Transcript Medico-legal aspects of abortion in Europe

Medico-legal aspects of abortion
in Europe
Bojana Pinter
University Dept. Of Ob/Gyn
Ljubljana, Slovenia
Why are teenagers still getting pregnant?
6th Seminar, ESC, 8 Oct. 2001, Coimbra
Pregnancies in the world

210 million women
get pregnant
annually
– 15% miscarriages,
stillbirths
– 22% induced
abortions
– 63% live births
miscarr.,
stillbirths
induced
abortions
live
births
Abortion – a response to
unwanted pregnancy

50 million abortions occur annually

20 million abortions are unsafe,
usually illegal

every day more than 200 women die
of unsafe abortion
Abortion in Europe
–
–
–
–
culture
economic status
religion
law
Aspects of abortion
 laws

rates

practices
ABORTION LAWS IN EUROPE
Abortion:
 completely prohibited
 to save woman’s life, protect her
physical health
 … to protect woman’s mental health
 … on socioeconomic grounds
 … on demand
Completely prohibited

Ireland

Malta
To save woman’s life, to protect
her physical health

Poland (R, I, F)
… to protect woman’s mental health
Northern Ireland
 Portugal (R,F)
 Spain (R,F)
 Switzerland

… on socioeconomic grounds
Finland
 Great Britain
 Hungary

… on demand














Albania
Austria
Belarus
Bosna-Hercegovina
Belgium
Bulgaria
Croatia
Czech Republic
Denmark
Estonia
France
Germany
Greece
Italy














Latvia
Lithuania
Macedonia
Moldova
Netherlands
Norway
Romania
Russia
Slovak Republic
Slovenia
Sweden
Ukraine
Turkey
Yugoslavia
Gestational limits
10 weeks: Slovenia, Turkey
 12 weeks: others
 14 weeks: Belgium
 22 weeks: Netherlands

Consent

parental consent
– Austria, Czech Republic, Denmark,
Germany, Greece, Hungary, Italy,
Netherlands, Norway, Russia, Sweden,
Turkey

partner consent
– Turkey
Counselling and waiting period

counselling: Albania, Belgium,
France, Germany, Hungary,
Netherlands, Poland, Russia, Spain,
Turkey

waiting period: 3 – 8 days: Belgium,
France, Germany, Hungary,
Netherlands, Poland
Accessability
facilities: governmental, private
 practitioner: Ob/Gyn spec., GPs
 abortion charged: Czech Republic,
Hungary, Latvia, Russia, Turkey
 accessability?: Austria, Germany,
Spain, Portugal

Data on illegal abortion
Poland?
 Northern Ireland?
 Portugal?
 Russia?

ABORTION RATES IN EUROPE
Western Europe
Eastern Europe


Netherlands:
6.5/1000 women
15-44 yrs
– abortion ratio: 10.6
– total ab. rate: 0.2
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
Alan Guttmacher Institute, 1999: 54.
Netherlands
Belgium
Switzerland
Scotland
Greece
Israel
England&Wales
Sweden
0
5
10
15
20
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
Alan Guttmacher Institute, 1999: 54.
Croatia
Slovak republic
Czech Rep.
Slovenia
Turkey
Albania
Macedonia
Lithuania
Hungary
Moldova
Latvia
Bulgaria
Estonia
Yugoslavia
Ukraine
Belarus
Russia
Romania
0
10
20
30
40
50
60
70
80
90
ABORTION PRACTICES

Safe abortion
– early in pregnancy
– by well-trained practitioner
– using surgical or medical method
– in legal setting
First trimester abortion
vacuum aspiration
 dilatation and curretage
 medical abortion

– mifepristone & prostaglandins
– methotrexate & prostaglandins
The history of vacuum aspiration
1863: Simpson (Scotland)
 1927: Bykov (Russia)
 1958: Tsai, Wu, Wu (China)
 1961: Zubejev (Russia)
 1964: Novak (Slovenia)
 1968: Novak - transfer to the West

Medical abortion (mifepristone & PG)

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

Available
–
–
–
–
–
–
–
–
–
–
–
–
–
Austria
Belgium
Denmark
France
Germany
Israel
Netherlands
Russia
Slovenia
Spain
Sweden
Switzerland
United Kingdom

Not available
–
–
–
–
–
–
–
–
Czech Republic
Greece
Hungary
Ireland
Italy
Poland
Portugal
Turkey
Second trimester abortion

medical induction with
prostaglandins

dilatation and evacuation

intrauterine instillation of
prostaglandins, hypertonic saline
CONCLUSION
good family planning service
 appropriate legislation of abortion
law and practice

are the essential conditions
to reduce the need for abortion
 to prevent unsafe abortion

Acknowledgments







Ann Verougstraete
Sven Skouby
George Creatsas
David Cibula
Gyoergy Bartfai
Mary Short
Melanija Orlean








Jany Rademakers
Rob Beerthuizen
Medard Lech
Irina Savelieva
Vera Prilevskaia
Carme Coll
Sinan Ozalp
Ann Webb