Attitudes of women, media and society towards contraception: Are we making progress?
Mirella Parachini (Italy)
San Filippo Neri Hospital, Via Cola di Rienzo 190, 00192, Rome, Italy
Objective. A review of the main modifications about the attitudes towards contraception of women, media and society in the last years.
Results. The diffusion of modern contraception has certainly contributed to the reduction in the number of unwanted pregnancies in developed countries. These new methods have been adopted by individuals and couples because of the major changes of attitude towards sexuality, the nature of marriage and other forms of union, the place of women in societies and, more specifically, the position of women in the work place. In developing countries surveys find that awareness of contraception is nearly universal among married women and that most people approve of family planning. In most countries the mass media, especially television and radio, are a key source of information about family planning. Despite great progress over the last several decades, more than 120 million women worldwide want to prevent pregnancy, but they and their partners are not using contraception. Millions more are using family planning to avoid pregnancy but fail, for a variety of reasons.
Conclusions. The job of family planning will never be finished.
Examples from Italy
The Italian law no.194 approved in 1978, is often considered one of the most advanced inWestern Europe. An abortion may only be carried out in a public hospital and there are no special abortion clinics inItaly. The conscience clause is partially responsible for many of the difficulties in availability of services. The Article 9 provides for the non-participation of staff of any level who work in hospitals and do not want to participate in abortions for reasons of conscience. The objectors are freed from activity specifically directed to the interruption of pregnancy but not from assistance before or after the abortion. It is the responsibility of the hospital to ensure the procedure is efficient and the Region is responsible for the to the provision of the services. This brings to remarkable differences from one region of the country to another. For example the Region of Emilia Romagna, where social and medical facilities are easily available, offers better services with access to medical abortion. Conscientious objection is a major limiting factor in the implementation of the law. According to the Secretary for Health’s last report, at a national level nearly 71 % of the gynaecologists are conscientious objectors and in some regions this percentage reaches 80-85%. Medical abortion has been approved since 2009, but only within 49 days of amenorrhea, in spite of the European mutual recognition procedure. In all cases, with only two regional exceptions , a compulsory hospitalization is requested. So far the medical procedure is not readily accessible in all localities. Restrictions in access to abortion and lack of having the choice between a medical or a surgical procedure are currently the major problems.
How to overcome the resistance against medical abortion
Mirella Parachini, MD
San Filippo Neri Hospital, Rome, Italy
OBJECTIVE: To understand how it is possible to overcome the resistance against medical
abortion in order to improve the right of women to choose.
RESULTS: Since the introduction of a pharmacological method to induce early abortion
there has been a strong resistance to it, even in those countries where legal abortion is
allowed with surgical techniques. Today the question about the choice of the method
seems to replace the historical debate about the interruption of an unwanted pregnancy
among pro-life groups and conservative politicians. Many claim that the “abortion pill”
makes women less responsible for their behaviour. On the other hand, even among those
not ideologically against abortion, there is a refusal of medical abortion concerning the lack
of health care assumed with a “self abortion”. Moreover in some countries abortion clinics
are refusing to offer it for fear of legal repercussions. Both medical and surgical abortion
are currently safe and effective when performed by trained practitioners according to
tested protocols under adequate conditions. However anti-choice campaigners try to
involve the public opinion and doctors about the risks of the drug, in an attempt to oppose
the access of the drugs in some countries, like in Canada, Australia and Italy. It is
therefore necessary to increase the information, considering that any medical procedures
is submitted to a scientific control, but keeping out of the debate ideological aims to
maintain restrictions on women’s right to choose.
CONCLUSIONS. There is a strong resistance at various levels against medical abortion
and a continuous scientific debate is requested from the abortion providers, beyond
Instability of misoprostol tablets stored outside the blister: a potential serious concern for clinical outcome in medical abortion
Veronique Berard1, Christian Fiala2 ,6, Sharon Cameron3, Teresa Bombas4, Mirella Parachini5, Kristina Gemzell-Danielsson6 1ICB - CNRS, Division MaNaPI, Département Nanosciences, Université de Bourgogne, Dijon, France, 2Gynmed Clinic, Vienna, Austria, 3Chalmers Centre, NHS Lothian, Edinburgh, Scotland, UK, 4Obstetric Service, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal, 5San Filippo Neri Hospital, Rome, Italy, 6Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden - firstname.lastname@example.org
Objectives: Misoprostol (Cytotec®), is recognised to be effective for many gynaecological indications including termination of pregnancy, management of miscarriage and postpartum haemorrhage. Although not licensed for such indications, it has been used for these purposes by millions of women throughout the world. Cytotec® tablets are packaged as multiple tablets within an aluminium strip, each within an individual alveolus. When an alveolus is opened, tablets will be exposed to atmospheric conditions. The effect of prolonged exposure upon bioactivity of misoprostol and resultant clinical efficacy is unknown. Therefore, this study was undertaken to assess possible changes in tablets exposed to usual European temperature and humidity conditions. Design and Methods: To compare the pharmaco-technical characteristics (weight, friability), water content, misoprostol content and decomposition product content (type A misoprostol, type B misoprostol and 8-epi misoprostol) of misoprostol tablets Cytotec® (Pfizer) exposed to air for periods of 1 to 720 hours (30 days), to those of identical non-exposed tablets. Four hundred and twenty tablets of Cytotec® (Pfizer) were removed from their alveoli blister and stored at 25°C/60% relative humidity. Water content, and misoprostol degradation products were assayed in tablets exposed from 1 to 720 hours (30 days). Comparison was made with control tablets (N=60) from the same batch stored in non-damaged blisters. Results: By 48 hours, exposed tablets demonstrated increased weight, friability, and water content (+78.8%) compared to controls. Exposed tablets also exhibited a decrease in Cytotec® active ingredient (misoprostol) dosage (-5.1% after 48 hours) and an increase in the inactive degradation products (+ 25% for type B, +50% for type A and +60% for 8-epi misoprostol after 48 hours) compared to controls. Conclusion: Exposure of Cytotec® tablets to ‘typical' European levels of air and humidity results in significant time-dependent changes in physical and biological composition that could impact adversely upon clinical efficacy. Health professionals should be made aware of the importance of appropriate storage and handling of Cytotec® tablets.
Psychological assessment in Italian and immigrant women requesting TOP in two central Italian hospitals
Marina Marceca1, Pietro Are2, Mirella Parachini3, Giovanna Scassellati Sforzolini4, Patrizia Facco5, Daniela Valeriani4, Gelsomina Orlando6, Cristina Francesca Damiani6, Paola Lo Pizzo6, Anna Pompili7 1San Giovanni Evangelista Hospital, Tivoli (Rome), Italy, 2ASL Latina, Latina, Italy, 3San Filippo Hospital, Rome, Italy, 4San Camillo Hospital, Rome, Italy, 5Sandro Pertini Hospital, Rome, Italy, 6San Giovanni Hospital, Rome, Italy, 7ASL RM E, Rome, Italy - email@example.com
During the last two decades the number of foreign citizens resident in Italy has been progressively increasing: in 1991 they were 625,000 (361,000 females), incresing to 4,570,317 in 2011 (7.5% of the Italian resident population). Females are 51% of them, about 4.5% of total resident female population. In Italy the induced abortion rate is lower than in other countries, but there are great differences between Italian and immigrant women resident in Italy: in 2009 the induced abortion rate among Italian women was 6.6/1000, compared with 24.1/1000 among foreign women. This study is part of a multicentre one, in press, performed in Italy between women requesting induced termination of pregnancy, in order to evaluate if there are differences in experiences of physical or psychological violence among Italian and immigrant women. Our data concern women who required TOP in Tivoli and Palestrina hospitals, two cities in central Italy, with high foreign populations. A group of 142 women (88 of which were Italians and 54 foreigners) received an anonymous questionnaire during the first visit before abortion. Comparing the results obtained we did not find significant differences between Italian and immigrant women regarding history of intimate violence, but the two groups showed different variables like education, number of children and moreover between repeated abortions.
Indications for mid-trimester abortion throughout Europe
San Filippo Neri Hospital, Roma, Italy
Laws regulating mid-trimester abortions in Europe are more restrictive than first trimester in most countries. European countries can be classified into various categories indicating the circumstances under which a woman can legally obtain mid-trimester abortion. The indications range from countries that prohibit abortion altogether or permit it only to save the life of a woman to countries with additional grounds such as: to preserve the physical and mental health of the woman; in case of pregnancy resulting from rape or incest; in case of risk of foetal impairment. These differences lead to the persistence of the so-called abortion tourism but it has also to be considered that there are legal differences in the access to abortion services for foreign women in various European countries. It is very important for the abortion providers working in countries with restricted access to mid-trimester abortion to be updated about these different legal frameworks. Nowadays, women have access to the internet, giving them authoritative and reliable information. This presentation will provide an overview of the indications for mid-trimester abortion throughout Europe.