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University of Groningen Reproductive Health Care for Women in Curaçao University of Groningen Reproductive health care for women in Curaçao Boersma, Adriana Akke IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below. Document Version Publisher's PDF, also known as Version of record Publication date: 2011 Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Boersma, A. A. (2011). Reproductive health care for women in Curaçao: induced abortion and contraception. [S.n.]. Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons). Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Download date: 28-09-2021 Reproductive health care for women in Curac;ao Induced abortion and contraception ADRIAl'NAAKKE BOERSMA ·· . ... -� Reproductive health care forwomen in Curac;ao Induced abortion and contraception ADRIANA AKKE BOERSMA Stellingen behorende bij het proefschrift "Reproductive healthcare for women In Cura�ao. Induced abortion and contraception" 1. Medicamenteuze abortus op Curac;aomet mifepristone thuis gevolgd door buccale toediening van misoprostol is een veilige en effectieve methode voor zwangerschaps­ afbreking tot 70 dagen amenorroeduur. Dit proefschrift 2. Als alternatief voor de behandeling genoemd in stelling 1 kan methotrexaat gevolgd door vaginaal misoprostol gebruikt warden voor zwangerschapsafbreking tot 56 dagen amenorroeduur. Dit proefschrift 3. Op Curac;ao is de negatieve houding ten opzichte van moderne, betrouwbare anticon­ ceptie te wijten aan beperkte sexuele voorlichting en wordt gevoed door een cultureel in stand gehouden geloof in negatieve gezondheidseffecten van deze middelen. Dit proefschrift 4. Het risico op complicaties na een medicamenteuze abortus is beperkt in vergelijking met de voordelen van medicamenteuze abortus. 5. Op Curac;ao beschikken de artsen over de vrijheid en kennis abortus uit te voeren, maar vrouwen hebben wettelijk gezien geen recht op deze diensten. 6. In Nederland dient medicamenteuze abortus genoemd te warden als alternatief voor instrumentele abortus; het kan uitgevoerd warden in de eerste lijn. 7. De perfecte geografische ligging van Curac;ao tussen Europa, de Verenigde Staten en Zuid Amerika staat in schril contrast met de ge'isoleerde ligging in wetenschappelijk opzicht. 8. Het invoeren van vernieuwingen op Curac;ao is moeilijk daar pogingen tot implementeren van veranderingen meestal teniet gedaan warden door herstel van het oude machtseven­ wicht. 9. Caribische Nederlanders kunnen veel leren van Europese Nederlanders, net als andersom. 10. De Rooms Katholieke Kerk in Zuid Amerika is niet tegen legaliseren van abortus vanwege het redden van foetussen maar om invloed in de regio te behouden. 11. Verstoringen in arbeidsrelaties op Curac;ao vertalen zich vaak in fysieke klachten, die aan de huisarts gepresenteerd warden; maar het analyseren, verhelpen en voorkomen van verstoringen in de arbeidsrelaties is een taak van de bedrijfsarts. 12. In plaats van het lege artis uitvoeren van abortus provocatus te criminaliseren, zou het vervoeren van in auto's rondspringende, kleine kinderen op Curac;ao als mistj.9.ad moeten __ warden bestempeld. Cc.1 u t\,kdbt.., M Adriana Akke Boersma, 18 april 2011 Bibhotheek C Groningen G Niets uit deze uitgave mag warden verveelvoudigd en/of openbaar gemaakt door middel van druk, fotocopie, microfilm of op welke andere wijze ook, zonder vooraf­ gaande schriftelijke toestemming van de uitgevers. ISBN: 987-99904-1-423-3 Vormgeving en lay-out: I-Design NV Drukwerk: Gildeprint Drukkerijen Omslag: "Sterke vrouwen van Curac;ao" RIJKSUNIVERSITEIT GRONINGEN Reproductive health care forwomen in Curac;ao Induced abortion and contraception Proefschrift ter verkrijging van het doctoraat in de Medische Wetenschappen aan de Rijksuniversiteit Groningen op gezag van de Rector Magnificus, dr. E. Sterken, in het openbaar te verdedigen op maandag 18 april 2011 Ccnlrale V om 16.15 uur Medische M Bibliutheek C Groningen G door Adriana Akke Boersma geboren op 6 augustus 19 59 te Boornbergum Promotoren: Prof. dr. K. van der Meer Prof. dr. B.Meyboom- de Jong Prof. dr. J. G.M. de Bruijn Beoordelingscommissie: Prof. dr. A.L.M. Lagro- Janssen Prof. dr. A.J. Duits Prof. dr. M.J.E. Maurits Voor mijn ouders, Hugo, Patrick en Anja - Content General introduction 9 Chapter 1 Contraception and Induced Abortion Chapter 2 in The West Indies: a Review 19 Termination of Pregnancy in Curac;ao: Need for Improvement Chapter 3 of Sexual and Reproductive Health Care 31 Good Results of Early Medicinal Pregnancy Te rmination in Chapter 4 a General Practice in Curac;ao 45 Mifepristone followed by Home Administration of Buccal Chapter 5 Misoprostol for Medical Abortion up to 70 Days of Amenorrhoea in a General Practice in Curac;ao 57 Medical Abortion in Primary Care: Pitfalls and Benefits Chapter 6 71 Attitude toward Contraception and Abortion among Chapter 7 Curac;ao Women: Ineffective Contraception due to Limited Sexual Education 79 General discussion 101 Chapter 8 111 Summary Samenvatting Resumen 121 Acknowledgements Guidelines of induced abortion in Curac;ao 125 Appendix 135 Curriculum vitae Chapter 1 General introduction 9 Introduction On a Friday afternoon a Colombian woman and a man entered my room. Ner­ vously the woman told me she was pregnant but it was impossible for her to keep the pregnancy. She was sent to Curar;ao to support her family in Colombia, who lived in very poor circumstances. She had already left three children in the care of her mother, so she could not come back with another child. The ultrasound showed a pregnancy of almost 15 weeks. I told her that I could not help her, but I saw in her eyes that she was determined to end this pregnancy. "I know my way" she said and I realized how uncomfortable I felt letting her go knowing what risks she was going to take. The only thing I could stumble was "whatever you do and whatever happens, you can always come back here". She smiled the friendlysmile of the Caribbean people and left me be­ hind with the miserable thought that I already had left her in the lurch so why should she come back to somebody like me? Three days later she came back. The ultrasound showed an empty uterus. She had bought Cytotec on the black market and after 10 hours she had pushed out the fetus. She declined to see it so the man had taken it away and buried it in the yard at the back of the house. After that they cried formany hours. Since the origin of mankind there have been unwanted pregnancies and there always will be. Also abortion is from all times and all cultures 1 . Women and men try to find a solution for an unplanned, unwanted pregnancy. In the past different kind of herbs were used as well as all kind of (sharp) instruments which were inserted via the vagina in the uterus. In a lot of countries these practices are still common, mostly because of restricted abortion laws, but also because of difficult access to abortion clinics in countries where abortion is legal. In most West Indian islands there are restrictive abortion laws. In some islands, like Curac;ao, St. Maarten, Haiti and the Dominican Republic, abortion is totally prohibited, while in among oth­ ers Jamaica, St Lucia, Trinidad, St Kitts abortion is only permitted to save the life of a women or to protect her physical or mental health. Barbados is one of the islands which has expanded its abortion laws and also includes socio-economic grounds as a reason for abortion. In the French islands, Cuba and Puerto Rico (U.S.) abortion is allowed on request of a woman. In Curac;ao women used herbs like yerba di lagadishi, lumbra blancu, shimarucu machu, jerba di kabritu and basora pretu to terminate an unwanted pregnancy2. Of course nothing is known about success rates of abortion or about complications after treatment with these herbs. Since the fifties of the last century abortion practices were performed illegally and in dangerous circumstances by "back alley" abortionists, who were neither trained nor capable. One of my older colleagues told the following story about abortion practices. "Dr. X. started aborting in the early sixties or maybe even in the fifties. His motivation for performing abortions were obscure, he worked under unhygienic circumstances and infections and retained fetal rests were common. He used non flexible iron curet­ tes, did not wear gloves and often forgot the vaginal examination, so that more than once he ended up taking out fetuses of a gestational age of more than 3 months. After the death of a woman due to an abortion he was prosecuted and sent to jail. There he committed suicide beforehe was sentenced. 10 Working in Curac_;:ao as locum general practitioner in the nineties of the last century, I noticed a high number of induced abortions compared to the Netherlands. Abortion is an offence ac­ cording to the law in Curac_;:ao and these abortions were performed by general practitioners who worked independently. The income earned with the abortions raised questions on the profes­ sional and ethical integrity of the medical doctors who performed abortions. Their views and procedures varied considerably and there was no control over the quality of their work. The fact that abortions were conducted out of the public eye interfered with the quality of care, and with referrals to secondary care.
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