Abigail Aiken


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    Do as we say, not as we do: experiences of unprotected intercourse among Society of Family Planning fellows

    Abigail Aiken1, James Trussell2 1University of Texas at Austin, Austin, Texas, USA, 2Princeton University, Princeton, New Jersey, USA - araa2@utexas.edu

    Objectives: Despite our role in preventing unintended pregnancy and STI transmission, very little is known about reproductive health professionals’ own experiences of sexual risk-taking. We examined the prevalence and circumstances of unprotected intercourse among Society of Family Planning (SFP) fellows in the United States. Methods: A link to an anonymous online survey was sent via email to 477 SFP fellows. Within the first week, 321 (67%) responded, and we expect around an 80% total response rate. We asked whether respondents had ever and in the past year had unprotected vaginal intercourse when not intending a pregnancy, and if so, how many times, under what circumstances, and at what age the first time. We then asked about unprotected vaginal, anal, or oral intercourse ever and in the past year under three different scenarios: 1) partner not known to be infection-free, respondent infection-free; 2) partner known to be infection-free, respondent not infection-free; 3) partner known to have an infection, respondent infection-free, including the number of times, applicable circumstances and age the first time. Results: Among respondents so far, 46% have ever had unprotected vaginal intercourse when not intending pregnancy; 35% more than 10 times, and 13% in the past year. Sixty percent have had unprotected vaginal, anal, or oral intercourse with a partner not known to be infection-free; 38% more than 10 times, and 22% within the past year. Eight percent have ever had unprotected intercourse with an infection-free partner when they themselves had an infection, and 5% have ever had unprotected intercourse with a partner known to have an STI. Conclusions: Preliminary results suggest that despite a high level of medical knowledge, risk-taking with respect to pregnancy and STIs is common among reproductive health professionals.

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    The Irish abortion referendum represented an historic moment for reproductive rights in Ireland. Strikingly, the overwhelming “Yes” vote from Irish voters was echoed and supported by a broad spectrum of Irish politicians. This presentation will describe the critical role played by scientific evidence in shaping the policy conversation and influencing the opinions of politicians. We will discuss both quantitative and qualitative findings about how women in Ireland access abortion and their experiences both traveling abroad to clinics and self-managing using online telemedicine. Looking ahead, we will also examine elements of the new legislation Irish politicians are drafting to grant access to abortion up to 12 weeks gestation. Finally, since the political spotlight has now turned to Northern Ireland, where abortion laws remain among the strictest in the world, we will preview new research examining women in Northern Ireland’s decision-making and experiences around abortion and discuss strategies for how this research might help support change. 

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    Measurement of unintended pregnancy and its importance for predicting negative life impacts.

    Abigail Aiken1 ,2
    1University of Texas at Austin, Austin, TX, USA, 2Princeton University, Princeton, NJ, USA

    Unintended pregnancy is a key public health metric for gauging efforts to improve women’s reproductive health. Research has demonstrated complexity in women’s intentions, desires and emotional orientations towards pregnancy, as well as the propensity of each to change over relatively short periods of time. Yet current approaches to preventing unintended pregnancy and improving pregnancy outcomes are narrowly focused on the ideal that all women must form timing-based intentions regarding whether/when to have a(nother) child and then specifically plan either to achieve or to avoid pregnancy. In reality, many women hold ambivalent, indifferent or incongruent attitudes towards pregnancy, while others do not find planning meaningful in the context of their lives or may be unable to attain normative ideals regarding readiness for pregnancy and parenthood. Moreover, the main public health and clinical rationale behind preventing unintended pregnancy is that it necessarily results in adverse health and social outcomes. The evidence for such negative outcomes, however, is mixed and many studies suffer from serious methodological limitations. We review cutting-edge research examining pregnancy intentions, feelings and desires from women’s perspectives, as well as the evidence linking intentions to both negative and positive life impacts. We conclude by examining how shifting our emphasis from preventing unintended pregnancies to preventing truly undesired pregnancies could advance reproductive justice and result in more woman-centreed policy and practice.

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    Safety and effectiveness of medical abortion outside the formal healthcare setting: do women seek timely care for potential complications?

    Abigail Aiken1 ,2, Rebecca Gomperts3, James Trussell1
    1Princeton University, Princeton, NJ, USA, 2University of Texas at Austin, Austin, TX, USA, 3Women on Web, Amsterdam, The Netherlands

    Objectives: Medical abortion provided outside the formal healthcare setting is an important option for women in countries where abortion is illegal or highly restricted. Yet very little is known about its safety and effectiveness. We address this important knowledge gap using high-quality data from a setting where women commonly rely on this pathway to abortion.
    Methods: We examine outcomes and complications among 1,234 women in Northern Ireland (representing 79% follow-up) who conducted medical abortion through Women on Web between March 30th 2009 and December 31st 2012. Women used a regimen of 200mg oral mifepristone and 1200mcg buccal misoprostol (with additional misoprostol provided if required).
    Results: At the time of consultation, 77% reported gestational age under seven weeks, and 23% between seven and nine weeks. Abortions typically occurred between five and 21 days later (women were strongly discouraged from performing abortion after 12 weeks gestation). Virtually all women (99.0%) were able to end their pregnancies and 95.1% were able to do so without surgical intervention. Three women (0.2%) required a blood/blood product transfusion and 23 (1.9%) were given antibiotics. Nine percent of women reported bleeding lasting more than two hours soaking more than two maxi pads per hour; fever >39C or purulent discharge; or pain persisting several days postabortion. Among women reporting these possible symptoms of serious complications, 97% sought timely medical care (the other 3% suffered no harm). Among women not reporting a potentially serious complication none received treatment for one.
    Conclusions: Despite a variety of gestational ages (including some beyond nine weeks) and the likely possibility that some providers performed surgical intervention and prescribed antibiotics unnecessarily, findings show that medical abortion provided outside the formal healthcare setting is highly effective and safe. Crucially, women are able to self-identify potentially serious complications and seek appropriate and timely medical assistance.