Anna Glasier


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    Bridging Hormonal emergency contraception prevents
    between one half and two thirds of pregnancies.
    Traditional on-going methods of contraception are
    far more effective. A consultation for emergency
    contraception (EC) should therefore be regarded
    as an opportunity to provide women with an
    on-going method of contraception which will
    prevent pregnancy more effectively than repeated
    use of EC. The on-going method is best started
    immediately to prevent pregnancy immediately
    including those resulting from further acts of
    unprotected sex in the cycle in which EC was
    used (so-called bridging).
    In most European countries most women now
    get EC from pharmacies over (or behind) the
    counter. Pharmacists are unable to provide
    on-going effective contraception without a
    doctor’s prescription and a mystery shopper
    study undertaken in Edinburgh demonstrated
    that most pharmacists give little or no advice
    about bridging. Even when EC is issued by a
    health professional who can provide an on-going
    method, a disappointingly low number of women
    are provided with an effective bridging method.
    Strategies to enhance bridging from EC to an
    effective on-going method need to be developed
    and tested.

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    Royal College of Obstetricians and Gynaecologists Leading Safe Choices Project: An overview

    Anna Glasier1, Alison Glasier2
    1University of Edinburgh, Edinburgh, UK, 2Royal College of Obstericians and Gynaecologists, London, UK

    Obstetricians, gynaecologists and allied healthcare workers are in an ideal position to improve the provision of family planning and abortion services, but sadly these services are often regarded as low priority. The Royal College of Obstetricians and Gynaecologists (RCOG), with 14,000 members worldwide, is in an ideal position to influence both clinical practice and the attitudes of the profession. The RCOG Leading Safe Choices (LSC) initiative aims to put the evidence into practice by strengthening the competence and raising the standing of family planning and abortion care professionals. In collabouration, initially with colleagues in South Africa and Tanzania, the initiative aims to promote best practices in postpartum contraception and comprehensive abortion care (CAC) in South Africa, and comprehensive postabortion care (CPAC) in Tanzania. A three-pronged approach is being taken.

    1. Evidence based, practical Best Practice Papers on postpartum family planning and comprehensive, and postabortion care have been developed and disseminated.
    2. Short, intensive theoretical and skill training courses have been developed based on the best practice papers, with subsequent ‘on-the-job' training and supportive supervision.
    3. The initiative aims to support professionalisation of family planning and CAC/CPAC services through certification and accreditation.

    The Leading Safe Choices Initiative is now well underway in South Africa and the outcomes of the programme are being monitored and evaluated to determine impact. Development of training materials continues as lessons are learnt along the way. Progress is being made in establishing the initiative in Tanzania. Barriers to successful implementation are being addressed with enthusiasm for the initiative but remain a challenge. Leading Safe Choices has stimulated the RCOG to look closely at both postpartum contraception and the delivery of abortion services in the UK.