Background: Medical Terminations of Pregnancy (MTP) was legalised in Italy in 1978 with the aim of reducing clandestine abortions‘ practice and related risks. Objectives: This study investigates the phenomenon of MTP in the Abruzzo region (Italy) and its determinants for an effective primary and tertiary prevention. Underlying values and principles: Empowering women and family in gain greater control over decisions and actions affecting reproductive health issues. Reducing suffering related to the voluntary abortion, both physical and psychological. Achieving equity in reproductive health care. Re-orienting health services. Knowledge base/ Evidence base: Previous studies on voluntary abortion demonstrated the role of sociocultural determinants as well as psychological and relational, in particular into emergent at risk groups, such as immigrates and younger women. Nevertheless, the most part of prevention study were only knowledgebased and ignored the comprehensive social approach. Context of intervention/project/work: Health Services setting, in particular an obstetric-gynaecological ward and a Family Advisory Centre (FAC). Methods: Two approaches have been used. The first one analysed data concerning the compulsory notifications of MTP performed in Abruzzo region in 1995 - 2001 and 2006-2009 (28,371 notifications). The second one is a questionnaire survey, case – control designed. 371 women have been enrolled in all: 213 cases seeking abortion at the Ortona Hospital and at FAC of Chieti; 158 controls, within the patients or women visiting persons or accompanying aborters in the same health services. Results and Conclusions: The overall trend of voluntary abortion changed in Abruzzo region from last decades: the absolute number of MTP and the specific epidemiological indices decreased. In terms of phenomenon characteristics, the relative frequency of MTPs increased in younger and in foreign females. The case-control study indicates the immigrate women as main target, above all the employed and at low educational level. The FAC showed a significant role in primary prevention, but only in the case in which the women go there for health issues not concerning specifically the abortion. On the contrary, these services failed in the tertiary prevention, i.e. in the prevention of repetition of MTP by women going there for this specific issue (f.e. certification pre-MTP). Lastly, the multivariate analysis demonstrated the supremacy of social norms, attitudes and contraceptive self-efficacy in respect to the knowledge. Concluding, our study provides elements for health promotion planning and indicates useful strategies, such as the correct involvement of reproductive health services, i.e. FACs, the conceiving and validation of structured programmes that could help the operators in realizing effective counselling as well as in organizing training courses and in catching-up at risk subjects by means of peer to peer approach too. These programmes should be centred not only on theoretical knowledge, but also on practical skills in management and compliance for contraceptive methods. Moreover, they have to reinforce the intra and interpersonal skills. Disclosure of Interest: None declared

Socio demographic, intrapersonal and interpersonal determinants of voluntary abortion in Abruzzo Region (Italy). Which perspectives for primary and tertiary prevention?

SCATIGNA, MARIA;
2010-01-01

Abstract

Background: Medical Terminations of Pregnancy (MTP) was legalised in Italy in 1978 with the aim of reducing clandestine abortions‘ practice and related risks. Objectives: This study investigates the phenomenon of MTP in the Abruzzo region (Italy) and its determinants for an effective primary and tertiary prevention. Underlying values and principles: Empowering women and family in gain greater control over decisions and actions affecting reproductive health issues. Reducing suffering related to the voluntary abortion, both physical and psychological. Achieving equity in reproductive health care. Re-orienting health services. Knowledge base/ Evidence base: Previous studies on voluntary abortion demonstrated the role of sociocultural determinants as well as psychological and relational, in particular into emergent at risk groups, such as immigrates and younger women. Nevertheless, the most part of prevention study were only knowledgebased and ignored the comprehensive social approach. Context of intervention/project/work: Health Services setting, in particular an obstetric-gynaecological ward and a Family Advisory Centre (FAC). Methods: Two approaches have been used. The first one analysed data concerning the compulsory notifications of MTP performed in Abruzzo region in 1995 - 2001 and 2006-2009 (28,371 notifications). The second one is a questionnaire survey, case – control designed. 371 women have been enrolled in all: 213 cases seeking abortion at the Ortona Hospital and at FAC of Chieti; 158 controls, within the patients or women visiting persons or accompanying aborters in the same health services. Results and Conclusions: The overall trend of voluntary abortion changed in Abruzzo region from last decades: the absolute number of MTP and the specific epidemiological indices decreased. In terms of phenomenon characteristics, the relative frequency of MTPs increased in younger and in foreign females. The case-control study indicates the immigrate women as main target, above all the employed and at low educational level. The FAC showed a significant role in primary prevention, but only in the case in which the women go there for health issues not concerning specifically the abortion. On the contrary, these services failed in the tertiary prevention, i.e. in the prevention of repetition of MTP by women going there for this specific issue (f.e. certification pre-MTP). Lastly, the multivariate analysis demonstrated the supremacy of social norms, attitudes and contraceptive self-efficacy in respect to the knowledge. Concluding, our study provides elements for health promotion planning and indicates useful strategies, such as the correct involvement of reproductive health services, i.e. FACs, the conceiving and validation of structured programmes that could help the operators in realizing effective counselling as well as in organizing training courses and in catching-up at risk subjects by means of peer to peer approach too. These programmes should be centred not only on theoretical knowledge, but also on practical skills in management and compliance for contraceptive methods. Moreover, they have to reinforce the intra and interpersonal skills. Disclosure of Interest: None declared
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11697/41551
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