Countries in the European Union (EU) which allow termination of pregnancy (TOP) on request do not have higher TOP rates than countries with more restrictive access, finds a new study published today in BJOG: An International Journal of Obstetrics and Gynaecology.
The EU currently consists of 27 member states, which have different traditions, attitudes and legislation related to termination of pregnancy.
This paper looks at the current legislation and trends across the EU. The total number of terminations of pregnancy was calculated per 1000 women aged 15-49 years.
In general, termination of pregnancy rates have declined in recent years, the study found. In total 10.3 terminations were reported per 1000 women aged 15-49 years across the EU in 2008.
Looking at termination of pregnancy rates, Southern Europe had the lowest rates (8.9/1000) compared to Central and Eastern Europe (10.8/1000) and Northern Europe (10.9/1000).
However, countries with unrestricted access to early termination of pregnancy (11/1000 women with a country variation from 6 to 25 per 1000 women) did not report higher rates than countries that required an indication for termination (12.3/1000 women with a country variation from 9 to 14 per 1000 women).
However, there is no information on the number of women who had to travel to other countries for a termination. In Ireland, Malta and Poland, there is no or restrictive access to termination of pregnancy.
The study also looked separately at women aged less than 20 and over 35 years. Every ninth termination of pregnancy (14.1%) in the EU was performed among women who are aged less than 20 years. This proportion for terminations in teenagers was higher in Northern Europe (17%) than in the Central and Eastern Europe (11%) and in Southern Europe (10%).
Every fifth termination of pregnancy (21.2%) was performed in women aged 35 years or more. This proportion was lower in the Northern European countries (19%) than in Central and Eastern European (23%) and Southern European countries (24%).
Overall, the highest terminations of pregnancy rates were reported in Central and Eastern Europe, especially in Estonia, Romania, and Bulgaria with at least rates that double the EU average.
The authors conclude that this may reflect the differences in childbearing patterns. In Northern European countries, many terminations of pregnancy represent unwanted or mistimed pregnancies among young women who wish to postpone childbearing.
However, in the Central and Eastern European countries, the mean age at childbearing is still significantly lower than in other parts of the EU, and more terminations of pregnancy are performed after the desired family size has been reached.
Mika Gissler, THL National Institute for Health and Welfare, Finland, co- author of the study said:
“There are large variations across the EU and it is interesting to see that restricting women’s access to termination doesn’t mean the rates of termination are lower.
“Teenage termination of pregnancy rates were higher in the Northern European countries. These high rates can be reduced by improved access to youth-friendly reproductive and sexual health services, better sexual education in schools, and free or heavily subsidised contraceptives.”
BJOG Scientific Editor, Patrick Chien, said:
“This study highlights the importance of sexual education and provision of access to reliable and affordable contraception. This is vital in order to achieve low rates of termination of pregnancy.
“More research is needed looking at the number of women who enter other countries to access termination of pregnancy services.”
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Please include a link to the paper in online coverage: http://dx.doi.org/10.1111/j.1471-0528.2011.03189.x
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Gissler M, Fronteira I, Jahn A, Karro H, Moreau C, Oliveira da Silva M, Olsen J, Savona-Ventura C, Temmerman M, Hemminki E, the REPROSTAT group. Terminations of pregnancy in the European Union. BJOG 2011; DOI: 10.1111/j.1471-0528.2011.03189.x.