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North East Sexual Health Update

North East Sexual Health Update. Unwanted Pregnancy and Abortion September 2008 Gillian Flett. Delivering the service- what are we trying to achieve?. 70% of abortions at 9 weeks or under mechanism to ensure all women who have TOP are offered full range of contraception

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North East Sexual Health Update

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  1. North East Sexual Health Update Unwanted Pregnancy and Abortion September 2008 Gillian Flett

  2. Delivering the service- what are we trying to achieve? • 70% of abortions at 9 weeks or under • mechanism to ensure all women who have TOP are offered full range of contraception • 60% of women after TOP leave with effective contraceptive method • post TOP counselling available within 4 weeks if requested • Agreed NHS Board referral mechanism (where services not available locally) for women requiring TOP ut to legal limit 24 wks

  3. How well does NHSG achieve on QIS standards?

  4. % of terminations at < 10 wks by NHS Board, 2006 and 2007

  5. % of total terminations in Scotland by deprivation category, 2007

  6. ARI – abortion by method 2007 TOTAL

  7. Contraceptive method in use prior to TOP

  8. Contraceptive method chosen after TOP (2005)

  9. Delivering the service- do we meet QIS standards? • 70% of abortions at 9 weeks or under  • mechanism to ensure all women who have TOP are offered full range of contraception  • 60% of women after TOP leave with effective contraceptive method  • post TOP counselling available within 4 weeks if requested  • Agreed NHS Board referral mechanism (where services not available locally) for women requiring TOP up to legal limit 24 wks 

  10. Direction for future • refer early • provide advance information about choices of TOP method • introduce future contraceptive choice /provide supplies • sexual health risk assessment and screening as integral part of consultation

  11. Challenge of repeat abortion rate • 13,703 therapeutic abortions in 2007 in Scotland • 26.3% repeat TOPs • range 19.2% in Island Boards – 30.4% in NHSGrampian • background higher rate of TOP in NHSG • concerted efforts and resources are being directed at implementing a national SH strategy – why the failure??

  12. Repeat Abortion – the opinions these women: • lack organisation and motivation • don’t use contraception consistently and carefully • use abortion as method of “family planning”

  13. Repeat Abortion- the facts • High abortion rates – high repeat rates • Age- tend to be over 30 yrs • Parity – more likely to have had prior deliveries, 3 or more • Deprivation markers • No evidence for lower contraceptive use • Physical abuse, sexual abuse, violence, conflict difficulties with partner – use repeat abortion as screening tool • No evidence of psychological mal-adjustment

  14. Repeat Abortion – the facts • Remembering contraception difficult • Cost of contraception • Less likely to report large circle of friends, plans for the future • More likely to have STI diagnosed, previous HIV testing • More likely than 1st time abortion women to report missed pills

  15. Some Thoughts • Motivation may not be as high as health professionals might wish • Risk taking may be hooked into some deeper, perhaps unconscious desire • Professional perception of safe, planned, under control, negotiated and responsible sex is not the reality • “Sex is an act of intimacy and trust”- serodiscordant HIV positive couples

  16. “Contraception is about doing something to prevent something that might not happen anyway” Glasier 2006

  17. Acknowledgements • Pregnancy advisory sisters • Medical colleagues • TOPs database steering group NHSG / Aberdeen University • Dr Premila Ashok

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