Gunta Lazdane


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    Experience of application of WHO tools and guidelines in the WHO European Region

    in improving quality of abortion services

    Gunta Lazdane, MD, PhD, Regional Adviser Sexual and Reproductive Health and Research, WHO Regional Office for Europe


    Prevention of unsafe abortion is one of the five core aspects of the WHO Global Reproductive Health Strategy adopted by the World Health Assembly in 2004. However, up to 20 % of all deaths during pregnancy in several countries of the European Region are due to unsafe abortion. There is a lack of reliable data on morbidity after abortion. Many Member States and ministries of health (in the countries of central and eastern Europe, France, Luxemburg, the Netherlands, Sweden) have focused on prevention of unwanted pregnancy and unsafe abortion and improvement of reproductive health services at primary

    health care.

    The role of the WHO in the Region includes distributing existing evidence on abortion, assisting countries in evaluating health systems’ response to the needs of women with unwanted pregnancies and building the capacity of health care professionals in counselling and abortion care. 

    WHO has assisted governments and professional organizations in developing national policies on sexual and reproductive health policies based on the detailed analysis of the country situation in prevention and management of unwanted/unplanned pregnancies and quality of abortion services. Recently this exercise has been carried out in Azerbaijan, the Republic of Moldova, the Russian Federation, the former Yugoslav Republic of Macedonia, and Ukraine. In most of these countries WHO’s Strategic Approach tool has been used to answer the question on how to reduce the recourse of abortion and improve the existing health services. National guidelines on safe abortion have been developed with the WHO assistance in Armenia, the Republic of Moldova, the former Yugoslav Republic of Macedonia, Tajikistan, and Ukraine. Summary of the challenges in improving access to quality abortion services in the WHO European Region will be presented.

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    Recent developments in Eastern Europe
    Gunta Lazdane, MD WHO Regional office for Europe, Regional Adviser
    for Reproductive Health and Research, Copenhagen, Denmark
    During the last two years, several countries in the eastern part of the WHO European
    Region have developed and approved national reproductive health strategies and
    programmes including the component of reproductive choice and access to abortion
    services. The analysis of the present situation has been made based on the official
    statistics as well as results of surveys and research projects carried out in these countries.
    The trend of declining in abortion rates is obvious in eastern Europe; however, the number
    of abortions in adolescents and young women remains high. Different barriers have led to
    discrepancies between official and survey-based abortion rate, for instance, in Georgia
    according to official data the number of induced abortions per woman in 2005 was 0.3, but
    it was 3.1 according to the Reproductive Health Survey carried out by the Ministry of
    Labour, Health and Social Affairs of Georgia, Center for Disease Control USA, United
    Nations Population Fund and United States Agency for International Development.
    The number of death cases from unsafe abortion has decreased as well, however, it some
    countries it is still almost 20 per 100 000 live births: the quantitative target of the WHO
    European Regional Strategy on Sexual and Reproductive Health (2001) is less than 5 per
    100 000 live births.
    Since 2003 when “Safe Abortion: Technical and Policy Guidance for Health Systems” was
    published by WHO, it has been translated into Russian and used in many countries
    (Armenia, Georgia, Kyrgyzstan, the Republic of Moldova, the Russian Federation,
    Tajikistan, Ukraine, etc.) to develop national guidelines and to improve access to
    reproductive health services and the quality of care.
    With WHO assistance, strategic assessment of reproductive health services, including
    those for abortion, has been carried out in the Republic of Moldova and the outcomes will
    play an important role in further development of the plan to implement the recently
    approved National Reproductive Health Strategy. In 2006-2007 strategic assessment
    projects are planned in the Russian Federation and Ukraine.

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    Situation of induced abortions in Europe and policy changes


    Gunta Lazdane , WHO Regional Office for Europe


    There are 52 Member States in the European Region of WHO with a diverse political, economic, religious and social situation. There are countries with diversity of legal grounds to perform abortion, and countries with the lowest and highest numbers of induced abortions in the world.

    The numbers of induced abortions have been decreasing all over the Region for the last 10 years, yet the rate of abortions per 1000 women 15-19 years old is much more stable and even increasing in some parts of the Region. The same trend is observed in some migrant groups or in ethnic minorities.

    Despite the improved access to information, reproductive health services and contraception that decreases the number of unwanted pregnancies, there are still many problems to be solved:

    -   in some countries more than 20% of maternal deaths are due to the complications of abortion,

    -   the complication rate after abortion is high,

    -   there is a lack of statistics in many countries,

    -   there is a lack of political will to face and solve the problems related to abortion.

    The Reproductive Health and Research programme in the WHO Regional Office for Europe has included the reduction of induced abortions as one of the objectives and targets in the WHO European Regional Strategy on Sexual and Reproductive Health (2001) and recommends the implementation framework to reach this target. WHO assists those Member States who have prioritized this problem as one of the major causes of women’s ill-health in their countries.