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

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!

Abortion laws in Europe 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 practice (abortion on soc. - ec 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

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.

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.

Abortion: accessability in Europe Different backgrounds The Netherlands France United Kingdom Slovenia Hungary Turkey

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

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%

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 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

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%

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

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%

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

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%

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

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

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