AOGOI, a woman-friendly hospital to prevent repeat abortions

Between 2011 and 2013, 30.000 cases of repeat abortions each year at a cost, avoidable, of between 117 and 135 million euros over three years. According to an analysis conducted by the Association of Italian Hospital Obstetricians Gynecologists (AOGOI) in 70 of the most important Italian hospitals, in 78% of cases a counseling course is carried out after voluntary interruption of pregnancy (IVG) and in 60% of the centers a contraceptive is prescribed immediately and the contraceptive program is verified at discharge. Presented, as part of the 91st SIGO National Congress – 56th AOGOI National Congress – 23rd AGUI National Congress, the AOGOI program “Voluntary Interruption of Pregnancy: a pathway in the woman-friendly hospital”.

Every euro spent on prevention of repeat IVGs equals 10 euros in savings.

Rome, Oct. 17, 2016 – “In Italy, 27 percent of voluntary interruptions of pregnancy (IVGs) are performed by women with previous abortion experience. The cause can be traced to the adoption of an inappropriate contraceptive method or inadequate counseling received at the time of the previous abortion, but the figure is still alarming,” says Vito Trojano, President Association of Italian Hospital Obstetricians Gynecologists (AOGOI). “These observations prompted AOGOI to initiate two observational surveys that would give a snapshot of how Italian hospitals handle IVGs and how women perceive the counseling course offered to them. Our ultimate goal is to create a woman-friendly pathway in centers that practice IVG, sensitizing providers to the importance of ensuring due attention to post-IVG contraception by offering women adequate counseling after the procedure,” he adds.

“The first analysis, now being completed, was conducted in the most important Italian hospitals where voluntary interruption of pregnancy is practiced. Of the 70 who have responded so far, 40 have a dedicated outpatient clinic and multidisciplinary team,” he says Joseph Hector, Director Maternal-Infantile Department ARNAS Garibaldi-Nesima, Catania, Italy. “In 2015 alone – he continues – an average of 338 IVGs were performed per center for a total of 21.000 cases. In 78% of the centers there is a post-IVG counseling pathway as indicated by Law 194/78, and in 60% a contraceptive method was prescribed immediately and the contraceptive program verified at discharge. Among the contraceptive methods of choice post-IVG were intrauterine devices and subcutaneous implants (60%). This confirms the World Health Organization’s recommendation that Long-Acting Reversible Contraception (Larc), as the safest contraceptive methods and one that guarantees a higher rate of adherence at 12 months.

Such devices have the advantage that they can be inserted during the same surgery without further inconvenience to the woman”.

In July, AOGOI initiated a second observational study to take a snapshot of women’s perceived adequacy of contraceptive counseling in the post-IVG setting. “We prepared an anonymous questionnaire, distributed to a sample of 50 facilities throughout Italy, with the aim of analyzing about 3.000 questionnaires,” he explains Silvia Von Wunster, Director Operative Unit of Obstetrics and Gynecology, Pesenti Fenaroli Hospital, Alzano Lombardo. “We aim to verify the contraceptive methods chosen and whether or not they were made available from hospital discharge by asking women directly about their perception of the service they received. Verifying that women are given the option of inserting a LARC device during IVG surgery is indeed one of the main goals of our analysis, as this technique is shown to be a truly effective strategy in reducing repeat IVGs. Based on the results achieved, a series of educational events will be organized by AOGOI and informational materials on contraception in post-IVG will be produced and distributed for physicians and patients,” he clarifies.

“If in Italy the average cost of a voluntary interruption of pregnancy is estimated, with the DRG, at around € 1300-1500, it is possible to estimate the costs attributable directly to the National Health System,” she points out Emilio Arisi, President SMIC, Italian Medical Society for Contraception. “Considering that repeat abortions are around 30.000 cases per year, in the last three years for which we know the final data, i.e., 2011, 2012, and 2013, we can safely calculate that the annual direct expenditure for the health care system was €39-45 million, which means €117-135 million over three years. A huge expense that could largely be reduced with much less investment in projects to prevent repeat abortion. For example, based on a cost of about 100 euros per long-acting contraceptive system (Larc), it is estimated that each euro spent on contraception is equivalent to a savings of about 10.

All this, without forgetting the psychological and personal costs of the woman who has an abortion, related to lost work or school days, transportation, and family logistics, which in turn are certainly not insignificant,” he concludes.