ASHM Report Back

Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.

Reproductive Health: Contraception, Access and Equity

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Amy Moten from ShineSA dispelled some myths regarding intrauterine devices (IUDs) causing pelvic inflammatory disease (PID). Amy explained the reasons behind the poor uptake of IUDs in Australia in comparison to other countries.

The legacy of the Dalkon Shield has cast a shadow on the use of IUDs in Australia. The Dalkon Shield was an intrauterine device manufactured in the 1970’s. It became infamous for its serious design flaw-a porous, multifilament string upon which bacteria could travel into the uterus causing sepsis, miscarriage and in some cases death.  There are three intrauterine devices available in Australia- the progesterone IUD called Mirena and the non-hormonal IUD’s-copper T 380A and Multiload. IUDs are extremely effective long acting methods of contraception, which are under utilised in Australia. Only 3.2% of Australian women use IUDs V 35% of Vietnamese women.

Data from 12 randomised studies revealed that modern IUDs showed an overall rate of PID of 1.6 cases per 1,000 woman-years of use.

 There is strong evidence to indicate PID is related to the insertion process. 20 days post insertion the risk of having PID is the same as a non IUD user.

 Take home messages

·      There is no difference in outcome for women with PID who retained the IUD compared to those who had it removed

·      All women who are diagnosed with PID should be reviewed in 24-72 hours

·      IUDs can be used in nullips and there is no increased risk of complications in younger women

·      IUDs are a cost effective method of contraception and clinicians can help by dispelling myths regarding side effects

·      Contraception is very much a very personal choice. It is important that clinicians suggest appropriate contraceptive options for their patients/clients. Long active contraceptive options can be a great choice for women of all walks of life, especially those with chaotic lifestyles. I often suggest LARC for our ‘at risk’ young clients who are often homeless and using drugs.

      Angela Taft (La Trope University)-Medication abortion: access and equity following Mifepristone on the PBS

Medical termination of pregnancy (MTOP) has become more available Australia since restrictions were lifted on mifepristone. Mifepristone can be taken for 63 days/9 weeks after conception. Women can now choose their preferred method and the MTOP can be preferred over surgical interventions for many reasons. Taft explores access and equity in obtaining a termination, including reported challenges, preferred methods and out of pocket expense. The data was from Marie Stopes clinics from November 2014 to April 2015.

Demographics @ Marie Stopes clinics-

·      49% nulliparous but 35% had previous abortions

·      Over 83 % attended for TOP within the first trimester

·      Little difference in the cost of surgical terminations and medical terminations at  Marie Stopes clinics- non Medicare holders can pay up to $1160

·      Identified factors associated to late presentations include distance to clinic, not aware that MTOP was available, and financial difficulties

      Take home messages

Mifepristone is now available in Australia but there can be a significant cost involved which reduces access to lower income earners. 1 in 5 study participants expressed concerns about the cost of abortion and relied on the financial assistance of others. 

35% of clients attending for TOP have had previous abortions. It would be great if contraceptive advice and free LARC could be offered on the day women attend for terminations.  Angela Taft’s talk sparked some debate on why the price of medical termination of pregnancy (MTOP) was so expensive.

 KRC can offer free contraception to ‘at risk’ young people and other target populations. Free contraceptive options include the combined contraceptive pill, emergency contraception, implanon and mirena or copper IUD. Clinicians at KRC often refer clients for TOP and with the clients permission can liaise with the clinic and make a plan regarding contraception options post procedure.

 This session was followed on nicely by the amazing initiative of Lauren Coelli who established Clinic 35 in the Hume region. Her work has undoubtedly improved access for marginalised population groups.

 Increasing access to medical terminations of pregnancy through nurse-led models of care/Decentralising abortion services: The Integration of Medical Termination of pregnancy into a Rural Primary Health Care Setting-Lauren Coelli

Commenced MTOP in 2015

·      Accessible and equitable service-no Medicare required

·      Nurse-led model excellent opportunity to increase access to MTOP

·      Requires good working relationship with GP + Pharmacy who has undertaken MS2Step Training

·      Few GPs complete training as consultations associated with MTOP are lengthy (>45 mins) and there is suboptimal remuneration for GP.

·      The nurse’s role includes triage, pregnancy options, holistic assessment, investigations and referrals for ultrasound and specialist referrals.

·      The cost of MTOP at Clinic 35 costs between $0 and $38.20

·      In-depth planning process and ongoing communication is essential for the program to be successful

 Take home messages

This service is awesome. It is a step forward in the movement for sexual and reproductive empowerment of women in Australia and hopefully it can be emulated in other countries worldwide

 

 

 

 

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