Speeches
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Oct. 2, 2014, 12:00
Community involvement in promotion of safe abortion among vulnerable groups in Kazakhstan
Galina Grebennikova1, Bibigul Alimbekova1 1Kazakhstan Association on Sexual and Reproductive Health (KMPA), Almaty, Kazakhstan, 2International Planned Parenthood Federation EN, Brussels, Belgium - galina.kmpa@gmail.com
Background: The initiative was aimed at improving access to high quality comprehensive abortion care for low-income women, including internal and external migrants, and youth. KMPA established cabinets in community clinical centres of two regions populated by low-income people. KMPA cabinets provided services within a comprehensive package of SRH services in the framework of national legislation to meet high standards of care. Services were oriented and based on client rights and providers needs model. KMPA provided educational workshops on safe abortion techniques, postabortion counselling and quality of care for service providers in respective centres with the following M&E for further dissemination of experience to other community medical centres. Objective: To improve awareness of low-income population, including migrants and the youth on their sexual and reproductive rights and availability of comprehensive abortion care in local healthcare facilities of pilot regions by the end of 2013. Method: Primarily KMPA selected volunteers among women working in the local trade markets to be trained on the following topics: advantages of safe abortion and accessing sites for obtaining of services. Trained volunteers distributed the information materials on safe abortion and contraception among vulnerable groups in the markets. Results: After training 20 volunteers actively working at Black Market and providing information about free safe abortion services and contraceptives in the pilot outpatient clinics, the number of requests for safe abortion at primary healthcare (PHC) level increased by 2.5 times. The outcome indicates an improvement of women's awareness of the available medical abortion services for free. Conclusion: Involvement of local community in education and dissemination of information and knowledge about safe abortion services at PHC level significantly improves the level of awareness and visits of vulnerable population of PHC outpatient clinics.
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Oct. 13, 2006, 04:00
Comprehensive pain treatment in abortion care
Inga-May Andersson, Midwife Msc
Karolinska University Hospital, Stockholm
Background: Pain during abortion is a complex condition with many aspects to pay
attention to in the nursing care of women undergoing abortion. Management of pain during
abortion has been given insufficient attention.
Materials and Methods: Review of the current literature.
Results: The abortion methods have been given a lot of attention in different research
projects. Several studies focus on the regimen of medical abortion. The methods for
surgical abortion are also well evaluated.
Studies show that women’s experience of pain varies with gestational age, maternal age
and parity. Visceral pain, as abortion pain belongs to, is deep and poorly localised often
with high intensity score. Systematically given opioids are not optimal treatment in pain
from urogenithal region; regional blockades are more effective. Early treatment of pain
reduces the pain intensity.
Anxiety is related to pain in a number of procedures and situations. Anxiety combined with
physical (nociceptive) pain makes the total experience of pain more intensive. To reduce
stress related to the physical and emotional aspects of the abortion information is helpful.
It is important for the women to have accurate information before the procedure and high
quality care throughout. The information and care should be as effective as possible in
meeting the needs for the individual woman.
Other non-medical pain management strategies should also be given the necessary
attention. The woman should be offered a choice of abortion methods because women
report less pain if the choice of early abortion has been their own decision. The importanceof positive staff attitudes and a non-judgemental atmosphere in the quality of care is
emphasised.
Conclusions: Pain treatment in abortion care is a complex challenge. Correct information,
positive attitudes together witn non-judgemental atmosphere are important parts to reduce
stress for the women. Medical pain management during abortion should be mixed with
drugs acting both central- and periphere. Paracetamol, kodein and NSAID is
recommended. Local anaesthetic by paracervical blockade is an effective method if
needed. Prophylactic pain treatment should be considered. -
Sept. 11, 2004, 11:00
Concerning abortion
Irina Savelieva, MD, Russia
The growing economic difficulties have made it hard to implement universal access to health in Russia. Significant cuts in the public health care budget have resulted in a decrease of state-guaranteed health services for women and children. Due to the lack of appropriate contraceptives and counseling services, abortion was and still remains the principal means of fertility regulation in Russia, sometimes exceeding the number of live births by two or three times. Though the number of abortions performed annually has declined drastically over the past decade (the abortion rate was 100.3 per 1,000 in 1991 compared with 47.7 per 1.000 women of reproductive age in 2001) abortion remains to be an important cause of preventable morbidity and mortality among women of reproductive age. In 2001, abortion accounted for 27,7% of maternal deaths in Russia, as compared with an estimated 13% of maternal deaths attributable to abortion globally. At the same time the number of post-abortion complications remains high, and according to some research can reach 40-60% with high level of incomplete medical abortions, of which nearly half (46.2%) required hospitalization. There are also several safety issues (abortion in nulliparous women, multiple pregnancy terminations, second trimester abortion) which have not be addressed adequately and need special attention, not to mention the psycho-social effects of multiple abortions and possible secondary infertility, and the growing interest and practice of assisted reproduction techniques, such as in vitro fertilization (IVF). These data demonstrated that quality abortion care in Russia does not satisfy world standards and WHO recommendations.
Abortions are more common among women ages 20 to 34 (approximately 70%), with 15.3% women who were pregnant for the first time; the mean number of abortions is 2.8-3.07. Almost 40% of abortion clients had already terminated a pregnancy by abortion during the previous 12 month. About half (43%) were using contraception at the time of their last pregnancy (39% were using condoms, 20% - natural family planning, 12% - spermicides and 11% - pills). The principal reasons for abortions (62,3%) were indicated as socioeconomic reasons; and 20,0% did not want more children. Only 36,9% of abortion clients, including young adults and primigravidae, what is of a crucial importance, received family planning counseling prior to the discharge and only 22,0% left medical facility with a contraceptive method of their choice. Since many women who are terminating an unwanted pregnancy intend to have a child later, it is extremely important to identify high level of post-abortion complications on subsequent reproductive function. The entire population is covered by a national health insurance, but abortion as a procedure has not been included. The country has adopted the Essential Drug Policy but has not included contraceptives in the Essential Drug List.
Clinical abortions are performed in medical facilities. The services are provided in maternity hospitals, consultancies of obstetrics and gynecology, private practices and Family Planning Centers. According to state regulations and laws all state institutions provide family planning counseling and abortions free of charge, but the present socio-economic situation has triggered a growing habit of charges made for clinical abortions.
Increasing and more human counseling, improved and good quality of services, good technology (including new medications), good facilities, better information through well-trained providers, careful follow-up, offer choices of contraceptive methods to women and help them to avoid unwanted pregnancies and consequent maternal health risks.
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Oct. 22, 2010, 08:00
Contraception before and after abortion at home
Pascale Roblin, Claire Ricciardi, Aubert Agostino and Raha Shojai, France
Objective: In France, despite a wide range of highly effective, easily accessible and reimbursed contraceptive methods, the rate of abortions remains high and one third are repeat procedures. We analyzed womens’ contraceptive path surrounding a medical abortion.
Methods: A retrospective study of 450 women who had medical abortion at home before 7 weeks was realized in a community care office in Marseille between 2006 and 2010. All women were seen at the post abortion visit and had received contraceptive counselling before and after the procedure with emphasis on long acting reversible contraceptives (LARC). The last declared failed contraceptive method leading to the unwanted pregnancy and the method finally adopted by the patient at the immediate follow-up visit were noted.
Results: Before abortion, 43 (9,5%) used no contraception, 92 (20,5%) used natural methods and 244 (54,2%) used condoms. Women declared using COC in 71 cases (15,8%) and the vaginal ring in one case. None had an IUD or an implant. After abortion, 37 (8,2%) requested no prescription of contraception, 259 (58%) had COC, 15 (3,3%) used a vaginal ring and 12 (2,7%) opted for a transdermal patch. Following abortion, 31% of patients switched to LARC (121 IUD and 18 implants) and 37% to highly effective forgettable methods. Among the 244 pre-abortion condom users, 163 (73%) switched to COC. Among the 71 pre abortion COC users, 45% still maintained COC as their preferred method and 34% switched to IUD.
Conclusion: Most unwanted pregnancies occurred with the use of male condoms. Immediately after abortion, the majority of women opted for combined oral contraceptives. On the short term, peri-abortion contraception counseling may however encourage women to switch to more effective and forgettable methods (IUD or implant).
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Oct. 15, 2016, 02:00
CS12.1
Coping with UK Abortion Law
Allan Templeton
University of Aberdeen, Scotland, UKWhen the 1967 Abortion Act came into practice in England, Scotland and Wales, it was seen as a major step forward in Women’s Health. Now almost fifty years later, the Act’s evident limitations inhibit best practice in several respects. Abortion in the UK is illegal unless the conditions of the 1967 Act are met and confirmed by two doctors. In the majority of cases a woman requests an abortion and an abortion is justified because it is safer than having a baby, condition c states “that the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if the pregnancy were terminated”. This may not be what the Act intended and is certainly not what the GMC now advises in recognising a person’s right to make decisions about her own healthcare.
Furthermore the advent of medical abortion particularly has highlighted the inadequacies of the current Act with regard to safe and effective service provision. Nurses are prohibited from sanctioning and performing abortions. The obverse interpretation of the Act which requires both mifepristone and misoprostol to be given in clinics makes abortion at home (the preferred option of the majority of eligible women) both more inconvenient and uncomfortable than necessary. Within the UK, abortion has now been devolved to Scotland, and although it has been made clear there will be no early attempt to amend current legislation, changes which improve service provision will be considered. This highlights the dilemma of those wishing to improve matters, namely whether to campaign to strike out the laws which make abortion illegal and so recognise a woman’s right to abortion, or whether to interpret and amend current laws to improve service provision, as was very nearly achieved in 2008. -
Oct. 14, 2006, 11:00
Current problems and solutions on abortion in Eastern Europe (EE)
Rodica Comendant MD,
Reproductive Health Training Center, Director, ICMA Coordinator, Chisinau, Moldova
Description of the problem: Despite the widespread availability of abortion on legal
grounds for 50 years in most of the EE countries, the quality of services remain poor: the
main method is D&C, no patient centered care concept. Unsafe abortions account for 24%
of maternal deaths in region. Abortion rates remain high, and is commonly used as a
primary means to regulate fertility. Access to abortion services has been challenged in
recent years. Concerns about declining birth rates, pressure from religious groups have
reduced support for family planning and abortion in the region.
MVA project: The goal of the project was to improve the quality of abortion care with of
institutionalization of Manual Vacuum Aspiration (MVA), and promote patient centered
care concepts within the framework of clinical safety and reproductive rights. This project
was initiated by NAF, funded by the Open Society Institute, and in collaboration with Ipas.
The seven selected countries included Moldova, Macedonia, Kyrgyzstan, Georgia,
Albania, and Russia. The training project was successful in the goals of introducing MVA
in the countries and presenting a model of comprehensive evidence-based abortion care
with a woman-centered approach.
Medical abortion implementation: Mifepristone is currently registered in 10 EE
countries, Misoprostol is used off-label in ob/gyn practice in whole region. But still the MA
method is expensive and unavailable for general population. Introductory studies, with
seminars and trainings for policymakers and health providers have been conducted by
Gynuity Health Project in the region, with the aim to offer practical clinical experience with
evidence-based protocols and provide useful data to revise existing guidelines and
protocols or to establish new one.
A need for creative, individual, country-level, sustainable strategies: Strategic
assessment of the contraception and abortion, currently taking place in some countries in
the region will assist in improving the quality of services. Trainings of providers;
development of standards and guidelines; IEC, targeting potential users, to increase the
demand for better and affordable services among women, advocacy campaigns forwomen right to the access to the fruits of modern science, could be listed.
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Oct. 2, 2014, 12:00
Death after medical abortion not linked to mifepristone
Silvio Viale Sant'Anna Hospital, Turin, Italy - silvioviale@libero.it
The death of a woman of 36 years with no previous known medical condtions after a medical abortion in Turin last April 9 attracted great attention in the media, . The headlines were "death after RU486", but the first report of the medical examiner appointed by the coroner said that RU486 was not responsible for the death . The protocol was mifepristone 600 mg on the first day and gemeprost 1 mg on the third day. On the third day ketorolac 30 mg IM for pain was also administered together with methylergometrine maleate 0.2 mg IM to reduce blood loss. Shortly after the expulsion the woman developed shortness of breath and loss of consciousness followed by cardiac arrest. The first cardiac arrest occurred at around 12:30 and the woman died at 22:45 in the ICU. From the first evidence the autopsy did not reveal any relevant items. Unfortunately, this is not the only death that has occurred in Italy in 2014 after an abortion. Two other women died recently after an abortion. One woman died in Nocera Inferiore, near Salerno, from abdominal bleeding after surgical abortion in a woman with myomas and previous caesarean section. The other woman died in Turin from acute liver failure two days after a surgical procedure for missed miscarriage. In the first case the media interest was mostly local. In the second case the media didn't known about it. These three deaths remind us that there is no zero-risk in pregnancy and that, though rare, it is possible to die during an abortion procedure even in countries with advanced health care systems. Regarding the death after medical abortion that occurred in Turin, we can say that mifepristone is not responsible in any way.
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Oct. 2, 2014, 12:00
Deciding on the method and location for induced abortion: a Flemish survey study
Joke Vandamme1, Ann Buysse1, Inge Tency2, Guy T'Sjoen1 1University of Ghent, Ghent, Belgium, 2KAHO Sint Lieven, Ghent, Belgium - jokel.vandamme@ugent.be
Introduction The Belgian health insurance system prescribes that women who opt for medical abortion should stay at the abortion centre when using mifepristone and misoprostol. A lot of women currently decide for the more rapid surgical method under local anaesthesia. In this study, we map the process of deciding for one of the abortion methods along the different stages of information provision. Method. During a four month study period in four Flemish abortion centres, all Dutch-speaking adult women with a gestational period of less than 8 weeks were asked to participate. During the first visit, they were questioned about the sources they had consulted to get information on the abortion methods and were asked for their initial preference. Afterwards, they were shown a standardized videotape with accurate information on both methods and were asked for their preferences again. In a second video, women learned about the possibility of performimg the misoprostol phase at home and were questioned about their final preferences. Results. Preliminary results show that, when entering the abortion centre, the majority of women (>70%) preferred medical above surgical abortion. Most of the women (>60%) sought information on the official abortion centre website. However, one in three had visited other websites and one in four got information from external professionals. After the provision of standardized information, the percentage that prefers medical abortion drops to 50%. If the misoprostol at home option were available, only one in five would still prefer medical abortion with use of misoprostol in the abortion centre. Conclusion. Flemish women may have an inaccurate idea about the current medical abortion process. The misoprostol at home possibility would be a good alternative for the ones who would otherwise decide for the surgical method as well as for those preferring medical abortion.