Speeches
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Oct. 24, 2008, 09:30
Society’s responsibility to provide a legal setting
Christian Fiala (Austria)
Gynmed Clinic, Vienna, Austria
christian.fiala@aon.at
For most women, the diagnosis of an unwanted pregnancy is unexpected. Women are therefore unprepared for either carrying the pregnancy to term or having an abortion. They need a great deal of information within a very short space of time. If they decide to terminate the pregnancy, they must have fast access to medical facilities.
This presentation analyses legal requirements and regulations in European countries to see how far they support women in finding a solution.
Societies react differently to the needs of women, but the past was largely dominated by a rigid paternalism, coupled with the belief that pregnant women could not responsibly make decisions regarding their own pregnancy. Society therefore “had” to intervene in order to ensure that the “right” decision was made. People who were not directly involved with these unwanted pregnancies dominated the public debate and decided on the relevant laws. Not surprisingly, they operated on wrong assumptions or basic misunderstandings of how a pregnant woman should be treated and cared for.
Huge progress has been made in the last few decades to overcome this approach and respect women and their needs, including the legalisation of contraception and abortion. However, there are still many remnants of the old thinking, such as obligatory waiting (“cool off”) periods of an arbitrary number of days or mandatory ‘counselling’, even though counselling is voluntary by definition.
There is no evidence that these restrictions are of any benefit. They do, however, cause delays in the provision of treatment and have negative effects on the physical and psychological health of those affected. Examples and comparisons of European countries are given in the presentation.
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Oct. 2, 2014, 12:00
Sociological aspects of violating the natural gender balance of newborns in Georgia
Gulnara Shelia1, Nino Tsuleiskiri2 1NGO"Association HERA-XXI", Tbilisi, Georgia, 2Tsereteli State University, Kutaisi, Georgia - dodoshelia@yandex.ru
Objective: Explore the sociological aspects of disturbing the natural gender balance and reasons behind “skewed sex ratios”at birth (111 boys for 100 girls) in Georgia. Method: 1600 women have been interviewed. The target groups of investigation were women of childbearing age and their families, also medical staff of 4 cities . Quantitative and qualitative data analysis was conducted using the computer program SPSS. Results: Analysis of the data shows, that sex selection in Georgia really exists. As a consequence there is significant evidence of prenatal sex identification practice. Additionally to the existing stereotype, technological innovations and disseminated information about modern family planning methods resulted in determination of the number of children and identification of the sex of the fetus by women.This behaviour is not inhibited by service providers.The existing economic and social conditions and level of education are contributing factors to having an abortion. Religion is the only deterrent to abortion.To the question “how important to you is the sex of the future child ?“, 52-72% answered that ”has no relevance“, but correlative analysis shows inconsistency of this response with other answers. 63% of the investigated women had undergone their first abortion; for 24% it was the second. Conclusion: Abortion is still the main method of birth control in Georgia. Termination of pregnancy, by interviewed women , is socially conditioned.There is the practice of prenatal sex selection with the termination of unwanted pregnancy in Georgia. Directly and spontaneously or under pressure Georgian women decide not to give birth to daughters, who are considered a burden to their family and unable to perpetuate the family lineage. This situation (the prenatal sex selection and related selective abortion) requires more adequate attention from authorities and development of specific measures for prevention.
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Oct. 24, 2008, 09:00
Sociologic Aspects of Legalized Abortion in Portugal. 1 Year Experience
Renato Martins, Marisa Moreira, Teresa Bombas, Teresa Sousa Fernandes, Paulo Moura (Portugal)
Genetics, Reproduction and Fetal Maternal Medicine Department, Coimbra University Hospitals, Portugal
renato.alessandre@gmail.com
Introduction. According to United Nations, about 13% of maternal deaths in world were attributed to complications after non safe abortions. In Portugal, in last decades, ten maternal deaths occurred per year due to complications of illegal abortion. Since, July 16th of 2007 abortion is legal before ten weeks.
Objectives. Characterization of the female population that came to our Service for abortion.
Material and Methods. We analysed the clinical files of medical abortion appointment during the period of 1 year from 16th July 2007.
Results. We included 298 females. Average age 28,2±7,6 years.(11,8% adolescents and 20,1% more than 35 years). We reported a 10% of non Portuguese women in our sample. Almost 52% were married. In this sample the authors report an average of 27% of women that had no contraceptive method in use before the abortion. In 90% of the cases this was the first abortion, and the majority of women pointed out economics reasons to justify it. Nearly 90% had a medical interruption, with few cases of complications associated to the method.
Conclusions. The great group of women that come for abortion are not adolescents as it was firstly expected. The majority are Portuguese and live with their partner. A great number of women are not users of Family Planning Services.
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Oct. 2, 2014, 12:00
State report on pregnancy termination among raped adolescent girls in Korean metropolitan city, Busan
Myoungseok Han1 ,2, Chul Kwon Kim1 ,2, Byung Moo Choi1 1Dong-A University Hospital, Busan, Republic of Korea, 2Centre for Sexually Assaulted Women, Busan, Republic of Korea - hmsobgy@dau.ac.kr
Objective: To investigate real state of pregnancy termination among raped adolescent girls from 2010 to 2013 in a Korean metropolitan city. Method: We reviewed the annual reports published by the institution, that had been built to provide medical and social support for the raped women. From 2010 to 2013, adolescent girls registered or consulted at the institution were recruited for analysis. Results: The institution was responsible for the metropolitan city, Busan, whose population is 3,590,101. 1762 adolescent victims had visited or inquired to the institution during the period, complaining of being raped. Among them, 26 pregnancies had been terminated after obstetric evaluation. 9 cases (34.6%) were first trimester and 17 cases (65.4%) were second trimester. Of the second trimester cases, 6 were over 20 weeks of gestation. All of them had been reimbursed the medical cost of termination by the government. Conclusion: The cases of second trimester termination were much more than that of first trimester. It could be concluded that the possibility of pregnancy among raped girls might be ignored by their parents.
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Oct. 24, 2008, 09:00
Status of reproductive health of women after surgical abortion
O. Revenko, I. Vovk, A. Kornatskaja (Ukraine)
Institute of pediatrics, obstetrics and gynecology, Kiev, Ukraine
olegdoc@voliacable.com
In branch of planning of family the statistical analysis of 300 histories of illnesses of patients with pelvic inflammatory diseases with the purpose of definition of risk factors is spent. Wereresearch of the woman with secondary infertility - 1 group (150 women) and with not broken reproductive function - 2 group (150 women).
Women with not broken reproductive function authentically connected the beginning of disease with the beginning of a sexual life 78 (52,0 %) is more often, while women with secondary infertility the main reason of disease considered surgical abortion - 78 (52,0 %) against 8 (5,3 %) - in 2 group).
Operative intervention in the anamnesis was at 98 (65,3 %) women of 1-st and at 53 (35,3 %) women of 2-nd group, authentically more often at women with secondary infertility, (р <0,05).
At the same time, there are more than complications after abortions it was marked at women with secondary infertility: in 76 (50,7 %) against 24 (16,0 %) women with not broken reproductive function.
At gynecologic survey presence of chronic inflammatory diseases of internal genitals has been diagnosed for all women of 1-st group.
Thus, the comparative analysis of data of clinical inspection has shown, that for the majority of women with secondary infertility (78,0 %) which were in marriage interruption of the first non-planned pregnancy by means of surgical abortion (46,7 % against 18,7 % at women with not broken {disturbed} reproductive function), and also smaller quantity of sorts of 30,6 % (against 81,4 % accordingly) and greater percent of operative interventions - 65,3 % (against 35,3 % accordingly) is characteristic.
The received results testify, that interruption of non-planned pregnancy is beyond especially medical question and is an actual social problem.
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Oct. 14, 2006, 02:00
Summary of current evidence
Helena von Hertzen, MD, WHO, Geneva
During the last ten years the use of misoprostol has escalated in the area of reproductive
health due to its many advantages compared to other prostaglandins, and a substantive
scientific evidence has accumulated suggesting that misoprostol is safe and effective for
various indications, provided the dosage is correct. However, with very few exceptions,
misoprostol has not been licensed for use in obstetrics and gynaecology and this has left
many doctors unsure of their position regarding the use of an off-label drug.
Depending on the indication the strength of scientific evidence varies: experts will agree
e.g. on the benefits of misoprostol compared to other available options for labour induction
and medical abortion. Consequently, misoprostol has been included in the complementary
list of WHO Essential Medicines Library: 25 microgram tablet for the induction of at-termlabour; and the termination of pregnancy of up to 9 weeks (200 microgram tablets) to be
used after mifepristone pretreatment.
More research results may be needed to assess whether evidence-based guidance can be
given regarding other indications. Clinicians agree that cervical priming prior to vacuum
aspiration, or other gynaecological procedures, has become easier thanks to misoprostol.
In addition to the sequential regimen with mifepristone, misoprostol may be used alone to
induce abortion in settings where mifepristone is not available, provided a somewhat lower
effectiveness is acceptable. Misoprostol may also be useful in the treatment of incomplete
abortion, intrauterine fetal death, or in the prevention, and perhaps also in the treatment, of
postpartum haemorrhage, but experts need to agree whether there is enough evidence to
recommend its routine use for these indications. -
Sept. 11, 2004, 02:00
Surgical method
Janna Westerhuis MD, & Daan Schipper MD, medical director Bloemenhovekliniek, Heemstede, Holland
Since 1973, second trimester pregnancy terminations have been carried out using the D & E method introduced to us by Arnold Finks. This method has been subjected to adjustments by the introduction of prostaglandin induction with F2, Sulproston, E2 gel and now misoprostol. With the assistance of prostaglandin alone, a fully successful method has never been found within the reduced time frame of around 8 hours, which is dependant on the maximum time women can stay in the clinic (limit of 24 hours). Furthermore, it has always been strongly asserted in the Netherlands that attempts should be made to reduce the suffering of the woman during the abortion procedure as far as possible.
This is why there is still a great deal of emphasis placed on maintaining the skills and training of young doctors in this surgical technique. An approach has since been developed in Heemstede which occupies the middle ground between surgical abortion and procedures involving the use of medication.
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Oct. 20, 2012, 02:00
Task sharing in post-termination of pregnancy care
at district level in Uganda; healthcare providers’
perception on safe TOP, post-TOP care and
contraceptive counselling – an exploratory study
Allvin, MK1; Paul, M1; Gemzell-Danielsson, K1;
Kiggundu, C2
1 Department of Obstetrics and Gyanecology Karolinska Institutet,
Stockholm, Sweden; 2 Mulago University Hospital, Kampala, Uganda
Background: Termination of pregnancy (TOP) is restricted in
Uganda and poor access to family planning results in unwanted
pregnancies forcing women to have unsafe TOPs and thus posing
a great burden on the Ugandan health system. Post-TOP care is
implemented and unofficial task shifting is taking place as a
pragmatic response to the workload.Objective: To explore the healthcare providers’ perception on
post-TOP care, with regard to professional competences, medical
and surgical methods, contraceptive counselling and task shifting/
sharing in post-TOP care.
Methods: In-depth interviews (n = 27) with healthcare providers
participating in post-TOP care were conducted in seven health
facilities in the Central region of Uganda. Data was organised
using thematic analysis with an inductive approach.
Results: Post-TOP care was perceived necessary, however
controversial, and together with poor conditions it provoked
frustration, mainly among the midwives. Task sharing was
generally implemented and midwives were identified as the main
providers. Different uterine evacuation skills were recognised and
midwives would sometimes perform interventions not approved
by hospital guidelines, due to absence of doctors. Misoprostol was
rarely used or accessible at district level, however those with
experience perceived it efficient and safe. An overall demand and
need for further training was identified.
Conclusions: Developing policies and service guidelines in order
to implement evidence based use of misoprostol in post-TOP care
as well as provision of in-service training is recommended.
Implementation of official task shifting in post-TOP care would
further be a systematic approach to improve quality of care and
accessibility of services in order to reduce TOP-related mortality
and morbidity. -
Oct. 23, 2010, 02:00
Gabrielle Falk, Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Sweden
Co-authors: A.B.Ivarsson, School of Health and Medical Sciences, Örebro University and J.Brynhildsen,
Faculty of Health Sciences, Linköping University, Sweden
Topic and problem: Teenage pregnancy rate in Sweden is low compared to other European countries. However abortion rates are high despite education in school about sexual and reproductive health (SRH) and access to youth clinics and subsidized contraceptives. To find reasons for this we conducted an interview-study with questions aimed at examine teenagers experiences with contraceptives and to explore the reasons behind their contraceptive choices. The participants attended an out-patient clinic.
Methods: Twelve teenagers who had applied for induced abortion were interviewed three to four weeks after abortion. The interviews comprised open questions about contraceptive experiences focusing on hindrance for contraceptive use. Six topic questions were used with further exploring questions posed when needed. Qualitative content analysis was resorted to.
Results:One theme was identified:Struggling with feelings of uncertainty and patterns of behaviour. Three categories emerged from the analysis. Uncertainty dealt with decisions and behaviours that varied with time and between the different individuals. Factors that influence contraceptive use dealt with the persons that the participants had discussed contraceptives with, how they acquired knowledge about contraceptive use and the nature of their behaviour. Anxiety dealt with the side effects of contraception and feelings of fear related to contraceptive use.
Conclusion: The participants had feelings of uncertainty, anxiety and fear towards contraceptive use which led to non use and inconsistent use. They revealed insufficient knowledge about SRH at times. Guidance from health care providers and access to youth clinics varied and was sometimes unsatisfactory. Parents were supportive of contraceptive use but not active in the process of initiate it. Friends and the Internet were the main sources for acquiring information that was not always correct.
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Oct. 19, 2012, 09:00
Te Mahoe Unit-Wellington NZ-an overview
O’Callaghan, C
Te Mahoe Unit, Wellington, New Zealand
The poster will contain an overview of the Te Mahoe Unit which
is the Early Pregnancy Counselling and Termination Unit in
Wellington, New Zealand.
There will be a brief description of the New Zealand law with
regard to termination of pregnancy (TOP). The referral process
and certification process will also be explained.
All procedures that are provided will be described e.g. surgical
termination with local anaesthetic and conscious sedation up to
14 + 5 weeks of gestation — early medical termination with
miferistone and misoprostol up to 9 weeks of gestation.
A section on products of conception and what happens to
them. Some explanation around Maori cultural beliefs.
Also nursing care, after care, on call issues and statistics. The
latest complication rates and causes of same.
Finally, law reform issues and looking to the future.