Speeches
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Oct. 4, 2014, 02:00
Access to safe abortion reduces the number of complications and financial costs
Galina Dikke1, Dmitry Kochev2 1Russian Peoples Friendship University, Moscow, Russia, 2JSC "Pentkroft Pharma", Moscow, Russia - pentcroft@mail.ru
The main method of terminating unwanted pregnancies in Russia remains a D&C (62%, 2012). Medical abortion (MA) is 8% and vacuum aspiration (VA) 30%. In several regions administrative measures have been taken to implement usage of safe methods into clinical practice. Objective: To evaluate the dynamics of the numbers of early complications and financial costs. Material and methods: We choose two regions in the Ural - Sverdlovsk region (SR) and Tyumen region (TR). SR implemented VA in outpatient and inpatient hospitals up to 12 weeks of gestation (N = 2640). TR introduced the method (the combination of mifepristone/misoprostol (200 mg/400 mcg) up to 42 days of amenorrhoea (N=2758). Results: In 2013, in the SR VA was used in 99.2 % of cases (compared to 45.3% - in 2012). Ambulatory holds 35 % VA procedures, the rest - in the hospital. The number of early complications decreased by 3 times (2.0 % vs. 6.0 % respectively), mainly due to incomplete abortion and postpartum endometritis. MA in the TR was used in 97% in early pregnancy, 34.8% of all medical abortions up to 12 weeks. Numbers of early complications decreased by 3.5 times (4.0 % vs. 13.7% respectively), mainly due to bleeding, haematometra and postpartum endometritis. Costs of treatment of early complications observed were 3 times lower in both regions. Cost savings to perform an abortion is 44 % due to the lack of need for inpatient beds, operating, disinfectants, instruments, medicines, including narcotic drugs, equipment, anaesthesia, etc. Conclusions: The introduction of sound technologies and accessibility of abortion contributes to the preservation of reproductive health (reducing complications 3-3.5 times) and lower financial costs of the procedure to perform an abortion (2 times) and the treatment of early complications (3 times).
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Oct. 4, 2014, 02:00
Medical abortion in the United States and Canada: why so different?
E. Steve Lichtenberg1, Heidi Jones2, Katharine O'Connell White3, Maureen Paul4, Edith Guilbert5, Christopher Okpaleke6, Wendy Norman7 1Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA, 2CUNY School of Public Health, Hunter College, New York, New York, USA, 3Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts, USA, 4Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA, 5Institut National de Sante Publique du Quebec, Quebec, Canada, 6University of British Columbia, Vancouver, British Columbia, Canada, 7University of British Columbia, Vancouver, British Columbia, Canada - jodotter@aol.com
Objectives: To understand differences in medical abortion provision in the United States compared to Canada. Methods: We conducted a cross-sectional survey of abortion facilities identified via publicly available resources simultaneously in the United States (n=705) and Canada (n=94) from June through December 2013, which included questions on socio-demographic characteristics and medical abortion procedures for up to 5 clinicians per facility. Results: In Canada 78 (83%) and in the US 379 (54%) of all abortion facilities participated, with respectively 60 and 348 medical abortion clinicians participating from 32 and 286 facilities providing medical abortions. In Canada all medical abortions are provided by physicians with nearly two thirds of these (59.3%) being family physicians/general practitioners compared to over three quarters of physician providers in the US (84.9%) who are specialists. In the US, 56% of providers were physicians, 26% nurse practitioners, 11% physician assistants and 6% certified nurse-midwives. In both countries, the majority of providers were female (78.7% in the US and 79.7% in Canada). Providers reported 2706 (Canada) and 135,129 (US) first trimester and respectively 322 and 1646 second trimester medical abortions. Among reported procedures in each country, medical abortion comprised 3.8 % (Canada) and 35.6 % (US) of all first trimester abortions, and 6.7% (Canada) compared to 4.3% (US) of all second trimester abortions. In the US, the majority provided medical abortions through 63 days LMP (79.1%) compared to 49 days LMP in Canada (63.3%). Providers in both countries reported practices predominantly aligned with evidence-based guidelines. Conclusion: Medical abortion is provided much less commonly in Canada where mifepristone is not an approved drug, and is more often provided by family physicians compared to the United States, where specialists or non-physicians provide most medical abortions.
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Sept. 15, 2018, 11:00
The RCOG stipulates that 'Feticide should be performed before medical abortion after 21 weeks and 6 days of gestation to ensure that there is no risk of a live birth.' Live birth is to be avoided for 'emotional, ethical, and legal reasons.' But live births happen with medical abortions at earlier gestations and can occur prior to surgical abortions in the second trimester if labour is precipitated by cervical preparation agents. Furthermore, the very same emotional and ethical matters apply to surgical termination in the second trimester, because the same questions are raised regarding how best to end both a woman's pregnancy and a fetal life. I argue that if there are compelling reasons to perform feticide prior to second trimester medical termination, the reasons are even more compelling prior to surgical termination. Both women undergoing abortion in the second trimester and their care providers should have the choice of using feticide, regardless of the method chosen.
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Nov. 25, 2000, 12:30
The International Federation of Professional Associates of Abortion and Contraception (FIAPAC) is an association created in 1996 through the joint efforts of three national abortion associations (Belgian, French and Dutch).
The association is governed by French law for non-profit organizations (law of 1901). It’s Headquarters are located at Hôpital BROUSSIAS in Paris.
It is open to any medical or para-medical professional of abortion and contraception. Membership to FIAPAC for these professionals can be obtained through the approbation by the General Assembly of their demand following proposal by the Executive Committee.
The objectives of the FIAPAC are:
- to allow for all women to decide freely whether they want to keep their pregnancy or not,
- to put at their disposal the best abortion techniques available and to accompany them in this difficult moment,
- to facilitate access to a quality contraception method they choose to use.
It is for this reason that the FIAPAC thinks it is important for professionals working in the abortion and contraception fields, who come from different backgrounds, to meet and exchange ethical viewpoints on the legal problems encountered, as well as on their techniques.
The FIAPAC thus organizes a congress every year. Three have already taken place (Amsterdam - 1997, Brussels - 1998, Maastrich - 1999), with a simultaneous translation in two languages allowing for everyone to participate and exchange information.
To summarize, the FIAPAC is a meeting place for professionals of abortion and contraception who think that women are responsible for themselves, and who think that they are free to decide what is best for themselves in the event of an unwanted pregnancy.
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Oct. 22, 2010, 08:00
Final stage of early medical abortion at home : womens experiences and impact on a hospital abortion service
H.Dewart , S.T.Cameron, A.Glasier and A.Johnstone - Dean Terrace Centre, NHS Lothian, Royal Infirmary of Edinburgh, Department of Reproductive and Developmental Sciences, University of
Edinburgh, United Kingdom
Background and methodology: Research has shown that many women would prefer to be at home rather than in hospital, to pass the final stage of an early medical abortion. A pilot was therefore conducted over six months at a hospital abortion service in Edinburgh, Scotland, that allowed women up to 8 wks gestation to be discharged home soon after misoprostol administration. An anonymous questionnaire of womens’ experiences was conducted one to two weeks later. An audit of the numbers of abortions performed by each method, during the pilot and the same period the previous year, was also conducted.
Results:A total of 250 women chose to go home after misoprostol. This corresponded to 34% of the total number of women having an early medical abortion. A 24% increase in the total numbers of women having a medical method (n=142) was observed compared to the same period the previous year. A total of 100 women completed questionnaires out of 145 distributed (69%). The commonest reasons given for choosing to go home were, to have treatment sooner (53%) and to be in the privacy of one’s own home (47%). Most women stated that bleeding (81%) and pain (55%) were as, or not as bad as expected. Most would recommend this method to a friend (84%).
Discussion and Conclusions: Discharge home for the final stage of a medical abortion was highly acceptable to women. Since availability is not limited by hospital bed space, more women can be treated by medical methods
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Oct. 13, 2006, 02:00
First trimester surgical abortion under local anaesthesia
Raymonde MOULLIER, Vice-President of ANCIC www.ancic.asso.fr; Martine Hatchuel,
Sylvie Osterreicher, Nathalie Trignol
CIVG S. Veil, CHU de Nantes and CIVG C. Vautier, clinique J. Verne, Nantes, France
In France, abortion was legalized in 1975, and suction vacuum aspiration under local
anesthesia (LA) became prevalent especially in non-hospital autonomous clinics. As the
government decided to integrate abortion units within hospitals, surgical abortion under
local anesthesia decreased while the use of general anesthesia increased particularly for
the 12 to 14 weeks of amenorrhea. This trend seems to be occurring throughout Europe.
However, aspiration under LA remains a reliable technique for well trained personnel,
and ideal for the woman who chose LA when it is combined with psychological guidance
and an empathetic staff. This support is of prime importance in patience comfort and
satisfaction.
Moreover, since 1975, improvements have been made in the procedure:
cervical priming with misoprostol 400µg 2 or 3 hours before suction or even better with 200
mg of mifepriston 36 or 48 hours before suction, or with association of mifepriston and
misoprostol, especially for the 12 to 14 weeks of amenorrhea.
local anesthesia with lignocaïne 1% or lignocaïne + adrenalin by local infiltration of the
cervix or paracervical block or both is used routinely.
Treatment with ibuprofen (400 mg) 2 hours before suction helps prevent the pain during
the uterin contraction at the end of the procedure. Consequently, pain is either not
perceived or is tolerable for most women.
As adjunct analgesia, some providers are now using auto – inhalation of nitrous oxide and
some practice acupuncture.
All these improvements coupled with attention and empathy from the staff should give LA
a primary place in abortion practice. LA should be routinely proposed to women, and
medical teams trained in the technique. -
Oct. 13, 2006, 02:00
For the counsellor
Christiane Der Andreassian, Hospital Broussais, Paris, France
To give information takes time.
Counselling doesn’t need necessary to be done by doctors.
Well trained, nurse or midwife who belongs to the team can easily do it.
Make sure that woman‘s decision to abort is firmly settled.
Listen to the woman’s motivation behind her choice of the method.
Ensure a proper understanding of the method.
Make sure that women is psychologically able to take upon herself and to comply with the
schedules of the appointments, in particular coming back for ultra sound and follow up visit
Be able to reach an emergency area, during the following 2 weeks, in case of problems.
Discuss any concerns at the follow up visit.
What the women say
Avantages of medical abortion
- Pill, no surgical intervention
- Its more natural
- No doctors touching my body
- Conscious and self experience
- Choose to come back for the misoprostol at the clinic or to stay home in their
own environment
Disadvantages of medical abortion
- Not sure when abortion will take place
- More blood loss
- Anxious about cramps, nausea, or eventually diarrhoea
CONCLUSION
Receive the patient in her request,
- With respect
- With a positive attitude,
- Listen to her in the globality of her situation.
- And of course, provide her with the advice’s most relevant to her choice.
- Giving her the relevant information fitted to her case,
- Understand that the team is available if she needs help.
- Allow her to take responsibility for her own actions with more autonomy and confidence
all along the procedure.
A patient correctly informed will be more comfortable and will improve the chances of
succes of method. -
Oct. 13, 2006, 02:00
For the doctor
Sophie Eyraud, MD; Sophie Gaudu, MD, seyraud@wanadoo.fr
Hôpital Antoine Béclère, Centre de régulation des naissances, Clamart, France
The doctor must make sure it is the best solution and the right time for the patient, not
only from a medical, but also from a psychological point of view.
Therefore we should check :
- The intra-uterine location of the pregnancy
- The length of the pregnancy
- The advisability of the treatment
- The treatment of pain
We also must be able to weigh the advantages and disadvantages in terms of the patient’s
perceptions :
Women tend to see the method as less agresive given the absence of surgical intervention
and the possibility to „do their own abortion“ in a familiar environment.
The fact that it takes place rather early in the pregnancy also makes it safer.
But it requires for the woman undergoing the abortion to be actively involved.
We must explain carefully that, unlike aspiration, the procedure takes place over several
days and is statistically less efficient (the failure rate is approximately 2-3%).
As long as the doctor is assured that the method is medically and psychologically
appropriate, medical abortion makes an excellent option for a well-informed woman. -
Oct. 16, 1999, 10:00
In France from 1990 to 1995 1,000,000 legal abortions were carried out. There
were 4 deaths linked without certitude to an infection, 1 0/00 peritonitus and
about 1% of minor complications with up to 12 weeks of amenorrhia There are
few long term post-infection effects.
Women with a history of pelvic infection run a real risk of infectious complications.
The speaker quotes an American study:
1/1400 abortion leads to hospitalisation.
1/4500 leads to a serious infection.
What antibiotic therapy: 1 dose of DOXYCYCLINE 200mg 2 hours before, 200mg
12 hours after.
To recap:
At the moment the incidence of infection is not known.
The majority of centres do not practise a systematic antibiotic therapy.
The discussion underlined the different medical practices. In Spain
DOXYCYCLINE is systematically used for 5 days, in Germany there is screening
for Chlamydia with treatment in positive cases.
The specific case of Russia where women under go a high number of abortions
shows a linked rise in the incidence of Chlamydia.
In conclusion: although this is a quantifiable field consensus is not possible -
Oct. 13, 2006, 09:30
From abortion to contraception
Giuseppe Benagiano, Carlo Bastianelli, Manuela Farris
Department of Gynaecologic Sciences, Perinatology and Child care,
University “la Sapienza”, Rome, Italy
Voluntary abortion has been the source of bitter disagreement even among gynaecologists
and the ethical considerations brought forward in favour or against abortion are so
opposing that nothing one can say will ever create unanimity.
In spite of this reality, attempts should be made at establishing a minimum dialogue
because there is a sufficiently large portion of the international community which would
easily agree with the goal to minimize the need to recur to the voluntary termination of a
pregnancy (VTP).
The best way to start such a dialogue is to explain why restrictive legislation might be good
to appease the conscience of policy makers and a part of the public, but definitely has
never deterred women from terminating a pregnancy when they felt strongly they could not
afford it, nor has it - per se - moved women to prevent unwanted pregnancies.
In addition, per se legalizing abortion does not entail a more widespread utilisation of theprocedure, and may - on the contrary - help decrease its incidence, provided
decriminalisation is linked to a series of other public health measures. The situation is
however very complex and, in Europe alone, there conflicting examples.
Notwithstanding this diversity, in most countries a law that forbids VTP does not cause a
decrease in the number of women who recur to the procedure, while it has two important
negative consequences. The first is an adverse effect on the reproductive health of
women: illegal abortions are often unsafe and the consequences can be an increased rate
of pregnancy-related morbidity higher secondary infertility and mortality among pregnant
women. The second is the very clear tendency that, because VTP is illegal, nothing is
done to actively reduce its incidence, or, rather, to reduce the reasons leading to the need
for terminating a pregnancy. Finally, decriminalisation makes it possible to evaluate the
true dimension of the problem and set in motion a process aimend at reducing it.
There is no question that contraception is the corner-stone of any fight to reduce abortion,
although the relationship between contraception and abortion is fairly complex. Data from
several industrialized countries indicate that where contraception is well established andutilised by the vast majority of people and it is associated with a proper sex education, the
need to resort to an abortion has substantially decreased.
To successfully move from abortion to contraception, people's attitudes and behaviour
must be changed. This requires massive training and education programmes, as well asthe will of governments to educate potential users and remove medical obstacles to a wide
utilization. In addition, other obstacles, such as cost of contraceptives, should be removed,
especially in countries with no local production, where the need to purchase them with
hard currency makes them simply unaffordable. Education is the key to success because
a lack of knowledge about the real attributes of individual methods both within the
population and the providers, is at the basis of low prevalence. It is also necessary to fight
misconceptions about the safety of modern contraceptives.In this connection, more
research concerning sexual behaviour and knowledge, attitudes and practice of
contraception is needed in order to change the situation. Also, a proper training for
providers and educational programmes for consumers are badly in demand. Finally, the
possibility for potential users to choose among methods is another very important issue:
It must be stressed that ethical considerations influence the choice of strategies aimed at
decreasing the need to terminate a pregnancy. A good example is the possibility to recur
to emergency contraception. For those accepting the definition of pregnancy endorsed by
a WHO Scientific Group in 1992, emergency contraception - acting before nidation - does
not interrupt a pregnancy and therefore is a means to prevent voluntary abortion. The
problem is thae this definition establishes biological criteria, not moral norms.In conclusion, we hope that the beginning of the third millennium will be remembered as
the time when a major effort will be made to decrease the need for VPT, protect human life
and ensure the continuation of its natural progression. Decreasing the need to terminate a
pregnancy is an achievable goal if we unite our forces rather than loose an opportunity by,
instead, underlining what divides us. We hope that the International community will begin
to work together, using as a common denominator the desire to reduce the need to recur
to voluntary pregnancy termination.