APPENDIX 8 - HOSPITAL VERSUS CLINIC

If a country is ripe for legislation of abortion and the issue is openly discussed abortion is generally considered a major operation which can only be carried out in a hospital. But in most countries where abortions are legalised most are done in special dedicated clinics. All hospitals and abortion clinics are under legal obligation to report all their cases and the incidence of complications to the Ministry of Health. As an example I give here the figures of 1993:

PREGNANCY	CLINICS	HOSPITALS	TOTALS
1st trimester 2nd trimester Total	. 19731 83% 3980 17% 23711 100%	2125 95% 101 5% 2226 100%	21856 84% 4081 16% 25937 100%
1st trimester 2nd trimester Total	19731 90% 3980 98% 23711 91 %	2125 10% 101 2% 2226 9%	21856 100% 4081 100% 25937 100%

Over eighty percent of all terminations and nearly all second trimester terminations are done in abortion clinics. Many hospitals actually refer their second trimester cases to the clinics. The percentage of complications is about 0.2% in the clinics and 2.3% in hospitals. That means that complications occur more than ten times as often in a hospital than in a clinic. The reason for this is in the first place the lack of routine in clinics where gynaecologists do only a few terminations. In the second place the fact that hospitals tend to use general anaesthesia. In a hospital in Amsterdam halothane is used in all cases, although it is a well known fact that this invokes uterine blood loss.

There are a number of advantages of abortion clinics above general hospitals:

HOSPITALS | CLINICS

Staff may refuse cooperation or try to forbid abortion in the hospital. Board or superintendent may refuse abortions	Staff and board are selected on their positive attitude concerning abortion.
Abortions are considered an operation which requires the theatre and the usual theatre routine. General anaesthesia is the rule.	A specific routine to do an abortion is followed. General anaesthesia is an exception.
Patients are confronted with infertility and maternity cases.	All patients come for the same.
Treatments occur on an in patient basis.	Treatments occur on an out patient basis.
Doctors and staff are not trained for abortions.	Clinic staff build up a phenomenal experience, not only technically but also in counselling the abortion patient.
Complications occur in 2 - 2.5 % .	Complications occur in less than 0.5 % .
High costs.	Low costs.

The only advantage of a hospital is the possibility to treat a serious complication. For this reason an abortion clinic must have a well established cooperation with a general hospital, so that in case of a complication the patient can be admitted without delay.

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