Galina Dikke
Speeches:
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Access to safe abortion reduces the number of complications and financial costs
Galina Dikke1, Dmitry Kochev2 1Russian Peoples Friendship University, Moscow, Russia, 2JSC "Pentkroft Pharma", Moscow, Russia - pentcroft@mail.ru
The main method of terminating unwanted pregnancies in Russia remains a D&C (62%, 2012). Medical abortion (MA) is 8% and vacuum aspiration (VA) 30%. In several regions administrative measures have been taken to implement usage of safe methods into clinical practice. Objective: To evaluate the dynamics of the numbers of early complications and financial costs. Material and methods: We choose two regions in the Ural - Sverdlovsk region (SR) and Tyumen region (TR). SR implemented VA in outpatient and inpatient hospitals up to 12 weeks of gestation (N = 2640). TR introduced the method (the combination of mifepristone/misoprostol (200 mg/400 mcg) up to 42 days of amenorrhoea (N=2758). Results: In 2013, in the SR VA was used in 99.2 % of cases (compared to 45.3% - in 2012). Ambulatory holds 35 % VA procedures, the rest - in the hospital. The number of early complications decreased by 3 times (2.0 % vs. 6.0 % respectively), mainly due to incomplete abortion and postpartum endometritis. MA in the TR was used in 97% in early pregnancy, 34.8% of all medical abortions up to 12 weeks. Numbers of early complications decreased by 3.5 times (4.0 % vs. 13.7% respectively), mainly due to bleeding, haematometra and postpartum endometritis. Costs of treatment of early complications observed were 3 times lower in both regions. Cost savings to perform an abortion is 44 % due to the lack of need for inpatient beds, operating, disinfectants, instruments, medicines, including narcotic drugs, equipment, anaesthesia, etc. Conclusions: The introduction of sound technologies and accessibility of abortion contributes to the preservation of reproductive health (reducing complications 3-3.5 times) and lower financial costs of the procedure to perform an abortion (2 times) and the treatment of early complications (3 times).
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Whether contraception is effective enough
Galina Dikke1, Liubov Erofeeva2 1Russian Peoples Friendship University,, Moscow, Russia, 2All-Russian Association for Population and Development, Moscow, Russia - erofeevfamily@mail.ru
Relevance. Despite the wide choice of contraception in Russia the number of unwanted pregnancies is 41%, most of them are terminated artificially totalling about 1 million per year. Objectives: To study the frequency of the contraception methods used, their effectiveness in the population of the Russian women. Material and methods. In-depth and structured interviews conducted with 1027 women aged 18-45 years in 7 Federal Russian districts in 34 localities. Anonymous survey of 161 patients who applied for abortion on request. Results. Contraception was used by 85%, 15% did not use it. Modern methods (LNG IUSs) used - 46%, condoms - 45%, natural/traditional - 32%. Two methods simultaneously used by 38%. Condoms the most popular - 45%, COC - 30%, coitus interruptus - 23%. LARC: copper IUDs - 11%, releasing systems used by 4.5%. 3 months before this pregnancy 52% used contraception: natural methods - 9%, traditional amounted to 14%, modern - 87% (IUD - 16%, COC - 60%, condoms - 25%). In the structure of hormonal methods, proved ineffective were: COC - 37%, transdermal patch - 27%, vaginal ring - 16%, injection - 6%. 56% of women were looking for, but could not get a doctor's consultation for family planning. Discussion. Half of women who became unwillingly pregnant were using modern contraceptive methods. Nearly 60% of the "failure" is among COCs users, which is 2.5 times higher than among condom users, which does not coincide with the theoretical data on these methods effectiveness (the Pearl Index for condoms is higher than for COCs). Conclusion. The reason for the lack of effectiveness of hormonal methods is its inappropriate use by the consumers because of the limited accessibility to medical care and advice on this matter. Another possible reason is the prevalence of traditional methods and the lack of LARCs among promoted ones.