Contents of this
issue:
• Message from the
new president
• Reproductive
health in Hungary
• Selected practice
recommendations update WHO
• Q&A
• Facts &
Figures, News
MESSAGE
FROM THE NEW
ESC
PRESIDENT, DR. DAVID CIBULA, CZECH REPUBLIC
Dear ESC
members,
Dear colleagues,
Hopefully you enjoyed the 8th ESC congress in Edinburgh. I believe that the
feeling of satisfaction of most of the attendees is pretty similar to mine. We
managed to organise a brilliant meeting: highest attendance in ESC history
reaching over 1.500 participants, smooth organization, complex (holistic)
scientific programme without weaknesses, charming Scottish city of Edinburgh.
All together we welcomed 34 plenary lectures and the highest numbers of
submitted abstracts ever (7th congress in Genova: 179, vs Edinburgh: 279). The
scientific recognition of the ESC is undoubtedly growing. A long list of names
contributed significantly to this successful meeting, but the highest credit
goes to a few people who should be listed here: Prof. John Newton and Dr. Sarah
Randall (Local Organising Committee), Prof. S. Skouby (Scientific Committee),
and Peter Erard, Ria Maes & Ann Wattez (ESC Central Office).
However, this message should not be a praise to the past, but rather a
practical guide for the future. Allow me to summarize topics which, I believe,
are interesting and important to you – members of the ESC:
• Congress
2008. I am proud to announce that the city chosen to hold the 10th ESC
congress in 2008 is Prague. Although only 11 Czech members were present at the
General Assembly in Edinburgh, Prague was chosen by the majority of the
attendees.
• Bids
for the congress 2010. In two years time, a new venue will be chosen for
the 11th ESC congress in 2010. Each country is welcome to submit a bid. All
requirements and application forms are available, on request, from the ESC
Central Office.
• ESC
website. We are very pleased that our website is becoming a regular and
integral part of the daily life of the Society. At the beginning of 2004 we
reached an average of more than 4.600 monthly visits, with a peak of more than
11.000 monthly visits in March and April, before the start of the 8th congress.
Credit goes especially to Rob Beerthuizen, our webmaster. All new information,
scientific contributions, feedback from the past congress and more can be
easily found there. http://www.contraception-esc.com
• New
Executive Committee and Board of Directors. Although an effort was made to
limit the size of the Board, currently the number of members has increased due
to the necessity of accepting former mandates. However, this is only a
transitory situation and the size will decrease in two years time, during the
next congress in Turkey, based on newly approved changes to the Rules.
Composition of the new Executive Committee is as follows: Dimitrios Lazaris -
Greece (vice-president), Olga Loeber - The Netherlands (secretary general),
George Bartfai - Hungary (assistant secretary), Medard Lech - Poland (treasurer),
Sinan Ozalp - Turkey (assistant treasurer) and myself as new president. For the
composition of the new Board of directors, I invite you to visit the ESC
website (go to 'About ESC') where all the names are listed. We warmly welcome
Dr. Riris, representing Cyprus, a new country on the Board.
• Seminar. Due to safety
reasons the venue of the 8th ESC seminar in 2005 was relocated from Israel to
Poland. We greatly appreciate that Medard Lech was willing to take on this
responsibility. I would highly recommend you to consider your participation.
The two seminars I attended in Coimbra and Budapest were both exceptional
experiences, held in a special atmosphere, focusing on one topic only, and
giving emphasis to fruitful discussions. All details will be soon presented on
our website.
• Next
congress in Turkey. Although the UK congress finished recently, it is
appropriate to already insert the dates of the 9th ESC Congress in your
diaries: 3 to 6 May 2006, Istanbul, Turkey. Remember: if you want to present a
new paper there, it is time to start collecting data!
• Granted
projects. Each ESC member is invited to apply for financial support from
the Society. The procedure is described in the Rules of Procedures (to be found
on our website) and application forms are available on request from the ESC
Central Office.
• Statutes
and Rules of Procedures. A current version of the official Rules of the
Society, with many changes implemented, is available on our website. I wish to
use this opportunity to express my thanks to the Executive Committee, the
members of the Board and all participants of the General Assembly in Edinburgh
for their excellent co-operation on the proposed changes. You are more than
welcome to visit our rules in case you are uncertain about guidelines about
practical situations, as for example how to apply for a grant, how to raise a
bid for a seminar or congress, etc. Without your interest our struggle to make
the Rules clear and updated will not become a part of daily life.
In conclusion: I strongly believe that the ESC is on the right path to be a
significant and recognized Society in the field of contraception in Europe. We
(the Executive Committee and the Board) shall do our best to offer you even
more opportunities to actively participate in scientific, social and
educational activities of the Society. As the newly elected president, I am
honoured to contribute to this effort.
David Cibula
Reproductive Health in Hungary,
by Prof. Istvan Batar
The current state of reproductive health (RH) is very contradictory in
Hungary nowadays. The reasons are political, economical and behavioral. Nearly
fifteen years after the fall of the iron curtain, and even now that we are
members of the European Union, one can ironically state that the former
“socialist” regime was more pro “family planning” as it was called in those
days, than any government since 1990 has been for “reproductive health” as it
is now called (political factor).
At the latest ESC Seminar held in Budapest last September, a special
Hungarian session dealt with the country’s RH-related questions, and the
conclusions identified the following.
Contraception
Compared to international (even western) data, the Hungarian
contraception rate is considered good: according to cross-sectional
investigations, between 1958 and 1993, it increased from 59% to 73% among women
of fertile age living in wedlock. However, the figure (72%) has not changed
since 1977. Longitudinal studies on
marriage conducted between 1988 and 2001 yielded somewhat better results: the
proportion of women relying on contraception 6 and 16 years after getting
married in one study, and 10 years following marriage in another one was 67%,
68% and 73% in 1989, 1990 and 2001, respectively.
However, it should be mentioned that there are no fresh cross-sectional data concerning the past
ten years, and we are also lacking regular studies, repeated at least every
5-10 years, which cover the whole fertile population (including single women as
well).
Hungary has played a pioneering part in emergency contraception as, for over twenty years now, we have had
a lot of experience with Postinor (known as Rigesoft today), a drug containing
levornorgestrel (LNG) and produced by a Hungarian pharmaceutical company
Richter. However, many countries (especially the western ones) have overtaken
us in everyday practice. Other countries have greater usage rates which are
closely associated with the approach of doctors, pharmacists and the lay public
alike. More and more (western) countries have provided over-the-counter (OTC)
access to these preparations, which is not the case in Hungary.
Practically all forms of contraceptives are available, but owing to
steadily rising prices many find them inaccessible (economical factor). This is especially true of the young
population. The National Health Insurance (NHI) has not subsidized any type of
contraceptives since 1993, and people have to pay full price for pills, IUDs
and even for sterilization.
Abortion
Despite the high contraception rate, and in the view of all of the
parameters, the proportion of induced
abortions is unacceptably high in Hungary. On the one hand, lack of
information on the appropriate use of contraceptives plays a role in high
abortion rates (behavioral factor:
the method is known but applied inconsequently, or less effective methods are
used). On the other hand, the high price of contraceptives is also a powerful
limiting factor.
Vacuum aspiration is the main form of induced abortion up to 12 weeks of
gestation under general anesthesia. Mini suction (“menstrual regulation”) is
used only in selected, mostly university centers. “Medical abortion” with Mifepristone (RU486) is not available in
Hungary. A few years ago, attempts were made to present the method in the
Journal of Hungarian Gynecologists but soon after that, still in the phase of
preparation, we had to give up the idea – and not for professional reasons.
There is a
network (Family Protection Service = FPS) run by specially trained nurses where
a woman seeking an abortion has to attend. This two-session discussion
(pre-abortion counselling) is compulsory before surgery. The first session is
conducted anonymously. Following this, there is a 3-day waiting
(thinking/decision) period. After that the nurse records the case, and
completes the strict administrative procedures set by law in the second session.
The abortion can then be performed even on the same day.
The abortion
cost (approximately Euro 100) are not covered by the national health insurance
(unless the reason is medical). However, the price can be reduced by 50%, 70%
or 100% according to the woman’s social/economical situation. (There is a
detailed official list of circumstances based on which the reduced fee is determined
by the staff of FPS.)
Sexually transmitted infections
(STI)
All over Europe, the rise in STI
incidence has posed a problem. AIDS – fortunately – is not a very serious
problem in Hungary as yet. Syphilis and Gonorrhea are on the rise, but not as
much as in the ex-Soviet countries. Special emphasis has recently been given to
Chlamydia trachomatis, a disease not frequently identified or treated in
Hungary previously. According to surveys based on the latest observations by
several centers, its incidence rate is 5.4%. However, screening is often made
difficult because of the high costs of detection using up-to-date techniques.
Since NHI finances the cheaper but less effective methods of detection,
“screened” (but undetected) infections only worsen the situation.
Sex education
Owing to the above, it is imperative that the lay public is precisely, objectively, responsibly and fully
informed (education in family life, information at school, counseling about
reproductive health at FP centers/polyclinics, etc.). To achieve that goal, the
training and retraining of professionals
(teachers, health care workers, and doctors) is required, and the media, as well as the decision-makers (politicians) should be
involved in giving publicity to the topic.
Written by István Batár,
Associate Professor, Head of Family Planning Center, Dept. Ob/Gyn, University
of Debrecen, Hungary
SELECTED
PRACTICE RECOMMENDATIONS,
UPDATE
WHO - MAY 2004
What can a woman do if she misses combined oral
contraceptives (COCs)?
UPDATE:
For 30-35 mcg ethinylestradiol pills:
Missed 1 or 2
active (hormonal) pills:
• She
should take an active (hormonal) pill as soon as possible and then continue
taking pills daily, one each day.*
• She
does not need any additional contraceptive protection.
Missed 3 or
more active (hormonal) pills or if she starts a pack 3 or more days late:
• She
should take an active (hormonal) pill as soon as possible and then continue
taking pills daily, one each day.*
• She
should also use condoms or abstain from sex until she has taken active
(hormonal) pills for 7 days in a row.
• If she
missed the pills in the third week, she should finish the active (hormonal)
pills in her current pack and start a new pack the next day. She should not
take the 7 inactive pills.
• If she
missed the pills in the first week and had unprotected sex, she may wish to
consider the use of emergency contraception.
* If
a woman misses more than 1 active (hormonal) pill, she can take the first
missed pill and then either continue taking the rest of the missed pills or
discard them to stay on schedule.
Depending on
when she remembers that she missed a pill(s), she may take 2 pills on the same
day (1 at the moment of remembering, and the other at the regular time) or even
at the same time.
For 20 mcg or less ethinylestradiol pills:
• If the
woman misses 1 active (hormonal) pill, she should follow the guidance above for
“Missed 1 or 2 active (hormonal) pills.”
• If the
woman misses 2 or more active (hormonal) pills or if she starts a pack 2 or
more days late, she should follow the guidance above for “Missed 3 or more
active (hormonal) pills or if she starts a pack 3 or more days late.”
For both 30-35 mcg and 20 mcg or less ethinylestradiol
pills:
Missed any
inactive (non-hormonal) pills:
• She
should discard the missed inactive (non-hormonal) pill(s) and then continue
taking pills daily, one each day.
Further
reading and literature:
http://www.who.int/reproductive-health/publications/spr_2/
Comment from Dr. Olga Loeber, ESC Secretary General:
This news item was really an eye opener to me, because in
the Netherlands a different, more strict advice is given. Even one forgotten
pill in the first and third week of the pill strip is considered as a (minimal)
risk for an ovulation.
I would be very interested in the opinion of other
colleagues. Is everyone ready to accept these new recommendations?"
In Newsletter
2, Dr. Olga Loeber launched a call for feedback to all readers with regards to
the use of misoprostol as premedication for an abortion.
Dr. Christian
Fiala advises readers to visit the following website with extensive literature
on the subject:
www.misoprostol.org
Thank you Dr.
Fiala, for your contribution!
One in five British women use sterilization as contraception
Higher than European
Average
Research indicates that one in five British women use sterilization as a form
of birth control, double the European average. They are either sterilized
themselves or their partner has had a vasectomy.
A survey of 12.000 women in Britain, France, Germany, Italy and Spain indicated
that the average for the five nations was one in ten, in Italy less than one in
100 use sterilization as a form of birth control. The study also found that the
average age of sterilization in Britain was 32, two to three years younger than
women in other countries.
Out of the 2.500 British women interviewed, six out of ten of them felt
that they had not been adequately informed of alternative and reversible
forms of contraception such as the pill, coil or condoms.
However, the pill is the most common form of contraception used in the UK, 27
per cent of 15-49 year old women take the pill.
A spokesperson form the UK Family Planning Association said that women need to
be told of the pros and cons of all forms of contraception.
(Source: The Metro, 28 June 04)
The following 2 news items were read in July 04 on the
website of the Int’l Planned Parenthood Federation, www.ippf.org, ‘news’
section:
US to withhold $34 million funding for UNFPA
The Bush administration will withhold $34 million in congressionally approved
assistance to the UN Population Fund (UNFPA) because of the fund's connection
to China and forced abortions.
The State Department said it was convinced the fund helped China manage
programmes that involved forced abortions. Secretary of State, Colin Powell
said in a letter to Congress that the administration would continue to help
women and children around the world through other programmes.
This was the third year the Bush administration had blocked congressional
assistance to UNFPA, despite the results of an investigation carried out two
years ago by the State Department, who found no evidence of the funding being
linked to coercive abortions.
And Rep. Nita M. Lowey, a Democrat Representative told Associated Press:
"The administration has made the shortsighted decision to withhold
assistance to all of UNFPA's 136 country programs unless UNFPA withdraws from
China or, unbelievably, unless China changes its national laws. His decision
will not help Chinese law. It will only hurt the poorest women and children
around the world."
Powell told
Congress that the administration remains committed to women's reproductive
health, as to other health programmes.
The United States is the largest donor of bilateral assistance to help improve
the health of women and children and is providing more than $1.8 billion this
year through the US Agency for International Development fund.
Department spokesman Richard Boucher said this includes $429 million for
reproductive health, including family planning.
The Republican-led House Appropriations Committee, meanwhile, has blocked a
proposal to spend $25 million for a family planning programme by the United
Nations in Iraq, Afghanistan and four Asian and African countries.
Associated
Press reported in Push Journal 16 July 04.
(Source: Push Journal, 16 July 04)
Guidance on sex advice for young (UK)
Doctors and health professionals have been issued with guidance on how to
provide advice on contraception and sexual health to people under 16, reports
the BBC online.
The
Department of Health guidance highlights the need to establish a rapport with
the young person to help them make an informed choice. It replaces existing
guidance, issued in 1986 after a case brought by family rights campaigner
Victoria Gillick. This established a young person's right to confidential
contraceptive advice.
However, it also made it plain that the duty of confidentiality was not
absolute, and could be overridden if there was a serious concern about the
health, safety or welfare of the young person.
The new
guidance does not change the basic thrust of the 1986 version, but it does try
to give health professionals clearer guidance on the best way to handle what
can be a very delicate situation.
It says health workers should discuss:
a) The emotional and physical implications of sexual activity, including the
risks of pregnancy and sexually transmitted infections.
b) Whether the relationship is mutually agreed or whether there may be coercion
or abuse.
c) The benefits of informing their GP and encouraging discussion with a parent
or carer. Any refusal should be respected.
d) In the case of abortion, where the young woman is competent to consent but
cannot be persuaded to involve a parent, every effort should be made to help
them find another adult to provide support, for example another family member
of specialist youth worker.
e) Any additional counselling or support needs.
Read this BBC
report in full by clicking on the link below: http://news.bbc.co.uk/1/hi/health/3939185.stm
(Source: BBC News Online, 30 July 04)
We are
looking forward receiving your contributions to the upcoming ESC Newsletters.
Mail to:
esccentraloffice@
contraception-esc.com
8th
ESC Seminar 2005, "Sexual education: the key issue of reproductive
health",
23-24
September 2005, Warsaw, Poland
9th
ESC Congress 2006, "Improving life quality through contraception and
reproductive health care",
3-6
May 2006, Istanbul, Turkey
- END -
Chief editor: Olga Loeber
Contributors to this newsletter: David Cibula, Istvan Batar,
Anne Webb.
All materials to be included in the ESC Newsletter should be
submitted (electronically) to:
ESC Central Office / Ann Wattez:
Opalfeneweg 3, 1740 Ternat, Belgium
T. +32 2 582 08 52, F. +32 2 582 55 15
All Newsletters are also to be found on the website of the
Society:
www.contraception-esc.com
(go to 'News')