1. ABORTION (SITUATIONAL ANALISIS) REPUBLIC of MOLDOVA Dr. Rodica Comendant, National coordinator FIGO WORKING GRUP ON UNSAFE ABORTION

2. Legal and regulatory framework-key elements Abortion on request up to 12 weeks of gestation was legalized in 1955. The Moldovan Government amended the previous Soviet legislation in August 1994 (Order no.152), and legalized the abortions before 28 weeks of gestation on medical and broad list of social indications. As per the 1994 Ministry of Health Order No. 152, the abortion via vacuum aspiration or dilatation and curettage is allowed before 12 weeks of pregnancy, carried out only in public inpatient facilities and only by obstetricians and gynecologists. This remains pretty much the same today.

3. Legal and regulatory framework-key elements New stipulations were issued in 2007, when Moldova approves the World Health Organization definitions of live and still births, when the legal limit for late term abortion was reduced to 22 weeks. 2 nd trim abortion indications: To save the women’s heath or life – no limitations. Severe foetal malformation – yes, up to 22 weeks. Pregnancy resulting from rape or incest – yes, up to 22 weeks. Husband’s death or divorce – up to 22 weeks Imprisoned women or privation of maternal rights Socioeconomic reasons – no.

4. Quality of abortion care D&C still used often, manual or electrical vacuum Aspiration, general anesthesia Misoprostol alone or after mifepristone for second trimester Very few providers offer good counseling, including on family planning Practice differs very much and is not standardized No monitoring and evaluation on how new programmes are implemented WHO recommendations are poorly known, there are not incorporated in the actual training Curricula

5. Quality of abortion care Women still often resort to abortion as a means of fertility regulation and are likely to persistently re-enter the cycle of unwanted pregnancy and abortion, as contraceptive counselling and services generally do not form an integral part of post abortion care. The lack of accessible and affordable contraceptives compounds this problem

6. Access to abortion Limited for poor, women from rural aria and adolescents The decision of MoH to cover abortion on medical or social ground by insurance doesn’t work well Access is limited by the price, by the lack of trained providers and lack of equipment, the low level of knowledge among women

7. Number of live births/number of abortions (2000-2007)

8. Unsafe abortion Though safe abortion services are available in private and public facilities, there still exist a number of unsafe, illegal abortions (11 registered in 2007, according to the statistics of the Ministry of Health). The exact percentage of illegal and unregistered abortions is not known, it is estimated at about 2-50%. The main part of these happen in the second trimester, on women denied by the commission

10. Abortion related morbidity and mortality An analysis showes that the main causes of maternal mortality in the period of time 1992-2002 were abortions related complications (30,3%), For the period 2001-2005, abortion related deaths constituted 10% The majority of the deaths happen due to complications after second trimester abortion

11. Maternal mortality, direct causes (2001-2005)

12. Unwanted pregnancy and family planning According to the Reproductive Health Study in the Republic of Moldova in a 1997 conducted on a sample of 4023 women in reproductive age use contraception methods constituted 73,7%, inclunding modern methods - 50,0%. Unmet needs of modern contraception were estimated at 29, 0%.

13. The use of modern contraceptive methods

14. Educational level o the population In 2005 it was an attempt to introduce “Life skills” course, with elements of sexual education, as obligatory course, in the schools of Republic of Moldova. This problem was discussed by the parents, representatives of the Christian-orthodox church and the medical community. At the end, due to a very strong opposition from the church and the government, it failed and the discipline was excluded from the school curricula.

15. Efforts to improve the abortion situation MVA implementation in 2002: trainings of providers in comprehensive abortion care, elaboration and approval of MVA guideline Mifepristone approval in 2004, trainings of providers in MA, introductory clinical studies Decision to adopt WHO Strategic Approach to the Enhancement of the Quality of Abortion and Reproductive Health Services, conducted the Strategic Assessment in 2005. National RH Strategy 2005-2015: Priority No 5 Abortion

16. Bibliography: Strategical Assessment of Policies, Quality of and Acces to Contraception and Abortion Services in the Republic of Moldova. Chisinau 2006 Demographic and Health Survey.Moldova 2005. Knowledge, Attitudes, Practices (KAP) Study. Chisinau 2005. National Strategy on Reproductive Health for years 2005-2015. Ministry of Health statistics