Situational analysis Situational analysis – Slovak Republic– Slovak Republic

FIGO working group on unsafe FIGO working group on unsafe abortion, Chisinau, Moldovaabortion, Chisinau, Moldova

28. 9. – 1. 10. 200828. 9. – 1. 10. 2008

Abortions in Slovakia – Abortions in Slovakia – legal framework legal framework

• Abortions in Slovakia are legal from 1957 Abortions in Slovakia are legal from 1957 (in that time as a part of former (in that time as a part of former Czechoslovakia)Czechoslovakia)

• Condition for women – Condition for women – interview in interview in „abortion „abortion committee”committee”

• Amendment of abortion law 1986 – deletion of Amendment of abortion law 1986 – deletion of “abortion committees”“abortion committees”

• Abortions in Slovakia are registered and Abortions in Slovakia are registered and published due to official publications of National published due to official publications of National Health Information Centre from 1960.Health Information Centre from 1960.

• Template: Template: Request for induced interruption of Request for induced interruption of pregnancypregnancy and and abortion reportabortion report

• In Slovakia does not exist problem of unsafe In Slovakia does not exist problem of unsafe abortion yetabortion yet

Incidence of unwanted Incidence of unwanted pregnanciespregnancies

• EEnd of the 80-ies in 20th century Slovakia nd of the 80-ies in 20th century Slovakia (as part of former Czechoslovakia) was at (as part of former Czechoslovakia) was at the top among countries with the highest the top among countries with the highest number of abortionnumber of abortionss in the world in the world

• In 1989In 1989: 48603: 48603 abortions on request abortions on request 43/1000 women in fertile age 43/1000 women in fertile age (NCZI).(NCZI).

• In 2006In 2006: 11 971: 11 971 abortions on request abortions on request <<10/1000 women in fertile age 10/1000 women in fertile age (NCZI).(NCZI).

Reasons for high number of Reasons for high number of abortionsabortions

• Liberalization of abortion law in 50 –iLiberalization of abortion law in 50 –iees was in s was in environment without sex education and environment without sex education and without contraceptionwithout contraception

• Introduction of contraception in 60-ies was in Introduction of contraception in 60-ies was in environment with negative attitude not only environment with negative attitude not only from lay public but professionals as well from lay public but professionals as well

• Sterilization was almost out of reach Sterilization was almost out of reach (legislative barrier) (legislative barrier)

• Abortions was free of charge Abortions was free of charge • Abortions were used to regulate fertility Abortions were used to regulate fertility

instead of contraception.instead of contraception.

Changes in social Changes in social environment after political environment after political

transformation in 1989transformation in 1989• Pro life versus pro choice activitiesPro life versus pro choice activities• Foudation of Slovak FPAFoudation of Slovak FPA (1991) in (1991) in

IPPF networkIPPF network• SupportSupport for for family planning philosophy, family planning philosophy,

protectiprotectionon basic basic reproductive reproductive human human rights, supportrights, support for for sexuality education, sexuality education, contraception and quality of contraception and quality of reproductive health services. reproductive health services.

• AActivities for maintenance of access ctivities for maintenance of access to safe abortion services for women.to safe abortion services for women.

Tab.1. Abortions by type and age of women

Statistical Yearbook of the Slovak Republic 2006

Age group1999 2000 2001 2002 2003 2004 2005

 

Total 25 557 23 593 22 792 22 141 21 159 20 075 19 332

of which:

Spontaneous abortions 5 608 5 125 4 766 4 759 4 937 4 768 4 905

Induced abortion 19 949 18 468 18 026 17 382 16 222 15 307 14 427

Abortion per 1000

inhabitants 4,74 4,37 4,24 4,12 3,93 3,73 3,59

15 – 49 17,7 16,3 15,8 15,3 14,7 13,9 13,5  

Graph. 1.Graph. 1. Development of natality Development of natality and artificial abortionsand artificial abortions (NCZI- national (NCZI- national

center for health information)center for health information)

0

10 000

20 000

30 000

40 000

50 000

60 000

70 000

80 000

90 000

1988 1994 2000 2006

No of deliveries No of artificial abortions

Graph. 2.Graph. 2. Relationship between Relationship between deliveries and artificial abortion deliveries and artificial abortion (NCZI)(NCZI)

0

20 000

40 000

60 000

80 000

100 000

No. of deliveries No. of artificial abortions

1988

2000

2006

Decrease: 36 %

Decrease: 76 %

Graph. 3.Graph. 3. Relationship between artificial Relationship between artificial abortions and contraception abortions and contraception (NCZI)(NCZI)

0

50000

100000

150000

200000

250000

300000

350000

400000

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

No. of artificial abortions No of contraception users

94 100

116 000

136 200

156 400

183 000195 000

0

50 000

100 000

150 000

200 000

250 000

1997 1998 1999 2000 2001 2002

Graph4Graph4. Hormonal contraception in Slovakia . Hormonal contraception in Slovakia (Source: IMS(Source: IMS))

Tab.3.Tab.3. Vulnerable groupsVulnerable groups – asylum seekers – asylum seekers

Indicator 2001 2002 2003 2004 2005

Number of asylum applications 8 151 9 743 10 358 11 395 3 549

Granted asylum 18 20 11 15 25

Requested cases 130 309 421 1 595 827

Terminated procedure 5 247 8 053 9 788 11 782 2 930

Granted citizenship          

Of the SR 11 56 40 21 2

Women without permanent residence in Slovakia do not have access to legal abortion services

Vulnerable groupsVulnerable groups – Roma community – Roma community

• Quantitave Quantitave aspectsaspects of the problem of the problem8-10% of population participates in 8-10% of population participates in some regions by 40 and more % on some regions by 40 and more % on natalitynatality

• Qualitative Qualitative aspectsaspects of the problem of the problem low education level, disability to low education level, disability to

succeed on work market succeed on work market • Regions with almost 100% of Roma Regions with almost 100% of Roma

unemployment, high morbidity and unemployment, high morbidity and low life expectancylow life expectancy

Graph.5.Graph.5. Two models ofTwo models of demogra demographicphic behaviour behaviour – tree of life – tree of life

– – zdroj – Populační vývoj ČR - 1995zdroj – Populační vývoj ČR - 1995

whole whole populatipopulationon::

RomaRoma::

Vulnerable groupsVulnerable groups – Roma – Roma communitycommunity

• Roma community is not homogenous. Problematic Roma community is not homogenous. Problematic is the part of Roma community livis the part of Roma community livinging segregated, in segregated, in settlements often without any basic infrastructure, settlements often without any basic infrastructure, legal relationships legal relationships referring to the rights of propertyreferring to the rights of property, inadequate , inadequate hygienic and social conditions, and low educational hygienic and social conditions, and low educational and cultural level.and cultural level.

• UUnequal position of Roma women in family nequal position of Roma women in family hierarchy, multiparity, lack of information about hierarchy, multiparity, lack of information about possibility how to control own fertility and lack of possibility how to control own fertility and lack of support from community. support from community.

• There are still existing economical barriers There are still existing economical barriers towards family planning methods. towards family planning methods.

Tab.4.Tab.4. Unemployment rate in Slovakia Unemployment rate in Slovakia

(Comparison with selected EU countries)(Comparison with selected EU countries)

Country2000 2001 2002 2003 2004 2005

Slovakia 18,8 19,3 18,7 17,6 18,2 16,4

Czech Republic 8,7 8,0 7,3 7,8 8,3 7,9

Poland 16,1 18,2 19,9 19,6 19,0 17,7

Spain 11,4 10,8 11,5 11,5 11,0 9,2

EU-25 8,6 8,4 8,8 9,0 9,1 8,7

(Statistical Yearbook of the Slovak Republic 2006)

Tab.5.Tab.5. Infant death under 1 year of age/1000 life Infant death under 1 year of age/1000 life

birthbirth in Slovakia in Slovakia (Comparison with selected EU countries) (Statistical Yearbook of the Slovak Republic 2006)

CountryInfant deaths under 1 year of age per 1 000 live-

births

1999 2000 2001 2002 2003 2004 

Slovakia 8,3 8,6 6,2 7,6 7,9 6,8

Czech Republic 4,6 4,1 4,0 4,1 3,9 3,7

Poland 8,9 8,1 7,7 7,5 7,0 6,8

Spain 4,5 3,9 3,4 1) 4,1 3,6 3,5

EU-25 • 5,2 5,0 2) 4,8 1) 4,6 1) 4,5

Vulnerable groupsVulnerable groups – Young – Young peoplepeople

  yes no don’t know, don’t recall

TOTAL: 34 60 7

below 15 years old

0 100 0

15-17 years old 39 57 4

18-19 years old 31 63 5

20-21 years old 28 58 4

22-23 years old 27 66 7

above 23 years old 32 68 0

Tab. 6. Contraception usage at the first sexual intercourse by age (in %)

Focus 1997

Tab.2.Tab.2. Changes in prevalence of artificial abortions Changes in prevalence of artificial abortions according to ageaccording to age (NCZI)(NCZI)

Years of age 2001 – 2003 1999 – 2001

15-19 13% 7,9%

20-24 18% 12,7%

25-29 12% 12,0%

30-34 4% 14,6%

35-39 8% 13,1%

40-44 10% 11,5%

Research on sexualityResearch on sexuality Public opion pool – Public opion pool – FOCUS 1997FOCUS 1997

• 92 % of women aged below 45 years had previous sexual 92 % of women aged below 45 years had previous sexual experience at the time of their marriage. experience at the time of their marriage.

• 70 % of fertile-age women think that the optimum 70 % of fertile-age women think that the optimum number of children is two. number of children is two.

• The view that under all circumstances a woman should The view that under all circumstances a woman should have the right to decide on her pregnancy including have the right to decide on her pregnancy including abortion highly prevails in Slovakia.abortion highly prevails in Slovakia.

• The most serious obstacle to the use of contraception is The most serious obstacle to the use of contraception is the fear of health side-effects, followed by religious the fear of health side-effects, followed by religious reasons. reasons.

• Slovakia do not have systematic collection of specific data regarding sexual behaviour.

Sexuality educationSexuality education

• Lack of official curricula for sex. educationLack of official curricula for sex. education

• Lack of preparation teachers for sex. educationLack of preparation teachers for sex. education

• Double track education – religious versus ethical Double track education – religious versus ethical education – conflicts of two points of view education – conflicts of two points of view (civic versus religious)(civic versus religious)

• Lack of minimum sex education standardLack of minimum sex education standard

• Result of situation – increasing number of Result of situation – increasing number of unwanted pregnancies et STIs in age group 15-unwanted pregnancies et STIs in age group 15-25.25.

Pro life activitiesPro life activities

• Good coordinatedGood coordinated:: on the level of official Catholic on the level of official Catholic Church, Parliament, and Catholic NGOs.Church, Parliament, and Catholic NGOs.

• Long-time tendency to put abortion out of law – Long-time tendency to put abortion out of law – criminalization of women, physicians and pro choice criminalization of women, physicians and pro choice activists.activists.

• So called polish strategySo called polish strategy: mass medial activities, : mass medial activities, emotional wordsemotional words: : physicians are murderers of unborn physicians are murderers of unborn children, attacks against ethical code of medical chamber, children, attacks against ethical code of medical chamber, effort to get existing law against Slovak Constitution, effort to get existing law against Slovak Constitution, attacks against sex.education and contraception attacks against sex.education and contraception (human life is worth to be protected) (human life is worth to be protected)

Vatican agreement and aVatican agreement and abuse of conscientious buse of conscientious objectionobjection

• Vatican agreementVatican agreement – uncertainty defined: obligation of – uncertainty defined: obligation of Slovakia to respect Catholic attitude towards sexuality, origin Slovakia to respect Catholic attitude towards sexuality, origin of life – trap in future development.of life – trap in future development.

• Conscientious objection – right of individual persons not right – right of individual persons not right of health facilityof health facility..

• Abuse of this right by heads of health facilitis and expansion of Abuse of this right by heads of health facilitis and expansion of this right to whole facility.this right to whole facility.

• Reduction of access to reproductive health services Reduction of access to reproductive health services including abortion services. including abortion services.

• Lack of state policy to secure quality of Lack of state policy to secure quality of reproductive health services and accessibilityreproductive health services and accessibility

– – risk of development towards unsafe risk of development towards unsafe abortionabortionss..