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Contraception and abortion: where are the women’s needs

Contraception and abortion: where are the women’s needs. Marcel Vekemans, MD, Ob/Gyn IPPF Central Office, London Moscow 2005. Contraception and abortion in Europe. Contraception versus abortion: not a fair dilemma.

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Contraception and abortion: where are the women’s needs

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  1. Contraception and abortion: where are the women’s needs Marcel Vekemans, MD, Ob/Gyn IPPF Central Office, London Moscow 2005

  2. Contraception and abortion in Europe

  3. Contraception versus abortion: not a fair dilemma “Until having an abortion is considered as acceptable morally as using contraception, women will not have gained their full reproductive rights”* In some countries, contraception is not favoured. *Løkeland M. Reproductive Health Matters 2004;12(suppl 24):167-173

  4. Is the choice between abortion and contraception really based on women’s needs?Choices can be made freely only if:- basic needs are met (shelter, food, clothes, health care, security, basic education, mobility, job)- the options can be accessed - information is complete- no coercion is exerted

  5. Contraception versus abortion • Abortion • is not a pleasant experience • is stigmatized • entails more health risks than contraception • Contraception • is often feared (health? hormonal disturbances, or “foreign body”; leads to promiscuity?)

  6. Prevention ? • Abstinence • Contraception • Emergency contraception -------------------------------------------------- • Abortion What do the women need? • High quality services • Information

  7. Prevention ? Yes, but …1. Abstinence • Sex life is part of normal life • hormones, puberty, adulthood, love • Peer pressure • Societal pressure • media, publicity, literature, … • Partner’s pressure • Coercion, violence; rape; incest

  8. Prevention ? Yes, but …2. Contraception (1) Not so easy ! • Available? (method mix) • Accessible? (geography, transport) • Acceptable? (fears: of side effects, of complications, of low effectiveness, of medical exams and procedures) • Affordable? (costs) • Medical eligibility (WHO criteria) • Side effects, complications • Opposition (parents, partner, educators, physicians – some make a living from abortion - )

  9. Prevention ? Yes, but …2. Contraception (2) • The adolescent case (1) • Doesn’t know it exists, or what it is • I do not have sex • It’s dangerous • How do you use it? buy it? hide it? • Ethical moral, religious objections • … is there, after all, free, informed choice, for all adolescents?

  10. Prevention ? Yes, but …2. Contraception (2) • The adolescent case (2) Adolescents need friendly services, and correct information • Peer counsellors? • Sex education • Should start at kindergarten (with adequate content) • Not limited to anatomy, contraception, STIs • Include body changes, masturbation, sexuality, love, feelings, self-confidence, “saying yes or no”, peer pressure, respect, generosity, etc.

  11. Prevention ? Yes, but …3. Emergency contraception • Not yet widely available, accepted, accessible • [Medically: no contra-indications at all with levonorgestrel]

  12. Prevention ? Yes, but …3. Requesting or not an abortion (1) • Most often, women feel obliged to abort • Pregnancy is unwanted • - too soon in life, too late, too soon after previous delivery, too many children; problems with school or job, etc. • Pregnancy is stigmatized • - adolescence, older age, single, poor, widow, sick, family problems, etc. • Problems with partner, husband • Coercion, violence, rape, incest • Health problems (woman, foetus) “I’m against” … except for me (or my daughter) ? Sex of foetus ? Embryo reduction after IVF?

  13. Prevention ? Contraceptive prevalence (CPR)

  14. Contraception: unmet need Russia (DHS) • Among all women of reproductive age (15-49) (WRA): • Unmet need is 11% • Met need is 59% - Demand is 70% • 30% do not want contraception • Not feeling at risk • Opposed • Unmet need for modern contraception is only 3.5% • Proportion of unwanted pregnancies: 66%

  15. Abortion or not? Specific problems • 30% of abortions are repeat abortions. NORMAL: if risk of abortion is 30%, risk for two abortions is 9%, for three, 2.7% etc. Moreover, if you had an abortion you are “less gifted for contraception” • Denied abortionresults in a statistical increase in bad outcomes, mental illness, asocial behaviour • There AREcoerced abortions

  16. Is the choice between abortion and contraception really based on women’s needs?A few additional considerations • The choice depends on knowledge and services available. These result from an ideological struggle (in which the medical establishment participates) • Governments limit access to abortion to claim to moral legitimacy • Contraception and abortion have made (young) women’s sexuality visible, independent of marriage, of parental and male leaders’ authority. The patriarchal control over the (young) women’s is lost • The real issue is not control over life, is not the (public) health issue, it is CONTROL over sex.

  17. THE END Thank you !

  18. References • www. .infoforhealth.org .un.org .guttmacher.org .siecus.org .prb.org .overpopulation.com/faq/ .gesis.org mvekemans@ippf.org

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