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Tackling Women InequalitiesTackling Women InequalitiesAddressing ComprehensiveAddressing ComprehensiveReproductive Health CareReproductive Health Care
22n International Conference on Health Promoting Hospitalsand Health Services. April 23-25, 2014 Barcelona.
Elvira Méndez, MDGeneral Director Asociación Salud y Familia
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 AsociaciónSalud y Familia (ASF), a non profit NGO.
• The Programme is based on a partnershipinvolving collaborations between public healthcareservices, private abortion clinics, social and womenassociations and ASF itself.
• The Programme offers a portfolio of pro-choiceservices in reproductive health care for vulnerablegroups of women and families.
THE PORTFOLIO OF THE PROGRAMME“CARING FOR MATERNITY AT RISK” (I)
• Pregnancy test and pregnancy crisis pro-choicecounselling.
• Support to free decision-making of pregnant women.
• Co-financing voluntary interruption of the pregnancyuntil 2010 and afterwards only undocumentedwomen because public healthcare services cover theabortion cost.
THE PORTFOLIO OF THE PROGRAMME“CARING FOR MATERNITY AT RISK” (II)
• Active prevention of repeated abortion through familyplanning counselling and free provision of long actingcontraception during post-abortion.
• Free provision of long acting contraception (IUD andImplanon) to vulnerable groups as adolescents, poorfamilies and migrant women.
• Support and Counselling groups for migrant mothersand adolescents mothers of all origins.
ADDITIONAL SERVICES TO THEPORTFOLIO PROGRAMME (I)
During pregnancy crisis prochoice counsellingDuring pregnancy crisis prochoice counsellingor 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 ofpartner violence (three professional visits for supportand orientation).
ADDITIONAL SERVICES TO THEPORTFOLIO PROGRAMME (II)
During pregnancy crisis prochoice counsellingDuring pregnancy crisis prochoice counsellingor family planning visits we offer:or family planning visits we offer:
• Immediate free juridical counselling for victims ofpartner violence (three professional visits).
• Access to free juridical and psychosocialorientation and support for family problems.
WHY TO FOCUS ON WOMEN BELONGINGTO VULNERABLE GROUPS?
• Are less likely to access public healthcare servicesand seek advice for family planning andcontraception.
• Have higher abortion rates.
• Are a greater risk of repeated abortion.
• Are less information on family and women rights.
PROGRAMME COVERAGE(2009-2013) (I)
• The Programme has served 29.018 womenduring the period 2009-2013.
• 62,8% (n= 18.229) women requested advice forpregnancy crisis and, also, received counsellingon long-lasting contraception.
• 32,8% (n= 9.512) women requested activeadvice for long-lasting contraception.
PROGRAMME COVERAGE(2009-2013) (II)
• User’s profile related to age, civil status andgestational age was similar to that of womenwho had abortions in the period 2009-2010 inCatalonia.
• User’s profile related to migrant background,educational level, work status, previousabortions, previous use of FP Centres andcontraception was worse to that women whohad abortions in the period 2009-2010 inCatalonia.
PROGRAMME COVERAGE(2009-2013) (III)
• The Programme covered 20% of legal abortionin Catalonia during the period 2009-2010 (*).
• Among Programme users the ratio of womenrequesting long-lasting contraception respect tothe aborting was 52,2%.
(*) From 2010 Abortion law changed to terms until 14th gestational week.
REPRODUCTIVE HEALTH PROFILE OF WOMENSEEKING ABORTION OR CONTRACEPTION
ADVICE
79%
22,7%
54,7%
64,4%
3.7622012
92,4%
25,8%
51,4%
57,9%
4.0992011
49,2%81,9%78%No FP consultation over thelast 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.
DISPARITIES OF LONG LASTINGCONTRACEPTION 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
REASONS FOR DISPARITIES BETWEENLL.C ACCEPTANCE AND EFFECTIVE USE
• Organizational separation between abortionclinics and family planning services.
• Medical provider attitude and misconceptions.
• Good acceptance of IMPLANON diminishesdisparities.
• Negative popular beliefs about the IUD increasesdisparities.
MAIN RESULTS (I)
• Coverage of 29.018 women (2009-2013) who were20% of yearly abortions in Catalonia until 2010.
• Highly vulnerable socio-economic position.
• Most of the women were in the first trimester ofpregnancy.
• About 50% did not use contraception consistently.
MAIN RESULTS (II)
• More than 75% did not attend Family Planningservices over the last year.
• About 47% were repeated abortions.
• Long lasting effective contraception requestingratio respect abortion was 52,2%
CONCLUSIONS (I)
•• SUSTAINABILITYSUSTAINABILITY: Framework of public andprivate partnership has ensured the programmefor 23 years.
•• EQUITYEQUITY: The Programme improves access tocomprehensive reproductive health care forvulnerable women.
CONCLUSIONS (II)
•• INTEGRATIONINTEGRATION: The Programme integratesgreater accessibility to safe abortion and freepost-abortion and post-partum long-lastingcontraception.
•• ADDED VALUEADDED VALUE: The Programme combatsrepeat abortions and other relevant risks aspartner violence.
ACKNOWLEDGEMENTSTo 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.
