Abstract

Background and objectives. Access to safe pregnancy termination prevents harm to women’s health. Clinical practices that uphold personal autonomy, equality and non-discrimination is a fundamental right for women. In Estonia, data on pregnancy and childbirth have been regularly collected since the 1990s. However, women’s experiences with pregnancy termination in Estonia have not been analysed until now. The aim of the study was to analyse and describe changes in abortion trends during the last 30 years and assess women’s satisfaction regarding abortion related healthcare services and treatment in Estonia during the last 20 years. Additionally, the study seeks to learn about the effect of COVID-19 pandemic on the accessibility of abortion services.

Methods. Data from three survey years (2004, 2014, 2024) of the Estonian Women’s Health Study and Pregnancy Information system were analysed. The analysis examined the total number of abortions by age group, trends in total fertility rate, the abortion rate and ratio, and the use of surgical and medical abortion methods. From the population-based cross-sectional study respondents (2024), 1328 women aged 16–59 with an experience of pregnancy termination were included in the data analysis. To compare survey years, additional respondents were added to the analysis, which focused on their experiences regarding explanations received during pregnancy termination, treatment at healthcare facilities and contraceptive counselling. Data were described using relative frequencies, and associations were analysed using binary logistic regression.
Results. During 1994–2023, there was a significant decline in the abortion rate: from 70.1 in 1991 to 11.4 in 2023, a nearly sevenfold decrease. Medical abortion has become the primary method for pregnancy termination, implemented in 93% of all induced abortions. Two thirds of women are satisfied with the explanations and counselling received during abortion, with younger respondents expressing higher satisfaction. Between 69% and 75% of respondents were satisfied with their treatment in healthcare facilities in 2024 study. The vast majority of women, including 93% of those aged 18–24, have received counselling on contraceptive methods. The proportion of those who have received counselling has increased four times, from 22% in 2004 and 80% in 2024. Compared to 2004, respondents in 2024 had a higher chance of being very satisfied with the explanations received from healthcare professionals regarding pregnancy termination – OR 4.5 (95% CI 3.4–6.0), the potential risks associated with pregnancy termination – OR 2.7 (95% CI 2.0–3.6), and receiving counselling on contraceptive methods – OR 9.6 (95% CI 7.3–12.7).
Conclusions. The decline in the abortion rate and ratio is significant and has not occurred at the expense of decreased births. The primary method for pregnancy termination is medical abortion. Respondents’ satisfaction with the explanations, contraceptive counselling and treatment during abortion indicates that healthcare professionals’ care is highly rated. Restrictions during the COVID-19 pandemic did not have a major negative impact on the accessibility of pregnancy termination.