Speeches
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Oct. 13, 2006, 09:30
Are the laws patient centred?
Christian Fiala, MD, PhD, Gynmed Clinic, Vienna, AustriaFor most women the diagnosis of an unwanted pregnancy is unexpected. The women are
therefore unprepared, be it for carrying the pregnancy to term or having an abortion. They
need a great deal of information within a very short space of time. In case they have taken
the decision to terminate the pregnancy, it is crucial for them to get fast access to medical
facilities.
It is interesting to analyse legal requirements and regulations in European countries, as to
how far they support the women in this crisis situation in finding a solution.
Societies react differently to the needs of the women, although the past was dominated by
a rigid paternalism, coupled with beliefs 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 taken.
A huge progress has been made over the last decades to overcome this approach and the
legalisation of abortion has been a corner stone. However there are still many remnants of
the old thinking like obligatory waiting (“cool off”) periods of an arbitrary number of days or
an obligatory counselling.
So far there is no evidence that these restrictions are of any benefit. They do, however,
lead to a delay in the provision of the treatment and have negative effects on the physical
and psychological experience of those affected.
Examples and comparions of european coutries are given in the presentation. -
Oct. 13, 2006, 08:00
The song „The Knitting Needle Bill“
Carol Shand, MD New Zealand
Explanatory notes for the song by Dr Carol Shand & Dr Margaret Sparrow
This song* was written in 1976 at the height of the abortion debate in New Zealand (NZ).
In the 19th Century, abortion laws in NZ and Australia (based on UK law) were restrictive.
A test case occurred in June 1938 when Dr Aleck Bourne, London, carried out an abortion
on a 14 year old girl who had been raped. Mr Justice Macnaghten directed the jury that an
abortion was not unlawful if carried out on the grounds of preserving the health (as
opposed to the life) of the woman. In 1967 a more liberal law was passed in the UK but NZ
and Australian did not follow suit. Most abortions were clandestine acts. NZ women with
money could travel to the UK or Japan for a legal abortion. Poor women relied on do-it-
yourself techniques, backstreet abortionists or doctors acting covertly within NZ.
Each State in Australia has different abortion laws. In 1969 a Melbourne court case
exposed police corruption and political interference but the result was an acquittal,
liberalising the law in the State of Victoria. In Sydney in 1971 the jury in another trial
involving an abortion “clinic” again failed to convict, effectively liberalising the law in the
State of New South Wales. After this, clinics in these two States operated more openly and
the trans-Tasman traffic increased greatly. (Auckland to Sydney is 2146 km)
In May 1974 a private abortion clinic opened in Auckland to test whether NZ would also
accept a more liberal interpretation of the law. Rich or poor now had access to a safe NZ
service. The police raided the clinic in September 1974 and one of the operating doctorswas brought to trial. Fearing that a NZ jury might not convict (as had happened in
Melbourne and Sydney) anti-abortionists lobbied for parliamentary change.
In September 1974 Dr Gerald Wall MP introduced a Bill (The Knitting Needle Bill) to try
and close down the Auckland clinic, by restricting abortions to hospitals. The Bill was
passed in May 1975 but never enacted due to an error of drafting. The clinic remained
open. Another attempt in August 1976 to restrict abortions to hospitals was made by the
Minister of Health, Air Commodore Gill. Parliament rejected this as they had already
appointed a Royal Commission in June 1975 to review contraception, sterilisation and
abortion. The Commission produced a very conservative report in March 1977. This
resulted in a redrafting of the abortion laws which although still restrictive on paper, in
practice deliver a reasonable although excessively bureaucratic service. The Prime
Minister at the time, Rob Muldoon was also anti-abortion.
The writer of the song, Dr Erich Geiringer (1917-1995), a medical doctor, a refugee from
Vienna, ran a weekly talkback radio session and this song was one of the satirical songs
he wrote and sang on Radio Windy. The illustrations depict from Top left: a rampant
farmer in black wool singlet, and gumboots, smoking heavily. Top centre: Coat of Arms per
Qantas (Australian airline) with NZ icons of rugby, sheep, beer and knitting needles. Top
right: Bernadette. The bottom scenes depict various illegal abortion methods: Higginson
syringe, herbs, potions, hot bath and gin etc. The satire ostensibly mocks the rich young
miss who hopes to enjoy a days shopping, trip to the opera and visit to the famous Bondi
beach after her quick Australian abortion and is cross that liberalised legal practice might
limit her fun. In fact the song was intended to remind the politicians that a repressive law
would oppress only the poor who would be forced to resort again to dangerous backstreet
abortions.
*Tune: Victorian Music Hall song “She was poor but she was honest”
Chorus: “It’s the same the whole world over, it’s the poor wot gets the blame. It’s the rich wot gets the gravy. Ain’t it all a bleeding
shame.” -
Oct. 19, 2012, 09:00
Asurvey of attitudes of staff working within a
sexual and reproductive health centre, towards
undertaking early medical termination of
pregnancy
Michie, L1,2; Cameron, S1,2
1 Chalmers Sexual Health Centre, Edinburgh, UK; 2 University of
Edinburgh,UK
Introduction: In Scotland, most termination of pregnancy (TOPs)
are provided in hospital departments of Obstetrics and
Gynaecology. Since high quality contraceptive provision should be
integral to TOP, this raises the question of whether TOP services
would be better provided by clinicians in community sexual and
reproductive health services (SRH). We aimed to determine views
of these clinicians about potentially offering TOP servicesMethods: An anonymous internet questionnaire of staff working
in a large SRH service in Edinburgh (Chalmers) was conducted
between January and March 2012. The questionnaire consisted
mainly of ‘drop-down’ list options with additional free text
response to some questions.
Results: A 69% response rate was obtained. (62 out of 90;
doctor = 22, nurses = 25, admin staff = 15). The majority of
responders (69%) felt that provision of abortion services would be
a natural extension to existing services and the majority, (69%)
would be personally willing to provide abortion care. Only 11%
stated that they would refuse to be involved in TOP care due to
moral objections. Respondents agreed that TOP care from this
setting would offer advantages for women including better
provision of contraception (71%) and better management of
sexual infection (53%), amongst others. Only 23% of responders
(n = 14) felt there would be some disadvantage to offering
abortion services from this setting.
Conclusion: Most staff felt that providing TOP services within a
community SRH service is a natural extension to existing services
and that this would offer improved contraception and sexual
health care to women undergoing TOP. -
Oct. 22, 2010, 02:00
Barriers to access&use of contraception in immigrant women presenting for abortion
Ellen Wiebe, Canada
Background: About half of the women presenting for abortion in Vancouver are immigrants and most of these are from Asia. In previous studies of contraception and ethnicity, we found that the contraceptive practices and attitudes of immigrant women differ from those reported by other Canadian women. Specifically, we found that among Chinese and Korean immigrant groups in Vancouver, women expressed a deep suspicion towards hormonal methods of contraception, such as birth control pills, and were reluctant to use them. This study examined the experiences, attitudes and beliefs of immigrant women with regard to contraception in order to identify difficulties involved in accessing contraception in Canada. Our main concern was to understand more about the barriers for women accessing contraception prior abortion and if there were more barriers for immigrant women.
Method: This was a survey of women presenting for abortion using a questionnaire asking about women’s usage and experiences of both hormonal contraceptives and natural family planning methods, their attitudes towards medical contraceptive methods (hormonal and intrauterine), any barriers to contraceptive access they have encountered and the sources of information women rely on to make their contraceptive decisions. The site was an urban abortion clinic and the questionnaires were available in English, Chinese and Punjabi. Data was entered into an SPSS database for statistical analysis. The analysis included an examination of the differences in contraceptive practice, experience, and attitudes between immigrant women and other Canadian women, as well as a needs assessment.
Results: Of the 1000 subjects planned for this study, we have data on 143 at the time of writing this abstract. Of the 77 immigrants, 64% had previously used hormonal contraception compared to 94% of the 62 non-immigrants (p=<.001); 71% of the immigrants compared to 88% of the non-immigrants believed hormonal birth control was safe (p=.02); 25% of immigrants compared to 12% of non-immigrants had some problems accessing contraception; 30% of immigrants compared to 15% of non-immigrants had become pregnant “counting safe days” (p=.04).
Conclusion: More immigrants were using less effective methods of contraception when they got pregnant and they had more difficulties accessing contraception prior to the abortion. When the data is complete, we will be able to understand more about which groups of immigrants have the most difficulties. By determining the extent of inadequate information about contraception and barriers in access to contraceptive methods in immigrant women, we may be able to help plan solutions.
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Nov. 25, 2000, 04:00
Termination has been legal since 1990.
It is authorised on the demand of the woman and on medical grounds up to 14
weeks of amenorrhoea.
The woman has to declare that she is in a situation of distress, and must make
her request in written form.
Beyond 14 weeks of amenorrhoea, termination is possible only after the
consent of two doctors, provided that there is a serious health risk to the
woman, or if there is an abnormality of the foetus.
There is a mandatory waiting period after the first counselling of 6 days. -
Sept. 10, 2004, 02:00
Emergency contraception
Emergency contraception, can it be handed out without medical prescription?
E. Aubény, gynecologist, President French Association for Contraception ,
Hopital Broussais, Paris. Co-founder and Past President of Fiapac
Levonorgestrel can be used in emergency contraception (EC) at a dose of 1.50 taken in oneintake. This progestin has no contra-indications, and its efficacy is greatest when taken very quickly after unprotected intercourse (95% success rate if taken within 24 hours). Taking into account these facts, in 1999 the French government approved the sale of levonorgestrel emergency contraception on a non-prescription basis in pharmacies. This makes its use easier and quicker as pharmacies are widespread and have on-call service. Since that time, many other countries have authorized this distribution without medical prescription in Europe :(Albania, Belgium, Estonia, Denmark, Finland, Latvia, Lithuania, Netherlands, Portugal UK) and outside Europe. In Norway and Sweden the product is available over the counter in pharmacies : the user does not need to ask a pharmacist for the product. In France the product can also be directly delivered for free by high-school nurses to pupils and by pharmacists to minors. Since these decisions, the product has been widely used. In France and in the U.K. 80 000 women use it per month. In others countries, sales of levonorgestrel EC pills keep increasing. Post-marketing surveillance of EC has not detected any unexpected side effects in any country. Women use EC properly; they do not use EC as a regular contraceptive method (focus group study), and in France sales of birth control pills continue to increase. Even so, many women who have unprotected intercourse do not use EC because they do not think they are at risk of pregnancy. E.C is under utilized, an information process must be increased.
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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. 2, 2014, 12:00
Caring for women undergoing second trimester medical termination of pregnancy
Inga-Maj Andersson, Kristina Gemzell-Danielsson, Kyllike Christensson Karolinska Institutet, Stockholm, Sweden - inga-maj.andersson@ki.se
Objective: To explore the experiences and perceptions of nurses/midwives caring for women undergoing second trimester medical termination of pregnancy (MTOP). Method: Semistructured interviews took place at one gynaecological clinic in a general hospital in Stockholm. Twenty-one nurses/midwives with experience in second trimester abortion care were interviewed following a semistructured interview guide. The interviews were recorded, transcribed verbatim and then analyzed using qualitative content analysis to identify common themes. Results: The analysis revealed two themes: "The professional self," with six subthemes describing the experiences and perceptions described in terms of professional behavior: "Being familiar with the process", "Balancing objective information", "Finding ways for pain treatment", "Looking for the woman's needs", "Handling the fetus" and "Needing time for reflection". The theme "The personal self" has four subthemes containing the experiences and perceptions described in terms of personal values: "Conflicting duty and behavior", "Dealing with emotions", "Identifying oneself with the woman" and "Developing inner safety and maturity". Conclusions: Taking care of women undergoing second trimester MTOP is a task that requires professional knowledge, empathy and the ability to reflect on ethical attitudes and considerations. Difficult situations that arise during the process are easier to handle with increased knowledge and experience. Mentorship from experienced colleagues and structured opportunities for reflection on ethical issues enable the nurses/midwives to develop security in their professional roles and also feel confident in their personal life situation. The feeling of supporting women's rights bridges the difficulties nurses/midwives face in caring for women undergoing second trimester MTOP.
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Oct. 25, 2008, 04:00
Cervical priming prior to surgical abortion
Helena von Hertzen (WHO)
WHO, Geneva
vonhertzenh@who.int
Cervical priming before surgical abortion is especially beneficial for young women and for those in the advanced stages of pregnancy, with cervical anomalies, as they have a higher risk of cervical injury or uterine perforation. When the use of laminaria was the main method to prepare the cervix, the WHO Scientific Group on Medical Methods for the Termination of Pregnancy recommended routine priming for durations of pregnancy of over 9 completed weeks for nulliparous women, for women younger than 18 years of age and for all women with durations of pregnancy of over 12 completed weeks.
This recommendation may need to be review, as recent research suggests that all women may benefit from routine priming of the cervix with misoprostol: a WHO study involving 4791 women demonstrated that routine priming of the cervix with two misoprostol tablets of 200 µg administered vaginally 3 hours prior to vacuum aspiration in pregnancies of up to 12 weeks, decreased the need for further dilatation of the cervix, shortened the time to complete the procedure and significantly decreased the rate of incomplete evacuations. The use of laminaria now seems outdated, as comparative studies report more complications after laminaria than after prostaglandins.
The optimal dose of misoprostol is 400 µg: lower doses are less effective and higher doses only produce more side effects. The appropriate interval between vaginal misoprostol and vacuum aspiration is 3 hours; shorter intervals are not sufficient for full priming effect, even if the dose is increased. The interval may be shortened to 2 hours when misoprostol is administered sublingually. Only the use of mifepristone can compete with misoprostol in efficacy and low rate of side effects, but its high price and the long interval required between the treatment and procedure render it less attractive.
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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.