Medico-legal aspects of abortion Medico-legal aspects of abortion in Europein Europe

Bojana Pinter

University Dept. Of Ob/Gyn

Ljubljana, SloveniaWhy are teenagers still getting pregnant?

6th Seminar, ESC, 8 Oct. 2001, Coimbra

Pregnancies in the worldPregnancies in the world

210 million women get pregnant annually– 15% miscarriages,

stillbirths– 22% induced

abortions– 63% live births

miscarr.,stillbirthsinducedabortionslivebirths

Abortion – a response to Abortion – a response to unwanted pregnancyunwanted pregnancy50 million abortions occur annually

20 million abortions are unsafe, usually illegal

every day more than 200 women die of unsafe abortion

Abortion in EuropeAbortion in Europe

– culture– economic status– religion– law

Aspects of abortion laws rates practices

ABORTION LAWS IN EUROPEABORTION LAWS IN EUROPE

Abortion: completely prohibitedto save woman’s life, protect her

physical health… to protect woman’s mental health… on socioeconomic grounds… on demand

Completely prohibitedCompletely prohibited

Ireland

Malta

To save woman’s life, to protect To save woman’s life, to protect her physical healthher physical health

Poland (R, I, F)

… … to protect woman’s mental healthto protect woman’s mental health

Northern IrelandPortugal (R,F)Spain (R,F)Switzerland

… … on socioeconomic groundson socioeconomic grounds

Finland Great BritainHungary

… … on demandon 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 limitsGestational limits

10 weeks: Slovenia, Turkey12 weeks: others14 weeks: Belgium22 weeks: Netherlands

ConsentConsent

parental consent– Austria, Czech Republic, Denmark,

Germany, Greece, Hungary, Italy, Netherlands, Norway, Russia, Sweden, Turkey

partner consent– Turkey

Counselling and waiting periodCounselling 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

AccessabilityAccessability

facilities: governmental, private practitioner: Ob/Gyn spec., GPs abortion charged: Czech Republic,

Hungary, Latvia, Russia, Turkeyaccessability?: Austria, Germany,

Spain, Portugal

Data on illegal abortionData on illegal abortion

Poland? Northern Ireland?Portugal?Russia?

ABORTION RATES IN EUROPEABORTION RATES IN EUROPE

Western Europe

Netherlands: 6.5/1000 women 15-44 yrs– abortion ratio: 10.6– total ab. rate: 0.2

Eastern Europe

Romania: 78/1000 women 15-44 yrs– abortion ratio: 63.0– total ab. rate: 2.3

Abortion rates in Western EuropeAbortion rates in Western Europe(abortions/1,000 women 15-44 yrs) (abortions/1,000 women 15-44 yrs) Source: Source: The Alan Guttmacher Institute. Sharing responsibility. Women society and abortion worldwide. New York: The Alan Guttmacher Institute, 1999: 54.

0 5 10 15 20

Sweden

England&Wales

Israel

Greece

Scotland

Switzerland

Belgium

Netherlands

Abortion rates in Eastern EuropeAbortion rates in Eastern Europe(abortions/1,000 women 15-44 yrs)(abortions/1,000 women 15-44 yrs)Source: Source: The Alan Guttmacher Institute. Sharing responsibility. Women society and abortion worldwide. New York: The Alan Guttmacher Institute, 1999: 54.

0 10 20 30 40 50 60 70 80 90

RomaniaRussia

BelarusUkraine

Yugoslavia

EstoniaBulgaria

LatviaMoldova

HungaryLithuania

MacedoniaAlbania

TurkeySlovenia

Czech Rep.

Slovak republicCroatia

ABORTION PRACTICESABORTION PRACTICES

Safe abortion– early in pregnancy– by well-trained practitioner– using surgical or medical method– in legal setting

First trimester abortionFirst trimester abortion

vacuum aspirationdilatation and curretagemedical abortion–mifepristone & prostaglandins–methotrexate & prostaglandins

The history of vacuum aspirationThe 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 Medical abortion (mifepristone & PG)(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 abortionAvailability 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 abortionSecond trimester abortion

medical induction with prostaglandins

dilatation and evacuation

intrauterine instillation of prostaglandins, hypertonic saline

CONCLUSIONCONCLUSION

good family planning service appropriate legislation of abortion

law and practice

are the essential conditions

to reduce the need for abortionto prevent unsafe abortion

AcknowledgmentsAcknowledgments

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