Short background information on abortion in Eastern Europe
Frank Lüdicke
Geneva WHO Collaborating Centre for Research in Human Reproduction
Reproductive Health is becoming an integral part of human culture in its full significance of physical, mental and social well-being and not just absence of pregnancy, disease or injury. There are few indicators, which can characterise Reproductive Health service in any country:
* Maternal morbidity and mortality
* Infants and child mortality
* Infertility
* Induced abortions
* Sexually transmitted disease
A major goal of WHO is to improve Reproductive Health service in developing countries. States of the former USSR can be regarded as developing countries especially in the field of reproductive medicine.
In the RUSSIAN FEDERATION the years 1992 and 1993 have been characterised by substantial legislative activities in the field of maternal and child health care. January 1992 the President of the Russian Federation established a co-ordinating committee, which seeks to ensure collaboration between State agencies, public and other organisations in order to achieve a unified family policy at the level of the state and to formulate a strategy to improve the status of the women and to ensure the protection of maternity and childhood. July 1993 the Supreme Soviet adopted the « Principles of the legislation of the Russian Federation on the protection of health of the citizens ». The document places strong emphasis on the protection of the civil and human rights in the field of health and recognises the fundamental role of health protection. Thus, it is laid down that the State is to guarantee pregnant women the right to work under conditions that are appropriate to their physiological circumstances and their state of health. With regard to voluntary termination of pregnancy, it is stated that every woman has the right to decide for herself whether she wishes to carry the pregnancy to term. Voluntary termination is carried out at the women's request, within the first 12 weeks of pregnancy; the period may be extended to 22 weeks in the presence of medical indications, with the woman's consent. Concerning sterilisation, it is laid down that it may only be performed in response to a written declaration by the woman who must be at least 35 years of age and got at least two children.
In KYRGYZSTAN, 1992 a law on the protection of public health proclaims that every woman has the right to take her own decisions as to maternity. In another newly independent State the UKRAINE, a long term programme for the « Improvement of the condition of women and family and for maternal and child protection » was adopted by the cabinet of Ministers in July 1992. It seeks to improve women's conditions in the production sector, improve living conditions of women with children and to protect maternal and child health.
HUNGARIAN law on the protection of the life of the foetus was issued by the Minister of Social Welfare December 1992. The preamble of the law indicates that the Parliament of the Hungarian Republic is conscious that: « The life of the foetus must be respected and protected from the time of conception; the protection of the life of the foetus can only be assured by granting increased assistance to pregnant women; pregnancy termination can not be considered as means of family planning or both control; family planning is both a right and a responsibility on the part of the parents ». Legal abortion continues to be available in the first twelve weeks of gestation if there is a danger to the health of the pregnant women, if there is a danger of handicap or defect to the foetus and if the woman was raped. Counselling on contraceptives and on abortion alternatives with a representative of the Family Protection Office is mandatory. Women have to wait three days after counselling but not more than eight days before the procedure can be performed.
The ALBANIAN decision of May 1992 endorses family planning activities in the country. The law which permitted abortion only on narrowly defined grounds was revoked 1991. The new directive makes abortion available on request up to 12 weeks, for social reasons up to 15 weeks and on for medical reasons no time limit was given. Since legalisation of abortion in 1991, abortion-related maternal mortality decreased from 57 % to 32 % of all maternal mortality in 1992.
In ROMANIA an order from 1990 approved technical standards for hormonal contraceptives and intrauterine devices. The existing restrictive abortion law was enacted in December 1989. In POLAND a strict anti-abortion law became effective March 1993. It overturned the liberal 1956 legislation and permits abortion in public hospitals only when threat to the life or health of the pregnant woman is demonstrated and is as such certified by three physicians. Permission is also given when serious and irreversible malformation of the foetus was proven or when the pregnancy resulted from a criminal act. Since the installation of the law a substantial number of women with the request of pregnancy interruption are now travelling to the Ukraine and Russia.
SLOVAK REPUBLIC. The government has not formulated a Reproductive Health or population policy. After the adoption of the new liberal Act on legally induced abortion in 1986, the abortion incidence started to increase. In fact we may say that government started to support the use of abortion as a method of fertility regulation. Women now pay for contraceptives, including sterilisation, while abortion up to the eight week of pregnancy is free of charge.
In many countries abortion has become the main method of fertility regulation accompanied with limited access to contraception, as a result from government policies or the lack of them.
More than six million legal (and the same number of illegal ?) abortions took place annually in the countries of the former USSR.
Dynamics of induced abortions in the former USSR
| Year | Absolute number in thousands | Induced abortions per 1000 women | Induced abortions per 100 pregnancies |
| 1975 | 7135 | 105.7 | 153 |
| 1980 | 7003 | 102.3 | 143 |
| 1985 | 7034 | 100.3 | 127 |
| 1986 | 7116 | 101.2 | 126 |
| 1987 | 6818 | 97.1 | 121 |
| 1988 | 6008 | 86.6 | 112 |
Although the information on illegal performed abortions are poor the table indicates a somewhat decreasing trend in the number of abortions. The reason of this overall decrease may be due to a gradual increase of contraceptive use in former USSR. Depending on factors such as law, traditions, use of contraceptive methods, etc. the use of induced abortion varies greatly in different countries of the former USSR.
Induced abortion statistics in the former USSR
Number of abortions per 1000 women
| Countries | 1975 | 1980 | 1985 | 1988 |
| RSFSR | 126.3 | 122.3 | 123.6 | 105.2 |
| Moldavia | 89.7 | 90.7 | 96.0 | 88.4 |
| USSR | 105.7 | 102.3 | 100.3 | 82.3 |
| Estonia | 107.1 | 96.7 | 91.4 | 77.3 |
| Latvia | 91.4 | 92.5 | 88.7 | 76.8 |
| Kazakh | 108.7 | 99.2 | 90.7 | 72.2 |
| Kirgkiz | 84.1 | 76.6 | 73.8 | 67.7 |
| Ukraine | 88.3 | 94.1 | 92.2 | 61.1 |
| Belorussia | 78.7 | 81.1 | 80.0 | 54.1 |
| Georgia | 74.0 | 67.7 | 52.4 | 52.5 |
| Uzbekistan | 51.9 | 43.8 | 46.9 | 50.8 |
| Turkmenistan | 60.8 | 51.1 | 40.9 | 43.1 |
| Tajikistan | 53.4 | 45.3 | 39.5 | 38.6 |
| Lithuania | 53.0 | 50.9 | 46.3 | 38.0 |
| Armenia | 60.5 | 38.8 | 38.4 | 30.2 |
| Azerbaijan | 43.1 | 39.0 | 30.8 | 22.4 |
The former USSR was the first country to make abortion available on request in 1920, reversing the policy in 1936 and re-liberalising again in 1955 in order to control the health hazard from illegal abortions and to grant women the right to decide « the question of motherhood » for themselves. Although the former USSR has experienced a high number of legally performed abortions, there was no decline in births as compared to other Eastern European nations. This may be explained in part by the gradual post-war equalisation in the sex ratio, which caused a continuos decline of the proportion of women not married. However, the former USSR reflects the pattern observed elsewhere in Eastern Europe and other countries: in urban areas, where abortion rates are highest, birth rates are lower than in rural areas, where abortion rates are lower.
The data offer evidence that contraceptive services are inadequately available and, therefor, the rates of abortion are unnecessarily high. Restrictive abortion laws in « best case » induce travelling of the women requesting for abortion in countries with more liberal laws, in « worst case » they will generate an increase in maternal mortality due to a high number of abortions performed under unsafe conditions. Little is known on the medical and economic resources spent on the treatment of abortion complications, nor on the characteristics (i.e. contraceptive knowledge) of the women with a history of induced abortion. Information on both will help to define a strategy of intervention in order to increase contraceptive use and to provide also other methods for fertility regulation than induced abortion.