Abortion in Europe, 1920-91: a public health perspective

Stud Fam Plann. Jan-Feb 1992;23(1):1-22.

Abstract

This article grew out of a keynote address prepared for the conference, "From Abortion to Contraception: Public Health Approaches to Reducing Unwanted Pregnancy and Abortion Through Improved Family Planning Services," held in Tbilisi, Georgia, USSR in October 1990. The article reviews the legal, religious, and medical situation of induced abortion in Europe in historical perspective, and considers access to abortion services, attitudes of health professionals, abortion incidence, morbidity and mortality, the new antiprogestins, the characteristics of abortion seekers, late abortions, postabortion psychological reactions, effects of denied abortion, and repeat abortion. Special attention is focused on the changes occurring in Romania, Albania, and the former Soviet Union, plus the effects of the new conservatism elsewhere in the formerly socialist countries of central and eastern Europe, particularly Poland. Abortion is a social reality that can no more be legislated out of existence than the controversy surrounding it can be stilled. No matter how effective family planning services and practices become, there will always be a need for access to safe abortion services.

PIP: A review of induced abortion in Europe encompasses historical perspective of legal, religious, medical, and legislative activity; access to abortion services; abortion incidence and trends including characteristics of abortion seekers, mortality and morbidity, late abortions, and postabortion psychological responses; emerging trends in central and eastern Europe by country; prevention from abortion to contraception; barriers to be overcome in public health oriented efforts; and conclusions. Also included is the Tbilisi Declaration. The article is a byproduct of a conference on Abortion and Public Health Approaches to Reducing Unwanted Pregnancy through Improved Family Planning (FP) Services, held in Tbilisi, Georgia, USSR, in October 1990. One thought was that the 1990s are a time of "desperate women, troubled health professionals, and scared politicians." During the reproductive years in developed countries, a woman is trying to become or actually is pregnant 10% of the time, and 90% of the time she is avoiding more births or trying to postpone births. Abortion rates show a decline in the countries where legal abortion is part of a comprehensive family planning program. The lowest rates are in the Netherlands. Historically Plato recommended abortion for women 40 years, while Hippocrates spoke against it. During the Dark and Middle Ages, women managed their own fertility regulation including clandestine abortions. In England in 1803, severe restrictions were put on abortion and other European and North American countries followed the example. The focus was on preventing life-threatening infection. The early Hebrews fined for abortion, and the Christians followed, with neither group considering the act as murder. The techniques had been around for 2.5 millennia, and the last refinement of technique occurred in 1972. The Catholic Church in 1869 punished with excommunication the aborting woman and the provider and in 1895, condemned explicitly and publicly any therapeutic abortion. Medical restraints were common in Europe in the 20th Century. Abortion law has fluctuated in restrictiveness since the turn of the century. Restrictions have been eased due to recognition of the public health threat, support for women's rights. access to modern contraceptives, and liberalization of legislation on fertility regulation. There is a growing awareness that abortion cannot be obliterated by legal codes. It is expected that increases use and access to modern contraceptives will lead to a decline in abortion. The Tbilisi Declaration affirms the right of reproductive freedom.

Publication types

  • Historical Article

MeSH terms

  • Abortion, Induced / history*
  • Abortion, Induced / statistics & numerical data
  • Abortion, Induced / trends
  • Abortion, Legal / history*
  • Europe
  • Female
  • Health Services Accessibility
  • History, 19th Century
  • History, 20th Century
  • History, Ancient
  • History, Medieval
  • Humans
  • Legislation, Medical
  • Pregnancy
  • Pregnant Women
  • Public Health
  • Romania
  • Social Change*