Pregnancy Advisory Service Research Articles

Contraception--The Morning After

Although no postcoital method has been developed for safe and effective regular use, postcoital contraception is being offered in Canada and Western Europe on an emergency basis to people who experience such problems as a burst condom. It is little known in the US, however. The 1st commercial version of a postcoital method recently became available to women in England. A former postcoital contraceptive was diethylstilbestrol (DES) which has been linked to cancer in the daughters of women who had taken the drug to prevent miscarriage. A new postcoital contraceptive regime was developed by Albert Yuzpe and consists of 4 ordinary contraceptive pills combining estrogen and progestin to be taken over a 12-hour period. In the US, this is the formulaion of birth control pill marketed under the trade name Ovral by Wyeth Laboratories. England and Germany are the only countries in which the Yuzpe method is officially approved for use as an emergency postocital contraceptive, but the method is used to some degree in most European countries, being well-known in France and Denmark. The most frequent side-effect reported by Yuzpe is vomiting experienced by 29% of women; another 22% felt nauseated. Other side effects, e.g. headache, were infrequent. The findings of the Pregnancy Advisory Service and the Brook Advisory Centre in Britain are reported. Overall very few side effects were found. Postcoital contraceptive treatment may cause the length of the cycle in which it occurs to be irregular. Treatment before day 15 has been found to shorten the cycle, whereas treatment after day 15 lengthens it. The majority of women who become pregnant due to treatment failure tend to seek an abortion. Ectopic pregnancy incidence may also be a result of treatment failure. In 1981, the International Planned Parenthood Federation (IPPF) issued a statement endorsing the use of postcoital contraceptives. Reasons for using them include rape, problems with barrier methods, ineffective use of the pill and IUD expulsion. No drug company in the US has expressed interest in getting FDA approval to market a postcoital contraceptive, partly because its usage might not be widespread. Opposition to approval from groups who believe life begins at conception and consequently that postcoital contraceptives are an abortifacient is expected.

Book Reviews : Postcoital Contraception: Methods, Ser vices and Prospects: A Symposium pre sented by PAS, PP. 87. Published by Pregnancy Advisory Service, 1983. Price £2.00

Book Reviews : Postcoital Contraception: Methods, Ser vices and Prospects: A Symposium pre sented by PAS, PP. 87. Published by Pregnancy Advisory Service, 1983. Price £2.00

Experiences of Women Refused National Health Service Abortion

SummaryOut of 197 Wessex women undergoing a legal abortion at the British Pregnancy Advisory Service (BPAS) clinic at Brighton, 31 (15·7%) had already been refused a termination of pregnancy by at least one National Health Service doctor in Wessex. Almost all of these pregnancies were terminated for reasons covered by the social clause of the 1967 Abortion Act.The principal reasons given for refusal of termination were that the women had insufficient grounds for termination under the Abortion Act, or that they were too late. Some were given misleading information. Refusal of an operation may have led to one woman having a second trimester rather a first trimester procedure when she went to BPAS. Some of these patients reported medical consultations which they had found to be upsetting or hurtful. It is suggested that the interests both of women seeking abortion and of doctors opposed to abortion would be best served if the Health Authorities were to provide alternative referral pathways to special abortion facilities.

Experiences of women refused National Health Service abortion.

Out of 197 Wessex women undergoing a legal abortion at the British Pregnancy Advisory Service (BPAS) clinic at Brighton 32 (15.7%) had already been refused a termination of pregnancy by at least 1 National Health Service doctor in Wessex. Almost all of these pregnancies were terminated for reasons covered by the social clause of the 1967 Abortion Act. The principal reasons given for refusal of termination were that the women had insufficient grounds for termination under the Abortion Act or that they were too late. Some were given misleading information. Refusal of an operation may have led to 1 woman having a 2nd trimester rather than a 1st trimester procedure when she went to BPAS. Some of these patients reported medical consultations which they found to be upsetting or hurtful. It is suggested that both the interests of women seeking abortion and of doctors opposed to abortion would be best served if the Health Authorities were to provide alternative referral pathways to special abortion facilities. (Authors)

Provision of induced abortion in Wessex Health Region: unmet need and feasibility of compensatory day care.

A study of routinely collected data showed that in 1975 only 42% of Wessex abortion patients obtained a National Health Service operation in their own region. Within this average the range for own district National Health Service operations was from 8.7% (Central Hampshire) to 68% (South West Hampshire) when known paybed operations had been excluded. Most of the remaining patients obtained private operations outside the region and of these about 50% obtained an operation at the British Pregnancy Advisory Service Clinic (BPAS) at Brighton.A survey of Wessex women obtaining induced abortions at BPAS, Brighton, found that 85% of a sample of patients interviewed would have been willing to have a National Health Service operation locally but it had not been available. Only 24% of these women had been referred by way of a formal and accepted path, and had obtained their operation before ten weeks gestation, a suggested maximum for day-care provision.It this proportion is representative of Wessex patients obtaining operations outside the region, the numbers of patients involved in 1975 would have been 643 and the feasibility of a day surgical unit specially providing for this number would be questionable.It is suggested that by reducing delays in the referral process and accepting patients by nontraditional referral paths at least a further 21% of the patients would have qualified for day care. On the basis of this estimate a Regional Day Abortion Unit is probably a practicable proposition.

THE WESSEX ABORTION STUDIES: I, INTERDISTRICT VARIATION IN PROVISION OF ABORTION SERVICES

An analysis of fertility and the provision of abortion and abortion-related services in the health districts of Wessex showed considerable variation between districts in the provision of formal family-planning services. The patterns of fertility varied between the districts and there appeared to be some relationship between family-planning provision and the rates for illegitimate and "legitimated" births and induced abortion. Although the region as a whole was meeting the demand of 42% of its abortion patients within the National Health Service, there was a considerable variation from district to district which could be explained only in part by variations in the provision of resources. The main differences could be accounted for by the attitudes of the women and of their general practitioners and consultants. Of Wessex women obtaining induced abortions privately at the British Pregnancy Advisory Service (B.P.A.S.) clinic at Brighton, 85% said they would have been willing to have an N.H.S. operation locally if one had been available but that no choice had been offered. It is concluded that the differences in provision between the health districts are more likely to be explained by the attitudes of doctors to providing this service than by the wishes of women to use private medical treatment.

Continued use of hormonal pregnancy test.

In both 1975 and 1977, the Committee on Safety of Medicines reported an association between hormonal pregnancy tests (HPTs) and subsequent congenital abnormalities and stated that such tests should no longer be used. Despite these findings, the Secretary of State declined to ban the proprietary drug involved (Primodos). Following the 1977 warning, 600 consecutive abortion patients at 6 branches of the British Pregnancy Advisory Service (BPAS) were asked whether they had been given HPTs. 12 patients (2%) indicated they had received such tests. Since most women had not consulted a general practitioner before coming to BPAS, this figure is probably an underestimate of actual use. Although a few doctors may have prescribed an HPT in the belief that the pregnancy would be terminated anyway, some HPTs were administered by doctors who subsequently refused to refer the patient for an abortion. If banning Primodos is considered an unacceptable infringement of professional freedom, the Department of Health and Social Security should consider making it a controlled drug, with the requirement that physicians ascertain through an immunological test that the recipient is not pregnant.

Withdrawal of Allegations against British Pregnancy Advisory Service

Withdrawal of Allegations against British Pregnancy Advisory Service

An appraisal of abortion counselling

Abstract Abortion counselling is examined on the basis of 306 cases seen in a pregnancy advisory service. Its aims and process are compared with other forms of counselling; problems of ambivalence, pressure from others, economic reasons and patient fears are discussed. Because of the many clients who presented with these problems and with relationship difficulties, it is suggested that a more broadly-based ‘watershed counselling’ service be established. Such counselling could provide full information about abortion and its alternative, and could also provide useful aftercare.