Induced abortions in Bulgaria: Trends during the period 1986-1996

Abstract

Background: Bulgaria is in a state of socioeconomic transition. Along with the political, economic and social system, the current changes affect the health care sector. The present article focuses on the issue of induced abortions. Bulgaria has one of the highest abortion rates in Europe, and this poses an important public health concern. Methods: Data were collected from the Bulgarian Ministry of Health, the Bulgarian National Statistical Institute, articles and the reports of WHO, UNDP, UNICEF, and AIHA. The data was analysed by stratifying abortion rates according to age, marital status, parity, socio-economic status, level of education, and ethnicity. In addition, possible contributing factors were reviewed. The main factors included were demographic characteristics of the country; legislation related to induced abortions; financing of the health care system; organization of family planning services; and data on contraceptive prevalence and practices. Results: Abortion rates show a general trend of shift towards younger age groups, as well as to single nullipara women. Definite associations with ethnicity, level of education and socio-economic status could not be established, mainly because sufficient data was not available. The observed cases of multiple abortions indicate the inadequacy of the post-abortion counselling. The new financing system is expected to make the family planning services more effective. Finally, recent data still show a relatively low rate of modern contraception prevalence. Conclusions: The objective of this review is to contribute to a better understanding of the problem of high rates of induced abortions in Bulgaria. Detailed analysis of associations between different factors related to the problem would be important for developing adequate strategies for intervention, i.e. reduction of the number of induced abortions. This would undoubtedly be of social, financial and public health benefit for Bulgaria.