Access Access Quality Choice

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Access

  • Access

  • Quality

  • Choice

  • Sustainability



Unsafe abortions account for 24% of maternal deaths in region (WHO, 1998)

  • Unsafe abortions account for 24% of maternal deaths in region (WHO, 1998)

  • Abortion rates remain high

  • Percentage of women using modern contraception remains low (Population Reference Bureau, 2002)

  • Abortion commonly used as a primary means to regulate fertility



Widespread availability of abortion on legal grounds for 50 years in many countries, but…

  • Widespread availability of abortion on legal grounds for 50 years in many countries, but…

  • Poor access for social-vulnerable groups

  • Poor quality of services in public sector: main method D&C, no counseling, no choice of the methods, general anaesthezia for pain control, poor infection prevention, no contraception post-abortion,

  • No evidence-based guidelines, no trainings in CAC



Access to abortion services has been challenged in recent years

  • Access to abortion services has been challenged in recent years

  • Concerns about declining birth rates, pressure from religious groups have reduced support for family planning and abortion



MVA not only an other abortion technique

  • MVA not only an other abortion technique

  • MVA as a possibility to improve abortion care, to implement patient care system, to change practice and policy…

  • Partners: NAF, OSY-New York, Soros Ipas

  • In the region: Ministries of Health, Medical Universities, Key-people,Hospitals, NGOs, abortion providers, distributors, women



It’s a safe, efficient, recommended by WHO method, that can be used in all the situations when uterine evacuation is needed.

  • It’s a safe, efficient, recommended by WHO method, that can be used in all the situations when uterine evacuation is needed.

  • No ‘checking curettage’ is needed (tissue exam)!

  • It’s a cost-efficient method: Procedure costs, staff time and other resources are significantly reduced where MVA is used.

  • Local anaesthezia, less risky than general can be used

  • MVA increases the patients’ satisfaction and patients’ flow

  • MVA as educational tool for both – providers and patients!







Training of Trainers in Comprehensive MVA abortion care, conducted by experts from NAF, with the support of Ipas and OSI (USA)

  • Training of Trainers in Comprehensive MVA abortion care, conducted by experts from NAF, with the support of Ipas and OSI (USA)

  • Training curricula is based on adult learning principles and includes: patient-centered elements of care, counseling, use of local anaesthezia, infection prevention, postabortion care and contraception following abortion.

  • Lectures, case studies and practice with models and patients are used.

  • Countries: Moldova, Russia (Moscow and St. Petersburg)/ Ukraine, Georgia, Kyrgyzstan / Kazakhstan, Albania





Trainings were done after an assessment of local situation

  • Trainings were done after an assessment of local situation

  • Trainings satisfied the real needs of national context (both providers and women)

  • Offered a new for us approach - women centered and evidence-based approach, changed the mentality…

  • Built a team of local experts – the real “pioneers” and champions of the method and of CAC

  • Pushed the things forward, initiated changes in abortion policy…



Trainings in cascade of national abortion providers, provided by local team of trainers

  • Trainings in cascade of national abortion providers, provided by local team of trainers

  • Publication of training materials, MVA is incorporated in University curricula

  • Official approval by MoHs of MVA equipment and method (<=12 weeks), Establishment of local distributor

  • Guidelines, protocols on MVA with the elements of CAC were developed and approved

  • Education-information campaigns on safe abortion, raising community awareness and increasing the demand for better quality of services







Russia

  • Russia

  • Georgia

  • Moldova

  • Ukraine

  • Lithuania

  • Uzbekistan

  • Kazakhstan

  • Tajikistan

  • Turkmenistan

  • Kyrgyzstan

  • Armenia (?)

  • Romania

  • Turkey

  • Albania



Establishment of MVA National Centre, with the goal of

  • Establishment of MVA National Centre, with the goal of

  • MVA implementation as a routine method on the national level, and at primary level of care

  • Medical abortion implementation

  • Strategic assessment of abortion services: (with WHO, Ipas, EEIRH,UNFPA) was conducted in September 2005

  • New MoH order, abortion standards are developed and submitted

  • National Strategy of RH for 2005-2015 developed, with WHO expertise (abortion quality is one of the priority)

  • System of continuing CAC education (MVA & Medical abortion) is developing now







WHO meeting on Safe abortion and Strategic Approach in Riga, June 2004 (Russia, Ukraine, Moldova, Lithuania, Latvia)

  • WHO meeting on Safe abortion and Strategic Approach in Riga, June 2004 (Russia, Ukraine, Moldova, Lithuania, Latvia)

  • Strategic Assessment of Abortion services (WHO, MoH):

  • done in Romania, Moldova. Soon Russia, Ukraine (?)



NAF: www.prochoice.org

  • NAF: www.prochoice.org

  • Astra www.astra.org.pl

  • Ipas: Training Forum www.ipas.org

  • ICMA: International Consortium for medical Abortion www.medicalabortionconsortium.org

  • Gynuity Health Projects:

  • www.gynuity.org







  • Safe Abortion: Technical and Policy Guidance for Health Systems, WHO, 2004

  • Traci Bird, Sarbaga Folk and Entela Shehu Shifting focus to the women: comprehensive abortion care in central and eastern. Europe. Entre-nous, No 59-2005.p. European Magazine for Sexual and Reproductive Health

  • Bird, Harvey, et al. Similarities in women’s perceptions and acceptability of manual

  • vacuum aspiration and electric vacuum aspiration for first trimester abortion. in 2003 Contraception 67  (2003) 207-212.

  • Greenslade, Forrest, Ann Leonard, Janie Benson and Judith Winkler. 1993. Manual vacuum aspiration: A summary of clinical and programmatic experience worldwide. Carrboro, NC: Ipas

  • International Planned Parenthood Federation (IPPF). 2001. International Medical Advisory Panel (IMAP) statement on safe abortion. IPPF Medical Bulletin, 35(5).

  • International Planned Parenthood Federation (IPPF). 2001. International Medical Advisory Panel (IMAP) statement on safe abortion. IPPF Medical Bulletin, 35(5).



  • Cates, Willard J. and David A. Grimes. 1981. Morbidity and mortality of abortion in the United States. In Hodgeson, J.E., ed. Abortion and sterilization: Medical and social aspects. London, Academic Press.

  • Grimes, David A., Kenneth F. Schulz, Willard Cates, Jr. and Carl W. Tyler, Jr. 1977. The Joint Program for the Study of Abortion/CDC: A preliminary report. In Hern, Warren and B. Andrikopoulos. eds. Abortion in the Seventies. New York, National Abortion Federation.

  • Thonneau, Fougeyrollas, et al. Complications of abortion performed under local anesthesia. In European Journal of Obstetrics & Gynecology and Reproductive Biology 81 (1998) 59–63

  • G. Dean, L. Cardenas, et al. Acceptability of manual versus electric aspiration for first trimester abortion: a randomized trial. In Contraception 67 (2003), 202-2007

  • Blumenthal PD and Remsburg RE. A time and cost analysis of the management of incomplete abortion with manual vacuum aspiration. International Journal of Gynecology and Obstetrics 1994; 45:261-267.

  • Joffe, C. Abortion in historical perspective. In Paul, M, Lichtenberg, ES, Borgatta, L, Grimes, DA, & Stubblefield, PG (Eds.). A Clinician’s Guide to Medical and Surgical Abortion. Philadelphia: Churchill Livingstone, 1999.




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