Medico-legal aspects of abortion in Europe Bojana Pinter University Dept. Of Ob/Gyn Ljubljana, Slovenia Why are teenagers still getting pregnant? 6 th Seminar, ESC, 8 Oct. 2001, Coimbra
Pregnancies in the world l 210 million women get pregnant annually – 15% miscarriages, stillbirths – 22% induced abortions – 63% live births
Abortion – a response to unwanted pregnancy l 50 million abortions occur annually l 20 million abortions are unsafe, usually illegal l every day more than 200 women die of unsafe abortion
Abortion in Europe – – culture economic status religion law Aspects of abortion l laws l rates l practices
ABORTION LAWS IN EUROPE Abortion: l completely prohibited l to save woman’s life, protect her physical health l … to protect woman’s mental health l … on socioeconomic grounds l … on demand
Completely prohibited l Ireland l Malta
To save woman’s life, to protect her physical health l Poland (R, I, F)
… to protect woman’s mental health l Northern Ireland l Portugal (R, F) l Spain (R, F) l Switzerland
… on socioeconomic grounds l Finland l Great Britain l Hungary
… on demand l l l l Albania Austria Belarus Bosna-Hercegovina Belgium Bulgaria Croatia Czech Republic Denmark Estonia France Germany Greece Italy l l l l Latvia Lithuania Macedonia Moldova Netherlands Norway Romania Russia Slovak Republic Slovenia Sweden Ukraine Turkey Yugoslavia
Gestational limits l 10 weeks: Slovenia, Turkey l 12 weeks: others l 14 weeks: Belgium l 22 weeks: Netherlands
Consent l parental consent – Austria, Czech Republic, Denmark, Germany, Greece, Hungary, Italy, Netherlands, Norway, Russia, Sweden, Turkey l partner consent – Turkey
Counselling and waiting period l counselling: Albania, Belgium, France, Germany, Hungary, Netherlands, Poland, Russia, Spain, Turkey l waiting period: 3 – 8 days: Belgium, France, Germany, Hungary, Netherlands, Poland
Accessability l facilities: governmental, private l practitioner: Ob/Gyn spec. , GPs l abortion charged: Czech Republic, Hungary, Latvia, Russia, Turkey l accessability? : Austria, Germany, Spain, Portugal
Data on illegal abortion l Poland? l Northern Ireland? l Portugal? l Russia?
ABORTION RATES IN EUROPE Western Europe l Netherlands: 6. 5/1000 women 15 -44 yrs – abortion ratio: 10. 6 – total ab. rate: 0. 2 Eastern Europe l Romania: 78/1000 women 15 -44 yrs – abortion ratio: 63. 0 – total ab. rate: 2. 3
Abortion rates in Western Europe (abortions/1, 000 women 15 -44 yrs) Source: The Alan Guttmacher Institute. Sharing responsibility. Women society and abortion worldwide. New York: The Source: Alan Guttmacher Institute, 1999: 54.
Abortion rates in Eastern Europe (abortions/1, 000 women 15 -44 yrs) Source: The Alan Guttmacher Institute. Sharing responsibility. Women society and abortion worldwide. New York: The Source: Alan Guttmacher Institute, 1999: 54.
ABORTION PRACTICES l Safe abortion – early in pregnancy – by well-trained practitioner – using surgical or medical method – in legal setting
First trimester abortion l vacuum aspiration l dilatation and curretage l medical abortion – mifepristone & prostaglandins – methotrexate & prostaglandins
The history of vacuum aspiration l 1863: Simpson (Scotland) l 1927: Bykov (Russia) l 1958: Tsai, Wu (China) l 1961: Zubejev (Russia) l 1964: Novak (Slovenia) l 1968: Novak - transfer to the West
Medical abortion (mifepristone & PG) l 1992: France – 49 days: 600 mg mifepristone + 400 g misoprostol 200 mg mifepristone + 800 g misoprostol – 63 days: 600 mg mifepristone + 1 mg gemeprost 200 mg mifepristone + 800 g misoprostol
Availability of medical abortion l Available – – – – Austria Belgium Denmark France Germany Israel Netherlands Russia Slovenia Spain Sweden Switzerland United Kingdom l Not available – – – – Czech Republic Greece Hungary Ireland Italy Poland Portugal Turkey
Second trimester abortion l medical induction with prostaglandins l dilatation and evacuation l intrauterine instillation of prostaglandins, hypertonic saline
CONCLUSION l good family planning service l appropriate legislation of abortion law and practice are the essential conditions l to reduce the need for abortion l to prevent unsafe abortion
Acknowledgments l l l l Ann Verougstraete Sven Skouby George Creatsas David Cibula Gyoergy Bartfai Mary Short Melanija Orlean l l l l Jany Rademakers Rob Beerthuizen Medard Lech Irina Savelieva Vera Prilevskaia Carme Coll Sinan Ozalp Ann Webb
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