Situational analysis – Slovak Republic

1. Situational analysis – Slovak Republic FIGO working group on unsafe abortion, Chisinau, Moldova 28. 9. – 1. 10. 2008

2. Abortions in Slovakia – legal framework • Abortions in Slovakia are legal from 1957 (in that time as a part of former Czechoslovakia) • Condition for women – interview in „abortion committee” • Amendment of abortion law 1986 – deletion of “abortion committees” • Abortions in Slovakia are registered and published due to official publications of National Health Information Centre from 1960. • Template: Request for induced interruption of pregnancy and abortion report • In Slovakia does not exist problem of unsafe abortion yet

3. Incidence of unwanted pregnancies • End of the 80-ies in 20th century Slovakia (as part of former Czechoslovakia) was at the top among countries with the highest number of abortions in the world • In 1989: 48603 abortions on request 43/1000 women in fertile age (NCZI). • In 2006: 11 971 abortions on request <10/1000 women in fertile age (NCZI).

4. Reasons for high number of abortions • Liberalization of abortion law in 50 –ies was in environment without sex education and without contraception • Introduction of contraception in 60-ies was in environment with negative attitude not only from lay public but professionals as well • Sterilization was almost out of reach (legislative barrier) • Abortions was free of charge • Abortions were used to regulate fertility instead of contraception.

5. Changes in social environment after political transformation in 1989 • Pro life versus pro choice activities • Foudation of Slovak FPA (1991) in IPPF network • Support for family planning philosophy, protection basic reproductive human rights, support for sexuality education, contraception and quality of reproductive health services. • Activities for maintenance of access to safe abortion services for women.

6. Tab.1. Abortions by type and age of women Statistical Yearbook of the Slovak Republic 2006

7. Graph. 1.Development of natality and artificial abortions(NCZI- national center for health information)

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

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

10. Graph4. Hormonal contraception in Slovakia (Source: IMS)

11. Tab.3.Vulnerable groups – asylum seekers Women without permanent residence in Slovakia do not have access to legal abortion services

12. Vulnerable groups – Roma community • Quantitave aspects of the problem 8-10% of population participates in some regions by 40 and more % on natality • Qualitative aspects of the problem low education level, disability to succeed on work market • Regions with almost 100% of Roma unemployment, high morbidity and low life expectancy

13. whole population: Roma: Graph.5.Two models of demographicbehaviour – tree of life – zdroj – Populační vývoj ČR - 1995

14. Vulnerable groups – Roma community • Roma community is not homogenous. Problematic is the part of Roma community living segregated, in settlements often without any basic infrastructure, legal relationships referring to the rights of property, inadequate hygienic and social conditions, and low educational and cultural level. • Unequal position of Roma women in family hierarchy, multiparity, lack of information about possibility how to control own fertility and lack of support from community. • There are still existing economical barriers towards family planning methods.

15. Tab.4. Unemployment rate in Slovakia(Comparison with selected EU countries) (Statistical Yearbook of the Slovak Republic 2006)

16. Tab.5.Infant death under 1 year of age/1000 life birth in Slovakia (Comparison with selected EU countries) (Statistical Yearbook of the Slovak Republic 2006)

17. Vulnerable groups – Young people Tab. 6. Contraception usage at the first sexual intercourse by age (in %) Focus 1997

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

19. Research on sexualityPublic opion pool – FOCUS 1997 • 92 % of women aged below 45 years had previous sexual experience at the time of their marriage. • 70 % of fertile-age women think that the optimum number of children is two. • The view that under all circumstances a woman should have the right to decide on her pregnancy including abortion highly prevails in Slovakia. • The most serious obstacle to the use of contraception is the fear of health side-effects, followed by religious reasons. • Slovakia do not have systematic collection of specific data regarding sexual behaviour.

20. Sexuality education • Lack of official curricula for sex. education • Lack of preparation teachers for sex. education • Double track education – religious versus ethical education – conflicts of two points of view (civic versus religious) • Lack of minimum sex education standard • Result of situation – increasing number of unwanted pregnancies et STIs in age group 15-25.

21. Pro life activities • Good coordinated: on the level of official Catholic Church, Parliament, and Catholic NGOs. • Long-time tendency to put abortion out of law – criminalization of women, physicians and pro choice activists. • So called polish strategy: mass medial activities, emotional words: physicians are murderers of unborn children, attacks against ethical code of medical chamber, effort to get existing law against Slovak Constitution, attacks against sex.education and contraception (human life is worth to be protected)

22. Vatican agreement and abuse of conscientious objection • Vatican agreement – uncertainty defined: obligation of Slovakia to respect Catholic attitude towards sexuality, origin of life – trap in future development. • Conscientious objection – right of individual persons not right of health facility. • Abuse of this right by heads of health facilitis and expansion of this right to whole facility. • Reduction of access to reproductive health services including abortion services. • Lack of state policy to secure quality of reproductive health services and accessibility – risk of development towards unsafe abortions.