The Long March from Abortion to Contraception• Daniel Pierotti & Chantal Blayo

18 World Health • 47th Year, No. 3, Moy-June 1994 The long march from abortion to contraception• Daniel Pierotti & Chantal Blayo the former USSR from 2.5 to 4 Contraceptive production in abortions per woman and for the rest of Eastern Europe around 1.5. By Eastern Europe has collapsed contrast, in the West the figure is no higher than 0.63 per woman. The everywhere except in difference is even more striking as Hungary. The unfamiliar regards the type of woman who seeks an abortion. In the East, she is market economy obliges a married woman with a family, countries to pay for aged over 25, who has already aborted and returns for another. In contraceptives with foreign the West, she is an unmarried woman with no children, aged 20 or currency, and abortion is what less, requesting her first abortion. Broadly speaking, in Western is mostly resorted to by many All couples should hove the right and possibility to plan the number and spacing of their Europe, abortion represents an women. Nevertheless, children. isolated accident- a contraceptive solutions are being found to fai lure; repeated abortions are the end of the 1950s. The East unusual because contraception is the chronic shortages of European countries were thus universally practised. In Eastern unique in having legalized abortion Europe, however, abortion is still contraceptives and- with before the advent of the contracep the preferred and often the only patience - it may prove that tive revolution, and some 15 to 25 means of birth control; except in a years before the countries of the few countries such as Hungary, the countries of the former West followed suit. family planning is limping along. Eastern bloc are just beginning The abortion laws vary widely, An international conference held some countries being more restric in October 1990 in Tbilisi, Georgia, their long march from tive than others, and some have specifically aimed at the Eastern taken a step backwards. The best countries, proposed a plan of action abortion to contraception. known and most tragic case was that based on three essential principles: of Romania with its annual toll of • the fundamental right to plan the hundreds of women dying from number and spacing of children; clandestine operations, the terrible • the big public health problem very year, countries around consequence of a double legal ban stemming from unwanted preg the world report between 30 on both abortions and contracep nancies and abortions carried out Eand 40 million legal abortions. tives. But in general the climate under non-surgical conditions; The former Soviet Union and its favoured the introduction of a policy • the promotion of contraception East European neighbours ( 10% of of legal abortion, except in those and an effective strategy to the world's population) are responsi countries with a strong moral or reduce abortions. ble for one-third of these abortions. religious tradition; only Poland and These facts lend support to the Lithuania, both strongly Catholic, Three years after that conference, no notion that these countries are distanced themselves somewhat substantial changes can be seen. The specialists in this field. from this model. legalization of abortion in Romania Russia legalized abortion on Recourse to abortion still request in 1920, followed two years remains very widespread in the later by the other Soviet republics. 1990s, ranging in the countries of Its more recent allies fell into line at World Health • 47th Year, No . 3, May-June 1994 19 and Albania suggested a certain contraceptives, as well as the affects all social and economic progress but was overshadowed by unavailability of the most up-to-date aspects of society - health included. the disturbing potential of a new law methods, make it unlikely that they This crisis cannot last for ever. restricting abortions which was will change their ways and cam Already there are some indications approved in 1992 by the Polish paign for contraception. Moreover, of recovery. This region has many parliament. the fact is that the present plague of advantages, with an educated As for contraception, efforts abortions is a source of considerable population, economically independ have only rarely been successful. and regular income for the doctors. ent women, a high proportion of The situation generally remains The former networks and traditional doctors, and health indicators static because of economic stagna supervisory patterns have not been approaching those of the West. In tion, organizational collapse and replaced by anything new, and the the field of birth control, more and lack of motivation on the part of attitude of individual survival and more care-givers are getting special health professionals, not to mention "everyone for himself' predomi ized training either abroad or the destabilizing effect of ethnic nates to the detriment of the quality locally, while the news media conflicts in many states. In 1994 the of public service and of contracep operate across the frontiers and smooth transition from abortion to tive care intended for women. facilitate exchanges of information, contraception seems more like a The donor agencies and those encouraging new partnerships to be distant dream than a fruitful and responsible for specialized tech formed. Ways are being found to desirable goal. Most of these niques maintain their reserve; the solve the chronic shortages of countries are bogged down in fall of the Berlin Wall has not given contraceptives. Foreign aid is disastrous social and economic Eastern Europe any special priority, gradually being mobilized. crises, and demographic trends are and the opening of frontiers has not Patience is hardly the first alarming in the sense of non-renewal been followed by a windfall of attribute of decision-makers and of the generations (other than in the technical and humanitarian assist politicians. But with patience it may Asian republics of the former ance. Some urgent contraceptive aid be seen that the countries of the USSR). Contraceptive production has been provided to the most needy former Eastern bloc are just at the has collapsed everywhere except in countries and a few limited pro beginning of their long march from Hungary. The new laws of the grammes have appeared. As for any abortion to contraception. • market economy oblige countries to common interagency strategy, that pay for contraceptives with foreign has yet to be created. Or Daniel Pierotti is Chief, Family Planning and currency, while modern methods are However, the situation is not Population in the Division of Family Health , in direct competition with desper quite as dramatic as it seems. World Health Organization, 12 1 1 Geneva ately needed essential drugs and Eastern Europe is passing through 27, Switzerland, and Or Chantal Blayo is Director of Research at the National Institute of basic medical equipment. an acute period of crisis which Demography (/NED), 27 rue du Commandeur, Long before the advent of 75675 Paris, France. modern, effective and user-friendly contraceptive methods, men in Western Europe had accepted responsibility for the traditional forms of contraception: the condom in the North, withdrawal in the South. Men in Eastern Europe have forgotten such practices and this apparent lack of interest in tradi tional methods, in conjunction with the shortage of modern contracep tives, plays a big part in increasing the numbers of abortions. Care-givers have an essential role to play and physicians can do much to improve the situation. But the weakness of their training in this field and their basic lack of belief in Schoolchildren in Romania, a country which shares with others of Eastern Europe the advantages of a good level of education. .

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