Impact Of Covid-19 On Access To Abortion, Post Abortion Care, And .
Impact of Covid-19 on access to abortion, post abortion care, and contraception Kristina Gemzell Danielsson, MD, PhD, Prof. WHO CC, Department of Women’s and Children’s Health Karolinska Institutet/ Karolinska University Hospital Stockholm, Sweden the Global Voice for Women’s Health https://www.kth.se/polopoly opia%29.jpg
WHO Collaborating Centre for Research in Human Reproduction Karolinska University Hospital, and Karolinska Institutet UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO,Geneva COI; Gemzell-Danielsson serves ad hoc as invited lecturer/advisory boards for Merck (MSD), Bayer, Exelgyn, Actavis, Gedeon Richter, Mithra, Exeltis, Ferring, Natural Cycles, and HRA-Pharma Reproductive Health Research From bench - to bed - to the hands of women to improve women’s health the Global Voice for Women’s Health
Effective contraceptive methods and safe abortion care are prerequisites for Reproductive Health Sexual and reproductive health and rights constitute fundamental human rights, form a vital aspect of the women s empowerment and are a key to the achievment of gender equality the Global Voice for Women’s Health
Main cause of MM- key interventions Lancet 2016 Complications of abortion Family planning Safe abortion services Post abortion care Sepsis & other maternal infections Tetanus toxoid Clean delivery Antibiotics WASH Other maternal disorders Caesarean-section Other emergency obstetric care Obstructed labour Caesarean-section Hypertensive disorders Early identification & timely delivery Magnesium sulphate Calcium Aspirin Anti-hypertensive Caesarean-section the Global Voice for Women’s Health 9% 18% 22% 18% 8% 12% Haemorrhage Uterotonics Blood transfusion Balloon tamponade Surgery NASG 13% Indirect causes Iron folate supplements Malaria intermittent treatment Insecticide-treated nets Anti-retrovirals Koblinsky M, Moyer C, Calvert C, Campbell J, Campbell O, Feigl A, Graham W, Hatt L, Hodgins S, Matthews Z, McDougall L, Moran A, Nandakumar A & Langer A. Quality maternity care for every woman, everywhere: a call to action. Lancet 2016
COVID-19 has devastating effect on women and girls UNFPA; about 7 million unintended pregnancies across the globe due to the pandemic, This may lead to thousands of deaths from unsafe abortion and complicated births because of the lack of access to emergency services. We must look at (new) ways of mitigating these effects in access to SRH services Cousins S. Lancet 2020;396:301-2 the Global Voice for Women’s Health .
SRH access during COVID-19 In response to COVID-19, countries have taken different approaches to changing abortion regulations and family planning practices ranging from imposing restrictions to alleviating certain requirements. The absence of a unified approach to sustain abortion services, restrictions and border closures will widen inequities in access to contraception and abortion care. Moreau et al., BMJ SRH 2020 the Global Voice for Women’s Health
Access to abortion care during COVID-19 New restrictions include delay or denial of abortion care to women having or living with people having C19 symptoms, and decreased availability of surgical abortion. Reduced in-person clinical visits, expanded availability via telemedicine, and relaxed regulations around mifepristone delivery Moreau et al., BMJ SRH 2020 the Global Voice for Women’s Health https://www.kth.se/polopoly opia%29.jpg
Development of medical abortion 70ies, Prostaglandin analogues (PG) discovered by prof S Bergström and team at KI, Awarded the Nobel Price in 1982 Induced uterine contractions and cervical ripening; Shown to act in synergy with progesterone receptor modulator; Mifepristone (RU486) E Bauileu, Fr Developed into Medical abortion mifepristone 200 mg misoprostol 800 mcg pv/ sl ( 400 mcg) Bygdeman M, Gemzell Danielsson K, Marions L: JAMWA 55: 3: 195-6, 2000. the Global Voice for Women’s Health Bygdeman & Swahn 1985
Medical abortion is one of the safest medical procedures, with minimal morbidity and a negligible risk of death. Increased access to medical abortion can lead to a decline in maternal morbidity and mortality the Global Voice for Women’s Health
2012- update on WHO guidance on safe abortion Emphasizes the simplifying or streamlining of abortion care, Notes a high value on research to demedicalize abortion care Affirms that home use of misoprostol is a safe option for women The Guidance suggests the evaluation of internet provision and telemedicine, as further alternative service delivery channels of safe abortion the Global Voice for Women’s Health
How can we increase access to high quality, safe abortion care? Development and implementation of simplified medical abortion 1. ”Home use” of misoprostol 2. Task - shift / - sharing 3. Simplified procedures for Follow Up 4. Expanded access (from very early to beyond 9 weeks) 5. Post Abortion Care (PAC) Telemedicine Sunde Oppegaard K, .Gemzell-Danielsson K. Lancet 2015, Iyengar K, . Gemzell-Danielsson K. , Lancet Global Health 2015 the Global Voice for Women’s Health
Medical abortion provided by telemedicine www.womenonweb.org Telemedicine service started in 2006 Online consultation with a medical doctor Medical abortion conducted by internet/ email Helpdesk the Global Voice for Women’s Health Name Surname
www.womenonweb.org the Global Voice for Women’s Health
the Global Voice for Women’s Health
Summary Further efforts are needed to improve access to safe and effective abortion care Abortion is lowest where contraception and safe legal abortions are universally available, ObGyns urged to act as individual providers and through their FIGO member societies to protect women’s health and rights Telemedicine is a way to increase access to safe, acceptable and effective abortion care and allows women increased autonomy Endler M, Lavelanet A, Cleeve A, Ganatra B, Gomperts R, Gemzell-Danielsson K. Telemedicine for medical abortion: a systematic review. BJOG. 2019 the Global Voice for Women’s Health
"Women are not dying because of diseases we cannot treat. They are dying because societies have yet to make the decision that their lives are worth saving.” Professor M.F. Fathalla Former President of FIGO Professor of Obstetrics and Gynaecology, Assiut University, Egypt the Global Voice for Women’s Health
THANK YOU! Reproductive Health Research From bench - to bed - to the hands of women to improve women’s health the Global Voice for Women’s Health
www.womenonweb.org Telemedicine service started in 2006 Online consultation with a medical doctor Medical abortion conducted by internet/ email Helpdesk Medical abortion provided by telemedicine Name Surname. the Global Voice for Women's Health www.womenonweb.org.
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