abortion in europe: accessibility and availability b. pinter, slovenia e. aubeny, france g. bartfai,...
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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