Tackling women inequalities adredding comprehensive reproductive health care. 9th European IUHPE Health Promotion Conference. 27-29 september 2012

1. TACKLING WOMEN INEQUALITIES
ADRESSING COMPREHENSIVE
REPRODUCTIVE HEALTH CARE
Elvira Méndez, MD
General Director. Asociación Salud y Familia
9th European IUHPE Health Promotion Conference
27-29 September 2012 Tallinn. Estonia

2. BACKGROUNG OF THE PROGRAMME
“CARING FOR MATERNITY AT RISK”
The Programme “Caring for Maternity at
Risk”, Spain (1991-2011) is leading by the
Asociación Salud y Familia (ASF), a non
profit NGO.
The Programme is based on a partnership
involving collaborations between public
healthcare services, private abortion clinics,
social and women associations and ASF
itself.
The Programme offers a portfolio of pro-
choice services in reproductive health care
for vulnerable groups of women and
families.

3. THE PORTFOLIO OF THE PROGRAMME
“CARING FOR MATERNITY AT RISK” (I)
Pregnancy test and pregnancy crisis pro-
choice counselling.
Support to free decision-making of pregnant
women.
Co-financing voluntary interruption of the
pregnancy until 2010 and afterwards only
undocumented women because public
healthcare services cover the abortion cost.

4. THE PORTFOLIO OF THE PROGRAMME
“CARING FOR MATERNITY AT RISK” (II)
Active prevention of repeated abortion
through family planning counselling and free
provision of long acting contraception during
post-abortion .
Free provision of long acting contraception
(IUD and Implanon) to vulnerable groups as
adolescents, poor families and migrant
women.
Support and Counselling groups for migrant
mothers and adolescents mothers of all
origins.

5. ADDITIONAL SERVICES TO THE
PORTFOLIO PROGRAMME (I)
During pregnancy crisis prochoice
counselling or family planning visits we
offer:
Active screening of partner violence and
abuse.
Immediate free psycho-social care for
victims of partner violence (three
professional visits for support and
orientation).

6. ADDITIONAL SERVICES TO THE
PORTFOLIO PROGRAMME (II)
During pregnancy crisis prochoice
counselling or family planning visits we
offer:
Immediate free juridical counselling for
victims of partner violence (three
professional visits).
Access to free juridical and psychosocial
orientation and support for family problems.

8. WHY TO FOCUS ON WOMEN BELONGING
TO VULNERABLE GROUPS?
Are less likely to access public
healthcare services and seek advice
for family planning and contraception.
Have higher abortion rates.
Are a greater risk of repeated
abortion.
Are less information on family and
women rights.

9. PROGRAMME COVERAGE
(2009-2011) (I)
The Programme has served 20.647
women during the period 2009-2011.
73,1% (n= 15.087) women requested
advice for pregnancy crisis and, also,
received counselling on long-lasting
contraception.
26,9% (n= 5.560) women requested
active advice for long-lasting
contraception.

10. PROGRAMME COVERAGE
(2009-2011) (II)
User’s profile related to age, civil
status and gestational age was
similar to that of women who had
abortions in the same period.
User’s profile related to migrant
background, educational level, work
status, previous abortions, previous
use of FP Centres and contraception
was worse to that women who had
abortions in the same period.

11. PROGRAMME COVERAGE
(2009-2011) (III)
The Programme covered 20% of
legal abortion in Catalonia during
the period.
Among Programme users the ratio
of women using long-lasting
contraception respect to the
aborting was 36,8%.

13. REPRODUCTIVE HEALTH PROFILE OF
WOMEN SEEKING ABORTION OR
CONTRACEPTION ADVICE
2009 2010 2011
women attended
7.394 6.296 4.099
One o more previous abortion (%)
44% 44,6% 57,9%
Any prior use of contraception (%)
40% 39% 51,4%
Hormonal contraception use (%)
19,4% 20,9% 16,9%
Condoms erratic use (%)
33,7% 33,9% 25,8%
No FP consultation over the last
year (%)
78% 81,9% 92,4%

14. DISPARITIES OF IUD ACCEPTANCE
AND INSERTION
2009 2010 2011
IUD Acceptance
2.973 3.086 2.230
IUD Insertion (%)
68% 65,5% 67,9%
IUD ratio respect
abortion 30,1% 37,9% 49,9%

15. REASONS FOR DISPARITIES BETWEEN
IUD ACCEPTANCE AND INSERTION
Organizational separation between
abortion clinics and family planning
services.
Medical provider attitude and
misconceptions.
Negative popular beliefs about the
IUD.

17. MAIN RESULTS (I)
Coverage of 20.647 women (2009-2011)
who are 20% of yearly abortions in
Catalonia.
Highly vulnerable socio-economic position.
Most of the women were in the first
trimester of pregnancy.
About 50% did not use contraception
consistently.

18. MAIN RESULTS (II)
More than 80% did not attend Family
Planning services over the last year.
About 47% were repeated abortions.
IUD ratio respect abortion was 36,8%

19. CONCLUSIONS (I)
SUSTAINABILITY: Framework of
SUSTAINABILITY
public and private partnership has
ensured the programme for 20 years.
EQUITY: The Programme improves
EQUITY
access to comprehensive
reproductive health care for
vulnerable women.

20. CONCLUSIONS (II)
INTEGRATION: The Programme
INTEGRATION
integrates greater accessibility to
safe abortion and free post-abortion
long-lasting contraception.
ADDED VALUE: The Programme
VALUE
combats repeat abortions and other
relevant risks as partner violence.

21. ACKNOWLEDGEMENTS
To funding public administrations
Servei Català de la Salut
Ministerio de Sanidad,
Igualdad y Política Social.
To board of Asociación Salud y Familia for
support, inspiration and lasting commitment.

23. THANKS
Email: emendez@saludyfamilia.es
Web: www.saludyfamilia.es