Speeches
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Oct. 19, 2012, 11:30
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. -
Sept. 10, 2004, 09:00
Christian Fiala (A)
Easy access to safe and effective contraception as well as to legal and safe abortion – both free of charge for those in financial need: no other intervention in human history has had a similarly strong effect in improving women’s health and survival. But it is not women alone who profit from this cultural achievement: men too feel the positive impact of a better health of their mother, sister, partner or daughter. Not to talk about children who need their mother. And even society as a whole is benefiting from improved health status of women. It is safe to say that we would never have reached the high standard of living we currently enjoy, if half of the population would still be at serious risk of health and even life.
We have succeeded in making most of Europe a safe place for women. But there is still a lot to do. A few countries still have no legal access to voluntary abortion: Ireland, Nothern Ireland, Portugal, Malta and Poland. But even in those countries which have a provision for legal access, an unacceptable number of various obstacles do exist resulting in an unnecessary delay in access to abortion. And there is even a high number of women in Europe who have no access to medical abortion, 15 years after it’s first marketing in France.
Looking beyond Europe, most parts of the world still stick to medieval European laws on reproductive health. These laws had been introduced by the former colonial powers and have not been changed so far. Consequently women in their daily life run a high risk for the terrible consequences of illegal abortion, including death.
It is in this context that the association of FIAPAC has been founded, following the congress “Abortion Matters” in Amsterdam in 1995. During this congress it became obvious how much there is to do to overcome the prevailing barriers in access to contraception and abortion and to guarantee a standard of care in “reproductive health”. A few professionals working in the field, recognised the urgent need for regular meetings on this topic. The association was founded thanks to their engagement. Since, 5 congresses have been organised with an increasing number of participants.
This conference would not have been possible without the engagement and support of many dedicated individuals. The FIAPAC board which has already organised 5 other conferences, has planned since two years. Very important, the team of our clinic which has calmly managed the additional workload while continuing to run the clinic and being dedicated to every single patient. These are mainly Barbara Laschalt, Leila Akinyemi and Margot Schaschl. Some of you may remember being in contact with Florian Hahn who has done all the registrations with admirable patience. Finally I would like to thank the friendly staff of the technical University.
Nobody is perfect although all of us have tried to come as close as possible. But some mistakes may have occurred during the preparation of the congress and some are probably going to occur during these 2 days. May I kindly ask you for you to forgive us and please let us know or note them on the evaluation form.
My special thanks go to the pharmaceutical companies who understand that our patients need a reliable and safe contraception after the abortion. It is my hope that more contraceptive producers will be present at the next congress.
There are some special events I would like to briefly mention:
We are working very hard to open a museum of contraception and abortion. It will be located very centrally in Vienna. Furthermore all items will be displayed on the website, together with old books. Unfortunately we did not succeed to open the museum until this congress. But we brought 4 panels displaying a small part of what the museum will be. You may have a look in the entrance hall.
I would like to take the opportunity to kindly ask you to donate or let us any historic objects or publication.
There is a list of films dealing with abortion, which will be displayed during these days. They cover a long range of time from 1929 to a new one about the impact of the policy by President Bush. The films are very touching and make clear why we engage in this field. Please find the films on the separate program. It has not been easy to bring together all these films together. Therefore a website abortionfilms.org will soon be online with a list of different films dealing with abortion. Please let us know in case you know of any other important film on abortion.
There is the training model for vaginal ultrasound during early pregnancy and medical abortion. We have worked hard to finalise in time and you may be able to try it during the congress for a small fee. This is a new device allowing training without a patient. This system is routinely used in Germany since some time, but it can be used for training for medical abortion and early pregnancy. Tomorrow there is also a presentation about this device.
Concerning the program, one small mistake has made it in the final version. Please note that tomorrow we will start at 14 00 and not at 14 30 as stated in the printed program.
Before giving the word to the next speaker I would like to make a short remark on the role of men in this debate.
As we all know, men cannot become pregnant nor can they have an abortion. Preserving the reproductive health of women is nevertheless in our very own interest and we directly feel the consequences.
It is therefore our duty to ensure a legal framework and easy access to standard of care abortion services so that women, who after all got pregnant by us, can terminate an unwanted pregnancy without unnecessary delay and suffering.
To further improve women’s health has been the motivation for all of us to come together. We are looking forward to exchange experiences, listen to each other, learn from each other and find ways to further improve the standard of care of our patients or clients. The success of the congress depends mainly on your engagement. We have been careful in the planning to let enough time for “networking” between the presentations. I hope we will use this opportunity and make these two days an occasion worth to remember.
Please let me underline how much we appreciate the support, moral and financial of the city of Vienna. Reproductive health is not an empty word in this city, as shown by the impressive engagement in this field. I am therefore very happy to announce Sybille Straubinger, member of the local parliament who is representing the city
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Sept. 14, 2018, 01:00
Progress in medical abortion in Thailand
Kamheang Chaturachinda, WHRRF, Thailand
Prior to 2002 Misoprostol was freely available over- the- counter in Thailand at a cost of US 40 cents each. In 2002 the Ministry of Health had the first ever female Minister. She was from an ultra- conservative religious right political party (Palang Dhama Party). This party viewed abortion as immoral and sinful. Misoprostol was therefore put on the restricted drug list that needed to be prescribed only in hospital by a physician. The cost of the tablet in the market rocketed from 13 Bahts (40 US cents) up to 2,500 Bahts (70 USD ) and even to 5,000 Bahts (160 USD ) per tablet. A combination of Mifepristone 200 mg and Misoprostol 800 microgram package (commercial name MEDABON) was introduced in to Thailand in 2009 by the Concept Foundation. This was first introduced in to 3 leading medical schools in Bangkok(and later in to Provincial medical schools) as a research project. The second phase research of the efficacy and effectiveness of MEDABON was launched by WHO and our Foundation (WHRRF) at Ramathibodi hospital in Bangkok in 2010. After the publication of this study, we vigorously pushed for the registration of the drugs in Thailand as well as listing in the essential drug list (EDL). Listing in EDL allows the National Health Security Office (NHSO) to obtain the drugs for use in the Women’s Reproductive Health Entitlement Package at a reduced price. Registration was successful in 2014 . And listing in EDL in 2016. Medabon is now bought by the NHSO at a reduced price for distribution and use in the Women’s Reproductive Health Entitlement Package free of charge (market price 500 B./package: NHSO price 230 B./package). Even though Medabon is registered for use to terminate pregnancy, Safe Abortion is still not universal available to women in Thailand. The main reason for inaccessibility of women in Thailand to medical termination of pregnancy is the negative attitude of the healthcare providers. WHRRF together with the Royal Thai College of Obstetricians and Gynaecologists are trying to overcome this obstacle by education and training.Progress in medical abortion in Thailand
Kamheang Chaturachinda, WHRRF, Thailand
Prior to 2002 Misoprostol was freely available over- the- counter in Thailand at a cost of US 40 cents each. In 2002 the Ministry of Health had the first ever female Minister. She was from an ultra- conservative religious right political party (Palang Dhama Party). This party viewed abortion as immoral and sinful. Misoprostol was therefore put on the restricted drug list that needed to be prescribed only in hospital by a physician. The cost of the tablet in the market rocketed from 13 Bahts (40 US cents) up to 2,500 Bahts (70 USD ) and even to 5,000 Bahts (160 USD ) per tablet. A combination of Mifepristone 200 mg and Misoprostol 800 microgram package (commercial name MEDABON) was introduced in to Thailand in 2009 by the Concept Foundation. This was first introduced in to 3 leading medical schools in Bangkok(and later in to Provincial medical schools) as a research project. The second phase research of the efficacy and effectiveness of MEDABON was launched by WHO and our Foundation (WHRRF) at Ramathibodi hospital in Bangkok in 2010. After the publication of this study, we vigorously pushed for the registration of the drugs in Thailand as well as listing in the essential drug list (EDL). Listing in EDL allows the National Health Security Office (NHSO) to obtain the drugs for use in the Women’s Reproductive Health Entitlement Package at a reduced price. Registration was successful in 2014 . And listing in EDL in 2016. Medabon is now bought by the NHSO at a reduced price for distribution and use in the Women’s Reproductive Health Entitlement Package free of charge (market price 500 B./package: NHSO price 230 B./package). Even though Medabon is registered for use to terminate pregnancy, Safe Abortion is still not universal available to women in Thailand. The main reason for inaccessibility of women in Thailand to medical termination of pregnancy is the negative attitude of the healthcare providers. WHRRF together with the Royal Thai College of Obstetricians and Gynaecologists are trying to overcome this obstacle by education and training.
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Sept. 10, 2004, 11:30
Providing safe surgical and medical abortion services in low-resource and legally restricted environments: The Latin American Abortion Provide Network
Dee Redwine, MPH, regional Director for Latin America and the Caribbean, Planned Parenthood Federation of America- International, PPFA-I
Heather Blank, associate Regional Director for Latin America and the Caribbean,PPFA-I
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In Latin America and the Caribbean, Planned Parenthood Federation of America-International (PPFA-I) focuses on establishing and strengthening safe abortion services through partnerships with women’s organizations that advance sexual and reproductive rights and health services. Many of these agencies in Latin America and the Caribbean suffer from a sense of isolation, as they provide life-saving services under severely restricted legal circumstances, in politically difficult and dangerous situations.
Unsafe abortion in Latin America and the Caribbean can be described as nothing less than a public health crisis. The correlation between access to safe, legal abortion and maternal mortality in the region is shocking: approximately 20 percent of maternal deaths in Latin America and the Caribbean are due to unsafe abortion, a higher proportion than in any other region of the world. In 1995 there were 4.2 million abortions in Latin America and the Caribbean region, 4 million of which were illegal. Except for Eastern Europe, Latin America has the highest global abortion rate (37 abortions per 1,000 women aged 15-44) and abortion ratio (27 abortions per 100 pregnancies) (AGI, 1999).
The average Latin American woman is likely to have at least one abortion in her lifetime, with women in some countries, such as Peru (AGI, 1999), having an average of nearly two abortions. Since the vast majority of these procedures are performed illegally and most likely under unsafe conditions, women are taking enormous risks to prevent unwanted childbearing. This situation results in approximately 800,000 hospitalizations per year in the region.
Access to safe abortion services is critical to preventing maternal mortality and morbidity. In developing countries, regardless of the legal status of abortion, it is poor women in rural areas and poor young women who are most at risk of undergoing unsafe abortion, and most likely to die. However, in various Latin American countries, there are a growing number of health care providers who are committed to combating this trend. In areas where women are most likely to die from an unsafe abortion, client-centered sexual and reproductive clinical services must be provided for poor and marginalized women – the very ones who are most likely to face an unwanted pregnancy, seek out an untrained provider, and most likely to suffer severe consequences.
The reproductive health provider network supported and facilitated by PPFA-International is a forum to link these providers in a mutually constructive and supportive way, in order to regularly exchange ideas and expertise. They represent 8 different Latin American countries.
All of these providers offer life-saving services under extremely difficult circumstances, in both geographic and legal terms. From the rural areas to the rapidly expanding urban slums, these providers offer high-quality health services to those most in need. The network offers a forum in which critical mutual support can be lent to those working in this harsh environment as well as an opportunity for the exchange of information and expertise.
The specific goal of the network is to strengthen and expand sexual and reproductive rights through improved and increased access to services coupled with advocacy efforts in countries where the political and social climate is very restrictive. In order to reach this goal, the network facilitates the professional support needed by local groups working to reduce restrictions on abortion and improves services where they exist, as well as increases the sense of solidarity among service providers in the region.
Furthermore, the group is working to increase access to medical abortion throughout the region through the integration of a misoprostol-only regimen of early first trimester medical abortion. This is being piloted in order to decrease the consequences of unsafe abortion, and create alternative pathways for women to access safe abortion.
Throughout Latin America, misoprostol is cheap, easily accessible, and badly mis-used. From physicians to pharmacists, off-label use of misoprostol for pregnancy termination is increasingly common. Misoprostol has been shown to have a high rate of efficacy for abortion, but it must be used with the correct dosages, within certain gestational age ranges, and with clear instructions for follow up for the woman in order to be successfully used. Even so, given the severe legal restrictions on abortion in the region, a widely disseminated protocol for misoprostol, either for clinic- or home-based use, could radically change not only how abortion is viewed, but also prevent women from resorting to other invasive, highly dangerous forms of abortion.
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Sept. 10, 2004, 11:30
Psychosocial background factors and mental health-consequences of
induced abortion in Austrian women[1]
Erika Baldaszti and Beate Wimmer-Puchinger
Ludwig Boltzmann Institute for Women’s Health Research, Vienna, Austria
Objective:The aim of this study was to gain knowledge about the role of psychosocial conditions, contraceptive use, partnership and sexuality in the decision-making process about unplanned pregnancies of Austrian women seeking abortion. Furthermore aspects of choosing medical or surgical abortion and the prevalence of post-abortion depression are addressed.
Materials and methods:350 women who underwent surgical abortion and 227 women choosing medical abortion answered a questionnaire after abortion; as controls 400 women continuing pregnancy answered after week 12 of gestation. A follow-up questionnaire was administered three months after abortion.
Results:Women who decided to terminate pregnancy were found to have more often instable partnerships. At the time of conception 40% of women undergoing an abortion had not used any contraceptive method, of those who did, 50% had used condoms; dissatisfaction with contraception was high. Comparing the medical to the surgical method of abortion satisfaction of women with both procedures is high. Depression score assessed by means of HAD Depression Scale was not increased at time of abortion or three months after. At time of abortion half the participants felt sure about their decision for termination of pregancy, three months after abortion two thirds of the women had the feeling that the decision for abortion was right.
Conclusions:Once more our results indicate that prevention of abortions is a matter of making contraceptives more accepted and easily obtainable for all groups in society. All women surveyed in this study decided to terminate pregnancy after a thoroughly reflexion about the basic conditions of their life. This can be seen as the main reason that mental health consequences after abortion like feelings of guilt, fear or depression were within a normal range.
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Oct. 14, 2006, 11:00
Recent developments
Kristina Gemzell MD, PhD, Professor
Dept. of OB/Gyn, Karolinska University Hospital/Institutet, Stockholm, Sweden
Medical abortion using the antiprogestin mifepristone (Exelgyn; Paris, France) combined
with a prostaglandin has been available in Europe since 1988 for termination of pregnancy
up to 49 days of amenorrhea. In the UK (1991), Sweden (1992) and later on Norway the
method is approved up to 63 days of amenorrhea. Further development of the method will
be discussed in the workshop and include reduced doses of mifepristone, research on the
optimal type, dose and route of administration of the prostaglandin analogue and reduced
treatment intervals. Furthermore home-use of misoprostol allows women more flexibility,
privacy and control in their abortions. More recently medical abortion has also become
increasingly used in the interval 9 to 13 weeks as well as for midtrimester terminations with
an increased need to optimise pain management.
Anti-D immune globulin is given in most places after early abortion, although evidence is
lacking for the need of this intervention. As a result of the lack of evidence-based data, a
high number of women are receiving foreign immune globulins based on a questionable
indication. Furthermore this practice increases the costs of induced abortion. The need for
studies to clarify the indication of RH-prophylaxis is obvious especially when it comes to
medical abortion.
The generally accepted obligation in medicine to offer every patient the best evidence
based care should also apply to women with an unwanted pregnancy. An increasing
number of women in Europe now opt for medical instead of surgical abortion. A shift which
is expected to continue during the next year’s world-wide.
The need for more research to further improve the procedure, reduce side effects and
facilitate access is obvious. -
Oct. 2, 2014, 12:00
Regarding medical abortions at the Gynaecological Clinic in Majorna
Monika Axelsson Närhälsan Västra Götaland, Gothenburg, Sweden - monika.axelsson@vgregion.se
We started the office with the idea of facilitating so-called early medical abortions that are terminated at home. After contact with and visits from the The National Board of Health and Welfare, in addition to hard work on routines and quality as well as medical safety, we finally managed to get the permit to open our doors. To summarize the results from the survey, the information given corresponds with the patients´ expectations. The patient receives sufficient analgesics to take home which is crucial. Measuring the level of pain is difficult but I have used a scale without numbers that goes from no pain to severe pain and most fall in the middle of the scale. 37% have chosen the lower end of the scale, meaning less pain, while 42% have chosen the higher end of the scale. 17% chose the middle of the scale. 82% thought they had received enough analgesics. 7% asked for emergency care during 4 weeks following the procedure due to bleeding, dizziness, pain, and so on. An interesting finding was the choice of contraception, where most patients have chosen combined birth control pills (32%) or no protection (22%). The conclusion is that we offer a good service at the gynaecology clinic in Majorna to women that wish to carry out an abortion. What could be explored further, and should be discussed, is the fact that such a high percentage of the women chose to use no contraception after abortion. One solution could be to offer an additional follow-up visit later on. However, important is to be able to offer abortions that are as good and safe as possible.
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Oct. 22, 2010, 02:00
Title: The experience of use of medical abortion for HIV-infected women at home in Ukraine
Posokhova Svitlana
ABSTRACT TEXT
Women with HIV have a right to decide about their reproductive choice. There is no reason why HIV positive women cannot use medical abortion. HIV positive women may be at higher risk of reproductive tract infections from retained products of conception, but this may occur with medical or surgical abortion.
The aim of our study was to assess the efficacy and acceptability of home administration of misoprostol for early medical abortion up to 63 days of amenorrhoea for HIV-infected women.
Methods. This case-control study included 68 cases of medical abortion in HIV-infected women who did not receive antiretroviral therapy. About 20% of women lived in the rural regions. Among of them 10 (14.7%) of women had previous cesarean sections Medical abortion was used the first time in 89.7% of women, the second time – 8.9%, the third time – 1.4%. About 2% of women came back to the hospital after misoprostol because they were worried (25% of them had previous cesarean section).
Results. The method was effective in 95.5% of cases. Three failures (4.5%) were recorded which included incomplete abortion (1.5% of cases), heavy bleeding (1.5% of cases), continuing pregnancy (1.5% of cases). In case of complications we performed vacuum-aspiration. We did not have cases of serious infections after medical abortions. The complete abortion has occurred after taken of misoprostol in the first 3 hours in 46.9% of cases, after 6-9 hours – in 49.4% of women, at the third day – in 2.6% of women and at the fifth day – in 1% of women.
Conclusion
Our study shows very high results of success and minimal complications of medical abortions in HIV-infected women at home (95.5% of cases). More than 80% of women were satisfied. Our data suggest that the use medical abortion at home is the safe effective alternative to surgical abortions for all women.