Abortion in Europe: accessibility and availability

1
Abortion in Europeaccessibility and availability

• B. Pinter, Slovenia
• E. Aubeny, France
• G. Bartfai, Hungary
• O. Loeber, the Netherlands
• S. Ozalp, Turkey
• A. Webb,  United Kingdom

2
Abortion a response to unwanted 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!

3
Abortion laws in Europe

• Abortion
• completely prohibited
  Malta
• to save womans life
  Ireland
• protect her physical health Poland
• to protect womans mental health Northern
  Ireland, Portugal, Spain Switzerland

4

• 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

5
Conditions of abortion practice(abortion on
soc.- ec. grounds, on request)

• Gestational limits 10-12 weeks, 22-24 weeks
• Facilities authorized
• Practitioners gynecologists, GPs
• Parental consent minors
• Counselling pre-abortion
• Waiting period to one week
• Abortion fee health insurance

6
Abortion rates in Western Europe(abortions/1,000
women 15-44 years, 1996) Source The Alan
Guttmacher Institute. Sharing responsibility.
Women society and abortion worldwide. New York
The Alan Guttmacher Institute, 1999 54.
7
Abortion rates in Eastern Europe(abortions/1,000
women 15-44 years, 1996)Source The Alan
Guttmacher Institute. Sharing responsibility.
Women society and abortion worldwide. New York
The Alan Guttmacher Institute, 1999 54.
8
Abortion accessability in Europe

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

9
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

10

• Facilities special abortion clinics, rarely
  hospitals
• Practitioners GPs, well trained
• Abortion fee governmental separate insurance
• Medical abortion lt1
• No illegal, unsafe abortion
• Religion no interference
• Observations rising ab. rates and repeated
  abortions

11
France

• 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

12

• 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

13
United Kingdom

• On soc.-ec. grounds (GB)
• Gest. limit 24 weeks
• Counselling no
• Waiting period no
• Parental consent /-
• Ab. rate (EnglandWales) 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

14

• 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

15
Slovenia

• 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

16

• Facilities authorized centers (hospitals)
• Practitioners gynecologists, well trained
• Abortion fee health insurance
• Medical abortion lt1
• No illegal, unsafe abortion
• Religion small influence
• Observations trends towards limitation of
  abortion availability

17
Hungary

• 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

18

• 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

19
Turkey

• On request
• Gest. limit 10 weeks
• Counselling no
• Waiting period no
• Parental consent , partners 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

20

• 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

21
Conclusions

• 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

22

• Western Europe
• trends towards improvement of accessibility of
  abortion
• Eastern Europe
• trends towards limitation of accessibility of
  abortion