Speeches
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Sept. 12, 2004, 12:30
WOMEN IN DISTRESS - WO
Part One (Frauennot - Frauenglück, 1. Teil) Sergej Eisenstein´s and Grigori
Alexandrov‘s film Women in Distress – Women‘s Happiness was shot in Switzerland.
The first part of the film takes the plight of women who have unwanted pregnancies
as its theme Texpressive descriptions of the suffering and the deaths of women who
secretly consult a back-street abortionist are contrasted with shots of Zurich
University Clinic, where abortions can be performed safely and without any
problems provided that the abortion is legal for medical reasons.
Switzerland 1929, 40 min, original german version with English and French subtitles
Directors: Sergej Eisenstein, Grigori Alexandrov Camera: Eduard Tissé, Music:
Martin Uhl Production: Lazar Wechslerplus
MR BUSH‘S SECOND CRUSADE (DER ANDERE KREUZZUG DES MR.BUSH)Since 2001, for ideological and religious reasons, the American administration has
cut any financial support for those organisations that defend the right to abortion.
As a consequence, numerous clinics had to be closed, a fact that has made the
situation of women in Kenya become more and more drastic. More than 4,000
women die there annually, due to the catastrophic medical and hygienic
circumstances surrounding illegal abortions in some kind of backrooms.
France and Germany 2004, TV, 12 min, German version Arte report, first broadcast
on June 16, 2004 Director: Ludovic Fessart, ARTE GEIE/Hirkaki Productions -
Sept. 11, 2004, 09:00
More than 15 years of experience – new developments,
Kristina Gemzell Danielsson. MD. PhD, Associate Professor in Obstetrics and Gynecology at the Karolinska Institute, Stockholm, Sweden
Senior consultant in obstetrics and gynecology at the clinic of Sexual and Reproductive Health, Department of Woman and Child Health, Division for Obstetrics and Gynecology.at the Karolinska Hospital, senior research position at the Karolinska Institute sponsored by the Swedish Research Council
Head of the WHO collaborating centre for research in Human Reproduction, Karolinska Hospital, head of the research group at the WHO-centre. Supervisor of 3 PhDs and 9 PhD students. research nurses and laboratory technicians.
Secretary Swedish association of Obstetrics and Gynecology, task force on Family Planning
Board member of FIAPAC (International federation of abortion and contraceptive associates), and ICMA (International consortium of medical abortion)
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Medical abortion with a combined regimen of mifepristone and a prostaglandin analogue was first approved in France in 1988 followed by approvals in the UK and Sweden, and has been used in China since 1992. In China and France medical abortion is used to 49 days amenorrhea. In the UK and Sweden the method is approved to 63 days amenorrhea. Today medical abortion is available in around 30 countries. During the last 15 years since introduction of the method research has focused mainly on the following issues: To find the optimal dose of mifepristone, the optimal type, dose and route of administration of prostaglandin and to increase acceptability of the method
Pharmacokinetic studies have shown that single doses of mifepristone above 100 mg resulted in similar serum concentrations. Randomised controlled trials have shown that 600 mg of mifepristone is equally effective as 200 mg when followed by a sufficient dose and suitable type of prostaglandin. The prostaglandin most commonly used today is misoprostol (Cytotec, Pfizer), a prostaglandin E1 analogue widely available for the prevention of gastric ulcer in patients taking non-steroidal anti-inflammatory drugs. Although licensed for oral use vaginal administration of misoprostol is becoming a common practice in medical abortion. Several clinical studies have found that vaginal administration is more effective than oral administration. When the absorption kinetics was compared between oral and vaginal treatment it was shown that the systemic bio-availability after vaginal misoprostol was three times higher than after oral misoprostol. This was directly reflected in the effect on uterine contractility. A drawback with the vaginal route is the large individual variation in plasma levels suggesting inconsistent absorption through this route. Furthermore most women prefer to take the tablets by the oral route. Recently the new route of sublingual administration has been described. Preliminary studies suggest that sublingual administration is a promising method for medical abortion. This is supported by pharmacokinetic and uterine contractility data indicating that this is probably the most potent route to administer misoprostol in its present form.
Current research also focuses on the possibility to reduce the time interval between mifepristone and misoprostol. Furthermore home administration of prostaglandin has been shown to be safe and effective, to reduce the number of visits to the clinic and to be preferred by many women in both developed and developing countries
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Sept. 10, 2004, 06:30
ABORTED (ABGETRIEBEN)
Based on the sensational trial against gynaecologist Dr. Theissen from the city of
Memmingen, Norbert Kückelmann directed a television film in 1992 in which he
strictly adhered to the legal facts of the case. Dr. Heß, as he is called in the film,
was accused of performing abortions on women who did not provide the legally
required medical consultation certificate. Heß is said to have relied solely on his own
competence to judge these women’s social or psychological difficulties. He is
arrested because of this fact and many of the women on whom he carried out
abortions are questioned about every possible detail in a public trial and are
eventually sentenced, since the court does not acknowledge their reasons as
personal plight.Kückelmann’s film does not so much put forward arguments for or
against abortion. Rather, it conveys a picture of how - being confronted with a sensationalist public - the most intimate feelings are mercilessly exposed in this matter. The sympathy in this film is clearly on the side of those women who havegive evidence before an inhumane male-dominated court.
Germany 1992, 90 min, German versionDirector: Norbert Kückelmann Starring: Hans Zischler, Christine Neubauer, Dominic
Raacke, Axel Milberg, Ruth Drexel, and others -
Sept. 12, 2004, 12:30
CIDERHOUSE RULES (GOTTES WERK UND TEUFELS BEITRAG)
When John Irving adapted his novel of the same name for the screenplay of
Ciderhouse Rules, he compromised to a certain extent by doing without the depth
and details that had previously been part of the humanitarian themes connected
with abortion, incest and responsibility. Nevertheless, Lasse Hallstrom‘s brilliant film,
which was awarded two Oscars, captivates its audience with its sober, Scandinavian,
but also conciliatory focus on the shortcomings, peculiarities and desires of its
characters. Homer (Tobey Maguire), a young man growing up in a Maine orphanage,
is instructed by the director of the orphanage, Dr Larch (Michael Caine), into
medical skills and into how to carry out safe abortions, which are illegal during the
Second World War, though. During an abortion he gets to know Candy and her
friend Wally and joins them in order to get away from the orphanage. He takes a job
on a farm, where he is confronted with violence, but also with love. Dr Larch tries to
get Homer back and wants him to be his successor. Homer, who takes a critical view
of abortion, is thus drawn into a moral conflict and has great difficulty freeing himself from itUSA 1999, 131 min, original version with German subtitles
Director: Lasse Hallstrom Screenplay: John Irving, adapted from his novel of the
same nameCamera: Oliver Stapleton Cut: Lisa Zeno Churgin Music: Rachel Portman Starring:
Tobey Maguire, Michael Caine, Charlize Theron, Delroy Lindo, Paul Rudd and others
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Oct. 4, 2014, 11:00
Getting to hard to reach places: expanding access to rural Nepal through nurse provision of first trimester medical abortion
Alison Edelman1, Kusum Thapa2, Deeb Shrestha Dangol2, Indira Basnett2 1Ipas, Chapel Hill, North Carolina, USA, 2Ipas Nepal, Kathmandu, USA - edelmana@ohsu.edu
In Nepal, abortion was legalized in 2002. It is permitted for any reason to 12 weeks, for rape or incest up to 18 weeks and for maternal or fetal indications at any gestational age. First trimester abortion services became more readily available in 2004. However, Nepal is a country of extremes with mountainous regions that are challenging to access and areas that are impassable at certain times of the year. Health care services are also limited by the number and type of provider. Creating access for women seeking life-saving care such as safe abortion and contraceptive services entails innovative strategies including task sharing. The Nepali Ministry of Health and Ipas have been working to increase abortion access in these hard to reach places. A pilot project was performed in 2010-2012 to train auxiliary nurse midwives (ANMs) from primary health centres/health posts in first trimester medical abortion (MA). As of June 2012, 216 ANMs were trained. Following training, 89% (233) have provided MA with 6056 women served [mean 4.6 women/month (SD=3.3)]. Overall service quality was high; 100% of women received pain management and 88% received postabortion contraception. Perceived enabling factors for MA provision identified by providers and facility managers included community awareness through media and volunteers, well-established referral mechanisms, support by facility administration and clients' beliefs about MA. Similarly, perceived barriers included a stable supply of MA drugs and equipment, insufficient counselling areas, inability to manage severe complications, medication costs and service disruption due to transfer of trained providers. Overall, 98% of women reported being very/mostly satisfied with services. Expanding the abortion provider base to include ANMs has increasing availability of safe services to Nepal's predominantly rural population. With the success of this pilot project, the Nepali government has incorporated the training of ANMs in MA into their national curriculum.
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Oct. 3, 2014, 12:45
25 years of mifepristone
Kristina Gemzell Danielsson
Karolinska Institutet/ Karolinska University Hospital, Dept of Woman and Child Health, Division of Obstetrics and Gynecology, Stockholm, Sweden - Kristina.Gemzell@ki.se
Based on the combined regimen of a progesterone receptor modulator, RU 486, developed by Roussel Uclaf and the Nobel prize awarded discovery of prostaglandins, medical abortion with mifepristone and a prostaglandin analogue was developed into a safe and effective method for induced abortion in the 1980ies. A team of researchers led by Pr. Baulieu was critical in the development of mifepristone (RU486) as was the French Ministry of Health. Further researches from Pr. Bygdeman’s team in Sweden described the combined regimen with prostaglandin. Then the WHO and later the company Exelgyn further endorsed this method which provided women with an alternative to surgery. Since the 1980ies research has focused on improving the regimen and care of medical abortion. Today the prostaglandin analogue of choice is misoprostol and medical abortion is a safe option for termination of pregnancy at all gestational lengths. An increasing number of women worldwide benefit from this development. Besides even if there are still differences from country to country not only in access to medical abortions (legal situation, home use, gestational age) but also in the clinical routines of medical abortion care (protocol, reflection delay), Medical methods for termination of pregnancy tend to replace the surgical options in many countries. There is also an increasing recognition that medical abortion can improve access to safe abortion in countries with restrictive abortion laws or lack of abortion providers. However, several barriers remain that limit global access to safe abortion services. Simplifying medical abortion could potentially contribute to increased access and acceptability. Possible approaches include the option to self-administer misoprostol at home, also beyond 9 weeks of gestation. Another possibility is task sharing with midlevel providers to allow these health care professionals to be more involved with the care of healthy women undergoing medical abortion. These possibilities have major impact to increase access to safe induced abortion in countries were medical resources are scarce.
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Oct. 24, 2008, 09:00
Abortion among minors. A French perspective
A. Durrieux, Pascale Roblin, A. Agostini, F. Bretelle, R. Shojai (France)
University Hospital of Marseille, France
pascaleroblin@yahoo.fr, raha.shojai@ap-hm.fr
Objective.The rate of abortions among teenagers is steadily increasing in France. We aimed to analyse the medical and social characteristics of minor patients requesting an abortion in order to improve preventive actions.
Patients and Methods.A retrospective analysis of 184 minor patients requesting an abortion in our department between 2005 and 2007. Minors represented 16% of the population requesting an interruption of pregnancy in our center.
Results.Mean age was 16.2 years (rang 14-17), 10% had already a child and 5% had repeat abortions during this period. Mean gestational age at abortion was 63 days. One third had a medical abortion and 70% surgical aspiration with general anaesthesia. The adolescents were accompanied during the procedure by their companion in 26% of cases. In 35% of cases, teenagers came with no family members and were accompanied by a social counsellor. Teenagers had been referred to the abortion clinic through a family physician in 47% of cases, through the Family Planning associations in 11% and had come directly to our center in 43% of cases. Concerning contraception, 51% had declared using a condom, 25% used no method and 16% used an oral contraceptive. None of our patients used a dual contraception combining a condom and hormonal contraceptives. Only 5% had used an emergency hormonal contraception. Post abortum contraception prescriptions were : 75% oral contraception, 6% long term reversible contraceptions (IUD or implant) and 4% contraceptive patch or vaginal ring. 15% of the teenagers refused a contraception prescription. At the post abortum visit 46% did not show up for further explanations on their contraceptive method.
Conclusion.Minors accessed at our abortion center at advanced gestational ages often unaccompanied by their companions. Condoms were frequently used by minors but seem insufficient in preventing unwanted pregnancies. Use of emergency contraception was exceptional. Post abortion contraception was mainly tailored on oral contraceptives and follow-up visit attendance for further contraceptive counselling was low. Other contraceptive options such as IUD or implants were underutilized in post abortum and need to be evaluated.
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Oct. 25, 2008, 04:00
Abortion care over the Internet: New options for women
Rebecca Gomperts (The Netherlands)
gomperts@womenonwaves.org
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.
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Oct. 24, 2008, 09:00
Abortion in Portuguese Health Primary Care
Cunha José Manuel, C. Ribeiro, R. Aguiar, C. Lomba, A. Mateus, F. Fonseca, A. Simões, L. Campos, C. Silva (Portugal)
Administração Regional de Saúde do Norte, Porto, Portugal
jmscunha@gmail.com
Introduction. The fulfilment of the new Portuguese legislation on the interruption of pregnancy by woman’s free option made it necessary the creation of a public care rendering net that involved Hospitals and Health Care Centres. The Centres were attributed the generic function of women reference to the hospitals where if it carried the medical and surgical interruption takes place. The availability of some professionals allowed to organise in three Centres a consultation of medical interruption of the pregnancy by option of the woman until 10 weeks. There is a protocol of joint with the nearby hospitals that answer to the complications and the situations of medical abortion failure.
Objectives. Description of medical abortion practice by the woman’s option, done by general practitioners in family health services.
Method. The women appeal to the consultation voluntarily or referred by other institutions. The process consists of previous consultation where dating of pregnancy is confirmed by ultrasonographic scan. The law imposes three days of reflection, followed by a 2nd consultation where the therapeutic with Mifepristone starts; 36 - 48 hours later the process is completed with Misoprostol. Pregnancy termination is confirmed 2- 3 weeks later by ultrasonographic scan.
Results. Since October 2007 until May 2008, 118 abortions had been carried through. There were 4 medical abortion failures which required surgical termination and 1 case of hemorrhagic complication that needed curettage.
The study of the evaluation of the women’s satisfaction confirms a high level of satisfaction.
Conclusions. The results of abortions by the woman’s option done in these family Health Services are similar to the published ones in literature.
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Oct. 14, 2016, 02:00
CS03.1
Abortion in women with cardiac disease
Oskari Heikinheimo
Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, FinlandThe presentation will cover:
Presentation of cardiac conditions and their treatment in which continuation of pregnancy predisposes the woman to high-risk of cardiac or obstetric complications. These include conditions such as history of cardiomyopathy (especially with comprised cardiac function), pulmonary hypertension and/or conditions in which cardiac disease or its treatment requires anticoagulation or treatment with teratogenic medication(s);
Management of abortion (either medical or surgical) in women with cardiac disease, especially as concerns management of haemodynamics, and current recommendations concerning anticoagulation and possible antibiotic prophylaxis;
Recommendations concerning multidisciplinary treatment of women with underlying cardiac disease faced with unwanted pregnancy and situations where continuation of pregnancy is considered contraindicated.