Eva Rodriguez

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    Advantages of the Implementation of a Quality Control System in a Abortion Clinic
    Rodríguez, E.; Gómez, M.; Serrano, J.; González, M.; Martin, M. Rubio, C.
    Clínica El Sur, Sevilla, Spain
    Quality control programs are being used more often to promote business . Since they have
    been proved to be very effective we believe that they could also be implemented in the
    medical sector, specifically in interruption of pregnancy. After four years of quality control
    program which we have implemented in our clinic it has been succesfull. In colabaration
    with other specialist we have brought this poster so that it might encourage others to
    introduce this program in their clinics.
    The supervision, and certification of a quality control program by an international
    enterprise which specialises in QUALITY CONTROL means describing, documenting and
    making protocols with regards to all the practices in that business, establishing a
    consensus on the standards at all levels.
    The main objective of our quality management program is client satisfaction. It involves
    establishing mechanisms in order to obtain a continuos improvement in the service which
    we offer i.e. performing abortions. It also involves monitoring the results of these
    standards. In order to achieve this we plan the objectives of organization, formation of our
    personal, control and analize our desviations that occur so that we can rectify them and
    hence securely value the most important areas of our enterprise, suppliers, products,
    maintance of our equipment, infrastucture, the satisfaction of our clients etc.

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    Misoprostol with and without mifepristone in advanced pregnancy cases

     

    Eva RodriguezMD, ACAI – Sevilla, Spain

    Objectives  To establish the effect of mifepristone on pharmacological late abortion (more than 16 weeks) performed with misoprostol and the effect of factors such as misoprostol dosage.

    Subjects and methods: Retrospective study (753 subjects) comparing fails and time of induction in two groups, with (325) and without (428) mifepristone by means of survival analysis and the effect of others factors by means of non-parametric tests.

    Results: Lesser time of induction was observed in the group with mifepristone (rate of finalization 0,0634, statistically different from rate of control group: 0,0906), without more adverse effects. Lesser time of induction with misoprostol each 3 hours and greater in primipara.

    Conclusions: The late pharmacological abortion goes better adding mifepristone to misoprostol. The dosage of misoprostol each 3 hours is slightly better than the use each 4 hours.

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    Termination is allowed up to 22 weeks of amenorrhoea, with no requirement
    for a waiting period. 97.3% of terminations are done for psychological reasons;
    15% concern adolescents.
    The private sector performs 97% of terminations. Although the law is
    restrictive, access to termination is good. There is a need, however, for fairer
    legislation. The present reporting system is insufficient.

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    The campaign to liberise the law in Spain : ACAI´s mark on a new act

    Eva Rodriguez, Spain

    Twenty-three years since the enacting of the 1965 Abortion Bill, Virginia’s right to decide, like that of

     thousands of other women, was once again called into question in Spain, with the outbreak of an unprecedented crisis. Following a report by the Catholic organisation E-Christians on illegal abortions, on the 26th November 2007 the Civil Guard searched the clinics of Dr. Carlos Morín, arresting seven people and seizing the medical records of 2,780 women. The Morín case, still pending a court ruling, burst into the scene, reinstating the dichotomy: abortion yes, abortion no, which the political elite of the Transition had tried to resolve.

    The abortion indications law, which legalised abortion in three possible cases: foetal pathology, rape, and in the interests of the pregnant woman's health, allowed professionals to work with the same perspective on health as that of the WHO, which comprehends not only the absence of illnesses but also physical, psychological and social well-being. This professional decision made it possible for 90% of Spanish women to have the option to interrupt their pregnancies during the last 25 years.

    If the ambiguity of the Law permitted the standardisation of abortion in Spain, this very same ambiguity has aided the anti-abortion groups which have played the leading role in one of the fiercest battles against this women's right; the politically-instigated inspections, the reporting to the police, the attacks and the circulation of distorted information have diminished the legal and personal safety of medical professionals and women over the last three years.

    One of the most serious violations took place in January 2008, when agents of SEPRONA Unit of the Civil Guard appeared at the homes of 25 women, urging them to give evidence. These facts were used in the case against the Isadora Clinic, opened by Judge Sierra, who for a year and a half has been proceeding with criminal charges against three doctors of this Clinic, on suspicion of carrying out illegal abortions and irregular treatment of the remains.

    In the same week in which 25 women were investigated for having illegal abortions, 40 clinics - more than half of those in Spain - suspended activity because it was no longer possible for them to guarantee the provision of their services, nor safety. The 2,000 abortions that were not carried out between 7th and 13th January 2008 prove that it is the private clinics that undertake a provision of a service that is technically covered, but not provided, by the Spanish National Health System.

    The suspension of activity ended on the 13th January with the publication of a manifesto in the newspaper El País. In it, 66 national and international organisations joined forces with the clinics, to call for respect and personal and legal safety for both women and medical professionals, but above all, to call for a change in the law.

    The pressure served to speed up the action and the dialogue between the clinics and the political parties. Also  during  those  days,  came  the  reactions  of  the  Spanish  Government and also of an Executive in

    charge of delegating mediation with the clinics to its Ministers of Health and Justice.

    During those days, the feminist movement, along with civil, legal, trade union and health platforms, took the debate to the streets, with rallies and protests in favour of the right to abortion taking place all over Spain. Instigated by the Alcerín Women’s Association, a campaign was started in Vigo, which would present to different courts all over Spain more than 15,000 voluntary pleas of guilty to having an abortion, while at the port of Valencia the boat of the organisation “Woman on Waves” arrived. On 9th March 2008, the Socialist Party (PSOE) won the election. The electoral victory cleared the way for reformation of the Abortion Law. The Ministry of Equality, headed by Bibiana Aído, was the body commissioned to tackle this reform, for which purpose it would create a committee made up of experts, whose deliberations would be made public to the groups and platforms both for and against the legislative change, among them, the Association of Authorised Clinics.

    While the ministerial work was under way, a parliamentary sub-commission, in which would appear experts and spokespersons for both supporters and opponents of a new law, was created. The President of the Association of Authorised Clinics, Santiago Barambio, would participate, at the suggestion of the party in government, in the said sub-commission on 25th November 2008.

    The action taken by the Catalan Family Planning Association, coordinated and led by its Vice-president, Isabel Iserte, and the State Family Planning Federation, proved to be essential in the incorporation of some of the historic demands of these Platforms. 

    As the bill overcame the obstacles involved in its processing, on the streets the position between supporters and opponents of the right to abortion becomes increasingly heated with the approach of the final reading,which took place in the Senate on the 24th February 2010. The bill was carried with 132 votes in favour and 126 votes against and the Sexual and Reproductive Health and Voluntary Termination of Pregnancy Act became law.