Rebecca Gomperts


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    Demographic characteristics of 400 women from Ireland and the Philippines who completed the online consultation form of the telemedical abortion service Women on Web

    Rebecca Gomperts, Marlies Schellekens Women on Web, Amsterdam, The Netherlands -

    The study analyzes the data of 200 women from the Philippines and 200 from Ireland who completed the online consultation form of Women on Web telemedical service in 2012. The study found that the geographical, cultural and political differences of Ireland and the Phillipines correspond to the demographic characteristics of women who completed the online consultation. For example average rates of contraceptive usage in the Philippines is 41% to 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%). Women in Ireland often already had children and reported failed contraception as a reason for their pregnancy (Table).

    Ireland Philippines p-value

    Total 200 200

    Mean age 28 26

    Reason for abortion:

    I am too young 20 (10%) 50 (25%) 0.0008

    Reason for abortion:

    I am too old 10 (5%) 2 (1%) 0.012

    Reason for abortion:

    family is complete 51 (25.5%) 14 (7%) 0

    Nulliparous 88 (44%) 106 (53%) 0.07

    No contraceptive use 83 (41.5%) 141 (70.5%) 0

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    Regional differences in surgical intervention
    following medical termination of pregnancy
    provided by telemedicine
    Gomperts, R1,2; Jelinska, K1,2; Sabine, S1,2;
    Gemzell-Danielsson, K1,2; Kleiverda, G1,2
    1 Women on Waves; 2 Department of Obstetrics and Gynaecology,
    Karolinska Institutet, Stockholm, Sweden
    Objective: Analysis of factors influencing surgical intervention
    rate after home medical termination of pregnancy (TOP) by
    women in countries without access to safe services using the
    telemedical service ‘Women on Web’.
    Design: Cohort study.
    Setting: Women with an unwanted pregnancy <9 weeks pregnant
    who used the telemedicine service of Women on Web between
    February 2007 and September 2008 and provided follow-up
    Sample: Women who used medical TOP with a known follow up.
    Methods: Information from the online consultation, follow-up
    form and emails was used to analyse the outcome of the TOP.
    Main Outcome Measures: Ongoing pregnancy, reason for surgical
    intervention, perceived complications and satisfaction.
    Results: Of the 2323 women who did the medical TOP and had
    no ongoing pregnancy, 289 (12.4%) received a surgical
    intervention. High rates were found in Eastern Europe (14.8%),
    Latin America (14.4%) and Asia/Oceania (11.0%) and low rates in
    Western Europe (5.8%), the Middle East (4.7%) and Africa (6.1%;
    P = 0.000). More interventions occurred with longer gestational
    age (P = 0.000). Women without a surgical intervention more
    frequently reported satisfaction with the treatment (P = 0.000).
    Conclusions: The large regional differences in the rates of
    reported surgical interventions after medical TOP provided by
    telemedicine cannot be explained by demographic factors or
    differences in gestational length. It is likely that these differences
    reflect different clinical practice and local guidelines on
    (incomplete) abortion rather than complications that genuinely
    needed surgical intervention. Surgical interventions significantly
    influenced womens’ views on the acceptability of the TOP.

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    Women on Waves
    Rebecca Gomperts, MD, Amsterdam, The Netherlands 
    Women on Waves, a Dutch non-profit organization, operates a mobile reproductive health
    clinic on board a Dutch ship. Outside the territorial waters of countries where abortion is
    illegal , the abortion pill can be provided safely and legally to women with unwanted
    pregnancies. Women on Waves set sail to Ireland in 2001 and to Poland in June 2003 and
    in August 2004 to Portugal. The three campaigns created enormous public interest. The
    presentation will address the obstacles, successes and failures of the 3 campaigns. It will
    also present Women on Web, a online abortion help service.

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    PS01.1Improving the journey through medical abortion.

    Rebecca Gomperts1 ,2

    1Women on Web, Toronto, Canada, 2Women on Waves, Amsterdam, The Netherlands, 3Karolinska Institute, Stockholm, Sweden

    Women on Web, a telemedical abortion service was founded 10 years ago and today answers 10,000 emails per month. Telemedicine has a great potential to improve the journey though medical abortion especially for women in rural and remote areas, as well as urban areas with a shortage of health care providers or where access to abortion is legally restricted.

    So far scientific research has been published about three telemedical abortion services Women on Web (WoW), Willow Women’s Clinic and Planned Parenthood of the Heartland. Lately several new telemedical abortion services were initiated including one in Australia by the Tabbot Foundation and in the USA by Gynuity.

    In this talk I will present

    1. Examples of women who contacted Women on Web because they could not obtain regular abortion services even if they are living in countries where abortion is “legal” and “available” due to economic and social circumstances and domestic violence. 

    2. Criminal prosecution of women using Women on Web in a high resource setting. 

    3. Criminal prosecution of women using Women on Web in a low resource setting. 

    While these cases are caused by the local, legal context it shows clearly that, even if telemedical services can give access to medical abortion in places where this is not available, we have to continue to work on changing abortion laws and making sure local, safe abortion services will become more easily accessible even in countries where it seems abortion services are available as they are still not available for those women who are in the most vulnerable social economic situations.
To improve the journey through medical abortion for women we have to improve it for all women.

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    All restrictions to access abortion services, legal logistic financial, creates social inequality.  Women with access to financial means and information will always be able to access safe abortion services and women without the financial resources are most affected by these obstacles. abortion laws.  Women on Waves and Women on Web use new technology (drones, robots, internet, apps) and research, to break the taboo around abortions and change policies and laws and in the same time make sure women have access to contraceptives and safe medical abortions. This presentation will highlight some of the work, achievements and challenges in the past years.

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    Women on Web

    Rebecca Gomperts Women on Waves, Amsterdam, The Netherlands -

    Women on Web is a telemedical abortion service for women with an unwanted pregnancy up to 9 weeks living in countries without safe abortion care. Three studies looked at the outcome and factors influencing the surgical intervention rate after the medical abortion provided to women through telemedicine. One retrospective study analyzed information from 484 women who received a medical abortion at their home addresses in 2006 and 2007. Sixteen of the 265 (6.0%) women who provided follow-up information reported that they did not use the medication. Of the remaining 249 women who did the medical abortion at home, 13.6% reported having a surgical intervention afterwards and 1.6% reported a continuing pregnancy. After the follow-up rate increased from 54.8% to 77.6% of the cases, 12.6% of the women reported they did not take the medication and only 6.8% of the women having the medical abortion at home underwent a surgical intervention afterwards. Another study analyzed the influence of geographical location on the outcome of the 2323 women. High rates were found in Eastern Europe (14.8%), Latin America (14.4%) and Asia/Oceania (11.0%) and low rates in Western Europe (5.8%), the Middle East (4.7%) and Africa (6.1%; p=0.000). The third study evaluated the data from women living in Brazil.. Of the 370 women who used the medicines, 307 women provided follow-up information about the outcome of the medical abortion. Of this group, 207 (67.4%) of the women were up to 9 weeks pregnant, 71 (23.1%) were 10, 11 or 12 weeks pregnant, and 29 (9.5%) of the women were at least 13 weeks pregnant. There was a significant difference in surgical intervention rates after the medical abortion at the different gestations (19.3% at <9 weeks, 15.5% at 10-12 weeks and 44.8% at >13 weeks, p=0.06). However, 42.2% of the women who had received a surgical intervention afterwards did not have any symptoms of a complication. This research shows that medical abortion can be safely and effectively provided to women themselves through telemedicine. Surgical intervention rates after the medical abortion provided via telemedicine reflect local medical practices. The risk of surgical intervention and ongoing pregnancy after home medical abortion only tends to increase after 12 weeks of pregnancy.