Speeches
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Oct. 24, 2008, 02:00
Different strategies to legalize abortion: Successes and lessons from Switzerland
Anne-Marie Rey (Switzerland)
arey@svss-uspda.ch
Situation in Switzerland before start of pro choice campaign in 1971. Penal Code of 1942: abortion allowed for health reasons only, to be certified by a second doctor. By 1971, 6 out of 25 cantons applied the law quite liberally and accepted mental and social health reasons for legal abortion, most of the other cantons stayed rather or very restrictive. Hence:
- abortion tourism from conservative to liberal cantons or to other countries,
- 20.000 illegal abortions estimated per year, with concomitant complications and death cases,
- some 100 women condemned each year for illegal abortion.
30 years of campaigning. June 1971 launch of a radical initiative for a constitutional amendment aiming at the repeal of abortion legislation. Its primary purpose was to break the taboo and raise public and parliamentary debate.
1975: launch of a second „reasonable“ initiative (abortion on request within the first 12 weeks of pregnancy), which was narrowly rejected on the ballot in 1977, by 51.7% of the votes.
1978: referendum and vote on a very unsatisfactory compromise law, rejected by a 2/3 majority.
1985: an initiative by the antis to write the right to life from conception into the constitution was rejected by 69% of the votes.
1993: a parliamentary bill proposed legalization of abortion on request in the first few months of pregnancy.
In March 2001 Parliament finally approved a corresponding amendment to the Penal Code. Conservatives immediately asked for a referendum.
June 2002: 72% of voters approve the new legislation. On the same ballot, an anti-initiative asking for a total abortion ban is defeated by a 82% majority.
Achievements.
- Gradual liberalization of abortion in practice over a period of 30 years (1971-2001).
- Reimbursement of the costs of abortion by health insurance (1981).
- Obligation for the cantons to create family planning counselling centers (1981).
- Abortion on request in the first 12 weeks of pregnancy (2002), no compulsory counselling except by the doctor himself, no „cooling off period“, no parental consent necessary for minors. Explicit mention of severe mental distress as a legally accepted reason for later abortions, without compulsory second medical opinion. Cantons have to designate clinics and doctors authorized to perform abortions.
Particularly successful strategies used.
- Personal contacts with the media, giving them regular and factual information,
- networking, building alliances with women’s, youth, political and professional organizations, mobilizing and briefing them,
- lobbying of parliamentarians, intensive personal contacts with some of them,
- formulating legislative texts and amendments for members of parliamentary committees,
- pragmatism, readiness to compromise, using moderate language and adapting our arguments to the changing situation.
Other reasons for our success.
- Decreasing influence of religion,
- changing role of women in society,
- growing open-mindedness in matters concerning individual lifestyles and sexuality.
In conclusion. Strategies must adapt to the situation, to political and religious forces present in a country and to the strength of pro choice mobilisation. Our experience: every time a broad public debate arose, some progress resulted. But: the battle for women’s right to decide whether and when to become a mother is hard and long. It needs dedication and perseverance. But in the end, I think, we have the better arguments.
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Oct. 14, 2006, 11:00
Doctors working in a public hospital
Giovanna Scassellati, MD,
Hopsitial St. Camillo, Rome
Abortion is legal and part of medical practice in Italy since 1978.
In these 28 years it is allowed only if interruptions of pregnancy are performed in public
hospitals.
Pharmacological abortion, widely used in many countries in Europe, is not allowed in Italy
and this because mifepristone (RU 486) is not registered yet.
This limitation causes frustration on doctors and nurses and it is necessary operate on
patients all the times even though a lot of patients could succeed using medical abortion.
In Turin, northern Italy, in S. Anna Hospital, Dr. Viale has been the first doctor who
received special permission by the Ministry of Health to start a clinical trial with RU 486, on
October 2005.
It seems a little strange to start experimentations using a drug well known in the whole
medical world since 1980.
Italian women are not different from the French or Spanish ones. -
Oct. 22, 2010, 08:00
Does a previous abortion modify womens’ contraceptive choice?
Pascale Roblin, Lisa Tichane, Sylvie Camil, Aubert Agostini and Raha Shojai, France
Objective: Care givers often expect that women with a previous abortion are more likely to use highly effective contraceptive devices to prevent further unwanted pregnancies. We assessed the failed contraceptive method used before an abortion between women with and without a previous abortion.
Methods:In a series of 450 women requesting a medical abortion at home before 7 weeks in a community care center in Marseille, France, there were 157 (35%) patients who had a history of at least one previous abortion. We realized a case –control study to compare the failed contraceptive method leading to an unwanted pregnancy between 157 women with a previous abortion and 293 women without a previous abortion. Chi-2 test was performed and considered significant for p<0.05.
Results: The rate of women using no contraception, natural methods or condoms were similar in both groups. The rate of COC users was 16% in the group of patients with a previous abortion vs 14,7% in the control group (p=0,8). None of the patients used IUD or implants in both groups.
Conclusion:The contraceptive profile of women with an unwanted pregnancy is similar between women with and without a previous abortion. In our population, a history of abortion did not modify womens’ contraceptive choice towards more effective methods.
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Sept. 11, 2004, 02:00
Do we need a law on abortion at all?
Joyce Arthur(Canada)
Director Pro-Choice Action Network
Editor of the Pro-Choice Press
"Keep Your Laws Off My Body!"
Canada is the only democratic, industrialized country in the world with NO laws against abortion (since 1988). Abortion is managed like any other necessary health procedure, and as a result, services have flourished and improved significantly, with no ill effects or abuses. Legal restrictions against abortion are leftover artifacts from the days of criminal abortion and are fundamentally unjust, with many negative consequences: They reduce access to abortion, pose arbitrary obstacles, marginalize abortion outside the medical mainstream, stigmatize healthcare professionals, turn abortion into a political target for extremists, and breed hypocrisy and disrespect for the law. Most importantly, they discriminate against women and violate women's constitutional right to equality. Laws against abortion amount to a publicly-sanctioned judgment against women's moral reasoning, their sexuality, and their right to control their own lives.
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Oct. 15, 2016, 09:00
PS04.1
Early and very early medical abortion
Philippe Faucher
Hôpital Trousseau, Paris, FranceEarly medical abortion will be defined in this presentation by termination of pregnancies with Mifepristone/Misoprostol when no visible gestational sac is visible on ultrasound. Very early medical abortion will be defined by termination of pregnancies before the date of expected menstruation. Providers are reluctant to provide medical abortion so early mainly because of the fear of a missed diagnosis of ectopic pregnancy. Consequences for women are not negligible: repeated consultations, repeated ultrasound, repeated HCG could delay the termination of the pregnancy and induce problems of costs, confidentiality or emotional distress. Arguments will be presented to reassure providers about the possibility to provide early medical abortion safely. A protocol for follow up of early medical abortion will be presented based on correct information given to the women (especially symptoms that must induce a visit to the emergency service) and serum HCG testing seven days after the medical abortion. The second argument is the possibility of a reduced efficacy of medical abortion in the early period of pregnancy which was suggested in one study. Published data on this fact will be presented. Finally very early medical abortion will also be considered in this presentation on the basis of recent studies.
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Oct. 2, 2014, 12:00
Early, liberal provision of intrauterine contraception after first trimester abortion is not associated with an increased risk of postabortal adverse events or complications
Elina Pohjoranta, Maarit Mentula, Satu Suhonen, Oskari Heikinheimo Helsinki University Central Hospital, Helsinki, Finland - elina.kuronen@helsinki.fi
Objectives: We carried out a randomized prospective study to assess the effects of early provision of intrauterine contraception (either LNG-IUS or Cu-IUD) vs. routine practice of starting contraception following first trimester induced abortion. This is a secondary analysis comparing early (i.e. within 3 months) adverse events/complications in the two groups. Method: Altogether 756 women undergoing an induced abortion were randomized into two groups (378 in the intervention and 372 in the control group). In the intervention group, 70 (19%) women chose surgical abortion; 68 (97%) of them received an IUS/IUD at the time of abortion. Of the 308 women choosing medical abortion, 290 (83%) received the IUS/IUD at the follow-up visit 2-3 weeks after abortion, the remaining 61 (17%) later. The women in the intervention group had an appointment with the study nurse at 3 months after the abortion. For the control group, a follow-up and future contraceptive counselling was scheduled in primary health care, which is the normal practice. All women were advised to contact the hospital should complications arise. The hospital charts were reviewed for postabortal complications (i.e. bleeding, residual tissue, ongoing pregnancy or infection requiring treatment) within 3 months. Results: 58 (15%) women in the intervention group and 45 (12%) women in the control group were treated for an adverse event (p=0.196). The rate of complications among all women choosing medical abortion was 82 (13%) and 21 (15%) among those choosing surgical abortion. In the intervention group, 24 (41%) patients' complications were detected before the follow-up, 31 (53%) at the follow-up visit, and 3 (5%) at 3 months. Altogether 20 (5.3%) IUS/IUD expulsions occurred by 3 months, 7 (35%) of which were before 2-3 weeks. Conclusions: The early insertion of an IUD after first trimester abortion does not increase the overall risk of adverse events/complications nor cause extra visits to the clinic.
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Oct. 22, 2010, 08:00
Early medical abortion as the first choice method at the University Department of Obstetrics and Gynaelacogy in Ljubljana, Slovenia
Andreja Štolfa Gruntar and Bojana Pinter, Department of Obstetrics and Gynecology, University Medical
Centre Ljubljana, Slovenia
Medical abortion was introduced as a method of first trimester induced abortion 20 years ago, when as one of WHO collaborating centres in the area of reproductive health our Department of obstetrics and gynecology was offered the possibility to carry out the studies investigating the efficacy and safety of abortion inducing drugs, although the drugs had not been registered in Slovenia.
Until 7 years ago medical abortion was performed only in women enrolled in various WHO studies. However, when the direct import of the needed drugs (mifepristone and misoprostol) became possible, we started to perform early medical abortions on a regular basis in women who decided on this method for early abortion of an unwanted pregnancy. Knowing the method well we wanted it to become the predominant method of early abortion. But since there was no agreement among gynecologists that it should be the method of choice for an early abortion, women still choose the method they prefer. Dilatation and curettage under general anesthesia is still the most frequently used method, although some women decide on endometrial aspiration without anesthesia, too.
The reasons why women decide on a surgical abortion under general anesthesia are: not being aware of what is being done, fear of pain, gynecologist's advice. Many gynecologists still advise their patients the abortion done under general anesthesia, because it has been done successfully for years, and as they are still sceptical about medical methods due to the lack of knowledge and personal experience.
Our intention is to increase the percentage of medical abortions among the eligible women wanting to end an unwanted pregnancy. Due to the aforementioned reasons our aim has not been achieved yet. There are around 1500 early abortions to end an unwanted pregnancy at the Department per year (e.g. 1546 in 2006, 1334 in 2008). Of these there are 13,5% endometrial aspirations without anesthesia, 55,6% surgical abortions under general anesthesia, and only 30,9% medical abortions. Obtaining good results with medical abortion and spreading the knowledge among patients and gynecologists, and with efficient motivation for medical instead of surgical procedure, the rates of early medical abortion to end an unwanted pregnancy have been slightly increasing, but the rates could be further improved. So in March 2010 we organized a seminar to promote medical abortion as the first choice method and to exchange experience with other abortion-care practitioners in the rest of Slovenia.
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Sept. 15, 2018, 02:00
Medical abortion in Bulgaria is available in unusual circumstances. Abortion in Bulgaria is allowed up to 12 weeks upon wish, up to 20 weeks - for medical conditions or foetal anomalies, and after that - in extreme circumstances.
The legislation regarding abortion has been made in 1990 and last reviewed in 2000. Medical abortion doesn’t exist in it. It is written envisaging surgical procedures only. It requires blood tests (FBC, MSU, clotting, blood group, Rh) and vaginal swab prior to every abortion. It also requires the abortion to start and end in a medical facility. It otherwise classifies the act as a criminal offence and envisages imprisonment of up to 5 years and if repeated - up to 8 years.
Medical abortion, however, has been performed in the country over the past 10 years or so. Prior to the official availability of registered drugs, Cytotec was in wide circulation. It still is, regardless of the lack of registration in the country.
Mifepristone and Misoprostol have been first registered in 2012, reaching the market in the end of 2014. Their registration is for distribution in pharmacies, by prescription. The obs&gynae society, however, is largely against the wide availability of the medications, being afraid women will self medicate, and are reluctant to prescribe them, seeing it as illegal to participate in abortion outside medical facility. Very few hospitals offer MTOP or medical management of miscarriage as an inpatient procedure. Professional knowledge on medical abortion is limited. It is widely believed that every pregnancy must end with delivery or curettage.
A few hospitals and doctors do provide medical abortion, albeit in variation of regimens, and more and more women request it.
It is because of women’s increasing interest and the few doctors fighting for the cause, that medical abortion is surviving in Bulgaria. -
Oct. 22, 2010, 08:00
Early post abortion insertion of Mirena IUS
Ingrid Sääv, MD and Kristina Gemzell Danielsson, Professor, MD, PhD, Dept of Woman & Child Health,
Div of Obstetrics & Gynaecology, Karolinska University. Hospital / Karolinska Institutet, Sweden
Background: Today a majority of early abortions are conducted medically, in accordance to the woman’s choice. When opting for an IUS/IUD as contraception method, the insertion routinely takes place at the check up visit 3-4 weeks after the abortion. This means an obvious risk of a new pregnancy.
Objectives: We wanted to study if early post abortion insertion of Mirena IUS could be conducted in a safe way and without increased risk of expulsion or infection. Furthermore, we wished to investigate however early insertion would have an impact on the bleeding patterns during the first 4 weeks, and if Mirena use during the first year is comparable between the two groups.
Material and methods: 65 women undergoing elective early medical abortion up to 9 weeks gestation and opting for a Mirena IUS were included. They were randomized to either early insertion on day 5-9 (34 women), or routine insertion at 3-4 weeks (day 21-31) (31 women). The medical termination was performed according to clinical routine. Antibiotic prophylaxis was not administered routinely, but a screening test for Chlamydia infection and bacterial vaginosis was performed. An ultrasound examination was performed before Mirena insertion. Hb and S-hcg was determined on day 1 and at the day of insertion. The patients were scheduled for control visit 4 weeks after Mirena insertion and complications such as infection and expulsion was recorded, and a diary of the bleeding pattern was collected from the patient. Hb was determined, and a urine pregnancy test was performed.
Results: 34 women were randomized to early insertion (day 5-9). 4 women were excluded, of these one was diagnosed with missed abortion and scheduled for vacuum aspiration, one was booked to late by mistake, one did not show up and one woman had regrets and requested a cupper IUD instead. 31 women were randomized to routine insertion (day 21-31). 3 women were excluded, one was diagnosed with a viable pregnancy and was scheduled for a vacuum aspiration and two did not show up for insertion. There were no infections in either group. There were 5 expulsions (17%) in the early group, compared to 3 (11%) in the late group. The bleeding pattern post IUS insertion did not differ between the groups; neither did the acceptability of the patient regarding insertion of the IUS or further use.
Conclusion: There was no difference in safety between the groups. There was no case of endometritis or pelvic infection. Acceptability and bleeding patterns did not differ between the groups. The expulsion rate was substantially elevated in both groups, compared to routine insertion in a non-pregnant woman. We conclude that all women undergoing post-abortion insertion should be scheduled for a control visit
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Oct. 25, 2008, 09:00
Eastern Europe: Turning back the wheel?
Rodica Comendant, Galina Maistruk, Irina Savelyeva (Moldavia)
Reproductive Health Training Center, Moldavia
comendantrodica@yahoo.com
Despite the widespread availability of abortion on legal grounds for more than 50 years, unsafe abortions account for 24% of maternal deaths in Eastern European (EE) region (WHO, 1998). Abortion rates remain high. Abortion is commonly used as a primary means to regulate fertility; the use of modern contraception methods remains low. Access to abortion services in EE has been challenged in recent years. Concerns about declining birth rates, pressure from religious groups have reduced support for family planning and abortion. The low quality of services is influenced by the lack of quality of care standards and quality control.
In this context, the recent registration of Mifepristone in many of EE countries, hasn’t much contributed to the improvement of the quality of abortion care. Medical abortion is still inaccessible for general population and remains an “elite” method for most of the women. The analysis of the access to medical abortion in several EE countries has showed the following common trends:
- Cost of the pills is prohibitive;
- statistic is virtually inexistent;
- low level of the awareness about the method in the population, low demand for comprehensive abortion care services, many existing myths;
- lack of providers motivation to use a new method, the misuse, low efficacy;
- unwillingness of the public health systems to take the necessary steps for the implementation of the medical abortion services, and unnecessary barriers imposed by their regulations.
Recently launched by the leading abortion professionals and women advocates from 10 EE countries network „European Alliance for Reproductive Choice“ , supported by ICMA, among other objectives, has decided to focus on developing strategies, to make MA technology accessible in practice in EE countries. Experience-sharing, information, education, communication (IEC) activities, targeting potential users, to increase the demand for better and affordable services among women, advocacy for women rights to the access to the fruits of modern science, the improvement of providers knowledge among providers, transforming them in women advocates, advocacy events to register and utilize medical abortion are some of the listed strategies to consider.