Medical abortion ratios and gender equality in Europe: an ecological correlation study

Figures & data

Figure 1. Medical abortion ratios in Europe, most recent year available (2017, 2018, or 2019). Source: Author’s own elaboration. For the data sources, see Table 1.

Notes: 1. We intended to investigate medical abortion ratios in all of EU 28 countries (when the research was conducted, the UK was still part of the EU), plus Norway, Switzerland, and Iceland. However, for a few countries, where medical abortion is legal and performed, no data are available – for the following reasons: (i) not published and statistical office and/or public health institute did not respond to the author’s data request (countries: Czech Republic, Greece, Romania, and Bulgaria), (ii) data not collected (Austria collects only data for hospital-based abortions, Luxembourg and Latvia do not collect data by method of abortion). 2. About the UK: England and Wales and Scotland are administered under different National Health Services, and data are available separately. We, therefore, decided to look at them independently. However, for the gender equality measures, there is only one figure available, at the UK level. In Northern Ireland, all types of abortion were prohibited until March 2020, therefore not allowing enough time for inclusion in the study. In Ireland, all types of abortion were prohibited until 2018, also not allowing enough time for inclusion in the study. 3. In Croatia, medical abortion was approved in 2019, therefore not allowing enough time for inclusion in the study. 4. In six countries (Cyprus, Hungary, Poland, Lithuania, Malta, Slovak Republic), medical abortion is not legally performed, and therefore the medical abortion rate is 0.

Table 1. Key characteristics of medical abortion practice in the countries where it is legal

Country	Medical abortion (MA) ratio (latest year available)	Year since when MA is available^a	Week of pregnancy until which MA is available^b	Main abortion providers^c
Belgium	28.4 (2017)^Citation53	1999^Citation54	7^Citation55	Family planning centers and hospitals^Citation53
Denmark	77.3 (2017)^Citation56	1999^Citation54	9^Citation57	Gynecologists in hospital or outpatient practices^Citation57
England and Wales	73 (2019)^Citation58	1991^Citation42	10^Citation58	Hospitals and approved independent sector providers^Citation58
Estonia	82.8 (2019)^Citation59	2003^Citation54	9^Citation60	Hospitals and outpatient medical practices^Citation61
Finland	97.7 (2019)^Citation62	2000^Citation54	12^Citation56	Hospitals with referral from general practitioner (GP)^Citation63
France	70 (2019)^Citation64	1988^Citation42	9^Citation65	Midwifes, GPs, family planning centers, gynecologists and hospitals^Citation64
Germany	28.3 (2019)^Citation66	1999^Citation67	9^Citation68	Preliminary consultation by third sector providers, then hospitals, gynecologists, or GPs^Citation68
Iceland	78.5 (2018)^Citation69	1999^Citation54	9^Citation70	Main hospital gynecological ward^Citation70
Italy	24.4 (2018)^Citation71	2010^Citation72	7^Citation73	Public hospitals^Citation73
Netherlands	26 (2018)^Citation74	1999^Citation54	9^Citation74	Family planning centers and hospitals^Citation74
Norway	89 (2017)^Citation56	1998^Citation75	12^Citation76	Hospitals^Citation76
Portugal	67.6 (2018)^Citation77	2007^Citation77	10^Citation77	Public health centers and private clinics^Citation77
Scotland	88 (2019)^Citation78	1991^Citation42	9^Citation78	Hospitals and approved independent sector providers^Citation78
Slovenia	72.4 (2019)^Citation79	2013^Citation54	9^Citation43	Public hospitals^Citation43
Spain	41,9 (2018)^Citation80	1999^Citation54	7^Citation81	Accredited clinics and outpatient medical practices^Citation81
Sweden	96,4 (2019)^Citation82	1992^Citation42	12^Citation83	Hospitals and gynecological clinics^Citation83
Switzerland	74 (2019)^Citation84	1999^Citation85	7^Citation86	Hospitals and outpatient medical practices^Citation86

a. This date refers to the year when the medical abortion pill and procedure have been first approved. In most countries, there is a 1- or 2-year delay before medical abortion (and data on medical abortion) became available in practice.

b. This is subject to change. This reflects information retrieved at the time of the study.

c. The words and phrases used to describe providers are the ones used in each national context. They represent a variety of settings and systems and are not directly comparable.

Figure 2 . Scatterplots of medical abortion ratios (x-axis) and gender equality indices (y-axis) with linear regression line

Table 2. Correlation coefficients between medical abortion ratio and gender equality indices

	Correlation coefficient	p-value
GII UN 2019 (n = 23)	−0.613	0.002
GEI Social Watch 2012 (n = 23)	0.678	0.001
GEI Economy	0.564	0.005
GEI Education	0.366	0.087
GEI Empowerment	0.640	0.001
GGGI WEF 2018 (n = 23)	0.761	<0.0001
GGGI Economy	0.625	0.001
GGGI Education	0.132	0.547
GGGI Politics	0.721	0.0001
GGGI Health	−0.222	0.308
GEI EIGE 2019 (n = 20)	0.735	0.0002
GEI Work	0.636	0.003
GEI Money	0.372	0.106
GEI Time	0.686	0.001
GEI Knowledge	0.384	0.094
GEI Power	0.763	<0.0001
GEI Health	0.365	0.114
GEI Violence (2017)	0.385	0.093
SIGI OECD 2019 (n = 22)	−0.586	0.004
SIGI Families (n = 23)	−0.418	0.047
SIGI Finance (n = 22)	−0.493	0.019
SIGI Physical (n = 22)	−0.180	0.422
SIGI Liberties (n = 23)	−0.470	0.024

Note: In bold are the indices which show a statistically significant correlation with the medical abortion ratio.

Table 3. Regression models’ results with MA ratios as dependent variable

	Model 0: Unadjusted model, maximum number of observations^a		Model 1(a)^b: Adjusted for date since when MA is available, maximum number of observations		Model 1(b): Adjusted for date since when MA is available, countries with no MA removed		Model 2(a)^c: Adjusted for number of weeks until MA is available, maximum number of observations		Model 2(b)Adjusted for number of weeks until MA is available, countries with no MA removed
	Regression coefficient	P-value	Regression coefficient	P-value	Regression coefficient	P-value	Regression coefficient	P-value	Regression coefficient	P-value
GII	−4.18	0.001	−1.51	0.228	−0.324	0.898	0.441	0.665	0.138	0.943
MA available since			−0.021	0.002	−0.009	0.363
Number of weeks							0.0789	<.0001	0.102	0.004
GEI Social Watch	3.88	0.001	2.043	0.035	2.213	0.070	0.632	0.441	0.588	0.633
MA available since			−0.018	0.002	−0.006	0.522
Number of weeks							0.068	<.0001	0.090	0.032
GEI Economy	2.98	0.005	1.535	0.06	2.97	0.007	0.822	0.184	1.726	0.184
MA available since			−0.02	0.0003	−0.0005	0.949
Number of weeks							0.068	<.0001	0.059	0.184
GEI Empowerment	1.627	0.001	0.794	0.068	0.586	0.277	0.064	0.861	0.019	0.966
MA available since			−0.019	0.005	−0.008	0.377
Number of weeks							0.073	<.0001	0.102	0.009
GGGI	5.29	<0001	3.183	0.009	3.072	0.037	1.541	0.140	1.640	0.226
MA available since			−0.015	0.008	−0.005	0.583
Number of weeks							0.061	<.0001	0.080	0.030
GGGI Economy	3.89	0.001	2.816	0.001	3.049	0.002	1.408	0.048	1.746	0.096
MA available since			−0.021	<.0001	−0.012	0.103
Number of weeks							0.065	<.0001	0.068	0.064
GGGI Politics	1.54	0.0001	0.860	0.068	0.665	0.193	0.276	0.400	0.29	0.470
MA available since			−0.017	0.014	−0.0046	0.644
Number of weeks							0.067	<.0001	0.093	0.013
GEI EIGE^d	3.06	0.0002	1.11	0.378	1.06	0.506	0.214	0.783	0.20	0.834
MA available since			−0.017	0.071	−0.005	0.729
Number of weeks							0.069	0.0002	0.125	0.007
GEI Work	5.03	0.003	1.857	0.239	3.19	0.112	1.35	0.205	0.873	0.559
MA available since			−0.019	0.004	0.0003	0.978
Number of weeks							0.065	<.0001	0.114	0.021
GEI Time	2.01	0.001	8.50	0.173	0.785	0.300	0.27	0.561	0.14	0.806
MA available since			−0.018	0.009	−0.007	0.53
Number of weeks							0.0678	<.0001	0.124	0.009
GEI Power	1.59	<.0001	0.79	0.190	0.59	0.426	0.12	0.776	0.12	0.809
MA available since			−0.014	0.123	−0.005	0.668
Number of weeks							0.069	0.001	0.125	0.007
SIGI^d	−4.45	0.004	−1.62	0.225	−1.11	0.673	−0.29	0.781	−2.25	0.261
MA available since			−0.02	0.001	−0.01	0.281
Number of weeks							0.07	0.000	0.11	0.003
SIGI Families	−1.98	0.047	−0.80	0.274	−0.42	0.671	−0.34	0.516	−0.82	0.278
MA available since			−0.02	0.000	−0.01	0.343
Number of weeks							0.07	0.000	0.11	0.572
SIGI Finance	−3.21	0.020	−1.29	0.214	−0.22	0.234	−0.03	0.972	0.33	0.850
MA available since			−0.023	0.000	−0.01	0.306
Number of weeks							0.07	0.000	0.11	0.012
SIGI Liberties	−2.11	0.024	0.22	0.80	1.25	0.313	−0.04	0.945	−1.17	0.273
MA available since			−0.03	0.01	−0.12	0.233
Number of weeks							0.07	0.000	0.12	0.003

a. The maximum number of observations is 23 for the GII, the GEI, the GGGI and the SIGI Families and Liberties, 20 for the GEI EIGE, and 22 for the SIGI and SIGI Finance. In models (b), the total number of observations is 17 for the GII, the GEI, the GGGI and the SIGI Families and Liberties, 14 for the GEI EIGE, and 16 for the SIGI and SIGI Finance.

b. For Model 1(a), the date of introduction of MA was artificially set at “2020” for the countries where it is still not legal.

c. For Model 2(a), the number of weeks until when MA is allowed was artificially set at “0” for the countries where it is still not legal.

d. For the sake of clarity and consistency with other indices, the GEI EIGE and SIGI scores (and their sub-scores) have been converted to values between 0 and 1 instead of between 0 and 100.

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