Speeches
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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. -
Oct. 20, 2012, 04:00
Alternative ways for follow up Women who choose outpatient medical abortion
are typically given an appointment for a follow up
visit several days to two weeks after they have
used the medications. Yet almost no women
require intervention or additional treatment at
such follow up visits. Providers and women have
sought safe ways to reduce the number of women
who need to return to the clinic. This presentation
discusses strategies to reduce the need for
universal return visits, including telemedicine, use
of various electronic media, and the development
and promise of semi-quantitative pregnancy tests,
including data from recent research. -
Oct. 22, 2010, 08:00
Analysis of medical abortion in first trimester in a small regional hospital in Slovenia
Eva Macun, General Hospital Jesenice, Slovenia
Introduction: Medical abortions have been performed in General Hospital Jesenice since 2005. The first attempts were made during our participation in the WHO supported study which was coordinated by Gynecological Department of the University Medical Center in Ljubljana. Both drugs that are used regularly for medical abortions (mifepriston and misoprostol) are not register at the Agency for Medicinal Products and Medical Devices of Slovenia. Therefore a special approval is needed for their import. Our doctors needed time to accept the method but since 2009 two thirds of all abortions have been performed using this method. One step forward has been made and a clinical pathway for medical abortion is being prepared. Our final goal is to make the method widely available, to educate all the involved professionals and to make it possible for home use.
Methods: In the current presentation an analysis of all performed medical abortions from 2005 to 2009 is shown. All data were collected by hand. A WHO protocol was used for medical abortions under 9th week of pregnancy. Women were given 200mg of mifepriston orally and after 36-48 hours 800µg of misoprostol vaginally. For women, who were pregnant 9 to 12 weeks, the protocol was adjusted for every single pregnancy.
Criteria for successful abortion that we used after 14 days were: no gestational sac, endometrial lining thinner than 15 mm, if there were hiper- and hipoechogenic areals in the endometrial lining from 15 to 20 mm, we prescribed uterotonic and antibiotic therapy and ultrasound control after menstrual period. In case of prolonged bleeding we did a curettage.
In other cases we took this as unsuccessful abortion and completed it with a curettage.
Results:We performed 124 medical abortions in this time. Till 49 days of amenorrhea we performed 75 abortions: 3 patients needed curettage, because there remnants of trophoblast in the endometrial lining after 14 days. Success rate of the method in our department was 96%.
Between 7th and 9th week we performed 39 abortions. Two needed additional curettage (5%).
We also performed 10 abortions between 9th and 12th weeks. All were successful.
All together the success rate was 93.4%. for abortions performed in women who were pregnant less than 12 weeks. We found no complications (heavy bleeding, infection).
Conclusions:In our department the method is very successful. We see a lot of potentials in promoting medical abortion in Slovenia, because we have really good experience with it, our patients prefer medical over surgical abortion, we need less professionals, we will make a clinical pathway for hospital use. But our goal is to perform medical abortion at home, because the method is safe. In this project good cooperation would be achieved with local gynecologists who will follow the patients at home.
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Oct. 2, 2014, 12:00
A national campaign to de-stigmatize abortion in France: why?
Danielle Gaudry, Marjorie Agen, Shiva Bernhard Le Planning Familial, Paris, France - d.gaudry001@wanadoo.fr
Abortion and contraceptive methods are a fundamental part of Human Rights: women have a right to choose whether to be pregnant or not. WHO guidelines about safe abortions demonstrate that the legalization and improved safety and accessibility of abortion are essential for women's health: postabortion deaths disappear, postabortion complications, including accidental infertility, are reduced. In the August 2011 report to the UN "Right of everyone to enjoyment of the highest attainable standard of physical and mental health" the Special Rapporteur considers "the impact of criminal and other legal restrictions on abortion conduct during pregnancy; contraception and family planning and the provision of sexual and reproductive education and information. Some criminal and other legal restrictions in each of those areas, which are often discriminatory in nature, violate the right to health by restricting access to quality goods, services and information. They infringe human dignity by restricting the freedoms to which individuals are entitled under the right to health, particularly in respect of decision-making and bodily integrity." It is violence against women to oblige them to stay pregnant when they don't choose to be pregnant. In French society, as well as other European countries, the model of pregnancy and maternity in a heteronormative family is prevalent. Traditionalists, in the "la manif pour tous" movement, dream about a social standard where women are the complement of men and where equality between the sexes doesn't exist. The rejection of the Estrella report by the EU parliament and the "one of us" initiative have demonstrated easily that "obscurantism is at our doorstep" (Veronique Keyser). Some official decisions recently taken in France, including the 100% refund for abortion and the change of law on the reference to distress, are positive signs, and the campaign in Luxembourg for instance, contribute to lifting the taboo on the right to abortion. Many hospitals and abortion centres however have disappeared since 2001, with governmental budget cuts resulting in the merger of French hospitals. Women are obliged to wait two to three weeks for an appointment, often traveling 60 to 80 km to access surgical or medical abortion. These facts are real difficulties in the exercise of the right to abortion. For these reasons, it is critical to provide a communication platform to women, their relatives, and medical professionals, to allow a debate about abortion without prejudice or guilt. So, the Planning Familial has created a website where everyone can improve abortion rights, by answering a questionnaire, monitoring social networks and forums, sharing the poster and the site address. More than 1,000 questionnaires have been completed to date, since April 2014. We would like to present the site "l'avortement, un droit à defendre" to the FIAPAC.
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Oct. 24, 2008, 09:00
And after the Referendum?
Matilde Salta, Mara Carvalho, Vasco Freire (Portugal)
Médicos pela Escolha – Doctors for Choice in Portugal
medicospelaescolha@gmail.com
In Portugal, in the past 11th of February of 2007, a certainty became evident: that an important majority of the Portuguese society identified clandestine, illegal abortion like a Public Health problem, legitimizing the right to safe abortion by the woman’s request, as part of a plenum exercise of Sexual and Reproductive Rights, Universal Human Rights.
The new abortion law respects a person’s autonomy as an ethical principle, ensuring a free and universal access to safe abortion, a procedure performed by or with the help of qualified health care professionals. This new legal setting allows us to have concrete numbers about abortion, so that, by evaluating the numbers, we identify vulnerable groups, try to know its causes and consequences and provide the necessary support and interpret possible variations over the time, with longitudinal studies.
The DGS – Direcção Geral da Saúde (General Health Bureau in Portugal) predicted for the year after the implementation of the law 20000 abortions. In a study made by APF – Associação para o Planeamento da Família (the Family Planning Association) the number predicted was around 17000 abortions a year. Still awaiting annual results, in the first 5 months of law application, 6000 abortions were registered, and after eleven months the number was 12000, numbers a bit low when compared with the initial predictions. Why this happened and what can happen next are important discussions in terms of evaluating the effectiveness of the system and constantly, the level of information of the people.
Regardless of if the next annual numbers corroborate or not the tendency of the first eleven months, it is necessary to stretch the experience in other European countries where abortion is legal for several years: clandestine abortion tends to become almost absent with the legalization, but it’s a process with several years of evolution; the diminishing of the abortion rate and the raising of the women/couples doing effective contraception (to avoid unwanted pregnancies) is fundamentally related with the implementation of an effective Sexual Education and Health Care policies that improve the access to Family Planning and modern Contraception. In Portugal, one year after the implementation of the law, it’s still urgent to:
- Inform all the women that they have a new right of choice, an informed choice, with access to non-directive and specialized, support and care.
- Implement consistent Sexual Education policies, with obvious medium/long term benefits in preventing other Public Health Problems, like all the STDs.
Improve the Family Planning and abortion network. For example: creating conditions so that medical abortion is accessible to women in all the public primary care health services; equip the national health system with more human and technical means that answer not only to the needs of the women that want to interrupt their pregnancies, but also to the ones related to requests for definitive chirurgical contraceptive methods; all the hormonal contraceptives should be freely distributed.
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Oct. 22, 2010, 08:00
A pilot study on women’s experiences with misoprostol at home or in the hospital in medical abortion up to 63 days of pregnancy.
Monica Johansson, Eneli Salomonsson and Helena Ekberg, Dept of Woman and Child Health,
Division of Obstetrics and Gynecology, Karolinska Institutet / Karolinska University Hospital, Sweden
Background: Home-use of misoprostol in medical abortion up to 63 days of pregnancy was approved in Sweden in 2004. It is now an increasingly popular option for women undergoing first trimester induced abortion. The experiences with misoprostol at home or in the hospital were explored among abortion seeking women.
Methods: Mifepristone 200 mg was given orally in hospital under nursing supervision. Women were provided with misoprostol tablets 800 g and advised to take them vaginally 36–48 hours later either at home or in the hospital. A follow-up visit was performed a few weeks after the misoprostol treatment.
The main outcome measures were:
1) acceptability assesses as satisfaction with the choosen method.
2) feasibility, assessed through successful completion of abortion at home without the need for hospital admission.
In addition contraceptive choice and uptake was investigated.
Results: A total of 53 women participated in this pilot study. Of these, 29 women aborted at home and 24 in the hospital. The majority of women were satisfied with their choice of method and place of treatment. Two women per group reported not being satisfied. No surgical interventions were reported but two women per group had unscheduled visits to the clinic before the Follow-up (FU).
Follow-up was performed after a mean of 24 or 20 days among women who administered misoprostol at home or in the clinic, respectively. At that time all women except two per group reported that they considered it highly important to avoid another pregnancy at the moment. Six or 7 women per group had had sex before the FU. Among them 6 and 4 women, respectively, had not started any contraceptive method. In the first group (home-use of misoprostol) 6 women had started contraception before the FU and 12 started at the FU while in the second group 9 women started before the FU and 7 at FU.
Conclusions: This study supports that women should be free to choose their preferred location of the induced medical abortion. The reason why so many women postpone post abortion contraception despite stressing the importance to avoid a pregnancy needs to be further explored.
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Oct. 4, 2014, 02:00
Can we eliminate the mifepristone visit in medical abortion?
Elizabeth Raymond Gynuity Health Projects, New York, USA - eraymond@gynuity.org
The requirement to present to a clinician in person to receive abortifacient drugs is problematic for some women. Eliminating this requirement would enable intriguing new service delivery options, including provision of medical abortion in non-traditional, non-clinical venues and provision by prescription or mail. This presentation will review data regarding the utility of examination and ultrasound prior to medical abortion and will discuss potential alternative approaches to assess eligibility that could be used over the telephone or internet.
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Oct. 22, 2010, 02:00
Challenges and perspectives in advocacy of safe abortion
Daniela Draghici, Roumania
Central and Eastern Europe (CEE) is a region where abortion rates remain high, despite efforts to encourage contraceptive use and secure supplies of modern methods. Strategic assesments in Roumania, Moldova, Russia, and Ukraine have shown that abortion remains the preferred method of fertility conrol because it is often cheaper than contraception and widely available. Abortion, however, remains of low quality; unsafe abortions account for 24% of maternal deaths (WHO, 1998).
Characteristics include: unsafe technologies, low level of motivation and training of providers, no counseling or choice of methods, and no post-abortion free contraception. Manual Vacuum Aspiration (MVA) and Medical abortion (MA) drugs are registered in several CEE countries; nevertheless, access to these methods is very limited especially for vulnerable groups (youth, low income families, HIV positive women, etc).
The Eastern European Alliance for Reproductive Choice (EEARC) purports to raise awareness, sensitize providers, motivate women’s groups, develop new evidence-based training curricula, and to improve access to and quality of safe abortion, including medical abortion services. EEARC has a multidisciplinary membership structure and works to collect and disseminate evidence-based information on safe abortion, including medical abortion, through country reports shared across the network. The Alliance is actively increasing its membership and promotes exchange of advocacy strategies and educational materials across the network.
Through presentations at national and international conferences, members of EEARC have raised awareness about the need for better access to safe abortion services, including medical abortion, especially to audiences of providers and women's organizers. This presentation will review EEARC's network development, awareness raising, and advocacy activities and discuss their impact in a challen-ging environment, including their success in building of broader support for safe abortion, including medical abortion that has been demonstrated among healthcare providers and women's organizations. The Alliance is working as a catalyst to coalesce advoca-cy efforts to counteract restrictions recently imposed by governments and parliaments in CEE countries. Country examples from Lithuania, Moldova, Roumania, Russia, and Ukraine will be presented in the context of regional challenges in maintaining abortion rights amidst an increa-sing conservative opposition movement.
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Oct. 25, 2008, 02:00
Challenges in post-abortion contraception
Oskari Heikinheimo (Finland)
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, POBox 140, 00029-HUS, Helsinki, Finland
oskari.heikinheimo@helsinki.fi
The influence of contraceptive use and counseling on the risk of repeated abortion is unclear. In a recent prospective study, specialist counseling and provision of contraceptives did not have an effect on the rate of repeated abortion (Schunmann and Glasier, Human Reproduction, 2006). However, in randomized clinical trials the use of intrauterine contraception, initiated at the time of surgical abortion, has been effective in reducing further unintended pregnancies (Pakarinen et al., Contraception, 2003).
We analyzed recently risk factors for repeat abortion among a cohort of 1269 women undergoing medical abortion between August 2000 and December 2002 (Heikinheimo et al., Contraception, 2008). Contraceptive use was assessed at the time of follow-up performed at 2-3 weeks following the abortion; intrauterine contraception was initiated at the clinic at the time of follow-up, or within 2 months. The subjects were followed prospectively via the Finnish Registry of Induced Abortions until December 2005, the follow-up time (mean ± SD) being 49.2 ± 8.0 months.
In comparison with combined oral contraceptives, use of intrauterine contraception was most efficacious in reducing the risk of another pregnancy termination. In multivariate analyses the hazard ratios (95% Cl) of repeat abortion were 0.33 (0.16 to 0.70) among Cu-IUD users and 0.39 (0.18 to 0.83) among LNG-IUS users when compared to users of combined oral contraceptives. The incidence of repeat abortion was highest among women the postponing initiation of contraceptive use.
Contraceptive choices made at the time of abortion have an important effect on the rate of re-abortion. Use of intrauterine contraceptives for post-abortal contraception is most efficacious in decreasing the risk of repeat abortion.