Gunilla Kleiverda


  • close

    Abortion care over the Internet: New options for women

    Rebecca Gomperts (The Netherlands)


    Unsafe abortion causes the death of 70 000 women every year. 1 in 300 women undergoing an unsafe abortion dies. These death are totally preventable. Medical abortion with Mifepriston and Misoprostol has a mortality risk of less than 1 per 500.000.

    Women on Web is a service which uses telemedicine to help women access mifepristone and misoprostol in countries with no safe care for termination of pregnancy (TOP). After an online consultation, women with an unwanted pregnancy of up to nine weeks are referred to a doctor. If there are no contraindications, a medical TOP is conducted by mail. The presentation will discuss the impact of the online abortion help service by looking at women’s acceptability, efficacy and curettage vacuum aspiration rate after the medical abortion.

  • close
    More medical abortion but high secondary intervention rates in an alternative abortion setting in the Netherland

    Gunilla Kleiverda, MD, PhD, gynaecologist and Elles Garcia, MD, Flevoziekenhuis, Almere, Netherlands

    Abortion clinics provide the vast majority (94%) of abortions in the Netherlands. Of the 11807 first-trimester abortions performed in 2008, 10% were medical abortions, the remaining 90% instrumental procedures.

    In Almere, a vast-growing city close to Amsterdam, no traditional abortion clinic is present. The local Flevoziekenhuis started therefore an out-patient abortion clinic as a satellite in 2008. The clinic, not located in the hospital, offers possibilities of medical and instrumental abortion, and anonymous and non-anonymous care. Non-anonymous instrumental abortion up to 12-14 weeks is performed in the Flevoziekenhuis. For anonymous abortion and abortion after 12-14 weeks gestation, women are referred to abortion clinics in Amsterdam.

    Women were referred either by their general practitioner or by self-referral. In the first year, 616 patients were seen. 127 did not have a termination of pregnancy, because a decision to keep the pregnancy, because of not being pregnant or a non-viable pregnancy. 56 women were referred to abortion clinics because of the wish to have an anonymous treatment or advanced gestational period.

    Of the remaining 435 women, 239 (55 %) had a medical abortion, 196 (45%) had an instrumental first trimester abortion. The percentages of women who requested a medical abortion was high compared to national figures. However, rates of secondary aspiration were high as well, 35 (14.6%) in the medical abortion group, 5 (2.6%) in the primary aspiration group. Patient and health-care characteristics related to this high curettage risk will be presented and discussed.

  • close

    Why different intervention rates after online medical abortion and why do they matter?

    Gunilla Kleiverda, gynaecologist, Women on Waves, Netherlands

    Co-authors:  Kinga Jelinska, project manager Women on Web, Rebecca Gomperts, MD, director of

    Women on Waves

    The online non-profit project Women on Web was set up in 2006 with the aim of increasing access to safe TOP and improving maternal health in countries where TOP is not available without restrictions. The website [] refers women to a doctor who can provide them with a medical TOP using the combined regimen of mifepristone and misoprostol, provided they fill in the online consultation form, meet the specified inclusion criteria and none of the exclusion criteria.

    A previous evaluation of the service provided by Women on Web showed a surgical intervention rate of 13.6%, and after maximizing the follow-up, of 6.8%. We will present data about the follow-up of 2323 women who had a medical TOP and spontaneous start of expulsion from February 2007 to September 2008. Of these women, 289 (12.4%) had an additional surgical intervention

    Intervention rates varied widely by region, from around 5% in Western Europe (mainly Ireland) up to nearly 15% in Eastern Europe (mainly Poland) and Latin America/Caribbean. The differences will be related to patient characteristics, patient’s acceptability.  The reasons and implications of those differences for the medical abortion clinical procedure, public perception of MA and accessibility will be discussed during the presentation.