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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
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Pregnancies in the worldPregnancies in the world
210 million women get pregnant annually– 15% miscarriages,
stillbirths– 22% induced
abortions– 63% live births
miscarr.,stillbirthsinducedabortionslivebirths
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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
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Abortion in EuropeAbortion in Europe
– culture– economic status– religion– law
Aspects of abortion laws rates practices
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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
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Completely prohibitedCompletely prohibited
Ireland
Malta
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To save woman’s life, to protect To save woman’s life, to protect her physical healthher physical health
Poland (R, I, F)
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… … to protect woman’s mental healthto protect woman’s mental health
Northern IrelandPortugal (R,F)Spain (R,F)Switzerland
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… … on socioeconomic groundson socioeconomic grounds
Finland Great BritainHungary
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… … 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
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Gestational limitsGestational limits
10 weeks: Slovenia, Turkey12 weeks: others14 weeks: Belgium22 weeks: Netherlands
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ConsentConsent
parental consent– Austria, Czech Republic, Denmark,
Germany, Greece, Hungary, Italy, Netherlands, Norway, Russia, Sweden, Turkey
partner consent– Turkey
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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
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AccessabilityAccessability
facilities: governmental, private practitioner: Ob/Gyn spec., GPs abortion charged: Czech Republic,
Hungary, Latvia, Russia, Turkeyaccessability?: Austria, Germany,
Spain, Portugal
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Data on illegal abortionData on illegal abortion
Poland? Northern Ireland?Portugal?Russia?
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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
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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
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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
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ABORTION PRACTICESABORTION PRACTICES
Safe abortion– early in pregnancy– by well-trained practitioner– using surgical or medical method– in legal setting
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First trimester abortionFirst trimester abortion
vacuum aspirationdilatation and curretagemedical abortion–mifepristone & prostaglandins–methotrexate & prostaglandins
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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
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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
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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
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Second trimester abortionSecond trimester abortion
medical induction with prostaglandins
dilatation and evacuation
intrauterine instillation of prostaglandins, hypertonic saline
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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
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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