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Caruso E. The hyper-regulation of abortion care in Italy. Int J Gynaecol Obstet 2023; 163:1036-1042. [PMID: 37724041 DOI: 10.1002/ijgo.15150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
This paper argues that the current abortion regulation by Law 194/1978 is an inadequate basis for the provision of good quality abortion care and must be reformed. First, the paper explains why Law 194/1978 creates a hyper-regulatory regime that is inconsistent with the best clinical evidence and practices in the field as well as relevant international human rights law, as outlined in the World Health Organization's (WHO) 2022 Abortion Care Guideline. Second, it highlights gaps between what the law says and what happens in practice, pointing out how the everyday life of Law 194/1978, especially in the practices of gynecologists, is far removed from international standards of quality abortion care and has yet to comply with international human rights law. Third, it sets out some alternative routes to abortion access "outside" Law 194/1978. Finally, it concludes with some suggestions for a change in the practice of gynecology and a call for the reform of Law 194/1978, in favor of a bodily autonomy model of regulation grounded on decriminalization, demedicalization, dehospitalization, and self-management to ensure compliance with the WHO standards and international human rights law.
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Affiliation(s)
- Elena Caruso
- University of Waterloo, Waterloo, Ontario, Canada
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Podolskyi V, Gemzell-Danielsson K, Marions L, Gomperts R. Preabortion ultrasound - a patient perspective. EUR J CONTRACEP REPR 2023; 28:268-273. [PMID: 37698511 DOI: 10.1080/13625187.2023.2249158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/14/2023] [Accepted: 08/11/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE To explore women's perception of the need for an ultrasound scan before medical abortion provided by telemedicine services. METHODS We have analysed women's requests for medical abortion through the website www.womenonweb.org from the 1st of January 2019 to the 5th of October 2020. Before receiving abortion drugs for self-managed medical abortion, women received online counselling and were asked to complete an online survey on pre-abortion ultrasound scan and the reasons for having or not having one. The initial dataset included 62641 entries from 207 countries. Each entry corresponded to a person's request for medical abortion. Women reported only one or multiple reasons for not having a pre-abortion ultrasound scan. RESULTS Among 59648 women requesting a medical abortion, 45653 (76,54%) did not have any pre-abortion ultrasound scan and specified a reason for that. The countries with the highest rates of women not having a pre-abortion ultrasound scan were Thailand, Poland, Northern Ireland, Mexico, South Korea, Japan, Chile, Indonesia, Germany, and Brazil. The main reasons for not having a pre-abortion ultrasound scan were being confident regarding pregnancy length; and thus, no need for a scan stated by 10910/34390 women (31.7%), lack of resources stated by 10589/34390 women (30.8%), and privacy issues stated by 6472/34390 women (18.8%). CONCLUSION Most women opting for medical abortion through telemedicine did not undergo a pre-abortion ultrasound scan. The main reason stated was that women did not find it necessary, lack of resources and privacy issues.
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Affiliation(s)
- Volodymyr Podolskyi
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- WHO-Centre, Karolinska University Hospital Solna, QB:84, Stockholm, Sweden
- Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine, Kyiv, Ukraine
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- WHO-Centre, Karolinska University Hospital Solna, QB:84, Stockholm, Sweden
| | - Lena Marions
- Department Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
- Department Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Dibben A, Stabile I, Gomperts R, Kohout J. Accessing abortion in a highly restrictive legal regime: characteristics of women and pregnant people in Malta self-managing their abortion through online telemedicine. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:176-182. [PMID: 36792359 PMCID: PMC10359543 DOI: 10.1136/bmjsrh-2022-201730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To examine the numbers and characteristics of women and pregnant people in Malta seeking at-home medical abortion using online telemedicine from 2017 to 2021. DESIGN Population-based study. SETTING Republic of Malta PARTICIPANTS: Between 1 January 2017 and 31 December 2021, 1090 women and pregnant people requested at-home medical abortion through one online telemedicine provider (Women on Web). Mifepristone and misoprostol were shipped to 658 women (60.4% of requests). MAIN OUTCOME MEASURES The numbers and demographics of persons to which abortion pills were shipped, their reasons for accessing abortion, and reasons for requesting medical abortion via telemedicine between January 2017 and December 2021 were analysed. Selected data were compared across different groups. RESULTS The number of people in Malta to whom medical abortion pills were shipped increased significantly in the 5 years analysed. Women and pregnant people requesting medical abortion were diverse with respect to age, pregnancy circumstances and reasons for seeking an abortion. More than half had existing children and over 90% reached out to Women on Web at <7 weeks. Among those completing a medical abortion, 63% did not use contraception, and in 30% there was contraception failure. The most common reasons for ordering medical abortion pills online were difficulty accessing abortion because of legal restrictions (73%) and abortion pills not being available (45%) in the country. CONCLUSIONS Despite a complete ban on abortion, the number of women and pregnant people residing in Malta completing at-home medical abortions is considerable and has been steadily increasing.
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Affiliation(s)
- Andreana Dibben
- Department of Social Policy and Social Work, University of Malta, Msida, Malta Majjistral, Malta
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Cui N, Gemzell-Danielsson K, Gomperts R. Why women choose self-managed telemedicine abortion in the Netherlands during the COVID-19 pandemic: a national mixed methods study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:105-111. [PMID: 36410763 DOI: 10.1136/bmjsrh-2022-201591] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The COVID-19 pandemic has imposed strict lockdown restrictions that have introduced barriers to in-person abortion clinic visits in the Netherlands. Women on Web (WoW) is a global medical abortion telemedicine service operating outside the formal health sector. AIM To understand the motivations and perceived barriers women faced when choosing telemedicine abortion outside the formal health sector, and how this was affected by the pandemic. METHODS 178 women who completed an online consultation on the Dutch WoW website during the period 6 March 2020 to 5 March 2021 were included in this cross-sectional cohort study and exploratory qualitative study. Patient characteristics and motivations were analysed and associated with the severity of COVID-19 restrictions. Email exchanges in which women could further describe their requests were also examined for recurrent clarification of motivations. RESULTS Women experienced barriers to regular abortion care due to COVID-19 restrictions and had the preference to (1) self-manage their abortion, (2) stay in the comfort of their own home, and (3) keep their abortion private. In particular, women who did not live in the cities where abortion clinics were located experienced barriers to abortion services. As COVID-19 restrictions tightened, it was more frequently mentioned that women sought help from WoW because COVID-19 restrictions and abortion care were not accessible to them in the Netherlands. In the qualitative analysis of email exchanges, the reasons of COVID-19, privacy concerns, and domestic violence were particularly evident. CONCLUSIONS In the Netherlands, barriers to receiving adequate abortion care were exacerbated for women in vulnerable positions such as being geographically farther away from an abortion clinic, being in a deprived socioeconomic position, or being in an unsafe home situation. Similar to other medical care, abortion care should be deliverable online.
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Affiliation(s)
- Nanke Cui
- Amsterdam Public Health, Amsterdam UMC Locatie AMC, Amsterdam, Noord-Holland, The Netherlands
- Women on Web International Foundation, Amsterdam, The Netherlands
| | | | - Rebecca Gomperts
- Women on Web International Foundation, Amsterdam, The Netherlands
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Izdebski Z, Wąż K, Warzecha D, Mazur J, Wielgoś M. Factors Associated with Uptake of Effective and Ineffective Contraceptives among Polish Women during the First Period of the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12748. [PMID: 36232046 PMCID: PMC9564462 DOI: 10.3390/ijerph191912748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/01/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic has burdened the healthcare system and influenced individuals' health-related choices. The aim of the study was to estimate the prevalence and to identify the correlates of the use of more and less effective contraceptive methods among Poles in the initial period of the COVID-19 pandemic. The cross-sectional online study was conducted among the representative sample of 642 female respondents aged 18-49. Three groups of contraception choices (only effective methods-42.2%, mixed effective and ineffective methods-26.8%, none-31.0%) were distinguished and 11 potential determinants were considered. One in ten women declared having difficulty in accessing contraception during the first months of the pandemic. A multinomial logistic regression model explained 48.7% of the variation in contraceptive method choice. Both effective and ineffective methods were more often declared by young women, and less often in case of lower education, planning children or subjective no need for contraception. In addition, factors that reduced the chance of effective contraception were poor financial situation, already having children and a relatively higher degree of religiosity. The study confirmed that a significant share of Polish women do not opt for effective methods of contraception. Their choices had strong demographic, social and cultural determinants.
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Affiliation(s)
- Zbigniew Izdebski
- Department of Biomedical Aspects of Development and Sexology, Faculty of Education, Warsaw University, 00-561 Warsaw, Poland
- Department of Humanization in Medicine and Sexology, Collegium Medicum, University of Zielona Gora, 65-729 Zielona Gora, Poland
| | - Krzysztof Wąż
- Institute of Pedagogy, Faculty of Social Sciences, University of Zielona Gora, 65-729 Zielona Gora, Poland
| | - Damian Warzecha
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-015 Warsaw, Poland
| | - Joanna Mazur
- Department of Humanization in Medicine and Sexology, Collegium Medicum, University of Zielona Gora, 65-729 Zielona Gora, Poland
| | - Mirosław Wielgoś
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-015 Warsaw, Poland
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Cornelius JB, Smoot JM. The Impact of Technology on Adolescent Sexual and Reproductive Needs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148684. [PMID: 35886536 PMCID: PMC9321257 DOI: 10.3390/ijerph19148684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/09/2022] [Indexed: 02/04/2023]
Abstract
The call for articles for the International Journal of Environmental Research and Public Health Special Issue "Using mobile technology to promote adolescent sexual and reproductive health (SRH)" was proposed to identify efforts to provide adolescent SRH services during the COVID-19 pandemic [...].
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Affiliation(s)
- Judith Bacchus Cornelius
- School of Nursing, University of North Carolina at Charlotte, Charlotte, NC 28223, USA
- Correspondence:
| | - Jaleesa Marshay Smoot
- Program in Public Health: Epidemiology and Health Informatics and Analytics, University of North Carolina at Charlotte, Charlotte, NC 28223, USA;
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Giansanti D, Morone G, Loreti A, Germanotta M, Aprile I. A Narrative Review of the Launch and the Deployment of Telemedicine in Italy during the COVID-19 Pandemic. Healthcare (Basel) 2022; 10:healthcare10030415. [PMID: 35326894 PMCID: PMC8955340 DOI: 10.3390/healthcare10030415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 02/04/2023] Open
Abstract
Telemedicine is making an important contribution to the fight against the COVID-19 pandemic and to supporting the health domain. Its use has registered initial problems with often-patchy practise. The objective of this study was to analyze the launch and deployment of telemedicine in Italy through a narrative review. The narrative review faced two points of view: (a) the first point of view revised the institutional initiatives of the Italian government developed to promote the use of telemedicine; (b) the second point of view reviewed the evolution of scientific literature in the sector, with reference to the Italian situation. In the second point of view, we applied both a standard narrative checklist and an eligibility approach. The first point of view reported an analysis of national documents aimed at promoting, through indications and recommendations, the use of telemedicine. The second point of view analyzed 39 qualified references. The analysis highlighted: (a) that initially, there was a disorientation, followed by reflections that emerged immediately after; (b) a telemedicine application not only in the traditional sectors (e.g., diabetology, cardiology, oncology, neurology) but also in new and fields never explored before; and (c) a high level of acceptance and a desire to continue in the after-pandemic future (which emerged in some studies through dedicated questionnaires). The study offers stimuli for both stakeholders and scholars to improve the use of telemedicine during the pandemic and in the future.
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Affiliation(s)
- Daniele Giansanti
- Centro Nazionale Tecnologie Innovative in Sanità Pubblica, Istituto Superiore di Sanità, 00161 Rome, Italy
- Correspondence:
| | - Giovanni Morone
- Dipartimento di Medicina Clinica, Sanità Pubblica, Scienze della Vita e dell’Ambiente, Università degli Studi dell’Aquila, 67100 L’Aquila, Italy;
| | - Alice Loreti
- Facoltà di Medicina e Psicologia, Università Sapienza, 00185 Roma, Italy;
| | - Marco Germanotta
- Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (M.G.); (I.A.)
| | - Irene Aprile
- Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (M.G.); (I.A.)
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