MESSAGE
FROM THE ESC PRESIDENT, PROF. SVEN O. SKOUBY, DENMARK
The latest
cyber net project we are developing is an ESC
Newsletter, the first of which you have already received two months ago.
We think a Newsletter can contribute to the interaction between the members of
the European Society of Contraception. Of course we have the Journal covering
the scientific interests and the congresses and seminars doing the same in a
personal manner. However, aside from scientific articles and presentations
there are many interesting news items for which the journal or a presentation
are not the right platform.
We have an
active website (www.contraception-esc.com), but not everybody visits this
website regularly. In this day and age more and more members use their e-mail
almost on a daily basis. Therefore the board members supported the
initialisation of an ESC Newsletter. The contents of which is not
finalized and will depend on what members want and initiate. Of course there are
ideas: in this second newsletter you will find some of them. Whether this
project will be a success will also depend on the enthusiasm of the contributors.
We call upon
all of you to react to our newsletter in any way you want. It could be in the
form of news items concerning your country, as a question to put to other
members, it could be a reaction to the contents of this newsletter, a
discussion forum or anything you want
to share concerning matters of reproductive heath of the organisation, new ideas,
proposals etc. You can mail your reaction to:
Hope to hear
from you!
Kind regards,
Sven O. Skouby
Upcoming 8th ESC Congress:
"A holistic approach to sexual health: is it needed,
appropriate and possible?", 23-26 June 2004,
Edinburgh (Scotland, UK).
For more information and the updated scientific programme:
www.contraception-esc.com/edinburgh.htm
Registering is still possible!
‘Here and Now’ in the Netherlands,
by Dr. Olga Loeber
History of contraception and unwanted pregnancies
Until 1965
discussing family planning and sexuality was more or less taboo. The birth-rate
was one of the highest in Western Europe and the Netherlands were one of the
most traditional societies in Western Europe. Only condoms and diaphragms were
available (under the counter).
Then a rapid
economic growth occurred, and an increase of the general educational level, a
decline of the influence of the church. The pill was introduced in 1961 and
immediately immensely popular with women, medical doctors and the government
(fear of overpopulation).
Contraception
was and is provided by family doctors and was paid for by general health
insurance since 1971. It quickly became part of everyday life. Abortion was
available since 1971, legalized in 1981.
Since the
eighties a moral revolution regarding the acceptability of sex before marriage
occurred. Acceptance of teenage sexuality has become more general. Women get
their first baby at the late age of almost 30 on average. This means that
temporary contraception has to be used for a long time
(the average
sexual debut is a little over 16 years of age).
The abortion
rate has always been low. The lowest rate was 5.1 in the beginning of the
nineties but has risen over the years to 8.8 in 2002. The explanation for this
rise partly can be found in the high number of immigrants and asylum seekers
during the last ten years (60 % of the abortion clients are first and second
generation from outside the Netherlands) and partly in the tendency to more
risk taking especially by teenagers. (STI are also on the rise).
In general the pill is the most widely used contraceptive with about half of all women who are in need of contraception using this method! 70 % of the youngsters between 18 and 24 use the pill. Second in place is sterilisation. There are more men than women who use this method. Condoms and IUDs come next and it is remarkable that a reliable method as the IUD is not used more often. With the arrival of the hormonal IUS this may change in due time.
New contraceptives available, emergency contraception OTC, abortion pill
In 2003 the
hormonal ring and the hormonal patch became available and trials are running
with methods for hysteroscopic sterilisation and male hormonal methods.
In 2004
progestogen emergency contraception probably will be available OTC. The fact
that this is not yet the case, as well as the fact that the abortion pill is
still less used than women would like, could be somewhat explained by our self
satisfied idea that the Dutch have a leading role in matters of contraception
and reproductive health. This is an outdated idea, as is clearly demonstrated
in our abortion number and the level of perinatal mortality which is higher
than elsewhere in Europe.
In the
Netherlands general practitioners provide the bulk of the contraception, with
the gynaecologists playing only a small role except for sterilisations. Until
January first of 2004 all contraception was paid for by basic insurance. In our
system the cheapest pill is reimbursed, for the more expensive pills the extra
cost must be borne by the consumer.
From January
first this system is still valid for women under 21 and for indications other
than contraception. Women over 21 years of age must pay for their
contraception. It is as yet totally unclear what the effect will be of this
measure. In the first trimester 10% less contraceptive pills have been provided
by the pharmacy. Most insurances have made provisions for this and still cover
contraception for an extra contribution.
At the end of
2003 it became clear that for the first time in ten years the total number of
abortion has been more or less stable. Further investigations have to follow to
find an explanation. The stricter admission regulations for fugitives and
asylum seekers could well be the cause.
In 2004 the
abortion law of 1981 will be evaluated. The law requires a referral and a
waiting period of 5 days, the woman has to be in a crisis situation for which
there is no other solution than a termination of pregnancy. A pregnancy can be
terminated until 22 weeks in hospitals and clinics with a licence to do so. The
evaluation will probably check if the requirements are all met by the
providers. Abortion providers fear the definition of a crisis situation might
be more strictly defined as a result of this evaluation.
Written by Dr. Olga Loeber, General Secretary ESC and
Managing director of the Mildredhuis-Rutgershuis
Centre for Contraception, Sexuality and Abortion, Arnheim,
The Netherlands
In our clinic
we use misoprostol as premedication for an abortion, mainly for nulliparae with
pregnancies less than 7 weeks and second trimester abortion; for medical
abortion; for treatment of bleeding postabortion due to incomplete contraction
of the uterus and as premedication for IUD insertion in nulliparae. My
experience is that for all of these indications it sometimes works wonderfully,
sometimes not.
My question
is: does anyone have done research on the percentage of women for whom it does
not work and why? Are there other indications? What about dosage and ways of
administration?
Question from Dr. Olga Loeber, please respond to:
esccentraloffice@
contraception-esc.com
Read in June
04 on the website of the Int’l Planned Parenthood Federation, www.ippf.org
(section ‘news’):
Gel
Could Save Women From Chlamydia
A gel
designed to protect women against sexually transmitted infections (STIs) is
about to complete its first clinical trial. Early tests show it may work
against a wide range of diseases, including chlamydia, herpes, hepatitis B and
HIV.
The gel,
expected to be the first of the so- called 'nanomedicines' or designer drugs, could
revolutionise the way women protect themselves against the growing incidence of
STIs. Pre-clinical trials show the gel is up to 100 per cent effective. The
first use is expected to be against HIV, but other infections will follow. It
has already been shown to respond to chlamydia and herpes.
(Source:
Daily Mail reported in Push Journal, 10 June 04)
New
Survey of Diaphragm Users shows Positive Results for Protection Against STIs
A new study
of the vaginal diaphragm as a means of preventing acquisition of sexually
transmitted infections (STIs) has been met with a positive reaction from
participants in the study. The researchers at the Multnomah County Health
Department and Oregon Department of Human Services, Oregon (USA) conducted
telephone interviews of 215 women between the ages of 19 and 49 who said they
had used the diaphragm in the past 3 months.
The women
provided information to shed light on their risk of STIs and their experiences
of using the contraceptive device. Although only 42 per cent of participants
reported consistent use in the past 3 months, 79 per cent were satisfied with
the method and 85 per cent planned to use it at next vaginal intercourse.
(Source:
Women's Health Law Weekly reported in Push Journal, 7 June 04)
Sweden
to Launch Emergency Condom Delivery Service
A plan to
establish an express condom delivery service has been announced by the Swedish
Organization for Sexual Education (RFSU). It is hoped that the service will
increase the awareness of contraception and stem the spread of sexually
transmitted infections (STIs).
(Source: Push
Journal, Source Date: 27 May 04).
Gaps in
sexual and reproductive health care account for nearly one-fifth of the worldwide
burden of illness and premature death, and one-third of the illness and death
among women of reproductive age. These gaps could be closed and millions of
lives saved with highly cost-effective investments, according to Adding it Up:
The Benefits of Sexual and Reproductive Health Care, a new report released on 3
February 04 by The Alan Guttmacher Institute (AGI) and UNFPA, the United
Nations Population Fund.
Should you
have interesting facts and figures from your country which you would like to
share with your colleagues ESC members, please do not hesitate to forward them
to:
esccentraloffice@
contraception-esc.com
We are
looking forward receiving your valuable contributions to the upcoming ESC
Newsletter.
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