeches:

  • close

    Termination of pregnancy among teenagers – why
    more surgical terminations?
    Dufey-Liengme, C; Coquillat, F; Demierre, M;
    Renteria, S-C
    Centre for Sexual Health and Planned Parenthood, Unit for Psycho-
    social gynaecology and obstetrics, ObGyn Department, Centre
    Hospitalier Universitaire Vaudois, Lausanne, Switzerland
    Introduction: In 2012, a study by K. Chatziioannidou and S-C.
    Renteria showed that teenagers chose to undergo a surgical
    termination of pregnancy (TOP) more often than a medical TOP
    (mifepristone followed by misoprostol) when they decided to
    terminate a pregnancy. It also showed that the teenagers’ choice
    for a medical versus surgical method is inversely proportional to
    the adults’ choice although the efficiency of the medical method
    showed even better results for teenagers than for adults.

    Accordingtothehypothesismade,thereasonsforthischoice
    mightbeinfluencedbythefollowingfacts:(i)thebelatedcalltomake
    anappointment,themedicalprocedurenotbeingavailableafter
    9 weeksofgestation;(ii)theimperativerequestforconfidentiality;
    (iii)thebeliefsandsubjectiveappreciationofthemedicalstaff.
    Objectives: The aim of this retrospective and qualitative study is
    to analyse the reasons why, in case of a TOP, teenagers chose the
    surgical method more often than their adult counterparts.
    Material: (i) All teenagers who were admitted for an abortive
    procedure during 2011 in the in- or outpatient ward.
    (ii) The professional team (midwives and sexual and
    reproductive counsellors) in charge in the case of a TOP request.
    Methods: The information about the patient’s history and the bio-
    psycho-social data was retrieved from thepatient files filled out by
    midwives and sexual and reproductive healthcounsellors during the
    first appointment for a TOP request orduring its process.
    The professionals’ appreciation was evaluated by means of a
    semi-structured questionnaire.
    Results: Concerning the choice of the method for a pregnancy
    termination, the results of our research show that:
    (i) Out of 47 teenagers, 27 chose the surgical method and 17
    the medical method.
    (ii) Three had a second trimester abortion (which includes use
    of the medical method).
    (iii) Fifteen teenagers out of the 27 who chose a surgical
    method consulted between the 9th and 14th weeks of
    amenorrhoea and therefore did not have any other choice.
    The reasons for their ‘late arrival’ will be explained in detail.
    The 12 teenagers who arrived before the 8th week of
    amenorrhoea and chose to undertake abortion by suction &
    curettage under general anaesthesia did it for the following
    reasons:
    (i) Four were afraid of bleeding and pain.
    (ii) Five thought that the organisation of the surgical procedure
    was easier.
    (iii) Two did not trust the abortion pill.
    (iv) One was taken to her mother’s gynaecologist where she
    had a D&C.
    Confidentiality was requested nine times out of 27 when

    choosing the surgical method, and six times out of 17 when
    choosing the medical method.
    Therefore, although confidentiality concerns a third of the
    teenagers’ pregnancy termination requests, it does not seem to be
    a significant element for the choice of the method.
    As for the subjective appreciation of the professionals, the first
    results of the discussions seem to show that teenagers were
    reluctant or resistant towards the medical method.
    Conclusion: This study shows that the reasons why teenagers still
    prefer the use of the surgical over the medical method compared
    to adults, seem to include the late request for an appointment,
    fear of pain and bleeding and organisational issues.
    Confidentiality does not seem to greatly influence the teenagers’
    choice. Nonetheless, medical professionals seem to favour the
    suction curettage procedure performed under anesthesia because
    they associate young age with vulnerability and psychological
    frailty and consequently diminished ability to cope with pain and
    emotional distress during the medical procedures.

Christian Fiala

Speeches:

  • close

    Contraceptive development has taken place in
    3 milestones:
    1. Discovery of the fertile days by Knaus and Ogino
    in the 1920s. – For the first time ever, women
    were able to understand what was happening in
    their bodies and roughly identify the fertile days.
    But they were not able to control their fertility.
    2. Controlling fertility according to the individual
    desire and possibilities (pill and IUD) in the
    ’60s. - The dream of humankind came true:
    separate fertility from sexual activity. For the
    first time ever, women were able to control their
    fertility themselves and make their own choices
    concerning the number of children. Regular
    menstruation, however, continued. Even in
    women who take the pill and thus have no
    ovulation have their monthly bleeding.
    3. Limiting menstruation to the fertile cycles by
    continuous intake of oral contraception or the
    intrauterine system. – Women can effectively
    control both their fertility and menstruation
    according to their own wishes and limits.
    Currently we are in the process of making the 3rd
    milestone widely accessible and a free choice for
    women. The medical knowledge and technology
    are there. But social acceptance is a slow process,
    which will accompany us for some time to come.

  • close

    The effects of bad storage conditions on the
    quality and the related effectiveness of Cytotec﷿﷿
    Be´rard, V1; Fiala, C2
    1 University of Bourgogne, France; 2 Gynmed Ambulatorium, Vienna,
    Austria
    Cytotec﷿ (Misoprostol 200 lg tablet) has been extensively studied
    in reproductive health, and is widely used for various indications
    including induction of pregnancy termination (MToP).

    Misoprostol, a PEG1 is chemically unstable except under very
    specific conditions. This is due to susceptibility to relative
    humidity and temperature factors. If these factors are not strictly
    respected until the moment of intake, misoprostol turns into three
    main degradation products: A-form and B-form prostaglandin
    and 8-epimer.
    Whenusedduringmedicalabortions,thecliniciangivesthe
    patient2ormore200 lgtabletsofCytotec﷿ totake24–48 hours
    aftertakingmifepristone.Cytotec﷿ tabletsarepackagedinboxesof
    50or60tabletsof200 lgeach.Thetabletsarepackagedinheat-
    sealedaluminumblisterpacks,eachcontaining10tablets.Each
    tabletisseparatelysealedinanalveolusandtheblisterisnotpre-cut.
    Thedoctorwillgiveapatient2ormoretablets,whichhavetobecut
    fromthisaluminiumblister.Howeverthetabletsarearrangedin
    suchawaythatitisalmostimpossibletocuttabletsfromablister
    withoutinadvertentlydamaging/openingoneormorealveoli.
    The aim of this research is to study the effect on the stability of
    misoprostol if a tablet has been exposed to normal air/humidity if
    the alveoli has inadvertently been opened when 2 or more tablets
    have been cut from the blister. A possible instability would have a
    potential negative effect on the treatment of MToP.
    Methods: To study the changes of Cytotec﷿ tablets from a
    technical-pharmaceutical and analytical viewpoint, once they have
    been taken out of their blister pack, they are stored over a period
    of time (a few hours to 1 month) at 25 ﷿C and 60% RH
    (standard condition of ambient air in Europe),
    After the time elapsed, the pharmaco-technical characteristics of
    Cytotec﷿ tablets were studied according to the European
    Pharmacopeia i.e. Mass uniformity, friability, disintegrating time,
    dissolution time (by HPLC). The dimensional measure of tablets
    were also measured.
    Furthermore Cytotec﷿ tablets were analysed to determine the
    uniformity of dosage units of misoprostol (by HPLC),
    decomposition products dosage (by HPLC): A-form misoprostol
    (Pharm. Eur. impurity C), B-form misoprostol (Pharm. Eur.
    Impurity D) and 8-epi misoprostol (Pharm. Eur. impurity A).
    Water content by Karl Fischer determination was also done.
    Conclusions: The results of this research clearly show that
    Cytotec﷿ tablets suffered from a significant time dependent

    decrease in their technical-pharmaceutical characteristics and
    effectiveness if they come into contact with normal air because
    they were either taken out of their blister or kept in a blister
    which was damaged during cutting out some tablets. As early as
    the first day of storage, (with a maximum 48 hours after) in
    humidity and temperature corresponding to normal conditions in
    Europe the mass (+4.3%), the diameter (+1.2%), and the
    thickness (+4.8%) of the tablets increases, which is a sign of the
    swelling of the HPMC. However the hardness of the tablets
    decreases dramatically ()32.0%).
    The water dosage by Karl Fischer clearly shows that there is a
    rapid increase of water inside each tablet (+78.8% after 48 hours).
    This water penetration, associated with a storage temperature
    of 25 ﷿C speeds up the process of transforming the misoprostol
    into decomposition compounds. This leads to a decrease in
    Cytotec﷿’s active ingredient dosage ()5.1% after 48 hours) with
    related consequence on effectiveness. It is clear that under the
    current conditions of Cytotec﷿ use for MToP, cutting up the

    blister packs should not be recommended because the risk of
    damaging the heat formed alveoli around the tablets is too high
    (we have no data to make such a strong statement, even if it is
    true). This drastic change is observed in chemical composition
    after 6 hours only of storage and reaching a maximum on the 2nd
    day, which is the day the patient normally takes the tablet.
    If a Cytotec﷿ tablet is kept in a damaged blister (previously cut
    to deliver tablets to the previous patient) and stored in normal
    environmental conditions, its effectiveness will be likely seriously
    decreased for the next patient.
    This research concerns all uses of Cytotec﷿ for MToP and even
    when used as gastric protection, where the tablets, which can be
    divided into equal parts, can be taken by halves, the second half is
    stored in the open alveoli for an undetermined period.
    In conclusion, special caution must be taken in delivering
    Cytotec﷿ tablets.

Jane Fisher

Speeches:

Ruth Fletcher

Speeches:

  • close

    Travelling for Abortion:
    A Framework for Future
    Advocacy and Research This presentation will discuss the ways in which
    the Irish Crisis Pregnancy Programme (formerly
    the Crisis Pregnancy Agency) has developed
    public governance of cross-border abortion
    care. In doing so my aim is to think more about
    the limits and potential of abortion travelling
    as an option for women living with restrictive
    abortion regimes. The governance of abortion
    travelling does seem to have the negative effect
    of consolidating the non-development of local
    lawful abortion services. But the Programme
    has also had the effect of providing publicly
    subsidised support for women who travel,
    enabling the reporting of extra-territorial abortion
    rates as national abortion rates, and of promoting

    abortion after-care on return. These public health
    measures, limited as they are, provide evidence
    of some public support for abortion use and may
    provide future resources for tackling domestic
    resistance to abortion provision.
    In analysing the Crisis Pregnancy Agency’s
    administration of an outward flow for abortion care,
    I identify its 4 key technologies of governance as
    the non-development of local abortion services,
    provision of support for exit, reporting of extra-
    territorial abortion rates, and promotion of aftercare
    on return. These technologies illustrate how state
    agencies may actively mobilise ‘the peripheral’
    as they claim to address local needs through
    participation in the regulation of cross-border
    healthcare. In so doing they configure a conception
    of the peripheral that does not want to become
    core and participates in transnational networks on
    its own terms. Secondly, this peripheralism is not
    constituted by the core, but cultivates dependency
    on core provision of healthcare in other
    jurisdictions. Thirdly, this peripheralism comes into
    being by focusing on marginal healthcare services
    (information, counselling, check-ups) on the fringes
    of abortion provision.

Ann Furedi

Speeches:

  • close

    We often voice our support for
    abortion because it is necessary.
    Necessary as a back-up to
    contraception, as a ‘second-chance’ method of
    birth-control when contraception fails or we fail to
    use it. And necessary when a pregnancy becomes
    no longer wanted - because something changes
    in our lives or about how we feel.
    We present abortion as an unfortunate fact of life.
    When our opponents claim abortion is evil, we often
    reply that it is a necessary evil. Our opponents take
    the moral stance, and we claim to be of the ‘real
    world’: pragmatic realists considering health risks
    and benefits and not what is ‘right’ and ‘wrong’.
    But there is a moral case to be put for freedom
    of choice. There is an argument that it is wrong
    to deny women that freedom – because to
    take away our capacity to make decisions for
    ourselves, is to take away what makes us human.
    The right to choose is more than a matter for
    women; it’s a matter for humanity.

Bela Ganatra

Speeches:

Kristina Gemzell-Danielsson

Speeches:

  • close

    Midlevel versus physician provision of medical
    termination of pregnancy– a randomised controlled
    study
    Gemzell-Danielsson, K1; Johansson, M1;
    Salomonsson, E2; Gomperts, R1; Kopp Kallner, H1
    1 Department of Obstetrics and Gynaecology, Karolinska Institute,
    Stockholm, Sweden; 2 Karolinska University Hospital, Stockholm,
    Sweden
    Objective: To evaluate feasibility, efficacy and acceptability of
    midlevel provision of medical termination of pregnancy (TOP) in
    clinical practice through a randomised study of midwife or
    physician examination and counselling prior to medical TOP.
    Background: Midlevel provision of medical TOP is common in
    less developed countries and has been shown to be acceptable.
    However, access to a gynaecologist is a limiting factor in medical
    TOP also in developed countries and causes unnecessary waiting
    periods. In developed countries vaginal or abdominal ultrasound
    is routinely performed before TOP and has been an obstacle to
    midlevel provision of medical TOP.
    Methods: Two midwives highly experienced in TOP care with no
    previous training in ultrasound were trained in vaginal ultrasound
    of early pregnancy. Inclusion criteria for this study were being
    healthy with no ongoing medication and willing to participate.
    Women signed informed consent and were randomised
    accordingly. All patients with pregnancy longer than 63 days
    gestational age or without having visible intrauterine pregnancy
    were referred to a gynecologist.
    Results: So far 1200 patients have been included. A total of 1260
    women will be randomised. No serious adverse events have been
    recorded. Preliminary results show that acceptability of midlevel
    provision of medical TOP is higher than physician provision.
    Conclusion: Midlevel provision of medical TOP in a clinical
    setting in a developed country is highly feasible. Midwives can be
    trained in vaginal ultrasound and thereby provide the complete
    spectrum of early TOP services.

Anna Glasier

Speeches:

Rebecca Gomperts

Speeches:

Kate Guthrie

Speeches:

  • close

    The impact of implants and intrauterine
    contraceptives provided at an index surgical
    termination of pregnancy (Jan–June 2008) on
    repeat termination of pregnancy within 3 years:
    an audit
    Latham, F1; Guthrie, K2; Trussell, J1
    1 Hull York Medical School; 2 Community Health Care Partnership
    Hull, UK
    Background: Implants and intrauterine contraceptives have lower
    failure rates and higher continuation rates than the other
    reversible methods of contraception. We hypothesised that the
    patients who chose these long lasting reversible methods after
    their index surgical termination of pregnancy (STOP) would have
    a reduced incidence of subsequent termination of pregnancy
    (TOP) in comparison to those who chose other reversible
    methods (injections, oral contraceptive pills, patch, ring and
    condoms).
    Methods: Index cases were recorded retrospectively from theatre
    registers at Hull Royal Infirmary for all STOPs between January
    and June 2008. Type of contraception chosen at procedure was
    recorded: Implanon, Mirena, IUD, Depo-Provera, Sterilisation and
    ‘Other’ (oral contraceptives, patches, rings, condoms). The
    hospital information system for the subsequent 3 years was
    searched for another TOP (surgical or medical). The data were
    analysed. A secondary objective was to record contraceptive
    choices in two age groups (<25 and ‡25 at index STOP).
    Results: Women choosing Implanon, Mirena and IUDs had a
    significantly lower repeat TOP rate than those choosing other
    reversible methods at 2 (3.4% vs. 9.3%, P = 0.008) and 3 (6.8%
    vs. 12.4%, P = 0.04) years. As age increased, use after an index
    STOP of Implanon decreased (32% vs. 8%) and Mirena increased
    (13% vs. 41%) significantly.
    Conclusion: A 50% increase in the uptake of implants and
    intrauterine contraceptives would decrease the repeat TOP rate
    within three years by 16%.

Anja Guttinger

Speeches:

D. Halleb

Speeches:

  • close

    Medical termination of pregnancy by mifepristone
    and sublingual misoprostol: preliminary results of
    their use in reproductive health centre of Nabeul
    in Tunisia
    Halleb, D1; Temimi, F2; Belcaid, A1; Ben Khedija,
    W1; Wahbi, H1
    1 Centre de la Sante´ de la Reproduction, Nabeul, Tunisia; 2 Office
    National de la Famille et de la Population, Tunis, Tunisia
    Introduction: Medical termination of pregnancy (TOP) is a
    method increasingly used worldwide. It was introduced in Tunisia
    by the National Office of Family and Population, since 1994 as
    part of research. Then it was extended in 22 of the 24
    reproductive health centres. Medical TOP was introduced in the
    Nabeul Centre since November 2002. We used three different
    protocols; the third protocol was introduced since March 2010.
    The aim of the study was to describe the effects of this protocol
    on medical TOP effectiveness; frequency of side effects, and
    frequency of TOP failure.
    Methods: We conducted a retrospective observational study
    performed in the reproductive health centre of Nabeul from April
    2010 to June 2010 about women who chose medical TOP.
    For all women consulting for TOP, the medical staff explained
    the interest of medical TOP and the risks of this method
    compared to the surgical one.
    On the first day, counselling was conducted, clinical and
    ultrasound examinations were made to identify no exclusion
    factors: anaemia, ectopic pregnancy, and pregnancy off the pill,
    kidney failure and liver failure. Then 200 mg of mifepristone was
    administered by the midwife or the physician.
    On the second day, 400 lg of misoprostol was administered by
    the sublingual route. On the fifteenth day, a check was performed
    by a clinical and ultrasound examination.
    We considered as method failure: surgical aspiration for
    ongoing pregnancy, a total retention or significant bleeding.
    Withdrawals were not recorded as such.
    The study analysis was performed by SPSS with statistical
    verification by the v2 and ANOVA at a significance level of 5%
    (P £ 0.05).

    Results: We included 562 women (27.48% single and 72.52%
    married) who have chosen medical TOP during the study period.
    The average age was 32 years, ranging from 18 to 50. Educational
    level was illiterate for 5.1%, elementary or secondary for 78.8%
    and university for 16%. In 77% of cases women had not had a
    medical TOP before, 16.5% of them had one previously, 4.7%
    twice and 1.9% three or more times. The age of pregnancy was in
    60% of cases <6 weeks of gestation, in 34.7% of cases between 6
    and 7 weeks of gestation, and in 6.9% of cases between 8 and
    9 weeks. The expulsion occurred in 54.2% of cases before 4 hours
    and in 44.4% after 4 hours. Pain was reported in 10.5% of cases
    and need appropriate treatment. Surgical abortion was used in
    1.2% (ongoing pregnancy in 1% of cases and bleeding 0.2% of
    cases).

    Statistical analysis showed: (i) a significant relationship between
    gestational age and the period of expulsion (P = 0.047); no
    significant relationship between the gestational age and the failure
    of the TOP; no significant relationship between educational level
    and gestational age at the time of first consultation (P = 0.243).
    Conclusion: The protocol adopted in this study appeared to be
    safe, effective and acceptable to women. However we must be
    aware and explain to women that the use of medical TOP does
    not replace contraception, contrary to popular belief.

W. Hellerstedt

Speeches:

  • close

    Is perceived partner pregnancy intention associated
    withmaternal prenatal and postpartumwell-being?
    Hellerstedt, W
    Division of Epidemiology & Community Health, School of Public
    Health, University of Minnesota, Canada
    Background: While ‘pregnancy intention’ is often crudely assessed
    by a question concerning satisfaction with pregnancy timing, data
    with this measure support that unintended and unwanted
    pregnancies are associated with adverse infant and maternal health
    outcomes. Few studies have examined similar associations with
    perceived paternal intention.
    Methods: We examined data from Minnesota’s (USA) Pregnancy
    Risk Assessment Monitoring System (PRAMS), involving 7266
    women surveyed 2–4 months after delivery of a live-born between
    2004 and 2008. We used weighted multivariate logistic regression

    to examine the associations of perceived partner intention with
    maternal demographics, as well as prenatal and postpartum
    behaviors and experiences.
    Results: Thirty-seven percent of recent mothers reported that
    their pregnancies were unintended by their partners. Compared to
    those who perceived their partners intended the pregnancy, these
    mothers were significantly (P < 0.01) more likely to report that
    they themselves did not intend the pregnancy, smoked prenatally,
    experienced intimate partner violence, experienced postpartum
    depressive symptoms and had prenatal mood problems. They
    were less likely to report that they received adequate prenatal,
    postpartum or well-woman care; father helped with infant care; or
    that they used contraceptives in the postpartum.
    Conclusions: In this population-based sample, more than one-
    third reported their partner did not intend their recent pregnancy.
    We cannot validate whether maternal report of perceived paternal
    intention is accurate, but we also have no reason to doubt it.
    Irrespective of the objectivity of this measure, perceived partner
    pregnancy intention is an independent indicator of a variety of
    maternal and infant risk markers.

Donald Henderson

Speeches:

Wye Yee Herbert

Speeches:

Leila Hessini

Speeches:

Lesley Hoggart

Speeches:

  • close

    ‘Trust me to be the awkward one’: young women’s
    experiences with the contraceptive implant
    Hoggart, L; Newton, V
    University of Greenwich, UK
    This paper will present the findings of a recently completed
    qualitative study examining ‘premature’ implant removal amongst
    young women (aged 16–24) in London. The paper will explore
    young women’s contraceptive journeys with the implant and
    examine how and why the implant was initially selected as a
    contraceptive of choice and then removed within one year or less
    of fitting. The focus of the paper is on the complex process of
    contraceptive decision-making, and how this may change as a
    result of bodily experiences subjectively associated with the
    implant. The paper will begin by discussing young women’s
    reasons for choosing the implant. We will then examine how
    individual and collective experiences of the method contribute to
    the decision to have the implant removed. These experiences
    include a range of perceived side effects, issues concerned with
    bodily control, and changes in sexual relationships, as well as
    service related factors. The research has shown that young women
    who have made a positive choice in favour of the implant will
    tolerate a considerable amount of discomfort before reaching a
    ‘tipping point’ at which they decide to have the implant removed.
    During this period they often feel unsupported and isolated, and
    even attach blame to themselves for the ‘failure’ of their body to
    accept the implant. We also suggest that negative experiences and
    a lack of support may contribute towards negative attitudes
    towards other long-acting reversible contraceptive methods.

G. Horgan

Speeches:

  • close

    The politics of termination of pregnancy in
    Northern Ireland
    Horgan, G
    University of Ulster, UK
    Policy and politics in relation to termination of pregnancy (TOP)
    remain mired in issues of religiosity, morality and class
    everywhere in the world but perhaps nowhere more so than in the
    one part of the UK where TOP remains illegal – Northern Ireland.
    There, the Health Minister is a creationist and avowed ‘pro-life’
    advocate who has failed to comply with a court ruling to clarify
    for doctors when it is legal to perform a TOP.
    Control over TOP was not devolved to Scotland or Wales,
    despite Scotland having the same control over matters of criminal
    justice as the NI Assembly. Instead, it was admitted in
    Westminster that in relation to TOP, the UK government was
    making ‘….a distinction between Northern Ireland and the rest of
    the United Kingdom for a multiplicity of pressing political and
    other reasons’. As a result, women in NI are not guaranteed even
    life-saving TOPs, still less ‘social’ ones.
    The ‘multiplicity of pressing political and other reasons’ which
    led to TOP being a devolved issue has much to do with British
    politicians needing the votes of the fundamentalist Democratic
    Unionist Party to pass controversial measures, and nothing to do
    with the social or health needs of women in Northern Ireland.

    This paper looks at the politics of TOP in NI and how religious
    fundamentalism has influenced the development of policy in
    relation to TOP in this part of the United Kingdom.

Manuelle Hurwitz

Speeches:

Ronald Johnson

Speeches:

Bojan Jovanovski

Speeches:

Nathalie Kapp

Speeches:

Desta Kebede

Speeches:

D. Kirkham

Speeches:

  • close

    Long-acting reversible contraception (LARC)
    take-up following termination of pregnancy.
    A local audit
    Kirkham, D1; Holt, E2; Agass, R3; Holland, C4;
    Dodsworth, B4
    1 Stockport NHS Foundation Trust, UK; 2 Royal Bolton NHS
    Foundation Trust, UK; 3 Pennine Acute Hospital NHS Trust, UK;4 Salford Royal NHS Foundation Trust, UK
    Objectives: Identify the percentage of women undergoing a
    termination discharged with LARC, and factors influencing take-
    up.
    Methods: Age, contraceptive history, parity, previous termination,
    and discharge contraception were recorded for women attending a
    termination clinic over two months. Ninety-nine cases were
    included.
    Discharge contraception was discussed with 100% of cases;
    92.9% made a contraception decision, 79.8% were discharged with
    a chosen method, 13.1% were guided to a family planning centre,
    7.8% declined contraception (condoms supplied), 59.6% were
    discharged with LARC.
    Relevance/Impact: Less than 10% of unintended pregnancies are
    due to true contraception failure, 30–50% because no method was
    used, the remainder due to incorrect/inconsistent use. In
    unintended pregnancies 40.6% lead to termination of pregnancy
    (TOP); 27–48% of all TOP are repeats. Women seeking TOP are
    highly motivated to seek effective contraception. LARC methods

    are not user-dependent, so are very effective. LARC is more cost-
    effective than the combined oral contraceptive pill (COCP) after
    just 1 year. A reduction in unwanted pregnancies and
    terminations benefits the physical/mental health of women and
    the NHS financially.
    Outcomes specific patient groups may benefit from targeted
    counselling to increase uptake of LARC: (i) Patients conceiving
    on the COCP (ii) 14–17 year olds (iii) Nulliparous women
    (iv) Patients with previous terminations.
    Discussion: Sixty-five percent of patients using no contraception
    or condoms, and 75% of women aged 18–22 years old were
    discharged with LARC. Only 32% of patients conceiving on the
    COCP were discharged with LARC, and only 40% of 14–17 year
    olds, with 53% being discharged on the COCP and one with
    condoms. Forty-two percent of nulliparous women were
    discharged with LARC. Patients with previous terminations were
    no more likely to be discharged with LARC.

Helena Kopp Kallner

Speeches:

  • close

    Unplanned pregnancy- a common reason for
    ectopic pregnancy
    Kopp Kallner, H
    Karolinska Instiutet, Department of Obstetrics and Gynecology,
    Danderyd Hospital, Stockholm, Sweden
    Objectives: The primary objective of this study was to investigate
    what proportion of ectopic pregnancies arises as a consequence of
    unplanned pregnancies and the proportion of women receiving
    contraceptive counselling after treatment.
    Background: Ectopic pregnancy is a potential life threatening
    condition. It has a negative impact on future fertility which is
    often desired. It is often forgotten that an ectopic pregnancy can
    be a consequence of an unplanned pregnancy.
    Methods: This was a retrospective study of a total of 68 patients’
    electronic medical records. Inclusion criteria were a certain
    diagnosis of an ectopic pregnancy and first visit at Danderyd
    Hospital AB between 1 June 2011 and 30 November 2011.

    Results: Fifty-four percent of the ectopic pregnancies were a
    consequence of an unplanned pregnancy, 31% were planned and
    information was missing for 15% of the patients. In the group of
    patients with unplanned pregnancy 70% of the patients in need of
    counselling on future contraceptives did not get it upon
    completed treatment.
    Conclusions: A large proportion of ectopic pregnancies are a
    result of unplanned pregnancy. The individual and the healthcare
    system have a lot to gain by ectopic pregnancy prevention which
    can be achieved by increased use of contraceptives which protect
    patients against all unplanned pregnancies. Patients with
    unplanned ectopic pregnancies should receive counselling on
    future contraceptives after finished treatment.

Ali Kubba

Speeches:

  • close

    De-medicalising contraception
    Access to contraception is a reproductive health
    right. While sex ‘just happens’, women need to
    go through several hoops to obtain contraception.
    Regulations, protocols and guidelines drive
    service provision but do affect the perceptions
    of both users and providers. Evidence-based
    de-medicalisation of contraception may remove
    personal and systematic barriers to effective use of
    family planning methods. Emergency contraception
    is a case study in this area. Other models of care
    have emerged in the last decade. These include
    over and under the counter oral contraception,
    vending condoms and emergency contraception
    and web based services. Themes emerging
    from such models suggest that research, service
    provision and advocacy schemes should aim to
    push the boundaries of contraceptive regulation
    towards user-friendly non-medicalised care.

V. Lavoue

Speeches:

  • close

    Screening for chlamydia trachomatis using
    self-collected vaginal swabs at a public pregnancy
    termination clinic in France: results of a screen-
    and-treat policy
    Lavoue´, V; Vandenbroucke, L; Lorand, S;
    Pincemin, P; Bauville, E; Boyer, L; Martin-
    Meriadec, D; Minet, J; Poulain, P; Morcel, K
    CHU de Rennes, Centre IVG, Service d’obste´trique, Hoˆpital Sud,
    France
    Objective: To assess the prevalence of Chlamydia trachomatis
    (CT) infection and the risk factors for CT infection among
    women presenting for a termination of pregnancy (TOP) at a
    clinic in France.
    Methods: Women seeking surgically induced TOP were
    systematically screened by PCR on self-collected vaginal swabs
    between January 1, 2010, and September 30, 2010. CT-positive
    women were treated with oral azithromycin (1g) prior to the
    surgical procedure.
    Results: Out of the 978 women included in the study, 66 were
    CT-positive. The prevalence was 6.7% (95% CI 5.1–8.3%). The
    risk factors for CT infection were the following: age <30 years
    (Odds ratio [OR] = 2.0 [95% CI 1.2–3.5]), a relationship status of
    single (OR = 2.2 [95% CI 1.2–4.0]), having 0 or 1 child
    (OR = 5.2 [95% CI 2.0–13.0]), not using contraception (OR = 2.4
    [95% CI 1.4–4.1]) and completing 11 weeks or more of gestation
    (OR = 2.1 [95% CI 1.3–3.6]). Multiple logistic regression
    indicated that four factors – having 0 or 1 child, a single
    relationship status, no contraceptive use and a gestation of
    11 weeks or more – were independently associated with CT
    infection. The rate of post-TOP infection among all patients was
    0.4% (4/978).
    Conclusions: These results reveal a high prevalence (6.7%) of CT-
    positive patients among French women seeking induced abortions.
    A cost-effectiveness study is required to evaluate this screen-and-
    treat policy.

Philippe Lefèbvre

Speeches:

Patricia Lohr

Speeches:

Mette Løkeland

Speeches:

Lena Luyckfasseel

Speeches:

Galina Maistruk

Speeches:

Jaana Männistö

Speeches:

Lena Marions

Speeches:

Natalie McDonnell

Speeches:

  • close

    The Situation in the Republic
    of Ireland This presentation will set out the basis of
    abortion in law in Ireland and examine recent
    developments pertaining to the manner in which
    Ireland’s constitutionally enshrined ban on
    abortion operates. The application of international
    human rights norms and standards reveal the
    manner in which the ban – and the failure to
    attain legal clarity in relation to its operation –
    provides real opportunities for change. One
    such opportunity arose in the context of A, B,
    C v Ireland, the case taken to the European
    Court of Human Rights in which the Grand
    Chamber of the Court, in 2010, found a breach
    of the Convention in the case of C, due to the
    lack of clarity and the illusory nature of the right
    to access a termination under Irish law where
    there is a real and substantial risk to the life of
    a woman. The options available to the State to
    ensure compliance with the judgment will also be
    explored in this presentation.

MRI Mejia

Speeches:

  • close

    Is there possible sexism in termination of
    pergnancy decision-making?
    Mejı´a, MRI
    Centro de Atencio´n Integral a la Pareja, A. C, Mexico
    In April 2007 voluntary termination of pregnancy (TOP) up to
    week 12 of gestation was legalised in Mexico City. Since its
    decriminalisation we have observed at least four hegemonic
    attitudes in male sexual partners with respect to reproductive and
    contraceptive decision-making in the medical services of Centro
    de Atencio´n Integral a la Pareja, A. C: (i) those who go with their
    partner and support the decision; (ii) the ones who decide and
    pressure their partner, (iii) those who do not support the decision
    and do not go with their partner in order to prevent her from
    having an abortion and (iv) those who do not support the
    decision but who go with their partner.
    There is insufficient research on the subject of males’ role in
    reproductive decision-making and its implications on males’
    subjectivities and in their partners’ bonding. This study responds
    to the following questions: In what circumstances do men support
    or deny women’s decision-making? What is the perception of
    women regarding their partners’ participation in the process?
    Within the context of legalisation and in light of new ways of
    sexual and loving bonding practices, is it important to integrate
    males and create friendly services that allow people to express
    their needs and emotions without abuse. Is it fundamental, as
    well, to review their contributions to the process of women’s
    citizenship within this context? This study acknowledges the
    fundamental role of men in the processes undergone by women,
    despite the lack of services to integrate and strengthen the
    democratic advance in equity contexts.

  • close

    Taking care of teenage termination of pregnancy
    during the second trimester of pregnancy with
    solidarity
    Zavala, AMC; Mejı´a, MRI; Zavala, AMC
    Centro de Atencio´n Integral a la Pareja, A. C, Mexico
    If we think that termination of pregnancy (TOP) within the
    second trimester is only an issue of public policy or legality, we
    would minimise a more complex problem of a sexual modern age.
    If we consider that TOP within the second trimester of pregnancy

    presents a higher morbi-mortality risk than the first trimester of
    pregnancy, we could think that it is urgent to create alternative
    spaces to facilitate access to services for a teenage population. It is
    also urgent to train well prepared professionals to prioritise this
    topic within the present conditions of poor countries or emerging
    citizenships with sensibility. However, the tendency of legal
    openness–modern and conservative–has set important limits in
    order to reduce this phenomenon. Most research focuses on
    service providers and moral codes that rule contemporary science
    instead of focusing on the women who take advantage of those
    services. In this paper we will present the results of a qualitative
    and quantitative analysis of 100 teenagers who had a TOP in both
    clinics of the Centro de Atencio´n Integral a la Pareja, A. C. during
    the second trimester within a legal context where a woman’s
    decision is only possible up to week 12. This will lead us to
    discuss and contribute the teenagers’ experiences living in contexts
    of vulnerability which include legal restrictions, stigmatisation,
    and a lack of recognition of women as people in charge of their
    lives and sexuality.

C. Melville

Speeches:

  • close

    Interval insertion of IUDs after induced termination
    of pregnancy: do women come back?
    Melville, C; McInally, J; Struthers, G; Crombie, A
    NHS Ayrshire & Arran, UK
    Background: Long-acting reversible contraceptive methods are
    recognised as the most effective methods of contraception. Our
    termination of pregnancy (TOP) service offers IUD insertion at
    the time of surgical TOPs however IUD insertion is not available
    at the time of medical TOP. In 2010 we launched a post-TOP
    IUD fitting service. Women are offered an appointment 28 days
    after their medical procedure in line with FSRH guidance. We
    reviewed this service in order to inform future provision and to
    determine whether women would return for this appointment.
    Methods: A retrospective review of cases was performed using the
    electronic patient record (Eclipse) and the ward appointment
    diaries. The number of IUD appointments arranged, the number
    of patients who attended, and the type of IUD inserted were
    collected for the first 12 month period of the service (January–
    December 2010).
    Results: In the first year of the service, 76 IUD fitting
    appointments were made for women after induced TOP. Of these
    76, 29 women attended (38%). The DNA (did not attend) rate
    was 62%. Nineteen IUS devices were inserted and 10 copper
    IUDs.
    Conclusion: Although the DNA rate of 62% is high, this is
    reflected in other similar services and for other follow up
    appointments after induced TOP. Ideally, IUD insertion would be 

    available at the time of all induced TOPs, however with our
    current staffing model this is not possible. To increase attendance
    at the IUD service, we recommend using a text reminder service.

Lucy Michie

Speeches:

  • close

    Asurvey of attitudes of staff working within a
    sexual and reproductive health centre, towards
    undertaking early medical termination of
    pregnancy
    Michie, L1,2; Cameron, S1,2
    1 Chalmers Sexual Health Centre, Edinburgh, UK; 2 University of
    Edinburgh,UK
    Introduction: In Scotland, most termination of pregnancy (TOPs)
    are provided in hospital departments of Obstetrics and
    Gynaecology. Since high quality contraceptive provision should be
    integral to TOP, this raises the question of whether TOP services
    would be better provided by clinicians in community sexual and
    reproductive health services (SRH). We aimed to determine views
    of these clinicians about potentially offering TOP services

    Methods: An anonymous internet questionnaire of staff working
    in a large SRH service in Edinburgh (Chalmers) was conducted
    between January and March 2012. The questionnaire consisted
    mainly of ‘drop-down’ list options with additional free text
    response to some questions.
    Results: A 69% response rate was obtained. (62 out of 90;
    doctor = 22, nurses = 25, admin staff = 15). The majority of
    responders (69%) felt that provision of abortion services would be
    a natural extension to existing services and the majority, (69%)
    would be personally willing to provide abortion care. Only 11%
    stated that they would refuse to be involved in TOP care due to
    moral objections. Respondents agreed that TOP care from this
    setting would offer advantages for women including better
    provision of contraception (71%) and better management of
    sexual infection (53%), amongst others. Only 23% of responders
    (n = 14) felt there would be some disadvantage to offering
    abortion services from this setting.
    Conclusion: Most staff felt that providing TOP services within a
    community SRH service is a natural extension to existing services
    and that this would offer improved contraception and sexual
    health care to women undergoing TOP.

  • close

    Asurvey of professionals in sexual and
    reproductive health in the United Kingdom, about
    attitudes towards provision of termination of
    pregnancy care within community sexual and
    reproductive health (SRH) clinics
    Michie, L1,2; Cameron, S1,2
    1 Chalmers Sexual Health Centre, Edinburgh, UK; 2 University of
    Edinburgh, UK
    Introduction: In the UK, termination of pregnancy (TOP) services
    are predominantly based within National Health Service hospitals.
    However, community based sexual and reproductive health (SRH)
    clinics that provide specialist contraceptive services could offer an
    alternative setting and may provide high quality on-going
    contraception. We sought to determine the attitudes of those
    working within SRH towards participating in TOP and views on
    which setting is most appropriate for TOP care.
    Methods: A questionnaire was distributed to attendees at a large
    UK sexual and reproductive health scientific meeting in April
    2012. Information obtained included demographics, respondents
    current experience of TOP care and their response to a series of
    statements concerning, attitude and willingness to participate in
    and location of TOP care.
    Results: An 82% response rate was obtained (165 of 200). Eighty-
    eight percent (n = 146) of respondents were female. Ninety-five
    percent (157) were doctors and 4% (6) were nurses. Almost all
    responders already had some involvement in TOP care (97%
    n = 160); 78% (29) refer patients on to hospital TOP services,
    64% (106) assess patients and provide information, 62% (103)
    sign documents authorising TOP and 14% (24) undertake the
    procedure or administer medication. Whilst 78% (128) agree TOP
    care services (for 1st trimester, uncomplicated cases) would be
    best suited to community SRH, 51% (83) believe it should be
    divided across community, hospital and charity services.

    Conclusion: The overwhelming majority of doctors and nurses in
    SRH agreed that abortion services would be best delivered from a
    community SRH setting and would be willing to participate in
    providing this service.

Elizabeth Miller

Speeches:

Caroline Moreau

Speeches:

Raymonde Moullier

Speeches:

N. Mullin

Speeches:

  • close

    Do women attending a termination of pregnancy
    clinic wish to see the ultrasound scan image of
    their fetus?
    Mullin, N; Prabakar, I
    Countess of Chester Hospital NHS Foundation Trust, UK
    Objective: In our National Health Service termination of
    pregnancy (TOP) clinic we have noticed an increasing number of
    women and their partners asking to look at the ultrasound screen
    during their gestational dating scan and some women have also
    asked for a photograph.
    Method: A prospective pilot study was carried out to discover
    more about our patients’ wishes and their experience of
    ultrasound during their pre-abortion consultation.
    Results: Over 3 months, 53 questionnaires were returned,
    response rate 47% (53/112). All women who completed a
    questionaire had a first trimester TOP, mean age 25 years, range
    15–44 (women with a miscarriage were excluded). The majority of
    respondants, 94% (50/53) were expecting a scan; 32 women
    (60%) did not want to view the ultrasound image or have a

    photograph. The remaining 20 women (one did not respond) said
    they wished to view the image but only seven women actually did
    look at the ultrasound screen, and nine women wanted a
    photograph (median age 19 years, range 16–23). All the women
    were satisfied with the way the scan was carried out and with
    their care.
    Conclusions: Generally women do not want to see an image of
    their fetus when they attend a TOP service. However, a minority
    of younger women would like the opportunity to look at the
    image and this should be allowed as it may be helpful to some
    women. We now inform clients that they may look at the
    ultrasound screen if they wish; a partner may view the screen only
    with the woman’s permission. We do not provide a photograph
    due to cost.

  • close

    Who refuses chlamydia screening in a termination
    of pregnancy clinic?
    Mullin, N; Robinson, K; Carter, J
    Countess of Chester Hospital NHS Foundation Trust, UK
    Background: National United Kingdom guidelines recommend all
    women requesting a termination of pregnancy (TOP) are screened
    for Chlamydia Trachomatis (CT) infection beforehand. Two years
    ago in our hospital we had a gravely ill woman with a post-TOP
    pelvic infection, and after a significant event analysis the staff were
    trained to become more effective in offering screening to all
    women.
    Objectives: To audit the documented offer, uptake and refusal of
    CT screening pre-TOP.
    Method: Retrospective case notes review.
    Results: In 12 months, 471 women attended the pre-assessment
    (pre-TOP) clinic, age range 14–48 years, 250 (53%) were under
    24 years. All clients had a documented offer of CT screening,
    including women whose pregnancy was found to be non-viable or
    who decided to continue with their pregnancy. There were 143
    women who declined a test in clinic and in 68 (50%) cases there
    was a documented CT test taken prior to attending the TOP
    service. Of the remaining 75/471 (16%) clients (mean age
    25 years, range 16–43) these women mostly (94%) declined
    screening because they were in a long term relationship or had
    recently been tested in a new relationship.
    Conclusion: Despite staff strongly recommending CT screening to
    all women attending our TOP service, one in six women decline.
    However, this appears to be a self selected low risk group of
    women. No severe post-TOP infections have occured in our
    service recently (universal antibiotic prophlaxis is given as well as
    screening). Further work is needed to encourage referring agencies
    to offer CT screening at the first discussion of pregnancy options
    to ensure maximum uptake.

I. Nisand

Speeches:

  • close

    Medical management of unwanted pregnancy in
    France: modalities and outcomes. The aMaYa study
    Nisand, I; Bettahar, K
    Gynaecolgy Department CHU Strasbourg, France
    Background/Methods: Since WHO recommendations in 2003, the
    use of medical termination of pregnancy (MToP) has become
    wider in Europe, particularly in France where it concerns more
    than 50% of TOPs. However, there are still different practices
    according to various guidelines or drug approvals. Following the
    recent update of French recommendations (December 2010), a
    new observational study was performed to assess in real life
    modalities and outcomes in mToP.
    Results: One thousand five hundred and eighty-seven women
    (mean age: 27.6 ± 6.8; minor: 3.3%) were included by 48 French
    specialised centres from September 2011 to April 2012. At the
    inclusion, when women were given mifepristone, the gestation of
    pregnancy was £49 days of amenorrhoea (DA) for 71.7% of
    patients and >49 DA for 28.3% with >63 DA for 2.1%. Most of
    the time pregnancy dating was done by ultrasound. The most
    frequently used protocol was the one recommended by the French
    authorities (mifepristone 600 mg-misoprostol 400 lg oral) and
    concerned 35.4% of patients. But other protocols were given
    (mifepristone 600 or 200 mg in association with misoprostol
    800 lg) for respectively 23.4% and 13.5%. Gemeprost
    prostaglandin was used by 1.4% of patients only.
    Eighty-one percent of patients attended the follow-up visit
    3 weeks after inclusion. There was no ongoing pregnancy although
    10% of patients were lost to follow-up. Successful abortion rate
    was 94.4%, 5.6% of patients requiring a secondary surgical
    procedure. Seventeen serious adverse events (1.1%) were reported
    (mainly major bleeding).
    Conclusion: Although a relatively wide range of therapeutic
    strategies in MToP, this study emphasises a satisfactory success
    rate of 95% strongly consistent with the literature.

C. O’Callaghan

Speeches:

  • close

    Te Mahoe Unit-Wellington NZ-an overview
    O’Callaghan, C
    Te Mahoe Unit, Wellington, New Zealand
    The poster will contain an overview of the Te Mahoe Unit which
    is the Early Pregnancy Counselling and Termination Unit in
    Wellington, New Zealand.
    There will be a brief description of the New Zealand law with
    regard to termination of pregnancy (TOP). The referral process
    and certification process will also be explained.
    All procedures that are provided will be described e.g. surgical
    termination with local anaesthetic and conscious sedation up to
    14 + 5 weeks of gestation — early medical termination with
    miferistone and misoprostol up to 9 weeks of gestation.
    A section on products of conception and what happens to
    them. Some explanation around Maori cultural beliefs.
    Also nursing care, after care, on call issues and statistics. The
    latest complication rates and causes of same.
    Finally, law reform issues and looking to the future.

M. Olver

Speeches:

  • close

    What is the outcome of pregnancies that continue
    following administration of mifepristone?
    Olver, M; Scherf, C; Noble, N
    Cardiff and Vale NHS Health Board, UK
    Introduction: The number of medical terminations of pregnancy
    (TOPs) in England and Wales in 2010 compared with the year
    2000 shows an 8% increase. Despite the rapid increase there is
    little published evidence regarding the risks to a continuing
    pregnancy after mifepristone administration.
    Objectives: To investigate the outcome of all cases of continuing
    pregnancy after administration of mifepristone +/- misoprostol in
    the Cardiff and Vale University Health Board over a period of
    4 years.
    Methods: A retrospective case note review of all women with
    unplanned pregnancies who wished to continue their pregnancy
    after administration of mifepristone. Women were identified by
    non-attendance or cancellation for misoprostol, follow-up cases
    and searching antenatal records. The review period was 2007–2011.
    Results: Twenty cases of continuing pregnancies were identified.
    Of these, 10 resulted in live birth, five in miscarriage, two were
    lost to follow-up and three needed a second TOP procedure (one
    of them was given Clause E, fetal abnormality).
    Conclusion: This case series shows the most common
    complication following mifepristone administration is miscarriage
    in the first trimester. Those pregnancies leading to live birth did
    not result in adverse fetal outcomes. However, due to the small
    sample size, damage to the fetus cannot be ruled out and
    therefore close monitoring throughout pregnancy should be
    performed. This detailed case review highlighted the need for
    more work in this area to enable clinicians to provide correct
    advice to women in these difficult situations.

Mirella Parachini

Speeches:

Mandira Paul

Speeches:

G. Preti

Speeches:

  • close

    Who consults for an emergency pill? Survey about
    users profile. Comparison between 2008 versus
    2011 at the sexual and reproductive health and
    family planning centre, Geneva’s University
    Hospital, Switzerland
    Preti, G1,2; Bettoli, L1,2
    1 Unite´ de sante´ sexuelle et de planning familial de Gene`ve;2 Association Romande et Tessinoise des Conseille`res en Sante´ Sexuelle
    et reproductive (ARTCOSS), Suisse
    Context: In Switzerland, the sexual health and family planning
    centres ensure the provision of the emergency pill (EP) at reduced
    cost with relevant counselling on sexual and reproductive health
    (SRH) matters.

    Which kind of profile do women visiting for the emergency pill
    at the SRH centre in Geneva have? Can we observe an evolution?
    Methods: The first survey took place in 2008 and was repeated in
    2011. Both occurred in the months of December and January
    (2008: 139 women, 2011: 90 women).
    Conclusions: The age of women requiring EP at the SRH centre
    was between 14 and 30 years with a majority of women aged
    between 16 and 17. Younger women often visit Geneva’s centre
    with a friend or a partner. Seventeen percent of all women visit
    with their partners.
    Lack of contraception is the main reason for EP requests with
    40% prevalence, second in line of all requests is condom failure at
    39%.
    Women from other countries have a higher percentage request
    for non-use of contraception than Swiss women.
    Approximately a third of the situations have complex psycho-
    social elements.
    Between 2008 and 2011, we observed an improvement in time
    lapses between sexual risk and the EP requests (within 12 hours:
    22% in 2011, against 9% in 2008). Also, there are fewer repeated
    EP requests when comparing the second survey with the first.
    In 2011, we observed that at least 11% of surveyed women had
    had repeated unprotected sex, before and after their EP request.

Christian Prizac

Speeches:

M. Rajic

Speeches:

  • close

    Termination of second trimester pregnancies with
    mifepristone and misoprostol
    Rajic, M; Vrhkar, N; Stritar, BS; Tul Mandic, N
    Division of Gynaecology and Obstetrics, Department of Perinatology,
    University Medical Centre Ljubljana, Ljubljana, Slovenia
    Objective: To evaluate the safety and efficacy of termination of
    pregnancy (TOP) for medical reasons (structural fetal congenital
    anomalies, fetal chromosomal abnormalities, intrauterine fetal
    death, early preterm prelabour rupture of membranes) using
    mifepristone and misoprostol (MI-MI) between 11 and 22 weeks
    of gestation.
    Methods: We collected data from all women requiring TOP with
    MI-MI for medical reasons. The protocol consisted of 200 mg of
    mifepristone orally, 36–48 hours later 800 lg of misoprostol
    vaginally, followed by 400 lg buccally every 3 hours until TOP
    (maximum of four doses in 24 hours). If the placenta was
    retained, uterotonics were adminsitered, and a decision was made
    whether to evacuate the uterus surgically. The data were analysed
    using the statistical software program SPSS, version 18.
    Results: A total of 435 women were enrolled in the study (we
    analysed 157 cases, the remainder will be analysed by the
    beginning of FIAPAC Conference 2012). The mean gestational age
    was 16.5 weeks. For 58 (36.9%) women this was their first
    pregnancy. The method was successful in 156 (99.4%) cases. The
    average time interval from the beginning of the procedure till
    TOP was 47.3 hours (13.8–168 hours). The average duration of
    hospital stay was 39.3 hours (25.0–167 hours). In 40 (25.5%)
    cases surgical evacuation of the uterus after TOP was performed.
    Conclusions: The use of MI-MI is safe, effective and non-invasive
    regimen for TOP for medical reasons between 11 and 22 weeks of
    gestation.

Matthew Reeves

Speeches:

Åsa Regnér

Speeches:

Anne-Marie Rey

Speeches:

Sam Rowlands

Speeches:

Vicki Saporta

Speeches:

Irina Savelieva

Speeches:

Giovanna Scasselatti

Speeches:

  • close

    Activity of a termination of pregnancy department
    Scassellati, G; Bologna, M; Di Felice, M;
    Valeriani, D
    San Camillo Forlanini Hospital, Rome, Italy
    Termination of pregnancy (TOP) has been carried out in our
    hospital since 1978, the year in which TOP became legal in Italy.
    Our department is one of the most important TOP departments
    in Rome: during 2011, 2098 women were admitted to our hospital
    for a TOP, almost 30% of TOPs performed in the Lazio region. It
    is also the only hospital in Rome to use pharmacological TOP
    (mifepristone).
    Our department provides a complete service for women in the
    event of unwanted pregnancy. Besides the clinical activity, we
    guarantee psychological support during all the phases of a TOP.

    Since 2001, with the increase of the number of TOP requested
    by immigrant women, our department established a service of the
    so-called ‘intercultural mediation’ with the aim of preventing
    unwanted pregnancy and spreading the regular use of
    contraception among immigrants.
    A relevant part of our activity is dedicated to the clinical
    follow-up of women to ensure counselling and to encourage and
    help them to use a contraceptive method. We also ensure
    gynaecological consultation, a specific space for reproductive
    health care, with the aim of reaching women with difficulty
    accessing gynaecological treatments (women with lower level of
    education, housewives, immigrants) and to facilitate their access
    to public hospitals.

Raha Shojai

Speeches:

Audrey Simpson

Speeches:

  • close

    The situation in Northern
    Ireland
    Abortion is legal in Northern Ireland but only in
    very restricted circumstances. Rape, incest and
    fetal abnormality are not grounds for an abortion.
    Women and girls resident in Northern Ireland with
    a crisis or unplanned pregnancy who decide to
    end their pregnancy have to travel to England
    and other European countries and pay for a
    private abortion. Despite being UK citizens they
    are not entitled to a free abortion in Britain unlike
    women resident in Britain. This presentation will
    explore the financial, practical and emotional
    consequences of this denial of sexual rights and
    the political dynamics which underpin this denial.

Susheela Singh

Speeches:

Régine Sitruk–Ware

Speeches:

  • close

    Update on contraceptive
    developments Although contraceptive use showed a steady
    increase worldwide, the needs of a significant
    percent of couples have not yet been met, as
    unscheduled pregnancies increased.
    While implants and IUDs require a health provider
    for a proper insertion, vaginal rings, a mid-acting
    method, have the advantage of being user-
    controlled. While long-acting methods seem
    preferable for women with compliance issues,
    daily transdermal gels or sprays have shown high
    acceptability as the methods can be used privately.
    Progesterone receptor modulators (PRMs) to be
    used within 120 hours of unprotected intercourse
    have a definite role as emergency contraceptives.
    Continuous low-dose administration of a PRM
    from a vaginal ring has been shown to block
    ovulation and induce amenorrhoea.
    Contraceptives combined with other agents
    should provide dual protection against both
    pregnancy and another preventable conditions.
    Dual protection methods are tested as vaginal
    gels or rings delivering both a contraceptive and
    an agent active against HIV transmission. In
    addition, the potential of PRMs to prevent breast
    cell proliferation or the neuroprotective effects
    of progesterone and derived molecules are new
    areas of research for contraception with added
    medical benefits. These dual-purpose methods
    may increase users’ compliance, thus reducing
    failures and unwanted pregnancies.

    Men now tend to accept responsibility for the
    couple’s fertility control, leading to a growth in male
    contraceptives needs. Non-hormonal methods
    for men target the maturation of germ cells, or the
    sperm motility and activity. Novel approaches in
    women target meiosis as well as genes involved
    in follicular rupture. These methods will hopefully
    enter clinical testing during the current decade.

Margaret Sparrow

Speeches:

  • close

    Abortion then and now: New Zealand Abortion
    stories 1940–1980
    Sparrow, M
    Istar Limited, New Zealand
    Based on a social history book by Dame Margaret Sparrow
    available from Victoria University Press www.victoria.ac.nz/vup/.
    In the 1940s deaths from septic termination of pregnancy
    (TOP) were an ever-present fear.
    In the 1950s, due to antibiotics, deaths were less common but
    there was a network of clandestine abortionists.
    In the 1960s the contraceptive pill and feminism brought
    changes for women but New Zealand and Australia did not follow
    the 1967 law changes introduced in the UK. Those who could
    afford it went overseas.
    In the 1970s TOP was catapulted into the public arena with
    protest and debate bringing significant law changes in 1977–78.
    Finally doctors took responsibility for safe TOP services.
    From the years when illegal TOP was usually the only option
    for women, the author has collected personal stories from some
    70 contributors, women who had a TOP, doctors, police and
    activists. Some of the stories relate to women from New Zealand
    struggling with accessing abortion while living in the UK.
    The themes are universal and remind us that these injustices
    must never return.

Wattana Sripotchanart et al.

Speeches:

  • close

    Development of a post-termination of pregnancy
    care model
    Sripotchanart, W1; Chunuan, S1; Lawantrakul, J1;
    Pongpaiboon, P1; Lawantrakul, J2; Kosalwat, S1;
    Kritcharoen, S1; Buranasiri, L2
    1 Prince of Songkla University, Thailand; 2 Hatyai Hospital, Thailand
    This participatory action research (PAR) was aimed to (i) develop
    the post-termination of pregnancy (TOP) care model for women
    after a TOP and (ii) examine the obstacles in implementing the
    developed model for women after a TOP.

    The research processes were divided into four steps based on
    the PAR model: (i) assessing the existing care model and planning
    to develop the initial model; (ii) developing and implementing the
    developed model; (iii) revising the initial model to meet the needs
    of women after a TOP; and (iv) evaluating the results. The sample
    consisted of 12 nurses at a hospital in Southern Thailand and 60
    women after a TOP. Open-ended questions were used to collect
    data among these women. In-depth interviews, focus group
    discussion, and participant observations, were also used. Personal
    data and qualitative data were analysed by using descriptive
    statistics and content analysis, respectively. It revealed that the
    post-TOP care model for women after a TOP was a holistic care
    model comprising building an impressive relationship, having
    positive attitudes, giving advice and counselling and providing
    continuous care to meet the needs of women after a TOP. The
    identified obstacles of the model implementation were the nurses’
    overwork, stress, and weariness.
    In conclusion, in this participatory action research led nurses to
    recognise the importance of holistic care, have better attitudes
    towards women after a TOP and improve their service of giving
    advice and counselling by using the instructional media.

Alberto Stolzenburg

Speeches:

  • close

    Recent developments in Spain
    Recent events and the legal, police, political
    and social developments that have taken place
    in Spain in recent years are part of a global and
    conservative campaign and have generated in the
    new political context of this country vast concern
    for the rights of women regarding equality and
    sexual and reproductive health.
    The various recent historical stages are
    discussed, from the Second Republic (1936-
    1939) and the military dictatorship of Franco
    (1939-1975) to democracy (1975-2012)
    in relation to the legislation and practice of
    induced abortion, in particular highlighting the
    achievements and shortcomings of the Abortion
    Law of 1985 and the current Law on Sexual and
    Reproductive Health and Voluntary Termination of
    Pregnancy, in force since July 2010.
    The current political situation is described, with a
    Conservative Government and absolute majority
    in Parliament, and the statements of its main
    representatives regarding the change of the current
    law until end of year. Furthermore, we also present
    the upcoming trial of professionals from an abortion
    clinic in Barcelona and the attempt by retrograde
    sectors and anti-choice groups to use this case to
    put pressure on the Government and public opinion
    in favour of a radical restriction of the right to abortion.

Satu Suhonen

Speeches:

  • close

    Post-abortion contraception:
    start immediately
    Contraceptive failure - unprotected sex or failure
    in use of the chosen contraceptive method or use
    of an ineffective method - leads to unintended
    pregnancy. Most women choose abortion in this
    situation. Avoiding the same incident in future, that is
    reducing the risk of repeat abortion, is in the interest
    of the woman and also the society both medically,
    psychologically, socially and economically. Including
    contraceptive counselling in post-abortion care is
    important and emphasized also in recent guidelines
    (WHO, RCOG). However, counselling itself has not
    been shown to have a beneficial long-term effect on
    contraceptive use and risk of repeat abortion.
    Recovery of ovarian function after abortion is
    rapid, ovulation occurs within the first month after
    abortion in most women. Thus contraception
    should be started as early as possible after
    abortion. Immediate start of both hormonal
    (pill, patch, ring) and also long-acting reversible
    (LARC) methods (implant, injection, intrauterine
    contraception) is recommended in the above
    mentioned guidelines. After medical abortion
    LARC using implants, injections can be started on
    the day of abortion, intrauterine contraception as
    soon as an on-going pregnancy is excluded. There
    is evidence that if after abortion a LARC method
    is chosen, the risk of repeat abortion is reduced.
    Well-functioning, easy-access contraceptive
    services are important in the follow-up.

Allan Templeton

Speeches:

James Trussel

Speeches:

Tamuna Tsereteli

Speeches:

Joke Vandamme

Speeches:

L. Vicente

Speeches:

  • close

    Termination of pregnancy at women’s request in
    Portugal – data from the national registry
    2008–2011
    Vicente, L; Henriques, A; Almeida, T; Freire, A;
    Nogueira, P; Ramos, M
    Directorate General of Health, Portugal
    Termination of pregnancy (TOP) at women’s request was legalised
    in Portugal up to 10 weeks of gestation, in June, 2007. All public
    and private services that deliver TOP care are recorded in a
    national web-based database. It is a record of episodes of TOP
    and not a register of users, in which anonymity and
    confidentiality is guaranteed, to be used for statistical purposes of
    public health. Induced TOP at a woman’s request represent 97%
    of all legal induced TOPs. Sociodemographic charactristics of the
    users, distribuition by time of the procedure and contraception
    after TOP, will be presented and analysed. In Portugal more than
    65% of terminations are performed within the National Health
    Service (NHS), where medical TOP is mainly used (96%). Annual
    variation of the induced TOP at women’s request: the largest
    annual growth occurred between the years 2008 and 2009 – with
    an increase of 6.7%. Between 2009 and 2010, the variation was
    1.8% and 1.2% between 2010 and 2011.

Helena von Hertzen

Speeches:

Andrew Weeks

Speeches:

Tracy Weitz

Speeches:

Ellen Wiebe

Speeches:

  • close

    How can we best train primary care providers to
    insert IUDs?
    Wiebe, E; Trouton, K; Malleson, R
    University of British Columbia, Canada
    The purpose of this study was to determine how best to train
    primary care providers (PCP) to insert IUDs. This was a mixed
    method study with interviews and questionnaires of family
    physicians and nurse practitioners who presented for training in
    three different settings: at a 1-hour workshop, a one-on-one
    20 minute training at an exhibit booth or a 4-hour session in-
    clinic with patients. Questionnaires were completed at the time of
    the training and a convenience sample was interviewed 2–
    12 months later. The interviews were audio-taped and transcribed.
    On-going theme analysis was done and the interview guide was
    changed to explore some themes in more depth in subsequent
    interviews. A total of 71 PCPs completed questionnaires at the
    time of IUD insertion training and 19 of these were interviewed
    2–12 months later. The questionnaires revealed a significant lack
    of knowledge and skills; for example, 52% had inserted no IUDS
    in the past and 65% had never recommended an IUD to women
    <21 years of age. In the interviews, 16/19 PCPs said the training
    allowed them to start or to increase IUD insertions and 7/19 were
    now taking referrals from other clinicians. The barriers they
    identified included the lack of numbers in primary care, lack of
    support by colleagues and lack of equipment. Many said they
    would like more support after the training. From this study, we
    now have more information about how to improve knowledge
    and skills training and support for PCPs who wish to insert IUDs
    in their practices.

  • close

    Misconceptions about termination of pregnancy
    risks in pro-choice and anti-choice women having
    terminations
    Wiebe, E1; Littman, L2
    1 University of BC, Canada;2 Mt Sinai School of Medicine, USA
    Misinformation that exaggerates the risks and sequelae of
    pregnancy termination is common. The purpose of this study was
    to answer the following research question: Do anti-choice women
    having a termination of pregnancy (TOP) differ from pro-choice
    women having TOPs in their knowledge about health risks
    associated with TOP? This was a questionnaire survey of women
    having TOPs in an urban free-standing TOP clinic. The
    questionnaire was given to women when they arrived for their
    first clinic appointment and asked about women’s knowledge,
    attitude to TOP, where they received their information as well as
    demographics. Women with anti-choice attitudes were compared
    to pro-choice women with respect to their knowledge of risks. In
    228 completed questionnaires (94% response rate), 75% of
    surveyed women said that one first trimester TOP had greater or
    equal health risks compared to childbirth, 7% said that TOPs
    increases the risk of breast cancer, 29% said TOP increases the
    risk of depression and 26% said that TOP increases the risk of
    infertility. When asked about their attitude to pregnancy
    termination, 35% women said that there were reasons why some
    women should not be allowed to have a TOP. These anti-choice
    women were more likely to believe that TOP caused infertility
    (40% vs. 17%, P = 0.001) and more likely to believe that women
    had more depression after a TOP than childbirth (39% vs. 25%,
    P = 0.03). From this study, we concluded that misinformation
    about the risks of TOP is common in women having a
    termination and anti-choice women have more misconceptions
    about the risks than pro-choice women.

Eckart Wilding

Speeches:

Beverly Winikoff

Speeches:

Jennier Woodside

Speeches: