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Kristina Gemzell Danielsson, Department of Woman and Child Health, Division of Obstetrics & Gynecology, Karolinska Institutet / Karolinska University Hospital Stockholm, Sweden
• Abortion legislation varies widely in Europe.
• Also in countries with a rather liberal abortion law there
is a wide variation in access to abortion care;
– organization, access, type of clinics, HCP, training
– costs
– standard of care
– obligatory counseling
– approvals of two doctors
– obligatory waiting periods
– various limitations in access for minors
Induced abortion in Europe
22,5
22,4
21
20
18
16,3
16,3
15,1
13,5
12,8
10,9
8,5
8,4
8,1
8
7,6
7,5
6,6
6
5,2
2,9
0,03
0
0 5 10 15 20 25
Sweden
United Kingdom
Estonia
Romania
Hungary
Denmark
Bulgaria
France (metropolitan)
Spain
Finland
Latvia
Portugal
Belgium
Netherlands
Slovakia
Italy
Czech Republic
Slovenia
Germany
Lithuania
Greece
Poland
Malta
Teenage abortion rate – EU member states
Ambivalence about ge0ng pregnant
Teenage Pregnancy –a strange way out?
0 5 10 15 20 25 30 35 40 45 50
Bulgaria Romania
United Kingdom Slovakia
Latvia Estonia
Malta Hungary Lithuania
Ireland Poland
Portugal Spain
Czech Republic Greece
Belgium Austria France
Germany Finland
Italy Luxembourg
Cyprus Sweden
Denmark Slovenia
Netherlands
Teenage birth rate– EU member states
Lower abortion rates in countries with liberal laws
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Timeline of legalising abortion in Europe
Museum of Contraception and Abortion, www.muvs.org www.muvs.org
'to take the boat to England‘ Every year about 7 000 Irish women
travel to England and Wales for an
abortion. Source: Dept. Of Health, London 2003
Abortion travelling (“tourism”)
Abortion tourism has a negative impact on the physical and psychological health of women.
www.womenonweb.org • Austria and Italy: no training, doctors use outdated technique and
instruments for the curettage (still practising D&C) that are necessary
for medical reasons. > 70% do not perform induced abortion
• No training for residents in Ob/Gyn
• Most university hospitals don't even perform I-trim abortions
• France: Abortion done in all hospitals but no formal training or
curriculum
• Germany: Abortions rarely done in hospitals. No formal training •
Training of Ob/Gyns in induced abortion
• The Netherlands: most abortions on social indication (about 95%) are
performed in abortion clinics, so Ob&Gyn generally do only abortions in case of
congenital abnormalities
• However, 3 of the 8 University hospitals do have a Christian signature, as
several from our Dutch hospitals. They will never do ab on social indication,
only on medical indication
• There are residents who are unwilling to perform abortions, even to expel a
placenta after a woman has an abortion because of congenital malformations
• Macedonia: The training in abortion provision in OB/GYN clinics is not carry out
in systemized way
Training cont.
• Portugal: Legalization in 2007. Medical ab done in 90% of hospitals
• Norway: As part of the description and implementation plan in the
training of specialists in OB/Gyn in Norway, abortus provocatus is
specifically mentioned as a point that residents must have theoretical
knowledge in order to qualify. However, there has never been a formal
requirement for training in abortion provision/care for residents in OB/
Gyn
• Switzerland: Abortion performed in hospitals. Incl in training of Ob/Gyns •
Training of Ob/Gyns in induced abortion
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• Finland, Denmark, Sweden: Abortion is part of public service and also
part of the residency training in ob / gyn. All residents get trained and
participate in abortion care, similarly as in labor and delivery,
hysterectomy etc..
• Slovenia: The training in abortion provision/ care for residents in Ob/
Gyn in Slovenia is organized as essential part of training in the human
reproduction, which altogether takes 10 months. Incl. both thery and
practise
Training cont.
• Huge variations exists in training of residents in Obst/ Gyn
• Abortion illegal in Poland, Malta, Ireland (NI + Rep), Lichtenstein
• In several countries there is no training or no formal requirement for
training in abortion provision/care for residents in Ob/Gyn
• HCP in several European countries are even allowed to refuse to treat
abortion seekers on conscientious or religious grounds.
• There are also countries, such as Sweden, where you cannot train in
Ob/Gyn without accepting to train in - and carry out - induced abortions.
• No hospitals or residents in Ob/ Gyn can opt out from this obligation.
Conclusion
US-president Bush signing a law against late abortions, 2003
Who decides over fertility?
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