Mette Løkeland
Speeches:
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Medical abortion overtaking surgical in Norway
Mette Løkeland, Department of Obstetrics and Gynecology, Haukeland University Hospital, Norway
Co-author: Line Bjørge
Norway has abortion on request, completely free of charge and easily accessible at every gynaecology ward up to 12 weeks of gestation. Health personnel have the right to opt out form performing the procedure but not to treat the patients. Each clinic is obliged to make sure they have enough staff that is willing to do the procedure.
Medical abortion with mifepristone and misoprostol was introduced for abortion up to 9 weeks gestation in 1998. Gradually medical abortion has become an option at the majority of all gynaecology wards in Norway. In 2005 medical abortion for gestational age 9-13 weeks was introduced and is now available in all the five health regions.
At Haukeland University Hospital medical abortion was made the method of choice for early termination of pregnancy up to 9 weeks gestation and in 2007 for terminations of pregnancy at 9-13 weeks gestation. Medical abortion was made method of choice due to the general medical view that conservative treatment should always be preferred to surgical when the methods give equivalent treatment outcome. If there are personal or medical reasons the surgical method will be used instead. Home use of misoprostol was introduced as a voluntary choice in 2006 for terminations up to 9 weeks gestation.
Since 1998 the percentage of all abortions in Norway performed medically has increased every year. In 2007 the amount was 45.3% and the preliminary figures for 2008 show 55.9%. This give us reason to think there is a change in Norway from surgery to medical abortion.
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Women’s choices: Why do they opt for medical abortion?
Mette Løkeland, Line Bjørge (Norway)
Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
mette.loekeland@helse-bergen.no
Background. Norway has abortion on request, completely free of charge and easily accessible at every gynaecology ward up to 12 weeks of gestation. Up until April 1998 when medical abortion with mifepristone and misoprostol were implemented for pregnancies terminations performed at less than 9 weeks gestational length all first trimester abortions were performed surgically at Haukeland University Hospital. In 2003 medical abortion was made the method of choice for early first trimester abortions. Medical abortion for 9-12 weeks of gestation was implemented in 2005 and made method of choice in 2007. If there are personal or medical reasons the surgical method will be used instead. In 2006 97.3% of all the abortions up to 9 weeks and 54.5% of those between 9-12 weeks were performed medically.
Choice versus medical recommendations. A woman’s choice is dependent on different factors. Her personal experience, experiences of people she knows and relates to, what she believes is the best method and what health personnel advise her to. Most women do not have a strong opinion but will generally prefer what health personnel recommend them to do.
The success rate of medical and surgical abortion methods are the same.The general medical view is that conservative treatment should always be preferred to surgical when the methods give equivalent treatment outcome. Surgical abortion in a safe and legal environment preformed by skilled personnel has few complications. In comparison medical abortion has a lowere complication rate ; especially the severe complications are few. Medical abortions should therefore be offered as the method of choice.
To make an informed consent and be able to choose a method one need thorough information.Our experience is that women who opt for surgical abortion often do so because their family doctor or others who have no knowledge of medical abortion have told them that it would be the best method for them. They will normally change their opinion when informed about medical abortion. Less women opt for surgical abortion today than ten years ago.