Speeches
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Oct. 22, 2010, 08:00
Women experiences with legal abortion services in private clinics in Mexico City
Erika Troncoso (Ipas Mexico), Olivia Ortiz (Ipas Mexico), Raffaela Schiavon (Ipas Mexico)
Background: Decriminalization of induced abortion during the first trimester of pregnancy in Mexico City has broadened reproductive choices for women since April 2007. The objective of this study was identify the barriers and conditions that impact access to legal abortion (LA) in private clinics.
Methods: Seventeen semi-structured interviews were conducted with women who received a legal abortion in two clinics in Mexico City.
Results: The majority of the women interviewed were young, single with higher levels of education. Three women travelled to Mexico City to obtain a LA. The majority of women sought medical advice prior to arriving at the center and changed their decisions due to unfriendly care and lack of trust. Also, the majority of women obtained information on conditions and facilities offering services through the internet, as well were already aware of the legal changes pertaining to abortion. This allowed them to speak more openly on the subject with those most trusted, and even with healthcare providers when seeking consultation. Other factors that facilitated the experience included: being attended by trained medical personnel in legal and sanitary conditions, receiving comprehensive information about the procedure, and experiencing friendly and non- judgmental treatment by health personnel. Finally, establishing a personnel bond with one of the healthcare providers helped the process to be more comfortable. In respect to the barriers, the interviewed group identified what close relatives and friends perceived of them, informed by religious beliefs and moral judgments, as important. Other aspects were difficulties finding specific information on the way different methods work, the effects, and lack of economic resources to be treated immediately. Some women stated fear of feeling rejected by health personnel when requesting care. Women stated having distorted information produced and disseminated by the opposition concerning abortion. In addition, they found that some providers passed judgment or they felt hostility from health personnel in other areas, including prolonged waiting periods. However, these factors did not push them to change their decisions. The women stated their need for emotional support, something that was not considered in LA provision of services.
Discussion: Before arriving at the medical facility, the majority of the women was confronted by many complex and diverse situations and had made decisions as a method of self-defense and survival. Deciding to have a legal abortion served as an opportunity to change or avoid greater repercussions in the woman’s life. Legal abortion services must be aware of these situations because they will have an influence on the experience of the services. The analysis shows how women requesting legal abortion used various criteria to determine how much they trusted the service: both the legality and the expectation of care were used in order to determine who would be their health provider. Finally, this study shows the need to do further research on women’s emotional experiences, aiming to identify the factors that put them at risk in the immediate future with an unwanted or unplanned pregnancy.
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Oct. 3, 2014, 04:00
Pain and abortion: women’s perspective, including cultural aspects
Anne Verougstraete1 1-Sjerp-Dilemma-VUB: Family Planning and Abortion Centre: Vrije Universiteit Brussel, Brussels, Belgium, 2-Hôpital Erasme: Université Libre de Bruxelles (Obstetrics), Brussels, Belgium - ann.verougstraete@telenet.be
Surgical abortion: Surgical abortion is a very safe procedure and with local anaesthesia it is even safer than with general anaesthesia. In Europe, there are huge regional differences in the anaesthesia used for surgical abortion, and in a given region, some institutions perform the procedure only under local anaesthesia and others only under general anaesthesia. It seems very unlikely that these differences reflect the choice of women! A growing number of women choose "not to be there" at the moment of the abortion, while others prefer to be in control even if this means they will feel some pain.
Given the choice, many women appreciate emotional support during the surgical abortion procedure; some may want respect for a desired scheme (silence, music etc). Recently hypnotic techniques have been introduced in medical care: it is now used in emergency medicine, during interventional radiology, diagnostic procedures and surgical treatments. In some hospitals breast cancer operations and thyroid operations are performed under local anaesthesia and hypnosis so that general anaesthesia is not needed. There is growing interest in also using hypnosis during abortion procedures to reduce anxiety and pain, in women who desire it.
Medical abortion: Most women prefer home use of misoprostol but it is important to maintain the option to reside in the medical setting for those who wish. At home, women appreciate the possibility to have personal phone support or support by mobile phone messages in order to better manage pain and bleeding by reducing anxiety and stress. Conclusion: Woman-centred care should respect pain management and some rituals women wish for their abortion. In a lot of settings, women do not have this choice!
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Oct. 19, 2012, 02:00
Women’s preference for medical or surgical
method of termination of pregnancy at 9–12 weeks
of gestation
Dewart, H1; Johnstone, A2; Cameron, S2
1 Royal Infirmary of Edinburgh, UK; 2 Chalmers Sexual and
Reproductive Health Service, UK
Background and methods: Medical termination of pregnancy
(TOP) at less than 9 weeks of gestation and in the second
trimester, using mifepristone and misoprostol is well established
in Scotland. Although there is good evidence to support the
efficacy, safety and acceptability of medical TOP in the late first
trimester (9–12 weeks), it is not widely available. The TOP service
in Edinburgh, Scotland, UK currently offers only a surgical
method at this gestation band. A survey of women presenting to
this service at 9–12 weeks of gestation was conducted to
determine whether these women would choose a medical method
if this were available.
Results: Questionnaires were completed by a convenience sample
of 77 women over 5 months, representing 49% of all women at
this gestation during the study period. Women were of mean age
24.7 years (range 15–42). Most women (n = 51; 66%) stated that
they would choose a medical TOP if able to do so and a further
10 (13%) were unsure about preference of method. Most women
(n = 43; 56%) stated that they would still choose the medical
method, if they had to travel to another hospital (40 km away) to
have this. The commonest responses (out of 46 given) for
preferring a medical method was a perception that it was safer
(37%), easier (30%) and less invasive (28%).
Discussion and conclusions: Most women in our survey at 9–
12 weeks of gestation would in theory choose a medical method
of TOP, if this were available. Consideration should now be given
to offering this method to women as an alternative to surgery. -
Oct. 23, 2010, 02:00
Abortion and adolescents: case study from Kyrgyzstan
Tatiana Popovitskaya, Reproductive Health Alliance, Kyrgyzstan
Co-author: Galina Chirkina
For a long time abortion has been used as the main method of contraception in Kyrgyzstan. According to independent research, 7 out of 10 pregnancies end in an abortion. Young people under the age of 19 account for more than 200 abortions each year. This takes into account only the officially recorded and reported abortion figures. 70% of all abortions are still performed using dilation and curettage (D&C) contributing to the high level of post-abortion complications. The systematic underreporting of abortion figures is another sore point. Research performed by the Reproductive Health Alliance Kyrgyzstan (RHAK) showed that only one in 8 abortions performed in governmental clinics is registered and private clinics do not report their abortion figures.
According to the official figures of National Statistic Committee of Kyrgyz Republic the number of abortions has increased, especially amongst young people between 13 and 19 years of age*. At the same time we can see that the rate of contraceptive use by adolescents also decreased during the last 5 years by 1.8 times.
Several barriers to reproductive services influence the choices for adolescents in Kyrgyzstan:
- Adolescents have limited access to quality information and there is no sexuality education
- Adolescents have limited access to information on contraceptives and to contraceptives
- Adolescents are victims of violence based on tradition and violence within families and communities**
- Lack of quality of abortion care in the country; in 70% of the cases abortions are performed by D&C
- Lack of governmental commitment towards adolescents’ reproductive health
RHAK has played an important role in recognizing the need of young people to be able to access quality reproductive health services and has implemented several strategies to improve the reproductive health of young people in Kyrgyzstan. RHAK is now operating their own clinics providing high quality abortion services.
The Safe Abortion and Family Planning clinics in Bishkek (capital city) and Karakol were established under a Safe Abortion Action Fund project and further supported by IPPF EN through the GCACI project and SALIN+ project. The main goal of the clinics is to increase access to high quality information and services on abortion and family planning for young girls and women, especially poor, marginalized, socially excluded and underserved groups. The doctors were trained in safe abortion methods using Manual Vacuum Aspiration (MVA) and trained on providing pre - and post abortion counselling and contraceptive services. Clients can receive contraceptive services in the clinic and young people receive all services free of charge.
RHAK is recognised as the leading expert on safe abortion in the country and has delivered government sponsored training to a total of eight governmental clinics of family medicine and three maternity hospitals.
Besides medical services the RHAK clinics are also involved in prevention activities like information campaigns aimed at young people, open – door days, group consultations or discussions with students and schoolchildren which the aim to further reduce barriers to accessing services provided by RHAK clinics.
RHAK believes and proves that an NGO can be a good promoter of safe abortion and can successfully train service providers, assess the quality of care, increase the knowledge of the population as well as the medical and business community, support and develop safe abortion pilot clinics and projects, join forces
with key partners for advocacy and promotion of safe abortion.
*The official rate of abortions in the age group from 13 to 19 in 2009 was 3,6 for 1000 girls, in comparison with 2008 –3,0 and 2005 - 2,9 for 1000 girls.
**An example of such a violent tradition is bride napping or bride kidnapping also known as as marriage by abduction or marriage by capture.
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Oct. 19, 2012, 09:00
Young women’s experiences of termination of
pregnancy and miscarriage
Brady, G
University of Coventry, UK
In Britain, the politics and policy of teenage pregnancy places the
emphasis on ‘prevention’ of teenage pregnancy, positioning
parenthood for young people as a negative choice; this dominant
discourse is likely to influence young people’s reproductive
decisions and experiences. With this in mind, this paper focuses
on a key finding from a multidisciplinary empirical research
study, conducted in a city in the West Midlands of England, UK,
which considered and explored young people’s experience of
support before and following termination and miscarriage. Data
were collected via indepth interviews with professionals and
practitioners, young mothers and one young father. Although
termination and miscarriage are generally perceived as distinct
and different issues, the data suggest that the issues become more
blurred where younger women are concerned. The experiences of
young, ‘inappropriately pregnant teenagers’ often remain
unacknowledged and devalued. This paper highlights the social
and political context in which young women experience
termination and miscarriage, and suggests that termination and
miscarriage should be acknowledged as significant medical, social
and emotional events in the lives of young people. -
Oct. 14, 2016, 02:00
CS03.2
Abortion in women with haematological disease
Alison Edelman
Oregon Health & Science University, Portland, Oregon, USAControversy exists regarding the management of haematological diseases in women undergoing abortion. However, the overall risk of either haemorrhage or thrombosis is extremely rare in women undergoing abortion; as such, little change is likely to be necessary in the management of these women other than increased vigilance. Consideration of clinical setting, availability of emergency resources and gestational age may influence clinical management but will vary with the type and severity of the disorder and its risk of "bleeding" or "clotting". Anecdotally clinicians prefer aspiration or surgical abortion over medical in women at risk for bleeding because of the ability to control and monitor bleeding directly. As pregnancy exponentially increases the risk of thrombosis, a woman's choice to end the pregnancy returns her risk back to baseline. Measures to prevent bleeding and clotting and the evidence behind them will also be included. Finally, one of the most important aspects of the care for women with haematological diseases is the prevention of and planning for the next pregnancy as well as the non-contraceptive benefits that can be obtained from the use of a contraceptive method for these women. The current literature will be discussed as well as a brief review of the common haematological disorders likely to be encountered and a practical approach to the clinical management of these patients.
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Oct. 4, 2014, 11:00
Addressing abortion stigma in service delivery: the experience of Pakistan and Burkina Faso
Rebecca Wilkins1, Asifa Khanum2 1International Planned Parenthood Federation, London, UK, 2Rahnuma Family Planning Association of Pakistan, Lahore, Pakistan - rwilkins@ippf.org
Restrictive legislation and limited service provision remain obstacles to women who seek abortion services. These obstacles are worsened by the impact of abortion stigma and associated secrecy, shame, guilt and fear. Stigma prevents or delays access to safe abortion services as well as making lawmakers reluctant to improve legislation to facilitate access to abortion information and services. As part of its commitment to reducing abortion stigma at all levels, IPPF commissioned research to understand its effect on women accessing services through IPPF Member Association clinics. In-depth qualitative research using semi-structured interviews with abortion clients, service providers and client partners was conducted at Member Association clinics in Pakistan and Burkina Faso. The research aimed to identify the specific causes and manifestations of abortion stigma and to inform interventions designed to reduce abortion stigma. The research found commonalities in abortion stigma in Pakistan and Burkina Faso, as well as some issues that were unique to each country setting. The clinic client pathways, misconceptions and lack of knowledge about abortion, pre-abortion counselling, and the timeliness of seeking medical care were among some of the issues found to have an impact on, or were impacted by clients' experience of stigma. In both countries women who accessed abortion services had a high level of self-stigma which impacted on their expectations of quality of care in the clinics. Abortion stigma is an unspoken reality that significantly impacts both the attitudes and practices of medical professionals and women who access abortion services. However, the nature of abortion and the stigma surrounding it makes this a challenging topic to collect data and information on. The research findings illustrate the need for the pilot testing of interventions at both the community and service delivery levels in order to address abortion stigma through a more comprehensive and systematic approach.
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Oct. 3, 2014, 02:00
Empowering providers and patients as advocates
Vicki Saporta National Abortion Federation, Washington, DC, USA - vsaporta@prochoice.org
Although abortion has been legal in the United States for 41 years, we continue to see attacks on women's access to abortion care. In the last few years, anti-choice legislators have made restricting abortion access a priority and we have seen a record number of anti-abortion restrictions being introduced and passed at the state and federal levels. The stigma surrounding abortion has also contributed to this hostile political environment and a lack of understanding for abortion providers and women who access abortion care. One of the most effective ways to fight these attacks and work to dispel stigma is to ensure that the voices of providers and patients are included in the public debate about abortion. We have helped women come forward and speak out about their decision to obtain abortion care and to explain how proposed restrictions would have affected their ability to make the decision that was best for them. These stories have been successful in combating political stigma and challenging restrictions. We must continue to help women share their abortion stories. We have also worked to train and mobilize abortion providers to advocate with lawmakers and speak to the media. Abortion providers are invaluable messengers, who can offer expert medical testimony and dispute false claims made by abortion opponents. Abortion providers are also uniquely qualified to discuss the public health consequences of unsafe abortion and the necessity of ensuring that abortion care is safe, legal, and accessible.
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Sept. 14, 2018, 01:00
Ireland has one of the most restrictive abortion laws in the world: abortion is only permitted to save the life of the mother. That is about to change. In May 2018, by a referendum, the Irish people voted by a landslide majority to repeal the constitutional provision—the 8th amendment—that banned abortion and to empower the legislature to provide for abortion care in Ireland.
In 2017, a Citizen’s Assembly, 99 “Citizens” chosen by a random selection process to provide a geographical, gender, age balance, overseen by a senior judge, was convened to hear evidence from a wide variety of sources – medical, legal, activists on both sides of the issue.
The very liberal legislative model recommended by the Assembly inspired a subsequent parliamentary committee—which in its turn heard form medical and legal voices—to also recommend legislation to permit abortion on broad grounds. This led the government to call a referendum to repeal the 8th amendment.
The presentation will focus in particular on the ways in which health expertise, international best practice and public health evidence became tools of human rights advocacy. It will discuss the role of the Irish Family Planning Association in developing and using these tools, and, critically, in building the capacity and creating a community of healthcare practitioners who would become key advocates in the campaign to repeal the 8th amendment.
The presentation will also outline the new legal framework being proposed by the government, potential barriers to access and inequities in the system proposed. Finally, the presentation will discuss the challenges that now present us as we finally become committed, rights-based providers of abortion care.
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Oct. 3, 2014, 11:15
An update on unwanted pregnancy from Slovenia - with special focus on adolescents
Bojana Pinter Division of Ob/Gyn, University Medical Centre, Ljubjana, Slovenia - bojana.pinter@guest.arnes.si
Background: In Slovenia abortion has been permitted on request from 1977. The liberalization of the law was a consequence of improvements in vacuum aspiration technique in 1964 at the Dept. of Ob/Gyn in Ljubljana, Slovenia. This technique had been successfully presented to the world's professionals at IPPF conference in Santiago, Chile, in 1967 and evaluated in the American-Yugoslav joint project "Abortion study Ljubljana" in 1971−1973. Content: Abortion rates in Slovenia have decreased in the last thirty years: in 1980 the abortion rate was 40.3/1000 women aged 15−49 years, in 2012 8.7/1000. Among adolescents aged 15−19 years abortion rates decreased from 25.3/1000 in 1980 to 5.8/1000 in 2012. A decrease in unwanted pregnancies was evident in spite of an increase in sexual activity of adolescents. According to representative studies on sexual behaviour of Slovenian secondary-school students in the years 1996, 2004 and 2012 the percentage of sexually active students aged 17 years increased from 45% (male) and 44% (female) in 1996 to 53% (male) and 57% (female) in 2014. The decrease in abortion rates is in correlation with an increase in use of effective contraception (condom, hormonal contraception or double method): from 75% in 1996 to 85% in 2012, and a decrease in students using no contraception: from 19% in 1996 to 7% in 2012. In addition, contraception is widely accessible through outpatient Ob/Gyn services and fully covered by general health insurance. In the last twenty years the knowledge on contraception among providers has increased. In spite of the fact that sexuality education in schools is not mandatory, pupils and students get some information through special programmes held in schools. In addition, the media, on the subject of contraception, mostly work in collaboration with professionals. Conclusions: The decrease in abortion rates in Slovenia is the result of accessible services and increased knowledge of contraception among providers and users.