European Board and College of Obstetrics and Gynaecology Tackling Inequality in Access To Contraception In Europe International Session of EBCOG/TSOG/UNFPA- SRH Issues and Women’s Rights Dr Tahir Mahmood CBE MD, FRCPI, MBA, FACOG,FRCPE, FRCOG President EBCOG 18th May, 2017 Antalya International Session 18052017

International Session 18052017 Challenges Inequitable access to all forms of contraception Inequality in access to long acting contraceptives Inequality in access to abortion service provision either Surgical or Medical methods And the fall out in some countries: is high teenage pregnancy rates and High maternal mortality rates International Session 18052017

International Session 18052017 Taking stock - End of 2015 International Session 18052017 Rolled into SDG 3

International Session 18052017

International Session 18052017

Total methods across Europe Pill # 28% Hormonal implant 1% Contraceptive patch Injectable Vaginal ring Intrauterine system 3% Copper intrauterine device 5% Male condom (as only method) 17% Other methods * 18% No method 25% # Not for emergency contraception * Include emergency contraception, vasectomy and methods regarded as being less reliable such as cap, diaphragm, female condom, spermicides, natural methods (basal temperature, rhythm/calendar method, withdrawal), and Persona ® International Session 18052017

Unmet needs for Contraception In EECA Region International Session 18052017

International Session 18052017

International Session 18052017 Unmet need for Contraception leads to untimed Pregnancy, thus needs access to Abortion Services International Session 18052017

International Session 18052017

International Session 18052017

Percentage of pregnancies ending as abortion International Session 18052017

International Session 18052017

Abortion Provision Globally International Session 18052017

Abortion law around the world- Progress and Pushback 68- Countries currently prohibits abortion entirely or permits it only to save a women’s life 60- Countries allow a women to decide whether to terminate a pregnancy 57- Countries permit abortion to protect a women’s life and health 14- Countries permit abortion for socio-economic motives 39% of the world population lives in countries with highly restrictive laws governing abortion (Finer and Fine, 2013) International Session 18052017

Do women have a choice in all countries of Europe? International Session 18052017

International Session 18052017

Access to Abortion in Europe Countries with more restrictive legislation-4 Permit on socio-economic grounds- 4 Available on request with compulsory waiting and Counselling -7 Countries with liberal legislation (up to 12 weeks) - 21 International Session 18052017

How to improve Sexual and Reproductive Health of the Women ? International Session 18052017

Multi-faceted Approach Working with Organisations which can make a difference Understanding what works? Promoting availability of all effective methods of contraception including access to abortion Focusing on the totality of Sexual Health of Women as overall package Role of EBCOG and the National Societies International Session 18052017

International Session 18052017

WHO Europe Action Plan for Sexual and Reproductive Health 2030 Provision of information and services that enable people to make informed decisions about contraception Prevent sexual violence and exploitation Reduce unmet needs for contraception by removing medical barriers to contraception Reduce STI by providing dynamic preventive and curative services That abortion services offer comprehensive information International Session 18052017

International Session 18052017

Advocatıng A Comprehensıve Sexual and Reproductive Health Strategy A comprehensive strategy of Capacity Building, Integrated Service delivery model for family Planning and Pregnancy Care at the Primary care Level to meet the local needs (Long Acting contraceptives, Post coital contraception and Sex Education in Schools) Full provision of family Planning Services will add value to overall wellbeing of Women and the Society. International Session 18052017

International Session 18052017 Percentage of women experiencing an unintended pregnancy within the first year of use (Pearl index) International Session 18052017

International Session 18052017

Effective access to contraception reduces abortion rate-Ukraine International Session 18052017

Access to Medical Abortion as an Outpatient Procedure International Session 18052017

Measurable benefits of investing in Family Planning Services International Session 18052017

Factors contributing to the improvements for the use of contraceptive methods Training, Knowledge and skills by UNFPA/EBCOG Capacity Building and Communication National Society/Academic Institutions Political/Legal Framework committed to FP Adequate funding committed Capacity Building for SRH Professionals Individual user Govt. Policy for sexual and reproductive rights Advocacy for SRH strategy Socioeconomic and sociocultural system. International Session 18052017