Susanne Sjöström

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    Medical abortion provided by nurse-midwives or physicians: a cost-effectiveness analysis

    Susanne Sjöström1, Helena Kopp Kallner1, Emilia Simeonova2, Andreas Madestam3, Kristina Gemzell-Danielsson1 1Karolinska Institutet, Stockholm, Sweden, 2John Hopkins University, Baltimore, USA, 3Stockholm University, Stockholm, Sweden - susanne.sjostrom@ki.se

    Objective: To make a cost-benefit analysis of medical abortion provided by nurse-midwives and physicians. Study Design: A cost-effectiveness analysis is conducted based on a previously performed randomized controlled equivalence trial comparing efficacy, safety and acceptability of medical abortion performed by nurse-midwives or physicians in a high-resource setting. Materials and methods: Direct and indirect costs associated with the standard and intervention treatment have been calculated and an incremental cost-effectiveness analysis is performed. Equivalence in effectiveness was established for the primary and secondary outcomes in the original study, the outcome measures were complete abortion, and safety in terms of hospitalization, blood transfusion and acceptability. Direct costs include salaries including general payroll tax, rent, training of providers and costs for consultation (second opinions). Since the patients received the same treatment there was no difference in costs of disposables, ultrasound or medication. Indirect costs include women’s loss of salary and alternative cost for consultants (second opinions). Benefits emerging from increased prescription of long-acting contraceptives (LARCs) and also possible utility such as decreased waiting time for abortion seeking women from first contact to consultation/ treatment will be considered. All costs were taken from Karolinska University hospital where the parent study was conducted. Results: Preliminary results are that medical abortion provided by nurse-midwifes alone is more cost-effective than the standard treatment involving both nurse-midwives and physicians. The savings are mainly derived from lower salary costs for nurse-midwives but also from less total time for the visit.

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    Medical students' attitudes and perceptions on abortion: a cross-sectional survey among medical interns in Maharastra, India

    Susanne Sjöström1 ,2, Birgitta Essén2, Filip Sydén2, Kristina Gemzell-Danielsson1, Marie Klingberg-Allvin3 ,1 1Karolinska Institutet, Stockholm, Sweden, 2Uppsala University, Uppsala, Sweden, 3Dalarna University, Falun, Sweden - susanne.sjostrom@ki.se

    Introduction: Although abortion care as a procedure to prevent maternal death has been an established routine for decades in India, eight per cent of maternal mortality is attributed to unsafe abortion. Increased knowledge and improved attitudes among healthcare providers have a potential to reduce barriers to safe abortion care by reducing stigma and reluctance to provide abortion. Previous research has shown that medical students’ attitudes can predict whether they will perform abortions. The objective of our study was to explore attitudes toward abortion among medical interns in Maharastra, India. Study Design: A cross-sectional survey was carried out among 1,996 medical interns in Maharastra, India. Descriptive and analytical statistics interpreted the study instrument and significant results were presented with a 95% confidence interval. Results: A majority of the respondents rated their knowledge of sexual and reproductive health as good, but only 13% had any clinical practice in abortion care services. Most participants agreed that unsafe abortion is a serious health problem in India. However, many considered abortion to be morally wrong, one fifth did not find abortions for unmarried women acceptable, and one quarter falsely believed that a woman needs her partner or spouse’s approval to have an abortion. Conclusion: Despite good self-assessed knowledge of reproductive health, disallowing attitudes toward abortion and misconceptions about the legal regulations were common. Knowledge and attitudes toward abortion among future physicians could be improved by amendments to medical education, potentially increasing the number of future providers delivering safe and legal abortion services.