Transcript Diapositive 1
“Expanding Access to Medical Abortion: Building on Two Decades of Experience”
ICMA in collaboration with Ipas and Gynuity Health Projects Olissipo Hotel Lisbon, Portugal 02 March 2010
SELF MEDICATION IN WAR SETTING
Pierre A. PANDA GRAIFA -- DEMOCRATIC REPUBLIC OF CONGO
SOME CONSIDERATIONS (1)
According to World Health Organization (WHO), unsafe
abortion is a ‘procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards or both’
Each year approximately 46 million abortions are performed worldwide, 19 million of them are at risk and kill more than 70 000 women. This situation is more critical
in war situation.
Access to safe abortion is often difficult in conflict torn
era with restrictive abortion laws.
The growing need to make self-medication safer and
effective.
SOME CONSIDERATIONS (2)
– Medical abortion is more potential to self medication, safety
and it's being used both under medical control and through self-medication. ...
– Self - inducing abortion with misoprostol can avoid medical barriers, high costs and social stigma. – Women who are not suffering from serious diseases as anaemia are likely to use misoprostol without medical control.
– The prohibitive cost of modern health care is one of the major contributory factor. – The need to ensure proper use of self medication.
– Convey the social and economic value of responsible self-
medication to health professionals and health systems managers.
– Self medication can also save expenses for the national healthcare systems.
SOME CONSIDERATIONS (3)
– The self medicating use of misoprostol is more indicated at an earlier gestational stage. – Some episode of drug abuse. – The acceptable length of self medication treatment.
– Health care providers should provide advice to the patients about self medication. – Some limits of self medication (symptoms persisting, severe pain, failure, side effects, hyper-excitability ...) – The need of counselling Post Abortion Care. – Ignorance of health care provider of legal reforms and their
refusal to provide services.
– The right of each woman to control their fertility.
THE SITUATION IN CONFLICT SETTING (1)
– Women constitute a significant percentage of millions of refugees worldwide. – Safe abortion is often a RH need ignored despite the blatant and persistent sexual exploitation towards young women. – The reproductive health of women is generally alarming in
war setting.
– Increasing need for abortions caused by unwanted pregnancies due to rape. – Changes in gender relations affect negatively women’s reproductive health.
– The RH services are often less effective and operational. – Persistence of multiple unmet needs for sexual and reproductive rights.
– Women are malnourished, sick, hungry and without means of subsistence.
THE SITUATION IN CONFLICT SETTING (2)
– Resurgence of complications of pregnancy and childbirth.
– Existence of many risks to women’s sexual health.
– Sexual violence is often used as a weapon of war: a military officer
told to his soldiers that their sexual organ was also a weapon.
– Sexual slavery of girls in exchange of food, money, housing or
property.
– Limited access to contraceptives and information on appropriate medication abortion.
– Women are routinely subjected to sexualised violence.
– Attitudinal changes towards sexuality, procreation and abortion.
– The vulnerability of women reduces their ability to protect their reproductive rights.
– Persistence of maternal mortality following unsafe abortions - Data
from a rural clinic in DRC reported over 98% of cases of unsafe abortions in non-medical setting of which 38% were fatal only in 2009
WHY SELF MEDICATION IS IMPORTANT FOR WOMEN AFFECTED BY WAR
– Huge gap between the reproductive need of different groups of
women (refugees, adolescents, disabled, widows, illiterate, seropositive, poor, rural, indigenous)
– Access to medication abortion increases women's options when it comes to their reproductive health care. – Medical abortion is considered more beneficial for patients. – Medication abortion increases the access of many women to safe, confidentiality and good quality care. – It also allows women to control their fertility and exercise their reproductive rights. – It's essential to reduce maternal mortality and morbidity due to
unsafe abortion in conflict torn era.
– Medication abortion pills help women to self-medicate safely. – The women's reproductive health is very fragile in war setting. – The ongoing complications of pregnancy hamper women’s health and life.
MAIN CHALLENGES (1)
– Scarcity and lack of resources for RH services.
– Birth delivery service is often made at home for cultural reasons, as there is a strong tendency to practice clandestine abortion. – The inadequate quality and high cost of health care
could reduce the use of services
– Physicians' knowledge and opinions about medication abortion. – Women may live more than 2 hours away from emergency medical care (a hospital) – Difference between cultural fundamentalism and
alarming reality of women’s maternal mortality.
MAIN CHALLENGES (2)
– Young women often experience shame, fear and cultural taboos. – Upward trend in fertility rates in the refugee centers
and communities affected by conflict.
– Restrictive laws: the diagnosis must be confirmed by more than two medical doctors to perform abortions. – Low consensus on decisions related to contraception and childbearing among couples. – Contraindications and requirements of misoprostol
Protocol: Removal of IUDs, pregnancy testing, emotional support, test, ultrasound, ectopic pregnancy, anaemia ...)
MAIN CHALLENGES (3)
– High rate of illiteracy of women. – Need sufficient resources, support and continuous
monitoring to maintain service.
– Services of emergency obstetric care are often lacking, inadequate or ineffective. – Strict compliance of contraindications of Medabon (kidney, liver, asthma, bronchitis, anaemia, cardiovascular history ...) – Inadequate technical capacity of health care providers,
counselors and RH advocates.
– Poor information on men's reproductive health. – The low level of income, distance from service and
gender inequalities.
WAY FORWARD: INCREASING ACCESS TO MEDICATION ABORTION PILLS IN EMERGENCY SITUATIONS (1)
– Develop appropriate services at community level
(listening centers, training center ...)
– Distribution of abortion pills, contraceptives and dissemination of information.
– Public education regarding medical abortion care. – Community visits and care for patients under treatment of abortion pills. – Overcoming barriers in access to services for disabled,
indigenous, illiterate, teenagers)
– Include the communication on the needs of
adolescents affected by the conflict.
WAY FORWARD: INCREASING ACCESS TO MEDICATION ABORTION PILLS IN EMERGENCY SITUATIONS (2)
– Changing social norms on abortion and contraception.
– Use estimates of maternal deaths in advocacy for safe abortion. – Provide information on the proportion of deaths due to unsafe abortions in maternal mortality.
– Advocacy and awareness sessions with decision makers,
leaders and media in restrictive abortion laws settings.
– Access to medication abortion increases women's options when it comes to their reproductive health care. – Education and training of RH care providers, women
leaders, traditional chiefs and TBA.
WAY FORWARD: INCREASING ACCESS TO MEDICATION ABORTION PILLS IN EMERGENCY SITUATIONS (3)
– Training in providing medication abortion care. – Equitable participation of men and women in the designated programs. – I
nvolve a broad range of stakeholders, community advocates in RH programs.
– Use of community drama in advocacy means to break taboos on sexuality, abortion, maternal mortality. – Scenes on rape, unwanted pregnancies, abortions and maternal mortality. – Holistic Approach of abortion related services and
programs (counselling, FP, HIV prevention, emergency obstetric care, social needs)
WAY FORWARD: INCREASING ACCESS TO MEDICATION ABORTION PILLS IN EMERGENCY SITUATIONS (4)
– Advocacy for implementing the protocol & international agreements relating to reproductive rights including safe abortion.
– Reduce the incidence of unsafe abortions and maternal death related to unsafe abortion. – Document the new needs of RH caused by conflicts
and establish priorities.
– Promoting fair and responsible role of men – Some organizations have developed emergency contraception (KIT PEP) for raped women in DRC where abortion is criminalized except to save mother's life.