elvira méndez tackling women inequalites reproductive health care

TACKLING WOMEN INEQUALITIES ADRESSING COMPREHENSIVE REPRODUCTIVE HEALTH CARE

Elvira Méndez, MD

General Director. Asociación Salud y Familia

9th European IUHPE Health Promotion Conference

27-29 September 2012 Tallinn. Estonia

BACKGROUNG OF THE PROGRAMME “CARING FOR MATERNITY AT RISK ”

� The Programme ““Caring for Maternity at Caring for Maternity at RiskRisk””, Spain (1991-2011) 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 ASFitself.

� The Programme offers a portfolio of pro-choice services in reproductive health care for vulnerable groups of women and families.

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.

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.

ADDITIONAL SERVICES TO THE PORTFOLIO PROGRAMME (I)

During pregnancy crisis prochoice During pregnancy crisis prochoice counselling or family planning visits we counselling or family planning visits we offer: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).

ADDITIONAL SERVICES TO THE PORTFOLIO PROGRAMME (II)

During pregnancy crisis prochoice During pregnancy crisis prochoice counselling or family planning visits we counselling or family planning visits we offer: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.

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.

PROGRAMME COVERAGE (2009-2011) (I)

� The Programme has served 20.647 women during the period 2009-2011.

� 73,1% (n= 15.087) women requested advice for pregnancy crisis and, also, received counselling on long-lasting contraception.

� 26,9% (n= 5.560) women requested active advice for long-lasting contraception.

PROGRAMME COVERAGE(2009-2011) (II)

� User’s profile related to age, civil status and gestational age was similar to that of women who had abortions in the same period.

� 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 same period.

PROGRAMME COVERAGE (2009-2011) (III)

� The Programme covered 20% of legal abortion in Catalonia during the period.

� Among Programme users the ratio of women using long-lasting contraception respect to the aborting was 36,8%.

REPRODUCTIVE HEALTH PROFILE OF WOMEN SEEKING ABORTION OR

CONTRACEPTION ADVICE

92,4%81,9%78%No FP consultation over the last year (%)

25,8%33,9%33,7%Condoms erratic use (%)

16,9%20,9%19,4%Hormonal contraception use (%)

51,4%39%40%Any prior use of contraception (%)

57,9%44,6%44%One o more previous abortion (%)

4.0996.2967.394women attended

201120102009

DISPARITIES OF IUD ACCEPTANCE AND INSERTION

49,9%37,9%30,1%

IUD ratio respect abortion

67,9%65,5%68%

IUD Insertion (%)

2.2303.0862.973

IUD Acceptance

201120102009

REASONS FOR DISPARITIES BETWEEN IUD ACCEPTANCE AND INSERTION

� Organizational separation between abortion clinics and family planning services.

� Medical provider attitude and misconceptions.

� Negative popular beliefs about the IUD.

MAIN RESULTS (I)

� Coverage of 20.647 women (2009-2011) who are 20% of yearly abortions in Catalonia.

� Highly vulnerable socio-economic position.

� Most of the women were in the first trimester of pregnancy.

� About 50% did not use contraception consistently.

MAIN RESULTS (II)

� More than 80% did not attend Family Planning services over the last year.

� About 47% were repeated abortions.

� IUD ratio respect abortion was 36,8%

CONCLUSIONS (I)

�� SUSTAINABILITYSUSTAINABILITY: Framework of public and private partnership has ensured the programme for 20 years.

�� EQUITYEQUITY: The Programme improves access to comprehensive reproductive health care for vulnerable women.

CONCLUSIONS (II)

�� INTEGRATIONINTEGRATION: The Programme integrates greater accessibility to safe abortion and free post-abortion long-lasting contraception.

�� ADDED VALUEADDED VALUE: The Programme combats repeat abortions and other relevant risks as partner violence.

ACKNOWLEDGEMENTS

To funding public administrations

� Servei Català de la Salut

� Ministerio de Sanidad,

Igualdad y Política Social.

To board of Asociación Salud y Familia for support, inspiration and lasting commitment.

THANKS

Email: emendez@saludyfamilia.es

Web: www.saludyfamilia.es