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

Background: Bulgaria is in a state of socioeconomic transition. Along with the political, economic and social system, the current changes affect the h ealth care sector. The present article focuses on the issue of induced abor tions. Bulgaria has one of the highest abortion rates in Europe, and this p oses an important public health concern. Methods: Data were collected from the Bulgarian Ministry of Health, the Bulgarian National Statistical Instit ute, articles and the reports of WHO, UNDP, UNICEF, and AIHA. The data was analysed by stratifying abortion rates according to age, marital status, pa rity, socio-economic status, level of education, and ethnicity. In addition , possible contributing factors were reviewed. The main factors included we re demographic characteristics of the country; legislation related to induc ed abortions; financing of the health care system; organization of family p lanning services; and data on contraceptive prevalence and practices. Resul ts: Abortion rates show a general trend of shift towards younger age groups , as well as to single nullipara women. Definite associations with ethnicit y, level of education and socio-economic status could not be established, m ainly because sufficient data was not available. The observed cases of mult iple abortions indicate the inadequacy of the post-abortion counselling. Th e new financing system is expected to make the family planning services mor e effective. Finally, recent data still show a relatively low rate of moder n contraception prevalence. Conclusions: The objective of this review is to contribute to a better understanding of the problem of high rates of induc ed abortions in Bulgaria. Detailed analysis of associations between differe nt factors related to the problem would be important for developing adequat e strategies for intervention, i.e. reduction of the number of induced abor tions. This would undoubtedly be of social, financial and public health ben efit for Bulgaria.