Granted scientific projects

Below is a list of previously granted projects

– GRANTED PROJECTS 2019 –

Menstrual health and period poverty among young people who menstruate in the Barcelona metropolitan area (Spain)

The research on menstrual health is still scarce. Menstrual health is associated with the access of people who menstruate to accurate information about menstruation, menstrual products and clean and safe wash facilities. Also, with experiences related to the menstrual cycle and the use of menstrual health as a health promotion tool. A good menstrual health also includes tackling menstruation-related taboos, stigma and discrimination. Promoting menstrual health is key to reach gender equity and promote health people who menstruate. Also, it has been suggested that menstrual health should be incorporated as a vital sign and within sexual and reproductive health programmes. We would focus on “people who menstruate” rather than women no to exclude those who have a menstrual cycle but are not women/do not identify as women (i.e., transsexual and transgender).

Activist-led movements have increased awareness of the costs of menstrual products and socio-cultural practices and conceptions on menstruation that have a negative impact on women’s health and wellbeing. These movements aim at promoting “menstrual culture” to demystify the menstrual cycle, from a feminist and sociocultural perspective. These movements and some health professionals in Spain are already suggesting body awareness and knowledge about one’s menstrual cycle as tools for health promotion.

One aspect of menstrual health is the access to menstrual products. Research in other countries, such as the United Kingdom (Plan International UK, 2017), has highlighted experiences of period poverty among young women. This term refers to barriers (financial, social, cultural and political) in accessing menstrual products, and education of available products and menstruation.

Despite social movements to promote menstrual culture and reduce taxes of menstrual products in the last few years, menstrual health in Spain continues to be ignored. This is reflected on national and regional public health strategies, in which menstrual health is never present. Besides, even if 27,7% of children were at risk of poverty in Catalunya in 2017 (IDESCAT, 2018), experiences of period poverty have not been explored. Social, cultural, financial and political barriers to promote menstrual health, tackle stigma and discrimination and eliminate period poverty have also been overlooked.

Applicant: Laura Medina-Perucha (Spain)
Allocated amount by the ESC: 9.000 euro
Monitoring: P-2019-A-01
Full version of the application

Women’s opinions and experience of undergoing an ultrasound scan for gestational age before early medical abortion

Background and hypothesis: Medical abortion now accounts for 71% of terminations in England in Wales (DH 2018), and 86% in Scotland (ISD 2019). Most healthcare services in the UK perform ultrasonography to determine gestational age prior to medical abortion, despite guidance from the Royal College of Obstetricians and Gynaecologists (RCOG 2011) and the World Health Organization (WHO 2012) that routine use of ultrasound before abortions is unnecessary. Reasons for its persistent use are unclear but potentially include a desire to determine a precise gestational age so as not to exceed legal restrictions, to rule out extra-intrauterine pregnancy, and to document other findings such as multiple gestation or uterine fibroids.
A systematic review in 2014 reported on the accuracy of the last menstrual period (LMP) to determine gestational age up to 63 days of gestation (Schoenberg D et al. 2014). In the largest study in this review, only 1.6% of women had a gestational age by ultrasound in excess of 63 days of gestation when their LMP indicated the pregnancy was of a lower gestational age. This suggests that with the right screening criteria, early medical abortion without an ultrasound would be feasible for a large number of women. A recent
demonstration project tested this hypothesis in 365 women and found that medical abortion without screening ultrasound or pelvic exam was acceptable to women and resulted in no serious adverse events that were likely to have been prevented by those tests (Raymond EG et al. 2018).
Removal of the need to obtain an ultrasound to before medical abortion increases the potential for telemedical models of abortion care, including direct-to-patient models that are delivered online. There are few studies that explore women’s views on pre-abortion ultrasound. Most studies have focused on women’s experiences or opinions on viewing the ultrasound before the abortion and the relationship between that activity and decision-making around abortion (Simpson JD et al. 2019; Weibe E and Adams L 2009). This qualitative study will explore the opinions and experiences of women undergoing routine ultrasound for gestational age dating prior to abortion care.

Applicant: Patricia Lohr (UK)
Allocated amount by the ESC: 6.000 euro
Monitoring: P-2019-A-02
Full version of the application

Efficacy of Very Early Medical Abortion – a randomized controlled non-inferiority trial

Since its introduction into clinical routine medical abortion has changed the abortion practices dramatically in Sweden and is also gradually increasing in Europe and globally due to its high efficacy, safety and acceptability. During the last 25 years gestational age at an induced abortion has declined in countries, which have introduced medical abortion. This has resulted in more and more women presenting at a very early gestation for an abortion.
The possibility to do the abortion at a very early gestation has significant advantages for the women not only on a psychological level but also from a medical point of view. Very early medical abortion (VEMA) already before any intrauterine pregnancy can be visualized at an ultrasound examination may be of particular benefit to reduce pain and bleeding. In addition if women are encouraged to present early for their abortion it could give the opportunity to
detect and treat ectopic pregnancy in early gestation. However, a concern that VEMA may be less effective compared to treatment when an intrauterine pregnancy can be detected with ultrasound has led to inconsistent treatment protocols, demand of repeat visits to the abortion clinic, imposed unnecessary or harmful waiting times and impaired access. Most doctors in clinical routine as well as in clinical trials of medical abortion require confirmation of intrauterine pregnancy by ultrasound, excluding women who on transvaginal ultrasound have no visible gestational sac or the presence of an intrauterine anechoic structure without defining features of gestation, such as a yolk sac or fetal heart rate. Consequently there are only three published studies on the use of VEMA in women without confirmed intrauterine pregnancy. Two of these small retrospective studies the largest including 68 women, suggest that women undergoing VEMA might be more likely to experience treatment failure (i.e. ongoing pregnancy) and incomplete abortion. In contrast our research groups own analysis of a cohort of women undergoing VEMA compared with women with a confirmed intrauterine pregnancy undergoing medical abortion and including more than 1500 cases and matched controls indicates that VEMA is effective with no difference in efficacy compared with medical abortion in later gestation.
The risk of ectopic pregnancy is also of particular consideration and therefore, most health care providers delay the treatment until an intrauterine pregnancy can be visualized and confirmed. Clearly, more information is needed on the efficacy and safety of VEMA to develop evidence based clinical guidelines.

Applicant: Karin Brandell (Sweden)
Allocated amount by the ESC: 9.500 euro
Monitoring: P-2019-A-03
Full version of the application

– GRANTED PROJECTS 2018 –

POLKA 18 – youth-led research to advance adolescent sexual and reproductive health and rights in Poland

Poland remains among countries with the most restrictive legislations on sexual and reproductive health and rights (SRHR). Recent tries to introduce total abortion ban, emergency contraception being available only on prescription since July 2017, lack of comprehensive sexuality education programme at schools and increasing conscientious objection cases of providers denying SRHR services create a lot of misconceptions and keep Polish women and girls from receiving services they need. The stigma is particularly visible towards adolescent girls who are denied education and information about their bodies at schools, which makes them vulnerable towards negative health outcomes such as unintended pregnancies and sexually transmitted infections. The age of consent for sexual activity in Poland is 15, however young people needs parental consent to obtain sexual and reproductive health services until the age of 18. Recent changes in educational system is banning mentioning contraception and abortion and well as gender issues within the curricula.

After brief desk review, our team observed very limited and fragmentary evidence in the topic of sexual and reproductive health in Poland, especially in context of adolescents. Studies are usually outdated, not using standardised indicators and conducted only at regional or city level, due to limited funding possibilities, which makes creation of any evidence based policy and recommendations impossible. Conducting country-level population study gathering attitudes, myths and misconceptions among girls, elaborating integrated set of indicators for monitoring have the potential to address the gaps and promote behavior change and acknowledge adolescents as sexual beings.

Applicant: M. Drejza (Poland)
Allocated amount by the ESC: 8.000 euro
Monitoring: P-2018-B-03
Full version of the application

Contraception among HIV-positive women – knowledge, experience and factors that influence the choice

Every year almost 400 new cases of HIV infection are registered in Latvia and Latvia had the highest rate of new HIV cases among the European Union countries in 2017. A significant proportion of the infected people in Latvia are reproductive age women (35% in 2017).

Fertility of HIV-infected women is not significantly different from healthy women of childbearing age, and most of the HIV-infected women are sexually active. Nowadays, the availability of antiretroviral therapy (ART) and the prevention and treatment of opportunistic infections has significantly improved the life expectancy of HIV-infected patients, which has increased the need to improve the quality of life in this group.

Reduction of vertical transmission with ART and increasing life expectancy have also affected the opportunities and desires of reproductive potential for HIV-infected patients. Some HIV-infected patients have a low socio-economic status, which correlates with lack of knowledge and support, including the choice of contraception. These women are at risk of unplanned pregnancies.

Knowledge and access to effective methods of contraception play an important role in promoting sexual and reproductive health, achieving reproductive goals and preventing unintended pregnancies. The choice of contraception among women living with HIV who are aware of their serostatus have not been sufficiently studied in Latvia and in the neighboring countries..

The latest survey of sexual and reproductive health (SRH) in Latvia has been carried out in 2011 and showed very low prevalence of effective contraception. The number of HIV-positive people was too low to analyse the data separately.

National SRH survey in Latvia is planned for 2019 and will cover representative population from 15 to 64 years of age. However, the number of HIV positive women may be too low to have reliable results.

This study analysing contraception in HIV positive women is linked with the global policies of Universal Health Coverage as well as the WHO/Europe Action Plan for SRH: Towards achieving the 2030 Agenda for Sustainable Development in Europe – leaving no one behind. It is important to find out if HIV-positive women in Latvia receive adequate information on the possibilities of contraception, whether they have access to health services and whether they use the optimal methods of contraception according to their lifestyle and individual reproductive goals.

Read more in the full version of the application.

Applicant: G. Lazdane (Latvia)
Allocated amount by the ESC: 3.500 euro
Monitoring: P-2018-B-02
Full version of the application

A 3-D Approach to Intrauterine Contraception: Is a Ball Better than a T? A clinical randomized trial

The field of long-acting reversible contraceptives (LARCs) in general and IUDs in particular has seen few innovations in the last few decades. The classical IUDs are T shaped or U frame, and only a few are different (thread, rings and others); however, when deployed in the uterus, they all take a two-dimensional shape. Four years ago a new intrauterine device was invented by Baram I et al. (1): the intrauterine ball (IUB). The SCu300A IUB is a copper intrauterine device made by Nitinol and 17 copper pearls that, upon insertion in the uterus, takes a three-dimensional spherical form. Due to its form and deployment process, the IUB is expected to reduce perforation, malposition and expulsion rates and may also reduce dysmenorrhea and menorrhagia. The IUB is intended to have a lifetime of 5 years. This system has also intrigued mayor medical Journals: a 3-D approach to intrauterine contraception is better than a T? (see https://www.jwatch.org/na33399/2014/01/23/3-d-approach-intrauterine-contraception-ball-better-t). However, no published literature about its comparison with classical T shaped IUD is available today in the literature. For these reasons, we have decided to conduct a well designed clinical randomized comparative trial about the two types of IUDs in our University Hospital Service for Contraception.

Read more in the full version of the application.

Applicant: G. Grandi (Italy)
Allocated amount by the ESC: 9.500 euro
Monitoring: P-2018-B-01
Full version of the application

Internet application and education for young people via Facebook

The knowledge of young people is influenced mostly by misinformation via internet.They are attacked by not comprehensive things about contraception – this is they fisrtly find the information abou the harmfullness of using contraception. According my experience, in many cases, they get the same advice also from some teachers at the school. The aim of this project is to explain reproduction, how hormones work and why is necessary to have appropriate contraceptional method until they plan to have children, why is abortion harmfull. I would like to make 10 short sequences by pictograms (each dedicated to one topic) targeted on teenagers on Facebook. The topics are:

  1. How work the reporductive organs and menstrual cycle
  2. Concieving
  3. Methods of contraception
  4. Hormonal contraception – benefits and risks
  5. LARC -benefits and risks
  6. Barrier methods-benefits and risks
  7. Natural methods- benefits and risks
  8. STI
  9. Termination of pregnancy
  10. Who´m to contact for contraception, how the consultation looks like

Applicant: Tereza Smrhova Kovacs (Czech rep)
Allocated amount by the ESC: 3.000 euro
Monitoring: P-2018-A-01
– Full version of the application

Below is a list of previously granted projects

– GRANTED PROJECTS 2018 –

Internet application and education for young people via Facebook

The knowledge of young peple is influenced mostly by misinformation via internet.They are attacked by not comprehensive things about contraception – this is they fisrtly find the information abou the harmfullness of using contraception. According my experience, in many cases, they get the same advice also from some teachers at the school. The aim of this project is to explain reproduction, how hormones work and why is necessary to have appropriate contraceptional method until they plan to have children, why is abortion harmfull. I would like to make 10 short sequences by pictograms (each dedicated to one topic) targeted on teenagers on Facebook. The topics are:

  1. How work the reporductive organs and menstrual cycle
  2. Concieving
  3. Methods of contraception
  4. Hormonal contraception – benefits and risks
  5. LARC -benefits and risks
  6. Barrier methods-benefits and risks
  7. Natural methods- benefits and risks
  8. STI
  9. Termination of pregnancy
  10. Who´m to contact for contraception, how the consultation looks like

Applicant: Tereza Smrhova Kovacs (Czech rep)
Allocated amount by the ESC: 3.000 euro
Monitoring: P-2018-A-01
– Full version of the application

Survey on the Attitudes, Knowledge and Practices on Emergency Contraceptive Pill among Polish physicians

Polish Doctors for Women (Lekarze Kobietom) is an informal initiative that unites doctors from all across Poland willing to help women gain access to emergency contraception. The initiative has been a response reaction towards Polish Ministry of Health’s decision to reinstate the requirement for doctor’s prescription for emergency contraception. The Federation for Women and Family Planning serves as the secretariat and legal agent of the initiative. The idea is simple. After receiving a message from a patient in need, member of our organisation suggests her to have an appointment with ar General Practitioner, gynecologist or, if it’s a weekend or late evening, to visit the Emergency Department at local hospital. In many cases that’s enough – according to Polish law, every doctor with a valid medical license can issue a prescription for the emergency contraceptive pill (levonorgestrel 1,5 mg or ulipristal acetate 30 mg). Unfortunately, there are situations when a doctor refuses to write a prescription referring to the conscientious objection. Only in cases when such circumstances occur women are asked to contact Doctors for Women, she is then referred to one of doctors who is part of the initiative. Doctors for Women work as volunteers or charge patients symbolically “1 PLN” (0,23 EUR) for an appointment. Our daily activities are around three main areas:

  • direct management of the requests of the patients at the on-line platform
  • recruitment and reaching out to potential new providers
  • raising awareness on sexual and reproductive health and rights and addressing myths and misconceptions via social media channels, news and infographics.

OBJECTIVE: The purpose of this work is to explore the knowledge, attitudes, and beliefs of physicians (both members of the Doctors for Women and non-members) about intention to prescribe emergency contraception pills and to identify barriers to emergency contraception pill use. To determine how to structure and deliver messages about ECP and ensure effective communication it is essential to evaluate common fears, concerns, and misconceptions about ECP, as well as which specific knowledge gaps that need to be addressed. MATERIALS AND METHODS: We would like to survey about 1000 doctors practicing in Poland public and private health institutions. Surveying will be conducted online and during the annual meeting of Polish Society of Gynecologists and Obstetricians. We would like to divide participants into several categories: depending if they are members of Polish Doctors for Women or not and if they are Gynecologists and resident doctors of obstetrics and gynecology or other specialties. Doctors will be surveyed over the same period, using the same questionnaire, divided into five sections:

  • basic demography such as age, sex, specialty and type of practice;
  • the types of emergency contraceptives used, whether they provided emergency contraceptive pills in advance and their estimated workload;
  • 10 questions to test the subjects’ knowledge on current international recommendations on emergency contraception;
  • statements to evaluate their attitudes towards emergency contraception using a four-point scale from 1 (strongly disagree) to 5 (strongly agree);
  • statements to evaluate their attitudes towards more liberal delivery of emergency contraceptive pills using the same four-point scale.

To maximize the impact of this project an roundtable meeting will be held after analyzing the results of the survey. Its aim is to engage Doctors for Women members, practitioners, medical students and NGO leaders in a debate on a key challenges that are faced in Poland in terms of EC.

Applicant: Krystyna Kacpura (Poland)
Allocated amount by the ESC: 7.000 euro
Monitoring: P-2018-A-02
Full version of the application

Actual issues of contraception and reproductive health of Ukrainian military women in the zone of armed conflict

Increasing requirements for health care military women are related to the worldwide tendency of growth of female representation in the security and defense sphere. Ukrainian military women today is an unique, aever-growing demographic group, a part of modern European womanhood, who, in connection with the armed conflict in eastern Ukraine, have high health and life risks. According to previous studies, women soldiers in terms of military deployments seek medical help 2 times more often than their male counterparts. Wherein, the overwhelming majority of these appeals are connected with gender-specific medical problems, such as contraception, bleeding, menstrual cycle control/menstrual supression, hygiene issues, pregnancy. Such studies of reproductive health issues of Ukrainian military women in an armed conflict zone have not been held before. Study will be conducted in frames of valid memorandum with the Ministry of Defense of Ukraine №17116/з/1 dated from 01.11.2017. Objectives of the study are totally congruent with aims of ESC and are about carrying out epidemiological and sociological studies on contraception and reproductive health care facing female military servicewomen in the current war zone in the East of Ukraine. At the base of 3 Military Mobile Hospitals completion of questionnaires of 600 military women is planned, those, who serve in Joint Forces Operation zone in Donetsk and Lugansk regions. The level of awareness and use of different methods of contraception and STIs preventing by women in military conditions will be studied, as far as access to gender-specific medical assistance, availability of contraceptives and counselling services on reproductive health. Pregnant military women will additionally fill out the forms for London Measure of Unplanned Pregnancy (LMUP). Gained from first sources information will allow define the real state of the gender-specific medical problems of military women in the war zone and will facilitate the elaboration of mechanisms of its tackling. This study will become a base for further studies and will have not only expressive medical, but also social-economic impact. After the questionnaires, the consultations on contraception issues for military women will be held. According to the results of the study, the arrangement of round table together with politicians, deputies, healthcare organizers, military and civil medicians is planned. Outcomes: Poster or/workshop presentation to ESC Annual Congress, 2020

Applicant: Burlaka Olena (Ukraine)
Allocated amount by the ESC: 7.250 euro
Monitoring: P-2018-A-03
– Full version of the application
Interim report

Knowledge, perception and use of contraceptives among young people in Moldova

The Republic of Moldova is one of the countries with a high rate of abortion and HIV-AIDS among young people. The incidence of HIV among young people aged 15-24 has increased during last decade from 16.08 new cases per 100,000 inhabitants in 2006 to 21.28 per 100 thousand inhabitants in 2012.
The incidence of sexually transmitted infections among youth in Moldova is one of the highest in the region – about 180 new cases per 100,000 population of aged 15-24, about 50% higher than in the general population. Each 10th abortion is performed in a young girl aged 15-19 years. A study conducted in 2012 shows that of the total number of sexually active teenagers aged 15-19, only half used constantly the condom during the last year and about 20% did not indicate the use of contraceptive methods in current practice.
These health indicators reflect a limited access to information and contraceptive services, especially for adolescents in rural area.
From the communication with the yang patients, with students of the Medical University, we found out, that there are many myths, related to modern contraceptives, especially hormonal, and many misconceptions, leading to negative attitude and refusal to use contraception. Their documentation, as well as the identification of their sources, of the attitudes toward using them and of the barriers of accessing contraceptives would be very important. It would allow us to design new, targeted, informational-educational-communication programme for yang community, and increase their level of knowledge, thus – increase the use of modern contraceptives. In order to achieve these goals, we will conduct an Internet based survey with the use of self-administered questionnaire, distributed via Facebook and other social-media channels. The data will be collected with the help of the students from the State Medical and Pharmacy University of Moldova and the network of peer-to –peer educators “Y-Peer Moldova” in the group aged 15-24 years. In the questionnaires, they will be asked about their attitude toward contraception, their experience of using or not using it, myths they know, their exact source of this information (web pages, etc.), and barriers of the use.

Applicant: Comendant Rodica (Moldova)
Allocated amount by the ESC: 5.800 euro
Monitoring: P-2018-A-04
Full version of the application
Interim report

– GRANTED PROJECTS 2017 –

Use of prescribed contraception in Northern Ireland 2010-2016

Northern Ireland is in a unique position in the United Kingdom (UK) as abortion is only legal under very limited circumstances. The risk of an unintended, potentially unwanted, pregnancy is related to whether or not a woman uses any method of contraception and which method she uses. Evidence from studies of contraceptive use in Great Britain (which excludes Northern Ireland) and Ireland has found that contraceptive use is sociodemographically patterned. We do not know if, or how, contraceptive use in Northern Ireland varies by age or deprivation. If, as in the rest of the UK, the younger and most disadvantaged are least likely to use contraception, or to use effective methods of contraception, they will be at increased risk of having an unintended pregnancy. These same women will be those most impacted by the abortion laws in Northern Ireland due to the cost of travelling to England for an abortion. A new source of information on the use of contraception is data routinely collected by the health service. Research based on this administrative data would be free from recall and social desirability bias, which may be present in surveys of contraceptive use. In Northern Ireland, the Honest Broker Service (http://www.hscbusiness.hscni.net/services/2454.htm) facilitates research using routinely collected administrative health datasets. This includes all prescriptions dispensed to the Northern Ireland population since 2010. Through the Honest Broker Service this project aims to describe the use of prescribed contraceptives in Northern Ireland and explore how this varies based on a woman’s age and the deprivation in the area in which she lives. As the prescriber plays a critical role in determining medication use we will also explore how the use of prescribed contraceptives varies based on characteristics of the woman’s general practice such as size of general practice, urban/rural practice location and practice area deprivation. A population based cohort study will be conducted including all females aged 12- 49 registered with a General Practitioner in Northern Ireland 2010-2016. There were an estimated 472,875 females between the ages of 12 and 49 living in Northern Ireland between 2010 and 2016 with 2,316,075 prescriptions for a contraceptive. The prevalence of use of any, and the different methods of, prescribed contraceptive will be determined for each calendar year and for the 2010-2016 period. Descriptive statistics and multilevel logistic regression analyses will be used to explore the use of any, and the different methods, of prescribed contraceptive across age groups, area deprivation, general practice size, urban/rural practice location and practice area deprivation. A multilevel approach is necessary due to the clustering of women within general practices and the longitudinal nature of the data. At the end of the study, a policy brief will be published and a roundtable event will be held to engage clinicians, policy makers and academics. The results will also inform a subsequent study exploring a wider range of sociodemographic and health related factors associated with prescribed contraceptive use.
Applicant: Joanne Given (UK)
Allocated amount by the ESC: 4506 euro
Monitoring: P-2017-B-01
Full version of the application
Interim report
Final report

Incorporating WHO Safe Abortion Guidelines into abortion discourse and surveying attitudes to these guidelines of healthcare providers in Ireland

Rationale Ireland is at a critical juncture in terms of reproductive health. Notwithstanding historical stigmatisation and politicisation of abortion, a parliamentary committee on abortion recently recognised safe abortion access as a clinical necessity and integral to reproductive healthcare. A referendum on abortion access is likely in early summer 2018. With just 25 legal abortions provided in Ireland in 2016 however, healthcare providers’ familiarity with best practice in abortion care cannot be taken for granted. The IFPA’s experience from biannual delivery of contraception courses and other training is that knowledge is generally inconsistent, and HCPs largely uninformed about abortion care provision, notably medical abortion. At the same time, a growing public health crisis of clandestine access to abortion medication outside lawful healthcare pathways is motivating HCPs, as well as politicians, to recognise the need for law reform. Research elsewhere has suggested that knowledge of best practice in abortion care provision can decide individual attitudes to its provision, and hence influence care of women experiencing unintended or crisis pregnancy. In this context, lack of data on the attitudes towards abortion access in this cohort is of great concern. The scarcity of data on the views and knowledge of healthcare providers in Ireland on abortion is of concern for provision of a service susceptible elsewhere to access barriers and stigmatisation. Resources In late 2017, the aforementioned parliamentary committee heard evidence from 19 medical experts, including the World Health Organisation (WHO), British Pregnancy Advisory Service, a past president of FIGO, the Irish College of General Practitioners, the Irish Institute of Obstetricians and Gynaecologists (IOG), and the IFPA. We propose creating an online toolkit for healthcare providers in Ireland, using this evidence to build a comprehensive overview of best practice abortion care provision (and the integration of enhanced, affordable contraceptive care). The toolkit will highlight the alignment between WHO Safe Abortion Guidelines and medical ethics guidelines of the Irish Health Information and Quality Authority (HIQA) and potential future access to abortion for Irish residents. Methods The toolkit will be based on qualitative thematic analysis of official transcripts and documentation of the expert medical testimony presented to the parliamentary committee, using NVivo software to code the data. Data will be coded to themes of best practice abortion and contraception care provision and medical ethics highlighted in the WHO and HIQA guidelines. The toolkit will be disseminated to healthcare providers through professional bodies such as the IOG. We will design and disseminate a survey to record the views and self-reported knowledge of healthcare providers in Ireland regarding current (illegal) and future (legal) abortion care provision. Survey results will be analysed using Microsoft Excel and NVivo, using grounded theory methodology. Outcomes • Educational online toolkit for Irish healthcare providers on best practice abortion care provision.
• Rich analysis of views of healthcare providers in Ireland on abortion care provision.
• Insightful data and analysis for the European context regarding decriminalisation of abortion and introduction of community based abortion care. • Poster and/or workshop presentation to ESC Annual Congress in Ireland in 2020.
Applicant: Caitriona Henchion (Ireland)
Allocated amount by the ESC: 8125 euro
Monitoring: P-2017-B-02
Full version of the application
Interim report

Stigma and discrimination of Siberian people living with HIV(PLHIV) by Ob&Gyn specialists and discrimination-reduction programming

Rationale. A number of studies have shown that many people living with HIV (PLHIV) require adequate assistance regarding their reproductive health including consulting on contraception and infertility issues. At the same time HIV- related stigma and discrimination (S&D) by medical care providers are recognized as key factors preventing patients from receiving medical and counseling services. Currently there is an increase of PLHIV number in Russian Federation, the most significant among women of young reproductive age. Irkutsk Region, as well as all Eastern Siberia, are characterized by extremely high prevalence of HIV infection, however there is no data regarding HIV- stigmatizing attitudes within local Ob&Gyn service providers. Methods. To identify HIV-related S&D we will assess HIV stigmatizing attitudes among Ob&Gyn doctors and nurses in Irkutsk Region’s healthcare service settings and test some of the factors associated with HIV/AIDS-related stigma, using online survey, based on 2 validated tools: “A brief, standardized tool for measuring HIV-related stigma among health facility staff” (Srithanaviboonchai K, 2017) and “Questionnaire for doctors and nurses’ views on people living with HIV/AIDS” (Vorasane S.,2017). The results of survey will be used to create 2 different educational programmes (“Standart course” and “Training for trainers”) for Ob&Gyn specialists in 2 random health care settings (with pre-test and post-test to estimate the efficacy of interventions). The most effective educational approach to decrease stigma and discrimination of PLHIV will be disseminated and utilized in all Regions of Eastern Siberia.
Applicant: Larisa Suturina (Russia)
Allocated amount by the ESC: 6400 euro
Monitoring: P-2017-B-03
Full version of the application
Interim report

Empowering abortion-seeking women in contraceptive decision-making: an online contraception tool

Rationale: The prevention of unintended pregnancy is an important dimension of reproductive health strategies. Unintended pregnancies which are carried to term are expensive for society as they are associated with a higher rate of pre- and postnatal depression in parents, less prenatal care, and less positive parent-child interactions (e.g. Leathers & Kelley, 2000). Unintended pregnancies which are terminated by induced abortion are costly for society as well. Hence, strategies to increase effective contraceptive use for those who want to prevent unintended childbirth, are indispensable. Besides various distal risk factors for unintended pregnancies such as low educational level or young age (e.g., Wellings et al., 2013), an important proximal determinant for unintended pregnancies is a recent change in contraception behavior (e.g. Schreiber, Whittington, Cen, & Maslankowski, 2011). Hence, two groups of women are highly at risk for unintended pregnancies because of their need to decide upon (re)new(ed) methods for contraception: 1) women who recently gave birth to a child, and 2) women who had an induced abortion. Women in both groups are confronted with the decision to either continue the use of their previous method or to use a new method for contraception. In the abortion population, the decision for post-abortion contraception is often postponed, which leads to a higher risk for repeat abortion (Heikinheimo, Gissler & Suhonen, 2008). In addition, discussing current and future contraceptive use is often perceived as difficult by health care providers working in abortion clinics (Purcell, Cameron, Lawton, Glasier, and Harden, 2016). Although women who seek an induced abortion want to be informed about how to prevent future unintended pregnancies, they do not want to be perceived as ‘irresponsible’ as a result of their current unintended pregnancy. Hence, there is a need for non-judgmental contraception counseling in abortion clinics as a means to increase the tailored uptake of effective contraceptives in the post-abortion period.

Methods: SENSOA, the expert organization on sexual health in Flanders, recently developed an evidence based online contraception tool to help women make informed contraceptive choices (http://www.seksualiteit.be/anticonceptie). The tool is unique as it provides women an overview of the criteria which are frequently used to decide upon methods for contraception (including future desire to have children, needs regarding to the frequency of using the method or the use of hormones, as well as relational barriers such as the need to go to the medical doctor or privacy issues). The methods who meet the personal criteria of the women are enlisted. The price and trustworthiness of these methods is depicted, and women can request additional information about one specific method by clicking on a special button. Within this project, we want to test the added value of this newly developed contraception tool for women who seek an induced abortion and who need to decide upon future methods for contraception.

Specific approach: Randomized Control Study (RCT) in five LUNA abortion centers. The RCT has three conditions: (1) treatment as usual (discussing current and future contraceptive use and explaining and during the pre-abortion counseling session), (2) providing women an online information leaflet depicting all different methods for contraception (with their advantages and disadvantages) to women who had the treatment as usual, and (3) women individually filling out the SENSOA contraceptive tool following the treatment as usual. The information leaflet will include the same information that is given to women in condition 3 who push the ‘more information’ button after they have filled out the contraception tool. In each condition, 150 women will be recruited (which will take three months). Prior to the intervention and prior to the treatment as usual, women will be asked to fill out a paper-and pencil questionnaire in the waiting room of the abortion center regarding their current contraceptive use (satisfaction with current method, barriers in using this method…) as well their needs regarding to contraceptive use on the one hand and contraceptive counseling on the other hand. The intervention in condition 2 and 3 will take place between the treatment as usual and the abortion procedure by sending participants an e-mail with the request to either read the online information leaflet or fill out the contraception tool. Women in all conditions will be requested to fill out an online post-intervention questionnaire probing participants with questions about their awareness and decision process on future contraceptive use.

Outcomes:

  1. (Change in) awareness of personal needs regarding to future contraceptive use
  2. Satisfaction with contraceptive counseling and the decisional process regarding post-abortion method for contraception
  3. Planned method for contraception following the abortion (LARC versus other) / change in method for contraception
  4. Knowledge regarding the risk on future unintended pregnancy with the planned method for contraception
  5. Knowledge regarding the procedure for effective use of the planned method for contraception

Applicant: Joke Vandamme (Belgium)
Allocated amount by the ESC: 8.000  euro
Monitoring: P-2017-A-01
Full version of the initial application
Interim report

Multidisciplinary approach for improving sexual health in female cancer survivors

Rationale: With the advances in cancer diagnosis and treatment, the number of cancer survivors is constantly increasing, creating a special subgroup of the population whose needs are often unmet. Cancer survivors must readjust both professionally and socially to a disease-free lifestyle, a task that can be significantly impaired by chronic treatment side-effects, lack of communication with their physicians or psychologists or the absence of a support group. In many countries, sexuality is not frequent topic of discussion with cancer patients. This is due to both physician’s and patient’s reluctance. Additionally, in Eastern Europe countries, women may be afraid to discuss such issues with a physician or a psychologist and thus may have numerous misconceptions and prejudices. Currently, there is no standardized approach for addressing the sexual health issues of female cancer survivors in Romania. The aim of the study is to assess the effect of a multidisciplinary approach on sexual health in this population and, with the aid of the data we gather, to create a brochure that answers frequently asked questions in this area.

Method: Prospective randomized clinical trial

Approach: 100 patients who are premenopausal cancer survivors (all cancers)

Inclusion criteria:

  • women aged 18-55
  • diagnosed with a non-metastatic cancer for which they have received either surgery, chemotherapy radiotherapy or a combination of the three
  • have finished their cancer treatment at least three months prior to study enrollment and are currently considered “cancer free”

All female cancer survivors that fulfil the inclusion criteria will be asked if they are interested to participate in the study. If they agree, they will be asked to answer several sexuality-related questions derived from three validated questionnaires: SF-36, EORTC QlQ-C30 and QLACS.

Those that are not considered to have a satisfactory reproductive health will be randomly divided in one of two groups:

  • group A – observation only
  • group B – multidisciplinary counseling (three scheduled sessions with an oncologist, a psychologist and a gynecologist).

For group B, the first session will be mandatory, and additional sessions are left at the discretion of the participant. During these sessions, the investigators will identify potential physical/psychological/social issues that can lead to sexual problems in these women and, if possible, will try to address them either by counselling either by prescribing standard of care medication.

Six months after randomization, all participants will undergo the same questionnaire assessing reproductive health. It will assess if multidisciplinary counselling has improved sexual health in female cancer survivors. All sessions will be recorded. At the end of the study, a frequently asked questions (FAQ) brochure will be created so that other cancer survivors benefit from the information acquired throughout the project

Outcome

  1. Assessing the potential improvement of sexual health in female cancer survivors by means of multidisciplinary assessment
  2. Creating a brochure that tries to answer these individuals’ most frequently asked questions. The brochure can then be offered to all female cancer survivors

Applicant: Lucian Miron (Romania)
Allocated amount by the ESC: 8.750 euro
Monitoring: P-2017-A-02
– Full version of the initial application
Interim report

Unplanned and unwanted pregnancies in the emergency room- implications for providing contraceptive counseling

Unplanned and unwanted pregnancies are common in Sweden which has the highest number of abortions in Western Europe. In a retrospective study we could show that approximately 40% of ectopic pregnancies are a result of unwanted pregnancies. However, less than half of women received any contraceptive counseling at the end of treatment and were thus left with a risk of repeat unwanted pregnancy (submitted).

We now wish to perform a prospective study to further explore the problem of unplanned and unwanted pregnancies in especially ectopic pregnancy, miscarriage and hyperemesis gravidarum.

In this project all pregnant women seeking emergency care in the gynecological emergency room of Danderyd Hospital will be informed about the study and sign informed consent according to GCP should they choose to participate. Women will fill in an online questionnaire concerning demographic parameters, gynecological and obstetric history as the well as the London Measure of Unplanned pregnancy. They will receive care according to current clinical routine.

Three months after the first visit they will receive another online questionnaire concerning outcome of their pregnancy and any contraceptive counceling received. They will also answer questions regarding any sick leave taken or granted for a health economic analysis of unplanned and unwanted pregnancy.

Women with severe emergencies demanding immediate care will be excluded as will women with insufficient knowledge of the Swedish language (if results warrant a larger study- the questionnaires will be translated into the most common immigrant languages for future studies)

Applicant: Helena Kopp Kallner (Sweden)
Allocated amount by the ESC: 3.550 euro
Monitoring: P-2017-A-03
Full version of the initial application
Interim report
Final report

– GRANTED PROJECTS 2016 –

Contraceptive counselling training for clinicians everywhere! Development and delivery of a free ‘Massive Open Access Online Course’ (MOOC) for health professionals

We propose the development of a (free) Massive Open Access Online Course (MOOC) on contraception counselling. Massive open access online courses (MOOCs) aim at unlimited participation and open access via the internet. They deliver education through filmed lectures, animations, readings, discussion forums and knowledge tests. With no course fees, no travel or accommodation costs, MOOCs make training accessible. There are no quality assured, interactive, clinically focused, online courses teaching contraceptive counselling. This is an important gap. Contraceptive choices consultation facilitates informed decisions. Women who have an expert contraceptive choices consultation are more likely to be happy with their method and to use it effectively.

We propose to develop and evaluate a MOOC on contraceptive counselling that builds the competence of health professionals everywhere. We have match funding from the Faculty of Sexual and Reproductive Health Care to develop this course. The course will be delivered in English and available on the Future Learn platform (www.futurelearn.com) or the websites of relevant professional organisations such as the ESC and the FSRH. Future Learn is accessible on mobile, tablet and desktop, 24 hours a day with over 5 million learners from 140 countries.

Applicant: Paula Baraitser (UK)
Allocated amount by the ESC: 7.950 euro
Monitoring: P-2016-B-01
– Full version of the initial application
– Interim report
Final report

Larc Forward Counseling – LOWE
To test this we have designed a cluster randomized control trial

LARC methods are underutilized in Sweden although their superior effectiveness and user satisfaction in comparison to other methods is well known among contraceptive counselors and prescribers. Our hypothesis is that an intervention consisting of method specific education and training to service providers, pre-visit video information for women seeking contraceptive advise and structured LARC centered counseling will increase the prescription and uptake of LARC compared to standard counseling. To test this we have designed a cluster randomized control trial (intervention or standard counseling) that will include study participants from 4-6 youth clinics, 4-6 midwifery clinics, and 4-6 abortion clinics in Stockholm county. Prior to clinic randomization, comparisons will be made to ensure similar population with regard to demographic parameters such as clinic size, number of staff, baseline rates of LARC prescription and Swedish/non-Swedish born women for each type of clinic.

Primary outcome is LARC use at 6 months post intervention.

Secondary outcomes are (among others):
– compliance and continued method use
– satisfaction of LARC and other methods
– overall unintended pregnancy rates at 3, 6 and 12 months follow ups.
– User satisfaction with counseling by women and staff
– Cost effectiveness of LARC centered counseling

Applicant: Niklas Envall (Sweden)
Allocated amount by the ESC: 5.000 euro
Monitoring: P-2016-B-02
– Full version of the initial application
– Interim report
– Interim report 2

The relationship between the use of hormonal contraceptives, the composition of the vaginal microbiota, and the risk to acquire Chlamydia infection among women

Worldwide, approximately 50% of women use hormonal contraceptives (HC) and annually 131 million individuals acquire Chlamydia infection. The vaginal microbiota (VM) is one of the natural barriers for STI entry. HC use might affect VM composition, and thus, HC might also affect the protective function of the VM. We will explore how HC use relates to VM composition and CT risk, using data from 610 female participants of the Healthy Life in an Urban Setting (HELIUS) Study, using (multinomial) logistic regression analyses. We will account for sexual behavior and demographics (including ethnicity). HELIUS is a prospective cohort study among an urban multi-ethnic population that aims to unravel the impact of ethnicity on health, initiated in 2011 [Stronks K BMC Public Health 2013]. A better understanding of the interaction between HC use, VM composition and STI risk is needed, because the possible population impact of an association between HC and STI like Chlamydia may be substantial.

The results of this analysis will be used to inform a newly initiated cohort study among women to investigate the causal effects of HC use and VM composition on the risk to acquire sexually transmitted infections.

Applicant: A.A. Matser (the Netherlands)
Allocated amount by the ESC: 9.420 euro
Monitoring: P-2016-B-03
Full version of the initial application
Interim report
Final report

Is there a stigma for working on abortion field? The care provider’s perspective

Introduction: In Portugal, abortion is allowed by women request since 2007 and is performed mainly on public National Health System Services (NHS) (70%). Since then we performed near 19000 abortions per year, but paradoxically there are few professionals working on the field. The stigma generated between healthcare professionals is underestimated and could be one of the reasons for the gap on training and a future barrier on acess to safe abortion. Moreover, stigma may also contribute to increased stress, burnout, and strain on collegial relationships. If stigma represents a human resource issue in abortion, reducing its impact may improve the gap on training and the access to safe abortion care, an important indicator of public health.

Study Design: We will recruit health professionals (medical doctors, nurses and midwifes) who work on abortion at public NHS to complete an online survey anonymously. The evaluating providers’ experiences of stigma and its impact on their work and life will be studied using the 35-item Abortion Provider Stigma Survey Instrument developed by Lisa Martin and colleagues and correlated with demographic characteristics of the providers including years of practice. This scale was design specifically for abortion providers and included adaptations of items that targeted universal aspects of stigma in each of its domains as well as items that measured circumstances specific to abortion care, including stigma related to professional work.

The answers will be evaluated into five main topics:

Disclosure Management (providers’ experiences with disclosing their abortion work identity, including worries, consequences and actions associated with disclosure); Internalized States (providers’ responses to potentially positive aspects of their work) judgment (negative behavior from other health professionals), Social Support ( support of the family and friends about the work field) and Discrimination (perceived consequences of abortion stigma).

Applicant: Teresa Bombas (Portugal)
Allocated amount by the ESC: 7.300 euro
Monitoring: P-2016-B-04
– Full version of the initial application
– Interim report
– Final report

Perceptions and attitudes on reproductive health and contraception in obese teenagers

Obese adolescents tend to use contraception methods less than girls with normal weight, and excess weight is often used as a reason for poor compliance of contraceptive use. Obesity may add additional complications to the unwanted teen pregnancies such as gestational diabetes, preeclampsia, hypercoagulability, intrauterine death. In the same time, lower self-esteem and reduced sexual quality of life is reported as consequences of obesity.

The aim of this project is to identify the influence of obesity on sexual behaviour and contraception usage in obese female teenagers and to achieve a focused educational intervention programme on reproductive health.

After signing an informed consent we will address questionnaires to obese female teenagers aged 15-18 in order to identify the level, duration and type of contraceptive usage, level of self-esteem, aspects of sexual behaviour, variations in body weight during contraception. Each participant will be rendered printed brochures with full range of contraceptive options, including the risks and benefits of each method. We will organise two workshops in the Regional Center for Diagnosis and Monitoring of Obese Children for health professionals working with obese teenagers. We will offer informations on reproductive health and contraceptive methods through a social media page dedicated to obese teenagers.

Applicant: Laura Trandafir (Romania)
Allocated amount by the ESC: 5.775 euro
Monitoring: P-2016-B-05
Full version of the initial application
Interim report

Exploring the feasibility of providing immediate postpartum contraception with copper intrauterine devices in Gwagwalada Area council of the Federal Capital Territory of Nigeria

Unmet need for family planning in Nigeria currently stands at 16 percent among married women. Immediate postpartum long-acting reversible contraception (LARC) has the potential to reduce unintended and short-interval pregnancy. However, provision of immediate postpartum contraception with LARC in Nigeria is practically non-existent due to lack of awareness, the population’s socio-cultural health beliefs and lack of trained providers. We know that only 20.6% of women in Abuja use modern forms of contraception, and there is the absence of data about provision and use of immediate postpartum contraception in this area.

This study aims to address this lack of data by assessing the feasibility of providing such a service through focusing on acceptability, demand, implementation and practicalities. We will obtain Institutional Ethics Committee approval. Acceptability will be assessed using a convenience sample of all pregnant women attending the obstetric service. A participant information leaflet will be given out, and those who elect to participate will complete a short questionnaire. We will assess the other areas of focus using standard feasibility study procedures.

This study has the potential to fill a significant gap in the literature and inform efforts by stakeholders to increase access to modern and highly effective contraceptive methods.

Applicant: Babalunde Gbolade (UK)
Allocated amount by the ESC: 5.000 euro
Monitoring: P-2016-B-06
– Full version of the initial application

Exploring Polish women’s experiences obtaining medication abortion through an online provider

Abortion is legally restricted in Poland. Since 1993, the government has banned abortion except in cases when the pregnancy threatens the life of the woman, results from a criminal act, or involves a serious fetal abnormality. In recent years, a number of local, national, and international efforts have been undertaken to raise awareness about the harms associated with the restrictive abortion law and identify avenues to expand safe abortion care.

Established in 2014, Women Help Women offers Polish women the option of consulting with an online provider and, if eligible, receiving a package of mifepristone/misoprostol for early abortion through the mail.

Our proposed study explores women’s experiences obtaining abortion care through this online service. In Phase I, we will review client data from January 1, 2015 through June 30, 2016 (approximately 400 cases) to evaluate clinical outcomes and acceptability. In Phase II, we will conduct in-depth telephone/Skype interviews with a sub-set of clients (n=20-30) in order to understand better women’s perspectives and experiences.

This mixed-methods study promises to make a significant contribution to the literature dedicated to telemedicine. Further, through engagement with local stakeholders we aim to inform efforts to improve and expand existing online abortion services in Poland. Given the ongoing efforts to roll-back reproductive rights in Poland, our study is especially timely.

Applicant: Angel M. Foster (Canada)
Allocated amount by the ESC: 9.000 euro
Monitoring: P-2016-A-01
– Full version of the initial application
 Interim report
– Final report

The Impacts of Restrictive Abortion Laws in Northern Ireland: Women’s Experiences and Opportunities for Policy Change

Northern Ireland has one of the most restrictive abortion laws in Europe. Abortion is illegal except to save a woman’s life or her permanent physical or mental health. Yet even these provisions have a murky legal interpretation. Providers, fearing prosecution, rarely implement them. Northern Irish women wanting an abortion have two main options: travel by plane or boat to Britain or access medication abortion outside the formal healthcare setting through online initiatives.

Yet very little is known about Northern Irish women’s abortion decision-making and experiences. The proposed project will address these important research gaps by conducting a rigorous exploration. Using in-depth interviews with 30-40 women who traveled to British Pregnancy Advisory Service (BPAS) clinics in England and 30-40 women who accessed abortion medications online through Women on Web, the specific aims of the proposed project are to:

  1. Investigate Northern Irish women’s decision-making processes surrounding abortion, including the factors influencing their chosen pathway to abortion.
  2. Examine Northern Irish women’s subsequent experiences with their chosen pathway to abortion, including outcomes, complications, economic cost, and social and emotional support.
  3. Explore Northern Irish women’s perspectives on the elements of care that ensure safe, successful, and satisfactory medication abortion experience, identifying any deficiencies.

Applicant: James Trussell (USA)
Allocated amount by the ESC: 7.000 euro
Monitoring: P-2016-A-02
– Full version of the initial application
– Final report

Identifying the onset and course of hormone withdrawal migraine to optimise treatment with prophylactic agents

The International headache Society (IHS) defines Menstrual Migraine as attacks fulfilling the following criteria:

  1. Migraine without aura
  2. Attacks occur exclusively on day 1±2 (ie, days -2 to +3) of Menstruation in at least two out of three menstrual cycles.

It is further described, that these headaches can either result from hormone withdrawal during the natural cycle as well as from hormone withdrawal in the case of oral contraceptive (CHC) use. Considering that women using CHC experience hormone withdrawal not in association with the bleeding but always at the first day of the pill-free interval the definition is unprecise and can cause confusion if pill users are not separated from women with natural cycles in clinical trials.

Bleeding associated attacks frequently do not respond to acute medication. Therefore prophylactic tripan use over several days is the only way to help this women. Because of the association of high triptan use with medication-overuse headaches the interval for use of these medication should be chosen as short as possible. In the natural cycle prophylactic agents are recommended to be started 2 days before bleeding and be continued for 5-7 days. In CHC users the onset of bleeding and the day of hormone withdrawal are more predictable. Better prediction of migraine onset in these women could allow to shorten the period of prophylactic triptan use. 200 CHC users with withdrawal migraines are followed for 3 months with headache.

Applicant: Gabriele Merki (Switzerland)
Allocated amount by the ESC: 5.200 euro
Monitoring: P-2016-A-03
Full version of the initial application
Interim report
Final report

Sexual and reproductive health among young individuals with intellectual disabilities

According to the UN Convention “Rights of persons with disabilities” from 2006, individuals with intellectual disabilities (ID) have the same human rights as other people have. Few studies have, however, investigated sexual and reproductive health issues, such as contraception and child-bearing among young individuals with ID. The aim of this study is to gain a deeper understanding of how young people with ID and their parents reason about and handle questions and situations related to sexual and reproductive health, including contraception.

Methods
This is a qualitative study. Four focus-group interviews with 20 personnel working to support young individuals with ID have been performed and analysis is ongoing. Prelminary findings; Difficult dilemmas often arise about sexual health and rights and some situations can be difficult to handle. The personnel can then feel a sense of powerlessness and be aware that they do not have enough tools and knowledge to solve the situations. Individual interviews with approximately 15 young people and 15 parents are planned and pilot interviews have been performed. All interviews are guided by a thematic interview guide with specific themes such as sexuality, sexual health, contraception, reproduction, parenthood and sexuality education. The method for analysis is content analysis. The findings will be presented in scientific journals and in a PhD thesis at Uppsala University.

Applicant: Maria Wickström (Sweden)
Allocated amount by the ESC: 9.000 euro
Monitoring: P-2016-A-04
– Full version of the initial application

 

– GRANTED PROJECTS 2015 –

Developing and implementing an educational programme for the prevention of sexual transmitted diseases and unplanned pregnancy in adolescents girls from rural area from North-Eastern Romania

According to the Romanian Ministry of Health about 18,600 girls under 19 years old  were pregnant in 2014 (662 below 15 years), most of them from rural areas, where lack of sexual education and poor information about contraceptive methods are more pronounced.Teenage girls who start their sexual activity too early run a higher risk of contracting sexual transmitted diseases (STDs), having unplanned pregnancies, becoming single mothers, having more abortions and experiencing marital instability and poverty. The objective is to determine the effectiveness of a reproductive health education intervention programme in improving the knowledge of adolescent girls 14-18 years old from rural zone. First, we will administered a questionnaire which tested the knowledge on puberty changes, hygiene during menstruation, conception, contraception and STDs to about 250 girls from 5 villages (including Roma girls).Then, we will organize a health education programme that will include didactic lectures followed by interactive sessions. We also will give them current and age-appropriate knowledge through print media, brochures and an friendly portal on website to help this category of adolescents to avoid negative outcomes. The results will be statistically processed, communicated at the ESC Congress and  submitted for publication in Eur J Contracept Reprod Health Care.

Applicant: Dana Anton – Paduraru (Romania)
Allocated amount by the ESC: 4.838 euro
Monitoring: P-2015-B-01
– Full version of the initial application
– Interim report
– Final report
– Additional information

Obtaining information about contraception among Latvian women at the age from 18-40

This study is a randomized, stratified and qualitative research – an anonymous survey of 2000 women, 18-40 y.o., grounded in the previous study that was carried out in 2014-2015 on the results of safe contraception  use and non-use criteria showing that safe contraception is not used in Latvia mainly due to the following reasons: 1) negative perception of hormonal contraception is more expressed among women than men; 2) woman’s negative decision regarding the use of hormonal contraception is influenced by the doctor; obtaining information from the doctor facilitates more negative perception of hormonal contraception by a woman; 3) knowledge about contraception methods of 18-29 y.o. respondents is not sufficient. The aim of the study is to find out reasons of negative attitude towards different contraception methods represented both by doctors and patients and measures to be taken to change this attitude. The study is to be carried out in three stages. 1. Initially a theoretical basis and structure of the survey, including survey items in the Latvian and Russian languages, were elaborated. 2. Double testing of survey items were carried out in empiric pilot studies: self-validity and content validity were determined; psychometric analysis of survey items was carried out; the first and the second decision regarding inclusion of certain items in the survey were made. 3. Implementation of the study: testing of the Latvian and Russian respondents; randomized stratified sample (residents of urban and rural areas); psychometric analysis of items: testing reliability; determining statistical characteristics; determining statistically significant differences of inter-group results; and determining statistically significant correlations of various criteria. The survey will be carried out in presence of trained health-care specialists. After results are obtained, education level of doctors and patients in the field of contraception should be improved. The research organisation is being supported by the Ministry of Health of Latvia and the Riga Stradins University.

Applicant: Dita Baumane-Auza (Latvia)
Allocated amount by the ESC: 7.350 euro
Monitoring: P-2015-B-02
– Full version of the initial application
– Interim report
– Final report

Audit of pharmacists’ information needs and skills for counselling in hormonal contraception

Pharmacists play a significant role in providing women of fertile age with counselling on hormonal contraception. However the quality of this counselling is not audited or assessed. Therefore RAPD has decided to conduct audit of information needs and skills among pharmacists of 10 districts of Moscow city (out of 10 in total). In order to do so, RAPD will conduct questioning on information needs in hormonal contraception among pharmacists of Moscow city. Results of questioning will serve as a basis to compile a program of the trainings for pharmacists, which will be conducted by RAPD accordingly. In total there will be 5 trainings. Each of the training will be followed by publication of information package and  monitoring of the progress made, reflected in increased quality of counselling on hormonal contraception provided by pharmacists and in development of recommendations for improvement of that counselling. RAPD will also develop website page on counselling in contraception for pharmacists. Results of the project will be presented during ESC Congress in Basel, 2016.

Applicant: Lyubov Erofeeva (Russia)
Allocated amount by the ESC: 7.500 euro
Monitoring: P-2015-B-03
– Full version of the initial application
– Interim report
– Final report

Emergency contraception in Albania: A multi-methods study of awareness, attitudes and practices

The political, economic, and social turbulence in post-communist Albania have impacted the availability and accessibility of reproductive health services. Government reports indicate that women are well-aware of modern contraceptive methods [1,2], which have long been available both in walk-in clinics as well as from pharmacists. Yet independent studies have shown that lack of knowledge and misconceptions are very common among women, men, and health service providers [3,4,5]. In the Albanian context, progestin-only emergency contraception (EC) could play a significant role in addressing women’s need for a discrete, woman-controlled method of contraception [5,6]. However, the limited available information on EC in Albania suggests that use is minimal and misinformation abounds [7,8]. This multi-methods project combines an online, community-based survey of 200-300 women of reproductive age in different regions of the country with key informant interviews, structured interviews with retail pharmacists, and six focus group discussions with married and unmarried women to explore the dynamics shaping EC availability, access, and practices. Rigorous research promises to fill a significant gap in the literature and has the potential to inform efforts by non-governmental organizations, clinicians, and women’s organizations to increase access to contraceptive services and utilization of modern methods.

Applicant: Angel M. Foster (Canada)
Allocated amount by the ESC: 4.875 euro
Monitoring: P-2015-B-04
– Full version of the initial application
– Interim report
– Final report

Levonorgestrel-Intrauterine System (LNG-IUS) and Copper Intrauterine Device Insertion in the Postpartum Period: a Pilot study

Background: Long acting reversible contraceptives (LARCs) are an important strategy to areduce the burden of unintended pregnancies1. Postpartum intrauterine device (IUD) has been actively promoted by many countries to reduce unmet need2, Concerns related to immediate postpartum IUD insertion remain in developing country settings3, since postpartum hemorrhage and anemia are important causes of maternal mortality and morbidity. Immediate postpartum insertion of Levonorgestrel intrauterine system (LNG-IUS) has been associated with significant reductions of bleeding and a longer period of amenorrhea than the copper-IUD4, however a few studies have reported that it could be associated with shorter duration and less exclusive breast-feeding5. The aim of this pilot study is to compare effect of immediate postpartum insertion of LNG-IUS and Copper-IUD at 12 months after delivery in a primary care setting in India

Applicant: Kirti Sharad Iyengar (Sweden)
Allocated amount by the ESC: 4.532,5 euro
Monitoring: P-2015-B-05
– Full version of the initial application
– Interim report
– Final report

Randomized double blind study of mepivacaine or placebo for pain relief at insertion of intrauterine contraception

Aim: finding a new non-invasive method for pain relief at insertion of intrauterine contraception. Background: Use of long acting reversible contraception (implants and intrauterine contraception, IUC)- has been shown to reduce unwanted pregnancy- especially in young women. IUC is underused in nulliparous women- often due to fear of pain at insertion from both providers and women. Thus, finding new non-invasive methods for pain relief at IUC insertion is important and has the potential of increasing use of IUC in all women. Method: Nulliparous women over 18 years requesting insertion of IUC for contraception will be recruited for a double blind randomized controlled trial of 10ml of mepivacaine or placebo (NaCl) given through a hydrosonography catheter (a thin and bendable plastic tube) into the cervix and uterus before insertion of IUC. Pain will be measured during instillation, at tenaculum placement, sounding and before, during and after IUC insertion. 38 patients in each group will be included to be able to show 20% pain score reduction on the VAS scale. Women will have telephone follow up at 10 days, 3 months and 6 months for analysis of continuation rates and acceptability. The study has Ethical Review Board and European Medical Agency approval.

Applicant: Helena Kopp Kallner (Sweden)
Allocated amount by the ESC: 4.626 euro
Monitoring: P-2015-B-06
– Full version of the initial application
– Interim report
– Final report

Prevalence and predictors of intimate partner violence & sexual victims and related psychiatric consequence- cross sectional study in Romania and Hungary

Sexual violence, stalking, and intimate partner violence are public health problems known to have a negative impact on millions of persons in EU, not only by way of immediate harm but also through negative long-term health impacts. There is however limited data on violence in general and youth women violence in particular in Europe. The aim of the study explore with the interview and QR, the nature and scope of youth violence in Hungary to explore risk and protective factors at the individual, family, and environmental levels associated with sexual and physical violence victimization. Participants will be interviewed using an interviewer-administered questionnaire. Socio-demographic variables, social habits, and IPV (using the abuse assessment screen and the Severity of Violence against Women Scale to identify physical, sexual and psychological violence). The expected outcomes are the following : 1) Women will gain knowledge and understanding of current laws regarding sexual assault. 2) Women will gain knowledge on dynamics around sexual assault pertaining to victims and perpetrators. 3) Women will gain understanding of difficulties encountered with criminal justice system and intimate crimes

Applicant: Melinda Vanya (Hungary)
Allocated amount by the ESC: 2.625 euro
Monitoring: P-2015-B-07
– Full version of the initial application
– Interim report
– Final report

The influence of factors on the choice of the first contraception method 

In our study we’d like to get more information about the first choice of contraception of women in early age (14-20 years). Our focus will enlighten whose advice they prefer to take, or what other of circumstances are the most influential on their decision about when to start and which method to choose. We also like to get more information about why adolescents change the oral hormonal contraceptives. We examine the following reasons by a questionnaire: side effects, affect of the media, economic effects, advices from gynaecologists, doctors. We’re interested in the cost of applied contraceptives so far? We’d like to create a questionnaire with the following points:
1) who suggested first that particular contraceptive method
2) do they start using contraception before or after the first intercourse
3) in case of age 16 or below, were the requirements of Fraser guidelines fulfilled
We also would like to get a comprehensive picture of the participants’ knowledge about contraceptive methods. We are curious about the impact of social media and the internet on this topic application. After data analysis we’d like to create an application for mobile and pc, to inform adolescents about their possibilities in case of contraception methods.

Applicant: Zita Gyapjas (Hungary)
Allocated amount by the ESC: 4.500 euro
Monitoring:  P-2015-A-01
– Full version of the initial application
– Interim report

Bring the men to the table:  to evaluate knowledge around contraceptive methods, contraceptive behaviour and the desired role of young men in decisions regarding contraception within a relationship

To date it seems still to be reality that in young partnerships the responsibility for contraception is adopted by the women. One reason, is that men are much less informed about contraceptive methods. However, not all women and young girls are in a position to take the responsibility alone. Better education of men might contribute to the avoidance of unprotected intercourse and unplanned pregnancies. To improve education of the young males we need more information on what they know, what they think and on sexual behaviour. Aim of this pilot study is to collect information on young men`s knowledge on contraceptive methods, potential side effects, STD, EC and abortion regulations. Furthermore we aim to identify their preferred role and preferred extent of involvement into the responsibilities of prevention of pregnancies/STD in a shortterm or longterm relationship.

Applicant: Stefanie Felder (Switzerland)
Allocated amount by the ESC: 6.000 euro
Monitoring: P-2015-A-02
– Full version of the initial application
– Final report

Reproductive life planning (RLP) for adolescents

The trend towards riskier sexual practices among Swedish youth is worrisome; the number of sexual partners has increased while condom use has decreased. The incidence of sexually transmitted infections (ST!), especially Chlamydia remains high, which constitutes a potential threat to sexual and reproductive health, including future fertility. This calls for action in order to increase young people’s knowledge about sexual and reproductive health; how it can be protected, preserved and maintained. The Reproductive Life Plan (RLP) is a USA-developed tool for promoting reproductive health by encouraging reflection on intentions and strategies for successful family planning. It was recently tested in a clinical setting in Sweden and was found to increase women’s knowledge about fertility. It is likely that this concept would be useful also among adolescents’ and could advantageously be included in contraceptive counselling, and as pmi of sexuality and relationship education in schools. We will conduct focus group interviews with boys and girls in order to investigate how the RLP concept should be modified according to adolescents’ needs and requests. This study is the first pmi of a larger research project aiming to develop and implement RLP for adolescents in various settings.

Applicant: Magdalena Mattebo (Sweden)
Allocated amount by the ESC: 4.000 euro
Monitoring: P-2015-A-03
– Full version of the initial application
– Interim report
– Final report

Cost analysis of adolescent internet SRH counselling services in Estonia

Adolescents spend a considerable part of their time online. The Internet is an important source of their SRH knowledge. Providing professional sexual and reproductive health (SRH) counselling services for adolescents via the Internet is an essential component of SRH services. Organizations in many countries are considering, planning or already implementing online SRH counselling services for young people. There is considerable interest in the Internet SRH counselling services. However, little information is available on which counselling services are suitable for online and are the online services cost saving in comparison to usual face-to-face counselling. This practical research project will address these questions by analysing adolescent internet counselling services in Estonia. The results and recommendations will be useful for SRH programmes managers in other countries, and for international organization supporting their work as well. Estonian Sexual Health Association (ESHA) has been providing SRH counselling services for young people via the Internet since 1997. On their website (Amor.ee) young people can ask anonymous questions on topics like; puberty, intimate relationships, sexuality, pregnancy, contraceptives and STIs. Their questions are answered by professional personnel; youth counsellors, social workers, psychologists, sexologists or medical doctors. The results of this research will also be used to support management and fundraising for ESHA’s internet counselling services.

Applicant: 
Kai Haldre (Estonia)
Allocated amount by the ESC: 3.000 euro
Monitoring: P-2015-A-04
– Full version of the initial application
– Project cancelled, grant refunded to ESC

Identifying and tackling economic, cultural and social factors that lead to inappropriate sexual education in Romanian teens

With a teen birth rate of 39.4 %0 Romania holds second position in the EU after Bulgaria and before Slovakia. Despite Romanian laws and a recent UN Committee on Economic, Social and Cultural Rights recommendation to adopt a national strategy on sexual and reproductive health and to intensify the efforts to prevent unwanted teenage pregnancies, health education, including sexual education, is part of the optional school curriculum. Sexual education is provided only in a minority of schools due to a strong opposition from parents, NGO’s, teachers and even church. After signing an informed consent we will address questionnaires to teenagers and to their parents regarding their opinion about the opportunity of sexual education in schools, their knowledge about contraception, STD, risks of teen birth both for mother and new born and about their cultural and religious habits (early marriage), socioeconomic and educational status. Each participant will be rendered educative information on safe contraception by printed brochures. The result of the project will be presented in a Teen Contraception Info Day, organised with school and child protection authorities, representative of parents organisations, NGO’s, minorities and religious leaders, in order to empower community to sustain and promote sexual education in Romanian teens.

Applicant: Smaranda Diaconescu (Romania)
Allocated amount by the ESC: 3.000 euro
Monitoring: P-2015-A-05
– Full version of the initial application
– Interim report
– Final report

Biography on Hermann Knaus

In 1929, the Austrian gynaecologist Hermann Knaus demonstrated the role of the corpus luteum. He also was the first one to understand its dependency on the lifespan of the fertilized ovum. His findings revolutionized family planning. Simultaneously but independently he and Japanese gynaecologist Kyusaku Ogino developed a method to calculate the time of ovulation. Knaus should not only be seen as a the ‘Father of Prevention’. Thanks to his discoveries people could also calculate the optimum fertile period for ‘natural methods’ as well as for IVF. By connecting the beginning of pregnancy with ovulation – instead of menstruation – he also revolutionized our means of calculating the duration of pregnancy, which is/was important not only for the decision of actively intervening in the process of birth but also for legal questions. In 1936, Knaus was a candidate for the Nobel Prize, but was turned down. E. Ahlström, the person in charge wrote: “I cannot see such an importance in the papers by Knaus and Ogino on periodic fertility and infertility. But in case a great number of future papers would support his findings, e.g. that his rule is a general law or at least relevant for the majority of cases, it would be worth a Nobel Prize because the question is of vast social and medical importance.” The book will be the first biography of Hermann Knaus and is focusing on his scientific/medical importance for gynaecological surgery, contraception, artificial insemination and delivery.

Applicant: Christian Fiala (Austria)
Allocated amount by the ESC: 3.000 euro
Monitoring: P-2015-A-06
– Full version of the initial application
– Interim report part 1
– Interim report part 2

– GRANTED PROJECTS 2014 –

Delivery of audiovisual information on early medical abortion care to women via tablet

Women requesting abortion need to receive detailed, high quality information. This consultation takes time; the quality may be variable, inaccurate or reflect provider bias. Using audiovisual technology such as a tablet (eg.ipad) to provide information ensures that this is accurate and standardised. This could free time with a provider to discuss specific concerns/ future contraception.

We propose a multi country study to determine whether giving audiovisual information on abortion to women attending a clinic via a tablet is acceptable and informative. FIAPAC will develop a generic information film for women requesting early medical abortion. The original script (English) will be translated by board members into 3 different European languages. A similar film plan will be used for each country but undertaken locally.

The audiovisual film will be tested in a RCT in 4 countries (total 200 women), at each 50 women requesting early medical abortion will be randomised to receive information about the procedure/ aftercare via the tablet (n=35) or face-to face consultation (n=15). They will be interviewed immediately afterwards to assess recall of information and acceptability. Women randomised to tablet, will see a provider after this as usual. Provider acceptability (survey) of using the tablet will also be conducted.

Applicant: Sharon Cameron (UK)
Allocated amount by the ESC: 10.000 euro
Monitoring: P-2014-B-01
– Full version of the initial application
– Interim report
– Final report

Neuroprotective properties of desogestrel

The natural progestin progesterone has been shown to be neuroprotective in animal models of brain injury, including brain trauma and ischemia [1, 2]. The protective effects seem to be mediated by binding to progesterone receptors, which are abundantly expressed in the brain [3]. Desogestrel is a third generation progestin, which is widely used as progestin-only contraceptive (POC). A major advantage of POC is that in contrast to combined contraceptives; they do not increase the cardiovascular risk. Furthermore desogestrel has been shown to reduce migraine frequency and intensity [4, 5]. On the other hand, female migraineurs are at increased risk for ischemic stroke. To date studies about potential protective or detrimental effects of desogestrel on brain injury, particularly stroke, are lacking. In the proposed project we aim to explore the potential neuroprotective effect of desogestrel in a rodent model of stroke. Infarct size and functional deficits will be analyzed in mice subjected to transient middle cerebral artery occlusion (MCAO) [6]. The effect of desogestrel applied at two doses and two application time points (before and after ischemic injury) will be compared to progesterone. Potential mechanisms of this effect will be further characterized.

Applicant: Gabriele Merki (Switzerland)
Allocated amount by the ESC: 10.000 euro
Monitoring: P-2014-B-02
– Full version of the initial application 
– Interim report
– Final report

Effect of male factors on women’s decision making in contraception and abortion

Despite of all modern contraceptive methods are available in Hungary, the number of induced abortions is still high. Traditionally, the predominant methods of preventing births in most parts of the world were methods used by or requiring the cooperation of men. However, it is less examined in Europe.

The objective of the questionnaire-based population survey is to analyise the effect of male factors on contraceptive practice among induced abortion women,and to determine the influencing factors the male attitude toward family planning. An following aim’s of our study to serve a more extensive and effective prevention by exploring the background factors of induced abortions and ensure that women and men have information and access to the widest possible range of safe and effective Family Planning methods in order to enable them to exercise free and informed choice.

Applicant: Melinda Vanya (Hungary)
Allocated amount by the ESC: 5.000 euro
Monitoring: P-2014-B-03
– Full version of the initial application
 Interim report
– final report

Development of the Emergency Contraception Wheel

With the introduction of ulipristal acetate emergency contraception (EC) pills in most European countries, EC choices available to women are expanding. Yet, women in need of EC are not regularly offered different EC therapies. ECEC will develop a user-friendly tool to help health providers (including pharmacists) provide high-quality and evidence-based EC counseling and services to women. This tool will be a wheel, similar to WHO’s Medical eligibility criteria wheel for contraceptive use (2008), focused exclusively on EC methods (levonorgestrel and ulipristal acetate ECPs, and Cu-IUD) that will make it easier to guide each women in choosing the best EC

Applicant: Medard Lech (ECEC)
Allocated amount by the ESC: 8.000 euro
Monitoring: P-2014-A-01
– Full version of the initial application
– Final report
– Financial report

The effect of hormonal contraception on clinical course of migraine and tension-type headache-prospective follow-up study

Migraine is one of the most common primary headache disorder with typical clinical features (ICHD-3beta, Cephalalgia 2013). The two major subtypes of migraine are migraine without aura (M0) and migraine with aura (MA). The 1-year prevalence of migraine in adult is between 15 % to 18 % (Steiner et al. 2003, Rasmussen et al. 1991). A definitive sexual difference is observed : 3 :1 ratio between women and men. Menstrual migraine (MM) without aura affects approximately 20% of female migraineurs in the general population (Vetvik 2014). The pathophysiology of MM is not fully understood and probably heterogeneous. Clinical observations indicate an increased incidence of MM in conditions with falling levels of plasma estrogen such as in the perimenstrual phase of the menstrual cycle during the hormone-free interval in women taking combined hormonal contraception. Menses is a well-known trigger factor for migraine-type headache.

Applicant: Melinda Vanya (Hungary)
Allocated amount by the ESC: 5.500 euro
Monitoring: P-2014-A-02
– Full version of the initial application
 Interim report
– Full report

Consensus on “Conscientious Objection” to abortion and reproductive health care

In the past ESC Congress in Lisbon, Fialla, Rowlands and myself took part in a round table, as part of official program, on this subject, without getting a general agreement. My project is to arrange a discussion in which all members of the ESC Board would take a part in order to reach a Consensus, aided by the Delphi Method, in the next Board meeting (September 2015).
Steps:
1. Expert Committee, 4 persons (Fialla, Rowlands, Lertxundi and another one from the EC of ESC) with the aim of getting a draft ready before the end of 2014.
2. Contributions to the draft from all Board members (deadline 31.03.2015)
3. Expert Committee meeting in Bilbao (May 2015) to revise all the contributions and to modify the draft in order to present an amended version to the Board members as a questionnaire to be worked under Delphi Method rules.
4. Board member´s answers (deadline 15.07.2015)
5. Final discussion and approval of CONSENSUS in the Tel-Aviv meeting (September 2015)

Applicant: Roberto Lertxundi (Spain)
Allocated amount by the ESC: 5.000 euro
Monitoring: P-2014-A-03
– Full version of the initial application
– Published in the European Journal of Contraception and Reproductive Health care, Vol 21, Issue 3, June 2016, pages 198 – 201


– GRANTED PROJECTS 2013 –

Implementing a Reproductive life plan (RLP) in contraceptive counseling

In a randomised controlled trial we found that using RLP-based information in contraceptive counselling increased women’s  knowledge of reproduction and that 90% thought that midwifes routinely should discuss the RLP with their patients. We therefore want to implement the RLP in routine contraceptive counselling and evaluate both the feasibility of implementation and the counsellor’ s experiences. The project group will inform and educate all midwives in Uppsala County about the RLP in contraceptive counselling and provide an interview guide for the counselling as well as a specially designed brochure for the patients. All midwives will be invited to test the RLP in their contraceptive counselling, participation is voluntary. After three months, all midwives who have tested the RLP will be invited to participate in focus group interviews. Focus group interviews will be conducted in groups of 6-8 midwives from different clinics. Main outcomes will be attitudes to and experiences of advantages and disadvantages of using RLPbased information in contraceptive counselling. Interviews will be recorded, transcribed verbatim and analysed using content analysis. To compare participating with non-participating midwives, all midwives will also receive a short questionnaire with questions regarding their attitudes to and experiences of RLP in contraceptive counselling.

Applicant: Jenny Stern (Sweden)
Allocated amount by the ESC: 3.297 euro
Monitoring: P-2013-B-01
– Full version of the initial application
– Report

Contraceptive education for disabled people

APF produced and disseminated large amounts of leaflets, films and other materials on contraception that are used by health professionals and teachers to promote sexual and reproductive health education activities throughout the country. However these materials are not adapted neither to blind nor deaf people. This project intends to adapt 11 leaflets to blind people transforming them from written to audio materials. The project intends to introduce sign language in a film on contraception.

Applicant: Duarte Vilar (Portugal)
Allocated amount by the ESC: 19.750 euro
Monitoring: P-2013-B-02
– Full version of the initial application
– Final report

Men Speak Out : Engaging Men in Female Genital Mutilation – Prevention in Europe

Female Genital Mutilation (FGM) is a harmful traditional practice consisting of the removal of part of girls or women external genitalia. While FGM used to be considered an “African phenomenon”, it has become a global issue in the context of migration. The majority of sensitization work, particularly in Europe, is carried out by women and there is a lack of male involvement in combating the practice. Today, FGM is seen as a “women affair”. Men hardly interfere in the issue and are badly informed about what this practice really is. However, since the issue of FGM concerns communities as a whole, men can play an important role in the process of ending FGM. A qualitative research will be conducted in Belgium, UK and Netherlands to increase knowledge on men’s role in the perpetuation of the practice. Four key problems would be addressed: (1) Men’s inadequate understanding of FGM, its health risks and human rights violations, (2) Lack of communication between women and men about the practice of FGM, (3) Misconceptions about men’s opinions about FGM, (4) Lack of male involvement in the decision making process to end the practice. Results will help to design new FGM prevention programs involving men.

Applicant
: Fabienne Richard (Belgium)
Allocated amount by the ESC: 8.000 euro
Monitoring: P-2013-B-03
– Full version of the initial application
– Interim report
– Final report
– More information

Use of effective contraception after use of emergency contraception

The most effective emergency contraceptive pill is ulipristal acetate which is not available over the counter in Sweden. However, the most effective method for emergency contraception is insertion of a copper IUD which requires a trained provider. The copper IUD is a long acting reversible contraceptive method and thus provides the women with effective contraception in contrast to ulipristal acetate which requires barrier methods until more effective methods can be initiated. This project aims at comparing the use of effective methods for contraception (defined as combined oral contraception, medium dosed progestin pill, vaginal ring, patch, injection, implants or intra uterine contraception) at 3 and 6 months after the use of an emergency contraceptive method. The aim is to compare women who have a copper IUD inserted to women who choose ulipristal acetate.The hypothesis is that more women in the copper IUD group will use effective contraception at the 3 month follow up. In order to show a difference in effective contraceptive uptake of 30% 32 women in each group need to be recruited. The project could lead to increased use of the copper IUD for emergency contraception. The project is undergoing ethical review at Karolinska Institutet.

Applicant
: Helena Kopp Kallner (Sweden)
Allocated amount by the ESC: 2.408 euro
Monitoring: P-2013-B-04
– Full version of the initial application
– Final report

Criteria for contraception use and nonuse and predictable factors for safe contraception use in Latvia

This is a randomized, stratified qualitative study – an anonymous survey of 1500 females at the age of 20-40 years and 1500 males at the age of 20-40 years, to find out: 1) reasons due to which (of all possible aspects – psychological, social, religious, health, education, etc.) the population of reproductive age in Latvia insufficiently use safe contraception; 2) what measures should be undertaken to achieve the increase the number of safe contraception users. In Latvia, up to now, no studies have been done on the criteria of use and nonuse of contraception. The study is going to have 3 phases- 1.Development of theoretical background, structure and points of survey (in Latvian and Russian).2.Checking of survey points in the empirical research for detection of evident validity, psychometric analysis of points, adoption of the first and second level decisions on the points to be included in survey.3.Implementation of study (testing of Latvian and Russian respondents: every selection: males and females n= 1500; randomized stratified selection (urban and rural population); psychometric analysis of points: testing credibility, detection of statistical parameter curve, detection of statistically significant differences of intergroup results, detection of statistically significant correlations of various criteria). Survey will be held under the presence of trained health care professionals. Each participant of survey will be rendered educative information on safe contraception free of charge. The obtained data will be used in conferences of professionals and the data interpretation will be used for gynaecologists and family doctors’ education with an aim to increase the number of safe contraception users in Latvia. The organization of study is supported by Latvian Association of Gynaecologists and Obstetricians, the University of Latvia, Rīga Stradiņš University and Latvian Ministry of Health.

Applicant: Dita Baumane-Auza (Latvia)
Allocated amount by the ESC: 9.860 euro
Monitoring
: P-2013-A-01
– Full version of the initial application
– Interim report
– Final report

Sexual and reproductive health web-counseling for adult population in Estonia and improvement of reliable information source for RSHR stakeholders

The amor.ee web-counseling for youth up to 25 years was initiated in 1998 as a small scale project of the Estonian Sexual Health Association (ESHA). Additionally, series of articles about sexual and reproductive health and rights (SRHR) were compiled to inform community. A team of 40 specialists, most of whom work at youth counseling centers, answer about 4000 email queries on SHRH – mainly from (anonymous) adolescents – per year. A unique system of quality requirements, continuous auditing, support and supervision of those, who answer questions was created to ensure high professional standards of the answers. The amor.ee page used to include information about ESHA as a society, but recently the webpage was changed to be directed only to youth and society information stands separately in the old web-page renamed to www.estl.ee. By now there is a clear need for similar web-counseling system for adult population. Although the web page has always been promoted as the one targeted to youth and majority of those who ask advice have been under 25, a lot of questions come continuously from older people (around 10%). Estonia has one of the highest Internet penetration rates in the world. Another need to be met by the project is expressed by different partners (governmental and nongovernmental organizations, teachers, parents, medical personnel) of the ESHA to have easy access to reliable information about SRHR issues. Thus the idea of the project is to create similar information source and supervised web-counseling possibility for adult population (www.estl.ee) in accordance to their needs and to update and renew SRHR information source for the partners of the ESHA.

Applicant: Kai Haldre (Estonia)
Allocated amount by the ESC: 4.547 euro
Monitoring: P-2013-A-02
– Full version of the initial application
– Interim report
– Final report

Tackling repeat unwanted conceptions amongst young people in the UK

Pilot project to tackle unwanted conceptions in the London borough of Croydon, which has the highest rate of repeat abortion amongst young people under 25. One in three women in the UK will have an abortion during their lifetime and a third of those women will experience more than one. The percentage of women under 25 accessing more than one abortion is 32% in London (significantly higher than the England average of 26.4%) and peaks at 37% in Croydon. Research in Croydon has concluded that ‘sex and relationships education on the subjects of both contraception and abortion locally needs to speak to the problems of those who are perceived to be at risk of unintended and unwanted pregnancy’.1 This project will harness the existing research to work directly with young people and professionals in Croydon to develop strategies to tackle repeat unwanted conceptions amongst those under 25. Peer engagement and education will assess what the barriers are for young people in accessing reliable contraceptive support and will tackle common myths about pregnancy and abortion. This information will be disseminated to professionals in the area through specialist training days to ensure their work is relevant and accessible to all young people.

Applicant: Simon Blake (UK)
Allocated amount by the ESC: 4.216 euro
Monitoring: P-2013-A-03
– Full version of the initial application
– Revised project
– final report

Post abortion contraception – Quick start of Nexplanon in medical abortion. A randomized controlled trial

Long acting reversible contraceptives (LARCs, Implants and intrauterine contraception) are the most effective methods to help women avoid a repeat unwanted pregnancy after an abortion. Insertion of LARC at surgical abortion is associated with greater use and lower rate of repeat abortions at six months follow up (FU) than requiring women to return later to get the device. However, today the clinical routine in medical abortion is to insert LARCs at the FU 2 to 3 weeks after the abortion. Frequently women choose to do part of the abortion treatment at home and do not return for FU. Thus, the possibility to “quick start” a contraceptive method in medical abortion would be a major advantage. In a prospective randomized controlled equivalence trial 600 women requesting medical abortion up to 9 weeks and opting for implant for post abortion contraception will be randomized to Group 1) Nexplanon® insertion at the time of mifepristone administration (Day 1). Group 2) Nexplanon® insertion according to the clinical routine at FU 2-3 weeks after mifepristone administration. FU will be done at 2-3 weeks after the medical abortion. Further FU will be done over telephone at 3, 6 and 12 months after the administration of mifepristone.

Applicant: Kristina Gemzell Danielsson (Sweden)
Allocated amount by the ESC: 7.557 euro
Monitoring: P-2013-A-04
– Full version of the initial application
– Interim report
– Final report

Education of Roma youth in order to prevent the unwanted pregnancies teen pregnancies and induced abortion among Roma population

In Hungary the number of unwanted pregnancies and induced abortions are very high, although it somewhat decreased in the last few years. We have to emphasise that the Gipsy population represent a high percentage of these data, as they usually live in poor social circumstances and they are less educated. The reasons for not using safe and reliable contraceptive methods in most of the cases are not just financial but educational. Due to the sweeping world we are living in, sexarche is shifted to a very young age when adolescents are not aware of sexually transmitted diseases or unwanted pregnancies. Usually they can’t afford any contraception method, and they are hardly aware of their own bodies. For these reasons we are planning course series for students in the primary and secondary schools in Gyula (Csongrad and Bekes county). The courses will be held in every 2 months, starting with a simple questionnaire about their knowledge of contraception, STD, menstruation and reproduction. On the courses peer-educators will present the problematic issues on sexual education, and new peer-educators will be trained to help the traditional prevention work in Gyula. After one year, the students will fill in the same questionnaire as for the first time.

Applicant: Melinda Vanya (Hungary)
Allocated amount by the ESC: 4.000 euro
Monitoring: P-2013-A-05
– Full version of the initial application
– Interim report
– Final report