Speeches
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Oct. 22, 2010, 08:00
Abortion practice in Swiss hospitals – results of an inquiry by APAC-Suisse in 2009
Anne-Marie Rey, secretary of APAC-Switzerland
Despite a liberal legislation since 2002 (abortion on request in the first 12 weeks of pregnancy and without time limit if it is necessary to turn away from the pregnant woman the „risk of a serious emotional distress“), we suspected certain gaps in service provision in Switzerland.
In summer 2009, we made an inquiry among private and public hospitals, including some day care clinics we were aware of. Out of 157 clinics contacted, we received 113 answers that could be evaluated (72%). Among these, 93 clinics (82%) practice abortions.
In the first trimester, two thirds of them offer the surgical as well as (in the first 7 or 9 weeks) the medical method with mifepristone plus misoprostol. Only 12 clinics (13%) offer local anesthesia for surgical abortions.
As for abortions after 12 weeks, an earlier inquiry among family planning centers had revealed that almost half encountered difficulties in their region in this respect. In fact, after 12 weeks gestation, only 49% of the clinics accept psychosocial indications as defined by law and most limit abortions for these reasons to 14 or 16 weeks.
Access to abortion in the second trimester or later remains very restricted in Switzerland. The range of discretion allowed by the law is not sufficiently used. Moreover, the surgical method is very rarely offered in the 2nd trimester
These are the reasons why a certain „abortion tourism“ still exists, estimated at 50 women who every year have to seek second trimester abortions in clinics in other countries.
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Oct. 2, 2014, 12:00
Abortion providers' resilience to anti-choice tactics in the United States and Canada
Maureen Paul1, Katharine O'Connell White2, Wendy Norman3, Edith Guilbert4, E. Steve Lichtenberg5, Heidi Jones6 1Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA, 2Baystate Medical Center/Tufts University School of Medicine, Springfield, Massachusetts, USA, 3University of British Columbia, Vancouver, British Columbia, Canada, 4Institut National de Sante Publique du Quebec, Quebec City, Quebec, Canada, 5Family Planning Associates Medical Group, LTD, Chicago, Illinois, USA, 6CUNY School of Public Health, Hunter College, New York, New York, USA - jodotter@aol.com Objectives: To estimate the prevalence of anti-choice tactics on abortion facilities and to evaluate abortion providers' experiences with stigma in the United States (USA) and Canada. Methods: We conducted a cross-sectional survey of abortion facilities identified via publicly available resources in the USA (N=705) and Canada (N=94) from June through December 2013. Clinic administrators responded to facility-level questionnaires; surgical and medical abortion clinicians responded to individual-level surveys which included a 15-item validated stigma scale. Results: 690 clinicians and 456 facilities participated; 54% of USA facilities and 83% in Canada. 83% of USA and 33% of Canadian facilities experienced at least one form of harassment in 2012, most commonly picketing without blocking (66%). These experiences were more common in private offices (88%) or ambulatory centres (83%) than hospital-affiliated facilities (29%). Only 7% of facilities (all in the USA) reported staff resignations due to harassment. 41% of USA-based clinicians and 18% of Canadian clinicians reported personally experiencing harassment in 2012. 99% disclosed being an abortion provider to their partner or close friend, 88% to a parent, and 74% to a child. The stigma scale showed high reliability with a Cronbach's alpha of 0.80. Only 1% had high stigma scores, 26% moderate to high, 65% moderate to low and 8% low, with no differences by facility type. One third reported always/often/sometimes feeling marginalized by other health workers, but 87% reported always/often feeling they are making a positive contribution to society. Conclusion: Abortion providers and facilities experience several forms of harassment, which is more commonly reported in the USA than Canada. However, providers demonstrate resilience to stigma in both settings.
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Oct. 24, 2008, 09:00
Abortion request during adolescence and management of confidentiality. A challenging issue
Danielle Wyss, J.-C. Suris, S.-C. Renteria (Switzerland)
Mutidisciplinary Unity for Adolescent Health (UMSA) and Family Planning Clinic, Psycho-social Unit, Department for Obstetrics and Gynecology, Centre Hospitalier Universitaire CHUV, 1012 Lausanne, Switzerland
Danielle.Wyss@chuv.ch
Introduction. The right for adolescents to access to confidential health services, including requests for abortion, is broadly recognized by the United Nations Convention on the Rights of the Child. It is widely approved and applied by reproductive health professionals, provided that the capacity to discern of the young person is deemed sufficient. This study focuses on the challenges due to the request for confidentiality towards the holders of parental authority in this context, and on the consequences of the different ways of taking care of it.
Objectives.To determine whether the situation of minor consultants asking for confidentiality differs from the others and to assess the risks of assuming confidentiality regarding the continuity of follow-up, the contraceptive compliance and the risk of a new unplanned pregnancy.
Material and methods.Retrospective study of 174 female aged less than 18 years who consulted a specialized unit for adolescents or a family planning center with an abortion request between 2003 and 2006. The sample was divided into two groups depending on whether confidentiality was requested or not. For the groups «without» (N=104) and « with »(N=70) a request for confidentiality, we compared the socio-demographic, relational and medical factors related to the decision and the medical and psycho-social follow-up post abortion.
Results.Adolescents «with» a request for confidentiality are more likely than those « without» to be of foreign nationality, especially from Africa or South America (59.4% versus 37.1%). They are more likely to be studying (80% versus 62.1%) and they more often live with both parents (47.1% versus 33.7%); they have more frequently a partner of about the same age (72.1% versus 57.3%) and are less ambivalent before the decision to abort (94.3% versus 83.7%). There was no difference between the two groups regarding the relationship with the parents, the age of the pregnancy, the experience with hormonal contraceptives before the pregnancy, the follow-up post abortion or the occurrence of a new unexpected pregnancy in the following year.
Conclusions. It seems to be more difficult for adolescents living in “intact” families or integrated in an educational or professional track to talk to their parents about their unexpected pregnancy. If the request for confidentiality is made in the setting of a specialized unit for adolescents with an explicit therapeutic agreement and closely scheduled follow-ups, it does not appear to have negative consequences on the compliance with follow-up or the risk of a subsequent unplanned pregnancy. In these circumstances, the assumption that recommends the ability to guarantee the care of adolescents in sexual and reproductive health matters in respect of confidentiality is compatible with the responsibility of caregivers vis-à-vis these underage patients, on the short and medium-term.
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Oct. 24, 2008, 09:00
Abortions at home in Gothenburg
Monika Axelsson, Liselotte Holmqvist (Sweden)
Sahlgrenska University Hospital, Gothenburg, Sweden
monika.axelsson@vgregion.se
Background. This poster describes patient satisfaction in women choosing to perform their abortions at home. Since 1975, the number of abortions in Sweden has varied between 30 000 and 38 000 annually; some 2 500 per year are performed at the Abortion Department at Sahlgrenska University Hospital/Östra. New abortion methods have been introduced since the Swedish Abortion Act was passed in 1975. Medical abortion in early pregnancy is undergoing constant development and more women currently choose it over the surgical method. An increasing number of women, currently 20-25%, want the possibility to conclude their abortions at home. A quality review was performed in order to develop and improve the method.
Method. A questionnaire was filled out by 60 women at their follow-up appointment with at midwife four weeks after the ”home abortion”.
Results. The average age was 34.3. Seventy-one percent had given birth, of whom 64.5% had given birth vaginally. Previous abortions were reported by 34.9%; 90.7 appreciated being scheduled for all abortion-related appointments at the first visit; 69.8 found the interval from the positive pregnancy test to the completed abortion appropriate, while the rest thought that the interval was too long.
Conclusion. Women choosing to conclude their abortions at home report that the method works well for them and they are satisfied with their choice. Questionnaire results also show that information and access to care are important.
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Oct. 19, 2012, 02:00
Acceptability of medical termination of pregnancy
up to 63 days of gestation with home
administration of misoprostol: assessment of
significant factors
Kopp Kallner, H1; Fiala, C2; Gemzell-Danielsson, K1
1 Department of Obstetrics and Gynaecology, Karolinska Institute 7,
Stockholm, Sweden; 2 Gynmed Clinic, Austria
Objective: The objective of this study was to identify significant
factors affecting acceptability of home administration of
misoprostol for medical termination of pregnancy (TOP) up to
63 days of gestation.
Methods: This study was conducted in a University Hospital
Outpatient Family Planning Clinic. Women who were in good
general health, above 18 years of age, with no contraindication to
medical TOP, requesting medical TOP with home administration
of misoprostol and with pregnancies up to 63 days of gestation as
evaluated by ultrasound were asked to participate. Women
received 200 mg of mifepristone in the clinic and were instructed
to self-administer 0.8 mg of misoprostol vaginally at home 36–
48 hours later. Women filled in questionnaires which were
answered after the TOP and at follow up. Patients also filled in
daily symptom diaries. Follow-up was 2 weeks later with physical
examination and low sensitivity urine-hCG according to clinical
practice. All factors extracted from the questionnaires which could
potentially affect acceptability were analysed using multivariate
logistic regression.
Results: In total, 395 women who opted for home administration
of misoprostol for medical TOP were recruited. We found that
the presence of a partner/friend during the TOP affected
acceptability in a positive direction (P = 0.021). In contrast,
having a positive low sensitivity urine hCG at follow up affected
acceptability negatively (P = 0.002), although most of these
women had a successful and complete TOP. In contrast to otherstudies on medical TOP, we could not find an influence of age,
gestational length or the requirement of extra pain medication on
overall acceptability of the procedure.
Conclusions: Home administration of misoprostol for medical
TOP up to 63 days of gestation is highly acceptable. Women
should be encouraged to have a partner/friend present during the
TOP if possible as this affected acceptability of the procedure in
this study. In order to further increase acceptability of home
administration of misoprostol, focus of future research should be
directed towards increasing the number of complete TOPs in a
shorter time frame. -
Sept. 15, 2018, 02:00
In Georgia during last decade medical service providers became decentralized and universal health care provision were launched. These changes in health system triggered increase in number of health providers and proportionally need for regulation of service provision and financing.
Non-preventable abortion in Georgia is legal and provision of service is distributed to primary and secondary health providers. Law of Georgia on health care allow abortion on request up to 12 weeks of gestation therefore mandates 5-day mandatory waiting time between consultation and abortion procedure. State policy regarding abortion is to increase childbirth while women’s choice and health is unsatisfactory level.
Despite liberal policy there still is low accessibility and availability to safe abortion services which is caused by uneven distribution of service providers that provide abortion service, ununiformed referral system, and diminishing number of abortion provider physicians (church influence, conscientious objection). As a result, women are forced to travel for service.
In Georgia unsafe abortion is widespread in spite of medical activity regulation on physician and medical facility levels. Due to no medical service quality appraisal, it is impossible to track standards of service provision and identify medical facilities where quality is not sufficient. For example, system does not track service providers where only D&C method is used or how frequently it is used. If consider D&C method, along with general anesthesia, no counseling, no post-abortion family planning and etc. as unsafe way of abortion service provision. Two above-mentioned issues make it difficult to prevent unsafe abortions.
Women searching for abortion services encounter accessibility and availability barriers that are Not enough Abortion Providers, Cost and Travel, Judgmental Gatekeepers, Conscience Clauses, Bad Referrals, Anti-choice Organizations (church), which makesprevention of unintended pregnancy difficult, leading to high abortion rates, low quality. -
Sept. 11, 2004, 09:00
Access in different countries and current status
Elisabeth Aubény, gynecologist, President French Association for Contraception, Hopital Broussais, Paris. Co-founder and Past President of Fiapac
The early medical abortion method is authorized in Europe in many countries. The authorized method, in France(since1989), Austria, Belgium, Denmark, Holland, Germany, Spain, Switzerland, Slovenia (since 1999), until 49 days of amenorrhea, is Day 1: mifepristone 600 mg taken at the abortion center with the patient going home immediately afterwards, Day 3: misoprostol 400 µg taken orally, followed by medical supervision for 3 hours in the center; Day 10-15: check-up visit. In Sweden (1993) in U.K,(1994) this method is authorized until 63 D.A. with gemeprost, as prostaglandin, taken vaginally. But among these countries, the use differs from one country to another. It is used in Sweden and Switzerland more than 50 %, in Belgium, France and Finland around 30 %, it is used in Holland and U.K, around 15 % and less than 5 % in others authorized countries. The use of medical abortion in a country depends of many factors: length of legal authorization, price of the abortion and its reimbursement by assurance to the patient, fee of doctors paid by assurance, but also reticence of doctors to change their habits for a method they don’t know exactly. In the future ameliorations can be bring to this method specially used without any hospitalization, practice by trained general practitioners in their on practice. Women who have the possibility to choice this method are very satisfied. It is our medical duty to propose it.
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Sept. 10, 2004, 09:15
Access to and reality of abortion in Europe
Marcel Vekemans, MD, Ob/Gyn, Medical Advisor, IPPF, London, UK.
In Europe, access to safe abortion is much easier than in the developing world, de jure and de facto. Legally, 81% of 59 developed countries (10%, in underdeveloped countries) allow induced abortion without restriction as to reason. Only 12% of the European countries (very small ones, except IRL and PL) restrict abortion to “physical risk to the pregnant wife”. Illegal abortion is not necessarily unsafe, or difficult of access, or entailing prosecution. And “legal” does not mean “safe”, or “easy to obtain” (P). Many European women still recourse to “abortion tourism” for discrete or second trimester abortions. But, de facto, Europeans are not equal concerning access to safe abortion, which depends on other than legal variables: availability of trained staff, restrictions on types of providers and facilities (in-, out-patient), dissuasive counselling, “experts” commissions, waiting periods (UK), permission from parents (I, DK) or husband (Turk), negative cultural/religious influences causing delays in care seeking, lack of trust in confidentiality, costs involved (social security reimbursement?), providers’ “conscientious objection” (I, D, Ö). Abortion services up to the full extent of the law should be accessible everywhere: health care providers are legally bound to this be it through referral. “Underserved groups” (adolescents, refugees, illegal immigrants) are targets for expanding our social role. Legal and other restrictions (and popes’ admonishments) do not eradicate induced abortion, as shown all over the world and throughout human history. Nor do prevention, such as modern and emergency contraception, sex education, abstinence vows and ignorance-only education. In the US, 60% of 1.3 million abortions per year are contraceptive failures. The 1991 Tbilissi recommendation “From Abortion to Contraception” has not been fully implemented.
A lack of staff trained in abortion techniques (medical, counselling) is alarming. Young professionals might be less motivated. Most have not seen women die after induced abortion. Training is not given enough attention. Also, better pain control and post-abortion contraception, and more humane attitudes, are needed. More training “Centres of Excellence” could be developed (and train providers from the underdeveloped world, where 13% of the maternal mortality, 220 deaths every day, is due to unsafe abortion). In (mainly Eastern) Europe, there remain 600 deaths/year after unsafe abortion, related to high incidence of abortion in some countries, use of less safe techniques (vacuum should replace curettage), and, at times, poor quality of care.
Advocacy for less restrictive laws and for keeping alive adequate laws remains necessary, in front of the anti-choice movement. The battle is never won for ever. Decriminalization (“l’avortement hors du code pénal!”) is an option: leave this medical issue to the private sphere, abortion being a normal, natural part of reproductive life.
Thanks to the commitment of governments, NGOs, and international organizations (the European Union has shown commitment to the respect of the women’s rights), access to safe abortion is quite satisfactory in Europe, but not everywhere and not for everybody. Continuous efforts are needed to improve the situation and to defend the progress made.
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Oct. 14, 2006, 11:00
Access to medical abortion
Marge Berer, Editor, Reproductive Health Matters and Chair, International Consortium for
Medical Abortion, London, UK
Although more than one method of abortion has been available for many years, in most
countries the provider chooses the method and may be skilled in one method only. This
paper discusses choice and acceptability of medical abortion from the perspective of both
women and abortion providers and argues that choice of method is important for both.
Safety, efficacy, number of visits, how the method works, how long it takes for the abortion
to be complete and cost all affect acceptability. Medical abortion is considered more
natural because it happens in women’s own bodies and can take place at home before
nine weeks of pregnancy; surgical abortion with vacuum aspiration is simple and over
quickly. Unless the costs of both methods are similar, however, women and providers will
tend towards whichever is the cheaper option, limiting choice. Medical abortion is effective
from when a woman misses her period through 24 weeks of pregnancy, and more women
and providers need to be made aware of this. In legally restricted situations, complications
tend to be less serious and easier to treat with early medical abortion than after unsafe
invasive methods. Ideally, both medical and surgical methods should be available, but
each can be provided without the other.