Reproductive health in the formerly socialist economies in Europe

Before 1989 the formerly socialist countries in Eastern Europe could be grouped as 1) countries with uncontrolled population growth 2) countries where induced abortion was the main method of birth control and 3) countries with stable or declining populations. When the Berlin Wall fell in 1989 the subsequent geopolitical changes among the formerly socialist countries affected the economy the medical systems and the reproductive health of the region. The first dramatic changes occurred in Romania when all restrictions on abortion up to week 12 were abolished. This was accompanied by an increase in the abortion rate and a dramatic drop in maternal mortality. Eventually a system of family planning clinics was established the abortion rate dropped birth rates stabilized and maternal mortality declined further. In countries where induced abortion was used for birth control abortion rates remained high and contraception remained unavailable. This situation is starting to improve as international agencies establish contraceptive services. The transition was smoother in the counties which had stable populations such as Hungary. The entire region requires new legislation to regulate the health system and to protect reproductive health as a basic human right. Improved service delivery and family planning education will result in improved mortality rates and increase the life expectancy for women which is 10 years shorter than that found in developed countries.