Speeches
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Oct. 19, 2012, 09:00
The impact of implants and intrauterine
contraceptives provided at an index surgical
termination of pregnancy (Jan–June 2008) on
repeat termination of pregnancy within 3 years:
an audit
Latham, F1; Guthrie, K2; Trussell, J1
1 Hull York Medical School; 2 Community Health Care Partnership
Hull, UK
Background: Implants and intrauterine contraceptives have lower
failure rates and higher continuation rates than the other
reversible methods of contraception. We hypothesised that the
patients who chose these long lasting reversible methods after
their index surgical termination of pregnancy (STOP) would have
a reduced incidence of subsequent termination of pregnancy
(TOP) in comparison to those who chose other reversible
methods (injections, oral contraceptive pills, patch, ring and
condoms).
Methods: Index cases were recorded retrospectively from theatre
registers at Hull Royal Infirmary for all STOPs between January
and June 2008. Type of contraception chosen at procedure was
recorded: Implanon, Mirena, IUD, Depo-Provera, Sterilisation and
‘Other’ (oral contraceptives, patches, rings, condoms). The
hospital information system for the subsequent 3 years was
searched for another TOP (surgical or medical). The data were
analysed. A secondary objective was to record contraceptive
choices in two age groups (<25 and ‡25 at index STOP).
Results: Women choosing Implanon, Mirena and IUDs had a
significantly lower repeat TOP rate than those choosing other
reversible methods at 2 (3.4% vs. 9.3%, P = 0.008) and 3 (6.8%
vs. 12.4%, P = 0.04) years. As age increased, use after an index
STOP of Implanon decreased (32% vs. 8%) and Mirena increased
(13% vs. 41%) significantly.
Conclusion: A 50% increase in the uptake of implants and
intrauterine contraceptives would decrease the repeat TOP rate
within three years by 16%. -
Oct. 22, 2010, 08:00
The impact of US Fellowship in family planning
Jema Turk, H.Steele, M.Fulton, U.Landy and J.Steinauer, USA/Canada
Objectives: To describe the US-based fellowship in family planning.
Background: In 1991, the Fellowship in Family Planning was established at the University of California, San Francisco to promote advanced training in contraception and abortion. The Fellowship in Family Planning provides two years of post-residency training in clinical care, research and policy training. The fellowship also requires an international placement in a low-resource setting and completion of a masters degree in clinical research or public health and is available to graduates of either obstetrics-gynecology or family medicine residency training.
Methods: The fellowship is assessed yearly through annual reports completed by faculty and fellows, bi-yearly site visits, and regular audits of fellowship publications.
Results: The Fellowship in Family Planning has grown to include 21 medical schools throughout the United States. To date there are 118 graduated fellows and 38 fellows currently in training. Fellows develop expertise in abortion care and complete a median of 168 first-trimester uterine aspiration and 102 second-trimester D&E procedures over two years, in addition to developing skills in contraception and maintaining non-family planning skills. Fellowship directors and graduated fellows have generated a wealth of research addressing some of the most critical questions in family planning, with over 120 peer-reviewed publications in 2009. Fellows have participated in international placements in 39 countries in four continents. Twenty-four (20%) graduated fellows have gone on to direct abortion training programs in residency programs.
Conclusions: The development of a fellowship in family planning in the US has led to a cadre of subspecialists and consultants in abortion and family planning clinical care and research who have become the leaders in training and research in the US.
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Sept. 10, 2004, 04:15
The importance of education on contraception
Bojana Pinter , MD, PhD. University Medical Center, Ljubljana -Slovenia
Introduction
Family planning, sexual and reproductive health are essential components of individuals, couples and societies. Information on sexual and reproductive health and sexual education are very important in improving the knowledge and practice of contraception and thus in preventing unwanted pregnancies, which mostly end in induced abortions, and in preventing sexually transmitted infections (STIs).
Sexual education
The aim of sexual education is to change the sexual behavior with improving KAS (K–knowledge, A–attitude, S–skills) through education in sexuality, contraception, abortion prevention, avoiding risk-taking behavior and STIs (with HIV). Sexual education can be formal or informal, at school, in the family, by the media and through service providers. It needs broader approach than simply giving information and education on contraceptive and other preventive methods. Mechanical and organic bodily information are not enough as people, especially adolescents, are much more concerned about other aspects of love and sexuality: emotions, thoughts and anxieties should be addresses and discussed. Besides, training in communication skills is an important aspect of sexual education.
Innovative approach in sexual education could be as SPICES: S – stimulating, P – problem oriented, I – interactive, C – community based, E – extensive, S – students centered. Studies and practice have shown that “peer education” is one of the most successful approaches in sexual education. However, sexual education is only one part of a holistic approach to sexual health promotion and behavioral change, which develops through consecutive steps: awareness – knowledge - attitude – intention – behavioral change – sustained behavioral change.
The majority of sexual education programs have some positive effects upon some outcomes (such as greater knowledge), but only some of the programs actually result in some behavioral change as: delay in the initiation of sex, increase in condom or contraceptive use, reduction of unprotected sex among youth and reduction of unwanted pregnancy and induced abortion rates. The studies show that effective sexual education programs:
- include a narrow focus on reducing sexual risk-taking behaviors that may lead to STIs or unintended pregnancy (e.g. delaying the initiation of sexual intercourse, using protection)
- use social learning theories as a foundation for program development
- provide basic, accurate information about risks of unprotected intercourse and methods of avoiding unprotected intercourse through experiential activities designed to personalize this information
- include activities that address social or media influences on sexual behavior
- reinforce clear and appropriate values to strengthen individual values and group norms against unprotected sex
- provide modeling and practice in communication and negotiation skills.
The studies also show that sexual education programs do not increase any measure of sexual activity.
Sexual education in Slovenia
Because most youth are enrolled in school for many years before they initiate sex and when they initiate sex, schools have the potential for reducing adolescent sexual risk-taking. Unfortunately, the practice in many European countries, as in Slovenia, is that there is no formal sexual education nor in primary nor in secondary schools. The study on sexual behavior of secondary-school students in Slovenia has shown, that the majority of students get the information on sexuality from friends, parents and different sources together and that the school is less important source of information. In the absence of formal sexual education other sources of information (e.g. internet, journals) could provide youths with minimal information. However, more cooperation on national level should be established to introduce formal sexual education in schools.
Triple protection
The suggestion made by the Population Council is that rather than dual protection, what many young and adult people need is “triple protection” against unintended pregnancy, STIs and infertility (which is possible consequence of STIs in women and men). Triple protection can be achieved by ABC approach: A – abstinence, B – being faithful and using contraception, C – condom use.
Conclusions
Effective sexual education programs can be an effective component in a larger initiative to reduce the unintended pregnancy, STIs and infertility risks in youth and adults
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Oct. 13, 2006, 09:00
The midwife’s role in care of abortion patients
Axelsson Monika. RNM, Holmqvist Liselott. RNM, abortion clinic, Göteborg, Sweden
In Sweden, abortion has been legal since 1975. The law stipulates that termination of
pregnancy is the woman’s own choice until week 18. After this gestational age, an
application must be made to the National Board of Health and Welfare. This application is
made jointly by the gynaecologist, who makes a medical assessment, and a social
worker/counsellor, who makes a socio-psychological assessment. The Board approves or
denies the application, based on the special conditions pertinent to the case.
Counselling with a social worker/counsellor is offered to all women until pregnancy week
18; after week 18 counselling is compulsory.
34 800 abortions are performed every year in Sweden. This corresponds to 20.1 abortions
per 1000 women. The most common age group is 20 – 24.The statistics for 2003 show a
decrease in abortions among teenagers for the first time since 1995.
The woman can choose the medical or surgical method surgery until the ninth week of
pregnancy. At the abortion clinic at Sahlgrenska University Hospital/Östra(SUÖ), the staff
consists of four midwives and two auxiliary nurses. Two doctors work at the clinic. Social
workers/counsellors are available when required for consultations. Midwives work in
abortion clinics in Sweden. In many clinics, midwifes are employed, and together with
gynaecologists, social workers/counsellors and auxiliary nurses run the organisation.
The midwife has a unique position, she has a broader view of both the woman’s and man’s
sexual health. She can thus provide information to the patient/woman and give advice and
support prior to the abortion decision. The midwife provides contraceptive information and,
according to Swedish law, prescribes hormonal contraceptives and inserts IUDs and
implants. Cooperation with the social workers/counsellors with their greater knowledge and
education about abortion issues, is positive.
In order to improve our care of and approach to our patients, we performed a study to
evaluate our work in 2001.With the help of a questionnaire, 50 women were questioned
during their follow-up visit. They answered 21 questions concerning clinic environment,
staff availability, information, competence, confidentiality, approach and pain relief.
Most patients were satisfied with the information, with the exception of that regarding pain.
Some patients felt that experiencing labour-like pains/contractions was unpleasant.
Bleeding was also an area, which surprised some of our patients, who had expected tobleed less. The majority of women were satisfied with their care, but thought that the
appointment with the gynaecologist was stressful. We will proceed to improve our
organisation, based on the results of our study.
It is our ambition that a midwife is the first person the patient meets when she requires an
abortion, because the midwife has a unique knowledge of women and their sexual health.
This knowledge should lead to the midwife being responsible for making appointments and
providing advice by telephone, including information on abortion and contraception
methods, so that the woman is well prepared when she comes for her gynaecologist’s
appointment. In our opinion, it is important that women be offered a follow-up appointment
with the midwife after the abortion, regardless of whether it is medical or surgical. Offeringbleed less. The majority of women were satisfied with their care, but thought that the
appointment with the gynaecologist was stressful. We will proceed to improve our
organisation, based on the results of our study.
It is our ambition that a midwife is the first person the patient meets when she requires an
abortion, because the midwife has a unique knowledge of women and their sexual health.
This knowledge should lead to the midwife being responsible for making appointments and
providing advice by telephone, including information on abortion and contraception
methods, so that the woman is well prepared when she comes for her gynaecologist’s
appointment. In our opinion, it is important that women be offered a follow-up appointment
with the midwife after the abortion, regardless of whether it is medical or surgical. Offeringbleed less. The majority of women were satisfied with their care, but thought that the
appointment with the gynaecologist was stressful. We will proceed to improve our
organisation, based on the results of our study.
It is our ambition that a midwife is the first person the patient meets when she requires an
abortion, because the midwife has a unique knowledge of women and their sexual health.
This knowledge should lead to the midwife being responsible for making appointments and
providing advice by telephone, including information on abortion and contraception
methods, so that the woman is well prepared when she comes for her gynaecologist’s
appointment. In our opinion, it is important that women be offered a follow-up appointment
with the midwife after the abortion, regardless of whether it is medical or surgical. Offeringbleed less. The majority of women were satisfied with their care, but thought that the
appointment with the gynaecologist was stressful. We will proceed to improve our
organisation, based on the results of our study.
It is our ambition that a midwife is the first person the patient meets when she requires an
abortion, because the midwife has a unique knowledge of women and their sexual health.
This knowledge should lead to the midwife being responsible for making appointments and
providing advice by telephone, including information on abortion and contraception
methods, so that the woman is well prepared when she comes for her gynaecologist’s
appointment. In our opinion, it is important that women be offered a follow-up appointment
with the midwife after the abortion, regardless of whether it is medical or surgical. Offeringthis service is our ambition, albeit a long-term goal, since it currently depends on the
economical situation in the hospitals. Unfortunately, these women are not a high priority. -
Oct. 13, 2006, 02:00
Policy of the US
Vicky Sapporta, MD, President of NAF (National Abortion Federation),
The Religious Right has grown as a political force in the United States. With widespread
access to the White House, members of Congress and state legislators, they have been
trying to restrict women’s access to abortion care by introducing legislation that would ban
abortion, require parental involvement for minors, reduce public funding, require biased
informed consent and waiting periods, and force clinics to comply with other politically
motivated restrictions.
Abortion providers can play a key role in countering the Religious Right by providing the
medical, scientific and provider perspectives in public policy debates about abortion. NAF,
as the professional association of abortion providers in the United States and Canada, has
successfully brought forward providers and patients to highlight the real-life consequences
of restrictive legislation and regulations. As a result, we have been able to expose and
defeat initiatives supported by the Religious Right to further restrict women’s access to
abortion care. -
Oct. 24, 2008, 09:00
The psycho-social aspect of the second trimester abortion with teenagers
Milica Berisavac, Rajka Argirovic, Radmila Sparic, Nebojsa Markovic, Ivan Pavlovic, Ivana Cmiljic (Serbia)
Institute for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia
radmila@afrodita.rcub.bg.ac.yu
Introduction. There are numerous barriers for establishing communication with and education of teenagers in respect of protection from unwanted pregnancies and sexual behavior. Unwanted pregnancy at this age is often detected in the second trimester, due to sense of fear and embarrassment to confide with the mother, friend, or partner, as well as to the sense of possible condemnation and lack of understanding of the environment. The legal procedure stipulating the abortion in the second trimester is explicit. Both the psychological and physical immaturity, uncompleted education, often unstable and temporary relationship, can cause a significant alteration of teenagers’ mental health. A sexual relationship with drug users additionally complicates the psychological state of the patients.
Method. The retrospective study encompasses all the patients who were hospitalized during the years 2006 and 2007 due to second trimester abortion. We analyzed the age of the patients, the knowledge of methods of protection from unwanted pregnancy, gestational age in which the unwanted pregnancy was diagnosed, the psychological state of the patients and indications for the abortion.
Results. During the study period there were 173 second trimester abortions at the Institute for Gynecology and Obstetrics Clinical Center of Serbia, 18 of which with under-age patients (9.33%). Teenagers did not have any or of little knowledge on contraceptive methods. In the group to the age of sixteen a greater gestational age was diagnosed (18-20 weeks). In the age group from 16 to 18 the gestational age was 16-18 weeks. Three teenagers were mentally retarded, and one pregnancy happened at the institution. Reactio depresiva was indication for abortion in 15 cases. The abortive procedure was performed by application of hypertonic Na Cl, with abortive interval of 20-24 hours.
Discussion. In younger life age, advanced gestations were detected. The fear of condemnation by the family and the environment affected the late reference at younger teenagers. Even with older teenagers, there were no decisions to continue the pregnancy because they did not have the support of the family, partner nor had they the financial means or completed education. The absence of knowledge on protection methods from unwanted pregnancy imposes the necessity of comprehensive education of this population group, and inappropriate relationships in the family deprived of sincerity and understanding, bring the under-aged patient to the medical institution late in the pregnancy.
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Sept. 10, 2004, 02:00
The role of the doctor
Pedro Peña Coello (Sp)
Clinica Campo de Gibraltar
San Roque Cádiz, Spain
The emergency contraception’s objective is to avoid a non-desired pregnancy in case of having had unprotected intercourse. We know that a large percentage of these intercourse’s end in non-desired pregnancies (NDP), which usually are terminated with an abortion, which we all intend to avoid.
The most frequently used molecule today as a contraceptive is the LEVONORGESTREL, a highly recognized and used drug, secure, functional and with almost no side- effects. How many over the counter drugs with these characteristics are available today?
The association which I represent (ACAI) believes unanimously that the benefits to any easy access to apc are larger than the risks.
We largely defend that APC could be recommended, given, or prescribed by any person with minimum health information about this subject, health agents, sexual educators, social workers, nurses, doctors, or pharmacists.
We believe that us doctors have a great responsibility; therefore, our role is an important one concerning the investigation, prevention, education, and care of the sexual and reproductive education, but not necessarily nor obligatory the APC should be given by medical authorization.
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Oct. 16, 1999, 10:00
98% of abortions are carried out in non-hospital situations with very few medical
staff. The antibiotics prescribed are chosen in relation to the age, the sexual
precociousness and the number of partners.
The talk underlined the frequency of asymptomatic carriers , the increase in the
occurrence of Chlamydia 3%. Gonorrhoea tending to disappear.
The criteria for screening are thus defined:
&Mac183; More than 2 partners per year
&Mac183; Request for abortion
&Mac183; Before putting in an I.U.D.
&Mac183; Partner infected with a S.T.D.
&Mac183; The pill before 18
&Mac183; Abdominal pains
&Mac183; Screening for S.T.D.
Treatment : 200mg DOXYCYCLINE for 2 days.
Abortion postponed for a week in the case of Chlamydia -
Oct. 20, 2012, 02:00
Training midwives and doctors in post-termination
of pregnancy care in Gabon and Cameroon
Alblas, M; Ndembi, AP; Pheterson, G; Mbia, C;
Mekui, JE
Middle Africa Network for Women’s Reproductive Health: Gabon,
Cameroon and Equatorial Guinea
The NGO Middle Africa Network for Women’s Reproductive
Health: Gabon, Cameroon and Equatorial Guinea – GCG is
devoted to research, education and training to understand
obstacles to better health care. This presentation focuses on one
central part of the mission: training midwives and doctors in
post-termination of pregnancy (TOP) care, mainly manual
vacuum aspiration. After a needs assessment initial field trip in
2009 it became clear that the morbidity and mortality among
women due to unsafe TOP is high in rural areas in Northern
Gabon, southern Cameroon and eastern Equatorial Guinea.
When complications from back street TOP arise, women arrive
late (or never) for emergency hospital care because they know
TOP is illegal and highly stigmatised, and often they have no
money either for transport to the hospital or for the medical aid
they need. If a doctor is present, he/she can do a sharp curettage
under general anesthesia, but this is expensive and in the more
rural areas often there is no doctor. Pregnancy and birth are
typically the domain of midwives, but they are not trained in
treating TOP-related complications since procedures such as MVA
or misoprostol use are not institutionally recognised, and only
doctors perform D&Cs.
Recently one of our trained midwives has been appointed by
the Ministry of Health to train all the midwives in the country in
post-TOP MVA. In the last 3 years this network has made asignificant first step in demonstrating that also in a country where
TOP is illegal, one can build capacity, mobilise attitude change
and enlist institutional support. -
Oct. 23, 2010, 02:00
Training of abortion providers: how and when
Vicki Saporta, President and CEO, National Abortion Federation, USA
In the 1990s, obstetrics and gynecology (OB/GYN) residency programs were falling short of their responsibility to train new physicians in abortion care and contraceptive services. Through targeted efforts, organizations addressed this problem with the introduction of a wide range of training opportunities, including newly established residency- and fellowship-based training programs in family planning and abortion care.
Residents receive hands-on training through residency program partnerships with freestanding clinics and private medical practices. Current providers have also partnered with some of these sites to learn abortion techniques, including later abortion procedures to expand their practices. Additionally, providers stay current in abortion practice through continuing medical education (CME) opportunities such as educational conferences and accredited online resources.
Despite the fact that OB/GYN residents have had more training opportunities in the past 15 years, this has not necessarily resulted in increased numbers of clinicians providing abortion care. Efforts are underway to train physicians in other specialties such as family practice, as well as to train advanced practice clinicians. By integrating abortion care into other broader practices, we hope to see an increase in the number of providers who actually go on to offer abortion care.