Advance provision of emergency contraception for pregnancy prevention (Review)

Background Emergency contraception can prevent pregnancy when taken after unprotected intercourse.Obtaining emergency contraception within the recommended time frame is difficult for many women. Advance provision could circumvent some obstacles to timely use. Objectives To summarize randomized controlled trials evaluating advance provision of emergency contraception to explore effects on pregnancy rates, sexually transmitted infections, and sexual and contraceptive behaviors. Search strategy In November 2009, we searched CENTRAL, EMBASE, POPLINE,MEDLINE via PubMed, and a specialized emergency contraception article database. We also searched reference lists and contacted experts to identify additional published or unpublished trials. Selection criteria We included randomized controlled trials comparing advance provision and standard access (i.e., counseling whichmay ormay not have included information about emergency contraception, or provision of emergency contraception on request at a clinic or pharmacy). Data collection and analysis Two reviewers independently abstracted data and assessed study quality. We entered and analyzed data using RevMan 5.0.23. Main results Eleven randomized controlled trials met our criteria for inclusion, representing 7695 patients in the United States, China, India and Sweden. Advance provision did not decrease pregnancy rates (odds ratio (OR) 0.98, 95% confidence interval (CI) 0.76 to 1.25 in studies for which we included twelve-month follow-up data; OR 0.48, 95% CI 0.18 to 1.29 in a study with seven-month follow-up data; OR 0.92, 95% CI 0.70 to 1.20 in studies for which we included six-month follow-up data; OR 0.49, 95% CI 0.09 to 2.74 in a study with three-month follow-up data), despite reported increased use (single use: OR 2.47, 95% CI 1.80 to 3.40; multiple use: OR 4.13, 95% CI 1.77 to 9.63) and faster use (weighted mean difference (WMD) -12.98 hours, 95% CI -16.66 to -9.31 hours). Advance provision did not lead to increased rates of sexually transmitted infections (OR 1.01, 95% CI 0.75 to 1.37), increased frequency of unprotected intercourse, or changes in contraceptive methods.Women who received emergency contraception in advance were equally likely to use condoms as other women. Authors’ conclusions Advance provision of emergency contraception did not reduce pregnancy rates when compared to conventional provision. Results from primary analyses suggest that advance provision does not negatively impact sexual and reproductive health behaviors and outcomes. Women should have easy access to emergency contraception, because it can decrease the chance of pregnancy.However, the interventions tested thus far have not reduced overall pregnancy rates in the populations studied.

Thinking Ethically About Emergency Contraception.

http://www.chausa.org/docs/default-source/health-progress/hp1001l-pdf.pdf?sfvrsn=0

Contraception and induced abortion in the West Indies: a review

ANTECEDENTES: La mayoría de las islas en West Indies no tienen leyes liberales sobre el aborto, ni programas para la prevención del embarazo (contracepción). El presente trabajo presenta los resultados de una revisión de la literatura sobre la actitud de los proveedores del cuidado de la salud y las mujeres hacia la contracepción y el aborto inducido (emergencia), prevalencia, métodos y aspectos jurídicos del aborto inducido y políticas de prevención. MÉTODOS: Se obtuvieron artículos de PubMed, EMBASE, MEDLINE, PsychINFO y SocIndex (1999 a 2010) que usaban como palabras claves contracepción, aborto inducido, terminación de embarazo, aborto médico y West Indies. RESULTADOS: Treinta y siete artículos correspondían al criterio de inclusión: 18 sobre contracepción, 17 sobre aborto inducido y 2 sobre ambos asuntos. Los resultados principales indicaron que los conocimientos de los proveedores de cuidado de la salud acerca de la contracepción de emergencia, eran pobres. Los estudios mostraron un conocimiento pobre de la contracepción, pero las sesiones de counseling aumentaron su efectividad. No se encontraron números exactos sobre la prevalencia del aborto. Se estima que el número total de abortos por año en West Indies es de 300 000. Uno de cada cuatro embarazos termina en aborto. El uso de misoprostol disminuyó las complicaciones de abortos inseguros.La legislación sobre el aborto varía ampliamente en las diferentes islas del Caribe: Cuba, Puerto Rico, Martinica, Guadalupe y San Martín tienen abortos legales. Barbados fue la primera isla angloparlante con legislación liberal para el aborto. Todas las otras islas tienen leyes restrictivas. CONCLUSIÓN: A pesar del alto número de abortos, según se estima, no hay investigaciones sobre la prevalencia del aborto. Los estudios mostraron un pobre conocimiento de la contracepción y un uso bajo entre los adolescentes. La mayoría de las islas del Caribe tienen leyes restrictivas contra el aborto.

Caribbean initiative on abortion and contraception: Acercando el Caribe a América Latina en la lucha por el aborto seguro, Puerto Rico

Describe las actividades realizadas en la visita a la región del caribe Oriental con el propósito de actualizar la situación del aborto, parece ser un momento histórico muy particular en esta región del Caribe Oriental con una clara tendencia hacia la liberalización en lo que toca a la legislación sobre aborto. Dado el contexto particular de ser regiones geográficas pequeñas, donde la intimidad y estigma se ven más vulnerados, la colaboración internacional en lo tocante al tema del aborto es bienvenida y ciertamente podría contribuir a facilitar el diálogo entre los tres sectores más afectados las mujeres, profesionales de salud y el sector gubernamental

Unsafe abortion: A neglected crisis in women's health

Women around the world risk their lives to end unwanted pregnancies. Created in 2003 and recently converted to a digital format, this short film highlights the toll that unsafe abortion takes on women and the comprehensive approach that Ipas takes to saving women's lives by improving access to safe abortion and contraception. Since this film was made, deaths from unsafe abortion have thankfully decreased to approximately 47,000 each year. However, the estimated number of unsafe abortions has risen to more than 21 million annually, largely due to the increase in population. We have a long way to go before the scourge of unsafe abortion is eliminated.

First-trimester medical abortion with mifepristone 200 mg and misoprostol: a systematic review

http://download.journals.elsevierhealth.com/pdfs/journals/0010-7824/PIIS0010782412006439.pdf

“Dishonourable disobedience” – Why refusal to treat in reproductive healthcare is not conscientious objection

In medicine, the vast majority of conscientious objection (CO) is exercised within the reproductive healthcare field – particularly for abortion and contraception. Current laws and practices in various countries around CO in reproductive healthcare show that it is unworkable and frequently abused, with harmful impacts on women's healthcare and rights. CO in medicine is supposedly analogous to CO in the military, but in fact the two have little in common. This paper argues that CO in reproductive health is not actually Conscientious Objection, but Dishonourable Disobedience (DD) to laws and ethical codes. Healthcare professionals who exercise CO are using their position of trust and authority to impose their personal beliefs on patients, who are completely dependent on them for essential healthcare. Health systems and institutions that prohibit staff from providing abortion or contraception services are being discriminatory by systematically denying healthcare services to a vulnerable population and disregarding conscience rights for abortion providers. CO in reproductive healthcare should be dealt with like any other failure to perform one's professional duty, through enforcement and disciplinary measures. Counteracting institutional CO may require governmental or even international intervention.

Achievements of the FIGO Initiative for the Prevention of Unsafe Abortion and its Consequences in South-Southeast Asia.

Since 2008, the FIGO Initiative for the Prevention of Unsafe Abortion and its Consequences has contributed to ensuring the substitution of sharp curettage by manual vacuum aspiration (MVA) and medical abortion in selected hospitals in participating countries of South-Southeast Asia. This initiative facilitated the registration of misoprostol in Pakistan and Bangladesh, and the approval of mifepristone for "menstrual regulation" in Bangladesh. The Pakistan Nursing Council agreed to include MVA and medical abortion in the midwifery curriculum. The Bangladesh Government has approved the training of nurses and paramedics in the use of MVA to treat incomplete abortion in selected cases. The Sri Lanka College of Obstetricians and Gynaecologists, in collaboration with partners, has presented a draft petition to the relevant authorities appealing for them to liberalize the abortion law in cases of rape and incest or when lethal congenital abnormalities are present. Significantly, the initiative has introduced or strengthened the provision of postabortion contraception.

Effectiveness of medical abortion with mifepristone and buccal misoprostol through 59 gestational days

BACKGROUND: From 2001 to March 2006, Planned Parenthood Federation of America (Planned Parenthood) health centers throughout the United States provided medical abortions principally by a regimen of oral mifepristone, followed 24-48 h later by vaginal misoprostol. In late March 2006, analyses of serious uterine infections following medical abortions led Planned Parenthood to change the route of misoprostol administration and to employ additional measures to minimize subsequent serious uterine infections. In August 2006, we conducted an extensive audit of medical abortions with the new buccal misoprostol regimen so that patients could be given accurate information about the success rate of the new regimen. OBJECTIVES: We sought to evaluate the effectiveness of the buccal medical abortion regimen and to examine correlates of its success during routine service delivery. METHODS: In 2006, audits were conducted in 10 large urban service points to estimate the success rates of the buccal regimen. Success was defined as medical abortion without vacuum aspiration. These audits also permitted estimates of success rates with oral misoprostol following mifepristone in a subset in which 98% of the subjects stemmed from two sites. RESULTS: The effectiveness of the buccal misoprostol-mifepristone regimen was 98.3% for women with gestational ages below 60 days. The oral misoprostol-mifepristone regimen, used by 278 women with a gestational age below 50 days, had a success rate of 96.8%. CONCLUSION: In conjunction with 200 mg of mifepristone, use of 800 mcg of buccal misoprostol up to 59 days of gestation is as effective as the use of 800 mcg of vaginal misoprostol up to 63 days of gestation.