In most European countries, the law allows abortion on request or provides such broad grounds on which abortion is permitted that it has been interpreted as allowing abortion on request. Nevertheless, access to abortion remains restricted in some countries.
High disparity is observed in Europe in abortion legalisation dates. Abortion could be considered to be legal since the 50s in the countries under the former Soviet Union.
Where abortion on request is legal, the upper time limit ranges between 10 and 22 weeks from the last menstrual period (LMP).
Few countries in Europe give women unrestricted access to abortion. Most require some conditions to be fulfilled. Procurement of written consent by women before abortion is one of these conditions. Written consent is to be obtained in all countries allowing abortion on request except Austria, Bulgaria, Sweden, and Great Britain (i.e., England, Wales, Scotland).
The mandatory waiting period between the pre-abortion and abortion visits is one of the conditions restricting women access to abortion. This waiting period is mandatory in some European countries and lasts between 2 and 7 days according to the country.
In France, this waiting period has been removed in 2016; nevertheless, a 2-day waiting period is mandatory when the woman visits the social worker before abortion. This visit is mandatory for minors.
Some countries in Europe restrict access to abortion for young women. In these countries, parents’ (or guardians’) consent is required prior to abortion. The age limit for parental consent varies between 13 and 18 years according to the country.
Medical abortion was introduced in Europe in 1988. Since then, it has been increasingly used. Today, women in most European countries have access to medical abortion. However, in some countries, there is a time limit for use. The gestational age limit, which is calculated from the last menstrual period (LMP), widely varies according to the country.
Medical abortion is a 4-step method: confirmation of intrauterine pregnancy, intake of antiprogesterone, intake of the prostaglandin, and verification of successful abortion. In some countries, the 2nd drug can be taken at home.
Abortion with antiprogesterone and a prostaglandin is a medical procedure usually performed by an obstetrician/gynaecologist (OB/GYN) or another physician. However, in some countries midwives and nurses (usually under the supervision of an OB/GYN or physician) can perform medical abortion.
As most clinical guidelines recommend Rh-immunisation in Rh-negative women, pre-abortion blood group and Rh-testing is recommended in most European countries. Ultrasound (US), which allows pregnancy confirmation, increases the standard of care and is a prerequisite for abortion in most European countries. Other tests or examinations are not clinically necessary although recommended in certain countries. They can be an opportunity for women who do not regularly visit a physician.
Abortion rate is the number of reported legal abortions per 1,000 women between 15 and 49 years of age (44 years in some countries). Abortion rate per 1,000 women aged 15-49 widely varies across Europe.
The overall number of induced abortions is the number of reported legal abortions. Unsurprisingly, it is lower in Iceland (about 300,000 inhabitants) and Estonia or Slovenia (1 to 2 million inhabitants) and greater in Germany, France, England & Wales, Italy, or Spain (about 80 to 47 million inhabitants) than in the other countries. It is particularly low in Poland (about 38 million inhabitants).
Abortion ratio per 1,000 live births is the number of reported legal abortions occurring in a specified reference period (e.g., one year: mainly 2017) per 1,000 live births. Abortion ratio varies widely across Europe. It was very low in Poland where abortion access is more restricted than in the other countries.
According to the country, abortion is exclusively or mainly performed in public hospitals or private facilities.
Today, abortion on request is usually the main ground for abortion in all countries where abortion on request is legal except in Croatia.
Today, women in most of the European countries have access to the drugs used in medical abortion. In 2016 or 2017, medical abortion was the most commonly used method in most countries where allowed.
☷ CHARACTERISTICS OF WOMEN HAVING INDUCED ABORTION
Women who had abortion were more commonly aged 30 years and over in some countries, in particular in Italy and in countries under the former Soviet Union domination (e.g., Baltic states, Poland).
Abortion is rare in women under 19 years of age, except in Belgium and England & Wales.
Almost all induced abortions were performed in resident women, except for The Netherlands, in Portugal, and in Slovakia where 12%, 18% and 19% of induced abortions were performed in non-resident women, respectively.
In Europe, a significant proportion of abortions are repeated abortions.
In Europe, a significant proportion of women getting abortion already have at least 1 child.
The fertility rate is the ratio of the number of children born during the considered year and the number of women aged 15-49 years (i.e., in age of childbearing). The average fertility rate in Europe is close to 1.6. The lowest fertility rates are observed in Southern European countries (Portugal, Italy…) and Eastern Europe (Poland…). France and Sweden have the highest fertility rate.
The lowest mean age of women at first childbirth is observed in the countries under the former Soviet Union domination. Spain and Switzerland stand at the bottom with a mean age of 32.
Too few data were collected to reach conclusions. However, the percentage of women between 15 and 49 years using a contraceptive method widely varies according to the country. With 97% of women using a contraceptive method (43% oral contraceptive), France ranked first.
Too few data were collected to reach conclusions. In addition, the high percentage of women using a pre-abortion contraception before abortion reported in most countries questions about the used contraceptive method.
Too few data were collected to reach conclusions. However, although it is recommended to start effective contraception immediately after abortion, it seems that there is no rules and that IUD or implant start date after abortion varies according to the country.
Long-acting reversible contraceptives (LARCs) are methods of birth control that provide effective contraception for an extended period without requiring user action and therefore being dependent on women compliance. They include intrauterine devices (IUDs) and subdermal contraceptive implants. Too few data were collected to reach conclusions. However, in countries with available data, LARC was usually placed in abortion facilities.
In several European countries, women have to pay for abortion.
In most European countries, health care professionals have the right to conscientiously object to rendering or participating in abortion services. Conscientious objection may have serious implications for women’s access to abortion services and health service planning.
In some European countries, abortion is not taught during healthcare professionals’ studies.
