Abortion in Europe:Abortion in Europe:accessibility and availabilityaccessibility and availability

B. Pinter, Slovenia

E. Aubeny, France

G. Bartfai, Hungary

O. Loeber, the Netherlands

S. Ozalp, Turkey

A. Webb,  United Kingdom

Abortion – a response to Abortion – a response to unwanted pregnancyunwanted pregnancy 50 million abortions occur annually 40% of abortions are unsafe, usually illegal every day more than 200 women die of

unsafe abortion

The main aim and the impact of better accessibility of abortion: maternal morbidity and mortality rates!

Abortion laws in EuropeAbortion laws in Europe

Abortion: completely prohibited:

Malta to save woman’s life:

Ireland … protect her physical health:

Poland … to protect woman’s mental health:

Northern Ireland, Portugal, Spain Switzerland

… on socioeconomic grounds: Great Britain, Finland

… on request: Albania, Austria, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, France, Germany, Greece, Hungary, Italy, Latvia, Lithuania, Macedonia, Republic of Moldova, the Netherlands, Norway, Romania, Russian Federation, Slovak Republic, Slovenia, Sweden, Ukraine, Turkey, Yugoslavia

Conditions of abortion practiceConditions of abortion practice(abortion on soc.-(abortion on soc.- ec. grounds, on request)ec. grounds, on request) Gestational limits: 10-12 weeks, 22-24 weeks Facilities: authorized Practitioners: gynecologists, GP’s Parental consent: minors Counselling: pre-abortion Waiting period: to one week Abortion fee: health insurance

Abortion rates in Western EuropeAbortion rates in Western Europe(abortions/1,000 women 15-44 years, 1996) (abortions/1,000 women 15-44 years, 1996) Source: Source: The Alan Guttmacher Institute. Sharing responsibility. Women society and abortion worldwide. New York: The Alan Guttmacher Institute, 1999: 54.

0 5 10 15 20

Sweden

Denmark

England&Wales

Norway

Israel

France

Greece

Italy

Scotland

Finland

Switzerland

Germany

Belgium

Spain

Netherlands

Ireland

Abortion rates in Eastern EuropeAbortion rates in Eastern Europe(abortions/1,000 women 15-44 years, 1996)(abortions/1,000 women 15-44 years, 1996)Source: Source: The Alan Guttmacher Institute. Sharing responsibility. Women society and abortion worldwide. New York: The Alan Guttmacher Institute, 1999: 54.

0 10 20 30 40 50 60 70 80 90

RomaniaRussia

BelarusUkraine

YugoslaviaEstonia

BulgariaLatvia

Moldova

HungaryLithuania

MacedoniaAlbaniaTurkey

SloveniaCzech Rep.

Slovak republicCroatia

Abortion: accessability in EuropeAbortion: accessability in Europe

Different backgrounds– The Netherlands– France– United Kingdom– Slovenia– Hungary– Turkey

The Netherlands The Netherlands

On request Gest. limit: 22 weeks Counselling: yes Waiting period: 5 days Parental consent: +/-

Ab. rate: 8/1000, 15-44 years Highest rates: 20-29 years Ab. ratio: 14/100 pregnancies Eff. contr. use: 79%, TFR: 1.72 Repeated abortions: 35%

Facilities: special abortion clinics, rarely hospitals

Practitioners: GPs, well trained Abortion fee: governmental

separate insurance Medical abortion: <1%

No illegal, unsafe abortion Religion: no interference

Observations: rising ab. rates and repeated abortions

FranceFrance

On request Gest. limit: 12 weeks Counselling: only for minors Waiting period: 7 days Parental consent: -

Ab. rate: 15/1000, 15-44 years Highest rates: 25-34 years Ab. ratio: 18/100 pregnancies Eff. contr. use: 79%, TFR: 1.89 Repeated abortions: 25%

Facilities: authorized centers Practitioners: gynecologists,

GPs, well trained Abortion fee: health insurance Medical abortion: 30%

No illegal, unsafe abortion Religion: no interference

Observations: rising rates of medical abortion

United KingdomUnited Kingdom On soc.-ec. grounds (GB) Gest. limit: 24 weeks Counselling: no Waiting period: no Parental consent: +/-

Ab. rate (England&Wales) : 16/1000, 15-44 years

Highest rates: 20-24 years Ab. ratio: 21/100 pregnancies Eff. contr. use: 82%, TFR: 1.65 Repeated abortions: 30%

Facilities: authorized centers Practitioners: gynecologists,

spec. in C/RH, well trained Abortion fee: health

insurance in public service Medical abortion: 11%

No illegal, unsafe abortion Religion: no interference

Observations: limited public ab. services in some regions

SloveniaSlovenia

On request Gest. limit: 10 weeks Counselling: no Waiting period: no Parental consent: -

Ab. rate: 16/1000, 15-49 years Highest rates: 30-34 years Ab. ratio: 29/100 pregnancies Eff. contr. use: 66%, TFR: 1.26 Repeated abortions: 29%

Facilities: authorized centers (hospitals)

Practitioners: gynecologists, well trained

Abortion fee: health insurance Medical abortion: <1%

No illegal, unsafe abortion Religion: small influence

Observations: trends towards limitation of abortion availability

HungaryHungary

On request Gest. limit: 12 weeks Counselling: yes, two rounds Waiting period: 3 days Parental consent: +

Ab. rate: 30/1000, 15-49 years Highest rates: 20-24 years Ab. ratio: 38/100 pregnancies Eff. contr. use: 68%, TFR: 1.32 Repeated abortions: 40%

Facilities: authorized hospitals Practitioners: gynecologists,

some inadequately trained Abortion fee: 80 EURO Medical abortion: only WHO

studies

No illegal, unsafe abortion Religion: interference

Observations: low ab. access (two-round counselling, inad. training, ab. fee), high rates of repeated abortions

TurkeyTurkey

On request Gest. limit: 10 weeks Counselling: no Waiting period: no Parental consent: +, partner’s

consent for married woman

Ab. rate: 25/1000, 15-49 years Highest rates: 45-49 years Ab. ratio: 15/100 pregnancies Eff. contr. use: 38%, TFR: 2.5 Repeated abortions: 24%

Facilities: qualified services Practitioners: gynecologists,

GPs under supervision (EA), no standards in practice

Abortion fee: free, health insurance

Medical abortion: no

No data on illegal, unsafe abortion

Religion: no interference

Observations: accessability and quality depend on region

ConclusionsConclusions

Determinants of accessibility and availability of abortion in Europe– abortion law– accessibility of abortion service– availability of qualified practitioners– abortion coverage– availability of medical abortion– interference of religion in abortion

politics

Western Europe– trends towards improvement of

accessibility of abortionEastern Europe– trends towards limitation of

accessibility of abortion