Abstract of the third conference of FIAPAC

Maastricht, Holland

The Dutch teams did a wonderful job in welcoming the participants and organising the debates.

This 3rd edition attracted an increasing number of participants, with over 100 people coming from different European countries: Belgium, Holland, Germany, Austria, Spain, Denmark, France, and Britain, as well as the United States.

In her welcoming speech, Elisabeth AUBENY, President of the F.I.A.P.A.C., called upon people to join the F.I.A.P.A.C.

Three successive round tables were followed by free discussion to close the day.

1st Round Table: Training of medical and paramedical personnel working in the field of abortion, chaired by Mr ALBLAS.

The situation in different countries was brought up.

South Africa :
M. ABLAS shared her experience in South Africa where the legislation does not solve all the problems of legal abortion, in particular relating to the mobilisation of doctors. The problems are obviously greater for the poor, the better off always being able to find solutions, albeit sometimes illegal.

Abortions are carried out by : gynaecologists and experienced general practitioners, nurses and midwives.
A free service is available in the public hospitals, but there are few doctors and few hospitals
In contrast there are more private clinics which are expensive and in the towns.
CYTOLEC is used to induce metrorragy , thus justifying hospitalisation.

U.S.A. :
In the 44 states where abortion is legal, it is carried out by specially trained general practitioners.

UK :
1/3 in hospital (NHS).
2/3 in private clinics where there is a lack of doctors.

Germany :
Gynaecologists trained in the public hospital system.
Easier in the North of the country.
The Profamilia Centres (non profit making) lack doctors.

France:
Gynaecologists and general practitioners, with practical training and for low pay, carry out abortions in registered public or private centres.

Belgium:
Gynaecologists in the public hospital system and general practitioners in private centres.
Flemish speaking areas: 41% in hospitals 59% in private clinics
French speaking areas: 11% in hospitals 89% in private clinics
There is a lack of doctors.

Holland:
Gynaecologists in public hospitals: 7%
General practitioners in private clinics: 93%
Doctors receive a specific training period for abortions carried out in the first or second trimester.

Denmark:
A hospital service deals basically with all the abortions.
Doctors are given an initial training.
A conscience clause exists.

Spain:
Most abortions are carried out in private clinics by gynaecologists up to late stages.

Austria:
General practitioners can carry out abortions in their surgeries.
The paramedical staff are recruited by the doctors without any specific training.
No control system or assessment of the work exists.

CONCLUSION:
In France, Belgium and Holland the teams are made up of multi-skilled staff : psychologists, social workers, nurses.
A counselling session is compulsory in France and systematic in Belgium.
C. BIRMAN (F) is worried that psychologisation is moving the problem of legal abortion from a collective one to one concerning the individual and thus bringing in a sexist attitude.
P. CESBRON (F) would like to see an exchange between professionals and militants.
Dr FIALA (A) reminds people of the important role of the paramedical team in drug induced abortion.
Dr GOLSTEIN (DK) emphasises the specificity of abortion and the need for the paramedical staff to have followed an appropriate training.

The 2nd Round Table: The responsibility of the professional when dealing with another country.
Chaired by: A. VEROUGSTRAETE (Belgium).

It is necessary to underline the fact that patients take a lot of time before finding the right address for their situation. Doctors consider that they apply the law to foreigners (with a reservation for abortion in the second trimester). Considering the distances involved, legal abortion becomes an emergency that must be dealt with within a day.


It is important to make sure the women know about the laws of the host country. Patients should be sent with a gynaecological and general health report. They should be told about the price, the travel arrangements, the town and the methods used. It is necessary to inform the Abortion Centre of complications that are seen at a later date during the follow up visit.
"Abortion tourism” is sometimes the term used. It is more appropriate to talk about involuntary migration of women.

In Europe:

Irish women go to the UK
Polish women go to Minsk and Holland
Portuguese women go to Spain

In Holland the service is free, but the E 111 form must be presented to get one’s money back.

In France and Germany, it is forbidden to give addresses abroad, this is contrary to the free circulation of information.

From the general discussion it came out that , while waiting for legal abortion to be available and carried out correctly in all countries, patients must be informed about the possibilities of legal abortions in the second trimester and doctors must find out about clinics where it is practised.

The M.F.P.F. ( the French family planing service) reminds participants that there is no legal action taken for giving information concerning the possibilities of abortion over the legal limit abroad.

In France ANCIC emphasises the fact that many doctors are prepared to accept women who are over the legal period.
They reminded those present of their position in wanting to make it a non-criminal offence and to extend the legal period for abortion up to the viability date, as well as their active struggle in this area.

Between Two round tables, a few brief points…

Presentation of the association of Spanish clinics (ACAI) who wish to join the FIAPAC.

The Spanish congress of ACAI in Servile in May 2000.

The story of a doctor from Lyon who had travelled to Albania and Kosovo and who brought peoples attention to the large number of rapes that had been committed their.

3rd round table : antibiotic treatment and abortion.
Chair: P. MOONENS (Belgium)

The Situation in Belgium: D.ROYNET.
98% of abortions are carried out in non-hospital situations with very few medical staff. The antibiotics prescribed are chosen in relation to the age, the sexual precociousness and the number of partners.
The talk underlined the frequency of asymptomatic carriers , the increase in the occurrence of Chlamydia 3%. Gonorrhoea tending to disappear.

The criteria for screening are thus defined:
&Mac183; More than 2 partners per year
&Mac183; Request for abortion
&Mac183; Before putting in an I.U.D.
&Mac183; Partner infected with a S.T.D.
&Mac183; The pill before 18
&Mac183; Abdominal pains
&Mac183; Screening for S.T.D.

Treatment : 200mg DOXYCYCLINE for 2 days.
Abortion postponed for a week in the case of Chlamydia.

Holland:
Chlamydia: 5 to 20%
Gonorrhoea: 0.2 to 3%
Current practices: Prophylaxy if the woman is under 30 years of age
DOXYCYCLINE 300mg the day before and then 100mg/ day for 2 days or 200mg for 7 days.

Holland (A.TALENS):
Prescription of METRODINAZOL over 18weeks amenorrhia taking into account that the risk increases with the length of pregnancy. The conclusion of the Dutch practice is that all women asking for abortions must be treated.

France (P. CRESBRON):
In France from 1990 to 1995 1,000,000 legal abortions were carried out. There were 4 deaths linked without certitude to an infection, 1 0/00 peritonitus and about 1% of minor complications with up to 12 weeks of amenorrhia There are few long term post-infection effects.
Women with a history of pelvic infection run a real risk of infectious complications.

The speaker quotes an American study:
1/1400 abortion leads to hospitalisation.
1/4500 leads to a serious infection.
What antibiotic therapy: 1 dose of DOXYCYCLINE 200mg 2 hours before, 200mg 12 hours after.

To recap:

At the moment the incidence of infection is not known.
The majority of centres do not practise a systematic antibiotic therapy.

The discussion underlined the different medical practices. In Spain DOXYCYCLINE is systematically used for 5 days, in Germany there is screening for Chlamydia with treatment in positive cases.

The specific case of Russia where women under go a high number of abortions shows a linked rise in the incidence of Chlamydia.

In conclusion: although this is a quantifiable field consensus is not possible.

Free exchanges:

MIFEPRISTONE: there are differences within Europe despite European authorisation (E. AUBENY et C. FIALLA):

Austria: only in hospitals
Germany: not available – under study
Greece: hospital
Holland: judged not useful
Spain: price not yet defined
Switzerland: RU486 = poison so forbidden

In France:
Reminder of the law. 75% of cost paid back.
A week to think over before taking MIFEPRISTONE as well as a psycho-social counselling session. Ultrasound between D10 – D14 if there is a doubt. Result : 98.5% success rate. Continued pregnancy 1 0/00.
Doctors are badly paid.

In Austria:
Abortions are carried out by doctors in their private surgeries with out time given to think it over. The Church puts pressure on the public hospital system.
40 000 abortions per year.
Only one public hospital prescribes MIFEPRISTONE.
Consultations take place by phone. There is a lack of information.
Success rate of 97%.


Choice of method:

In France:
The method is perceived as being less aggressive, "natural”.
It represents 14% of the legal abortions in 1990 and 30 to 40% in 1998.

In Austria:
The choice is made in relation to how early in pregnancy the request is made.
A non-surgical method with the possibility of the partner being present.
The question as to whether the method should be available up to the 63rd day is being asked.

The discussion showed the advantages that would arise from "de-medicalising” this method and using it at home (defended by A. BUREAU – France) up to the 49th day of amenorrhe.

It was accepted that studies must be carried out to reduce the dose of MIFEPRISTONE to 200mg and to look into different protocol.

This third seminar ended after a series of rich and formative exchanges on the practices of the different participants.

A change in the statutes was decided by the founder members. From now on the F.I.A.P.A.C. , for democratic and voting reasons, is no longer an association of associations but an association of individual members. The membership fee for 2000 is 250 F.

It was decided to meet again in Paris for the 4th seminar on 24th and 25th November 2000.