Contraception 89 (2014) 339 – 340
Editorial
New research at the 2014 National Abortion Federation Annual Meeting: continuously improving abortion care In April of this year, the National Abortion Federation (NAF) held its 38 th Annual Meeting in San Francisco, CA. As the professional association of abortion providers in North America, NAF's Annual Meetings are an opportunity for abortion providers, advocates and researchers from around the world to learn about the latest research and innovations in abortion care. A record number of abstracts were submitted for presentation at the Scientific Paper Sessions in 2014, and those selected for oral or poster presentation were the result of a juried ranking process undertaken by the Annual Meeting's scientific committee. This edition of Contraception contains the abstracts accepted for oral presentation, including social science research on new topics such as Peace Corps volunteers' (PCVs) experiences with abortion and doula support during abortion care; and clinical research on issues such as cervical preparation prior to surgical abortion procedures. Since 1979, annual appropriations bills have restricted abortion coverage for PCVs, and exceptions are not allowed even in cases of rape, incest or life endangerment. Foster et al. conducted in-depth interviews with 433 returned PCVs to document their exposure to and experiences with abortion while in service and to evaluate their understanding and support of the current regulations. Ten percent of PCVs had obtained or knew someone who had obtained an abortion while in service, suggesting that abortion experiences are not rare among this population. PCVs overwhelmingly disagreed with the current restrictions, and virtually all expressed support for abortion access in cases of rape, incest or life endangerment. These findings confirm that policy reform is needed and, at a minimum, PCVs should have access to abortion in the most extreme cases. Although doulas have long provided support during labor and delivery, more recently their roles have expanded to provide support throughout a full range of reproductive experiences, including miscarriage, adoption and abortion. Chor et al. conducted a randomized trial to evaluate the impact of doula support on women's first-trimester surgical abortion experiences. The authors found that doula support did not have a measurable effect on pain or satisfaction, but women overwhelmingly recommended that it be included in 0010-7824/$ – see front matter © 2014 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.contraception.2014.02.026
routine care. These patterns suggest that doula support may address important psychosocial needs of patients obtaining abortion care. State legislators often introduce and enact abortionrelated laws under the guise of promoting patient safety and protecting the health of women and their families. Burns et al. evaluated the legitimacy of these claims by comparing the number of state abortion restrictions to a range of health outcomes among women and children in the state. Their analysis found that the more abortion restrictions a state had, the worse it performed on indicators of women and children's wellbeing. New Hampshire, with two restrictions, had the highest well-being score while Indiana, with 13 restrictions, had the lowest. Dismantling antichoice claims could help argue against existing restrictions and galvanize support to prevent further restrictions from being implemented. Cervical preparation before dilation and evacuation (D&E) has long been recommended to decrease the risk of cervical trauma and other complications. Osmotic dilators have been commonly used for many years. Some providers place two sets of osmotic dilators prior to D&E. However, dilator placement can be uncomfortable and time consuming for patients. Increasingly, research is showing that medical methods of cervical preparation are effective methods either alone or in combination with osmotic dilators. Shaw et al. investigated the use of mifepristone with synthetic osmotic dilators to simplify cervical preparation prior to D&E after 20 weeks. Grossman et al. compared the use of buccal misoprostol to laminaria for cervical preparation before second-trimester D&E in South Africa. Sharing these data and exchanging abortion care experiences across countries will improve patient outcomes and satisfaction globally. Finally, the number of NAF members located outside the United States continues to grow, including those from Mexico and Colombia, where abortion laws have been liberalized in recent years. NAF members consist of public hospitals and both public and private clinics in Mexico City, and NAF welcomed its first provider members from Colombia in 2013. This year, abstracts
340
Editorial / Contraception 89 (2014) 339–340
were accepted for oral presentation about nurse-led medical abortion provision in public abortion facilities in Mexico City; public opinion on abortion in Mexico; and contraceptive use by Colombian women postabortion. As NAF's membership and work throughout Latin America continues to expand, it is likely that these shared abortion experiences and research will create a community of practice across the Americas. The research presented at the NAF Annual Meeting is one component of a continuing effort to improve abortion care, share knowledge and ensure patient safety. Like all areas of medicine, new research is needed to continue progression in improving the quality, safety and comfort of the abortion procedure. Death from induced abortion has declined rapidly in every country where it has been legalized. Not only must we not allow that to happen again in the countries we all serve, but we must strive together to work continuously to improve the quality of the care we provide.
Matthew F. Reeves National Abortion Federation Washington, DC 20036, USA E-mail address: [email protected] Paul D. Blumenthal Department of Obstetrics & Gynecology Stanford, Palo Alto, CA 94304, USA Rachel K. Jones Guttmacher Institute, New York NY 10038, USA Mark D. Nichols Department of Obstetrics and Gynecology OHSU, Portland, OR 97239, USA Vicki A. Saporta National Abortion Federation Washington, DC 20036, USA
Editorial
New research at the 2014 National Abortion Federation Annual Meeting: continuously improving abortion care In April of this year, the National Abortion Federation (NAF) held its 38 th Annual Meeting in San Francisco, CA. As the professional association of abortion providers in North America, NAF's Annual Meetings are an opportunity for abortion providers, advocates and researchers from around the world to learn about the latest research and innovations in abortion care. A record number of abstracts were submitted for presentation at the Scientific Paper Sessions in 2014, and those selected for oral or poster presentation were the result of a juried ranking process undertaken by the Annual Meeting's scientific committee. This edition of Contraception contains the abstracts accepted for oral presentation, including social science research on new topics such as Peace Corps volunteers' (PCVs) experiences with abortion and doula support during abortion care; and clinical research on issues such as cervical preparation prior to surgical abortion procedures. Since 1979, annual appropriations bills have restricted abortion coverage for PCVs, and exceptions are not allowed even in cases of rape, incest or life endangerment. Foster et al. conducted in-depth interviews with 433 returned PCVs to document their exposure to and experiences with abortion while in service and to evaluate their understanding and support of the current regulations. Ten percent of PCVs had obtained or knew someone who had obtained an abortion while in service, suggesting that abortion experiences are not rare among this population. PCVs overwhelmingly disagreed with the current restrictions, and virtually all expressed support for abortion access in cases of rape, incest or life endangerment. These findings confirm that policy reform is needed and, at a minimum, PCVs should have access to abortion in the most extreme cases. Although doulas have long provided support during labor and delivery, more recently their roles have expanded to provide support throughout a full range of reproductive experiences, including miscarriage, adoption and abortion. Chor et al. conducted a randomized trial to evaluate the impact of doula support on women's first-trimester surgical abortion experiences. The authors found that doula support did not have a measurable effect on pain or satisfaction, but women overwhelmingly recommended that it be included in 0010-7824/$ – see front matter © 2014 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.contraception.2014.02.026
routine care. These patterns suggest that doula support may address important psychosocial needs of patients obtaining abortion care. State legislators often introduce and enact abortionrelated laws under the guise of promoting patient safety and protecting the health of women and their families. Burns et al. evaluated the legitimacy of these claims by comparing the number of state abortion restrictions to a range of health outcomes among women and children in the state. Their analysis found that the more abortion restrictions a state had, the worse it performed on indicators of women and children's wellbeing. New Hampshire, with two restrictions, had the highest well-being score while Indiana, with 13 restrictions, had the lowest. Dismantling antichoice claims could help argue against existing restrictions and galvanize support to prevent further restrictions from being implemented. Cervical preparation before dilation and evacuation (D&E) has long been recommended to decrease the risk of cervical trauma and other complications. Osmotic dilators have been commonly used for many years. Some providers place two sets of osmotic dilators prior to D&E. However, dilator placement can be uncomfortable and time consuming for patients. Increasingly, research is showing that medical methods of cervical preparation are effective methods either alone or in combination with osmotic dilators. Shaw et al. investigated the use of mifepristone with synthetic osmotic dilators to simplify cervical preparation prior to D&E after 20 weeks. Grossman et al. compared the use of buccal misoprostol to laminaria for cervical preparation before second-trimester D&E in South Africa. Sharing these data and exchanging abortion care experiences across countries will improve patient outcomes and satisfaction globally. Finally, the number of NAF members located outside the United States continues to grow, including those from Mexico and Colombia, where abortion laws have been liberalized in recent years. NAF members consist of public hospitals and both public and private clinics in Mexico City, and NAF welcomed its first provider members from Colombia in 2013. This year, abstracts
340
Editorial / Contraception 89 (2014) 339–340
were accepted for oral presentation about nurse-led medical abortion provision in public abortion facilities in Mexico City; public opinion on abortion in Mexico; and contraceptive use by Colombian women postabortion. As NAF's membership and work throughout Latin America continues to expand, it is likely that these shared abortion experiences and research will create a community of practice across the Americas. The research presented at the NAF Annual Meeting is one component of a continuing effort to improve abortion care, share knowledge and ensure patient safety. Like all areas of medicine, new research is needed to continue progression in improving the quality, safety and comfort of the abortion procedure. Death from induced abortion has declined rapidly in every country where it has been legalized. Not only must we not allow that to happen again in the countries we all serve, but we must strive together to work continuously to improve the quality of the care we provide.
Matthew F. Reeves National Abortion Federation Washington, DC 20036, USA E-mail address: [email protected] Paul D. Blumenthal Department of Obstetrics & Gynecology Stanford, Palo Alto, CA 94304, USA Rachel K. Jones Guttmacher Institute, New York NY 10038, USA Mark D. Nichols Department of Obstetrics and Gynecology OHSU, Portland, OR 97239, USA Vicki A. Saporta National Abortion Federation Washington, DC 20036, USA
