1. Tackling Women InequalitiesTackling Women Inequalities
Addressing ComprehensiveAddressing Comprehensive
Reproductive Health CareReproductive Health Care
22n International Conference on Health Promoting Hospitals
and Health Services. April 23-25, 2014 Barcelona.
Elvira Méndez, MD
General Director Asociación Salud y Familia

2. BACKGROUND OF THE PROGRAMME
“CARING FOR MATERNITY AT RISK”
• The Programme ““Caring for Maternity at RiskCaring for Maternity at Risk””,
Spain (1991-2013) is leading by the Asociación
Salud y Familia (ASF), a non profit NGO.
• The Programme is based on a partnership
involving collaborations between public healthcare
services, private abortion clinics, social and women
associations and ASF itself.
• The Programme offers a portfolio of pro-choice
services in reproductive health care for vulnerable
groups of women and families.

3. THE PORTFOLIO OF THE PROGRAMME
“CARING FOR MATERNITY AT RISK” (I)
• Pregnancy test and pregnancy crisis pro-choice
counselling.
• Support to free decision-making of pregnant women.
• Co-financing voluntary interruption of the pregnancy
until 2010 and afterwards only undocumented
women because public healthcare services cover the
abortion cost.

4. THE PORTFOLIO OF THE PROGRAMME
“CARING FOR MATERNITY AT RISK” (II)
• Active prevention of repeated abortion through family
planning counselling and free provision of long acting
contraception during post-abortion.
• Free provision of long acting contraception (IUD and
Implanon) to vulnerable groups as adolescents, poor
families and migrant women.
• Support and Counselling groups for migrant mothers
and adolescents mothers of all origins.

5. ADDITIONAL SERVICES TO THE
PORTFOLIO PROGRAMME (I)
During pregnancy crisis prochoice counsellingDuring pregnancy crisis prochoice counselling
or family planning visits we offer:or family planning visits we offer:
• Active screening of partner violence and abuse.
• Immediate free psycho-social care for victims of
partner violence (three professional visits for support
and orientation).

6. ADDITIONAL SERVICES TO THE
PORTFOLIO PROGRAMME (II)
During pregnancy crisis prochoice counsellingDuring pregnancy crisis prochoice counselling
or family planning visits we offer:or family planning visits we offer:
• Immediate free juridical counselling for victims of
partner violence (three professional visits).
• Access to free juridical and psychosocial
orientation and support for family problems.

8. WHY TO FOCUS ON WOMEN BELONGING
TO VULNERABLE GROUPS?
• Are less likely to access public healthcare services
and seek advice for family planning and
contraception.
• Have higher abortion rates.
• Are a greater risk of repeated abortion.
• Are less information on family and women rights.

9. PROGRAMME COVERAGE
(2009-2013) (I)
• The Programme has served 29.018 women
during the period 2009-2013.
• 62,8% (n= 18.229) women requested advice for
pregnancy crisis and, also, received counselling
on long-lasting contraception.
• 32,8% (n= 9.512) women requested active
advice for long-lasting contraception.

10. PROGRAMME COVERAGE
(2009-2013) (II)
• User’s profile related to age, civil status and
gestational age was similar to that of women
who had abortions in the period 2009-2010 in
Catalonia.
• User’s profile related to migrant background,
educational level, work status, previous
abortions, previous use of FP Centres and
contraception was worse to that women who
had abortions in the period 2009-2010 in
Catalonia.

11. PROGRAMME COVERAGE
(2009-2013) (III)
• The Programme covered 20% of legal abortion
in Catalonia during the period 2009-2010 (*).
• Among Programme users the ratio of women
requesting long-lasting contraception respect to
the aborting was 52,2%.
(*) From 2010 Abortion law changed to terms until 14th gestational week.

13. REPRODUCTIVE HEALTH PROFILE OF WOMEN
SEEKING ABORTION OR CONTRACEPTION
ADVICE
79%
22,7%
54,7%
64,4%
3.762
2012
92,4%
25,8%
51,4%
57,9%
4.099
2011
49,2%81,9%78%No FP consultation over the
last year (%)
23,8%33,9%33,7%Condoms erratic use (%)
47,7%39%40%Any prior use of contraception
(%)
70,9%44,6%44%One o more previous abortion
(%)
4.6096.2967.394women attended
201320102009
Source: ASF database.

14. DISPARITIES OF LONG LASTING
CONTRACEPTION ACCEPTANCE AND
EFFECTIVE USE
79,7%
78%
1.338
2012
49,9%
67,9%
2.230
2011
178,5%37,9%30,1%LL. C ratio respect abortion
93,8%65,5%68%LL. C effective use
2.6143.0862.973LL.C acceptance
201320102009
(*) From 2011 the available LLC were IUD and IMPLANON

15. REASONS FOR DISPARITIES BETWEEN
LL.C ACCEPTANCE AND EFFECTIVE USE
• Organizational separation between abortion
clinics and family planning services.
• Medical provider attitude and misconceptions.
• Good acceptance of IMPLANON diminishes
disparities.
• Negative popular beliefs about the IUD increases
disparities.

17. MAIN RESULTS (I)
• Coverage of 29.018 women (2009-2013) who were
20% of yearly abortions in Catalonia until 2010.
• Highly vulnerable socio-economic position.
• Most of the women were in the first trimester of
pregnancy.
• About 50% did not use contraception consistently.

18. MAIN RESULTS (II)
• More than 75% did not attend Family Planning
services over the last year.
• About 47% were repeated abortions.
• Long lasting effective contraception requesting
ratio respect abortion was 52,2%

19. CONCLUSIONS (I)
•• SUSTAINABILITYSUSTAINABILITY: Framework of public and
private partnership has ensured the programme
for 23 years.
•• EQUITYEQUITY: The Programme improves access to
comprehensive reproductive health care for
vulnerable women.

20. CONCLUSIONS (II)
•• INTEGRATIONINTEGRATION: The Programme integrates
greater accessibility to safe abortion and free
post-abortion and post-partum long-lasting
contraception.
•• ADDED VALUEADDED VALUE: The Programme combats
repeat abortions and other relevant risks as
partner violence.

21. ACKNOWLEDGEMENTS
To funding public administrations
• Servei Català de la Salut
• Ministerio de Sanidad,
Servicios Sociales e Igualdad.
To board of Asociación Salud y Familia for support,
inspiration and lasting commitment.

23. THANKS
Email: emendez@saludyfamilia.es
Web: www.saludyfamilia.es