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Tackling Women Inequalities Addressing Comprehensive Reproductive Health Care

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  • 1. Tackling Women InequalitiesTackling Women Inequalities Addressing ComprehensiveAddressing Comprehensive Reproductive Health CareReproductive Health Care 22n International Conference on Health Promoting Hospitals and Health Services. April 23-25, 2014 Barcelona. Elvira Méndez, MD General Director Asociación Salud y Familia
  • 2. BACKGROUND OF THE PROGRAMME “CARING FOR MATERNITY AT RISK” • The Programme ““Caring for Maternity at RiskCaring for Maternity at Risk””, Spain (1991-2013) is leading by the Asociación Salud y Familia (ASF), a non profit NGO. • The Programme is based on a partnership involving collaborations between public healthcare services, private abortion clinics, social and women associations and ASF itself. • The Programme offers a portfolio of pro-choice services in reproductive health care for vulnerable groups of women and families.
  • 3. 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 pregnant women. • Co-financing voluntary interruption of the pregnancy until 2010 and afterwards only undocumented women because public healthcare services cover the abortion cost.
  • 4. 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.
  • 5. ADDITIONAL SERVICES TO THE PORTFOLIO PROGRAMME (I) During pregnancy crisis prochoice counsellingDuring pregnancy crisis prochoice counselling or family planning visits we offer:or family planning visits we offer: • Active screening of partner violence and abuse. • Immediate free psycho-social care for victims of partner violence (three professional visits for support and orientation).
  • 6. ADDITIONAL SERVICES TO THE PORTFOLIO PROGRAMME (II) During pregnancy crisis prochoice counsellingDuring pregnancy crisis prochoice counselling or family planning visits we offer:or family planning visits we offer: • Immediate free juridical counselling for victims of partner violence (three professional visits). • Access to free juridical and psychosocial orientation and support for family problems.
  • 7. WHY TO FOCUS ON WOMEN BELONGING TO VULNERABLE GROUPS? • Are less likely to access public healthcare services and seek advice for family planning and contraception. • Have higher abortion rates. • Are a greater risk of repeated abortion. • Are less information on family and women rights.
  • 8. PROGRAMME COVERAGE (2009-2013) (I) • The Programme has served 29.018 women during the period 2009-2013. • 62,8% (n= 18.229) women requested advice for pregnancy crisis and, also, received counselling on long-lasting contraception. • 32,8% (n= 9.512) women requested active advice for long-lasting contraception.
  • 9. PROGRAMME COVERAGE (2009-2013) (II) • User’s profile related to age, civil status and gestational age was similar to that of women who had abortions in the period 2009-2010 in Catalonia. • User’s profile related to migrant background, educational level, work status, previous abortions, previous use of FP Centres and contraception was worse to that women who had abortions in the period 2009-2010 in Catalonia.
  • 10. PROGRAMME COVERAGE (2009-2013) (III) • The Programme covered 20% of legal abortion in Catalonia during the period 2009-2010 (*). • Among Programme users the ratio of women requesting long-lasting contraception respect to the aborting was 52,2%. (*) From 2010 Abortion law changed to terms until 14th gestational week.
  • 11. REPRODUCTIVE HEALTH PROFILE OF WOMEN SEEKING ABORTION OR CONTRACEPTION ADVICE 79% 22,7% 54,7% 64,4% 3.762 2012 92,4% 25,8% 51,4% 57,9% 4.099 2011 49,2%81,9%78%No FP consultation over the last year (%) 23,8%33,9%33,7%Condoms erratic use (%) 47,7%39%40%Any prior use of contraception (%) 70,9%44,6%44%One o more previous abortion (%) 4.6096.2967.394women attended 201320102009 Source: ASF database.
  • 12. DISPARITIES OF LONG LASTING CONTRACEPTION ACCEPTANCE AND EFFECTIVE USE 79,7% 78% 1.338 2012 49,9% 67,9% 2.230 2011 178,5%37,9%30,1%LL. C ratio respect abortion 93,8%65,5%68%LL. C effective use 2.6143.0862.973LL.C acceptance 201320102009 (*) From 2011 the available LLC were IUD and IMPLANON
  • 13. REASONS FOR DISPARITIES BETWEEN LL.C ACCEPTANCE AND EFFECTIVE USE • Organizational separation between abortion clinics and family planning services. • Medical provider attitude and misconceptions. • Good acceptance of IMPLANON diminishes disparities. • Negative popular beliefs about the IUD increases disparities.
  • 14. MAIN RESULTS (I) • Coverage of 29.018 women (2009-2013) who were 20% of yearly abortions in Catalonia until 2010. • Highly vulnerable socio-economic position. • Most of the women were in the first trimester of pregnancy. • About 50% did not use contraception consistently.
  • 15. MAIN RESULTS (II) • More than 75% did not attend Family Planning services over the last year. • About 47% were repeated abortions. • Long lasting effective contraception requesting ratio respect abortion was 52,2%
  • 16. CONCLUSIONS (I) •• SUSTAINABILITYSUSTAINABILITY: Framework of public and private partnership has ensured the programme for 23 years. •• EQUITYEQUITY: The Programme improves access to comprehensive reproductive health care for vulnerable women.
  • 17. CONCLUSIONS (II) •• INTEGRATIONINTEGRATION: The Programme integrates greater accessibility to safe abortion and free post-abortion and post-partum long-lasting contraception. •• ADDED VALUEADDED VALUE: The Programme combats repeat abortions and other relevant risks as partner violence.
  • 18. ACKNOWLEDGEMENTS To funding public administrations • Servei Català de la Salut • Ministerio de Sanidad, Servicios Sociales e Igualdad. To board of Asociación Salud y Familia for support, inspiration and lasting commitment.
  • 19. THANKS Email: emendez@saludyfamilia.es Web: www.saludyfamilia.es