Book of abstracts - The European Society of Contraception and

Transcription

Volume 21 Supplement 1 April 2016
The European Journal of Contraception & Reproductive Health Care
The European
Journal of
&
ISSN 1362-5187
Contraception
Reproductive
Health Care
The Official Journal of the
European Society of Contraception and Reproductive Health
Book of Abstracts
The 14th Congress – 2nd Global Conference of the European
Society of Contraception and reproductive health
Basel, Switzerland
4-7 May, 2016
Editor-in-Chief
Johannes Bitzer
Volume 21 Supplement 1 April 2016
IEJC_I_21_S1_Cover.indd 1
Deputy Editors-in-Chief
Dan Apter
Iñaki Lete Lasa
Editors
Gretchen Hess
Paloma Lobo
Charles Picavet
Frans Roumen
Lee Shulman
Irving Sivin
4/27/2016 12:04:47 PM
The European Journal of Contraception and
Reproductive Health Care
The abstracts in this supplement have not been peer-reviewed
Contents
KEYNOTE LECTURES
Molecular biology and advanced technology for contraception ....................................................................................................................1
Sexual and reproductive rights ......................................................................................................................................................................................1
The history of syphilis – lessons learned ...................................................................................................................................................................1
KEYNOTE SESSIONS
Endometrial contraception...............................................................................................................................................................................................2
Green contraception ...........................................................................................................................................................................................................2
Permanent non-surgical contraceptive methods for women............................................................................................................................2
A way to improve training in reproductive health in Europe? ........................................................................................................................3
The collaboration between EBCOG and UEMS........................................................................................................................................................3
CONGRESS SESSIONS
The Romania example: does access to effective contraception and safe abortion influence demography? ...............................3
Gaps in reproductive and maternal health: the challenge of inequality .....................................................................................................4
Unsafe abortion in Thailand ............................................................................................................................................................................................4
Reproductive health care for asylum-seeking women .........................................................................................................................................4
Reproductive health in young Mexican women.....................................................................................................................................................5
Contraception in HIV-positive women ........................................................................................................................................................................5
Contraception and migraine ...........................................................................................................................................................................................6
Contraception in BRCA1/BRCA2-positive women...................................................................................................................................................6
Polycystic ovary syndrome, hormonal contraception, and thrombosis ........................................................................................................6
Selective progesterone modulators..............................................................................................................................................................................6
Continuous regimen ...........................................................................................................................................................................................................7
Estetrol and the breast ......................................................................................................................................................................................................7
Contraception as a behaviour: models of understanding ..................................................................................................................................7
Compliance – blame the women?................................................................................................................................................................................8
Hormonal contraception and venous thromboembolism ..................................................................................................................................8
Hormonal contraception and myocardial infarction .............................................................................................................................................8
Can non-oral E2 plus progestin definitively solve the cardiovascular problems? ....................................................................................8
Intimate partner violence: from notice to network intervention. The Coimbra experience ................................................................9
Sexual violence as a war strategy in Iraq ..................................................................................................................................................................9
Estimating prevalence of female genital mutilation in the European Union: existing evidence and
future opportunities to optimise estimations....................................................................................................................................................... 10
From female genital mutilation to female genital reconstruction: a surgeon’s approach ................................................................ 10
Developing male contraception: gap or abyss?................................................................................................................................................... 10
Gaps and limitations of contraception research: lots of opponents, very few advocates................................................................. 11
What is task sharing? Review of WHO Guidelines and ongoing research on task sharing of contraceptive services........... 11
Role of mid-level providers in abortion care......................................................................................................................................................... 11
Multidisciplinary provision of care, task sharing: user perspectives ............................................................................................................ 12
The contraceptive consultation for women living with HIV – role in promoting women’s health and
wellbeing as well as reducing mother-to-child transmission of HIV........................................................................................................... 12
Alcohol use identification and brief intervention in the sexual health setting – evidence and challenges.............................. 12
Role of HPV vaccination, cytology screening and colposcopy in modern Europe – what can the
contraceptive provider contribute? ........................................................................................................................................................................... 13
Partner tracing, notification and treatment: how?.............................................................................................................................................. 13
Polycystic ovary syndrome (PCOS): intervention according to phenotype and co-morbidity........................................................... 13
Contraception in women with cardiac malformations...................................................................................................................................... 14
Contraception and the treatment of medical disorders – endometriosis................................................................................................. 14
JOINT SESSIONS
Androgen-restored contraception.............................................................................................................................................................................. 15
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THE 14TH CONGRESS OF THE EUROPEAN SOCIETY OF CONTRACEPTION AND REPRODUCTIVE HEALTH
The fetal estrogen estetrol (E4) and the breast ................................................................................................................................................... 15
Contraception in modern Russia ................................................................................................................................................................................ 15
The results of the RAPD project ‘Strengthening reproductive health among certain groups of the
population in three regions of the Russian Federation’ (2014–2015) ........................................................................................................ 16
The European Society for Sexual Medicine (ESSM) educational activities and the Multidisciplinary
Joint Committee for Sexual Medicine (MJCSM) exam: the importance for gynaecologists.............................................................. 16
Impact of family planning research on decrease in maternal mortality ................................................................................................... 16
Vaginal rings as a user-controlled method for contraception ....................................................................................................................... 17
Contraception during lactation ................................................................................................................................................................................... 17
New developments in female contraception........................................................................................................................................................ 17
Dilemmas in sexual and reproductive health care in Central Europe........................................................................................................ 18
Quality of contraceptive care: essential for improving contraceptive coverage across Europe...................................................... 18
Quality of contraceptive counselling and care – a community and health care provider’s perspective .................................... 19
Impact of illegal abortion on maternal mortality................................................................................................................................................ 19
The Asian perspective on how to deal with illegal abortion by promoting contraception ............................................................. 19
Dealing with the barriers to access to abortion .................................................................................................................................................. 20
Legalisation of abortion: a window of opportunity for contraception ...................................................................................................... 20
New frontiers in education and training: The Safe Delivery App as a case study................................................................................ 20
Assessment in sexual health training ....................................................................................................................................................................... 21
Understanding the decline in teen fertility in the United States, 2007–2013......................................................................................... 21
Consequences of teen births in the United States............................................................................................................................................. 21
Is there a need for training in contraception across Europe? ....................................................................................................................... 22
The good news: simplified medical abortion – increased access to safe abortion care .................................................................... 22
The bad news: access to abortion still restricted................................................................................................................................................ 22
The ugly news: late abortion ....................................................................................................................................................................................... 23
The role of FIGO in contraception............................................................................................................................................................................. 23
Latin American challenges and solutions in contraception ............................................................................................................................ 23
The latest WHO guidelines in SRH ............................................................................................................................................................................ 24
Implementation of WHO guidelines in the WHO European region ............................................................................................................ 24
World Health Organisation recommendations on health worker roles in safe abortion
care and post abortion contraception ..................................................................................................................................................................... 24
Revival of Progestogen-only pills (POPs) ................................................................................................................................................................ 25
Long-acting reversible contraceptives (LARCs) – the Austrian view ........................................................................................................... 25
Update on emergency contraceptive methods and their mechanisms of action................................................................................. 25
Emergency contraception (EC) provision as an opportunity for contraceptive counselling............................................................. 26
Sexual health care in adolescence............................................................................................................................................................................. 26
Contraception use by women living with HIV (Particularités de la contraception chez les femmes VIH +)............................. 27
INTERNATIONAL CONSORTIUM FOR MALE CONTRACEPTION
Hormonal male contraception: new options ........................................................................................................................................................ 27
Promising targets for non-hormonal male contraception ............................................................................................................................... 27
DEBATES
Contraception and the media: a debate................................................................................................................................................................. 28
How the media may have a negative effect on the use of contraceptives ............................................................................................ 28
Contraception and the media: embracing new models of contraceptive care...................................................................................... 28
IUD/IUS for nulliparous patients ................................................................................................................................................................................. 29
IUS/IUD in nulliparas and adolescents – ‘Con’ ..................................................................................................................................................... 29
EXPERT GROUP SESSIONS
Young people with intellectual disabilities and sex education..................................................................................................................... 29
ZANZU: an internet-based approach to improved sexual health for migrants ...................................................................................... 29
Sexuality education for different target groups................................................................................................................................................... 30
Use of fertility awareness methods: information from internet resources and cycle apps ............................................................... 30
Female sterilisation a thing of the past? – ‘Pro’ .................................................................................................................................................. 31
Female sterilisation: a thing of the past? – ‘Con’................................................................................................................................................ 31
The cost-effectiveness ratio of contraceptive methods in the European Union.................................................................................... 31
New hormonal methods – recent and on the horizon .................................................................................................................................... 32
New controversies: hormonal contraception and venous/arterial thromboembolism ........................................................................ 32
Explanations for second trimester abortions; background contexts........................................................................................................... 32
Medical vs. surgical abortion, pro medical............................................................................................................................................................. 32
Medical versus surgical abortion in the second trimester – ‘Con’ ............................................................................................................... 33
Feticide before second trimester medical and surgical abortion: weighing the risks and benefits .............................................. 33
WORKSHOPS
Sexual health of young people in the WHO European Region .................................................................................................................... 33
THE EUROPEAN JOURNAL OF CONTRACEPTION AND REPRODUCTIVE HEALTH CARE
3
Youth-friendly clinics in Estonia – association with contraceptive use...................................................................................................... 34
Adolescent contraception and sexually transmitted diseases........................................................................................................................ 34
Theory and intervention: what works to improve compliance and continuation................................................................................. 34
The sexuality education programme ‘Long Live Love’: an Intervention Mapping Approach .......................................................... 35
MEET THE EXPERTS
Misconception in hormone and cancer................................................................................................................................................................... 35
Myths and misconceptions about long-acting reversible methods of contraception......................................................................... 35
Birth control in the USSR 1917–1991 ....................................................................................................................................................................... 35
GRANTED PROJECTS
Contraceptive education for disabled people ...................................................................................................................................................... 36
Criteria for contraception use and non-use and predictable factors for safe contraception use in Latvia ................................ 36
Stress and its influence on fertility............................................................................................................................................................................ 37
FREE COMMUNICATIONS
Effect on premenstrual syndrome of oral contraception based on natural estrogen: ZOCAL Study ........................................... 38
Disempowerment of individuals with mental disabilities to explore and practice sexual and
reproductive health, a Manitoba, Canada Study ................................................................................................................................................. 38
Barometer of women’s access to modern contraceptive choice in 16 EU countries – 2nd edition ............................................. 39
Experiences from a family planning vouchers program in rural Pakistan – evidence, challenges and way forward ............ 39
Impact on quality of life of oral contraception based on natural estrogen: ZOCAL Study .............................................................. 39
Growing up in one fell swoop: life course scenarios leading to teenage pregnancies...................................................................... 40
Developing strategies to address contraceptive needs of adolescents: exploring patterns of use
among sexually active adolescents in 45 low- and middle-income countries ....................................................................................... 40
Lowering the dose of the injectable contraceptive DMPA ............................................................................................................................. 41
Comparison between side-effects of one rod and two rod implants: results from a multicentre
randomized clinical trial for women, Jadelle and Implanon .......................................................................................................................... 41
Determinants of STIs/AIDS and viral hepatitis knowledge, attitudes and practices among Brazilian
youth (aged 18–29 years).............................................................................................................................................................................................. 42
Unicirc – a new instrument for performing minimally-invasive voluntary male medical circumcision
in the prevention of HIV/AIDS: meta-analysis of three studies ..................................................................................................................... 42
Uptake of sub-dermal contraceptive implant in the immediate postpartum period at the Moi teaching
and referral hospital, Eldoret Kenya.......................................................................................................................................................................... 42
Hormonal contraception and depression: a prospective cohort study...................................................................................................... 43
The WHO USAID UNFPA Family Planning Training Resource Package – a new online
resource for training materials .................................................................................................................................................................................... 43
Efficacy and safety of an injectable combination hormonal contraceptive for men ........................................................................... 43
Levonorgestrel Intrauterine System (LNGIUS) continuation in adolescents and adult women....................................................... 44
A cluster analysis of bleeding/spotting patterns in women using a novel 24/4 regimen of
Drospirenone 4 mg as a progestin only oral contraceptive........................................................................................................................... 44
Pharmacokinetics of levonorgestrel and ulipristal acetate emergency contraception in
women with normal and obese body mass index ............................................................................................................................................. 45
Pornography consumption among adolescent girls in Sweden................................................................................................................... 45
A prospective, open-label, single arm, multicentre study to evaluate efficacy, safety and
acceptability of the pericoital oral contraception using levonorgestrel 1.5 mg.................................................................................... 45
Can thrombohilia screening prevent thrombosis from combined oral contraceptive pills? A case report ............................... 46
Women’s preferences about menstrual bleeding frequency: results from the ISY 2
(Inconvenience due to women’S monthlY bleeding) Study ........................................................................................................................... 46
IUD and ultrasound by midwives – implementation of two new methods at a youth clinic ......................................................... 47
Combined oral contraception in hyperprolactinemic women....................................................................................................................... 47
Do beliefs about the combined hormonal contraceptive (CHC) influence the choice of method?.............................................. 47
Contraception and the Australian male: a survey of 2438 heterosexual men using an online dating service ........................ 48
A clinical study of septic abortions in a tertiary care referral centre in rural India – still a
neglected scenario which can be a preventable catastrophe ....................................................................................................................... 48
The status of having gynaecological problems among adolescents and their practices on this issue ....................................... 48
A randomised trial of Veracept, a novel nitinol low-dose copper intrauterine contraceptive,
compared to a copper T380S intrauterine contraceptive................................................................................................................................ 49
Combined hormonal contraceptives use and breast cancer development in a 3-fold
higher-risk population of women .............................................................................................................................................................................. 49
Quality provision of sexual and reproductive health commodities in pharmacies:
is this the way to reach youth? A systematic literature review and synthesis of the evidence ..................................................... 50
Effect of vitamin B1 on sexual desire (libido) in women with premenstrual syndrome .................................................................... 50
Decentralising medical abortion services in Victoria, Australia ..................................................................................................................... 50
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Sociodemographics features and knowledge of contraceptive methods between
teenage pregnant Brazilian women .......................................................................................................................................................................... 51
Contraceptive method choice and provision of desired methods among women
obtaining abortion in England and Wales ............................................................................................................................................................. 51
Male involvement in maternal health care: a qualitative study of men of reproductive age in
Ibadan South East and South-West, Nigeria.......................................................................................................................................................... 52
ACCEPTED ABSTRACTS
ABORTION
Factors contributing to the limited and declining use of MVA for postabortion care in
Malawi: a qualitative study of health workers’ opinions.................................................................................................................................. 52
Instruction-only versus demonstration of a low sensitivity pregnancy test for self-assessment of medical
abortion in South Africa; a multicentre non-inferiority randomised controlled trial............................................................................ 52
Are women well educated about available contraception methods?........................................................................................................ 53
Practices of abortion in post-revolutionary Tunisia: women as immoral and impious citizens ...................................................... 53
Experiences of non-resident abortion seekers in the United Kingdom: a pilot-study......................................................................... 53
Hydraulic dilatation: a novel approach to cervical dilatation......................................................................................................................... 54
Determinants of choice of the first trimester abortion method, acceptability of and satisfaction with the
chosen method.................................................................................................................................................................................................................. 54
Family Planning policy influences the induced abortion rate in China: trend analysis from 1979 to 2013 .............................. 55
Second trimester induction of labour standardisation: effects on clinical outcomes.......................................................................... 55
Acceptability, efficacy and safety of medical abortion in a Romanian private practice clinic ......................................................... 55
Pain management for first trimester medical termination of pregnancy (MToP) – an international survey
among providers ............................................................................................................................................................................................................... 56
Organisation and delivery of abortion and family planning service in Georgia .................................................................................... 56
Audio-visual-presentation for conultation before medical abortion ........................................................................................................... 57
Management of pain associated with first trimester medical termination of pregnancy (MToP)
using mifepristone-misoprostol regimens. A systematic literature review ............................................................................................... 57
A comparative study of vaginal misoprostol versus trans-cervical foley catheter insertion along with
vaginal misoprostol in termination of mid-trimester pregnancies............................................................................................................... 57
Ten years of pregnancy termination by the family planning centre of a tertiary hospital in Greece
including adolescents...................................................................................................................................................................................................... 58
Efficacy and safety of the medical method in the voluntary interruption pregnancy over
8 years – experience of a Portuguese medical centre...................................................................................................................................... 58
Safety and efficacy of outpatient mifepristone-misoprostol medical abortion through 76 days of
gestational age – Portuguese experience in a tertiary hospital ................................................................................................................... 59
Medical abortion in second trimester missed abortion pregnancies.......................................................................................................... 59
Evolution of the sociodemographic profile of women undergoing abortion in a tertiary centre in Portugal......................... 59
Subfertility consequent to 15 years of post-abortion retention of fetal skull bones and soft tissue........................................... 60
The changing face of abortion in Mexico: trends in complications and lethality at national and state level
in Mexico between 2000 and 2013........................................................................................................................................................................... 60
Termination of a pregnancy located in one horn of a bicornuate uterus: challenges and solution ............................................ 60
Perceptions of elective abortion among Palestinian women: religion, culture and access in the
occupied Palestinian territories ................................................................................................................................................................................... 61
The factors that cause induced abortion................................................................................................................................................................ 61
Unsafe abortions in India: is the MTP Act propitious enough? .................................................................................................................... 61
Obstetricians-gynaecologists’ experiences and attitudes towards abortion, stigma and conscientious
objection: a qualitative study in Italy and Spain (Catalunya)......................................................................................................................... 62
Outpatient mifepristone-misoprostol medical abortion through 77 days of gestation...................................................................... 62
The recent increase in spontaneous abortions in Turkey: medicalisation of pregnancy?.................................................................. 63
Abortion pills in women’s hands. Is the abortion rights movement working to make it happen? .............................................. 63
The outcome of home medical abortions provided through telemedicine ............................................................................................ 63
Abortion: findings from the ‘understanding fertility management in contemporary Australia national survey’ ..................... 64
Medical abortion provided by nurse-midwifes or physicians in a high resource setting: a cost-effectiveness analysis....... 64
Prevalence of uterine synechiae after abortion evacuation curettage....................................................................................................... 64
ADOLESCENT SEXUAL REPRODUCTIVE HEALTH CARE
A Family Planning Centre for an island................................................................................................................................................................... 65
Enabling international commitments to foster favourable adolescent sexual and reproductive health
services in Jamaica ........................................................................................................................................................................................................... 65
Contraceptive awareness in the area of reproductive health in female students ................................................................................ 65
Contraceptive knowledge among Mexican adolescents .................................................................................................................................. 66
Sexual risk behaviours among Mexican adolescents ......................................................................................................................................... 66
Abortion in adolescents and young people in our centre in Spain............................................................................................................ 66
5
Age at menarche and socio-economic status, intake of food groups, physical activities and stressful conditions ............... 67
Youngsters: condoms use under alcohol................................................................................................................................................................ 67
The assessment of physical growth and menarche/menstruation among adolescents aged 11–14............................................ 68
Promoting sexual and reproductive health in schools: characterisation of individual contexts in a
sample of Portuguese pregnant adolescents........................................................................................................................................................ 68
Adolescents and family planning methods ........................................................................................................................................................... 68
Sexual responsibility of adolescents ......................................................................................................................................................................... 68
Pattern of university students’ reproductive behaviour formation: role of educational programmes ......................................... 69
Health-promoting lifestyle and premenstrual syndrome in nursing students ........................................................................................ 69
Social, demographic, family and economic factors correlated with the occurrence of teenage pregnancy
and their reserved prognosis in North-East Romania........................................................................................................................................ 70
Assessing youth-friendly-health-services and supporting planning in the Republic of Moldova................................................... 70
How adolescent friendly are national contraceptive policies, strategies and guidelines? An assessment
of three countries’ normative documents using a human rights framework ......................................................................................... 71
What does not work in adolescent sexual and reproductive health: a review of the evidence on
interventions commonly accepted as best practices......................................................................................................................................... 71
Youth perception on received sexual education and consultation............................................................................................................. 71
BARRIER METHODS
Learning to use the one-sized SILCS Diaphragm in South Africa: improvements after five uses .................................................. 72
SILCS Diaphragm as a multipurpose prevention technology: new data from South Africa............................................................. 72
Why women change the first contraceptive method ....................................................................................................................................... 72
CARDIOVASCULAR RISKS OF HORMONAL CONTRACEPTION (INCL PROGESTINS)
Awareness of the risk of VTE associated with combined hormonal contraception ............................................................................. 73
CONTRACEPTION AND BEHAVIOURAL MEDICINE
Influencing factors of reliable contraceptive use: a nationwide cross-sectional survey ..................................................................... 73
How to assess acceptability and satisfaction of contraceptive methods including vaginal rings in clinical studies? ........... 74
Bring men to the table: to evaluate knowledge about contraceptive methods, contraceptive behaviour and
the desired role of young men in decisions regarding contraception within a relationship – a pilot study ........................... 74
Contraceptive prevalence in Austria and implications for reproductive health – the impact of hormone
fear and free of charge contraception..................................................................................................................................................................... 75
Contraceptive use among Canadian obstetrics and gynaecology residents ........................................................................................... 75
Contraceptive counselling to prevent repeat unintended pregnancy: the abortion client’s perspective................................... 75
CONTRACEPTION AND THE TREATMENT OF MEDICAL DISORDERS
Contraception and hyperandrogenism. Clinical effects of the drug containing chlormadinone acetate ................................... 76
Prognosis of complications and side-effects of hormonal contraception in women of reproductive age ................................ 76
Efficacy of the levonorgestrel-releasing intrauterine system in secondary pain treatment in
endometriosis in a reference hospital...................................................................................................................................................................... 76
Efficacy of the levonorgestrel-releasing intrauterine system in hypermenorrhagia treatment in a reference hospital ........ 77
Evaluating the influence of bariatric surgery on young females quality-of-life and sexual reproductive
health behaviours ............................................................................................................................................................................................................. 77
The concern of symptoms caused by bleeding: results from the ISY (Inconvenience due to women’S
monthlY bleeding) Study............................................................................................................................................................................................... 77
Evaluation of the effectiveness and acceptability of a hormonal contraceptive containing 1.5 mg
of 17b-estradiol and 2.5 mg of nomegestrol acetate........................................................................................................................................ 78
CONTRACEPTION IN ADOLESCENCE
Sexual health, reproductive health and responsible parenthood in the school health programme in
Florianópolis, Brazil........................................................................................................................................................................................................... 78
The perception of contraception among young male partners in China................................................................................................. 79
Perceptions of Mexican physicians regarding intrauterine contraception in adolescents ................................................................. 79
Ultrasonographic follow-up of post-placental IUD insertion in adolescents ........................................................................................... 79
Addressing the reproductive health needs and rights of married adolescent couples...................................................................... 80
The use of contraceptive vaginal ring compared to oral contraceptive pill containing two active ingredients,
estradiol valerate and dienogest, in two groups of adolescents. Preliminary report .......................................................................... 80
Decrease in combined oral contraceptive use in 15–19-year-old Danish women – no increase in the
number of unwanted pregnancies ............................................................................................................................................................................ 81
Adolescent contraceptive continuation rates in the Canton of Vaud (Switzerland) ............................................................................ 81
Preventing repeat teenage pregnancy effects of a family planning programme ................................................................................. 81
Contraception in adolescence: compliance with contraceptive methods ................................................................................................ 82
Evaluation of the effect of cultural factors in adolescent contraception.................................................................................................. 82
Reducing barriers for IUD insertion in adolescents: a comparison of IUD insertion experience and
clinicians’ utilisation at 4 months between adolescents and non-adolescents in Italy ...................................................................... 82
6
Adolescents’ knowledge, attitudes and practices towards family planning and contraceptive use: a
qualitative study from Kilifi County, Kenya............................................................................................................................................................ 83
CONTRACEPTION IN HIGH RISK PATIENTS
Challenges and needs in providing post-abortion family planning in routing abortion services in
China: findings from a nationwide randomised cluster trial .......................................................................................................................... 83
The specific features of contraceptive behaviour of women with adenomyosis .................................................................................. 84
CONTRACEPTION IN MEDICAL CONDITIONS AND DISABILITY
Reproductive characteristics in women after renal transplantation ............................................................................................................ 84
Family planning in transplanted women................................................................................................................................................................ 84
Sexual life and contraceptive use among Brazilian teenage girls with cancer....................................................................................... 85
CONTRACEPTION IN PREMENOPAUSAL WOMEN
Neurokinin B receptor antagonism suppresses ovarian follicle development and postpones ovulation ................................... 85
CONTRACEPTION IN SOCIALLY DISADVANTAGED GROUPS
Meeting the contraceptive needs of female migrant garment factory workers from a mobile clinic in Laos ......................... 85
Postcode lottery or differences in access – uneven regional availability of public funded contraception in Germany....... 86
Improving the sexual health of homeless young people resident in hostels......................................................................................... 86
Market segmentation research in Kosovo .............................................................................................................................................................. 87
CULTURE, RELIGION, REPRODUCTION AND SEXUALITY
Human Parvovirus B19 in Iranian pregnant women: a serologic survey................................................................................................... 87
Influence of tradition, religion and customs on the reproductive health of Roma population in Nis, Srbija........................... 88
The role of culture and religion on reproduction and sexuality in Ukraine............................................................................................ 88
Role of culture and religion in family planning and contraceptive use: a qualitative study
from Kilifi County, Kenya ............................................................................................................................................................................................... 88
Community perspectives on female genital cutting (FGC): comparing men and women’s views in
the Boston immigrant community ............................................................................................................................................................................ 89
Wrestling with the hymen: consultations and practical solutions ............................................................................................................... 89
Women’s empowerment and contraceptive use: the role of independent versus couples’ decision-making,
from a lower middle income country perspective ............................................................................................................................................. 89
Religious barriers affecting unmet need for contraception in India ........................................................................................................... 90
DELIVERY OF SEXUAL AND REPRODUCTIVE HEALTH CARE
Provision of a postnatal contraception service – a pilot study integrating community sexual health
services and maternity services................................................................................................................................................................................... 90
Determinants of unintended pregnancy among women in Ambanja district, Madagascar ............................................................. 91
Delivering a nurse-led subdermal implant clinic ................................................................................................................................................. 91
Workforce planning based on need for sexual, reproductive maternal and newborn health services ....................................... 91
Use of ultrasound within an integrated contraception and sexual health service ............................................................................... 92
Are UKMEC category 4 health risks including smoking status, blood pressure, BMI, History of migraine with
aura and VTE being assessed in patients prescribed the COCP at a community medical practice? ............................................ 92
The APPLES pilot: Access to Post Partum LARC in Edinburgh South......................................................................................................... 93
Could implementation of clinical outreach in the UK improve rates of unplanned pregnancy and
sexually transmitted infections?.................................................................................................................................................................................. 93
Developing a participatory approach involving health sector and community members, to increase
unmet needs for contraception through human rights principles.............................................................................................................. 93
Quality of care in family planning and contraceptive services as defined by communities and
health care providers: a scoping review ................................................................................................................................................................. 94
Participatory approaches in reproductive health services: success and challenges ............................................................................. 94
Efficient exclusion of pregnancy prior to initiation of long-active reversible contraception or
performance of an intrauterine procedure ............................................................................................................................................................ 95
The relationship between perceived social support and attitudes towards menopause of women............................................ 95
Survey of health professionals about the access to oral contraception over the counter in France ........................................... 96
The role of information for the effectiveness of contraception use in Russia........................................................................................ 96
Determinants of supply chain bottlenecks and their impact on contraception stock outs in low-and
middle-income countries: a systematic review of the literature................................................................................................................... 96
Participatory interventions involving both community and health care providers for family planning
and contraceptive services: a scoping review ...................................................................................................................................................... 97
Effect of counselling given to young people admitted to the youth friendly centre with suspicion of
unwanted pregnancy on repeated admission...................................................................................................................................................... 97
Taking a ‘sexual health’ history................................................................................................................................................................................... 98
DEMOGRAPHY
Demographic characteristics of 400 women from Ireland and the Philippines who completed the
online consultation form of the telemedical abortion service Women on Web ................................................................................... 98
Health status of seasonal agricultural female workers in rural areas of Eskisehir................................................................................. 98
7
Can medically assisted reproduction be viewed as a tool to increase the birth rate in the Czech Republic?......................... 99
The demographic problem of Greece: numbers and scepticism ................................................................................................................. 99
DIVERSITY AND SEXUAL/REPRODUCTIVE HEALTH (SRH) IN MULTICULTURAL EUROPE
Community-based education, towards diversity in sexual/reproductive health care in multicultural Europe.......................... 99
EDUCATION AND TRAINING FOR FAMILY PLANNING PROFESSIONALS
Exploring the awareness and knowledge regarding contraception among Malaysian house-officers.......................................100
Contraception choices and affecting factors of Turkish woman. Literature review ...........................................................................100
Long-acting reversible contraception (LARC) training in general practice .............................................................................................101
Abortion training in Canadian obstetrics and gynaecology residency programmes .........................................................................101
EMERGENCY CONTRACEPTION
Improving emergency contraception in UK general practice ......................................................................................................................101
Efficacy of ulipristal acetate for emergency contraception and its effect on the subsequent
bleeding pattern when administered before or after ovulation.................................................................................................................102
Use of effective contraception six months after emergency contraception with a copper intrauterine
device or ulipristal acetate – a prospective observational cohort study ................................................................................................102
A survey of knowledge and attitudes of emergency contraception among university students in Turkey............................102
Improving the quality of consultations on emergency contraception and uptake of
emergency intrauterine contraception ..................................................................................................................................................................103
Health care students’ knowledge and use of emergency contraception, Buenos Aires, Argentina............................................103
Emergency contraception: knowledge, attitudes and practice of pharmacy’s personnel in
Portuguese community pharmacies........................................................................................................................................................................104
Access to emergency contraception in the Balkans, the Commonwealth of Independent States,
and Eastern Europe countries....................................................................................................................................................................................104
GENDER ISSUES IN SEXUAL AND REPRODUCTIVE HEALTH
Gender empowerment to improve sexual and reproductive health of adolescent girls and young
women in Jamaica..........................................................................................................................................................................................................105
Male partners influence in the utilisation of family planning and contraception: challenges and
solutions for Kilifi County, Kenya .............................................................................................................................................................................105
HORMONAL CONTRACEPTION
Personality traits and attitudes towards the frequency of menstrual/withdrawal bleeding: a survey
in a clinical sample of Italian women ....................................................................................................................................................................106
Association between sexual health and quantity of androgen receptor CAG polymorphism in combined
oral contraceptive users ...............................................................................................................................................................................................106
High rates of women’s satisfaction after switching form ethinylestradiol (EE) containing COCs to a
combination of estradiol plus dienogest (E2V/DNG) versus progestin-only pills (POP) ...................................................................106
Contraception in Russia................................................................................................................................................................................................107
The effectiveness and acceptability of prolonged implantation of contraception .............................................................................107
The impact of contraceptive counselling in the prescription of combined hormonal contraceptives ......................................107
Are hormonal components of oral contraceptives associated with impaired female sexual function?
A questionnaire-based online survey of medical students in Germany, Austria, and Switzerland ..............................................108
Contraceptive use, births and abortions in the Nordic countries ..............................................................................................................108
Evaluation of functional ovarian reserve after surgical intervention on ovaries..................................................................................109
Physiopathology of endometrial bleeding disturbances in progestin only contraceptives users ................................................109
Effect of oral contraceptive for post-abortion care in China: a systematic review .............................................................................109
INTRAUTERINE CONTRACEPTION
Election of IUD as a contraception method ........................................................................................................................................................110
Interim six month report for a prospective, randomised, single blind, two arms controlled study to
confirm the safety and verify performance of the IUBÔ SCu300A spherical copper intrauterine device
ball in comparison to TCu380 IUD intra-uterine contraceptive device....................................................................................................110
Predictors of levonorgestrel intrauterine device early expulsion ...............................................................................................................111
Use of Jaydess Intrauterine system in Contraception and Sexual Health service (CASH)................................................................111
An audit reviewing Intrauterine contraceptive fitting at a community contraceptive clinic..........................................................112
Audit of retrieval of intrauterine contraceptive devices/systems where the threads are not visible .........................................112
Survey of gynaecologists’ attitudes and beliefs on the use of intra-uterine device in the
French-speaking part of Switzerland ......................................................................................................................................................................113
Attitudes and knowledge of Argentinian Ob-Gyns regarding intrauterine contraception for nulliparous women..............113
Attitudes and knowledge of Brazilian Ob-Gyns regarding intrauterine contraception for nulliparous women.....................113
Attitudes and knowledge of Mexican ob-gyns regarding intrauterine contraception for nulliparous women......................114
Comparison of one year and ten years continuation, reason for discontinuation of IUD insertion
in postplacental/early postpartum period with interval periods ................................................................................................................114
Missing threads management in an integrated sexual health clinic ........................................................................................................115
Perception of pain during the placement of the intrauterine device – experience of a Portuguese tertiary hospital.......115
8
Attitudes and knowledge of Colombian health care professionals regarding intrauterine contraception
for nulliparous women .................................................................................................................................................................................................115
Prevalence of perforation of the cervix by the strings of intrauterine devices and systems .........................................................116
Barriers to the uptake of intrauterine contraception: patient and practitioner perspectives.........................................................116
Could an improvement in Intra-uterine contraceptive device (IUCD) design reduce incidence of missing
threads amongst IUCD users?....................................................................................................................................................................................117
Laryngological forceps, an efficient tool for extraction of retained IUDs ...............................................................................................117
LONG-ACTING REVERSIBLE CONTRACEPTIVE METHODS
Investigating the choice and uptake of post abortion contraception in the Marie Stopes international
clinics among Australian women .............................................................................................................................................................................117
Enhanced acceptability and improved continuation rate with long acting reversible contraceptives,
by high capacity menstrual Cup ..............................................................................................................................................................................118
User characteristics, continuation rates and side-effects of copper intrauterine device use in a
cohort of Australian women ......................................................................................................................................................................................118
Long-acting reversible contraceptive (LARC) use six months post-abortion: benefits of specialist follow-up........................119
Ultrasound: gold standard for the location of no palpable single-rod contraceptive implant .....................................................119
Etonogestrel-releasing contraceptive implant use by women with sickle cell disease.....................................................................119
Preliminary report of a ‘safe minimal invasive surgical technique’ for 100 non-palpable implant removal............................120
MALE CONTRACEPTION
Determining men’s perspectives and experiences of family planning methods: systematic review ..........................................120
MOLECULAR BIOLOGY AND NEW TECHNOLOGIES
Primordial follicle formation and activation in newborn mouse whole ovary culture using of
granulosa- and cumulus cell-conditioned media ..............................................................................................................................................121
NEW CONTRACEPTIVE METHODS
The initiation of contraceptive use in India in its most populous state, Uttar Pradesh...................................................................121
Challenges and opportunities for the use of hormonal contraception (HC) in Multipurpose
Prevention Technologies (MPTs)...............................................................................................................................................................................121
Delayed reversibility in RISUG-mediated vas occlusion in rabbits .............................................................................................................122
When Smartphones are used for birth regulation. A comparison study of four symptothermal Apps in 2013
and completed in 2014 ................................................................................................................................................................................................122
NON-CONTRACEPTIVE BENEFITS OF CONTRACEPTIVE METHODS
A non-intervention study to observe the bleeding pattern after levonorgestrel releasing intrauterine
system?LNG-IUS?or copper intrauterine device?Cu-IUD?inserted immediately after induced abortion (POST)......................123
Novel targeted drug delivery to the cervix and vagina by a barrier contraceptives device: a
pilot study for proof the concept ............................................................................................................................................................................123
The effect of combined oral contraceptives on the course of multiple sclerosis ...............................................................................123
Influence of oral contraceptives with androgenic activity on the quality of life of Russian women with
heavy menstrual bleeding...........................................................................................................................................................................................124
POSTPARTUM CONTRACEPTION
Effectiveness of a package of postpartum family planning service delivery interventions on the adoption of
contraceptives during the first year after childbirth: formative phase of a complex mixed-method intervention ..............124
ROLE OF MIDLEVEL PROVIDERS
Social egg freezing as a new family planning tool? ........................................................................................................................................125
SEXUAL AND CONTRACEPTIVE BEHAVIOUR
What do we know about contraceptive use, pregnancy intention and decisions of young Australian women?
Findings from the CUPID study ................................................................................................................................................................................125
Rapid assessment of knowledge about modern contraception among urban versus rural
population groups in Kazakhstan ............................................................................................................................................................................126
‘As long as he is bent on having more children, he will go for another woman’: understanding fertility
preferences among men in Ghana..........................................................................................................................................................................126
Knowledge and personal contraceptive choice of Chinese female obstetrician-gynaecologists: results of a survey..........126
Evaluation of contraceptive behaviours and dynamics of Turkish women and their partners .....................................................127
SEXUAL AND REPRODUCTIVE RIGHTS
Determinants of sexual and reproductive health among Brazilian youth (aged 18–29 years)......................................................127
Sexual and reproductive rights and natural family planning methods ...................................................................................................127
SEXUAL DYSFUNCTION
Urogynaecological problems and sexual dysfunction: an epidemiologic study ..................................................................................128
Altered resting state functional connectivity in a sample of non-paedophilic child sexual offenders ......................................128
Relationship between sexual dsyfunction and sexual myths of women ................................................................................................129
SEXUAL HEALTH EDUCATION
Tolerance to sexual diversity, gender equity, sexual and reproductive rights: determinants of sex education
among Brazilian Youth (aged 18–29 years) .........................................................................................................................................................129
9
Development of Computer Assisted Instruction (CAI) entitled sex-education in early secondary
school students of Piboonbumpen Demonstration School of Burapha University ............................................................................129
My fertility matters! ........................................................................................................................................................................................................130
Need assessment results in introduction of adolescent education programme in lower classes ................................................130
Sexual health education and its impact on sexual behaviours and perceived sexual satisfaction in Turkish women .......130
SEXUALLY TRANSMITTED INFECTIONS
People who buy sex – experiences from our project .....................................................................................................................................131
Are the primary health care providers ready to perform a sexually transmitted infections control
programme? A survey from Iran ..............................................................................................................................................................................131
Homeopathy for treatment of herpes simplex virus........................................................................................................................................131
An audit cycle reviewing the offer of HIV testing in an integrated sexual health service..............................................................132
Sexual behaviours in Kinshasa (D.R.Congo): a case-control study on HIV-related knowledge,
attitudes and practices .................................................................................................................................................................................................132
Risk perception of HIV infection and sexual behaviour among young and adults from Kinshasa
(D.R.Congo): a case-control study ............................................................................................................................................................................133
The prevalence of human papillomavirus infection among female prisoners in Siberia .................................................................133
Increasing macrolide treatment failure in women with Mycoplasma genitalium in a public hospital......................................133
Sexually transmitted infections, a risk factor for infertility in rural West Bengal, India: a mixed method approach ...........134
Urogenital Chlamydia trachomatis infection among Portuguese women aged 25 and under – a brief look ........................134
Shifting threat to opportunity: global integrated network for increasing uptake of screening, testing,
and treatment of HIV/AIDS .........................................................................................................................................................................................135
SIDE-EFFECTS AND RISKS OF CONTRACEPTIVES
Venous thrombosis: anatomic localisation matters (on behalf of the Spanish Society of Contraception)...............................135
VIOLENCE AGAINST WOMEN
The influence of intimate partner violence on pregnancy symptoms .....................................................................................................136
VULNERABLE GROUPS
The analysis on education of HIV/AIDS prevention for out-of-school adolescents in China..........................................................136
Unmet family planning need among women in a correctional facility in Ontario, Canada ...........................................................136
OTHER
First Algerian national survey on infertility and assisted reproductive technology: about 1305 cases .....................................137
Association of hypo-vitaminosis D with metabolic disturbances in East Indian women with
polycystic ovary syndrome..........................................................................................................................................................................................137
Vitamin D supplementation in pregnancy – international recommendations......................................................................................137
‘It gets easier with practice’. A randomised cross-over trial comparing the menstrual cup to
tampons or sanitary pads in a low resource setting .......................................................................................................................................138
Characteristics of the Pictorial Blood Loss Assessment Chart (PBAC) among adolescents and students .................................138
The image of nurses in Turkey..................................................................................................................................................................................138
The effect of music on nonstress test....................................................................................................................................................................139
Expression of progesterone-membrane bound receptor may predict the risk and prognosis of
breast cancer as well as or even better compared to other prognosis parameters..........................................................................139
Swallowing the pill: a multimodal discourse analysis of contraceptive advertising to doctors....................................................139
Effects of progestins used for hormone therapy in contraception and post menopause on PGRMC1
overexpressing breast cancer cells ..........................................................................................................................................................................140
Health beliefs and breast self-examination among nurses working in a university hospital .........................................................140
Editorial
Dear participants of the Second Global Conference on
Contraception and Sexual and Reproductive Health and the
14th congress of the European Society for Contraception
and Reproductive Health (ESC).
This Congress is another milestone on the way towards
sexual and reproductive health and rights globally. The conference will be a follow up of the successful conference in
Copenhagen when ESC ‘‘went Global’’. Last year the
Millenium Developmental Goals were evaluated and it
became clear that the goal that is furthest from fulfilling is
Reproductive Health for all. The European Society has
always been at the upfront of these efforts. ESC is promoting international scientific exchange, providing information
and educational materials, supporting research activities
across Europe and internationally in collaboration with our
partners. Institutions, organisations and individuals from all
over the world involved in contraception, sexual and reproductive healthcare with a special focus to implement these
services. We are happy that so many of you are joining us
in Basel. The scientific committee together with the local
president have tried to include in the program all important
fields of reproductive health reaching from research into
molecular processes of reproduction to public health,
cultural and political issues – ‘‘from bench-to bed-to the
hands of women’’. The large number of abstracts submitted
reflects the commitment of the scientific and clinical community for contraception and reproductive healthcare.
We are very grateful for this huge interest in our common goal and want to thank all participants and especially
those who have actively contributed to make this event
happen. It is only by your active participation and engagement that a congress can become a success.
I would also like to thank the European and International
scientific and professional societies who have shown their
interest in the field by giving us the honor to organise sessions and symposia. Furthermore, we have free communication sessions allowing especially younger colleagues to
present their work to a very experienced and highly competent audience.
Maybe most important in all ESC meetings is our objective not only to exchange knowledge and ideas but also to
allow personal contact, encounters and build new
friendship.
Basel is a very good place to give the geographic and
cultural frame to all of this. The attractions of this city and
the sociocultural program provided by the local organizing
committee will help us to make this conference unforgettable. ESC is an important platform for promoting and
implementing research and efforts to promote SRHR. It has
been a great honor and inspiration for me to be the president of the society over the past years.
Thanks again to all of you
Kristina Gemzell Danielsson
THE EUROPEAN JOURNAL OF CONTRACEPTION & REPRODUCTIVE HEALTH CARE, 2016
VOL. 21, NO. S1, 1–141
http://dx.doi.org/10.3109/13625187.2015.1135897
KEYNOTE LECTURES
KL1
Molecular biology and advanced
technology for contraception
Regine Sitruk Ware
Population Council, New York, NY, USA
Access to effective contraception is an essential component of
reproductive health, ensuring that every child is wanted, and
reducing the burden of unintended pregnancies. Contraceptive
methods are not only important for individuals and couples, but
play an essential part in population dynamics. Research in this
area is needed to offer more options to women and men, to
prevent abortion still unsafe in many countries, and help
decreasing maternal mortality globally. Also, acceptability and
behavioural studies in various settings and populations are
needed to ensure effective use of both existing as well as new
products still to come. Emerging scientific opportunities may
shape the future scientific agenda in reproductive research in
the context of new and advanced technologies for the development of improved contraceptives. Research on genomics and
proteomics allowed the discovery of new targets in the male
and female reproductive systems and a few products will reach
the clinical stage in this decade. New materials designed for targeted delivery of novel molecules, avoiding systemic actions
and specific to the reproductive tract, may also become available in the next decade.
Improving existing contraceptive methods as well as developing
new products easy to use and distribute will increase access to
new options for men and women, helping to prevent unwanted
pregnancies and abortion and leading to a better quality of
reproductive health life.
KL2
Sexual and reproductive rights
Rajat Khosla
World Health Organisation, Geneva, Switzerland
In 1994 the International Conference on Population and
Development (ICPD) endorsed a Programme of Action that set
forth an ambitious population and development strategy. The
ICPD Programme of Action was remarkable in its recognition
that gender equality and equity, and the empowerment of
women and human rights, are cornerstones of population and
development. This led to a paradigm shift from earlier policies
targeting population control, to one that places the individual
at the centre and respects choice, rights and empowerment.
Since this landmark agreement, numerous intergovernmental
fora have reaffirmed the ICPD commitment to universal access
to sexual and reproductive health (SRH) and to the promotion
and protection of reproductive rights. The Beijing Declaration
and Platform for Action (BDPfA) and the Millennium Declaration
are two key milestones in this process. Remarkable achievements have been made over the last 20 years, including gains
in women’s equality, population health and life expectancy,
educational attainment and human rights protection systems.
However, inequities in coverage persist, both between and
within countries. Even among those countries that achieved the
ß 2016 The European Society of Contraception and Reproductive Health
Millennium Development Goals (MDGs), progress made on
equity varies considerably across countries. Furthermore, far too
often, human rights have been ignored in designing and implementing health and development policies. Gender inequality
and violation of women’s rights remain a key determinant that
produces health inequities and intersect with other forms of
health inequities that are produced by age, race, class and ethnicity as other social determinants.
The consequences of this lack of attention and reaffirmation of
human rights are very real. This has far too often resulted in
siloed funding and vertical interventions rather than the holistic
approach, with human rights at the centre. This presentation
will highlight the centrality of sexual and reproductive health
and rights in the promotion and protection of women’s health
with a particular reference to contraception and abortion.
KL3
The history of syphilis – lessons
learned
Jean-Jacques Amy
Faculteit Geneeskunde en Farmacie, Vrije Universiteit Brussel,
Brussels, Belgium
In Europe, the ‘pox’ probably was a sequel of the return of
Columbus in (1493) from the ‘West Indies’. Its explosive spread
was enhanced by the invasion of Italy by the army of Charles
VIII, King of France, the disbandment of the troops and the
return of the mercenaries to their countries of origin. Exotic diseases may have devastating effects in populations never
exposed before. Troop movements during and after wars cause
an upsurge in the incidence of venereal disease.
Some claim that the illness always existed in Europe. History is
not an exact science; it tends to be when it analyses primary
sources and accesses valid evidence.
When syphilis appeared in Europe, due to the lack of resistance
in the population, it was an acute and incapacitating ailment,
often rapidly leading to death. Because of the selection over
the next decades of less aggressive strains of the agent it
changed into a milder, chronic disorder. Conceivably the clinical
signs of the virulent early syphilis were an obstacle to sexual
intercourse, hence milder strains experienced a higher transmission rate. Pathogenic microorganisms may adapt to their hosts
and become milder.
Quackery prevailed during four centuries. Use was made of
steam baths; tropical Guaiacum wood; mercury. The latter,
administered in various dosage forms and via diverse routes,
caused terrible complications and often death from mercurial
poisoning. Until recently, useless and harmful treatments were
inflicted to credulous and obedient ‘patients’.
At first syphilis was interpreted as God’s punishment of lechery.
Later the interpretation of disease changed to one related to
man’s conduct. The development of proper diagnostic and
therapeutic approaches required a rational interpretation of the
meaning of disease.
The ‘pox’ being very contagious, public baths were closed.
Individual cleanliness regressed markedly. Attitudes fluctuated:
women were often considered the root of this evil; men, particularly artists, at times took pride in their licentious lifestyle
and considered that syphilis conferred them the privilege of
belonging to a selected group. Highly prevalent diseases influence attitudes and behaviours.
In 1717 the use of condoms was recommended; later, prevention campaigns were instituted. Rubber condoms became available in 1846. Between 1905 and 1909 Schaudinn identified
2
Treponema pallidum, Wassermann described a diagnostic test,
and Ehrlich synthesised Salvarsan. The first use of penicillin in
the treatment of syphilis dates from 1943. Advances in diagnosis and treatment have made syphilis become a disease like any
other.
KEYNOTE SESSIONS
KS1.1
Endometrial contraception
Karolinska Institutet, Stockholm, Sweden
Today many women are reluctant to use any of the existing
contraceptive methods due to side-effects or fear of experiencing such effects. The concept of endometrial contraception
refers to methods that exert their effect after fertilisation.
Compared to currently available contraceptives, which are all
designed primarily to prevent fertilisation, drugs that would
impair endometrial receptivity and implantation of a blastocyst
or dislodge the embryo after implantation might offer notable
advantages. A woman potentially could use such a method
once-a-month in the luteal phase of each menstrual cycle, no
matter how many prior coital acts she had had in that cycle. If
the method were effective when administered after implantation, timing would be flexible, and she might even be able to
limit use frequency on average to a few times a year when her
menstrual period was late. A method that had its main action
on the endometrium would also be effective an emergency
contraceptive or for ‘on-demand-contraception’. Mifepristone a
progesterone receptor modulator has been shown to be effective when used on demand post coital, once-weekly or once-amonth. Alternatively, a vaccine that rendered the endometrium
chronically inhospitable to the embryo could induce long-term
or even permanent sterility without the side-effects of systemic
hormonal methods and without a surgical procedure. Specific
proteins have been identified that could be targets for immunocontraception, and pilot trials of a vaccine against one of them,
human chorionic gonadotropin, have shown promising results.
These new options should be explored to allow women all possible options for controlling and preserving their reproductive
health and lives.
KS1.2
Green contraception
Diana Blithe
National Institute of Child Health and Human Development
(NICHD), National Institutes of Health, Bethesda, MD, USA
Effective contraception is inherently ‘green’ because it helps
maintain the population at a level that is desired and necessary
to sustain the health of the environment. However, several of
the most widely used hormonal contraceptive methods contain
potent synthetic compounds, such as 17-a ethinyl estradiol (EE),
that are excreted into waste water. EE has been observed in rivers at levels that can result in harm to fish or other wildlife populations. Risk models predict greater harmful effects if levels of
endocrine disrupters in natural or reclaimed water supplies are
not decreased. Thus, there is a need for new products that have
lower disruptive impact on the environment. In addition to
eliminating or substantially lowering the amount of EE, environmental impact can be minimised by developing products that
are long-lasting rather than requiring daily or monthly use.
Effectiveness of the method is a major consideration because a
completely ‘green product’ will not have much benefit if it has
a high failure rate among typical users. Increasing the use of
long-acting reversible contraceptives (LARCs) such as IUDs and
implants has benefits for the environment. In addition to being
the most highly effective methods, they do not result in excretion of potentially toxic hormonal products. New methods are
being developed with a goal of minimising environmental
impact. A proposed Green Score incorporates the elements of
effectiveness and satisfaction as well as the environmental
impact of production and use of the product. Green Scores can
be improved with the development of drugs or devices that are
long lasting and less dependent on user compliance compared
with current methods requiring daily dosing. Male methods,
either hormonal or non-hormonal, if demonstrated to be effective, may help to lower the collective excretion volume of EE. As
new products are developed for effective contraception, it is
important to maximise opportunities to improve green effects
and to minimise potential damage to the environment.
KS1.3
Permanent non-surgical
contraceptive methods for women
Jeffrey Jensena,b
a
Oregon Health & Science University, Portland, Oregon; bOregon
National Primate Research Center, Beaverton, Oregon, USA
The Oregon Permanent Contraception Research Center (OPERM)
was established at the Oregon National Primate Research
Center, Oregon Health & Science University in November 2014
through a generous grant from the Bill & Melinda Gates
Foundation (www.ohsu.edu/OPERM). The long-term goal of
OPERM is the development of a highly effective, safe, low cost,
and highly portable non-surgical method of female permanent
contraception to meet the unmet needs of women who have
completed desired family size and voluntarily seek such a
method. Globally, surgical sterilisation is the most common and
effective method of birth control. Unfortunately, the acceptability of this important method is limited by its relatively high
cost, a scarcity of surgical providers, and surgical risks (particularly in lesser-developed nations). The development of novel,
non-surgical approach to permanent contraception would
improve access to this family planning method and thus reduce
the number of unintended pregnancies, maternal morbidities,
and maternal and infant and child mortality.
OPERM provides grant funding, scientific expertise, a nonhuman primate (NHP) animal resource, laboratory and procedural infrastructure, and administrative support to investigators
who wish to evaluate novel agents or procedures for permanent
female contraception. The objective of OPERM is to identify and
complete preclinical development of one or more approaches
to non-surgical permanent contraception in a non-human primate model such that the approach can be transitioned into
early phase clinical trials in women. A new method of non-surgical female permanent contraception must be viewed as safe,
voluntary, and non-coercive to become highly acceptable. To be
successfully adopted, a new method of permanent female
contraception will need to follow a careful path toward concurrent regulatory approval in both lesser- and more-developed
nations. Since it is anticipated that approaches that adapt
approved drugs or technologies from other fields may have
fewer regulatory hurdles to overcome, these approaches are
particularly welcomed.
Our current lead approach involves transcervical administration
of polidocanol (hydroxy-polyethoxy-dodecane) foam (PF). We
have previously reported that transcervical PF results in tubal
occlusion in macaques and baboons. In baboons, histologic features consistent with complete tubal occlusion (complete
replacement of epithelium with collagen) confined to the intramural tubal segment occur following treatment with 5% PF.
Administration of intramuscular depomedroxyprogesterone
acetate (DMPA) appears to improve the success of PF treatment,
ABSTRACTS OF THE KEYNOTE SESSIONS
and studies are in progress to evaluate the potential mechanism. To provide further evidence to support human clinical trials
of PF, we recently conducted a fertility study of PF in baboons.
KS2.2
A way to improve training in
reproductive health in Europe?
Allan Templeton
University of Aberdeen, Scotland, UK
A central purpose of the European Board & College of
Obstetrics and Gynaecology (EBCOG) is to harmonise postgraduate training in obstetrics and gynaecology throughout Europe
so that the highest possible level of care is available to women
wherever they are. This is a challenge, recognising current
organisational, educational and cultural differences.
The EBCOG Hospital Visiting programme is an attempt to meet
this challenge. The central aim is to assess whether individual
centres and hospitals have the means to provide training programmes based on the agreed curriculum. The emphasis is on
service organisation and the trainees’ documented experience.
EBCOG recognises centres for both general and subspecialty
training. At present the recognised subspecialties are
Fetomaternal Medicine, Gynaecological Cancer, Urogynecology
and Reproductive Medicine. The example of Reproductive
Medicine, being nearest to Sexual and Reproductive Health, will
be used. The development of the curriculum, the visiting process,
and preparation of the report will be described. The possible
effects on service provision and training priorities will be
discussed.
The subspecialty visiting programmes have each been developed in collaboration with the relevant European specialist society, so for Reproductive Medicine all visits are jointly EBCOG
and the European Society of Human Reproduction and
Embryology (ESHRE). The question is whether the European
Society of Contraception (ESC) would wish to develop a curriculum, training programme and visiting system in Sexual and
Reproductive Health in collaboration with EBCOG.
KS2.3
The collaboration between EBCOG
and UEMS
Rolf Kirschner
Oslo University Hospital, Oslo, Norway
enne
The European Union of Medical Specialists, Union Europe
M
edecins Specialistes (UEMS), is the oldest medical organisation
in Europe, established in 1958. It has a current membership of
34 National Medical Member Associations. UEMS is the representative organisation of the National Associations of Medical
Specialists in EU and EEA, with the task of defending and promoting the interests of Medical Specialists. It represents more
than 50 medical disciplines through various bodies and structures. The most important ones are the 43 Specialist Sections,
10 Multidisciplinary Joint Committees and over 20 Divisions. All
are active in this regard. Each section has an operational Board.
UEMS has in this regard, made a number of Charters &
Declarations pertaining to Specialist and Postgraduate Training.
The European Board and College of Obstetrics and Gynaecology
(EBCOG), is the Board of the Obstetrics and Gynaecology
Section of the (UEMS). EBCOG began in 1996 as a fusion
between the European Board of Gynaecology and Obstetrics
(EBGO) and the European College of Obstetrics and
Gynaecology (ECOG). The members are the National Societies of
3
Obstetrics and Gynaecology and are, the ‘voice of European
Obstetrics and Gynaecology’. EBCOG represents obstetricians
and gynaecologists in 36 member countries. The aims and
objectives of EBCOG are ‘to improve the health of women
and their babies, by seeking to achieve the highest possible
standards of training and care in the field of obstetrics and
gynaecology in all European countries’.
The core activities are to set standards for post-graduate education, training and high quality clinical care. Through different
committees, the objectives are: recommending the standards
required for the training of specialists means of maintaining
those standards. It is achieved by examining the content and
quality of training in Europe, recommending the criteria for
training centres to conform, proposing and unifying training
programmes, maintaining and updating knowledge and skills,
developing systems to assess and recognise quality of training
and practice, promoting research and facilitate exchange of
trainees between European training centres to harmonise and
improve the quality of training. In 2016 ENCOG will arrange the
first European Fellowship Examination in Ob/Gyn.
EBCOG also works closely with four sub-specialist societies
and works with other European and International specialist
organisations. EBCOG collaborates very closely with the
European Network of Trainees in OBGYN (ENTOG), thinking
that it is vital to support the next generation of practitioners
in the field. EBCOG sit as observers on the FIGO Executive
Committee.
CONGRESS SESSIONS
CS01.2
The Romania example: does access
to effective contraception and safe
abortion influence demography?
Mihai Horga
East European Institute for Reproductive Health, Tirgu-Mures,
Romania
Few countries in history have made such dramatic shifts in family planning policy or availability that would allow the study of
causal links between access to contraception and abortion and
changes in reproductive outcomes.
Between 1966 and 1989, in an attempt to boost fertility,
Romania’s communist regime made abortion broadly illegal
and restricted access to contraception. The total fertility rate
(TFR) nearly doubled initially, but then fell again and stabilised around 2.3 births per woman during the period
1985–1989. Over the same period, maternal mortality from
unsafe abortion skyrocketed to 147 per 100,000 live births,
while maternal deaths from other obstetric causes continued
to decline.
Within days of the fall of the communist regime in December
1989, the anti-abortion law was abolished and abortion made
available on request. Within the span of one year, the maternal mortality rate fell by half and then decreased further to
5.2 in 2010. Family planning services were established and
included in primary health care, and modern contraceptives
were made available free-of-charge to vulnerable groups of
the population, resulting in increased contraceptive use,
accompanied by a decisive fall in the induced abortion rate
from 163.6 per 1000 women in 1990 to 10.1 in 2010. After a
drop from 2.2 in 1989 to 1.8 in 1990 and to 1.4 in 1993–1994,
the TFR in Romania has remained constant at 1.3, despite the
marked rise in contraceptive prevalence.
While the fertility patterns illustrated by the Romanian example
highlight the complex nature of fertility and its determinants,
two points emerge clearly. First, restricting access to safe abortion in Romania caused a dramatic increase in maternal mortality driven solely by unsafe abortion-related deaths. And second,
4
increased access to modern contraception in Romania over the
last 15 years has not reduced fertility in the country, but instead
has reduced the need for women to resort to abortion.
CS02.2
CS02.1
Kamheang Chaturachinda
Gaps in reproductive and maternal
health: the challenge of inequality
Raffaela Schiavon Ermani
International Pregnancy Advisory Services (Ipas), Mexico City,
Mexico
While the world struggles to improve socio-economic, public
health and human rights indicators through agreed-upon processes (Millennium Development Goals [MDGs]/Sustainable
Development Goals [SDGs]), it becomes evident that the biggest
challenge resides in reducing gaps and inequalities, both
among countries and within countries.
Maternal Mortality Rate (MMR) and Adolescent Fertility Rate
(AFR) are sensitive indicators of inequality, due to differential
socio-economic-educational status, age, urban-rural-ethnic characteristics; more generally, due to unequal opportunity of development, resulting in profound gaps in access to and quality of
essential RMH services.
Additionally, during pregnancy, abortion and delivery care,
women face unequal barriers in legal and normative frameworks, including family, community and social norms, which differentially discriminate against them, violating their human and
reproductive rights. MMR and AFR function as symptoms of
gender inequalities, reflecting diverse values attributed to
women within societies.
While MMR globally decreased from 380 to 210 maternal deaths
per 100,000 LB between 1990 and 2013, the reduction is
uneven. More so, the differential between developed and
underdeveloped world remains huge: in 2013, MMR in Africa
2013 was 30 times higher than in Europe.[1] The life-time risk of
dying for maternal causes was 1 in 17,000 in Italy/Israel, 1 in
3700 in the developed world but 1 in 38 in Sub-Saharian
Africa.[2]
In Mexico, MMR decreased nationally from 89 to 38 between
1990 and 2014. However, this rate profoundly differs for women
with the lowest and highest Human Development Index. In
2010, overall MMR was 3.4 times higher in the first group (142
vs. 42); relative risks was only twice for indirect obstetric causes,
but increased 7 times for haemorrhage (49 vs. 7) and 10 times
for sepsis, both directly related to poverty/marginalisation.[3]
AFR also profoundly differs according to social determinants of
health. In Mexico, recent trends show an overall increase
between 2009 and 2014 (69–77 LB per 1000 adolescents), but
rates go from 51 in Mexico City to 113 in Chihuahua.
Adolescents’ socio-economic status affects median age of sexual
debut (17.8 vs. 20.2 years low vs. high status), use of condom at
first intercourse (30% vs. 70%), and reasons for non-use, particularly the desire to get pregnant (26% vs. 9%). Approximately
6000 10–14-year-old adolescents give birth yearly. Socio-economic determinants both cause and impact RMH.
References
[1]
[2]
[3]
WHO Global Health Observatory (GHO), Maternal Mortality
[Internet] WHO. Available from: http://www.who.int/gho/maternal_health/mortality/maternal/en/index1.html
World Bank [Internet]. Available from: http://data.worldbank.org/
indicator/SH.MMR.RISK
Lozano R. La carga de la enfermedad y las desigualdades en
salud de las mujeres en Mexico. Gnero y Salud en Cifras
2012;10(1):11–20
Unsafe abortion in Thailand
Women’s Health and Reproductive Rights Foundation of
Thailand, Bangkok, Thailand
Women in Thailand are dying and being maimed every day
from unsafe abortion. Each year the National Health Security
Office (NHSO) spends at least 150 million Bahts (40.5 million
Euros) of limited health resources treating these unnecessary
unsafe abortion complications. This is because women in need
cannot access safe abortion services as any other health services. Abortion laws in Thailand, imported from Europe dating
back at least 150 years, were last repealed in 1956 to allow doctors to perform abortion for ‘health’ indications and for pregnancy arising from sexual crimes. Safe abortion technologies
both surgical, in the form of vacuum aspiration, is available. The
medical method, using Mifepristone and Misoprostol tablets
registered by the Thai FDA in December 2014, is also available
though not yet universally.
The prime barrier to the access is the service providers whose
attitude to abortion remains negative. To overcome this important barrier the Women’s Health and Reproductive Right
Foundation of Thailand with other stake holders: the Thai
Medical Council, Royal Thai Royal College of Obstetricians and
Gynaecologists, and Department of Health, have crafted a training programme for service providers since 2005. Trainees consist of obstetricians, general practitioners in charge of districts
and sub district hospitals. These are frontline health providers
who see women in need of safe abortion daily. Four training
centres in four regions of Thailand were established to facilitate
training of physicians.
The curriculum consists of subjects for conceptual training, to
modify or change trainees’ attitudes, and technical training.
Conceptual training consists of information on history of abortion in Thailand. These include history of Thai abortion laws,
international treaties on respect for women’s health and rights,
health and socio-economic repercussions of unsafe abortion,
value clarification, duties of physicians, professionalism, women’s
rights, pre and post abortion counselling, comprehensive abortion care and post abortion contraception. Technical aspects of
surgical abortion by vacuum aspiration (MVA) as well as medical
abortion are also covered. Uterine models in the form of tropical fruits (Hawaiian papaya and dragon fruits) are used in a special workshop to improve manual skill in using MVA before
moving on to operating on patients.
In every training cycle a demonstration of the use of MVA on
patients with unintended pregnancy requesting termination is
done prior to a closely supervised termination by MVA on the
patient. This is to increase the trainee’s technical skill so they
can use the MVA efficiently and safely when they return to their
home ground.
CS02.3
Reproductive health care for asylumseeking women
Sibil Tschudin
Department of Obstetrics and Gynaecology/University Hospital,
Basel, Switzerland
Among the female migrant population (about 40–50 million
women worldwide) the refugees and asylum-seekers are the
most vulnerable group. After forced migration, the protective
mechanism of the family are generally no longer functional and
as a consequence of the collapse of social structures women
are deprived of resources and support to take care of their
ABSTRACTS OF THE CONGRESS SESSIONS
children and of their own health. Traumatising experiences and
economic difficulties may compromise their health and the fear
of expulsion is recognised as a major stressor. With regard to
reproductive health, asylum-seeking women could be identified
as being at high risk for unmet needs for family planning, i.e.,
being women aged 15–49, married or in a union, who are fecund and sexually active but are not using any method of
contraception and report not wanting any more children or
wanting to delay the next pregnancy. Several studies revealed
that immigrants in general and asylum-seeking women in particular are at high risk for induced abortion and especially for
repeat abortion. This might be due to insufficient integration
resulting in a higher hurdle and worse access to contraceptive
counselling. Financial reasons may also play a role, as well as
reservations against certain contraceptives, e.g., long-acting contraceptives causing amenorrhea. Demographic and health surveys offered some hints on why women do not use
contraception, and the reasons differ among countries and
regions within countries. The main reasons include concerns
about health risks or side-effects, opposition to use, either by
the woman or her partner, for personal or religious reasons, perception that they would not get pregnant because they had sex
infrequently, had postpartum amenorrhea, or were breastfeeding, lack of knowledge about methods of contraception or
where they could get them and inability to obtain or afford
contraceptives. Not only language barriers, but also and especially these reservations and misconceptions have to be considered when planning and establishing more adequate and more
effective preventive strategies to improve reproductive and
contraceptive health of this highly vulnerable group. Aside from
presenting some literature findings, the talk will also focus on
practical experiences with reproductive health care of asylumseeking women.
CS02.4
Reproductive health in young
Mexican women
Josefina Lira-Plascencia, Alejandro Rosas-Balan and
Norma Velazquez-Ramirez
Instituto Nacional de Perinatologia, Mexico City, Mexico
In Mexico there are 22.4 million adolescents; some 23% have
had a sexual life, with an average age of debut at 15.9 years.[1]
Most Mexican adolescent women have intended sexual relations
and have their first (typically pleasant) experience in their own
home.[2] Around 90% have (partial) knowledge about contraceptive methods, 66.6% use a method in their first experience
(80% condom, 6% combined oral contraceptives [COCs]). The
pregnancy rate in this group increased from 69–77 in 1000 adolescents from 2009 to 2014, representing around 450,000 out of
the 2 million births reported in the country that year.[3]
One key element to this increase is lack of genuine knowledge
about contraceptives. A survey in our unit showed that only
64% know how to take COCs correctly, 21% believe the emergency pill is a routine method and 48% believe hormonal contraceptives can cause infertility.[4] Another survey made in our
unit found that adolescents that attend public schools are more
prone to have sexual activity, 49% have two or more sexual
partners, 7% have non-coital sex and 62% use a contraceptive.
Another survey in our unit found that health care professionals
(HCPs) think contraceptive counselling to adolescents can disturb their parents and could generate liability because they are
minor.[5] In summary: sexually active adolescents are increasing,
they know contraceptive methods and use them in their first
sexual relation, but the pregnancy rate in this age group has
increased in recent years. Potential solutions: to increase the
knowledge of contraceptive methods in this population and to
get committed involvement of HCPs in counselling and prescription of contraceptives.
5
References
[1]
[2]
[3]
[4]
[5]
CS03.1
Contraception in HIV-positive women
Birute Zilaitiene
Lithuanian University of Health Sciences, Institute of
Endocrinology and Department of Endocrinology, Kaunas,
Lithuania
The majority of women living with HIV (WLWH) are of reproductive age, and consequently family planning is a very important aspect of their life. Several studies reported that
pregnancies in this population are unintended in 50–83% of
cases.[1–3]
All the advantages and disadvantages of available contraceptive
options should be evaluated during contraceptive counselling
of WLWH and potential interactions with antiretroviral treatment
(ART) should be taken into the account. The male condom provides reliable STI/HIV protection, but it needs the partner’s
cooperation, may interfere with sexual intercourse, and prevents
pregnancy in only 85% of cases. The female condom has the
same advantage of STI/HIV protection; it can be controlled by
the woman but requires the correct technique, may interfere
with sexual intercourse, prevents pregnancy in 79% of cases
and its availability is limited. Oral contraceptive pills (OCP) have
well known advantages of high effectiveness in pregnancy protection, low blood loss, but drug-drug interaction (OCP-ART),
possibly increased viral shedding limits use of this contraception
method. Similar disadvantages can be attributed to the other
types of combined hormonal contraceptive methods – patch,
ring, injectable combinations. Drug-drug interaction and
increased viral shedding could not be ruled out when using
these methods, however, data is still lacking. Copper intra-uterine device and Levonorgestrel-releasing intra-uterine system
(LNG-IUS) provides convenient and long-lasting contraceptive
effects, but intrauterine contraception does not protect against
STIs/HIV. It should be mentioned that minimal research is available in HIV with LNG-IUS. Some studies had demonstrated possibly increased risk of HIV acquisition when using depot
medroxyprogesteroneacetate (DMPA) or norethisterone enantate as contraceptive methods. In the guidance of the Centers
for Disease Control and Prevention clarification comment
regarding inconclusive evidence about association between progestin-only injectable use and HIV acquisition for women at
high risk for HIV is provided. Several international guidelines
state that since condoms are poor at preventing pregnancy, but
are required to prevent HIV and STIs, dual protection including
a hormonal contraceptive (or copper intrauterine device) and a
condom is recommended.[4,5]
It is also recommended to the possible drug-drug interaction
when prescribing hormonal contraception to women on ART
via Department of Health and Human Services guidelines.
Availability of contraceptive counselling and further research on
contraceptive methods use in WLWH is needed to optimise
health care and ensure women know their rights.
References
[1]
[2]
[3]
[4]
[5]
Floridia et al., 2006
Koenig, Espinoza, Hodge, & Ruffo, 2007
Loutfy et al., 2012a
Department of Health and Human Services [DHHS], 2015
WHO, 2015
6
CS03.2
Contraception and migraine
the only efficient contraceptive method for those women would
be the copper-device.
In BRCA2 mutation carriers, the data are inconsistent. However,
two studies found an increased risk for breast cancer in women
with CHC use for more than five years.
Anne MacGregor
Barts Sexual Health Centre, London, UK
CS03.4
Migraine is a common headache disorder during the reproductive years, often associated with hormonal triggers. While
migraine without aura is triggered by ‘withdrawal’ of estrogen,
as occurs during the hormone-free interval of combined hormonal contraceptives and the late luteal phase of the menstrual
cycle, migraine with aura is associated with high estrogen
levels.
Migraine with aura, but not migraine without aura, is associated
with a 2-fold increased risk of ischemic stroke, although the
absolute risk is very low in healthy, non-smoking women.
Ethinylestradiol is also an independent risk factor for ischemic
stroke, which is dose-dependent. Low-dose pills currently used
are significantly safer than pills containing higher doses of ethinylestradiol but they are not risk-free. Consequently, migraine
with aura, but not migraine without aura, is a contraindication
for contraceptive use of combined hormonal contraception.
However, if combined hormonal contraceptives are used as a
medical treatment rather than solely for contraception, e.g., for
management of polycystic ovarian syndrome, the benefits to
the individual might outweigh the risks. Progestogen-only and
non-hormonal contraceptives can be more effective than combined hormonal contraception and their use is not associated
with increased risk of ischemic stroke.
There is no restriction to use of combined hormonal contraceptives in women with migraine without aura. If attacks occur during the hormone-free interval, continuous use or extended-cycle
is recommended.
Correct diagnosis of migraine type is important to ensure that
women with migraine without aura are not denied combined
oral contraceptives and women with migraine with aura are
offered safer alternatives. However, aura is often misdiagnosed
in women who report visual symptoms during the premonitory
stage of migraine, present in both types of attacks.
This presentation will provide simple tools to help diagnose
migraine with aura and migraine without aura and will review
the current guidelines for use of contraceptives in women with
migraine.
Polycystic ovary syndrome, hormonal
contraception, and thrombosis
Øjvind Lidegaard
Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
CS03.3
Introduction: Women with polycystic ovary syndrome (PCOS)
have an increased long-term risk of thrombotic diseases. The
aims of this study were to assess the risk of venous and arterial
thrombosis in women of reproductive age with PCOS and to
explore how obesity and use of hormonal contraception influence that risk.
Material and methods: This historical cohort study followed all
Danish non-pregnant women aged 15–49 who were free of previous thrombotic disease or cancer from January 2001 through
December 2012. Women were identified in four national registries for having a PCOS discharge diagnosis, use of hormonal
contraception, and a first-ever thrombosis diagnosis. Risk estimates were calculated by Poisson regression. Included confounders were age, year, education, use of hormonal
contraception, and Body Mass Index (BMI).
Results: Within 11,332,675 observation years, 2029 were
recorded with a first thrombotic stroke, 1674 with a first myocardial infarction, and 4184 with a first confirmed venous thrombosis, of which 25, 15 and 54, respectively, were in women with
PCOS. After adjustment for confounders BMI, women with PCOS
had a relative risk of 2.2 (95% CI 1.5–3.2) for thrombotic stroke,
1.9 (1.1–3.2) for myocardial infarction, and of 1.9 (1.5–2.5) for
venous thrombosis. Additional adjustment for BMI in a subcohort with this information reduced the arterial risk estimates
11% and 19%, respectively. The relative risk of venous thrombosis was reduced to 1.4 (0.8–2.3) with adjustment for BMI in
this sub-cohort.
Conclusion: Women of reproductive age with PCOS have about
a doubled risk of arterial and venous thrombosis, which is not
explained by use of hormonal contraception. In women with
PCOS, adiposity contributes only little to their risk for stroke,
more to the risk of myocardial infarction and with about one
half to the risk of venous thrombosis.
Contraception in BRCA1/BRCA2positive women
CS04.2
Gabriele Merki
Selective progesterone modulators
University hospital, Z€urich, Switzerland
Women with BRCA1/2 mutation have a 40–75% increased risk
of developing breast cancer. The risk to develop ovarian cancer
is also elevated for both mutations: 18–60% (BRCA1) and
11–27% (BRCA2).
Combined hormonal contraception (CHC) in these women
might further add to these risks. Therefore benefits have carefully to be weighed against the negative effect of contraceptive
formulations. In the normal population the relative risk for
breast cancer is 1.24.
Several studies indicate that use of CHC reduces the risk for
ovarian cancer in BRCA mutation carriers by around 50%. Data
for the effect on breast cancer are less clear. Newer studies indicate that for BRCA1 carriers, the use of CHC increases the risk of
breast cancer by 1.2–1.4, if use is initiated before the age of 20
and CHC are used for more than five years. However, there are
no data on the effect of progestin-only contraception. Therefore
Unsafe abortion is a major contributor to maternal mortality.
Therefore effective methods for contraception and safe and
acceptable methods for termination of unwanted pregnancies
are prerequisites for reproductive health, for gender equality
and for the empowerment of women. New methods for contraception are also needed including improved methods for emergency contraception and new mechanisms of action as well as
mode of delivery. Additional health benefits of contraceptive
methods such as protection against various cancers, and a wide
range of other benefits need to be better recognised. Based on
their mechanisms of action, progesterone receptor modulators
can be used for emergency contraception as well as regular
contraception by various modes of delivery. The use of progesterone receptor modulators for contraception and positive
health benefits such as the possible protection against breast
cancer as well as prevention of uterine leiomyomas and endometriosis should be further explored.
CS04.3
Continuous regimen
Cristina Guazzelli
Escola Paulista Medicina, S~ao Paulo, Brazil
Since the 1960s, oral hormonal contraceptives have become
one of the most popular family planning methods in the world.
The composition, doses and regimens of oral contraceptives
have changed over the last 50 years. Besides the traditional
regimen (21 days of active pills followed by a seven-day hormone-free interval), the use of oral contraceptives can also be
extended or continuous.
The concept of continuous or extended use of combined hormonal contraception is not new, having been reported in scientific studies since 1977.
There is no official international definition for what is an
‘extended regimen’. According to the 2006 Canadian consensus,
it is the use of combined hormonal contraceptive (oral, vaginal
or transdermal) for two or more contiguous cycles with a hormone-free interval. A ‘continuous regimen’ of combined hormonal contraceptives is the uninterrupted use of these
contraceptives without hormone-free intervals.
At present, these regimens are spontaneously used in several
countries by many women because of vacations, sports, professional reasons or special moments when they would prefer to
avoid menstruation.
There are some medical reasons to use continuous or extended
combined hormonal contraceptives. Besides reducing or stopping bleeding (amenorrhea), these regimens can also be prescribed for the treatment of medical conditions such as
menstrual symptoms, premenstrual syndrome, dysmenorrhea,
menstrual migraine, abnormal uterine bleeding or endometriosis. A 2014 Cochrane review of continuous combined oral
contraceptive concluded that extended-cycles regimens were
more effective than traditional regimens for the management of
withdrawal headache, tiredness, bloating and menstrual pain.
Before initiating the use of hormonal contraceptives, women
should be informed about possible changes in their bleeding
patterns. Absence of bleeding is common, affecting 56–81% of
users, depending on the contraceptive, and it tends to increase
with time of use. Women starting traditional or continuous hormonal contraception can experience irregular bleedings or spotting in the first months of use. All cyclic hormonal combined
contraceptive regimens are associated with unscheduled bleeding and/or spotting, which typically improves or resolves with
persistent use.
As with traditional regimens, continuous or extended combined
oral hormonal regimens are not associated with any significant
changes in lipid or carbohydrate profiles. Medical recommendations for continuous regimen follow the same criteria developed
by the World Health Organisation for traditional hormonal
contraception.
contrast to 5% for estradiol [E2]) and its long half-life of approximately 20–28 hours. This profile allows the potential use of E4
for Women’s Health applications such as combined oral contraception and hormone replacement therapy, which are currently
under development by Mithra Pharmaceuticals in Belgium. Nonclinical in vitro studies in human breast cancer cell lines have
shown that E4 is a weak estrogen agonist but in the presence
of E2, E4 behaves as an antagonist on the breast. DMBA in vivo
studies have shown that E4 is able to prevent tumour development in a dose-dependent way and existing tumours decrease
in size/disappear also dose-dependently. In a human pilot study,
performed in 30 women with recently diagnosed breast cancer,
E4 treatment had a significant pro-apoptotic effect on tumour
tissues.
High dose of estrogens was the endocrine treatment of choice
in postmenopausal women with advanced breast cancer for
several decades. In the 1970s, estrogen therapy was replaced by
tamoxifen. Although not more effective than high dose of estrogens, tamoxifen was shown to be less toxic and therefore considered to be the preferred agent. Recently, estrogen therapy
for breast cancer has gained new interest as several clinical
studies showed anti-tumour efficacy with high dose estrogens
in heavily pre-treated postmenopausal women with advanced
breast cancer in an estrogen-deprived setting. Several research
groups have found that the success of the estrogen therapy is
dependent on the menopausal status of the woman and how
long they have been deprived of estrogens. A Proof of Concept
study is in preparation to assess the anti-tumour efficacy of E4
in postmenopausal women with advanced ER þ breast cancer.
In summary, pre-clinical and clinical studies performed so far
give a strong indication that E4 treatment might have a favourable effect on breast cancer and data from a Proof of Concept
study are expected to confirm this concept.
CS05.1
Contraception as a behaviour:
models of understanding
Johannes Bitzer
University Hospital Basel, Basel, Switzerland
Contraception is usually looked upon as the field of knowledge
concerning contraceptive methods with their respective PIs,
side-effects, risks, additional benefits, etc.
The reality however is that contraceptive methods are only the
instruments for a long-term preventive health behaviour with
the aim to protect women against unwanted pregnancies.
In many studies it has been shown that the success or failure of
this behaviour depends on two major factors:
1.
2.
CS04.5
7
The characteristics of the methods (short-acting versus
long-acting, user-dependent vs. user-independent etc.).
The so-called long-acting reversible contraceptive
methods are largely independent of the individual
behaviour. But they are under the control of the health
care provider not the woman.
The characteristics of the individual behaviour like
adherence to the instructions, regularity, continuity, stability etc., which is relevant for all the methods under
the control of the woman.
Estetrol and the breast
Carole Verhoeven and Herjan Coelingh Bennink
Pantarhei Bioscience, Zeist, The Netherlands
Estetrol (E4) is a naturally occurring estrogen produced exclusively and in large amounts by the human fetal liver. E4 has a
relatively low affinity for the estrogen receptor (ER), but this is
largely compensated by its high oral bioavailability (80% in
For all methods under the control and the responsibility of the
woman, research on health behaviour change is relevant.
Several models for understanding and influencing the dynamics
of HBC have been suggested based on social cognition theory
dealing with factors which can predict behaviour; the health
belief model which focuses on the individual perception of risk
and benefit, the theory of planned behaviour based on the
probability/utility balance and the protection motivation theory
focusing on factors increasing motivation; finally, the
8
transtheoretical model of Prochasca and Clemente describing
the different phases of behavioural change. An integration of
these approaches adapted to the needs of contraceptive counselling will be presented.
genetic thrombophilia defects in women with a positive family
history. Each of the thrombophilia tests should be subjected to
a cost-effectiveness analysis. In addition, the value of the proposed biochemical markers of VTE in OC users (APC resistance,
SHBG, etc.) must be assessed in large clinical studies, and the
assays need to be standardised by international consensus.
CS05.2
Compliance – blame the women?
CS06.3
Ali Kubba
Hormonal contraception and
myocardial infarction
Guy’s and St Thomas’ Hospitals, London, UK
The definition of compliance is the degree of constancy and
accuracy with which a patient follows a prescribed regimen.
The term designates the contraceptive user as a passive follower when s(he) should lead and own the contraceptive
choice.
To put the user in the driving seat and to get her from A
[Asking for advice] to B [Being in charge] and C [Continue
effective use], we need to modify our attitude and practice:
• Establish rapport and work to achieve the user’s priority;
• Give evidence based information: knowledge is power;
• Give permission to question decisions and ask questions;
• Have a plan B if plan A does not suit;
• Think of communications as a continuum using face-to-face
but more electronic and web-based saving the user time
and money;
• And many more ideas would be exchanged in the
presentation.
CS06.1
Hormonal contraception and venous
thromboembolism
Sven O. Skouby
Endocrinological and Reproductive Unit, Copenhagen, Denmark
Combined hormonal contraception is linked to increased risk of
thrombotic events. Prospective observational studies have
shown that all currently marketed combined oral contraceptives
increase the risk of venous thrombosis three- to seven-fold, and
that this risk is highest in the first year of use with a regression
thereafter. Hormonal is therefore the most common risk factor
for venous thrombosis in young women, but nowhere is the
concept of absolute vs. relative risk as important as in advising
patients about the risk of thrombosis with combined estrogen
progestogen use. Whilst for an 18-year-old a three-fold risk may
appear concerning, the additional risk of thrombosis is one per
2000 users per year. The currently marketed preparations seem
to carry no increased risk of arterial thrombosis in healthy
women. Another important point is that pregnancy is a far
more profound thrombophilia risk with an overall risk of thrombosis. In the absence of reliable contraception, women of reproductive age face risks of VTE associated with pregnancy of up
to 29/10,000 woman years and in the immediate postpartum
period this risk is as high as 300–400/10,000 woman years.
Overall, combined hormonal contraception includes some of
the most tested and safe preparations available. However, in
women with a history of thrombosis, these preparations should
not be used unless the woman is to remain on anticoagulation.
In anticoagulated women, the anticoagulant blunts any prothrombotic effect of the combined hormonal contraception, and
the treatment offers the advantages of a reduction in menstrual
blood loss and protection from a high risk pregnancy. Future
research should strive to reduce the venous thrombosis rate further. Clinical prediction models for incident thrombosis should
be developed on the basis of clinical variables (age, BMI, smoking, family history, etc.) or clinical variables plus screening for
John Stevenson
National Heart & Lung Institute, London SW3 6NP, UK
Hormone replacement therapy (HRT), when used appropriately
in postmenopausal women, reduces coronary heart disease
(CHD) risk. HRT uses natural estrogen, either estradiol 17-b or
conjugated equine estrogens combined with a progestogen
when indicated. Oral contraceptive (OC) preparations predominantly combine ethinylestradiol with various different progestogens. Certain synthetic estrogen-progestogen combinations
have adverse effects on lipids and lipoproteins, glucose and
insulin, and coagulation, thereby increasing the risk of myocardial infarction (MI). Most combinations increase triglyceride levels, but effects on HDL and LDL cholesterol vary according to
the type and dose of the progestogen. Progestogen-only OCs
have little metabolic impact. OCs containing second-generation
levonorgestrel have the worst lipid profile and are associated
with a greater degree of insulin resistance and a larger insulin
response to a glucose challenge A meta-analysis in 2003
showed that overall current OC use increased the risk for MI
with an odds ratio (OR) of 2.48 (CI 1.91–3.22) compared with
never use. However, sub-group analyses demonstrated some
important differences. The type of progestogen had an impact,
with a significant increased risk for MI being seen with the use
of first- and second-generation progestogens but not with third
generation. Ethinylestradiol showed a dose-response relationship with MI risk, with a significantly increased risk seen with
doses of 30 mg or above, but not with 20 mg. Women using
OCs with pre-existing coronary risk factors such as smoking,
hypertension and hypercholesterolemia had greatly increased
risk of MI. The use of progestogen-only OCs was not associated
with an increased risk for MI. In contrast, the risk of venous
thrombo-embolism (VTE), whilst increased with all OCs, appears
slightly higher with those containing third-generation progestogens. Newer progestogens such as drospirenone are now used
in OCs, and drospirenone has the benefits of lowering blood
pressure and preventing or limiting weight gain. This could be
expected to give less cardiovascular risk, but preliminary data
suggest that the risk of arterial thrombosis with OC-containing
drospirenone is slightly higher than with those containing firstand second-generation progestogens, whereas the risk from
transdermal or vaginal ring OCs is not. It is not known if estradiol-containing OCs carry less risk for MI, although their metabolic profile might be more favourable. The increased risk for
MI from any OC is very low. However, care should be taken in
selecting the appropriate OC preparation for women with CHD
risk factors.
CS06.4
Can non-oral E2 plus progestin
definitively solve the cardiovascular
problems?
Alfred O. Mueck
University Women’s Hospital, Tuebingen, Germany
The by far main risk of contraception remains the risk of venous thromboembolism (VTE). Hormonal contraception needs a
progestin, for reliable contraceptive efficacy at least in a dosage high enough to suppress ovulation. Using progestin-only
can reduce, may even avoid an increased risk of VTE (with
the exception of intramuscular DMPA). Up to now it remains
unclear if new options like estetrol could also reduce the VTE
risk. Accordingly presently progestin-only regimens (oral, IUD,
implants) are recommended in women with increased risk of
VTE. However, without addition of an estrogen, often bleeding problems occur, especially in midlife women for whom it
is particularly needed to reduce the risk of VTE. In addition
also other non-contraceptive benefits like on bone, vascular
system, brain, vagina, use in PCOS, to reduce ovarian, endometrial, colon cancer etc., are lacking or at least not sure if
progestin-only or alternatives like estetrol are used. So the
solution should be a combination of estradiol (E2) plus progestin. Two combined oral contraceptives (COC) based on E2
instead of Ethinyl-Estradiol (EE) are available. First results,
however, do not suggest lower VTE risk. Obviously the E2
loading dosage during first pass in the liver with oral COC is
too high and activation of hepatic coagulation systems cannot be avoided. Developments of new contraceptives to
reduce or avoid the VTE risk should consider biological
(pharmacological) plausibility and results in the field of hormone replacement therapy (HRT). Derived from this, the use
of transdermal E2 should reduce VTE risk (until now never
seen in studies). Accordingly also vaginal E2 (e.g., applied by
vaginal rings) can avoid high estrogenic hepatic loading, by
this avoiding coagulation activation. Thus it can be expected
that ‘par-enteral’ applied E2 can reduce or avoid the VTE risk
whereby similar pharmacokinetic profiles should be achieved
like with patches or gel in HRT since peak levels (Cmax) and/
or high AUC may be important for haemostaseological features. For combination, the choice of a progestin should be
one which does not increase coagulation systems and/or may
increase fibrinolytic activities. If first or second progestin generation really are the best option remains unclear. Because of
their vasocontrictory action and impact on metabolic systems
they may increase arterial risks like stroke and coronary heart
disease. It may be that newer progestins like nomegestrol or
dienogest are the better option for combination with nonoral E2 which definitively could solve the cardiovascular problems in hormonal contraception.
CS07.1
Intimate partner violence: from
notice to network intervention. The
Coimbra experience
Joao Redondo
Coimbra Hospital and Universitary Centre, Coimbra, Portugal
Although women can be violent in relationships with men, and
violence is also sometimes found in same-sex partnerships, the
overwhelming burden of partner violence is borne by women
at the hands of men.[1] The consequences of intimate partner
violence (IPV) are profound, extending beyond the health and
happiness of individuals, affecting also the wellbeing of entire
communities.
We are talking about an important public health problem that
can be prevented and whose impact can be reduced. This calls
for the adoption of a systemic-ecological model and a multidisciplinary/multisectoral networking approach. In the region of
Coimbra, various sectors (hospitals and primary health care,
education, criminal justice, policy, social services, and others
involved in violence prevention) are working together since
2002 in tackling IPV, guided by a common vision, mission,
objectives and strategies (networks ‘Violence: Information,
Research, Intervention’, 2002 and ‘School Against Violence’,
9
2007. Both networks have the participation of the Family
Violence Unit, Department of Psychiatry – CHUC).
Dealing with violence in our region involves addressing: the
ability to improve data collection; investment in primary prevention (we defend that the health sector has a great potential to
take a much more proactive role in primary/secondary/tertiary
violence prevention); the integration of violence prevention in
social and educational policies; the implementation of programmes for victims and perpetrators; more effective coordination of action, avoiding unnecessary duplication of services/
interventions; the investment in the combining of knowledge/
networking/funding and facilities, in order to produce more
effective investments; the development of platforms that facilitate the exchange of information among all sectors, as well as
joint research (in 2013 we created the Agency for the
Prevention of Trauma and Violation of Human Rights).
We believe the prevention efforts and progress made from
micro to macro system – at individual, family, community, and
political level(s) – will be the key to achieving global reductions
in violence.
References
[1]
WHO, 2002
CS07.2
Sexual violence as a war strategy in
Iraq
Nazand Begikhani
University of Bristol, Bristol, UK
The paper will address the sexual violence and sexual slavery as
war strategies developed by the ISIS organisation in Iraq, focusing on the experiences of Yezidi women.
Following the ISIS attack on the Sinjar region in Iraq, 2 August
2014, thousands of Yezidis were driven out of their homes. That
led to a mass exodus of the Yezidi population towards the
Sinjar mount. A large number, mainly women and children,
were arrested and disappeared with thousands of women
reportedly kidnapped.
Yezidis are a Kurdish religious group, whose faith is drawing on
ancient religions, including Zoroastrianism, Christianity and
Islam. Their number is estimated at 700,000, who are spread
over different parts of Kurdistan.
The paper draws on a field research in Iraqi Kurdistan conducted between August 2014 and August 2015. The research
involved 52 in-depth interviews with eye witnesses, survivors,
Yezidi community leaders, government officials, MPs, women’s
and civil rights activists, local and international NGO, including
UN agencies. It is based on materials and information used in
two media articles I published in English as well as an interview
with the CNN in October 2014.
Although members of the ISIS group come from different
backgrounds with different cultures, experiences and histories,
which might influence or even inhibit the behaviour of each
individual, the group’s repertoire indicates that these patterns
of sexual violence have been developed as part of the strategic
aims of the ISIS organisation. Through these strategies, the
jihadists seek to subjugate the entire Yezidi community, to
inculcate fear among them, to undermine their community and
family structures and to pollute the bloodline of the population.
What is more, the jihadists aim to dishonour women and
through them the whole community, because the notion of
honour is centred on women’s bodies and sexuality.
The paper will look at the experiences of Yezidi women and the
strategies developed by the ISIS jihadists in their practice of sexual violence and sexual slavery.
10
CS07.3
Estimating prevalence of female
genital mutilation in the European
Union: existing evidence and future
opportunities to optimise estimations
Els Leye and Luk Van Baelen
Ghent University International Centre for Reproductive Health,
Ghent, Belgium
About 140 million girls and women worldwide are currently
living with the consequences of female genital mutilation
(FGM). Prevalence among migrant communities is unknown,
including in the European Union (EU). In the EU, there are no
ongoing, systematic, representative surveys that use a harmonised approach to gather data on FGM prevalence. Attempts to
measure the magnitude of FGM in EU countries have been
undertaken in a number of countries by a variety of actors
and using various methodologies, including FGM prevalence
estimation studies, surveys among health professionals, surveys
among other professionals, surveys among practicing communities, surveys among asylum seekers, compilation of data on
registered births in families originating from FGM risk countries
and data collection on the numbers of women from FGM risk
countries.
The importance for data collection on all forms of violence
has been underlined by the Council of Europe’s Convention
on Preventing and combating violence against women and
domestic violence (Istanbul Convention), that urges Member
States of the Council of Europe to engage in collecting disaggregated relevant statistical data and to conduct populationbased surveys at regular intervals to assess the prevalence and
trends. Providing information on the extent of FGM in Europe
is important as it can be used to identify EU countries most
affected, to better target prevention activities, to inform decision-makers, to determine resource allocation and to measure
the impact of interventions and policies. This presentation will
discuss existing prevalence studies in the EU, including their
limitations, and present findings from a study currently undertaken by the International Centre for Reproductive Health, to
develop a methodology to estimate prevalence of FGM across
European countries. This study aims at suggesting a methodology that will be able to present comparable estimations
across Europe.
CS07.4
From female genital mutilation to
female genital reconstruction: a
surgeon’s approach
Refaat B. Karima and Judith JJML Dekkerb
a
Kliniek Amstelveen, Amstelveen, bVumc, Amsterdam, The
Netherlands
By definition, female genital mutilation (FGM) does not serve a
medical purpose. It has immediate and late complications.
Due to the empowerment of the naturalised women from
Africa, the wish for reconstruction is growing throughout
Europa and has to be addressed by the medical community.
The French surgeon, Pierre Foldès was the first to reconstruct
the clitoris after FGM with good results. His procedure consists
of the removal of scar tissue, and lowering of the clitoris stump
by cutting ligaments that support it while preserving nerves
and blood vessels.
In 2010 the first patient came to our outpatient clinic with the
request for genital reconstruction after FGM. Since then there
has been a constant stream of patients coming to our clinic.
Many of these women have a common history of fleeing a warzone in Africa and facing war violence. Furthermore most of
them have memory of the initial rite. By taking this decision
they have a good chance of being alienated from their own
family and culture. While treating these patients we have to
keep this social/cultural context in our thoughts. We try to couple the patient with a female case manager who is easy
approachable for the patient and can support, inform and be
an advisor through the treatment. In the beginning we made
CT-scans to visualise the clitoral stump. At this moment we are
operating on at least two patients a month. The operation can
be done in day surgery under general anaesthesia. If the patient
also wants a labia minora reconstruction then they need to be
admitted for at least 24 hours.
FGM is recognised internationally as a violation of the human
rights. Today a total ban on all forms of circumcision in young
females is the standard policy in Europ. As we accept this as a
mutilation then we have to take the next step to try to reconstruct the patient if and when there is a demand for a reconstruction. Therefore we believe from a medical and ethical
viewpoint that the genital reconstruction after FGM should be
done by trained surgeons in this subject and the procedure
should be reimbursed from the basic health care insurance
policy.
Furthermore there is no better warranty than a reconstructed
mother to protect their daughters against FGM.
CS08.2
Developing male contraception: gap
or abyss?
Richard Anderson
University of Edinburgh, Edinburgh, UK
The absence of publicly available new developments in contraception for men contrasts starkly with the huge advances in
contraception for women over the past few decades with particularly the absence of any available hormonal method analogous to the large number of such methods available to women.
This area has been the subject for clinical research for more
than half a century and while much progress has been made, a
final product seems to remain elusive. Studies in the early
1990s by WHO demonstrated that hormonal contraception
could indeed induce sufficient spermatogenic suppression to
result in reliable contraception. Those methods used a testosterone-only approach, and over subsequent years much effort has
gone into refining this approach: the most promising approach
has been now for some years the combination of a progestogen with testosterone, with the progestogen providing most of
the gonadotrophin suppression required and the testosterone
largely providing add-back hormone replacement while also
contributing to gonadotrophin suppression. A recent WHO efficacy trial of this approach used a combination of two injectable
steroids, testosterone undecanoate with norethisterone enanthate, giving an eight-week injection schedule. Alternative preparations such as using gels are also in development, providing
the opportunity for self-administration of a hormonal contraceptive. An ongoing difficulty is the small number of men whose
spermatogenesis appears to remain resistant to adequate suppression with this approach.
Non-hormonal approaches are also in development, but with
most still at the laboratory stage exploring a wide range of testicular and epididymal functions. There are a number of
extremely promising approaches in development, but the gap
between laboratory success and clinical application remains
wide. Public sector funding continues to attempt to bridge this,
with a disappointing level of input from industry at present.
CS08.3
Gaps and limitations of contraception
research: lots of opponents, very few
advocates
Ann Furedi
British Pregnancy Advisory Service (BPAS), London, UK
Contraceptive research and development faces both the technical challenges that confront all clinical research plus additional
difficulties generated by the morally contested nature of birth
control.
Conservative and religious opposition to the separation of sexual expression from its reproduction is just one element of this.
Even modern societies that embrace the principles of family
planning prefer to see contraception developed and presented
as a responsible contribution to public health, rather than a
means to enable personal sexual liberation. New delivery systems for hormonal birth control, such as implants, are promoted
as ways to improve compliance with the aim of reducing rates
of abortion and teenage pregnancy. In some countries, one reason for restrictions on the sale of post-coital methods is to discourage reliance on a method that may normalise and validate
acceptance of unplanned, unprepared for sex. The 1960s and
1970s notion of contraception simply freeing women to enjoy
sex has long since been lost and birth control has been relocated within a framework of ‘public health’. Feminist discourse
often shares risk-narratives of ‘conservative caution’ suggesting
that the promotion of contraception has compromised women’s
ability to say ‘no’ to sex.
In many circumstances, movements that support sexual and
reproductive health care have failed women, by allowing a division to emerge between (acceptable) contraception and (problem) abortion by opportunistically encouraging ambivalent
donors to fund contraceptive programmes with the aim of
reducing abortion.
This presentation argues that the need to draw a bright line
between the prevention and end of pregnancy, along with the
need to demonstrate public-health impact, has inhibited some
of the most exciting and positive research into post-coital/pericoital and menstrual regulation.
CS09.1
What is task sharing? Review of WHO
Guidelines and ongoing research on
task sharing of contraceptive services
Mario Philip Festin
Human resource shortages in health services are acknowledged
as a threat to the attainment of the health-related sustainable
development goals (SDGs). A more rational distribution of tasks
and responsibilities among cadres of health workers can
improve access and cost effectiveness within health systems.
These may be improved by training and enabling ‘mid-level’
‘lay’ health workers to perform specific interventions usually
provided only by cadres with longer and specialised training.
Such task shifting/sharing strategies are particularly attractive to
countries that lack means to improve access to care within
short periods of time.
In 2012, the World Health Organisation published recommendations optimising health worker roles to improve access to key
maternal and newborn health interventions through task shifting and in 2015 health worker roles in providing safe abortion
care and post abortion contraception, which included guidelines
11
on task sharing of contraceptive services. These complied with
the WHO Guidelines Review Committee requirements, which
included the GRADE system of evaluating evidence in formulating recommendations.
The key recommendations include specialist and trained general
practitioners to provide all methods, as defined competencies.
Pharmacists and lay health workers are not recommended to
provide IUD insertion and permanent methods. Implants can be
inserted by lay health workers under rigorous research.
Provision of hormonal injectable contraceptives can be given by
lay health workers under targeted monitoring and evaluation.
This led to issues regarding scale-up of services in the context
of monitoring and evaluation.
A task sharing family planning research working group in 2014
addressed the research gaps and implementation issues.
Research needs include evidence using comparison studies,
with rigorous documentation and evaluation of existing programmes and the roles played by various types of health workers, implementation research on interventions to expand health
worker roles within health systems and at scale, and to identify
what works and what does not. Issues relate to implementation
include task sharing and expansion of health worker roles takes
place as a part of planned and regulated strategy accompanied
by appropriate mechanisms for training, certification, monitoring
and support. Task sharing should not be as an opportunistic or
de facto transfer of tasks because of unavailability or reluctance
to provide care. Other factors include competency-based training, stakeholder involvement with professional associations, and
evaluating and ensuring national laws and local policies need to
support task sharing and shifting.
Task sharing is an effective method of expanding proven
contraceptive delivery services, requiring important implementation issues.
CS09.2
Role of mid-level providers in
abortion care
Helena Kopp Kallner
In many countries the access to medical doctors in abortion
care is limited either by a general shortage of medical doctors
or by the unwillingness of medical doctors to be involved in
abortion care. Specially trained midlevel providers can often
perform services generally performed by physicians. The concept of task shifting or task sharing has been tried in obstetrics and gynaecology in many settings outside abortion care
such as midlevel providers performing caesarean sections in
countries where there is a lack of trained gynaecologists. In
abortion care the evidence in support of midlevel provision of
surgical and medical abortion and post abortion care in
increasing.
In some countries midlevel providers perform primary vacuum
aspiration for surgical abortion and this has been shown to be
equally effective as vacuum aspiration performed by medical
doctors. In South Africa, India, Bangladesh, Nepal and other
countries, midlevel providers supply medication and information
and thereby perform medical abortions. Medical abortion provided by midlevel providers in a low resource setting has been
evaluated in a large randomised trial in Nepal and was found to
be safe and effective.
In high resource settings, abortion is usually provided after the
patient has had an ultrasound determining the gestational
length. This is provided by a trained physician. However, access
to appointments for ultrasound may in fact increase the waiting
time to have an abortion. In many countries providers deny
women ultrasound if it is performed for an abortion due to their
own opinions about abortion care. In a large randomised trial it
12
has been shown that trained midlevel providers can perform
early medical abortion including the ultrasound as part of
standard care as effectively and safely as physicians.
Post abortion care is all health care provided after safe and
unsafe abortion. Women in countries where abortion is illegal
often self-induce the abortion surgically or medically. These
women may be denied health care when they experience
complications. This contributes to maternal morbidity and mortality. Midlevel providers who supply post abortion care including manual vacuum aspiration for incomplete abortion have
been shown to be safe and effective. In a large randomised
trial it has been shown that trained midlevel providers can
perform post abortion care as effectively and safely as physicians in rural as well as in urban settings in Africa.
CS09.3
Multidisciplinary provision of care,
task sharing: user perspectives
Toni Belfield
Hon Faculty of Sexual & Reproductive Healthcare (FSRH), Royal
College of Obstetricians and Gynaecologists (RCOG), London, UK
Prior to the introduction of ‘the pill’ – the forerunner of modern
hormonal contraception – medical professionals were not really
involved in the delivery of contraceptive services. Few today
will understand that in the early 1900s contraception was considered immoral and would encourage women’s infidelity.
Formidable women such as Margaret Sanger in the US and
Marie Stopes in the UK recognised that birth control was the
best weapon in the struggle to save women from the bondage
of unwanted pregnancies and as a means to offer them freedom, sexual satisfaction and joyful motherhood. Services run by
women for women were set up with nurse involvement. The
availability of modern contraception changed the face of sexual
health forever. Contraceptive services became medicalised, led
and carried out by doctors because it involved the prescription
of drugs, the ability to fit IUDs and carry out surgical sterilisation. It took the UK many years to see the value of multidisciplinary provision of care.
Today, we recognise the value of integrated sexual health care
which provides contraception, support with pregnancy planning or unsure choices and treatment for sexually transmissible
infections and help with sexual dysfunction. This holistic
approach benefits the whole person rather than providing disjointed care. We now have multidisciplinary health teams consisting of doctors, nurses, health advisors, counsellors
delivering services in many different settings – but where is
the patient voice? How are patients – consumers of sexual
health services – involved in the delivery of care? What role
do they have, or could they have, in improving services? How
might listening to patients more carefully help our understanding about where and from whom women and men would like
to receive care, what they really think about contraception,
how methods are chosen and used or not used. Why people
take sexual health risks and what they understand about risk.
How might involving consumers/patients in providing services
help to improve service delivery, service outcomes and patient
experiences? This presentation will look at some of these questions to support clinicians and patients to work more
collaboratively.
CS10.1
The contraceptive consultation for
women living with HIV – role in
promoting women’s health and
wellbeing as well as reducing
mother-to-child transmission of HIV
Fiona Fargie and Rebecca Metcalfe
The Sandyford Clinic, Glasgow, UK
The UK is currently estimated to have 103,000 people living
with HIV of whom 35,000 (33%) are women. Approximately
17,000 (17%) of all those living with HIV are currently undiagnosed. Some 54,000 (52%) of people living with HIV are heterosexual. Many women living with HIV in Britain are vulnerable
due to their immigration status and ongoing deprivation once
living in the UK and many will have experienced or be experiencing gender-based violence (domestic and sexual violence
and female genital mutilation).
A significant proportion of women living with HIV will conceive
a pregnancy potentially prior to knowing their HIV status. The
UK introduced routine opt-out screening for HIV at 12 weeks for
all pregnant women in 2002 with typical rates of uptake around
97–99% in 2014. The key justification for this measure was the
clear evidence that prevention of mother-to-child transmission
(PMTCT) of HIV is almost entirely avoidable (< 1%) if the mother
can be successfully treated with antiretroviral drugs with an
undetectable viral load prior to and at the time of delivery and
avoid breastfeeding in the postnatal period.
Contraceptive providers will consequently increasingly see
women living with HIV in their practice and can look for opportunities to improve their health outcomes in several different
areas. Key areas include opportunities for early diagnosis of HIV
and other Sexually Transmitted Infections prior to conception,
use of long-acting reversible contraceptives (LARC) and other
contraceptive methods to ensure women have the best options
for planning their families, clear information about risk of transmission of HIV in sero-discordant couples, achieving conception
in sero-discordant couples and good uptake of health-promoting programmes such as vaccination and cervical screening.
Supporting women to find out their HIV status and that of their
partners and possibly their children can be quite challenging for
care providers as HIV remains a highly stigmatised condition,
considering its excellent prognosis (if good adherence to treatment) and excellent quality of life and life expectancy.
Contraceptive providers are also well placed to enquire about
experiences of gender-based violence and provide referral for
ongoing emotional or physical care as required.
CS10.2
Alcohol use identification and brief
intervention in the sexual health
setting – evidence and challenges
Sue Mann
University College London, London, and Homerton University
Hospital, London, UK
There is an increasing body of evidence to suggest that excess
alcohol use is associated with poor sexual health outcomes
including teenage pregnancy, sexually transmitted infection,
regret at first sexual intercourse and sexual violence. The sexual
health setting presents an opportunity for providing broad integrated health care including identification of risky alcohol use
and appropriate intervention responses. Despite evidence of
effectiveness for identification and brief intervention in other
settings, particularly primary care and emergency care, the evidence of impact in this setting is mixed. This session will present the effectiveness evidence and critically discuss the policy,
organisational, stakeholder and user factors associated with the
variation in outcomes seen. Lastly, the evidence for effectiveness of other strategies with the potential to influence these
combined risk factors will be considered.
CS10.3
Role of HPV vaccination, cytology
screening and colposcopy in modern
Europe – what can the contraceptive
provider contribute?
Emilia M. Crighton
NHS Greater Glasgow and Clyde, Glasgow, UK
Cervical cancer is caused by oncogenic types of human papilloma virus (HPV) and is the second most common cancer in
women under the age of 35. In the UK, 2900 women a year are
diagnosed with cervical cancer, which is around eight women
every day. Around 970 women died from cervical cancer in 2011.
It is estimated that about 400 lives could be saved every year in
the UK as a result of vaccinating girls and cervical cytology
screening can prevent three-quarters of cervical cancers.
The HPV vaccine was introduced in the UK in 2008 and is routinely offered to secondary school girls aged 12 and 13. Overall
the Scottish uptake is high: 94.4% for the first dose and 92.5%
for the second dose.
HPV vaccine protects against HPV types 16 and 18 that cause
about 70% of cervical cancers and therefore regular cervical
screening is still important. Scotland monitored the impact of
the HPV vaccine among women attending for cervical screening
at age 20. By linking individual vaccination, screening and HPV
testing records, they have been able to determine the early
impact of the immunisation programme on pre-cancerous cells
and demonstrated that the high uptake of the HPV vaccine is
associated with a significant reduction of low and high grade
cervical abnormalities in young women in Scotland.
The NHS cervical screening programme has been in place since
1989 and invites women between the ages of 25 and 64 every
three to five years for early cervical abnormalities. Following the
invitation being issued, a woman will attend for a test in the
General Practice or Sexual and Reproductive Service. Women
can also have opportunistic smears at the time of attending
medical care for another reason like contraception advice.
Depending on the result of the test she will be recalled to
attend, if eligible, in three to five years or will be referred to colposcopy for diagnostic tests and treatment.
The screening uptake rate in Scotland in 2015 was 76.6%; the
uptake is lowest among women who live in the most deprived
areas and among the young. Some 90.3% of cytology tests
processed were reported to be normal.
Some 46.5% of women who developed cervical cancer had
incomplete cytology histories and 13.6% never had a smear.
Contraceptive providers are best placed to reinforce the message and offer effective preventative services that can eradicate
cervical cancer.
CS11.3
Partner tracing, notification and
treatment: how?
Iolanda Elena Blidaru
Gr. T. Popa University of Medicine and Pharmacy, Cuza Voda
Maternity University Hospital, Iasi, Romania
13
Partner services – consisting of partner tracing, notification and
treatment – aim to reduce STDs and HIV spread and to prevent
reinfection of patients with STD or HIV diagnoses (index
patients).
Through partner notification, index patients’ sex partners are
informed about their exposure to infection and the need to
seek medical evaluation. Previously defined as ‘contact tracing’,
partner notification is the process whereby providers or public
health authorities uncover sex partner information from index
patients, supporting their evaluation and treatment. These
objectives are accomplished by provider referral or patient referral. When partners receive treatment, the risk for reinfection of
index patients is reduced and, more broadly, partner notification
can disrupt STD transmission networks and reduce disease incidence. Index patients with STDs should therefore be encouraged to notify their sex partners and urge them to seek
medical care.
Partners’ therapy should primarily rely on recommended regimens, yet alternative regimens can be considered when facing
contraindications, such as drug allergies. For STDs with several
recommended treatment regimens, all regimens may be considered to have similar efficacy, rates of intolerance or toxicity.
When medical evaluation, counselling, and treatment of partners are unfeasible due to a patient’s or partner’s particular circumstances, or to resource limitations, other options include
patient-delivered therapy, a form of expedited partner therapy
in which infected patients’ partners are treated without previous
medical evaluation or prevention counselling.
These recommendations apply to various patient-care settings
such as family planning clinics, private physicians’ offices and
other primary-care facilities.
Presently, the internet brings new challenges and opportunities
for the prevention and control of STDs and HIV. Public health
authorities should develop strategies using the same technology
that facilitates the dissemination of STD to prevent and control
STDs. In addition to online partner notification, other strategies
may include: (1) providing health education and prevention
messages on websites frequently visited by heterosexuals and
homosexuals via pop-up ads and links to specialised websites;
(2) chat room conversations with health educators; and (3) offering online test-result reporting for HIV and STDs.
Interventions in the sexual/social networks in which individuals
are exposed to STDs preclude individual clinician efforts, but are
useful for STD-control programmes.
CS12.1
Polycystic ovary syndrome (PCOS):
intervention according to phenotype
and co-morbidity
Sven O. Skouby
Endocrinological and Reproductive Unit, Copenhagen, Denmark
The Rotterdam Criteria may be proper to diagnose polycystic
ovary syndrome (PCOS), but these criteria do not give enough
information about the metabolic risk profile of the women.
Moreover it is highly debated to what extent the heterogeneous
Rotterdam phenotypes represent different cardiovascular disease
(CVD) risk profiles. Results of the existing studies are inconsistent except for the hyperandrogenic phenotype being most clinical affected and prone to develop CVD at long term. However,
if hyperandrogenemia per se is an independent risk factor is a
matter of discussion, and should be considered in the perspective of broad consensus about the dominant role of IR and
obesity with associated metabolic dysfunctions indicative of
long-term risks, i.e., diabetes and CV events. Neither estimate of
IR nor obesity is a part of the diagnostic criteria, thus the
Rotterdam criteria are not clinically sufficient when evaluating
the CVD risk in women with PCOS. In the absence of firm concluding evidence, the evaluation of surrogate markers of CVD
14
has been the way to estimate the long-term risk of CVD in
women with PCOS. The studies assessing CVD risk in PCOS
women are either cross-sectional or retrospective with uncertain
diagnosis of PCOS and small sizes. Cross-sectional studies illustrate only a ‘snap-shot’ metabolic situation of an individual. It is
well-known that with increasing age, BMI, IR, body composition
and androgens changes, affecting CVD health. However, all of
the studies are debated whether increased CVD morbidity and
mortality is caused by PCOS per se, IR, obesity, metabolic syndrome (MBS) or type 2 diabetes (T2D). A body of studies document high prevalence of MBS and T2D in PCOS. The most
affected phenotype was BMI > 25 þ IR. It is therefore critical for
public health to stratify women with PCOS according to metabolic risk. It has been suggested that there should be two
names for the PCOS phenotypes: those with primarily reproductive consequences should continue to be called PCOS, and
those with important metabolic consequences should have a
new name. For those diet and life style changes are pivotal.
Add back include insulin sensitisers such as metformin and liraglutide. The use of specific antiobesity drugs and bariatric surgery call for further evaluation
CS12.2
Contraception in women with cardiac
malformations
Matthias Greutmann
University Hospital Zurich, Zurich, Switzerland
Most patients with congenital heart defects now survive to
adulthood. These adults are not cured. As a consequence,
there is a rapidly growing cohort of women with congenital
heart disease in childbearing age, many with important
residual hemodynamic lesions – some with markedly increased
risk for cardiovascular complications during pregnancy and
some with increased risk of premature death as young adults.
Some defects are associated with a prohibitive mortality risk
during pregnancy. These lesions include: all forms of pulmonary hypertension, severe mitral stenosis, severe symptomatic
aortic valve stenosis, Marfan syndrome with markedly dilated
aortic root or women with heart failure with severely impaired
left ventricular function (left ventricular ejection fraction
<\30%) or poor functional class. These women are generally
counselled against pregnancy. For most women, however,
careful assessment of many aspects is important to allow individual risk stratification:
Type of congenital cardiac defect;
Residual hemodynamic lesions;
Previous cardiac complications (e.g., arrhythmias,
stroke, etc.);
Patient specific cardiac risk factors (age, comorbidities,
etc.);
Patient specific obstetric risk factors (age, ethnicity, parity, etc.).
Assessment of pregnancy risks, adequate patient information
about these risks and provision of information about safe and
effective contraception are important tasks in our care for
women with congenital heart disease. As treating cardiologists
we have the obligation to assure access to appropriate contraception for women under our care. This requires close interdisciplinary collaboration with contraception specialists.
Types of contraception: While progestin-only preparations are
safe for most women with heart disease, combined hormonal
contraceptives are to be used with caution in a number of conditions, particularly in those women with increased risk of
thromboembolic complications (e.g., women with univentricular
hearts after the Fontan-operation) or women with increased
risk of catastrophic systemic embolisation in case of thrombo-
embolic disease (e.g., women with cyanotic heart defects or
women with residual intra-cardiac shunts).
Intrauterine devices may be a good choice in various cardiac
conditions. In some women, however, vagal reactions at the
time of insertion may be dangerous (e.g., women after the
Fontan-operation or women with pulmonary hypertension). In
these women we recommend insertion of intrauterine devices
in a properly monitored area with support of an experienced
anaesthetist.
CS12.4
Contraception and the treatment of
medical disorders – endometriosis
€mer
Thomas Ro
Department of Obstetrics and Gynaecology (OB/GYN), Weyertal,
Cologne, Germany
Endometriosis is a major woman’s health care problem. It
causes pain and/or infertility, and affects millions of woman
worldwide. The disease is characterised by the presence of
endometrium-like tissue – glands and stroma – outside the
uterine cavity. Different treatment options exist for endometriosis including medical and surgical treatments or a combination of the two approaches. The most commonly used
medications are non-sterioidal anti-inflammatory drugs, GnRH
agonists, androgen derivatives such as danazol, combined oral
contraceptive pills, progestogens and more recently the levonorgestrel intrauterine system. The medical treatment of endometriosis is effective at treating pain and preventing
recurrence of disease after surgery. Remarkably, the oral
contraceptive pill taken continuously is as effective as GnRH-a,
while causing far less side-effects. The oral contraceptive used
in a conventional manner was less effective than a GnRH analogue in the relief of dysmenorrhoea. No significant difference
was noted between the effectiveness of the oral contraceptive
pill and a GnRH analogue in the relief of dyspareunia or nonmenstrual pain. Some randomised controlled trials of combined
oral contraceptives (COC) in postoperative medical therapy for
endometriosis are available. There was a significantly higher
rate of total endometriosis remission [OR = 2.55] and a lower
rate of recurrence [OR = 0.31] in the COC group compared
with surgery alone. The use of COC and LNG-IUS after surgery
of endometriosis shows a significant reduction of recurrence
rate for dysmenorrhea, but no significant effects for improvement of dyspareunia and non-menstrual pain. COC use after
surgery of endometriomas show a significant reduction of
recurrence rate (anatomical relapses). Continuous use of COC
is more effective than cyclic use of COC. In selected studies,
COC containing dienogest are more effective than COC containing other progestins. There is limited but consistent evidence showing that postoperative LNG-IUD use reduces the
recurrence of painful periods in women with endometriosis.
The LNG-IUS had clinical efficacy equivalent to that of GnRH-a,
but may have some clinical advantages over GnRH-a in the
treatment of endometriosis-associated symptoms. LNG-IUS is
effective in reduction of recurrence of rectovaginal endometriosis and in treatment of adenomyosis. Depot MPA is also
effective the treatment of endometriosis.
Conclusions: Hormonal contraceptive methods play an important role in the symptomatic treatment of endometriosis. COC
and LNG-IUS are well established treatment options in the prevention of recurrence of this chronic disease.
ABSTRACTS OF THE KEYNOTE JOINT SESSIONS
JOINT SESSIONS
JS01.3
JS01.2
The fetal estrogen estetrol (E4) and
the breast
Androgen-restored contraception
Yvette Zimmerman and Herjan Coelingh Bennink
Pantarhei Bioscience, Zeist, The Netherlands
Combined oral contraceptives (COCs) are highly accepted, very
safe and extremely effective when used according to their
method of use. COCs are also known to reduce androgen levels,
especially testosterone (T), by inhibiting ovarian and adrenal
androgen synthesis and by increasing levels of sex hormonebinding globulin (SHBG).[1] Not much attention has been paid
to the potential clinical consequence of this endocrine sideeffect of COCs. However awareness of the importance of androgens for women is increasing and T deficiency in women has
been associated with a broad range of undesired effects including diminished wellbeing and quality of life, mood changes
(depression, irritation, moodiness), loss of energy, cognitive disturbances, interference with optimal sexual function, declining
muscle mass and strength and lowering of bone mass and
bone density.[2,3] Some of these complaints like mood disturbances and diminished sexual function have also been reported
as side-effects of COCs.[4–10]
Based on the idea that it would be useful to maintain physiological androgen levels in women using a COC, the natural
human adrenal androgen dehydroepiandrosterone (DHEA) was
added to the contraceptive pill. This novel concept of oral
contraception is referred to as Androgen Restored
Contraception (ARC). The endocrine and clinical effects of ARC
were evaluated during a series of clinical studies.
The results and conclusions of these studies show that:
1.
2.
3.
4.
All COC users experience a loss of androgens, especially
free T; mean change from baseline of 68% and 81%
for EE/LNG and EE/DRSP respectively (p < 0.0001);
COCs cause lower scores in some domains of sexual
function in healthy women who did not have sexual
function or mood complaints before COC use;
By adding 50 mg/day DHEA to a COC the loss of T can
be restored completely with an EE/LNG COC and partially with an EE/DRSP COC without inducing sideeffects (p < 0.0001);
Favourable clinical effects were observed on certain
aspects of sexual function and mood, especially menstrual cycle related symptoms.
References
[1]
[2]
[3]
[4]
[5]
[6]
[7]
[8]
[9]
[10]
Zimmerman Y, et al. Hum Reprod Update 2014;20:76105
Bachmann G, et al. Fertil Steril 2002;77:6605
Traish A, Guay A, Spark R, the Testosterone Therapy in Women
Study Group. J Sex Med 2007;4:122335
Rosenberg M, Waugh M, Meehan TE. Contraception
1995;51:2838
Rosenberg M, Waugh M. Am J Obstet Gynecol 1998;179:57782
Sanders S, et al. Contraception 2001;64:518
Westhoff CL, et al. Am J Obstet Gynecol 2007;196:412.e17
Oddens B. Contraception 1999;59:27786
Wallwiener M, et al. Contraception 2010;82:1559
Smith NK, Jozkowski KN, Sanders SA. J Sex Med 2014;11:46270
15
Gabriele Merki
University Hospital, Z€
urich, Switzerland
Estetrol (E4) is a natural estrogen produced exclusively by the
human fetal liver. In combination with drospirenone and levonorgestrel it blocks ovulation. It has been proposed that a special benefit of this estrogen might be a in comparison to
estradiol (E2) less strong effects on the mammary gland. In vitro
studies suggest that E4 is 100 times less potent than E2 to
stimulate the proliferation of human breast epithelial cells (HBE).
One reason why it is suspected that E4 mainly acts via the
estrogen receptor alpha is the finding, that the last effect can
be prevented by tamoxifen. Interestingly, if E4 is administered
along with E2 it antagonises the E2-induced stimulation of HBE.
On the other hand E2 and E4 stimulated the growth of estrogen receptor positive breast cancer cell lines at 109 to a similar
extent, at 1010 to a lesser extent. Furthermore the expression
of estrogen receptor alpha was strongest with E4. Altogether at
present data indicate that the effects of E4 on the breast are
not fully understood today. However, they seem to differ from
the effects of E2. Present data do not allow us to conclude that
E4 is neutral with regard to the breast or might be used as
estrogen in breast cancer patients. Clinical studies are needed
to compare the effects of E2 and E4 in vivo.
JS02.1
Contraception in modern Russia
Vera Prilepskaya
Research Center for Obstetrics, Gynecology and Perinatology,
Moscow, Russia
The problem of abortions and contraception in Russia is still
very actual because of the high incidence of abortions and relatively low contraceptive use. The number of abortions according
to the latest data in 2014 was 814,162, among youth – 9085.
Russia takes one of the first places in Europe using ineffective
contraceptive methods (interrupted intercourse, calendar
method). The dynamics of the use of hormonal contraceptive
methods throughout the years have been positive, along with
an annual decrease in the number of abortions and their complications. For example, the hormonal contraception rate was as
follows. In 2005 it was 94.0; in 2008: 108.1; in 2010: 125.5; 2013:
126.5; 2014: 127.6; intrauterine, respectively over the same years,
136.8; 131.4; 127.9; 121.1; 115.1 (index for 1000 women of childbearing age). According to the data of the Russian Ministry of
Healthcare, as a result of the development and introduction of
new contraceptive in the past five years (2010–2015) the
appointment of hormonal contraceptive methods for therapeutic purposes has increased significantly: 28% for PMS, 25%
for dysmenorrhea, 19% for endometriosis and 17% for
hyperandrogenia.
Emergency contraception is an important method in reducing
the number of unplanned pregnancies and abortions in Russia.
The emergency contraception is very popular in our country
applying the drug containing 1.5 mg levonorgestrel. Every year
15% of women in Russia use emergency contraception.
As shown by the results of the study, in our country consultation was one of the main factors in choosing a contraceptive
method by patients [The role of contraceptive choice among
counsel women (‘CHOICE’ in Russia, 2012)]. The details of consulting change the final decision of the patients and increase
the acceptability of contraception. Analysing the stages of introduction of contraception in Russia, it should be noted that it is
16
becoming part of the policy of reproductive health care and
population policies in general, in particular through the creation
of the new health centres and the education of teenagers,
improving education and post-graduate studies of doctors in
the field of contraception and reproductive health care.
JS02.2
The results of the RAPD project
‘Strengthening reproductive health
among certain groups of the
population in three regions of the
Russian Federation’ (2014–2015)
Lyubov Erofeeva
Russian Association for Population and Development, Moscow,
Russia
Objective: To advocate for an increase of access to emergency
contraception (EC) (free of charge) among vulnerable groups of
women in three pilot regions of Russia. This will be achieved
through capacity building on access to EC, promotion of evidence-based information and advocacy and arranging of the
system of EC distribution (free of charge) and information about
EC. The system of EC distribution incorporates women’s consultations, FP centres, pharmacies and NGOs.
Material: Reproductive health indicators and situation analyses
in three pilot regions. The EC use was less than 1%.
In Russia, contraception, including EC, is not covered by the
State Mandatory Medical Insurance and women still have poor
knowledge about modern contraception. The social status and
educational level of females play important role in the prevention of abortions. Well-educated and high-earning women are
the most protected. They have enough knowledge about their
reproductive health and they can afford to pay for private
medical services. In contrast, low-income females are in a risk
group.
Married women aged 20–24 and those aged 25–32, who
already have a child, have the majority of abortions. The second
group is young single women who do not use contraception;
this risk group is rather large: 20% of abortions are conducted
in such circumstances. The third group is teenagers aged 16–17
who often do not understand they are pregnant until late pregnancy – they are responsible for 8% of abortions. There is also
a large group who need to terminate pregnancy due to medical
reasons, as well as a group of victims of rape who wish to terminate their pregnancy.
Those mentioned were target groups for the EC promotion project, which was conducted by RAPD in three Russian regions for
two years. Administration from the three regions chose doctors
who were responsible for EC provision.
Results: Due to the implementation of communication strategy
– special media events, advertisements, contraceptive supplies,
and doctors’ refreshment training – we have monitored an
increase in the EC use in all three regions from 1% to 5% in
total. Different regions showed unequal success, from the best
of 7% to 3.2%.
Conclusion: The rate of EC use can be increased in certain
regions among groups of users by coordinated measures,
including doctors training in counselling, public communication
strategy and provision of EC.
JS03.1
The European Society for Sexual
Medicine (ESSM) educational
activities and the Multidisciplinary
Joint Committee for Sexual Medicine
(MJCSM) exam: the importance for
gynaecologists
Yacov Reisman
Amstelland Hospital, Amstelveen, The Netherlands
Sexual medicine is the branch of medicine concerned with
human sexuality and its disorders.
Patients are expecting their physicians to be open-minded even
to rare and uncommon sexual attitudes and needs. Physicians
are expected to show a certain level of understanding and
appreciation regarding the impact of psychological, medical and
surgical conditions on sexual functions. The best way to incorporate sexual medicine into clinical practice is to address actively
sexual problems. Most health care providers are either embarrassed or concerned about the time it takes to deal with sexual
issues of their patients.
Sexual dysfunction is a common problem which affects millions
of men, women and their partners across all age groups. Sexual
dysfunctions usually affect quality of life, self-image, confidence
and mood and quite often result in partnership and other social
problems. The majority of patients with sexual problems suffer
in silence without seeing a qualified specialist in sexual medicine, thus missing the chance for a better sexual life.
ESSM’s main focus is the education of colleagues interested in
Sexual Medicine to prepare them for the routine management
of patients presenting at their practices. All of these activities
aim at the highest standard of care and science according to
evidence-based medicine. In 2007 the first Oxford School of
Sexual Medicine was initiated by the ESSM with an annual twoweek basic course of intensive education in Sexual Medicine followed by additional upgrade courses. The ESSM School has
meanwhile developed into an international institution with participants from all continents of the world. ESSM implemented a
three-day ABC Master Course on all aspects of Sexual Medicine
later on complemented by workshops covering special topics.
In 2011 a MJCSM under the auspices of the UEMS (Union
Europ
eenne des M
edecins Sp
ecialistes) was convened on the
initiative of ESSM to set the administrative and legal basis for a
European qualification examination in Sexual Medicine. In 2012
the first qualification examination took place. Members of the
MJCSM are representatives of the European Board of Urology,
Gynaecology and Obstetrics, Psychiatry, Endocrinology and
Venerology.
The gynaecological clinical practice, by the nature of the specialisation, often involved issues with direct involvement of sexual organs and reproduction. Many gynaecologists are not well
trained in diagnosis and treatment of sexual issues. The educational activities of the ESSM and the certification by the MJCSM
aim to improve clinical practice and patient’s satisfaction also in
the gynaecological practice.
JS04.1
Impact of family planning research
on decrease in maternal mortality
John Townsend
Population Council, New York, USA
The universal right to health includes in principle the right of
women and men to decide the number and timing of their
children, as well as the right of access to services for safe delivery. The Sustainable Development Goals approved by the UN
General Assembly support this right and call for related investments in specific objectives and targets on gender equality and
reproductive health. Despite the progress made on decreasing
maternal mortality, there are still challenges that need to be
addressed by research, both on product development and
health system improvement.
The number of women dying due to complications during pregnancy and childbirth has decreased by 43% from about 532,000
in 1990 to 303,000 in 2015. Almost all of these deaths occurred
in low-resource settings, and most could have been prevented.
The number of maternal deaths is affected by two associated
processes. The first is the total number of pregnancies which
place women at risk, and the second is the availability of appropriate prenatal and emergency obstetric care to deal with the
actual causes of mortality. The primary causes of death are
haemorrhage, hypertension, infections, and indirect causes,
mostly due to interaction between pre-existing medical conditions and pregnancy.
Family planning plays a role in reducing maternal deaths by taking women who do not want to be pregnant out of the risk
pool. This is not an insignificant number as in many countries
nearly half of all pregnancies are reported as unintended or illtimed. Discontinuation of contraception for reasons that are
method-related, rather than changes in reproductive intentions,
is nearly 50% in the first year of use for most spacing methods.
Complications from unsafe abortion account for 13% of all
maternal deaths, amounting to 47,000 annually. About 21.6 million women experience an unsafe abortion worldwide each
year. Unmet need for contraception, i.e., women not wanting to
be pregnant but not using effective contraception, in the countries with high levels of maternal death ranges from 15 to 25%.
Maternal mortality is an indicator that shows very wide gaps
between rich and poor, urban and rural areas, both between
countries and within them. Research on closing these social
gaps in equitable access and care as well as improving availability to new technologies to improve safety, reduce discontinuation of contraception methods, and support women’s and
men’s decisions on reproduction is critical for reducing preventable maternal deaths.
JS04.2
Vaginal rings as a user-controlled
method for contraception
George W. Creasy
A wide range of options are available for family planning. User
attention intervals across contraceptive methods can be ondemand, daily, weekly, monthly, quarterly, multi-year, or permanent. With the exception of the non-hormonal IUD, non-hormonal methods are largely either on-demand or permanent;
whereas, user attention intervals with hormonal methods can
be on-demand, daily, weekly, monthly, quarterly, or multi-year.
The trade-off between frequent user attention and infrequent
user attention among the hormonal methods is bleeding and
control. Contraceptive methods with the least frequent user
attention intervals, the long-acting reversible contraceptives
(LARCs), unfortunately cannot be removed by the user and for
some women the associated amenorrhea or unscheduled vaginal bleeding is also undesirable. Multiple studies and surveys
have identified that for some women user control and bleeding
are barriers to LARC use. Monthly acting reversible contraceptives (MARCs) are a cyclic hormonal contraceptive method category populated by contraceptive vaginal rings (CVRs). CVRs
that are also MARCs are highly acceptable to women as
assessed in clinical trials and often preferred to oral contracepR /ethinyl estradiol (NES/EE)
tives (OCs). The re-useable NestoroneV
CVR neither disturbs the micro-flora nor increases the incidence
17
of vaginitis, and in the future may be the platform for a Multipurpose Prevention Technology (MPT) that reduces the risk of
pregnancy, HIV, Herpes Simplex Virus, and Human
Papillomavirus. A single-use MARC is currently available and the
NES/EE CVR, a 13-cycle re-useable MARC, will soon undergo
regulatory review. Currently, several CVR MPTs are in
development.
JS04.3
Contraception during lactation
Ruth Merkatz
To reduce adverse maternal, perinatal and infant outcomes following a live birth, the World Health Organisation (WHO) has
advised an interval of at least 24 months before attempting the
next pregnancy. Thus contraception for postpartum women
including lactating women is of primary importance, and
women must be informed and have access to safe and effective
methods. This is especially important in low resource settings
where changing social norms about the role of women and
growing urbanisation has resulted in a decline in the duration
of exclusive breastfeeding including a reduction in effective use
of the lactation amenorrhea method (LAM) for child spacing.
These factors have given rise to the need for methods that
extend the infertile period following childbirth. According to
WHO Medical Eligibility Criteria (MEC), several methods are suitable for breastfeeding women and can be recommended.
Progestin-only pills (POP) have a longer half-life than progesterone, but need to be taken daily at approximately the same
time. Long-acting methods such as a progestin implant or an
intrauterine device (IUD) require access to trained health care
providers for insertion and removal, which can be a significant
barrier. The progesterone vaginal ring (PVR) was developed as a
new user-initiated and controlled method for postpartum lactating women to extend the contraceptive effectiveness of lactation amenorrhea. The PVR delivers a low dose of a natural
hormone for 3 consecutive months; hence it does not require
daily attention by the user or dependence on existing health
delivery systems. Progesterone is metabolised quickly after
ingestion in breast milk, limiting the steroid exposure to the
infant. Approved in eight Latin American countries, renewed
efforts are underway to expand its availability and have
included a Phase 3 study conducted in India and an acceptability study conducted in three Sub-Saharan countries. Results of
these studies provide further evidence related to the safety, efficacy and acceptability of this method and offer promise for
expanding the method mix of contraceptives that may be
offered to postpartum women who are breastfeeding.
JS04.4
New developments in female
contraception
Thomas Rabe
University Women’s Hospital, Heidelberg, Germany
Background: Research in fertility control focuses on the
improvement of existing methods (efficacy, side-effects, easy
use, duration of action, manufacturing process, costs), on new
approaches (mode of action), bringing additional health benefits, and on new targets for non-hormonal contraception.
Counselling of women in view to contraceptive choices, based
on the individual risk (e.g., cardiovascular disease, thrombophilia, family risk of breast cancer, sexually transmitted diseases)
will gain more and more importance. Only a few companies
18
can afford research in contraception such as Bayer/Jenapharm,
TEVA, MSD, Ortho-McNeil, Pfizer, Gedeon Richter, Actavis, Mylan.
Ovulation inhibition: Preselection of patients to minimise the
individual risk; new oral contraceptive (OC) regimen, combined
oral contraceptives (COC) with new progestins (non-steroidal,
selective progesterone receptor modulators (SPRMs), natural
estrogens (estradiol, estradiol esters, estretrol), androgens
(DHEA), vitamins (folic acid) or cardioprotective agents; new regimens including long cycles, new progestin only contraceptives
with ovulation inhibition; new contraceptive patches (e.g., gestodene and ethinylestradiol (EE), levonorgestrel-only, levonorgestrel and EE), vaginal rings (progestins, SERMs þ estrogens); a
wide use of emergency contraceptives.
Fertilisation inhibition: New frameless copper-IUDs (e.g., intrauterine ball), levonorgestrel intrauterine systems (IUS) (Jaydess),
new frameless progestin-releasing IUS, subdermal implantable
systems and improved once-a-month self-injectables, long-acting steroidal contraceptives (including new delivery systems);
new contraceptive barriers (e.g., Caya diaphragm) loaded with
substances acting both as spermicide and as microbicides as a
dual protection (STI and contraception) by vaginal gel, pessaries
and vaginal rings; non-invasive methods of tubal occlusion;
immunocontraception for the female will not be available in the
near future; long-acting microchips releasing levonorgestrel.
Implantation inhibition: Selective progesterone receptor modulators: low dose regimen causing only morphological changes
of the endometrium surface, inhibiting implantation without
impact on the menstrual cycle; new substances for luteal phase
contraceptives.
STI: Clients requiring contraception must be informed about
the risk of sexually transmitted diseases and the way how to
prevent them (e.g., safer sex methods).
Future aspects: Risk reduction by preselection of patients with
pre-existing risks for selective prescription of contraceptives and
individual counselling; long-term use and drug safety of contraceptives; dual protection against STI and contraception; worldwide accessibility of contraceptives.
JS05.1
Dilemmas in sexual and reproductive
health care in Central Europe
Janos Annus
Retired WHO medical officer, Szeged, Hungary
Most of the issues regarding Reproductive Health Care (RHC)
have been controversial subjects in many societies throughout
history, including recent times in Central-European countries.
Such issues, being essential parts of human rights, include abortion, sexual education, dealing with STIs, contraception, social
and economic support for families. The consideration of issues
here and their solutions are involving and dependent on religious, ethical, practical, scientific and political considerations,
among others. Such issues have been leading to dilemmas in
almost all countries, including those in Central Europe, in its
East to West meaning.
Poland, the Czech Republic, Slovakia, Hungary, Serbia, Croatia,
and Slovenia have at least one common denominator: they are
all former socialist countries. Their demographic, ethnic, social
and RHC situations and the solutions applied are mostly
dependent on the actual political, economic and social situation
in general, and related to these dilemmas in particular. Recent
developments in Europe, especially the influx of refugees/
migrants is blurring these formerly relatively clear issues. Some
data-related RHC from these countries are presented and analysed here.
The conclusion is that without close and continuous collaboration of all involved partners, such as political leaders, scientists,
sociologists, politicians, economists, etc., the dilemmas cannot
be satisfactorily solved and the risk of selecting solutions that
are doomed to fail is very high.
JS05.3
Quality of contraceptive care:
essential for improving contraceptive
coverage across Europe
Lena Luyckfasseel
International Planned Parenthood Federation (IPPF) European
Network, Brussels, Belgium
Modern contraceptive usage rates vary in the Europe region. In
some countries, the rate is below 33.7% (which is the average
of the least developed countries).[1] Research conducted by
International Planned Parenthood Federation European Network
(IPPF EN) in 2012 [2] showed that the perception of modern
contraception as harmful and prevailing myths and misinformation is a main barrier. Further research conducted in 2014 [3]
indicates that also in countries where contraceptive prevalence
rates are relatively high, opportunities to improve contraceptive
care, especially for young people and vulnerable groups remain.
For IPPF, quality of care means the delivery of services in a way
that addresses the rights of clients as well as the needs of providers. Clients have the right to information, education and sexual and reproductive health services. They have the right to
choice, safety, privacy, confidentiality, dignity and comfort when
receiving services, continuity of care, and opinion. Providers also
have certain needs that must be met to enable and empower
them to provide quality services. These include training, information, adequate physical and organisational infrastructure, supplies, guidance, respect from clients and managers,
encouragement, feedback and freedom to express their
opinions.
IPPF EN considers the following areas as key to quality of
contraceptive care:
Government and policymakers’ commitment to contraceptive security;[4]
General awareness raising on the full range of modern
contraceptive methods addressing myths and
misinformation;
Evidence-based comprehensive sexuality education;
Attitudes, knowledge, skills and range of service
providers;
Provision of individualised and tailored counselling and
quality SRHR services;
Creating a safe and confidential environment with specific attention to young people and vulnerable groups;
Prevention of discrimination and stigma – addressing
social norms, expectations and gender dynamics as a
barrier to services;
Affordability and range of contraceptive methods.
Considerable gaps remain in these areas. Examples of European
countries will be provided to illustrate these as well as suggestions to address the gaps and increase the quality of contraceptive care.
Fulfilling clients’ rights and meeting providers’ needs is not the
sole responsibility of a clinic or service provider. The quality of
contraceptive care requires the implementation of public policies and programmes in all of the areas mentioned above.
References
[1]
[2]
[3]
IPPF EN. Available from:http://www.un.org/en/development/
desa/population/publications/pdf/family/
trendsContraceptiveUse2015Report.pdf
Key Factors Influencing Contraceptive Use in Eastern and
Central Europe (IPPF EN, 2012)
Barometer of Women’s Access to Modern Contraceptive Choice
in 16 EU Countries – Extended (IPPF EN, January 2015)
[4]
Contraceptive security has been achieved when individuals can
choose, obtain and use quality contraceptives whenever they
need them
JS05.4
Quality of contraceptive counselling
and care – a community and health
care provider’s perspective
Petrus Steyn
Department of Reproductive Health and Research (RHR), World
Health Organisation (WHO), Geneva, Switzerland
As efforts increase to reduce unmet need for Family Planning
and Contraception (FP/C), calls have been made to ensure that
sexual and reproductive health rights remain at the core of programmes and policies. There is a renewed interest in defining
and measuring Quality of Care (QoC) in FP. The Bruce-Jain
framework is often considered the key reference for quality in
FP/C. The framework identified six elements, applied to clinical
services in providing FP programmes, i.e., choice of contraceptive methods, information, technical competence, interpersonal
relationships, continuity and follow-up, and the appropriate collection of services. Several modifications have been added to
this framework over the past years.
The World Health Organisation (WHO) developed a framework
to assess different dimensions of human rights in sexual and
reproductive health to ensure the protection of women’s autonomy and choice in contraceptive services and information. It is
based on standards and principles recognised in international
human rights law applied to sexual and reproductive health
services. An indicator for one of the principles, QoC, is currently
being revisited.
The importance of QoC on contraceptive behaviour has been
demonstrated, and frameworks for assessing QoC from the client’s perspective have been employed. However, little is documented about community and provider shared definitions and
understandings of QoC. Community or user understandings of
QoC include aspects of care and technical aspects. A shared
vision for improved quality of care requires that health care
workers and the community agree that quality matters.
Increased efforts must be made to understand and motivate
providers, improve their performance, and help make them
partners in improving access to and quality of family planning
and reproductive health care services. Evidence suggests that
many community expectations regarding quality FP/C services,
which focused largely on personalised care, could be met without major expenditure.
It is important to understand QoC from the client’s perspective
taking into account cultural values, previous experiences; and
perceptions of the role of the health system in the community
to increase demand for services ensuring respect of individual
sexual and reproductive health rights. It is also important that
providers and the community get together and have a shared
vision of quality. Inclusion of health care providers’ perspectives
of QoC and identifying their needs and helping them to better
understand and address clients’ concepts of QoC is essential.
More evidence on definitions of QoC in the delivery of FP/C
services is needed to ensure community and provider voices
are taken into account.
JS06.1
Impact of illegal abortion on
maternal mortality
Luis Bahamondes
University of Campinas, Campinas, S~ao Paulo, Brazil
19
Unintended pregnancy account for almost for 50% of the pregnancies worldwide and, in general, it is not different between
developed and developing countries. In many cases, frequently
unintended pregnancy results in abortion. In settings in which
abortion is legal it is safe procedure and related complications
are rare. However, in many settings abortion is illegal and
women need to perform unsafe abortion. Unsafe abortion has
been defined by the World Health Organisation (WHO) as ‘a
procedure for terminating an unintended pregnancy carried out
by persons lacking the necessary skills or in an environment
that does not conform to minimum medical standards or both’.
In cases of unsafe abortion the incidence of abortion-related
morbidity and mortality is high. According to WHO estimates,
unsafe abortion accounts for 13% of maternal mortality (MM)
worldwide. In a recent study conducted by WHO in 23 countries, 322 cases of severe maternal outcome (SMO) were
reported, far fewer cases than expected, probably as a result of
underreport, or due to the fact that many women with abortion-related complications did not consult at a health facility.
Additionally, almost half of the cases came from settings with
very restrictive laws concerning abortion. In general, women
with SMO were young (between 20 and 34 years old), were illiterate or with low education levels. The fatality rate was 83
deaths/1000 women with SMOs associated with abortion in that
sample from WHO. Abortion-related SMO were most common
in very restrictive and restrictive legal environments regulating
abortion as well as countries with medium and low Human
Development Index. Furthermore, women transferred from
other facilities accounted for almost 41% of the women who
died. Regarding maternal near miss (MNM), haemorrhage was
the most common pathology associated; however, infection was
the most common condition associated to maternal death.
Furthermore, it is possible that many women may have died at
the community level mainly among those who live in countries
with more restrictive law. These women could never go to a
health facility for care. Additionally, even in settings with less
restrictive law the complications of abortion are related also to
access and prompt and appropriate care. Maternal mortality
and MNM are preventable by reducing unintended pregnancy.
One of the key tools is the use of contraceptive mainly long-acting reversible contraceptives.
JS06.2
The Asian perspective on how to
deal with illegal abortion by
promoting contraception
Jamiyah Hassan
University of Malaya, Kuala Lumpur, Malaysia
It is estimated that 210 million pregnancies occur around the
world every year and 75 million of those pregnancies end up in
stillbirths and spontaneous or induced abortions. The estimated
number of abortions in 2003 was 42 million and almost 50% of
those abortions were unsafe. Almost 95% of unsafe abortions
occur in developing countries and Asia has the largest number
of unsafe abortions. In Asian countries where abortion is illegal,
the services are provided by untrained persons in an environment which does not conform to medical standards. This will
increase the risk to women and globally, about 13% of maternal
deaths are due to unsafe abortions. Even countries like Malaysia
where termination of pregnancy is provided under The Penal
Code Amendment Act (Section 312, 1989) under certain provisions, many (including health care providers) perceive that termination of pregnancy is illegal. The data on abortion in
Malaysia is not readily available even though World Health
Organisation Regional offices for South East Asia and the
Western Pacific in 2008 quoted ‘38 out of every 1000 women
aged between 15 and 49 had undergone abortion in Malaysia’.
The unmet needs of contraception must to be addressed.
20
Obviously women consider abortion as a means of contraception. Safe motherhood and reproductive services with universal
access to contraception is part of their human right. Increasing
awareness and education on the various methods of modern
contraception must be continued especially in Asia.
Contraceptive prevalence must be one of the health indicators
to ensure that the goals of safe motherhood are met.
The cultural and upbringing of Asian women has an impact on
their attitude towards sexual health. Many Asian women are still
uncomfortable in openly discussing sexual issues including
contraception. There is a need to educate these women about
sexual health and the availability of the various options of
contraception including emergency contraception that they can
use to prevent pregnancy. Promoting the usage of effective
modern contraception can reduce the prevalence of abortion.
This also will reduce the complications of abortion especially
when it is performed illegally in countries where it is not provided by law. There is also a need to increase the competency
of health care providers in the field of contraception and in providing effective counselling.
JS06.3
Dealing with the barriers to access to
abortion
Roberto Lertxundi
Clinica Euskalduna, Bilbao, Spain
Introduction: Despite showing a decline between 1995 and
2003, the worldwide abortion rate stalled in the first decade of
the 21st century. The number of abortions was 29 per 1000 fertile women in 2008. The rate was 32 per 1000 in Latin America,
29 in Africa, 19 in Northern America and 12 in Western Europe.
And the rate of unsafe abortions is estimated to be about 28
per 1000 in Africa and Latin America. The access to legal abortion is important, because where abortion is permitted on broad
legal grounds, it is generally safe, but where it is highly
restricted it is typically unsafe. In the USA legal induced abortion results in only 0.6 deaths per 100,000 procedures. In SubSaharan Africa, the rate is 460 per 100,000.
Abortion law: Highly restrictive abortion laws are not associated with lower abortion rates. The lowest abortion rate is in
Western Europe, where abortion is generally permitted.
Between 1997 and 2008 the grounds on which abortion may
be legally performed were broader in 17 countries, most of
them in Africa. Mexico City also liberalised its abortion law. In
contrast, El Salvador and Nicaragua changed their already
restrictive laws to prohibit abortion entirely, while Poland withdrew socioeconomic reasons as a legal ground. In this last decade we have to remark that medical termination of pregnancy
(MtoP) using mifepristone and misoprostol have become more
common in both legal and clandestine procedures. Increased
use of medical abortion has likely contributed to decline in the
proportion of clandestine abortions that result in a severe morbidity and maternal death.
Recommendations to overcome the barriers to access to
abortion:
Obtain legal abortion access for all women around the
world. Legal abortion is the guarantee of safe abortion.
Ensure the presence of HCP with appropriate instruction to provide both abortion services, medical and
surgical.
Remove third-party authorisation requirements which
interfere with women’s rights to exercise control over
their bodies.
Eliminate barriers that impede women’s access to
health services such as high fees, long distances,
absence of appropriate public transport, etc.
Ensure that the exercise of conscientious objection
does not prevent individuals for accessing services to
which they are legally entitled.
Use the abortion demand as an adequate opportunity
to offer to the women the best contraceptive methods.
Improve women’s empowerment by developing the
services on sexual and reproductive health under a
prospective of gender medicine.
JS06.4
Legalisation of abortion: a window of
opportunity for contraception
Teresa Bombas
Obstetric Service A, Centro Hospitalar e Universitario de Coimbra,
Coimbra, Portugal
During a woman’s life, abortion could be prevented by promoting sexual education, overcoming barriers in access to family
planning and modern methods of contraceptives including free
access to emergency contraception and providing social protection for women who would like to have a child but don’t have
economic or social conditions to support one.
Access to safe abortion is a part of women’s human rights. It
has been clearly shown that access to legal abortion improves
physical and mental health outcomes both for women and for
children. During the past 50 years, most countries have
replaced Penal Code provisions pertaining to abortion by laws
that specify circumstances in which abortion can be legally
obtained. Most European countries have completed a process
that can be characterised as liberalisation of abortion laws.
Restrictive abortion laws are not associated with lower abortion rates but with higher rates of unsafe abortion. Women
who have had an abortion are at special risk of repeat
induced abortions. The rate of repeat abortion is completely
different between countries. In some settings where provision
of abortion services is a lucrative practice, providers may have
little incentive to promote family planning. However, providers
of abortion services have a professional responsibility to counselling about family planning.
All contraceptive methods should be readily available, and must
never be coercive. The information should be comprehensible
and concise. According to the WHO, for healthy women all
methods are eligible and could be started immediately after an
abortion. For unhealthy women, the eligible criteria for contraceptive use are exclusively dependent on the medical condition,
independent of the abortion event and could be started also
immediately at the time of abortion. The International
Conference on Population and Development (ICPD), held in
Cairo in 1994, approved a plan of action which addresses the
detrimental impact of unsafe abortion. Among other recommendations, the plan underscores the need for high-quality treatment of complications of abortion, and post-abortion family
planning counselling and services. This recommendation was
maintained by the Fourth World Conference on Women, held in
Beijing in 1995 and remains valid until today.
JS07.1
New frontiers in education and
training: The Safe Delivery App as a
case study
Anna Frellsen
Maternity Foundation, Copenhagen, Denmark
Every year, 300,000 women and more than 5 million newborns
die as a result of complications in pregnancy or childbirth. Of
these deaths, 99% are in developing countries. Globally, maternal mortality thus represents the health area with the greatest
inequality. The vast majority of deaths could be avoided if the
women in question had the support of a skilled birth attendant.
The Safe Delivery App is developed by Maternity Foundation,
University of Copenhagen and University of Southern Denmark.
It builds on the rapid proliferation of mobile telephony in Africa,
where there are already more than 600 million mobile phone
users. Mobile technology is paving the way for innovative solutions to global health problems that can be difficult to address
due to geographical distance and lack of training.
The Safe Delivery App features animated videos that provide
instruction for health workers in developing countries in handling childbirth complications, for example if the mother begins
to bleed after giving birth or the newborn is not breathing. The
videos, available both in English and local languages, can be
used irrespective of poor literacy skills and language barriers.
The Safe Delivery App therefore has significant and scalable
potential to reach health workers in rural districts, where it is
normally costly and difficult to provide conventional training
programmes.
The Safe Delivery App has recently undergone a clinical trial in
Ethiopia and Ghana, which showed that the ability of health
workers to handle postnatal bleeding and to resuscitate a newborn more than doubled after 12 months of using the app. The
biggest improvement in skills occurred among health workers
on the periphery of the health care system, i.e., at remote outposts where the starting point was lowest and the need for
training consequently highest.
Together with major partners, such as governments, foundations and other NGOs, we are now rolling out the app – which
can be downloaded free of charge – across sub-Saharan Africa
and South East Asia. Partnerships have already been established
with Red Cross in Guinea and Marie Stopes in Tanzania. In order
to reach as many health workers as possible, the app must be
integrated into national curricula on reproductive health. Our
goal is to reach 10,000 health workers before the end of 2017.
If we succeed, we will have ensured a safe birth to more than 1
million women.
JS07.2
Assessment in sexual health training
Jenny Heathcote
Faculty of Sexual and Reproductive Healthcare (FSRH), London,
UK
When considering assessment we need to ask the following
questions:
Why are we assessing?
What are we assessing? (e.g., knowledge, skills, problem
solving, attitudes, professionalism)
How does assessment relate to learning? (assessment
of learning or assessment for learning?)
How do we assess? (what tools do we use?)
Who are the assessors?
When should assessment be done?
Where does assessment fit in the design of a training
programme?
21
JS08.1
Understanding the decline in teen
fertility in the United States,
2007–2013
Laura Lindberga, John Santellib and Sheila Desaia
a
Guttmacher Institute, New York City, NY, bColumbia University
School of Public Health, New York, NY, USA
After substantial declines in teen pregnancy and birth rates in
the 1990s and early 2000s and a stall from 2006 to 2007, the
decline in US teen fertility accelerated after 2007. Modelling fertility change using behavioural data can provide insights for
adolescent policy development. Nationally representative household data from multiple rounds of the National Survey of Family
Growth were used to calculate a Pregnancy Risk Index (PRI),
which summarises the risk of pregnancy based on sexual activity, contraceptive use patterns, and method-specific contraceptive failure rates (CFRs). We calculated the PRI for adolescent
females (aged 15–19) in 2007, 2009 and 2012, and decomposed
PRI changes into change from shifts in levels of sexual activity
and in overall contraceptive risk.
We estimated that sexual activity in the last three months
among adolescents did not change significantly over time (31%,
2007; 33% 2009; 30% 2012). With less than one-third of adolescents sexually active, analyses of their contraceptive use were
underpowered and few statistically significant changes were
observed. From 2007 to 2012 there were significant increases in
the share of adolescent females reporting any contraceptive
method use (79–86%), as well as the share reporting use of two
or more methods (26–37%). Changes in specific methods
include a marginally significant increase in use of pills at last
sex (26–35%, p = 0.07), and non-significant increases in use of
condoms (49–56%), and withdrawal (15–20%). Combined LARC
use (injection, IUD, or implants) increased significantly from
2007 to 2009 (8–14%), but plateaued in the later period.
Together, these shifts in contraceptive use resulted in a significant decline in teens’ overall contraceptive risk (accounting for
contraceptive use patterns and method-specific CFRs). Overall,
the PRI declined by 26% from 2007 to 2012 (annual rate of 5%),
p = 0.07. Pregnancy risk estimated from behavioural data correlated well with changes in teen pregnancy rates (2007–2010)
and birth rates (2007–2012), with annual rates of about 6% and
4%, respectively. Decomposition analysis estimated that 86%
(95 CI = 43%, 132%) of this change over the entire period was
attributable to improvements in contraceptive method use, and
14% (95% CI = 32%, 52%) was attributable to changes in the
percentage of sexually active young women. Thus, the recent
declines in teen pregnancy rates in the US occurred despite stable levels of adolescent sexual activity. Instead, improvements
in contraceptive use were the primary proximal determinant of
declining rates.
JS08.3
Consequences of teen births in the
United States
Diana Foster
University of California, San Francisco, California, USA
Examples from medical education will be given. We will look at
what was learned from the development of assessments in the
UK for teaching and for ongoing training and revalidation of
sexual health doctors and nurses.
One in 20 teenage girls in America falls pregnant each year.
Most teen pregnancies (82%) in the United States are unintended and more than half (60%) end in birth. The most common reason for wanting to terminate an unintended pregnancy
is financial. Women seeking abortions in the US are disproportionately low income, 60% are already mothers and 18% are
teenagers. The social safety net in the US provides minimal
22
financial assistance to low income women with children
through the Temporary Assistance to Needy Families (TANF)
programme. Depending on the state, TANF assistance may be
limited to a lifetime cap of a specific number of years or a specific number of children covered. Thus, an additional child born
while the mother is receiving TANF may or may not receive any
additional financial assistance.
The consequences of early childbearing are hard to study
because characteristics associated with becoming pregnant and
carrying an unintended pregnancy to term are also independently associated with poor economic and education outcomes.
The US Turnaway Study examines what happens to women
who experience an unwanted pregnancy in the US and decide
to terminate that pregnancy. It compares women who receive
an abortion to women who are turned away and carry the
pregnancy to term. The study prospectively follows 956 women
seeking abortion for five years. In addition to quantitative measures of socioeconomic wellbeing, we have conducted interviews
with women about their experiences. One 19-year-old Latina
student from Florida described her reasons for wanting to terminate an unwanted pregnancy, ‘I am not finished with my
education, not married. Because my childhood was less than
awesome, if I do have a child I want to give it the best possible
life that I can and I am not in a place to do that right now.’ An
18-year-old white woman in North Dakota who works in a gas
station explained her reason for wanting an abortion, ‘Because I
felt that I wasn’t old enough, not financially, mental or physically ready to bring a child into the world.’ Consistent with women’s reasons for wanting an abortion, we find decreases in
financial wellbeing among women who carry the pregnancy to
term including an increased odds of being below the federal
poverty level, decreased likelihood of full-time employment and
increased use of public assistance.
JS09.1
Is there a need for training in
contraception across Europe?
Gabriele Merkia and Kai Haldreb
a
University Hospital, Z€urich, Switzerland, , bWest Tallinn Central
Hospital, Tallinn, Estonia
There is well-documented evidence (for example work by the
IPPF) that standards of care in sexual and reproductive health
vary considerably across Europe and this is likely to be resulting
in less than optimum access to services including contraceptive
choices. There is also need for education in practical skills
like IUD and implant insertion. The European Society of
Contraception and Reproductive Health (ESC) has an interest in
improving clinical standards in sexual and reproductive health
(SRH) as well as in supporting the skills and competencies of
HCPs who carry out any form of SRH consultation.
To achieve better educational standards ESC in a first step has
developed and sent out a questionnaire to two opinion leaders
or board members of most European countries in order to identify what is most urgently needed. On the basis of the answer it
is planned to offer courses and develop e-learning tools. Early
results of this survey will be presented at the congress.
JS10.1
The good news: simplified medical
abortion – increased access to safe
abortion care
Today medical abortion is a safe option for termination of pregnancy at all gestational lengths. Simplifying medical abortion
could potentially contribute to increased access to safe abortion
services. Possible approaches include the option of task sharing
with midlevel providers to allow these health care professionals
to be more involved with the care of healthy women undergoing medical abortion. An alternative for women living in
countries where access to safe abortion is restricted is to use
the telemedicine service provided by ‘Women on Web’ (WoW)
and self-administration of medical abortion. Our analysis shows
that outcome of care is comparable to other medical abortion
services provided in out-patient settings. A simplified treatment
regimen may also include home self-assessment of the outcome
of the abortion treatment and quick-starting effective long-acting reversible contraception.
Today medical abortion including post abortion contraception
can be offered as a ‘one stop clinic’.
JS10.2
The bad news: access to abortion still
restricted
Christian Fiala
Gynmed Clinic, Vienna, Austria, and Department of Women’s and
Children’s Health, Karolinska Institutet, Stockholm, Sweden
Although abortion is legally accessible in almost all countries in
Europe, all of them have some kind of restrictions in place that
limit women’s access or make it unnecessarily difficult to obtain.
These requirements are not oriented to the needs of pregnant
women. Rather, they reflect the erroneous beliefs of people
without professional experience who are not personally
involved.
There is no evidence that patronising women with things like
obligatory counselling or waiting periods has any benefit. These
restrictions do, however, lead to a delay in the provision of
abortion and have negative effects on the physical and psychological experience of those affected. Consequently, all guidelines
emphasise the advantages of early abortion. These kinds of
restrictions are deeply insulting for women and run counter to
human rights and self-determination. But the terms themselves
are also wrong:
‘Obligatory counselling’ is in fact a ‘state-mandated
instruction to women to continue an unwanted
pregnancy’;
Waiting periods, frequently called ‘reflection periods’,
are state-mandated refusals to treat;
‘Conscientious objection’ of health care providers is an
unjustified refusal to treat, because it undermines
democratically-decided laws and harms women. It
should be called ‘dishonourable disobedience’.
These aspects should be highlighted in the public discussion
and in the formulation of new general conditions.
Developments in recent years have been encouraging insofar as
the regulations in some countries have been changed and are
now less restrictive. For example, France lifted the requirement
for ‘obligatory counselling’ and a one-week waiting period,
Switzerland ended the requirement for a psychiatric diagnosis,
and Spain deleted the need for a medical indication.
The example of Canada is particularly worth mentioning. There,
the long-established view is that the termination of an
unwanted pregnancy is a medical treatment and requires no
legal interference. In 1988, after a long legal battle, the
Supreme Court of Canada declared the abortion law unconstitutional and abolished it. It will be interesting to see how long it
will take for this successful solution to replace the ideologicallymotivated regulations that exist in other countries, especially
those in the European region.
JS10.3
The ugly news: late abortion
Sharon Cameron
NHS Lothian, Edinburgh, UK
Availability of abortion (if legally permitted at all) varies
throughout Europe, as does the gestational limit up to which it
can be performed. Improving access to safe abortion and minimising the delays in obtaining abortion is important to ensure
that abortions can be performed at early gestations and by
medical methods. Although many parts of Europe have
observed a trend for increasing proportions of abortions to be
conducted within the first nine weeks of pregnancy, there
remain a small but consistent proportion of women who present towards the end of the second trimester requesting abortion. The key findings from a number of countries show that
the reasons for delayed presentation are due to a combination
of factors. Much of the delay is before the request for abortion,
not realising one is pregnant, difficulty in making the decision
about whether or not to continue the pregnancy and change in
circumstances, e.g., relationship breakdown. For young women
in particular there may be additional barriers, such as difficult
relationships with partners and/or parents, fear or lack of knowledge about what the abortion involves or how to access abortion. In countries where women have to pay for abortion, or
travel for abortion (illegal or unavailable above a certain gestation) this inevitably results in presentation at later gestations.
Abortion throughout the second trimester should be provided
and funded by public health services, as inability to pay for or
access abortion results in women having to continue an
unwanted pregnancy or leads to presentation for abortion at
later gestations. Future strategies need to consider better education about signs and symptoms of pregnancy, and availability
of high quality accurate information about the safety of abortion and how abortion services can be accessed. Women should
also be aware that they can discuss a possible termination of
pregnancy with an abortion provider without having made a
definite decision on whether or not to continue the pregnancy.
JS11.1
The role of FIGO in contraception
Giuseppe Benagianoa,b
a
Sapienza, University of Rome, Rome, Italy; bThe International
Federation of Gynaecology and Obstetrics (FIGO), London, UK
Although, through the FIGO-WHO Alliance, FIGO – the
International Federation of Gynaecology and Obstetrics – has
been attentive to issues concerning family planning, it is only
recently that the Federation decided to become directly
involved in contraception to the point of creating a specific
committee dealing with it.
This decision came as a donor, who wished to remain anonymous, granted a large sum to help FIGO addressing the unmet
need for contraception, especially in countries where the maternal mortality is high. Thanks to this donation, FIGO wants to
play a role in increasing the availability of long-acting reversible
contraceptives (LARCs), thereby reducing maternal mortality and
the number of abortions, improve birth spacing to reduce infant
mortality and decrease the use of sterilisation.
Many countries have achieved increasing rates of institutional
deliveries; however, the proportion of postnatal women leaving
facilities without receiving a contraceptive method remains
high. FIGO would fill the gap by training health service personnel to provide counselling and insertion of post-partum-IUDs
(PPIUDs). The supply of IUDs and equipment would be the
responsibility of the government, whilst training and monitoring
23
would be the function of FIGO and the affiliated national
societies.
The FIGO-PPIUD initiative seeks to address the gap in the continuum of maternal health care existing in a number of countries by institutionalising the practice of offering immediate
PPIUD in teaching hospitals in Bangladesh, India, Kenya, Sri
Lanka, Nepal and Tanzania, to increase the capacity of health
care professionals to offer PPIUDs; training community midwives, health workers, doctors and delivery unit staff and institutionalising the practice of counselling for the use of PPIUD
during the antenatal period.
The hospitals were selected on the recommendation of the
national societies with the pre-requisites that they should be
teaching hospitals with about 5000 deliveries each year and
that PPIUD was not a routine service provision.
A research component, conducted by Harvard School of Public
Health in collaboration with FIGO and the national societies in
Sri Lanka, Nepal and Tanzania, will study both the impact of the
initiative and the extent to which the initiative leads to the institutionalisation of PPIUD services.
JS11.3
Latin American challenges and
solutions in contraception
Luis Bahamondes
University of Campinas, Campinas, S~ao Paulo, Brazil
Latin America (LA) is a region with many countries. Although,
except for Brazil, the countries have a common language, the
level of development, the size of the population, the number of
indigenous people, cultural values, and the health systems are
different in each country. The Catholic Church has an important
role in some countries and this has an influence in the provision
and use of contraceptive methods. Furthermore, unintended
pregnancy (UP) accounts for at least 50% of all pregnancies
which occur in the region. In many cases these women had
unsafe abortions (due to the fact that abortion is illegal in many
LA countries) and this situation increases maternal mortality and
morbidity rates. Health systems and policy makers have responsibilities to reduce UPs. Unplanned pregnancies, particularly in
adolescents, increase public health costs, particularly relevant
for UPs in adolescence. Over the past few decades, the LA
countries have experienced a fertility transition noted by a
reduction in the total fertility rate and increase in use of contraceptive methods. However, the rate of induced abortion did not
change over the last years. Prevention of UP using publicly
funded programmes in many countries has generated cost savings for health services and public services. However, in many
LA countries, the governments did not implement specific divisions to evaluate this cost saving in UP prevention. For decades,
key donors like USAID and UNFPA have provided free contraceptives to governments and nongovernmental organisations in
many LA countries. However, in the last 20 years many of the
organisations began a process of phasing out these contraceptive donations. This created a contraceptive funding gap,
because many countries did not prepare adequately for this
situation and did not allocate appropriate funds for sexual and
reproductive health (SSR) activities including contraceptive
methods. Although many countries developed strategies for
dealing with the end of the donations, most of them still have
financial problems in this area. However, contraceptive activities
are beyond the provision of the methods. Contraception needs
a legal environment, the willingness of policy makers, budget
line items for contraceptives, adequate facilities which comply
with the needs of the population, trained health care professionals including those devoted to counselling, changes to the
medical and nursing curriculum, among others. The region
needs a great effort to increase the use of contraceptives,
mostly long-acting reversible contraceptives (LARCs) which are
proved to be more effective in the prevention of UPs.
24
JS12.1
The latest WHO guidelines in SRH
Stephen Nurse Findlay, Mary Lyn Gaffield,
Rajat Khosla, Nathalie Broutet, Toskin Igor and
James Kiarie
High quality evidence-based guidelines are essential for ensuring quality of care in sexual and reproductive health (SRH) services. Recent WHO SRH guidelines cover medical eligibility for
contraception use, cervical cancer prevention, brief sexuality
communication and Human Rights in contraception services.
The World Health Organisation (WHO) is currently supporting
research to strengthen its existing guidelines and developing
tools to support their implementation. In 2016 WHO has prioritised development of guidelines on infertility, STIs and sexual
reproductive health of women living with HIV.
The updated 5th edition of Medical eligibility criteria for contraceptive use (MEC) guidance provides over 2000 recommendations to programme managers, policy/decision-makers, and the
scientific community on the safety of various contraceptive
methods. In 2016, to complement the MEC, WHO will issue an
updated, 3rd edition of the Selected practice recommendations
for contraceptive use (SPR) guideline.
Cervical cancer is a priority non-communicable disease, the
Comprehensive cervical cancer control: a guide to essential practice (C4GEP) gives a broad vision of what a comprehensive
approach to cervical cancer prevention and control means.
Future WHO guidelines will integrate work from the ongoing
studies of cervical cancer screening and triage with HPV testing
and use of cheaper, more user friendly HPV tests.
Behaviour-change interventions are an essential part of comprehensive STI/HIV prevention to improve health outcomes. The
Brief Sexuality-Related Communication guidelines provide health
policy-makers and decision-makers in health professional training institutions with advice on the rationale for health-care providers’ use of counselling skills to address sexual health
concerns in a primary health care setting.
To strengthen health system capacity to monitor human rights
in contraceptive programmes WHO developed the framework
and implementation guide for ensuring human rights in the
provision of contraceptive information. WHO is in the process of
developing a tool that can be used globally in contraceptive
programmes to monitor the dimensions of human rights.
Infertility and STIs diagnosis and management practices have
changed significantly in the last few years. Accordingly, WHO is
leading an effort to develop guidelines and associated derivative products on diagnosis and management of infertility and
for treatment of major STIs as well as the screening and treatment for syphilis in pregnant women.
JS12.3
Implementation of WHO guidelines
in the WHO European region
Gunta Lazdane
World Health Organisation, Regional Office for Europe
One of the roles of the World Health Organisation (WHO) is to
provide technical expertise through the production, dissemination, and implementation of evidence-based guidelines. WHO
issues nearly 200 recommendations and policy statements every
year based on the requests of the Member States as well as the
result of the analysis of the global trends and challenges.
WHO Regional Office for Europe assists 53 very diverse countries in improving sexual and reproductive health (SRH). WHO
tools reach countries in different ways: some are downloaded
from the WHO web page by national policy-makers, academia
and professional organisations, others are used by the WHO
and aid development partners to provide technical assistance
to countries. UNFPA EECA Regional Office and Royal Colleague
of Obstetricians and Gynaecologists are assisting countries of
Eastern Europe and Central Asia in using the WHO guidelines in
the development of the national standards and protocols.
However, often important information does not reach countries
due to the lack of coordinated screening of the new WHO
guidelines and tools. In some countries there are national focal
points in SRH. This type of mechanism is very helpful in ensuring that the latest WHO tools reach the target audience in
good time.
WHO guidelines that have been praised the most in the
European Region and requested to be translated into national
languages are: ‘Medical eligibility criteria for contraceptive use’
(2015) and related publications; several tools on technical and
policy guidance on safe abortion (2014, 2015); WHO statements
on prevention and elimination of disrespect and abuse during
childbirth (2015) and on caesarean section rates (2015); documents related to SRH and human rights. WHO Regional Office
covers areas topical for the European Region. The most
requested as well as the most discussed WHO document developed in collaboration with BZgA, WHO Collaborating Center is
the ‘Standards for sexuality education in Europe’ (2010) and a
number of tools on improvement of the quality of maternal and
perinatal health.
Member States have alerted the WHO/Europe secretariat to the
lack of updated WHO guidance related to infertility and
menopause.
Conclusions:
It would be important to establish/clarify mechanisms
in every country to ensure that information on the
development and publication of new WHO SRH guidelines reach the audience in timely manner.
Feedback from the users of the WHO guidelines is very
important for further development of new SRH tools.
JS12.4
World Health Organisation
recommendations on health worker
roles in safe abortion care and post
abortion contraception
Bela Ganatra
World Health Organisation (WHO), Geneva, Switzerland
Although safe, simple and effective evidence-based interventions exist, nearly 22 million unsafe abortions take place every
year; these continue to contribute significantly to the global
burden of maternal mortality and morbidity. Among the many
barriers that limit access to safe abortion care, the lack of
trained providers is one of the most critical. It is estimated that
the global deficit of skilled health professionals will reach 12.9
million by 2035. Such shortages are especially critical in regions
of the world that also have a high burden of unsafe abortion
and related mortality. Additionally, most countries, including
many high-income ones have subnational disparities in the
availability of a skilled health workforce, with shortages being
particularly high in rural areas or within the public sector. While
shortages of all skilled professionals exist, the deficits and subnational imbalances are the greatest for physicians. The World
Health Organisation (WHO) has a broad and inclusive definition
of health workers and the 2013 WHO report on the global
health workforce highlights the fact that advanced practitioners,
midwives, nurses and auxiliaries are still insufficiently used in
many settings. Involving such health workers makes it more
likely that services will be available to women when they need
them.
In July 2015, WHO released its new guideline ‘Health Worker
Roles in providing Safe Abortion Care and post abortion
Contraception’. The guideline provides evidence-based recommendations on the role of a range of health workers (from specialist doctors to community-based workers) in the provision of
safe abortion care and post abortion contraception. The guideline also considers women as active partners in managing their
health care and provides recommendations on women’s roles in
the management of medical abortion in early pregnancy and in
the self-administration of injectable contraceptives.
The presentation will provide an overview of the guideline
and its recommendations as well as discuss the challenges
in moving to adoption and implementation of these
recommendations.
JS13.2
Revival of Progestogen-only pills
(POPs)
Adolf Schindler
Institute for Medical Research and Education, Essen, Germany
Progestogen-only pills (POPs) were first started at the beginning
of the 1970s, but no sufficient clinical results were obtained
either in the area of uterine bleeding or regarding contraceptive
efficacy.[1]
With the publications on increased thromboembolic events with
combined hormonal contraceptives (COCs), new interest
emerged to revive POPs since it was known that POPs are not
burdened with an increased risk of venous thromboembolism
(VTE).[2]
POP preparations such as levonorgestrel 0.03 mg/day or desogestrel 0.075 mg/day were associated with reduced coagulatory
activity,[2] since both have clinical problems such as unscheduled bleedings or as in the case of levonorgestrel, a not optimal
pearl index due to the insufficient dosing of this POP.
Therefore, investigations have been done to improve the quality
of POPs in regard to unscheduled bleeding and proper pearl
index. Three studies are underway to try higher doses of levonorgestrel reaching from 0.06–0.1 mg with which the pearl
index is improving and the bleeding pattern is getting more
acceptable.[3]
Another concept of POPs has been developed with drospirenone 4 mg/day in a 24/4 scheme.[4] The pearl index was fully
acceptable with 0.51; 95% CI, 1.054–1.492 and also the bleeding
pattern was improved compared to desogestrel POP (0.075 mg)
given daily continuously. In addition, no thromboembolic events
(VTE) occurred and haemostasiological studies confirmed the
non-thrombogenic effect of this type of POP.[5]
Overall, new types of POPs are going to be developed improving or eliminating the weak spots of previous POPs and therefore the clinical use and value of POPs will be increased.
References
[1]
[2]
[3]
[4]
Friedrich E, Keller E, Jaeger-Whitegiver ER, et al. Effects of 0.5 mg
Lynestrenol daily on hypothalamic ovarian function. Am J
Obstet Gynecol 1975;122:642–649
Schindler AE. Differential effects of progestins on hemostasis.
Maturitas 2003;46:31–37
Oettel M, Kochhar PS, Osterwald H, et al. The progestogen-only
pill (POP) is not a niche option: new preclinical and clinical data
about the interrelation between levonorgestrel dosage, peripheral as well as central contraceptive effects and bleeding behavior. J Reprod Med Endokrinol Online 2015 (Special issue)
Archer DF, Ahrendt HJ, Drouin D. Drospirenone-only oral contraceptive: results from a multicenter, non-comparative trial of efficacy, safety and tolerability. Contraception 2015 (submitted)
[5]
25
Regidor PA, Colli E, Schindler AE. Drospirenone as a new progestogen-only pill (POP). Gynecol Endocrinol 2015 (submitted)
JS13.3
Long-acting reversible contraceptives
(LARCs) – the Austrian view
Christian Egarter
Medical University of Vienna, Vienna, Austria
Current clinical expert opinion is that long-acting reversible
contraceptive (LARC) methods should have a wider role in
contraception and their increased uptake could help to reduce
unintended pregnancy.
In Austria, next to the use of condoms (46%) the combined pill
is still the mainstay of contraceptive prescribing (38%) and
LARCs are only used in approx.18%. Despite acceptance of the
value of LARCs in both, male and female practitioners, ambivalence towards LARCs is still evident. The real barrier to provision
appears to be lack of confidence with the own skills of a
gynaecologist.
As we know, there are a number of different conditions that are
less favourable for combined contraceptives. LARCs are providing estrogen-free options and there are very few conditions
which represent a contraindication; they can safely be used,
e.g., in risk patients for venous thromboembolism.
It is also well established that contraception is cost-effective.
LARC methods have a much higher efficacy than oral contraceptives; higher up-front acquisition costs are inaccurate predictors
of the total economic costs and the highest health care savings
are with LARCs.
In conclusion: Despite their proven safety, effectiveness and
higher economic value, LARCs are underrepresented in the
whole array of contraceptive measures. Reasons for lack of use
include doctors’ and women’s knowledge of and attitudes
towards the methods, practice patterns among providers, and
higher initial up-front costs associated with these methods. As a
project in the St. Louis region of USA could demonstrate, once
financial barriers are removed and women are informed in
detail about advantages and disadvantages of a specific
method, a high percentage (> 75%) finally choose a LARC
method.
JS14.1
Update on emergency contraceptive
methods and their mechanisms of
action
Hang Wun Raymond Li
Department of Obstetrics and Gynaecology, The University of
Hong Kong, Queen Mary Hospital, Hong Kong and The Family
Planning Association of Hong Kong, Hong Kong
Emergency contraception (EC) is an important back-up contraceptive method used to prevent pregnancy after unprotected
sexual intercourse (UPSI). The oral regimen consisting of a single
dose of 1.5 mg levonorgestrel (LNG) taken within 72 hours of
UPSI is the first-line hormonal EC available in most countries.
Studies have shown that LNG-EC is effective only when given
before, but not after, ovulation. This may be explained by its
mechanism of action. LNG acts as EC by blocking/delaying the
luteinising hormone (LH) surge only when administered before
the onset of the LH surge. LNG has no effect on sperm function,
fertilisation and implantation.
Anti-progestogens such as mifepristone and ulipristal acetate
(UPA) have better efficacies and a wider treatment window up
26
to 120 h after UPSI. A single dose of 25–50 mg mifepristone
(and possibly at the 10 mg dose though evidence is less) is the
most effective regimen for oral EC. It does not only inhibit ovulation, but also interferes with implantation, which contributes
to its higher efficacy. However, mifepristone at the 10 or 25 mg
dose (the EC dose) is only available in a very limited number of
countries. UPA at a single oral dose of 30 mg taken within 120 h
of UPSI has been introduced for EC in recent years. UPA has
lower failure rate than the LNG regimen. The main mechanism
of action of UPA is to delay or inhibit ovulation, and such effect
remains evident even after the onset but before the peak of LH
surge. In vitro data indicated that UPA at pharmacological concentrations could inhibit progesterone-induced acrosome reaction and hyperactivation of human sperm, as well as ciliary
beating and muscular contraction in the human fallopian tube,
but does not inhibit embryo-endometrial attachment. The efficacy of UPA is shown to be significantly better when administered before than after ovulation, suggesting that the main
action of this regimen is still on the ovulatory process.
The copper intrauterine contraceptive device is currently the
most effective method of EC, with a failure rate of 0.09%. It
can be used within five days after UPSI, or within five days
post-ovulation if it can be reasonably estimated. It can also be
retained as an ongoing regular contraception. Copper ions
may exert contraceptive action through both pre-fertilisation
(impairment of sperm and oocyte function) and post-fertilisation (impairment of implantation) mechanisms. No evidence
for the use of progestogen-releasing IUCD as EC is yet
available.
JS14.2
Emergency contraception (EC)
provision as an opportunity for
contraceptive counselling
Teresa Bombas
Obstetric Service A, Centro Hospitalar e Universitario de Coimbra,
Coimbra, Portugal
The best definition for emergency contraception (EC) is the
use of any drug or device after unprotected intercourse (UPI)
to prevent an unintended pregnancy. Currently, there are four
types of EC methods available: (1) Levonorgestrel-only EC pills
(LNG ECPs, included in the list of essentials medicine from the
WHO), (2) EC pills containing ulipristal acetate (UPA ECPs), (3)
EC pills containing mifepristone, and (4) copper intrauterine
devices (IUDs). Introduction of EC has generated much litigation and controversy. We can recognise different policies
between countries regarding access to ECPs. No access: only
Malta has this situation in Europe. Access with prescription:
the user needs a prescription for get it at the pharmacy. Over
the Counter (OTC): EC are available, without a prescription at
any location with no restrictions. Behind the Counter (BTC):
no prescription is required; the products are over the counter
but with some restrictions such as age, quantity or location
of sale.
The request of EC could be a sign of good information about
its potential to reduce the risk of unplanned pregnancies. All
the providers of the EC must be well informed about it and
give precise and concise information about it. The women must
be informed that ECPs will not protect her from pregnancy if
she engages in UPI in the days or weeks following treatment.
According to the WHO, for healthy women all methods are eligible after EC use. If the woman wishes to use combined hormonal contraception (pill, ring, patch) or progestin-only pill as
an ongoing method, she could start it on the day after ECPs
(with a condom use on the first seven days) and do a pregnancy test if she hasn’t had a menses by the end of the first
packet of pills. If she requests a long-acting method (LARC), the
copper IUD could be the best choice for EC. If she prefers an
implant, injectable or LNG-IUD, the best practice is to use a condom and postpone its use until the next menses. If it is not possible or not acceptable, we could insert the LARC on the day of
ECPs and perform a pregnancy test within five weeks. For
unhealthy women the criteria for an eligible contraceptive
method after EC must considerer the woman’s morbidity. The
EC provision must be an opportunity for contraceptive
counselling.
JS15.1
Sexual health care in adolescence
Saira-Christine Renteria
Departement Femme-Mère-Enfant, Centre Hospitalier
Universitaire Vaudois, Lausanne, Vaud, Switzerland
Over the last decades, awareness about adolescents and their
specific needs in sexual health fields has spread widely among
medical and psycho-social professionals.
Epidemiology shows that unwanted pregnancy and early
motherhood have decreased in countries where sexual education and access to contraception and counselling has not only
been enhanced but evolved to a point where this preventive
approach is broadly accepted by political, educational institutions and health carers. Sexual abuse prevention has led to
more frequent disclosures and earlier access to medical treatment, psycho-social care and child protection.
Scientific progress allows children with chronic disease to enter
adolescence thriving to access more freedom from caring
parents and to test at least as much as others explorative and
possibly risky behaviour. This new challenge includes the need
for contraceptive counselling adapted to each condition. To be
able to include sexuality into their approach, health professional
need first of all to enlighten patients about the light of
transition.
The identification of adolescence as an entity has emphasised
the role of the peer group. Social media has given this already
powerful group, which works either as resource or torture, the
power to act as a permanent mirror and judge. Such a degree
of social pressure has never been experienced by former generations. During the period of development and consolidation of
self-esteem and sexual personality, we see girls whose long-lasting sexual abuse is virtual, but maybe even more traumatising
or whose dysmorphophobia is reinforced. Request for severe
treatment for minimal skin problems or corrective surgery despite a normal morphology of the breasts or external genitalia
has become more frequent.
During the consultation, personal and family history as well as
developmental aspects and the so-called hidden agenda must
be addressed. As substance use is correlated to risky sexual
behaviour and sexual harassment, professionals should screen
for it, including dating violence.
Treatment for hyperandrogenic syndrome and endometrioses
with possible onset during adolescence is more efficient
if the diagnostic is confirmed early. Abnormalities of the
menstrual cycle and dysmenorrhea should therefore be investigated even though they are frequent during this period
of life.
The prevention and screening of sexually transmitted infections
and information about vaccination should be integrated in the
discussion and information about post-coital contraception
given systematically. Special attention regarding the culture of
virginity is necessary as possible manoeuvres may lead to
unprotected and potentially contaminating sexual activity.
ABSTRACTS OF THE ICMC
JS16.2
Contraception use by women living
s de la
with HIV (Particularite
contraception chez les femmes
VIH þ)
Jean-Jacques Amy
Vrije Universiteit Brussel, Brussels, Belgium
Theoretically, consistent condom use is the answer. Although
insufficiently effective in preventing the spread of ‘skin-to-skin’
and ‘skin-to-sore’ STIs (e.g., human papillomavirus, herpes simplex, syphilis, etc.), it does reduce the transmission of HIV. But –
even among stable, HIV-discordant couples counselled about
HIV risk and condom use – a considerable number do not comply with the instructions.
Most women living with HIV reside in sub-Saharan Africa. Many
resort to hormonal contraception, mostly depot-medroxyprogesterone acetate (DMPA). A large study of HIV serodiscordant couples from various African countries, with a similar self-reported
condom use between groups, showed that women using hormonal contraception, primarily DMPA, had a two-fold higher risk
of acquiring HIV. Women who were HIV-infected at initiation of
the study and employing an injectable contraceptive, transmitted the virus to their uninfected male partners twice as often.
Also prospective observational studies revealed greater risks of
HIV acquisition with DMPA use. The biological mechanisms
responsible are unknown. A randomised trial of hormonal
contraception and HIV acquisition is needed.
Yet, as effective contraception is associated with less maternal
morbidity and mortality, improved socioeconomic status of
women, and better health of children through birth spacing,
WHO considers that the benefits of hormonal contraceptive use
outweigh any potential harm among women at risk of, or living
with HIV. In view of this, in the fifth edition (2015) of its Medical
eligibility criteria for contraceptive use, the WHO recommends the
following approach.
Except for the LNG-IUS, hormonal contraceptives may be used
without restriction (Category 1) by women at high risk of acquiring HIV, as well as by those living with HIV, whether the disease
is asymptomatic or not (WHO stage 1 to 4). Women at risk and
those with asymptomatic or mild HIV disease (stage 1 or 2) may
generally start using (Category 2) a LNG-IUS, whereas those at
stages 3 or 4 of the disease should preferably abstain (Category
3) until the disease, under treatment, has abated and evolved
to a stage 1 or 2. Women already wearing a LNG-IUS, who
develop an advanced stage of the disease, do not need to have
the device removed (Category 2 for continuation).
The recommendations for LNG-IUS utilisation also apply to copper IUDs.
Antiretroviral medications reduce the risk of transmitting HIV
through breastfeeding. The latter, including exclusive breastfeeding (lactational amenorrhoea method), is therefore recommended when certain socioeconomic conditions prevail,
provided the woman living with HIV receives adequate antiretroviral treatment.
INTERNATIONAL CONSORTIUM FOR MALE
CONTRACEPTION
ICMC.3
Hormonal male contraception: new
options
Christina Wang and Ronald Swerdloff
Harbor-UCLA Medical Center, Torrance, California 90509, USA
27
To avoid some of the potential adverse events of androgens
and progestins, selective androgen/progesterone receptor modulators have been synthesised. The non-steroidal androgenic
compounds designed for stimulating muscle mass and strength
are not available for contraceptive clinical trials. New steroidal
androgenic molecules such as 7a-methyl-19-nortestosterone
(MENT) are not 5a-reduced to form dihydrotestosterone and
may have less stimulating effects on the prostate. Supported by
the Population Council, a study showed that four MENT acetate
implants inserted in healthy men resulted in severe suppression
of spermatogenesis. Another two synthetic androgens with
structure similar to MENT are Dimethandrolone (DMA, 7a -11bdimethyl-19-nortestosterone) and 11 beta-methyl-19 nortestosterone (11bMNT) have prostate sparing properties are being
developed by National Institute of Child Health and Human
Development for male contraception. Both DMA and 11bMNT
have both androgenic and progestational activities. DMA is
esterified to DMA undecanoate (DMAU) and a phase 1 study of
DMAU in healthy men is underway. Administration of a single
dose DMAU as powder in capsule with food resulted in doserelated levels of DMA and DMAU in the serum. Within a 24-h
period there was significant suppression of both gonadotropins
and testosterone compared to placebo. Without a fatty meal,
the absorption of DMAU was markedly lower. DMAU is being
developed as a single agent male hormonal contraceptive for
oral and intramuscular administration. Phase 1 study of 11bMNT
will begin this year. Because these steroids are not aromatised
to estrogenic steroids, the participants in longer-term clinical trials must be monitored for bone mineral density, fat mass and
sexual function because estrogens are important for these functions in men. Nestorone (16-methylene-17alpha-acetoxy-19-norpregn-4-ene-3,20-dione) is a potent progestin that has minimal
binding to the androgen and estrogen receptors. Nestorone is
being developed as female contraceptive vaginal rings and
transdermal gels with good safety profiles in women. Nestorone
at a dose of 8 mg together with testosterone gel (100 mg)
applied to the skin daily suppressed spermatogenesis to <1 million/ml in 89% of healthy men much more than testosterone
gel alone. Based on the results of the six-month
Nestorone þ testosterone gel study, the NIH, NICHD is initiating
a trial of about 200 couples to assess the efficacy of Nestorone
and testosterone in preventing pregnancy in late 2016. The
goal is to find the best hormonal combination male contraceptives that are efficacious, available, acceptable, affordable and
safe for men.
ICMC.4
Promising targets for non-hormonal
male contraception
Regine Sitruk Ware
New contraceptive methods have been developed to meet the
objectives of expanding contraceptive choices for both women
and men and answering unmet needs. While clinical research
on male hormonal methods is advanced, and several combinations of androgen and progestin proved effective, no method
has been fully developed. Non-hormonal methods are still at
an early stage of research. New areas of basic research include
studies on genes, proteins and enzymes involved in the reproductive system. New approaches target the maturation of
germ cells, a critical component of sperm development, or the
sperm motility. These methods aim at inducing reversible infertility without interfering with hormones secreted by the hypothalamus, pituitary gland, and testis. Among the new
approaches identified, disruption of the tight junction between
sertoli cells, by analogs of Lonidamine, such as Adjudin
[Adherens Junction Disruption] or H2-Gamendazole, inhibit
movement of the germ cells, resulting in release of immature
28
sperm. Inhibition of the testicular retinoic acid biosynthesis is
also a promising target for male contraceptive development.
Selective inhibition of the bromodomain activity during spermatogenesis, targeting the male germ cell is another recent target for contraception. Antibodies to the Epididymal Protease
Inhibitor (EPPIN) localised on the sperm surface inhibit human
spermatozoid motility. Other molecules designed to inhibit targets such as CatSper, a pH-regulated, calcium-selective ion
channel, and the sperm-specific enzyme Glyceraldehyde 3phosphate dehydrogenase-S (GAPDS) involved in sperm motility may also become contraceptives for men. There is an obvious need to provide men with choices for their fertility
regulation but advocacy for this research needs to expand and
convince the industry that there is a market with unmet needs
that deserves attention and investments.
DEBATES
D1.1
Contraception and the media: a
debate
Sharon Cameron
NHS Lothian, Edinburgh, UK
With most medications, it is the doctor who chooses the most
appropriate and effective treatment for patients. However,
contraception differs in that choice of method (assuming medical eligibility) is made by the user. The user’s choice is largely
influenced by information from friends, family, and prior experience, in addition to that from contraceptive providers. However,
the media, i.e., newspapers, magazines, television, radio, music,
the internet and social media, also influence a woman’s choice
of contraception and may also influence whether or not she
continues to use that method.
The media, and increasingly digital media, is an important tool
that can be used positively to deliver high quality, standardised information about contraception to women and to
improve uptake of the most effective methods and continuation rates.
Long-acting methods of contraception (LARC) are the most
effective at preventing unintended pregnancy. There is evidence
that high quality audiovisual information about LARC delivered
via digital media is as acceptable to women as a face-to-face
consultation with a provider and can effectively increase knowledge of a method. Text messaging (SMS) can be used to
remind women of pill taking or when an appointment is due
for repeat supplies of contraception (e.g., the injectable) and to
deliver other sexual health messages. Internet sites on contraception can usefully address frequently asked questions about
methods, help dispel myths and misinformation, and provide
decision-making aids to assist women to choose a method that
is appropriate for them. Social media has the advantage that it
permits rapid dissemination of information to a wide network
of women. For contraceptive providers, digital media (internet,
apps) has facilitated rapid dissemination of clinical guidelines on
contraception. It has the advantage that it can be continuously
updated to keep in check with emerging evidence. Software on
mobile phones or web-based (Apps) have also been developed
to assist clinicians determine women’s medical eligibility for
contraceptive methods.
Contraceptive providers should therefore engage with the
media, particularly digital and social media, as a means of
improving knowledge, uptake and continuation with effective
methods of contraception.
D1.2
How the media may have a negative
effect on the use of contraceptives
ndes
Anibal Fau
The International Federation of Gynaecology and Obstetrics
(FIGO), Campinas, and University of Campinas (UNICAMP),
Campinas, Brazil
The media is a very important source of information on contraception; thus, it has a very important role in how correctly or
incorrectly informed are the people in any country. When the
media properly plays that role, it has a very important positive
impact in the utilisation of contraception with its positive effect
over women’s health. It may have a negative effect if the information provided is not correct or if it fails to play the role of
properly informing the public. One problem is that some media
appears to understand that bad news has a greater power of
attraction to the public. Alarming news reports about methods
of contraception are easily published while the media rarely use
its power to educate the public with correct information that
would protect women from unplanned pregnancies.
The media was very successful in alarming the public with the
news that women taking third-generation combined oral contraceptives (COC) have a higher risk of venous thromboembolism
than second-generation COC. The result was that many women
stopped using the pill altogether and there was a significant
increase in abortion, documented in Europe, but probably
expanding to the rest of the world. Many accuse the CSM of
not giving a better balanced description of risk and benefit, but
without the amplification capacity of the media, eager for bad
news, the effect may have been greatly reduced. Some studies
have found that women may have even received more erroneous bad news about contraceptives, such as young women in
New York reporting the TV as a source of information that the
patch could cause cancer.
The main complaint concerning the media, however, is of not
taking seriously their social duty of educating the public on
issues that will help to preserve and protect their health. They
frequently inform about vaccination and announce vaccination
campaigns. They have not yet taken as their duty to properly
inform in a balanced way about the benefits, risks and ways of
effective use of the different contraception methods. This is particularly important in the case of emergency contraception,
because to be used on time, the women should not require
medical care but direct access to the pill. The current data show
that even in the most developed countries and the more educated, there is a big gap in knowledge, which only the media
can cover, as it is a basic source for information on the subject.
D1.3
Contraception and the media:
embracing new models of
contraceptive care
Wayne Shields
Association of Reproductive Health Professionals, Washington,
DC, USA
Sexual and reproductive health, prominently including family
planning and contraception, is moving more toward evidencebased self-guidance and further away from one-on-one provider
interactions, particularly due to access and time constraint
issues. These practical issues combine with a move toward virtual media, telemedicine, and informed self-care. Media – both
professional/academic and mainstream – serve a key informative role in this transition. I propose that it is time for the field
ABSTRACTS OF DEBATES
to embrace new models of contraceptive care that incorporate
the best aspects of patient-focused digital and Web-based care
while enhancing evidence-based, in-person care. This position
features a prominent strategic role for all types of media.
29
EXPERT GROUP SESSIONS
EGS1.1
D2.1
Young people with intellectual
disabilities and sex education
IUD/IUS for nulliparous patients
€fgren-Mårtenson
Charlotta Lo
Malm€
o University, Malm€o, Sweden
Gyorgy Bartfai
University of Szeged, Szeged, Hungary
According to the medical eligibility criteria of the World Health
Organisation (WHO), neither young age (teenage) nor nulliparity
are contraindications to the insertion of IUD or IUS. Both the
American College of Obstetrics and Gynaecology (2007) and the
WHO (2008) considered these methods as safe and reliable
ones for patients younger than 20 years.
However, by some practitioners the IUD and IUS are not recommended for nulliparous women or teenagers. There are myths
and misconceptions around this contraceptive method.
Contrary to these myths and misconceptions, scientific evidence
shows that side-effects/consequences of wearing modern IUD
or IUS does not cause permanent infertility provided the insertion guidelines are followed correctly. In such cases, fertility
returns at the next cycle, i.e., almost immediately.
Furthermore nowadays smaller IUD/IUS models and thinner
insertion tubes are available. With these the insertion is as easy
as it is in parous women. The findings from clinical studies did
not show the suspected higher expulsion rate either.
It is also well established that if one follows the guidelines at
the insertion and make the necessary precautions in the high
risk/vulnerable groups of patients, pelvic inflammation is rare
and is not more frequent than that is in the multiparous group.
Finally, contrary to some myths, the cost-effectiveness of the
devices is rather good in the long run. For a three- or five-year
term, this device is one of the less expensive methods and
meanwhile being a very reliable method.
In summary, if one meticulously follows the guidelines and
attains good insertion skills the IUD/IUS is an excellent choice
for nulliparous and teenage patients for long-acting reversible
contraception.
D2.2
IUS/IUD in nulliparas and
adolescents – ‘Con’
Diana Mansour
New Croft Centre, Newcastle upon Tyne, UK
Unintended pregnancy is a worldwide problem with many clinicians believing that increasing the provision of intrauterine contraceptives to nulliparous women and adolescents to be the
answer. Surely IUCs offer highly effective, reversible birth control
to those who are fertile and want to postpone starting their
family until they are in their late 20s. However, even when
these methods are freely available by healthcare providers giving unbiased information, the majority of women choose alternative methods.
In this debate I will look at some of the reasons why nulliparous
women and adolescents choose other methods and why we
should help couples choose contraceptive options that best suit
their needs and cultural beliefs – not ours. It is a contentious
issue and I welcome the challenge.
Background: In Sweden sex education has been compulsory
since 1955. However, access to sex education seems to be insufficient in schools with special education programmes. Students
with intellectual disability (ID) still have limited information
about their own bodies, sexuality and relationships. The national
standards of sex education are too general and the aim of providing a quality curriculum is difficult to attain. This also applies
to the standards adapted to the varying developmental, maturational and intellectual levels of this particular population.
Concerns about unwanted pregnancies, sexual abuse and sexual
risk situations make personnel insecure about how to best deal
with the subject. In addition, a largely heteronormative perspective of sex education renders young gay people with intellectual
disability an invisible group. Stereotyped gender norms where
girls are supposed to be oriented towards love and relationships
and boys towards sexuality make it more difficult for young
people with intellectual disability to find a more subtle way to
act.
Aim and research questions: The aim of this study is to
strengthen sexual health among young people with intellectual
disability, and to develop a knowledge base culled from their
own experiences that can help teachers in special schools to
supply sufficient sex education. What are the experiences of sex
education in young people with intellectual disability aged
16–21? In what way, and by whom, should sex education be
supplied? What themes do the young people with intellectual
disability consider important?
Method and theory: Qualitative research interviews with 16
young females (nine) and males (seven) with intellectual disability aged 16–21 years have been conducted. Guiding the analyses is an interactionist perspective on sexuality. Specifically,
sexual script theory is used as the basis of understanding and
describing experiences of sexual health and knowledge related
to sex and relationship issues among young people with ID.
Results and conclusion: The descriptive results are presented
based on: (a) the informant’s experience of sex education, (b)
what the informant learned/wanted to learn, (c) the ways in
which information was learned, and (d) by whom and when
information should be given. Results show that a restrictive
script is geared toward informants with intellectual disability,
focusing on sexual risks instead of challenging a discourse of
pleasure, desire and intimacy. Using critical pedagogy can help
personnel to develop a professional and adequate teaching
model for sex education at schools for adolescents with intellectual disability.
EGS1.2
ZANZU: an internet-based approach
to improved sexual health for
migrants
Christine Winkelmann
Federal Centre for Health Education, Cologne, Germany
Migration is an increasingly common phenomenon in a globalised world. However, there are many reasons that people
migrate, including conflict, economics, human rights, marriage,
natural disasters and politics.
30
Migrants who have just arrived in a new country often lack language skills and a knowledge of local customs, regulations and
structure. This is particularly true in the area of sexual health.
Sexuality is a sensitive topic in many – perhaps all – cultures
and, due to various factors, many migrants have not received
adequate information about the different aspects of sexuality
and sexual health in their originating countries.
At the same time, migrants can be more vulnerable to sexual ill
health due to the migration process and they need access to
quality-assured information on a wide range of topics relating
to sexual health. They also need information about how to
access sexual health services in their new country.
The Federal Centre for Health Education has collaborated with
Sensoa, a Belgian NGO specialising in sexual health, to develop
a multilingual website covering different aspects of sexual
health including information on the human body, family planning and pregnancy, infections, sexuality, relationships and feelings, rights and laws. The website is available in 10 languages.
The content is presented in clear, easy-to-understand language
and illustrations help explain complex issues such as how to
use a female condom or the delivery of a baby. The website
also includes ReadSpeaker/text-to-speech capability to broaden
access to the information.
The website is designed to reach both intermediaries and individual patients/clients. Intermediaries include medical doctors
who deliver sexual health care (e.g., general practitioners,
gynaecologists, family doctors) and counsellors on issues such
as HIV, sexual violence and abortion. The website is designed to
help intermediaries explain sensitive topics and to provide the
patients/clients with customised printouts about relevant
topic(s).
The website was developed based on a needs assessment and
expert interviews in Belgium and Germany. Feedback on various
elements of the website was collected from organisations that
work with migrants. An international advisory board has also
supported the development process. The website is currently
online in German and Belgian versions, other country versions
are likely to follow. The generic parts of the website are
grounded in principles of sexual health and rights and are common across versions; country-specific details such as national
regulations are added to each country version.
EGS1.3
Sexuality education for different
target groups
€fgren-Martenson and Christine Winkelmann
Lotta Lo
Centre for Sexology and Sexuality Studies Malm€o University
Scylla, Malm€o, Sweden, Federal Centre for Health Education,
K€oln, Germany
Sexuality education is an important part of a more general education and by that affects the development of personality. Its
preventive nature not only contributes to the prevention of
negative (health) consequences but can also improve quality of
life, health and wellbeing of the general population. According
to the WHO-Europe standards, holistic sexuality education is
defined as the learning about the cognitive, emotional, social,
interactive and physical aspects of sexuality. Good quality sexuality education is grounded in internationally accepted human
rights and covers all stages of life, from early childhood to
adulthood.
The need for sexuality education has been triggered lately, e.g.,
by globalisation and migration of new population groups with
different cultural and religious backgrounds, the rapid spread of
new media, increasing concern about sexual abuse of children
and adolescents and changing attitudes towards sexuality and
sexual behaviour.
Since sexuality education is in general a challenging task but
unfortunately specific target groups are often neglected in talking about this sensitive issue, this session will focus specifically
on specific target groups and their gaps, progress, challenges
and aspects of sexuality education and present concrete solutions, for, e.g., disabled children and adolescents, as well as on
sexuality education with migrants.
EGS2.1
Use of fertility awareness methods:
information from internet resources
and cycle apps
Petra Frank-Herrmanna, Lisa-Maria Wallwienerb,
€nter Freundlb
Marcus Krahlischb and Gu
a
Women’s University Hospital, Heidelberg, Germany,bSection
Natural Fertility of the German Society for Gynaecological
Endocrinology and Fertility Medicine, Heidelberg, Germany
Background: Over the last three decades fertility awareness/
natural family planning (NFP) methods have been developed
and standardised. They are based on self-observation of the
fertile window in the menstrual cycle and can be used to
achieve or avoid pregnancy. They differ in NFP-methodology,
efficacy, teaching approach and cultural setting. The access to
internet resources and the development of cycle apps have
changed the situation in two ways: firstly, the personal NFP
teacher is replaced by self-learning via cycle apps and internet
communities; secondly, the rules to determine the fertile window are no longer applied by the users themselves but by
app programmes. Many of those programmes deviate to some
extent from scientifically sound rules, e.g., using mere calendar
calculations. In addition, nearly no data exist on the effectiveness of fertility awareness methods when learned via cycle
apps.
The aim of the research group ‘Sektion Nat€
urliche Fertilit€at
(SNF)’ of the German Society for Gynaecological Endocrinology
and Fertility Medicine is to identify cycle apps which are suitable for effective natural family planning.
In a first step, the SNF identified selection criteria for cycle apps
which are suitable for being included in research studies. It was
decided to include cycle apps which try to rely as close as possible on the Sensiplan method as that method is scientifically
validated and has achieved good results in European countries.
Sensiplan relies on self-observation of body symptoms (basal
body temperature and cervical secretions) and determines the
fertile window according to the double-check principle. Also for
that method, there is no data on effectiveness when using it via
internet resources/cycle apps.
Studies needed: After the selection procedure a prospective
observational study was initiated by the SNF on three variations
of cycle apps/internet learning. The aim of the study is to measure overall unintended pregnancy rates, method efficacy and
continuation rates.
The participating women have to be between 18 and 40 years
of age, beginners with the method, willing to deliver their documented cycles for at least one year and to record sexual
behaviour.
The statistical methods used will be the life table method and
the perfect use approach according to Trussel.
Actually, all three subgroups together contain 213 participants
with 1607 cycles (targeted database: 200 women, 2600 cycles in
each subgroup).
Conclusion: A scientific selection process of current cycle apps
is necessary. Cycle apps based on calendar calculations can be
excluded. The remaining apps need prospective effectiveness
studies.
ABSTRACTS OF EXPERT GROUP SESSIONS
EGS2.2
Female sterilisation a thing of the
past? – ‘Pro’
Mireille Merckx
University Hospital ‘Vrouwenkliniek’, Ghent, Belgium
According to population growth based on current trends, our
human count is expected to reach 9 billion in 2040. According
to the United Nations, the world population is currently growing
by more than 70 million people per year. Almost all growth
takes place in less developed regions. In more developed
regions it remains mostly unchanged. In the near future, international immigrations may have an influence on the demographic numbers. The average world fertility is expected to
decline to two children per woman. Birth control policies also
influence this growth.
Meanwhile, the continuing explosion of the world population
has increased the world’s ecological footprint. The choice to
reproduce is a human right, and so is sterilisation. The popularity of sterilisation has been in decline since the 1990s. However,
thanks to advancements in the field of ambulatory care and
new methods, the number of sterilisation procedures may once
again increase in the future.
Counselling and awareness about health care coverage and
sterilisation techniques can reduce unintended pregnancies.
Sterilisation is a contraceptive option with excellent quality of
care. From an oncologic viewpoint, salpingectomy diminishes
ovarian cancer risk. This additional benefit makes this surgical
procedure a valued alternative, and it may even become the
new standard.
EGS2.3
Female sterilisation: a thing of the
past? – ‘Con’
Amos Ber
Maccabi Health Centers, Tel Aviv, Israel
Female sterilisation is the most widely used contraceptive
method in the world today. Approximately 20% of married
women worldwide aged 15–49 who use contraception have
been sterilised. Most of the sterilisations are done in East Asia
and South America. In the western world except for USA,
Canada and Australia, the female sterilisation rate is very low.
There is no question that this is a very effective way of contraception. In selected cases, for example, a woman in her late 30s
or early 40s who already has children and is in the process of
having a caesarean section (CS), this can be a good solution.
The question that we have to ask ourselves is whether it is reasonable to take a woman to an elective operation for contraception? Easy as it may be, this is still an operation that carries
a risk.
Major complications of laparoscopic and minilaparotomy procedures (requiring laparotomy) occur in approximately one in
every 1000 procedures. The most common complications
include infection, injury to other organs, internal bleeding, and
problems related to anaesthesia (last year 12 women died in
India during the procedure). Those risks are increased by obesity, an inexperienced operator and abdominal adhesions
The failure rate is 0.5–1% and if this happens there is a higher
risk of the pregnancy being ectopic. The risk of pregnancy was
highest among women who underwent sterilisation under the
age of 30 and among women who had clips placed on the
tubes.
Some 15% of US women aged 25–34 had sterilisation with
higher rates in less educated and poor women (55% of women
who had not completed high school compared with 16% in
31
college graduates). Taking into account a 50% divorce rate in
the USA, how can we be sure that 27-year-old women (some of
them childless) will not regret the procedure in the future even
if today she signs an informed consent? Data shows that
between 2% and 20% of women regret their decision to
undergo sterilisation.
Today we have the contraceptive pills and the LARC with a low
failure rate and with much lower complications rate, so why not
use them and leave sterilisation only to those who are older
with children, or those who fail in using other forms of reversible contraception methods?
EGS2.4
The cost-effectiveness ratio of
contraceptive methods in the
European Union
Manuela Farris, Carlo Bastianelli,
Roberta Costanza Bruno Vecchio and Elena Rosato
Sapienza University, Rome, Italy
The role of contraception is to avoid unintended pregnancy,
but in several European countries besides a wide use of contraceptive methods, voluntary pregnancy termination rates are still
high. There is indeed, a broad difference in contraceptives use
in various countries with higher percentage reported in northern Europe where abortion rates are also higher. In France,
where contraceptive methods are used by some 50% of the
female population in reproductive age, a stability of abortion
rates has been observed over the time, but rates have increased
among teenagers (15–19 years), from 14 per 1000 per year in
2001 to 15.6 per 1000 per year in 2007. Figures for abortion are
similar in Italy, while a decrease in abortion rates has been
observed (7.9 per 1000 in 2012 and 7.6 in 2013), the rates for
the same age range remained stable over the years (4.4 per
1000 for the same years).
The problem with teenage pregnancy is that this can affect the
life chances of both the mother and her child. Babies of teenage mothers have a higher risk of dying in their first year and
have a significantly increased risk of living in poverty, achieving
less at school and being unemployed in later life. More than
50% of teenage pregnancies end in abortion
In the UK, where the British Government from the late 1980s
launched ‘The Teenage Pregnancy Strategy’, a policy for reducing abortion rates in women under 20 years of age, utilising
long-acting contraceptives (LARC) (injectables, implants, intrauterine devices, and intra-uterine systems), conception rates per
1000 girls aged, < 18 years decreased by 34.1%, from 46.6 in
1998 to 30.7 in 2011, and this change was shown to be statistically significant.
Investment in contraception can save money by reducing unintended pregnancy rates. This, in turn, will reduce costs for antenatal and postnatal care for mothers and healthcare for babies
and children, education and welfare.
To ensure cost-effective contraception, it is important to provide
information about the full range of contraceptive methods available, including emergency contraception (both oral and intrauterine) and LARC, the benefits and risks of each method and
how to manage any side-effects, in order to meet woman’s
choice and a consistent use.
Available evidence suggests that IUDs are more effective and
have higher rates of satisfaction also in adolescent women compared with oral contraceptives. Moreover, LARCs are more costeffective even after years of use.
32
EGS3.1
New hormonal methods – recent and
on the horizon
Zara Haider
Kingston Hospital, Surrey, UK
Year on year, there has been an increase in the range of contraceptive methods available, improving the choice for men and
women. We now have a large variety of hormonal methods,
delivered in numerous different ways. In this talk I will look at
the hormonal methods of contraception that have become
available in the last year or so and look to the future for what is
under development, on the horizon and likely to appear in a
clinic near you in the next year or three!
Within the last year we have seen the arrival of the new smaller
IUS, Jaydess, a new way of delivering medroxy progesterone
acetate in Sayana Press, new combined pills taken in extended
cycle regimes and with reduced pill free interval and a new
transparent patch. Under development and in the pipeline is a
new estrogen based on fetal estrogen which could potentially
cause fewer side-effects, new vaginal rings including a ring that
is anti HIV, anti HSV and antipregnancy! Other exciting new
innovations are just around the corner – a contraceptive transdermal gel and a hormonal chip that is inserted subdermally
and can be switched on and off remotely and new ways of
using ulipristal acetate but as a contraceptive method. There
are also new methods being developed for men including a
subdermal implant. Maybe the perfect method of contraception
is on the horizon. . .
EGS3.3
New controversies: hormonal
contraception and venous/arterial
thromboembolism
Angelo Cagnacci
University of Modena and Reggio Emilia, Obstetrics and
Gynaecology, Modena, Italy
Venous and arterial cardiovascular events share a common final
mechanism, i.e., the formation of a blood clot occluding vessel
lumen. The only exception to this rule is the rupture of an arterial vessel leading to haemorrhagic lesions. Beside this, risk factors for venous and arterial events are different.
Thromboembolism (VTE) is favoured by reduced blood flow in
the veins and genetic or acquired blood hypercoagulability.
Myocardial infarction and ischemic stroke are not dependent on
blood flow and hypercoagulability. Instead, they are dependent
on a progressive vessel occlusion by atheromatous plaques that
suddenly may break and provoke an obstructing blood clot.
Accordingly, the main risk factors for arterial events are those
involved in atherosclerosis formation such as smoking, and the
components of the metabolic syndrome such as lipid abnormalities, hypertension and diabetes.
Combined hormonal contraceptives (CHC) may influence both
venous and arterial risk factors. Epidemiological data indicate
that non-estradiol-based CHC increase the risk of VTE, as the
consequence of estrogen-induced thrombophilia, the eventual
role played by blood flow having been neglected. The risk
seems to be dependent on the estrogenicity of the combination
being higher with higher estrogen doses. At similar estrogen
doses, the risk is higher with weak anti-estrogenic progestin
such as those with low or no androgenic properties. For the
time course of arterial disease, epidemiological studies should
be performed in older women having or not having used a
given CHC. Available epidemiological studies instead are
performed in young current or former CHC users, who did not
have the time to develop different degrees of arterial atherosclerosis. Accordingly, reported arterial events are limited to
those occurring acutely, as the consequence of haemodynamic
modification or existing plaque rupture.
Based on animal data and risk factor modification, the effect of
CHC on atherosclerosis progression and thus on main arterial
cardiovascular risk might be negative or positive depending on
the CHC used. Looking at risk factors for atherosclerosis such as
blood pressure, lipid or insulin sensitivity worsening or improvements have been reported during CHC. In this case estrogenicity of the non-estradiol based low-dose CHC does not seem to
be negative and by contrast to be advantageous.
EGS4.1
Explanations for second trimester
abortions; background contexts
Roger Ingham
University of Southampton, Southampton, UK
Previous research has identified various reasons why some
women seek abortions in the second trimester of pregnancy.[1–3] These studies generally report quantitative data in
grouped categories of reasons for delays; these include the realisation and/or acceptance of pregnancy, getting tested, seeking
assistance, making decision, changed circumstances, access to
services and procedures, etc.
As part of a larger study on second trimester abortions in
England, qualitative material was obtained which provides more
insight into the realities behind some of the reasons for delayed
presentation and provision. This paper will present some of
these data for the first time. They reveal a wide array of background factors which assist in understanding the complexities
and unpredictable nature of some women’s lives, the ways that
staff attitudes and service availability can affect timings, and
other issues. Some implications for service provision will be
highlighted.
References
[1]
[2]
[3]
Ingham et al. 2008
Lee and Ingham 2010
Ingham 2014
EGS4.2
Medical vs. surgical abortion, pro
medical
Oskari Heikinheimo
University of Helsinki and K€atil€oopisto Hospital, Helsinki
University Hospital, Helsinki, Finland
Since its introduction in the 1990s/early 2000s, medical abortion
by means of sequential administration of mifepristone and
misoprostol has become the dominant method of induced
abortion in several countries. In Finland, Scotland and Sweden,
80–90% of all abortions were performed medically in the early
2010s. In the UK and USA, the corresponding figures for early
abortions were approximately 50% and 25%, respectively.
In early studies assessing the reasons why women choose medical instead of surgical abortion arguments such as avoiding surgery/anaesthesia, more natural and increased privacy have been
the most frequently cited.
One of the few randomised trials on the selection of medical vs.
surgical abortion [1] found that a majority (> 69%) of the
ABSTRACTS OF WORKSHOPS
randomised women were content with their method of abortion
before and after the abortion. However, significantly more
women found surgical abortion acceptable at two weeks after
the abortion.
Having a choice between the abortion methods and a woman’s
active participation in the decision process are important determinants of eventual patient satisfaction. In a large French
study performed among women undergoing an early abortion
(<seven weeks of amenorrhea) who were given a choice
between the methods, it was found that they were four times
more likely to choose medical than surgical abortion.[2]
Besides being an individual decision, providing medical abortion
necessitates changes in health care services for the women.
When the service provision of medical abortion is appropriately
designed, the number of clinical visits which are needed can
ideally be reduced to one (depending on local legislation etc.).
Postabortal contraception can in most cases be started on the
same visit. Medical abortion also offers the advantage of selfadministration of misoprostol at home, also a possibility for telemedicine in some circumstances.
Introduction of medical abortion shifts much of the abortionrelated health care needs from surgical to outpatient units. As
operating room time is expensive, providing medical abortion is
cost-effective. However, increasing need for outpatient care and
counselling must be appropriately resourced. Similarly, home
administration of misoprostol is likely to be cost-saving.
However, the 24/7 gynaecological on-call services for possible
adverse events of medical abortion (such as bleeding, infection)
must be in place, easily accessible and generally accepted.
References
[1]
[2]
Robson et al., Health Technol Assess 2009
Moreau et al., Contraception 2011
EGS4.3
Medical versus surgical abortion in
the second trimester – ‘Con’
pez-Arregui
Eduardo Lo
33
The risk of infrequent but serious injury is probably higher with
surgery than with STMA. The major complication is failure to
avoid trauma: perforation of fundus, lateral perforation into uterine artery, and laceration of internal cervical os. Other complications seem to be independent of the doctor’s competence:
uterine atony, uterine anomalies, postabortion hematometra or
amniotic fluid embolism.
In my opinion, except in cases of fetal malformation and the
need of fetal autopsy, or in cases where surgery is contraindicated . . . only medical abortion in the second trimester, no
thanks.
But in conclusion. . . ‘Let each woman choose from surgical or
medical management’.
EGS4.4
Feticide before second trimester
medical and surgical abortion:
weighing the risks and benefits
Patricia Lohr
British Pregnancy Advisory Service, Stratford-Upon-Avon,
Warwickshire, UK
Feticide has been widely practiced by abortion providers to
make dilatation and evacuation faster and easier, and is recommended to avoid the medico-legal dilemmas with signs of life
at delivery. There is also some evidence that women prefer to
know that the fetus is dead before undergoing second trimester
abortion. However, few studies demonstrate a clinical benefit
of feticide. In addition, the most commonly used feticidal
procedures – injection of intra-cardiac potassium chloride or
intra-amniotic or intra-fetal digoxin – are associated with pain,
gastrointestinal side-effects, injection-site reactions, bleeding,
extra-mural delivery and, very rarely, serious complications such
as sepsis or cardiac arrest. This lecture will explore the clinical
evidence around feticide in the context of second trimester
medical and surgical abortion as well as the potential benefits
for women and providers undertaking abortion at peri-viable
gestational ages.
Clınica Euskalduna, Bilbao, Basque Country, Spain
Discussion between strict medical or surgical abortion in the
first trimester (FT) remains valid, but this subject in the second
trimester (ST) is becoming obsolete. On one hand, it is unthinkable to perform second trimester surgical abortion (STSA) without medical preparation of the cervix. On the other hand, it is
also unthinkable offering second trimester medical abortion
(STMA) without the operator skills required to solve the 5% of
cases (in best statistics) of incomplete abortion. A real picture
would be talking about medical-surgical abortion in the ST.
Women seeking ST abortion reflects the fact that health systems
have not been quick enough in the FT. The best method for ST
abortion is to prevent and to avoid this situation. The complication rate is 13 times higher in the ST than in the FT one. There
are some risk factors associated with the delay to ST: young
women, prinigravids, low educational level, single, low
income. . . but not previous abortions. Only a few doctors and
centres offer this service in ST. After 16 weeks the number gets
smaller, and even more smaller after 20 weeks.
We must advise women objectively and without opinion on the
advantages, disadvantages and risks of each method, regardless
of what our centre can offer, or our technique mastery. In other
words, we should not assume exclusive options. In the same
way that each woman has her ideal contraceptive method, each
abortion procedure has its ideal candidate, moment or country.
In experienced hands (preoperative diagnosis and evaluation,
high level of operator skill, atraumatic surgical technique, and
carefully postoperative supervision) the success in STSA is near
100% and complications happens in only 0.7% of the cases.
WORKSHOPS
WS1.1
Sexual health of young people in the
WHO European Region
Evert Ketting and Christine Winkelmann
German Federal Centre for Health Education (BZgA), K€oln,
Germany
This paper provides a comprehensive overview of the state of
youth sexual health in the WHO European Region, as well as a
listing of tools and policies aiming at its improvement and recommendations to that effect. After a clarification of concepts
used and an overview of existing European data sources and
their limitations, epidemiological data on youth sexual health
are presented and discussed in the context of changing conditions of youth in Europe. The main indicators used are age at
first intercourse, contraceptive (including condom) use, teenage
pregnancy and abortion, STIs and HIV, and sexual abuse and
violence. Some attention is also paid to sexual satisfaction.
Although in some respects remarkable progress has been
made, particularly in contraceptive and condom use, which
has caused substantial decreases in teenage pregnancy rates,
there is also a need for concern and for targeted action. There
34
is still a large discrepancy in youth sexual health status
between Western and Eastern Europe; some problems, like the
risk of chlamydia infection, are largely underestimated; and
there is a need for a much stronger gender focus, particularly
where sexual abuse and violence are concerned. This last issue
also requires more international comparative research. Much
progress can still be made in the two core intervention fields
for improving youth sexual health: introduction of holistic
school sexual education, for which new European tools have
become available since 2010, and making sexual health services more youth friendly.
WS1.3
Youth-friendly clinics in Estonia –
association with contraceptive use
Kai Part
University of Tartu, Tartu, Women’s Clinic of Tartu University
Hospital, Tartu, and Tartu Sexual Health Clinic, Tartu, Estonia
Research on the effectiveness of youth-friendly sexual health
services on young people’s health has shown positive results
but is limited.
In Estonia, contraceptive counselling was traditionally provided
by gynaecologists in women’s outpatient clinics. Since the mid1990s, new health care services – private gynaecological practices, a family doctor system, and a network of youth-friendly
clinics (YFC) – became available.
YFCs are specially designed to meet the needs of young women
and men up to 25 years of age, providing contraception counselling, testing for HIV and STIs, counselling in case of an unexpected pregnancy and psychosexual counselling.
Hormonal contraceptive methods and IUDs are prescribed by
doctors and midwives, and one needs to visit a service provider
in order to start using these methods.
The objective of this study was to explore the association
between visiting youth-friendly counselling services and the use
of effective contraceptive methods among young women aged
16–24.
From a population-based cross-sectional study carried out in
2004 (response rate 53.8%), the data of 16–24-year-old women
requiring contraception (n = 868) were analysed. Factors associated with the use of effective contraceptive methods and, specifically, hormonal methods, were explored using multiple
logistic regression analysis.
Multiple logistic regression analysis adjusted for age (16–19,
20–22, 23–24 years), native language (Estonian, non-Estonian),
type of contraceptive service (women’s outpatient clinic, YFC,
private gynaecology clinic and family doctor) and schoolbased sexuality education (yes, no) showed that the use of
effective contraception (hormonal methods, condom, IUD) at
last sexual intercourse was positively associated with visiting
YFC (AOR 1.82; 95% CI 1.03–3.23) or private gynaecology
clinic (AOR 2.08; 95% CI 1.11–3.92). More specifically, the use
of hormonal methods was positively associated with visiting
YFC (AOR 2.87; 95% CI 1.54–5.37), private gynaecology clinic
(AOR 2.44; 95% CI 1.20–4.95) or family doctor (AOR 2.37; 95%
CI 1.17–4.78).
Conclusions: Finding an effective methodology with which to
evaluate the independent effect of SH services for young people is challenging. Although causal association cannot be
proved, the findings suggest that using effective contraception
among teenage and young women is, at least partly, attributable to visiting youth-friendly services. Easy access to youthfriendly sexual health services is needed to ensure better uptake
of effective contraceptive methods.
WS1.4
Adolescent contraception and
sexually transmitted diseases
George Creatsas
University of Athens, Athens, Greece
Prevention of adolescent pregnancies, as well as, prevention
and treatment of sexually transmitted diseases (STDs) and other
gynaecological pathologies are the main goals of Paediatric and
Adolescent Gynaecology. The condom and the new-generation
combined oral contraceptives (COCs) are the methods recommended for the prevention of unwanted pregnancies during
adolescence. The combination of these methods also prevents
STDs as the papilloma virus infections or other infections due to
the Mycoplasma sp., Chlamydia trachomatis and other aerobic
and anaerobic pathogens. The failure rate of COCs during adolescence is reported to be between 5% and 15%. The new
COCs with 17B estradiol and new progestins such as the dienogest, drospirenone, nomegestrol acetate and others, present
several beneficial effects during adolescence. These include the
regulation of the menstrual cycle, the improvement of acne and
hirsutism, the endometriosis, as well as the prevention of ovarian and endometrial cancers. The 17B COCs also provide beneficial effects on the lipid and the carbohydrate metabolism, as
well as on the liver and thyroid function. The use of long-acting
reversible contraceptive methods is also recommended as these
methods provide better compliance, especially during adolescence. However there is no protection from STDs. Emergency
contraception is recommended in cases of no contraception
use, breakage or incorrect use of condom and failure of coitus
interruptus. Young girls using emergency contraception should
be also tested for STDs. Further data is needed for the use of
the mini levonorgestrel intrauterine devices during adolescence.
In any case, consultation and sexual education are very important tools for the prevention of unwanted pregnancies and
STDS. Information should be provided by experts in Paediatric
and Adolescent Gynaecological Centres and Family Planning
Units. During the consultation with the young girl, it is recommended to avoid medical terms to overcome future social and
psychosocial problems.
WS2.2
Theory and intervention: what works
to improve compliance and
continuation
Katarina Sedlecky
Institute for Mother and Child Health Care of Serbia, and
Republic Family Planning Centre, Belgrade, Serbia
Despite the increase in modern contraceptive prevalence rate,
approximately 40% of pregnancies worldwide are still unintended. Inconsistent and incorrect use, stopping or switching
contraceptive methods are some of the explanations for this
unfavourable situation. Contraceptive behaviour is shaped by an
individual’s motivation to prevent pregnancy and capacity to
control fertility by using contraception. Many bio-psycho-social
factors may influence contraceptive use and support or compromise continuation and adherence. Contraceptive counselling
has a significant impact on satisfaction of women with chosen
contraceptive method and contraceptive continuation.
Establishment of a good interpersonal relationship between a
health care provider in the role of counsellor and a patient facilitates open discussion about sensitive issues related to sexuality
and family planning and contributes to optimising decisionmaking. Health behaviour theories and interventions that allow
ABSTRACTS OF MEET THE EXPERTS
for individualised interventions and tailoring contraceptive
choice to the specific needs of women or couples may be
more appropriate. The concept of shared decision making that
respects both professional expertise of health care provider
and the patient’s expertise regarding her personal values and
preferences allows respect for patient’s autonomy such as in
the informed choice model, as well as accentuating highly
effective methods, having in mind the fact that a woman will
make a final choice. Strategies to promote improved use of
chosen contraceptive method are essential for compliance and
continuation. Contingency counselling is a general strategy
that is directed to identifying and addressing additional problems that may arise during the use of a particular method of
contraception. Contingencies include both barriers related to
the access to contraceptive services or procurement of contraceptives and method-specific side-effects. Interventions, such
as making follow-up visits, providing enhanced supply of contraceptives, mobile phone-based interventions, were found to
increase continuation rate in some studies. In a systematic
review that examined theory-based interventions for improving
contraceptive use, trials with favourable results were more
likely to have targeted adolescents, to be based on social cognitive theory or another social cognition model, and to have
provided group sessions. Other effective interventions were
based on motivational interviewing and provided individual
sessions. Behaviour change techniques to increase modern
contraceptive use in low and middle income countries were
classified in seven categories: (1) information techniques; (2)
performance techniques; (3) problem-solving techniques; (4)
social support techniques; (5) providing materials; (6) media
techniques; and (7) male partner involvement. More research
on contraceptive interventions for improving contraceptive
continuation of use is needed.
WS2.3
The sexuality education programme
‘Long Live Love’: an Intervention
Mapping Approach
Fraukje Mevissen and Gerjo Kok
Maastricht University, Maastricht, Limburg, The Netherlands
The Netherlands are often recognised for the relative positive
sexual health of Dutch young people as compared to other
developed countries as shown, for example, by the low rates of
teenage pregnancies. Several papers suggested that this may
be related to the content of the sexuality education programmes. One such sexuality education programme in the
Netherlands that is well-known by teachers and health workers
and has been proven effective is the Long Live Love programme (LLL).
The first LLL programme was developed, implemented and
evaluated in 1994. Since then, several updates and additions
have been developed. In 2012, LLL was updated again and now
includes several sub-programmes targeting different age groups
and different educational levels. LLL focuses on several sexuality-related themes such as sexual diversity, STI/HIV prevention,
wishes and boundaries, and contraception use.
The LLL programme is developed using the Intervention
Mapping approach (IM). IM provides programme planners with
a systematic framework for effective and theory-based decisionmaking at each step in the developmental process. IM distinguishes six steps: a needs assessment (step 1), which focuses on
a thorough problem analysis; the programme objectives (step
2), in which planners select target groups and formulate objectives for change at the behavioural and the social-cognitive
level based on importance and changeability; selection of theory-based methods and practical applications (step 3), which
are then integrated into the final programme (step 4).
Programme adoption and implementation is considered in step
35
5, while the programme evaluation plan is described in the last
step (step 6).
In this presentation, I will show how we applied each step of IM
for the LLL theme ‘contraception use’ and show how IM helps
in clearly structuring your programme and formulating your
programme goals. I will provide examples of different programme components that we developed as well as a tool developed for teachers to improve their use of the LLL programme.
MEET THE EXPERTS
MTE1.1
Misconception in hormone and
cancer
Anne Gompel
Universite Paris Descartes, Port Royal Cochin, Paris, France
Worldwide, women are more and more reluctant to use hormonal contraceptives. This trend has different potential factors. It is
likely that the large amount of publicity for the ‘negative’ results
from the Women health initiative study has impacted on the
women’s representation of the risks associated with an exogenous administration of sexual hormones. In addition, other potential risks such as a venous thrombotic risk of the pill have also
contributed to these fears. Among the resistance to hormonal
contraception are fears of infertility, cancer and weight gain.
These personal fears may result in poor compliance and use of
natural methods which lead to high rates of abortion. Several
studies have shown that some physicians may also be ‘vehicles’
of some misconceptions. It is thus important to increase the
information on real risks associated with hormonal contraceptives by giving absolute risks if any and communications on the
benefits on gynaecological and colon cancers. Developing tools
for the information should help to communicate on these
issues.
MTE1.2
Myths and misconceptions about
long-acting reversible methods of
contraception
Paula Baraitser
Kings College Hospital, London, Kings College London, and
Faculty of Sexual and Reproductive Health Care, London, UK
This session considers myths and misconceptions about intrauterine, injectable and subdermal contraception. It will equip
delegates to effectively challenge misconceptions in clinical and
public health practice and looks to a future where inaccurate
information no longer prevents women from choosing long-acting reversible methods of contraception.
MTE3.3
Birth control in the USSR 1917–1991
Lyubov Erofeeva
Russian Association for Population and Development, Moscow,
Russia
The recent history of Russia can be divided into three epochs,
during which significant social, economic, political and
36
demographic changes can be found: (1) traditional agrarian
society (before 1917); (2) the industrial Soviet society
(1917–1991); and (3) modern post-industrial society (1991–present). In terms of birth control, intentional abstinence, prolonged breastfeeding, interrupted intercourse, and secretly
induced miscarriage were known among the population.
Induced abortion in Tsarist Russia, as in other Soviet states, was
illegal and considered a felony and a sin.
In November 1920 was the first time the state took the decision
to legalise abortion. Under the state totalitarianism, the main
objectives were the achievement of total control over the individual and sexuality was denied. However, a legislative ban of
abortions in 1936 did not lead to the expected results: fertility
remained low and abortions were high. Doctors were carrying
out abortions illegally, but this led to increased maternal mortality and infanticide. In the 1950s, condoms were of poor quality
and women undertook a popular but terrible procedure, repeatedly inserting a 5% alcohol solution of iodine into the uterus.
The lack of proper sex education at the time was leading to serious consequences. In the 1960s and 1970s, the lowering of age
of sexual debut, and also the lack of effective contraception led
to the massive spread of unplanned pregnancies and abortions.
In the mid-60s, surveys showed that Russian women had no
idea about IUDs and hormonal preparations. During these years,
Russia was leading the world in the number of abortions –
registering 5.6 million in 1964 since it was the only easily available method of birth control. For many years the USSR Ministry
of Health continued to focus on the analysis of complications of
hormonal methods; in 1981 they issued an order ‘about combined oral contraceptives’ adverse reactions’. By the 1980s, publicity had radically changed as well as the socio-psychological
climate in the country. Sexuality became quickly polarised and
politicised. This has created a lot of acute political, ethical and
aesthetic challenges. A change of paradigm from the ‘anti-abortion’ struggle to contraception was due to the active introduction of modern contraceptives, creation of training centres and
education of doctors by pharmaceutical companies.
Thus, the processes that have taken place in other countries
over several decades have occurred in our country in a much
shorter period. In 1991, the time of the collapse of the Soviet
Union, we saw the formation of independent republics with different policies and approaches towards family planning.
GRANTED PROJECTS
GP1
Contraceptive education for disabled
people
Duarte Vilara,b,c
a
APF, Lisbon; SPSC – Portuguese Society of Clinical Sexology,
Lisbon; bAPS – Associaç~ao Portuguesa de Sociologia, Lisbon;
c
Lisbon Lusıada University, Lisbon, Portugal
Although Portugal has one of the highest levels of contraceptive use (around 90% of people in need) in the world, several
groups of the population experience difficulties in accessing
contraception and contraceptive education, due to age factors,
social exclusion, cultural barriers or intellectual, physical and
sensorial disabilities.
APF (Family Planning Association of Portugal) was born in 1967
and is the most important NGO on sexual and reproductive
health and rights in Portugal. Since then, APF has developed a
wide range of educational activities, including the production
and dissemination of educational materials such as leaflets,
posters, educational games, and contraceptive kits. APF has also
a consolidated experience on sex and contraceptive education,
directed to specific groups.
In 2014–2015, APF developed a project named ‘Contraceptive
education for Disabled People’ which had the financial support
of ESC. This project aimed to adapt some of the educational
materials of APF, a set of 12 flyers on contraceptive methods,
abortion, HPV, HIV and STI, as well a video film on ‘contraceptive methods’. The first materials were adapted to blind and
amblyopic people; the film was adapted for people with
deafness.
The project was developed in collaboration with several organisations of people with these disabilities. The project activities,
products and results will be presented.
GP2
Criteria for contraception use and
non-use and predictable factors for
safe contraception use in Latvia
Dita Baumane-Auzaa, Marija Vacietea,
Vitauts Virbicksa, Inara Pundurea, Inguna Karklinaa,
Eduards Osinsa, Reinis Osinsa, Irina Simonenkovac,
Kristina Dabolab, Erika Urtanea, Olena Fjodorovaa,
Anna Dobicinaa, Juliana Gabnea and Luiza Romana
a
Latvian Psychosomatic and Reproductive Health Development
Foundation, Riga; bSociety EKSAVI, Jekabpils, Latvia; cThe
Vidzeme University, Valmiera, Latvia
Objective: To discover the reasons why the population of
reproductive age in Latvia use safe contraception insufficiently,
taking into consideration all the possible aspects – psychological, social, religious, health, education, etc.
Design and methods: A randomised, stratified and qualitative
anonymous survey of 3102 respondents was conducted comprising of 38% males and 62% females; 54% Latvians and 46%
Russians. Some 40% were representatives from six main cities,
36% from smaller towns and 24% from rural areas of Latvia.
The respondents were also from different religious backgrounds.
The design of the study was quasi-experimental as the variables
were not affected. The study consisted of three phases: (1)
Development of theoretical background, structure and survey
items in Latvian and Russian; (2) Checking survey items through
empirical research to determine self-validity, psychometric analysis of items, adoption of the first and second level decisions
on the items to be included in the survey; (3) Implementation
of the study – testing Latvian and Russian respondents.
Results: Development of the survey was started in September
2013 by initial determination of basic factors which influence
the forming of perceptions of contraception. From July to
December, 2014, the final survey was carried out. Six basic factors were determined: (1) Awareness of contraception; (2)
Obtaining information about contraception in a family; (3)
Obtaining information about contraception at school; (4)
Communication on the contraception subject with friends; (5)
Conversations about contraception with a partner; and (6)
Attitude towards contraception in the context of religion.
Conclusions: (1) Educational information on contraception
issues that is obtained at school facilitates positive perception
of hormonal contraception and its price. Therefore, it would be
recommendable to educate about methods of hormonal contraception at schools. (2) The 18–29-year-old respondents are not
sufficiently informed about methods of hormonal contraception.
(3) Existing negative correlation between perception of prices
and hormonal contraception indicates that price for hormonal
contraception is too high. (4) Health care professionals play a
major role in the choice of contraception. Obtaining information
at the doctor influences a more negative attitude towards hormonal contraception. (5) It would be recommendable to continue the research work, in order to find out reasons of
negative attitude among doctors and patients towards hormonal contraception.
ABSTRACTS OF MEET THE EXPERTS
GP3
Stress and its influence on fertility
Carolyn Cesta
Karolinska Institute, Stockholm, Sweden
Long-term stress has been associated with a number of adverse
health outcomes, yet little is known about its effect on fertility.
Anecdotal evidence of the negative effects of emotional stress
on fertility exist in widespread stories of spontaneous conception in infertile couples after a holiday, an adoption, a successful
fertility treatment, or discontinuation of unsuccessful fertility
treatments – when the strain to continue trying to conceive has
lessened. However, basic science, clinical, and epidemiological
studies have yet to fully capture this phenomenon and provide
a clear understanding of the potential pathways through which
stress may influence the ability to conceive.
In epidemiological research, stress is assessed by a number of
different methods, including measurement of stress-related biomarkers (e.g., cortisol), self-reported stress questionnaires, or
assessment of symptoms of depression and anxiety. Infertile
women and women receiving fertility treatment have a higher
prevalence of depression and anxiety symptoms and while
some studies report that depression and anxiety symptoms are
37
associated with a decreased pregnancy rate following in vitro
fertilisation (IVF) treatment, other studies find no association
with IVF treatment outcome. However, a recent meta-analysis
suggests that psychosocial intervention for couples in fertility
treatment was effective in both reducing psychological distress
and improving clinical pregnancy rate, indicating some level of
effect of stress.
Treatment of depression and anxiety with antidepressants, specifically selective serotonin reuptake inhibitors (SSRI), has
increased both in general and among women of reproductive
age. Little is known about the effect of SSRIs on fertility and the
ability to conceive. While the up to 4% of patients undergoing
fertility treatment take SSRIs, the pregnancy rate among these
women has only been explored in a limited number of small
studies reporting inconsistent results.
Two studies and their results will be described. The first is a
prospective cohort study of women and men undergoing fertility treatment in Sweden where stress (measured through questionnaires and salivary cortisol levels) is related to IVF treatment
outcomes including the number of oocytes and embryos,
embryo quality, sperm quality, pregnancy rate, miscarriage rate,
and live birth rate. The second study utilises data from the
Swedish national registers to investigate depression and antidepressant use in women undergoing their first IVF cycle and
the association with IVF outcome including pregnancy, miscarriage, and live birth.
38
FREE COMMUNICATIONS
FC1.1
Effect on premenstrual syndrome of
oral contraception based on natural
estrogen: ZOCAL Study
~aki Lete, Esther de la Viuda,
In
Ezequiel Perez Campos, Maria Angeles Gomez,
Rainel Sanchez, Jesus Novalbos and
Rafael Sanchez Borrego
University Hospital Araba, Vitoria, Spain
Background: The most recent change in the evolution of the
pill is the use of estrogens and progestins close or identical to
endogenous hormones.
Objectives: To compare the satisfaction degree related to premenstrual syndrome (PMS) and cycle control between women
using a combined oral contraceptive (COC) with a natural estrogen (E2 or E2V) and those using barrier contraception or COCs
with ethinyl estradiol (EE) 20/30 mg.
Methods: A post-authorisation, prospective, and multicentre
study conducted in Spain among a population of 780 women
who were divided into three groups: women using condoms as
their contraceptive method and continuing with this method
(Group 1; n ¼ 72); women using condom and deciding to initiate a COC containing a natural estrogen (E2 or E2V)(Group 2;
n ¼ 224); women using a COC with EE (< 20 or > 30 mg) and
deciding to switch to a COC containing a natural estrogen
(Group 3; n ¼ 489).
PMS, intensity and duration of withdrawal bleeding, spotting,
and comfort or discomfort were evaluated with a visual analogue scale. Data were analysed with SPSS 15.0. Each participant
gave written informed consent.
Results: For PMS, Group 2 showed worse scores at baseline and
achieved a greater improvement at six months. In Group 3,
regardless of the EE dosage in the COC previously used, PMS
did not vary after switching to COCs containing a natural estrogen. For intermenstrual bleeding, more episodes were observed
at baseline in Group 3; their number was significantly reduced
after switching to natural estrogen COCs. Discomfort related to
intermenstrual bleeding greatly improved in Groups 2 and 3.
At baseline, women in Group 2 had longer periods and were
less satisfied with their periods than women in other groups.
Satisfaction was higher after switching to natural estrogen
COCs.
Conclusion: The use of COCs with natural estrogen improved
perception of PMS and increased satisfaction with cycle control.
FC1.2
Disempowerment of individuals with
mental disabilities to explore and
practice sexual and reproductive
health, a Manitoba, Canada Study
Michael Zywina and Carola Vergara
Centre for Creative Change, Community Health and Wellbeing,
Winnipeg, Manitoba, Canada
Objectives: In Manitoba, Canada, The Vulnerable Persons Living
with a Mental Disability Act – (VPA) was proclaimed in 1996.
While acknowledging basic human rights, the Act identified that
when a person with a Mental Disability was not considered capable, a Substitute Decision Maker (SDM) would be identified to
assist only where the individual was not able to make those
decisions. This ongoing study examined the level that individuals with Mental Disabilities have been restricted from independently accessing sexual and reproductive health information, the
impact this has on their ability to engage in healthy sexual practices and susceptibility to exploitation, their risk for Sexually
Transmitted Infections, and their right of parenting.
Method: Those considered Vulnerable Persons, adults who
turned 18 (Age of majority in Manitoba), since the proclamation
in 1996, were the subjects of this study. Individuals in Manitoba
are considered to be able to receive services when assessed to
have a Functional IQ (FSIQ) under the benchmark of 70, prior to
their 18th birthday. The level of support varies for each individual, as does their opportunity to make decisions, including sexual and reproductive decisions. Among the other criteria used is
the Adaptive Behaviours Assessment System II, which does not
take into consideration under Social, or Health and Safety Skills,
anything related to Sexual or Reproductive Health. The individual’s expressed desires, are often minimised, or ignored, primarily
to simplify those functioning in a supporting role (SDMs). The
study assessed the level to which Vulnerable Persons have
access to information to help them to explore and participate in
healthy sexual and reproductive practices. It also assessed who
benefits most from this application of the VPA.
Results: While still an ongoing study, early indications are that
>80%, of the adults who have turned 18, since the proclamation of the VPA do not experience opportunities to have safe,
supportive sexual and reproductive health opportunities. Most
are disempowered from the process, and then resort to unsafe,
risky, sexual behaviours, that subject them to higher risk for
Sexually Transmitted Infections, and greater susceptibility to
exploitation. Frequently, this is a result of facilitating the system’s goals and not those of the individual.
Conclusions: This study provides the opportunity to explore
and address the discrimination and disempowerment of the
most vulnerable population in Manitoba. It also provides the
opportunity to address the need to support individuals with all
available resources to make healthy sexual and reproductive
choices.
ABSTRACTS OF FREE COMMUNICATIONS
FC1.3
FC1.4
Barometer of women’s access to
modern contraceptive choice in 16
EU countries – 2nd edition
Experiences from a family planning
vouchers program in rural Pakistan –
evidence, challenges and way
forward
Marieka Vandewiele
IPPF European Network, Brussels, Belgium
Objective: To provide a policy and status overview on women’s
access to modern contraceptive choice across 16 EU countries:
Bulgaria, Cyprus, Czech Republic, Denmark, Finland, France,
Germany, Ireland, Italy, Latvia, Lithuania, The Netherlands,
Poland, Romania, Spain and Sweden
Method: Eight different policy areas and corresponding benchmarks were used to evaluate and rate the countries’ situation
with regard to access to modern contraceptive choice:
Policy making and strategy;General awareness of SRHR
and modern contraceptive choice;
Sexuality education at schools;
Education and training of health care professionals and
service providers;
Provision of individualised counselling and quality
services;
Existence of reimbursement schemes;
Prevention of discrimination;
Empowering women through access to modern contraceptive choice.
To ensure consistency with the 2013 edition, the same methodology was used for the increase from 10 to 16 countries.
National experts completed an online multiple choice questionnaire. There was a point allocation for each multiple choice
answer to enable consistent cross-country comparison of results
and a scoring system to reflect the weight and importance of
every policy measure within each policy benchmark.
Results: Less than 50% of countries examined have a comprehensive SRHR strategy focusing on fertility control and access to
modern contraceptive choice. Only three out of 16 countries in
the survey had government funded SRHR awareness campaigns.
Sexuality education is only mandatory in just over half of the
countries but it is insufficient as it lacks complete scientific
information on the full range and use of contraceptives. Only
10 countries have postgraduate programmes on individualised
counselling and less than 50% of all countries have satisfactory
training for health care professionals and service providers on
fertility control, family planning and contraceptive choice. No
country ensures full reimbursement. Policy measures fail to consider economic and social barriers to equitable access, and have
little focus on vulnerable groups. Only three out of 16 countries
include fertility control and access to modern contraceptive
choice as components of gender equality policies.
Conclusion: The research shows that very few policies have
improved since 2013, and in most countries, the situation has
stagnated, or even worsened. In the six new countries examined, women continue to face many challenges. The Barometer
pinpoints the need to substantially improve equitable access to
modern contraception through consistent, targeted policies. It
also illustrates the urgent need to re-establish reproductive
health as a priority policy on the EU and national agendas.
39
Khurram Azmat
Marie Stopes Society, Karachi, Pakistan
Pakistan has a high burden of maternal mortality. Current modern contraceptive prevalence rate of 26.1% is unacceptably low
and is lowest among the poorest segment of the population. A
staggering 20% of the currently married women have an unmet
need for family planning (FP). Marie Stopes Pakistan funded by
Packard Foundation implemented a programme to increase
access to long acting reversible contraception (LARC) and test
the effectiveness of free single-purpose vouchers for FP services
using a Social Franchising approach in rural Pakistan.
Methodology: A quasi-experimental study with a before-andafter design with control was implemented from 2012 to 2014.
This study aimed to test a demand-side financing approach,
using vouchers to improve FP uptake through private sector
health providers. The approach was supported by a dedicated
field health educator through the social franchise model and
which examined the ability to provide FP services to approximately a quarter of a million women in experimental district.
Although the voucher is intended to increase access to intrauterine device (IUD) and implants, it is also redeemable for
short-term methods, to ensure wider FP choice. A cross-sectional baseline survey preceded implementation which showed
low contraceptive use and high unmet need in the targeted
community and groups. The end-line data survey collection has
been completed (sample size of base and end-line were kept
the same 5000 women) and upcoming analysis will estimate
the contribution of the programme in reducing unmet FP need
by better targeting, and increasing access to information, products and services to contraceptives.
Results: Between 2012 and 2014, almost 176,000 women were
reached through Field Health Educators and a total of 23,000
free vouchers were distributed for short- and long-term FP
methods. Approximately 84% of the vouchers were redeemed
from the total distributed. Of those redeemed, more than 90%
were redeemed in the rural areas and 78% were redeemed in
the urban areas through project health services providers. More
than 91% of the voucher clients belonged to the two lowest
quintiles. The most preferred method cited was LARC – (provision of 13,000 IUDs and 2000 implants). A cumulative 97% of
clients who received services through the vouchers reported
high levels of satisfaction. Result also noted that utilisation of FP
services increased, targeting for the poor women were better
and quality of services also improved.
Conclusion: This programme demonstrates that FP vouchers
can substantially expand FP access, utilisation and choice for
the most underserved populations.
FC1.5
Impact on quality of life of oral
contraception based on natural
estrogen: ZOCAL Study
~aki Lete, Esther de la Viuda,
In
Ezequiel Perez Campos, Marıa Angeles
Gomez,
Rainel Sanchez, Jesus Novalbos and
Borrego Rafael Sanchez
University Hospital Araba, Vitoria, Spain
40
The most recent change in the evolution of the pill is the use
of estrogens and progestins close or identical to endogenous
hormones.
Objective: The ZOCAL Study was designed to evaluate the
impact on quality of life (QoL) of combined oral contraceptives
(COCs) containing a natural estrogen, compared with barrier
contraception and with COCs containing ethinyl estradiol (EE).
Methods: A post-authorisation, prospective, and multicentre
study was conducted in Spain among a population of 780
women that was divided into three groups: women using condoms as their contraceptive method and continuing with this
method (Group 1; n ¼ 72); women using condoms and deciding
to initiate a COC containing natural estrogen (Group 2; n ¼ 224);
women using a COC with EE and deciding to switch to a COC
containing natural estrogen (Group 3; n ¼ 489). Among the 653
patients who received COCs with natural estrogen, 646 (98.9%)
used a monophasic 24/4 combination of estradiol and nomegestrol acetate (ZoelyV) and 7 (1.1%) a multiphasic 26/2 combination of estradiol valerate and dienogest (QlairaV).
Patients completed the QoL scale SEC-QOL (the only validated
questionnaire for women using contraceptive methods), and
satisfaction degree at baseline and at six months. Data were
analysed with SPSS 15.0. Each participant gave written informed
consent.
Results: The persistence with COCs containing natural estrogen
at six months was 91.4%. At baseline, women in Group 2 had a
worse QoL, both globally and for each dimension. In groups 2
and 3, an increase in QoL was observed six months after switching to natural estrogen COCs. Improvement was significantly
greater in Group 2.
Conclusion: COCs with natural estrogen were well tolerated
and significantly improved the patient QoL, especially in previous condom users.
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relationship. On the other hand, there are also girls who had a
difficult start in life, but who do manage to stay out of trouble,
until their contraception fails. From all these life stories we have
analysed six different scenarios.
Another finding is that abortion is nowadays a strong taboo.
Many girls who discover their pregnancy find abortion ‘not an
option’. In addition girls who did undergo abortion are confronted with hostile reactions from peers and family. This negative verdict makes abortion less accessible for girls. The choice
to continue the pregnancy is not a choice to become mother,
but the absence of an intervention.
Conclusions: The research delivered new findings for the development of effective prevention of teenage pregnancies. In the
life courses prior to the pregnancy, patterns of risk factors can
be identified. Because the life stories of the girls differ on a
number of points substantially, it is important to take the different scenarios as starting points for prevention, in order to
address the diversity within the group.
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FC1.7
Developing strategies to address
contraceptive needs of adolescents:
exploring patterns of use among
sexually active adolescents in 45
low- and middle-income countries
€
Amanda Kalamar, Ozge
Tunçalp and
Michelle Hindin
World Health Organization, Geneva, Switzerland
FC1.6
Growing up in one fell swoop: life
course scenarios leading to teenage
pregnancies
Marianne Cense and Eline Dalmijn
Rutgers, Utrecht, The Netherlands
Objectives:
Gain insight in the risk factors leading to the teenage
pregnancy
Gain insight in the diversity in the life stories and the
different scenario’s behind teenage pregnancies
Method: Qualitative research conducting narrative interviews
with 46 girls who have been pregnant before the age of 20.
The interviews included the drawing of a lifeline, in order to
explore their life course and meaningful events.
Results: In the life stories of the majority of the interviewed
girls the lack of stability and the insecurity at home are main
risk factors. Conflicts, divorced parents, domestic violence, addictions and mental problems of the parents lead to loneliness
and low self-esteem. Shocking events in their childhood like
being bullied for a long time reduce their resilience. This leads
to a greater reliance on boyfriends and an earlier sexual debut
than average. Many relationships with boyfriends are characterized by inequality and physical, emotional or sexual violence.
Next phase is that birth control fails. General practitioners prescribe the pill without considering whether this is the appropriate means for these girls. Many girls do not use it properly and
some have a low risk perception.
At the same time, there are also girls with another life story.
Who grow up in a loving family, but during puberty things go
wrong. They get mental problems or get involved in an unequal
Background: Each year, 16 million girls aged between 15 and
19 years old and 2 million girls under 15 years of age give birth,
and it is estimated that a lack of access to contraception leads
to 7.4 million unintended pregnancies among adolescents.
Unintended pregnancies resulted in an estimated 3.2 million
unsafe abortions worldwide in 2008, and complications related
to pregnancy and childbirth are the leading cause of death for
women aged 15–19. Fertility decisions made during adolescence have a life-long impact. Increasing attention to preventing unwanted pregnancies in this population has led to an
interest in contraceptive use.
Objective: To identify strategies to promote adolescent knowledge and choices of more effective contraception based on
their past and current profiles of use.
Methods: Using data from Demographic and Health Surveys in
45 countries, we estimate the weighted prevalence of contraceptive use among 15–19-year-olds at the time of the DHS survey, limiting the analytic sample to non-pregnant adolescent
girls who reported ever having sexual intercourse or being currently/ever married or in a union. We use random effects metaanalysis to provide summary measures of contraceptive use
across the 45 countries.
Results: We identified five categories of use among sexually
active adolescents: never users, past users, current users of a
traditional method, current users of a modern short-term
method, and current users of a longer-acting reversible method.
The majority of sexually active adolescents (61%) have never
used a contraceptive method, 15% previously used a method
but stopped, 4% rely on traditional methods, 12% are using
effective methods, and 6% are using long-acting reversible
methods. These summary measures mask the heterogeneity of
adolescents-married vs. unmarried, sexually active in the past
but not currently – and the cultural norms and preferences
within and between the 45 countries.
Conclusions: As global efforts, such as FP2020 and others, focus
on adolescents’ needs for contraception, our data suggest that
there is no ‘one-size fits all’ strategy to address the needs of
adolescents. Where never use is high, strategies to address reasons for non-use are paramount. Where many ever users exist,
identifying reasons for discontinuation among this population
can help to transition these adolescents back to current users.
Service providers, working within supportive health systems,
who are well-trained to work with adolescents, to counsel on
effective methods, and in IUD and implant insertion and
removal are needed to help make the shift from least effective
methods to most effective methods.
FC2.1
Lowering the dose of the injectable
contraceptive DMPA
Vera Halpern, Laneta Dorflinger, Doug Taylor and
Anja Lendvay
FHI 360, Durham, NC, USA
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Objectives: Depo-ProveraV Contraceptive Injection (DepoProvera CI) and its subcutaneous formulation depo-subQ provera 104V (Depo-subQ 104), both also known as depot medroxyprogesterone acetate (DMPA), provide contraceptive protection
for three months and are the most popular injectable contraceptives worldwide. The broad use of DMPA is due to its relatively long duration of action, high effectiveness, and ease of
administration, as well as its non-contraceptive health benefits,
including prevention of endometrial cancer and reduced risk of
anemia. Many side-effects of DMPA, including metabolic effects
and effect on bones, may be dose-dependent. Therefore, lowering the dose of DMPA is important to improve its safety profile.
Methods: Developing a lower-dose DMPA contraceptive is a
key component of the FHI 360’s Contraceptive Technology
Innovation (CTI) product development portfolio. Here we present current CTI research activities that further the lower-dose
DMPA agenda.
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An
ongoing
Phase
I
randomised
trial
‘Pharmacodynamics (Suppression of Ovulation) and
Pharmacokinetics Following a Single Subcutaneous
Administration of Depo ProveraV CI 150 mg/mL, Depo
ProveraV CI 300 mg/2mL, or Two Cycles of Depo-subQ
Provera 104V’ is evaluating the potential of the existing
3-month Depo-Provera CI to provide contraceptive protection for six months if injected subcutaneously. The
first interim analysis is scheduled for mid-2016.
A planned Phase I randomised trial ‘A Study to
Evaluate Pharmacodynamics and Pharmacokinetics
Following a Single Subcutaneous Administration of 50
mg, 75 mg and 100 mg of Depo ProveraV CI, or During
One Cycle of Depo subQ Provera 104V’ is designed to
determine how long ovulation is suppressed in each
dose group of Depo Provera CI when injected subcutaneously. The overall goal is to select the lowest dose
that provides three or more months of contraceptive
protection and pursue a pivotal contraceptive effectiveness trial with the identified dose. Initiation of the
Phase 1 PK/PD study is planned for mid-2016.An
ongoing project to develop a new six-month DMPA
contraceptive injectable (in collaboration with a
pharmaceutical partner). Initiation of a Phase 1 dosefinding study is planned for mid-2016.
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Conclusions: DMPA has been a cornerstone of family planning
programs for decades. The aforementioned research activities
are key to improve safety, increase acceptability and potentially
reduce the cost of DMPA. Lowering the dose of DMPA will have
important positive health implications for millions of women
worldwide.
41
FC2.2
Comparison between side-effects of
one rod and two rod implants:
results from a multicentre
randomized clinical trial for women,
Jadelle and Implanon
Ndema Habib and Sihem Landoulsi
World Health Organization, Geneva, Switzerland
Background: Contraceptive implants are increasingly popular in
the world. Implanon (ENG) is a single-rod, non-biodegradable
implantable contraceptive (68 mg etonogestrel), providing
contraceptive protection for up to three years. Jadelle (LNG) (75
mg levonorgestrel) rods and provides protection up to five
years. The safety and efficacy of a single-rod versus two rods
implantable contraceptives were investigated in a multicentre
clinical trial.
Objectives: The main objectives were to compare the threeand five-year cumulative rates of contraceptive effectiveness,
method continuation, the incidence of common complaints
associated with use of progestogen-only contraception and that
of the non- hormonal TCu380A IUD.
Methodology: This was an open parallel group RCT with 1:1
allocation ratio of the ENG- and the LNG-releasing implant and
a non-randomised age-matched group of women choosing
TCu380A intrauterine device (IUD). The women admitted to the
study were scheduled for follow-up visits at two weeks after
device(s) placement, at three and six months, and semi-annually
thereafter for three years or until pregnancy occurs, removal or
expulsion of the implant/IUD, whatever occurred first. The study
took place in family planning clinics in Brazil, Chile, Dominican
Republic, Hungary, Thailand, Turkey and Zimbabwe. A total of
2963 women were randomised to three arms and results from
995 etonogestrel implant users, 997 levonorgestrel implant
users, and 971 IUD users were analysed.
Results: Main reasons for implant removal were similar, albeit
bleeding disturbances was the most frequent reason for discontinuation of use among both implant users, reaching threeyear cumulative rates of 16.7 (95% CI 14.4–19.3) per 100 and
12.5 (95% CI 10.5–14.9) per 100 for ENG- and LNG- implants,
respectively. Three-year cumulative discontinuation rates for
personal reasons were similar. Headache and dizziness were
the most frequently reported complaints but were reported
similarly among implant and IUD users. Acne, amenorrhoea,
irregular or prolonged bleeding were more frequently reported
by implant-users than IUD-users, while heavy bleeding and
lower abdominal pain occurred more often among IUD- than
implant-users.
Conclusion: The results show that both implants are safe and
highly effective. The result also discusses the reason for discontinuation, main side-effects of implants versus IUD and
implications of the results on policy and practice. Findings of
the study can inform policy makers and clinicians about choice
of implant, but also about TCu380A IUD in relation to
implants.
42
FC2.3
FC2.4
Determinants of STIs/AIDS and viral
hepatitis knowledge, attitudes and
practices among Brazilian youth
(aged 18–29 years)
Unicirc – a new instrument for
performing minimally-invasive
voluntary male medical circumcision
in the prevention of HIV/AIDS: metaanalysis of three studies
Miguel Fontesa, Rodrigo Crivelaroa, Alice Scartezinib,
David Limac and Alexandre Garciad
a
b
John Snow, Brasilia, Federal District, Brazil; Instituto Social Caixa
Seguradora, Brasilia, Federal District, Brazil; cUniversidade de
Brasılia (UnB), Brasilia, Federal District, Brazil; dOpin~ao
Consultoria, Brasilia, Federal District, Brazil
Objective: The objective of this study is to evaluate the level of
vulnerability of Brazilian youth for STDs/HIV-AIDS and Viral
Hepatitis. The study was approved by the Ethics Committee of
the Medicine Faculty of the University of Brasilia, and it received
support from the Panamerican Health Organization and the
Department of STD/HIV-AIDS and Viral Hepatitis of the Ministry
of Health.
Method: A total of 1208 youth aged 18–29 in 15 states and the
Federal District were interviewed. The margin of error of
research regional and nationally adjusted was 2.8%. A scale
with 35 questions (35 to þ35 points) regarding knowledge,
attitudes and practices related to STDs/HIV-AIDS and Viral
Hepatitis was used as main dependent variable. Adjusted linear
regression models identified the demographic and social determinant factors that explain scale variations. The scale has also
reached a satisfactory level of consistency (Alpha-Cronbach:
0.689).
Results: The mean score of KAP for HIV/AIDS, STIs and Viral
Hepatitis among Brazilian youth is þ14.03 points (95% CI). Even
though 40% of Brazilian youth still distrust condoms as an
effective method to prevent from STIs, 36% have not used condoms in last sexual intercourse, and 9.4% have visited a health
post during past 12 months to access information and treatment for STIs, only 13,6% believe they are at high-risk of STIs.
Sociodemographic factors associated to scale variations include:
gender, race, education and civil status. The level of knowledge,
attitudes and practices regarding HIV/AIDS, STIs and Viral
Hepatitis is significantly lower (p-value < 0.05) for men, nonwhite, low-educated, and married youth. Social determinants
associated to scale variations, controlling for socio-demographic
variables include: frequency of discussions about sexuality with
parents and health professionals, alcohol consumption, leisure
and being part of a social movement organization, access to
the internet, interest in learning, and having the father and/or
teacher as a personal reference.
Conclusions: Brazilian youth are vulnerable to the transmission
of STIs/HIV AIDS and viral hepatitis. Public policies are required
to promote the engagement of parents, health professionals
and teachers in issues related to sexuality. Even though these
sources of sexual education were significantly associated to
higher levels of KAP for HIVAIDS and viral hepatitis, their level
of exposure is still low compared to friends and internet. In addition, programs targeted at young males are important to
reduce their vulnerability to STIs/HIV-AIDS and viral hepatitis.
Traditional cultural norms, such as machismo, should be questioned and gender equality should be promoted.
Norman Goldstucka and Peter Millardb
a
University of New England, Portland, Maine, USA; bDepartment
of Obstetrics and Gynaecology, Faculty of Medicine and Health
Sciences, Stellenbosch University and Tygerberg Hospital, Cape
Town, Western Cape, South Africa
Objective: To evaluate Unicirc, a new instrument for performing
circumcisions, in terms of operative ease, tolerability and sideeffects, complications and cosmetic appearance, compared to a
surgical comparison group.
Methods: This is a participant-level meta-analysis of three studies of a second-generation Unicirc device. The studies consist of
two controlled studies versus standard surgical circumcision,
and one open evaluation. Either conventional local anaesthetic
or topical anaesthetic (Emla# cream) was used. Surgical circumcisions used either forceps-guided or dorsal slit techniques. The
RCT compared 50 Unicirc to 25 surgical circumcision, the quasiexperimental study compared 50 Unicirc to 50 surgical, and the
open evaluation consisted of 110 subjects. Statistical analysis
was performed on the technical aspects of the procedures as
well as on the complications and cosmetic appearances at the
end of the procedure.
Results: A total of 210 Unicirc circumcisions and 75 surgical circumcisions were performed. None of the Unicirc procedures
required intraoperative suturing. The median blood loss for the
Unicirc circumcisions was 1.5 ml vs. surgical 5.5 ml (p < 0.001).
The median operative time for the Unicirc was 9.7 min vs. surgical 22.6 min (p < 0.001). 7 (3.3%) Unicircs had post-operative
bleeding which required suturing and 2 (2.7%) of the surgical
(p ¼ NS). There were more minor (< 2 cm) wound disruptions in
the Unicirc participants [21 (10%) vs. 2 (2.7%)] (p ¼ 0.05), but
overall healing was superior at four weeks after Unicirc circumcision [182 (86.7%) vs. 49 (65.3%)] (p < 0.001). The cosmetic
appearance was superior in the Unicirc group (regular scar line
91.0% vs. 29.3%) (p < 0.001).
Conclusions: The Unicirc is a rapid and efficient method of performing Voluntary Male Medical Circumcision as an adjunct to
the prevention of HIV/AIDS. It is faster to perform, produces less
blood loss and post-operative infection, and has a better final
cosmetic appearance, compared to surgical circumcision.
FC2.5
Uptake of sub-dermal contraceptive
implant in the immediate postpartum
period at the Moi teaching and
referral hospital, Eldoret Kenya
Richard Mogeni, Emily Mwaliko and Philip Tonui
Moi University, Eldoret, Kenya
Objectives: To determine the proportion of women who adopt
subdermal contraceptive implant and the factors that influence
its uptake in the immediate postpartum period at Moi Teaching
and Referral Hospital (MTRH).
Methods: Descriptive cross-sectional study conducted among
postpartum women at Moi Teaching and Hospital labour-wards.
Eligible women were systematically sampled. Every fourth postpartum woman, four per day recruited till the sample reached,
between January and April 2014. Data was collected from 353
respondents using pre-tested structured interviewer administered questionnaires and analysis done using STATA version 12
SE. Chi and t-test were used to test for association among variables. Logistic regression at 5% level was used to determine the
relationship between variables and uptake of contraceptive
implant.
Results: The mean age of respondents was 27(SD: 5) years, 325
(92.1%) were Christians, 152 (43.1%) had attained secondary
level of education, 102 (29.2%) trading as their main source of
income, 261 (73.9%) married and 31 (8.8%) were HIV positive
while 124 (35%) had a desired family size. A total of 156
(44.6%) took up contraceptive implant. Christians (p ¼ 0.005),
older women (p ¼ 0.036), those who had reached their fertility
desires (p ¼ 0.003), those whose current pregnancy was planned
(p ¼ 0.027), those who had used sub dermal contraceptive
implant before (p < 0.001) and those who were HIV positive
(p ¼ 0.001) were more likely to use contraceptive implant.
Conclusion: The uptake of contraceptive implant was high
(44.6%) compared to previous Kenyan-based community survey
data in which the uptake was 1.3%.This finding was similar to
another study done in the country. Christianity, older age,
achieved fertility desire, previous use, HIV positivity and planned
birth influenced uptake. Offerig contraceptive implant in the
immediate postpartum period may assist in widening access to
contraception hence increasing uptake.
FC2.6
Hormonal contraception and
depression: a prospective cohort
study
Charlotte W. Skovlunda, Lina Steinrud Mørcha,
Lars Vedel Kessingb and Øjvind Lidegaarda
a
Rigshospitalet, University of Copenhagen, Copenhagen,
Denmark; bRigshospitalet, University of Copenhagen,
Copenhagen, Denmark
Objectives: Female sex hormones exert an influence on women’s mood. Our aim was to quantify the influence of different
types of hormonal contraception on the risk of depression.
Methods: In a prospective study all women living in Denmark
aged 15–34 years without previous depression were followed
during 2000–2013. The National Prescription Registry provided
individually updated exposure information on use of hormonal
contraception and subsequent first prescription of antidepressants. The Psychiatric Central Research Registry provided primary discharge diagnoses of depression. Among women
starting hormonal contraception, Poisson regression was used
to calculate adjusted incidence rate ratios of depression one
year after initiation as compared with incidence rates of depression before initiation. Incidence rate ratios of depression were
also calculated among prevalent users with non-users of hormonal contraception as reference.
Results: The included 1.1 million women contributed 6.9 million
persons-years, with 55.5% on current or recent use of hormonal
contraception. Compared with before use, starters of combined
oral contraceptives experienced within the first year with levonorgestrel a rate ratio of a first use of antidepressants of 1.4
(95% CI 1.2–1.5), with norgestimate 1.5 (1.3–1.6); desogestrel 2.3
(2.0–2.6); drospirenone 1.7 (1.5–1.8); patch 2.7 (1.9–3.7); vaginal
ring 1.7 (1.4–2.2); progestogen-only pills with norethisterone 1.4
(1.1–1.8), with desogestrel 1.5 (1.2–1.9); implant 2.3 (1.8–2.9);
and with levonorgestrel intrauterine system 1.4 (1.0–1.8). For
depression diagnoses slightly higher estimates were found. The
rate ratio of depression with hormonal contraceptive use
decreased with increasing age. Among prevalent users the risk
estimates of antidepressant use were slightly lower and of a
depression diagnosis substantially lower as compared with starters of hormonal contraception.
43
Conclusion: Users of hormonal contraception have an increased
risk of depression irrespective of type of hormonal contraception used.
FC2.7
The WHO USAID UNFPA Family
Planning Training Resource Package
– a new online resource for training
materials
Mario Philip Festin
Objective: The Family Planning Training Resource Package
(FPTRP) is an online resource for institutions and individuals
who are interested in developing or using materials for training
on family planning or contraception. It is intended to provide a
standardised, regularly updated and evidence-based resource
for FP materials.
Methods: There are many modules available, either on the various contraceptive methods, or on supplementary materials on
providing family planning methods, such as the use of the
WHO Medical Eligibility Criteria and other guidelines,
Counselling on Family Planning, and the Benefits of Family
Planning. Each module includes a session plan, a facilitator’s
guide, annotated powerpoint slide sets, evaluation tools and
checklists, role play and discussion guides, handouts, and references (with online links). The training materials could be
adapted depending on the desired competencies of the trainees (physician, nurse, midwife, lay health provider, student, etc.),
time available, and others.
Results and conclusions: The FPTRP has been used in various
workshops in many countries, either as a complete workshop
on most methods, or on a specific method. Aside from the
English versions, the main training materials are available in
French, and soon will be in other languages. The website is
found at fptraining.org.
FC3.1
Efficacy and safety of an injectable
combination hormonal contraceptive
for men
Hermann Behrea, Michael Zitzmannb,
Richard Andersonc, David Handelsmand,
Silvia Lestarie, Robert McLachlanf,
M. Cristina Meriggiolag, Man Mohan Misroh,
Gabriela Noei, Frederick Wuj, Mario Philip Festinm,
Ndema Habibm, Kirsten Vogelsongk,
Marianne Callahanl, Kim Lintonl and Doug Colvardl
a
Martin Luther University, Halle Wittenberg, Germany; bUniversity
of Munster, Munster, Germany; cUniversity of Edinburgh,
Edinburgh, UK; dUniversity of Sydney, Sydney, Australia;
e
University of Indonesia, Jakarta, Indonesia; fMonash Medical
Center, Melbourne, Australia; gUniversity of Bologna, Bologna,
Italy; hNational Institute of Health and Family Welfare, New Delhi,
India; iInstituto Chileno de Medicina Reproductiva, Santiago,
Chile; jManchester Royal Infirmary, Manchester, UK; kBill &
Melinda Gates Foundation, Seattle, WA, USA; lCONRAD, Arlington,
VA, USA; mWorld Health Organization, Geneva, Switzerland
Objective: The development of an effective, reversible, safe,
and acceptable hormonal method for male contraception by
44
co-administration of progestogen and testosterone.
Methods: A prospective multicentre study was performed to
address the following primary objectives: (1) The rate of suppression of spermatogenesis below the threshold criterion for
contraception of sperm concentration 1 million/ml induced by
a regimen of intramuscular injections of the progestogen norethisterone enantate combined with the androgen testosterone
undecanoate, administered every eight weeks up to four times;
and (2) the level of contraceptive protection during an efficacy
period of up to 56 weeks with continued eight-weekly injections. Secondary objectives included reversibility, safety, and
acceptability of the regimen. This was in 10 study centres in
seven countries and four continents. Healthy men, aged 18–45
years, and their 18–38-year-old female partners, both without
known fertility problems and in stable, monogamous relationships, along with a coital frequency of twice/week on average,
were included.
Results: Of the 320 participants who received at least one injection, 95.9 of 100 continuing users (95% CI 92.8–97.9) suppressed
to a sperm concentration 1 million/ml within 24 weeks
(Kaplan-Meier method). During the efficacy phase of up to 56
weeks, four pregnancies occurred among the partners of the
266 male participants, with the rate of 1.57 per 100 continuing
users (95% CI 0.59–4.14). The cumulative reversibility of suppression of spermatogenesis after 52 weeks of recovery was 94.8
per 100 continuing users (95% CI 91.5–97.1). The most common
adverse events were acne, injection site pain, increased libido,
and mood disorders. Following the recommendation of an
external safety review committee the recruitment and hormone
injections were terminated before the planned end of the trial.
Conclusions: The study regimen led to a near-complete and
reversible suppression of spermatogenesis. The contraceptive
efficacy was relatively good compared to other reversible methods available for men. While most adverse study events were as
expected, the frequencies of mood disorders were relatively
high.
FC3.2
Levonorgestrel Intrauterine System
(LNGIUS) continuation in adolescents
and adult women
Joy Beissel, Kathy MacLaughlin, Vicki Jacobsen and
Petra Casey
Mayo Clinic, Rochester, Minnesota, USA
Background and Objectives: Half of pregnancies in U.S.
women are unintended and therefore, effective and acceptable
contraception is needed across age groups. The Contraceptive
CHOICE project showed that when cost was removed, two
thirds of women aged 14–45 years chose long-acting reversible
contraception (LARC). Recent studies have found no difference
in rates of early LNGIUS discontinuation in adolescents vs. adult
women, but are limited by less than five years of follow-up. We
investigated the effect of age on removal rates, and reasons for
removal in first time LNGIUS users over a five year length of
use. Associations between postpartum and breastfeeding status
and removal rates were also assessed.
Methods: Retrospective review included 1062 women, who
were 15–44 years old at LNGIUS insertion during the interval of
interest 2006–2009. Primary outcome was time to LNGIUS
removal for side-effects (SEs) in adolescents (aged 15–21 years)
and adult women (aged 22–44 years). Secondary outcomes
included reported SEs, post LNGIUS contraception, associations
removal with postpartum and breastfeeding. Rates ‘without
removal for SEs’ were evaluated using the Kaplan Meier
method. Comparisons of baseline features, reasons for removal
and contraception after removal utilised the Wilcoxon rank sum,
chi square and Fisher exact tests. Associations with time to
removal for SEs used Cox models.
Results: Of 1062 eligible women who chose LNGIUS for contraception, 79% (838) had a follow-up. Of those 838, 24.7%
requested removal for SEs during the study interval. Overall,
35% of adolescents and 23.9% of adult women had LNGIUS
removed early for SEs. Each one-year increase in age was associated with a 3% decrease in removal risk for SEs (HR 0.97,
p ¼ 0.004). Adolescents were 69% more likely to request
removal for SEs (HR 1.69; p ¼ 0.02), and choose less reliable
alternative contraception (p ¼ 0.001).We did not find significant
association between postpartum or breastfeeding status, or in
rates without removal of LNGIUS for SEs.
Conclusions: In our study, adolescents had early LNGIUS
removal for SEs more frequently than adult women, though the
method was overall well accepted. Understanding of removal
patterns and patient expectations is crucial in guiding contraceptive counselling. Age specific counselling prior to LNGIUS
insertion may help define expectations and improve method
satisfaction. LNGIUS was equally well accepted in postpartum
and breastfeeding women in both age groups.
FC3.3
A cluster analysis of bleeding/
spotting patterns in women using a
novel 24/4 regimen of Drospirenone
4 mg as a progestin only oral
contraceptive
David Archera and Enrico Collib
a
Department of Obstetrics and Gynecology at Eastern Virginia
Medical School, Norfolk, Virginia, USA; bExeltis Healthcare SL,
Madrid, Spain
Objectives: Progestin-only hormonal contraceptives are estrogen free and have an excellent safety profile. The incidence of
unscheduled endometrial bleeding associated with progestinonly contraception remains a significant barrier to their widespread use. A novel Drospirenone 4 mg (DRSP) only regimen of
24/4 days per month has been developed to improve consumer
acceptability and compliance. A further analysis of our complete
clinical protocol study 301 was performed to identify patterns
and acceptability of unscheduled bleeding/spotting.
Methods: The 301 clinical trial included 713 healthy sexually
active women who were at risk for pregnancy. The data set had
information on demographic and gynaecological and medical
history with laboratory and vital signs assessments, prior/concomitant medications/contraceptive use and daily bleeding and
spotting information that was obtained during the clinical trial.
A total of 74 baseline (BL) and 77 performance (PERF) parameters were selected to characterise the participants at baseline
and the effect of the treatment, respectively. The variables were
organised by type: for example, 16 BL variables were related to
patient and demographic characteristics and 15 PERF variables
were related to change in vital signs during the study.
Three bleeding related endpoints were captured: total number
of bleeding/spotting days per cycle, total number of scheduled
bleeding/spotting days per cycle and total number of unscheduled bleeding/spotting days per cycle.
Hierarchical clustering analysis was performed for each participant and correlations were sought between these parameters
and the total number of scheduled bleeding/spotting days per
cycle and the total number of unscheduled bleeding/spotting
days per cycle.
Results: Four cluster patterns were identified based on bleeding
information obtained from cycles 2 to 13. Cluster 1 Optimal
Bleeding Pattern – Baseline parameters not sufficient for characterization. Cluster 2 Frequent Unscheduled bleeding/spotting –
High level of education, < 20 years of age, smokers. Cluster 3
Slight to no Bleeding or spotting – Higher BMI, higher blood
pressure, higher cholesterol levels. Cluster 4 Very unfavorable
Bleeding/spotting – Prior heavy menstrual bleeding (association
is not very strong due to small sample size). More than 85% of
the participants fell in clusters 1, 2 and 3, which correlated with
treatment acceptability rated as excellent or good by more than
85% of them.
Conclusion: The results of this innovative analysis identified
women with high BMI, blood pressure and higher cholesterol
levels as having the best unscheduled bleeding/spotting profile.
The reasons for this new finding are unknown at this time.
45
FC3.5
Pornography consumption among
adolescent girls in Sweden
Magdalena Matteboa, Tanja Tydena,
€m-Nordinb, Kent W Nilssona and
Elisabet H€aggstro
Margareta Larssona
a
Uppsala University, Uppsala, Sweden; bM€alardalen University,
V€asterås, Sweden
FC3.4
Pharmacokinetics of levonorgestrel
and ulipristal acetate emergency
contraception in women with normal
and obese body mass index
Piyapa Praditpan, Anne Davis and Carolyn Westhoff
Columbia University Medical Center, New York, New York, USA
Objectives: The proportion of unintended pregnancies in the
United States has remained relatively unchanged despite
increased availability and use of different types of emergency
contraception (EC) pills. Reanalysis of data from levonorgestrel
(LNG) and ulipristal acetate (UPA) EC efficacy studies conducted
in the US, UK and Ireland have suggested a relationship
between increasing body mass index (BMI) and EC pill failure,
especially LNG EC failure. Gemzell-Danielsson, Kardos and von
Hertzen recently reanalysed World Health Organization (WHO)
LNG EC efficacy studies and found no relationship between BMI
and LNG EC failure. Whether a mechanism for any observed differences in LNG EC metabolism by BMI exists is unknown. Our
primary objectives are to describe and compare the pharmacokinetic (PK) profiles of LNG EC and UPA EC between women
with normal and obese BMI.
Methods: This is a pharmacokinetic study of women of reproductive age who were given single doses of an FDA-approved
LNG EC pill and UPA EC pill. Women were admitted to the university clinical research unit and received a 1.5 mg dose of LNG
EC or a 30 mg dose of UPA EC during two separate 24-h admissions. Study staff collected fourteen blood specimens (0, 0.5, 1.0,
1.5, 2, 3, 4, 6, 8, 10, 12, 16, 24, 48 h).
Results: We enrolled 34 healthy women into this study (18 normal BMI, 16 obese BMI). We recruited two more subjects than
originally planned because one participant had poor venous
access at the time of her first admission, making collection of
blood specimens difficult, while a second participant withdrew
consent after her first admission. The majority of participants
self-identified as Hispanic (59%), followed by White (23%),
African American (12%) and Asian (6%). Women’s mean age
was 30 (range 19–45), mean normal BMI was 22.0 (range
18.8–24.6) and mean obese BMI was 34.3 (range 30.6–39.9). Lab
analyses are currently underway. We are measuring serum concentrations of LNG and UPA to calculate the following PK
parameters of interest: area under the curve of concentration
versus time (AUC0-24 h and AUC0-1), peak concentration
(Cmax), time to peak concentration (Tmax), elimination half-life
(t1/2), volume of distribution (Vd) and clearance (CL). We will
use t-tests to compare LNG and UPA serum levels in women
with normal BMI and obese women. We anticipate data analysis
to be complete by March 2015.
Conclusion: Pending data analysis.
Objectives: The aims were to describe patterns of pornography
consumption, investigate differences between consumers and
non-consumers of pornography regarding sexual experiences,
health and lifestyles, and determine associations between pornography consumption and sexual experiences, health and lifestyles among adolescent girls. The hypothesis was that
adolescent girls categorised as pornography consumers
reported sexual experiences, a riskier lifestyle and poorer health
compared with non-consumers.
Methods: This study had a descriptive, comparative cross-sectional design performed in classroom environment. A classroom
survey was conducted among 16-year-old girls in the first year
of high school (N ¼ 400).
Results: Roughly one-third (29%) consumed pornography and
in this group a higher proportion reported over all sexual experiences to a higher extent compared with peers. In the group of
pornography consumers 30% reported experience of anal sex
compared with 15% among non-consuming peers (p ¼ 0.001).
Furthermore, peer-relationship problems (17% vs. 9%,
p ¼ 0.015), use of alcohol (86% vs. 70%, p ¼ 0.001) and daily
smoking (28% vs. 15%, p ¼ 0.002) were reported to a higher
extent among consumers compared with non-consuming peers.
Pornography consumption, use of alcohol and daily smoking
were predictors for having experienced casual sex (one-night
stands, sex with friends, group sex) indicating that adolescents
who consume pornography may be sexually interested and
active to a greater extent and report experience of a riskier lifestyle compared with their non-consuming peers.
Conclusions: Pornography consumption may influence the
sexualisation and lifestyles among pornography-consuming girls.
This is important to acknowledge when designing and implementing sexual health programmes among adolescents.
FC3.6
A prospective, open-label, single arm,
multicentre study to evaluate
efficacy, safety and acceptability of
the pericoital oral contraception
using levonorgestrel 1.5 mg
Mario Philip Festina, Luis Bahamondesb,
Thi My Huong Nguyena, Ndema Habiba,
Manopchai Thamkhanthoc, Kuldip Singhd,
Arundhati Gosavid, Gyorgy Bartfaie, Tamas Bitoe,
M. Valeria Bahamondesb and Nathalie Kappf
a
World Health Organisation, Geneva, Switzerland; bUniversity of
Campinas, Campinas, Brazil, cMahidol University, Bangkok,
Thailand; dNational University Hospital, Singapore, Singapore;
e
University of Szeged, Szeged, Hungary; fIndependent Consultant,
Geneva, Switzerland
Objective: Levonorgestrel (LNG) 1.5 mg is an effective emergency contraception following unprotected intercourse. Some
users take it repeatedly, as their means of regular contraception.
This study will determine whether the use of levonorgestrel
46
(LNG) 1.5 mg taken at each day of coitus by women who have
relatively infrequent sex be an efficacious, safe and acceptable
contraceptive method
Methods: A total of 330 healthy fertile women at risk of pregnancy who reported sexual intercourse up to six days a month,
were recruited from Bangkok, Thailand; Campinas, Brazil;
Singapore and Szeged, Hungary to use LNG 1.5 mg pericoitally
(24 h before or after coitus) as their primary method of contraception in an open-label, single-arm, multicentre Phase III trial
study from January 2012 to November 2014. The participants
were also instructed to maintain a paper diary, on which they
recorded the timing for every coital act and tablet intake, use of
other contraceptive methods and vaginal bleeding patterns.
Pregnancy tests were performed monthly and pregnancies
occurring during product use were assessed by ultrasound. At
the 2.5-month and final visit at 6.5 months, acceptability questions were administered.
Results: There were 321 women who were included in the
evaluable population, with 141.9 W-Y of observation and with a
rate (95% Confidence Interval [CI]) of 7.1 (3.8; 13.1) pregnancies
per 100 W-Y of typical use, and 7.5 (4.0; 13.9) pregnancies per
100 women-years (W-Y) of sole use. In the primary evaluable
population (less than 35 years old, the rate was 10.3 (5.4; 19.9)
pregnancies per 100 W-Y of typical use, and 11.0 (5.7; 13.1)
pregnancies per 100 W-Y of sole use. There were three reported
severe adverse events and 102 other mild adverse events, with
high recovery rate. The most common were headache, nausea
and abdominal and pelvic pain. Vaginal bleeding patterns
showed a slight decrease in volume of bleeding and the number of bleeding-free days increased over time. The method was
considered acceptable, as over 90% of participants would
choose to use it in the future or would recommend it to others.
Conclusion: Typical use of LNG 1.5 mg taken pericoitally, before
or within 24 h of the sexual act, provides contraceptive efficacy
of up to 11.0 pregnancies per 100 W-Y in the primary evaluable
population, and 7.1 pregnancies per 100 W-Y in the evaluable
population.
FC3.7
Can thrombohilia screening prevent
thrombosis from combined oral
contraceptive pills? A case report
Anastasia Vatopouloua, Panagiotis Tsikourasb,
Irene Iordanidoua, Alexios Papanikolaoua,
Dimitris Goulisa and Basil Tarlatzisa
a
Aristotle University of Thessaloniki, Thessaloniki, Greece;
Democritus University of Thrace, Alexandroupolis, Greece
b
Objective: To present a case of a young woman on treatment
with the combined pill for severe PCOS, admitted through the
Emergency Room (ER) with massive deep venous thrombosis of
the left limb, two years after the initiation of treatment.
Method: A 19-year-old woman, presented initially with oligomenorrhea (3–4 menstruations/year), severe hirsutism and acne.
Her BMI was 22, she did not smoke and her personal and family
history was free of disease. After being screened negative for
thrombophilia, she was given a low dose combined oral contraceptive pill in order to have regular menstruation and regression of acne. She was followed up regularly every six months
with a good response.
Results: After a period of two years, she presented at the ER
with numbness, pain and edema of the left thigh. Triplex ultrasound examination revealed a massive thrombosis of the left
iliac and femoral vein, which was confirmed by a CT-scan. Chest
spiral CT didn’t show any signs of pulmonary embolism. She
was hospitalised for seven days and received high doses of lowmolecular-weight heparin (LMWH) with quick resolution of
symptoms. Massive deep venous thrombosis although rare is
the most serious complication of oral contraceptives. It usually
occurs in adult women and becomes more common with
increasing age. It is believed to be less common with low dose
oral contraceptives than with the higher dose ones.
Conclusions: Close monitoring remains essential even for
patients on low dose oral contraceptive regimes. Additionally,
as is shown in our case, blood screening and personal-family
history, although essential for evaluation of the patient, cannot
exclude the possibility of thrombosis.
FC4.1
Women’s preferences about
menstrual bleeding frequency: results
from the ISY 2 (Inconvenience due to
women’S monthlY bleeding) Study
Christian Fialaa, Rossella Nappib,
Nathalie Chabbert-Buffetc, G€
unther H€auslerd,
e
f
~aki Lete , Axelle Pintiauxg and
Christian Jamin , In
h
Paloma Lobo
a
Gynmed Ambulatroium, Mariahilferg€
urtel 37, A-1150 Wien,
Austria; bResearch Center for Reproductive Medicine, and Unit of
Gynecologic Endocrinology and Menopause, IRCCS Policlinico San
Matteo, Department of Clinical, Surgical, Diagnostic and Pediatric
Sciences, Unive, Pavia, Italy; cDepartment of Obstetrics and
Gynecology, APHP Tenon Hospital, University Pierre and Marie
Curie Paris 06, Paris, France; dAKH-Wien, Abteilung f€
ur
Allgemeine Gyn€akologie und Gyn€akologische Onkologie,
Waehringer Guertel 18-20, A-1090 Wien, Austria; e169, boulevard
Haussmann, Paris, FrancefDepartment of Obstetrics and
Gynaecology, University Hospital Araba, Vitoria-Gasteiz, Spain;
g
Department of Obstetrics and Gynecology, Citadelle Hospital,
Liège University, Liège, Belgium; hService of Obstetrics and
Gynecology, Hospital Universitario Infanta Sofıa, San Sebastian de
los Reyes, Madrid, Spain
Objectives: For many women, monthly bleeding is painful,
inconvenient and affects everyday life. Our objective was to
assess the level of inconvenience associated with monthly
bleeding, determine how many women would prefer less frequent bleeding, and what would motivate this choice.
Method: From 28 August to 29 September 2015, a 15-minute
quantitative online survey was conducted among 2845 women
aged from 18 to 45 years old in six European countries (Czech
Republic, Germany, Hungary, Latvia, the Netherlands, and
Portugal). Among the participants, 1420 used a combined hormonal contraceptive (Group A) and 1425 a non-hormonal
contraceptive (excluding copper intrauterine devices) or no
contraceptive (Group B). The relationship between the participant’s profile, the contraceptive used, the menstrual period pattern and the preferred bleeding frequency was investigated.
Each participant gave written informed consent.
Results: Age, education, and number of previous pregnancies
were the only significant differences between the two groups.
The menstrual period was significantly longer (5.1 days vs. 4.6
days), heavier (14% heavy menstrual flow vs. 7%), and with
more symptoms (5.7 vs. 5.0) in Group B than in Group A
(p < 0.005). Pelvic pain, mood swing, and irritability were
reported in more than half of the women in each group. Given
the choice, 66% of women in Group A and 60% in Group B
would opt for longer intervals between periods. Lifestyle reasons, such as sexuality, social life, work and sporting activities,
were key factors for this decision.
Conclusions: This survey showed that the majority of women
want less than once monthly menstrual periods, with a frequency ranging from once every three months to no periods at
all. This can be explained by the desire to avoiding the unpleasant aspects of menstruation and its negative impact on one’s
private and professional life.
FC4.2
IUD and ultrasound by midwives –
implementation of two new methods
at a youth clinic
Gabriella Falk, Lotta Thyrenb, Ingej€ard Janssonb,
€rnstrandb
Anette Nybergb and Gunnel To
a
Obstetrics and Gynaecology, Division of Women and Child
Health, Link€oping, Sweden; bYouth Clinic, Link€oping, Sweden
Objectives: Long-acting reversible contraceptives are promoted
to young women in order to lower abortion rates. At the Youth
€ping, Sweden, IUDs to young women <26 years
Clinic in Linko
of age were not offered as a routine in 2012 and we wanted to
alter that. We also wanted to make check-ups with ultrasound
available when needed by training midwives to perform the
examinations. The aim with this study was to evaluate IUD
insertions and ultrasound examinations done by midwives.
Method: Four midwives with previous experience of IUD insertion participated in the study. A physician trained the midwives
to perform ultrasound examinations to judge when the IUDs
were in correct position. One hundred young women who
received an IUD either a Cu380Ag device (Cu-IUD) or a levonorgestrel-releasing device (LNG-IUD) were followed up at six
weeks, and 67 women after 18 months. Each young woman
paid about 10 Euros for their IUD.
Results: All young women were nulliparous, median age 21 for
Cu-IUD (N ¼ 58) and for LNG-IUD (N ¼ 40) 19 years of age. There
were two unsuccessful insertions, midwives inserted 88% of the
IUDs. Of the insertions, 86% were uncomplicated. Ultrasound
examinations were performed in 88% and the devices were all
properly fitted. For pain evaluation the Visual Analogue Scale
(VAS) was used and for both IUDs the median score was 7
(range 0–10). Eight vasovagal reactions occurred. At the six
weeks follow-up 90% respectively 83% showed up and the IUDs
in each group were correctly in place.
After 18 months 67 were available for follow-up, 44% in the
Cu-IUD group had been to additional visits and 54% in the
LNG-IUD group. Causes for additional visits were mainly bleeding disorders or pain. Of the 67 young women 14 (34%) in the
Cu-IUD group had their device taken out 4 (10%) on account
of pregnancies all intrauterine (5–8 months after insertion), one
expulsion and the others because of bleeding disorders or pain.
In the LNG-IUD group 7 (27%) had their IUD removed on
account of hormonal side-effects, bleeding and/or pain, one
expulsion no pregnancies occurred in this group.
Conclusion:
IUDs were inserted without more complications than
expected. After a training period midwives could judge
IUD placement accurately with ultrasound.
Additional visits to check the IUDs were requested by
almost half of the young women.
An unexpected high number of pregnancies occurred
in the Cu-IUD group which needs considerations.
FC4.3
Combined oral contraception in
hyperprolactinemic women
Larisa Suturina, Lyudmila Lazareva and
Alina Atalyan
Scientific Center of Family Health and Human Reproduction,
Irkutsk, Russia
47
Objective: The objective of this study was to investigate the
changes in serum prolactin levels in users of COCs with
hyperprolactinemia.
Methods: We performed a prospective study for a period of
one year in 50 women with idiopathic hyperprolactinemia, who
desired to use COCs and were eligible for its use. Patients with
prolactinoma, diabetes mellitus with retinopathy and nephropathy, chronic venous diseases associated with smoking more
than 15 cigarettes per day, were excluded. Standardised assessment forms were used in all women including obstetric and
gynaecological history, previous morbidity, medications use, as
well as any complaints. Physical exam included weight, height,
blood pressure and other vital signs. Serum PRL, TSH, LH, FSH,
estradiol levels were assessed by ELISA using commercial kits.
Normal value of prolactin was 490 mIU/ml. Mann-Whitney and
Wilcoxon tests, v2 test and Fisher’s exact test were used for statistical analysis. A p < 0.05 was considered statistically significant.
Results: A total of 71% of hyperprolactinemic women had a
decrease in serum prolactin by the 3rd month compared to
baseline (756.9 ± 364.9 vs. 471.2 ± 156.6, pW ¼ 0.0001). Only 29%
of women with an initially elevated prolactin demonstrated an
increase in prolactin with COC use compared to pretreatment
levels (753.1 ± 277.8 vs. 955.8 ± 357.2, pW ¼ 0.01, 0–3 month). It
was also shown that COCs use did not affect the subsequent
fertility of women with hyperprolactinemia.
Conclusions: We conclude that the use of COCs is not associated with an increase in prolactin levels in the majority of
women with idiopathic hyperprolactinemia. Our study limitations included a high rate of drop-outs, by the 6th and 12th
month in the group with hyperprolactinemia there were only
21 (42% of included).
FC4.4
Do beliefs about the combined
hormonal contraceptive (CHC)
influence the choice of method?
Jose Cruz Quıleza, Diana Loisa, Tania Arribaa,
Saioa Ajuriagogeaskoaa, Marıa Sancheza,
Nahia Antolına, Marta Legorburua, Sara Tatoc,
Marıa Antonia Obiolb, and Roberto Lertxundid;
behalf of the Spanish Society of on Contraception
a
Hospital Universitario de Basurto, Bilbao, Spain; bC.S.S.R. Fuente
de San Luis, Valencia, Spain; cHospital Universitario Virgen de la
Macarena, Sevilla, Spain; dClınica Euskalduna, Bilbao, Spain
Objective: The main objective of the study is to assess whether
reasonable belief or not about the possible side-effects of the
CHC can influence the choice of the method by the user. Rating
the Nocebo effect.
Methods: We have prepared a 15-item survey (collecting items
among the six most frequent causes of discontinuation –
Rosenberg 1995) and asking for the attitude towards these
methods. Users are also asked if they have received occasional
contraceptive advice and from whom.
This study was developed in offices of Gynaecology at primary
care centres and included women aged 16–50 years, who are
potential users of the combined hormonal contraceptives, currently using this method or any other contraceptive method. A
bivariate analysis was performed.
Results: A total of 370 surveys were collected at the end of the
study period. With regard to nausea and vomiting more than 1/
3 of the participants believed that if a CHC produces headache
it contraindicates the use of this preparation or another hormonal method. Less than half of the participants believed that the
preparation will not produce change in your weight. Almost half
of the participants tend to not relate the headache with the
CHC but very few know (24%) that some type of headache can
be improved with the use of this product. Overall, 42% of users
48
associated CHC with the creation of cancers if they don’t rest
regularly, and only 7.5% seem to understand the protection provided against different types of them. While more than half
(60%) do not associate the use of the contraceptive pill to
breast cancer, one-quarter of users believed that it is advisable
to have mammographic testing regardless of the age of the
wearer. We found low rates of the use of ACH among users
who respond negatively to such matters. In fact, many of them
request more information after filling in the survey of our study.
Conclusions: It seems clear, according to the results that the
beliefs of users about hormonal methods can influence the
choice of the method. Taking into account the constant
demand among those surveyed from more information to take
a proper decision, it seems a new issue have been opened. Has
our contraceptive advice been too high-powered? Are professionals prepared to shoot down these myths? These questions will
be addressed in a new study currently underway.
FC4.5
Contraception and the Australian
male: a survey of 2438 heterosexual
men using an online dating service
Mary Stewart, Todd Ritter, Kevin McGeechan,
Edith Weisberg and Deborah Bateson
Family Planning NSW, Sydney, NSW, Australia
Objectives: While contraception is generally seen as ‘women’s
business’, the role of the male partner can be significant in
determining a couple’s contraceptive choice. We surveyed
Australian men using an online dating service aimed at heterosexual singles to determine their knowledge about specific
methods, history of personal and partner use, contraceptive
decision-making and beliefs about the impact of specific methods on the health of the user, sexual desire and sexual pleasure.
Method: A personalised email providing a brief introduction
and link to an anonymous survey was sent in August 2014 to
males aged 18 years and above who had logged onto the
national online dating site within the previous 12 months. The
survey was piloted in 33 men and took approximately 15 min
to complete. It collected demographic and contraceptive data
as well as information regarding relationships which were categorised as either ‘one-night stand’, ‘casual’ or ‘long-term’.
Results: We analysed 2438 completed responses from men
aged below 30 years (9%) to 60 þ years (22%). The majority
used a contraceptive method at last sex (82% of men below 50
years versus 69% of older men [p < 0.0001]). However, 26% did
not want children at present or ever reported non-use of
contraception. Condoms (35%), vasectomy (22%) and the
contraceptive pill (21%) were the most commonly used methods with older men being less likely to use condoms than
younger men (p < 0.0001). Over 80% had heard of all methods
with the vaginal ring, injection and implant being least well
known (‘never heard of’ by 19%, 18% and 14%, respectively).
The emergency contraceptive pill rated least favourably in relation to perceived harmfulness (32% thought it was ‘harmful to
the health of the user’ versus 30% for the pill and 19% each for
the IUD and implant); male condoms were perceived as least
harmful to health but least favourable for reducing interest in
sex (51%) and reducing sexual pleasure (76%) compared with
10% and 6% respectively for the pill. Belief that contraceptive
decision-making should be shared between partners increased
from 57% in a ‘one-night stand’ to 75% in a ‘casual’ relationship
and 92% in a ‘long-term’ relationship.
Conclusions: Most men wanted to share contraceptive decision-making with their partners, especially in long-term relationships. This finding, coupled with lack of awareness of some
methods and misperceptions about the safety of hormonal
contraceptive methods, highlights the need for improved education for men of all ages.
FC4.6
A clinical study of septic abortions in
a tertiary care referral centre in rural
India – still a neglected scenario
which can be a preventable
catastrophe
Vijayasree Medarametla
Mamata Medical College, Khammam, Telangana State, India
Introduction: In spite of the MTPact in 1972 which legalized
abortions in India, unsafe abortion still continues to be a significant contributor of maternal morbidity and mortality.
Objectives: The aim of the present study was to assess the
magnitude of septic abortions in a tertiary care referral hospital
and study their complications.
Methods: A retrospective study of patients who were admitted
from January 2010 to December 2014 in our hospital. A total of
132 patients were included in the study. The demographic and
clinical profile in relation to age, parity, marital status, indication
of abortion, the methods of abortion used, the qualifications of
the health care provider, complications and maternal mortality
were evaluated.
Results: Unsafe abortion constitutes 11.6% of total abortion
cases. A total of 70.45% women were in their third decade, 89%
were married and 60% had abortion for birth spacing. In 30%
of cases primitive methods were used, but the majority of them
were terminated by D&E. Overall, 60% of abortions were done
by unqualified persons. The majority of women were admitted
with serious complications like peritonitis (70%), visceral injuries
(60%), hemorrhagic and septic shock, renal failure (17.4%), and
other conditions like DIC, hepatic failure and encephalopathy.
Out of 73 women requiring laparotomy, 22% were done within
24 h of admission and 49% were performed beyond 24–48 h.
Conclusion: The present study confirms that education and
accessibility of contraception, and readily available, quality abortion services by trained health providers can limit morbidity and
mortality arising from unsafe abortion.
FC4.7
The status of having gynaecological
problems among adolescents and
their practices on this issue
Zubeyde Eksia and Fatma Eserb
a
itim ve
Marmara University, Istanbul, Turkey; bOkmeydanı Eg
Araştırma Hastanesi, Istanbul, Turkey
Adolescence period is between ages 10 and 19 and regarded as
the process of transition from childhood to adulthood and constitutes the most important stage of the period of change. In
this period, changes occur that lead to physical, psychological
and sexual growth and development. In the adolescence period,
various reproductive health and sexual problems especially
experienced by girls are among the issues that take up a significant place in adolescents’ life. They form an important group in
terms of health behaviours or risks within the scope of reproductive health services.
Objective: The study was prepared as a descriptive one in order
to assess the gynaecological problems that adolescents girls
(aged 10–19) have and the practices they adopt for these problems in a descriptive way.
Method: The study was completed with 250 students from a
state high school in Istanbul between 13 March 2015 and 30
April 2015. The adolescent diagnostic form was used for data
collection.
Results: At the end of the study, the mean age of the adolescents was found to be 14.96 0.61. When the gynaecological
complaints of the adolescents were studied, the common problems were hirsutism (21.2%), dysmenorrhea (52%), excessive
menstrual bleeding (20%) and smelly vaginal discharge (19.6%).
It was stated that 62% of the adolescents did not know about
vaginal infections and 68.4% about cancer types. Adolescents
wanted health services for them to be given in hospitals
(73.6%) and at schools (36%). Overall, 80.8% of them stated that
they primarily required privacy in the services given.
Conclusions: It was demonstrated that about 30% of the adolescents experienced gynaecological problems and their knowledge on this issue was not at an adequate level.
FC4.8
A randomised trial of Veracept, a
novel nitinol low-dose copper
intrauterine contraceptive, compared
to a copper T380S intrauterine
contraceptive
Matthew Reevesa, Mark Hathawayc,
Juan Canela Oleagad, Bob Katzb and Michael Talb
a
Johns Hopkins Bloomberg School of Public Health, Baltimore,
Maryland, USA; bContraMed, Campbell, California, USA; cJHPIEGO,
Baltimore, Maryland, USA; dClinica Canela, La Romana, Dominican
Republic
Objectives: To compare VeraCept, a novel low-profile nitinol
intrauterine contraceptive with 175 square-mm of copper surface area, to a commercially available copper T380S.
Methods: We performed a randomised subject-blinded comparison of VeraCept and a copper T380S in a 2:1 fashion. The
primary outcome was total continuation at 12 months. We also
examined pain on insertion, ease of placement, expulsion, satisfaction, tolerability and pregnancy. Satisfaction ratings were on
a 5-point Likert scale. We have continued to follow participants
and report data from insertion through an 18-month follow-up.
Results: We enrolled women in a single clinic with 199 allocated to VeraCept and 101 to the T380S. Insertion was successful in 198 women for VeraCept and 100 for the T380S (p > 0.2).
Mean age was 25 years, and median parity was 2 (range 1–4),
with 39% having only had Caesarean deliveries. No women
developed clinical infection or reported serious adverse events.
In the VeraCept and T380S groups, mean pain at insertion was
1.4 and 2.4, respectively (p < 0.01). At the 12-month primary
endpoint for VeraCept and T380S, respectively, continuation was
84% and 68% (p < 0.001). At the 18-month visit for VeraCept
and T380S, respectively, continuation was 81% and 64%
(p < 0.002) with partial and complete expulsions in 5.0% and
12.0% (p < 0.05) and removal for pain/bleeding in 3.5% and
17.0% (p < 0.01). One ‘luteal phase’ pregnancy was identified at
the first follow-up with conception estimated at one to one and
a half weeks prior to VeraCept insertion. One ectopic pregnancy
was identified at the 12-month follow-up in a VeraCept user. No
intrauterine pregnancies were diagnosed after insertion. With
281.6 and 113.9 women-months total use, pregnancy rates were
0.36 (95% CI 0.01, 1.97) and 0.00 (95% CI 0.00, 3.18) per 100
woman-years for VeraCept and T380S, respectively.
Conclusions: VeraCept resulted in less pain at insertion, fewer
expulsions and higher total continuation than the T380S, with
similar contraceptive efficacy to date.
49
FC5.1
Combined hormonal contraceptives
use and breast cancer development
in a 3-fold higher-risk population of
women
Giovanni Grandia, Angela Tossb, Laura Cortesib,
Luigi Marchesellib and Angelo Cagnaccia
a
Department of Obstetrics Gynecology and Pediatrics, Obstetrics
and Gynecology Unit, Policlinico University Hospital, Modena,
Italy; bDepartment of Oncology, Haematology and Respiratory
Disease, Policlinico University Hospital, Modena, Italy
Objectives: To verify the effect of combined hormonal contraceptives (CHC) use on breast cancer risk in a 3-fold higherbreast cancer risk population.
Methods: We analysed the characteristics of 2712 women who
attended the Modena Family Cancer Clinic (MFCC) between
May 2010 and December 2014. They were classified according
to the Tyrer-Cuzick model of developing breast cancer,[1] as at
low risk (RER1, general population risk), intermediate risk (RER2,
2-fold increased) and high risk (RER3, 3-fold increased). In our
population, RER3 had an adjusted hazard ratio (HR) of 5.48
(95% CI 2.99–10.00, p < 0.001) of developing breast cancer
when compared to RER 1-2. Only RER3 women who reported
precise data about type and length of use of a CHC were evaluated. The cumulative HR was considered at a woman’s age of
60 years old, which is the time of breast cancer peak of incidence. Analyses take into consideration different ethinyl-estradiol (EE) doses and type of progestin were performed.
Results: The final population consisted of 540 RER3 women,
with a mean age of 46.9 ± 12.6 years (range 22–90 years) and a
BMI of 23.5 ± 5.1 kg/m2 (range 15.7–50.1). Among these women,
49/540 (9.1%) had developed a breast cancer. Of these cancers,
27 (55.1%) were hormone receptor positive. 267/540 (49.4%) of
these subjects reported CHC use (Ever users) during their reproductive life for a mean duration of 4.0 ± 5.9 years (range 0.3–36),
while 273 (50.6%) reported never having used CHC (Never
users). Only 8/267 (3.0%) have used a preparation with 50 mg
of EE. The most diffused progestins were gestodene (n ¼ 115),
cyproterone acetate (n ¼ 53), drospirenone (n ¼ 43), desogestrel
(n ¼ 40) and levonorgestrel (n ¼ 23). Ever use of CHC was not
associated with an increased risk for breast cancer (Ever use < 5
year adjusted HR: 1.00 95% CI 0.62–1.61, p ¼ 0.995; Ever use
5–10 years adjusted HR: 0.94 95% CI 0.49–1.82, p ¼ 0.867; Ever
use > 10 years adjusted HR: 0.90 95% CI 0.43–1.78, p ¼ 0.780).
The EE dose ( or < 30 mcg of EE) did not influence the risk of
breast cancer. Among progestins, use of gestodene was associated with a reduced risk (p ¼ 0.025).
Conclusions: CHC use does not seem to be associated with an
increased risk of breast cancer in high risk women.
Reference
[1]
Tyrer J, Duffy SW, Cuzick J. A breast cancer prediction model
incorporating familial and personal risk factors. Stat Med 2004;
23:1111–30.
50
FC5.2
FC5.3
Quality provision of sexual and
reproductive health commodities in
pharmacies: is this the way to reach
youth? A systematic literature review
and synthesis of the evidence
Effect of vitamin B1 on sexual desire
(libido) in women with premenstrual
syndrome
Lianne Gonsalves and Michelle J. Hindin
Sareh Abdollahifarda and Majid Maddahfarb
a
Jahrom University of Medical Sciences, Jahrom, Iran, Jahrom,
Fars, Iran; bBHOWCO Trading GmbH, Frankfurt, Germany,
Frankfurt, Germany
Objective: To conduct a systematic literature review and evidence synthesis on the quality of service in pharmacy provision
of sexual and reproductive health (SRH) commodities to young
people.
Methods: We searched relevant databases (e.g., PubMed,
Embase) for publications from 2000 through 10 June 2015. To
be eligible for inclusion, articles had to address the provision of
SRH commodities to young people (under < 30 years old) via
pharmacies. The included articles vary in quality; however, we
present results of all studies that met the inclusion criteria, recognising the importance of accounting for all evidence in an
understudied area.
Results: A total of 426 articles were identified, of which 27 satisfied the inclusion criteria. A majority of studies were conducted
in high-income countries; only three were conducted in LMICs.
Provision of emergency hormonal contraception was the focus
of 23 of the 27 studies. Six studies focused on the experiences
of pharmacy personnel, while 22 followed pharmacy clients.
Pharmacy access was found to be appealing to young people
due to the discretion and anonymity offered by pharmacies; the
speed of consultation and commodity access; pharmacies’ convenient operating hours and locations; and satisfactory service
provided by pharmacists.
Additionally, all evidence rejected the notion that increasing
access to SRH commodities for young people would correspond
to increases in sexually risky behaviour. Rather, increasing access
resulted in high uptake among young people, especially those
under age 25.
Despite the evidence above, both pharmacists and young people had continued reservations about the reliability and appropriateness of pharmacists as SRH counsellors and pharmacies as
SRH commodity dispensaries. Additionally, both groups also
worried about increased pharmacy access having an adverse
effect on the SRH decision-making of young people.
Possibly as a result, even in settings where regulations allowing
for pharmacy access were in place, pharmacists sometimes
acted as gatekeepers, creating unnecessary barriers to access or
refusing access all together.
Additionally, evidence suggested that certain populations of
youth, (younger adolescents or rural, poor or minority group
youth) might face added barriers to access.
Conclusion: Pharmacy access can meet the demonstrated need
young people have for SRH commodities, and legal policies
have steadily become more favourable to over-the-counter
access. More research is needed, particularly in two areas:
improving and expanding pharmacy service provision, and careful study of challenges to access for the full range of young
populations.
Introduction: The most common cause of anxiety among
women in health care centres, due to the nature of low sexual
desire that proper treatment is important. Low sexual desire is a
prevalent symptom. When accompanied by distress, loss of
libido is known as hypoactive sexual desire disorder, which can
have a significant impact on a woman’s wellbeing. The etiology
of hypoactive sexual desire disorder is multifactorial and its
management requires a combination of psychosocial and
pharmacological interventions. Low sexual desire is a complaint
that many pharmacological agents used to treat it. The drug is
used to treat Low sexual desire vitamin.
Due to the absence of a fully effective medication and sideeffects, this study was conducted to determine the effect of
vitamin B1 on the treatment of Low sexual desire-related PMS.
Materials and methods: In a randomised clinical trial (RCT) two
blind, 120 young women with Low sexual desire in the age
group 18–30 years were divided randomly into two groups. In
one group of 60 students they were given 100 mg vitamin B1
daily for three months, and a second group of 60 students a
placebo was administered for three months. Low sexual desire
severity and Low sexual desire chart was assessed daily. T tests,
Wilcoxon and Mann-Whitney tests were analysed.
Results: There was no significant difference among the studied
variables in terms of confounding variables. The comparison of
the vitamin B1 group before the intervention with that after the
intervention showed that vitamin B1 increased sexual desire
(36%) significantly (p < 0.01). At the end of the three months,
36% of the vitamin B1 group responded to the treatment but
only 0.96% of the placebo group responded to the placebo
(p < 0.1). Vitamin B1 was well tolerated and caused no sideeffects.
Conclusion: It seems that vitamin B1 is effective in recovery of
mental and physical symptoms of PMS such as Low sexual
desire. Therefore, this vitamin can be used to reach a major
goal of midwifery, that is, reduction of symptom severity of
PMS – especially libido – without any side-effects. Vitamin B1 is
a safe and effective drug therapy to treat Low sexual desire and
it is known that most of the upper side is better tolerated. This
study is the result of an original article that recognised the
effect of vitamin B1 on the treatment of cyclic Low sexual
desire in young women.
FC5.4
Decentralising medical abortion
services in Victoria, Australia
Saima Wani, Angie Giasli, Dinesh Epitawela and
Paddy (Patricia) Moore
The Royal Women’s Hospital, Victoria, Australia
Objective: To describe and catalogue the process of decentralising medical abortion services from The Royal Women’s Hospital
to rural and regional communities by training primary health
care providers in early medical termination of pregnancy (MTOP).
Method: Around half of all Australian women experience an
unplanned pregnancy and almost one in three women will
choose a termination at some point in their life. In Victoria
abortion was removed from the crimes act with the Victorian
Abortion law Reform Act in 2008. The Therapeutic Goods
Administration Australia approved use of Mifepristone for medical abortion in August 2012 and this medication was made
available at low cost via the Australian Pharmaceutical Benefit
Scheme in August 2013. These events paved the way for
improved access for medical abortion services.
The Royal Women’s hospital commenced medical abortion provision in March 2011. The inpatient management of the first
100 patients confirmed the previous published excellent safety
profile. By 2012 the majority of women were receiving outpatient care. During this time we noted there was an increase
demand in the number of women seeking medical termination
of pregnancy who contacted the Pregnancy Advisory Service at
The Royal Women’s Hospital. However, overall access to low
cost abortion services in Victoria, both medical and surgical,
remained poor. In recognition of regional inequalities in provision of early medical abortion, in 2013, the hospital developed
a program to train primary care physicians to make this service
available in the community. In response to this initiative, a number of regionally based General Practitioners began providing
medical abortion services to women in their local community.
The programme included initial training and follow up with tertiary consults as necessary. Ongoing regional based training and
continued medical education were provided.
Results: Since the start of MTOP provision, a total of 225
women have had a medical termination of pregnancy through
The Royal Women’s Hospital. At the time of writing there are
already 14 rural-based General Practitioners in Victoria providing
this service. It is anticipated that at the time of our presentation
this number will have risen further. This outcome together with
the number of women seen and the acceptability of the model
to doctors and patients will be reported on.
Conclusion: Our presentation will demonstrate early medical
abortion through community providers is safe, efficacious and is
acceptable to women as a viable option seeking abortion care
across Victoria.
51
rates of early school leaving (GI: 30% vs. GII: 50%, p ¼ 0.07). The
overwhelming majority (80%) reported that their pregnancy was
unintended due to irregular condom use. The education level
was lower in GI (66.7% vs. 44.1%, p < 0.05), as first sexual intercourse (GI: 12.7 ± 0.8 vs. GII: 14.31, p < 0.05) and further partner
age (GI: 18.1 ± 1.6 vs. GII: 20.6 ± 4, p < 0.05). In addition, the
majority would like to use contraceptive injection (40.4%), intrauterine device (19%) and combined pill (10%) after pregnancy.
Overall, 83.3% rejected using condoms. Moreover, the most CM
known in descending order were condom (91%), combined pill
(83.3%) and contraceptive injection (75.6%), respectively. It
found that the majority would not use condoms (83.3%) and
less than half had no knowledge about long-acting reversible
contraception methods.
Conclusion: The results indicated that the sociodemographic
risk factors known to be more prevalent in teenage pregnancy
were poverty, low education level, as well as unmarried status.
In fact, it might be associated with increased social complications, such as early school leaving and unintended pregnancies.
Our findings could have been affected by unplanned reproductive life plan, resulting in inadequate knowledge of CM and condom use. Furthermore, unprotected sex leads to higher risk of
obtaining STD.
FC5.6
Contraceptive method choice and
provision of desired methods among
women obtaining abortion in
England and Wales
Abigail Aikena, Catherine Aikenb, James Trussella
and Patricia Lohrc
a
Princeton University, Princeton, NJ, USA; bCambridge University,
Cambridge, UK; cBritish Pregnancy Advisory Service, London, UK
FC5.5
Sociodemographics features and
knowledge of contraceptive methods
between teenage pregnant Brazilian
women
Fernanda Alves, Marlene Souza, Samara Requi~ao
and Milena Brito
Bahina School of Medicine, Salvador, Bahia, Brazil
Objectives: To describe sociodemographic features as well as
to analyse the previous knowledge and use of contraceptive
methods (CM) among teenage pregnant Brazilian women.
Methods: A cross-sectional study, descriptive and analytical, in
which pregnant women aged between 10 and 19 years were
involved, performed in a primary health care centre, in Salvador,
Bahia, Brazil. The subjects were divided into two groups (GI:
10–14 years old and G2: 15–19 years old). Available information
in this linked data set include: marital status, skin color, socioeconomic and marital status, education level, first sexual intercourse, early school leaving, previous sexually transmitted
disease (STD), sexual partner age, reproductive life plan and previous knowledge and use of CM, performed in a questionnaire.
The exclusion criteria were unfilled or untrusted forms and
patients taking sleeping pills.
Results: The study population included 100 women, the mean
age was 13 ± 0.5 years old in GI and 16.2 ± 1.4 years old in GII.
Teenage mothers were more likely to be unmarried (GI: 71.4%
vs. GII: 62.1%, p ¼ 0.539), mixed-race Brazilian (65%), household
income under US$375.00 (65.6%), living together with their
parents (GI: 62% vs. GII: 42.4%), no one reported STD and high
Objectives: In England and Wales, 67% of abortions are provided under contract to the National Health Service (NHS) by
independent sector providers. Provision of post-abortion contraception within these services has not previously been examined.
Moreover, very little is known about the contraceptive methods
women in England and Wales desire at the time of abortion or
how frequently they receive their desired methods. We address
these gaps by examining post-counselling contraceptive choices
and assessing fulfillment of demand for desired methods
among women accessing care from the largest non-NHS provider in Britain; the British Pregnancy Advisory Service (bpas).
Methods: We employ data from 108,473 women who obtained
contraceptive counselling and an abortion from bpas clinics
between January 2011 and December 2014. Women who
declined counselling or whose contraception was provided outside of bpas are excluded. Data on contraceptive methods provided by bpas are available for 83% of the sample (n ¼ 89,759).
The geographical distribution of our sample covers all bpas clinics across England and Wales. We examine the methods women
desire post-counselling and compare these both with the methods they were using at the time of conception and the methods they received post-abortion. We then assess factors
associated with choice and receipt of intrauterine contraceptives
(IUCs) and implants, since these highly effective methods have
been shown to have high satisfaction and continuation rates
and to reduce subsequent unintended pregnancies.
Results: Following contraceptive counselling, 51% of women
chose an IUC or implant, 33% an injectable, pill, patch, or ring,
and 9% condoms or a less effective method. On average, 91%
of women received their desired method, including 98% of
those who chose IUCs and implants. Among women who were
using either no method or condoms or a less effective method
at the time of conception, 55% and 56% respectively chose and
received an IUC or implant post-abortion. Women who were
52
married, white, having their second or subsequent abortion,
having surgical abortion, or using a method at the time of conception were significantly more likely to choose and to receive
an IUC or implant (ORs: 1.30, 2.33, 1.41, 4.10, 1.89, respectively,
p < 0.01).
Conclusions: Virtually all women receiving abortion care,
contraceptive counselling and method provision at bpas
received their desired contraceptive method. The majority chose
and received a method that was more effective than the one
they were using at the time of conception, and over half chose
and received an IUC or implant.
FC5.7
Male involvement in maternal health
care: a qualitative study of men of
reproductive age in Ibadan South
East and South-West, Nigeria
Oyindamola Soremekuna and Stella Akinsob
a
Society for Family Health, Ibadan, Oyo, Nigeria; bNigerian Urban
Health Initiative, Ibadan, Oyo, Nigeria
Background: Men’s involvement in reproductive health is significant, though their participation has been poorly demonstrated. Men are the primary decision makers of most families
in Nigeria; and invariably their involvements in maternal health
issues influence their partner’s reproductive health choices, decision-making and behaviours. Research studies have shown that
men’s involvement in maternal health is a promising strategy
for promoting maternal health; yet, the determinants and factors that influence male participation and spousal support are
varied and frequently multi-faceted.
Objective: The study aimed to identify factors that hinder
men’s participation in maternal health care, particularly access
to Family planning and uptake.
Method: This is a community-based participatory research and
it was conducted using qualitative (QD) descriptive design. Six
focus group discussions were conducted to complement individual interviews and to examine from a group perspective.
Data was collected from January to December 2014 at six communities within two Local Government Areas from a representative sample of 300 adult males aged 18 years and above.
Results: The study revealed that the majority of Nigerian men
do not understand their ‘maternal health responsibilities’,
because these responsibilities have traditionally been left for
women. The study revealed that the men are oblivious to the
fact that their responsibilities include supporting contraceptive
use by women, helping pregnant women to stay healthy,
arranging for skilled care during delivery, avoiding delays in
seeking medical care, helping after the baby is born, and being
responsible fathers (effective parents).
Conclusion: Enlightenment programs should be implemented
by governmental agencies, non-governmental organisations and
other voluntary groups and religious bodies. The need to
emphasise the involvement of men in promoting maternal
health care and also being agents of change in improving the
quality of life of women as it relates to maternal health cannot
be overemphasised.
ACCEPTED ABSTRACTS
ABORTION
A-001
Factors contributing to the limited
and declining use of MVA for
postabortion care in Malawi: a
qualitative study of health workers’
opinions
Sinead Cook
Cardiff and Vale NHS, Cardiff, UK
Objectives: Malawi has one of the highest maternal mortality
ratios in the world. Unsafe abortions are an important contributor to Malawi’s maternal mortality and morbidity, where abortion is illegal except to save the woman’s life. Postabortion care
aims to reduce adverse consequences of unsafe abortions, in
part by treating incomplete abortions. Although global and
national postabortion care policies recommend Manual Vacuum
Aspiration (MVA) for treatment of incomplete abortion, usage in
Malawi is low and appears to be decreasing, with sharp curettage being used in preference. There is limited evidence regarding what influences rejection of recommended postabortion
care innovations. Hence, drawing on Greenhalgh et al.’s [1]
diffusion of health care innovation framework, this qualitative
study aimed to investigate factors contributing to the limited
and declining use of MVA in Malawi.
Method: Semi-structured interviews were conducted with 17
postabortion care providers in a central hospital and a district
hospital in Malawi and thematic analysis performed on the data
gathered.
Results: The findings indicate that a range of factors coalesce
and influence postabortion care and MVA use in Malawi. Factors
pertain to four main domains: the outer context (abortion
stigma; power dynamics), the health workers (attitudes; power
dynamics) the organisation (shortages of material and human
resources; lack of training, supervision and feedback) and the
innovation (perceived risks and benefits to MVA use).
Conclusions: Effective and sustainable postabortion care policy
must adopt a broader health systems approach which considers
all these factors, their interactions and the wider socio-cultural,
legal and political context of abortion and postabortion care.
Reference
[1]
Greenhalgh et al.’s (2004)
A-002
Instruction-only versus
demonstration of a low sensitivity
pregnancy test for self-assessment of
medical abortion in South Africa; a
multicentre non-inferiority
randomised controlled trial
Deborah Constanta, Kristen Daskilewicza,
Jane Harriesa, Landon Myera and
Kristina Gemzell-Danielssonb
a
University of Cape Town, Cape Town, Western Cape, South
Africa; bKarolinska Institutet, Stockholm, Sweden
ACCEPTED ABSTRACTS – ABORTION
Objectives: To compare instruction-only to demonstration of a
low-sensitivity pregnancy test for self-assessment of abortion
outcome.
Methods: This non-inferiority randomised controlled trial was
conducted in six public sector abortion clinics in South Africa.
Eligible women were 18 years and older, with a confirmed
intra-uterine pregnancy up to 63 days’ gestation, clinically eligible for medical abortion, fluent in English or isiXhosa, have a
working cellphone with them at enrollment, and be willing to
receive abortion-related text messages on their phone.
Consenting women received standard care with mifepristone
and home administration of misoprostol. All were sent automated reminders and support text messages over 14 days following enrollment, given a low-sensitivity pregnancy test and
checklist, and asked to attend in-clinic follow-up two weeks
later. Computer generated randomisation with block sizes
(8–20) assigned participants in a 1:1 ratio to study groups. The
instruction-only group were issued with a pre-scripted set of
test instructions, the demonstration group practiced the lowsensitivity pregnancy test on their urine sample in the clinic,
guided by fieldworkers using the same set of instructions. All
women were asked to attend in-clinic follow-up two weeks
later. Primary outcome was accurate home self-assessment of
the need or not for surgical or medical treatment to complete
the abortion. Secondary outcomes included ease of doing the
test and preference for follow-up method. Analysis was by
intention to treat and the non-inferiority margin was set at six
percentage points.
Results: Of the 525 enrolled, 252 were assigned to instructiononly and 263 to demonstration. At follow-up 208 and 218 had
primary outcomes, and 227 and 231 had secondary outcomes
in the instruction-only and demonstration groups, respectively.
In-clinic follow-up showed complete abortion with no additional
treatment (MVA or additional misoprostol) for 91% (190/208;
199/218) in both groups. Accuracy of self-assessment was 85%
(177/208) for the instruction-only and 88% (191/218) for demonstration group. Of the three ongoing pregnancies in the study,
one from the demonstration group reported a negative pregnancy test. Some 99% (224/227) and 99.6% (230/231) found the
pregnancy test easy to do, and 91% (207/227) and 93% (214/
231) preferred the combination of pregnancy test, checklist and
text messages for abortion assessment.
Conclusion: Instruction-only is not inferior to a pregnancy test
demonstration for accurate assessment of the need or not for
additional treatment following medical abortion. However, introduction of routine self-assessment, though preferred by women,
requires counselling to ensure ongoing pregnancies are not
missed and complications are recognised.
A-003
Are women well educated about
available contraception methods?
Vesna Stepanic and Vlastimir Kukura
Clinical Hospital Merkur, Zagreb, Croatia
Objective: To investigate the information that women who
decide to terminate an unintended pregnancy know about
widely available contraception methods, and why do they
decide to terminate unwanted pregnancy.
Methods: During nine months of 2014, women who had unintended and unwanted pregnancies and who had decided to
terminate the pregnancy were given a questionnaire about the
reason(s) for their decision to terminate the pregnancy. A total
of 185 women completed the questionnaire, and the data were
analysed by predictable statistical methods.
Results: The participants’ mean age was 31.03 (18–45 yrs). The
reasons given for deciding to have an abortion were: personal
reasons without details, 88 (47.57%); financial reasons, 46
(24.86%), unknown reasons, 30 (16.22%), and medical reasons
53
from their perspective, 21 (11.35%). Regarding parity, 127
(68.65%) had already had a child/children, and 69 (37.30%) had
already had an abortion, either spontaneous or planned. The
participants’ education level was as follows: 155 (83.78) with
secondary school level, 27 (14.60%) with high educational level,
and 3 (1.62%) did not declare. Almost 100% of these women
had not considered any contraceptive methods.
Conclusions: An unintended pregnancy is a pregnancy that is
unplanned or unwanted at the time of conception, and is associated with an increased risk of problems for the mother and
baby. Although many different contraceptive methods are
widely available, the number of unwanted pregnancies remains
high and is a serious health problem. The majority of the
women had not considered using any contraceptive methods
and they were not aware of possible complications and sideeffects of terminating pregnancies (either physical, or mental
complications). Because women who have abortions vary in
age, educational level, and socioeconomic background, no
unique model of counselling about contraception exists.
Regardless of what measures are performed, unwanted pregnancies will remain a serious health problem. The goal of all
contraceptive counselling should be to reduce the number of
unwanted pregnancies and to educate women about their
reproductive health and responsible sexual behaviour.
A-004
Practices of abortion in postrevolutionary Tunisia: women as
immoral and impious citizens
Irene Maffi
University of Lausanne, Canton de Vaud, Switzerland
During a one-year research in Tunisia (2013–2014) I have conducted an ethnographic investigation on how the Revolution
has affected contraception and abortion practices. Abortion has
become a topic of public debate when, 40 years after it was
established, Islamists – in power between October 2011 and
February 2014 – have threatened the right to abortion of
Tunisian women. This paper intends to show how previous
forms of control over women’s bodies and subjectivities have
been reinforced and transformed by new religious discourses
used to discourage women seeking abortion.
To demonstrate this, I will draw on detailed observations I have
done in government family planning clinics and on the numerous interviews I have realised with both women seeking abortion and health care providers. This material will show that after
the Revolution the attitudes and behaviours of some medical
and paramedical personnel have changed reinforcing the stigmatisation of certain categories of women and creating new
important practical constraints.
A-005
Experiences of non-resident abortion
seekers in the United Kingdom: a
pilot-study
Caitlin Gerdtsa, Silvia De Zordob and
Joanna Mishtalc
a
Ibis Reproductive Health, Oakland, California, USA; bUniversitat
de Barcelona, Barcelona, Catalunya, Spain; cUniversity of Central
Florida, Orlando, Florida, USA
Objective: This pilot study aimed to improve understanding of
European women’s experiences travelling to England to seek
54
abortion services at the British Pregnancy Advisory Service
(BPAS). We examined women’s experiences related to abortion
travel, especially with respect to the possible impact that
national abortion laws and conscientious objection have on
women’s abortion experiences across European countries. While
much has been written about travelling to obtain abortion services in Canada, the United States, and Australia, few studies
have examined this issue within the European context.
Methods: Between August, 2014 and March, 2015, we surveyed
58 non-UK residents seeking abortions at three abortion clinics
in London, UK. Research sites were chosen based on the volume of non-resident clients at these facilities within the past
year. Participants received remuneration of £8 per survey. We
conducted descriptive, bivariate, and stratified analyses of sociodemographic characteristics, country of birth and residence,
reproductive history, abortion seeking experiences, abortion
decision making, and travel logistics.
Results: Participants travelled to the UK from 16 countries: 41%
from Western Europe, 32% from Ireland/Northern Ireland, 5%
from Northern or Eastern Europe, and 18% from the Middle
East. More than 30% of women reported being delayed by not
recognising that they were pregnant. Women in our study had
a range of experiences with abortion decision making, but
nearly half of participants (41%) found the decision to be ‘difficult or very difficult’. The most common reason stated for travel
was abortion not being legal in their country of residence
(62%), followed by having passed the gestational limit for a
legal abortion in their country (41%). Most (95%) of the women
travelled by airplane and 88% stayed overnight. Women paid
an average of £631 for travel expenses, and an average of £210
for accommodation. More than 50% found it ‘difficult or very
difficult’ to cover travel costs.
Conclusions: These results indicate that women seeking abortion services travel to England not only from countries with
very restrictive abortion laws (i.e., Ireland, Poland, Saudi Arabia),
but also from countries with ostensibly liberal abortion laws (i.e.,
Italy and France), primarily due to gestational limits on legal
abortion. These results also suggest that not recognising pregnancy and/or difficulties in decision making may be important
reasons for delays in accessing abortion. Finally, these data
reveal that abortion travel represents an economic burden that
is difficult for many women. A larger mixed-methods study is
needed to further study this phenomenon.
randomly assigned to one of the following three groups:
Control group consisted of 40 pregnant women who did not
undergo a dilatation procedure; Group I (40 pregnant women),
who had undergone cervical dilatation using Hegar’s dilators
(HeD) and Group II (40 pregnant women), who had undergone
hydraulic dilatation. Some tissue material of the cervix, for the
histological evaluation, was obtained after every dilatation.
Results: The CCBD dilations were successful and had no complications in all 40 patients of Group II. The cervical tissue was
markedly less damaged after CCBD dilation compared with HeD
dilation (epithelium damage: 95% (HeD) vs. 45% (CCBD),
p < 0.001; basal membrane damage: 82.5% (HeD) vs. 27.5%
(CCBD), p < 0.001; stromal damage: 62.5% (HeD) vs. 37.5%
(CCBD), p < 0.01). Intracervical hemorrhage was observed in
90% of the patients after HeD dilation vs. in 32.5% of the
patients after CCBD dilation.
Conclusion: CCBD dilation is a new, original, non-invasive, fully
controllable and safe technique for cervical dilation, with clear
advantage over the current methods of mechanical dilatation.
The future studies about CCBD are necessary to further prove
its effectiveness and to determine biomechanical aspects of
mechanical cervical dilatation.[3]
References
[1]
[2]
[3]
Arsenijevic, Slobodan, et al. Continuous controllable balloon dilation: a novel approach for cervix dilation. Trials 2012;13:1–7.
Available from: http://www.isrctn.com/ISRCTN54007498
Arsenijevic, Petar, et al. Analysis of cervical resistance during
continuous controllable balloon dilatation: controlled clinical
and experimental study. Trials 2015;16:1–8.
A-007
Determinants of choice of the first
trimester abortion method,
acceptability of and satisfaction with
the chosen method
Sara Vodopivec and Bojana Pinter
A-006
Hydraulic dilatation: a novel
approach to cervical dilatation
Petar Arsenijevica, Aleksandar Zivanovica and
Gordana Vukcevic-Globarevicb
a
Faculty of medical sciences, Kragujevac, SerbiabMedical faculty,
Podgorica, Montenegro
Objective: A prerequisite for any intervention in the uterine
cavity is the dilation of the cervical canal. It is the most commonly used procedure in gynaecology practice, and basically,
always represents an act of violence. Cervical dilation is used
before both diagnostic and therapeutical interventions, most
frequently it is used before curettage, for the termination of
unwanted pregnancy. No matter the reason that is applied for,
the cervical dilation is a risky intervention, painful for the
patient and stressful for the physician. In the aim to reduce the
risk and to make the procedure of cervical dilatation less risky
and painful, we have created a continuous controllable balloon
dilator (CBBD).[1]
Methods: In the aim to prove the advantage of the CCBD over
the current methods of mechanical cervical dilatation, a multicentre clinical study was conducted at the Clinical Centre
Kragujevac,
Serbia
and
Clinical
Centre
Podgorica,
Montenegro.[2] The study included 120 pregnant women
University Medical Center, Division of Ob/Gyn, Ljubljana, Slovenia
Objectives: To determine women’s motivation for choosing surgical or medical abortion, differences in acceptability and in satisfaction with the method chosen. Research was also done on
satisfaction with counselling before abortion and on the question whether women would choose to use misoprostol at
home, if they had the possibility. Our hypotheses were that:
choice of abortion method is related to women’s age; choice of
abortion method is related to women’s reproductive history;
there is no difference in acceptability of the two methods; there
is no difference in the satisfaction with the two methods.
Methods: A cross-sectional study was performed from 20
January 2015 to 30 June 2015 at our clinic. We included 235
women who presented for abortion, and were pregnant up to
10 weeks. The women were divided into two study groups considering the method of abortion: surgical abortion (n ¼ 38) and
medical abortion (n ¼ 191). All subjects completed an anonymous questionnaire. Descriptive statistical analysis was done and
in addition, Student’s t-test, Chi-square test, Mann-Whitney test,
Friedman’s test and Spearman correlation were used. A p-value
less than 0.05 was considered statistically significant.
Results: The choice of method was related to the number of
deliveries, miscarriages and previous abortions (p < 0.05) and
also to gestational age at the time of abortion (p < 0.001), while
it was not related to patients’ age. There were no differences in
the general acceptability of procedure between groups.
However, pain during the procedure was significantly stronger
in the medical abortion group (p < 0.001), and so was bleeding
(p < 0.001). Nausea (p < 0.001) and chills (p < 0.001) were more
frequent in medical abortion group, and there were no differences in vomiting, diarrhea, dizziness and headache between
groups. Women in the surgical group were more satisfied with
the method (p ¼ 0.026). The majority of the patients were satisfied with the counselling before abortion. A quarter of women
would choose home use of misoprostol.
Conclusions: We confirmed that choice of abortion method
was related to women’s reproductive history. There were no differences among general acceptability of the two methods. In
contrast with our expectations, the choice of abortion method
was not related to women’s age. Women were more satisfied
with surgical abortion. Non-directly the study showed that
health care workers should provide more education on postabortion use of contraception.
A-008
Family Planning policy influences the
induced abortion rate in China: trend
analysis from 1979 to 2013
Longmei Tanga, Dianwu Liua, Marleen Temmermanb
and Wei-Hong Zhangb
a
School of Public Health, Hebei Medical University, Shijiazhuang,
China; bInternational Centre for Reproductive Health (ICRH),
Ghent University, Ghent, Belgium
Objectives: In China, Family Planning (FP) policy has implemented since 1979 for birth control. Induced abortion is legal
and available on request for women and is a commonly used
as a way to end an unplanned or unintended pregnancy. The
annual number of abortions in China has been reported to be
between 6 and 13 million by different sources. The abortion
data is needed to monitor progress toward improvement of
maternal health and access to family planning services. This
study assesses trend in the number of induced abortion in
China from 1979 to 2013.
Methods: The numbers of induced abortion were obtained
from the Health Statistical Yearbook of China (2013). The FP policy was referenced by the State Council Gazette of the People’s
Republic of China and the Review of Population and Family
Planning Event of China. All the data was included in analysing
the tendency, while only the data after 1990 was used to forecast. Dynamic series analysis was used to analyse both tendency
and forecast, ARMA (1,1) and GM (1,1) were used to forecast.
Results: The growth rate of abortion varied from 38.14% to
45.73%. The number of abortions began to increase after the
implementation of the one-child policy in 1979, and reached its
highest level in the early 1980s until the beginning of the
1990s, the period when the PF policy was strictly executed. The
predicted value of abortion numbers in 2013 according to three
forecast methods are 6,346,910, 6,456,978 and 6,833,985
respectively. And considering the ‘two-child policy for only-child
parents’ beginning in 2013, the number of abortions might be
lower than 6,833,985.
Conclusions: FP policy in China influences the number of
induced abortions. Reproductive health is a right for all that
includes the right of access to safe, effective, affordable and
acceptable methods of FP to avoid unintended or unplanned
pregnancy.
A-009
Second trimester induction of labour
standardisation: effects on clinical
outcomes
Michelle Holman and Mary Catherine Tolcher
Mayo Clinic, Rochester, MN, USA
55
Objectives: Second trimester induction of labour may be
required for termination of pregnancy, most commonly in the
setting of fetal anomalies or fetal death. The process is unpleasant for women and can lead to complications including retained
placenta and haemorrhage. We standardised the process aiming
to decrease the length of induction and minimise the need
for dilation and curettage (D&C) and the need for blood
transfusions.
Methods: All women who underwent an induction of labour
between 13 0/7 and 26 6/7 weeks gestation at Mayo Clinic
Rochester from 1 July 2012 to 30 June 2015 were reviewed (18
months before and 18 months after implementation of a clinical
guideline). The guideline recommends vaginal misoprostol 600
mcg once followed by 400 mcg every 3 h thereafter. Oxytocin,
IV or IM, is administered immediately following delivery of the
fetus. If the placenta has not delivered within 2 h of oxytocin,
providers administer either one dose of misoprostol or carboprost. D&C is recommended if the placenta has not delivered
within 4 h of delivery of the fetus, or at any time if there is concern for maternal haemorrhage, infection, or instability. The primary outcome was the time from the start of induction of
labour to delivery of the fetus (t-test). Secondary outcomes
included the need for D&C and blood transfusion (Chi-square or
Fisher’s Exact Test).
Results: During the study period, 62 women met the inclusion
criteria; 38 underwent induction of labour pre-intervention and
24 post-intervention. When women induced pre-intervention
were compared with those who were induced post-intervention,
there was no significant difference in mean gestational age at
the time of induction (20.3 versus 19.5 weeks, p ¼ 0.240). There
was a significant difference in the time from start of induction
to delivery of the fetus (median 740 versus 516 min, 12.3 versus
8.6 h, p ¼ 0.032). The total dose of misoprostol did not differ
between the two groups (median dose 1400 mcg for both
groups). There was no significant difference in need for D&C (8/
38 (21.1%) versus 5/24 (20.8%), p ¼ 0.984). Two women in the
pre-intervention group and none in the post-intervention group
required a blood transfusion (2/38 (5.3%) versus 0/24,
p ¼ 0.518).
Conclusion: Evidence-based standardisation of second trimester
induction of labour can decrease the time from induction to
delivery. There was no significant difference in need for D&C or
transfusion; however future studies should be powered to
detect a difference in these outcomes.
A-010
Acceptability, efficacy and safety of
medical abortion in a Romanian
private practice clinic
Demetra Gabriela Socolov, Razvan Socolov and
Iolanda Elena Blidaru
1Gr.T.Popa University of Medicine & Pharmacy, Iasi, Romania
Introduction: Abortion on demand is legally approved in
Romania until up to 14 weeks of amenorrhea. It may be provided only by obstetrician-gynaecologists, both in public hospitals and in private outpatient offices. Medical abortion, using
mifepristone and misoprostol, has been approved in Romania
since 1 February 2009. This study aims to evaluate the acceptability, efficacy, and safety of early medical abortion, performed
in a private outpatient clinic in the North East of Romania.
Methods: Two endovaginal ultrasound exams were performed.
The first assessed the intrauterine gestation and dated the pregnancy; the second confirmed the ovular sac expulsion after
the procedure. Medical abortion, with mifepristone 200 mg
followed by misoprostol 400 mg/800 mg after 48 hours, was proposed for pregnancies aged between 5 weeks and 63 days of
amenorrhea.
56
Results: A total of 1350 first-trimester induced abortions were
performed during 52 months in a private clinic in Iasi, Romania.
Of these, 320 patients (23.7%), aged 16–46, were suitable and
accepted the medical abortion method, but only 292 (91.25%)
completed the procedure. Two patients vomited the mifepristone and asked for termination by suction curettage; 25 patients
(7.8%) expulsed the ovular sac before taking the misoprostol
dose; and one patient didn’t return for the misoprostol dose.
From this last group, 269 (92%) expulsed the ovular sac during
the first week; 23 patients were submitted to conventional suction termination, because expulsion of the ovular sac did not
produce during the next seven days in 22 cases; and because
one patient had important bleeding during the expulsion. At
the end of the treatment phase, the patients evaluated the procedure. Common complaints related to the procedure were: pelvic pain (75%; n ¼ 219), chills without fever (71.91%; n ¼ 210),
nausea without vomiting (8.56%; n ¼ 25), and severe vomiting
in one patient. Accompanying bleeding was evaluated as moderate by most patients (88.7%; n ¼ 259). Overall, 13 patients presented persistent bleeding for 2–3 weeks after expulsion,
requiring curettage.
Conclusions: Medical abortion was shown to be an acceptable,
efficient, and safe procedure. However, it does not currently represent the first option for our patients, because they consider it
expensive, they are not informed about, and many are not able
to complete the procedure. It may become a preferred method
for early termination of pregnancy in Romania, if women would
become more aware of its advantages. They also should be
convinced it cannot replace the need for contraception.
A-011
Pain management for first trimester
medical termination of pregnancy
(MToP) – an international survey
among providers
Christian Fialaa, Sharon Cameronb, Teresa Bombasc,
Mirella Parachinid, Aubert Agostinie and
Kristina Gemzellf
a
Gynmed Clinic, Vienna, Austria; bUniversity of Edinburgh,
Edinburgh, UK; cCentro Hospitalar e Universitario de Coimbra,
Coimbra, Portugal; dSan Filippo Neri Hospital, Rome, Italy;
e
Hôpital de la Conception, Paris, France; fKarolinska University
Hospital, Stockholm, Sweden
Objectives: There is no consensus about the best pain management for medical termination of pregnancy (MToP) and
evidence-based guidelines give different recommendations. A
survey among providers was done to analyse regimens being
used in clinical routine.
Method: A questionnaire on details of pain management for
first trimester (MToP) was developed by a group of experts.
Health Care providers all over the world offering MToP were
invited to complete it through a FIAPAC dedicated website.
Results: A total of 283 questionnaires from all regions of the
world were analysed: Europe 59%, North America 21%, Asia 8%,
Australia and New Zealand 6%, Africa 4%, Latin America 2%.
Systematic prophylaxis for pain was given by 233 providers
(82%), upon request by 34 (12%) and not at all by 16 (6%) participants. Those using systematic pain prophylaxis most frequently prescribed step I drugs (Paracetamol 38% or NSAID
85%) n ¼ 226 (97%), step II (weak opioids) were prescribed by
117 practitioners (50%) and step III by 49 (21%). Only 24 providers (10%) started pain treatment already after mifepristone.
Systematic prophylaxis was given more frequently by female
practitioners, 85% (181/213) compared to 74% (52/70) males.
Practitioners who did not prescribe any pain treatment were
mainly male 11.4% (8/70) compared to 3.8% (8/213) of the
female providers. Systematic prophylaxis was more frequently
provided by experienced practitioners. Most practitioners
did not adapt the analgesic treatment to gestational age or
according to place of intake of misoprostol (home or at the
clinic/hospital) and most (173/253, 68%) did not perform
systematic pain assessment.
Conclusions: There is widespread variation in the assessment
and management of pain during MToP, reflecting the lack of
evidence-based guidelines. This is a clear indication for improvement of using available and effective pain treatment to avoid
unnecessary pain by patients.
A-012
Organisation and delivery of abortion
and family planning service in
Georgia
Nino Tsuleiskiri, Gulnara Shelia and
Nikoloz Tsuleiskiri
Association HERA-XXI, Tbilisi, Georgia
Objectives: To investigate abortion and family planning service
organisations and delivery by assessing the demand and supply
in Georgia.
Method: For fulfilling the purpose of this research, both qualitative and quantitative research methods were used. The study
area encompassed all regions of Georgia. Data was collected
twice at a ten-month interval between December 2014 and
September 2015. Quantative research methodology was used to
evaluate availability and readiness of medical facilities for provision of abortion services and to identify the supply of abortion
and family planning services. A sample framework was acquired
from the Ministry of Labour Health and social affairs of Georgia,
and consisted of 655 service medical facilities that are licensed
for provision of gynaecological services. Clinic administrators
and obstetrician/gynaecologists, from those medical facilities
that provide abortion and family planing services were interviewed. Medical facilities were assessed by service availability
criteria: service interventions provided, available human resource
for health, infrastructure and health products to facilitate provision of interventions. Service readiness criteria: health service
delivery organisation and leadership capacity needed to provide
the services. Qualitative research methodology was used to
identify the demand and accessibility of abortion and family
planning services through focus group discussions with 147
women represented from all regions of Georgia.
Results: There is a low level of availability and readiness of
medical facilities in Georgia, only 17% of total 655 medical facilities provide abortion services. Furthermore, 95% of medical
facilities that provide abortion services are secondary health
care facilities. Generally, secondary health care facilities are
multi-profile clinics and are located in cities. Only 5% of primary
health care facilities provide abortion and family planning services. Qualitative research revealed that a lot of women use abortion as the primary method of family planning, moreover
answers received from respodents confirmed a low level of
knowledge on methods of contraception and lack of supply of
contraception. These solid findings show a high demand for
abortion and low demand for family planning services in all
regions of Georgia.
Conclusions: This research is the first nationwide large-scale
investigation related to abortion and family planning service
organisations and delivery in Georgia. It reveals lack of availability and readiness of medical facilities to provide abortion and
family planning services, and does not give women the opportunity to receive adequate abortion and family planning
services.
A-013
Audio-visual-presentation for
conultation before medical abortion
Galina Dikke, Dmitry Kochev and
Eugenia Scherbatyh
Pentcroft Pharma, Moscow, Russia
Background: Provision of information to the doctor over a sufficiently large range of these issues, takes a relatively long period
of time with respect to the total amount of time allotted to the
reception of one patient. In order to reduce the time spent directly on the physician providing standard information, we have
developed an audio-visual-presentation lasting 18 min. Patients
have the opportunity to listen to it before the first visit to the
doctor with a pen tablet or their smartphone, or in the period
of ‘waiting’ before a final decision on the termination of pregnancy by mifepristone at home on their computer through the
Internet. Audiovisual recording is a presentation containing the
information, accompanied by comments from obstetriciangynaecologists. After listening to her, patients have the opportunity to ask questions of their doctor during the next visit.
Objective: To evaluate satisfaction with the quality of medical
advice on the standard questions provided before an abortion
using audiovisual presentations
Methods: Information is collected with the help of a specially
designed questionnaire for physicians. A total of 100 questionnaires were analysed.
Results: All the doctors expressed their satisfaction with the
quality provided in the audiovisual presentation of information.
The time it takes to receive one patient was reduced by 30 min.
The average number of questions that the patient asked the
doctor was 1.2. Questions were clarifying in nature. The number
of telephone calls was significantly reduced (by three times)
between misoprostol and follow-up visits. No additional visits
were requested. All patients have chosen the planned method
of contraception (COCs and IUDs), the use of which was started
immediately after the abortion (COC began to take on the day
of mifepristone, the IUDs introduced during the follow-up visit
between 10 and 14 days after mifepristone).
Conclusion: The quality of information for patients seeking to
terminate an unwanted pregnancy, provided via audio-visualpresentation on modern gadgets, was highly appreciated by
physicians and enabled them to improve the consultation
process.
Conflict of interest: The distribution of audio-visual-presentation was carried out with the support of JSC ‘Pentkroft Pharma’.
A-014
57
Objective: This systematic literature review was performed to
provide data to a group of experts for an expert consensus
regarding the management of pain associated with first trimester medical termination of pregnancy (MToP)
Methods: A group of experts in the field of MToP was identified across Europe. This group identified clinically important
questions regarding pain associated with first trimester MToP.
A systematic bibliographic search looking at publications in
English up to end of March 2015 was performed to answer
these questions. The PubMed search looked at pain treatment/
pain assessment and medical termination of pregnancy.
In addition, publications cited in the list of references of the
publications found during the literature search were used if
appropriate.
Results: Three main clusters of questions were identified: epidemiology, pain assessment and pain treatment. Epidemiology
included questions regarding pain definition, frequency and
time of occurrence, predictive factors. Pain assessment included
questions regarding the need for pain assessment, the need for
a systematic or selective pain assessment, the methods to be
used for pain assessment, the ideal time for pain assessment,
and the possible relationship between pain assessment and
treatment. Pain treatment included questions regarding the
objective for pain treatment, the need for a selective or systematic pain treatment, the need for a prophylactic or curative pain
treatment, the need for pain treatment stepping, and questions
regarding the more appropriate pharmacological agents, the
best pharmacological protocols, and the non-pharmacological
strategies.
Literature data was found regarding epidemiology, but was
scarcer regarding assessment of pain associated with first trimester MToP or analgesic protocols which demonstrated their
efficacy.
Conclusions: There is a need for better consideration regarding management of pain associated with first trimester MToP.
Both pain assessment and analgesic protocols should be
explored.
A-015
A comparative study of vaginal
misoprostol versus trans-cervical
foley catheter insertion along with
vaginal misoprostol in termination of
mid-trimester pregnancies
Vijayasree Medarametla
Mamata Medical College, Khammam,Telangana State, India
Management of pain associated with
first trimester medical termination of
pregnancy (MToP) using
mifepristone-misoprostol regimens. A
systematic literature review
Christian Fialaa, Teresa Bombasb, Aubert Agostinic,
Sharon Camerond, Roberto Lertxundie,
Marek Lubuskyf, Mirella Parachinig and
Kristina Gemzell-Danielsonh
a
Gynmed, Vienna, Austria; bCentro Hospitalar e Universitario de
Coimbra, Coimbra, Portugal; cLa Conception University Hospital,
Marseille, France; dUniversity of Edinburgh, Edinburgh, UK;
e
Clinica Euskalduna Bilbao, Euskadi, Spain; fPalacky University
Hospital, Olomouc, Czech Republic; gSan Filippo Neri Hospital,
Rome, Italy; hKarolinska University Hospital, Stockholm, Sweden
Introduction: Second trimester termination of pregnancy represents 10–15% of total abortions performed globally. Misoprostol
has been widely used in different dosages and routes for
second-trimester pregnancy terminations. The Foley’s catheter is
also used as an effective method in ripening the cervix. Its use
is common in developing countries because it is safe, inexpensive and has low incidence of contractile abnormalities.
Objective: The aim of this study was to find out the efficacy of
a trans-cervical Foley’s catheter along with misoprostol against
400 mg vaginal misoprostol alone in terminating mid trimester
pregnancies.
Methods: The study was conducted in the Department of
Obstetrics and Gynaecology in a tertiary care referral centre. A
total of 100 antenatal women in the mid trimester (13–24
weeks) who were admitted with an indication for termination of
pregnancy were included in the study and were divided into
two groups. Patients with previous caesarean scar, chorio
amnionitis and low lying placenta and contraindications to
misoprostol were excluded from the study.Termination was
58
carried out in group A (50 women) using 400 mg vaginal misoprostol while in group B (50 women), trans cervical Foley’s catheter was inserted and the bulb was distended along with
misoprostol regimen as in group A.
Results: In both the groups, the majority of women (group A
60%, group B 70%) were between 18 and 20 weeks of gestational age.The combined group B showed shorter induction to
abortion interval at any gestational age (group A: 22.9 ± 6.4 versus group B: 16.6 ± 5.9 hours; p < 0.05). There was no significant
difference in the occurrence of side-effects in terms of manual
removal of the placenta, surgical evacuation, blood loss, nausea,
vomiting, abdominal pain and infection between the two
groups. In our study an incidence of incomplete abortion and
surgical evacuation was 20% in the misoprostol group where as
it is only 10% in the combined group.
Conclusion: A combination of transcervical Foley’s catheter and
400 mg of vaginal misoprostol is more effective than misoprostol
alone in terminating mid-trimester gestations. Since, these procedures are cost effective it would definitely benefit patients
with low socioeconomic status.
A-016
Ten years of pregnancy termination
by the family planning centre of a
tertiary hospital in Greece including
adolescents
Peter Drakakis, Spyros Marinopoulos,
Myrtia Sotiropoulou, Paraskevi Baka and
Dimitris Loutradis
Family Planning Center, 1st Department of Ob/Gyn, Athens
University Medical School, National and Kapodistrian University of
Athens, Alexandra Hospital, Athens, Greece
Objectives: Our Family Planning Centre provides consultation
for couples creating their own future family and tries to preserve their sexual health and also receives patients who desire
to discontinue an undesirable pregnancy. Although in Greece
abortions can be granted without restriction as to reason, there
are some limitations which are imposed. These include restriction by gestational age before the limit of 12 weeks and having
parental consent if aged under18 years. Adolescents are defined
by the WHO as aged from 10 to 19 years. A proportion of teenage childbearing takes place in some countries because of
restrictive abortion laws. Teenage pregnancy is strongly associated with social disadvantage. This includes unemployment,
poverty and discrimination. Teenage mothers are also more
likely to remain as single parents throughout their adult life.
The objective of our review was to see the percentage of adolescents that underwent an abortion and the distribution of all
patients that terminated their pregnancy with respect to various
demographic parameters.
Method: We present in review cases of pregnancy termination
under the supervision of our Centre during a 10-year-time
period (2006–2015). Reviews and statistics focus on abortion
rate, the age of these patients, their marital status, how they
were accompanied when they came to our Centre, their professional and educational status. We also included the percent of
adolescents (less than 18 years of age) as well as the ethnicity
of the patients.
Results: Our data describes not only national statistics, but also
much wider regional and ethnical characteristics of aborting
women, European 77.5%, African 10%, Asian 10.8%, American
1% and Australian 0.7%. Domestic population covers 33.4% of
the cases. Percentage of adolescents (under 18 years of age)
was 3.1%, with native born holding the majority (70%). Most
women originated from the neighbouring country of Albania,
followed by the ones from Eastern Europe. The unsuccessful
contraceptive methods used, were described. The history of previous abortions was documented, as well as the time interval
from the last desired pregnancy. The parity of women presenting for abortion varied from none (30%) to more than three
(13%), with one and two accounting for 27% and 30%,
respectively.
Conclusion: Early age at first intercourse is significantly associated with pregnancy under 18 years. Comprehensive sex education, which includes information about all contraceptive options
and their optimal use, is essential. Contraceptive methods are
differently accepted by specific groups and minorities.
A-017
Efficacy and safety of the medical
method in the voluntary interruption
pregnancy over 8 years – experience
of a Portuguese medical centre
^
Angela
Rodrigues, Inês Coutinho, Teresa Bombas,
Paulo Moura and Maria do Ceu Almeida
Centro hospitalar e Universitario Coimbra, Coimbra, Portugal
Introduction: Over the past three decades, medical methods of
abortion have been developed throughout the world and are
now a standard method of providing abortion care. For the
Portuguese National Health System (NHS), most of the abortions
by women request were performed using mifepristone combined with misoprostol. An increase in safety and efficacy of
medical method demonstrated over time has made this method
more available worldwide, including in low-resource environments. The aim of this retrospective and comparative study was
to describe efficacy and complication rate of medical abortion
among women up to 76 days of pregnancy in a tertiary hospital
in Portugal.
Methods: This study included all pregnant women up to 76
days of gestation who requested medical abortion from 2007 to
December 2014 in a Portuguese tertiary hospital (N ¼ 6031).
Two groups were defined by year of medical abortion: Group 1:
between 2007 and December 2010 (n ¼ 2874), Group 2: January
2011–December 2014 (n ¼ 3157). We defined complete abortion
as the expulsion of the sac found in the follow-up appointment.
Results: There was a significant difference between the two
groups with respect to mean age (28.63 vs. 29.12 years,
p ¼ 0.01), basic education level (38.6% vs. 26.1%, p < 0.01), marital status (p ¼ 0.01), previous voluntary abortion (15.2% vs.
18.7%, p < 0.01) and mean gestational age of medical abortion
(48.99 vs. 49.68 days, p < 0.01). Medical method efficacy rate
was significantly higher since 2011 (98.4% vs. 99.2%, p ¼ 0.008).
Although there were no statistical differences between the
groups (0.3% vs. 0.5%), the incidence of missed abortion has
increased since 2011. Ongoing pregnancy (1.3% vs. 0.3%,
p < 0.001) and incomplete abortion (6.6% vs. 5%, p ¼ 0.008)
have decreased significantly since 2007 to 2014. Overall, 89
women (1.48%) required a subsequent surgical intervention,
without differences between the groups. The incidence of complications was low: Infections (sepsis or endometritis) in 0.2%,
severe haemorrhage (0.7%) and uterine perforation suspect
(0.03%), without differences between groups.
Conclusions: Since 2007 to 2014, voluntary medical abortion
effectiveness has increased significantly, and a slight decrease
has occurred in the incidence of complications and the need
for subsequent surgery.
A-018
Safety and efficacy of outpatient
mifepristone-misoprostol medical
abortion through 76 days of
gestational age – Portuguese
experience in a tertiary hospital
^
Angela
Rodrigues, Inês Coutinho, Teresa Bombas,
Paulo Moura and Maria do Ceu Almeida
Centro hospitalar e Universitario Coimbra, Coimbra, Portugal
Objective: Medical abortion using mifepristone and misoprostol
is a safe and effective method of pregnancy termination.
Extensive evidence exists regarding the efficacy and safety of
medical abortion through 63 days of gestational age (GA).
Recent research demonstrates continued high rates of efficacy
over 63 days. The aim of this retrospective and comparative
study was to analyse the effectiveness of medical abortion in
different groups of gestational age up to 76 days.
Methods: This study included all pregnant women up to 76
days of gestation who requested medical abortion of pregnancy
(MTOP) from 2007 to December 2014 in a Portuguese tertiary
hospital. Three groups were considered: GA 49 days (group
A), GA 50–62 days (group B) and GA 63 days (group C). All
the women received the MTOP with Mifepristone 200 mg and
misoprotol 800 mcg vaginal. According to Portuguese NSH, it is
considered medical method failure when there wasn’t expulsion
of the gestational sac at ultrasound exam on the follow-up.
Results: A total of 6031 pregnant women (mean age:
28.89 ± 7.34 years) were included. 3730 (61.8%) in group A,
1329 (22.1%) in group B and 972 women (16.1%) in group C.
There was no significant difference between groups in respect
to mean age (p ¼ 0.059), nationality (p ¼ 0.583), parity
(p ¼ 0.972) and previous voluntary abortion (p ¼ 0.929). Basic
educational level increased with gestational age of medical
abortion (p < 0.01). The successful abortion rate following treatment was 98.8% and it was higher at lower gestational ages
(99.4% group A vs. 97.9% group B vs. 97.6% group C, p ¼ 0.03).
In the remaining 1.2%, missed abortion occurred in 0.4% and
continuing pregnancy in 0.8%. The incidence of these increased
significantly with gestational age (p < 0.01). Incidence of complications was low (7.2%) and it was significantly higher in
GA 63 days compared with other groups (p < 0.01):
Incomplete abortion occurred in 5.8%; 10 (0.2%) women were
given antibiotics for presumed infection (sepsis or endometritis)
and severe haemorrhage occurred in 42 (0.7%) women, of
whom 10 required blood transfusion. A total of 114 women
(1.9%) required a subsequent surgical intervention, without difference between groups. This was necessary to control haemorrhage (n ¼ 22) and evacuation of uterus in incomplete abortion
(n ¼ 56), continuing pregnancy (n ¼ 22) and missed abortion
(n ¼ 11).
Conclusions: The effectiveness of medical abortion was high
(98.8%), although it has decreased with increasing gestational
age. Despite being less effective and with more complications,
this method is safe in GA > 63 days.
A-019
Medical abortion in second trimester
missed abortion pregnancies
Andreja Stolfa Gruntar
University Clinical Center, Ljubljana, Slovenia
Objectives: Second trimester missed abortion pregnancies were
interrupted by medical abortion as a method of first choice.
59
Only in women with contraindications and with strong disagreement to the medical abortion method was the pregnancy was
interrupted surgically.
Method: We used the standard medical abortion method for
the second trimester pregnancy interruption: on day 1 a 200
mg mifepriston pill was taken by the patient and on day 3 she
was given 800 mcg misoprostol vaginally followed by 400 mcg
misoprostol sublingually up to four consecutive times every
three hours if needed. After the visible expulsion of the fetus
and placenta ultrasound examination was done and the need
for further misoprostol application assessed. Pain killers (mostly
non-steroid antiinflammatory drugs) were given together with
the first dose of misoprostol and repeated whenever needed,
and with unbearable pain pain killers were given i.m. and i.v. If
the procedure did not result in abortion, it was repeated once
again. If the two cycles would not achieve expulsion of conceptus, an intraamniotic application of PGF-2alpha and/or a surgical
intervention would follow.
Results: Many of the patients returned to the hospital earlier
than on day 3 because the bleeding and pain started sooner. A
few needed a surgical procedure, because the gynaecologist on
duty decided so because of excessive bleeding or pain because
of ongoing abortion. But most of them as well as the patients
that returned on day 3 successfully and completely aborted
after the application of misoprostol (84%). The rest had surgical
intervention after the first or the second cycle of application of
drugs for medical abortion, sometimes because of profuse
bleeding but also because they did not want to go on with the
medical procedure, but asked to proceed to surgical intervention to remove the rest of the placental tissue. Only one patient
received PGF2-alpha intraamniotically because nothing happened after two completed cycles. She aborted in a few hours
and curettage was performed. Overall, 6% of patients returned
after two weeks or later with residual tissue and had curettage
or hysteroscopic treatment.
Conclusions: The experiences of the use of medical procedure
in second trimester missed abortion pregnancies are not as
good as in second trimester medical abortion on demand. The
reasons are in the psychological differences of women treated,
but also in the gynaecologist’s decisions that also depend on
women’s expectations.
A-020
Evolution of the sociodemographic
profile of women undergoing
abortion in a tertiary centre in
Portugal
^
Ine^s Coutinhoa, Angela
Rodriguesb, Catarina Silvaa,
a
Teresa Bombas , Maria Ceu Almeidab and
Paulo Mouraa
a
Maternidade Daniel de Matos, Centro Hospitalar e Universitario
de Coimbra, Coimbra, Portugal; bMaternidade Bissaya Barreto,
Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
Introduction: Abortion by women request was decriminalised
in Portugal in 2007, when carried out up to the first 10 weeks
in official or officially recognised hospitals/centres. Since then,
and up to December 2014, 138,744 abortions were carried out
in Portugal. The number of procedures has been gradually
declining since 2011, registering the lowest rate in 2014.
Objective: This study aims to compare the sociodemographic
profile of women who underwent voluntary termination of
pregnancy in the first and in the last two years since decriminalisation, in a tertiary centre in Portugal.
Methods: A retrospective cohort study based on medical
records of women who were attended for abortion between
July 2007 and December 2014. Two study groups were
60
established and used for descriptive and comparative analysis
of sociodemographic variables: those who had undergone the
procedure in 2007–2008 (A) versus 2013–2014 (B). Statistical
analysis used SPSS StatisticsV 20.
Results: We included 1145 women in group A and 1444 in B
group, aged 13–49 years. There was a significant increase in
mean age between the two groups (28.65 vs. 29.38 years,
p < 0.05). There was no significant difference between the two
groups regarding nationality (p ¼ 0.724) and parity (p ¼ 0.322).
In the second group we found a significant reduction in the
proportion of women living as a couple (p < 0.05), and an
increase in the proportion of women with higher education
(56.8% vs. 76.2%, p < 0.01), although with a higher unemployment rate (19.4% vs. 11.7%, p < 0.01).
There was a significant difference in the history of prior abortion
(19.9% vs. 14.1%, p < 0.01) and in relation to gestational age at
the moment of the procedure, a decrease in the proportion of
women with less than 7 weeks of gestation (68% vs. 52%,
p < 0.01).
In 2013 and 2014 there was a decrease in the number of
women that attended a family planning consultation in the year
prior to the abortion (68% vs. 53%, p < 0.01) and increased
choice of long-term contraception (intrauterine contraception
and implant) (p < 0.01) after the procedure.
Conclusions: In the past few years, there has been a change in
the sociodemographic profile of women undergoing abortion in
Portugal. There was an increase in women’s age, education
level, number of previous abortions and gestational age, as well
as a decrease in family planning consultation frequency and
increased use of long-term contraception.
R
A-021
Subfertility consequent to 15 years of
post-abortion retention of fetal skull
bones and soft tissue
Babatunde A. Gbolade
Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
Objective: To report the case of a woman who presented with
a history of irregular menstruation and subfertility and was
found to have retained fetal skull bones and soft tissue for 15
years after a mid-trimester surgical abortion. We discuss variations in clinical presentation and review the literature.
Method: Case report and review of the literature.
Case report: A 33-year-old nulliparous African woman presented with a 15-year history of irregular menstruation and a
3-year history of secondary infertility following a mid-trimester
surgical abortion in an African country. A pelvic ultrasound
scan revealed a densely echogenic area measuring 16 mm
long within the lower endometrial cavity, with the suggestion
of calcification of old retained products of conception or endometrial ossification (usually seen in much older women). At
hysteroscopy, fetal cranial bones and soft tissue were removed
and these were confirmed by pathologic examination.
Following removal of the fetal bones and tissue, she reverted
to a regular menstrual pattern and is currently trying for a
pregnancy.
Conclusion: Immigrants who have undergone surgical termination of pregnancy in countries where termination of pregnancy
is illegal can present years after the event, with a variety of clinical symptoms and signs, as a result of retention of fetal soft tissue and skeletal parts. Such women present a clinical diagnostic
challenge, but appropriate imaging studies usually provide
clues. Skeletal fetal parts may be embedded within the myometrium, presenting significant challenges for optimal management. Such situations may require skilled hysteroscopic surgical
interventions.
A-022
The changing face of abortion in
Mexico: trends in complications and
lethality at national and state level in
Mexico between 2000 and 2013.
Raffaela Schiavon, Troncoso Erika, Ramirez Ruben,
Martinez Claudia and G Polo
Ipas Mexico, Mexico City, Mexico
Objectives: To analyse abortion-related hospitalisations, overall
complications, specific types of complications and abortionrelated lethality rate in Mexico over the last decade. The analysis covers only public health sector and women attended by
the Ministry of Health (SSa), who lack social security system or
private health insurance.
Methods: Analysis of hospitalisations used as primary sources
official database from the Automated System of Hospital
Discharges (SubSistema Automatizado de Egresos Hospitalarios:
SAEH) from Mexican Ministry of Health, for years 2000–2013. All
ICD-10 codes O00-O08 ‘pregnancy with abortive outcome’ were
included. The overall level of complications was calculated as
the proportion of cases with fourth-character decimal subcategories of .0, .1, .2, .3, .5, .6, .7 and .8 (for ICD-10 codes O03–O07)
and the whole O08 category among all abortion-related hospitalisations (AH). The number of women aged 15–44 was used to
calculate Abortion Hospitalisation Rates (AHR), according to official population projections for corresponding years. Analysis of
abortion deaths used official sources from National Registry of
Deaths in Mexican Population (INEGI/SALUD, DGIS; Defunciones
n de M
de la Poblacio
exico, 1990–2013). A modified Abortion
Lethality Rate (ALR) was expressed as number of abortionrelated deaths per 100,000 abortion-related hospitalisations.
Results: Overall, 1,473,167 women were hospitalised in this
period, with absolute numbers increasing from 2000 to 2013.
The major proportion of abortion cases (85.6%) were classified
as ‘uncomplicated’, with small variations over time; ectopics and
trophoblastic disease increased from 4.77% to 6.13%; all types
of complications decreased from 9.85% in 2000 to 7.67% in
2013. Trauma steadily accounted for a very small proportion of
all complications; infections decreased significantly while haemorrhage increased slightly in the period. Rates for abortion hospitalisations, uncomplicated cases and complicated cases in
2000 were 557, 475 and 55 per 100,000 women 15-44 years,
respectively; and 705, 605 and 54 per 100,000 in 2013. Analysis
of MALR showed a decline over the same period, from 53.6
deaths per 100,000 hospitalizations in 2000 down to 36.6 in
2013. A statistically significant inverse correlation was found
between ALR and AHR, both at national (r: 0.83 with p < 0.01)
and state level (r: 0.73 with p < 0.01)
Conclusions: According to official database analysis, over the
last decade, AH have increased, both in absolute numbers and
in rates. The proportion of complicated cases decreased, with
lower rates of severe complications. Accordingly, a downward
trend in ALR over time is documented.
A-023
Termination of a pregnancy located
in one horn of a bicornuate uterus:
challenges and solution
Objective: To report a surgical evacuation of a retained 15week-old fetus in one horn of a bicornuate uterus without
resorting to laparotomy and hysterotomy, discuss the challenges
faced and solution, and review the literature.
Method: Case report, discussion of challenges faced, solution
and review of the literature.
Case report: A 16-year-old primigravida presented for a surgical
termination of pregnancy. An initial ultrasound scan revealed an
intrauterine pregnancy at five weeks and six days’ gestational
age, and an apparently normal uterus. She underwent a suction
termination of pregnancy by Manual Vacuum Aspiration (MVA)
under continuous intraoperative ultrasound guidance with
apparent success. However, she presented two months later
with an ongoing pregnancy and ultrasound scan confirmed a
viable single intrauterine pregnancy of 14 weeks and two days
duration but without identifying the uterine anomaly. During an
attempt at an electric surgical termination of pregnancy,
bimanual examination suggested the presence of a uterine
anomaly and a detailed repeat ultrasound scan confirmed the
presence of a bicornuate uterus, with the fetus in the left uterine horn. Medical termination of pregnancy with a combination
of Mifepristone and Misoprostol was only partially successful as
there was retention of the fetus and placenta. The opening into
the left uterine horn was at almost a right angle to the cervical
canal. A surgical evacuation of the retained products of conception was undertaken with a malleable threaded cannula, using a
combination of hysteroscopy and continuous ultrasound-guided
dilation of the opening into the left uterine horn. The procedure
was completed without any complications. The patient remains
well.
Conclusion: A combination of very early pregnancy and
unknown uterine anomaly pose a significant risk of failure to
terminate the pregnancy. Medical abortion may not always be
successful, and recourse may need to be made to surgical termination. Intraoperative real-time ultrasound guidance and surgical versatility are required to avoid laparotomy and
hysterotomy and decrease the incidence of retained products of
conception in these relatively rare situations.
A-024
Perceptions of elective abortion
among Palestinian women: religion,
culture and access in the occupied
Palestinian territories
Sarrah Shahawya and Megan Diamondb
a
Harvard Medical School, Boston, MA, USA; bHarvard T.H. Chan
School of Public Health, Boston, MA, USA
Objectives: Termination of pregnancy remains a highly contested women’s health issue in the occupied Palestinian territories (OPT) given its unique sociopolitical climate. The aim of this
study is to explore perceptions of abortion and access to abortion services among women living in the OPT and how these
views are reconciled with religious, ethical, and social realities.
This is the first study to explore women’s views on abortion in
Palestine.
Method: A total of 60 individual interviews among women
ranging from 18 to 70 years old were conducted in Arabic using
an open-ended questionnaire to explore the attitudes of
Palestinian women on the religious implications, social consequences and accessibility of elective abortions. Convenience
sampling was used to recruit Palestinian women from the
department of Obstetrics and Gynaecology at Al-Makassed
Islamic Charitable Hospital in East Jerusalem. Interviews were
transcribed, translated to English, and qualitatively coded for
reoccurring themes.
Results: The majority of participants were Muslim, married, with
a high school education or less. Preliminary themes arising from
61
the interviews emphasised the centrality of religion and culture
in making decisions about when it was appropriate to electively
terminate a pregnancy. Most women initially expressed opposition to abortion on religious and cultural grounds, except when
the mother’s life was at risk from the pregnancy. However,
when further probed about specific circumstances, participants’
views diverged on cases of fetal anomalies, extra-marital pregnancy and rape. The timing of abortion was considered important for most women, in reference to when a fetus is considered
to have a soul. Most women identified social, rather than legal,
consequences associated with the discovery of an abortion by
the community. Beyond social ramifications, barriers to accessing abortion services included legal restrictions, hospital policy,
prohibitive prices at private clinics, and differing levels of access
to abortion services depending on whether women lived in
Jerusalem, the West Bank, or Gaza.
Conclusions: The findings from this study suggest a general
societal resistance to elective abortions in the occupied
Palestinian territories with some areas of ambiguity. The study
also highlights the differential levels of access Palestinian
women have to abortion depending on their wealth and ID status. Understanding the interplay between politics, religion, history and reproductive rights in the region has the potential to
direct women’s health organisations to areas of need, encourage additional research on women’s health in ambiguous legal
settings, and inform quantitative assessments of women’s health
needs in the intimately challenging circumstances of abortion.
A-025
The factors that cause induced
abortion
P. Chituleaa, R. Gheraib and L. Ardeleanb
a
University of Oradea, Oradea, Romania; bEmergency Clinical
County Hospital Oradea, Oradea, Romania
The question of how abortion relates to psychological issues
has been investigated throughout time in different ways and it
seems that most studies in the last 30 years have found abortion to be a relatively benign procedure in terms of emotional
effect. Identifying factors that lead to miscarriage, or otherwise,
the main reasons women choose abortion detrimental to the
maintenance of pregnancy, we found out that the first place
among the factors is occupied by the financial situation. The
second factor in total observations (15%) is the lack/abandonment of partner, closely followed by factor three: the existence
of other children at home (12%). Pregnant women who resorted
to abortion have a large age range: 14–45 years.
A-026
Unsafe abortions in India: is the MTP
Act propitious enough?
Suresh Sharma
Institute of Economic Growth, Delhi, India
In India abortions are legal and with the exceedingly liberal and
broadened law that was passed in 1971, the ‘Medical
Termination of Pregnancy Act’ has opened a new window to
women’s freedom and choice over their fertility. This paper
would like to focus upon the factors responsible for or leading
to unsafe abortion as well as such high incidence of abortion in
India which can help in understanding the ways in which we
can prevent this apathy. To study the intricacies involved in
delivering safety to womanhood in terms of safe abortion practice which includes more trained personnel, detailed
62
explanation and consequences of conducting an abortion, fine
reporting, awareness regarding family planning measures and
not only pressurising them to sterilise immediately after an
abortion but also prior to that informing them and, lastly, easy
accessibility of contraceptives with educated and brief information on that. Data has been drawn from various sources such as
the National Family Household Survey (1, 2 & 3), Health
Management Information System and Annual Health Survey. To
safeguard the interests of women when it comes to complications resulting from unsafe abortions, Reproductive Health laid
strict adherence to it in its guidelines. The Government could
induce more measures in terms of family planning measures
and increase the number of the skilled medical health force,
chiefly in rural areas to prevent the illegality of abortions. But
before that fine reporting on the number of abortions performed will gave an insight to this very issue. Only then will
policies and programmes work much better in favour of
women.
A-027
Obstetricians-gynaecologists’
experiences and attitudes towards
abortion, stigma and conscientious
objection: a qualitative study in Italy
and Spain (Catalunya)
Silvia De Zordo
Universitat de Barcelona, Barcelona, Catalunya, Spain
Objectives: This presentation explores obtetricians-gynaecologists’ experiences and attitudes towards abortion, its stigmatisation and conscientious objection based on two qualitative
studies respectively undertaken in Italy in 2011–2012, and in
Spain (Catalunya) between 2013 and 2015.
Methods: Short questionnaires and in-depth interviews were
conducted with 54 obstetricians-gynaecologists at four public
hospitals providing abortion care in Rome and Milan, and with
23 obstetricians-gynaecologists working at two hospitals and
one clinic providing abortion care in Barcelona. Key informants
(gynaecologists and midwives in charge of abortion care) were
also interviewed at a few other health facilities. Finally, I collected national and regional data on abortion and conscientious
objection and participated in the scientific and political debate
on abortion in both countries.
Results: A medical/moral classification of terminations emerged
in the discourse of most obstetricians-gynaecologists interviewed in Italy and Catalunya, regardless of their religiosity and
of their status as objectors or abortion providers. The ‘most
acceptable’ ones, both from a medical and moral perspective,
were terminations for severe fetal malformations, while the
‘least acceptable’ ones were repeat abortions. My studies show
that this is the result of physicians’ ‘stratified expectations’
about reproduction as well as of the increasing medicalisation
of contraception and pregnancy. Prenatal screening techniques
in particular have transformed the fetus into a ‘patient’ and
have contributed to increase abortion stigma. The medicalisation of reproduction is a global phenomenon, but, as my studies
show, its social/cultural impact on abortion stigma and gynaecologists’ attitudes and choices varies. Most abortion providers
in both countries, including religious ones, prioritise the woman
as their main patient, at least until fetal viability. However, in
Italy unlike in Spain abortion providers’ numbers have
decreased, while conscientious objection rates have significantly
increased over the last decade.
Conclusions: Abortion is stigmatised in the public debate and
abortion care is marginalised in obstetrics-gynaecology both in
Italy and in Spain (Catalunya). However, my studies show that
this impacts differently on gynaecologists’ experiences with
abortion, on the organisation and quality of abortion provision
and, ultimately, on physicians’ attitudes and decisions in regards
to conscientious objection in the two countries. I argue that the
different organisation of abortion provision in Italy and Spain,
between public hospitals (providing most terminations in Italy,
but not in Spain) and private clinics subsidised by the State
(providing most terminations in Spain) strongly influences abortion stigmatisation as well as physicians’ choices in regards to
conscientious objection.
A-028
Outpatient mifepristone-misoprostol
medical abortion through 77 days of
gestation
Ilana Dzubaa, Erica Chonga,
Mark-Christopher Adamsb, Rose Alic,
Gulnara Rzayevad, Curtiss Hannume,
E. Steve Lichtenbergc, Nguyen thi Nhu Ngocf,
Ashlesha Patelg, Patricio Sanhuezah,
George Tsertsvadzei and Beverly Winikoffa
a
Gynuity Health Projects, New York, NY, USA; bAtlanta Women’s
Center, Atlanta, GA, USA; cFamily Planning Associates, Chicago, IL,
USA; dScientific Research Institute of Obstetrics and Gynecology,
Baku, Azerbaijan; eThe Women’s Centers, Cherry Hill, NJ, USA;
f
Center for Research and Consultancy in Reproductive Health, Ho
Chi Minh City, Viet Nam; gJohn H. Stroger, Jr. Hospital of Cook
County, Chicago, IL, USA; hSecretariat of Health of Mexico City,
Mexico City, Mexico; iDavid Gagua Clinic, Tbilisi, Georgia
Objectives: The published literature demonstrates that medical
abortion effectiveness decreases slightly as gestational age
increases. Current evidence supports outpatient medical abortion through 70 days of gestation. The efficacy of medical abortion at 71–77 days of gestation has not been rigorously
explored in outpatient settings and without repeat doses of
misoprostol. This open label, non-inferiority, multi-country study
compares the efficacy, side-effects, and acceptability of a mifepristone and buccal misoprostol regimen for pregnancy termination among women with pregnancies 64–70 days and 71–77
days of gestation.
Methods: A total of 691 women are required to determine
non-inferiority of success in women 71–77 days’ LMP (one-sided
margin of 6%, 90% power, a ¼ 0.05). Women with intrauterine
pregnancies 64–77 days gestational age by abdominal ultrasound seeking abortion services in study sites in five countries
and who meet standard eligibility criteria for medical abortion
are invited to participate in the study. All consenting participants take 200 mg mifepristone followed 24–48 h later by 800
mcg buccal misoprostol and return one week after to determine
abortion status by ultrasound. Women keep a home diary to
record drug administration, pregnancy expulsion (if observed),
daily bleeding and pain score.
Results: The primary outcome is rate of successful medical
abortion without surgical intervention. Data collection is currently ongoing. To date, more than 520 women have been
enrolled, and recruitment should be completed in the first quarter of 2016. Data will be analysed prior to the meeting and final
results will be presented.
Conclusion: Increasingly, providers are offering outpatient medical abortion to clients through 70 days’ LMP. Due to a lack of
evidence and provider concerns of reduced efficacy, increased
complications, or challenges with managing the expulsion at
home, women are typically denied medical abortion if the estimated gestational ages of their pregnancies exceed 70 days.
The results of this study will contribute much-needed information on medical abortion through 77 days of gestation and
guide a more informed selection of the most appropriate pregnancy termination method.
A-029
The recent increase in spontaneous
abortions in Turkey: medicalisation of
pregnancy?
Tugba Adali, Alanur Çavlin and Ezgi Berktas
Hacettepe University Institute of Population Studies, Ankara,
Turkey
Objectives: The most recent Demographic and Health Survey in
Turkey (TDHS-2013) revealed a spontaneous abortion level of 14
per 100 pregnancies, which is significantly higher than the last
four data points between 1993 and 2008.
The aim of this study is to understand the underlying reasons
for the observed increase in spontaneous abortions. Three
potential reasons were investigated: (1) Could induced abortions
have been recorded as spontaneous abortions because of social
desirability? (2) Provided the increase in assisted reproductive
techniques (ART) in Turkey, could it be that more women are
getting pregnant with higher risks of miscarriage? (3) Could it
be that the increase is not a real one, but is rather a reflection
of women noticing their pregnancies earlier as well as their first
trimester miscarriages?
Method: TDHS data from 1993 to 2013 were utilised in the
analysis. Mean number of cumulative induced abortions and
cumulative spontaneous abortions were calculated for birth
cohorts to check for inconsistencies over time. Descriptive analysis of ever having had a spontaneous abortion for women
who got pregnant through ART was performed. Receiving
antenatal care and its timing were assessed for the last two
decades. The month of spontaneous abortion and the duration
of current pregnancy were examined to see whether reporting
was increasing over time due to earlier recognition of
pregnancy.
Results: Cohort estimates of cumulative spontaneous and
induced abortions revealed some deficiencies in the reporting
of the latter but no peculiarities were observed for the former.
An increase in the use of ART were apparent, from TDHS-2008
to TDHS-2013. In the meantime, the proportion getting pregnant among users declined, and the proportion of ever having
a spontaneous abortion among women used ART increased.
The month of spontaneous abortion over the past 20 years
showed an increase in the proportion of 1st month spontaneous abortions. The duration of pregnancy for women pregnant
at survey date also showed an increase in the share of 1st
month pregnancies.
Conclusions: We concluded that the rise in spontaneous abortion in Turkey can be explained with the medicalisation of pregnancy, provided the change in the month of spontaneous
abortion, current pregnancies, increase in the use of ART, and
increasing antenatal care over the past 20 years.
A-030
Abortion pills in women’s hands. Is
the abortion rights movement
working to make it happen?
Kinga Jelinska and Susan Davies
Women Help Women, Amsterdam, The Netherlands
Objective: To stimulate discussion about the boundaries of
the involvement of lay activists in expanding access to safe
abortion methods, and the potential strategies to facilitate
access to medical abortion despite of local legal restrictions
in order to counter the current unreliable sources of
medicines.
63
Method: A panel designed by activists working on putting the
medicines in women’s hands, including: sharing lessons learned,
strategies and challenges of their work.
Result: The participants will learn about the experience of
women searching for abortion pills online and in communities,
and strategies used by lay activists to address their needs. This
paradigm challenges the classical provider-patient relation, and
raises public health and ethical questions about our commitment and measures we are willing to take as a movement to
reduce maternal mortality due to unsafe abortions.
Conclusion: The safety of abortion with mifepristone/misoprostol and misoprostol alone at home in the first (at least) nine
weeks of pregnancy is well established. Yet, maternal morbidity
and mortality from unsafe abortion continues around the world.
Even in countries where medical abortion is practiced within
the official health care system, the procedure is often over-medicalised. There is a lack of reliable providers of medicines meeting the actual demands in countries where abortion is
restricted. The mobile and online interventions, the Internet provision, as well as community interventions have yet to reach
the potential.
Many women are still dependent on the black market, and
the plethora of unreliable sellers. The relative passivity of the
movement is justified by legal risks and security concerns.
But is it ethical to wait? Additionally, the empowering potential of the technology of medical abortion needs to be
reached, and the isolation and stigma surrounding the experience of self-administration reduced. It is time that human
rights advocates to unite to exponentially expand women’s
choices.
A-031
The outcome of home medical
abortions provided through
telemedicine
Marlies Schellekens, Rebecca Gomperts,
Gunilla Kleiverda and Kristina Gemzell Danielsson
Women on Web, Amsterdam, The Netherlands
Objectives:
1.
2.
3.
To evaluate the outcome and acceptability of home
medical abortion provided via telemedicine.
To analyse which factors influence the surgical
intervention rate following a medical abortion at home
provided via telemedicine.
To assess the efficacy, safety and acceptability of
medical abortion provided through telemedicine.
Methodology: Women, living in countries with restricted
access to safe abortion and who completed the online consultation from, obtained the medical abortion through telemedicine and provided follow-up information, were included
in the study. Women with a gestational age up to nine weeks
were advised to take 200 mg mifepristone, followed 24 h later
by 800 mcg misoprostol sublingually and a repeat dose of 400
mcg misoprostol sublingually after four hours.
Data were obtained from the interactive web-based questionnaire, follow-up forms, emails and telephone calls. Women
provided information about their pregnancy duration based on
LMP or as confirmed with ultrasound. They also provided information about their age, parity, contraceptive use, any diseases
or allergies, and the current use of medication.
Demographic data (age, parity, contraceptive use, geographic
location) duration of pregnancy at the time of the consultation,
doctor or hospital visit after the medical abortion and outcome
of the abortion measured in ongoing pregnancy, surgical intervention and acceptability of the abortion were analysed by
using data obtained
64
Results: Three different retrospective studies analysed the data
of in total almost 3000 women, who obtained and used the
medical abortion through telemedicine. The analyses showed
that the reported surgical intervention rate after the medical
abortion varied between 4.7% and 14.8% depending on followup rate, geographic location, and hospital visits. One of the
studies showed a significant difference in surgical intervention
rates after the medical abortion at the different gestations.
However, 42.2% of the women who had received a surgical
intervention afterwards did not have any symptoms of a
complication.
Conclusions: Home medical abortion provided through telemedicine is a safe and effective and an important harm reduction strategy for women in countries where there is no access
to safe abortion services. Task shifting may result in increased
access to and availability of medical abortion services while
maintaining the same quality of care. While task shifting can be
done to other health care professionals, it can also be done to
women themselves with the use of telemedicine.
A-032
Abortion: findings from the
‘understanding fertility management
in contemporary Australia national
survey’
Heather Rowea, Sara Holtona, Maggie Kirkmana,
Christine Baylyb, Vicki Sinnottc, Lynne Jordand,
Kathleen McNameed, John McBaine and
Jane Fishera
a
Monash University, Melbourne, Victoria, Australia; bRoyal
Women’s Hospital, Melbourne, Victoria, Australia; cVictorian
Government Department of Health and Human Services,
Melbourne, Victoria, Australia; dFamily Planning Victoria,
Melbourne, Victoria, Australia; eMelbourne IVF, Melbourne,
Victoria, Australia
Objectives: Very few publicly available data on abortion are
available in Australia. There is no unified national law; abortion
is governed by individual laws in the eight states and territories
and remains in the criminal code in some jurisdictions. Two
states publish mandated annual reports on abortion procedures
but no national statistics are kept. In order to inform health policy and service provision, a survey of an Australian national sample of women and men of reproductive age was funded in
partnership by the Australian Research Council, the Royal
Women’s Hospital, The Victorian Government Department of
Health, Family Planning Victoria and Melbourne IVF. The aim of
this paper is to describe the personal and sociodemographic
factors associated with undergoing or being a partner in an
abortion among survey respondents.
Methods: A population-based cross-sectional survey was conducted. The survey and a letter of invitation to participate were
mailed to a random sample of people aged 18–50 extracted
from the Australian Electoral Roll. Information was collected
about age, sex, socioeconomic and educational status,
Aboriginal and Torres Strait Islander status, importance of religion in fertility decisions, country of birth, satisfaction with sexual and reproductive health services, comfort negotiating
contraception use, sexual coercion and experiences of abortion.
Factors significantly associated with abortion in univariable analyses were entered in multivariable analysis.
Results: The survey was sent to 15,590 people (7795 women;
7795 men), yielding a broadly representative sample (n ¼ 2235;
n ¼ 1543, 69.1% women; n ¼ 691, 30.1% men; recruitment fraction 16%; mean (SD) age 36 (9.7) years). Of respondents who
had ever had (or been a partner in) a pregnancy, 24% women
and 18% men reported experience of abortion. In adjusted analyses, women who were socially disadvantaged, for whom
religion was not important in fertility decisions, who were not
comfortable negotiating contraception with a sexual partner
and had experienced sexual coercion, and men who lived in a
metropolitan area or had experienced sexual coercion were significantly more likely to have experienced or been a partner in
an abortion, respectively.
Conclusions: The results contribute to the scant information
about abortion in Australia. Comprehensive sex education and
contraceptive counselling should enhance skills to recognise
and address sexual coercion within relationships. The findings
are further evidence that Australia’s low- or no-cost universal
health services should provide comprehensive reproductive
health care that includes abortion.
A-033
Medical abortion provided by nursemidwifes or physicians in a high
resource setting: a cost-effectiveness
analysis
€stro
€ma, Helena Kopp-Kallnera,
Susanne Sjo
Emilia Simeonovab, Andreas Madestamc and
Kristina Gemzell-Danielssona
a
Karolinska Institutet, Stockholm, Sweden; bJohn Hopkins
University, Carey School pf Business, Baltimore, USA; cStockholm
University, Department of Economics, Stockholm, Sweden
Objective: To calculate the cost-effectiveness of early medical
abortion performed by nurse-midwifes or physicians in a high
resource setting, where ultrasound dating is part of the
protocol.
Method: Data of the clinical outcomes were collected from a
previous randomised-controlled equivalence study of medical
abortion provided by physician or nurse-midwifes in an outpatient family-planning clinic at a university hospital in Sweden.
A total of 1180 women seeking early medical TOP were randomised. The average direct costs of the intervention employing
nurse-midwifes and the standard procedure using physicians,
as well as the indirect costs of complications were established.
The incremental cost-effectiveness ratio (ICER) was calculated
for direct and total costs.
Results: The average direct costs per procedure were EUR 44
for the intervention compared to EUR 58 for the standard procedure. Costs of complications were EUR 11 less in the intervention group. Both the cost and the efficacy of the intervention
were superior to the standard treatment resulting in a negative
ICER at EUR 9 using direct costs and EUR 18 for total costs
per additional percent increase in efficacy associated with the
intervention.
Conclusion: Medical termination of pregnancy by nurse-midwifes is cost-effective in a high resource setting. In the longer
perspective, society’s total cost for TOP could be reduced by
the intervention as nurse midwives prescribe higher proportions
of long-acting reversible contraception.
A-034
Prevalence of uterine synechiae after
abortion evacuation curettage
Thiago Guazzellia, Mayara Montinoa, Henry Korkesa,
Cristina Guazzellib, Grecy Kenjya and
Geraldo De Nadaia
a
Hospital Municipal Maternidade Escola de Vila Nova
Cachoeirinha, S~ao Paulo, Brazil; bUniversidade Federal Sao Paulo,
S~ao Paulo, Brazil
ACCEPTED ABSTRACTS – ADOLESCENT SEXUAL REPRODUCTIVE HEALTH CARE
Objectives: To evaluate the prevalence of uterine synechiae
after abortion evacuation curettage and its association with epidemiological profiles of this patients.
Methods: This was a cross-sectional study at the Gynaecologic
Endoscopy Unit, Hospital Municipal Maternidade Escola de Vila
Nova Cachoeirinha. During 5 months (February–June 2015) all
women who had been subjected to uterine curettage following
abortion were invited to this study. The hysteroscopy was performed 30–90 days after the curettage and they answered a
short questionnaire to collect socio-demographic data.This study
included 25 women who desired future pregnancy and were at
least 18 years old.
Results: Of the 25 participants, seven (28%) had intra uterine
synechiae. This study included 18–45-year-old women with an
average age of 29.1. A total of three (12%) of the patients had
infection symptoms and signs when they were subjected to
uterine curettage following abortion and two (66.6%) of them
had synechiae.
Conclusions: In the present study, 28% of the women subjected to uterine curettage following abortion had intra uterine
synechiae. Women who had infection symptoms and signs
increased the prevalence of synechiae.
ADOLESCENT SEXUAL REPRODUCTIVE HEALTH CARE
A-035
A Family Planning Centre for an
island
Orlando Saporiti and Myriam Sotomayor
Hospital Insular, Arrecife de Lanzarote, Canary Islands, Spain
Background: The Canary Islands are well known as a tourist
spot. However it is not well known for its health care. On
Lanzarote the Family Planning Centre (FPC) has existed since
1983, is located in the Hospital Insular and belongs to El
Cabildo, the local goverment of the island. Is it possible
to analyse the benefits of this FPC to young people below
30 years?
Objective: To check the impact on the young population of a
FPC that can reach all the island. Lanzarote is an island big
enough (100,000 inhabitants) to have such a health care programme, and small enough to cover an educational program in
all schools.
Methods: We used two areas of study: Clinical assistance at the
FPC and Educational assistance in all schools. Clinical assistance:
data was taken in the FPC in young people aged between 14
and 24 years old. Abortion demand, contracepction demand,
new contraceptive methods, IUD, etc. Tarde Joven (Teenagers
afternoon): at the FPC on Thursday afternoons the Centre is
open to young people, the nurse provides information, the
morning after pill, and pregnancy tests for free. Educational
assistance: during all these years two psychologists have been
for a week in each school to attend to 14-year-old children.
Sexual behaviour, oral contraception, and unexpected pregnancies were the topics discussed; details about the FPC, and its
address, were also given.
Conclusions: Lanzarote has not been a closed island over the
last 30 years. Increase in the Spanish population, European community, South American, and African immigrants are the new
demands. New challenges are coming but the FPC remains a
reference for teachers, students, and GPs.
65
A-036
Enabling international commitments
to foster favourable adolescent
sexual and reproductive health
services in Jamaica
Tazhmoye Crawford
The National Family Planning Board, Kingston, Jamaica
This hermeneutic phenomenological research aims to determine
the extent to which adolescent sexual and reproductive health
services in Jamaica are consonant with specific principles governing the International Convention on the Rights of the Child,
the International Conference on Population Development, and
the Universal Declaration on Human Rights, to which Jamaica is
signatory.
A qualitative approach was used to capture information from a
sample size of 10 adolescent mothers; five adolescent fathers
(18–19 year olds) and five policy personnel, including health
care professionals (via snowball and purposive sampling methods respectively) in rural and urban Jamaica. The research
explored pertinent theories that added value to its conceptual
underpinning and discourse; namely, Kantian, Black Feminism,
and Gender – of course, with recognition of the Caribbean’s
culture of Matrifocality.
According to the literature, approximately 200 adolescent mothers succumb to complicated pregnancy and childbirth every
day – an increase in maternal morbidity throughout the world.
Adolescent pregnancy and childbearing represent approximately
23% disability adjusted life years. Adolescent-related pregnancy
and STI have also contributed to 13% burden of disease among
women in their reproductive years and 2% burden of disease
worldwide. In Jamaica, pregnancy and incidences of HIV/STIs
among adolescents place them at great health risk, thus resulting in at least 40% unplanned pregnancy and 294 HIV/STI cases
(225 females; 69 males). Adolescent fertility rate is also among
the highest in the Caribbean, with 72 births per 1000 girls
within the age cohort of 15–19 years.
The findings revealed that the majority of the respondents
reported feeling a sense of being denied the right to health
care services and comprehensive SRH education that would protect them from further vulnerabilities, including powerlessness
and insecurity. Few respondents claimed that duty bearers
upheld due diligence in the best interest of the adolescent. All
the respondents admitted to gender bias treatment, being
more favourable to males than females. While access to quality
health care and services is part of the Government of Jamaica’s
protocol and priority arrangements to achieve ‘a healthy and
stable population’ by 2030, the action of some health care professionals and educators, rest on personal positionalities.
Incongruities among local policies, legislation and practices, as
well as international commitments, also spur actions that are
contrary to the best interest of the adolescent.
A-037
Contraceptive awareness in the area
of reproductive health in female
students
Irina Kopobayeva
Karaganda State Medical University, Karaganda, Kazakhstan
Background: Since youth reproductive potential preservation
along with possibility of reproductive function implementation
66
in fertile age is one of the most important medical and social
tasks of modern medicine, an increase in the number of adolescent pregnancies in Kazakhstan is an alarming factor that identified young women as a target group of this research.
Objective: Studying the level of contraceptive awareness in the
area of ??reproductive health in female students of medical and
non-medical faculties.
Methods: Among students of medical and non-medical faculties, a questionnaire and an anonymous survey were conducted
aimed at identifying reproductive anamnesis, use of contraceptive methods, awareness of dangers of abortion, and moral
guidelines.
Results: A total of 147 young women were questioned (97 students of medical and 50 of non-medical faculties). The age of
the respondents ranged from 16 to 21 years, enrolled as 1 or
2-year students. The main priorities of medical and non-medical
students are: health of close people – 70% and 35%, family relationships – 15% and 35%, presence of children – 8% and 14%,
their own health – 3% and 9%, work – 4% and 7%. Most of the
non-medical and medical students (77% and 94%, respectively)
do not smoke and do not drink alcohol (63% and 85%); is critical to health (13% and 27%). Overall, 65% of non-medical students at the time of the survey were sexually active versus 10%
of medical students. The first sexual intercourse occurred with a
‘familiar person’ (44% and 38%); the reason for the first sexual
intercourse was noted as ‘feelings for partner’ (67% and 80%);
‘interest in the process’ (12% and 29%). The optimal age for the
first sexual intercourse is 22–23 years (46%) among medical students, 18–19 years among non-medical students (40%). Most of
the surveyed used contraception at the first sexual intercourse
(49% and 60%). The bulk of respondents were aware about possible complications after abortion; about possible infertility –
96% of medical, 85% of non-medical students; about inflammatory diseases 97% and 91%, respectively; about subsequent miscarriage 96% and 73%; possible hormonal disorders – 96% and
89%; strongly opposed to abortion 15% and 26%.
Conclusions: According to the survey results, a lack of knowledge and awareness on contraceptive use was revealed, as well
as abortion complications in students of medical and non-medical faculties, indicating the necessity of work and implementation of informative preventive measures in order to preserve
young women’s reproductive health.
A-038
Contraceptive knowledge among
Mexican adolescents
Victor Marin-Cantua, Josefina Lira-Plascenciab,
Rodrigo Guarneros-Valdovinodc,
Alejandro Rosas-Balanc and Sayra Ayala-Encisoc
a
HCSAE Petroleos Mexicanos, Mexico DF, Mexico; bHospital
Angeles del Pedregal, Mexico DF, Mexico; cInstituto Nacionald e
Perinatologia, Mexico DF, Mexico
Objectives: To estimate the overall knowledge of contraceptive
methods among adolescents attending an adolescent medical
unit.
Methods: Data collection was performed using a previously
validated anonymous questionnaire, consisting of 11 multiplechoice questions regarding contraception. The survey was
conducted among 85 adolescents (between the ages of 13 and
19), mostly women (89.1%). Data are presented in frequency
distribution tables.
Results: A total of 86% of the respondents had previously had
sexual intercourse. About 62% had been or were pregnant at
the time. Overall, 65% believed that the male condom was the
most effective method to prevent pregnancy (when compared
to oral contraceptives, IUD, and implant). About 4% chose the
implant as a contraceptive method that prevented sexually
transmitted diseases (when compared to the condom). Only
half of the respondents knew that the contraceptive implant
could prevent pregnancy for up to three years. Around 35% did
not know the proper use of oral contraceptives and 65% did
not know that a type of copper IUD could remain effective for
up to ten years. Around 21% believed emergency contraception
should be used as a regular contraceptive method. Almost half
of the respondents believed that prolonged use of contraceptive methods could lead to infertility.
Conclusions: Mexican adolescents have inadequate knowledge
about contraception; many of them believe that the prolonged
use of contraceptive methods can cause infertility.
A-039
Sexual risk behaviours among
Mexican adolescents
Victor Marin-Cantua, Josefina Lira-Plascenciab,
Rodrigo Guarneros-Valdovinosc,
a
HCSAE Petroleos Mexicanos, Mexico DF, Mexico; bHospital
Angeles del Pedregal, Mexico DF, Mexico; cInstituto Nacional de
Perinatologia, Mexico DF, Mexico
Objectives: To describe the patterns of adolescents’ sexual
behaviour, and the factors that affect them.
Methods: Data collection was performed using a previously validated anonymous questionnaire, consisting of 10 multiplechoice questions regarding risky sexual behaviour. The survey
was conducted among 498 adolescents (between the ages of
13 and 19, 69.3% women and 30.7% men), before the presentation of sexual health workshops in public and private schools in
Mexico City (67.3% public, 32.7% private). Statistical analysis was
conducted using measures of central tendency, relative frequencies and Pearson Chi square test.
Results: Overall, 24.3% of 498 participants reported they had
ever had sexual intercourse. Of those 121 adolescents with previous sexual life, 49% had had two or more sexual partners during their life, 38.2% did not use condoms, 15% had had anal
sex, 47.6% reported alcohol consumption and 37.3% had ever
been involved in violent situations. Adolescent women from
public schools (56) more often reported having sex before,
when compared to adolescents from private schools (13), that
had a significant difference (p ¼ 0.049).
Conclusions: Risky sexual behaviour is common among adolescents, beyond exposure to unintended pregnancies.
A-040
Abortion in adolescents and young
people in our centre in Spain
Guldrıs Nieto, Gajino Suarez and Valdes Pons
CHUVI, Vigo, Pontevedra, Spain
Objective: To describe the variables associated with induced
abortions in adolescents and young people in our centre.
Methods: A retrospective, descriptive, series of case studies
were carried out. Women aged between 10 and 24 years old
who asked for an induced abortion up to 14 weeks of pregnancy were included. A database was obtained from medical
reports including social and medical characteristics, as well as
contraceptive methods. Review of the literature was carried out
that was identified through the Medline, ScienceDirect, Google
and Popline databases and relevant expert opinions up to 2013.
Statistic analysis was carried out with SPSS 17 software.
Results: We have reported 183 cases of induced abortion in
2012, one patient was excluded from our study because of
incomplete data. The age range included women between 15
and 24 years. A total of 80% of the patients were native to
Spain. We did not find differences between native and foreign
women. The contraceptive methods most used before intervention were condoms (48%) and the pill (16%), while 30% of adolescents had not used any method. Overall, 18% of the women
had had one previous abortion, but even within this group 28%
did not use any contraceptive method. There were no differences in gestational age between women who ask for an abortion
more than once. The pill was the most chosen contraceptive
method after having an abortion (68%) followed by the intrauterine device (21.9%). Just over half (52%) of women seek an
abortion between seven and nine weeks of pregnancy. Most
(88%) of our induced abortions were carried out with vacuum
aspiration in the first trimester of pregnancy.
Conclusions: The highest risk is in the 20–24-year-old age
group with low academic level or working in untrained jobs.
Most of those unwanted pregnancies were caused by an inconsistent use of condoms. Preventing unplanned pregnancy
among adolescents is still a challenge because many of them
fail to use effective contraception. Providing appropriate health
care would contribute to achieving less risk of undesired
pregnancy.
67
hours led to lower AAM by 0.3 years (p < 0.01) in a trimmed
models.
Conclusion: The study contributes to the phenomena of declining trend in AAM in other parts of the world and in India. The
finding that greater milk intake was associated with a higher
risk of early menarche while fruit consumption leading to late
menarche was a consistent and strong finding. Our findings
especially mothers’ education level leading to late menarche
may serve as reference for sexually and reproductive health
interventions. However, further studies may be needed to determine the complex behaviors of independent contribution to
early menarche.
A-042
Youngsters: condoms use under
alcohol
Geneviève Preti and Jean-Marc Theler
Geneva University Hospital, Geneva, Switzerland
Age at menarche and socio-economic
status, intake of food groups,
physical activities and stressful
conditions
Introduction: Several social and health departments in Geneva
(Switzerland) report youngsters’ sexual risks under alcohol. In
2012, an interinstitutional prevention project with distribution of
condom boxes was set up. A total of 30,000 boxes were supplied until 2015. Especially informed professionnals and volunteers delivered the boxes in various places. The Geneva
Federation against Alcohol Abuse (FEGPA) coordinated and
financed it. The study took place in this project.
Objectives: Amidst a population of youngsters aged between
12 and 25:
Richa Saxenaa and Vijender Kumarb
1.
2.
A-041
a
Amity, Ghaziabad, Uttar Pradesh, India; bUniversity of Delhi,
Delhi, India
Objective: The timing of Menarche, the first menstruation, one
of the most important events in a woman’s reproductive life,
varies across populations and depends upon biological, social
and family factors. The objective of this study was to explore
the impact of intake of basic food groups, socio-economic status, parents’ education, sleeping hours, stressful conditions etc.
on age at menarche (AAM).
Method: This cross-sectional retrospective study utilised a quantitative survey for data collection. The non-probability purposive
sampling was employed in a selection of girls at school.
Permission from the principal was taken before administering
the survey. Due to ethical considerations and privacy, the entire
school was selected for the survey. Girls who did not experience
menarche were later excluded. In total, sample of 330 girls were
considered for the study.
IBM PASW was employed to conduct descriptive, independent
t-test, ANOVA, survival and multinomial regression analysis.
Wealth index based on 30 assets and non-assets variables were
constructed using principal component analysis.
Results: Kaplan-Meier procedure estimated median survival
age of girls to be 13 years. The mean duration of menstrual
bleeding was 4.4 days ± 1.4 SD and average duration flow was
28.8 days ± 4.7 SD. We found a statistically significant difference in AAM between girls who faced quarrels at home than
those who did not. In the overall regression model, AAM and
the consumption of vegetables, and non-vegetables, physical
activities were not associated. Absence of father, mother or
both insignificantly associated with lower AAM. Girls in middle
wealth quartile had almost significant higher AAM than the
girls in lowest family quartile (b ¼ 0.35, p ¼ 0.055). While the
regular consumption of fruits (b ¼ 0.65, p < 0.05) led to late
AAM, milk intake was associated with the early menarche age
(b ¼ 0.28 years, p < 0.05). We found that higher education level
(primary and above) of the mother significantly predicted the
late AAM (b ¼ 0.26, p < 0.05) and a greater number of sleeping
To assess the use of condoms during alcoholised episodes.
To assess how the prevention project with condom
boxes was welcomed.
Method: A total of 298 young people aged between 12 and 25
answered a first survey, over a period of 1–3 months before the
condom boxes were supplied. Amongst them, 183 were
reviewed 1–5 months later for a second survey, during which
they gave their opinion about the project.
Results: Our sample consisted of 39% boys and 61% girls. The
majority were aged between 15 and 17 years old (70%), and in
secondary school, including high school (63%).
1.
2.
3.
4.
5.
A total of 46% said they were in a relationship and
77% of participants had consumed alcohol in the
period of 1–3 months before the survey.
The minority confirms to have taken condoms with
themselves during alcoholised episodes (36%). Chi
squared shows that there is no link between age nor
the type of training education and the fact of carrying
condoms. However, gender was associated with boys
carrying condoms more often than girls (p ¼ 0.033).
Overall, 20% of young people in our sample have not
used condoms with a chosen partner, and 7% have not
used condoms with an unchosen partner.
The majority (91%) considered that the project was
useful. Amongst them, 65% think that the project was
useful for themselves, and 35% thought that it was useful for others.
Around 10% used the condom box to have a talk with
their partner, 25% with friends and 4.6% with their
parents.
Conclusion: This study shows that few youngsters think about
having condoms with themselves in alcoholised episodes. Boys
affirm to have taken them more than girls. There is a quite high
proportion of sexual intercourse without protection. We can
consider that if the studied period was longer, sexual intercourse without protection during alcoholised episodes would be
higher. The last assessment showed that youngsters find
68
prevention with the supply of condom boxes useful. This results
encourages professionals to continue with such projects.
A-043
The assessment of physical growth
and menarche/menstruation among
adolescents aged 11–14
Gulcan Tandogrua and Nilay Kalayb
a
Fatih Sultan Mehmet Egitim ve Araştırma Hastanesi, Istanbul,
Turkey; bMarmara University, Istanbul, Turkey
Objective: The study was performed in order to assess the
influence of physical growth (height, weight, BMI) on the
menarche/menstruation status among adolescent girls aged
11–14 years.
Method: The study sample consisted of 353 female students
aged 11–14 studying at two secondary schools in _Istanbul. The
data were obtained through the adolescent diagnostic form
and the percentiles of height, weight and BMI data found in the
form were calculated and assessed according to the existing criteria. Percentage and arithmetic mean were used in the data
analysis.
Results: It was found out that more than half of the adolescent
girls aged 11–14 (63.7%) had menarche and the average menarche age was 12.12 ± 1.01. When the menstrual cycle durations
of adolescent girls are examined, it was detected that 80.4% of
them had cycles of 21–35 days and their menstrual bleeding
lasted about 4–7 days (85.9%). It was stated that almost all of
them (91.1%) used hygienic pads. It was seen that most of
them (49.8%) changed their pads three or four times a day during this period. When the percentile ranges of the adolescents
taking part in the study were investigated, it was found out
that 25.5% of the height percentile was in the 51–75 range,
31.2% of the weight percentile was in the 51–75 range and
27.2% of the BMI percentile was in the 26–50 range.
Conclusions: When the height percentiles of the participants
were examined, it was seen that approximately 35% of them
were taller than normal height ( 86 or 97). When the weight
percentiles of the participants were assessed, it was found out
that about 20% were overweight ( 86 or 95). When the BMI
percentiles of the participants were assessed, on the other
hand, it was discovered that around 18% of them were obese
( 86 or 95).
A-044
Promoting sexual and reproductive
health in schools: characterisation of
individual contexts in a sample of
Portuguese pregnant adolescents
Paula Saraiva Carvalhoa, Raquel Piresb and
Maria Cristina Canavarrob
a
Department of Psychology and Education, University Beira
Interior, Covilh~a, Portugal; bFaculty of Psychology and Educational
Sciences, University of Coimbra, Coimbra, Portugal
Introduction: The available data emphasises a consistent trend
in the European Union and the United States, showing a
decrease in teenage pregnancies. Despite the positive evolution
of this indicator, it continues to be highly unfavourable, proving
at present to be a compelling social problem. This study intends
to contribute to new insights on the occurrence of teenage
pregnancies in Portugal as compared to non-pregnant young
people, at the same time trying to identify individual variables,
thereby contributing to a better understanding of the occurrence of pregnancy at a young age
Methodology: This sample consists of 630 adolescents, 306 of
whom had a history of pregnancy and 324 adolescents with no
pregnancy history. Information regarding individual contexts
was gathered through various sources (responses given by the
pregnant girls, self-response questionnaires and also information
from their medical records).
Results: Adolescents with a history of pregnancy have a low
level of education and a very high school drop-out rate. As a
result of their lower education level, they possess lower academic and professional expectations.
Conclusion: The results of this study allows for the planning of
educational interventions, preventing or mitigating the consequences of pregnancy at a young age.
A-045
Adolescents and family planning
methods
Manuela Neagu, Bogdan Luchian,
Adriana Constantin and Cristina Neagu
Panait Sarbu Clinical Hospital, Bucharest, Romania
Background: Family planning plays an important role in society
because of the early beginning of sexual activity. Contraception
can reduce the risk of an unwanted pregnancy, abortions and
sexually transmitted disease. In Romania family planning
evolved after the 1990s and in a modern society the needs of
contraception are normal. Nowadays adolescents are exposed
to unwanted pregnancy and Romania has some of the highest
teenage birth rates in Europe.
Methods: A retrospective study was conducted in the National
Family Planning Centre from Panait Sarbu Hospital Bucharest
regarding the contraceptive methods used by adolescents. The
study population included women aged 12–18 years who
referred to the health centre. It was conducted from January
2013 to October 2015 and data were collected from 199 adolescents. The study analysed chosen contraceptive methods by
adolescents depending on the moment of beginning their sexual activity or besides their gynaecological history and, of
course, the moment they came for counselling. The age, the
place of origin (urban or rural), the smoking status and attendance in the education system were also noted.
Results: The most common choice is represented by low combined oral contraceptive pills. The high percentage (31.54%) of
the young women who have already an obstetric history (births
and abortions) before making the decision to use a contraceptive method is worrying. One of the causes of low use of
contraception might be due to shortage of information
obtained through effective sources and consequently receiving
incorrect information from other individuals.
Conclusions: Despite the efforts made by the health system
many teenagers came to family planning when a pregnancy
occurred or after an abortion. Hence, efforts should be made to
educate teens about the safety and convenience of modern,
long-term, reversible methods of contraception.
A-046
Sexual responsibility of adolescents
ley Bender
So
University of Iceland, Reykjavik, Iceland
Objectives: One of the cornerstones of sexual and reproductive
health is sexual responsibility. The purpose of this study was to
explore this concept.
Method: A literature review of the concept sexual responsibility
was carried out by exploring national and international literature
regarding adolescents including a gender focus.
Results: The results showed that the concept of sexual responsibility is used in an extrapersonal, interpersonal and intrapersonal way. The extrapersonal use of the concept has to do with
the societal responsibility, such as sexuality education. The purpose of sexuality educational programmes is often to encourage
sexual responsibility among adolescents. Interpersonal use refers
to parents having the responsibility to discuss sexual issues and
partners to show responsibilities in their relationships. Overall,
the concept seems to be mostly used in an intrapersonal way
where it refers to the responsibility of the individual, to prevent
sexual dangers. Thus it is frequently presented in context with
the use of contraception, to prevent unplanned pregnancy and
sexually transmitted diseases. The discourse about sexual
responsibility is more frequent regarding adolescent girls than
boys. The girls are expected to be more responsible when having sex.
Conclusions: By focusing mostly on responsibility on the individual level is making the bigger picture of responsibility less
visible and ignores the possible influence of the inter- and
extraperosnal factors on the responsibility of the individual.
There is a need for gender equality regarding sexual responsibility of adolescents.
69
trichomoniasis (p < 0.05), chlamydial infection (p < 0.05) were
significantly higher in the second cluster. It was determined
that reproductive behaviour course takers higher evaluate their
own reproductive health knowledge (p < 0.05), have higher
acceptability of reproductive behaviour programmes (p < 0.05),
and health keepers as source of information (p < 0.05), well
informed about contraception methods (p < 0.05), have higher
rate of regular COCs consumption (p < 0.05).
Conclusion: The formation of high infectious risk reproductive
behaviour of university students is predetermined by early
sexual intercourse, sexual promiscuity, COCs consumption with
refusal of barrier method, non-professional sources of reproductive behaviour information. The necessity of introducing reproductive behaviour courses into university programmes was
confirmed.
A-048
Health-promoting lifestyle and
premenstrual syndrome in nursing
students
€lu
€fer Erbil
Nu
A-047
Pattern of university students’
reproductive behaviour formation:
role of educational programmes
Marina Khamoshina, Maria Arkhipova,
Olga Poustotina and Marina Lebedeva
Peoples’ Friendship University of Russia, Moscow, Russia
Objectives: To determine the pattern of university students’
reproductive behaviour formation.
Method: Interviewing of 1821 students of Peoples’ Friendship
University of Russia was conducted and analysed. A study group
was formed (n ¼ 427) according to entry criteria (age 18–25,
Russian citizenship, resident studies). Factor analysis and kmeans cluster analysis were performed. For efficacy evaluation
of sexual and reproductive educational programmes all students
were divided into two groups on the criteria of taking and not
taking the course (110 and 317 relatively), intergroup difference
was significant with p < 0.05.
Results: Factor analysis proves that students’ reproductive
behaviour is defined by early sexual intercourse (16 years old)
(3389), the level of STD awareness (3099), acceptability of reproductive behaviour information (2873), sources of reproductive
behaviour information (2796), criteria of contraception choice
(2704), using coitus interruptus (2601), personal reproductive
plan (2528), consumption of COCs (2483), sexual motivations
(2483). Two empirical types of reproductive behavior were distinguished with the help of K-means cluster analysis: ‘low infectious risk reproductive behaviour’ (first cluster) and ‘high
infectious risk reproductive behaviour’ (second cluster). The first
cluster students start sexual life after 16 years old. They are
mostly monogamous. The rate of COCs in this group is low in
comparison with the high rate of barrier method and coitus
interruptus. The first cluster students have low level of STD
awareness. They gather reproductive behaviour information
from numerous sources. They accept educational course on
reproductive behaviour. The second cluster students have high
level of STD awareness. They have low acceptability of reproductive behaviour courses preferring peers to professional
speakers. They have early onset of sexual life (before 16 years
old). The second cluster students accept sexual promiscuity. The
rate of regular COCs consumption is high in this cluster but
without using a condom. The rate of syphilis (p < 0.05),
Ordu University, School of Health, Department of Nursing, Ordu,
Turkey
Objective: To investigate whether there were any relationships
between a health-promoting lifestyle profile and premenstrual
syndrome.
Methods: This descriptive study enrolled 163 female nursing
students. Data were collected with a questionnaire form, HealthPromoting Lifestyle Profile (HPLP II) and Premenstrual Syndrome
Scale (PMSS). The HPLP II instrument is a self-report of healthpromoting lifestyle habits and composed of 52 items that covers six domains. The HPLP was developed by Walker et al. [1]
and was translated into the Turkish language and the reliability
and validity of the translated version has been demonstrated
an.[3]
by Bahar et al.[2] The PMSS was developed by Gençdog
The PMSS has 44 items.
Results: Nursing students’ mean age was 20.55 ± 1.93, and their
mean age at menarche was 13.43 ± 1.29. The PMSS mean score
was 122.98 ± 32.93. Three-fifths of nursing students (60.7%) had
a PMSS score of 111 or higher, and the PMSS mean score for
this group was 143.09 ± 24.17. Considering the average points
that were taken from PMSS subscales, it was determined that
71.8% of girls had changes in appetite, 66.3% of them had irritability, 62.6% of them had fatigue, 74.8% of them had swelling,
68.1% of them had pain, 65% of them had depressive feelings,
60.1% of them had changes in sleeping habits, 46% of them
had depressive thoughts, and 37.4% of them had anxiety.
Totally HPLP II score mean was found to be 129.98 ± 17.63.
Subscale mean scores of HPLP II of students were found that
health responsibility was 21.34 ± 4.27, physical activity was
15.72 ± 4.09, spiritual growth was 26.94 ± 4.13, interpersonal relationships was 26.20 ± 3.92, nutrition was 19.98 ± 3.73, stress
management was 19.74 ± 3.63. There were positive significant
correlations between health responsibility with pain (r ¼ 0.116,
p ¼ 0.141) and changes in appetite (r ¼ 0.229, p ¼ 0.003); nutrition and changes in appetite (r ¼ 0.206, p ¼ 0.008); interpersonal
relationships with pain (r ¼ 0.189, p ¼ 0.016) and changes in
appetite (r ¼ 0.253, p ¼ 0.001). Also, there was a positive significant correlation between total HPLP II score and changes in
appetite (r ¼ 0.229, p ¼ 0.003). There were negative significant
correlations between stress management with depressive feelings (r = 0.194, p ¼ 0.013) and irritability (r = 0.216, p ¼ 0.006).
Conclusions: The health-promoting lifestyle profile of the students was at a moderate level. Most of the nursing students
had premenstrual syndrome symptoms. It was found that positive affects were on premenstrual syndrome symptoms of
health-promoting lifestyle of nursing students. To promote
healthy lifestyle behaviours in nursing students we recommend
70
the organisation of training programmes about healthy lifestyle
behaviours.
References
[1]
[2]
[3]
Walker et al.
Bahar et al. (2008).
Gençdo
gan
A-049
Social, demographic, family and
economic factors correlated with the
occurrence of teenage pregnancy
and their reserved prognosis in
North-East Romania
Demetra Socolova, Iolanda Blidarua, Alin Lucab,
Nicoleta Mocanub, Razvan Socolova,
Alexandru Carauleanua and Magda Iorgab
a
University of Medicine and Pharmacy Gr T Popa, Iasi, Romania;
b
Hopsital of Obstetrics Gynecology Cuza Voda, Iasi, Romania
Objectives: To establish the relationship between the social,
demographic, economic, family factors and the incidence of
teenage pregnancy in North-East Romania,
Methods: It is a retrospective study, conducted in the
University Hospital ‘Cuza Voda’, Iasi, between January 2007 and
December 2014, using the electronic database, with the purpose to gather information on the following factors: social,
demographic, economic and family ones.
Results: From a total of 47,066 deliveries, 1304 (2.69%)
occurred in teenagers, aged between 12 and 17 years old,
median 17. From 1304 deliveries, 1056 (80.98%) came from
rural areas, and 248 (19.02%) came from urban areas.
Regarding the characteristics of the mothers: 13.5% were illiterate, 29.4% had only primary education, 53.6% had not yet
completed their secondary school and only 3.5% were attending high school. Concerning the mothers’ occupations: 32
(2.5%) were employed, 174 (13.34%) were at school and
84.16% were unemployed. Data analysis of parity show that
from 1304, 1225 (93.94%) are primiparous, 68 are secundiparous and one is triparous. From the 69 teenage mothers, who
had experienced at least two births:
1.
2.
3.
52 were from rural and nine are from urban areas, rural
teenage mothers.
40 of the patients gave birth to the second child in the
next year the first delivery,
At the age of 14 years, two patients were mothers of
two children.
The fathers of the children were aged between 15 and 43 years
old, median 27, 67 of them being teenage (< 18 years old).
Their characteristics were: illiterate 35 (2.68%), primary school
232 (17.79%), attending gymnasium 650 (49.84%), attending
high school 372 (28.52%), and professional school 10 (0.76%),
only 5 (0.38%) presenting higher education. Their occupations
are: student 61 (4.67%), unemployed 762 (58.43%), unskilled
labourers 453 (34.73%), day labourers 26 (2%), employee with
higher education 2 (0.17%). A number 53 (4.06%) of these couples are legally married (mother > 16 years old). At the discharge from hospital, the child will go: in his family (for married
couples) in 53 (4.06%) cases, in the teenage mother’s family in
1243 cases (95.33%) and in a maternal centre in eight cases
(0.61%).
Conclusions: The study found that age, socioeconomic status,
parents’ occupation, the educational level of both parents, were
associated with teenage pregnancy in the geographic region of
North-East Romania. This information is useful for the structuring of public health, sexual and reproductive health policies
applicable for our geographic area.
A-050
Assessing youth-friendly-healthservices and supporting planning in
the Republic of Moldova
Susanne Caraib, Stela Bivolc and
Venkatraman Chandra-Moulia
a
World Health Organization, Geneva, Switzerland; bIndependent
Consultant, Berlin, Germany; cIndependent Consultant, Chisinau,
Republic of Moldova
Objectives: Several countries have set up youth-friendly-healthservices. Relatively little is known about approaches to systematically assess their performance against set standards in terms of
quality and coverage and define improvement activities based
on the findings. The objective of this paper is to fill this gap
and to describe the methods and findings of an external review
of youth-friendly-health-services in Moldova and the use of the
findings to support further planning. The Republic of Moldova
scaled up youth-friendly-health-services (YFHS) nationwide with
the target of setting up at least one youth-friendly-health-centre
(YFHC) in each of the 35 districts.
Methods: We carried out an external review of the YFHS in
Moldova using a framework that examined the project’s design,
implementation and monitoring, outputs, outcomes and impact.
We collected primary data – obtained from health worker and
client exit interviews with semi-structured questionnaires, direct
observation and focus group discussions – and used secondary
data from progress reports, previous studies and surveys and
national level data.
Results: While impressive progress with geographical scale up
had taken place, services were not always provided to the
required quality and comprehensively in the newly established
YFHC, thereby diminishing chances of achieving the desired
outcomes and impact. The causes of this were identified, and
possible ways of addressing them were proposed.
Designating health facilities to be made youth friendly and
assigning health workers to manage them can be done fairly
quickly, improving performance takes time and effort.
Approaches that go beyond training such as collaborative learning and job shadowing may hold the best opportunity to
improve the knowledge, understanding and motivation of
health workers in the newly designated YFHC to address the
problem of poor quality.
Conclusions: The Healthy Generation project was well designed
and energetically implemented in line with the plan. It has contributed to tangible improvements in the quality of health service provision, and to their uptake. While progress has been
made, considerable work is needed, especially in the newer
centres. If the efforts of the Healthy Generation project are
stepped up, if weaknesses in its planning and implementation
are addressed, if complementary activities to build knowledge,
understanding, skills and an enabling environment are carried
out, the project can be expected to improve the health and
wellbeing of Moldova’s young people.
A-051
How adolescent friendly are national
contraceptive policies, strategies and
guidelines? An assessment of three
countries’ normative documents
using a human rights framework
Andrea Hoopesa, Venkatraman Chandra Moulib,
Petrus Steynb, Melanie Pleanere,
Tlangelani Shilubanef, Kathya Cordova Pozog,
Alma Virginia Camachoc, Junice Melgard,
Alfredo Melgard and Mario Festinb
a
University of Colorado School of Medicine, Aurora, Colorado,
USA; bWorld Health Organisation, Geneva, Switzerland; cUnited
Nations Population Fund, Panama City, Panama; dLikhaan Center
for Women’s Health Inc., Quezon City, The Philippines; eWits RHI,
University of Witwatersrand, Johannesburg, South Africa; fUnited
Nations Population Fund, Pretoria, South Africa; gSouth Group,
Cochabamba, Bolivia
Objective: To examine the adolescent content of national
contraception policies, strategies, and guidelines of three countries in order to identify facilitators and barriers to contraception
information and service provision for adolescents.
Methods: We used the World Health Organisation (WHO)
Human Rights Guidance and Recommendations for Provision of
Contraception Information and Services as an analytic framework. We assessed publicly available policies, strategies, and
guidelines in South Africa, the Philippines, and Paraguay in relation to each WHO summary recommendation. Specifically, we
determined where normative guidance pertaining to adolescents is present and whether it is adequate, normative guidance
pertaining to all populations but not specifically adolescents is
present, or normative guidance for that recommendation is
missing from the normative documents in each country. We
developed an analytic table to discuss with co-authors and
draw conclusions.
Results: We identified integration of human rights principles
and specific measures to address adolescents’ unique contraceptive needs in normative documents from all three countries.
South Africa’s and Paraguay’s guidance highlight laws protecting the rights of adolescents to obtain contraceptive services
while laws in the Philippines are less inclusive of adolescents.
Filipino minors can access contraceptive counselling and education in government facilities but must have written consent
from a parent to obtain contraceptive services. While all countries ensure that contraceptives are free in the public sector,
both Philippines and Paraguay mandate government funding
for this purpose. Normative documents from South Africa and
the Philippines include health outreach services designed to
reach adolescents and other marginalised populations. An
emphasis on privacy and confidentiality for adolescent clients is
present in normative documents from all countries while
Paraguay and the Philippines describe specific training of health
personnel to identify health determinants of adolescents and
support sexual and reproductive health decision-making. The
Philippines ensures involvement of civil society organisations
and community members including young people in the
design, implementation, and monitoring of contraceptive programs while there were no clear community participation strategies in South Africa’s or Paraguay’s guidance. Monitoring and
evaluation mechanisms to ensure accountability were clearly
described in normative documents from the Philippines and
Paraguay.
Conclusions: Efforts to address adolescent reproductive health
and rights are found in normative contraception documents
from all three countries, yet policy gaps remain that may leave
adolescents vulnerable to discrimination and create barriers to
71
accessing contraceptive services. These findings provide insight
for the revision and development of adolescent-inclusive sexual
and reproductive health policies in all settings.
A-052
What does not work in adolescent
sexual and reproductive health: a
review of the evidence on
interventions commonly accepted as
best practices
Venkatraman Chandra-Mouli
Objectives: To synthesise from published reviews evidence of
what does not work in Adolescent Sexual and Reproductive
health policies and programmes.
Methods: A review of reviews.
Results: Youth centres, peer education, and one-off public
meetings have generally been ineffective in facilitating young
people’s access to sexual and reproductive health (SRH) services,
changing their behaviours, or influencing social norms around
adolescent SRH. Approaches that have been found to be effective when well implemented, such as comprehensive sexuality
education and youth-friendly services, have tended to flounder
as they have considerable implementation requirements that
are seldom met. For adolescent SRH programs to be effective,
we need substantial effort through coordinated and complementary approaches.
Conclusions: Unproductive approaches should be abandoned,
proven approaches should be implemented with adequate fidelity to those factors that ensure effectiveness, and new
approaches should be explored, to include greater attention to
prevention science.
A-053
Youth perception on received sexual
education and consultation
Gozde Demirsoy, Pelin Karatas and
Arsenis Tselengidis
Adnan Menderes University, Aydin, Turkey, Turkey
Objectives: To learn more about young people’s sexual behaviours, sexual safety and education needs.
Method: A convenience sample of European young people
aged 19–35 were approached (N ¼ 469) via an online survey.
The questionarrie was published on the webpage of a youth
association. We obtained the data from 15 countries; East, West,
North, South Europe and Non-Europe countries (Germany,
France, Netherlands, Poland, Norway, Finland, Spain, Italy,
Portugal, Greece, Sweden, Hungary, Turkey, Azerbaijan, Russia
Federation). Statistical analysis was conducted with the statistical
software SPSS 19.0 and it included descriptive analysis, frequencies and chi-square. For the research, we used the variables of
age, sex, education, first sexual behaviours, received sexual consultancy in health care, sexual safety, education of sexually transmitted diseases and requirements from health professionals
Results: The average age of the participants was 22 ± 3.37 years
and ranged from 17 to 35 years. Just over half (55.1%) of the
participants were women, 83.6% were students and 76.2% were
university students. Overall, 26.2% of the participants were from
East Europe, 19.6% were from South Europe, 22.1% were from
72
West Europe, 19.6% were from North Europe and 12.1% were
from non-European countries. Almost one-quarter of the sample
had no sexual experience (25.1%). The age of participants’ first
sexual experience ranged from 11 to 27 and the average age
was 15 ± 2.27. A total of 72.1% (n ¼ 339) had received sexual
education, with 43.1% of them receiving it in primary school.
Most of them learned this knowledge only at school, parental
communication was significantly weak in north, east and nonEU countries. Overall, 76.2% of participants thought that they
have a safe sexual life (n ¼ 358), 66.2% have knowledge about
sexually transmitted diseases (n ¼ 311) and 53% of them
wanted counselling on sexually transmitted diseases (n ¼ 249)
from health professionals. Participants want to get more information about symptoms of sexually transmitted diseases, sexual
safety, risks of unsafe sexual life and consultation departments
of hospitals.
Conclusion: The results of our survey suggest that health professionals’ approach can make a big impact on young people’s
lives. Health professionals need to provide the right knowledge
to young people.
BARRIER METHODS
A-054
Learning to use the one-sized SILCS
Diaphragm in South Africa:
improvements after five uses
Mags Beksinskaa, Jenni Smita, Busi Maphumuloa,
Ross Greenera, Nonhlanhla Mphilia, Jennifer Fosterb
and Maggie Kilbourne-Brookb
a
MatCH Research, Department of O&G, University of The
Witwatersrand, Durban, South Africa; bPATH, Seattle, USA
Objective: To assess the ability of women in a public-sector setting in South Africa to successfully fit and learn to use the SILCS
diaphragm, and to evaluate changes in ease-of-use and
reported problems over the first five uses.
Methods: The study from which these data are derived was a
randomised, crossover study among 115 women in Durban,
South Africa, designed to assess the acceptability and preferences for the SILCS diaphragm used for gel delivery compared to
gel delivery from prefilled applicator. The data analysed here is
limited to the SILCS gel delivery arm. Data were collected via
coital logs, questionnaires, and focus group discussions with
women and male partners. Literate, sexually active, non-pregnant women, 18–45 years, in a monogamous relationship for at
least 6 months, using a non-barrier method of contraception
were eligible. Women used the SILCS with gel applied directly
to the device during five separate sex acts. Confidence about
inserting/using the SILCS, and perception about ease of use and
acceptability were evaluated after one and five uses.
Results: A total of 115 black women, aged 18–44, were enrolled
and 106 (92%) completed the study. Only four women were
unable to fit the SILCS after training. Ease of insertion improved
over time, with 72% reporting that the SILCS was easy to insert
at first use, compared to 87% reporting ease of insertion at use
5. Most (83%) also felt comfortable after two–three insertions.
Experience of gel leakage before sex reduced from 14.2% to
5.7% and leakage after sex declined from 2.8% at first use to
1.9% at fifth use. Women’s confidence of correct placement
increased from 76.4% to 80.2% after five uses.
Conclusion: These results show that with short-term training
and counselling women can learn to fit and use the SILCS
Diaphragm – even when they have never used a diaphragm
before. Within the first five uses, confidence and ease of use
increased, and the number of reported problems decreased.
A-055
SILCS Diaphragm as a multipurpose
prevention technology: new data
from South Africa
Mags Beksinskab, Jenni Smitb, Busi Maphumulob,
Ross Greenerb, Nonhlanhla Mphilib, Jennifer Fostera
and Maggie Kilbourne-Brooka
a
PATH, Seattle, WA, USA; bMatCH Research, Durban, South Africa
Background: The SILCS Diaphragm is a single-size, reusable
contraceptive developed through a user centred process to be
easy to use and comfortable for both partners. The innovative
design eliminates the need for a pelvic exam to determine diaphragm size. Researchers are now assessing the SILCS
Diaphragm as a reusable delivery system for microbicide gel. If
acceptable, the SILCS gel delivery system could protect from
both unintended pregnancy and HIV/STIs, thus serving as a multipurpose prevention technology (MPT).
Objective: To assess the acceptability and preference for the
SILCS Diaphragm used for (microbicide) gel delivery compared
to gel delivery from a prefilled applicator.
Method: A randomised, crossover study among 115 women in
Durban, South Africa. Data were collected via coital logs, questionnaires, and focus group discussions with women and male
partners. Literate, sexually active, nonpregnant women, 18–45
years, in a monogamous relationship for at least six months,
using a nonbarrier method of contraception were eligible.
Women used each method during five separate sex acts.
Acceptability and preference endpoints were summarized by
delivery system using means and medians (for continuous
measures) and frequencies and percentages (for discrete outcomes). Acceptability scores ranked on a 5-point scale were
compared for both gel delivery scenarios using Friedman’s
test.
Results: A total of 115 black women, aged 18–44, were
enrolled; 106 (92%) completed the study. Most women reported
good comfort with the SILCS Diaphragm during intercourse
(85%) and also felt comfortable after two–three insertions
(83%), similar to the learning curve for applicator use. Women
reported good comfort overall (gel and delivery system
together), with slightly more reporting applicator/gel was ‘very
acceptable’ (68%) compared to SILCS and gel (60%). While 18%
of women reported they would use the SILCS for pregnancy
prevention and 14% would use a microbicide for HIV prevention, 68% were interested in using SILCS plus gel if it could protect from both unintended pregnancy and HIV.
Conclusions: This study expands knowledge about South
African women’s experience with the SILCS Diaphragm as a
contraceptive and as a potential MPT, and may have implications for women in other countries as well. These results confirm that women can easily learn to use the SILCS Diaphragm;
they find SILCS comfortable during use; and they and their partners experience acceptable sex while using SILCS. Women in
this study recognised a benefit of using the SILCS Diaphragm
and microbicide gel as a potential MPT, and this greatly
increased women’s interest in using this method.
A-056
Why women change the first
contraceptive method
~ez Gallego,
Javier Valdes Pons, Teresa Nun
Patricia Velazquez Turnes and Eva Guldris
Complejo Hospitalario Universitario de Vigo, Vigo, Spain
ACCEPTED ABSTRACTS – CONTRACEPTION AND BEHAVIOURAL MEDICINE
Objectives: To find out contraceptive preferences at the start of
sex life and risk of unwanted pregnancy (and the main reasons
for changing contraceptive methods).
Method: A descriptive series of case studies were carried out
on 237 women for eight weeks in our Family Planning Centre.
The main reason for a medical consultation was to change the
contraceptive method. A database was obtained incluiding socioeconomic and medical characteristics, as well as contraceptives methods and the reasons for changing the contraceptive
method.
Results: The average age of the women was 30.4 years (age
range 18–49, SD 7.3). The age of first sexual intercourse and risk
of unwanted gestation was 19.08 years (13–32, 3.3 SD). The first
contraceptive methods used were: condom 76.7% (n ¼ 182),
hormonal method 18.5% (44), coitus interruptus 4.2% (10), intrauterine device 1% (0.4). In the condom group the reasons for
change were: contraceptive security 52.7% (n ¼ 96), contraceptive comfort 19.2% (35), dysmenorrheal treatment 6% (11),
unknown 4.3% (8), medical advice 3.8% (7), unwanted pregnancy 3.2% (6), try different method 2.1% (4), irregular menstruation 2.1% (4), acne treatment 1.6% (3), oligomenorrhoea 1%
(2), hirsutism 1% (2), others 2.1% (4). The mean time to changing condom use was 1589 days.
Conclusions: Condoms were the most popular contraceptive
method, more effectiveness and comfort were the main reasons
for leaving its use.
CARDIOVASCULAR RISKS OF HORMONAL
CONTRACEPTION (INCL PROGESTINS)
A-057
Awareness of the risk of VTE
associated with combined hormonal
contraception
Anya Cripps and Nicola Mullin
East Cheshire NHS Trust, Cheshire, UK
Objectives: To discover the level of knowledge of clinicians
working in a contraception and sexual health service regarding
the risk of venous thromboembolism (VTE) in women taking
combined oral hormonal contraception (COC).
Method: In July 2015 the Faculty of Sexual and Reproductive
Healthcare, UK (FSRH) issued a statement to its doctor and
nurse members on the VTE risk with COC in response to the latest published evidence.[1,2]
We work in an integrated contraception and sexual health
service and decided to investigate our colleagues’ level of
knowledge about VTE risk and COC; to discover if clinicians
were up-to-date and understood FSRH guidelines on prescribing
COC, using a voluntary individually completed quantitative and
qualitative questionnaire.
Results: Early results from nine different clinicians, four specialist contraception and sexual health nurses and five doctors in
genitourinary medicine, from a level 3 service, showed a range
of answers to each question. The only consistent answers were
all clinicians would offer a levonorgestrel (LNG) containing combined oral contraception pill to first time users, and were able
to indentify at least six additional risk factors for VTE, in line
with FSRH guidance. Only two members of staff (2/9, 22%) successfully completed a table quantifying risk of VTE in non-users/
not pregnant, postpartum, during pregnancy and with different
classes of COC; and only 1/9 (11%) could give an example of
each type or generation of progestogens when asked to list
four types. More individuals (6/9) knew that the risk of a VTE
decrease over the first few months of COC use.
Conclusion: Doctors and nurses in our integrated service do
not seem to be fully up-to-date in their knowledge of VTE risk
with COC but do understand and apply FSRH guidelines [3] for
73
the safe prescribing of CHC to patients. We plan to offer the
questionnaire to the remaining clinical staff in the service and
will identify and address any training needs.
References
[1]
[2]
[3]
FSRH Clinical Effectiveness Unit Statement on Use of combined
oral contraception and risk of venous thrombosis. May 2015.
Vinogradova Y, et al. Use of combined oral contraceptives and
the risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ
2015;350:h2135. 26 May 2015
FSRH Clinical Effectiveness Unit Guideline on Combined
Hormonal Contraception, October 2011 (updated August 2012).
CONTRACEPTION AND BEHAVIOURAL MEDICINE
A-058
Influencing factors of reliable
contraceptive use: a nationwide
cross-sectional survey
Ivan Devosaa, Norbert Pasztorc, Melinda Vanyab and
Zoltan Kozinszkyd
a
Teacher Training Faculty, Kecskemet, Hungary; bHealth Science
and Health Promotion Research Group, Kecskemet, Hungary;
c
Department of Obstetrics and Gynaecology, University of
Szeged, Szeged, Hungary; dDepartment of Obstetrics and
Gynaecology Blekinge Hospital, Stockholm, Sweden
Objective: To investigate the contraceptive and sociodemographic determinants of employment of contraceptive methods
among sexually active women.
Methods: A randomly selected representative sample of 4542
women aged 15–49 years participated in a prospective webbased survey between March and June 2015. Sexually active
women in the last three months completed questionnaires on
sociodemographic characteristics, contraceptive practice and
sexual activity. Pregnant women, women in the first postpartum
year, women with impaired fertility and those who wanted to
be pregnant were excluded in the analysis.Oral contraceptives,
intrauterine devices, male/female sterilisation, vaginal ring, plaster, implant and injection were regarded as reliable methods,
while barrier methods, periodic abstinence, withdrawal, spermicides, vaginal douche or no method were considered less
reliable methods based upon the Pearl index. Multiple logistic
regression analysis was applied to evaluate the factors influencing the contraceptive practice.
Results: The mean age of the women was 29.4 years (± 8), and
77% reported urban residents. The rate of use of reliable methods (hormonal contraceptives, intrauterine devices or sterilization) was 43%, while no method was used by 4.7% of the
women. Slightly more than half the women self-identified as
secondary educated (59%) and one third was higher educated.
A majority of women had 10 sexual partners during their lifetime (84.4%) and the vast majority (96.2%) had only one partner
at a time. They had stable sexual partnership (91.1%) predominantly and almost one tenth claimed that they had only occasional partner (8.9%). Eighty-nine percent reported weekly or
more often than sexual activity and 10.5% had monthly sexual
activity. Over half of the women (54.5%) had delivered at least
one baby, and 25% had had at least one previous abortion.
Future child wish was claimed by more than half of the participants (59%). Logistic regression indicated that high income was
favourable for the choice of modern contraceptive methods
(adjusted odds ratio (AOR): 1.1), like the increased sexual frequency (AOR: 1.1). The number of lifetime partners (AOR: 0.99)
and sexarche (AOR: 0.94) was correlated inversely with the use
of reliable contraceptives. Previous abortion (AOR: 1.4) or
74
delivery (AOR: 1.58) was correlated significantly with an
increased chance of reliable method use. Women with future
child wish are significantly less prone to the use of reliable
methods (AOR: 0.70).
Conclusion: Our large scale representative study demonstrates
that a complex interplay between sociodemographic and sexual
characteristics determine contraceptive preferences.
A-059
How to assess acceptability and
satisfaction of contraceptive methods
including vaginal rings in clinical
studies?
Therese Delvauxa, Vicky Jespersa and
Janneke van de Wijgertb
a
Institute of Tropical Medicine, Antwerp, Belgium; bInstitute of
Infection and Global Health, University of Liverpool, Liverpool, UK
Objectives: Quantitative methods, i.e., structured questionnaires
are commonly used in clinical studies or trials for assessing
acceptability and satisfaction of a contraceptive method, even
for methods that are introduced into the vagina, such as a
contraceptive vaginal ring, and are likely to affect a sexual relationship. The objective of this study was to review the research
methods used for assessing acceptability and satisfaction of
contraceptive methods, and the vaginal ring (VR) in particular.
Methods: A systematic literature review on research methods
used for assessing the acceptability and satisfaction of contraceptives and vaginal rings was conducted using the AMSTAR
checklist. Three electronic databases (PubMed, ISI Web of
Knowledge, POPLINE) were explored systematically in order to
retrieve relevant articles.
Results: Standard clinical trials in the field of contraception do
not include a qualitative research component. Earlier studies
on VR, mostly clinical trials often conducted by or with the support of pharmaceutical companies, tested acceptability using
quantitative methods i.e structured questionnaires filled in during clinical visits, or self-answered questionnaires filled in by the
patient after the visit or at home. User acceptability and satisfaction were assessed through a number of dimensions: ease of
use; clarity of instructions; ease of package instructions; sexual
comfort (whether the ring was felt by the woman or the male
partner or whether the partner minded about the ring); cycle
related characteristics (menstrual changes or pain); compliance
(including removals); and finally overall satisfaction. The studies
apart from investigating whether the ring was felt or not during sexual intercourse, did not enquire about the effect on
sexual life e.g., pleasure or frequency. The role and importance
of behavioural science and inclduing a qualitative component
to document acceptability in clinical studies emerged in early
2000s with microbicides trials which showed that adherence
was a key issue in order to achieve significant HIV prevention
results. It is only at the time VRs were tested in the field of
HIV prevention and multipurpose prevention trials, i.e., for
both pregnancy and HIV/STI, and particularly in sub-Saharan
Africa, that mixed methods including a qualitative component
started to be applied. Sexual encounter attributes, e.g.,
sexual pleasure and frequency were defined in frameworks
of acceptability and tested in placebo vaginal ring studies for
the first time.
Conclusion: These results indicate the potential role and
importance of qualitative and mixed methods in contraceptive
methods studies.
A-060
Bring men to the table: to evaluate
knowledge about contraceptive
methods, contraceptive behaviour
and the desired role of young men in
decisions regarding contraception
within a relationship – a pilot study
Stephanie Felder, Patrick Grossert and
Susanne Gabriele Merki-Feld
Klinik f€
ur Reproduktionsendokrinologie Universit€atsspital Z€urich,
Z€
urich, Switzerland
Background: In Switzerland little is known about the role of
young men and their knowledge regarding decisions about
contraception. Even though contraception is well established in
Switzerland and the abortion rate is very low (2014: 6.3 abortions
per 1000 women between 15 and 44 years) sexual education of
young men might contribute to further improvements. In our
pilot study we aimed to evaluate male student’s knowledge
about, attitude towards and willingness to contribute to contraception within a relationship to prevent unwanted pregnancy.
Methods: A link to an anonymous questionnaire was sent via
email to 1500 randomly chosen male students of the University
of Zurich, excluding students of medicine, biology and biochemistry to avoid preconditions. The questionnaire comprised 37
questions about contraceptive methods, behaviour, experience,
decision making and sexual experience. Within four weeks 192
complete forms were returned. The study was supported by an
ESC grant.
Results: Many students (60%) are in a steady relationship, 68%
used a contraceptive method when last having intercourse.
Most (89%) had used a condom at least once in a relationship
and 51% during the most recent intercourse. For 50%
Vasectomy is not an option until later in life. More than 90% of
the students have knowledge about: combined pill, condom,
vasectomy and emergency contraception. Less known methods < 55% are the progestin-only methods pill, injection and
implant. 98% are aware of the condom as the method protecting from STD. The combined pill is considered unhealthy by
37% and possibly affecting the libido by 40%. High efficacy, no
negative impact on libido and future fertility and good tolerability are the most important features expected of a contraceptive
method (> 70%). Regarding an unexpected pregnancy 94% of
the men would want to be informed and 74% would support
an abortion, regardless of their own feelings. In case of an unintended pregnancy 50% would appreciate optional counselling
for males.
Conclusion: Our pilot study showed that even highly educated
men with knowledge of most contraceptive methods have negative preconceptions about the effect of the contraceptive pill on
health and libido. These beliefs might have a negative effect on
long-term use. Although not being considered as a method
affecting health, Vasectomy was only considered as an option for
later life by 50%. Regarding unplanned pregnancy the majority
wish involvement and many would appreciate a counselling service for males. Sexual education of young males still needs
improvement.
ACCEPTED ABSTRACTS – CONTRACEPTION AND MEDICAL DISORDERS
A-061
Contraceptive prevalence in Austria
and implications for reproductive
health – the impact of hormone fear
and free of charge contraception
Christian Fialaa and Petra Schweigerb
a
Gynmed Clinic, Vienna, Austria; bGynmed Clinic, Salzburg,
Austria
Objectives: Knowing contraceptive prevalence and the motivation behind the use of various methods are crucial for interventions in reproductive health. But we also need a better
understanding of non-use of contraception
Method: A representative sample of the fertile population of
16–49-year-old women (n ¼ 1018) and men (n ¼ 1010) in Austria
answered an online survey in January 2015.
Results: A total of 71% of women reported use of a contraceptive method during the last year, down 10% from the last survey in 2012. Most (60% of all women) used an effective or
highly effective method, mainly OC (38%, down from 45% in
2012). Almost all of them used a hormonal method (57% of all
women). However 5.3% of all women specifically choose a nonhormonal method. The main reason for not using contraception
was infrequent or no intercourse (10.5% of all women) followed
by avoiding hormones (7.5%). Avoidance of hormones let 12.8%
of all women use a less effective method or no contraception
at all. Contraception in men remained stable since 2012 (73%),
most using condoms (84.6% of all men). We saw a slight
increase in vasectomy to 5% up from 3.6% in 2012. Costs of
contraception are currently not covered in Austria. However if
offered free of charge, 43% of those using contraception would
switch to a more effective method and 61% of those not using
a method would start contraception. We analysed the impact
this would have on abortions and found that covering costs of
contraception could reduce the number of abortions by 10,000
or one third of the current number.
Conclusions The avoidance of hormones has a significant negative impact on the use of effective methods of contraception,
whereas covering costs for contraception has a huge potential
to reduce abortions. The report provides further insight in the
motivation for choosing or avoiding a given method or not
using a method at all.
A-062
Contraceptive use among Canadian
obstetrics and gynaecology residents
Dustin Costescu and Gillian Dharmai
McMaster University, Hamilton ON, Canada
Objective: Between 39 and 50% of pregnancies in Canada are
unintended. Recent attempts at reducing unintended pregnancy have focused on increasing uptake of Long Acting
Reversible Contraception. Because birth control data is not
tracked in Canada, and because Obstetrics and Gynaecology
residents represent a group of younger women for whom barriers of education, access, and cost are not factors, we sought
to determine the birth control use trends in this Canadian
cohort.
Methods: We surveyed Obstetrics and Gynaecology residents at
all training sites in Canada. Specifically, we inquired about
methods currently used for contraception by self or their partner, factors that affect contraceptive selection and factors that
affect uptake of intrauterine contraception.
Results: A total of 177 residents responded. Of these, 137
were included in the analysis, as they were heterosexually-oriented, sexually active, neither pregnant nor trying to conceive.
75
The mean age of patients was 28.5 years, 89.8% of respondents were female, and 79% are nulligravid. The LNG-IUS is the
most commonly used method overall, with 56.1% of women
and 28.6% of the partners of male residents reporting it.
Gravidity did not affect IUS use among females: 57.5% of nulligravid female residents use an LNG-IUS (vs. 60%, p ¼ 0.82).
The presence of insurance coverage was associated with
increased LNG-IUS use (66.7 vs. 46.1, p ¼ 0.025), and planning
for pregnancy between 2 and 5 years (as opposed to within
two years) was associated with increased use (OR ¼ 1.46,
p ¼ 0.0003).
Conclusions: In this cohort of young physicians, the use of
LNG-IUS is very high. Gravidity was not a factor in the decision
to use an LNG-IUS. Even though this cohort experiences few
barriers to care compared to the general population, insurance
coverage remains a potential barrier to IUS uptake. Female residents choose methods that meet their timeline to pregnancy.
This data provides reassurance to young women who are considering intrauterine contraception.
A-063
Contraceptive counselling to prevent
repeat unintended pregnancy: the
abortion client’s perspective
Olga Loeber
Rutgershuis Oost, Arnhem, the Netherlands
Objectives: Some women have trouble preventing repeat unintended pregnancies. A description is given of the opinions of
abortion clients about their contraception and the contraceptive
counselling they received. Suggestions are formulated for the
adaptation of the counselling strategy of health care professionals (HCPs) and other interventions to encourage effective
contraceptive behaviour.
Methods: In one clinic in the Netherlands, a questionnaire was
given to abortion clients with questions about their contraceptive method and the contraceptive counselling they had
received. Face-to-face interviews were conducted with ten
women who had experienced at least three unintended pregnancies about the type of contraceptive counselling they had
received and about their opinions regarding the contraception
information they would like to access.
Results: A total of 217 questionnaires and 10 interviews were
studied. Most women did not find contraception difficult to use.
The majority of the clients wanted to change their method of
contraception but often did not discuss this with their health
care providers (HCPs). Many women with several unintentional
pregnancies could not find suitable advice; some tried to access
information through the internet, asked friends or looked for
written information.
Conclusion: Women with repeat unintended pregnancies
should receive contraceptive counselling that offers more than
just evidence-based knowledge of the different methods.
Counselling should address individual behavioural characteristics
that prevent the effective use of contraception. The respondents
stated that they would appreciate other sources of information,
such as brochures or support through other forms of communication. The formation of a working group would be helpful in
delivering these services.
76
CONTRACEPTION AND THE TREATMENT OF MEDICAL
DISORDERS
A-064
Contraception and
hyperandrogenism. Clinical effects of
the drug containing chlormadinone
acetate
Vera Prilepskaya, Elena Mezhevitinova and
Elena Tsallagova
Federal State Budget Institution ‘‘Research Center for Obstetrics,
Gynecology and Perinatology’’ Ministry of Healthcare of the
Russian Federation, Moscow, Russia
Objective: To assess contraceptive, therapeutic efficacy and tolerability of a combined hormonal contraceptive, containing 30
mg ethinylestradiol (EE) and 2 mg chlormadinone acetate (CMA)
in women with symptoms of hyperandrogenism.
Methods: The study included 76 women aged 19–39 years with
acne of mild and moderate symptoms that met the criteria of
inclusion and exclusion. Physical examination, clinical, laboratory, statistical and instrumental methods of examination were
used. The severity of seborrheic dermatitis and acne was
assessed by counting the lesions on the face and special techniques with microporous polymer film, which allows the evaluation of the activity of the sebaceous glands. Also, take into
account the subjective assessment of the condition of the skin
of the patients using a visual analogue scale. Assessed skin condition was at baseline, after one, three and six months of
treatment.
Results: In the analysis of the therapeutic efficacy after one
month of taking the drug, improvement of the skin on the
face of most patients was noted, after three months reduced
severity of seborrheic dermatitis was noted in the forehead
area. After six months of therapy in 69.7% of women the
rash had decreased significantly, or disappeared. A subjective
rating obtained through a visual analogue scale, showed that
after one, three and six cycles, 69%, 93% and 98% of
patients, respectively, were satisfied or very satisfied with the
effect of therapy, which was accompanied by increasing selfesteem and confidence. The contraceptive efficacy was 100%.
In addition, we analysed the side-effects of the drug. During
the first one–three months of therapy 2.6% of patients complained of intermenstrual bleeding, and 3.9% of dyspepsia. All
adverse reactions disappeared spontaneously within two–three
months and did not require additional therapy or withdrawal
of HC.
Conclusions: COC containing CMA is a highly effective
contraceptive. In any patient throughout the observation
period the occurrence of pregnancy is not marked. COC containing CMA, has high acceptability and low rate of adverse
reactions. Due to the pronounced antiandrogenic effect,
69.7% of patients reported improvement or disappearance
of acne after six months of use of the drug. Overall, 98% of
women were satisfied or very satisfied with the effect of
therapy, which was accompanied by increasing self-esteem
and confidence.
A-065
Prognosis of complications and sideeffects of hormonal contraception in
women of reproductive age
Elena Ivanova, Elena Mejevitinova, Igor Nikitin and
Andrew Donnikov
Federal State Budget Institution ‘‘Research Center for Obstetrics,
Gynecology and Perinatology’’ Ministry of Healthcare of the
Introduction: The choice of contraceptives for women and their
effect on liver function, haemostasis and blood lipid spectrum
remains very important.
Objective: To increase the acceptability of hormonal contraception by developing personalised approaches to prescribing hormonal contraception in accordance with clinical and moleculargenetic predictors.
Methods: A total of 300 patients of reproductive age who
wished to use a reliable method of contraception were enrolled
in our study. Overall, 210 women met the inclusion criteria and
were divided into two groups. The first group of women
(n ¼ 105) was given COC containing 3 mg of drospirenon and
20 mcg of ethinylestradiol, the scheme of 1 tab per day
(24 þ 4). The second group (n ¼ 105) were given a vaginal ring
containing 11.7 mg of etonogestrel and 2.7 mg of ethinylestradiol once a month (seven days break). Duration of contraceptive
use and monitoring of patients continued for 12 months.
Evaluation of side-effects with the use of hormonal contraceptives was based on the examination of the impact of the role of
genetic polymorphism p-450 and aromatase.
Results: The results of the study proved high efficiency of hormonal contraception (100%). The risk of mastalgia, intermenstrual bleeding, hypercoagulation and hyperlipidemia, the trend
towards increased if women have A/A genotype polymorphism
of aromatase. Interestingly, women with genotype A/G had
haemostatic changes at the three and six month study stages.
In women with genotype A/A these changes occurred after six
months. Often such changes were observed in patients with
genotype A/A using COC.
Conclusions: In women with the presence of A/A genotype
polymorphism of aromatase, careful dynamic monitoring of
haemostasis, biochemical analysis and lipid spectrum of blood
must continue throughout the use of hormonal contraceptives.
Women with genotype A/G must be more closely monitored for
three and six month use of hormonal contraception. For women
with genotype G/G surveillance is also recommended.
A-066
Efficacy of the levonorgestrelreleasing intrauterine system in
secondary pain treatment in
endometriosis in a reference hospital
Thiago Guazzellia, Talita Angimahtza,
Cristina Guazzellib, Afonso Vieiramarquesa,
Kleber Carrapatosoa and Geraldo De Nadaia
a
Cachoeirinha, Sao Paulo, Brazil; bUniversidade Federal Sao Paulo,
Sao Paulo, Brazil
Objective: To evaluate the use of levonorgestrel-releasing intrauterine system (IUS) in the treatment of hypermenorrhagia in
patients with previous use of other hormonal methods in order
to avoid surgical therapy.
ACCEPTED ABSTRACTS – CONTRACEPTION AND MEDICAL DISORDERS
Methods: A retrospective study of 39 patients from the
Gynaecological Endoscopy clinic in the period from March 2013
to March 2014 submitted to treatment with IUS. Their follow-up
and complaints were evaluated after three and six months.
Results: The IUS was inserted in 39 patients. An improvement
of bleeding was observed in 66.6% (26) of the patients three
months after insertion and in 58.9% (23) after six months. A
total of 5.1% (two) of the patients presented expulsion or displacement of the IUS, in which one was successfully repositioned by hysteroscopy, followed by amenorrhea after 90 days.
Overall, 12.8% (five) of the patients were lost to follow-up after
three months, and 30.7% (12) after six months. A total of 10.2%
(four) of the patients still complained of bleeding after six
months. Only two patients (5.1%) had to undergo surgery, a
hysterectomy and other endometrial ablation hysteroscopy.
After six months, 27 women were evaluated, excluding patients
lost to follow-up, there was improvement in 85.1% (23) of the
patients.
Conclusion: Clinical treatment with the IUS has been responsible for significant improvement of vaginal bleeding in 58.9%
of patients after six months and no improvement in 10.2%,
reducing the need for surgical treatment.
A-067
Efficacy of the levonorgestrelreleasing intrauterine system in
hypermenorrhagia treatment in a
reference hospital
Thiago Guazzellia, Talita Angimahtza,
Cristina Guazzellib, Affonso Vieiramarquesa,
Marcelo Piresa and Geraldo De Nadaia
a
Cachoeirinha, Sao Paulo, Brazil; bUniversidade Federal Sao Paulo,
Sao Paulo, Brazil
Objective: To evaluate the use of levonorgestrel-releasing intrauterine system (IUS) in the treatment of hypermenorrhagia in
patients with previous use of other hormonal methods in order
to avoid surgical therapy.
Methods: A retrospective study of 39 patients from the
Gynaecological Endoscopy clinic in the period from March 2013
to March 2014 submitted to treatment with IUS. Their follow-up
and complaints were evaluated after three and six months.
Results: The IUS was inserted in 39 patients. An improvement
of bleeding was observed in 66.6% (26) of the patients three
months after insertion and in 58.9% (23) after six months. A
total of 5.1% (two) of the patients presented expulsion or displacement of the IUS, in which one was successfully repositioned by hysteroscopy, followed by amenorrhea after 90 days.
Overall, 12.8% (five) of the patients were lost to follow-up after
three months, and 30.7% (12) after six months. A total of 10.2%
(four) of the patients still complained of bleeding after six
months. Only two patients (5.1%) had to undergo surgery, a
hysterectomy and other endometrial ablation hysteroscopy.
After six months, evaluated 27 women, excluding patients lost
to follow-up, there was improvement in 85.1% (23) of the
patients.
Conclusion: Clinical treatment with the IUS has been responsible for significant improvement of vaginal bleeding in 58.9%
of patients after six months and no improvement in 10.2%,
reducing the need for surgical treatment.
77
A-068
Evaluating the influence of bariatric
surgery on young females quality-oflife and sexual reproductive health
behaviours
Marie McCormack, Jill Shawe and Jane Ogden
University of Surrey, Guildford, Surrey, UK
Background: Bariatric surgery (BS) has been demonstrated to
be an effective and viable treatment to sustain weight loss for
severe obesity, have a positive influence on adverse medical
conditions, and aid long-term health benefits including resolving menstrual irregularities leading to improved female fertility.
The number of younger women (18–25 years) undergoing BS is
increasing, and corresponds to the age when female fertility is
peaking. Menstrual dysfunctions experienced by obese women
may mean that contraceptives are not perceived as necessary.
In comparison with the general population, obese women have
limited contraceptive choices because of health-related issues,
and options decrease further, initially post-BS. As weight
reduces and stabilises so contraceptive choices increase, but
this does not necessarily reflect uptake and as such young
women who are undergoing any form of BS are at risk of
becoming pregnant sooner than planned.
Objectives: To evaluate quality-of-life and health behaviours
with relation to sexual reproductive health and contraception
use with young females (18–25 years) who are preparing for
and/or who have undergone any form of Bariatric Surgery.
Methods: A mixed methods design with three studies (two
quantitative studies) using a modified self-reporting questionnaire which will be delivered either ‘on-line’ or via QR app (for
mobile phones): (1) a prospective cohort (before/after surgery);
(2) a cross-sectional post-surgery study and (3) a follow on
qualitative, semi-structured interview study. Recruitment was via
an advertisement posted on the website of a national weightloss charity (www.wlsinfo.co.uk), together with posters at the
University of Surrey, and referrals from nominated BS centres.
The qualitative sample will be drawn from volunteers who have
completed the survey-questionnaire. The semi-structured interviews will be digitally recorded and incorporate a topic guide
with open-ended questions relating to: quality-of-life, relationships, sexual/reproductive health.
Results: Initial results will be presented. Analysis for the quantitative data will use SPSS and the qualitative data will use NViVo
10 software analysis to organise emerging themes and facilitate
analysis using an interpretative approach (IPA).
Conclusion: This is the first study to focus on and explore
young women at their fertility peak undergoing any form of BS,
and the influences on quality-of-life and health behaviours in
relation to sexual reproductive health and contraception use.
A-069
The concern of symptoms caused by
bleeding: results from the ISY
(Inconvenience due to women’S
monthlY bleeding) Study
Paloma Loboa, G€
unther H€auslerb, Christian Jaminc,
d
~ aki Lete , Axelle Pintiauxe, Rossella Nappif,
In
Nathalie Chabbert-Buffetg and Christian Fialah
a
Service of Obstetrics and Gynecology, Hospital Universitario
Infanta Sofıa, San Sebastian de los Reyes, Madrid, Spain; bAKHWien, Abteilung f€
ur Allgemeine Gyn€akologie und Gyn€akologische
Onkologie, Wien, Austria; c169, boulevard Haussmann, Paris,
78
France; dDepartment of Obstetrics and Gynaecology, University
Hospital Araba, Vitoria-Gasteiz, Spain; eDepartment of Obstetrics
and Gynecology, Citadelle Hospital, Liège University, Liège,
Belgium; fResearch Center for Reproductive Medicine, and Unit of
Gynecologic Endocrinology and Menopause, IRCCS Policlinico San
Matteo, Department of Clinical, Surgical, Diagnostic and Pediatric
Sciences, Unive, Pavia, Italy; gDepartment of Obstetrics and
Gynecology, APHP Tenon Hospital, University Pierre and Marie
Curie Paris 06, Paris, France; hGynmed Ambulatroium, Wien,
Austria
Objectives: For many women, monthly bleeding is painful,
inconvenient and affects everyday life.
To study inconvenience associated with monthly bleeding such
as the occurrence of menstruation-related symptoms prior to
and/or during menstruation.
Method: From 4 February to 19 February 2015, a 15-minute
quantitative online survey was conducted among 2883 women
from 18 to 45 years old in six European countries (Austria,
Belgium, France, Italy, Poland, and Spain). Among the participants, 1319 used a combined hormonal contraceptive (CHC)
(Group A) and 1564 used a non-hormonal contraceptive
(excluding copper intrauterine devices) or no contraceptive
(Group B). Level of intensity, frequency, onset of menstrualrelated symptoms, and need to take medications for relief were
investigated. Non-contraceptive reasons for taking CHC were
also studied. Each participant gave written informed consent.
Results: Symptoms were significantly more frequent in Group B
than in Group A (6.1 vs. 5.6, respectively) and significantly more
intense for the majority of them. Pelvic pain, bloating/swelling,
mood swing, and irritability were reported in more than half of
the women in each group. Treatment needs for relief were similar in the two groups and more frequent with headache and
pelvic pain. Menstrual irregularities were the most important
motivation for taking a CHC (42%).
Conclusions: This survey showed that CHC users experience
fewer menstrual-related symptoms and that menstrual bleeding
is a concern. Reducing the frequency of menstrual bleeding
could also reduce withdrawal-related symptoms.
A-070
Evaluation of the effectiveness and
acceptability of a hormonal
contraceptive containing 1.5 mg of
17b-estradiol and 2.5 mg of
nomegestrol acetate
Vera Prilepskaya, Anna Mgeryan and
Elena Mejevitinova
Federal State Budget Institution, Moscow, Russia
Objective: To evaluate the efficacy and acceptability of contraceptives containing 1.5 mg of 17b-estradiol and 2.5 mg of
nomegestrol acetate 24 þ 4 for women of reproductive age
with symptoms of premenstrual syndrome (PMS).
Methods: Under observation there were 80 fertile women aged
18–45 years, with PMS from mild to moderate severity, requiring
contraception. Inclusion criteria: women requiring contraception
who suffer from PMS with easy and moderate severity, the
absence of contraindications to hormonal contraception.
Exclusion criteria: contraindications to hormonal contraceptives
according to WHO (2009) criteria.[1] Applied clinical, laboratory,
and statistical methods of inspection were carried out. Along
with this, an analysis was conducted on ‘PMS-diaries’ of patients
to assess the severity of premenstrual syndrome. The severity of
the symptoms (mood swings, depression, headache, etc.) was
evaluated on a scale from 1 to 3 as slight, moderate, and
severe. The results were evaluated in the dynamics of observation after six and 12 months.
Results: The average age of the patients was 29.0 ± 3.2 years.
All women were ovulating and had a menstrual cycle. A total of
58 (73%) of the women were diagnosed with mild premenstrual
syndrome and in 22 (27%) with medium severity. During one
year of observation there was not a single case of pregnancy.
Undesirable side-effects were observed: intermenstrual bleeding
in 11 (14%) and dyspepsia in three (4%). Neither condition was
the basis for cancellation of contraceptive. After six months
from start of drug, complaints of PMS symptoms (headache,
anxiety, breast tenderness, depression) were presented by 61
(76%) women. Observation continued to 12 months from start
of treatment. The remaining 55 (69%) patients noted significant
improvement in general and no PMS symptoms were reported.
In 35 (31%) women, most of the PMS symptoms remained.
Conclusions: Combined hormonal contraceptive, containing 1.5
mg of 17b-estradiol and 2.5 mg of nomegestrol acetate has a
high contraceptive effect. The number of undesirable sideeffects before taking the drug was small and only noted in 14
(18%) women. Thus, the drug in addition to high contraceptive
effectiveness and good tolerability, has a positive affect on PMS
symptoms, mainly in patients with light severity of PMS.
Reference
[1]
World Health Organisation (2009).
CONTRACEPTION IN ADOLESCENCE
A-071
Sexual health, reproductive health
and responsible parenthood in the
school health programme in
polis, Brazil
Floriano
Luciana Cristina dos Santos Mausb,
Candice Boppre Besena and
Evanguelia Kotzias Atherino dos Santosb
a
Prefeitura Municipal de Florianopolis, Florianopolis/Santa
Catarina, Brazil; bUniversidade Federal de Santa Catarina,
Florianopolis/Santa Catarina, Brazil
The School Health Program (SHP) constitutes a national strategy
that seeks to promote collective management of health and
education activities aimed at promoting the integral health of
students and the school community. Encouraging educational
activities so as to better work issues related to sexual health,
reproductive health and responsible parenthood is one of SHP
maxims. The objective of this paper is to describe how the
polis by illustrating the activSHP was implemented in Floriano
ities developed at the school and presenting the results
achieved so far.
polis, the SHP has been developed
For seven years, in Floriano
alongside the Municipal Health and Education Secretary and the
State Department for Education. In 2012, 100% of the State and
the Municipal Public Schools, with elementary school teaching,
had implemented the SHP. Moreover in 2013/2014, with the
expanding of the SHP, it comprised of 86 family health teams
responsible in the Program. In 2014/2015 one hundred and
nine educational units were included in the Program with
40,513 students attended and 89 family health teams linked to
the SHP. Among the education units there are 36 Municipal
Public Schools and 33 State Public Schools, totaling 35,728 students of elementary and high school participants of the SHP.
Since SHP implementation, Florianopolis has already achieved
the following results: the implementation of the theme ‘sexual
and reproductive health’ at the schools’ Pedagogical Political
Project; 1st Exhibition of the Health Prevention Work in Schools;
ACCEPTED ABSTRACTS – CONTRACEPTION IN ADOLESCENCE
IV Seminar of SHP: Culture of Peace and Sexuality; I and II
Meeting of Young Multipliers of SHP: Meeting of the School’s
teenagers who debated and presented sexuality and reproductive health work; Delivery of the Teenager’s Handbook to 100%
of the students in the age group 10–14 years old in the SHP
schools, always following the training topics covered in the
books; and the reduction in the rate of teenage pregnancy in
the county. All these actions made it possible due to the
construction of shared knowledge with different characters
involved.
The participation of the teenagers, and the validation of the
actions by professionals, show that the results achieved, by
using these strategies, can be realised by increasing the link
between school and health centre and also through the health
care provided to teens directly, i.e., when a request is made
related to contraceptive methods, and particularly in the
attempt to break with the patterns of risky sexual and reproductive behaviours.
A-072
The perception of contraception
among young male partners in China
Xiaoming YU and Yating MA
Peking University Health Science Center, Beijing, China
Objectives: Unwanted pregnancy among young people has
exhibited an increase over the past two decades in China.
Young male partners play an important role in preventing
unwanted pregnancy, because they are key decision-makers on
sexual intercourse and contraception adoption. However, the
study on the contraceptive perception and behaviours of male
partners are scarce. The purpose of this study was to understand male partners’ contraceptive perceptions and its relative
factors.
Methods: The study was conducted through non-probability
and convenience sampling. The data were collected by a selfadministered questionnaire. A total of 467 young males, who
accompanied their female partners (aged 15–24) for induced
abortion, were recruited in three family planning clinics in two
cities of China respectively.
The average age of male partners participating in the study was
23.4 years (range from 17 to 36 years), 72.5% of them were
aged 15–24 years. Among them, 19.8% were still students, and
about one-third had educational level equal to college or
higher. The male partners reported that their sexual debut was
at 20.25 ± 2.72 years on average, and 29.0% initiated sex under
18 years.
Results: Our study found that the knowledge level related to
contraception use among male partners was low to poor. Nearly
half of the male partners did not know how to use a condom
correctly, and for the low-educated group (i.e., middle school or
lower), this rate reached 73.5%. Only 14.9% males had consistently used condoms when they had had sex during the past 12
months. However, less effective contraceptive methods such as
withdrawal and safe period contraception were commonly used
by male partners, being next to the condom use, and there were
differences by age and educational level. The analysis by multivariate logistic regression showed that attitude toward contraception and sexual intercourse before marriage and style of
coping with problems significantly associated with contraceptive
use among male partners. Those who have more on-limits sexual
attitude inclination and negative coping style are likely to have
more behaviour of non-consistent contraceptive use.
Conclusions: Special efforts are needed to improve male partners’ contraception perception and skills, especially providing
some scientific and accurate information and training about
effective contraception to reduce risk of unwanted pregnancy
79
A-073
Perceptions of Mexican physicians
regarding intrauterine contraception
in adolescents
Josefina Lira-Plascenciaa, Victor Marin-Cantub,
Norma Velazquez-Ramırezc, Alejandro Rosas-Balanc
and Sayra Ayala-Encisoc
a
Instituto Nacional de Perinatologia, INPer, Mexico DF, Mexico;
HCSAE Petroleos Mexicanos, Mexico DF, Mexico; cInstituto
Nacional de Perinatologia, Mexico DF, Mexico
b
Objectives: To find out about the perceptions of Mexican physicians regarding intrauterine contraception in young and nulliparous women.
Method: Data collection was performed using a previously validated anonymous questionnaire, consisting of 20 multiplechoice questions, conducted among 209 physicians (between
the ages of 24 and 65), attending nationwide medical conferences. Data description was performed using relative frequencies.
Results: A total of 58.7% of the physicians surveyed were
gynaecologists, 30.8% were general practitioners, and 10.5%
were medical residents. Overall, 62% of the respondents were
women, and 38% men. From the 209 participants, 18.4%
believed the IUD effectiveness was modified by parity, 19.6%
believed the IUD was not an adequate contraceptive method
for nulliparous women, 63.6% believed IUD expulsion rates
were modified by parity, 30.3% believed IUD could modify
future fertility, 24.9% believed the IUD was not an adequate
contraceptive method for adolescents and only 9.2% reported
having frequently placed IUD in adolescent patients.
Conclusions: Mexican physicians consider intrauterine contraception an option for nulliparous and young women; however
they rarely place them in these types of patients.
A-074
Ultrasonographic follow-up of postplacental IUD insertion in adolescents
Josefina Lira-Plascenciaa, Victor Marin-Cantub,
Norma Velazquez-Ramirezc, Margarita Ruiz-Huertac,
a
Instituto Nacional de Perinatologia, INPer, Mexico DF, Mexico;
HCSAE Petroleos Mexicanos, Mexico DF, Mexico; cInstituto
Nacional de Perinatologia, Mexico DF, Mexico
b
Background: The choice of a post-obstetric event contraceptive
remains a challenge, and an IUD is the most often chosen in
that moment for those that accept it.
Objective: To find out how frequently the IUD is correctly
placed in a group of adolescents after an obstetric event.
Methods: In this retrospective study, 242 adolescents with a
mean age of 15.9 years who received a TCu 380A IUD after an
obstetric event were selected for analysis. In 92.1% of them it
was her first pregnancy and 77.7% did not use any contraceptives previously. The pregnancy was normal in 66.9% and with
any type of complication in 33.1% of cases. Follow-up at 6
weeks, three, six, nine and 12 months after placement were performed with transvaginal ultrasound for determining the position of the IUD.
Results: The number of adolescents that came to review at six
weeks, three, six, nine and 12 months were 140 (57.9%), 90
(37.2%), 60 (24.8%), 33 (13.6%) and 14 (5.8%), respectively. The
quantity of adolescents with the IUD in a correct placement
80
was 118 out of 140 (84.28%) reviewed at six weeks. The total
number of replacements was 37 (15.2%) including 22 (9%) due
to expulsions, 14 (5.7%) for incorrect placing and one (0.4%) for
extraction
Conclusions: The IUD post obstetric event is an excellent
contraceptive option. The amount of IUD in situ and well placed
after an obstetric event is high, and ultrasound monitoring
allows us to correctly identify and monitor the position of the
device.
A-075
Addressing the reproductive health
needs and rights of married
adolescent couples
Aparajita Gogoi, Swati Parmar, Manju Katoch and
Md. Ziauddin
Centre for Catalyzing Change(C3), formerly CEDPA India, New
Delhi, India
Objective: The overall objective was to empower married adolescent couples to lead healthy and productive lives by exercising their right to regulate their own fertility through information
and access to family planning services.
Methods: The project was implemented with 1000 married adolescent couples (MACs), not specifically addressed for their
contraception and reproductive health needs, in 50 villages in
Ramgarah district in the State of Jharkhand, India.
Comprehensive interventions were directed at individual, family
and community levels to provide information on various contraception methods and reproductive health services, to make
informed choices about their reproductive and sexual health
and increased utilisation of such services. A participatory mixed
method approach, concurrent design with parallel samples, was
employed to conduct the impact evaluation through quantitative and qualitative questionnaires. On the demand side, out of
1000 MACs, 100 MACs (MAGs, married adolescent girls; HMAGs,
husbands of MAGs) were selected using systematic random
sampling under Baseline quantitative survey. On the supply
side, 30 grassroot service providers comprising of Accredited
Social Health Activist (ASHA), Auxiliary Nurse Midwifes (ANMs),
and Medical Officers (MOs) were interviewed using qualitative
questionnaires at Baseline and Endline. A separate qualitative
questionnaire was also administered to assess the knowledge of
mothers-in-law of MAGs. IBM PASW statistical software was
used to compute descriptive, parametric (paired t test) and nonparametric statistics (Chi-square and McNemar’s test).
Results: About 91% MAGs and 97% HMAGs were aware about
condoms at the Endline compared to 26% and 39% at the
Baseline respectively. A total of 58% (MAGs) and 49% (HMAGs)
points increase was registered in awareness of copper-T/IUD
device. Overall, a 47% points increase in MAGs being advised
by ASHA/ANM to delay the first pregnancy was reported during
Endline. Overall, the project indicated a 41% points increase in
the usage of contraception methods. Implementation and qualitative evaluation(s) revealed that MACs are more interested in
utilising the information and services for spacing children rather
than for delaying the first child.
Conclusion: An overall 20% points increase in awareness and
acceptance of contraception methods by MACs was achieved.
The project showed better linkages with service providers as
more MACs reported service providers as their source of information for family planning methods. The result indicates that
systematic capacity building of MACs on reproductive health
and linking and improving access to service providers is
required. Special strategies/efforts need to be designed and
implemented to reach married adolescent couples on contraception methods (despite societal barriers).
A-076
The use of contraceptive vaginal ring
compared to oral contraceptive pill
containing two active ingredients,
estradiol valerate and dienogest, in
two groups of adolescents.
Preliminary report
Panagiotis Tsikourasa, Bachar Manava,
Anastasia Vatopouloub, Anastasios Liberisa and
Georgios Galaziosa
a
Democritus University of Thrace, Alexandroupolis,Evros/Thrace,
Greece; bAristoles University of Thessaloniki, Thessaloniki, Greece
Objectives: The use of effective birth-control methods on a
regular basis is the primary strategy for preventing unintended
pregnancies. In teenagers, the lack of orientation and the premature sexual activity are the main reasons of unintended pregnancies. Teenagers are insufficiently informed about
contraception by their parents, at school, or through public
media. The purpose of this study was to compare the efficacy
and acceptability of two contraception methods.
Method: Data was collected from the family planning centre in
the Department of Obstetrics and Gynaecology of Democritus
University of Thrace during the period from 1 January 2010 to
31 December 2014. The study included 85 teenage participants
aged 13–19 years, 55 Christian Orthodox (Group A) and 30
Muslims (Group B) living in Thrace. All participants had signed a
written consent. None of them had contraindications in the use
of oral contraceptives (OCs). In subgroup Aa, including 35 teenagers, combined Oral contraceptive pills contained estrdiol valerate and dienogest were administered, while in the
participants of subgroup Ab, including 20 participants, NuvaRing
was used in accordance to the instructions of the product information. In Group B the use of OCs and Nuvaring was given in
20 participants in subgroup Ba and 10 teenagers in subgroup
Bb respectively. All teenagers completed a questionnaire regarding adverse events. Statistical analysis was performed using one
way analysis of variance (ANOVA), followed by Turkey’s test,
Chi-square test and multiple logistic regression analysis.
Results: The participants were observed for 24 consecutive
cycles. There were no significant differences in demographic
characteristics between the two groups. The number of the participants in both Nuvaring subgroups declined to 18, 15, 10 in
subgroup Ab and 8, 7, 6 in subgroup Bb at 2, 5 and 8 months
respectively. The reasons were adverse effects like vomiting,
nausea, headache, decreased libido, and vaginitis. In one case in
subgroup Ab and in two cases in subgroup Bb pregnancy was
reported. Adverse effects and unintended pregnancies in the
subgrups of OC Aa and Ba were not mentioned .The participants in the OC subgroups did not notice any adverse effects
except mid menstrual bleeding and emotional instability
because of the daily pill administration.
Conclusions: Although the study sample was small, the
NuvaRing is a good alternative to an OC in teenagers, but more
prospective studies are necessary to confirm the effectiveness
of the NuvaRing in this population. Information about contraceptive use in teenagers can be used to guide the development
of state programmes regarding unwanted pregnancies.
A-077
Decrease in combined oral
contraceptive use in 15–19-year-old
Danish women – no increase in the
number of unwanted pregnancies
Maja Laursen
The Danish Health Data Authority, Copenhagen, Denmark
Objectives: The new scientific evidence during 2009–2011 discovering higher risk for thromboembolism if using 3rd or 4th
generation combined oral contraceptives compared to the use
of 2nd generation led to health authority recommendations and
great media attention from 2011 onwards encouraging women
to use 2nd generation combined oral contraceptives. We
describe the use of combined oral contraceptives in 15–19-yearold women in Denmark 2011–2014, the use of other hormonal
contraceptives and the concomitant rate of unwanted pregnancies within this age group.
Methods: We used data on hormonal contraceptive use from
The Register of Medicinal Product Statistics, for pregnancies, we
used data from The Register of Legal Abortions and The Birth
Register, all registers covers the total population and are located
at The Danish Health Data Authority. Data is public available as
online statistics (medstat.dk, esundhed.dk).
Results: Of women aged 15–19 years, 50% are users of combined oral contraceptives. Since 2011, the women changed
from 3rd and 4th generation combined oral contraceptives to
the recommended 2rd generation. Moreover, the women
decreased their use of combined oral contraceptives from 2011
to 2014 and slightly changed their use between the different
types of hormonal contraceptives towards remedies containing
only progestogens. Rates of births and legal abortions in the
same age group decreased concurrently.
Conclusions: The recommendation from the health authorities
followed by a heavy media attention from 2011 onwards to
change from 3rd and 4th generation combined oral contraceptives to 2nd generation has resulted, more or less, in the
intended change; however, it apparently also made young
women reconsider their general use of hormonal contraceptives. We discovered a new trend in a lower use of combined
oral contraceptives and a small rise in the use of contraceptives containing only progestogens. The overall decrease in
the use of hormonal contraceptives was surprising, seen with
a simultaneous decrease in the number of unwanted
pregnancies.
A-078
Adolescent contraceptive
continuation rates in the Canton of
Vaud (Switzerland)
C
ecile Diserensa, Adeline Quachb, Patrice Matheveta,
Saira-Christine Renteriaa, Pierluigi Ballabenia and
Martine Jacot-Guillarmoda
a
CHUV (Centre Hospitalier et Universitaire Vaudois), Lausanne/
Vaud, Switzerland; bProfa - Planning familial, Lausanne/Vaud,
Switzerland
Objectives: The objectives of this study, the first of this kind in
Switzerland, were to determine the contraceptive continuation
rates among adolescents in the Canton of Vaud, to identify the
prescribed contraceptive methods, and to assess potential predictive factors of discontinuation.
81
Methods: A prospective observational study with an exploratory
nature was performed on 12–19-year-old girls recruited during
consultations for new contraceptive prescriptions at seven family planning centres, and during gynaecologic consultations at
adolescent units and at a private practice centre, both located
in Lausanne University Hospital. Patients were interviewed one
year later. Associations between continuation and potential predictors were assessed using contingency tables and Fisher’s
exact tests.
Results: A total of 204 patients with a 17.28 years median age
were included. Among the patients, 85.78% chose the oestroprogestative pill, 4.41% the progestative pill, 2.45% the ring,
0.98% the patch, 3.43% the injection and 2.94% long-acting
reversible contraception (LARC). All patients were nulligests at
the beginning of the study. Overall, 145 patients answered one
year later (a high 71% response rate). The original contraceptive
continuation rate was 73.1%. Among these patients, 93.4% were
satisfied with their contraceptive method. The factors statistically affecting the continuation rate were the contraceptive
method, the place where the patient lived one year later, and
sexual activity one year later. Age, nationality, smoking, occupation, the fact that the legal representative was informed about
the contraception or not, had no influence on adherence. The
continuation rates were: 100% for the LARC method, 75.2% for
the oestroprogestative pill, 75% for injection, 60% for the progestative pill, and 0% for patch and ring. The main reasons
given for discontinuation were absence of sexual intercourse
followed by the side-effects. Patients changing contraceptive
method were considered as having discontinued the contraceptive method; they represented 22.86% of those who interrupted
contraception. Two patients became pregnant during the study.
Conclusion: The contraceptive continuation rate among adolescents in this canton was good. The only predictive factor of discontinuation identified upon prescription was the contraceptive
method. The main prescribed contraception remains the oestroprogestative pill despite recent controversies over its thromboembolic risks. The excellent rate of continuation and satisfaction
with LARC methods strengthens the recommendation of prescription of these methods to adolescents. Care should be exercised when prescribing a patch or a ring as the continuation
rate is very low. The significant impact of the contraceptive
method on the continuation rate stresses the importance of
individualised counselling.
A-079
Preventing repeat teenage pregnancy
effects of a family planning
programme
Isabella Ferrari, Cristina Guazzelli and
Marcia Barbieri
Universidade Federal S~ao Paulo, S~ao Paulo, Brazil
Background: The beginning of sexual activity among teenagers
has been increasingly precocious, frequently causing an
unplanned pregnancy. Worse than an early pregnancy is its
recurrence, which presumes a series of emotional and obstetric
problems. Through a descriptive and retrospective study, conducted at the Family Planning Sector from Universidade Federal
~o Paulo, the effects of an educational and assistance prode Sa
gram were evaluated as a result of recurrent pregnancy in
adolescents.
Method: Medical records were studied, referring to adolescents
with at least one pregnancy prior to registration in the program.
Use of contraceptive methods, continuity rate of methods, outgoing attendances and repeat pregnancy rates were evaluated.
Results: Six hundred and seventy adolescents were registered
in the Family Planning Programme during a five-year period.
Records of 147 adolescents with at least one pregnancy prior to
registration were included. Fifty-two of them kept attending for
82
more than 12 months, whereas 29 adolescents attended just
the first medical appointment. The results reveal that the
menarche occurred on average at 12 years old, the first sexual
intercourse on average at 14.7 years old and the first pregnancy
1.7 years after that. By their registration in the programme most
were primiparas and two had already had two gestations. The
most used contraceptive methods were male condom and
injectable combined hormones. There were two cases of repeat
pregnancy after registration in the programme. These data
reinforce the importance of providing family planning programmes, focusing on the education and the assistance by providing contraceptive methods for adolescents.
A-080
Contraception in adolescence:
compliance with contraceptive
methods
cia Correia and Fatima Palma
Nisa F
elix, Lu
Maternidade Dr. Alfredo da Costa, Lisboa, Portugal
Objectives: To evaluate compliance with contraceptive methods
within 12 months, and the adherence to the appointments at
the adolescents’ outpatient clinic.
Methods: We developed a retrospective study, based on the
data collected from the clinical files of the adolescents’ outpatient clinic (AOC) of Dr. Alfredo da Costa Maternity after
contraceptive counselling and choice, between 2010 and 2013.
The adherence to the AOC, the contraceptive choice and its
compliance were evaluated at three, six and 12 months.
Results: A total of 495 adolescents were included with a
median age of 16 years (range 11–18 years); 70.1% (n ¼ 347)
had at least one previous pregnancy, 37.4% (n ¼ 185) of which
with a living child, and only 27% (n ¼ 136) were still studying.
The main findings were:
1.
2.
3.
4.
5.
346 (69.9%) adolescents were already using contraception, 95.4% (n ¼ 330) non-long acting reversible contraceptives (LARC), mostly condom (47.7%, n ¼ 165) and
estroprogestative pill (37.6%, n ¼ 130), and 4.6%
(n ¼ 16) LARC (implant). After contraceptive counselling,
86.1% (n ¼ 298) users changed method; higher in non
LARC users (89.4% versus 18.7%).
After the first appointment, 69% (n ¼ 297) opted to
continue or chose LARC, mostly implant (59%, n ¼ 292).
Only one patient continued using condom as single
method and the estroprogestative pill became the
most preferable non LARC (30.5%, n ¼ 151).
At 3 months, 29.3% (n ¼ 145) users were lost for followup. The remaining 70.7% (n ¼ 350) had 100% (228/228)
compliance to LARC and 87.7% (107/122) to non LARC.
At 6 months of follow-up, 51.9% (n ¼ 257) came to the
AOC. At this stage, the compliance to LARC was 95.8%
(184/192) and non LARC 84.6% (55/65).
At 12 months, 42.2% (n ¼ 209) kept the follow-up. The
LARC compliance was 94.8% (164/173) and non LARC
94.4% (34/36).
Conclusions: After counselling most adolescents changed
method (86.1%) and the preferable contraceptive choice was
the implant (59%). In the group of non LARC, the estroprogestative pill was the most chosen (30.5%). LARC users had less dropout to AOC (41.6%), compared to non LARC (81.8%). Given the
high dropout rate, it was not possible to assess the true compliance to the different contraceptive methods, but in the adolescents who kept the follow-up during 12 months, the
compliance was 94.7% (164 of 173) to LARC and surprisingly
94% (34 of 36) to non LARC, contrary to the published results in
many international studies.
A-081
Evaluation of the effect of cultural
factors in adolescent contraception
Eda Sahin, Ilknur Yesilcinar and Tulay Yavan
G€
ulhane Military Medical Academy, Ankara, Turkey
Objectives: The sexual practices and behaviours of young people can have short- and long-term consequences that can be
either positive or negative. Research consistently points to low
sexual and contraceptive health knowledge among adolescents
and detects risky sexual behaviour in their everyday lives. Their
characteristics and cultures may present barriers to effective
contraception by adolescents. This review of recent literature
concerning the effects of culture, acculturation and significant
relationships, aimed to provide recommendations for nurse
practitioners who work with adolescents in the primary care
setting.
Method: A literature search was conducted using multiple databases, including Pub Med, Medline, Science Direct, Web of
Science, Springer Link, and Ovid database. Literature searches
were conducted using the following terms: ‘adolescent’, ’youth’,
‘teen’, ‘teenager’, ‘young adult’, ‘contraception’ and ‘culture’. All
studies that were identified were conducted between 2005 and
2015, a 10-year time frame.
Results: Sexual experience before marriage is a serious problem
among young people in developed and developing countries.
Age of sexual experience in developing countries with patriarchal structures such as Turkey, is older than in developed
countries. Depending on the decreasing age of first sexual
experience, risky sexual behaviour is increasing. Adolescents’
contraceptive use and first sexual experience age varies according to the country’s development level. In developed countries
STI and teenage pregnancy prevention are focused, however in
developing countries with the patriarchal structure, have
focused on prevention of unwanted pregnancies due to early
marriage.
Conclusions: Cultural factors are important in adolescents’ decisions about using contraception. Psychosocial and cultural
aspects relate to the norms and attitudes individuals and
groups have regarding the family, social relationships, sexuality,
and gender. Nurse practitioners should effectively counsel adolescents concerning contraceptive use and sexual health, while
a basic understanding of the unique sociocultural factors influencing adolescents’ sexual activity is important.
A-082
Reducing barriers for IUD insertion in
adolescents: a comparison of IUD
insertion experience and clinicians’
utilisation at 4 months between
adolescents and non-adolescents in
Italy
Novella Russo
Demetra Medical Centre, Grottaferrata, Italy
Objective: Despite international guidelines endorsing IUDs in
adolescents, many gynaecologists remain concerned about IUD
tolerance and safety in adolescents. In order to identify the
main barriers to this LARC method a study was conducted on
adolescents and adult women.
Methods: A retrospective cohort study among adolescents and
adult women less than 40 years of age who had an IUD
insertion was conducted at a private clinic in Italy. Patients were
asked to answer a questionnaire regarding IUD post-insertion
experience including a VAS scale for pain at insertion, device
discontinuation and sexually transmitted infection (STI) rates.
The devices included in this study were LNG-IUS 12, LNG-IUS 20
and Copper IUD 380.
Results: Among the patients included in this study 14% were
adolescents and 86% were adult women. During the 4 months
post-insertion period, 72% of adolescents and 41% of adults initiated IUD related post-insertion clinical contact for bleeding
changes and pelvic or abdominal pain. There were no significant differences between groups in pain at insertion, IUD expulsion, removal or STI rates.
Conclusions: Barriers for IUD insertion in adolescents seem to
be mainly mental prejudices as proven from this and other
studies. Adolescents will experience the same clinical concerns
as adult IUD users, the same reason for and rate of device discontinuation and low STI rates will be present in both groups if
an accurate selection to identify and treat patients at risk of STI
precedes the insertion.
83
offer dual protection from unplanned pregnancies and STIs.
Lack of privacy and confidentiality discourage adolescents from
accessing FP/C services.
Conclusion: There is a need to improve adolescents’ knowledge
on FP/C by providing complete and accurate information on
contraceptives including long-acting and permanent methods
through comprehensive sexuality education. Although adolescents prefer to use condoms, long-term reversible contraceptive
(LARC) methods have been shown to be more effective than
condoms. Sexually active adolescents should therefore be
encouraged to consistently use condoms along with LARC
methods. Provision of youth-friendly services which emphasise
confidentiality and privacy can encourage adolescents to take
up FP/C health services.
CONTRACEPTION IN HIGH RISK PATIENTS
A-084
A-083
Adolescents’ knowledge, attitudes
and practices towards family
planning and contraceptive use: a
qualitative study from Kilifi County,
Kenya
Peter Gichangia, Janet Mugoa, Petrus Steynb,
Irene Njaua and Joanna Corderob
a
International Centre for Reproductive Health, Mombasa, Kenya;
b
Department of Reproductive Health and Research, WHO,
Geneva, Switzerland
Objective: To explore adolescents’ knowledge, attitudes and
practices towards family planning and contraceptive use. In
many Kenyan cultures, adolescents are expected to abstain
from pre-marital sex. However, adolescents have some of the
poorest sexual and reproductive health outcomes. Teenage
pregnancy is widespread and a leading cause of schoolgirls
dropping out of school. Around 15% of women aged 15–19
have already had a birth while 18% have begun childbearing. A
total of 11.5% women and 22.3% men report having had their
sexual debut before the age of 15 years, and this number
increases as the age increases with 47% of women and 58% of
men having sexual intercourse by age 18. Lack of adequate
information and access to family planning and contraceptive
(FP/C) information and services among adolescents results in
unwanted pregnancies, unsafe abortions and increased risk of
contracting STIs including HIV/AIDS. Previous research on the
knowledge, attitudes and practices towards FP/C use has
focused on adults.
Methodology: Three focus group discussions with 8–10 adolescent boys and girls aged 15–19 years were conducted. Parental
consent was sought for adolescents aged 18 years and below
before assent was sought from the adolescents.
Results: Findings show that adolescents had low knowledge of
FP/C. Many were aware of condoms, pills and injections but
none mentioned a permanent method. Furthermore, knowledge
on FP/C was often incorrect e.g., misnaming of methods and
wrong use of particular FP/C methods. Participants were knowledgeable about the benefits of FP/C use such as spacing of
children and keeping girls in schools. However, the adolescents
expressed a few misconceptions such as implants and injections
are meant for adults or those with children. Birth defects, infertility and promiscuity were also associated with contraceptive
use. Participants especially the adolescent males overwhelmingly preferred condoms because they were easily accessible
from shops and condom dispensers, as well as their ability to
Challenges and needs in providing
post-abortion family planning in
routing abortion services in China:
findings from a nationwide
randomised cluster trial
Yan Chea, Xu Qianb, Shangchun Wuc,
Marleen Temmermand, Jian Lie, Jørn Olsen Olsenf,
Jiong Lig, Rachel Tolhursth and Wei-Hong Zhangd
a
Shanghai Institute of Planned Parenthood Research, Shanghai,
China; bFudan University, School of Public Health, Shanghai,
China; cNational Research Institute for Family Planning, Beijing,
China; dInternational Centre of Reproductive Health, Ghent
University, Ghent, Belgium; eChinese Society of Family Planning –
Chinese Medical Association, Beijing, China; fUniversity of Aarhus
- Danish Epidemiology Science Centre, Aarhus, Denmark;
g
Chongqing Medical University, Chongqing, China; hLiverpool
School of Tropical Medicine, Liverpool, UK
Objectives: Around 7–13 million induced abortions were annually performed in China in recent years, of which more than half
experienced repeat abortion. The overall goal of this interventional study is to assess the effect of integrating post-abortion
family planning (PAFP) into existing abortion services on repeat
abortion in China. We report here the challenges and needs of
providing PAFP services in hospital setting in China.
Methods: A comprehensive review of China’s policy and practice of family planning/abortion and a situation analysis in 300
hospitals across the country between 2012 and 2013 were conducted to develop context-specific interventions Ninety hospitals were selected from 30 provinces and allocated randomly
into two intervention and one control arms in June 2014.
Around 18000 participants have been recruited and are following up at one, three and six months after abortion. Qualitative
and quantitative methods were used to collect data of pre- and
post-intervention from key stakeholders of PAFP.
Results: No PAFP regulation was identified in China. Situation
analysis showed that two thirds of service users had repeat abortion and 93% of them were due to no contraceptive use (37%) or
failures of less effective methods (56%) respectively; PAFP service
was highly inadequate due mainly to heavy work load, time constraints, insufficient counselling skills and lack of free contraceptive methods at hospitals. However, intervention implementation
of this trial encountered great challenges from all key stakeholders, particularly that health managers provided inadequate support for this service, which echoed by shortage of service
providers, limited counselling space and equipment, inadequate
counselling skill, no/weak motivations for PAFP service. Service
84
users, in particular those unmarried, paid little concern on the
risk of abortion that would diminish the effect of PAFP service.
Conclusions: A PAFP regulation is urgently needed and should
be integrated into routing abortion services in hospital setting
in China.
A-085
The specific features of contraceptive
behaviour of women with
adenomyosis
Natalia Artymuk, Olga Zotova and Larisa Danilova
Kemerovo State Medical Academy, Kemerovo, Russia
Objective: The objective of this study was to estimate the particularities of the contraceptive behaviour of women with
adenomyosis.
Methods: It was a retrospective observational study. This study
included 804 women. Group I consisted of 268 women with histologically verified adenomyosis. A total of 40.4% of women
from group I had a combination of myoma and adenomyosis,
31.4% of them had a combination of adenomyosis and endometrial hyperplasia. Group II consisted of 536 women without
proliferative diseases of the uterus. The mean age in Group I
was 49.3 ± 5.51 years in group II – 48.5 ± 8.69 years (p ¼ 0.169).
We used questionnaires, clinical and statistical methods.
Results: The age of onset of contraceptive use in both groups
had differences. Women from group I used contraception from
20 years, in group II from 28.5 years (25th percentile ¼ 16.75
percentile ¼ 38 years) (p < 0.001). The types of contraceptive use
also revealed statistically significant differences (v2 ¼ 9.0,
p ¼ 0.003). Patients with adenomyosis used significantly more
often the intrauterine device (IUD) (45.8% [95% CI: 85.3–90.7]) in
contrast to the patients of group II (0.85% [95% CI: 85.3–90.7]),
p < 0.001. The application of IUD was a significant risk factor for
adenomyosis, odds ratio – 6.1 [4.3–8.7], (v2 ¼ 11.559, p ¼ 0.003).
The hormonal contraception was used by 12.7% of women
from group I and 11.5% from group II; barrier methods were
used by 25.3% and 30.7% women respectively (p > 0.05).
Overall, 16.6% of women from group I and 16.7% of patients
from group II had never used any contraceptive methods.
Conclusion: Patients with adenomyosis during the reproductive
period, statistically significantly more often use intrauterine
contraception. The use of intrauterine contraceptive device is a
risk factor for adenomyosis.
CONTRACEPTION IN MEDICAL CONDITIONS AND
DISABILITY
A-086
Reproductive characteristics in
women after renal transplantation
Poliana Lasanha, Patricia Yoshida, Marina Cristelli,
Marcia Barbieri, Helio silva, Jose Pestana and
Cristina Guazzelli
Introduction: Patients with renal chronic disease present ovarian dysfunction with irregular cycles, amenorrhea or anovulation. After the transplantation, an unplanned pregnancy can
endanger the graft and carry risks to the patient and fetus.
Therefore family planning is important to minimise any
complications.
Objective: To acknowledge the reproductive characteristics in
women after renal transplantation at childbearing age.
Method: Transversal and descriptive case studied in the posttransplantation ambulatory ward of the Kidney Hospital at the
Universidade Federal de Sao Paulo, with 113 female renal transplant recipients. Data were collected by a structured
questionnaire.
Results: The average time after transplantation was 3.7 years
and the average age of the participants was 34 years old.
Seventy-three patients (65%) were cadaveric donor recipients.
Concerning medical counselling, 77 patients (68%) did not
receive any information about contraceptive methods after
transplantation, whereas 65 (37%) were advised of the risks of
pregnancy complications and graft rejection. Sixty-four patients
(57%) had already become pregnant before the transplantation.
Regular menstrual cycles were observed in 102 patients (92%)
40 days after transplantation, on average; 82 of these patients
(73%) had sexual intercourse and 71 of them (87%) were using
contraceptive methods – 31 patients preferred condoms (27%)
and 28 of them used combined hormonal contraceptive pills
(24.3%). There were 12 pregnancies in the case group, and five
of them (42%) were not planned.
Conclusion: Effective contraceptive methods usage was low
among transplanted women, which reflects the high rate of
unplanned pregnancies. These data prove the need of intensifying family planning in this population.
A-087
Family planning in transplanted
women
Marcia Barbieri, Patricia Moraes, Luis Carbone,
Poliana Lasanha and Cristina Guazzelli
Universidade Federal Sao Paulo, Sao Paulo, Brazil
Background: Women with advanced stages of kidney disease
and women undergoing dialysis denote dysfunction in the
hypothalamic-gonadal axis that can cause infertility. Fertility is
usually restored in the first months after renal transplantation
procedure, with incidence of unplanned pregnancies up to
92.9%.
Objective: To identify the reproductive profile of women after
renal transplant procedure.
Methods: Prospective descriptive study in Family Planning of
the Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.
The sample consisted of 60 women, enrolled in the family planning program at UNIFESP, from October 2014 to October 2015.
Results: Women enrolled in the program had a mean age of
30.2 years, ranging from 11–50. The mean number of pregnancies and parities were 0.78 and 0.65, respectively, both ranging
from 0 to 4. For the prevention of pregnancy, 21.6% of patients
opted for oral contraceptives, 20% for injectable hormonal
contraceptive, 18.3% for condoms, and 15% opted for intrauterine device or intrauterine system. About 25% of them did not
opt for any contraceptive method because they were not sexually active at the time of the study, or they were afraid to use
contraceptive methods that could interfere with the transplantation procedure.
Conclusion: The results of the study reinforce the importance
of offering family planning programmes that cover education,
assistance with the provision of highly effective contraception;
and interdisciplinary work between gynaecologists and nephrologists is recommended when treating women after renal
transplant.
ACCEPTED ABSTRACTS – CONTRACEPTION IN SOCIALLY DISADVANTAGED GROUPS
A-088
Sexual life and contraceptive use
among Brazilian teenage girls with
cancer
Tamires Franca, Gustavo Barison, Regina Torloni,
Marcia Barbieri and Cristina Guazzelli
Introduction: Due to improvements in diagnosis and treatment,
the survival and quality of life of adolescent girls with cancer is
improving. Adolescence is also a period of social interactions
and sexual awakening. Unprotected sex during this period can
lead to unplanned pregnancy with consequences for the treatment and prognosis of these girls.
Objective: To assess the use of contraceptive methods by adolescent girls with cancer.
Methods: This was an observational cross sectional survey. We
interviewed 72 adolescent girls (10–19 years) with diagnosis of
cancer receiving treatment at the outpatient clinic of a single
institution specialized in the treatment of pediatric cancer in
~o Paulo, Brazil, between November 2013 and January 2015.
Sa
The girls were selected by computer software and a questionnaire specifically created for this study was used to collect information on gynaecological and obstetric history and use of
contraceptive methods.
Results: Among these 72 adolescents the mean age was 15.2
(± 2.6 SD) years most were Caucasians (73.6%) and single
(98.4%) mean age at menarche was 12 (± 2 SD) years. Most adolescents showed tumour in the central nervous system (37.4%),
bone tumour (Ewing’s sarcoma and osteosarcoma) (25%) and
leukaemia (20.8%). Approximately 18% were sexually active and
mean age at first intercourse was 14.6 (± 2.0 SD) but only 29.2%
of these said that they had received contraceptive counselling.
The most frequently used methods were: hormonal contraceptive (83%) and 60% of adolescents had amenorrhea and 33%
irregular bleeding during or after treatment with these contraceptives. Three girls (4.1%) had at least one previous unplanned
pregnancy.
Conclusions: Most adolescents in treatment for cancer have
been using hormonal contraceptives. However, over half of
them report inadequate use of the methods, and no guidance
about the importance and the risks of a pregnancy during the
treatment period and cancer remission time. There is a need for
more information and counselling among this population.
Furthermore, there is a need to establish management protocols
on the appropriate dose of hormones, orientation of patients
and alternative contraceptive methods.
CONTRACEPTION IN PREMENOPAUSAL WOMEN
A-089
Neurokinin B receptor antagonism
suppresses ovarian follicle
development and postpones
ovulation
Karolina Skorupskaite, Jyothis T. George and
Richard A. Anderson
University of Edinburgh, Edinburgh, UK
Objective: Normal follicle development and ovulation requires
coordinated interaction between GnRH-driven gonadotropin
stimulus to the ovary, and hormonal feedback. Neurokinin B
(NKB) is a key modulator of GnRH secretion, as loss-of-function
85
mutations result in hypogonadotropic pubertal delay. We have
investigated the role of NKB in the control of follicle development in normal women using pharmacological blockade of
NK3R.
Method: Six healthy women with regular menstrual cycles were
administered the NK3R antagonist AZD4901, 80 mg/day orally
for 7 days starting on cycle day 5–6. All women had a no treatment control cycle, the order of cycles being randomised.
Serum hormones, leading follicle diameter and endometrial
thickness were assessed through the follicular phase of treatment and control cycles, and urine was collected daily. Data
were compared by t-test. Ethical approvals and informed consent were obtained.
Results: Follicle development was suppressed during NK3R
antagonist treatment, the diameter of the leading follicle being
significantly smaller than in controls at the end of treatment on
cycle day 12–13 (8.9 ± 0.8 vs. 14.5 ± 1.4, p < 0.02). No differences
in serum LH and FSH were observed. Serum estradiol was
reduced in NK3R antagonist cycles (122 ± 57 vs. 406 ± 151 pmol/
l, p ¼ 0.05) and the endometrium was thinner (5.3 ± 0.4 vs.
7.6 ± 0.6 mm, p < 0.04) at the same time point. After treatment,
follicle development was observed (16.6 ± 1.4 vs 16.9 ± 1.3 mm
on day of LH surge, ns) and estradiol secretion increased
(540 ± 105 vs. 608 ± 121 pmol/l, ns) with an LH surge on day
23 ± 2 vs. 15 ± 1 (p < 0.02). The delayed LH surge and ovulation
were confirmed by a similarly delayed rise and day of peak urinary progesterone (cycle day 32 ± 2 vs. 22 ± 1, p < 0.02) and prolonged cycle length (37 ± 2 vs. 30 ± 2 days, p < 0.04); luteal
function was not affected by the NK3R antagonist (urinary progesterone 80 ± 17 vs. 61 ± 14, pmol/mol creatinine on surge
day þ7, ns).
Conclusions: In this study of NK3R antagonism in healthy
women, follicle growth and estradiol secretion were suppressed,
and ovulation delayed by the duration of treatment. After treatment was discontinued, follicle development resumed with evidence of normal ovulation and luteal function. The arrest of
follicle development is likely to be mediated via reduced GnRH/
gonadotropin secretion, although this was not apparent with
single time point sampling. Our data confirm the involvement
of NKB in the neuroendocrine control of female reproduction
with potential therapeutic application in non-steroidal
contraception.
CONTRACEPTION IN SOCIALLY DISADVANTAGED
GROUPS
A-090
Meeting the contraceptive needs of
female migrant garment factory
workers from a mobile clinic in Laos
Aileen McConnell, Dalayvanh Keonakhone and
Ya Phoummolino
Vientiane Women’s Youth Centre for Health and Development,
Vientiane, People’s Democratic Republic of Lao
Geographically Laos is a remote land locked country and travel
to the nearest medical service can take days. Reaching adolescents and youth can be challenging for Vientiane Women’s
Youth Centre for Health and Development (VWYCHD), the only
youth-friendly clinic in the country. In Laos, an estimated 20,000
people are employed in over 100 low-cost garment factories.
Most of the workers are young (17–25 years old), female (85%),
have migrated from rural areas, and work long hours staying
onsite in dormitories. This puts them in an isolated socially disadvantaged position resulting in increased vulnerability due to
restricted time, no means of transportation, little translated
information available and no access to health care services.
They experience inadequate treatment for STIs and other
86
genital conditions, use of fake illegitimate medication,
unplanned pregnancies, and having to deal with physical and
sexual violence or coercion into the sex industry.
Our aim was to provide outreach sexual and reproductive
health services and train local health educators, enabling factory
employees to better manage their staff health and well-being.
Two trained Doctors, both male and female, conducted the
clinic sessions and a Nurse provided a limited pharmacy with
subsidised medication providing oral contraception, condoms,
syndromic treatment for STIs and one-to-one counselling or
referral on to another provider for other health concerns.
VWYCHD delivered the mobile clinic service in three districts of
Vientiane, covering 18 factories with over 7,000 workers. During
each mobile clinic session around 30 clients had a consultation.
The mobile clinic popularity highlights an obvious gap in sexual
and reproductive health services for garment factory workers
and currently this is the only project that targets migrant communities in urban settings.
Trialling new and innovative ways to improve reproductive
health care provision is paramount to improving our service
and reaching those who may be physically out of reach. The
opportunity to engage with these women also highlighted their
need for further support in issues surrounding dental health
and genital skin care. Health systems in Laos prioritise maternal
and child health issues in rural areas, more focus is needed on
reproductive health care needs of migrant workers. Due to clinic
limitations, including time, we could not administer Implanon
on-site although many women requested this option. This highlighted the growing popularity in longer acting reversible
contraception within this group.
A-091
Postcode lottery or differences in
access – uneven regional availability
of public funded contraception in
Germany
show: Differences in access also manifest themselves within the
great area states, because there are marked regional variations
discernible. Reimbursement schemes vary considerably in core
features. This applies to the form and range of cost coverage
such as the entitled persons, the contraceptive methods, rules
of procedure, level of benefits and promotion of programs.
Conclusions: The data presented here offer a broad and up-todate insight into regional variations in access to publicly funded
contraceptives for people on a low income. They form a solid
basis for assessing this regulatory area and point to the political
need for regulation at national level. Regional programs are
uneven, confusing and often unknown. The group of eligible persons, the application procedure, the amount of coverage, and
the contraceptives covered depend on the place of residence.
A-092
Improving the sexual health of
homeless young people resident in
hostels
Fiona McGregor, Jill Shawe and Ann Robinson
University of Surrey, Guildford, Surrey, UK
Background: Little is known about the sexual health (SH) of
young people (YP) who are homeless and resident in hostels.
They are a vulnerable group, many of whom are in transition
from the care system,[1] have a history of previous abuse,[2]
and require support to make the shift to adulthood and independent living.[3] Overall, long term general health outcomes
for homeless people are poor.[4] The study aims to examine
knowledge and attitudes around sexual health and contraceptive use amongst young people who are homelessness and resident in Local Authority hostels.
Objectives:
1.
Ines Thonkea and Johannes Staenderb
a
Pro Familia Central Office, 60596 Frankfurt, Germany; bFaculty of
Health Sciences of the University of Bielefeld, Bielefeld, Germany
Objectives: Following changes in social and health law implemented during the last decade, financing of contraception has
become difficult for people on low incomes. Before the implementation of these reforms the cost of prescription contraceptives for eligible women was funded by social welfare offices.
The discontinuation of national rules has led to far-reaching
regional variations in the availability of publicly funded contraceptives. Moreover, in view of the perceived need many local
authorities have reopened access to free contraceptives for lowincome people or established alternative support models. No
overview data on these programs exist
Method: In cooperation a family planning organisation and the
faculty of health sciences of a University carried out a nationwide survey to gain an overview of regional public programmes
providing contraceptive coverage for financially disadvantaged
women and men. The aim was to identify regional differences
in programmes and barriers to access. To get a broad picture of
the situation in Germany, the survey relied on local family planning counselling centres as important and reliable information
sources. Counsellors were asked to participate in the survey
even if no regional or local programme was in place. Each
municipality is represented only once. The survey was carried
out with a standardised online questionnaire. SPSS was used for
the statistical evaluation of the data.
Results: The results provide up-to-date information of 361
municipalities nationwide on where public programmes exist
and how they are designed. There are substantial differences
whether public programs exist: Germany’s eastern states strike
the eye. In none of them are public programmes in place. The
described regulations of the other federal states of Germany
2.
To improve the sexual health and contraceptive use of
homeless young people resident in Local Authority
hostels
To develop a set of standards for sexual health care
provision for young living in Local authority hostels.
Methods: An ethnographic case study methodology is
used. The case under study is homeless young people living
in local authority hostels in London. A total of 25 young
people 16–21 years and five key workers will be interviewed
using a semi structured format. Observations of residents
meetings and the hostel settings have being carried out.
National and local policies and documents concerning the
sexual health of young people in hostel accommodation are
being examined. A constructivist theoretical framework is
used to underpin the study. Analysis of data will uses six
stage thematic analysis combined with computer assisted
thematic analysis using Nvivo.
Results (intermediate): Based on initial interviews and observations, preliminary results have been generated. Although several
themes are emerging, contraception issues centre on:
1.
2.
3.
Male contraceptive knowledge is poor
Females have particular concerns about obtaining
contraception in non-traditional ways such as over-thecounter,
Relationships of trust and confidentiality with professionals are important.
Conclusions: Qualitative emerging data indicates that both
male and female YPs concerns around SH are similar to that of
the general YP population. Within hostels male knowledge is
ACCEPTED ABSTRACTS – CULTURE, RELIGION, REPRODUCTION AND SEXUALITY
inferior to that of female, and both sexes feel that more individually tailored information should be available to them, with
safety issues of primary concern. To date, it is concluded that
homeless young people and resident in hostels require support
with their sexual health needs in order to ensure good outcomes. This needs to be delivered in the form of addressing
sexual health needs within the hostels. This should be done in
a confidential manner through close work with the key personnel acting as mentors to these hostel resident young people.
11.
12.
13.
87
Injectable, e.g., medroxyprogesterone, are relatively
cheap and probably could be marketed for couples in
all three segments.
Free public sector contraceptives should be targeted
to the poorest third of the population.
The present social marketing is working well and is an
extremely valuable system for getting condoms to
most areas in the country at a relatively low cost.
Conclusions:
References
[1]
[2]
[3]
[4]
1.
2.
3.
A-093
Market segmentation research in
Kosovo
4.
All contraceptives available in Kosovo either commercially or from donations should be registered with the
Kosovo Medicines Agency.
The MoH should consider the targeting of free or subsidised contraceptives to those families who cannot
afford to purchase them in the commercial sector.
Education programmes covering family planning should
include undergraduate medical students, specialty training of gynaecologists and family medicine doctors in
their continuing education.
Any initiative to improve the supply of modern contraceptives must be accompanied by a detailed behaviour
changing communication initiative.
Zarife Miftaria, Visare Mujko-Nimania, Merita Vuthajb
and Bajram Maxhunia
a
United Nations Population Fund (UNFPA), Pristhina, Kosovo;
Ministry of Health, Prishtina, Kosovo
b
CULTURE, RELIGION, REPRODUCTION AND SEXUALITY
Objective: The main purpose of Market Segmentation Research
is to identify the most vulnerable groups of populations for the
public sector to provide comprehensive reproductive services
including modern contraceptives to those most in need.
Methodology:
1.
2.
3.
Analyse current policies, laws, and regulations that
affect family planning and commodity availability.
Review the MICS 2013–2014 and other relevant
documents;
Key informant interviews.
Results:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Contraceptives in Kosovo are available at no cost from
the government; social marketing programme; at commercial sector.
94.9% of women aged 15–49 know at least one modern contraceptive.
The percentage of married women aged 15–49 years
using modern contraceptives has fallen.
For individual contraceptives to be considered for
registration, Kosovo Medicines Agency (KMA) requires
a submission of items, similar to those required by
pharmaceutical registration authorities elsewhere in
Europe.
Several contraceptives available in Kosovo either commercially or donated are not registered with the KMA.
Couples who would have to exceed 1% of income on
contraceptives are considered to be unable or less
likely to pay.
The poorest third of the population can only afford
the cheapest, CoC, and copper T IUD.
The middle income segment in addition to the copper
T IUDs can afford only the cheapest oral pills
(Rigevidon), most use condoms.
Most couples in the richest third segment of the
population can afford all the available brands of condoms, the cheapest oral contraceptives and emergency contraceptives.
Copper T IUDs are the least expensive method of all
types of contraceptives and should be made more
widely available.
A-094
Human Parvovirus B19 in Iranian
pregnant women: a serologic survey
Zakieh Rostamzadeh, Fatemeh Garejedagi,
Maedeh Hashemi, Razieh Barzegari and
Zahra Shirmohamadi
Medical Science Urmia, Urmia, Iran
Background: Parvovirus B19 infection is associated with some
clinical symptoms that are very different from slight to severe.
The important clinical manifestations are erythema infectiosum
or the fifth disease, transient aplastic anaemia in patients with
haemoglobinopathies, acute polyarthralgia syndrome in adults,
hydrops fetalis, spontaneous abortion and stillbirth. Acute infection in non-immune pregnant women can lead to fetal hydrops.
Nowadays many important complications are attributed to this
specific infection; therefore its diagnosis would be very important in pregnant women. In this study we aimed to investigate
the seroprevalence of anti-Parvovirus B19 IgG and its association
with the history of abortion in an Iranian population of pregnant women.
Methods: Serum samples from 86 pregnant women were collected between May and September 2011 in West Azerbaijan
province of Iran. Every pregnant woman completed a questionnaire including age, history of tattooing, blood transfusion and
abortion. Anti-B19 specific IgG was detected by using commercial enzyme-linked immunosorbent assays (ELISA).
Results: Anti-B19-specific IgG antibody was detected in 75.6%
of pregnant women (65 positive samples out of 86 sera). The
mean age was 25.56 ± 5.30 years and three women had a history of previous blood transfusion (two of them were seropositive for B19). Abortion history was reported in 18 cases of the
women and among those 18 participants, 88.88% were IgG
positive (n ¼ 16). The frequency of abortion sessions in the seropositive group (ultimately 25 sessions of abortion: 11 women
had experienced one abortion, two women had had two abortions, two women had had three abortions and one had experienced four) is 4.03 times greater than abortion in seronegative
group (2 abortions/21 seronegative).
88
Conclusion: Our study confirms previous reports regarding the
higher frequency of abortion among anti-B19 IgG seropositive
pregnant women, and a possible role of this viral infection in
the pathogenesis of abortion.
A-095
Influence of tradition, religion and
customs on the reproductive health
of Roma population in Nis, Srbija
another major factor that has a huge impact on both sexuality
and reproduction and it is the basis of most decisions.
Conclusions: Many people of reproductive age have different
views and beliefs about both sexuality and reproduction. Most
of these views and beliefs are preformed and subconsciously
programmed in relation to cultural and religious beliefs. The
best way as advocates and physicians is to understand that different factors in society play an important role in the decisions
of our patients and it will be of greater benefits if we respect
some of these beliefs rather than discarding them out-rightly.
The three most important factors to be considered are cultural,
religious and economic beliefs. More emphasis should also be
placed on correcting some outdated cultural norms and beliefs.
Olivera Sulovic and Katarina Milenkovic
The house of Health, Nis, Serbia
Ethnicity, traditions, customs and characteristics inherent to the
Roma population in Serbia and the city of Nis, related to reproductive health, were the subject of research in this paper.
According to the official census, in 2011 Serbia had about
150,000 members of the Roma population, however according
to unofficial data, it was much more, around 400,000–500,000.
In Nis, the second administrative centre of Serbia, according to
the census of 2011, there were 6996 Roma, and half of them
were women. The subordinate position of women, low education rates, strict respect for tradition, and the stigmatising deviations from this, early marriage, a large number of births, a large
number of induced abortions, minimal use of contraceptives,
failure of women to appear for medical check-ups, resulting in
higher mortality and morbidity rates and extremely short life
expectancy of women. In order to improve the general situation
of the Roma population, various measures were taken. Involved
NGOs organised debates and lectures. In Nis, an organisation
called ‘Dawn’ was founded in which Roma women were encouraged to become mediators, visiting Roma, holding lectures, visiting women, to advise on family planning and actively
participate together with gynaecologists from the health centre
in the organisation of medical examinations and family planning
counselling.
Conclusions. Despite major efforts by Serbia in providing youth
education and improving living conditions the situation is still
not satisfactory.
A-096
The role of culture and religion on
reproduction and sexuality in Ukraine
Ayo Falade and Eniola Ajayi
V.N. Karazin Kharkov National University, Kharkov, Ukraine
Objective: To examine the part played by culture and religion
on reproduction, family size and individual sexuality (including
sexual identification and orientation) in Ukraine, a country
located in Eastern Europe, a former Soviet Union State with a
population of 45.49 million people.
Methods: Questionnaires were used, consultations were made,
articles and literatures were also thoroughly researched to identify the beliefs related to sexuality, and also its influence and
impact on reproduction. Some local information was also gathered during the course of our research. The level of control that
culture and religion have on sexuality and reproduction were
also evaluated based on the available data.
Results: It was observed that religious and cultural beliefs play a
major role in the formation of attitudes, orientations and perceptions. Sexuality has been oppressed while there is greater liberty
on reproduction. Religion has little or no effect on reproduction
and family planning due to most interpretations and knowledge
of it being in line with most methods of family planning but the
cultural impacts are still obvious. The economic situation is
A-097
Role of culture and religion in family
planning and contraceptive use: a
qualitative study from Kilifi County,
Kenya
Peter Gichangia, Janet Mugoa, Petrus Steynb,
Irene Njaua and Joanna Corderob
a
International Centre for Reproductive Health, Kenya, Mombasa,
Kenya; bDepartment of Reproductive health and research, WHO,
Geneva, Switzerland
Objective: To explore the role of culture and religion in family
planning and contraceptive use. Access to family planning and
contraceptives (FP/C) is a human right which allows couples
and individuals to decide freely the number, spacing and timing
of their children and families. Despite investments in family
planning, unintended pregnancies continue to occur in large
numbers. A number of factors can affect a woman’s access to
and effective use of contraception. The health system barriers
to FP/C use have been well documented. However, there is a
dearth of information on the role of culture and religion.
Methods: Seven focus group discussions with 8–10 women of
reproductive age were conducted. To get unique insights,
unmarried women and women with no children were also
included.
Results: Findings show that decision-making for FP/C use was
influenced by the male partner and mother-in-laws. The male
partner decides when a woman should use and remove the FP/C
method, and decides the number of children the family should
have. Threats of gender-based violence and divorce were mentioned by participants as some of the consequences of FP/C use
without the male partner’s permission. Mother-in-laws preferences for large families to ensure continuation of family names also
influences uptake of FP/C use. For the unmarried women and
those with no children, FP/C use was associated with promiscuity.
Religion associated FP/C use with ‘killing’, a ‘sin’ which goes
against God’s word of ‘filling the earth’ and discourages women
from using FP/C. However, there were mixed messages; some
religious leaders encouraged only natural methods, others discouraged all use of FP/C while others encourage people to have
families they can manage but discourage FP/C use. Emphasis on
abstinence till marriage discouraged the unmarried women from
using FP/C. Religion reinforces some cultural norms such as the
man as the head of the home and a woman should not use FP/C
if the male partner disagrees.
Conclusion: Men, mother-in-laws and religious leaders influence
a woman’s decision to use FP/C and should be involved in FP/C
programs. They should be targeted with information on benefits
of FP/C use such as protecting health of the mother and child,
improved quality of life due to smaller families and reduction of
abortion and maternal mortality. Culturally acceptable methods
shown to be effective such as lactational amenorrhea method
can be encouraged, and effectiveness of modern methods
should be emphasised.
ACCEPTED ABSTRACTS – CULTURE, RELIGION, REPRODUCTION AND SEXUALITY
A-098
Community perspectives on female
genital cutting (FGC): comparing men
and women’s views in the Boston
immigrant community
Sarrah Shahawya, Hanna Amanuelb and
Nawal Nourc
a
Harvard Medical School, Boston, MA, USA; bHarvard College,
Boston, MA, USA; cBrigham and Women’s Hospital, Boston, MA,
USA
Objectives: Female genital cutting is an important cultural practice among Somalis and those from other African countries like
Egypt, Kenya, Sudan, and Ethiopia. There is a significant influx
of immigrants and refugees from these countries into Western
ones like the United States. A growing body of literature indicates that women who undergo FGC are at increased risk of
adverse obstetric, gynaecologic, and psychological effects. While
current literature has focused on women’s views of the practice,
our study aims to compare men and women’s views in these
communities on the effects, current status and future of the
practice.
Method: A total of 50 individual interviews among men and
women living in Boston, USA, originating from countries where
FGC is practiced, were conducted using an open-ended questionnaire to explore their attitudes on the practice of FGC, its
effects on their personal, family, and community lives, and on
current and future trends in their countries of origin.
Convenience sampling was used and interviews were then transcribed and qualitatively coded for reoccurring themes.
Results: The majority of participants were Muslim and married,
with all the female participants having undergone FGC themselves. Preliminary themes arising from the interviews indicate a
general disapproval of the practice of FGC among Boston immigrants and refugees, often associated with a recognition that
the practice is largely cultural, not religious, and that it has
harmful consequences to women’s health, sexual satisfaction,
and quality of life. Most participants denied that FGC is practiced by immigrants in the United States and believed that the
incidence of the practice is decreasing in their countries of origin due to successful educational campaigns by governments,
religious organisations, and community and health workers.
Most participants felt that their views in the diaspora community could have an effect on changing views in their countries
of origin and most of the male participants felt that men in the
community had a significant role to play in stopping the
practice.
Conclusions: These results indicate that both men and women
in the diaspora might share negative attitudes towards the
practice of FGC. The changing views in the diaspora could
potentially play a significant role in changing views and practice
in Somalia and other African countries, as members of the diaspora across many countries have the potential for power and
influence in their homeland if their views are voiced.
A-099
Wrestling with the hymen:
consultations and practical solutions
Olga Loeber
Rutgershuis oost, Arnhem, The Netherlands
Objective: To study the consultation and treatment options for
young women who desire revirgination surgery, and to offer
recommendations.
89
Methods: During her initial visit to a Dutch clinic, each of these
women discussed with a physician her reasons for consulting
and the treatment options.
Results: Some 154 women sought advice for virginity-related
issues. They were planning to marry or had experienced some
form of sexual violence. Of these, 48 chose hymen reconstruction (HR), 26 a temporary hymen suture (THS), and 27 to resort
to some expedient for staining the sheets or to another alternative for surgery. At follow-up, 13 of the 17 women who had
THS and six of the 11 who had HR reported blood loss on their
wedding night, whereas all six women who inserted a capsule
with food colouring stated they had stained the sheets.
Conclusions: Cost-effective procedures help young women who
are no longer virgins to avoid reprisals by their husband or family. Pelvic floor exercises will tighten the vaginal opening. THS
seems more effective than HR for producing blood loss. There
are alternatives should no blood loss occur during penetration.
A-100
Women’s empowerment and
contraceptive use: the role of
independent versus couples’
decision-making, from a lower
middle income country perspective
Waqas Hameed and Khurram Azmat
Marie Stopes Society, Karachi, Pakistan
Background: There is little available evidence of associations
between the various dimensions of women’s empowerment
and contraceptive use having been examined and of how these
associations are mediated by women’s socio-economic and
demographic statuses. We assessed these phenomena in
Pakistan using a structured-framework approach. The research
question was to assess the role of independent versus couples’
decision-making in the uptake of modern contraception.
Methodology: We analysed data on 2133 women who were
either using any form of contraceptive or living with unmet
need for contraception. The survey was conducted during
May–June 2012, with married women of reproductive age
(15–49 years) in three districts of Punjab. The dimensions of
empowerment were categorised broadly into: economic decision-making, household decision-making, and women’s mobility.
Two measures were created for each dimension, and for the
overall empowerment: women’s independent decisions, and
those taken jointly by couples. Contraceptive use was categorized as either female-only or couple methods on the basis of
whether a method requires the awareness of, or some support
and cooperation from, the husband. Multinomial regression was
used, by means of Odds Ratios (OR), to assess associations
between empowerment dimensions and female-only and couple contraceptive methods.
Results: Overall, women tend to get higher decision-making
power with increased age, higher literacy, a greater number of
children, or being in a household that has superior socio-economic status. The measures for couples’ decision-making for
overall empowerment and for each dimension of it showed
positive associations with couple methods as well as with
female-only methods. The only exception was the measure of
economic empowerment, which was associated only with the
couple method.
Conclusions: Couples’ joint decision-making is a stronger determinant of the use of contraceptive methods than women-only
decision-making. This is the case over and above the contribution of women’s socio-demographic and economic statuses.
Effort needs to be made to educate women and their husbands
equally, with particular focus on highly effective contraceptive
methods.
90
A-101
Religious barriers affecting unmet
need for contraception in India
Shraboni Patra
International Institute for Population Sciences, Mumbai,
Maharashtra, India
Objectives: The existing large gap in the prevalence of unmet
need between Hindu and Muslims plays an important role in
contributing to population growth in India. Hence, it is important to investigate the role of the family planning programme in
reducing population growth from a religious perspective.
Therefore, the present study focuses on the differentials in the
prevalence of unmet need for contraception among Hindu and
Muslim in India, with an emphasis on religious barriers to use of
contraception.
Methods: The third round of District Level Household and
Facility Survey (DLHS-3) data is used which is one of the largest
ever demographic and health surveys (2007–2008) carried out
in India covering all the districts. The present analysis is based
on 468,366 Hindu and 70,016 Muslim currently married women
across the country. In the present study, bivariate and multivariate analyses are used.
Results: A large gap exists in the contraceptive prevalence rate
(CPR) between Hindu (56.7%) and Muslim (43.2%) women, and
among Muslims the CPR is well below the national level
(54.8%). Among Hindus, unmet need for contraception is 19.7%
that consists of the unmet need for spacing (7.1%) and unmet
need for limiting (12.6%). But among Muslims, the total unmet
need is much higher (about 28% of which 8.8% is for spacing
and 18.8% for limiting). Surprisingly, about 9% of Muslim
women did not use contraception due to religious opposition.
Future intention to use the spacing method is much lower
among Muslims (6.9%) than among Hindus (15.6%), but intention to use the limiting method is higher among Muslims
(30.8%) compared to Hindus (24.7%).
Conclusions: The unmet need for family planning among
women, irrespective of religious background, decreases with
improvement in their educational status and decision-making
power. The results show potential demand for family planning
services among Indian Muslim women. The use of permanent
means of contraception is not allowed in Islam unless pregnancy would pose a threat to the health or life of the expectant
mother. The spread of awareness and increase in reproductive
health knowledge among Muslim women are of the utmost
importance to diminish religious barriers hindering acceptance
of family planning methods. Similarly, awareness and proper
knowledge of contraception can change the choice of the
method from traditional to modern contraception among
Hindus. Religious leaders and scholars can play an important
role in spreading awareness in their community.
DELIVERY OF SEXUAL AND REPRODUCTIVE HEALTH
CARE
Introduction: Between January and April 2015, 17% of women
attending for a termination of pregnancy within the Aneurin
Bevan University Health Board had given birth within the previous 12 months.[1] A survey conducted in 2014 within the same
health board highlighted that 83% of women were interested in
receiving contraception prior to discharge. Following this survey
a pilot integrated service commenced involving provision of
postnatal contraception prior to discharge by community sexual
health services. The aims of this pilot service were to improve
access for women to contraception services and subsequently
reduce unplanned pregnancies in the postnatal period.
Method: Between September 2014 and September 2015 a community sexual health doctor provided a ward round service
offering contraception one morning a week. All women had an
individual bedside contraception consultation offering condoms,
progesterone only pills, injections and implants.
Results:
1.
2.
3.
4.
5.
6.
7.
Despite the lower uptake of long acting reversible contraception, further breakdown of the results highlights that 45% of
progesterone-only pill and 70% of condom users were being
used as bridging methods.
Conclusion:
1.
2.
3.
4.
5.
Provision of a postnatal
contraception service – a pilot study
integrating community sexual health
services and maternity services
Michelle Olver
Aneurin Bevan University Health Board, Newport, UK
Results of the pilot study have demonstrated that
women are happy to discuss and accept contraception
in the early postnatal period.
Provision of a bridging method is acceptable to women
who would like to think about their contraceptive
option or require a method which cannot be supplied
at that present time.
The weekly ward rounds have also facilitated women
accessing contraception services who have not previously engaged with the service and allowed interaction
with hard to reach groups such as the travelling community, asylum seekers and women whose first language is not English.
The initial survey revealed an unmet need for postnatal
contraception and this integrated approach provides a
woman with a holistic way of managing her postpartum reproductive needs.
This intervention will potentially prevent unplanned
pregnancy in the puerperium as well as providing more
efficient, convenient and patient focussed care.
Reference
[1]
A-102
418 women had a contraception consultation;
Six women did not need contraception due to infertility
or sterilisation;
314 (76%) women received a method of contraception;
44% received a progesterone only pill;
22% received some condoms;
20% had an implant inserted;
14% had the progesterone only injection.
Postnatal Sexual and Reproductive Healthcare, Faculty of Sexual
and Reproductive Health, CEU Guidance [Internet]. [Cited 2016
Sep
1].
Available
from:
http://www.fsrh.org/pdfs/
CEUGuidancePostnatal09.pdf
ACCEPTED ABSTRACTS – DELIVERY OF SEXUAL AND REPRODUCTIVE HEALTH CARE
A-103
A-104
Determinants of unintended
pregnancy among women in
Ambanja district, Madagascar
Delivering a nurse-led subdermal
implant clinic
Oriane Lacoura, Ania Salema, Stefano Scaringellac,
Anne Caroline Benskib, Giovanna Stancanellid,
Pierre Vassilakosb, Patrick Petignatb and
Nicole Schmidtb
a
Faculty of Medicine, University of Geneva, Geneva, Switzerland;
Department of Obstetrics and Gynaecology, University Hospitals
of Geneva, Geneva, Switzerland; cCentre Medico-chirurgical Saint
Damien, Ambanja, Madagascar; d4AISPO, Associazione Italiana
Solidarieta tra I Popoli, Milan, Italy
b
Objectives: Unintended pregnancies have been associated with
negative health consequences including the risks of unsafe
pregnancy termination, poor maternal and child health. The
objective of the study was to estimate and describe determinants of unintended pregnancy among women in their first
year postpartum.
Method: We used secondary data of a prospective, unmatched
case-control study about maternity service utilisation in
Ambanja (Madagsacar) and analysed the percentage of unintended pregnancies among 287 women aged 14–45 years. The
dependent variable was coded as a two-outcome variable and
defined as either intended pregnancy (if the pregnancy
occurred at the desired time) or unintended pregnancy (if the
pregnancy was either mistimed or not wanted at all). The analysis was restricted to the last born child. We considered various
independent variables such as maternal education, working status, age, martial status, parity, history of abortion, women’s decision-making autonomy, and household size. Bivariate and
multivariate analyse was used and a p-value <0.05 was considered as statistical significant.
Results: The study found that 36.9% of the women referred to
their last pregnancy as unintended, either mistimed (23.69%) or
not wanted at all (13.24%). The regression model shows that
unintended pregnancies were significantly more frequent in single women (Odds Ratio (OR) ¼ 3.82, 95% CI: 2.05–7.09). Women
living in households with more than five members (OR ¼ 2.07,
95% CI: 1.04–4.12) and mothers with five or more pregnancies
(OR ¼ 3.40, 95% CI: 1.36–8.50) had a significantly increased likelihood of the pregnancy being unintended. No significant association was found in respect to women’s education, age or
employment status. Importantly, nearly all women (98.95%)
attended antenatal care (ANC) during their last pregnancy with
an average first visit in the fifth month (Mean ¼ 4.05 ± 1.36).
Furthermore, 77% of women had a health facility in their village
and 87.11% of women could reach the next health facility in
less than an hour walking.
Conclusion: The prevalence of unintended pregnancy was
much higher than the 13% reported in Madagascar’s last
Demographic Health Survey (2008). The prevalence rate was
more similar to 35% reported for the African Continent in 2012.
Importantly, 87.11% of the in the study included women were
living relatively close to the next health facility (less than an
hour walking distance) and 98.95% had attended ANC at least
once during their last pregnancy. This highlights the importance
to include the WHO recommended family planning information
and counselling into ANC to avoid future unwanted pregnancy.
91
Helen Munro, Elzbieta Volkman and
Ana Nageswaran
Whittington Hospital, London, UK
Objectives:
(1) To evaluate patient experience in attending a nurse- led
CASH service for the provision of Subdermal Implants (SDI)
(2) To assess standards of record-keeping in the nurse- led SDI
clinic
Methods: The audit was conducted at a large integrated CASH
service in north London where a hub and spoke model of care
encompasses four nurse led clinics. Data was collected prospectively over a three-month period commencing on the 12 August
2013. The collection of data was in two parts. Part 1 included a
patient satisfaction questionnaire. The first two questions were
completed by the patient following their appointment and
insertion of the SDI and before they left the clinic. The remaining two questions were completed two weeks later by telephone. A total of 40 questionnaires were distributed in the
three month period and 39 were returned with a 98% response
rate. Part 2 involved manually reviewing EPR for five SDI procedures completed by each trained nurse, and auditing against
FSRH Service Standards for Record Keeping.
Results: Patients were asked to rate their experience under four
headings with 1 (Poor) to 5 (Excellent):
1.
2.
3.
4.
Q1:
Q2:
Q3:
Q4:
Booking their appointment,
The consultation and procedure,
Counselling and information provided,
Overall experience.
Twenty-eight (72%) patients rated the booking procedure as
excellent, eight (21%) as good, two (5%) satisfactory and one
non-responder. With regard to a nurse led consultation and fitting of the SDI, 36 (92%) patients rated their experience as
excellent, 3 (8%) as good. Patients were then contacted by telephone two weeks later to complete question 3 and 4. Twentytwo (56%) patients rated the counselling and information provided to them at the time of consultation as excellent, four
(10%) as good and 13 (33%) were non-contactable. Patients
overall experience was rated highly with 25 (64%) describing
the experience as excellent, two (5%) as good and 12 (31%)
patients were non-contactable. Results from Part 2 of the audit
found that documentation on EPR was below the 100% standard in three of the four criterions, in particular fully documenting the procedure (70%).
Conclusions: Overall patients had a positive experience of the
nurse led SDI clinic. The majority of patients participating in the
questionnaire felt that the consultation, procedure and information provided were ‘excellent’. Comments made by patients
included ‘‘ten out of ten’’ and ‘would recommend this service to
a friend’. The audit has shown that documentation could be
improved and recommendations to review the EPR templates
have been made.
A-105
Workforce planning based on need
for sexual, reproductive maternal and
newborn health services
Andrea Novea, Luc de Bernisb, Sofia Castro Lopesa,
Maria Guerra Ariasa and Francisco Pozo Martina
a
ICS Integrare, Barcelona, Spain; bUNFPA, Geneva, Switzerland
92
Objectives: (1) To estimate the number of health workers
needed to deliver essential sexual, reproductive, maternal and
newborn health (SRMNH) services in 73 low- and middle-income
countries, and how much of this workload is due to the need
for contraception and prevention/management of STIs. (2) To
use this evidence to inform decisions on the ideal mix of different cadres of health worker needed to provide SRMNH services.
Methods: The 2014 State of the World’s Midwifery report estimated the level of need for SRMNH services in 73 of the 75
countries with the highest burden of maternal and newborn
mortality. The estimate was based on the working time needed
to deliver all 46 of the Partnership for Maternal, Newborn and
Child Health (PMNCH) essential interventions for SRMNH to all
those in need. The working time was converted into the number of full-time equivalent health workers needed to deliver the
services, and disaggregated according to the types of services
needed (e.g., family planning, STI management/prevention,
antenatal care, delivery care, postpartum care).
Results: In these 73 countries, there should be 10–12 full-time
equivalent health workers per 10,000 women of reproductive
age (WRA), just to deliver sexual and reproductive health (SRH)
services including contraception and prevention and management of STIs. In all regions except sub-Saharan Africa, this represents over half of the total SRMNH workload. The exact number
of health workers per 10,000 WRA needed to deliver services
varies by country and by region, depending on factors including
the contraceptive method mix and prevalence of STIs. Properly
educated and enabled midwives could meet 87% of the need
in these 73 countries.
Conclusions: Methods for estimating the number of health
workers needed to provide universal coverage of SRMNH services should not underestimate the level of need for SRH services
in addition to maternal and newborn health services. For
example, planning the size of the SRMNH workforce based on
the expected number of births will significantly under-estimate
the number of health workers needed. Midwives, if properly
educated and enabled to practise to their full scope, can meet
the majority of the need for SRMNH services because they operate across the whole continuum from contraception and STI
screening, through pregnancy and birth to post-partum care (a
conclusion supported by the evidence presented in the 2014
Lancet Series on Midwifery). However, the need can be met
fully only if midwives operate within a functional referral
system.
Patients Records. Data was collected on Excel programme and
analysed
Results: A total of 34% of referrals were from CASH staff or
local GPs.Out of 85 female patients, 79 feedback forms 92%
were returned. Patients were aged between 16 and 61 years.
Overall, 11.7% patients had Nexplanon-related consultation. 4/
10 deep SDI were successfully removed with USS and 3/10-sent
to specialist centre for removal of SDI. A total of 75 patients
(88%) were presented with issues related to intra-uterine contraceptives. Overall, 16 patients presented with lost threads: 14 –
position of IUD was correct, and 2 – referred for an abdominal
X-ray. A total of 31% of patients had additional USS findings: 12
had fibroids, five had dermoid or simple ovarian cysts, two had
PCOS, two had PID and one had endometrial hyperplasia (later
confirmed as endometrial cancer).
Conclusion: This study demonstrated the significant benefit
from additional USS facilities to patients, CASH clinicians and
local GPs. Patient’s written feedback post consultation was
100% positive with some additional comments. Irrespective of
age or ethnicity patients reported feeling reassured by the
results of the scan, feeling more comfortable and supported
with the procedure and recommending more patients have the
opportunity to have a scan post intra-uterine device insertion.
Positive patient’s experience during LARC procedures may
increase their uptake. Almost third of patients had additional
medical pathology (one case of endometrial cancer) which was
investigated and treated accordingly due to USS findings. The
referral clinic is beneficial in managing patients with complex
contraception needs. It supports CASH staff and local GPs in
complex cases, and offers complex and comprehensive care to
our patients in primary care avoiding or reducing the number
of referrals for hospital level gynaecological investigations.
A-107
Are UKMEC category 4 health risks
including smoking status, blood
pressure, BMI, History of migraine
with aura and VTE being assessed in
patients prescribed the COCP at a
community medical practice?
A-106
Sally-Ann Botchey and Omotoke Oshin
Use of ultrasound within an
integrated contraception and sexual
health service
University of Liverpool, Merseyside, UK
Elena Valarchea and Abha Govindb
a
Whittington Hospital, London, UK; bNorth Middlesex Hospital,
London, UK
Background: Use of ultrasound is widely recommended to confirm correct placement of intra-uterine devices and finding deep
subdermal implants (SDI). It may give additional information to
clinician if patient is symptomatic.
Objective: To analyse use of ultrasound scan service in CASH
(Contraceptive and Sexual Health) service, source of referrals
and additional clinical information obtained during USS.
Methods: We conducted a prospective study to review feedback and details of procedures for patients with intrauterine or
Nexplanon procedures in a CASH clinic with USS facilities from
9 June 2014 to 24 November 2014. All Intra-Uterine procedure
patients were offered a choice of having pelvic USS before and
after their procedure to confirm placement of device and to
exclude additional pelvic pathology (verbal consent obtained).
Patients were given an anonymous feedback form before leaving the clinic. Details of procedures were reviewed by Electronic
Objectives: To check whether all UKMEC category 4 risks factors
were reviewed and documented for patients prescribed the
combined oral contraceptive pill (COCP). Audit standards were
set with a compliance rate of 70% for assessment of risk factors.
From the first audit cycle, assessment was poor for assessing
history of VTE (17% in follow-up patients) and history of
migraine with aura (25% in follow up patients). The assessment
for new patients was far better than that in follow up patients.
To improve assessment, a poster was made and placed in each
consulting room to remind all medical personnel to assess and
document UKMEC category 4 risk factors included within the
audit.
Methods: An electronic medical information system at a community medical practise was used to collate data of all patients
prescribed with the Combined oral contraceptive pill (COCP)
over two periods of three months; September–October 2014
(cycle 1) and January–March 2015 (cycle 2). In total 234 patient
records were analysed; 137 (cycle 1) and 97 (cycle 2).
The following were assessed for each patient:
1.
2.
3.
4.
5.
Age;
New or follow-up;
Hx of (Venous thromboembolism) VTE;
Hx of migraine with aura;
Smoking status;
6.
7.
Blood pressure recording;
Weight and height (BMI).
The percentages for each specific risk factor and all risk factors
were calculated.
Results: Assessment of risk factors in new patients had
improved – in 61% of patients all five risk factors were assessed
compared to only 31% in the first cycle. The assessment of risk
factors in follow-up patients had not improved – only smoking
(72%) and blood pressure (90%) reached the compliance rate.
Conclusions: Overall, assessment of UKMEC category 4 risk factors was better in new patients compared to follow-up patients.
This may have been because of the increased cautiousness
when assessing new patients. In addition assessment of BMI,
blood pressure and smoking history were better than assessing
history of migraine with aura and VTE. To improve assessment,
a re-training session for all staff involved in COCP prescribing
was recommended. In addition, generation of an on-screen
reminder to ensure patients receive full yearly reviews and
including specific risk factors in the online contraceptive proforma was suggested.
A-108
The APPLES pilot: Access to Post
Partum LARC in Edinburgh South
Sharon Camerona, Fatim Lakhaa, Annette Gallimorea,
Alison Craiga, Rebecca Hellerb and Dona Milnea
a
NHS Lothian, Edinburgh, UK; bUniversity of Edinburgh,
Edinburgh, UK
Objectives: Improved uptake of postpartum contraception, particularly long-acting reversible contraception (LARC) has the
potential to prevent unintended pregnancies and short inter
pregnancy intervals for more women. This study aimed to
determine the feasibility and acceptability of introducing routine
antenatal contraceptive counselling and provision of contraception after delivery, in an area of Edinburgh, UK, of mixed deprivation and affluence.
Methods: Women in the pilot had a discussion about planned
contraception after delivery with the community midwife at
their 22 weeks antenatal visit. Where possible, the chosen
method of contraception was provided at discharge from the
maternity hospital. Evaluation was conducted by (1) self-administered survey of women on their views of the antenatal contraceptive intervention; (2) planned contraception and actual
method provided; and (3) qualitative research with health care
professionals and women.
Results: There were a total of 1003 women in the cohort.
Antenatal surveys were completed by 710 (71%). A total of 78%
of respondents had a discussion with the community midwife
about contraception and 74% agreed that this was helpful and
had been at ‘about the right time’ during the pregnancy.
Overall, 43% of respondents were planning to choose a LARC
method postpartum. Only 6% of women in the cohort left with
a LARC method. Qualitative research indicated that availability
of trained contraceptive providers and short hospital stays
impacted upon ability to provide LARC for women.
Conclusions: Introducing antenatal contraceptive counselling,
delivered by community midwives, is feasible and highly acceptable to women. However, providing women’s chosen method
of contraception, particularly LARC before they are discharged
home remains a challenge.
93
A-109
Could implementation of clinical
outreach in the UK improve rates of
unplanned pregnancy and sexually
transmitted infections?
Nicola Murphy, Jacqui Mawdsley and Paula Briggs
Southport and Ormskirk Hospital NHS Trust, Merseyside, UK
The UK has the highest rate of unplanned pregnancy in
Western Europe. In Sefton, Merseyside, there are areas of
deprivation which are associated with particularly high
unplanned pregnancy rates, despite widespread availability of
free contraception from the Community Sexual Health Service
and General Practitioners and the availability of emergency hormonal contraception from community pharmacy, accident and
emergency departments and walk in centres. To address this
issue, an outreach service was developed to support those
women with difficulty accessing mainstream contraceptive services. This poster summarises the experience of the outreach service during a three-month period.
A total of 75 patients were seen of whom 10 were male, and
50 were younger than 25. Two of the patients were homosexual
(men who have sex with men). Consultations were undertaken
in Children’s Centres, charitable venues, patients’ homes, and a
variety of non-mainstream venues. All patients seen were
offered contraception, where appropriate and screening for
infection. Referrals to other agencies was undertaken where
deemed necessary and this included collaboration with GPs,
sexual health doctors for more complicated problems including
insertion of intrauterine contraception, counselling services, and
the sexual assault referral centre. In addition telephone follow
up was undertaken if required.
In addition to the clinical engagement described above, the
outreach service was also involved in supporting the provision
of contraception by the pregnancy advisory service. Rates of
abortion in Sefton are high with 38% of women undergoing
repeat abortion. A baseline audit of contraception provided to
women at the time of discharge from the termination of pregnancy service in Ormskirk District General Hospital showed that
rather than providing women with the contraceptive method of
their choice, they were being directed to clinics. This practice
was reviewed and a re-audit subsequently showed that all
women had the option of contraception including all long acting reversible choices prior to discharge. Telephone follow-up
was provided by the outreach team 5-8 weeks after discharge
to support continued use of contraception. This is a novel and
important facet to the outreach service. The impact of this service on measureable outcomes including unplanned pregnancy
rates and abortion including repeat abortion is not currently
available due to the nature of public health reporting.
A-110
Developing a participatory approach
involving health sector and
community members, to increase
unmet needs for contraception
through human rights principles
Petrus Steyna, Joanna Corderoa, Jenni Smitb,
Theresa Nkolec, Peter Gichangid, James Kiariea and
Marleen Temmermana
a
Geneva, Switzerland; bMaternal, Adolescents and Child Health
94
Research, Durban, South Africa; cUniversity Teaching Hospital,
Lusaka, Zambia; dInternational Centre for Reproductive Health,
Nairobi, Kenya
Objectives: To develop an intervention that will enable replication, and ensure transparency through a theory of change (ToC)
and complex intervention methodology. The application of
human rights (HR) principles to contraceptive service provision
is critical in addressing unmet need and increasing method satisfaction. One of these principles, community participation
remains inadequately addressed in large-scale family planning/
contraception (FP/C) programmes. Measuring the impact of participation and identifying reasons why programmes succeed or
fail have been the major challenges resulting in the lack of evidence to guide sustainability and scale-up. The British Medical
Research Council developed guidelines for complex designed
interventions, which are well-suited for the design and evaluation of participatory interventions as it consists of multiple
components that may act and interact in different ways.
Complex intervention monitoring and evaluation, provide
adequate importance to understanding the processes involved
in delivering the intervention and in assessing the corresponding impacts, but keeping the essential role of the final evaluation outcomes.
Methods: A study was designed based on the hypothesis that
a participatory approach involving the community and health
care providers within Human Rights framework increases met
needs for family planning and contraception using a ToC framework. Evidence was gathered through the scoping reviews and
consultation with the working group comprising experts in the
relevant fields. Several rounds of consultations with the Project
Group (WHO and country investigators) and input from an
expert panel informed the framework. It will be refined as
inputs from stakeholders and study participants are gathered.
Results: Developed by backward mapping the requirements to
achieve the long-term goal to address the unmet need for FP/C,
the Project’s ToC framework defined community and health
care provider participation as its main pathway with the intermediate outcome of improved QoC. The ToC outlines the
planned intervention package comprising the approach for
involving both the community and health providers, and
domains (i.e., WHO defined HR principles for FP/C) developed
for the different settings. The intervention phase will follow the
pre-testing of the intervention package and refinement of
domains. The M&E will be performed throughout the process.
Conclusions: Explicit use of theory to develop an intervention
prior to testing, and incorporating insights from the theory into
an explicit model of how the intervention might alter behaviour,
or affect other links in the causal chain between intervention
and outcome, may lead to better-developed interventions, and
also to better-designed evaluations.
A-111
Quality of care in family planning
and contraceptive services as defined
by communities and health care
providers: a scoping review
Jenni Smita, Petrus Steynb, Joanna Corderob,
Theresa Nkolec, P Peter Gichangid, James Kiarieb
and Marleen Temmermanb
a
Maternal, Adolescents and Child Health Research, Durban, South
Africa; bDepartment of Reproductive Health and Research,
Geneva, Switzerland; cUniversity Hospital Zambia, Lusaka, Zambia;
d
International Centre for Reproductive Health, Mombasa, Kenya
Objectives: To conduct a scoping review to examine evidence
on community and health care provider definitions and understandings of Quality of Care for delivering FP/contraceptive
services. The human rights context considers barriers to accessing contraception at the level of policies and guidelines, but
also at the services and community level. The importance of
QoC on contraceptive behaviour has been demonstrated, and
frameworks for assessing QoC from the client’s perspective have
been employed. However, little is documented about community and provider definitions and understandings of QoC.
Methods: We conducted a systematic search of five electronic
databases. Studies included were primary literature, not
restricted by country of origin or date and English only.
Results: Twelve studies focussing on community/user and
health care provider definitions and understandings of QoC
span across seven countries and were published between 1987
and 2014. Five were published prior to 1995 and six from 2005
to 2009. Seven occurred in developed and five in developing
countries, only one was conducted in Africa (Uganda).
Methodologies included FP client interviews, computer-administered interviews and mail surveys, community-based telephonic
surveys, simulated clients, focus group discussions, and key
informant interviews. Ten studies reported community or user
understandings of QoC. Only one of these, a telephonic survey,
was community-based, hence most definitions and understandings were those of FP clients. Aspects of care focused on personalised care and information exchange: courtesy, respect,
privacy, interactions with providers, time for counselling (including sexuality counselling), seeing the same provider, languageappropriateness, involvement of partners). Technical aspects
(availability of service, choice of and information about methods, provider competence, presence of a doctor), facility environment (promptness/waiting times, cleanliness) and financial
accessibility were also regarded as important. Only three studies
directly sought provider understandings of QoC, one of which
reported on reproductive health generally, rather than on FP
specifically. Only one of the studies was on community users’
and health care providers’ shared vision of QoC in the delivery
of FP/C services. Provider perceptions of QoC related to both
interpersonal (courtesy to participants, misconceptions, community leadership support, male partner participation) and organisational/technical (stock, workload, provider knowledge and
skills) aspects of care.
Conclusions: Available evidence suggests that many community expectations regarding quality FP/C services, which focused
largely on personalised care, could be met without major
expenditure. Research on the definition of QoC in the delivery
of FP/C services to elicit community and provider voices, in particular examination of their ‘shared vision’, is needed.
A-112
Participatory approaches in
reproductive health services: success
and challenges
Petrus Steyna, Joanna Corderoa, Peter Gichangib,
Theresa Nkolec, Jenni Smitd, James Kiariea and
Marleen Temmermana
a
Department of Reproductive Health and Research, Geneva,
Switzerland; bInternational Centre for Reproductive Health,
Mombasa, Kenya; cUniversity Hospital Zambia, Lusaka, Zambia;
d
Maternal, Adolescents and Child Health Research, Durban, South
Africa
Objectives: To identify the main challenges to community participation in reproductive health, specifically family planning (F/
C) and proposed solutions. Community participation has been
recognised as a key component in defining essential health care
that is scientifically sound and socially acceptable since the
Alma-Ata declaration (1978). Cultural differences in women, their
families and community preferences and health worker treatment may limit the use of care even when improved services
are available. One of the approaches identified to ensure
good-quality care and increased use of services is to involve the
community through all phases of planning, management and
evaluation of services. Despite its recognised importance, participation is seen as one of the key principles of the Alma-Ata that
has not been adequately addressed.
Methods: A desk review was conducted to collect data from
secondary sources to identify the main challenges to community participation in reproductive health, specifically FP/C, and
the proposed solutions.
Results: Confusion about the purpose and definition of community participation has been a major barrier to effective implementation. Two major typologies were identified: (1) the
utilitarian model where participation is viewed as a means to
making a programme more efficient, effective or cheap; (2) the
empowerment model where the community takes responsibility
for diagnosing and solving their own health and development
problems. Operationalisation has, by consequence, ranged from
discrete interventions addressing specific logistical needs to
empowerment processes that have long-term effects.
Comparability and generalisability of findings have been a challenge. Critical questions have been raised, including: how and
which ‘public’ participates revealing the complexity of power
relations in these processes. How health care providers and
health systems can facilitate or undermine participatory programmes has also been analysed. Reasons why programmes
succeed or fail remains elusive, and cannot solely be explained
by the study design or participation approaches. Rigorous evaluation methodologies used in biomedical studies, which were
often applied to participatory interventions, are unsuitable to
measure its impact.
Conclusions: Participation is key in ensuring quality reproductive health, including access to FP/C. However, why and how
this should be done are not clear. An approach involving both
the community and health providers to improve efficacy and
sustainability should be explored further. Improved process
evaluation and critical examination of all components of these
participatory programmes are essential to improve understanding of the role of community participation approaches in FP/C
programmes.
A-113
Efficient exclusion of pregnancy prior
to initiation of long-active reversible
contraception or performance of an
intrauterine procedure
Margaret Long, Lisa Ahlberg, Joy Beissel,
Adela Cope, Gayle Fosterling-Pearson and
Petra Casey
Mayo Clinic, Rochester, MN, USA
Objectives: To identify women who are reasonably not pregnant and those who may benefit from point of care urine
human chorionic gonadotropin (hCG), thus safely and efficiently
facilitating same day contraceptive procedures. To describe a
standardised process for consistent exclusion of pregnancy in
an Obstetrics and Gynaecology outpatient practice.
Methods: A multidisciplinary quality improvement team developed a process for identification of women who might benefit
from point-of-care urine hCG. A patient questionnaire was
adapted from the World Health Organisation criteria for determining with reasonable certainty that a woman is not pregnant.
The questionnaire was implemented into the clinical setting.
The provider reviewed the questionnaire and determined
whether point of care hCG testing was indicated. The questionnaire responses and, in appropriate cases hCG, informed the
clinician’s decision whether to proceed with intrauterine procedure or implant insertion on the same day or whether rescheduling the procedure was most appropriate. Data collection
95
included patient age, clinical setting in Obstetrics or
Gynaecology, and questionnaire response.
Results: A total of 426 complete questionnaires were collected.
Ages ranged from 15.3 to 45 years with a mean of 30.3 years in
Obstetrics and 30.4 years in Gynaecology. A total of 79% of
women were identified as reasonably not pregnant based on
the tool with the remaining 21% requiring point-of-care pregnancy testing to possibly exclude pregnancy. Only 20.9% would
have been identified as not pregnant without hCG testing using
conservative criteria of current menses or IUD use. Women
were identified as reasonably not pregnant based on the
following factors: reliable use of hormonal contraception
(21.8%); abstinence since a recent menses, delivery, or abortion
(34.5%); bleeding from a normal menses on the day of the
questionnaire (10.8%), current IUD (10.1%), and recent pregnancy end (1.4%).
Conclusions: A simple process can be used in an outpatient
setting to be reasonably certain that a woman is not pregnant
before intrauterine procedures. Benefits include resource efficient use of hCG testing and safely expanding the timing for
performing gynaecologic procedures.
A-114
The relationship between perceived
social support and attitudes towards
menopause of women
N€
ul€
ufer Erbil and Mehtap G€
um€
usay
Turkey
Objective: To investigate the relationship between perceived
social support and attitude towards menopause of women.
Methods: The study was conducted as a descriptive and crosssectional design. Ninety-three women who were 45 years old or
older were enrolled in the study. The data were collected with
a questionnaire form, the Multidimensional Scale of Perceived
Social Support (MSPSS) and Attitudes towards Menopause Scale.
Results: It was determined that the average age of the women
was 51.21 ± 4.71 (range 45–60). Over half of the women (64.5%)
were postmenopausal, transition to menopause of half of
women were naturally. Thirty three percent of the women had
a chronic disease. It was determined that ‘family’ subscale mean
score was 21.61, ‘friend’ subscale mean score was 18.40 and ‘a
special person’ subscale mean score was 14.91 of MSPSS. The
average total MSPSS score of social support scale was 54.93.
The average score of Attitude towards Menopause Scale was
36.31. The Attitude towards Menopause scale score of women
indicated a negative attitude towards menopause. The statistically positively significant correlations were found between MPSS
scores (p ¼ 0.000), family support subscale (p ¼ 0.000), friend
support (p ¼ 0.000), a special person support (p ¼ 0.006) and
attitude towards menopause scale score of women. The MPSS
average scores according to education level (p ¼ 0.000),
employee status (p ¼ 0.002), place of residence (p ¼ 0.000), the
income perception (p ¼ 0.012), physical exercise status
(p ¼ 0.004) of women were compared and the differences
between groups were statistically significant. The attitude
towards menopause average scores according to educational
level (p ¼ 0.000), work status (p ¼ 0.001), family type (p ¼ 0.036),
their spouse living condition (p ¼ 0.008), their spouse education
level (p ¼ 0.013), place of residence (p ¼ 0.001), the income perception (p ¼ 0.006), information about menopausal status
(p ¼ 0.009) and physical exercise status (p ¼ 0.010) were compared and the differences between groups were statistically significant. The statistically negatively significant correlations were
determined between MPSS scores and age of women
(p ¼ 0.003), and between attitude towards menopause scores
and body mass index (p ¼ 0.000).
96
Conclusions: In this study, attitudes toward menopause of
women were negative, and their perceived social support was
at a low level. Attitudes towards menopause of women are
associated with perceived social support. Women should be
empowered with education and counselling about menopausal
life periods from childhood to perimenopausal ages. Health professionals have a major role in strengthening the social support
and preparation to the menopausal period of women.
A-115
Survey of health professionals about
the access to oral contraception over
the counter in France
Aurore Billebeau, Solene Vigoureux and
Elisabeth Aubeny
French Association for Contraception, Paris, France
Objectives: Oral contraception over the counter is already available in many countries, offering easier access to efficient contraception and greater autonomy over their reproductive lives to
women. The main objective of this study was to clarify the opinions of health professionals about over-the-counter access to
progestin-only pill in France. A second objective was to identify
the barriers to free sale according to health professionals.
Method: In our study, anonymous multiple choice questions
were sent by email to health professionals concerned with
contraception in France (internal, obstetricians, medical gynaecologists and midwives) from several national associations of
professionals and students.
Results: The response rate was 15.4% (956/6198). A total of
53.4% of respondents were in favour of over-the-counter access
to progestin-only oral contraceptive pills. After adjustment for
professional categories, medical gynaecologists were the least in
favour of access to over-the-counter access to progestin-only
pill (adjusted odds ratio ¼ 0.63 [0.46–0.87]). Overall, 19.3% of
respondents supported over-the-counter access to combined
oral contraceptives. Missing examination of medical contraindications against the use of oral contraception was the main obstacle reported by health professionals (91.1%) to free access to
oral contraceptives.
Conclusions: Respondent health professionals were mainly in
favour of over-the-counter access to progestin-only oral contraceptive pill and against over-the-counter access to combined
hormonal contraceptives prescriptions.
A-116
The role of information for the
effectiveness of contraception use in
Russia
Galina Dikkea and Lyubov Erofeevab
a
Moscow People’s Friendship University, Moscow,
RussiabAssociation for Population and Development, Moscow,
Russia
Objectives: To study how information influences the use and
contraceptive effectiveness among the general population of
women in Russia
Methods: A total of 1007 women aged 18–45 years in seven
Federal Okrug in RF were given face-to-face interviews.
Anonymous interviews were also held with 161 abortion
patients.
Results: Overall, 85% of those interviewed stated their recent
use of contraception. A high level of information (87% – COC
vs. 71% – Cu IUD) was shown, although they were less well
informed about LARCs (30–56%). Condoms are frequently used
(45%), also hormonal methods (35%) and coitus interruptus
(23%). Among LARCs, 11% of users are Cu-IUD, others are rarer
– LNG IUS 3%, implant, ring, patch and injections 1.5%. Two
methods at the same time were used by 38%. Natural and traditional methods were more popular among 35 y.o., 2 times
higher than in the younger group (34 and less), 8–13% vs.
4–6%, respectively. Two times more active users are among
women with high education (23% against 10%). But their use of
Cu-IUDs is lower (6% vs. 12–17%) and LNG IUS (1% vs. 4–5%).
Women chose condoms and coitus interruptus (68% in total),
relying more on men’s involvement and contraceptive responsibility. Before this pregnancy 52% were in contraceptive use for
at least 3 months, natural methods – 9%, 91% were using more
reliable methods, 14% – traditional, 87% – modern. Hormonal
methods showed less effectiveness in this cohort: COCs – 37%,
patch – 27%, vaginal ring – 16%, injectables – 6%. The most
alarming issue is that 56% needed consultation on contraception, but could not obtain it due to various reasons.
Conclusion: Contraceptive use in Russia can be better
achieved by improving its public health organisations, increase
of availability of contraceptives and could be more efficient
due to better counselling and the wider use of the prolonged
methods.
A-117
Determinants of supply chain
bottlenecks and their impact on
contraception stock outs in low-and
middle-income countries: a
systematic review of the literature
Moazzam Alia and Mukasa Bakalib
a
World Health Organization, Geneva, Switzerland; bWalden
University, Minneapolis, USA
Background: Following a decade during which investment in
contraception had waned, the family planning summit in 2012
and the resulting Family Planning 2020 global partnership provided an impetus and opportunity for increased funding in
contraception. Establishing well-functioning supply chain systems that integrates the role of public and private sectors,
skilled health professionals, and community-based health workers in family planning (FP) and contraception programs will play
a critical role in efforts to address the challenge of unmet need
in low- and middle-income countries (LMICs).
Objectives: The purpose of this review was to assess the factors
that determine the functioning of supply chain systems for
modern contraception in LMICs and to identify the gaps that
potentially contribute to contraception stock outs leading and
contributing to unmet needs.
Methods: The following electronic databases were searched;
PubMed, MEDLINE, POPLINE, CINAHL, Academic Search
Complete, Science Direct, Web of Science, Cochrane Central,
Google Scholar, and WHO databases, FP and contraception specialized journals and websites of key organisations including,
USAID, UNFPA, MSH, FHI360, PSI, JSI, and MSI. No restriction
was placed on the date of publication.
Results: Studies indicated that supply chain system inefficiencies significantly affects availability of modern FP and contraception commodities in LMICs, especially in rural public facilities
where distribution barriers were acute. Supply chain failures/bottlenecks are attributed to several barriers, including weak and
lack of institutionalised LMISs, poor physical infrastructures in
LMICs, lack of trained and dedicated staff, inadequate funding,
and rigid government policies.
Conclusions: Based on the evidence provided in the reviewed
studies, it is concluded that supply chain bottlenecks contribute
significantly to the persistent high stock out rates of modern FP
and contraceptives in LMICs. Interventions aimed at enhancing
uptake of contraceptives to reduce the problem of unmet need
in LMICs should strongly consider strengthening supply chain
management systems of health commodities in these countries.
To gain further understanding and to draw more concrete conclusions about the determinants of supply chain bottlenecks and
their impact on stockouts of FP and contraception commodities,
there is an urgent need to carryout high quality intervention
study on FP and contraception supply chain systems.
97
Conclusions: Although limited evidence exists, the review
shows that community and health care provider participation
for FP/C is promising and feasible. Careful considerations should
be made in promoting meaningful dialogue and collaboration
between community and health care providers. Lessons learned,
especially from new programmes need to be analysed and
tested. It is time to re-assess the value of participatory intervention and ensure robust evidence exist to guide health ministers,
programme managers, health providers and community members in addressing unmet needs for FP/C.
A-118
Participatory interventions involving
both community and health care
providers for family planning and
contraceptive services: a scoping
review
Petrus Steyna, Joanna Corderoa, Peter Gichangib,
Jennifer Smitc, Theresa Nkoled, James Kiariea and
Marleen Temmermana
a
Geneva, Switzerland; bInternational Centre for Reproductive
Health, Mombasa, Kenya; cMaternal, Adolescents and Child
Health Research, Durban, South Africa; dUniversity Teaching
Hospital, Lusaka, Zambia
Objectives: Previous experience in community participation in
health has shown that the health care providers and planners
may serve as barriers to successful implementation. Conflicts
may exist between community and health system, with health
professionals prioritising quick results and community groups
requiring time to get organised. Programmes faced difficulties
because community members were not able to articulate and
communicate their needs. This scoping review aims to identify
existing approaches for involving community and health care
providers for family planning/contraceptive services.
Methods: Using the key concepts of ‘Family planning/contraception’, ‘community participation approaches’ and ‘critical and
important project outcomes’, five online databases were
searched. A targeted Google search was conducted. Relevant
primary and grey literature of all designs were included.
Results: A total of 28 specific programmes were reported in 25
articles. These articles were published between 1972 and 2014.
Programmes involving community and health care provider participation have been implemented to improve use and accessibility of FP/C services. The most common approach used was
health committees. Other approaches used to involve community and health care providers include Community-oriented,
Provider efficient (COPE), Implementation teams, community
scorecard, collaboration with self-help organisation (SHO) and
collaboration with Family Planning Associations. Early attempts
to implement programmes demonstrated limited success.
Subsequent analysis has shown that major challenges to participatory approaches involving clients and providers, include the
lack of resources and infrastructure for participation. The mistrust of modern methods of FP/C coupled with low or non-existing infrastructure for FP/C service provision also undermined
efforts. Programmes failed because they lacked the understanding of and did not make provisions to account for the difference in power relations. Recently, promising avenues are being
explored incorporating lessons learned from past experience
and reflecting the current environment:
1.
2.
3.
Needs assessment and priority setting through
committees;
Accountability and programme evaluation;
While previous focus was on expanding FP/C access
and uptake, more recent attempts have explored clientprovider frameworks for quality improvement.
A-119
Effect of counselling given to young
people admitted to the youth
friendly centre with suspicion of
unwanted pregnancy on repeated
admission
€ u
€
€
€
€
€l Orsal,
Ozg
S. Sinan Ozalp,
Ozlem
Orsal
and
Pinar Duru
Eskisehir Osmangazi Unversity, Center of Medico Social,
Department of Youth Friendly Center, Turkey
Objective: To determine the effect of counselling given to
young people admitted to the Youth Friendly Centre at
Eskisehir Osmangazi University (ESOGU YFC) with suspicion of
unwanted pregnancy on repeated admission, and to do planning and to regulate the necessary infrastructure for the prevention of unwanted pregnancies and repeated admissions.
Method: This is a retrospective registry study carried out on
569 students admitted to ESOGU YFC with the suspicion of
unwanted pregnancy between the years 2005 and 2015. The
students admitting for ‘emergency contraception’ within 72
hours and those admitting for a pregnancy test in urine or
blood within 10 weeks after an unprotected sexual intercourse
were considered as having ‘suspicion of unwanted pregnancy’.
Statistical analysis was performed by using chi-square and structural equation model (SEM).
Results: Of our university population, 1.4%, 1.6% and 2.7%
were admitted to YFC for ‘emergency contraception’, pregnancy
termination and contraceptive supply, respectively. Of the students with a mean first sexual intercourse age of 19.3–19.5
years, 23.9% and 27.8% were admitted with suspicion of
unwanted pregnancy within the first 10 weeks and first 72
hours and the remaining 48.2% were admitted for contraceptive
supply. Of these students, 72.2%, 19.0% and 8.8% were admitted with suspicion of unwanted pregnancy for one time, two
times and three or more times, respectively. Of the 294 patients
admitted with suspicion of unwanted pregnancy, pregnancy
was terminated in 20.7% at the Department of Obstetrics and
Gynaecology. Approximately 1/3 of these students reported that
they had not used any contraceptive method before admitting
to YFC. The use of withdrawal method was more common in
students admitting with suspicion of unwanted oregnancy
within 10 weeks or first 72 hours compared to those admitting
for contraceptive supply (54.6% and 39.6% vs. 6.1%) condom
method was only used by students admitting for contraceptive
supply.The SEM analysis performed to determine the factors
affecting the frequency of admission shows that the counselling
given to high-risk group of students resulted in decreased frequency of admission to YFC with suspicion of unwanted pregnancy among the students who underwent an invasive
intervention for unwanted pregnancy(p < 0.001).
Conclusion: The frequency of unwanted pregnancy among
young people was found to decrease with the effective counselling as well as with emergency contraception and pregnancy
termination functions. Therefore, it should be the major
approach to educate young people in order to prevent
98
unwanted pregnancies. The prevention of unwanted pregnancies among university students will also preclude medical, social
and psychological problems.
A-120
Taking a ‘sexual health’ history
ley Bender
So
University of Iceland, Reykjavik, Iceland, University Hospital,
Reykjavık, Iceland
Objectives: Studies have shown that health care professionals
have experienced many hindrances in talking to their clients
about sexuality. These issues need to be discussed before sexual
problems have developed. The health-oriented approach
instead of the problem-oriented aproach is explored when conducting a ‘sexual health’ history.
Method: Students in classes in a sexual and reproductive health
(SRH) course within a Midwifery program at the University of
Iceland interviewed 30 women about their sexuality applying
the health-focus approach. They either knew the women
beforehand or they were their clients. The students followed a
framework of questions focusing on healthy sexuality.
Results: Students realised that taking a sexual health history
was easier than they expected. The interviews showed that self
esteem and body image was an important part of women’s
wellness as sexual beings and in their sexual relationship.
Communication, trust and emotional as well as physical intimacy were highly valued in their relationships. What affected their
SRH were negative body image, problems with communication,
issues regarding unplanned pregnancy, childbearing and health
problems. This affected their sexual life and sexual pleasure.
Conclusions: Applying the health-oriented approach while taking a ‘sexual health’ history opens the possibility for discussion
and provision of information which can contribute to improved
sexual health of the woman which can possibly also be of benefit for the relationship.
DEMOGRAPHY
A-121
Demographic characteristics of 400
women from Ireland and the
Philippines who completed the
online consultation form of the
telemedical abortion service Women
on Web
Marlies Schellekens, Rebecca Gomperts and
Gunilla Kleiverda
Women on Web, Amsterdam, The Netherlands
Objectives: Women on Web is an online abortion service for
women living in countries where there is no access to safe
abortion services. This research looked to see if the different
policies concerning contraceptives were visible in the demographic information of women from Ireland and from the
Philippines who fill in the online consultation
Methods: A sample of 400 women who completed the online
consultation of the Women on Web service in 2012 from the
Philippines and Ireland were analysed. This study analysed the
differences in age, number of children, cause of unwanted pregnancy and reason for abortion between Ireland and the
Philippines. The groups were compared by performing
Chi-Square tests. Any p-values < 0.05 were considered statistically
significant.
Results: In 2012, the average woman in the Philippines using
Women on Web was 26 years old. In Ireland, the average age
was slightly higher, at 28 years. There was a significant difference
in the reported cause of pregnancy between each country. The
majority of women in the Philippines were pregnant because
they did not use contraception (n ¼ 141) whereas women in
Ireland predominately listed failed contraception as the cause of
their pregnancy (n ¼ 111). Also differences were found in the
reported cases of rape as a cause of pregnancy, and in how age
factored into the decision to have an abortion. Irish women additionally listed ‘I am too old’ as a reason more frequently than
Filipino women. The most common reason for an abortion from
both the Philippines and Ireland was ‘I just cannot have a child at
this point in my life’ (n ¼ 146, n ¼ 114 respectively.)
Conclusions: We found that geographical cultural and political
differences also correspond with demographic characteristics of
women who completed the online consultation. For example
average rates of contraceptive usage the Philippines is 41–50%.
On the other hand in Ireland contraceptives are widely available
and accessible and 64.8% of people aged 18–49 use contraceptives. Our analyses found that more women from the
Philippines reported that the unwanted pregnancy was caused
because they did not use contraceptives compared to women
from Ireland (70.5% vs. 41.5%).
A-122
Health status of seasonal agricultural
female workers in rural areas of
Eskisehir
€
€ u
€
€z, Selma Metintas,
Ozay,
Fatih Ons
Ozkan
€lsu
€m Emiral
Burhanettin Isikli, Emine Ayhan and Gu
Eskisehir Osmangazi University Medical Faculty Department of
Public Health, Eskisehir, Turkey
Objectives: This study aimed to determine the health status
and health-related problems of seasonal agricultural female
workers in rural areas of Eskisehir and to define the differences
from local female residents.
Method: This is a cross-sectional study performed between July
and August 2015 on seasonal agricultural female workers working in rural areas of Eskisehir and permanent female residents
of that area. There were seven settlements having more than
20 tents.By visiting each tent, 306 female agricultural labourers
aged over 18 years and 259 randomly selected permanent
female residents, who were 18 years or older were included in
the study.The survey form, prepared by using the ‘Turkey
Demographic and Health Survey’ and ‘Turkey Burden of Disease’
studies also included questions about health problems was conducted via face-to-face interviews. The values expected in the
study group were calculated by using the rates of health problems of local residents. The comparative disease index was calculated by multiplying the standard population rates with the
ratio of expected values to the observed values, and standard
error was calculated as the inverse fraction of the square root
of observed value (1/冑 observed value). Comparison was made
with 95% confidence intervals.
Results: The mean age of seasonal agricultural female workers
was 34.5 ± 13.2 years (range 18–80 years) and 46.7 ± 16.3 years
(18–84 years) for local residents.Of the seasonal agricultural
female workers; 80.7% had never attended school, 88.9% were
married, 45.1% had a low income, 21.2% were smokers, 40.8%
were overweight and 45.1% were vaccinated against tetanus.
Being younger than 50 years old, never attending school and
being married were more common among the seasonal agricultural female workers.Smokers, overweight people and being
vaccinated against tetanus were more frequent in local residents. The frequency of physician diagnosed hypertension, cervical and lumbar disc herniation, asthma, arthritis, diabetes
ACCEPTED ABSTRACTS – DEMOGRAPHY
mellitus and anemia were lower among agricultural labourers,
while the frequency of oral and dental diseases was higher than
the local residents.
Conclusions: Seasonal agricultural female workers have difficulties in accessing health services. It was concluded that health
care services should be planned and implemented for female
seasonal agriculture workers as soon as possible.
A-123
Can medically assisted reproduction
be viewed as a tool to increase the
birth rate in the Czech Republic?
Karolina Novakovaa, Ludek Sidlob and
Hana Konecnac
a
Department of Psychology, Faculty of Social Studies, Masaryk
University, Brno, Czech Republic; bDepartment of Demography
and Geodemography, Faculty of Science, Charles University,
Prague, Czech Republic; cDepartment of Clinical and Preclinical
Disciplines, Faculty of Health and Social Studies, University of
South Bohemia, Ceske Budejovice, Czech Republic
Objectives: The Czech Republic – similarly to other European
countries – faces fertility rates below those required to sustain
replacement levels of the population. This study aims to contribute to the discussion about possible effects of medically assisted
reproduction (MAR) on fertility rate.
Methods: Analysis of TFR data published by Eurostat and WHO;
and MAR data collected by the Czech National Register of
Assisted Reproduction.
Results: Over the past 25 years, the upward trend of delaying
childbearing has significantly contributed to the decline of fertility rate in the Czech Republic. In the 1990s, the total fertility
rate (TFR) dropped under the population replacement needs
and has remained there ever since. Simultaneously, the use of
MAR increases – most dramatically in the group of patients
between 35 and 39 years of age. Furthermore, MAR has played
a part in the rise of multiple births. The number of births after
IVF in the Czech Republic is relatively stable, accounting for ca.
2.5% of the total number of live births. However, the structure
of women who give birth after IVF changes slightly – while in
2010 the proportion of children born after IVF to mothers aged
35 and over was around 29%, in 2013 it was already 37%. This
corresponds with the overall trend of increasing the proportion
of births given by mothers older than 35 (the proportion of
these births between 2010 and 2013 increased the total number
of births from 15.6% to 19.6%).
Conclusions: Naturally, IVF cannot be seen as the whole answer
to the decline of the TFR in the Czech population. Nevertheless,
MAR can make a significant contribution and may be viewed as
a component of an overall policy aiming to reverse the fall in
TFR.
A-124
The demographic problem of Greece:
numbers and scepticism
Charalampos Grigoriadis, Aliki Tympa, Maria Creatsa
and Dimitrios Botsis
University of Athens, Medical School, Aretaieion Hospital, Athens,
Greece
Background: Several demographic rates show that Greece has
a serious demographic problem. In contrast to the past, when,
for example, the hero of the Greek Revolution of 1821, General
99
Makrygiannis had 12 children, synchronous Greek people seem
to be negative to the idea of a large family.
Objective: The aim of this study was to examine parameters
associated with the demographic problem of Greece in order to
investigate possible etiological factors and ideal solutions.
Methods: This was a review study, which tried to collect and
analyse parameters associated with the demographic problem
of Greece, mainly through the National Statistic data, in order to
find useful conclusions about the reasons that led to the problem and its ideal management.
Results: It is true that life expectancy among the Greek general population is estimated at 79.8 years (for men at 78.2 and
for women at 81.9 years). In addition, infant mortality rate,
according to the National Statistic Service, decreased from
29.6/1000 in 1970 to 4.06/1000 in 2004. Also, the perinatal
mortality rate in Greece is estimated at 6.7/1000. Both infant
and perinatal mortality rates have shown a declining tendency
during the last few decades in Greece. These markers, as well
as the high life expectancy among the Greek population show
the high standards of obstetric/perinatal and health care in
our country, suggesting that the main reason for the demographic problem of Greece is the very low fertility rate, estimated at 1.35 in Greece, when all studies suggest that the
baseline of fertility rate should be the magic number of 2.1. In
reality, the fertility rate among Greek citizens is lower than 1
(between 0.8 and 0.9).
Conclusions: The low fertility rate seems to be responsible for
the demographic problem of Greece. Social and economic
advantages should be given to large families. A national and
European politic friendly to large families could be the key to
solve this serious problem.
DIVERSITY AND SEXUAL/REPRODUCTIVE HEALTH
(SRH) IN MULTICULTURAL EUROPE
A-125
Community-based education,
towards diversity in sexual/
reproductive health care in
multicultural Europe
Chantal Nyiraguhirwa
World Health Organization, Department of Reproductive Health
and Research, Geneva/Switzerland, Switzerland, Faculty of
Medicine and Health Sciences Ghent University, Ghent/Flanders,
Belgium
Background: One of the key benefits of Family Planning is in
empowering women to choose how many children they have,
improving maternal health and reducing maternal and child
morbidity and mortality. In a densely populated developing
country like Rwanda, where the average number of children per
family is estimated at six, it is evident that Family Planning
awareness in rural areas will play a key role in contributing to
guarantee a better health and survival of women and children,
the achievement of universal education, and poverty reduction
in the long run.
The Family Planning Education Project (FPEP) is a partnership
between two organisations the Medical Students Association of
Rwanda and International Medical Cooperation Committee from
Denmark. The two organisations have been collaborating closely
since 2004 and the goal of the project is poverty reduction
through family planning. The Danish Youth Council finances all
activities in the project. The Rwandan medical students are
trained by professionals from Rwanda and Denmark on giving
informative sessions on Family Planning and Contraception.
These health education activities are completed in eight rural
health centres in the Southern Province in Rwanda, in
Kinyarwanda, the local language.
100
Objectives:
(1) To increase the awareness at the community level in the
Southern Province of Rwanda on Family Planning;
(2) To increase women’s demand for safe contraceptive methods available in the health centres and inform them about the
possibility of referral for methods unavailable in health centres.
Methods: Trained students will give informative sessions to
women at local health centres on safe contraceptive methods.
Results: During the period of three years from 2005 to 2008
the nurses working in the family planning clinics noticed an
increase in the number of women coming for contraception
requests in comparison to the demand before the intervention.
This was also noticed from the statistical report of the health
centres in the Southern Province.
Conclusions: This intervention project on Family Planning
Education at the community level has shown a positive impact.
Studies have shown that ‘Family Planning’ has a wider range of
potential positive impact on human kind than any other medical intervention. In this era of massive migration in Europe and
when the concept of making ‘Every birth’ wanted becomes a
global priority, the above described community-based education
project can be inspiring.
EDUCATION AND TRAINING FOR FAMILY PLANNING
PROFESSIONALS
A-126
Exploring the awareness and
knowledge regarding contraception
among Malaysian house-officers
Somaskandar Sivasuntharam, Sw Tan and
Knox Ritchie
Penang Medical College, Penang, Malaysia
Background: Contraception is a major component of reproductive health and has been cited as essential to achieve the
Millennium Development Goal (MDG) in this country. The usage
of modern contraception among Asian women has been shown
to be less than global average, despite a large number of modern contraceptive methods available in the market today.
Objective: To assess the levels of awareness and knowledge
regarding contraception among recent medical graduates in
Malaysia.
Methods: A cross-sectional study was conducted from
September to October 2014 among Malaysian house officers.
The subjects were gathered from various public hospitals in
Northern Malaysia. A total of 111 subjects participated and completed a self-administered questionnaire in hard copies. The
questionnaire assessed their socio-demographic information,
levels of familiarity and knowledge regarding contraceptive
methods available in Malaysia.
Results: The population consisted of 55 male and 56 female
doctors with a mean age of 25.2. Among the respondents, only
57.7% have good awareness on all 13 out of 17 contraceptive
methods which they were expected to know. The top five
methods which the house officers were most aware of included
the male condom, oral contraceptive pill, tube ligation, rhythm
method and vasectomy. Meanwhile, only one (0.9%) subject
correctly answered all 13 selected true/false questions (15 questions in total) about the facts, mechanism of action and usage
of contraceptive methods. However, the majority of them
(82.9%) scored between 8 and 12.
Conclusion: There is only a moderate amount of awareness on
modern contraceptive methods among our recent medical
graduates. Our study indicates that more efforts should be
made to improve the awareness of the various types of contraceptive methods available in this country. There is a greater
need for improved medical education on contraception at the
Medical colleges as these young medical graduates are the very
personnel who will serve as patient educators on family planning issues, in order to minimise unwanted pregnancies, reduce
illegal abortions which would in return contribute to the reduction in maternal and perinatal morbidities and mortalities.
A-127
Contraception choices and affecting
factors of Turkish woman. Literature
review
€çu
€kkelepçe, Sinan Aslan and
Didem Şimşek Ku
Emine Derya Ister
High School Health/Adıyaman Unıversty, Adiyaman, Turkey
Objectives: To review the studies which were published
between January 2010 and November 2015 in order to determine the contraceptive method choices and the influencing factors and to compile the findings obtained from these studies.
Method: Google Acaemical and Turkish Reference Index were
scanned in order to determine family planning method choices
of women and the influencing factors. The scan was performed
in the Turkish language by using five keywords which are familiy planning, contraceptive method, contraception, family planning methods, FP and influencing factors. At the end of the
scanning we found 11 publications which satisfied the inclusion
criteria determined within the study.
Results: According to the 2013 results of the Turkey
Demographic and Health Survey, while 73% of married women
in Turkey used a contraceptive method, the use of modern and
traditional methods was respectively 47% and 26%. The prevalence of contraceptive use in the study ranged from 65 to 80%.
The frequency of use of traditional and modern contraceptive
methods respectively ranges from 15 to 37%, and 45 to 71%.
When we look at women’s contraceptive choices; the women’s
and her husband’s education level, socio-economic status, age,
her number of pregnancies, duration of marriage, unwanted
pregnancy and abortion history, family sources of information
about contraceptive methods, were reasons related to the
method affecting the choice of women’s contraceptive methods. While women who have a low education level prefer traditional contraceptive methods, women with higher levels of
education prefer modern contraceptive methods. Most frequently used traditional contraceptive methods are the calendar
method, vaginal douche, vaginal foams, gels, suppositories and
breastfeeding practices. Women who have a history of
unwanted pregnancy, abortion, and curettage, prefer more
modern contraceptive methods. Age factor is an important variable in the choice of contraceptive methods. With increasing
age, women prefer modern contraceptive methods and permanent contraception methods are more preferred by women
aged 35 and over. Women’s sources of information about
contraception are health organisations, family, their circle of
friends and the media. Women who have health organisations
as a source of information preferred modern contraceptive
methods while women who have family and friends as a source
of information prefer more traditional methods.
Conclusions: Many factors affect women’s choice of contraceptive methods. The usage of a modern method which is reliable
and has high protection is affected by the education level of
women and their spouses.
ACCEPTED ABSTRACTS – EDUCATION AND TRAINING FOR FPPS
A-128
Long-acting reversible contraception
(LARC) training in general practice
Laura Heatha, Hannat Akintomideb, Alison Adamsb
and Chris Wilkinsonb
a
John Radcliffe Hospital, Oxford University Hospitals NHS Trust,
Oxford, UK; bMargaret Pyke Centre, CNWL NHS Camden Provider
Services, London, UK
Objective: The majority of women in the UK visit their general
practice for contraception. A pilot training scheme was set up
to increase long acting reversible contraception (LARC) provision
in this setting. This scheme trained general practitioners and
practice nurses in the provision of subdermal implants (SDIs)
and intrauterine contraception in their own general practices.
The success and impact of the scheme – Improving Choices in
Contraception through Training (ICCtT) – which ran from May
2009 to March 2012 was evaluated.
Method: Questionnaires were developed and administered to
participants in the training scheme one year after completion of
their training.
Results: A total of 256 practitioners registered for training in
the provision of SDIs and/or intrauterine contraception, of which
165 completed training. A total of 104 practitioners were trained
in SDI insertion, 91 in SDI removal and 37 in intrauterine contraception techniques. Sixty-five practitioners (39%) returned the
post-training questionnaire, most of whom had no problems
providing SDIs (90%) and intrauterine contraception (82%) in
their first year following training. Of those practitioners that had
experienced problems, lack of confidence was the most common reason for SDIs whereas for intrauterine contraception it
was failed insertions.
Conclusions: There was high interest in as well as uptake
and completion of LARC training during the ICCtT pilot
scheme. High satisfaction with the training programme was
related to the training having been made available at practitioners’ usual place of work. These findings show that training
practitioners in LARC provision within their general practices
is feasible.
A-129
Abortion training in Canadian
obstetrics and gynaecology residency
programmes
Dustin Costescu, Jessica Liauw and Brigid Dineley
McMaster University, Hamilton, ON, Canada
Objectives: It is an accreditation standard that graduating
obstetricians/gynaecologists be able to independently perform
a dilation and curettage, a dilation and evacuation in the early
second trimester, and with supervision, a dilation and evacuation of a pregnancy greater than 14 weeks gestation. Beyond
this, no further direction is provided in terms of the necessary
components of abortion training, despite the fact that one
third of women in Canada experience abortion in a lifetime. In
order to develop a national abortion training curriculum, we
first set out to quantify what training is available across the
country.
Methods: Residents and programme directors at all 16 residency training programmes in Canada were surveyed using a
web-based or paper-based questionnaire. We assessed both
whether training for specific abortion procedures is available,
and whether residents expected to be competent in performing
these procedures. We compared results from a similar study
performed in senior OB/GYN residents in 2004.
101
Results: A total of 301 residents (55% response rate) and 15
programme directors (94%) responded. Half of the residency
programmes offer ‘opt-out’ (training occurs unless the resident
declines) training, and half offer ‘opt-in’ (residents use electives
or selective to obtain training). Overall, 88% of residents had
access to surgical abortion in the operating room, but only
71% had access to abortion training in an ambulatory setting
(where most abortions take place). While 90% of residents and
87% of programme directors felt that they would be competent in first trimester surgical abortion in the OR, only 35% of
residents and one program director felt that residents would
be competent in second trimester abortion. Compared to
2004, residents are less likely to report having access to abortion training. 69% of residents would like more abortion training during residency.
Conclusions: Canadian residency programmes do not meet the
current accreditation standard for abortion training, and most
residents expressed a desire for more training. In fact, abortion
training opportunities have decreased in the past 10 years.
There is a need for a structured, evidence-based national abortion training curriculum to supplement the currently-available
training opportunities.
EMERGENCY CONTRACEPTION
A-130
Improving emergency contraception
in UK general practice
Charles Heffer
Bradford-on-Avon & Melksham Healthcare Partnership, Bradfordon-Avon, Wiltshire, UK
Objectives: Around 7% of all reproductive women within the
UK receive Emergency Contraception (EC) each year1. Yet
national data demonstrate that knowledge of EC amongst these
women is inadequate, particularly regarding Cu-IUD and its
use.[1] This study utilised the UK’s Faculty of Sexual and
Reproductive Healthcare (FSRH) guidelines to evaluate EC provision in multiple large general practices and investigated
whether EC modified subsequent contraceptive behaviour.
Methods: This retrospective one-year cross sectional study was
conducted from a reproductive population of nearly 5000
women via the practice databases. Data from this population
included patient age, EC incidence and method, frequency of
EC administration and engagement with contraception services
post EC. From this data relevant local stakeholders in need of
improved EC provision were identified and specific clinical tools
were subsequently developed for these groups. For validation
of these strategies these clinical tools were presented to a
‘focus group’ of 28 local GPs and Practice Nurses who deal with
EC on a regular basis and were modified according to their
responses.
Results: A total of 63 women sought EC within one year. Only
25% were offered Cu-IUD as an option against a 100% FSRH
guideline. Disappointingly, 32% had no regular contraception
strategy on follow-up with half of these women being 20 years
or younger. There was a small subset of women (10%) who
were using EC several times a year as their preferred method of
contraception.
Conclusions: Three groups of women were identified as stakeholders in need of improved EC provision. These stakeholders
were: women not being offered the Cu-IUD as an EC method,
women using EC as a form of regular ongoing contraception
and mainly teenage women not engaging with regular contraceptive services post EC. The impact of this study has led to the
creation of three original clinical tools to specifically target these
stakeholders. These tools include a Clinician EC Prescription
Tool, a Patient EC Information Tool and a novel Four-Week Call
102
Back follow-up system to reach out to non-engaging young
women with high risk of pregnancy.
This study was unable to capture EC provision in other community or secondary care settings showing a need for further
research in this area with improved information technology to
track a whole population through time.
Reference
[1]
Lader D. Contraception and sexual health. London: Office for
National Statistics 2008.
A-131
A-132
Use of effective contraception six
months after emergency
contraception with a copper
intrauterine device or ulipristal
acetate – a prospective observational
cohort study
Niklas Envalla, Nina Groes Kofoedc and
Helena Kopp-Kallnerd
a
Efficacy of ulipristal acetate for
emergency contraception and its
effect on the subsequent bleeding
pattern when administered before or
after ovulation
Hang Wun Raymond Lia, Sue Seen Tsing Lob,
Ernest Hung Yu Nga and Pak Chung Hoa
a
Department of Obstetrics and Gynaecology, The University of
Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong; bThe
Family Planning of Hong Kong, Hong Kong, Hong Kong
Objectives: Research carried out in the area of emergency
contraception (EC) has aimed at finding agents that are more
effective and less restrictive in timing of use after unprotected
sexual intercourse. Levonorgestrel is effective as an emergency
contraception (EC) only when administered before but not after
ovulation. Whether the same applies to ulipristal acetate (UPA)
is not known. This study aimed at comparing the efficacy of
UPA for EC when administered before and after ovulation.
Methods: This was a prospective, open-label, uncontrolled clinical study conducted between May 2011 and March 2014 at the
Family Planning Association of Hong Kong. A total of 700
women with regular menstrual cycles who were requesting EC
within 120 hours of a single act of unprotected sexual intercourse in the current menstrual cycle were recruited. Of them,
693 completed follow-up. Each participant received a single oral
dose of UPA 30 mg. The main outcome measure was the percentage of pregnancies prevented (PPP). Secondary outcome
measures included failure rate and changes in the next menstrual bleeding.
Results: The PPP was significantly higher in subjects who were
pre-ovulatory (77.6%) compared to those who were post-ovulatory (36.4%) at the time of UPA administration (p < 0.0001). The
observed pregnancy rate following UPA administration was significantly lower than the expected pregnancy rate only in the
pre-ovulatory group (p < 0.0001) but not the post-ovulatory
group (p ¼ 0.281). The overall failure rate was 1.7% (1.4% vs. 2.1%
in the pre- and post-ovulatory groups respectively). Pre-ovulatory
administration of UPA resulted in a small delay (median of three
days), whereas post-ovulatory administration resulted in a minimal advancement (median of one day), of the next menstruation
respectively compared to that predicted from the subjects previous menstrual pattern. More pre-ovulatory subjects (19.1%) than
post-ovulatory subjects (7.8%) had deviation of the next menses
by more than seven days (p < 0.001).
Conclusions: The efficacy of UPA-EC was significantly better
when administered before than after ovulation. UPA-EC taken in
the pre-ovulatory or post-ovulatory phases resulted in different
bleeding patterns.
RFSU – The Swedish Association for Sexuality Education,
Stockholm, Sweden; bDepartment of Women’s and Children’s
Health, Karolinska Institutet, Stockholm, Sweden; cDepartment of
Obstetrics and Gynaecology, Danderyd Hospital, Stockholm,
Sweden; dDepartment of Clinical Sciences at Danderyd Hospital,
Objectives: Emergency contraception must be followed by the
use of an effective method for contraception in order to reduce
future risk of unplanned pregnancy. Provision of long-acting
reversible contraception (LARC) such as the copper intrauterine
device (Cu-IUD) is highly effective in preventing unplanned
pregnancy. The aim of this study was to compare use of an
effective method of contraception six months following insertion of a Cu-IUD or intake of ulipristal acetate (UPA) for emergency contraception (EC).
Methods: Women (n ¼ 79) presenting with need for EC at an
outpatient midwifery clinic chose either Cu-IUD or UPA according to preference. Follow-up was three and six months later
through telephone interviews. Primary outcome was use of an
effective contraceptive method at the six month follow up.
Secondary outcomes included use of an effective contraceptive
method at three months follow up and acceptability of Cu-IUD.
Results: A total of 30/36 (83.3%) of women who opted for CuIUD had an effective contraceptive method six months after
their first visit compared to 18/31 (58.1%) of the woman who
used UPA (p ¼ 0.03). In the Cu-IUD group 28/36 (77.8%) where
still using Cu-IUD at six months and 31/36 (86%) stated that
they would recommend the Cu-IUD to others as an EC method.
Conclusions: Significantly more women who chose Cu-IUD for
EC used an effective method for contraception at the six month
follow-up. The results of this study support increased use of CuIUDs for EC.
A-133
A survey of knowledge and attitudes
of emergency contraception among
university students in Turkey
€
€rkana, Fazil Bozkurtb and Hasan Circira
Can Gu
Ozlem
a
Nursing Division, Faculty of Health Sciences of Marmara
University, Istanbul, Turkey; bVan Baskale Public Hospital, Van,
Turkey
Objective: To evaluate the information and attitudes of university students towards emergency contraception (EC) techniques.
Method: This cross-sectional descriptive study was conducted
with a total of 648 students who were eager to participate in
the study, aged between 18 and 24 and studying at the
Departments of Nursing, Midwifery, Physiotherapy-Rehabilitation
and Nutrition and Dietetics at Marmara University Faculty of
Health Sciences between February 2015 and April 2015. The
data were obtained through a questionnaire form aiming to
assess the demographic characteristics of the participants and
ACCEPTED ABSTRACTS – EDUCATION AND TRAINING FOR FPPS
their information and attitudes towards emergency contraception techniques.
Results: The mean age of the participants was 20.46 ± 1.4 years,
18.2% were male (n ¼ 118) and 81.8% were female (n ¼ 530).
Overall, 42.3% of the participants (n ¼ 274) stated that they had
information about EC techniques, 20.2% (n ¼ 131) stated that
they heard about emergency contraception techniques but did
not have information about them, and 37.5% (n ¼ 243) said that
they had never heard about emergency contraception
techniques.
Of those participants who stated that they had information
about EC techniques, 36.1% (n ¼ 99) knew EC pills and 24.5%
knew intrauterine device (IUD) as EC techniques. The rate of
those who stated that EC techniques could be used after each
unprotected sexual intercourse was 51.5% (n ¼ 141). The rate of
participants who said that EC pills could be used several times
a month, on the other hand, was 19.7% (n ¼ 54). The rate of
participants who stated that there were EC techniques that
males could use was 46% (n ¼ 126) and 46.7% of the participants (n ¼ 128) pointed out that the condom could be used as
an EC technique. The rate of those who knew the side-effects
of emergency contraceptive pills correctly was 40.9% (n ¼ 112).
When they were asked which EC technique they would use
when needed, 26.3% (n ¼ 72) said they did not know which
technique to use, and 19.7% (n ¼ 54) stated they would prefer
EC pills and 8% (n ¼ 22) IUD.
Conclusion: This study demonstrated that most university students were not informed of EC techniques, and that a significant number of those who stated they were informed actually
had inaccurate information. Preparing banners, brochures, spot
films and education programmes is of great importance with
regard to informing the students.
103
GUM (previously CCC 100%, GUM 50%). The IUD uptake
increased in the community contraception clinic between
audits: 0% (0/15) in 2012 vs. 12% (6/50) 2014 but not in GUM
20% (2/10) in 2012 vs. 4% (1/23) in 2014.
In CCC 31/50 (62%) of women were eligible for Cu-IUD and 6/
31 (19%) accepted an IUD. Another four women (8%) were eligible but there was no documentation of an offer of an IUD for
EC. In GUM 12/23 (52%) women were eligible for an IUD, only
one woman accepted it and another woman was eligible but it
was not discussed.
Conclusions: A re-audit has shown that the only standard
reaching 100% in both audits was STI screening in the GUM
department. There are low numbers accepting in IUD in both
settings which we must strive to improve in the future but
there was better documentation of all EC options and future
contraception, and more STI screening being offered in CCC.
We believe this is due to ongoing education and integration of
both services resulting in nurses and doctors working in both
settings and sharing their expertise.
A-135
Health care students’ knowledge and
use of emergency contraception,
Buenos Aires, Argentina
Belen Provenzano-Castroa,
Belen Provenzano-Castrob, Silvia Oizerovicha and
Babill Stray-Pedersena,b
a
A-134
Improving the quality of
consultations on emergency
contraception and uptake of
emergency intrauterine contraception
Victoria Greensill and Nicola Mullin
East Cheshire NHS Trust, Chester, Cheshire, UK
Objectives: To re-audit and compare consultations in a hospital department of genito-urinary medicine (GUM) and a
community contraception clinic (CCC) clinic against Faculty of
Sexual and Reproductive Health (FSRH) UK standards on
Emergency
contraception
(EC)
and
Quick
Starting
Contraception. To evaluate any changes or improvements
since the original audit was performed in 2012, taking into
account its recommendations.
Method: A retrospective case note review of patients attending
both original sites from May to October 2014, 25 women were
identified in GUM and 80 in CCC (random 50 included). A larger
sample size was recommended for the re-audit (previously 10 in
GUM and 15 in CCC). All standards set at 100%: including documented discussion of all EC options, sexually transmitted infection screening (STI) offered, future contraception, when to quick
start, use of additional contraception, pregnancy test after three
weeks, condoms offered.
Results: Two women were excluded from the GUM population
analysis because one recieved advance provision of EC with barrier contraception and one took EC to cover removal of IUS
for medical reasons. Multiple options for EC were discussed in
44/50 (88%) women in CCC and 22/23 (96%) in GUM, initial
audit showed CCC 60% and GUM 20%. STI screening was
offered to 40/50 (80%) women in CCC and 23/23 (100%) in
GUM (previously CCC 73%, GUM 100%). Future contraception
was documented in 47/50 (94%) in CCC and 22/23 (96%) in
Gynaecology Division, Faculty of Medicine, University of Buenos
Aires, Buenos Aires, Argentina; bInstitute of Clinical Medicine,
Faculty of Medicine, University of Oslo, Oslo, Norway
Objective: To assess Faculty of Medicine students’ knowledge
and use of emergency contraception (EC). EC is a safe and
effective postcoital method used to prevent pregnancy after
unprotected sexual intercourse. In Argentina, progestin-only
EC pills (levonorgestrel – LNG-ECP) are available by prescription. As of 2007, LNG-ECP is provided free at hospitals and
primary care centres. LNG-ECP can prevent unintended pregnancies resulting from failure of regular contraception or
unprotected sex, thus reducing maternal mortality and morbidity due to unsafe abortions in a country where abortion
is restricted. Information on the use, effectiveness, safety and
relevance of LNG-ECP is crucial for future health care providers and the population at large.
Methods: A self-administered, anonymous survey was applied
in 2011–2012, to assess knowledge and use of EC, to 555
Argentinians, 18–24 years old and first year health care students. For the analysis, SPSS 15 was used. Ethical clearance was
obtained.
Results: A total of 81.9% were aware of LNG-ECP. This was not
influenced by gender, field of study or sexual debut. Among
the 83% who had had their sexual debut, less than 2% had
used LNG-ECP at sexual debut while 3.1% used it as their regular contraceptive method. Overall, 54% of female students said
they had used LNG-ECP, whereas 27.9% of male students
answered that their sexual partner had used it. The reason for
using LNG-ECP was: 58% contraceptive method failure, 33% no
use of contraception, 17.7% in doubt of contraceptive effectiveness. Most (86%) received it over the counter.
Most (82.8%) and (90%) knew that LNG-ECP is used after unprotected sex or rape respectively; 95.2% knew that to maximise its
effectiveness, it has to be taken within the first 72 h after sexual
intercourse; One out of three thought that there is a limited
number of LNG-ECP that can be taken per year; 23.3% thought
LNG-ECP is as effective as other modern contraceptive methods;
Almost all believed that it has many contraindications while
44.8% believed LNG-ECP is abortive (medical students were
104
significantly more likely to choose this option than midwives
and nursing students, p < 0.05), while 51.2% admitted not
knowing the mechanism of action and 18.3% knew that it
delays ovulation.
Conclusions: We observed a high level of awareness of LNGECP among health care students. However, they showed some
deficits in knowledge and misconceptions. These results should
raise awareness of the need of addressing this issue in the
university.
A-136
Emergency contraception:
knowledge, attitudes and practice of
pharmacy’s personnel in Portuguese
community pharmacies
Barbara Moitaa, Inês Ramalhoa, Zita Ferraza,
Pedro Viana Pintob, Teresa Bombasa and
Paulo Mouraa
a
Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal;
Centro Hospitalar de S~ao Jo~ao, Porto, Portugal
b
Objective: Emergency contraception is a method that prevents
an unintended pregnancy, in situations where sexual intercourse
has occurred without the use of contraception or when the
contraceptive method used has failed. It is the only contraceptive method effective after a sexual intercourse. There are several choices including hormonal (Levonorgestrel and Ulipristal
acetate) and non-hormonal (copper intrauterine device) methods. In Portugal, emergency contraceptive pills (Levonorgestrel
and Ulipristal Acetate) are available directly from pharmacists,
without
a
prescription
at
pharmacies.
Additionally,
Levonorgestrel is also available in some shops and supermarkets. Pharmacists are front line health care providers and thus
play a key role in counselling and providing emergency contraceptive pills. The objective of this study was to gather information about the Portuguese community pharmacists’ knowledge,
attitudes and practice.
Methods: Cross-sectional descriptive study carried out between
January 2014 and December 2014; the population was composed of pharmacists, pharmacist assistants and students in the
last year of graduation in pharmacy, attending a workshop
regarding emergency contraception. Data were collected before
the workshop by application of a standardised, validated,
anonymous questionnaire.
Results: Most respondents had graduated in pharmaceutical sciences (85.3%). All of them had heard about emergency contraception but only 19.4% knew the three hormonal methods
available. Around 40% mentioned not having enough knowledge to counsel. Less than half of the respondents correctly
identified the action mechanism of hormonal methods and
20.5% considered it as an abortive method. Almost 80%
reported that hormonal emergency contraception has the same
contraindications as combined hormonal contraception. About
70% believe emergency contraception constitutes a ‘hormonal
bomb’, while 61% believe that the promotion of its use constitutes a risk factor for an increase in the incidence of sexually
transmitted infections.
Conclusions: Pharmacies play an important role as providers of
emergency contraception and reproductive health care counsellors. Consequently, these places are uniquely positioned to help
tackle such public health problem which is unintended pregnancy. The results of the study reflect the lack of knowledge
and miss understood concepts by the pharmacies staff. Findings
suggest that educational campaigns are needed, in order to
ensure that women can receive quality counselling and access
to emergency contraception.
A-137
Access to emergency contraception
in the Balkans, the Commonwealth of
Independent States, and Eastern
Europe countries
Natalia Zarbaiova, Jamie Bassb and
Cristina Puig Borrasa
a
European Consortium for Emergency Contraception, Targu
Mures, Romania; bInternational Consortium for Emergency
Contraception, New York, USA
According to a number of Human Rights treaties, including the
Convention for the Elimination of All Forms of Discrimination
Against Women (CEDAW), emergency contraception (EC) should
be available without a prescription and provided free to victims
of sexual violence, including adolescents.
An expert-based survey was conducted between 2014 and 2015
to assess emergency contraception (EC) accessibility in Albania,
Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, FYR
Macedonia, Georgia, Kazakhstan, the Republic of Moldova,
Russia, Serbia, Tajikistan, Ukraine, and Uzbekistan. The survey
assessed the availability and legal status of different EC methods; prescribers and places of delivery; costs and reimbursement
policies; availability of data on estimated frequency of use and
of clinical guidelines; and common practices at the country
level.
Currently, the primary EC method available in the surveyed
countries is levonorgestrel emergency contraceptive pills (LNG
ECPs). Ulipristal acetate emergency contraceptive pills (UPA
ECPs) are registered in all the countries except for Albania,
Azerbaijan, Macedonia, Georgia and Uzbekistan. Additionally,
mifepristone ECPs are available in Armenia, Republic of
Moldova, Russia and Ukraine. In Albania, Bosnia and
Herzegovina, Kazakhstan, and Russia a prescription is still
required to buy ECPs. In certain countries and for certain populations, ECPs are provided in public health centres, such as family planning clinics, women’s health clinics and youth-friendly
health centres.
There are large differences in the price of ECPs across all 14
countries, but UPA ECPs are consistently more expensive than
LNG ECPs. The average price for LNG ECPs in most countries is
?10, while for UPA ECPs, it is ?16. The highest prices for EC are
in Bosnia-Herzegovina, where women pay ?14.5–22.5 for LNG
ECPs and ?25–30 for UPA ECPs. Generally, no reimbursement
mechanisms exist in these countries, and the full cost of EC
comes directly out of the user’s pocket. If compared to the relative cost of ECPs in European Union countries, the higher relative cost seems to be an important barrier to access.
All countries surveyed have some statistics on modern contraceptive method use, although the date of data collection for
each country differ and range from 1999 to 2014. Only in six
countries was women’s knowledge of EC assessed.
In these subregions, national governments should make EC
more accessible and affordable in order to protect and promote
their population reproductive rights.
ACCEPTED ABSTRACTS – GENDER ISSUES IN SRH
GENDER ISSUES IN SEXUAL AND REPRODUCTIVE
HEALTH
3.
A-138
Gender empowerment to improve
sexual and reproductive health of
adolescent girls and young women in
Jamaica
Andrea Campbell, Denise Chevannes-Vogel,
Sandra Knight and Juliet Hall
National Family Planning Board, Kingston, Jamaica
Background: With an adolescent fertility rate of 72 per 1000,
Jamaica compares unfavourably to the global average of 50 per
1000. Impoverished, poorly educated and rural girls are more
likely to become pregnant than their wealthier, educated and
urban peers. Adolescent childbearing is normative with 40% of
women reporting a pregnancy at least once before age 20.
Women and girls between ages of 10 and 29 are more likely
than their male counterparts to contract HIV.
Objectives:
1.
2.
3.
To increase gender empowerment and knowledge of
adolescent girls and young women to identify and
adopt methods to improve sexual and reproductive
health (SRH) by preventing HIV, STIs and pregnancy.
To reduce social vulnerabilities amongst adolescent
girls and young women through knowledge based
interventions and one-to-one interactions.
To build men’s capacity to support the SRH decisionmaking of their female partners.
Method: Operational research was conducted in a pilot project
that focused on the development and implementation of SRH/
HIV integrated interventions to improve sexual and reproductive
health. Gender Empowerment and Behaviour Change
Communication strategies were employed in order to improve
the life skills and competencies of beneficiairies to care for their
sexual and reproductive health, foster their skills to negotiate the
terms of sexual relations – including condom use, and avoidance
of unwanted or coercive relations – and to address genderrelated and other social determinants of vulnerability and
behaviour.
Results:
1.
2.
3.
Increased knowledge to adopt methods for preventing
unplanned pregnancy, HIV, and STIs.
Increased contraceptive use as well as improved skills
in the correct use of the condom.
Reduced gender and social vulnerability through
increased enrollment in remedial education and income
generating activities.
Conclusions: The operational research has demonstrated a critical need to:
1.
2.
Broaden Gender Empowerment strategies and address
other structural barriers such as poverty, unemployment and poor education.
Increase and expand availability and access to gender
transformative, friendly adolescent SRH services. The
service strategies should facilitate open dialogue on
sexuality, gender, and HIV and family planning issues
among adolescent girls and young women, promote
self-esteem, critical thinking and negotiation skills, and
challenge negative gender roles and stereotypes.
105
Implement screening methods which identify psychological and mental health care needs, indicators of gender based violence, and systematically identify the
levels of psychosocial care that different categories of
adolescent girls and young women need.
A-139
Male partners influence in the
utilisation of family planning and
contraception: challenges and
solutions for Kilifi County, Kenya
Peter Gichangia, Irene Njaua, Petrus Steynb,
Janet Mugob and Joanna Corderob
a
International Center for Reproductive Health, Kenya, Mombasa,
Kenya; bWorld Health Organisation, Geneva, Switzerland
Objective: To assess the role of men in the uptake of family
planning and contraception (FP/C) and develop solutions to
increase the met needs for family planning in Kilifi. Male partners influence the uptake of family planning and contraceptives.
In many settings, men have been excluded from participating in
family planning issues as they are viewed as a ‘woman’s affair’.
Additionally, most communities view men as the key decision
makers in the family. Therefore, they play a critical role in determining the number of children that the women should have
and whether they should utilise FP/C methods or not.
Determining their attitudes toward FP/C is critical for developing
solutions to increase the met needs for FP/C.
Methods: A total of 12 Focus Group Discussions among community members (male and female) aged 15–49 years and two
among health care providers were conducted in Kilifi.
Results: The findings revealed that most men in Kilifi view the
utilisation of FP/C as a ‘woman affair’ and have little or no
involvement in matters regarding the same. Moreover, the
majority of the men in the region were against the use of FP/C
indicating side-effects such as barrenness, reduction of sexual
pleasure, and interference with the menstrual cycle among the
women. As a result of the negative male attitudes toward FP/C,
most women are forced to utilise these methods in secret. The
research also revealed that most women in the area prefer
injectable or implant methods in comparison to the pills as they
are unlikely to be noticed by their husbands. The Mijikenda
(major tribe in Kilifi) culture treasures families with many children and hence women are expected to ensure that they give
birth to as many children as possible. It is the role of the men
as decision makers to ensure that this culture is respected.
Conclusion: The lack of male involvement in family planning
issues starts from the policy level as much of the attention is
focused on the woman. It is important to develop community
sensitisation programmes to empower male partners on issues
relating to FP/C. In addition, such programmes should ensure
that the men are appointed as advocates of family planning.
Engaging the men would also promote shared decision making
in the family and increase the utilisation of family planning and
contraception among both parties.
106
HORMONAL CONTRACEPTION
A-140
Personality traits and attitudes
towards the frequency of menstrual/
withdrawal bleeding: a survey in a
clinical sample of Italian women
Lara Tiraninia, David Bosonia, Laura Cucinellaa,
Silvia Martellaa, Federica Campolob, Gabriele Lanzob,
Arsenio Spinilloa, Chiara Benedettob and
Rossella E. Nappia
a
Department of Clinical, Surgical, Diagnostic and Paediatric
Sciences, University of Pavia, Pavia, Italy; bDepartment of Surgical
Sciences, Obstetrics and Gynaecology I, Ospedale S. Anna,
University of Turin, Turin, Italy
Objectives: We investigated attitudes towards the frequency of
menstrual/withdrawal bleeding by using a combined hormonal
contraception (CHC) in a clinical sample of fertile women, taking
into account their personality traits.
Methods: A cross-sectional study was conducted in two university hospitals in northern Italy. Current, past and never CHC
healthy users (n ¼ 545; aged 18–44 years) completed a selfadministered questionnaire, composed of a semi-structured
interview and a validated personality questionnaire (TIPI). Data
were analysed using frequency tables, v2 test and other statistics, as appropriate.
Results: Forty-five percent of responders would prefer to change
the frequency of menstrual/withdrawal bleeding by using a CHC.
Women > 39 years (57%) and > 30 years (45%) were more willing
to change their bleeding pattern than women between 30 and
39 years (31%) (v2: 9.1; p ¼ 0.01). Past (51%) and current (49%)
CHC users preferred to modify the bleeding frequency, whereas
never users reported a negative attitude to do so (71%) (v2: 18.7;
p ¼ 0.001). Among the different bleeding patterns, a flexible regimen was the preferred choice (33%), followed by an extended
regimen designed to bleed every three months (22%) and ‘to
never bleed’ (18%). The main reasons behind women’s preference to change the bleeding pattern were to avoid dysmenorrhea (43%) and to have more freedom in sexual (36%) and active
(35%) life, whereas the main reason for a negative attitude is that
menstrual rhythm ‘is natural’ (59%). Women who were prescribed
CHC for menstrual disorders preferred ‘to bleed in a flexible way’
(50%) and ‘to never bleed’ (46%). Scores of openness (p ¼ 0.005)
and extraversion (p ¼ 0.001) were significantly higher in those
women more favourable to modifying their bleeding pattern by
using a CHC.
Conclusions: Age, use of CHC, menstrual disorders and open
and extraverted personality were associated with a positive attitude to change the menstrual/withdrawal bleeding pattern,
mainly taking a flexible and extended (three months)-regimen.
A-141
Association between sexual health
and quantity of androgen receptor
CAG polymorphism in combined oral
contraceptive users
Lina Ciaplinskienea, Ingrida Zutautaiteb,
Alina Smalinskienec, Guoda Juskeviciuted and
Birute Zilaitienea
a
Lithuanian University of Health Sciences,Institute of
Endocrinology, Kaunas, Lithuania; bLithuanian University of Health
Sciences, Medical Academy, Medical and Veterinary Genetics,
Kaunas, Lithuania; cLithuanian University of Health Sciences,
Medical Academy, Institute of Cardiology, Kaunas, Lithuania;
d
Lithuanian University of Health Sciences, Medical Academy,
Medicine faculty, Kaunas, Lithuania
Objectives: First, we wanted to determine androgen receptor
(AR) gene polymorphism. Second, we wanted to determine the
link between sexual health changes and combined oral contraceptive (COCP) usage, and third, we aimed to determine the
association between sexual function changes and AR gene polymorphism in COCP users.
Methods: A randomised case-control study took place during
the period from February 2013 to February 2014. The study
included 98 healthy 18–40-year-old women with regular menstrual cycles (25–35 days), who were consulted for the usage
of contraception. The control group (n ¼ 40) consisted of
women, using barrier contraception or natural family planning
methods. The study group (n ¼ 58) was composed of women
using COCP (ethinylestradiol 0.03 mg/drospirenone 3 mg). The
Female Sexual Function Index (FSFI) questionnaire was implemented to evaluate women sexual function. Women were
asked to fill out the FSFI in the beginning of the study and
after six months.
Results: Homozygote women with short-short (SS) alleles were
dominant in both groups: 50.7% (n ¼ 30) for the control group
and 56.0% (n ¼ 22) for the study group. The average count of
homozygote women with long-long (LL) alleles was found to
be, respectively, 30.7% (n ¼ 23) and 29.0% (n ¼ 12). The lowest
number of heterozygote women with short-long (SL) alleles was
discovered in the study population: 18.6% (n ¼ 14) for the study
group and 15.0% (n ¼ 6) for the control group. FSFI showed risk
for sexual dysfunction (FSFI 26.55) for more than half the
patients in the study group (55.2%; n ¼ 32) and for one third of
women in the control group (30.0%; n ¼ 12). After evaluating
FSFI subscales, it was detected that women in the study group
were significantly more likely to experience pain during sexual
intercourse if compared to the control group (p ¼ 0.01). Sexual
arousal, lubrication, orgasm, satisfaction scores did not differ significantly between the groups respectively (p ¼ 0.6; p ¼ 0.4;
p ¼ 0.5; p ¼ 0.3). There was no statistically significant correlation
between CAG repeats and desire, sexual arousal, lubrication,
orgasm, satisfaction, pain and overall scores (p > 0.05).
Conclusions: AR gene CAG repeat polymorphism was determined in the study group as: homozygote women with SS
50.7%, homozygote with LL 30.7% and heterozygotes with SL
18.6%. In the control group 56.0%, 29.0% and 15.0%, respectively. Short CAG repeats are dominant among Lithuanian
women population AR genes. Women, using COCS, were more
likely to experience pain during sexual intercourse if compared
to barrier contraception or natural family planning methods
users. There was no significant association between sexual function changes and AR gene polymorphic CAG repeats.
A-142
High rates of women’s satisfaction
after switching form ethinylestradiol
(EE) containing COCs to a
combination of estradiol plus
dienogest (E2V/DNG) versus
progestin-only pills (POP)
Ralf Bannemerschult
Bayer Healthcare, Berlin, Germany
Objectives: To compare continuation rates, bleeding and satisfaction of E2V/DNG versus POP within the first year of use after
direct switch from EE-containing COCs.
ACCEPTED ABSTRACTS – HORMONAL CONTRACEPTION
Methods: The CONTENT study was a prospective, non-interventional, observational trial conducted between October 2010 and
March 2014 at 375 centres in 11 countries: Czech Republic,
France, Germany, Greece, Hungary, Israel, Italy, Russian
Federation, Slovakia, Sweden and UK. A total of 2558 women in
the E2V/DNG group and 592 in the POP group were included
for a follow-up of up to one year. Women were eligible if EEcontaining COC use took longer than three months, before direct switch to either E2V/DNG or POP.
Results: Time to discontinuation due to bleeding (p < 0.0001) or
other reasons (p ¼ 0.022) were both significantly longer in the
E2V/DNG group versus the POP group. The E2V/DNG COC was
also associated with shorter (48.7% vs. 44.1%), lighter (54% vs.
46.1%), and less painful bleeding (91.1% vs. 73.7%), and greater
user satisfaction (80.7% vs. 64.6%) than POP use, already within
the first three–five months after switching from the previously
taken COC. Women’s satisfaction rate was consistently higher in
the E2V/DNG group, independent of age (satisfaction rate of
women aged 18–25 years: E2V/DNG 79.4% vs. POP 65.0%,
26–34 years: 81.0% vs. 63.3%, 35–50 years: 87.2% vs. 64.7%,
respectively).
Conclusions: The E2V/DNG COC was associated with higher
rates of continuation, bleeding profile acceptability and user satisfaction than POP use and may be an alternative option for
women who are dissatisfied with their current COC.
A-143
Contraception in Russia
V.N. Prilepskaya, N.M. Nazarova, E.A. Mezhevitinova
and Y.S Khlebkova
Research Center for Obstetrics,Gynaecology and Perinatology,
Moscow, Russia
The problem of abortions and contraception in Russia is very
topical because of the high incidence of abortions and low
contraceptive use. The number of abortions according to the
latest data in 2014 was 814,162, among youth it was 9085.
Russia takes one of the first places in the Europe using ineffective contraceptive methods (interrupted intercourse, calendar
method). The dynamics of the use of hormonal contraceptive
methods throughout the years has been positive, along with
an annual decrease in the number of abortions and their complications. For example, hormonal contraception was used:
in 2005 – 94.0; in 2008 – 108.1; in 2010 – 125.5; 2013 – 126.5;
2014 – 127.6; intrauterine, respectively, 136.8; 131.4; 127.9;
121.1; 115.1 (index for 1000 women of childbearing age).
According to the data of the Ministry of Healthcare of the
Russian Federation, as a result of the development and introduction of new contraceptives in the past five years
(2010–2015) the appointment of hormonal contraceptive methods for therapeutic purposes has increased significantly: 28% for
PMS, 25% for dysmenorrhea, 19% for endometriosis, and 17%
for hyperandrogenia.
Emergency contraception is an important method in reducing
the number of unplanned pregnancies and abortions in Russia.
Emergency contraception is very popular in our country especially the drug containing 1.5 mg levonorgestrel (Eskapel,
‘Gedeon Richter’). Every year 15% of women in Russia use emergency contraception. As shown by the results of our study, in
our country consultation was one of the main factors in choosing a contraceptive method by patients [The role of contraceptive choice among counsel women (‘CHOICE’ in Russia, 2012].
The detail of consulting changes the final decision of the
patients and increases the acceptability of contraception.
Analysing the stages of introduction of contraception in Russia,
it should be noted that it is becoming part of the policy of
reproductive health care and population policies in general, in
particular through the creation of the new health centres and
the education of teenagers, improving education of doctors in
the field of contraception and reproductive health care.
107
A-144
The effectiveness and acceptability of
prolonged implantation of
contraception
Elena Mejevitinova, Patimat Abakarova,
Vera Prilepskaya and Elena Tsalagova
Federal State Budget Institution ‘Research Center for Obstetrics,
Gynecology and Perinatology’ Ministry of Healthcare of the
Objective: To assess the contraceptive effectiveness and acceptability of prolonged subcutaneous contraceptive that contains
68 mg of etonogestrel (Implanon NCTSV) in women of reproductive age.
Methods: The observation of 48 women aged 19–45 years
(mean age 28.0 ± 1.7 years) who need effective long-term
contraception that meet all the criteria for inclusion and exclusion. Inclusion criteria: reproductive age, the interest in reliable
contraception, the absence of contraindications to progestin
contraception. Exclusion criteria: contraindications to the use of
progestin hormonal contraception medical eligibility criteria the
WHO (2009); pregnancy or suspected pregnancy; the use of hormonal contraception within the last three months, uterine
bleeding of unclear etiology; use of physical examination, clinical, laboratory, statistical and instrumental methods of examination. The observation period is one year.
Results: During the whole observation period in any patient
not registered with a pregnancy. Complication during insertion
of the implant in the form of haematoma was observed in 1
(2.1%) women. The most common adverse events were changes
in the nature of vaginal bleeding. By the end of the first year of
using the implant in 11 (22.9%) women was observed amenorrhea, in 17 (35.4%) experienced occasional spotting, frequent
bleeding – 10 (20.8%), prolonged spotting in 10 (20.8%). The
weight gain on average 2 kg was observed in two (4.2%)
women. Five women (10.4%) refused further use of subcutaneous contraceptive during the period of observation, mainly due
to prolonged and frequent bleeding.
Conclusions: Subcutaneous hormonal implant Implanon NCTSV
is an effective and acceptable contraceptive. The most common
adverse reactions when using prolonged subcutaneous implant
Implanon NCTSV are changes in the nature of bleeding,
frequency, and duration correlated with the duration of use
of contraceptive. The contraceptive implant acceptability is
enhanced through counselling prior to prescription of
contraceptive.
R
R
R
A-145
The impact of contraceptive
counselling in the prescription of
combined hormonal contraceptives
E. Said Plascencia-Nietoa, Josefina Lira-Plascenciab,
Roberto Gonzalez Habibc,
Cuauhtemoc Celis-Gonzalezd,
Rodrigo Guarneros-Valdovinosb and
Alejandro Rosas-Balamb
a
Instituto Politecnico Nacional, Mexico City, Mexico; bInstituto
Nacional de Perinatologıa, Mexico City, Mexico; cHospital Christus
Muguerza, Monterrey, Mexico; dHospital de Ginecologia y
Obtetricia N 4 IMSS, Mexico City, Mexico
Objectives: To prove the importance of systematic counselling
based on the individual needs of women in contraceptive
choice.
108
Methods: A multicentre trial that included 1226 women who
received contraceptive counselling regarding the pill, the vaginal ring, and the contraceptive patch. The following indicators
were evaluated before and after counselling: Contraceptive
choice, intention and reasons for choice. Exploratory data analysis was performed, and before and after answers were compared with McNemar’s test.
Results: The choice of oral contraceptive before and after counselling was 40.9 and 35.5% respectively (p < 0.001); for the
contraceptive ring, 9.8 and 25.9% (p < 0.001); for the contraceptive patch, 24.3 and 24.1% (p > 0.80). The intended choice
before and after counselling was, for the oral contraceptive,
51.6 and 35.5% (p < 0.001); for the contraceptive patch, 45.8
and 24.1% (p < 0.001); for the contraceptive ring, 18.8 and
25.9% (p < 0.001). Reasons for choosing the contraceptive ring
were: ease of use, monthly change, and discretion.
Conclusions: Women change their contraceptive choice once
they have been counselled, preferring an easy, monthly
changed, and discrete method.
A-146
Are hormonal components of oral
contraceptives associated with
impaired female sexual function? A
questionnaire-based online survey of
medical students in Germany,
Austria, and Switzerland
a
b
Christian Wallwiener , Lisa-Maria Wallwiener ,
€nfischa, Alfred Muecka,
Harald Seegera, Birgitt Scho
c
Johannes Bitzer , Stephan Zipfeld, Sara Bruckera,
Florin-Andrei Tarana and Markus Wallwienere
a
Department of Women’s Health, University of T€ubingen,
T€
ubingen, Germany; bDepartment of Obstetrics and Gynaecology,
Ludwig Maximilian University of Munich, Munich, Germany;
c
Department of Obstetrics and Gynaecology, University of Basel,
Basel, Switzerland; dDepartment of Psychosomatic Medicine and
Psychotherapy, University of T€ubingen, T€ubingen, Germany;
e
Department of Obstetrics and Gynaecology, University of
Heidelberg, Heidelberg, Germany
Objectives: To investigate in a large cohort of young university
women whether different progestins and different ethinyl estradiol (EE) dosages in oral hormonal contraceptives (OHCs)
adversely affect sexual function.
Methods: Female medical students from German, Austrian, and
Swiss universities (14/1/1) completed an anonymous online
questionnaire comprising the 19 Female Sexual Function Index
(FSFI) questions and 17 additional questions concerning demographics, lifestyle, sexual activity, and contraceptive use. OHCs
were categorized by EE dose ( 20, < 20– 30, and > 30 mg)
and partially androgenic or antiandrogenic progestins. FSFI
scores were analysed by contraceptive method using descriptive
statistics and standard nonparametric tests.
Results: We analysed 2612 questionnaires submitted by
respondents aged 30 years (mean age (SD) 23.5 (2.5) years).
Of 2126 contraceptive users, 1535 (72.2%) used OHCs. Median
FSFI total scores (ranges) were 28.2 (2.0–36.0) for all respondents. Median FSFI was significantly lower in non-users (24.4) versus users (28.7) of contraception (p < 0.001). Stratified analysis
showed that 279/486 (57.4%) respondents were using no contraceptives, 563/1535 (36.7%) were using OHCs, 71/227 (31.3%)
using non-oral hormonal contraceptives, and 96/351 (27.4%)
using non-hormonal contraceptives were at risk for female sexual dysfunction (FSFI total score < 26.55). FSFI scores for the
three EE dosage categories and progestin components did not
differ significantly.
Conclusions: For OHCs, the FSFI score was lower than for other
contraceptives but there was no significant association with EE
dose or progestins, possibly due to small sample sizes. Further
research needs to clarify the role of OHCs in female sexual
function.
A-147
Contraceptive use, births and
abortions in the Nordic countries
Helena Hognerta, Finn Egil Skjeldestadb,
Kristina Gemzell Danielssonc, Oskari Heikinheimod,
Ian Milsome, Ojvind Liedegaardf and Ingela Lindhg
a
Department of Obstetrics & Gynecology, Sahlgrenska University
Hospital, Gothenburg, Sweden; bResearch Group Epidemiology of
Chronic Diseases, Department of Community Medicine, Faculty of
Health Sciences, UiT The Arctic University of Norway, Tromso,
Norway; cDepartment of Women’s and Children’s Health, Division
of Obstetrics and Gynaecology, Karolinska Insitutet/Karolinska
University Hospital, Stockholm, Sweden; dDepartment of
Obstetrics and Gynecology, Helsinki University Hospital, Helsinki,
Finland; eDepartment of Obstetrics & Gynaecology, Sahlgrenska
University Hospital, Gothenburg, Sweden; fDepartment of
Obstetrics & Gynaecology, Faculty of Health Science, University of
Copenhagen, Copenhagen, Denmark; gDepartment of Obstetrics
& Gynecology, Sahlgrenska University Hospital, Gothenburg,
Sweden
Objective: To compare contraceptive use, birth rates and abortion rates in the Nordic countries
Method: National data concerning contraception, abortions and
births were collected from Denmark, Finland, Iceland, Norway
and Sweden (fertile female population 15–49 years, 5,813,937).
Data on prescriptions for hormonal contraceptives and sales figures for copper intrauterine devices (Cu-IUD) were obtained
from national databases and manufacturers for 2008–2013.
Abortion and birth rates were collected from National registries
1975–2013. The prevalence of abortions and births were
reported as the number of births or abortions/1000 women
aged 15–44. Age-specific data on hormonal contraceptives
could be retrieved for Denmark, Norway, and Sweden.
Results: The total usage rates of Cu-IUD’s and hormonal contraceptives were similar in the Nordic countries, with the highest
rate in Denmark and lowest in Iceland, but the distribution of
different hormonal methods varied between countries and
between different age groups. Denmark had the highest use of
combined oral contraceptives (COCs) and Sweden the highest
use of progestogen-only pills (POP) and Cu-IUDs, while Finland
had the highest use of the levonorgestrel-releasing intrauterine
system (LNG-IUS). Combined hormonal contraceptive (CHC) use
was more common among 15–34 years olds and the LNG-IUS
among the 35–44-year-old women in all countries. Denmark
had the highest contraceptive use in all age groups except
among 40–44-year-old women. Sweden and Norway had similar
rates in all age groups apart from 20–24-year-olds, where
Sweden had lower use. In Sweden the highest abortion rate
was recorded in this age group. Birth rates have been stable in
Finland, Norway and Sweden while it has declined in Denmark
from 70 to 53/1000 women a year. Iceland’s birth rate has
declined from 95 to 65/1000 women, but is still the highest in
the Nordic countries. The abortion rates have declined during
1975–2013 in Denmark (from 27 to 15/1000) and Finland (from
20 to 10/1000), but remained stable in Norway (17 to 15/1000)
and Sweden (20/1000), and increased in Iceland (from 6 to
15/1000).
Conclusions: Contraceptive use was highest in Denmark and
Sweden. CHC followed by the LNG-IUS were the most common
methods. Finland had the lowest abortion rate and Sweden the
highest. The birth rate was highest in Iceland and lowest in
Denmark. There were small variations in total contraceptive use
ACCEPTED ABSTRACTS – HORMONAL CONTRACEPTION
and the differences in abortion rates cannot be explained by
total user rates. The distribution of methods and user rates varied between age groups and countries, where Sweden had a
lower contraceptive use and a higher abortion rate among
20–24-year-olds.
A-148
Evaluation of functional ovarian
reserve after surgical intervention on
ovaries
Maria Kazhyna, Irina Yagovdik and Olga Titko
Womens’ Health Care Clinic, Grodno, Belarus
Objectives: Surgical intervention on ovaries influences on the
ovarian reserve (OR) as well as reproductive potentiality.
Surgical treatment of functional ovarian cysts, vaporisation of
ovaries, adnexectomy could decrease the ovarian reserve and
cause infertility.[1,2]
Methods: We examined OR in females planning pregnancy
(n ¼ 189), who were undergoing surgical treatment on ovaries
(resection, one-side adnexectomy). Age of patients: 30–40 years
old. Patients in the examined group were indicated to use combined oral contraceptives (COC) within 9–12 months after surgery as rehabilitation of reproductive function (n ¼ 102). Patients
in the control group didn’t take COCs (n ¼ 87). The evaluation
of OR was fulfilled according to evidence-based standards:
examining of anti-Mullerian hormone in blood; quantity and
determination of antral follicules’ diameter using ultrasound
examination; transvaginal ultrasound evaluation of ovarian
volume.[3]
Results: Application of COCs does not lead to persistent, statistically significant decreasing of anti-Mullerian hormone level in
blood. We didn’t register the decreasing effect of small antral
follicules (less than 6 mm) quantity in examining group. The OR
in compared groups did not significantly vary. The study proved
the absence of suppressive influence of COCs on functional
reserve of ovaries.[4]
Conclusion: Using COCs leads to preservation of female fertility
after surgical treatment. Suspense of cyclic ovarian work
decreases the intensity of oocytes lost within the period of hormonal treatment.[4] At the same time the braking of ovulation
excludes the traumatisation of cortex and ovarian tissues during
egg exit. It is important that COCs prevent the recurrence of
functional cysts by suppression of hormonal peaks in the hypothalamic-pituitary-ovarian system.
References
[1]
[2]
[3]
[4]
109
Objectives: To describe the changes in endometrial growth and
structure under the influence of progestin-only contraceptives
that may lead in some of its users to a subsequential endometrial spotting, prolonged or irregular bleeding.
Method: A literature review.
Results: The uterine lining of reproductive-age women, the
endometrium, has a single layer of columnar epithelium resting
on a layer of connective tissue known as stroma. Stromal tissue
is traversed from the surface to the basal layer by the uterine
glands and blood supply structures, the spiral arteries. Two
layers, known as basal and functional, can be normally distinguished in the endometrium, the functional layer being the one
that is shed during menstruation. Menstruation is determined
by the orderly sequential liberation of the ovarian sex hormones, during the ovulatory process. Described as an ‘inflammatory process’ that includes the presence of leukocyte types
and immune cells (uterine natural killer cells, macrophages,
mast cells, neutrophils, dendritic cells and Tregs), a range of different inflammatory mediators, proteolytic enzymes, eicosanoids,
and growing factors (tissue and vascular). Since its inception,
hormonal contraceptive have disrupted this process by completely or partially blocking the ‘hypothalamus-pituitary-ovary’
axis in its users, and also by mainly altering the order of the
exogenous ‘ovary-like’ hormones that are used, estrogens and
progestins. Intent to keep the natural ‘estrogen-progesterone’
sequence was made with the ‘sequential’ contraceptive cycles
that are no longer in use. Then, it should be no surprise that
the endometrium under the influence of the presently used
contraceptive regimens, combined or progestogen only, whose
circulating hormone levels differ in order of magnitudes and in
its sequence with the natural cycle, should grow differently
than the physiological endometrium of the ‘menstrual cycle’,
since the endometrial morphology is altered. This is even more
different with the progestin-only regimens, giving a completely
different structure to the endometrium layers and its vasculature. This is to say, different cellular structure arrangement
because of a different balance of growing factors and also a
range of disturbances in endometrial immune cell numbers, distributions and functions. Endothelial growth factors are also differentially affected by the different exogenous hormones
resulting in spotting, leaking and fragile blood vessels because
of its different layer conformation.
Conclusions: Bleeding disturbances in hormonal contraceptive
users are something that should be expected because of the
effect of the exogenous hormones on the endometrial growth
and its vasculature, and the inconsistency of a complete blockage of the follicle growth.
A-150
Effect of oral contraceptive for postabortion care in China: a systematic
review
Yan Chea, Xiaoting Liub, Bin Zhangb and
Linan Chenga
a
A-149
Physiopathology of endometrial
bleeding disturbances in progestin
only contraceptives users
Pablo Lavina, Alejandra Lavina, Pablo A. Lavin Bb
and Carmen Bravoa
a
SIAPMED – Universidad de Chile, Santiago, Chile; bSIAPMED –
Universidad Pedro de Valdivia, Santiago, Chile
Shanghai Institute of Planned Parenthood Research, WHO
Collaborating Centre for Research in Human Reproduction,
Shanghai, China; bLibrary & Institute of Medical Information,CAMS
& PUMC, Beijing, China
Objective: In the lack of evidence consistently supporting the
effect of oral contraceptives (OC) for post abortion care, we performed this systematic review and meta-analysis to examine the
effect of OC post abortion on duration and volume of vaginal
bleeding, menstruation recovery time, endometrial thickness,
associated complications and recurrence of unintended
pregnancy.
Methods: We have searched eight major authorised Chinese
and English databases from January 1960 to November 2014.
Relevant research literatures were retrieved concerning OC use
110
post medical or surgical abortion. In this review we included
Chinese randomised clinical trials (RCTs) and divided them into
three groups (OC post-medical abortion [Group 1], OC post-surgical abortion [Group 2] or OC þ uterotonic post-surgical abortion [Group 3]). Jadad scale was adopted to assess the quality
of the RCTs. Two independent authors screened titles and
abstracts, selected relevant studies and extracted data. Metaanalysis was performed using RevMan 5.3.5 software. A significance level of a ¼ .05 was used for the statistical tests.
Results: A total of 119 studies were included in this review: 10
studies in Group 1 included 1712 participants; 31 studies in
Group 2 included 8788 participants; and 78 studies in Group 3
included 19,707 participants. Meta-analysis demonstrated that
OC significantly reduced the duration and volume of vaginal
bleeding and the duration of menstrual recovery in Group 1
(MD = 3.1, 95%CI [4.68, 1.51]; MD = 18.09, 95% CI
[34.04, 2.13] and MD = 7.97 95% CI [9.28, 6.67] respectively), Group 2 (MD = 2.46, 95% CI[2.90, 2.02]; MD
= 11.54, 95% CI [18.67, 4.40] and MD = 8.50, 95% CI
[9.66, 7.34] respectively) and Group 3 (MD = 2.37, 95% CI
[2.70, 2.05]; MD = 20.80, 95% CI [25.24, 16.35] and MD
= 7.62, 95% CI [8.49, 6.74] respectively). Moreover, endometrial thickness was significantly more favourable for OC users
2–3 weeks after abortion in Group 2 or 3. OC users were also
significantly less likely to have PID, intrauterine or cervical adhesion, amenorrhea and unintended pregnancy again in Group 2
or 3. Funnel plots were used to demonstrate the possibility of
publication bias.
Conclusion: Use of OC immediately after abortion may reduce
the duration and volume of vaginal bleeding, shorten the duration of next menstruation, increase endometrial thickness 2–3
weeks after abortion, and reduce risks of complications and
unintended pregnancies again. However, more studies with
large sample sizes are demanded to confirm these conclusions
due to limitation of the quantity of and quality of included
studies.
INTRAUTERINE CONTRACEPTION
by these women were (in order): Condom, pill, no contraception, contraceptive patch, vaginal ring and change of IUD. Upon
attending the clinic 51% of the women said they had limited
information about IUD, 36% had sufficient information and 13%
said they had no information. When asked their reasons for
selecting IUD, 57% stated convenience, 14% to avoid using hormonal methods, 14% were recommended IUD by their doctor,
11% stated they were not satisfied with their current form of
contraception and 4% wanted to try something new. These
women also stated that IUD provides greater health monitoring
through regular health checks, that is it an ideal method for this
age (46 years old) and overall they consider it to be safer than
other forms of contraception. Furthermore, 80% stated that IUD
is beneficial for their health.
Conclusions: Frequently people who present themselves at clinics seeking contraception state misguided information on certain aspects of these methods. In this regard, it is important to
provide the information needed to make a clear decision. The
experiences of the women should be reviewed periodically.
A-152
Interim six month report for a
prospective, randomised, single
blind, two arms controlled study to
confirm the safety and verify
performance of the IUBTM SCu300A
spherical copper intrauterine device
ball in comparison to TCu380 IUD
intra-uterine contraceptive device
ilan Barama and Amos Berb
a
Community Women’s clinic, Modiin, Israel; bMaccabi health
services, Tel Aviv, Israel
A-151
Election of IUD as a contraception
method
Marıa Joaquina Durana, Javier Valdesa,
Patricia Velazqueza, Ana Sanchoa,
n Meraa and
s Sanchezb, Concepcio
Marıa Jesu
a
Marıa Jos
e Di
eguez
a
Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra,
Spain; bCentro de Salud de Monteporreiro, Pontevedra, Spain
Introduction: The IUD is designed for women wishing to avoid
unwanted pregnancies. It is suitable for women that are unable
to use hormonal contraception. It is unsuitable for women with
unidentified gynaecological problems. The most important criteria in the efectiveness of the IUD is sexual behaviour.
Objectives: In the face of increasing demand for IUDs, our
objective was to find out which factors had an impact in its
selection as a contraceptive method.
Methods: Restrospective research study. At our family planning
centre and over a period of six months we selected through
random sampling 56 women who came seeking an IUD implant.
They were aged between 19 and 47 with an average of 34
years and we used a questionnaire to source the data for our
findings.Before receiving the IUD implant, a clinical history
review, a gynaecological examination and a hysterometry were
carried out on the women.
Results: The women first heard of IUD as a form of contraception through family and friends (48%), health professionals
(43%), magazines and newspapers (7%) and via the internet
(2%). Prior to the IUD insertion the contraceptive methods used
Objective: To evaluate the safety, efficacy and quality of life of
the IUBTM SCu300A, a spherical copper intrauterine device compared to a T-shaped copper IUD.
Method: A prospective, randomised, single blind, two arms,
controlled, multi-centre study. A total of 362 subjects aged
18–45 (mean ¼ 33) were enrolled in 12 centres throughout
Romania and Bulgaria, randomised and underwent insertion of
the study device IUB or the control IUD. No major protocol
deviation is known. Of the total number of subjects enrolled
240 (66.3%) were assigned the IUBTM SCu300A and 122 (33.7%)
were assigned a TCu380A T-shaped copper IUD. Recruitment
was initiated in June 2014 and the last patient was enrolled on
January 2015. No statistically significant differences were
observed between the study arms regarding age, height,
weight, BMI, marital status, prior pregnancies and prior contraceptive use.
Results: A total of three pregnancies in the IUBTM arm and one
in the TCu380A arm were recorded, reflecting a pregnancy rate
of 1.25% & 0.83% (95%CI 0.26%;3.61% & 0.02%;4.52%) respectively. Expulsion rate of 5.4% (13 out of 240) for the IUB and
0.8% (1 out of 122) for the T IUD were noted. No perforations
were recorded in either arm. Measured blood markers were
found comparable.
Bleeding, pain and cramping parameters were found to be overall superior in the IUBTM arm with a trend of improvement into
the four-month visit. Pain and cramping scores were statistically
significant with 2.3 & 2.9 (p ¼ 0.002) at the one-month follow up
and 1.9 & 2.4 (p ¼ 0.010) at the four-month follow-up for the
IUBTM and TCu380A respectively. Graphical renderings of days of
menstruation, bleeding amount and menstruation description
demonstrate overall superiority of the IUBTM compared to the
TCu300A although not statistically significant (p > 0.05).
Subject satisfaction was higher in the IUBTM arm both at one
ACCEPTED ABSTRACTS – INTRAUTERINE CONTRACEPTION
month (2.4 vs. 2.8; p ¼ 0.127) and at four months (2.1 vs. 2.5;
p ¼ 0.107). At four months user recommendation to an acquaintance scoring were higher in the IUBTM arm (2.4 vs. 2.8; p ¼ 0.127).
Conclusions: The initial months of IUD use are usually related
to negative user quality of life experiences. This data demonstrates improved user quality of life parameters such as bleeding, pain and cramping compared to the TCu380A with
comparable efficacy rates. Higher IUBTM expulsion rates were
observed. The recent addition of larger and stiffer IUBTM variants
can be expected to further reduce expulsion rates. Further
studies are planned.
A-153
Predictors of levonorgestrel
intrauterine device early expulsion
Sara Tato Varelaa, Ma Nieves Gaitan Quinteroa,
Maria Antonia Obiol Sainzb, Jose C. Quılez Condec,
Roberto Lertxundid and behalf of the Spanish
Society of on Contraception
University Hospital Virgen Macarena, Sevilla, Spain; bCSSR
Fuente de San Luis, Valencia, Spain; cHospital Universitario de
Basurto, Bilbao, Spain; dClinica Euskalduna, Bilbao, Spain
111
(5.3%), irregular menstrual bleeding (20%), severe endometriosis
(8%) and contraceptive/substitute hormonal therapy (4.7%), with
no specific indication being associated with a higher risk of an
early expulsion.
Without a significant difference existing, it was apparent that
women with early expulsion had a bigger hysterometry
(8.7 ± 3.02 cm) when compared with the control group (7.2 ± 1.6
cm). Insertions were considered mostly easy (85.3%), and difficult insertions were practically the same in both groups (14.3%
in the early expulsion group and 14.7% in the control group). A
significant correlation was found with doctor expertise, with
71.4% of the expulsed LNG-IUDs and only 41.2% of the control
LNG-IUDs being inserted by residents (p < 0.05). There was no
correlation between expulsion and having had a previous IUD
or uterus position.
Conclusions: LNG-IUDs have become a great tool in the treatment of dysfunctional uterine haemorrhages. Although many
studies prove that the IUD is a safe alternative in young and
nulliparous women, our data suggests that patients without
children should be informed of the higher risk of early LNG-IUD
expulsion. University-associated hospitals should also be aware
that, although the LNG-IUDs have an easy insertion device, residents can raise, especially at first, the rate of expulsion.
a
Objectives: To evaluate the impact of certain factors such as
parity, uterine position, benign gynaecological pathology and
doctor’s experience in the Levonorgestrel Intrauterine Device
(LNG-IUD) early expulsion rate (first month after insertion).
Method: We conducted a retrospective evaluation of 150 LNGIUD insertions between 2014 and 2015. Medical records from
both the insertion appointment and first revision (one month
afterwards) were retrieved. The collected data included age, parity (vaginal birth or caesarean), previous intrauterine device,
cause for LNG-IUD insertion, hysterometry, uterus position, difficulty of insertion, doctor’s experience (senior or resident) and
first revision outcome. A bivariate analysis was performed.
Results: Median age of our sample was 41.22 ± 5.39 years. Early
expulsion rate was low, occurring in only 9.3% of the patients.
Nulliparity was positively correlated with early expulsion (28.6%
in the expulsion group compared with 5.9% in the control
group, p < 0.05) whereas no correlation was found when previous deliveries were via c-section (14.3% in the expulsion group
and 15.3% in the control group).
LNG-IUD indications varied between idiopathic heavy menstrual
bleeding (62%), presence of a symptomatic submucous myoma
A-154
Use of Jaydess Intrauterine system in
Contraception and Sexual Health
service (CASH)
Elena Valarche, Rita Browne and Rajah Thamby
Whittington Hospital, London, UK
Background: Intrauterine contraception was available as either a
copper intrauterine device (Cu-IUD) or the levonorgestrel intrauterine system (LNG-IUS) until April 2014, when JaydessV (Bayer
plc.) was launched onto the UK market. Jaydess is designed to
administer levonorgestrel into the uterine cavity at a lower daily
dose than Mirena. It is known as SkylaV in the USA where it has
been licensed since 2013. Jaydess will not replace Mirena but
will instead afford women greater contraceptive choice.
Objectives: In Haringey (Whittington Health) CASH service it
became available from the end of 2014. Retrospective audit
conducted to evaluate the indications for using Jaydess intrauterine system (IUS) in a Contraception and Sexual Health
(CASH) and compliance with standards for insertion. Audit
R
R
112
period: 1 January 2015 to 30 September 2015 (8 months).
Clinical practice was audited against criteria for intra-uterine
procedures based on National Institute of Clinical Excellence
(NICE) and Faculty of Sexual and Reproductive Healthcare
(FSRH) recommendations. We expected all standards to be
achieved 100% (follow up 90%)
Method: Data analysis using Excel of electronic patient records
from all patients with Jaydess IUS inserted in CASH between 1
January 2015 and 30 September 2015.
Results:
1.
2.
3.
4.
5.
6.
7.
8.
9.
39 patients had Jaydess inserted;
Median age: 31 years;48% nulliparous;
No complications at insertion;
15% patients postnatal;
48% Caucasian;
Commonest reason for choosing Jaydess: lighter
periods;
3/39 device removed: two due to acne, one due to
irregular vaginal bleeding;
46% patients returned to clinic for review. Telephone
enquiries increased follow-up to 85%;
Only 77% had assistant present despite FSRH
recommendation.
Conclusions: Jaydess was used following FSRH and NICE guidelines, except for having an assistant present. Jaydess proved an
acceptable LARC method for women wishing to have lighter
periods and offered women greater contraceptive choice. 54%
did not attend for follow-up. FSRH guidance now recommends
women return only if they develop symptoms. The clinical team
thus designed a patient information leaflet for patients and
stopped routine follow-up.
We undertook this project to evaluate the use of
insertion of IUC. [Auditable standard 97%]
(3) An appropriately trained assistant should be present during
insertion of IUC. [Auditable standard 97%]
Methods: The Lillie electronic patient record system was used
to collate the data of all patients who attended the St Helens
sexual health clinic for intrauterine contraceptive insertion
between 15 January and 15 February 2015. In total 33 patient
records were found, however three patients were excluded due
a last minute change in mind of coil insertion therefore 30
patients in total were analysed. A Microsoft Excel spreadsheet
was constructed in which the following was recorded by the
authors: age, prior method of contraception, type of intrauterine
device, offer of an STI test prior to insertion, bimanual/pelvic
assessment performed before insertion and presence of a
trained assistant at insertion.
Results: The age range of the patients was 15–48 years and the
most common form of prior contraceptive method was a condom. Overall, 90% of women had the copper (IUD) inserted and
30% had the Mirena coil (IUS) inserted.
Audit Standard 1: 83% of women requesting intrauterine contraception were offered a sexually transmitted infection screening.
Audit Standard 2: 100% of women had a pelvic assessment
either by bimanual examination or ultrasound scan before insertion of IUC.
Audit Standard 3: 80% of women had an appropriately trained
assistant present during insertion of IUC.
Conclusions: Audit standard 2 was met with a figure of 100%,
however, audit standard 1 and 3 were not met. Though audit
standards 1 and 3 reached 80% and beyond, improvements are
still needed in these areas to meet the auditable standards of
97%. The following recommendations were made to improve
standards.
1.
2.
3.
Update trust guidelines to include the three auditable
standards as recommendations.
Reminders to encourage all responsible personnel to
offer an STI screen (via poster format or having a pop
up on the Lille medical records system).
Encouraging and offering more staff training for intrauterine contraceptive insertion.
A-156
Audit of retrieval of intrauterine
contraceptive devices/systems where
the threads are not visible
Karin Piegsa
A-155
Sexual Health NHS Fife, Kirkcaldy, Fife, Scotland, UK
An audit reviewing Intrauterine
contraceptive fitting at a community
contraceptive clinic
Objectives: To assess the feasibility and patient experience of
outpatient-based removal of intrauterinedevices/methods with
non-visible threads.
Method: The audit included over 100 consecutive women presenting to a Community Sexual Health Service for removal or
change of an intrauterine contraceptive device/system with
non-visible threads. The following parameters were looked at:
patient demographic data (age, parity, mode of delivery),
whether a pelvic ultrasound was arranged prior to removal
attempt, need for local anaesthesia and/or cervical dilation,
removal technique, removal success rates, ease of removal procedure, pain scores, retrospective perception of discomfort
experienced during removal, and immediate post-procedure
complications.
Results: Over 95% of intrauterine devices/methods with nonvisible threads were successfully removed without significant
difficulties. A considerable proportion of women underwent
the removal procedure without prior pelvic ultrasound to
Dawn Friday, Nurul Annuar and Sally-Ann Botchey
St Helens and Knowsley Teaching Hospitals, Merseyside, UK
Objectives: To ensure that contraceptive fitting at a community
sexual health clinic meets the auditable standards suggested by
the FSRH clinical standards committee.
Standards (FSRH clinical standards committee auditable outcomes)
(1) The proportion of sexually active women offered sexually
transmitted infection screening requesting intrauterine contraception (IUC). [Auditable standard 97%]
(2) The proportion of women who had a pelvic assessment
either by bimanual examination or ultrasound scan before
determine that intrauterine method still in utero. Virtually all of
these removal attempts were successful. The majority of
women did not chose or require local anaesthetic and/or cervical dilation. When asked retrospectively the majority of
women felt that the discomfort experienced during the procedure had been acceptable, and that local anaesthesia was
not needed. There was no significant correlation between age,
parity, mode of delivery and pain scores, requirements for
local anasthesia, and ease of procedure. The majority of ‘lost
thread’ removals were straightforward. Post-procedure recovery
was uneventful in all women. There were no perforations and
no serious complications.
Conclusions: Outpatient-based removal of intrauterine devices/
systems is feasible and well tolerated by women.
A-157
Survey of gynaecologists’ attitudes
and beliefs on the use of intrauterine device in the French-speaking
part of Switzerland
Ya€
el Zimmermannb and Michal Yarona
a
Geneva University Hospitals, Geneva, GE, Switzerland; bGeneva
Faculty of Medecine, Geneva, GE, Switzerland
Objective: To investigate and evaluate beliefs, barriers and benefits concerning intra-uterine device (IUD) use amongst Swiss
Romande gynaecologists. Knowledge of the World Health
Organization Medical Eligibility Criteria for contraceptive use
was reported.
Method: The available Global Survey questionnaire investigating
IUD use was modified and adapted to the French part of
Switzerland. An anonymous online link to a MonkeySurveyO
questionnaire was sent to 750 gynaecologists practicing in private and public sectors. Prevalence and participant’s practices
around IUD use are reported.
Result: Out of the 750 targeted gynaecologists, 156 (21%)
responded to the on-line questionnaire. Most responders (87.8%)
were trained in Switzerland and practiced in private clinics
(53.9%). Most participants (93.6%) offered IUD to their patients.
Among them, 58.7% recommend frequently (25%) to multiparous but rarely (<25%) to nulliparous women. Less than 10% offer
an IUD to all women and 29.4% do not recommend IUD at all.
Female gynaecologists prescribe IUD the most. The proportion of
frequent IUD use is much higher in multiparous (68.5%) than in
nulliparous women (11.9%) (p < 0.0001). Most of the commonly
mentioned benefits of IUD use were considered as important or
very important by >70% of gynaecologists. Benefits such as
emergency contraception or cancer risk reductions were of less
importance. Important or very important perceived benefits by
the gynaecologists seem to increase the probability of frequent
IUD use. The most notable perceived barriers to IUD use in nulliparous women were preoccupations linked to painful insertion
(61.5%), difficulty of insertion (50%), sexual context (37.8%), and
PIDs (33.3%). The five most identified perceived benefits of IUD
use in nulliparous women were: compliance (95.6%), efficiency
(94.9%), long-term contraception (94.2%), freedom for the
woman (92.0%) and appreciation by women (90.5%). Only 52%
of gynaecologists correctly recognised the WHO MEC 2 category
for IUD use in nulliparous women.
Conclusion: Most surveyed gynaecologists recommend IUD to
their patients. Most benefits of IUD use were perceived as
important or very important and were positively associated with
frequent IUD use. Most barriers were positively associated with
frequent use in multiparous in contrast to nulliparous women.
This survey provided a valuable insight on gynaecologists’ perception of IUD use in Swiss Romande. Additional evidencebased information might help minimise attitude discrepancies
in treating nulliparous versus multiparous women.
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A-158
Attitudes and knowledge of
Argentinian Ob-Gyns regarding
intrauterine contraception for
nulliparous women
Luis Bahamondesa, Josefina Lira-Plascenciab and
Victor Marin-Cantuc
a
CEMICAMP, Campinas SP, Brazil; bHospital Angeles del Pedregal,
Mexico DF, Mexico; cBayer de Mexico, Mexico DF, Mexico
Objective: To assess attitudes and knowledge about intrauterine contraceptives (IUC) for nulligravida women among 100 ObGyns in Argentina.
Methods: A survey was conducted online and answers from
100 Argentinian Ob-Gyns were analysed
Results: A total of 60, 16 and 24 had private, public practice
and a different practice, respectively and attendance from 20 to
200 patients regarding contraception/day. When asked about
length of experience, 24%, 36% and 40% had 1–10 years;
11–20% and more than 20 years, respectively. Ninety per cent
of them inserted IUC by themselves as well as trained and
supervised the insertion by other HCPs. About the number of
insertion of IUC/month, 69%, 22% and 5% inserted 1–5; 6–10
and 11–15, respectively. When asked about main drivers of IUC,
the responses were: convenient, long-term contraception, costeffective and high efficacy. When asked about barriers to use
IUC, the Ob-Gyns reported that nulliparity, PID and cost were
the more frequent concerns. When asked about barriers to use
IUC in nulliparous, the interviewed reported that PID, difficulty
for insertion and infertility were the more frequent concerns.
When asked about the insertion of IUC in nulliparous, 70%
accept to do it and 30% never do it. Only 10% of the Ob-Gyns
considered IUC when counselling about contraception to
nulliparous < 18 years old and 28% in nulliparous between 18
and 29 years old. When a nulliparous woman asked for an AIU,
only 17% of the participants placed in < 18 years old and 43%
in 18–29 years old. 90% considered the efficacy of AIU in nulliparous is the same than in parous women, 8% a little less in
nulliparous and 2% much less in nulliparous. Overall, 6% considered the risk of PID much higher and 59% a little higher in nulliparous than in parous and 76% considered it a little bit more
difficult and 15% much more difficult to insert an IUC in nulliparous. 75% considered a little more pain and 16% much
more pain when inserting an IUC in nulliparous vs. parous
women. 54% knew the correct category of use of IUC among
nulliparous according to the MEC of WHO (benefits outweigh
risks), 11% considered a MEC 3 and 0% a MEC 4
(contraindicated).
Conclusion: Misperceptions regarding IUC for nulligravida
women are widespread in Argentina, even between Ob-Gyns.
A-159
Attitudes and knowledge of Brazilian
Ob-Gyns regarding intrauterine
contraception for nulliparous women
Luis Bahamondesa, Josefina Lira-Plascenciab and
Victor Marin-Cantuc
a
CEMICAMP, Campinas, SP, Brazil; bHospital Angeles del Pedregal,
Mexico, DF, Mexico; cBayer Latinoamerica, Mexico, DF, Mexico
Objective: To assess attitudes and knowledge about intrauterine contraceptives (IUC) for nulligravida women among 100 ObGyns in Brazil.
114
100 Brazilian Ob-Gyns were analysed.
Results: 87, 10 and 3 had private practice, public practice and a
different practice, respectively. and attendance of from 20 to
200 patients regarding contraception/day. When asked about
time of experience, 28%, 33% and 39% had 1–10 years; 11–20%
and more than 20 years, respectively. Some 86% of them
inserted IUC by themselves and 9% trained and supervised the
insertion by other HCPs as well. About the number of insertion
of IUC/month, 71%, 19% and 5% inserted 1–5; 6–10 and 11–15,
respectively. When asked about main drivers of IUC, the
responses were: long-term contraception, efficacy and additional
benefits in menstrual cycle. When asked about barriers to use
IUC, the Ob-Gyns reported that PID, nulliparity and cost were
the more frequent concerns. When asked about barriers to use
IUC in nulliparous, the interviewed reported that PID, difficulty
for insertion and infertility were the more frequent concerns.
When asked about the insertion of IUC in nulliparous, 79%
accept to do it and 21% never do it. Only 11% of the Ob-Gyns
considered IUC when counselling about contraception to nulliparous <18 years old and 47% in nulliparous between 18–29
years old. When a nulliparous woman asked for an AIU, only
15% of the participants placed in < 18 years old and 58% in
18–29 years old. Overall, 91% considered the efficacy of AIU in
nulliparous is the same as in parous women, 6% a little less in
nulliparous and 3% a little better in nulliparous. 8% considered
the risk of PID much higher and 66% a little higher in nulliparous than in parous. A total of 74% considered a little bit more
difficult and 16% much more difficult to insert an IUC in nulliparous. 64% considered a little more pain and 13% much
more pain when inserting an IUC in nulliparous vs. parous
women. 73% knew the correct category of use of IUC among
nulliparous according to the MEC of WHO (benefits outweigh
risks), 8% considered a MEC 3 and 2% a MEC 4
(contraindicated).
women are widespread in Brazil, even between Ob-Gyns.
A-160
Attitudes and knowledge of Mexican
ob-gyns regarding intrauterine
contraception for nulliparous women
Fernando Duarte-Carona, Josefina Lira-Plascenciab,
Victor Marin-Cantuc and Luis Bahamondesd
a
Bayer Latinoamerica, Whippany, New Jersey, USA; bHospital
Angeles del Pedregal, Mexico DF, Mexico; cBayer Latinoamerica,
Mexico, DF, Mexico; dCEMICAMP, Campinas, SP, Brazil
Objective: To assess attitudes and knowledge about intrauterine contraceptives (IUC) for nulligravida women among 100
Ob-Gyns in Mexico.
100 Mexican Ob-Gyns were analysed
Results: 64, 35 and one had office based, hospital-based practice and a different practice, respectively and attendance of
from 20 to 200 patients regarding contraception/day. When
asked about length of experience, 37%, 36% and 27% had
1–10 years; 11–20% and more than 20 years, respectively.
Ninety per cent of them inserted IUC by themselves as well as
trained and supervised the insertion by other HCPs. About the
number of insertion of IUC/month, 58%, 20% and 22%
inserted 1–10; 11–20 and more than 20, respectively. When
asked about main drivers of IUC, the responses were: longterm contraception, high efficacy, cost-effective and convenient. When asked about barriers to use IUC, the Ob-Gyns
reported that pain during insertion, PID and nulliparous
women were the more frequent concerns. When asked about
barriers to use IUC in nulliparous, the interviewed reported
that pain during insertion, PID and infertility were the more
frequent concerns. When asked about the insertion of IUC in
nulliparous, 81% accept to do it and 19% never do it. Only
18% of the Ob-Gyns considered IUC when counselling about
contraception to nulliparous <18 years old and 66% in nulliparous between 18–29 years old. When a nulliparous woman
asked for an AIU, only 32% of the participants placed in < 18
years old and 67% in 18–29 years old. Overall, 64% considered
the efficacy of AIU in nulliparous is the same as in parous
women, 19% a little better in nulliparous and 15% much better in nulliparous. 10% considered the risk of PID much higher
and 58% a little higher in nulliparous than in parous. 47%
considered it a little bit more difficult and 45% similarly difficult to insert an IUC in nulliparous. A total of 62% considered
a little more pain and 12% much more pain when inserting
an IUC in nulliparous vs. parous women. 52% knew the correct
category of use of IUC among nulliparous according to the
MEC of WHO (benefits outweigh risks), 13% considered a MEC
3 and 3% a MEC 4 (contraindicated).
women are widespread in Mexico, even between Ob-Gyns.
A-161
Comparison of one year and ten
years continuation, reason for
discontinuation of IUD insertion in
postplacental/early postpartum
period with interval periods
Gulcihan Akkuzua and Kafiye Eroglub
a
Baskent University Faculty of Health Sciences Nursing
Department, Ankara, Turkey; bKoc University Nursing School,
Istanbul, Turkey
Objective: To compare immediate postplacental (IPP) and early
postpartum (EP) intrauterine device (IUD) insertions with interval
(INT) IUD insertions with respect to continuation, reasons for discontinuation and contraceptive choices between at the end of
10th years and 1st year follow-ups.
Method: This is a retrospective cohort type study. 84 IPP (less
than 10 min), 46 EP (10 min to 72 h) and 138 INT (more than
6 weeks) IUDs inserted women were included at the end of
one-year follow up. From that study group, 10 IPP, 4 EP and
30 INT IUD inserted women (total 44 women) were reached
by telephone at the end of 10 years. Many of the women had
moved or changed their telephone numbers or had a new
number or mobile so the final sample number was low (16%)
and the number and percent were used for the evaluation of
the data.
Results: Most of the women were between 30 and 34 years.
In the IPP group there were four women (40%) and in the EP
group two women (50%) and the highest continuation was up
to three years but in the INT group 12 women (40%) it was
up to 7–10 years. 24 women (54.4%) expressed any problemrelated method at the 10 years and most of them (44, 90.9%)
were satisfied with their IUD. Discontinuation reasons in the
EP group had the highest numbers of pregnancy desire and
partial expulsion (three women) in the IPP group and pregnancy desire (two women) and bleeding (five women) in the
INT group. Counselling was given by telephone interview to
two IPP and six INT group women that IUD should be
removed and continued with another method because they
were still satisfied or did not have any symptoms at the 10
years. Contraceptive choice after the 10 years mostly was condom (four women) in the IPP group and (two women) in the
INT group, IUD – two women in the IPP group and 13 women
in the INT group.
Conclusions: The first cohort type study (2006) in the literature
that compares all of the postnatal copper T (Cu-T) IUD insertions
in regard to complication and failure rates by the researchers.
IPP and EP insertion of the TCu 380A IUD is an effective and
convenient procedure for long-term use. Health professionals
should be more focused on IUD choice for postpartum contraception in antenatal care programmes in the country.
A-162
Missing threads management in an
integrated sexual health clinic
Madhusree Ghosh and Emeka Oloto
Staffordshire and Stoke on Trent Partnership Trust, Leicester,
Leicestershire, UK
Introduction: Lost threads is a common presentation encountered in the contraceptive services. But there is little or no data
in terms of the incidence, the type of intrauterine device more
commonly associated with this complication and probable
cause for such association.
Objectives: The main objective of this service evaluation was to
identify:
(1) The type of device most commonly associated with missing
threads.
(2) The method of removal of the devices with missing threads.
Methods: This was an observational study done in a tertiary
level contraception service, in the UK. Patients who attended
the clinics between July 2014 and June 2015 with missing
threads were included in the assessment.
Results: Ten percent (10%) of women referred to the clinic
with a diagnosis of missing threads had visible threads during
examination. The majority of these women (96.1%) had their
device fitted by a trained personnel, while the rest were fitted
outside the UK. A total of 75% of the devices were Mirena,
9.3% were Nova T, 5.4% were TT380, 2.3% were Multiload,
and the rest were not stated. Overall, 80.5% of cases were
managed in the clinic, while 3 (2.3%) patients were referred to
gynaecology for further management; two patients (1.6%) had
perforation of the uterus, three (2.3%) patients had expelled
their devices, and three (2.3%) patients were lost to follow-up.
10.9% patients chose to continue with the device once they
were reassured of its correct position. 21.5% of cases needed
special instruments for removal. 57% of patients had the
device in situ for more than five years, 28.9% for one–five
years, and the rest for less than a year. Overall, 91.8% patients
with missing threads had ultrasound scanning done in the
contraception clinic, 2% had scanning in the radiology department to locate the device. Thus ultrasound is a useful adjunct
to missing threads management.
Conclusion: Most (96%) of cases could be managed in the
clinic. The majority of the devices with missing threads were
Mirena. One-fifth of patients needed special instruments for
their removal. Further research is needed to explain the reason
why more missing threads were associated with Mirena devices.
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A-163
Perception of pain during the
placement of the intrauterine device
– experience of a Portuguese tertiary
hospital
Ana Regaloa, Catarina Reis de Carvalhob,
Joaquim Nevesb and Carlos Calhaz Jorgeb
a
Hospital Espırito Santo, Evora, Portugal; bCentro Hospitalar
Lisboa Norte, Lisboa, Portugal
Introduction: The intrauterine device (IUD) is an effective and
safe contraceptive for many women. However, a considerable
number refuse this option as they remain suspicious about the
hypothetical pain during the insertion of this device. In fact,
despite the fact that most IUD placements do not require pain
relief, there is very little literature regarding the average experienced pain and which patients experience more discomfort and
can possible gain with pain management strategies.
Objective: To evaluate women’s perception of pain during IUD
placement.
Methods: We prospectively studied women who were submitted to placement of a levonorgestrel-releasing (LNG) or copper
IUD between November 2014 and October 2015. The women
were asked to quantify the pain experienced during the procedure in a visual analogic scale (VAS) of pain (0–10). Statistical analysis was carried out using Excel V and SPPSV.
Results: We studied a total of 424 women. The mean age was
35 years (15–56 years). Overall, 36.2% of the women were nulligravida, 28.2% primigravida and 35.6% multigravida. Among the
cases studied, in 76.9% (326), the choice was a LNG-IUD 20
mcg/day, in 20% (85) a LNG-IUD 6 mcg/day and in 2.8% (12) a
copper IUD. The median intensity of the pain experienced was
3.8 (±2.5). There were no considerable differences between the
various age group (p ¼ 0.727). However, nulliparous women
experienced more pain (p ¼ 0.002).
Conclusions: Although some women have pain during the
placement of the IUD, in most cases, it seems to be bearable.
These results highlight the importance of counselling and creating a trustworthy, unhurried and professional atmosphere,
where the experience of the provider also has a major role, a
situation frequently referred as ‘verbal anaesthesia’.
R
R
A-164
Attitudes and knowledge of
Colombian health care professionals
regarding intrauterine contraception
for nulliparous women
Fernando Duarte-Carona, Victor Marin-Cantub,
Josefina Lira-Plascenciac and Luis Bahamondesd
a
Bayer Latinoamerica, Whyppany, New Jersey, USA; bBayer
Latinoamerica, Mexico DF, Mexico; cHospital Angeles del
Pedregal, Mexico DF, Mexico; dCEMICAMP, Universidade de
Campinas, Campinas, SP, Brazil
Objective: To assess attitudes and knowledge about intrauterine contraceptives (IUC) for nulligravida women among 100
health care professionals (HCPs) in Colombia.
100 Colombian HCPs (70 Ob-Gyns and 30 General Practitioners)
were analysed
Results: A total of 59 and 41 had office-based and hospitalbased practice, respectively, and attendance of from 20 to 200
patients regarding contraception/day. When asked about
116
length of experience, 45%, 38% and 17% had 1–10 years;
11–20% and more than 20 years, respectively. Overall, 76% of
them inserted IUC by themselves as well as trained and supervised the insertion by other HCPs. About the number of insertion of IUC/month, 43%, 25%, 6% and 9% inserted 1–5; 6–10;
11–15 and 15–20, respectively. When asked about main drivers
of IUC, the responses were: high efficacy, long-term contraception and cost-effectiveness. When asked about barriers to use
IUC in general, the Colombian HCPs reported that PID, having
no baby and cost were the more frequent concerns. When
asking about barriers to use IUC in nulliparous, the interviewed
reported that PID, infertility, difficulty and pain during insertion
were the more frequent concerns. When asked about the
insertion of IUC in nulliparous, 84% accept to do it and 16%
never do it. Only 9% of the Ob-Gyns considered IUC when
counselling about contraception to nulliparous < 18 years old
and 51% in nulliparous between 18–29 years old. When a nulliparous woman asked for an AIU, only 18% of the participants
placed in < 18 years old and 49% in 18–29 years old. 70%
considered the efficacy of AIU in nulliparous is the same than
in parous women, 7% a little better in nulliparous and 7% a
little less in nulliparous. 7% considered the risk of PID much
higher and 60% a little higher in nulliparous than in parous.
60% considered a little bit more difficult and 34% similarly difficult to insert an IUC in nulliparous women. 57% considered a
little more pain and 13% much more pain when inserting an
IUC in nulliparous vs. parous women. 51% knew the correct
category of use of IUC among nulliparous according to the
MEC of WHO (benefits outweigh risks), 9% considered a MEC
3 and 3% a MEC 4 (contraindicated).
women are widespread in Colombian HCPs, even between
Ob-Gyns.
A-165
Prevalence of perforation of the
cervix by the strings of intrauterine
devices and systems
Objectives: To establish the prevalence of perforation of the
cervix by the strings of intrauterine devices, determine its aetiology, ascertain optimal management and explore strategies for
prevention.
Method: A detailed search of the English literature using electronic databases, reference lists of identified key articles and
hand searching of relevant journals.
Results: Between 1978, when the first case was reported and
2015, we were able to identify only seven cases in the English
literature although there are a few anecdotal reports and there
may be reports in other languages that were not accessible.
Half of all the cases found were reported within the last 10
years, indicating either increasing occurrence or wider and better recognition of the condition. Majority of the women were
asymptomatic. The mean age of the women was 32 (23–47)
years, with a mean duration of IUD/IUS use of 33.6 (1–72)
months. A variety of IUD types were involved but all three
cases reported from 2010 were in women using the
Levonorgestrel Intrauterine System. The exit points of the
threads were variable with the lateral regions of the cervix
being the most common. Management was in most cases simple and straightforward. Following removal of the devices,
none of the women experienced any adverse effects. Various
hypotheses have been propounded in attempts to explain the
occurrence of this condition but no single hypothesis has
been deemed applicable to all cases. The condition remains
an enigma.
Conclusions: Perforation of the cervix by threads of intrauterine devices and systems is a very rare occurrence with less
than ten reported cases in the English literature. The significance and potential side-effects of this complication are not
known, and would appear to be not serious. None of the
explanations or hypotheses offered for its occurrence seems
applicable in all instances and its aetiology remains unclear.
However, the process by which the threads penetrate the cervical tissue (and especially where two threads together appear
through a single opening) is difficult to understand and has
yet to be discovered. In the absence of a plausible aetiological
model, it remains virtually impossible to develop a preventive
strategy. We therefore recommend that research be undertaken on this topic.
A-166
Barriers to the uptake of intrauterine
contraception: patient and
practitioner perspectives
Susan Walkera, Lesley Hoggartb, Victoria Newtonb
and Mike Parkera
a
Anglia Ruskin University, Chelmsford, Essex, UK; bOpen
University, Milton Keynes, UK
Objectives: Intrauterine contraception (IUC) is safe, longlasting and highly effective. Despite this effectiveness, of
those women attending UK community contraceptive clinics
in 2014, only 9.1% were using IUC (4.2% were using IUD
and 4.9% using IUS). Increasing IUC use in General Practice
has the potential to reduce unintended pregnancies and
provide women with a safe, long-lasting, highly effective
method whose failure rates, in typical use, are less than 1%
per year. We examined the views of women and practitioners in General Practice regarding barriers to the uptake
of IUC.
Methods: Our project, carried out in a selection of UK General
Practices, used a sequential mixed-method approach. In our
qualitative arm we interviewed 30 women (18–49 years), regarding their views and experiences of IUC, and subsequently surveyed 1244 women, using questions derived from the
qualitative data. We separately surveyed 208, and interviewed
13 practitioners. Qualitative data was analysed thematically.
Quantitative data was analysed descriptively, and in the patient
survey arm, using single-predictor binary logistic models, relating current usage to other variables.
Results: Preliminary binary logistic regression analysis of the
demographic and attitudinal features of survey respondents
indicated the predictors of non-use of IUC included considering the long acting nature of the device a disadvantage
(OR ¼ 8.280 (5.709, 12.404) p < 0.001), disliking the thought of
IUC (OR ¼ 3.135 (2.612, 3.817) p < 0.001), being worried about
womb damage (OR ¼ 2.239 (1.874, 2.701) p < 0.001), and
being worried about the method making it harder to get
pregnant in the future (OR ¼ 2.601 (2.134, 3.209) p < 0.001). In
the qualitative interviews women described embarrassment
and unpleasantness around fitting, and anxieties about the
IUC as a ‘foreign object’ in the body. These attitudes and
anxieties were confirmed by the survey data in which more
than 40% of respondents reported worrying about the
unpleasantness of fitting or removing IUC, and the thought
of the device moving ‘inside me’. Practitioners reported, as
barriers to providing IUC, time and cost of training, difficulties
maintaining competency, and logistical issues surrounding the
need for an appropriate room and two staff to be present.
Practitioners were less inclined to recommend an IUC to
younger women.
Conclusion: Our poster highlights barriers to the greater use of
IUC in general practice in the UK. Many of these could be overcome by addressing the concerns of women regarding the
method, and by improving the organisational and logistical barriers to having an IUC fitted.
This project was funded by Bayer PLC.
A-167
Could an improvement in Intrauterine contraceptive device (IUCD)
design reduce incidence of missing
threads amongst IUCD users?
Usha Kumara, Gursharan Kalsia, Ajit Rajeb and
Deepak Mehrac
a
King’s College Hospital NHS Foundation Trust, London, UK;
Pregna International Ltd, Mumbai, India; cVidurneeti, Mumbai,
India
b
Objective:
(1) To analyse design-related factors that may contribute to
retraction of IUCD threads resulting in missing threads.
(2) To propose a design modification to minimise upward
movement of IUCD threads.
Methods: A total of 50 random samples of framed copper and
progestogen-releasing IUCDs removed from women with missing threads were examined. These women had presented to a
specialist contraceptive clinic between 2010 and 2015 for an
ultrasound scan to locate the IUCD and removal of the device.
Upon removal of the IUCD using Hartmann crocodile forceps,
visual analysis of the position of the threads in relation to the
IUCD frame was carried out. Photographic evidence of the
removed IUCD with retracted threads was collected anonymously. Based on the findings, a concept emerged to explain a
possible cause of thread retraction. A design modification was
proposed to address this problem.
Results: In the observed cases, the IUCD threads were noted to
have retracted inside the uterine cavity and were found aligned
with the vertical stem of the device. In some cases, threads
were observed to have wound around the stem of the device
or were stuck to it with blood and mucus. In commonly used
framed IUCDs, threads are attached to the vertical stem of the
device by means of a looped knot. This looped knot forms a fulcrum which enables the threads to rotate about the line of the
stem, making it possible for the threads to fold up next to the
stem. We speculate that uterine contractions result in device
movement, further contributing to thread retraction. We propose modifying the current design of framed IUCDs to restrict
upward movement of the IUCD threads.
Conclusion: Framed IUCDs have been in the market for over
50 years and missing threads continue to remain a problem.
We aspire to address this problem through a change in design.
In collaboration with an international manufacturer of IUCDs,
patent applications for improved designs have been filed globally. Work is in progress to obtain the necessary approvals for
the modified designs from regulatory bodies.
The contents discussed and disclosed herein are provisionally
protected by patent applications filed globally. Unauthorized
use of information is liable for action as per provisions of law in
respective countries.
117
A-168
Laryngological forceps, an efficient
tool for extraction of retained IUDs
pez-Arregui
Eduardo Lo
Clinica Euskalduna, Bilbao, Spain
Objective: To describe the efficiency of a laryngological forceps
(Storz 8591A) for removal of retained IUDs.
IUD strings that are not visible at the external cervical os are a
common complication of IUD removal. In the majority of cases
the devices can be easily retrieved in-office even in a ‘blind’
way. For more difficult cases a variety of tools and procedures
has been described: thread retrievers, hooks, suction curettes,
and more usually grasping forceps or under direct vision by
hysteroscopy. The main limitations are the morphology of the
tip of forceps or the need of a hysteroscopist.
Method: The laryngological forceps is 23 cm in length, less
than 1 mm in width at the end and nearly 2 mm in width at
the hand extreme. Its fulcrum is placed at only 3 mm from the
tip which allows it to be opened completely within the uterine
cavity even in the cervix or near the hostia tubarica (unlike
other forceps). It is stronger than hysteroscopic tools and IUDs
do not slip when grasped.
400 mcg of intravaginal misoprostol was used 90 minutes
before. Cervical anaesthesia and 5 mg oral diazepam was
offered. The procedure was ultrasound guided in all the cases.
In the last 20 years, 268 non-pregnant women have been
referred because of unsuccessful attempts of IUD or broken
arms removal, by others colleagues. Overall, 17.91% were postmenopausal women, and 82.19% were still with menses, 86.57%
were parous women, and 13.43% nulliparous. In 22 cases
(8.21%) they were nulliparous postmenopausal women.
Results: Only in one case (0.4%) propofol anaesthesia and
other strong forceps were needed. It was about an unsuspected Dalkon in the first year of experience. In another case,
of broken retained arm, diagnostic hysteroscopy was needed
because the ultrasound failed to locate it. The remaining 266
cases were successfully recovered in no more than 10–15
minutes in-office. The type of IUDs removed were: 11 cases of
broken arms; four Lippes loop; six ‘V’ shape; 36 chinese rings;
114 ‘T’ shape; 96 anchora; one Dalkon. No strong pain, haemorrhage, cervical damage nor misoprostol adverse effects were
observed.
Conclusions: The laryngological forceps is, probably, the most
efficient tool for retained IUDs. After a short period for training
and under ultrasound control, it allows any professional to
remove IUDs in easy and difficult cases, avoiding the need for
an experienced hysteroscopist.
LONG-ACTING REVERSIBLE CONTRACEPTIVE
METHODS
A-169
Investigating the choice and uptake
of post abortion contraception in the
Marie Stopes international clinics
among Australian women
Yachna Mehtaa, Philip Goldstoneb, Kirsten Blacka
and Kevin McGeechana
a
University of Sydney, Sydney, Australia; bMarie Stopes
International Clinics, Sydney, Australia
118
Objectives: To examine the use of post-abortion contraception
and uptake of long-acting reversible contraceptive (LARC)
methods amongst women seeking abortions in a developed
country like Australia. The main outcome measure was the
uptake and immediate provision of LARC contraception post
abortion.
Method: Cross sectional study of post abortion contraception
choices and uptake in all Marie Stopes International (MSI)
clinics across Australia between September and December
2012 under ethics approval granted by the human research
ethics committee at The University of Sydney and was in
keeping with the guidelines set forth by the National
Statement on Ethical Conduct in Research Involving Humans.
The analysis was based on the 6348 women with completed
demographic details. The statistical analyses were carried out
using SAS 9.3.
Results: Only 27.4% chose a LARC method for use after abortion and of those immediate provisions occurred in 71%.
Women aged 20–24 were more likely to choose a LARC
method. Also LARC method choice was associated with number
of children, with the likelihood of LARC choice increasing with
number of children. Immediate insertion occurred more frequently in women aged over 30 compared to younger women
and in women who were Australian or African born. Women in
the lowest socio-economic quintile were the least likely to get
the LARC method inserted. LARC provision occurred more often
after surgical abortion.
Conclusion: Abortion services recognise the need to ensure
women leave their services with reliable contraception. Given
the good evidence that LARC provision can reduce the chance
of repeat abortion, there needs to be greater emphasis on
ensuring that LARC methods are made more accessible and
more affordable. This will enable more women to avoid a further unintended pregnancy.
A-170
Enhanced acceptability and improved
continuation rate with long acting
reversible contraceptives, by high
capacity menstrual Cup
Alfred Shihataa and Steven Brodyb
a
Scripps institution of Medicine and Science, San Diego
California, USA; bUniversity of California, La Jolla California, USA
Background: Unpredictable and irregular bleeding is the main
reason for dissatisfaction and subsequent discontinuation of
Long-Acting Reversible Contraceptives (LARC). Women report
that heavy irregular bleeding disrupts their social and sexual
lives.
Objectives: (1) To enhance the acceptability of Long Acting
Reversible Contraceptives.
(2) To prolong the duration of user satisfaction and overall continuation rate of LARC.
Methods: We conducted a pilot study involving 20 women,
aged 25–44, who requested removal of their contraceptive
implant (n ¼ 18) or copper IUD (n ¼ 2). This was due to the
heavy irregular vaginal bleeding. We have developed a high
capacity menstrual cup made of silicone for the collection of
menstrual fluid. This so-called ‘menstrual cup’ has a high capacity for up to 12 hours. Consequently, it is an excellent alternative to pads and tampons. We offered menstrual cups to these
women and instructed them how to use it, and asked them to
call us as needed and return to the clinic every month for three
months. We monitored their level of satisfaction, ease-of-use,
and the number of hours without leakage.
Results: Sixteen women out of the 20 managed their bleeding
by using the high capacity menstrual cup for the entire threemonth study period. These 16 women were free of menstrual
leakage for 8–12 h and, as a result, were able to keep their
implants or IUD in place. All 16 expressed satisfaction with using
the device. Four women, all with implants, declined to use the
menstrual cup and had their implants removed.
Conclusions: A menstrual cup with high capacity allowed 80%
of women to keep their long acting reversible contraceptive
implant or IUD to their intended duration of use. Additional
studies are warranted to validate this concept.
A-171
User characteristics, continuation
rates and side-effects of copper
intrauterine device use in a cohort of
Australian women
Deborah Batesonb, Caroline Harveyb, Lieu Trinhb,
Mary Stewartb and Kirsten Blacka
a
University of Sydney, Sydney, Australia; bFamily Planning New
South Wales, Sydney, Australia
Objectives: Copper IUD (Cu-IUD) use in Australian women is
low despite being a highly effective, cost effective non-hormonal method with reported continuation rates at 12 months of
85% compared to only 59% for the oral contraceptive pill. This
study aimed to examine the characteristics of Cu-IUD users in
the Australian context, their experiences of side-effects, continuation rates and reasons for discontinuation.
Methods: We undertook a prospective cohort study of consecutive women presenting for Cu-IUD insertion to family planning
clinics in Queensland and New South Wales from August 2009
to January 2012 with three years of follow-up. Continuation
rates were calculated using survival analysis and univariate and
multivariable analyses were used to characterise the users, their
experiences at six months, one, two and three years, reasons for
early discontinuation and pre-insertion factors associated with
discontinuation.
Results: Of the 211 enrolled women, just over a third (36%)
were under 30 years of age and a third were nulliparous
(36.5%). The most common reason for choosing the method
was that it was hormone-free. Overall Cu-IUD continuation rates
were 79.1% at one year and 62.1% at three years. At 12 months
of use almost half (44%) reported being bothered by heavy
menstrual bleeding in the previous month with heavy bleeding
cited as the most frequent cause of early discontinuations –
accounting for 18 out of the 60 removals due to complications
or side-effects. Having two or more live births reduced the risk
of early method discontinuation (aHR 0.22 95% CI 0.09-0.50).
Conclusions: Available data suggests a low uptake of Cu-IUDs
in Australia but this study highlights that in family planning clinics the method is chosen by a range of women; both nulliparous as well as parous from across the reproductive lifespan. The
main reasons they cited for selecting the Cu-IUD were because
it offers hormone free contraception that is highly effective.
While heavy menstrual bleeding was the most frequent reason
for discontinuation and bleeding-related side-effects were relatively common, overall continuation rates were high. Increasing
awareness of women’s views and experiences of the Cu-IUD
amongst health professionals, as well as strategies to manage
troublesome heavy bleeding, will help ensure that this method
of contraception is included in discussions for women who are
making contraceptive choices.
ACCEPTED ABSTRACTS – LARC METHODS
A-172
Long-acting reversible contraceptive
(LARC) use six months post-abortion:
benefits of specialist follow-up
Usha Kumara, Louise Pollarda, Lucy Campbellb,
Selin Yurdakula and Abdel Douirib
a
King’s College Hospital NHS Foundation Trust, London, UK;
King’s College London, London, UK
b
Objective: To compare the use of LARC (Implants, Injectable,
IUD, IUS) in women receiving specialist follow-up support during
six months following an abortion with those receiving standard
ad-hoc follow-up.
Methods: A multicentre randomised controlled trial was conducted between October 2011 and February 2013 recruiting
569 women from three abortion clinics. Patients were randomised to receive follow-up support from a specialist in contraceptive care by telephone/face-face consultation at two–four
weeks and three months post-abortion (Intervention arm;
n ¼ 282), or standard follow-up (Control arm; n ¼ 287).
Participants completed a standardised questionnaire at baseline
prior to their abortion and a telephone questionnaire at six
months post-abortion, to determine uptake and continuation of
effective contraception (primary outcome). Information on
contraceptive use at two–four weeks and three months was collected during the consultation in the intervention group.
Comparison of proportions was investigated using Chi-squared
tests. Analysis of covariance (ANCOVA) was used to assess the
change from use of non-LARC method immediately prior to
abortion to LARC method at six months post-abortion.
Results: A total of 96 patients from the Intervention arm completed the two–four-week and three-month intervention and
six-month follow-up. Overall, 148 patients from the control arm
completed the six-month follow-up. Intervention and control
groups were balanced in their baseline characteristics and their
demographics were similar to those who did not complete the
six-month follow-up. 53% had had a previous live birth and
51% had had at least one previous abortion. 49% of women in
the Intervention group versus 33% in the control group were
using LARC at six months (p =0.01). 48% of women in the intervention group changed from using a non-LARC method immediately prior to their abortion to LARC method at six months
post-abortion compared to 28% (p ¼ 0.002) women in the control group. The change from non-LARC prior to abortion to
LARC at 6 months post-abortion was 2-fold higher in the intervention group compared to control group, OR ¼ 2.0 [CI 1.2–3.4].
Amongst women using a LARC method at six months, more
women in the intervention group (30%) reported starting that
method between one and six months post-abortion compared
to control group (4%).
Conclusion: Women receiving specialist contraceptive follow-up
support post-abortion perform better with uptake and continuation of LARC at six months post-abortion compared to women
who do not routinely receive such support.
A-173
Ultrasound: gold standard for the
location of no palpable single-rod
contraceptive implant
Rafael Buitron-Garcıaa, E. Said Plascencia-Nietob and
Juan Gonzalez-de la Cruza
a
Hospital General de Mexico, Mexico City, Mexico; bInstituto
Politecnico Nacional, Mexico City, Mexico
119
Introduction: The subdermal single rod contraceptive implant
is used by women worldwide (in Mexico it is calculated that
more than 1,000,000 implants have been placed), in a small
number of cases deep insertion technique determines a difficult
location.
Methods: A descriptive, retrospective, cross-sectional clinical
study in the period from January 2011 to September 2015 in
the Family Planning Service of the General Hospital of Mexico
‘Dr. Eduardo Liceaga’.
Results: A total of 62 patients were included, in all cases the
implant was not palpable, in 61 patients it was found by ultrasound and removed, the time between application and removal
averaged 3.2 years. A total of 58 implants were applied in the
left arm and three on the right, 24 implants in fatty tissue, one
in fascia, 32 in muscle, two in fatty tissue and muscle and two
were located in the armpit.
Conclusion: For easy access and simple study, ultrasound is the
method of choice to locate non palpable deep implants.
A-174
Etonogestrel-releasing contraceptive
implant use by women with sickle
cell disease
Milena Britoa, Flavia Pimentela, Caroline Barrosa,
Camila Bonfima and Anelise Strevab
a
Bahiana School of Medicine, Salvador, Bahia, Brazil; bHematology
Center of the Bahia state, Salvador, Bahia, Brazil
Objective: Women with sickle cell disease have an increased
risk of pregnancy-related complications and need safe, effective
contraceptive methods to prevent unintended pregnancy.
The Etonogestrel (ENG)-releasing contraceptive implant is one
of the most effective contraceptives available. However, as far
as we know, its effects in women with sickle cell disease have
never been described. Thus, the objective of this study was to
assess clinical and metabolic effect of ENG-releasing contraceptive implant in women with sickle cell anaemia during six
months.
Methods: Twelve women with sickle cell disease aged 18–40
years old, non-obese, with pain crisis and without comorbidity
were selected. Blood samples were collected to evaluate complete blood count (reticulocytes, haemoglobin, platelets and leukocytes), hepatic function (Alkaline phosphatase, gammaglutaryl transferase, amino alanine transferase, aspartate amino
transferase, total bilirubin and its fractions), Lipid profile (total
cholesterol, HDL, LDL and triglycerides), Lactate dehydrogenase
(LDH) before and six months after the implant insertion. A pain
questionnaire was answered before the insertion and every day
after it. The statistical analyses used were Paired Student t-test,
Wilcoxon Rank Test and frequency, as appropriated.
Results: There was a reduction in Lactate dehydrogenase during six months (LDH0: 1451.8 ± 830.8 IU/L vs. LDH6:
1182.1 ± 630.0 IU/L, p < 0.05). The other laboratory variables analysed showed no difference between the baseline period and
six months after the implant insertion. The most common
bleeding partner during the first three months was infrequent
(44.4%), followed by normal (22.2%), frequent and prolonged
(22.2%) and amenorrhea (11.2%). And, in the second trimester
was normal bleeding (50%), followed by infrequent (17%),
amenorrhea (16.7%) and frequent and prolonged (16.3%).
Regarding adverse effects, 50% reported abdominal pain, headache, irritability and nausea. None of them had gone to hospital
and one of them declined from the implant use because of prolonged bleeding. Neither number nor intensity of pain crisis
modified compared with the six months before the implant
insertion.
Conclusion: The ENG-releasing contraceptive implant represents
an option for contraception in women with sickle cell disease.
120
The partial results of this research showed neither clinical
change in metabolic parameters or in pain crisis, and good
acceptability.
A-175
Preliminary report of a ‘safe minimal
invasive surgical technique’ for 100
non-palpable implant removal
MALE CONTRACEPTION
A-176
Determining men’s perspectives and
experiences of family planning
methods: systematic review
€lay Yavan and Ilknur Yesilcinar
Tu
Gulhane Military Medical Academy, Ankara, Turkey
ngorab,
Pablo Lavına, Camen Bravoa, Carlos Go
a
c
Alejandra Lavin and B Lavin Pablo
a
UNICERH – Universidad de Chile, Santiago, Chile; bACHS –
Hospital del Trabajador, Santiago, Chile; cUPV, Santiago, Chile
Objectives: To describe the results of an ambulatory minimal
invasive surgical technique, performed at the office of a referral
centre, with local anaesthesia and a short longitudinal incision,
to handle 100 deeply fitted contraceptive implants, and to
show the characteristics of the implant location site, diagnosis
method, demographics of cases, basic data at insertion and
association between some variables.
Method: The use of descriptive statistics and analysis of the
data collected during two years for 100 cases of deeply fitted
contraceptive implants.
Results: A total of 100 cases of deeply fitted implants of
women aged between 17 and 54 years (mean 29.2; mode 32)
were ambulatory treated at UNICERH in order to locate and
remove a lost implant. Implants were fitted elsewhere between
2006 and 2014, seven by a physician, one by a midwifery student, 91 by a registered midwife and one unknown, at 61
health centres throughout Chile. Three women said that they
had palpated the implant after insertion and the three had it
sub facially. Prior extraction attempts were not made in 68
cases, one attempt in 24 cases and two attempts in seven cases.
Presently, in 95 cases it was not palpable and in five palpable
with difficulty. All but one (which was not present) implants
were located with ultrasound and marked previously to the
removal procedure, then removed with a longitudinal incisions
of 0.3–0.5 cm in length in 46%, 0.7–1.0 cm in 49% and 1.5–2.0
cm in 3% of the cases.
Overall, 49 implants were placed intramuscularly in women
aged 17–46 years: 5 (10.2%) were fitted by a physician and 44
(89.8%) by a registered midwife, they came from 34 health
centres. Of the cases studied, 3 (6.1%) subjects said they had
palpated the implant initially. Presently three (6.1%) implant
were palpable with difficulty. A total of 32 (65.31%) subjects
had no prior removal attempt, 1 attempt in 11 (22.45%) and 2
attempts in 6 (12.24%). All sub aponeurotic implants were
removed, with incisions of 0.3–0.4 cm in 2 (4.08%) subjects;
0.7–1.0 cm in 44 (89.79%) and 1.5–2.0 cm in three (6.12%)
subjects.
Conclusions: After ultrasound location, removal of deep
inserted contraceptive implants can be securely done at the
office in an outpatient clinic, with local anaesthesia and simple
minimal invasive surgical techniques if the expertise is there.
Expertise can be built up.
Objectives: According to the World Health Organization,
throughout the world the use of contraceptive methods has
increased in many parts. Globally, in 1990 using a modern
method rate was 54% and in 2014 this rate had increased to
57.4%. On the whole, men’s rates of use of contraceptive methods is less than women and their choice is limited to vasectomy
and condoms. Most of the family planning methods applied
throughout the world are focused towards women because
most of family planning methods are for women. In family planning education and practices women are the target groups.
However, in the use of family planning methods and to decide
the number of children they want to have, men have very
important roles. In many countries men are dominant and especially in developing countries have traditional family structure.
Therefore this is known that men have important effects on
women’s reproductive behavior. Today, gender equality
defended in many subjects and also family planning responsibility should be shared equally. Because of this, men should be
target groups in family planning studies and family planning
services at least as women. Men’s perspectives should be considered in family planning. Providing men with a more active
participation in family planning has an important role in the
development of a healthy society. The aim of this literature
review is to present men’s views and experiences about family
planning methods.
Methods: Literature, MEDLINE, SCIENCE DIRECT and Web of
Science, Springer Link, Ovid, in the PubMed search engine
were screened with the words ‘men and contraception’ to
find studies conducted between January 2005 and August
2015. We found 2481 reports, but only 118 of them were
related with our topic, and only 56 of them are full text.
Research articles written in English and Turkish affecting
men’s participation and perpective of family planning were
included in the study.
Results: Especially in male-dominant cultures male participation in family planning needs to improve. Programmes need
to educate men about contraceptive options. In some studies,
men have good knowledge of male contraceptive methods,
however only a very small number are practicing the contraceptive methods. Especially in developing countries, studies
demonstrate the insufficiency of male involvement in family
planning usage.
Conclusions: Male partners are influential in contraceptive use.
It is important to know barriers and facilitating factors to
improve men’s participation in family planning.
ACCEPTED ABSTRACTS – NEW CONTRACEPTIVE METHODS
MOLECULAR BIOLOGY AND NEW TECHNOLOGIES
NEW CONTRACEPTIVE METHODS
A-177
A-178
Primordial follicle formation and
activation in newborn mouse whole
ovary culture using of granulosa- and
cumulus cell-conditioned media
The initiation of contraceptive use in
India in its most populous state,
Uttar Pradesh
121
Rohit Singh
Mohammad Jafari Atrabia,
Mojtaba Rezazadeh Valojerdb,
Ramezan Khanbabaeia and Rouhollah Fathib
a
Department of Biology, Qaemshahr Branch, Islamic Azad
University, Qaemshahr, Mazandaran, IranbDepartment of
Embryology, Reproductive Biomedicine Research Center, Royan
Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
Background: The effects of granulosa- and cumulus cell-conditioned media on primordial follicles culture have not been
studied so far. The cardinal aim of the current study was to
evaluate the effects of granulosa- and cumulus cell-conditioned
media on primordial follicles formation and activation within
the newborn ovary of one-day-old mouse after six days of
culture.
Methods: In each repetition, 10 ovaries were removed from
one-day-old NMRI mice and categorized into five groups: (1)
control I (one-day-old mouse intact ovaries), (2) control II (sixday-old mouse intact ovaries), (3) CBM (ovaries Cultured in Base
Medium),
(4)
CGCM
(ovaries
Cultured
in
base
medium þ Granulosa cell-Conditioned Medium), (5) CCCM (ovaries Cultured in base medium þ Cumulus cells Conditioned
Medium). After six days, all ovaries were fixed and then were
histologically evaluated. Real time PCR and ELISA techniques
respectively were applied to assess the Pten, Pi3k and Cx37
genes expression and estradiol level.
Results: The results showed that the mean number of primordial
follicles formed in each group was lowest in the CCCM group
(56.52) and this data was significant with Control II group
(116.96) and there were not comparable data between the other
groups. About activation rate per ovary (mean number of activated follicles in each group), a considerable and significant data
was observed after six days of culture in the CGCM group (11.52)
that was the highest rate and was comparable with data of
Control I (0) and CCCM (5.58) groups. Q-PCR technique showed
a considerable result in Pten gene expression that decreased in
CGCM (0.35 ± 0.06) similar to Control II and significantly
increased in CCCM (2.45 ± 1.16) groups. In addition, Pi3k gene
expressed in the highest rate in Control II (0.59 ± 0.05) as compared to the other groups. Expression of Cx37 gene was similar
to Pi3k but the second rate of Cx37 gene expression was
observed in CGCM (0.39 ± 0.02) group that was significant comparing to CCCM (0.01 ± 0.002) group. Finally, estradiol level was
equal in all cultured and control groups.
Conclusions: Granulosa cell-conditioned medium improved
the formation and activation of primordial follicles within the in
vitro cultured mouse ovaries compared to the cumulus cell-conditioned medium. Also, use of granulosa cell-conditioned
medium can increase the rates of formation and activation of
primordial follicles especially in ovarian in vitro culture of premature girls.
International Institute of Population Sciences, Mumbai, India
The paper attempts to examine the timing of initiation of
contraceptive use at first time and after recent childbirth among
currently married women and the relative risk associated with
initiation of contraceptive use by socio-economic and demographic characteristics. We tested the hypothesis –whether
women who do not want any additional children initiate contraceptive use early. Three rounds of NFHS data have been used.
Cox-regression model has been used to analyse calendar data.
The study reveals that a larger proportion of younger women
start using a method without having any children. More than
three-quarters of women aged 15–19 years begin to use a family planning method with less than two surviving children,
whereas most of the older women wait until they have had at
least two surviving children. Interestingly, for illiterate women
the acceptance of family planning at 3 þ living children as first
use has gone up from 38 to 43% during 1992 to 2006.
However, it is high among younger women. Prevalence of limiting method users is increasing over the period and most of the
women have gone for sterilisation in the same month as the
last birth (i.e., around 35%) in India. The multivariate analysis
suggests that programme variables like ANC and place of delivery (institution) affects the relative risk to initiate the use of
contraceptive method after childbirth.
A-179
Challenges and opportunities for the
use of hormonal contraception (HC)
in Multipurpose Prevention
Technologies (MPTs)
Bethany Young Holta and Anke Hemmerlingb
a
Initiative for MPTs, Folsom, CA, USA; bUniversity of California,
San Francisco, CA, USA
Objective: Multipurpose Prevention Technologies (MPTs) are
an innovative class of products in development that combine
prevention against unintended pregnancy and STIs, including
HIV. Building on half a century of contraceptive research and
25 years of microbicides research, a main focus in MPT development currently is on intravaginal rings (IVRs) that deliver
various ARVs to prevent HIV in combinations with the contraceptive hormone levonorgestrel (LNG). This presentation aims
to assess the research gaps and challenges critical to successfully combining hormonal contraceptives and ARVs into MPT
products.
Methods: The Initiative for Multipurpose Prevention
Technologies (IMPT) is tasked with convening the scientific discussion around the development of MPTs and actively engaging
stakeholders including scientists, developers, policy makers, funders, regulators, advocates, and future users of such products. In
collaboration with leading funding agencies, the IMPT is facilitating a series of meetings and key informant surveys with leading
experts on HC and MPT developers in order to review relevant
contraceptive research and discuss its application to the MPT
development pipeline.
122
Results: A number of challenges and research gaps critical
to advancing work on combining HC and ARV in MPTs have
been identified. Among the research gaps are the uncertainty
about safe and effective dosing regimens for systemic and
topical applications for products combining HC and ART,
drug interactions, pharmacodynamics and pharmacokinetics
(PK/PD), the lack of surrogate markers for effectiveness, and
drug release thresholds needed for efficacy of combined
products, balancing effectiveness with side-effects and acceptability such as irregular bleeding patterns, and the influence
of body weight on PK. Further, broader social-behavioural
issues relevant to acceptability, adherence and product
demand need to be explored for different geographies and
cultural settings.
Conclusions: Priority should be placed on critical research and
innovation that will benefit MPT development and contraception. Research organisations, developers, and supporting agencies should partner to systematically identify and fill critical
research gaps and develop streamlined criteria to decide
whether to proceed or abandon a strategy. Such a collaborative
process can help to avoid duplication of efforts, ensure that the
most pressing questions are prioritised, and make the most
effective use of limited resources. Given the rapidly evolving
evidence and discourse around interactions between HC and
ARVs, the field needs to follow all developments in this arena
that are currently being pursued by the larger fields of HIV and
family planning.
A-180
Delayed reversibility in RISUGmediated vas occlusion in rabbits
Abdul S. Ansari, Ayesha Badar and Nirmal K. Lohiya
Centre for Advanced Studies, Department of Zoology, University
of Rajasthan, Jaipur, India
Objective: Intravasal injection of RISUG produces instant
contraception. Safety and efficacy of RISUG have also been
successfully demonstrated in humans during Phase I and
Phase II clinical trials and the multicentric Phase III clinical
trial is in progress. However, in order to make the procedure
more acceptable than that of the traditional vasectomy, reversal of vas occlusion, has been attempted in animal models.
Therefore, the present study aimed to evaluate the effect and
mechanism underlying reversal of RISUG-induced vas occlusion with DMSO and sodium bicarbonate (NaHCO3) in adult
male rabbits.
Methods: Animals were grouped into seven groups (n ¼ 5), viz.,
sham-operated control, vas occlusion with RISUG (5–7 ml) for 90
days and 360 days and reversal with DMSO (250–500 ml) and
5% NaHCO3 (500–700 ml). Success of vas occlusion and reversal
was established by periodical semen analysis, fertility tests and
toxicological investigations.
Results: Fortnightly semen analysis revealed that sperm count
steadily declined after vas occlusion and complete azoospermia
was attained between 30 and 60 days of post injection.
Spermatozoa reappeared between 60 and 75 days of reversal
and normospermia was noticed between 135 and 150 days of
post reversal. All spermatozoa were found to be non-motile and
a decline in the percentage of viable sperms during 15–45 days
of post-injection. Sperm abnormalities like head-tail separation,
damaged acrosome, bent midpiece, coiled tail and bent tail
were recorded in vas occluded animals (15–30 days of postinjection) and those subjected to reversal (60–120 days postreversal). Presence of large number of macrophages were
observed engulfing spermatozoa in the seminal plasma of the
reversal groups. A slow but gradual recovery in sperm motility,
viability and abnormality was observed which normalised during
105–135 days of reversal. Animals subjected to intra-vasal
administration of RISUG were found to be sterile during the vas
occlusion period. With the reappearance of spermatozoa
following vas occlusion reversal, a gradual recovery in the fertility was noticed. Complete fertility was observed following
135–150 days of reversal when compared with the sham-operated control group. F1 progeny of reversed animals was found
to be normal. Other parameters remained unaltered during all
phases of the study.
Conclusions: The present study suggests instant sterility and
safety following vas occlusion with RISUG. This study indicated
a delayed reversibility compared with the previous study on
rats. However, no significant difference was observed in the duration of reversibility using both approaches.
A-181
When Smartphones are used for
birth regulation. A comparison study
of four symptothermal Apps in 2013
and completed in 2014
Harri Wettstein
SymptoTherm Foundation, Lully-Lausanne, Switzerland
Objective: To find out whether there are any apps on AppStore
and Google Play that are able to indicate the fertile window as
precisely as the best manual symptothermal method nfp-sensiplan. This study was operated in summer 2013 and completed
in summer 2014.
Methods: The 2013 study compares the seven symptothermal
applications that can currently be found on the AppStore,
Google Play Store and windows store among some 100 fertility
apps which have been excluded right from the beginning as
they are not adapted at all for effective birth regulation and
highly misleading for this purpose. In 2013, we focused on
quantitative criteria: the identification of false negatives and
false positive results compared to an ideal solution (in which
there is 0 false negative, 0 false positive result per cycle). The
false positive days indicate wrongly infertile days as fertile and
shorten the amount of infertile days per cycle (longer abstinence period); the false negative days wrongly indicate fertile
days as infertile and drastically increase the unwanted pregnancies. The 2013 study only analysed the postovulatory end of the
fertile window. The study of 2014 comprehends the whole fertile window from the first fertile day until the last; it tests more
than 160 cycles out of three unknown women on sympto (free
users) with more than 13 cycles each. In 2014 qualitative criteria
were added to complete the quantitative analysis. The main
ones are the userfriendliness of the whole system, the completeness of the cycle chart, the completeness of the entry
bord, etc.
Results: The best results were found on sympto (AppStore and
Google Play), followed by myNFP (AppStore), CycleProGo, from
Couple to Couple League (AppStore and Google Play) and Lily
(AppStore).
Conclusions: In the 2nd study, new technologies to identify the
complete fertile window of the female cycle are presented and
discussed. sympto is the only app containing a message box
system which enables personal online counselling. The educational approach of sympto also facilitates the learning process
of the beginners and increases the competence of the expert
user.
ACCEPTED ABSTRACTS – NEW CONTRACEPTIVE METHODS
NON-CONTRACEPTIVE BENEFITS OF CONTRACEPTIVE
METHODS
A-182
A non-intervention study to observe
the bleeding pattern after
levonorgestrel releasing intrauterine
system?LNG-IUS?or copper
intrauterine device?Cu-IUD?inserted
immediately after induced abortion
(POST)
Jian Lia, Xiaoning Chenb, Qianxi Lic, Xiaoye Wangd
and Lijuan Mae
a
Beijing Obstetrics and Gynaecology Hospital, Beijing, China;
Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi,
China; cLiuzhou Maternal and Child Health-Care Hospital,
Liuzhou, Guangxi, China; dPeking University Third Hospital,
Beijing, China; eBayer Healthcare Pharmaceutical Company,
Beijing, China
b
Objectives: To observe the bleeding pattern of LNG-IUS or CuIUD inserted immediately after induced abortion within six
months and compare the satisfaction, continuation rate and
safety.
Method: Our study was designed as a national, multi-centre,
prospective, cohort, non-interventional one. A total of 512
reproductive women applied IUC immediately after the first trimester surgical abortion, with regular cycle history were
recruited in the study: 312 and 200 subjects were recruited in
LNG-IUS and Cu-IUD group respectively. There were total three
visits (V1–V3) following up until six months after IUD insertion.
The number of bleeding/spotting days assessed over the
second 90-day reference period postabortion was the main outcome, which was analysed with Full analysis set (FAS) and Per
Protocol Set (PP). The main outcome between the two groups
was compared by Wilcoxon test.
Results: The total bleeding/spotting days over the second 90day after abortion in Cu-IUD group (mean: 19.4 days; median:
18 days) outnumbered those in LNG-IUS group (mean: 14.6
days; median: 14.5 days) (p < 0.0001). And for LNG-IUS users
less experienced dysmenorrhea than Cu-IUD users. The bleeding
days related to abortion in LNG-IUS group (mean: 9.8 days;
median: 8 days) were more than those in Cu-IUD group (mean:
7.6. days; median: 7 days). The continuation rates in LNG-IUS
group and Cu-IUD group were similar, 86.7% vs. 91.0% at V3. A
total of 70.9% subjects felt satisfied and very satisfied at V3 in
LNG-IUS group was comparable to 75.1% in Cu-IUD group. The
incidence rate of pelvic inflammatory was both 1.0; the expulsion rate was higher in Cu-IUD group (2.5%) than in LNG-IUS
group (1.9%).
Conclusions: The bleeding pattern of immediate insertion postabortion in LNG-IUS group was preferable to that in the Cu-IUD
group.
Conflict of interest: The authors disclose that they received
sponsorship from Bayer for this study.
123
A-183
Novel targeted drug delivery to the
cervix and vagina by a barrier
contraceptives device: a pilot study
for proof the concept
Alfred Shihataa and Steven Brodyb
a
Scripps Institution of Medicine and Science, San Diego
California, USA; bUniversity of California School of Medicine, La
Jolla, California, USA
Background: The vast majority of Sexually Transmitted
Infections (STIs) and cervicitis are treated with drugs that come
with potential systemic side-effects. The few infections that are
treated topically require gels or creams to be inserted into the
vagina by traditional vaginal applicators. The vagina expels
these gels and creams shortly after the insertion, rendering
them less effective.
Objectives:
(1) To test a barrier contraceptive device’s potential to deliver
drugs topically for the treatment and prevention of STIs such as
HPV, HIV, Gonorrhea, and Chlamydia.
(2) To eliminate the need for destructive surgery on the cervix
when treating HPV.
(3) To enhance the safety and efficacy of topical treatments to
the cervix and vagina.
Methods: We applied a stained vaginal gel over the cervix and
vagina, using a vaginal applicator in 10 women. We applied the
same stained gel with a barrier contraceptive device in 10 other
women. We then compared the retention of the stained gel by
photographing the cervix and vagina for the presence of the
stained gel at six, 12 and 24 hours after application.
Results: The stained gel was present over the cervix 24 hours
after application with the contraceptive barrier device. It was
absent after six hours when applied with the vaginal applicator.
Conclusion: This pilot study has demonstrated that gels or
creams inserted into the vagina using the barrier contraceptive
device have much better retention. Thus, more prolonged contact with an offending pathogenic agent would be anticipated.
This study may lead to a topical method for the prevention and
treatment of STIs, including HPV and HIV infections. Topical
treatment may also lead to better safety and higher efficacy
than systemic treatment.
A-184
The effect of combined oral
contraceptives on the course of
multiple sclerosis
Anastasiia Kochetkova
Siberian State Medical University, Tomsk, Russia
Background: Multiple sclerosis (MS) is an autoimmune disease
of the central nervous system characterised by inflammation,
demyelination, gliosis, pathology of oligodendrocytes and axons
and progressive increase of neurological symptoms. Studies
indicate that sex hormones may influence the pathogenesis and
course of MS, so the assignment of combined oral contraceptives (COCs) for contraception in women with this disease
seems logically justified.
Objectives: To assess the effects of COCs on the clinical course
of relapsing-remitting MS.
Methods: The study included 55 women with relapsing-remitting course of MS. Mean age of patients was 27.9 ± 7.3 (19–45
years). There were 35 (63.6%) women of the early reproductive
age (19–35 years) and 20 (36.4%) women of the late
124
reproductive age (36–45 years). The average age of the onset of
the disease was 26.4 ± 7.9 (11–44 years). The average duration
of the disease was 6.4 ± 4.8 (1–18). Depending on the COC
using patients were divided in three groups: (I) patients, who
never used COCs, (II) patients, who used COCs before the onset
of MS, and (III) patients who used COCs after the onset of the
disease. Patients of groups II and III used COCs for contraception. The first phase of the study included the collection of
detailed data concerning the course of MS, obstetric and gynaecological history; then patients had a comprehensive examination, including bimanual examination, cervical cytology, vaginal
smear and neurological examination. The assessment of functional disorders was made with the Kurtzke Expanded Disability
Status Scale.
Results: The average duration of using COCs in groups II and III
was 3.5 ± 2.0 and 3.0 ± 2.4, respectively. The average EDSS score
in patients who used COCs before the onset of MS (group II)
and after the diagnosis of MS (group III) was 2.4 ± 1.68 points,
indicating a mild disability (II degree) in two functional systems
(FS). In the group of patients who never used COCs (group I)
the average EDSS score was 3.5 ± 1.4, indicating a moderate
degree of disability (III degree) in one FS and II degree in one
or two FS; or III degree in two FS.
Conclusion: Patients who used COCs before and after the diagnosis of MS had lower EDSS scores compared with patients
who never used COCs. Thus, the assignment of COCs to
patients with MS revealed a positive neuroprotective side-effect.
75.43 ± 4.85, p < 0.05), SF (62.92 ± 3.25 vs. 73.88 ± 4.95, p < 0.05),
RE (56.67 ± 6.33 vs. 75.14 ± 2.76, p < 0.05), MH (84.53 ± 4.36 vs.
96.19 ± 1.45, p < 0.05).
Conclusions: Oral Contraceptives with androgenic activity have
a consistent positive impact on Role Physical, General Health
and Social Functioning in Russian women with heavy menstrual
bleeding. EE/DRSP has a greater positive influence on Vitality,
Role Emotional and Mental Health in compare with EE/CPA and
E2V/DNG. Consistent improvement of all measures was
observed in E2V/DNG group.
POSTPARTUM CONTRACEPTION
A-186
Effectiveness of a package of
postpartum family planning service
delivery interventions on the
adoption of contraceptives during
the first year after childbirth:
formative phase of a complex mixedmethod intervention
A-185
Influence of oral contraceptives with
androgenic activity on the quality of
life of Russian women with heavy
menstrual bleeding
Marina Khamoshina and Ekaterina Tsapieva
Peoples’ Friendship University of Russia, Moscow, Russia
Method: A total of 92 women aged 18–45 years seeking hormonal contraception with confirmed diagnosis of HMB and no
recognizable pathology were recruited in a state hospital in
Russia. The women were randomised to receive one of three
oral contraceptives: ethinylestradiol/cyproterone acetate (0.035
mg EE/2 mg CPA; n ¼ 30), ethinylestradiol/drospirenone (0.02
mg EE/3 mg DRSP; n ¼ 32) or estradiol-valerate/dienogest (E2V/
DNG; four-phasic oral contraceptive; n ¼ 30) for six treatment
cycles (168 days). The outcomes assessed included Physical
Functioning (PF), Role Physical (RP), Bodily Pain (BP), General
Health (GH), Vitality (VT), Social Functioning (SF), Role Emotional
(RE), Mental Health (MH), measured by SF-36 questionnaire at
baseline and at the end of the sixth cycle.
Results: Greater improvements from baseline to the end of
treatment were observed in EE/DRSP group. In EE/CPA group
changes were observed in some scales only: Bodily Pain
(43.10 ± 6.28 vs. 80.34 ± 4.73, p < 0.001), Role Physical
(76.38 ± 5.23 vs. 80.19 ± 5.31, p < 0.05), General Health
(56.14 ± 6.23 vs. 84.94 ± 7.55, p < 0.001), Social Functioning
(59.48 ± 4.62 vs. 73.4 ± 6.33, p < 0.001), Role Emotional
(43.68 ± 8.12 vs. 75.24 ± 4.43, p < 0.001). In EE/DRSP group the
changes were more pronounced for the scales closely associated with mental health: Vitality (53.39 ± 7.11 vs. 94.25 ± 2.52,
p < 0.001), Role Emotional (44.09 ± 7.82 vs. 91.53 ± 4.91,
p < 0.001) and Mental Health (62.39 ± 5.32 vs. 91.35 ± 3.14,
p < 0.001). The changes for the scales associated with physical
health were less significant: Physical Functioning (62.10 ± 4.56
vs. 73.77 ± 6.31, p < 0.05), Bodily Pain (74.58 ± 8.37 vs.
89.45 ± 6.26, p < 0.05). In E2V/DNG group significant improvement of both mental and physical health scales were registered:
PF (72.83 ± 3.43 vs. 75.13 ± 2.45, p < 0.05), RP (63.33 ± 6.22 vs.
79.91 ± 3.24, p < 0.05), BP (73.37 ± 3.82 vs. 86.25 ± 5.64, p < 0.05),
GH (78.93 ± 3.44 vs. 88.14 ± 5.26, p < 0.05), VT (64.00 ± 5.2 vs.
Nguyen Toan Tran, Suzanne Reier and
Mary Lyn Gaffield
WHO, Geneva, Switzerland
Objectives: Postpartum family planning (PPFP) is critical to
reduce unmet need for family planning, maternal deaths and
child deaths. We are currently conducting the formative phase
of a multisite operations research project on postpartum family
planning in Burkina Faso and the Democratic Republic of Congo
(DRC). The aim of this phase of the research is to identify a
package of effective interventions to increase the uptake of
modern family planning methods during the first year postpartum. The effectiveness of service provision using the package
will be compared to usual care during the intervention phase.
Method: The study applies a complex intervention design with
interlinked phases. The formative phase aims to (1) identify
PPFP barriers and catalysts through a participatory approach
using a qualitative methodology (focus group discussions with
women and service providers and in-depth interviews with key
community stakeholders), (2) shape a set of PPFP interventions
(including a PPFP counselling tool) to strengthen antenatal and
postnatal care services through consensus building among
research, program, policy, and clinical stakeholders, and (3)
examine its feasibility. The intervention phase will use a cluster
randomised design and will implement the package of newly
designed PPFP interventions with the experimental group.
Results from this group will be compared with those of usual
care being offered in the control group. The study will conclude
with a qualitative research component that will seek to understand the reasons for success or failure of PPFP services in the
intervention group as well as in the control group.
Results: Expected results of the formative phase includes a
field-tested and improved PPFP counselling tool, and a set of
feasible interventions to strengthen enablers and address barriers related to the provision of PPFP in antenatal and postnatal
services. These components will make up the final package of
PPFP interventions to be tested in the intervention phase.
Conclusions: We expect that the results from the formative
phase of our complex intervention design is essential in defining a rights-based, community-informed, and acceptable set of
PPFP interventions that has the potential to strengthen existing
antenatal and postnatal services and increase the uptake of
modern FP methods during the first year postpartum.
ACCEPTED ABSTRACTS – NON-CONTRACEPTIVE BENEFITS
ROLE OF MIDLEVEL PROVIDERS
SEXUAL AND CONTRACEPTIVE BEHAVIOUR
A-187
A-188
Social egg freezing as a new family
planning tool?
What do we know about
contraceptive use, pregnancy
intention and decisions of young
Australian women? Findings from the
CUPID study
Karolina Novakovaa and Hana Konecnab
a
Department of Psychology, Faculty of Social Studies, Masaryk
University, Brno, Czech Republic; bDepartment of Clinical and
Praeclinical Disciplines, Faculty of Health and Social Studies,
University of South Bohemia, Ceske Budejovice, Czech Republic
Objectives: In the Czech Republic, the average age of women
bearing their first child has increased rapidly over the last two
decades. This is an important reproductive health problem as
fertility declines with increasing female age. While egg freezing
was primarily an option for women who wanted to preserve
their fertility due to medical reasons (young women undergoing
chemo- or radiation therapy affecting their reproductive health);
it is also offered to women for elective reasons that would
make pregnancy or parenting difficult or undesirable at the present time. Hence, such practice shifts the attention from a medical procedure to a social phenomenon. We aim to analyse a
supply and demand of social freezing (SF) in the Czech
Republic; as well as ethics and social desirability of egg freezing
for non-medical reasons.
Methods: Mixed research strategy. Analysis of ART centres’
offers and interviewing ART professionals.
Results: In the Czech Republic, SF is by media and ART clinics
themselves presented as a part of reproductive strategies of
women. There are 41 registered ART clinics; out of which 15
offer SF programs – being referred to as ‘preventive programs
of preserving future fertility’. SF is also financially very burdensome. Price range is very wide, but average cost of one cycle
including consultations, hormonal stimulation, oocyte extraction,
conservation, vitrification and storing for five years accounts for
ca. 1300 Euros (plus additional costs for medication).
Nevertheless, ART clinics in many cases fail to inform in their
online offers that usually more cycles are required in order to
retrieve more eggs; and therefore the expenses will be much
higher. The position of Czech ART expert society is that women
should be given the information about SF, but certainly should
not be encouraged to use these services.
Conclusions: From the ethical point of view we find current
situation questionable problematic; we lack any data about the
success of the procedure; there is a risk of manipulation of
women by their employers; we also doubt that SF will decrease
the need of donor eggs. The current way of presentation of SF
by its providers is in our opinion also rather problematic, as it
leads away from the real problem – postponing childbearing to
advanced age and decreasing of birth rate. Any positive support
of early parenthood is absent in the Czech Republic.
125
Jacqueline Coombea, Melissa L. Harrisa,
Britta Wiggintonb, Deborah Loxtona and
Jayne Luckec
a
Research Centre for Gender, Health and Ageing, University of
Newcastle, Callaghan, NSW, Australia; bSchool of Public Health,
The University of Queensland, Herston, QLD, Australia; cAustralian
Research Centre in Sex, Health and Society, La Trobe University,
Melbourne, VIC, Australia
Objectives: To explore the contraceptive practices and pregnancy intentions of young Australian women aged 18–23 in the
Contraceptive Use, Pregnancy Intention and Decisions (CUPID)
study.
Methods: A total of 3795 young women were recruited at baseline. Recruitment was monitored against the Australian Census
resulting in a sample demographically representative of the
broader Australian population (with a slight overrepresentation
of educated women). Quantitative and qualitative analyses have
been conducted using the baseline survey data. The following
highlights some of these findings.
Results: Contraceptive practices: Although the pill (29.8%) and
condoms (12.7%), alone or in combination (17.3%), remain the
most popular methods overall among women in the CUPID
cohort, we found use of long-acting reversible contraception
(LARC) to be higher than in other studies exploring similar age
ranges (Implanon 8.7%, Mirena 2.8%). Unintended pregnancy: Of
the women reporting ever being pregnant (n ¼ 716), 84.6% indicated that their pregnancy was an accident, with 73.4% reporting using contraception at the time of unintended pregnancy.
The oral contraceptive pill used alone or in combination with
another method (39.1%) was most commonly cited. Profile of
LARC users: Women reporting a previous pregnancy were more
likely to use a LARC (OR ¼ 2.91 95% CI ¼ 2.3, 3.7) compared to
women who did not. Women who indicated use of contraception for its non-contraceptive effects, including management of
their periods, bodies and medical conditions, were less likely to
use one of these methods (period OR ¼ 0.74 95% CI ¼ 0.6, 0.9,
body OR ¼ 0.52 95% CI ¼ 0.4, 0.8, medical OR ¼ 0.3 95% CI ¼ 0.1,
0.7, combined p ¼ 0.0001). Contraceptive change: These findings
are supported by our qualitative analysis of reasons why young
women changed their contraceptive method, which indicated
that non-contraceptive effects are a strong motivator for
method change.
Conclusions: There is a significant lack of Australian research
that explores the contraceptive practices and pregnancy intentions of young women. Additionally, data collected on contraceptive practices among young women have usually been
collected from larger health surveys, thus lacking a nuanced
and focused analysis. CUPID is unique in its collection of sexual
and reproductive health data in the context of a survey, and
provides an opportunity for evidenced based discussions about
pregnancy intention and contraceptive practices; discussions
that until recently have been precluded by a lack of representative data.
126
A-189
Rapid assessment of knowledge
about modern contraception among
urban versus rural population groups
in Kazakhstan
Galina Grebennikova, Nafisa Mirzaraimova,
Bibigul Alimbekova, Nadezhda Kobzar and
Liliya Bamurzayeva
Kazakhstan Association on Sexual and Reproductive Health
(KMPA), Almaty, Kazakhstan
Objectives and Methods: Questioning of population (women
and men) of reproductive age who live in South-Kazakhstan
and Zhambul oblasts (rural population) and Almaty city (urban
population) about modern contraception.
Results: Of 400 respondents (50% rural and 50% urban population), the age distribution ranged from 24 to 34 years old; 60%
have married status and 40% have unmarried status; 57.5%
respondents have higher education and the rest have secondary
level education; 53% have children. The analysis revealed that
among rural population 36% of respondents didn’t know about
contraception, while among urban inhabitants that number indicated 24%; only 30% of rural inhabitants versus 73% of urban
inhabitants responded that contraception prevents pregnancy
and STIs. Besides, 23% of urban inhabitants and 0.5% of urban
inhabitants are against contraception; only 2% of parents from
rural areas devoted time for sexual education of their children,
while in urban areas 34.5% of parents communicated with their
children on sexual aspects. It was identified that the majority of
the rural population has a negative attitude to hormonal methods of contraception – 69%, while in urban areas this indicator
amount was only 40%. The key sources of information about
modern contraception were doctors/pharmacist, mass media
and peers for both studied population groups.
Conclusion: The study showed lack of knowledge about modern contraception among both urban and rural population
groups, however the rural population is in need for more attention and efforts in raising awareness and education on modern
methods of contraception. Health care professionals should target rural areas to deliver IEC specific interventions to improve
the level of knowledge and attitude towards modern contraception, including hormonal methods.
A-190
‘As long as he is bent on having
more children, he will go for another
woman’: understanding fertility
preferences among men in Ghana
Amanda Kalamar and Michelle Hindin
Johns Hopkins Bloomberg School of Public Health, Baltimore,
MD, USA
Background: While women’s fertility preferences have been
well-studied, men’s preferences and related characteristics have
been under-examined in the literature. Little is known about
factors that influence fertility preferences among men and what
might be motivating inconsistent responses to quantitative
questions aimed at measuring their preferences.
Objectives: To explore Ghanaian men’s beliefs and preferences
around child-bearing using qualitative data, and to use the
results to inform and test a quantitative model to explore the
factors associated with inconsistent responses to fertility preferences questions among men.
Methods: A mixed methods approach was taken utilising data
from eight focus groups of men in Kumasi, Ghana and quantitative data from 799 men in Round 1 of Family Health and
Wealth Study in Kumasi. A thematic coding approach identified
major themes emerging from the qualitative data. These themes
were mapped onto the quantitative data and translated into
measured variables. The relationship of these variables with
inconsistent responses to fertility preferences questions was
tested using multivariate logistic regressions.
Results: Five major themes emerged from the qualitative data
related to fertility preferences among men: economics, relationship quality, religion, health concerns, and multiple partners. In
the quantitative model, wealth expectations were positively
associated with men’s inconsistent responses to fertility preferences questions (AOR ¼ 1.63, 95% CI 1.18–2.25). Three dimensions of relationship quality were also associated with these
inconsistent responses, Love, Communication, and Happiness
(AOR ¼ 1.05, 95% CI 1.03–1.07 for love; AOR ¼ 0.96, 95% CI
0.93–0.98 for communication; and AOR ¼ 0.73, 95% CI 0.58–0.90
for happiness). Religion was negatively associated (AOR ¼ 0.90,
95% CI 0.84–0.97) while increasing self-rated health was also
protective against inconsistent responses in comparison to men
rating their health as average or below (AOR ¼ 0.61, 95% CI
0.41–0.90 for good health and AOR ¼ 0.59, 95% CI 0.46–0.77 for
very good health).
Conclusions: This is one of the first mixed methods studies
exploring underlying fertility preference motivations among
men and context likely matters. Relationship quality and health
concerns are newly identified influential factors and their inclusion in future studies exploring men’s fertility preferences
should be considered. Understanding men’s preferences and
inconsistent responses can help programmes be more responsive to the need and unmet need for contraception.
A-191
Knowledge and personal
contraceptive choice of Chinese
female obstetrician-gynaecologists:
results of a survey
Xin Yanga, Junxiu Weib, Xiaodong Lib, Yanjie Wanga,
Xiaojing Heb and Yang Zhaoa
a
Peking University People’s Hospital, Beijing, China; bThe Second
Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
Objectives: To determine the personal choices of contraceptive
methods among Chinese female medical staff, and to know
their practice about contraception.
Method: A total of 4500 self-administered questionnaires were
sent to female medical staff attending the gynaecological endocrinology workshops and health seminars held from February
2013 to May 2013 in 15 provinces and cities in China.
Results: Overall, 4253 eligible questionnaires were collected.
The average age of the female medical staff was 36.40 ± 9.6
years. Among them, 662 (14.6%) obstetrics-gynaecologists (OB/
GYNs). A total of 1581 (37.2%) reported to have had abortions
due to unintended pregnancies. Among them, 49.4% were due
to no reliable contraceptives. Regarding the choice of contraceptives in 2621 medical staff whom after completion of the
family, the three most common methods were the IUD 30.45%,
condom plus rhythm method 17.55%, condom every time
15.22%. As for their knowledge of combined oral contraceptives
(COCs) among OB/GYNs and non-OB/GYNs, taking COC may not
increase the risk of breast cancer by 48.3% and 35.6%; taking
COC for long term may not cause amenorrhea and premature
ovarian failure by 77.5% and 49.3%; After taking COC, pregnancy should start three–six months after stopping intake
65.6% and 33.0%.
Conclusions: This survey among Chinese female medical staff
involved in contraceptive choice showed that the IUD was the
ACCEPTED ABSTRACTS – SEXUAL AND CONTRACEPTIVE BEHAVIOUR
most frequently used method. The rate of unintended pregnancy and abortion was high, and the contraceptive methods
commonly used by most medical staff were not reliable and
they were worried about the side-effects of COCs. Education
about safe and effective contraception should be strengthened
for them.
A-192
Evaluation of contraceptive
behaviours and dynamics of Turkish
women and their partners
Sezai Sahmaya, Erkut Attarb and Cihat Unluc
a
Cerrahpasa Medical Faculty, Istanbul, Turkey; bIstanbul
University, School of Medicine, Istanbul, Turkey; cAcibadem
University, Istanbul, Turkey
Background: The use of modern contraceptive methods has
remained very low over the years in Turkey. Unplanned pregnancies are very common (24%) and abortion rates are very
high. Previous research data shows that the reason for this is
the choice of unreliable contraceptive methods, withdrawal
(coitus interruptus), being the most common, while oral contraceptive usage is lower than most of the developed and developing countries (4.6%).
Objective: The objective of this study was to investigate the
reasons which lead to the failure in choosing reliable contraceptive methods. The investigated areas are: the behavioural-demographic profile of women and their partners, their sources of
information, common misperceptions on oral contraceptives
and behavioural pattern on contraceptive choices.
Methods: This research is representative of Turkey and it
includes 750 women, aged 15–49. A cross-sectional survey was
used to collect information and the ‘boost method’ was used to
get reliable data on areas for further investigation. The questionnaire was pilot-tested prior to the study. After the study,
there were follow-up boost surveys and focus group studies
(with men) to get detailed data.
Results: The choice of unreliable contraceptive methods correlates with reasons such as lack of information on modern methods, misperceptions, religious and cultural barriers. Women’s
main and most reliable information sources are their partners
and friends. Most (70%) of women are influenced by their partners on birth control. The level of contraceptive information is
lower in women who take their partners as the main information source. Meanwhile, follow-up data shows that men were
not well informed on their contraceptive choices and failure
rates of different methods. Both for men and women, knowledge on oral contraceptives is very limited and there are common misperceptions. There is a big variation in different cities,
on contraceptive knowledge and this variation mostly correlates
with socio-economic status.
Conclusions: This study yields findings which are useful in planning educational programmes to inform women and partners
about contraception. Public health and educational efforts to
increase modern contraceptive use must include men and be
targeted to both male and female partners. It also points out
the crucial areas which constitute the general misperceptions
on hormonal methods and which need to be focused to
increase awareness on noncontraceptive health benefits of combined oral contraception. Our results also indicate that improving modern contraceptive methods requires policies and
strategies to address the inequalities caused by socio-economic
factors and education.
127
SEXUAL AND REPRODUCTIVE RIGHTS
A-193
Determinants of sexual and
reproductive health among Brazilian
youth (aged 18–29 years)
a
John Snow, Brasilia, Federal District, Brazil; bInstituto Social Caixa
Brasilia (UnB), Brasilia, Federal District, Brazil; dOpini~ao
Objectives: To assess and investigate the main determinants of
sexual and reproductive health of Brazilian youth. The study
was approved by the Ethics Committee of the Medicine Faculty
of the University of Brasilia, and it received support from the
Panamerican Health Organization and the Department of STD/
HIV-AIDS and Viral Hepatitis of the Ministry of Health.
Method: A total of 1208 youth aged 18–29 in 15 states and the
Federal District were interviewed at their residences. The margin
of error of the research, regional and nationally adjusted, was
2.8% with a confidence interval of 95%. A KAP scale (knowledge, attitudes, and practices) with 17 questions (17 to þ17
points) was generated subdivided into three domains:
Knowledge (six variables), attitudes (seven variables), and practices (four variables). A questionnaire was pre-tested for consistency and validity. Using the KAP scale as the main dependent
variable, adjusted linear regression models were used to identify
significant differences.
Results: The mean KAP score for sexual and reproductive health
among Brazilian youth is low (5.65 points). Major gaps in specific and key variables were identified. Over 70% of the Brazilian
youth aged 18–29 years, including women, do not know when
a women’s fertile period is. Furthermore, over 42% of youth do
not recognise condoms as a method to prevent unwanted
pregnancy and STIs. The main factors associated with explaining
variances in KAP scale levels are gender, education, religion,
access to health services, having had sexual intercourse in the
last 12 months, and having friends as the main personal reference (p < 0.05). Furthermore, none of the various sources of sex
education suggested in the research (including parents, teachers, health professionals, etc) was associated to a positive variation in sexual and reproductive health KAP scale.
Conclusions: Even though consistency and validity tests demonstrate that the KAP scale represents a good measurement for
assessing sexual and reproductive health of Brazilian youth, only
a few possible determinants were associated with higher KAP
levels of sexual and reproductive health. Therefore, new public
policies and programmes should be developed for extensive
promotion of sexual and reproductive health KAP.
A-194
Sexual and reproductive rights and
natural family planning methods
Françoise Solera and Enriqueta Barranco-Castillob
a
acodiplan, Barcelona Barcelona, Spain; bb Andalusian Regional
Health Service. Obstetrics and Gynaecology Clinical Management
Unit, San Cecilio University Hospital, Granada, Spain
Objective: To answer the question: ‘Are natural family planning
methods (NFP) included in books about SRR?’
Methods: First a reminder of the mention of NFP in
International Conferences on Population and Development.
Mexico 1984: ‘Recommendation 25: Governments should, [. . .]
make universally available information, [. . .] to assist couples
128
and individuals to achieve their desired number of children.
Family planning information, [. . .] including natural family planning, to ensure a voluntary and free choice in accordance with
changing individual and cultural values [. . .]’. Cairo 1994: 7.2
‘‘Reproductive Health therefore implies that people are able to
have [. . .] the capability to reproduce and the freedom to
decide if, when and how often to do so. Implicit in this last condition are the right of men and women to be informed and to
have access to safe, [. . .] methods of family planning [. . .] as
other methods of their choice for regulation of fertility which
are not against the law [. . .]’. The 21 special session of United
Nations (8 November 1999) on the Cairo conference mentioned
in 57 (a): [. . .] ‘acceptable family planning and contraceptive
methods including new options and underutilised methods’.
Does this implicitly stand for NFP (among others)?
We assessed the space given to NFP and SRH in books available
by internet navigator.
Results: We find the below readings:
1.
2.
3.
4.
5.
6.
Sexual and Reproductive Health Core competencies in
primary care (WHO 2011). The need of FP appears in
the competency 7. Fertility Awareness Methods are
named in point 6 ‘Assess individual/couple for infertility
and refer if needed’: Only Standard Days mentioned.
Programming strategies for Postpartum Family Planning
(WHO 2013). Lactational Amenorrhea Method is offered
for Breastfeeding women. NFP is omitted.
Medical eligibility criteria for contraceptive use (WHO
2015) indicated a median for FAMs: a scientific aberration since methods differ.
References about FAMs are absent.
Medical eligibility criteria wheel for contraceptive use
(WHO 2015), LAM is not mentioned in Postpartum and
breastfeeding, neither is any NFP.
Ensuring human rights in the provision of contraceptive
information and services, guidance and recommendations (WHO 2014). Contraceptives are named more
than 150 times, emergency contraception 14, NFP is
omitted.
The list is not exhaustive.
Conclusion: The aim to ‘Ensure that women and men have
information and access to the widest possible range of safe and
effective family-planning methods in order to enable them to
exercise free and informed choice’ demands better NFP
information.
SEXUAL DYSFUNCTION
A-195
Urogynaecological problems and
sexual dysfunction: an epidemiologic
study
Charalampos Grigoriadis, Elias Liapis,
Nikolaos Sigelos and Angelos Liapis
University of Athens, Medical School, Aretaieion Hospital, Athens,
Greece
Background: Urogynaecological problems have been correlated with an adverse effect on female sexual activity.
Recently published studies reported that among sexually
active postmenopausal women with UI, 22% believe that sexual intercourse could cause urine loss. In addition, this category of women presents an increased prevalence of sexual
distress.
Objective: The aim of this study was to examine the impact of
urogynaecological problems, such as urinary incontinence (UI),
pelvic organ prolapse (POP), vaginal atrophy or recurrent urinary
tract infections (UTIs) on female sexuality.
Methods: This was a questionnaire-based epidemiologic study,
which included 2000 women, aged between 20 and 80 years
old. Half (50%) of the questionnaires were collected from the
main cities, while 22% and 28% of answers came from smaller
towns and rural areas respectively.
Results: A total of 531 women in the study group (27%)
reported urinary incontinence. Among women aged between
20 and 70 years, 409 presented UI. The vast majority of
them (274/409, 67%) were sexually active. Even in the group
of older women (60 70 years old) with UI a high percentage (40%) remain sexually active, while 8% expressed limitation in their sexual life because of urinary incontinence and
vaginal atrophy.
Sexual distress with pain during sexual intercourse was present in 20% and 15% of sexually active women with and
without UI, respectively. Vaginal dryness was correlated with
pain during sexual function in 33% of women diagnosed
with UI. In the majority of cases (49%), women with UI
answered that sexual distress occurred occasionally. On the
other hand, in 23.6% of sexually active UI patients, sexual distress was always present.
Conclusions: The degree of the adverse effect of urogynaecological problems on female sexual function is proportional to
the frequency of distress episodes. Treatment of these pathological conditions via pelvic floor muscles exercises, pelvic floor
reconstructive surgical methods, or midurethral sling procedures
increases coital frequency and decreases fear of incontinence
with coitus.
A-196
Altered resting state functional
connectivity in a sample of nonpaedophilic child sexual offenders
Jonas Kneer and Tillmann Kr€
uger
MHH, Hanover, Germany
Child sexual abuse is a worldwide concern and occurs across
most ethnic, religious and socioeconomic groups. In numerous
studies child sexual abuse and neglect has been related to an
increased risk for the development of a wide range of behavioural, psychological and sexual problems and increases the rate
of suicidal behaviour. Although there is a large number of studies focusing on the negative effects of child sexual abuse, very
little is known about the characteristics of child sexual offenders
as well as neuronal underpinnings. To our knowledge this is the
first study investigating the neurobiological mechanisms of nonpaedophilic child sexual offenders (CSO-P) through resting state
functional magnetic resonance imaging using a seed-based
approach. We focused on regions relevant for processing of sexual, and other emotional stimuli, antisocial behaviour as well as
two of the most prominent resting state brain networks (default
mode network and salience network).
Initial results suggest that both areas related to emotional and
sexual processing show abnormal functional connectivity during
rest in 20 CSO-P compared to 20 healthy controls. These results
show that the understanding of the interplay between emotion
and sexual processing may contribute to a better understanding
of the occurrence of child sexual abuse and may lead to more
differentiated and effective diagnostics and treatment.
ACCEPTED ABSTRACTS – SEXUAL HEALTH EDUCATION
A-197
Relationship between sexual
dsyfunction and sexual myths of
women
€ lu
€fer Erbil
Nu
Turkey
Objective: To investigate the relationship between sexual dysfunction and sexual myths of Turkish women.
Method: Data of this descriptive and correlational study was
collected using the Female Sexual Function Index (FSFI), sexual
myths form and questionnaire form. A FSFI total cut-off score
of 26.55 was used to identify women with sexual dsyfunction
(SD).
Results: The mean of the total FSFI score of women was 25.01
(SD 7.06, range 1.20 36.00). The mean of the sexual myths of
women was 22.59 (SD 8.73, range 0 46). FSFI subscales;
orgasm (r = 0.065), satisfaction (r ¼ 0.012) did not correlate
with sexual myths score, while desire (r = 0.136), arousal (r
= 0.115), lubrication (r = 0.114), pain (r = 0.135) and total
FSFI score (r = 0.108) did negatively correlate. The mean score
for sexual myths of women with sexual dsyfunction (24.42) was
higher than women with normal sexual function (20.62), and
the difference was statistically significant.
Conclusions: The study exposed a relationhip between sexual
dysfunction and sexual myths in women. It was determined
that women with sexual dysfunction believed sexual myths
more than women with normal sexual function. Sexual education is recommended to correct wrong sexual beliefs starting
from childhood by teachers, health professionals and the mass
media.
SEXUAL HEALTH EDUCATION
A-198
Tolerance to sexual diversity, gender
equity, sexual and reproductive
rights: determinants of sex education
among Brazilian Youth (aged 18–29
years)
a
John Snow, Brasilia, Federal District, Brazil; bInstituto Social Caixa
Brasilia (UnB), Brasilia, Federal District, Brazil; dOpini~ao
Objectives: To evaluate the level of sexual education of
Brazilian youth regarding sexual diversity, gender equity, and
sexual & reproductive rights. The study was approved by the
Ethics committee of the Medicine Faculty of the University of
Brasilia. The Panamerican Health Association (PAHO) and the
Department of STDs/HIV-AIDS and viral hepatitis of the Brazilian
Ministry of Health supported this study and Caixa Seguradora (a
Brazilian insurance company) funded the research.
Method: Residential interviews were conducted with 1208
youth aged 18–29 years based on a probabilistic sample in 15
States and the Federal District. The research margin of error,
standardised regional and nationally, was 2.8%. Women represented 55% of the total sample. A sexual education scale was
generated, incorporating variables on sexual diversity, gender
equity and sexual & reproductive rights. Adjusted linear
129
regression models were created to identify socio-demographic
determinants explaining the variance on the sexual education
scale among Brazilian youth. The consistency of the sexual education scale with 15 variables (four on sexual diversity, six on
gender equity, and five on sexual, seven on reproductive rights)
reached an Alpha Cronbach of 0.7.
Results: The final range of the sexual education scale varied
from minus to plus 15 points. The mean reached by
Brazilian youth was 7.8 points. Out of the six main sociodemographic variables included in the final regression model:
gender, religious affiliation, and education were significantly
associated to variation in sexual education levels (p < 0.05).
As per social determinants, having teachers as the main
source of sex education, accessing the internet, having an
interest in learning, not participating in religious groups, having frequent conversations with parents, frequency of sexual
intercourse, and confidence in his/her sexual health were all
positively associated to higher levels of sexual education
(p < 0.05).
Conclusions: Based on socio-demographic and social determinants associated to positive variations in levels of sex education, programmes and policies should be implemented for
reducing stigma, gender inequity, and increasing awareness
of sexual and reproductive rights among Brazilian youth. Sex
education curriculum restricted to information about human
sexuality is not enough to promoting skills related to tolerance for sexual diversity, gender equity, and sexual and
reproductive rights.
A-199
Development of Computer Assisted
Instruction (CAI) entitled sexeducation in early secondary school
students of Piboonbumpen
Demonstration School of Burapha
University
Kitti Krungkraipetch and
Luksanaporn Krungkraipetch
Burapha University, Chonburi, Thailand
Objectives: To create a CAI entitled sex-education and compare
early secondary schools students’ knowledge in sex-education
before and after studying via a CAI entitled sex-education.
Methods: The sexual education topics derived from a survey
among parents, teachers and students in this school. The top
three votable topics were ‘sexual development’, ‘manners of
man and woman’ and ‘what do they think between man and
woman’. CAI dialogues and cartoon animations were created by
medical students and an IT man. After validation and trials, we
took them for pre/post test in the targets. There were 301 participants chosen by cluster sampling from 765 students in an
early secondary school level of Piboonbumpen Demonstration
School in 2012. The percentage, mean ± SD and paired t-test
were used to analyse the data.
Results: Out of the total of 301 participants, 165 were male and
136 were female. There was a statistically significant difference
in pre-post test scores in the main group and subgroup analysis
(gender, class level and GPA level) (p < 0.01). There were significant score improvements after CAI learning. Most of them
enjoyed and paid more attention to these assisted media for
sexual education learning hours.
Conclusion: CAI is one of the good tools in sex education. In
some contexts that are difficult for traditional teaching, CAI can
be a useful method.
130
A-200
My fertility matters!
Jenny Heathcote, Hilary Hodgson and
Elisabeth Raith-Paula
MFM Project UK, Cheshire, UK
Objectives: England and Wales have the highest levels of teenage pregnancy in Western Europe. There is widespread lack of
knowledge about how our bodies work, and the changes experienced at puberty. Many young people say that they get their
information about their bodies from watching pornography.
Methods: The MFM Project was launched in Germany in 1999;
a one-day interactive workshop prepares girls for the changes
that happen to their bodies at puberty. A parents’ session
before the workshop offers them the language and confidence
to talk about puberty at home. When boys protested that they
were missing out on information that was vital to them, a programme was written to support the changes they were experiencing on their journey to manhood.
Results: MFM is highly successful in mainland Europe; workshops are being delivered in Germany, Austria, Switzerland,
France, Hungary, Belgium, Latvia (and most recently in China),
and have reached over 500,000 young people and parents. The
programme is currently being translated and developed to
reach a UK audience as MFM Project UK (‘My Fertility Matters’).
The girl’s ‘Cycle Show’ is for 9–12 year olds. Using a colourful
interactive floorshow the girls learn the secret clues that show
that they are developing into women – changes in their anatomy, how hormones and negative feedback works, and why
periods and cervical mucus are so important. They look at the
natural cycle of receiving a message to get ready for a special
guest, making the preparations, and then tidying up afterwards,
ready to start again.
The boys show, ‘Agents on a Mission’ has a James Bond-style
journey through the male anatomy, with lots of physical activities, moving on to learn about the female body and how an
egg is fertilised. They learn about caring for and respecting their
own and women’s bodies.
The young people discover that each of them is a double winner made from the winning sperm (from around half a billion in
an ejaculate), and the queen egg (from the 400,000 follicles that
a girl has at puberty). The premise is that ‘I can only protect
what I value and respect’.
Conclusions: Feedback from the parents, teachers and pupils of
the first UK schools where this has been delivered is very positive both in terms of knowledge gained and increased selfesteem.
skills to manage their concerns pertaining to SRH. Udaan, (AEP)
being implemented by Centre for Catalyzing Change in
Jharkhand, India, with the State Education Department is a programme which aims to establish a cadre of healthy and
empowered adolescents. Udaan, AEP is being implemented
with students from grades 9 and 11, since 2006. Years of programme implementation experience highlighted the fact that
there were comparatively low attitudinal and behavioural
changes among students in grade 11, as compared to grade 9,
reflecting the fact that it is more difficult to change attitudes
and behaviour among older adolescents and that if such a programme is introduced at a younger age, it would greatly impact
perceptions and behaviour of young people.
Methods: For introduction of AEP in lower classes, it was thus
important to gather evidence and identify state specific key
issues and needs of students in early adolescence and also
assess knowledge, attitudes, perceptions and intentions pertaining to adolescence among students in this age group. A cross
sectional study was carried out through quantitative and qualitative approaches with 800 students from six selected districts
as well as district officials, school principals, teachers and community members
Results: The study revealed that 84% students expressed a
need to know more about communication and relationship
building, 93% students showed keenness to learn about
changes that occur during adolescence. Most commonly known
changes in boys reported were visible changes like increase in
height, weight, appearance of facial hair, change in voice, etc.
but level of awareness on changes like night fall (6.4%) and
semen formation (3.5%) was very low. Only 7% boys and 16%
girls were able to identify five correct characteristics of puberty
for girls and boys.
Conclusion: Results of the study highlighted the need for building awareness among students of this age group on adolescent
issues, which resulted in the initiation of AEP with students of
classes 6, 7 and 8 in selected schools in the state of Jharkhand
in 2014.
A-202
Sexual health education and its
impact on sexual behaviours and
perceived sexual satisfaction in
Turkish women
Erkut Attara, Sezai Sahmayb and Cihat Unluc
a
Istanbul University School of Medicine, Istanbul, Turkey;
Cerrahpasa Medical Faculty, Istanbul, Turkey; cAcibadem
University, Istanbul, Turkey
b
A-201
Need assessment results in
introduction of adolescent education
programme in lower classes
Aparajita Gogoi, Vinita Nathani, Manju Katoch and
Vijender Kumar
Centre for Catalyzing Change (C3), New Delhi, India
Objective: A large body of literature suggests that adolescents
often are not aware about their sexual and reproductive health
(SRH) which results in them being denied the right to make
safe and informed decisions that affect their health and wellbeing. They also face risky behaviours such as violence, AIDS,
substance abuse, sexual harassment, etc. The National
Adolescent Education Program (AEP) in India aims to equip
every adolescent with scientific knowledge, information and
Background: In Turkey, sexual education is not offered as a
part of school education. The information is received from
friends, internet, close family and not very easily discussed,
especially for women.
Objective: To understand the sources of sexual information,
evaluate the reach for sexual health support from HCPs, perceived quality of sexual life and the factors which affect the
quality of sexual life. The correlation of these factors with
behavioural-demographic profile of women is also investigated
in detail.
Methods: This research is representative of Turkey and it
includes 750 women, aged 15–49. A cross-sectional survey was
used to collect information and the ‘boost method’ was used to
get reliable data on areas for further investigation. The questionnaire was pilot-tested prior to the study.
Results: The most pronounced methods of sexual health information are close friends and family. Gynaecologists are usually
not regarded as a source of information on sexual health.
Women usually are conserved on their questions about sexual
health. Half (50%) of young women do not trust anyone on
ACCEPTED ABSTRACTS – SEXUALLY TRANSMITTED INFECTIONS
sexual health information. Cultural barriers impose difficulty to
get sexual health information and use contraceptives before
marriage, even for treatment. Perceived sexual satisfaction is
affected by education level, level of communication with partner and factors such as childbearing.
Conclusions: This inadequate knowledge on sexual health leads
to outcomes such as not going to routine gynaecologist visits,
not talking to partner, decreased sexual satisfaction and not
choosing reliable methods for contraception and disease prevention. As a consequence, it affects society’s well-being.
Women who can talk to a gynaecologist about their sexual wellbeing have both more information on sexual health and more
perceived satisfaction. Efforts should promote sexual health education to be given by reliable sources and at earlier ages before
the first intercourse.
SEXUALLY TRANSMITTED INFECTIONS
A-203
People who buy sex – experiences
from our project
Anders Royneberg
131
care providers’ knowledge and perceived need for education
about STIs in Rasht, north of Iran.
Methods: A cross-sectional study conducted on 219 primary
health care providers who were involved in an STI control
programme in Rasht, north of Iran from October to
November 2014. For data collection we used a valid Persian
version of Sexually Transmitted Disease Knowledge
Questionnaire (STD-KQ) with a score range from 0 to 26 and
a research-made need assessment questionnaire with a 1–5
point Likert scale.
Results: Nearly 41% of participants were in high or very high
category of educational need. The first ranked STI was
Granuloma Inguinale, where 40.8% of participants reported their
need as high or very high. Mean of STIs knowledge score was
17.92 ± 4.68 and about 69% of total score was gained by participants. STIs knowledge score was significantly higher in female
(p ¼ 0.009). Mean of STI knowledge and need for education
score among different groups of educational level (p ¼ 0.0001),
field of graduation (p ¼ 0.0001), and time since graduation
(p ¼ 0.021) were significantly different, but they were not significantly different among different groups of job title, area of
workplace, and years of experience (p > 0.05).
Conclusion: Primary health care providers in Rasht, Iran, do
not have sufficient knowledge about STIs and they need to be
more educated about STIs. Designing and performing comprehensive and continuing educational programmes to promote
primary health care providers’ knowledge is recommended.
Sex og samfunn, Oslo, Norway
Objectives: To prevent human trafficking and the spread of
STIs among people who buy sex. The project is funded by the
Norwegian Ministry of Justice and Public Security and the
Directorate of Health and Care Services.
Sex og samfunn is Norways’s largest centre for sexual and
reproductive health and has for more than 40 years worked to
improve people’s sexual health.
Methods: Our data is based on patient conversations. The service is open for all genders and ages, and for partners of people
who buy sex. The patients are offered standard STI testing and
given an opportunity to talk to experienced health personnel.
Results: Since the implementation in July 2014, we have had
about 400 patients. Many of the patients have concerns related
to buying sex and see the service as a possibility to talk about
their thoughts and behaviour. The reasons for buying sex are
not one-dimensional, but rather complex and vary from loneliness to seeking pleasure. Diagnosing only a few incidents of
STIs may indicate that people who buy sex in Norway are not
at higher risk of contracting STIs, as we may believe.
Conclusions: Meeting people who buy sex without prejudice
offers a rare opportunity to talk about difficult subjects. We
work systematically to obtain knowledge about people who buy
sex and hope this knowledge will give us a better foundation in
providing the best services possible, how to reduce the number
of people being exploited and reduce the spread of STIs.
A-204
Are the primary health care providers
ready to perform a sexually
transmitted infections control
programme? A survey from Iran
Davoud Pourmarzi and Seyedeh Hajar Sharami
Reproductive Health Research Center, Guilan University of
Medical Sciences, Rasht, Iran
Objectives: Primary health care providers have an important
role in the sexually transmitted infections (STIs) control programme in Iran. This study aimed to evaluate primary health
A-205
Homeopathy for treatment of herpes
simplex virus
Sareh Abdollahifarda and Majid Maddahfarb
a
Jahrom University of Medical Sciences, Jahrom, Iran; bBHOWCO
Trading GmbH, Frankfurt, Germany
Background: Herpes simplex is a viral disease caused by herpes simplex viruses; HSV infections are very common worldwide. There are two types of HSV. HSV type 2 is the one
that most commonly causes genital herpes. The infection
causes painful sores on the genitals in both men and
women. HSV-2 is sexually transmitted. People with weakened
immune systems, such as people with HIV/AIDS, or those
who take immunosuppressant drugs to treat an autoimmune
disease or because of organ transplant, are at increased risk
for severe cases of herpes.
Objective: To review the present knowledge of HSV genital
inflammation and material-medica Homeopathy causative to
treatment of HSV genital.
Methods: A systematic review was conducted with Medline,
PubMed, EMBASE, ProQuest, Google Scholar and 32 studies to
identify relevant studies that involved the effect of
Homeopathy on treatment of HSV in men and women up to
December 2012.
Results: The best general management of HSV is to maintain
good hygiene, eat a nutritious diet, keep affected parts clean
and take adequate physical and mental rest. Although there is
no cure in conventional medicine for genital herpes, health care
workers might prescribe one of three medicines to treat it as
well as to help prevent future episodes.The best of the
chemical drugs are Acyclovir (Zovirax), Famciclovir (Famvir), and
Valacyclovir (Valtrex). But these drugs have many side-effects.
Nowadays
most
scientific
references
recommend
Complementary and Alternative Medicine (CAM) to treat HSV.
One of the best CAM fields is Homeopathy.
Homeopathy is a pre-scientific practice based on two tenets:
‘like cures like’’’ which holds that the correct remedy for a
patient is a substance that, when given to a healthy person,
produces symptoms similar to those of the patient; and
132
‘potentisation’, which holds that serial dilutions and ‘succussions’
(shakings) render a ‘remedy’ increasingly potent.
Conclusion: Many homeopathic remedies have been known to
cure genital herpes. Some of these are – Natrum mur,
Petroleum Causticum, Crot-t, Dulcamara, Graphites, Hepar-sulph,
Medorrhinum, Merc-sol, Sepia, Tellurium, Thuja, Anancardium,
Aur-met, Calcarea, Crot-h, Jug-r, Nit-ac, Ph-ac, Sars, Sil, Ter, Rhustox. Homeopathy treats the person as a whole. It means that
homeopathic treatment focuses on the patient as a person, as
well as his pathological condition. The homeopathic medicines
are selected after a full individual examination and case-analysis,
which includes the medical history of the patient, physical and
mental constitution etc.
A-206
An audit cycle reviewing the offer of
HIV testing in an integrated sexual
health service
Dawn Friday and Sally-Ann Botchey
St Helens and Knowsley Teaching Hospitals, Merseyside, UK
Objectives: To determine if the offer of an HIV test at a community sexual health clinic adhered to national guidelines (Offer
of HIV testing 97% BASHH). In the first audit cycle (October
2014) the offer of an HIV test (84%) failed to comply with
national guidelines. In addition, the uptake of HIV testing was
only 12%. Based on the findings, HIV awareness among attendees to the clinic was increased. Dry Blood Spot tests were also
introduced for patients who declared needle-phobia.
Methods: A retrospective review of the electronic patient
record (EPR) system was conducted during the month of
September 2015. The first 100 patients with a code P1B (HIV
test offered and refused) and PIC (HIV test inappropriate) were
selected. A Microsoft Excel spreadsheet was constructed in
which the following was recorded: demographics, sexual behaviour, drug use, offer of an HIV test, offer of dry blood spot testing, who offered the test and reasons for decline.
Results: The offer of HIV testing remained at 84%. The HIV test
uptake was 31%. Of the patients who declined HIV testing, a
number of reasons were cited. The most common reason was
‘does not feel there is a risk’ at 53%. Of these patients that did
not feel there was a risk, only 12% admitted to using condoms.
Only 8% of patients were documented to have been offered a
dry blood spot test. The age range of the patients audited varied between 17 and 82 years, with 66% being female. The
majority of the tests were offered by nurses 86%, doctors 10%
and 4% not documented.
Conclusion: The offer of an HIV test was satisfactory; however,
this failed to comply with national guidelines falling short by
13%. The uptake of the HIV testing improved with a 19%
increase of uptake from the first audit cycle. The introduction of
dry blood spot testing and increasing HIV awareness after the
first audit may have led to the better uptake in the second
cycle. However only 8% of patients were documented to have
been offered the dry blood spot test and this can be improved
by introducing a dry blood spot test offer section in the consultation proforma. In addition increased awareness to patients and
staff can be improved via posters, flyers and having computer
pop-up reminders.
A-207
Sexual behaviours in Kinshasa
(D.R.Congo): a case-control study on
HIV-related knowledge, attitudes and
practices
Cristina Lopez-del Burgoa,b,d, Silvia Carlosa,b,d,
~oe, Alfonso Osoriob,c,
Eduardo Burguen
Adolphe Ndarabue and Jokin de Iralaa,b,d
a
Department of Preventive Medicine and Public Health,
University of Navarra, Pamplona, Navarra, Spain; bInstitute for
Culture and Society, University of Navarra, Pamplona, Navarra,
Spain; cSchool of Education and Psychology, University of
Navarra, Pamplona, Navarra, Spain; dIdiSNA, Navarra Institute for
Health Research, Pamplona, Navarra, Spain; eMonkole Hospital,
Monkole, Kinshasa, Congo
Background: Sub-saharan Africa has one of the highest prevalences of HIV in the world, heterosexual transmission being the
main route for infection.
Objective: To evaluate the prevalence of sexual behaviours
in an outpatient centre of Kinshasa (D.R. Congo) and to analyse the association between these behaviours and HIV
infection.
Methods: A case-control study was carried out from
December 2010 until June 2012. A total of 1614 participants,
aged 15–49, attending Monkole-Hospital in Kinshasa for HIVVoluntary-Counselling-Testing or blood donation were
recruited. Before HIV testing, a face-to-face interview on HIVrelated knowledge, attitudes and behaviours was conducted.
Cases and controls were respondents with new diagnosed
HIV-positive or HIV-negative test, respectively. Logistic regression was used to analyse the association between sexual
behaviours and HIV positivity.
Results: Overall, 274 cases and 1340 controls were recruited.
Cases were more likely than controls to be female, aged > 25,
with low educational level and to have multiple (serial or
concurrent) sexual partners, to have had some sexual relationships without consent and to refer inconsistent or no condom use. Consistent use of condom was very infrequent
(1.46% cases, 6.27% controls). Abstinence from sex was also
low among those aged < 25 years (8.81%). Having multiple
partners was independently associated with being male
(adjusted OR ¼ 2.68; 95% CI 1.97–3.63) and being >25 years
old (adjusted OR ¼ 2.10; 95% CI 1.56–2.82). On the other
hand, having an HIV positive test was independently associated with having had multiple sexual partners, both concurrent (adjusted OR ¼ 3.59; 95% CI 2.32–5.56) and serial
(adjusted OR ¼ 2.89; 95% CI 2.10–4.05). The consistent use of
condoms was a protective factor for being HIV þ (adjusted
OR ¼ 0.23; 95% CI 0.08–0.68). The magnitude of the detrimental effect of having multiple partners was higher than the
protective effect of the consistent use of condoms when
both variables were present in the same regression model
(i.e., adjusted for each other).
Conclusions: Among young adults in Kinshasa, use of condoms is scarce while having multiple partners is highly
prevalent, especially among men. Preventive strategies in
Kinshasa need to focus on reducing the number of sexual
partners and not only on promoting the consistent use of
condoms.
A-208
A-209
Risk perception of HIV infection and
sexual behaviour among young and
adults from Kinshasa (D.R.Congo): a
case-control study
The prevalence of human
papillomavirus infection among
female prisoners in Siberia
a,b,d
a,b,d
Cristina Lopez-del Burgo , Silvia Carlos
~oe, Alfonso Osoriob,c,
Eduardo Burguen
Adolphe Ndarabue and Jokin de Iralaa,b,d
,
a
Department of Preventive Medicine and Public Health,
University of Navarra, Pamplona, Navarra, Spain; bInstitute for
Culture and Society, University of Navarra, Pamplona, Navarra,
Spain; cSchool of Education and Psychology, University of
Navarra, Pamplona, Navarra, Spain; dIdiSNA, Navarra Institute for
Health Research, Pamplona, Navarra, Spain; eMonkole Hospital,
Monkole, Kinshasa, Congo
Background: Sub-saharan Africa has one of the highest prevalence of HIV in the world. Avoiding risky sexual behaviours is
essential for the prevention of HIV and other STIs and it requires
that people perceive their risk.
Objective: To evaluate the perception of risk of HIV in an outpatient centre of Kinshasa (D.R. Congo) and to analyse predictors of perceiving risk of HIV infection.
Methods: A case-control study was carried out from
December 2010 until June 2012. Patients aged 15–49 attending a primary outpatient centre in Kinshasa were invited to
participate in the study. They were HIV Voluntary Counselling
and Testing attendees (VCT) and blood donors. Before HIV
testing, an interview on HIV-related knowledge, attitudes and
behaviours was conducted. Personal HIV risk perception was
evaluated (‘Do you think you have any risk of HIV?’ No risk/
low/high/don’t know). Cases and controls were respondents
with newly identified HIV-positive or HIV-negative test,
respectively. Logistic regression was used to analyse predictors of perceiving risk.
Results: A total of 1615 participants were recruited (274 cases
and 1340 controls). Half of the cases reported, before having
the HIV test result, that they did not have any risk or did
not know their chance of infection. Thirty one percent of
controls were also unaware of their risk of infection. Among
those participants referring multiple sexual partners or inconsistent or no use of condoms, that is, with real risk of infection (n ¼ 1310), 32% were unaware of their risk, 31%
perceived no risk at all and only 37% perceived any risk. This
perception was independently associated to being female
(OR ¼ 1.56; 95%CI 1.16–2.11), having high education
(OR ¼ 1.77; 95% CI 1.10–2.85), requesting HIV VCT (OR ¼ 1.74;
95% CI 1.30–2.31), being informed about ABC (‘abstinence, be
faithful, condom use’) preventive strategy (OR ¼ 2.15; 95% CI
1.66–2.78), having had serial (OR ¼ 1.59; 95% CI 1.20–2.10) or
concurrent (OR ¼ 1.84; 95% CI 1.24–2.74) multiple sexual partners. Only 36% of participants with inconsistent or no condom use perceived risk of infection, but condom use was not
statistically significantly associated to perceiving risk in multivariate analysis (OR ¼ 1.20; 95% CI 0.85–1.81).
Conclusions: A high percentage of young and adults in
Kinshasa are unaware of their personal risk of HIV infection despite referring risky sexual behaviours or even having the infection. More efforts are needed to improve correct and complete
knowledge about risk factors of HIV infection, especially among
males and less educated people, in order to effectively prevent
HIV infection.
133
Natalia Artymuk and Kristina Marochko
Kemerovo State Medical Academy, Kemerovo, Russia
Objective: To detect the prevalence of human papillomavirus
infection (HPV) among female prisoners in the Kemerovo Region
(Siberia).
Methods: It was a population-based study. This study included
75 female prisoners aged from 25 to 65 years (average age was
37.8 ± 8.3). We used clinical methods, self-sampling device for
HPV testing (QvintipV) with instruction and physician-collected
cervical specimens for HPV testing (Physician-HPV testing). The
material was sent to the laboratory and then analysed for the
presence of high-risk HPV types by polymerase chain reaction
(PCR) amplification of HPV DNA.
Results: The results of our study showed that 37.3% (28/75) of
these women were high-risk HPV positive. We found positive
HPV in 25 (89.2%) women with self-HPV testing and in 21
(75.0%) women physician–HPV testing. Self-sampling and physician-collected cervical smears demonstrated the comparable
accuracy for detection of high-risk HPV DNA.
The number of prisoners infected with human immunodeficiency
virus (HIV) was 29.3% (22/75). Among this group 72.7% of
women (16/22) were positive for high-risk HPV, and 27.3% (6/
22) had negative results. Overall, only 42.8% of women with positive HPV (12/28) were negative for HIV infection. The prevalence
of HPV was higher in women of reproductive age (less than 45
years) (25/28). The most common risk factors among HPV-positive women were: smoking (100%), drug addiction (60.7%), HIV
infection (57.1%), alcohol addiction (39.3%), and first sexual
intercourse under 16 years (53.6%). Average lifetime number of
sex partners was 4.1 ± 3.5. All of the women had no information
about their infection with HPV and the possibility of
vaccination.
Conclusions: The prevalence of HPV infection among female
prisoners is high. Female prisoners are in the risk group of HPV
infection because of sexual behaviour, their addictions (smoking,
drugs, alcohol etc.) and HIV infection.
R
A-210
Increasing macrolide treatment
failure in women with Mycoplasma
genitalium in a public hospital
Saima Wania, Alex Marcegliaa, Anna-Maria Costab,
Sepehr Tabrizib and Suzanne Garlandb
a
Sexual Health Service, The Royal Women’s Hospital, Victoria,
Australia; bMicrobiology Infectious Diseases, The Royal Women’s
Hospital, Victoria, Australia
Background: Mycoplasma genitalium (MG) has been implicated
in the aetiology of urethritis, cervicitis, pelvic inflammatory disease and adverse pregnancy outcomes. Increasing rates of
resistance to first line macrolide antibiotic, azithromycin has
been reported worldwide. An audit was undertaken at the Royal
Women’s Hospital, Victoria Australia, to determine the rate of
MG treatment failure and a subset of which were also evaluated
for macrolide resistance markers. MG testing commenced at the
134
Royal Women’s in 2009. All women who presented to the
Pregnancy Advisory Service were screened for MG prior to surgical or medical termination of pregnancy and in 2013 this testing expanded to other areas of the hospital.
Method: We conducted a retrospective audit on 10,441 samples
sent for molecular detection of Mycoplasma genitalium at The
Royal Women’s Hospital, Victoria between January 2014 and
October 2015.
Selected MG-positive samples were analysed for 23S rRNA gene
single nucleotide polymorphism (SNP), associated with higher
rate of resistance, using high resolution melt. Samples were
sent for resistance testing where the results would determine
future management of these patients.
We also audited a period between August 2009 and December
2010 with 1636 women tested for MG. During this period, resistance testing was not available. However, response to treatment
was monitored by a test of cure at 4–6 weeks post treatment.
Results: Overall 239 (2.3%) samples were positive for MG
between January 2014 and October 2015. Among the 52 of the
239 (21.8%) positive samples evaluated for mutation in the
23rRNA gene, 25 samples had mutation associated with macrolide resistance (48%, [95% CI 34–61%]).
In our earlier audit (August 2009 to December 2010) 74 women
(4.5% [CI 3.5–5.6]) were positive for MG. One hundred percent
of the 55 women had no treatment failures with azithromycin
in this period as determined by negative test of cure. The
remaining 19 women (26%) were lost to follow up.
Conclusion: Our standard management of MG is azithromyin as
the 2009–2010 audit showed 100% success rate in treatment
with no failures in the 55 women who had a test of cure.
However our recent audit showed a macrolide resistance mutation in 48% of samples sent for resistance testing. This suggests
we can no longer recommend azithromycin as first line therapy.
Second line therapy with quinolones presents challenges in a
population with a high proportion of pregnant women and
emerging reports of resistance.
A-211
Sexually transmitted infections, a risk
factor for infertility in rural West
Bengal, India: a mixed method
approach
Shraboni Patra and Sayeed Unisa
International Institute for Population Sciences, Mumbai,
Maharashtra, India
Objectives: In India, the prevalence of sexually transmitted
infections (STIs) has been rapidly increasing during the last decade. In this country, more than 18% women had ever experienced any symptoms of STIs, and in the state of West Bengal
the prevalence is 26%. A considerable proportion of women
experiencing infertility has reported having STDs. Hence, the
present study focuses on the STDs in association with infertility
in India, with a special emphasis on the state of West Bengal.
Methods: A mixed method research approach is applied.
Quantitative analyses are performed based on national level
data from DLHS-3, whereas, qualitative techniques are used to
collect information from 31 childless couples (in-depth interview), and 128 women who ever had experienced infertility
problem (open-ended questions). Pearson’s Chi-square test and
multivariate logistic regression analysis were used.
Results: The prevalence of STIs is alarmingly high among
women ever experienced infertility in West Bengal. The knowledge about transmission varies by residence, educational
attainment, husband’s education and wealth index. About 26%
of ever-married women aged 15–49 years have reported having
symptoms of RTIs/STIs and 21.5% have experienced abnormal
vaginal discharge Among those who have heard of RTIs/STIs,
48.1%, 33.6%, 17.1%, 11.8%, 9.5% and 6.7% have reported
unsafe sex with persons who had many partners, unsafe sex
with sex worker, unsafe delivery, unsafe abortion, unsafe IUD
insertion and unsafe sex with homosexuals, respectively. About
43% of women have sought treatment, either from a government clinic (19%) or from private doctors (48.3%). Further, about
84% childless women reported experiencing any symptoms of
STIs like itching or irritation over the vulva, foul-smelling discharge, smoky and deep red urine, etc. About 45% of childless
men have experienced symptoms of abnormal discharge from
their penis, ulcers, sores or blister near the penis, swelling or
lumps in the groin area and swelling of testicles during the last
six months of the survey. Prevalence of STIs is found to be
higher (OR ¼ 2.801, p < 0.001) among childless women than
among women who have been pregnant at least once.
Conclusions: Awareness of the symptoms and modes of transmission of STIs among rural couples is urgently needed in West
Bengal. Knowledge of preventive measures of STIs and use of
condoms can be helpful to reducing STIs prevalence, as well as
the risk of secondary infertility in the state. Access and affordability to receive treatment for STDs and infertility at the community level requires to be prioritised in the reproductive
health programmes.
A-212
Urogenital Chlamydia trachomatis
infection among Portuguese women
aged 25 and under – a brief look
Catarina Reis de Carvalho, Joaquim Neves and
Carlos Calhaz Jorge
Centro Hospitalar Lisboa Norte, Lisboa, Portugal
Introduction: Despite the knowledge that Chlamydia trachomatis is one of the most common sexually transmitted
diseases, little is known in Portugal on the prevalence of this
infection. Several sequelae can result from Chlamydia trachomatis in women, the most serious of which include PID,
ectopic pregnancy, and infertility. Futhermore asymptomatic
infections are common. Our aim in this study was to investigate the presence of Chlamydia trachomatis infection and
associated factors among asymptomatic women in a
Portuguese central hospital.
Methods: We prospectively studied all women aged 25 and
under, who attended a medical consultation requesting contraceptive counselling and reported no urogenital symptoms. We
investigated parameters like age, menarche, parity, age of sexual initiation, number of sexual partners and contraceptive use.
A urine sample was collected for polymerase chain reaction
testing for Chlamydia trachomatis. Statistical analysis was carried
out using ExcelV. Between-group differences were analysed
using the Chi-square test and Student’s t-test.
Results: We studied a total of 171 women but 55 were
excluded for lack of information. Among the included women
(n ¼ 116), the median age was 21 years. The average sexual life
debut was at 16 years and the number of sexual partners, three.
About the parity, 84.25% were nulliparous. Half of them used
oral contraceptives, 14.6% barrier methods and only 7.8% no
contraception. Chlamydia PCR test was positive in 19%. We
found an association between positive test and >1 sexual partners (p ¼ 0.0355) and early beginning of sexual life (p ¼ 0.0008).
There were no considerable differences between the various
age groups (p ¼ 0.515) and the various contraceptive methods
(p ¼ 0.328).
Conclusions: These results show the significant prevalence of
Chlamydia trachomatis in Portugal. They also suggest the
importance of targeting women who may be worth screening, which is already done in some countries. Further study is
need.
R
A-213
SIDE-EFFECTS AND RISKS OF CONTRACEPTIVES
Shifting threat to opportunity: global
integrated network for increasing
uptake of screening, testing, and
treatment of HIV/AIDS
A-214
Jocelyn Rivers, Jeffery Wilson and
Andrew Papadopoulos
University of Guelph, Guelph, ON, Canada
Objectives: The emerging hypothesis is that there is increased
uptake of testing and treatment of HIV when networks are
highly engaged. Existing network and public health expertise,
and data integration will help shape the different aspects of
who is part of the networks and what defines engagement. To
identify the multi-sectorial stakeholders in relations to HIV/AIDS,
consisting of the government, academic, corporate, non-governmental, community and individual levels. To collaborate and
ascertain mutually beneficial opportunities through two pilot
projects in Ontario, Canada, and in the country Lesotho in
southern Africa, to increase uptake of screening, testing and
treatment of HIV/AIDS.
Methods: Through this multifaceted approach combining development, epidemiology, and public health, is necessary for ethical program implementation. Drawing on international
development literature, this process will have strong theoretical
foundation while having immensely practical outcomes. A multivariable linear analysis will be applied using current HIV/AIDS
data in Lesotho. Using appropriate qualitative methods, which
may include stakeholder interviews and focus groups, a balanced perspective will be used to inform the results and best
practices. A cohesive pilot plan will deliver the pilot project,
bring the network together and develop an operational strategy
for scalable use.
Results: While this research is currently in process, there has
been positive participation in the stakeholder mapping at various levels. These projects have taken the form of enhancing
entrepreneurship, supporting AIDS orphans, and providing clinics for psychosocial support for the promotion of wellbeing. All
of these are making constructive impact in Lesotho. More benefit can be accrued by having existing networks engage the
community to increase the activities of prevention and treatment, including the reduction on co-infections. Comparing
lower-income a nation with a high-income country provides
insights into scalability.
Conclusions: The project is not reinventing the network, but
building with present stakeholders to create a cohesive governance plan. A formal ongoing engagement is anticipated, drawing on resources and feedback from participation and
evaluation. The characteristics make Lesotho and Ontario ideal
for building a scalable model to reduce HIV rates in both lower
and higher income countries. Our future goal is to develop a
model where existing community agencies and networks can
maximise their effectiveness and reduce the burden on HIV in
Lesotho, Canada, and the world.
135
Venous thrombosis: anatomic
localisation matters (on behalf of the
Spanish Society of Contraception)
Maria Antonia Obiol Saiza, Jose Cruz Quılez Condeb,
Sara Tato Varelac and Roberto Lertxundid
a
CSSR Fuente de San Luis, Valencia, Spain; bHospital Universitario
de Basurto, Bilbao, Spain; cHospital Universitario Virgen
Macarena, Sevilla, Spain; dClinica Euskalduna, Bilbao, Spain
Background: From the first introduction of combined contraceptive treatments their association with venous thrombosis has
been a well-known event.
Objective: To evaluate the impact of the anatomic localisation
of the thrombosis on the prognosis of this entity in combined
contraceptive users. We present cases diagnosed with venous
thrombosis in a variety of locations, such as cerebral venous
sinus, upper extremities, lungs, and lower extremities. The physical characteristics of the patients, combined contraceptive
method used, clinical onset and evolution of the thrombosis
were evaluated.
Method: An anatomic localization review.
Results: For cerebral venous sinus:
Case 1: A 41-year-old woman. Thrombophilia study: protein C
deficiency. Lifelong treatment with warfarin necessary.
In the upper extremities:
Case 2: A 32-year-old woman. Obese. Care worker.
Thrombophilia study: positive factor V Leiden mutation. Good
clinical evolution.
Case 3: A 36-year-old woman. Bodybuilder. Typist.
Thrombophilia study: negative. Post-thrombotic syndrome in
clinical follow-up. Lungs.
Case 4: A 31-year-old woman. Obese. Bedridden due to depression for one month. Leiden thrombophilia study: negative.
Good clinical evolution.
Case 5: 32-year-old woman. Pill user for 10 years .She was fit
but she gained weight (10 kg in a year). Bedridden due to
depression. Thrombophilia study: negative. Good clinical evolution. Lower extremities.
Case 6: A 17-year-old woman. Leiden thrombophilia study:
homozygous factor V mutation. Good clinical evolution.
A variety of women have distinct risk of suffering from venous
thrombosis in different anatomical locations:
1.
2.
3.
thrombosis at lower extremities is associated with obesity and sedentarism,
thrombosis at upper extremities can be found in workers or sporty women after heavy physical effort using
their arms or repetitive strain,
pulmonary thrombosis can be a common complication
produced by the migration of emboli from any
location.
Conclusions: Functional prognosis varies according to the anatomic localisation, and it is common in the lower extremities
and in the lungs. The severity of the post thrombotic syndrome
affects the prognosis in patients with upper extremity thrombosis. Finally, patients with intracranial venous sinus thrombosis
recovered but they needed chronic anticoagulant therapy for
the rest of their lives.
Venous thrombosis is a multifactor event influenced by anatomic localisation. We need to re-evaluate the risk factors
through time. Including new risk factors is essential in order to
achieve a safer and more efficient and acceptable contraceptive
counselling.
136
VIOLENCE AGAINST WOMEN
A-215
The influence of intimate partner
violence on pregnancy symptoms
€
€rkana, Zu
€beyde Eksia, Derya Denizb
Can Gu
Ozlem
a
and Hasan Circir
a
Nursing Division, Faculty of Health Sciences of Marmara
University, Istanbul, Turkey; bTunceli State Hospital, Tunceli,
Turkey
Objective: To evaluate the influence of intimate partner violence on pregnancy symptoms.
Method: This cross-sectional descriptive study was conducted
in the antenatal service of one of the biggest maternity and
children hospitals within the Istanbul province between March
2014 and March 2015.
A total of 310 pregnant women (who were willing to participate
in the study, aged between 18 and 40, married, who had a singleton pregnancy, and did not have any systemic diseases) who met
the sampling criteria were accepted to the study. The data were
obtained through the Domestic Violence against Women
Screening Form and the Pregnancy Symptoms Inventory (PSI). In
our study, the types of violence perpetrated by partners against
women during marriage and in the past one month were
assessed using the Domestic Violence Against Women Screening
Form. The symptoms that the participants experienced were
assessed using the PSI developed by Foxcroft et al. (2013).[1]
Higher scores of the PSI indicated higher severity of the symptoms during pregnancy increases. Chi-square test, t-test and
Mann-Whitney U Test, and descriptive analyses were used in this
study.
Results: The mean age of the participants was 28.6 ± 5.6 years,
and the mean gestational week was 30.1 ± 5.2 weeks. The proportion of the participants who stated that they had received
emotional/verbal violence over the last one month was 34.8%,
the rate of experiencing physical violence was 5.8%, that of sexual violence was 7.1%, and the rate of the participants who
stated that they had received economic violence was 28.1%.
The Pregnancy Symptoms Inventory scores of those participants
who had been exposed to physical, emotional or sexual violence over the last one month were significantly higher than
those who had not been exposed to violence (p < 0.05). The PSI
scores revealed similarity among those who received and did
not receive verbal violence.
Conclusion: The findings of our study showed that pregnant
women who are exposed to physical, economic and sexual violence by their partner might have more severe symptoms during pregnancy. It is recommended that the women who
experience numerous and severe symptoms during pregnancy
should be screened for intimate partner violence.
Reference
[1]
Foxcroft et al. (2013)
VULNERABLE GROUPS
A-216
The analysis on education of HIV/
AIDS prevention for out-of-school
adolescents in China
Xiaoming Yu, Lu Wang, Yuanying Qiu and Bingqi Lv
Peking University Health Science Center, Beijing, China
Objective: Out-of-school adolescents have been regarded as a
vulnerable group for infection by HIV/AIDS because they cut
themselves off from the school’s protective environment.
Meanwhile, a large number of out-of-school adolescents joined
in the stream of migrant people for survival in China, which
made them at marginalised condition of HIV/AID prevention.
Our study aim was to find out the status and impact of existing
HIV/AIDS preventive education for out-of-school adolescents in
China so as to develop suitable strategy.
Methods: A systematic analysis was performed through reviewing the relevant studies on the education of HIV/AIDS prevention for out-of-school adolescents in China, which published
from January 2002 to December 2012. Databases searched
included four Chinese databases (EMBASE, CNKI, VIP, CMD
Digital Periodicals) and one English database (PubMed), and
analysis was undertaken based on set criteria.
Results: Overall, 18 studies on the education of HIV/AIDS prevention for out-of-school adolescents were identified that were
published between 2003 and 2012.The total sample size was
11,004, and 90% of the study objects were unmarried and
nearly half had a low educational level. The top reasons for
them to stop schooling were being weary of learning and
owing to their family economic difficulties.
These studies involved various topics on HIV/AIDS preventive
education for out-of-school adolescents, mainly covering basic
preventive knowledge, building positive prevention attitudes,
and reducing discrimination for HIV infectors. Different kind of
educational approaches were adopted including a course of lectures, peer education, face-to-face consultations, internet dissemination and general propagation. Overall these preventive
types of education had a significant improvement on the key
points of knowledge and positive attitude for preventing HIV
infection. Also, protective sexual behaviour, mainly condom use
at sex intercourse, was increased by 13% (95% CI 1–25%)
through education.
Conclusions:
(1) The education of HIV/AIDS prevention for out-of-school adolescents in China has been drawn attention to in recent years.
Various kinds of participated approaches were used widely in
this kind of education.
(2) The effectiveness of existing HIV/AIDS preventive education
among out-of-school adolescents indicated a somewhat different approach in improving knowledge, attitude and behaviours
for HIV/AIDS prevention, knowledge and attitude improvement
better than behaviour changing.
A-217
Unmet family planning need among
women in a correctional facility in
Ontario, Canada
Jessica Liauw, Jessica Foran, Dustin Costescu,
Brigid Dineley and Fiona Kouyoumdjian
McMaster University, Hamilton ON, Canada
Objectives: Studies from the United States have shown that
women in correctional facilities have a greater unmet need for
contraception compared to the general population, and that
the provision of family planning services in correctional facilities
may improve access to contraception. No study has examined
these issues in women in correctional facilities in Canada. We
aimed to describe the rates of unintended pregnancy and
contraceptive use for incarcerated women in Ontario.
Method: Women in a provincial correctional facility in Ontario
were surveyed in 2014. We calculated the prevalence of prior
unintended pregnancy, prior therapeutic abortion, contraception
use, and pregnancy intention. The unmet need for contraception was calculated based on recent sexual activity, pregnancy
intention and contraception use.
ACCEPTED ABSTRACTS – VULNERABLE GROUPS
Results: Of 85 participants, 85% had at least one prior pregnancy and of those who had been pregnant, 77% had at least
one unintended pregnancy and 57% had a therapeutic abortion. Regarding the most recent pregnancy, 23% scored the
pregnancy as unplanned, 50% as ambivalent and 27% as
planned. Of women who were at risk for unintended pregnancy
prior to incarceration, 80% were not using a reliable form of
contraception.
Conclusions: Incarcerated women in Ontario have higher rates
of unintended pregnancy and unmet need for contraception
compared to the general population. The provision of family
planning services during and after incarceration may provide an
opportunity to improve the health of individuals and to reduce
costs for society overall.
OTHER
A-218
First Algerian national survey on
infertility and assisted reproductive
technology: about 1305 cases
Fizazi Anissa and Bendahmane Malika
Department of Biology, Faculty of Science and Life, University of
Djilali Liabes, Sidi Bel Abbes, Algeria
Objectives: To take stock about infertility of couples and assess
the results of the activities of assisted reproductive technology
(ART) in the western region of Algeria.
Methods: Our investigation consisted of a retrospective study
conducted between 2009 and 2011 on 1305 couples at three
ART centres in western region of Algeria.
Results: The results revealed that the average age of the
patients was 33.5 ± 2 years and the average duration of infertility was 7 ± 2 years. Men are increasingly infertile because the
origin of the couple’s infertility is male in 50% of cases and
female in only 17% of cases. The investigation has also
allowed us to assess the ART activities carried out in three
centres and showed that the pregnancy rate is equal to 15%
in artificial insemination and 28.9% and 32.6% in in vitro fertilization and intra cytoplasmic sperm injection, respectively.
However, a substantial portion of infertile couples feel skepticism towards these techniques because of the lack of financial
resources (45%) and lack of information about these artificial
techniques (35%).
Conclusions: The results obtained in our study show that in
Algeria, infertility is mainly of male origin and that the success
rate in ART in western Algeria was satisfactory in comparison
with international literature data.
A-219
Association of hypo-vitaminosis D
with metabolic disturbances in East
Indian women with polycystic ovary
syndrome
Dipanshu Sur and Ratnabali Chakravorty
Department of Obstetrics & Gynaecology, ILS Hospital, Kolkata,
India
Introduction: Women with polycystic ovary syndrome (PCOS)
frequently suffer from metabolic disturbances, in particular from
insulin resistance. Polycystic ovary syndrome (PCOS) is the most
common metabolic disorder occurring in women of reproductive
137
age. It has been proved that vitamin D might be a causal factor
in the pathogenesis of PCOS; however, the exact role remains
unknown. There is some suggestion that the combination of vitamin D deficiency, together with dietary calcium insufficiency may
contribute to the menstrual abnormalities in PCOS.
Objectives: To determine the association of Vitamin D deficiency and infertility in East Indian women with polycystic ovarian syndrome.
Methods: A case control study was conducted. It enrolled 100
cases of PCOS based on Rotterdam criteria and 100 ovulatory
normal cases matched for their age and BMI. The concentration
of serum calcium was measured using colorimetric complexometric method and 25 hydroxyVitamin D was measured using
the electrochemiluminescence method. All subjects were aged
between 20 and 35 years and had a BMI between 25 and 30
kg/m2.
Results: Women with PCOS had significantly lower total serum
calcium (8.4 ± 0.25 mg/dl versus 9.8 ± 0.17 mg/dl in controls),
and 25 hydroxy vitamin D (21.2 ± 2.56 ng/ml versus 32.6 ± 2.23
ng/ml in control group) than ovulatory normal women. This difference remained significant for both groups after adjustment
for BMI. Obese women in both groups had significantly lower
concentrations of calcium and 25 hydroxy Vitamin D than normal weight patients in this study.
Conclusion: Our study shows that the majority of the patients
and controls had vitamin D deficiency and there was a significant difference in the vitamin D levels in the PCOS group and
controls as well as in the obese and non-obese groups. This
may reflect the vitamin D deficiency status of the community.
Vitamin D deficiency should be looked upon as a serious problem among the East Indian population, which demands immediate attention.
A-220
Vitamin D supplementation in
pregnancy – international
recommendations
Niko Heiss
Cabinet de Gynecologie, N^ımes, France
Introduction: Low vitamin D levels during pregnancy have
been associated by recent studies with pregnancy complications
like preeclampsia, intrauterine growth restriction, gestational
diabetes, primary caesarean section and preterm delivery.
Despite this world-wide problem, there is no consensus about
optimal vitamin D levels and the international recommendations
about Vitamin D supplementation during pregnancy vary
widely, proposing between 400 IU/d and 2000 IU/d of Vitamin
D3 independently of their geographical situation. This work
compares the approaches in different countries on different latitudes and resumes the knowledge of clinical significance of
vitamin D in pregnancy.
Method: Comparison of recommendations concerning vitamin
D supplementation in pregnancy of seven European countries,
USA, Canada, Australia, Marocco. Review of recent publications concerning vitamin D and pregnancy by pubmed
research.
Results: The most recent (2012) Cochrane review on vitamin
D supplementation for women during pregnancy reported a
decrease of IUGR in supplemented women, but there is limited statistical significance and no evidence for prevention of
other pregnancy complications was found. The authors conclude that further rigorous randomised trials are required to
evaluate the role of vitamin D supplementation in
pregnancy.
Conclusions: Vitamin D deficiency is a world-wide problem.
Various pathologies have been associated with vitamin D deficiency, including adverse pregnancy outcomes. However, the
138
benefit of supplementation concerning other organs than bone
is not well established at present. Further studies are requested
to evaluate the effects of vitamin D supplementation in pregnancy and to issue evidence-based guidelines.
A-222
A-221
Raul Martos-Garcıac, Enriqueta Barranco-Castilloa,
~oza and
Françoise Solerb, David Molina-Mun
a
Aurora Bueno-Cavanillas
‘It gets easier with practice’. A
randomised cross-over trial
comparing the menstrual cup to
tampons or sanitary pads in a low
resource setting
Mags Beksinskaa, Jenni Smita, Ross Greenera,
Busi Maphumuloa, Catherine Toddb,
Mei-Ling Ting Leec and Vivian Hofmannd
a
MatCH Research, Department of Obstetrics & Gynaecology,
University of The Witwatersrand, Durban, South Africa; bFHI 360,
Asia Pacific Regional Office, Bangkok, Thailand; cUniversity of
Maryland, Maryland, USA; dInternational Food Policy Research
Institute, Washington, USA
Objectives: To assess the ability of women in a public-sector
setting in South Africa to successfully fit and learn to use the
menstrual cup and to evaluate changes in ease-of-use and
reported problems over three menstrual cycles of use.
Methods: The study from which these data are derived was a
randomised, crossover study among 110 women in Durban,
South Africa, Participants aged 18–45 years with regular menstrual cycles had water from the municipal system as their primary water source and had no sexually transmitted infections
were eligible for inclusion. Participants used the menstrual cup
over three menstrual cycles and were interviewed at baseline
and monthly follow-up visits.
Results: Of 124 women assessed, 110 were eligible and randomly assigned to selected menstrual products. A total of 105
women completed all follow-up visits. By comparison to pads/
tampons (usual product used), the MC was rated significantly
better for comfort, quality, menstrual blood volume collection,
appearance, and preference. Both these comparative outcome
measures, and likelihood of continued use, recommending the
product, and future purchase increased for the MC over time.
The data shows clearly that experience of use of the MC
across the three use cycles resulted in improvements in use
with ease of insertion increasing from 38% of women at visit
1 to 96% at visit 3. At visit 1, over half (58%) of women
reported that initial difficulties with insertion became easier
with use. Similarly, ease of removal changed from visit 1 to
visit 3 with 96% of women saying the MC was very easy to
remove at visit 3 compared to two-thirds (67%) at visit 1.
Problems related to discomfort with the MC at time of insertion also reduced.
Conclusion: In a population of novice users, initial
concerns and user problems were overcome by almost all
women over a three-cycles of use. Acceptance of the MC in this
population, many with limited experience with tampons, indicates that there is a pool of potential MC users in low resource
settings.
Characteristics of the Pictorial Blood
Loss Assessment Chart (PBAC) among
adolescents and students
a
Granada University, Granada, Spain; bACODIPLAN, Barcelona,
Spain; cAndalusian Regional Health Service, Priego de C
ordoba,
Spain
Objectives: To determine the characteristics of the pictorial
blood loss assessment chart (PBAC) in a cohort of school girls
and university students aged under 26 years.
Method: Prospective observational study of the PBAC of 82 secondary school and university students aged 12–25 years. The
link between variables was determined using the v2 test,
Pearson’s linear correlation coefficient, binary or multinomial
logistic regression, the Mann-Whitney U test and the KruskalWallis H test (significance level 5%).
Results: Overall, an average of 19.72 menstrual hygiene products (MHP) were discarded per menstruation (95% CI:
17.18–22.26) with different levels of saturation. The sanitary
pads and tampons discarded were of low or medium capacity
and were not completely saturated when discarded. The number of women at risk of suffering from High Menstrual Bleeding
(HMB) with an average PBAC score of 171.01 versus 121.99 fluctuates depending on where the PBCA score cut off is situated,
and the score assigned to the completely saturated MHP, which
were generally of low or medium capacity.
Conclusions: In the sample overall, the PBAC score was > 100
which would suggest that the population studied was at risk
for ferropenic anaemia due to HMB. However, if the cut-off
was increased to 185, as proposed by other authors, this
would not be the case. When only 10 points were attributed
to completely saturated pads, the average PBAC score
dropped to 121.99. This leads us to conclude that this criterion
is more reasonable for a young population as presented in
this study, since the percentage suffering from anaemia as a
result of HMB would only be 30%. Likewise, we consider it
vital to use appropriate measuring criteria adapted to the MHP
used and its saturation capacity. It was observed that the
population studied rarely used high saturation capacity products. This choice was partly based on aesthetic considerations
and comfort, but we feel it is highly relevant when calculating
the PBAC score.
A-223
The image of nurses in Turkey
€
€rkan, Seda Aydin,
Zubeyde Eksi, Ozlem
Can Gu
Çigdem Baspinar, Sule Çalisir, Hasan Circir,
Mehmet Fatih Elmas, Nilay Kalay, Ramazan Kaya
and Elif Şahin
Marmara University, Istanbul, Turkey
The profession of nursing is a service offered to individuals,
family and society. The valid status of a profession closely
related to the image of the group forming that profession
within that society and it is of great significance for the members of profession. The professional image, on the other hand,
is the evaluation of a group by the society and the widespread
acceptance of these values. Professions cannot be regarded separately from societies. The importance of a profession is evaluated with the importance the society attaches to that
profession. The opinion of the society on the image of nursing
ACCEPTED ABSTRACTS – OTHER
influences the nursing profession and the members of profession positively or negatively.
Objective: The study was planned as a descriptive one in order
to determine the opinions and thoughts of the society about
the nursing profession.
Method: The study was completed with 959 people that were
chosen on the street in three major squares in the city of
Istanbul, who had completed the age of 18 and agreed to take
part in the study, between 3 and 26 April 2015. The study data
were obtained through face-to-face interviews using an 18-item
questionnaire form.
Results: Overall, 46.8% of the participants were females and
53.5% were males, and the mean age was found to be
32.46 ± 14.32. The participants considered the reputation of
nursing as bad by 8.8%, medium by 24.3%, good by 43.6% and
very good by 23.3%. They considered the general outlook of
the profession of nursing in hospitals as bad by 7.6%, medium
by 33.6%, good by 41.2% and very good by 17.7%. The participants stated that nurses mostly ‘performed injections/measured
tension’ (90.2%) and ‘did what the doctors told them to do’
(71.5%), while 34.0% of them said ‘they provided patients with
physical, spiritual and social care’.
Conclusions: It was concluded that the general outlook and
professional reputation of nurses was regarded to be at a
medium level and the roles of professional nursing were not
known by people adequately.
A-224
The effect of music on nonstress test
Didem Simsek K€
uç€
ukkelepçea and
Sermin Timur Tashanb
a
High School Health, Adimyaman University, Adiyaman, Turkey;
Faculty of Health Sciences, In€on€u Unıversty, Malatya, Turkey
b
Objective: This study was conducted as quasi-experimental
with a post-test control group in order to determine the effect
of music listened to by pregnant women during a nonstress
test (NST) on the results of the test.
Methods: The population of the study was formed by women
who had applied to the polyclinic of NST who had experienced
at least one live birth, had had the NST before and whose gestational week was greater than 33. The sample was formed by a
total of 96 (48 experimental and 48 in the control group) pregnant women who met the study criteria, who were at 0.5 effect
size and 95% confidence interval with a 5% of margin of error
according to the performed power analysis and who had the
power to represent the population with a ratio of 98%.
The study was conducted at Adıyaman University Training
Research Hospital NST polyclinic between June 2012 and July
2014 and the data was collected at NST polyclinic by the
researcher between 3 March 2013 and 25 June 2013. The
Participant Introductory Form and NST Findings Registry Form
were used in the data collection. The data was evaluated using
descriptive statistics, t-test for independent groups, chi-square
test, and Fisher’s exact test.
Results: It was determined in the study that the pregnant
women in the experimental group had more positive feelings
compared to those in the control group (p < 0.05). In addition,
averages of fetal movement number and acceleration number
of pregnant women in the experimental group as a result of
NST were higher compared to those in the control group
(p < 0.001). Experimental group pregnants had a higher reactive
NST result than the control group pregnants (p < 0.05). The
results of the study did not suggest a significant difference in
the average heart rate of experimental and control group pregnant women (p > 0.05).
Conclusion: Our study findings demonstrate that music played
to pregnant women during NST increases fetal movement and
acceleration numbers and also leads to more positive feelings
experienced by them during the test.
139
A-225
Expression of progesteronemembrane bound receptor may
predict the risk and prognosis of
breast cancer as well as or even
better compared to other prognosis
parameters
Xiangyan Ruana, Marina Willibaldc, Harald Seegerb,
Hans Neubauerc, Tanja Fehmc, Sara Bruckerb and
Alfred Mueckb
a
Department of Gynecological Endocrinology, Beijing Obstetrics
and Gynaecology Hospital, Capital Medical University, Beijing,
China; bSection of Endocrinology and Menopause, Department of
Women’s Health, T€
ubingen, Germany; cDepartment of Obstetrics
and Gynaecology, University Hospital and Medical Faculty of the
Heinrich-Heine University Duesseldorf, D€
usseldorf, Germany
Objectives: Progesterone receptor membrane component
1(PGRMC1) has been shown to be more abundant in breast
cancer compared to normal tissue and if present, may increase
the risk of breast cancer in women getting hormone therapy or
contraceptives1. In a first clinical study in patients after breast
cancer we investigated if this marker also could predict the further prognosis of those patients compared with other already
well known parameters.
Methods: Expression of PGRMC1 was analysed by immunohistochemical staining of tissues from 69 breast cancer patients, and
correlated with various clinic-pathological characteristics such as
larger tumour size, lymph node metastasis and clinical outcome
like disease free survival and overall survival time.
Results: Overexpression of PGRMC1 correlated with larger
tumour size and lymph node metastasis. The Kaplan-Meier survival curves revealed that PGRMC1 overexpression is associated
with poor disease free and overall survival, both in breast cancer patients with ER (estrogen receptor) positive and negative
tumours.
Conclusions: PGRMC1 overexpression is significantly associated
with aggressive phenotypes and poor prognosis of breast cancer. These findings support the possible role of PGRMC1 not
only to predict the risk using hormones in therapy and contraception but also as a prognostic biomarker in ER-positive and
negative breast cancer.
Reference
[1]
Stanczyk F. Editorial. Menopause 2011;18:833–834.
A-226
Swallowing the pill: a multimodal
discourse analysis of contraceptive
advertising to doctors
Theo Van Leeuwene, Deborah Batesona,
Kumiyo Inouec, Bem Le Hunted, Alexandra Barrattb,
Kirsten Blackb, Marguerite Kellyc, Alison Rutherforda,
Mary Stewarta and Juliet Richtersc
a
Family Planning NSW, Sydney, NSW, Australia; bUniversity of
Sydney, Sydney, NSW, Australia; cUniversity of New South Wales,
Sydney, NSW, Australia; dUniversity of Technology, Sydney,
Sydney, NSW, Australia; eUniversity of Southern Denmark,
Odense, Denmark
140
Objectives: Direct-to-consumer advertising of prescribed pharmaceuticals is not permitted in Australia, but doctors are
exposed to contraceptive advertising in medical practitioner
magazines and journals. We analysed the degree to which
pharmaceutical companies provide medical information versus
their attempts to persuade doctors to get women to prefer their
products over those of the competition and the strategies used
to this end.
Method: A multimodal discourse analysis of all the contraception advertisements between 2002 and 2012 in five Australian
magazines and journals aimed at general practitioners, gynaecologists and obstetricians. The analysis focused on functionality (the way the structure of the advertisements functions as a
persuasive genre) and identity (how the multimodal style of
the advertisements identify the brand). The analysis included
28 different advertisements for 11 different products which
appeared in 1278 publication issues. Products included a hysteroscopic transcervical sterilisation device, levonorgestrel intrauterine system (LNG-IUS), etonogestrel contraceptive implant,
combined hormonal vaginal ring and combined oral contraceptive pills.
Results: The advertisements provide varying degrees of medical
information, either in a way that is minimally salient (the fine
print) or in a way that mixes the language of medical expertise
with promotional language. The strategies advertisers use are
two-fold: a structuring which links specific types of women to
specific products, product attributes and non-contraceptive benefits (for example the LNG-IUS is exclusively linked to women in
families or with children while the combined pill is linked to
young ‘carefree women’), and a branding which invokes the values and priorities which (again, according to the advertisers)
inform the lifestyles of women but is always only suggested
through aspects of colour and graphic design – and always
infused with the relentless positiveness which characterizes promotional discourse and which is far removed from the realities
of the consultation room.
Conclusions: The most salient information contained in the
sales messages is highly selective and in part represents what
women want (according to the advertisers) and in part stresses
various non-contraceptive benefits such as an improvement in
acne. The former positions medical practitioners as recipients,
not of medical information, but of the kind of information
advertisers claim as their specific expertise – knowledge of the
consumers, their lifestyles, their values, and their preferences.
The impact of contraceptive advertising on doctors prescribing
habits would be useful to investigate.
A-227
Effects of progestins used for
hormone therapy in contraception
and post menopause on PGRMC1
overexpressing breast cancer cells
Xiangyan Ruana, Marina Willibaldc, Harald Seegerb,
Hans Neubauerc, Tanja Fehmc, Sara Bruckerb and
Alfred Mueckb
a
Department of Gynaecological Endocrinology, Beijing Obstetrics
and Gynecology Hospital, Capital Medical University, Bejing,
China; bSection of Endocrinology and Menopause, Department of
Women’s Health, University Tuebingen, Tuebingen, Germany;
c
Department of Obstetrics and Gynaecology, University Hospital
and Medical Faculty of the Heinrich-Heine University Duesseldorf,
Duesseldorf, Germany
Objectives: The progesterone receptor membrane component1 (PGRMC1) might potentially offer a new pathway to explain
the observed effect of increased risk of breast cancer development of patients receiving progesterone-based hormone
replacement therapies, used in contraception and post
menopause. In preliminary studies we could show that various
progestins significantly increased proliferation of PGRMC1 overexpressing MCF-7 cells, revealing a potential role of PGRMC1 in
forwarding membrane-initiated signals into the cell.
Methods: To further study the downstream signaling of
PGRMC1 and to identify potential interaction partners after progestin binding, co-immunoprecipitation experiments were performed with PGRMC1/MCF-7 cells followed by western blot and
mass spectrometry analysis. To further study the influence of
PGRMC1 on tumour progression in breast cancer, proliferation
and apoptosis of MCF-7/PGRMC1 cells after progestin treatment
was investigated.
Results: We could show that deletion of specific PGRMC1
protein-protein interaction motifs leads to an inhibition of the
proliferative effect of specific progestins, assuming that phosphorylation of the CK2 binding sites and interaction with the
SH2 target sequence may be participated in recruitment of signalling proteins. Using western blot and mass spectrometry,
potential interaction partners after progestin binding could be
identified. Further, apoptosis studies with MCF-7/PGRMC1 cells
showed, that the progestin NET might be able to rescue MCF-7/
PGRMC1 cells from apoptosis.
Conclusions: The increased cancer risk observed for specific
progestins used in contraception and/or hormone therapy
might be mediated by PRGMC1. Thus women overexpressing
PGRMC1 should be treated with progestins that are neutral in
terms of cell proliferation via PGRMC1.
Reference
[1]
Stanczyk F. Editorial. Menopause 2011;18:833–834.
A-228
Health beliefs and breast selfexamination among nurses working
in a university hospital
b
€
€
€lu
€fer Erbila and Oznur
Nu
Ozdemir
a
Turkey; bIgdir University, Vocational School of Health Services,
Igdir, Turkey
Objective: To investigate the health beliefs about breast self
examination (BSE) of nurses.
Methods: This descriptive and cross-sectional study included
292 nurses who agreed to participate in the study. The study
was performed in a university hospital, Samsun province, in
Turkey. The data was collected with a self-report questionnaire
form and Turkish version of Champion Health Belief Model
Scale (CHBMS).
Results: The average age of the nurses in this study was
32.97 ± 7.29 (range 19–56 years), 79.8% of them had graduated
from university, 69.2% of them were married, the average age
of menarche was 12.58 ± 2.83. All of nurses had knowledge
about breast cancer (BC) and BSE. BSE was practiced ‘irregularly’
by 63.4% of nurses, 26.7% of them performed BSE ‘regularly’. A
fear of developing BC was an incentive for 34.6% of the nurses,
47.6% of them felt it was a necessity to practice BSE. In this
study, 11.3% of the nurses stated that they had had breastrelated discomfort in the past; 9.6% of them had family members with breast cancer, and 57.9% of them had friends and
acquaintances with breast cancer. The average scores of subscales of the CHBMS of nurses were as follows: the susceptibility
subscale of nurses was 7.51 ± 2.25; their seriousness subscale
score was 22.93 ± 5.46; the benefit subscale was 16.13 ± 4.31;
the barrier subscale was 23.15 ± 6.06; the confidence subscale
was 36.70 ± 7.58; and their health motivation subscale score was
24.92 ± 5.19. A negative correlation was found between the
nurses’ age and the susceptibility subscale score and benefit
ACCEPTED ABSTRACTS – OTHER
subscale score of the CHBMS. The susceptibility subscale score
of nurses who had family members with breast cancer was
higher than other nurses, and the difference was statistically significant (p ¼ 0.002). The seriousness subscale score of nurses
who had friends and acquaintances with breast cancer was
higher than other nurses, and the difference was statistically significant (p ¼ 0.007). The barrier subscale scores of nurses who
practice BSE regularly were lower than nurses who do not practice BSE regularly, and the difference was statistically significant.
141
The susceptibility subscale scores and health motivation of
nurses who practice BSE regularly were higher than nurses who
do not practice BSE regularly, and the difference was statistically
significant.
Conclusions: The results indicate the importance of training
programmes which educate not only nurses but all women
about breast cancer, the importance of early diagnosis and
regular BSE.

Book of abstracts - The European Society of Contraception and

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