Elvira méndez Tackling women inequalites reproductive health care
TACKLING WOMEN INEQUALITIES ADRESSING COMPREHENSIVE REPRODUCTIVE HEALTH CARE Elvira Méndez, MD General Director. Asociación Salud y Familia9th European IUHPE Health Promotion Conference27-29 September 2012 Tallinn. Estonia
BACKGROUNG OF THE PROGRAMME “CARING FOR MATERNITY AT RISK”The Programme “Caring for Maternity atRisk”, Spain (1991-2011) is leading by theAsociación Salud y Familia (ASF), a nonprofit NGO.The Programme is based on a partnershipinvolving collaborations between publichealthcare services, private abortion clinics,social and women associations and ASFitself.The Programme offers a portfolio of pro-choice services in reproductive health carefor vulnerable groups of women andfamilies.
THE PORTFOLIO OF THE PROGRAMME“CARING FOR MATERNITY AT RISK” (I)Pregnancy test and pregnancy crisis pro-choice counselling.Support to free decision-making of pregnantwomen.Co-financing voluntary interruption of thepregnancy until 2010 and afterwards onlyundocumented women because publichealthcare services cover the abortion cost.
THE PORTFOLIO OF THE PROGRAMME“CARING FOR MATERNITY AT RISK” (II) Active prevention of repeated abortion through family planning counselling and free provision of long acting contraception during post-abortion . Free provision of long acting contraception (IUD and Implanon) to vulnerable groups as adolescents, poor families and migrant women. Support and Counselling groups for migrant mothers and adolescents mothers of all origins.
ADDITIONAL SERVICES TO THE PORTFOLIO PROGRAMME (I)During pregnancy crisis prochoicecounselling or family planning visits weoffer:Active screening of partner violence andabuse.Immediate free psycho-social care forvictims of partner violence (threeprofessional visits for support andorientation).
ADDITIONAL SERVICES TO THE PORTFOLIO PROGRAMME (II)During pregnancy crisis prochoicecounselling or family planning visits weoffer:Immediate free juridical counselling forvictims of partner violence (threeprofessional visits).Access to free juridical and psychosocialorientation and support for family problems.
WHY TO FOCUS ON WOMEN BELONGING TO VULNERABLE GROUPS?Are less likely to access publichealthcare services and seek advicefor family planning and contraception.Have higher abortion rates.Are a greater risk of repeatedabortion.Are less information on family andwomen rights.
PROGRAMME COVERAGE (2009-2011) (I)The Programme has served 20.647women during the period 2009-2011.73,1% (n= 15.087) women requestedadvice for pregnancy crisis and, also,received counselling on long-lastingcontraception.26,9% (n= 5.560) women requestedactive advice for long-lastingcontraception.
PROGRAMME COVERAGE (2009-2011) (II)User’s profile related to age, civilstatus and gestational age wassimilar to that of women who hadabortions in the same period.User’s profile related to migrantbackground, educational level, workstatus, previous abortions, previoususe of FP Centres and contraceptionwas worse to that women who hadabortions in the same period.
PROGRAMME COVERAGE (2009-2011) (III)The Programme covered 20% oflegal abortion in Catalonia duringthe period.Among Programme users the ratioof women using long-lastingcontraception respect to theaborting was 36,8%.
REPRODUCTIVE HEALTH PROFILE OF WOMEN SEEKING ABORTION OR CONTRACEPTION ADVICE 2009 2010 2011women attended 7.394 6.296 4.099One o more previous abortion (%) 44% 44,6% 57,9%Any prior use of contraception (%) 40% 39% 51,4%Hormonal contraception use (%) 19,4% 20,9% 16,9%Condoms erratic use (%) 33,7% 33,9% 25,8%No FP consultation over the lastyear (%) 78% 81,9% 92,4%
DISPARITIES OF IUD ACCEPTANCE AND INSERTION 2009 2010 2011IUD Acceptance 2.973 3.086 2.230IUD Insertion (%) 68% 65,5% 67,9%IUD ratio respectabortion 30,1% 37,9% 49,9%
REASONS FOR DISPARITIES BETWEEN IUD ACCEPTANCE AND INSERTIONOrganizational separation betweenabortion clinics and family planningservices.Medical provider attitude andmisconceptions.Negative popular beliefs about theIUD.
MAIN RESULTS (I)Coverage of 20.647 women (2009-2011)who are 20% of yearly abortions inCatalonia.Highly vulnerable socio-economic position.Most of the women were in the firsttrimester of pregnancy.About 50% did not use contraceptionconsistently.
MAIN RESULTS (II)More than 80% did not attend FamilyPlanning services over the last year.About 47% were repeated abortions.IUD ratio respect abortion was 36,8%
CONCLUSIONS (I)SUSTAINABILITY: Framework ofSUSTAINABILITYpublic and private partnership hasensured the programme for 20 years.EQUITY: The Programme improvesEQUITYaccess to comprehensivereproductive health care forvulnerable women.
CONCLUSIONS (II)INTEGRATION: The ProgrammeINTEGRATIONintegrates greater accessibility tosafe abortion and free post-abortionlong-lasting contraception.ADDED VALUE: The Programme VALUEcombats repeat abortions and otherrelevant risks as partner violence.
ACKNOWLEDGEMENTSTo funding public administrations Servei Català de la Salut Ministerio de Sanidad, Igualdad y Política Social. To board of Asociación Salud y Familia for support, inspiration and lasting commitment.