ABORTION IN EUROPE This issue is co-published with the IPPF European Network THE EUROPEAN MAGAZINE FORNo. 55SEXUAL - 2003 AND REPRODUCTIVE HEALTH No. 59 - 2005 The European Magazine for Sexual and Reproductive Health CONTENTS Editorial Entre Nous is published by: By Fred Sai 3 Reproductive Health and Research Programme WHO Regional Office for Europe Abortion in Europe: Ten years after Cairo Scherfigsvej 8 By Gunta Lazdane 4 DK-2100 Copenhagen Ø Denmark The state of medical abortion in Europe today Tel: (+45) 3917 1341 By Hillary Bracken and Beverly Winikoff 7 Fax: (+45) 3917 1850 E-mail: [email protected] Abortion safety challenged in Sweden www.euro.who.int/entrenous By Silvia Sjödahl 10 Chief editor Why IPPF has chosen abortion as one of the five “A”s Dr Gunta Lazdane By Jeffrey V. Lazarus 11 Editor Shifting focus to the woman: comprehensive abortion care in central Jeffrey V. Lazarus and eastern Europe Editorial assistant By Traci L. Baird, Sarbaga Falk and Entela Shehu 13 Dominique Gundelach Layout HIV-positive women and their right to choose To om bord, Denmark. www.toombord.dk By Marcel Vekemans and Upeka de Silva 17 Print Central tryk Hobro a/s Why do women still die of abortion in a country where abortion is legal? The case of the Russian Federation Entre Nous is funded by the United Nations By Evert Ketting 20 Population Fund (UNFPA), New York, with the assistance of the World Health Organization Abortion in Europe: Are the laws and practices patient centred? Regional Office for Europe, Copenhagen, By Christian Fiala 23 Denmark. It is published three times a year. Present distri- Sexual and reproductive health and rights in the European Union bution figures stand at: 3,000 English, 2,000 By Mirjam Hägele 26 Spanish, 2,000 Portuguese, 1,000 Bulgarian, 1,000 Russian and 500 Hungarian. Abortion in Europe “Women on waves” debate at the European Parliament Entre Nous is produced in: By Patricia Hindmarsh 29 Bulgarian by the Ministry of Health in Bulgaria as a part of a UNFPA-funded project; Resources 30 Hungarian by the Department of Obstetrics and Gynaecology, University Medial School of Debrecen, PO Box 37, Debrecen, Hungary; Portuguese by the General Directorate for Health, Alameda Afonso Henriques 45, P-1056 Lisbon, Portugal; Russian by the WHO Information Centre for Health for the Central Asian Republics; Spanish by the Instituto de la Mujer, Ministerio de Trabajo y Asuntos Sociales, Almagro 36, ES-28010 Madrid, Spain. The Portuguese and Spanish issues are distri- buted directly through UNFPA representatives Page 4Page 7 Page 16 Page 30 and WHO regional offices to Portuguese and Spanish speaking countries in Africa and South America. Material from Entre Nous may be freely translat- ed into any national language and reprinted in journals, magazines and newspapers or placed on the Web provided due acknowledgement is made to Entre Nous, UNFPA and the WHO Cover illustration: © To ombord. Regional Office for Europe. Articles appearing in Entre Nous do not THE ENTRE NOUS EDITORIAL ADVISORY BOARD necessarily reflect the views of UNFPA Dr Assia Brandrup- Dr Evert Ketting Dr. Peer Sieben or WHO. Please address enquiries to the Lukanow Netherlands School of Public and UNFPA Representative and Country authors of the signed articles. Director, Division for Health, Occupational Health Director, Romania Education and Social Protection Utrecht,The Netherlands Ms Vicky Claeys For information on WHO-supported activities German Agency for Technical Co- Dr Malika Ladjali Regional Director and WHO documents, please contact the Family operation (GTZ) and Community Health unit at the address Senior Programme Specialist International Planned Parenthood given above. Mr Bjarne B. Christensen UNESCO/Headquarters, Paris Federation, European Network Please order WHO publications directly from the Head of secretariat, Sex & Samfund, Ms Adriane Martin Hilber (IPPF-EN), Brussels the Danish Member Association of WHO sales agent in each country or from Technical Officer, Department of Dr Robert Thomson IPPF Marketing and Dissemination,WHO, Reproductive Health and Research, Adviser on Sexuality, Reproductive CH-1211, Geneva 27, Switzerland Dr Helle Karro WHO Headquarters, Geneva Health & Advocacy, UNFPA Country Head, Department of Obstetrics and Technical Services Team for Europe, ISSN: 1014-8485 Ms Nell Rasmussen LLM Gynaecology, Medical Faculty, Director, PRO-Centret, Copenhagen Bratislava University of Tartu, Estonia Jeffrey V. Lazarus EDITORIAL Fred Sai Unsafe abortion: Europe is not spared Photo: Lazarus Jeffrey The high expectations for The ICPD Programme of Action, agreed omitted any mention of sexual and on by 179 countries in 1994, begins with reproductive health and rights, and thus reproductive health, the following words: “The implementa- missed the great opportunity of giving including sexual health and tion of the recommendations contained reproductive health the priority it in the Programme of Action is the sover- deserves in development planning. It rights, generated by the eign right of each country consistent must be stressed that without ensuring with national laws and development pri- that women know and exercise their full consensus reached at the orities, with full respect for the various sexual and reproductive rights and have International Conference on religious and ethical values and cultural full access to the benefits of modern con- backgrounds of its people, and in confor- traception, they will never be equal or Population and mity with universally recognized interna- able to properly be in control of planning tional human rights”.Yet the refusal to their lives. Development (ICPD) apply and respect this statement is the Europe is not an exception. Even have not been realized, cause of much unnecessary argument, today, millions of individuals and couples and nowhere is this truer than with in this Region, particularly in the more and even the principles regard to contraception and pregnancy deprived countries of central and eastern on which agreements were termination. Europe, do not have access to quality The right to religious freedom, provid- contraceptive services and supplies – a based on are being ed by many constitutions, is flagrantly situation akin to the majority of Africans. abused by some religious zealots who Moreover, emergency contraception is challenged by some impose their dogma and ideology on either completely banned or wrapped in governments and non-adherents, at times by misusing sci- controversy. entific evidence. The imposed exclusion In parts of the Region, the unmet religious groups. of hormonal contraception, including needs for contraception, coupled with a emergency contraception, and the disin- tradition that promoted abortion, has led genuous statements about the ineffective- to abortion rates that are the highest in ness of condoms are but a refusal to work the world. Since the quality of services is according to the fundamental principle often poor (e.g. the use of outdated drugs of the ICPD Programme of Action. Such and equipment and no updating of propaganda does not matter much to the providers’ skills), there is an unacceptable highly sophisticated, well-informed soci- rate of morbidity and mortality associat- eties of the advanced countries. But in ed with legal abortion. And even in the many countries in the world, where reli- European Union, some countries still gious doctrine may be what the poor and restrict or even ban abortion, especially disempowered live by, such misinforma- medical abortion, or employ complicated tion almost always amounts to a denial of requirements that discourage women the basic rights to correct information from obtaining an abortion, which fos- and access to the fruits of modern sci- ters illegal and unsafe abortion. It is esti- ence. mated that there are more than half a The United Nations system decided, million unsafe abortions throughout wisely, not to hold another international Europe annually. This timely issue of conference on population and develop- Entre Nous, following on the heels of the ment to mark the tenth anniversary of new WHO guidance on safe abortion, the highly successful ICPD. It was obvi- addresses these important issues and will ous from the five-year review to assess be one more tool to help women in progress and subsequent regional reviews Europe and all over the world. that that there are forces that would use any opportunity to seek a rewording of 3 the agreed positions rather than a sober assessment of what has been achieved Fred Sai and what more needed to be done. [[email protected]] Partly through the efforts of the same Presidential Advisor on groups, the United Nations Millennium Reproductive Health and Development Goals, launched in 2000, HIV/AIDS, Ghana This issue of Entre Nous has been specially funded by the International Planned Parenthood Federation European Network in order to address one of the most important public health problems facing women in Europe today. No. 59 - 2005 ABORTION IN EUROPE:TEN YEARS AFTER CAIRO By Gunta Lazdane UN Millennium Fig. 1 Grounds on which abortion is permitted – percentage of Development Goal No. 5: WHO Member States in Europe “Improve maternal health: reduce by three quarters On request 69 between 1990 and 2015 the Economic and social reasons 79 maternal mortality ratio” Fetal impairment 88 During the last ten years, many countries Rape and incest 87 in Europe have developed and approved To preserve mental health 90 national reproductive health strategies, policies and/or programmatic documents To preserve physical health 90 including the component of reproductive choice and access to abortion services. To save a woman's life 96 This is in line with the Programme of 0 102030405060708090100 Action of the United Nations Interna- tional Conference on Population and Development (ICPD), signed by 179 countries in Cairo in 1994. Of the 52 Fig. 2 Abortions per 1000 live births in the European Region WHO Member States in the European Region, all except Malta, which submit- ted a reservation, agreed that: “In no case should abortion be promoted as a method of family planning.