Abortion situation in Lithuania Esmeralda Kuliesyte MD, Executive Director Family Planning and Sexual Health Association FIGO project coordinator

Abortion is legal in Lithuania since 1955.

There is no abortion law in Lithuania. The 1994 order of the Minister of Health regulates abortion procedure.

Up to 12 weeks of pregnancy, abortion is allowed on women's request. After 12 weeks up to 22 weeks – according to medical indications.

Every year around abortions are performed on women’s request in Lithuania. 10,8 abortions per 1000 women of reproductive age. 33 abortions per 100 live births. Lithuanian Health Information Center, 2006

Unmarried women terminate pregnancy twice as often as the married ones. The biggest part of women who had abortion was not well educated. The main reason indicated as a barrier to have children – financial problems. Dissertation by Dr. Virginija Vanagiene „ The reasons for termination of pregnancy and the peculiarities of contraception consumption, conclusions and recommendations“, 2001

23 % of all abortions are performed in the age of years old. 13 % of all abortions are performed in the age of Lithuanian Department of Statistics Lithuanian Health Information Center, 2006, LHIC

The first termination of the pregnancy constitutes 24 % of all abortions. In the age group of this percentage is about 72 %. LHIC, data only from state institutions, 2006

Approximately 2500 women aged give birth every year. Unplanned pregnancies constitute 25 % in this age group. LHIC, data only from state institutions, 2006

No cases of death related to abortion have been registered. Illegal abortion is very rare. Medical abortion is not legal in Lithuania.

At the end of 2007 conservative parliamentarians proposed Protection of Human Life in Prenatal Stage Draft Law, which aims to prohibit abortion on women’s request, leaving two possible reasons for abortion – threat to women’s health and life and the case of rape or incest. In June State Family Policy Concept which recommends to protect human life from the moment of conception has been approved.

Such policies discriminate women and do not contribute to ensuring equal rights and equal opportunities to them. It is expected, that after banning of abortion in Lithuania, the number of illegal abortions and women’s deaths will increase.

According to the data of RAIT survey in 2005, 60,9 % of reproductive age (16-49 years) women do not use any contraception.

The most commonly used methods, RAIT: contraceptive pills – 20, 5 %, condoms - 13,9%, intra-uterine device – 5 %.

Women of reproductive age (16-49 years) reported not using contraceptive pills because they believe they are harmful for health (32, 6%), RAIT.

Contraception is mostly used by urban people of years old, whose monthly income exceed 600 Litas for one family member. Contraceptive pills are most commonly used by the women aged 16-34, whose monthly income is more than 1000 Litas for one family member, RAIT.

The reasons for not using effective contraceptive methods are mostly subjective: - trusting the partner, - carelessness and lack of interest in contraception, - underestimation of the risk to conceive. Objective reason – intolerance of used contraception. Dissertation by Dr. Virginija Vanagiene „ The reasons for termination of pregnancy and the peculiarities of contraception consumption, conclusions and recommendations“, 2001

Voluntary sterilization, which could be chosen by the couples who do not want more children, is not legal.

There is no National Family Planning Program aiming to increase awareness of the society, couples, women and youth about contraception and its usage. Contraception counseling after abortion in health care institutions is not sufficient or does not exist.

The information about family planning, contraception is spread poorly and often even erroneously in schools, the teachers very often talk about inefficacy and harmfulness of contraception. There is lack of society education on prevention of unplanned pregnancy and family planning methods.

Gynecologists, midwifes, nurses and family doctors are the main sources from whom women get information about effective contraception. Dissertation by Dr. Virginija Vanagiene „ The reasons for termination of pregnancy and the peculiarities of contraception consumption, conclusions and recommendations“, 2001m.

NATIONAL ACTION PLAN LITHUANIA Goal  To reduce the number of abortions in Lithuania.

ActivityResponsible Organization Time frameIndicator 1.1. To establish Unplanned Pregnancy Prevention Program MoH, LSOG, FPSHA, LSC, LCGP, LUM Increased contraceptive prevalence rate from 40 % to 60 % 1.2. To introduce a course on FP and contraception for family doctors MoHLSOG, FPSHA, LCGP No of trained family doctors. Increased knowledge on FP and counseling MoH – the Ministry of HealthFPSHA – Family Planning and Sexual Health Association MoE&S – the Ministry of Education and Science LSC - Lithuanian Society of Contraceptologists LSOG – Lithuanian Society of Obstetricians GynecologistsLCGP - Lithuanian College of General Practitioners LUM - Lithuanian Union of Midwifes Objective 1 To increase contraceptive prevalence rate up to 60 % in three years.

ActivityResponsible Organization Time frameIndicator 1.3. To establish training for trainers program for health care specialists, social workers, pedagogues MoH, MoE&S, LSOG, LSC Programm established. Increased knowledge on FP and contraception of public health specialists MoH – the Ministry of HealthFPSHA – Family Planning and Sexual Health Association MoE&S – the Ministry of Education and Science LSC - Lithuanian Society of Contraceptologists LSOG – Lithuanian Society of Obstetricians GynecologistsLCGP - Lithuanian College of General Practitioners LUM - Lithuanian Union of Midwifes Objective 1 To increase contraceptive prevalence rate up to 60 % in three years.

ActivityResponsible Organization Time frameIndicator 1.4. To review sexuality education program for schools To allow public health and heals care specialists (nurses, midwifes, doctors) to provide health education in schools MoE&S, LSOG, FPSHA, LSC, LCGP, LUM Increased quality of sexuality education Objective 1 To increase contraceptive prevalence rate up to 60 % in three years.  MoH – the Ministry of HealthFPSHA – Family Planning and Sexual Health Association  MoE&S – the Ministry of Education and Science LSC - Lithuanian Society of Contraceptologists  LSOG – Lithuanian Society of Obstetricians GynecologistsLCGP - Lithuanian College of General Practitioners  LUM - Lithuanian Union of Midwifes

ActivityResponsible Organization Time frameIndicator 1.5. To introduce a course for pedagogues on modern methods of FP and contraception MoH, MoE&SLSOG, FPSHA, LUM Inreased quality of education on FP, contraception Objective 1 To increase contraceptive prevalence rate up to 60 % in three years.  MoH – the Ministry of HealthFPSHA – Family Planning and Sexual Health Association  MoE&S – the Ministry of Education and Science LSC - Lithuanian Society of Contraceptologists  LSOG – Lithuanian Society of Obstetricians GynecologistsLCGP - Lithuanian College of General Practitioners  LUM - Lithuanian Union of Midwifes

Objective 2 To improve SRHR legislation and governmental support to SRHR in two years period. ActivityResponsible Organization Time frameIndicator 2.1. To establish National Reproductive Health Policy MoH, LSOG, FPSHA,LSC, LCGP Established National Policy and plan how to improve reproductive health and rights of population  MoH – the Ministry of HealthFPSHA – Family Planning and Sexual Health Association  MoE&S – the Ministry of Education and Science LSC - Lithuanian Society of Contraceptologists  LSOG – Lithuanian Society of Obstetricians GynecologistsLCGP - Lithuanian College of General Practitioners  LUM - Lithuanian Union of Midwifes

Objective 2 To improve SRHR legislation and governmental support to SRHR in two years period. ActivityResponsible Organization Time frameIndicator 2.2. To establish the Reproductive Health and Rights draft law MoH, LSOG, FPSHA, LSC, LCGP Law established, access insured to legal abortion 2.3. To introduce Medical Abortion MoH, LSOG, FPSHA Increased number of early abortions  MoH – the Ministry of HealthFPSHA – Family Planning and Sexual Health Association  MoE&S – the Ministry of Education and Science LSC - Lithuanian Society of Contraceptologists  LSOG – Lithuanian Society of Obstetricians GynecologistsLCGP - Lithuanian College of General Practitioners  LUM - Lithuanian Union of Midwifes

Objective 3 To improve abortion statistics in one year period. ActivityResponsible Organization Time frameIndicator To develop national norm on abortion statistics MoH2009National norm developed, more reliable data on abortion  MoH – the Ministry of Health

Objective 4 To improve awareness of emergency contraception (EC) of young people in one year period. ActivityResponsible Organization Time frameIndicator To organize education sessions on EC for students FPSHA2009Number of educated studentsIncrea sed knowledge on EC of students  FPSHA – Family Planning and Sexual Health Association