Bojana Pinter

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    Differences in circumstances regarding the decision on abortion or ongoing pregnancy among women in the Ljubljana region, Slovenia

    Bojana Pinter, S.Baznik and T.Vovko, Department of Obstetrics and Gynecology,

    University Medical Centre Ljubljana, Slovenia

    Objectives: The aim of this study was to obtain a broader insight into social-economic, religious, and other characteristics of pregnant women having an induced abortion (IA), and into the reasons for induced abortion, use of contraception before and after IA, and to analyze women's attitude towards professional counselling before IA in the Ljubljana's region.

    Design & methods: The study was based on two comparable questionnaires that were given to two groups of pregnant women: a study group of women that were having a first trimester IA at the Department of Obstetrics and Gynecology, University Medical Centre Ljubljana (323 subjects) and a control group of women in the first trimester of pregnancy that intended to give birth (60 subjects) and were attending out-patient clinics in the Ljubljana region. Participation in the study was voluntary and anonymous. The differences between the groups were analyzed using a chi-square test, and the correlations between individual characteristics were calculated using Pearson correlation coefficient. P values below 0.05 were regarded as significant.

    Results: The average age was 28.8 ± 3.4 years in the study group, and 28.6 ± 7.0 years in the control group, the difference was not statistically significant (p=0.737). In the study group there were significantly more women that had finished primary school only than in the control group (17.9 %: 0.0 %; p<0.05), and fewer had achieved graduate (18.8 %; 6.7 %; p<0.05) or post-graduate education (2.2 %; 11.7 %; p<0.05). In the study group fewer women were employed (56.9 %; 80.4 %: p<0.05), and more of them unemployed (18.2 %; 5.4 %; p<0.05), and fewer lived with their spouses or family (55.5 %; 76.7 %; p<0.05). Women in the study group considered their socio-economic status significantly lower and fewer declared themselves as Roman-Catholics (66.3 %; 92.6 %; p<0.05). There was a significantly higher rate of barrier contraception use in the study group before the pregnancy. The main reasons for IA were current lack of wish for a child (48.7 %), financial and social reasons (35.3 %) and school or career (29.7 %). The majority (84.0 %) of women in the study group had professional counselling and 42.1 % of women in the study group would want such counselling.

    Conclusions: Pregnant women who decided on an IA had poorer socio-economic status, fewer of them were Roman-Catholics, and they used less efficient contraception.

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    Sexual behaviour and knowledge on contraception and STIs among Slovenian secondary-school students: differences regarding type of school

    Bojana Pinter1, Tinkara Srnovrsnik1, Fani Ceh2 1Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia, 2The National Educational Institute, Ljubljana, Slovenia - bojana.pinter@guest.arnes.si

    Objective: To present the differences among secondary-school students on sexual behaviour and their knowledge on contraception and sexually transmitted infections (STIs), regarding type of school. Methods: The study was done on 969 randomly selected 3rd grade Slovenian secondary-school students of both genders by self-administered questionnaire in year 2012. Descriptive statistics and chi-square test were used. Results: Students were attending professional school, vocational school or gymnasium (12.6 %, 43.9 % and 43.5 %). Their average age was 17.5 +/- 0.7 years. Sexual intercourse have ever had was shown in 64.8 % of vocational-school students, 59.5 % of professional-school students and 47.2 % of gymnasium students (p < 0.001). Use of effective contraception (condom, hormonal contraception or double method) at last sexual intercourse was high (87.4 %) with no differences regarding type of school. Self-assessment of knowledge on different types of contraception revealed better knowledge among gymnasium students. Self-assessment of knowledge on STIs revealed poorer knowledge among vocational-school students. Vocational-school students were more likely to get information on sexuality from their parents and less likely from the internet than others; books and magazines were more often used by gymnasium students. Gymnasium students would more often use books and magazines, friend's advice or internet to get more information on sexuality. Sexuality education was most frequently performed in gymnasium (77.0 %) and least frequently in vocational school (64.7 %) but in the latter students were more satisfied with it. Conclusions: There were significant differences among secondary-school students in sexual behaviour and knowledge on contraception and STIs, regarding type of the school. Systematic sexuality education is needed to minimize the differences.

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    The importance of education on contraception

     

    Bojana Pinter , MD, PhD. University Medical Center, Ljubljana -Slovenia

     

    Introduction

    Family planning, sexual and reproductive health are essential components of individuals, couples and societies. Information on sexual and reproductive health and sexual education are very important in improving the knowledge and practice of contraception and thus in preventing unwanted pregnancies, which mostly end in induced abortions, and in preventing sexually transmitted infections (STIs).

     

    Sexual education

    The aim of sexual education is to change the sexual behavior with improving KAS (K–knowledge, A–attitude, S–skills) through education in sexuality, contraception, abortion prevention, avoiding risk-taking behavior and STIs (with HIV). Sexual education can be formal or informal, at school, in the family, by the media and through service providers. It needs broader approach than simply giving information and education on contraceptive and other preventive methods. Mechanical and organic bodily information are not enough as people, especially adolescents, are much more concerned about other aspects of love and sexuality: emotions, thoughts and anxieties should be addresses and discussed. Besides, training in communication skills is an important aspect of sexual education. 

     

    Innovative approach in sexual education could be as SPICES: S – stimulating, P – problem oriented, I – interactive, C – community based, E – extensive, S – students centered. Studies and practice have shown that “peer education” is one of the most successful approaches in sexual education. However, sexual education is only one part of a holistic approach to sexual health promotion and behavioral change, which develops through consecutive steps: awareness – knowledge - attitude – intention – behavioral change – sustained behavioral change.  

     

    The majority of sexual education programs have some positive effects upon some outcomes (such as greater knowledge), but only some of the programs actually result in some behavioral change as: delay in the initiation of sex, increase in condom or contraceptive use, reduction of unprotected sex among youth and reduction of unwanted pregnancy and induced abortion rates. The studies show that effective sexual education programs:

    -   include a narrow focus on reducing sexual risk-taking behaviors that may lead to STIs or unintended pregnancy (e.g. delaying the initiation of sexual intercourse, using protection)

    -   use social learning theories as a foundation for program development

    -   provide basic, accurate information about risks of unprotected intercourse and methods of avoiding unprotected intercourse through experiential activities designed to personalize this information

    -   include activities that address social or media influences on sexual behavior

    -   reinforce clear and appropriate values to strengthen individual values and group norms against unprotected sex

    -   provide modeling and practice in communication and negotiation skills. 

    The studies also show that sexual education programs do not increase any measure of sexual activity.

     

    Sexual education in Slovenia

    Because most youth are enrolled in school for many years before they initiate sex and when they initiate sex, schools have the potential for reducing adolescent sexual risk-taking. Unfortunately, the practice in many European countries, as in Slovenia, is that there is no formal sexual education nor in primary nor in secondary schools. The study on sexual behavior of secondary-school students in Slovenia has shown, that the majority of students get the information on sexuality from friends, parents and different sources together and that the school is less important source of information. In the absence of formal sexual education other sources of information (e.g. internet, journals) could provide youths with minimal information. However, more cooperation on national level should be established to introduce formal sexual education in schools.  

     

    Triple protection

    The suggestion made by the Population Council is that rather than dual protection, what many young and adult people need is “triple protection” against unintended pregnancy, STIs and infertility (which is possible consequence of STIs in women and men). Triple protection can be achieved by ABC approach: A – abstinence, B – being faithful and using contraception, C – condom use. 

     

    Conclusions

    Effective sexual education programs can be an effective component in a larger initiative to reduce the unintended pregnancy, STIs and infertility risks in youth and adults

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    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.