Speeches
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Sept. 11, 2004, 11:00
Continuing abortion tourism in Europe
Maria Francès RN, co-founder and Secretary General of Fiapac
Bloemenhove Kliniek - The Netherlands
There have always been women with an unwanted pregnancy who were forced, by lack of possibilities in their own country, to cross borders, spend money and take risks in order to get what should be their right: a termination of their pregnancy, after all the most performed medical act in the world.
Since the 1970 ‘s the countries – in western Europe - which receive most of these women are the UK, the Netherlands and since some years also Spain, where the implementation of the - not so liberal - law is quite loose.
Although the number of “abortion tourists” has dramatically – in a positive sense – dropped since several countries have liberalized their law (in 1980 26.200 German women came to Holland for an abortion, in 2003 not more than 1254, in 1985 18.000 women came to the UK for an abortion, in 1996 only 66…) there is still a too large number of women who have to undertake this unfair, costly and emotional heavy trip. In the Bloemenhove clinic where I work, the yearly number of patients is about 3300, of which still 60% are coming from abroad. At the same time we may expect an increasing number of women from the eastern part of the European Union with al their specific - for instance financial - problems.
In this short intervention I would like to emphasize one part of the subject: the responsibility towards the woman in demand.
It goes without saying that the first responsible is the woman herself. She has taken the decision not to continue her pregnancy – even if circumstances, financial, emotional or others, may have forced her to do so. After an appointment with her gynaecologist or her generalist, the most positive scenario is that this doctor will give her the address of a Centre or Clinic in the area where she lives to have the abortion as soon and as safe as possible, assuming that the term of her pregnancy is within the legal delay.
Unfortunately this is not always the case, and if yes the doctor sends her to a hospital or clinic the waiting time is very often so long that the legal delay will be passed at the moment she will get an appointment.
Then starts the search for a liable alternative, by experience I know that it takes some times more than 3 weeks to find an organization - like in France the MFPF – or a doctor who will cooperate to find a solution. The pregnancy in the mean time, is far beyond the legal delay in her country, the costs are doubled, the strain becomes unbearable.
What if, at the moment of her arrival in the Clinic of her choice, be it in the UK, Holland or Spain, she finds that her pregnancy has exceed the legal delay in the “guest” country, she happens to have a too low HB, ( Dutch hospitals are not prepared to give transfusions to foreigners unless there is danger of life), there is a problem with her coagulation, she is HIV positive, she has Hepatitis or she has simply not sufficient money,( this is what we experience frequently in our Centre in Holland). Do we send her back home, do we take risks concerning her health or our finances?
Who should we or she turn to: the organization in her home country? her gynaecologist?
Who is responsible for this woman, this moral problem often weights heavy and gives a feeling of powerlessness.
From these experiences one may get the tendency that country’s with a restrictive law give the impression to be more or less content at the idea that the neighbour will do the job and that consequently administrations do not move. I know that this negative thought is unfair towards all those who are risking their necks in order to improve the legal situation in their countries.
No – the sad reality, to my opinion, is, that abortion will never be “Salonfähig”, will always be a political “ non-issue” , and will continue to depend on militant “fieldworkers”.
I therefore urge that it is the duty of us, Fiapac members, to advocate the right of every woman to have a safe abortion, to help local organizations in reaching that goal and to develop teaching programs for doctors, nurses and social workers.
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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, 02:00
Counselling aspects
Catharina Zätterström, Midwife, supervisor for Family Planning Clinics and Youth Clinics in
SLSO South-West Stockholm, Sweden, catharina.zatterstrom@sll.se
Contraceptive counselling is usually given to the woman both before the abortion, by a
physicians or a midwife and after, at the post-aborton visit by a midwife. Roughly 50–60%
of the women will come back for a check-up 3-4 weeks after the abortion.
Women applying for repeat abortions have experienced more psychological problems
during their lifetime compared with women applying for their first abortion. Women who
have had previous abortion/abortions seem to need for special attention, which should
include not only efficient and acceptable contraception but also social and psychological
support based on the individual woman’s need.
In several studies the use of contraceptives amongst women applying for repeat abortion
had been affected by family circumstances more than amongst women applying for their
first abortion. This could indicate the need for including men in family planning programs.
In Sweden immigrant status seems to be an independent risk factor for induced abortion.
Immigrant women also have more early pregnancies and less knowledge and experience
of contraceptives. Immigrant status is also an independent risk factor for repeat abortions.
Although immigrant women after 10 years in Sweden are more socioeconomically equal to
the Swedish-born women regarding education, employment and marital status but they still
have more children and have experienced more induced abortions than Swedish-born
women.
Post-abortion check-up in Sweden is focused on the woman’s medical condition and on
her need for efficient contraceptives. It is seldom designed to suit the individual woman. -
Oct. 20, 2012, 04:00
Counselling: How do women
feel about it? One of the differences regarding abortion laws
worldwide, concerns the presence of a pre-
abortion counseling session. The necessity of
this counseling for women seeking first-trimester
abortions has been extensively debated.
Professionals often hold strong opinions on thisissue while the opinion of clients themselves is
not heard. Our study, performed in Flanders (i.e.
the Northern part of Belgium), asked 971 women
how they experienced this session. Results
showed that despite initial resistance towards
the session and high decisiveness regarding
the abortion, women valued the counseling
and felt significantly better afterwards. Besides
making an informed decision, non-directive
and client-centered counseling sessions - as
they are organised in Flanders - can have other
advantages for women seeking an abortion.
Examples of these are: the provision of correct
information about the procedure and its
consequences, the consolidation of an already
made decision, receiving emotional support for
the choices made… As a result, we support the
continuation of this pre-abortion counseling in
Flanders, in addition to the existing medical care. -
Oct. 15, 1999, 08:00
South Africa :
M. ABLAS shared her experience in South Africa where the legislation does not
solve all the problems of legal abortion, in particular relating to the mobilisation
of doctors. The problems are obviously greater for the poor, the better off
always being able to find solutions, albeit sometimes illegal.
Abortions are carried out by : gynaecologists and experienced general
practitioners, nurses and midwives.
A free service is available in the public hospitals, but there are few doctors and
few hospitals
In contrast there are more private clinics which are expensive and in the towns.
CYTOLEC is used to induce metrorragy , thus justifying hospitalisation.
U.S.A. :
In the 44 states where abortion is legal, it is carried out by specially trained
general practitioners.
UK :
1/3 in hospital (NHS).
2/3 in private clinics where there is a lack of doctors.
Germany :
Gynaecologists trained in the public hospital system.
Easier in the North of the country.
The Profamilia Centres (non profit making) lack doctors.
France:
Gynaecologists and general practitioners, with practical training and for low pay,
carry out abortions in registered public or private centres.
Belgium:
Gynaecologists in the public hospital system and general practitioners in private
centres.
Flemish speaking areas: 41% in hospitals 59% in private clinics
French speaking areas: 11% in hospitals 89% in private clinics
There is a lack of doctors.
Holland:
Gynaecologists in public hospitals: 7%
General practitioners in private clinics: 93%
Doctors receive a specific training period for abortions carried out in the first or
second trimester.
Denmark:
A hospital service deals basically with all the abortions.
Doctors are given an initial training.
A conscience clause exists.
Spain:
Most abortions are carried out in private clinics by gynaecologists up to late
stages.
Austria:
General practitioners can carry out abortions in their surgeries. The paramedical staff are recruited by the doctors without any specific training.
No control system or assessment of the work exists -
Sept. 10, 2004, 09:00
Cultural and linguistic mediation
Giovanna Scassellati and Teresa Perales, San Camillo-Forlanini Hospital – Rome
Since 2002, at the gynaecological ambulatory of the DH/DS 194 there is a service of cultural mediation. This service, supported by the Rome municipality, is particularly useful in order to establish continuative relationships with foreign women with the aim of clarifying the motivations of voluntary abortion and enacting preventive measures for abortion. 1.120 women were examined in the year 2002, 1.315 in 2003, and 407 in the first four months of 2004. The service is precious because often medical and paramedical personnel lacks adequate time for such activities, since an interview with a patient requires around 40 minutes on the average in order to be useful and explicative. Furthermore, the service is a useful tool to understand the real motives that drive foreign women to resort to abortion.
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Oct. 2, 2014, 12:00
Current medical and multi-sectoral challenges in sexual assault responses in Malta
Flavia Zimmermann Three Cities Foundation, Vittoriosa, Malta - chairwoman@threecities.org
The current legal and social framework in Malta poses a set of specific and compelling challenges for evidence-based medicine and service provision in the context of sexual violence and contraceptive care. This presentation aims to give an objective overview of facilities available to female victims of sexual violence in Malta. It will review services and interventions for underage and adult survivors of sexual assault, the circumstances (including withholding of emergency contraception) which affect standards of Care-and-Evidence in the medical, forensic and psycho-social sectors - along with the range of consequences on patients' health. A summary of critical or urgent issues to redress the effects of this significant public health crisis will be presented. It will also include victimology approaches for survivors' recovery. The main objective of this presentation is to initiate an ongoing discussion about viable reforms to develop an ethical, humane and effective multi-sectoral service. The evidence to be presented has been gathered and updated since 2010, as part of a previous Daphne-Cosai III-funded international project to assess and improve sexual assault services in Europe.