ABORTION (LEGAL STATUS, ACCESS, QUALITY)
All governments and relevant organizations are urged to deal with the health impact of unsafe abortion as a major public health concern and to reduce the recourse to abortion through expended and improved family planning services. In circumstances where abortion is not against the law, such abortion should be safe.1Governments are urged to consider reviewing laws containing punitive measures against women who have undergone illegal abortions .2
All Governments and relevant intergovernmental and non-governmental organizations are urged to strengthen their commitment to women’s health, to deal with the health impact of unsafe abortion as a major public-health concern and to reduce the recourse to abortion through expanded and improved family planning services. Health systems should train and equip health – service providers and should take other measures to ensure that such abortion is safe and accessible.3
Abortion is legal in most of the CEE countries. However, there is a strong movement to make abortion laws more restrictive in many countries of the region. The right to have access to abortion is not strongly grounded in national legal systems and can easily be challenged. We can observe continuing initiatives from anti-choice groups, often linked to church that grow in strength, in particular in Lithuania, Croatia, Slovakia, Hungary and Russia, where the Roman Catholic or Orthodox churches have considerable influence on public life.
Poland is the
first country in the region that has submitted to the pressures of anti-choice groups,
mostly inspired by the Roman Catholic Church. Since 1993 (except for the period between
October 1996 to December 1997) abortion is legal only for therapeutic reasons or if a
pregnancy is the result of a criminal act, and is not permitted on social or economic
grounds. The practice is even more restrictive than the law. In many cases women, who have
the right to legal abortion, are denied access to it. It is estimated that about 200,000
clandestine abortions per year are performed in Poland. The price for clandestine abortion
is high – around 2000 PLN (€ 500), which equals an average monthly salary. Thus, the
ban on abortion bears unproportionate burden on poor women, women from rural areas, who
cannot afford to use clandestine services4.
Abortion services often remain to be of poor quality. There is no government commitment for the development and more widespread use of safer, more effective and convenient techniques of induced abortion. Lack of support for the improvement of the quality of services is in part associated with the movement to restrict access to abortion. Abortion providers rely to the high extent on the dilation & curettage (D&C) method, rather than on vacuum aspiration or medical abortion. While D&C method haas been virtually replaced in Wester Europe by the quicker, easier and safer aspiration techniques. Many women in the region still do not have access to safe services. This usually results from the high costs of abortion services or difficulties in accessing quality services in rural areas.
Out of about 900,000 estimated unsafe abortions carried out
in Europe annually, 800,000 occur in Eastern Europe5.
In Georgia,
the general abortion rate in 1999 was 135 abortions per 1000 women aged 15-44.9
In many CEE
countries, where abortion is legal, prices of contraceptives are not significantly lower
than the price of abortion. For instance, in Romania, prices of contraceptives vary
between € 1- 5 and the price of abortion is € 5 – 15 in public settings and € 11
– 33 in private medical facilities. (while average salary in enterprise sector is €
56).11
EXAMPLE OF BEST PRACTICE
In Estonia, certain groups of women can obtain 90% subsidy for contraceptives if they are: full-time students, within the first three months following an abortion, within the first year after delivery. This idea was based on the lessons learned from a project conducted in years 1993 – 1995. The project demonstrated a significant decrease in the number of abortions and repeat abortions, when sufficient contraceptives have been effectively distributed to these categories of women.12 It is an example of a well-designed and effective special family planning program directed at reducing the recourse to abortion.
REFERENCES:
1 “Cairo Programme of Action”, supra note 1, par. 8.25.
2 “Beijing Platform for Action”, supra note 1, par. 106k.
3 “Cairo Plus Five”, supra note 13, par. 63(i).
4 FWFP, “The Anti-abortion Law in Poland”, supra note 20, p. 17-18.
5 WHO “Unsafe abortion: Global and regional estimates of incidence of a mortality due to unsafe abortion with a listing of available country data”, 3rd ed., 1997 Ref. WHO/RHT/MSM/97.16.
6 See id.
7 UNICEF (1999), “Women in Transition”, supra note 7, p. 63.
8 See id.
9 CDC, “Reproductive Health Survey Georgia”, supra note 15, p. 54.
10 UNICEF (1999), “Women in Transition”, supra note 7, p. 63.
11 M. Z. Poenariu, “Reproductive Rights and Health of Women, Perspectives from Romania”, paper presented at the Expert Meeting in Bratislava, 2001.
12 WHO, “Family Planning and Reproductive Health ...”, supra note 9, p. 27.