Across Europe, national approaches to abortion vary as much as the countries and cultures that span the continent. In Eastern and Central Europe, where Ipas focuses its work, abortion policies are typically among the world’s most liberal, a legacy of Soviet rule in which it was often easier to obtain abortions than contraception. In many countries, abortion on demand is permitted until the 12^th week of pregnancy. Until recently, a few countries such as Albania and Romania banned abortion; both dropped their bans in 1989.

Although the global trend is for governments to reform restrictive abortion legislation, some Eastern European countries — influenced by growing political conservatism and concerns about dwindling populations — have reduced the circumstances in which women can legally have abortions. For instance, in 1997, Poland drafted new legislation that dropped economic and social grounds for abortion. In 2000, Hungary restricted funding for abortions not required for medical reasons and in cases of rape. In 2003, the Russian Federation reduced the circumstances for second-trimester abortion, even though about 80 percent of deaths resulting from unsafe abortion were linked to unsafe second-trimester procedures.

Throughout the region, whether abortion has been legal or criminalized, abortion rates and the percent of deaths due to unsafe procedures have been high. In Moldova, half of maternal deaths in 2003 were related to abortion.

In those countries where abortion is permitted, women face uphill battles in obtaining legal services and when they do access them, they are often subject to procedures performed with outdated equipment and by providers who lack the training to provide high-quality comprehensive abortion care. Throughout Eastern and Central Europe, sharp curettage is still used by many providers, though the technique has higher rates of complications than electric vacuum aspiration (EVA) or manual vacuum aspiration (MVA), a cost-effective, low-technology method that can be easily used in a variety of rural or urban settings. The World Health Organization (WHO) recommends EVA or MVA as preferable methods for first-trimester abortion. 

Introducing the concept of comprehensive woman-centered abortion care and transitioning abortion providers to MVA and other advances in abortion technology remains one of the challenges of Ipas’s work in Eastern and Central Europe. Ipas’s Europe program concentrates its efforts on improving abortion care by distributing MVA in nations from Albania and Bulgaria to Turkey and Ukraine.

Equipping health-care providers with the right medical instruments must go hand-in-hand with training them to use the technology properly and to best to serve their patients. Ipas has established an effective network of European trainers with extensive technical and language skills to support the training efforts in the region. With its partners and distributors, Ipas has  conducted dozens of trainings to build a cadre of health-care professionals who are able provide high-quality abortion services.

To accomplish its goals, Ipas cultivates partnerships with community-based nongovernmental organizations, global agencies and government stakeholders. Working with the World Health Organization’s Europe office, Ipas helped distribute WHO’s landmark Safe abortion: Technical and policy guidance for health systems throughout the region. Through collaboration with Moldova’s Ministry of Health, Ipas contributed to a national assessment that recommended strategies to increase access to contraceptives and abortion. Similar assessments have been done in Romania and one is under way in Russia.

• Expand its MVA distribution network to ensure women have access to up-to-date, safe abortion technologies;
• Strengthen its core group of master trainers in the region;
• Explore the feasibility of introducing medication abortion in Eastern and Central Europe;
• Address the need to improve the quality of second-trimester abortion services;
• Use strategic partnerships to advance policy change that supports women’s right to reproductive health care.

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