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Abortion in Europe: accessibility and availability

Abortion in Europe: accessibility and availability. B. Pinter, Slovenia E . Aubeny, France G . Bartfai, Hungar y O. Loeber, the Netherlands S . Ozalp, Turkey A . Webb, United Kingdom. Abortion – a response to unwanted pregnancy. 50 million abortions occur annually

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Abortion in Europe: accessibility and availability

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  1. Abortion in Europe:accessibility 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 woman’s life: Ireland • … protect her physical health: Poland • … to protect woman’s mental health: Northern Ireland, Portugal, Spain Switzerland

  4. … on socioeconomic grounds: Great Britain, Finland • … on request: Albania, Austria, Belarus, Belgium, Bosniaand 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, GP’s • 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) 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)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: <1% • 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 (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%

  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: <1% • 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: +, 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%

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

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