Speeches
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Oct. 14, 2016, 02:00
FC07
Efficacy of very early medical abortion
Isabella Bizjak1, Christian Fiala2, Helena Kopp Kallner1, Ingrid Sääv1, Kristina Gemzell-Danielsson1
1WHO CCR, Department of Women´s and Children´s Health, Division of Obstetrics and Gynaecology, Karolinska Institutet, Stockholm, Sweden, 2GynMed Clinic, Vienna, AustriaBackground: In countries which have introduced medical abortion an increasing number of women present very early for their abortion. However due to limited data and fear of an adverse effect on a possible ectopic pregnancy many health care providers are reluctant to initiate the abortion treatment before an intrauterine pregnancy can be visualised and therefore tend to delay the treatment. This study was conducted to assess the effectiveness and safety of medical abortion in women with very early pregnancy (VEMA) and no confirmed intrauterine gestation (IUG).
Methods: Register based multicentree cohort study comparing women undergoing very early medical abortion (gestations ≤49 days) with or without a confirmed intrauterine pregnancy (i.e. yolk sac or foetal structure) at the initiation of the abortion treatment. 435 women without confirmed IUG were identified and compared with 870 controls with confirmed IUG, matched with regard to age, parity and date of initiation of abortion treatment.
Results: Women with no confirmed IUG were not more likely to experience VEMA failure (i.e. ongoing pregnancy or incomplete abortion) than those with gestations ≤49 days and confirmed IUG. Ectopic pregnancies (n=3) were diagnosed and treated without any serious adverse events.
Conclusion: VEMA failure is not more likely in women with very early pregnancy and no confirmed IUG on ultrasound than those with gestations ≤49 days and confirmed IUG. Hence our findings support that VEMA is both effective and safe for terminating pregnancies in women with no confirmed IUG. Women should, therefore, not be subject to unnecessary delay but should be offered medical abortion accordingly. -
Sept. 15, 2018, 02:00
Much attention is given to the alleged right of healthcare professionals to refuse treatment under the guise of “conscientious objection,” especially abortion. But what about those who conscientiously commit to providing this life-saving care despite stigma, obstacles, and legal risks? The organization Women Help Women believes in the ethical value of conscientious commitment to provide abortion care as a way to break the taboo around provision regardless of legal settings. WHW does this by equipping local activists and health workers to guide women through self-managed abortion in countries where abortion is illegal.
This presentation will share aspects of WHW’s unique partnership model, which is based on collaborative, participatory, feminist efforts to advance access and knowledge. WHW works horizontally, promotes local ownership of joint initiatives, and strengthens and develops capacities of local and regional movements. One example is WHW’s “Mobilizing Activists for Medical Abortion” network (MAMA), which operates in at least eight African countries.
MAMA expands community access to information and provides reproductive health training about misoprostol use and self-induction. In 2017, MAMA member organizations reached over 19,000 women with information and services.In Latin America, WHW collaborates with activists throughout the region, with a focus on Central America, Brazil, and Chile. The group helps local collectives launch and maintain new safe abortion hotlines, trains activists in counseling skills and medical abortion, and supports access to safe abortion via locally-led campaigns and awareness actions. For example, in Chile, the “Misoprostol for All” campaign used radio spots and street actions to promote information about the local safe abortion hotline and the use of misoprostol.
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Oct. 15, 2016, 11:00
FC16
Safety of medical abortion up to 10 weeks at home
Iolanda Ferreira, Filipa Coutinho, Manuel Fonseca, Elsa Vasco, Teresa Bombas, Maria Céu Almeida, Paulo Moura
Obstetrics Service A and B of Centro Hospitalar e Universitário de Coimbra, Coimbra, PortugalIntroduction: In Portugal, abortion by women's request is legal until 76 days of pregnancy. The rate of medical abortion is nearly 96% in the National Health System.
Objectives: Evaluate the safety of medical abortion at home before and after 9 weeks of pregnancy.
Methods: Retrospective evaluation of 6735 women (Group1-before 9 weeks; Group2-after 9 weeks), who attended our department between January 2007 and December 2015. For abortion the protocol used was mifepristone 200 mg and vaginal misoprostol 800 mcg after 48 hours. Statistical analysis was made using Independent T-test; Chi-Square and Mann-Whitney U test in SPSS 20.0.
Results: Medical abortion was an option in 98.8% (n= 6650) of cases; 56 (0.8%) at hospital and 6594 (99.2%) at home. Regarding abortion at home, the mean age was higher in group 1 (28.9 vs 28.3; p= 0.05).
According to national guidelines, an abortion is complete when there is no need for additional medical or surgical intervention. There was no difference in efficacy between groups (Group 1: 97.4% vs Group 2; 96.5%; p= 0.3). The most common side effect was pain, which was moderate (Group1: 34.3% vs Group2: 30.9%) intense (32.3% vs 38.2%) and maximal (11.6% vs 18.2%). Pain scores were significantly higher after 9 weeks of gestation (p= 0.04).
There were no differences between groups regarding complication rate (Group1: 7.9% vs Group 9.9%; p= 0.2). The most common complication was retained abortion (6.1% vs 6.5%); method failure (1.2% vs 1.6%); endometritis (0.2% vs 0.8%) and severe blood loss (1% vs 1%). The rate of admission to hospital due to complications did not differ between groups (3.7% vs 4.4%; p= 0.5).
Conclusion: Medical abortion is equally effective and was proven to be safe at home in both groups. The most common side effect was pain and it was significantly more intense after 9 weeks of gestation. -
Oct. 15, 2016, 02:00
FC31
Therapeutic abortion for maternal indications or how to reduce them?
Ben Amor Anissa1 ,2, Dimassi Kaouther1 ,2, Ben Aissia Nizar1 ,2, Triki Amen1 ,2
1Mongi Slim Hospital, La Marsa, Tunis, Tunisia, 2University Tunis El Manar, Faculty of Medicine of Tunis, Tunis, TunisiaBackground: Maternal medical conditions are an important reason for therapeutic abortions. Indeed several medical diseases may deteriorate or even develop during pregnancy.
Aim : The purpose of the study was to assess the reasons for therapeutic abortion for maternal indications in our department and to determine how to reduce them.
Methods: We conducted a retrospective study in the Mongi Slim Gynecology and Obstetrics department, La Marsa, Tunisia from 2005 to 2015. All cases of therapeutic abortion were included.
Results: There have been 127 therapeutic abortions done in 10 years, 32 of them were for maternal indications. The incidence was about 1 per 1000 births. The gestational age varied from 9 to 26 weeks' amenorrhoea. The causes were: obstetric diseases (12%), mainly severe preeclampsia (7%) and premature rupture of membranes (5%); maternal severe heart diseases (5%), mainly valvulopathies; maternal somatic diseases (2 cases : lupus and severe diabetic ketoacidosis); 8 cases (7%) of maternal cancer discovered while pregnant (5 cases of breast cancer, 1 of lung cancer and 2 of digestive cancer); and psychiatric conditions.
Conclusions: A quarter of therapeutic abortions done in our department were for maternal indications. It seems that chronic diseases not adequately followed up or diagnosed while pregnant are a major cause of therapeutic abortion despite the high frequency of obstetric causes. It is very important to encourage preconception consultations to improve the screening of these diseases and plan the pregnancy care properly. However, pregnancy still constitutes the only opportunity to have a detailed full check-up and to diagnose many diseases. -
Sept. 15, 2018, 11:00
Introduction: Increasing proportions of womenwho access abortion services in Europe choose to have an early medical abortion (EMA) (<= 9 weeks). Provision of quality information on EMA(medications, process, confirmation of success of the procedure and signs/symptoms after the procedurethatnecessitate medical review) is important. However, the quality of information provided to women on EMA may be variable and provider dependent. There is some evidence that audiovisual information (e.g. film or animation) can be an effective way of providing information about abortion. Objective To evaluate an audiovisual animation as a method of information provision on EMA for women seeking EMA in four European countries.
Method: We developed a short animation (3 mins) about EMA that summarises the key steps in theEMA process but is also adapted to reflect subtle differences in EMA practice and law in Scotland, France, Portugal and Sweden. Fifty women choosing EMA in each country (total 200 participants)will be randomisedto information provision on EMA delivered by the animation(n=35) versus a face-to-face consultation with a provider (n=15). Outcomes include information recall on EMA and womens acceptability of provision of information on EMA by the animation.
Results: The study is ongoing. Preliminary data (one country) indicate high levels of acceptability and utility of the animation and comparable levels of information recall to face to face consultations. Free text responses from women indicate that they feel positive about the diversity of female characters depicted in the animation.
Conclusion: Provisional data suggests that even a short audiovisual animation might adequately and acceptably deliver key information about EMA. If shown to be acceptable in the other countries, then this intervention could be used routinely to provide standardised and high quality information to women seeking EMA throughout Europe. -
Sept. 15, 2018, 02:00
Objective: About 26 million women refugees worldwide are affected by emergencies and face multiple sexual and reproductive health and rights (SRHR) risks, requiring access to key services. Women in humanitarian emergency settings face increased exposure to unintended pregnancies while lacking access to SRHR services, including safe abortion.
An overall growth in institutional capacity in SRHR in humanitarian settings has been reported, however with an exception for abortion-related services. Suggested reasons for this are legal uncertainties, health care providers’ personal moral/attitudes, and lack of quality commodities. However, research confirming or rejecting these hypotheses is lacking.
The aim of this study was to gain a better understanding of health care providers’ readiness to provide safe abortion services in humanitarian settings, and to identify obstacles and facilitators in service provision.
Methods: Ten individual in-depth interviews were conducted with health care providers with experience in working in humanitarian settings in Nepal and Pakistan. An inductive qualitative approach was used for analysis.Preliminary results: Induced abortion is rarely prioritized or discussed in medical training. Health care providers are willing to provide safe abortions, but often have inadequate knowledge, poor access to updated guidelines, and lack equipment and supplies. Despite being legal, access to abortion is limited. Stigma surrounding abortions consist a barrier both for patients and health care providers, since abortion services often are frowned upon by surrounding communities. Health care providers’ personal values, and involvement of influential people, such as religious leaders, were mentioned as both barriers and facilitating factors.
Conclusions: Further training addressing caregivers’ knowledge, attitudes and values is needed. Information on local legal situations, support to health care providers, in-service training and updated guidelines are lacking. As research on this topic is scarce, this study is of high importance for humanitarian actors with mandate and aim to provide safe abortion services.
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Oct. 14, 2016, 02:00
FC09
Stigma associated with abortion is influencing choice to provide or sidestep abortion services
Asifa Khanum1, Syed Kamal Shah1, Nadeem Mahmood1, syed Mustafa Ali2
1Rahnuma FPAP, Lahore, Pakistan, 2Individual Consultant, Lahore, PakistanThere is little evidence available on the manifestation of abortion stigma in Pakistan. There is marginalisation of abortion services within medical settings through its negligible inclusion in curriculum, knowledge about abortion law in Pakistan, perceptions about abortion and religion, socio-cultural disapproval, etc. These factors all contribute in the decision of healthcare providers to provide or sidestep abortion services. A research study was designed to understand the expression of stigma associated with abortion by service providers providing abortion services and those not providing these services.
Methods: A mixed method exploratory study was designed to understand perspectives of both types of service providers. Due to restrictive abortion law and taboos that are stigmatising abortion services and its providers, data was collected from 40 providers providing abortion services and 40 non-providers of these services from reference facilities in 4 districts of Pakistan. Basic descriptive analysis was carried out using SPSS.
Results: It is evident from analytical findings that the knowledge base of service providers on abortion law in Pakistan, perceptions about its religious permissibility, internalisation of negative community perceptions about abortion service providers and stigmatisation of women seeking abortion services are pertinent attributes influencing provider choice of extending abortion services or not.
Conclusion: In an effort to de-stigmatise abortion, immediate measures are required at various levels such as: integration/institutionalisation of essential contraceptive services including safe abortion services, formal/informal education and knowledge about abortion laws as explained by Shariat Court of Pakistan, Value Clarification and Attitudes Transformation (VCAT) workshops for providers, and behaviour change communications and education strategies for sensitising communities.