The European Journal of Contraception & Reproductive Health Care最新文献

{"title":"Yes we can! Successful examples of disallowing ‘conscientious objection’ in reproductive health care","authors":"C. Fiala, K. Gemzell Danielsson, O. Heikinheimo, Jens A Guðmundsson, Joyce H Arthur","doi":"10.3109/13625187.2016.1138458","DOIUrl":"https://doi.org/10.3109/13625187.2016.1138458","url":null,"abstract":"Abstract Reproductive health care is the only field in medicine where health care professionals (HCPs) are allowed to limit a patient’s access to a legal medical treatment – usually abortion or contraception – by citing their ‘freedom of conscience.’ However, the authors’ position is that ‘conscientious objection’ (‘CO’) in reproductive health care should be called dishonourable disobedience because it violates medical ethics and the right to lawful health care, and should therefore be disallowed. Three countries – Sweden, Finland, and Iceland – do not generally permit HCPs in the public health care system to refuse to perform a legal medical service for reasons of ‘CO’ when the service is part of their professional duties. The purpose of investigating the laws and experiences of these countries was to show that disallowing ‘CO’ is workable and beneficial. It facilitates good access to reproductive health services because it reduces barriers and delays. Other benefits include the prioritisation of evidence-based medicine, rational arguments, and democratic laws over faith-based refusals. Most notably, disallowing ‘CO’ protects women’s basic human rights, avoiding both discrimination and harms to health. Finally, holding HCPs accountable for their professional obligations to patients does not result in negative impacts. Almost all HCPs and medical students in Sweden, Finland, and Iceland who object to abortion or contraception are able to find work in another field of medicine. The key to successfully disallowing ‘CO’ is a country’s strong prior acceptance of women’s civil rights, including their right to health care.","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"4 1","pages":"201 - 206"},"PeriodicalIF":0.0,"publicationDate":"2016-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88703477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ukrainian medical students’ attitudes to parenthood and knowledge of fertility","authors":"I. Mogilevkina, J. Stern, D. Melnik, Elena Getsko, T. Tydén","doi":"10.3109/13625187.2015.1130221","DOIUrl":"https://doi.org/10.3109/13625187.2015.1130221","url":null,"abstract":"ABSTRACT Objectives: The aim of our study was to investigate Ukrainian medical students’ intentions and attitudes in relation to future parenthood, and their knowledge about fertility. Methods: A classroom survey was carried out of randomly selected groups among 3568 Russian-speaking medical students. The response rate was 88.8%; 858 were female and 407 were male; the mean age was 20.6 (standard deviation [SD] 2.4) years. Results: One in four male and 16% of female respondents did not want to have children, 3.3% had children and 17% wanted one child only. Female respondents wished to have their first child when they were 24.4 (SD 2.4) years of age, and male respondents when they were 26.8 (SD 3.4) years of age. Around 60% of respondents reported there was a pronounced decline in female fertility after the age of 45 years. Conclusions: The desire to have children in the future is not apparent among medical students, especially not among men. Gaps in students’ knowledge about fertility need to be addressed by sexual and reproductive education.","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"80 1","pages":"189 - 194"},"PeriodicalIF":0.0,"publicationDate":"2016-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75908349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How health services can improve access to abortion","authors":"S. Rowlands, E. López-Arregui","doi":"10.3109/13625187.2015.1109074","DOIUrl":"https://doi.org/10.3109/13625187.2015.1109074","url":null,"abstract":"Previous editorials have dealt with unsafe abortion in Africa [1] and the law in Spain.[2] This editorial will confine itself to factors within health services that affect access to abortion in high-income countries. Factors that either obstruct or facilitate access to abortion in such countries have recently been reviewed.[3] The quality of the health services of the country in which a woman resides will affect her access, both generally and more specifically, to abortion services. Health ministries often fail to take a lead in abortion care. Where there is not enough confidence in how the law should be interpreted, there may be unnecessary restrictions, as is the case in Northern Ireland.[4] World Health Organization (WHO) guidance recommends that policy-makers and health care managers should ensure that safe abortion is readily accessible and available to the full extent of the law.[5] Abortions are already being provided by general practitioners (GPs) in countries such as France, Switzerland and the Netherlands; WHO supports more abortion care at primary care level. Information on local abortion services should be widely available on websites, in telephone directories, in public libraries, in pharmacies and in GP premises. A system of direct access (self-referral) to abortion services avoids any delays associated with the need for referral. Central booking systems have been shown to facilitate access.[6] In many countries fees are charged for abortion.[7] Some countries subsidise abortions performed for medical reasons, rape and in the case of minors. In the USA, under the Hyde Amendment, 32 out of the 50 states do not provide Medicaid funding for abortion, and federal funding is prohibited.[8] For individuals without health insurance in systems in which charges for health care apply, an abortion may be simply unaffordable. In other countries abortion procedures are free, although there may be some charges for hospital stay and investigations. More needs to be done to assist women in countries that charge fees for abortion which cannot be reimbursed. Where fees are charged for abortion, such fees should be matched to women’s ability to pay, and procedures should be developed for exempting the poor and adolescents from paying for services.[5] As far as possible, abortion services should be mandated for coverage under insurance plans. The barrier of high costs to women is likely to generate much higher costs for the health system, by increasing the number of women who attempt to self-induce abortion or go to unsafe providers and, as a result, require hospitalisation for serious complications.[5] Depending on whether a referral is needed by the provider, the responsiveness of health services generally to booking appointments can affect a woman’s pathway to the appropriate provider. The need for a referral from a GP can cause a delay if that doctor has a negative attitude or is a conscientious objector. About one-quarter of GPs do not refer women","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"12 1","pages":"1 - 3"},"PeriodicalIF":0.0,"publicationDate":"2016-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87239852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extended regimen combined oral contraception: A review of evolving concepts and acceptance by women and clinicians","authors":"R. Nappi, A. Kaunitz, J. Bitzer","doi":"10.3109/13625187.2015.1107894","DOIUrl":"https://doi.org/10.3109/13625187.2015.1107894","url":null,"abstract":"ABSTRACT Objectives: The clinical utility of extended regimen combined oral contraceptives (COCs) is increasingly being recognised. Our objective was to understand the attitudes of women and clinicians about the use of these regimens. We present the rationale for extended regimen COCs from a historical perspective, and trace their evolution and growing popularity in light of their clinical benefits. We conclude by offering potential strategies for counselling women about extended regimen COC options. Methods: We conducted a MEDLINE search to identify and summarise studies of extended regimen COCs, focusing on attitudes of women and clinicians regarding efficacy, safety/tolerability and fewer scheduled bleeding episodes and other potential benefits. Results: The body of contemporary literature on extended regimen COCs suggests that their contraceptive efficacy is comparable to that of conventional 28-day (i.e., 21/7) regimens. For women seeking contraception that allows infrequent scheduled bleeding episodes, particularly those who suffer from hormone withdrawal symptoms and cyclical symptoms (e.g., headache, mood changes, dysmenorrhoea, heavy menstrual bleeding), extended regimen COCs are an effective and safe option. Although satisfaction with extended regimen COCs in clinical trials is high, misperceptions about continuous hormone use may still limit the widespread acceptance of this approach. Conclusions: Despite the widespread acceptance among clinicians of extended regimen COCs as an effective and safe contraceptive option, these regimens are underused, likely due to a lack of awareness about their availability and utility among women. Improved patient education and counselling regarding the safety and benefits of extended regimen COCs may help women make more informed contraceptive choices.","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"21 1","pages":"106 - 115"},"PeriodicalIF":0.0,"publicationDate":"2015-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75281725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstracts of Keynote Sessions","authors":"","doi":"10.3109/13625187.2014.894779.04","DOIUrl":"https://doi.org/10.3109/13625187.2014.894779.04","url":null,"abstract":"","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"7 1","pages":"S14 - S9"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74706185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract of Debate","authors":"","doi":"10.3109/13625187.2014.894779.08","DOIUrl":"https://doi.org/10.3109/13625187.2014.894779.08","url":null,"abstract":"","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"25 4 1","pages":"S57 - S58"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72703889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstracts of Free Communications","authors":"","doi":"10.3109/13625187.2014.894779.10","DOIUrl":"https://doi.org/10.3109/13625187.2014.894779.10","url":null,"abstract":"","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"17 1","pages":"S67 - S90"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85016818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstracts of Keynote Lectures","authors":"T. Kowalewski, W. Kosinski, J. Kompenhans","doi":"10.3109/13625187.2014.894779.03","DOIUrl":"https://doi.org/10.3109/13625187.2014.894779.03","url":null,"abstract":"","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"62 1","pages":"S7 - S8"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81178830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstracts of Pre-Congress Workshop","authors":"","doi":"10.3109/13625187.2014.894779.02","DOIUrl":"https://doi.org/10.3109/13625187.2014.894779.02","url":null,"abstract":"s of Pre-Congress Workshop The European Journal of Contraception and Reproductive Health Care S3 S4 The European Journal of Contraception and Reproductive Health Care Victoria, Melbourne, Victoria, Australia, 5 Melbourne IVF, Melbourne, Victoria, Australia Objectives: Australia faces the contradictory problems of high rates of unintended pregnancy and of infertility. These population patterns are well documented in demographic surveys, but little is known about how they are experienced in individual lives. The objective of this study, funded in partnership by the Australian Research Council, the Royal Women’s Hospital, The Victorian Government Department of Health, Family Planning Victoria and Melbourne IVF, was to investigate how Australians manage fertility. The aim of this paper was to describe the circumstances of unintended, mistimed, or unwanted fi rst pregnancies in an Australian national sample of women and men of reproductive age. Design and methods: A population-based crosssectional survey was conducted. The survey and a letter of invitation to participate were mailed to a random sample of people aged 18 to 45 extracted from the Australian Electoral Roll. Information was collected about management of fertility across the life-course, including about the circumstances of any accidental pregnancies. Responsibility for contraception and selfassessed risk of conception at the time of intercourse that led to the accidental fi rst pregnancy were each assessed in separate single questions. Respondents were invited to endorse up to 18 fi xed-choice reasons for the accidental pregnancy. Responses from women and men, and from three age cohorts (18 – 25; 26 – 40; 40) were compared. Results: The survey was sent to 15,590 people (7795 women; 7795 men), yielding a nationallyrepresentative sample (recruitment fraction 16%). Of the 18, reporting an accidental fi rst pregnancy, most agreed that men and women should share responsibility for contraception. Despite the fact that all but 1% had access to affordable contraception, approximately half reported awareness of the risk of pregnancy from sexual intercourse at the time. Ninety one percent reported one or two reasons for the accidental fi rst pregnancy; the three most common reasons were “using contraception correctly but it didn’t work”, “forgot to take or use contraception”; and “withdrawal too late” and were similar in the three age cohorts. Differences in women’s and men’s responses will be reported. Conclusions: These preliminary fi ndings confi rm that availability of contraception is insuffi cient to ensure that pregnancies are intended and not mistimed The European Journal of Contraception and Reproductive Health Care, 2014; 19 Supplement 1: S4–S5 PRE-CONGRESS WORKSHOP","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"4 1","pages":"S3 - S6"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79134026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstracts of Workshops","authors":"I. Vīberga, Natalja Mošna","doi":"10.3109/13625187.2014.894779.07","DOIUrl":"https://doi.org/10.3109/13625187.2014.894779.07","url":null,"abstract":"","PeriodicalId":22423,"journal":{"name":"The European Journal of Contraception & Reproductive Health Care","volume":"19 1","pages":"S47 - S56"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85405092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}