Abortion on request: 10 years' experience of implementation of national services
ESC Congress Library. Vicente L. May 10, 2018; 208141; ESC202
Dr. Lisa Vicente
Dr. Lisa Vicente
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Abstract
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In Portugal until 2007, illegal abortion was an important cause of morbidity and mortality. In 2007, abortion on request within 10 weeks gestation was decriminalized. Since then it has been performed within the National Health Service (NHS) or on private clinics officially recognized. All of them are obliged to report to a central database. Objectives: to present the results of 10-years' experience on national implementation of abortion services and its impact on complications due to illegal abortion. Methods: Secondary analysis of official data published by General Directorate of Health: data for legal abortion after 2007 was retrieved from national database and complications due to abortion were collected from national annual reports (2001- 2015).  Results: There was an annual variation of total abortions: increasing from 2007 to 2011 and decreasing thereafter (max. 2011: 19921 abortions; min. 2016: 15416 abortions). Which represented a variation from 8,2 to 7,2 abortions/1000 women on fertile age (15-49 years) and 204 - 183 abortions per 1000 live births, during the last 10 years. The majority of abortion services are public (69,5%,2010 and 71,2%,2015).  Medical abortion represented 65%- 72% of total legal abortions. About two thirds of abortions were done by women aged between 20 - 34 years (2007: 65% to 2015: 64%), which is consistent with the national distribution of live births by the mother´s age group. Abortions in women under 20 years decreased and remained low (2008: 12% to 2015: 11%). As for all women, resident migrants have access to free abortion services. They represented 16% (2008) to 19% (2015) of total abortions. Women who underwent an abortion had access to free contraception. The choice of contraception method ranged from 94% (2008) to 97% (2015). The use of reversible long acting methods increased from 26,5% to 38%. Between 2001- 2007 there were 14 reported maternal deaths due to abortion. Since then 2 deaths were reported: one related with an illegal abortion (2008) and one case of Clostridium Sordellii associated with medical abortion. Published reports show a decrease in complications in illegal abortions. On legal abortions, complications remain low. Conclusions: The implementation of abortion services was possible throughout a national network, along with the availability of mifepristone and misoprostol, the publication of national guidelines and the creation of an online registry, mandatory for all health care units. Safe abortion services resorted in a clear decrease in maternal deaths and severe complications due to illegal abortions.
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