Abortion in the framework of family planning in Estonia

Abstract

Objective: To analyze the legal status of abortion and trends in childbirth, abortions and contraceptive use in Estonia.

Design: National statistical data on induced abortions, spontaneous abortions, births and contraceptive use in Estonia.

Results: Even though induced abortion is legal in Estonia, the abortion rate has been declining but is still high and in 1994 was 53.8 per 1000 women of fertile age. Among young women under 20 years of age, abortions decreased slightly in the period 1992-94 (from 55.5 to 41.5 per 1000). The birth rate has been declining rapidly in recent years, resulting in a net population reduction. The use of modern contraceptives is increasing but is still low.

Conclusion: Survey on abortion and on contraceptive sales and use are needed. To improve family planning and prevent unwanted pregnancies it is important to increase awareness among the entire population--and especially among young people--by information, education and communication. A high standard of counseling, including pre- and postabortion counseling and in the youth services, is essential.

PIP: A post-independence (1992-93) decree issued by the Estonian Ministry of Social Affairs permits abortion on request up to 12 weeks of gestation and, on medical grounds, up to 20 weeks. According to reports received by the Estonian Medical Statistical Bureau, the 1994 abortion rate was 53.8/1000 women of reproductive age. Among women under 20 years of age, the abortion rate declined from 55.5/1000 in 1992 to 41.5/1000 in 1994. Only mini-abortions and abortions performed for medical reasons are free of charge; women with health insurance pay 50% of the cost of most procedures. Funds from abortion fees are used to subsidize contraception for full-time students, women in the first postpartum year, and women who had an induced abortion in the past three months. All other women must pay the full price of contraception. In 1994, only 234 out of every 1000 fertile women were using effective forms of contraception (IUDs and hormonal methods). However, the birth rate has been declining rapidly since 1990 and the rate of natural increase became negative in 1993 (-4.0). The fact that abortion but not contraception is subsidized has facilitated reliance on abortion as a family planning method. Recommended, to reduce the abortion rate and improve the family planning situation in Estonia, are improved contraceptive counseling, including pre- and post-abortion services, and school-based sex education.