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Sexual and reproductive health

Facts and figures about abortion in the European Region

  1. Some of the countries of western Europe have the lowest abortion rate in the world, at 12 per 1000 women of childbearing age, according to the European Health for All database (HFA-DB).
  2. By contrast, eastern countries (in this case: Belarus, Bulgaria, the Czech Republic, Hungary, Poland, the Republic of Moldova, Romania, the Russian Federation, Slovakia and Ukraine) have the highest estimated abortion rates in the world. In 2003 there were more abortions than live births: 103 abortions per 100 births.
  3. Nevertheless, eastern Europe has seen a dramatic decline in abortion incidence. It was estimated to be 90 per 1000 women of childbearing age in 1995 and 44 by 2004. The decrease coincided with substantial increases in contraceptive use in the region.[1]
  4. The data in many countries are unreliable. According to HFA-DB, in 2006 the abortion ratio was 95 per 100 live births in the Russian Federation and 68 in Romania. At the lower end, Belgium’s rate was 14 and Switzerland 15 in 2005. Tajikistan reported less than 5 per 100 in 2006, and Poland less than 1. According to the most recent figures, the European Union average is 30 per 1000, and that of the newly independent states 54.
  5. In a 2007 review, Armenia, Azerbaijan and Georgia had the highest levels of abortion in the European Region. During their lifetimes, on average each woman has close to three abortions. The use of modern contraceptives is low in these countries.[2]
  6. Unwanted pregnancies and induced abortions occur in every society for a number of reasons. Contraceptive methods may fail; couples do not always use them correctly or consistently; some women have partners who oppose contraceptive use; some become pregnant as a result of coerced sex, and some seek abortion for health reasons. Even a planned pregnancy can become unwanted if circumstances change.
  7. The availability of abortion varies across the European Region: almost all countries allow abortion to save a woman’s life and 90% to preserve mental or physical health; 88% of them allow abortion if the foetus is thought to be impaired, or in case of rape or incest. Nearly 80% allow abortion for economic and social reasons, and slightly fewer offer abortion on request.
  8. In Malta and Andorra abortion is illegal on any grounds. In Poland and Ireland, legal abortion is severely limited in availability.
  9. Legal restrictions on abortion do not affect its incidence; women seek desperate measures if they cannot obtain safe abortions. Data from Romania revealed that, when termination of pregnancy was banned by the Ceausescu regime, maternal mortality was more than 20 times higher than today.
  10. Unsafe abortion kills. Much has been done to improve abortion services in the Region, but up to 30% of maternal deaths are still caused by unsafe abortion in some countries of eastern Europe and central Asia.
  11. The cost of conducting a safe abortion is up to one tenth of the cost of treating the consequences of an unsafe abortion.
  12. The adolescent birth rate is an indicator for Millennium Development Goal 5, Target 5b, for universal access to reproductive health, but many countries focus on the adolescent abortion rate because, unlike the overall abortion rate, it is not decreasing. Pregnancy in adolescent girls is typically diagnosed late, which means a higher risk of complications during abortion. The amount of morbidity after such abortions requires further research.
  13. WHO’s publication “Safe abortion: technical and policy guidance for health systems” is available in Azerbaijani, Bosnian, English, French, Polish, Russian and Spanish, and has been adapted and used in many countries in the European Region.
  14. More evidence and information about new technologies can be obtained from the WHO Reproductive Health Library. This includes information on improved regimens of medical abortion, and evidence on the provision of abortion in the first trimester by mid-level providers, the cost of unsafe abortion to individuals and health systems and the impact of changing abortion laws on access and incidence.
  15. Data on abortion are useful because they can tell policy-makers about the success of their family planning or sex education policies, but the statistics do not reveal the whole story. Providers do not always report all the abortions they perform, even if they are legally required to do so. In some countries, only abortions performed at public facilities are reported, even if most are performed at private clinics. Medical abortions or early surgical procedures may be underreported in some countries. Estimates sometimes have to be based on data provided from health insurance claims, or from surveying women, who do not always want to reveal their experiences.

[1] Sedgh G et al. Legal abortion worldwide: incidence and recent trends. “International Family Planning Perspectives”, 2007, 33(3) (http://www.guttmacher.org/pubs/journals/3310607.html).

[2] Sedgh G et al. Legal abortion worldwide: incidence and recent trends. “International Family Planning Perspectives”, 2007, 33(3) (http://www.guttmacher.org/pubs/journals/3310607.html).

 

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