Switching emergency contraceptives to non-prescription status and unwanted pregnancy among adult and teenage women: A long-term European comparative study

Abstract   Aim: Unwanted pregnancy is an important social issue, not least among teenagers. Emergency contraceptives (EMCs) can prevent from unintended pregnancy, if taken quickly after unprotected sex. This study’s objective was assessing abortion/birth rates among adult and teenage women in Europe before/after an EMC switch to non-prescription status. Methods: National authorities were consulted for EMC consumption data and abortion/live birth statistics. Rates (n=26 countries) in the year before the switch (= year of reference) were compared with rates before/after the change (up to ±15 years). The focus was laid on the European Union and further countries closely related to the European Union. Results: All countries with available data (n=12) experienced a substantial increase of EMC consumption after the switch. On average, abortion rates among women aged 15–49 years were 83% higher 15 years before (compared with the year of reference) and 14% lower 15 years after the switch. Correspondingly, teenage abortion rates were 35% higher 15 years before and 40% lower 15 years after the switch. In 2017, no country had higher teen abortion rates than at time of the switch. Teen birth rates continued decreasing at almost the same rate after the switch as before. Conclusion: An EMC switch to non-prescription status increases EMC use and may contribute reducing unwanted pregnancy among teenage girls.   Conflicts of interest: None declared.     &nbsp

Switching emergency contraceptives to non-prescription status and unwanted pregnancy among adult and teenage women: A long-term European comparative study

Aim: Unwanted pregnancy is an important social issue, not least among teenagers. Emergency contraceptives (EMCs) can prevent from unintended pregnancy, if taken quickly after unprotected sex. This study’s objective was assessing abortion/birth rates among adult and teenage women in Europe before/after an EMC switch to non-prescription status. Methods: National authorities were consulted for EMC consumption data and abortion/live birth statistics. Rates (n=26 countries) in the year before the switch (= year of reference) were compared with rates before/after the change (up to ±15 years). The focus was laid on the European Union and further countries closely related to the European Union. Results: All countries with available data (n=12) experienced a substantial increase of EMC consumption after the switch. On average, abortion rates among women aged 15–49 years were 83% higher 15 years before (compared with the year of reference) and 14% lower 15 years after the switch. Correspondingly, teenage abortion rates were 35% higher 15 years before and 40% lower 15 years after the switch. In 2017, no country had higher teen abortion rates than at time of the switch. Teen birth rates continued decreasing at almost the same rate after the switch as before. Conclusion: An EMC switch to non-prescription status increases EMC use and may contribute reducing unwanted pregnancy among teenage girls. &nbsp

The Dutch long-term care reform: Moral conflicts in executing the Social Support Act 2015

On 1 January 2015, a new long-term care reform entered into force in the Netherlands, entailing amongst others a decentralization of long-term care responsibilities from the national government to the municipalities by means of a new law: the Social Support Act 2015. Given the often disputed nature of the reform, being characterized on the one hand by severe budget cuts and on the other hand by a normative reorientation towards a participation society, this article examines to what extent municipalities in the Netherlands take (potential) moral conflicts into account in their execution of the Social Support Act 2015. In doing so, the article applies a ‘coherentist’ approach (consisting of both rights-based and consequentialist strands of ethical reasoning), thereby putting six ethical principles at the core (non-maleficence & beneficence, social beneficence, respect for autonomy, social justice, efficiency and proportionality). It is argued that while municipalities are indeed aware of (potential) moral conflicts, the nature of the new law itself leaves insufficient room for municipalities to act in a sufficiently proactive and supportive/empowering manner on these challenges.   &nbsp

Towards a Code of Conduct for the European Public Health Profession!

Professionalization of public health is important to advance public health education, training, and practice. In our opinion, there is no contradiction that the profession of public health consists of members of different other professions – which also have their own values and conducts. Yet, if professions work under the roof of public health, the pillars – the core values – of the house that is built are the common denominators. Making the guiding norms and values explicit is important for the self-definition of the professional field/profession and giving guidance in pursuing a fair and respectful improvement of population health

A code of ethical conduct for the public health profession

Aim: Agreeing on a Code of Ethical Conduct is an essential step in the formation and definition of a public health profession in its own right. In this paper we attempt to identify a limited number of key ethical principles to be reflected as professional guidance. Methods: We used a consensus building approach based on narrative review of pivotal literature and theoretical argumentation in search for corresponding terms and - in a second step - attempted to align them to a limited number of key values. The resulting draft code of ethical conduct was validated employing a framework of the Council of Europe and reviewed in two quasi Delphi rounds by members of a global think tank. Results: The alignment exercise demonstrated the acceptability of five preselected key principles: solidarity, equity, efficiency, respect for autonomy, and justice whereas three additional principles were identified during the discussion rounds: common good, stewardship, and keeping promises. Conclusions: In the context of emerging and re-emerging diseases as well as increase in lifestyle-related diseases, the proposed Code of Ethical Conduct may serve as a mirror which public health professionals will use to design and implement public health interventions. Future public health professional chambers or an analogous structure should become responsible for the acknowledgement and enforcement of the Code

Enhancing health system’s governance through demographic and health surveys in transitional European countries: The example of Albania

To inform policymakers well, there is a need to promote different types of health examination surveys as additional sources of valuable information which, otherwise, would not be available through routine/administrative statistics. This is especially important for former communist countries of South Eastern Europe including Albania, where the existing health information system (HIS) is weak. Among many efforts to strengthen the HIS in Albania, there is currently a commitment to undertake a second round of a nationwide Demographic and Health Survey (DHS). This survey will involve a nationwide representative sample of about 17,000 private households, where all women aged 15-59 years and their respective partners will be interviewed and examined. Externally, the upcoming Albanian DHS will contribute to the European Union accession requirements regarding provision of standardized and valid health information. Furthermore, the DHS will considerably enhance the core functions of the Albanian health system in line with the WHO recommendations. Internally, the DHS will promote societal participation and responsibility in transitional Albania. Importantly, the forthcoming survey will promote good governance including transparency, accountability and health system responsiveness. Also, the DHS will allow for collection of internationally valid and standardized baseline socio-demographic and health information for: assessment of future national trends; monitoring and evaluation of health programs and interventions; evidencing health disparities and inequities; and cross-national comparisons between Albania and different countries of the European Region. Ultimately, findings of the DHS will enable rational decision-making and evidence-based policy formulation in Albania including appropriate planning, prioritization and sound resource allocation. However, transfer of the information collected and implementation in public health policies and interventional programs is rather challenging for most of the countries, particularly for transitional post-communist countries of South Eastern Europe including Albania.   &nbsp