Granted scientific projects

- 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

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

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 

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

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

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

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

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

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

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

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

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

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 

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 received on 24 Nov 2016

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

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

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

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

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

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

- GRANTED PROJECTS 2012 -
Experiences of non-resident abortion seekers in the United Kingdom: a pilot-study

In 2011, 6,151 women from over 20 European countries sought and received abortions in the UK. Aside from a limited set of statistics collected by the UK Department of Health (age, statutory grounds, and gestation) very little is known about the experiences of non-resident women from other European countries who seek abortions in the UK. Women may seek abortions outside of their home countries for many reasons including restrictive laws, gestational age limits, abortion related stigma, and physician conscientious objection. No quantitative studies have been conducted to assess predictors or correlates of being a non-resident abortion seeker in the UK, nor have qualitative data been systematically collected among this population. We propose to develop a survey instrument aimed at better understanding the experiences of women in Europe who travel to the UK to seek abortion services. Data will be collected using quantitative surveys with non-resident women at two London bpas abortion clinics. Data from this study aims to improve understanding of the impact that national abortion laws and services have on women living in European countries, and to inform services provided for nonresident women seeking abortion services in the UK.

Applicant: Silvia De Zordo (Spain)
Allocated amount by the ESC: 4.980 euro
Monitoring: P-2012-B-01
Full version of the initial (revised) application
- Final report

Stress and its influence on fertility

Stress may compromise the feedback regulation of the hypothalamic-pituitary-adrenal axis, releasing stress-related biomarkers and thereby affecting establishment of pregnancy. A number of studies have investigated the association between psychological factors such as stress (measured through questionnaires or biological markers) and distress (measured as anxiety or depression) and pregnancy outcomes. However, the results are inconsistent and the strength of any association remains to be clarified. The lack of consensus in the scientific literature is likely due to the heterogeneity of studies and lack of power. The growing use of Assisted Reproductive Techniques (ART) is mainly due to that women choose to delay childbearing, and thereby decrease their chances of conceiving spontaneously. ART are complex and stressful procedures and many studies are therefore investigating associations between stress and outcome of fertility treatments. Through the use of a large ongoing prospective cohort study of couples undergoing fertility treatment in Stockholm and Uppsala (UppStART study), we will investigate: 1. Whether psychological distress (measured as anxiety and depression) predicts difficulties to conceive (measured as years of involuntary childlessness). 2.  Whether psychological stress measurements (measured through questionnaires and saliva) in both men and women undergoing ART are related to ART treatment outcomes

Applicant: Anastasia Nyman Iliadou (Sweden)
Allocated amount by the ESC: 14.468 euro
Monitoring: P-2012-B-02
Full version of the initial application 
- Interim report

COMPASSO 2

This project aims to provide a formation program for Young women aged between 15-23 years old, unemployed or students living in residential quarters in Funchal, Região Autónoma da Madeira (Madeira Island). Madeira Island is a Portuguese Autonomic Region, widely known as a touristic destination. However, this region has significant social inequalities and a significant level of poverty. More than 20% of the city capital – Funchal – live in social housing quarters. Teenage pregnancy – mainly teenage motherhood - was 4% of the births in Madeira, in 2011. In 2010 ESC funded the project COMPASSO. The project had positive results as described in the article presented to Esc (in annex) and 2 youth groups were trained as mediators to promote sexual and reproductive health activities in their neighborhood. The aim of Compasso 2 is to continue the project of 2010, training news groups of youth to make them community mediators in the area of Sexual and Reproductive Health. The first phase will focus on training of young women through 15 training sessions, intending to cover a total of 15 young women from residential quarters. In a second phase, 10 sessions will be conducted by community mediators with young people in their residential quarters. These young women will have the role to disseminate information relating Sexual and Reproductive Health, so that information reaches all women residing in their neighbourhood.

Applicant: Duarte Vilar (Portugal)
Allocated amount by the ESC: 6.192 euro
Monitoring: P-2012-B-03
Full version of the initial application
Final report

Promoting the harmonization of emergency contraception services in Europe

Sexual and reproductive health is a fundamental human right. Scientific advances provide couples with an increasingly wide range of effective and safe contraceptive methods. Emergency contraception (EC) allows women to exercise this right. This project wants to promote the harmonization of EC access and provision services across Europe. To do so, the European Consortium for Emergency Contraception (ECEC) will: a) Work with European experts to develop a template guideline that addresses the key issues to be included in EC clinical guidelines and the most current scientific evidence to support evidence based recommendations on EC. The template will be based on the EC Clinical Guidance of the Faculty of Sexual and Reproductive Healthcare (UK, August 2011 updated January 2012) and the ICEC and FIGO guidelines (June 2012); both are based on a rigorous review of the most recent evidence available. b) ECEC will disseminate the template guideline among national contraception societies to promote an evidence based approach towards creating or revising EC national guidelines, adapted to the context of their own country. The template guideline will also be disseminated among regional networks and in regional events (i.e.: ESC Global Congress in Copenhagen 2013) to promote evidence based EC policies and recommendations.

Applicant: T. Bombas (Portugal)
Allocated amount by the ESC: 8.000 euro
Monitoring: P-2012-A-01
Full version of the initial application
Interim report 
- Final report

Contraceptive practice and use of women requesting the surgical termination of pregnancy in Latvia

This is a cross-sectional, descriptive study. Women attending a surgical termination the pregnancy on-request in the hospitals and out-department units in all Latvia during three month period will be asked to fill the semi-structured questionnaire regarding determinants of the unwanted pregnancy and induced abortion. Stratification of the number of participants will be done according to the regional distribution of female inhabitants in Latvia to reach the state representativeness.

Data will be collected by using an anonymous self-administrated partly structured questionnaire, consisting of: descriptive data (the region of living, income, the level of education); reproductive history (coitarche , the number of partners per lifetime and per year, past pregnancies); relationship with partner; contraceptive habits and use, and the future plans related to contraception; assessment of knowledge about contraception by multi-choice test use. One open question will be provided in order to clarify women’s own believes for reasons why the unintended pregnancy occurred.

Pilot testing for questionnaire will be done in corresponding population (n=10). Approval from Ethical comittee will be obtained.

Study results will contribute to find out the causes why the unintended pregnancy occurred and what would be possible done to improve SRH care level and suggested at the political level to decrease the induce abortions rate in Latvia.

Applicant: I. Viberga (Latvia)
Allocated amount by the ESC: 7.000 euro
Monitoring: P-2012-A-02
Full version of the initial application
Interim report 

Reproductive Health Survey among Low-income Roma drug injecting women in Bucharest, Romania

According to the National Antidrug Agency, the estimated number of injecting drug users in Bucharest was 18,316 in 2011 (National Report on Drugs). There is a lack of data about lowincome Roma drug injecting women access to and use of reproductive health services. Most likely, due to poor education for health, low self esteem, lack of ID papers and medical insurances, their access and use of these services are limited. The effects of these circumstances are linked with unwanted pregnancies, abortions, STIs, giving birth to drug addict babies, babies with STIs, precarious child care etc.

The project proposal Reproductive Health Survey among Low-income Roma drug injecting women in Bucharest, Romania aims to assess the access to and use of reproductive health services among this group, in order to develop/improve efficient interventions for prevention of reproductive health related risks and unwanted consequences.

The survey intends to be a short cross-sectional study of knowledge, attitudes and practices of low-income Roma drug injecting women, using questionnaire based interviews. The target group for this research consists of 200 persons, clients of the Caracuda – Ferentari harm reduction drop-in center (Bucharest) developed by Carusel Association.

The research is developed in partnership with the National Institute of Public Health.

Applicant: M. Ursan (Romania)
Allocated amount by the ESC: 15.000 euro
Monitoring: P-2012-A-03
Full version of the initial application
Interim report
- Final report

- GRANTED PROJECTS 2011 -

Attitudes to long acting reversible contraception

The Irish Family Planning Association has been fitting long acting reversible contraception (LARCs) since the early 1970’s.

LARCs are becoming increasing popular in Ireland eventhough there is little research in Ireland with regard to womens motivation for using LARCs. Family planning advocates regard LARCs as a safe, convenient, efficient and cost effective method of contraception. The IFPA wishes to carry out a survey of clients requesting LARCs to ascertain women’s attitudes and motivation in requesting LARCs.

The research will profile the motivations of women who have requested a LARC in the IFPA clinics. We will ascertain if the profile of LARC clients has changed over the last 10 years. We intend to profile LARC clients with respect to age, number of children and contraception used prior to LARC. We will also study the total number of clients availing of LARC to ascertain if that number is significantly increasing in the last ten years.  

The survey will also survey the motivations of LARC clients, with a focus on financial considerations, medical considerations and effectiveness.

The research findings will be launched in the media to ensure that the learning from the research will impact on service delivery, public policy and the promotion of LARCs.

Applicant: Caitriona Hechion (Ireland)
Allocated amount by the ESC: 13.000 euro
Monitoring: P-2011-B-01
- Full version of the initial application
- Final report

The post-partum contraception in South-Eastern Hungary: a multicentre cross-sectional study

Predictors and influencing factors of the choice of contraceptives in the postpartum period have scarcely been investigated, particularly in Europe. The objective of our study is to determine the exclusive breast-feeding practices, return of menstruation, sexual activity and contraceptive practices among breast-feeding mothers in the first year of lactation.

A consecutive series of women after delivery will be invited to answer a self-report questionnaire. Estimated number of participants will be 2,000-3,000 between January 1st, 2012 and January 1st, 2014 in South-Eastern Hungary. A structured questionnaire (Appendix) will be sent by post or partakers will receive a code to a secured webpage by email. Postpartum women will be contacted by 6 weeks, 6 months and 12 months after the delivery.

Applicant: Gyorgy Bartfai (Hungary)

Allocated amount by the ESC: 8.000 euro

Monitoring: P-2011-B-02

- Full version of the initial application
- Interim report
- Final report

Oral contraception - Our choice, our decision

According to UNFPA World Population 2010 Report, Macedonia is one of the countries in Europe with lowest percentage of women using modern contraception (9,8%). Only 1,6% of young girls between ages of 15 to 19 reported use of oral pills1. One of the leading reasons is that girls in Macedonia have incorrect beliefs around use of pills such as: increase in weight, hair growth, cancer and sterility.

This project aims to raise awareness, in particularly among girls, on use of oral pills as effective and reliable method for preventing unintended pregnancy. The activities of the project are built around creativity and entertainment and designed by the youth volunteers of the association.

  • Organizing one-day mass youth events on benefits of using oral pills in 4 cities in Macedonia. The events will include: screening of "Decision" film, theater play performance on modern contraception, distribution of IEC materials and educative sessions with medical professionals.
  • Creation of the Facebook fun page as a pool for sharing information and debates among young people on modern contraception use.
  • Producing short informational video which will be filmed during the youth events in order to generate youth awareness on usage of pills
  • Development and distribution of brochures

Activities in the project will be implemented and evaluated by HERA's youth volunteers.

1Quantitative Study: Access to services for SRH among the high school population in 4 capitals in the Balkans., 2004, International Center for Reproductive Health

Applicant: Bojan Jovanovski (FYROM)

Allocated amount by the ESC: 6.500 euro

Monitoring: P-2011-A-01

- Full version of the initial application
- Interim report
- Final report

The sexual and reproductive health research in Latvia. The satellite conference "Reproductive health and demography. Solutions and future challenges"

National research on sexual and reproductive health (SRH) situation in Latvia is accomplished. The data of quantitative research is collected and qualitative part - focus group discussions is finished. This is the first reliable SRH research in Latvia since 2003. Lacking evidence based data on SRH situation several speculations towards SRH and rights and demography issues arises. Reproductive rights in Latvia have been threatened, especially sexual and reproductive rights of young people and women's rights to choose safe abortion, comprehensive contraception. It is essentially important to provide evidence based data and information to decision makers.

Having the new data on SRH of population and developing recommendations for SRH policy, it is necessary to provide this information to main stake holders.

The project activities:

  • To develop publication on SRH situation for decision makers
  • Organize Conference at the Parliament of Latvia (14.10.2011). Invite decision makers, ministries' officials, SRH professionals, media and introduce with new data, main findings, recommendations. This will be satellite conference organized when 6th congress of Latvian gynecologists and obstetricians, and 4th RCOG Eurovision Conference will take place. Leading SRH experts will attend conferences, which give opportunity to share experience to Latvia's decision makers.
  • Distribute publication to stake holders.

Applicant: Iveta Kelle (Latvia)

Allocated amount by the ESC: 6.500 euro

Monitoring: P-2011-A-02

- Full version of the initial application
- Final report

Knowledge assessment on Sexuality and Contraception in Greece compared to the European average

The aim of this study is to collect information concerning the level of knowledge of the 16-18 years old boys and girls living and studying in Greece on Reproductive Health issues, such as: Sexuality, conception, STIs (and the methods of protection from them), as well as their sources of information and attitudes (sexual debut, number of partners, unwanted pregnancies, abortions). In addition the awareness of the adolescents on the modern methods of contraception, the actual use of each one of them as well as the needs of young people on information and accessibility to contraception will be recorded. In order to achieve these ESC interests related aims, we conducted a quantitative survey with the use of self-administered questionnaire. The data will be collected in the school class environment after appropriate authorization is achieved by the Ministry of Education. Interestingly, this is the first research on reproductive health ever conducted in Greece to this extent. The results of this survey shall constitute the cornerstone of our efforts to positively influence the Greek authorities towards establishing appropriate school curriculum on sexuality education as well as towards upgrading the adolescents' reproductive health in general. Hopefully the results shall be presented during the 12th ESC Congress in Athens.

Applicant: Dimitrios Lazaris (Greece)

Allocated amount by the ESC: 12.000 euro

Monitoring: P-2011-A-03

- Full version of the initial application

 

- GRANTED PROJECTS 2010 -

Evidence-based advocacy strategies and tools to promote the effective use of contraceptives in Eastern Europe.

Despite efforts to secure contraceptive supplies and use, high unsafe abortion rates signal the need for targeted advocacy strategies in Eastern Europe.
To serve women at risk in Eastern Europe, the Eastern European Alliance for Reproductive Choice (EEARC) proposes a 9-month project aiming to facilitate the development of evidence-based advocacy strategies and tools; advocacy skills, and international networking, in order to promote the effective use of contraceptives in Eastern Europe.

Drawing on EEARC's network, the participants are:

  1. qualified individuals from reproductive health and women's rights organizations in Albania; Macedonia; Poland; Slovakia; Lithuania; Latvia; Estonia; Russia; Ukraine; Moldova; Romania; Georgia; Armenia; Azerbaijan; Uzbekistan; Kyrgyzstan; Kazakhstan;
  2. representatvies from WHO and Health Ministries;
  3. selected advocates from ICMA, IPPF, ASTRA contribute best practice from other regions and organisations.

The project consists of three main activities:

  1. Preparation and running of an 3-day workshop to device medium-term advocacy strategies and tools.
  2. Conducting a survey regarding contraceptives and abortion (developed by Ipas) among the participating organizations to inform the workshop and to help to develop regional report and advocacy strategy.
  3. The development of a regional report "Contraception and abortion in East European Region" as a common advocacy tool, and its dissemination among key stakeholders in the participating countries, and through www.reprochoice.org and www.medicalabortionconsortium.org ICMA News letter, printing (booklet) in Russian and English.

Applicant: S. Posohova (Ukraine)

Allocated by the ESC: 12.000 euro

Monitoring: P-2010-B-01

- Full version of the initial application
- Final report

Routine follow-up versus self-assessment of complete abortion following medical abortion, effect on its success and acceptability: a randomized controlled trial

Current protocols for medical abortion include multiple consultations and follow-up visits (FU). Previous studies have shown that the number of visits required to the clinic has a major influence on the acceptability of medical abortion. So far, no evidence for FU is available.
Post abortal complications such as heavy bleeding, infection, etc. prompt women, especially if adequately counselled, to seek care outside of a routine follow up visit. thus the main reason for the routine FU is to detect an on-going pregnancy and to provide contraceptive counselling (which can be done already at the first visit). Furthermore, today there is no stand procedure in how the FU is conducted.
1200 women requesting medical abortion and who give their informed consent to participate in the study will be randomised to either route FU in the clinic or to self assessment using a semi quantitative urine hCG test 2 weeks after the abortion and a telephone FU.
This study could provide valuable evidence for new guidelines for optimal provision of care, possibly with implications for resource-poor settings.

Applicant: K. Gemzell Danielsson (Sweden)

Allocated by the ESC: 8.000 euro

Monitoring: P-2010-B-02

- Full version of the initial application
- Interim report
- Final report

Women, men and abortion pill: An anthropological approach of reproductive health issues in Cambodia

This project aims to explore both women's reproductive lives and social practices surrounding medical abortion in Cambodia. It is built on an ongoing research on reproductive issues started in 2008 and on an existing network of organizations. In Cambodia the use of abortive pills is common. Mifepristone and misoprostol are accessible on the market without prescription. Combined mifeprostone and misoprostol (Medabon ) is available since December 2009 and being provided at some certified health facilities. Thus, we may wonder why, how and to which extent gender norms, social organization of health care and political will to tackle the problem head-on as well as women and men experiences and attitudes regarding unwanted pregnancies shape medical abortion practices in Cambodia.

The specific objectives are:

  1. to approach the legitimization, the use and the circulation of authorized and non authorized drugs used for medical abortion in Cambodia
  2. to document the social impact of the distribution of the "official" abortive pill on women's reproductive choices and practices, on their partners, and on health care providers working both in formal and informal health care settings
  3. to establish an ongoing process of results dissemination with caregivers and stakeholders involved in reproductive health and medical abortion issues.

Applicant: T. Delvaux (Belgium)

Allocated by the ESC: 5.000 euro

Monitoring: P-2010-B-03

- Full version of the initial application
- Final report

Compasso

This project aims to provide a training program for young women with ages between 17-25 years old, unemployed or students living in residential quarters in Região Autónoma da Madeira. The aim is to make them community mediators in the area of Sexual and Reproductive Health. As community mediators, these young women will give training to other youth of their residential quarters, and these sessions will be supervised by a technician.

Contact/applicant: Sofia M. Alves - Associação para o Planeamento da Familia (Portugal)

Allocated amount by the ESC: 15.000 euro

Monitoring: P-2010-A-01

- Full version of the initial application
- Interim report
- Final report

Risk factors for unwanted pregnancy that results in induced abortion in age group 16 – 25, in Latvia.

This is a case – control study. Women aged 16 – 25 years attending first pregnancy on-request termination in hospitals and out-department units will be compared with control group of nullipara women, hospitalized in surgery departments without known gynecological diseases, but with risk of unwanted pregnancy (having intercourses at least once per month during last six months). Groups will be matched according age, region of living(representing whole Latvia) and level of education. Three controls per one case will be applied. Sample size will be 300 and 100 women respectively.Stratification will be done according to regional distribution of female inhabitants in this particular age group.

Contact/applicant: Ilze Vīberga (Latvia)

Allocated amount by the ESC: 8.000 euro

Monitoring: P-2010-A-02

- Full version of the initial application
- Interim report
- Final report

The sexual and reproductive health research in Latvia.

Qualitative study on young people’s sexual behavior and contraception use in Latvia.
The umbrella project aims to carry out national research on sexual and reproductive health (SRH) situation in Latvia.
The last research on SRH situation was conducted in 2003. Variety of circumstances affecting SRH of people has changed since then. There is no data available on SRH indicators, knowledge on SRH rights, choices.
The research method is quantitative survey.
The main goal of the umbrella project is to repeat the survey implemented in 2003 and use obtained information for advocacy purposes.
Realizing that young people in Latvia are specific population group it is essential to have data, information on sexual behavior and contraception use of youth.
In order to gather an in-depth understanding of young people’s sexual behavior and the reasons that govern such behavior it is necessary to carry out qualitative study.

Contact/applicant: Iveta Kelle (Latvia)

Allocated amount by the ESC: 2.000 euro

Monitoring: P-2010-A-03

- Full version of the initial application
- Final report

 

- GRANTED PROJECTS 2009 -

Translation of the extensive website of the ‘Museum of Contraception and Abortion’ from German into English.

Contact/applicant: Christian Fiala (Austria).

Allocated by the ESC: 12.000 euro

Monitoring: P-2009-04

- Full version of the initial application
- Interim report
- Final report

Summer hotline service for Polish teenagers

Contact/applicant: Polish Federation for Women and Family Planning on reproductive health issues

Allocated by the ESC: 8.000 euro

Monitoring: ¨P-2009-05

- Full version of the initial application
- Interim report
- Final report

Age disparate relationships, condom use and the spread of HIV among young men and women in Cape Town, South Africa

Applicant: Marleen Temmerman (Belgium)

Allocated by the ESC: 12.000 euro

Monitoring: P-2009-03

- Full version of the initial application
- Interim report
- Final report published in the European Journal of Contraception and Reproductive Health Care, February 2012; 17: 30-39

Women´s and men´s experiences and needs in relation to induced abortion

Applicant: Margareta Larsson (Sweden)

Allocated by the ESC: 8.000 euro

Monitoring: P-2009-02

- Full version of the initial application
- Interim report
- Final report

Creating a counterweight to pornography and sexualised media messages - the critical role of School health- and Youth clinics in the promotion of sexual health and gender equality

Applicant: Elisabet Häggström-Nordin (Sweden)

Allocated by the ESC: 10.000 euro

Monitoring: P-2009-01

- Full version of the initial application
- Interim report
- Final report

 

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