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Liberating Women - Removing Barriers and Increasing Access to Safe Abortion Care”

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Liberating Women - Removing Barriers and Increasing Access to Safe Abortion Care” THE th FIAPAC CONFERENCE 13 “Liberating women - removing barriers and increasing access to safe abortion care” Nantes, France La Cité, Nantes Events Center 4- 5 September 20 8 1 1 1 www.fiapac.org FIAPAC International*Federation*of*Professional*Abortion*and*Contraception*Associates Table of content Plenary sessions .................................................. 2 Concurrent sessions ............................................ 8 Lunch sessions .................................................... 21 Free communications ........................................... 27 Poster presentations ............................................ 45 Abbreviations PS: Plenary session CS: Concurrent session LS: Lunch session FC: Free communication P: Poster presentation Plenary sessions PS1.1 The Global Abortion Policies Database – a policy tool designed to increase the transparency of global abortion laws and policies and state accountability for the protection of women’s and girls’ health and human rights Antonella Lavelanet, World Health Organization, Switzerland WHO strives for a world where all women’s and men’s rights to enJoy sexual and reproductive health are promoted and protected, and all women and men, including adolescents and those who are underserved or marginalized, have access to sexual and reproductive health information and services. Access expressed through laws, policies, and guidelines is a key component of the enabling environment for safe abortion. However, abortion laws and policies can be punitive or protective; specific or non-specific; confusing and even contradictory at times, all of which may exacerbate a chilling effect on those who seek, provide or advocate for access to services. Launched in June 2017, the Global Abortion Policies Database (GAPD) contains abortion laws, policies, standards and guidelines for UN and WHO Member States designed to strengthen global efforts to eliminate unsafe abortion by facilitating comparative analyses of countries’ abortion laws and policies. The abortion laws, policies, and guidelines within the GAPD are Juxtaposed to information and recommendations from WHO safe abortion guidance, national sexual and reproductive health indicators, and UN human rights bodies’ guidance to countries on abortion. This presentation provides a brief overview of the GAPD, an analysis of selected countries, and demonstrates the vagueness and complexities that exist in laws and policies. 2 FIAPAC International*Federation*of*Professional*Abortion*and*Contraception*Associates PS1.2 Do we need abortion laws? Legal perspective Joanna Erdman, Dalhousie University, Canada This presentation interrogates the idea of ‘need’ in abortion law and explores how we assess claims of necessity under international human rights law. Using examples from the Global Abortion Policies Database, the presentation highlights the arbitrariness, overbreadth and dysfunction that characterize much abortion law worldwide, including many liberal regimes. These laws do not achieve the ends they purport to serve, and often undermine ends of public health, safety, and morality. The presentation focuses on the harms of unnecessary abortion law including: public health impacts of dysfunctional laws, access inequalities of overbroad laws and abuses of arbitrary laws. Particular attention is given to the harms by which abortion law becomes normative or even prescriptive of our lives. How law comes to shape the very ways we understand, experience and practice abortion. For example, how law and its institutional controls were traditionally used to define abortion safety, and the impact today on how we regulate self-managed abortion. We have given law much imaginative power over our field. For too long, we built norms of abortion practice in the image of the law, rather than having law serve aims of health and human rights. Today still, we carry over many falsehoods of abortion law into research, practice and policy, such as when health regulations carry on the gatekeeping and punitive work of criminal law. The presentation thus concludes with the idea of ‘freedom from law,’ an open and imaginative outlook that steers us away from the classic terms, binaries, and frames of abortion law that have patterned our field (e.g. risk and harm, time boundaries, set indications, protections and limits). The presentation extends an invitation to think ourselves away from the routines of abortion law and to ask: What do we need or want from law? PS2.1 Safe medical abortion at very early gestation Alisa Goldberg, Harvard Medical School, Brigham and Women's Hospital, United States Women are seeking abortion at increasingly earlier gestations, with 41% of first trimester patients in the U.S. receiving an abortion at <6 weeks gestation. The efficacy of medical abortion at <6 weeks gestation is not significantly different than at 6-7 weeks, however, seeking abortion very early in gestation increases the likelihood that providers will have difficulty visualizing the pregnancy on ultrasound, the current standard of care in many clinics. The most serious risk of treating women with an undesired pregnancy with mifepristone and misoprostol without first confirming a diagnosis of intrauterine pregnancy is a missed diagnosis of ectopic pregnancy. Studies suggest an incidence of ectopic pregnancy of 0.2- 0.3% among women presenting for medical abortion. Data support the practice of providing mifepristone and misoprostol medical abortion in the setting of undesired pregnancy of unknown location (PUL) using serial serum hcg testing to simultaneously exclude ectopic pregnancy and determine the efficacy of the medical abortion. Guidelines that enable provision of medical abortion in the setting of PUL, when the patient is asymptomatic, low- risk for ectopic and when combined with close follow up to exclude ectopic pregnancy exist to support this service development. This presentation will review the evidence for providing medical abortion at <6 weeks gestation including in the setting of PUL. 3 FIAPAC International*Federation*of*Professional*Abortion*and*Contraception*Associates PS2.2 Simplifying early surgical abortion Patricia Lohr, British Pregnancy Advisory Service, United Kingdom Medical and surgical methods of abortion are highly effective, safe, and acceptable to women. Women value being offered a choice of methods and receiving a preferred method is a strong predictor of satisfaction with care. For women who do not have a strong preference for a particular method, clinical trial evidence suggests that randomisation to a surgical abortion results in higher satisfaction rates than randomisation to a medical abortion. While providers may wish to optimise women’s abortion experience by offering a choice of methods, this can be challenging with the increasing shift toward medical methods and the very early gestational ages at which women now present for abortion care. Surgical abortion under general anaesthesia may be cost-prohibitive and the predominance of medical abortion in some settings can reduce opportunities for obtaining surgical skills. Providers may be uncertain of whether or how to offer surgical abortion in the earliest weeks of pregnancy. This talk will address the evidence supporting the offer of a choice of abortion methods and will discuss less resource intensive models of outpatient surgical abortion care as well as a protocol for providing surgical abortion before a gestational sac is visible on ultrasound. PS2.3 Immediate contraception after first trimester abortion Oskari Heikinheimo, University of Helsinki and Helsinki University Hospital, Finland When planning post-abortal contraception it is important to note that women seeking trimester termination of pregnancy (TOP) have demonstrated their high fertility and are at risk of subsequent induced abortion. The importance of the efficacy of the post-abortal contraceptive method has been increasingly recognized during the last decade. A safe and highly effective method with minimal dependency on the user compliance, i.e. long-acting reversible method of contraception (LARC) is clearly of value. When compared to use of LARCs and especially intrauterine contraception (IUD), use of oral contraceptives or postponing initiation of contraception is associated with a significantly increased risk of subsequent TOP. Placement of an IUD immediately at the time of first trimester surgical abortion is the standard of care and it is also recommended in international guidelines. In comparison to delayed insertion, the expulsion rate is somewhat higher (5 vs. 3 %). following immediate insertion. However, the number of IUD users during the follow-up is increased when compared to delayed insertion (92 vs. 77 %). Increasing use of the medical TOP and home administration of misoprostol pose challenges to provision of post-abortal contraception. However, progestin implants can be safely inserted on the day of mifepristone administration. A recent RCT comparing fast-track insertion (≤3 days vs. 2-4 weeks after misoprostol administration) of the levonorgestrel- releasing intrauterine system (LNG-IUS) after first trimester TOP has shown that also rapid initiation of intrauterine contraception is feasible. Fast-track insertion is associated an increased risk of partial expulsion (12.5 vs. 2.3%). 4 FIAPAC International*Federation*of*Professional*Abortion*and*Contraception*Associates However, fast tract insertion was safe with similar rate of adverse events, and identical bleeding profile as that associated with later
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