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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www.womenonweb.org •  Austria and Italy: no training, doctors use outdated technique and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?