Journal of Contraception Reproductive Health Care - The European ...

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The 8th Congress of The European Society of Contraception Abstracts of Free Communications FC3-03 A termination of pregnancy Care Pathway: worth the effort? K. Guthrie (1), C. Waudby (2), P. Arnott (3) Sexual and Reproductive Health Care Partnership, Hull and East Yorkshire, UK (1); Eastern Hull Primary Care Trust, UK (2); Women’s and Children’s Unit, Hull and East Yorkshire Hospitals NHS Trust, UK (3) Introduction: Termination of Pregnancy services in Hull were centralised under one consultant in 1994/5. This included a central booking line and a clinic doctors’ performa. However, co-ordination of elements of the service was difficult, duplication of work was evident and some aspects of the service were fragmented. Aims and Methods: To co-ordinate care between clinical areas, sites and professions and to ensure adherence to quality standards (RCOG Guidelines), a full Care Pathway was developed with supporting guidelines and patient information leaflets. This covered the patient’s journey from considering/requesting a termination until closure of the patient episode. Variances from the pathway were recorded as a quality tool. Results: The pathway and supporting elements will be described including the first 18 months variance analysis. Conclusion: The pathway has been very well received by patients and staff, has achieved its objectives and has fully justified the effort required in its production. FC3-04 The reproductive health needs of Somali women affected by female genital mutilation living in Manchester, United Kingdom N.H. Mullin (1), H. Lovel (2), Z. Mohammed (3) Highfield Clinic, Widnes, Cheshire, UK (1); University of Manchester School of Primary Care, Manchester, UK (2); Central Manchester Primary Care Trust, Manchester, UK (3) Background: Female genital mutilation (FGM), usually type 3 (the most severe form), affects over 90% of Somali women. FGM is illegal in the UK. There is a rapidly increasing Somali population in Manchester. In other parts of the UK, special African Well Woman Clinics have been set up to provide culturally sensitive reproductive health care to women affected by FGM. Objectives: A health needs assessment was carried out to discover the reproductive health needs of Somali women affected by FGM; and to ascertain if a community family planning service could provide an acceptable service to these women. Design and methods: A systematic literature search on FGM was performed. Somali women, men and Somali health professionals were interviewed individually for a video commissioned by the World Health Organisation. Focus groups comprising of representatives from the local Somali population were brought together to discuss topics of concern. A health questionnaire was developed from the discussions of the focus groups and was completed by other members of the Somali community. Results: Qualitative and quantitative analysis was used. FGM was reported to have influences across the life course. The main themes were consistent with the world literature. FGM in childhood is normal in Somali and is often associated with acute health problems including pain, bleeding, infection and urinary retention. Menstrual problems may occur in puberty, sometime necessitating de-infibulation (re-opening). In later life there may be sexual problems, effects on fertility and childbirth. We discovered socioeconomic and sociocultural reasons facilitating continuation and factors against FGM. Women complained of a lack of knowledge and understanding by UK doctors and midwives. This Somali population expressed a desire to have easy and timely access to the FGM reversal operation (before marriage and pregnancy) rather than having to wait to see the local female hospital gynaecologist. Conclusions: The adult Somali female population in Manchester suffers many complications of FGM. There is a need for an improved FGM reversal service in Manchester. This could be provided by the local family planning service when an acceptable location for the clinic is established and medical staff with gynaecological experience have been trained in the simple reversal procedure. Further work on FGM issues is being carried out within the Somali community. 38 The European Journal of Contraception and Reproductive Health Care
The 8th Congress of The European Society of Contraception Abstracts of Free Communications FC3-05 How good is the provision of sexual health services for young people across England? R. French (1), J.M. Stephenson (1), R. Kane (2), P. Kingori (1), A. Hadley (3), C. Dennison (4), K. Wellings (2) Centre for Sexual Health & HIV Research, Department of Primary Care & Population Sciences, Royal Free & University College London Medical School, UK (1); The Public & Environmental Health Research Unit, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK (2); Teenage Pregnancy Unit, Department for Education and Skills (3); Sexual Health and Substance Misuse, Department of Health (4) Background: One of the aims of the national Teenage Pregnancy Strategy in England is to halve under –18 conception rates by 2010. Improving provision of contraceptive services for young people is a major component of the strategy. Objective: to present a national picture of contraceptive services for young people in England and to assess the quality of provision against Best Practice Guidance from the Teenage Pregnancy Unit. Design and Methods: Two national surveys, distributed via local Teenage Pregnancy Co-ordinators, were conducted of contraceptive services and general practice in 2002. Results: Data were returned by 1295 contraceptive services (64% of all services in Sexwise database). Nearly a quarter of services had been developed since the start of the Teenage Pregnancy Strategy in 1999. 49% were mainstream services e.g. family planning or GU clinics, 39% were designated young people’s services and 12% were mainstream services with specific sessions for young people. The proportion of services meeting at least 5 of the Best Practice criteria was 14%, 27% and 39% respectively. About half of the young people’s services provided a wide range of contraceptive methods and screening for STI. Data were returned from 4020 /8910 (45%) general practices. 13% ran sexual health sessions for young people. Over 90% provided oral contraceptives and emergency contraception and only 50% provided condoms. 91% offered referral for NHS abortion, but 27% had at least one GP with conscientious objections to abortion. Notices explaining under 16s rights to confidentiality were displayed in 19% of practices, and in 14% of practices, at least one GP would not see under 16 year olds without a parent present. Contraceptive methods that are less reliant on the user e.g. injectables were less likely to be offered to those aged under 16. Conclusions: Mainstream contraceptive services do relatively well in terms of range of services offered and Best Practice criteria met. If designated young people’s services are to provide a level one standard of care, as outlined by the National Strategy for Sexual Health and HIV, further support will be needed, including effective referral pathways. In general practice, concerns remain about confidentiality and provision of services, particularly for under 16 year olds. These findings have stimulated further opportunities for training and interaction between the Teenage Pregnancy Unit, Royal College of General Practitioners, local commissioners and services providers in primary care. FC3-06 Improving access to abortion services: a local model E.J. Oloto Contraception, Sexual & Reproductive Health Services, University Hospitals of Leicester NHS Trust, Leicester, UK Local difficulties: Access to local services was poorly co-ordinated with considerable frustration and inconvenience to GPs, users and staff providing the service. There was very limited support for ultrasound scan services. There was also a limited choice of methods as only 23% of pregnancy terminations were carried out medically. About 26% of cases in one hospital were repeat outpatient visits. This was primarily said to be due to the difficulty in assessing the duration of pregnancy in the absence of an ultrasound scan machine. There were different, and sometimes complicated, paperwork for termination of pregnancy (TOP) services in the local hospitals. Staffing was problematic due to conscientious objection particularly by junior doctors. The net result was that the ‘first contact to procedure’ interval was in excess of the required target of 3 weeks (National sexual health strategy) and that 60% of cases referred to and 44% of those treated by the private sector were 12 weeks and under (local service level agreement is for cases above 12 weeks). Aim: To put a comprehensive system in place to facilitate early access to and choice for abortion services in the local population. Improvements required: These would include establishment of a community based centralised referral system for the efficient coordination of the appointments at the various clinics, theatres and wards; harmonisation of the paperwork and protocols for TOP services in the region; purchase of at least one portable ultrasound scan machine to facilitate early dating of pregnancy; expansion of existing service to reduce the number referred out of the region with significant reduction in cost to Primary Care Trusts (PCTs) and inconvenience to the clients; effective contraceptive backup in clinics, wards and theatres; staff training in basic ultrasound scanning; additional training in general and specialised contraception; recruitment of clerical, nursing and medical staff; and establishment of a robust database for TOP services for the purposes of audit and monitoring of local and national targets. Outcome measures: Overall improvement in access and choice for clients; efficient use of time by GPs and other health professionals; and in staff morale and job satisfaction. A GP or other health professionals would either ring, fax or email details to designated numbers rather than ringing round various services for an appointment. An ultrasound scan machine, used in-house, would eliminate the need for repeat outpatient visits and increase the option of a medical TOP. Provision of regular information to PCTs and other stakeholders about TOP services and how targets are being addressed. Contraceptive backup and further training for staff would hopefully reduce the number of unplanned and unwanted pregnancy. Results: The new system was set up in July 2003 and the first year experience would be presented. Also to be presented is the result of the questionnaires being sent to GPs and other health professionals to evaluate the impact of the changes. The European Journal of Contraception and Reproductive Health Care 39
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