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Abortion Advocacy: Yesterday, today and tomorrow 9th March 2012 Bangkok What we know now: • Sometimes a law is the last thing that changes, sometimes it’s the first. • A good law is necessary but not sufficient to make abortion safe. • Availability of and access to services of good quality, which meet set standards, and adequate numbers of trained and sympathetic providers, is also necessary. ….. but to make it happen………….. …a grassroots movement of women working with: • abortion providers and other medical professionals • community leaders and groups • mainstream women’s organisations • supportive lawyers, parliamentarians • progressive religious leaders • Many others........ How is today different from the 1970s, 80s ,90s ? • The anti-abortion movement is bigger, more sophisticated in its tactics and a better funded and more formidable opponent. • Abortion methods are much safer than they used to be even ten years ago, and require fewer medical skills. • Information technology has made communication easier What is the same? • The need for a critical mass of support: Until the practice of induced abortion becomes accepted by society as a legitimate health care service for women and an accepted choice for women with an unwanted pregnancy, no matter what their age or marital status, changes in abortion law and practice are likely to be slow in coming. Brazil: survey of ob-gyns • 4,261 physicians surveyed • 25% of female physicians and 33% of male physicians had had an unwanted pregnancy • 80% of these were aborted. • Even among those for whom religion was very important, almost 70% chose abortion when personally faced with unwanted pregnancy. • Thus, the closer physicians were to the problem of abortion, the greater their understanding that there are circumstances under which abortion is the best or only alternative. • (Faundes et al) Medical Abortion Pill The Game Changer !! • Where abortion is legal, use of medical abortion is steadily increasing. • Drug sources and therefore ‘service provision’ has changed (drug sellers, internet, wide range of providers) • Growing number of pharmaceutical companies producing the two drugs globally (also fake pills). Even clandestine abortion is changing • The abortion pill is becoming increasingly available, including where abortion remains legally restricted. It is replacing more dangerous procedures and reducing deaths. • More hospitals are willing to treat complications in women who have had unsafe procedures and more women are seeking treatment. Increasing role of non-physicians • France: with medical abortion, physicians confirm pregnancy and conduct follow-up visit. Nurses do the rest. (Hassoun 2001) • South Africa, Viet Nam, USA: nurse practitioners legally permitted to manage vacuum aspiration and medical abortions themselves. (Warriner et al 2006; Berer 2009) WHO safe abortion guidance 2003 • Abortion services should be provided at the lowest appropriate level of the health care system. • Vacuum aspiration can be provided at primary care level up to 12 completed weeks of pregnancy and medical abortion up to 9 completed weeks of pregnancy. • Mid-level health workers can be trained to provide safe, early abortion without compromising safety. What will tomorrow bring ?