The State of Reproductive Health and Fertility in the ... · To create a comprehensive Report that describes, in man and woman, the current state of SRH – fertility included –

The State of Reproductive Health and Fertility in the European Union

THE REPRODUCTIVE HEALTH REPORTDeliverable 15

2007110

June 2008 – May 2011

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The State of Reproductive Health and Fertility in the European UnionA three years Project:

Starting: June 2008

Ending: May 2011


27 Collaborating Partners

Project coordinator(AIDFM)

5 Steering Committe members

Associated Partner(UGent)

1 Research Assistant

The State of Reproductive Health and Fertility in the European UnionParticipants

Total: 29One from each Member State

+ WHO / Europe – Gunta Lazdane

+Research Assistant – Inês Fronteira

The State of Reproductive Health and Fertility in the European UnionParticipants professions

Gynaecologists 16General Practitioners 1Public Health Doctors 5Epidemiologists 3Psychologists 2Statisticians 3Total 29

The State of Reproductive Health and Fertility in the European UnionProject General Objectives

1. To create a comprehensive Report that describes, in man and woman, the current state of SRH – fertility included – within the European Union.


2.1 Identify and harmonize inequalities in SRH, promoting an integrated and intersctoral SRH strategy;

2.2 Suggestions to create / reformulate public policies and legislation in order to promote healthier SRH behaviours and outcomes.


▪ Each Member State has full autonomy to define their SRH policy

↕▪ Universal SRH measures and goals

. Gender mainstream approach → data collection and statistics;

. Attention to minorities and migrants (Prenatal, FP, Ob-Gyn levels).

The State of Reproductive Health and Fertility in the European UnionSRH trends in the European Union

Common trends: - decreased fertility rates+ ↓ induced abortions+ ↓ teenage motherhood- 1st childbearing postponing

SRH disparities: reliable contraceptive prevalence≠ infertility policies cancers prevention≠ HPV vaccination policy


Minimum of five essential key areas

Specific objectivesContraceptionTeenage SRHChildbearing supportART policyAbortion

The State of Reproductive Health and Fertility in the European UnionCollaborating partners’ tasks (until January 09)

■ SRH national data collection

(> 2 indicators/ specific objective,> 20 Member States).

. They may also use:

. previous REPROSTAT indicators as a guide;

. PERISTAT information sources

The State of Reproductive Health and Fertility in the European UnionCollaborating partners’ tasks (until January 09)

Milestone Delivery date Delivery nº

Local data collection(SRH Country Profile)

M8 – Jan / 09 D3

Local data translation M14 – July / 09 D4

Local data analysis M18 – Nov / 09 D5

Local data consolidation M21 – Feb / 10 D5

Information synthesis M30 – Oct / 10 D6

The State of Reproductive Health and Fertility in the European UnionGuidelines for Collaborating partners

Collect national SRH documentation(extensive review, Nov/08)

SRH Country Profile (M8 = January 09, D3)

The State of Reproductive Health and Fertility in the European UnionGuidelines for Collaborating partners (D1)

■ Literature review tools

■ Search terms / Key words

■ Inclusion / exclusion criteria

■ Schedules (dates to send)

■ Informations sources

■ Later translational needs (M14)


Literature review tools

■ legislation, public policies and guidelines;

■ scientific and academic papers, articles, books’chapters, reports;

■ NGO documentation;

■ relevant lay press analysis and “grey”literature.


Search terms / key words (examples)

contraception,

teenage pregnancy;

Infertility, sterility;

Childbearing support

Abortion.


Collected documents’ languages

English, German,French,

Spanish, Italian, Portuguese

Other native language → translation


Time schedule

M4SEPT/08

M8JAN/09

M14SEPT/09

M21FEB/10

M34MAR/11

M36MAY/11

Guidelines

SRH MS profile

Data collection

Data anlysed and consoli-dated

International Work-shop

SRH FinalReport


Dissemination (1)

M35APR/11

M36MAY/11

M36MAY/11

M34MAR/11

M36MAY/11

Booklet Papers Presentations InternationalWork-shop

SRH Final

Report


Dissemination (2)

M34

APR/11

M36MAY/11

M36MAY/11

Stakeholders contacts

SRH core survey module(EHIS and/or HBSC)

SRH indicators in ECHI lists

(Position paper)


Collected documents’ languages

English, German,French,

Spanish, Italian, Portuguese

Other native language → translation


Time schedule

M4SEPT/08

M8JAN/09

M14SEPT/09

M21FEB/10

M34MAR/11

M36MAY/11

Guidelines

SRH MS profile

Data collection

Data anlysed and consoli-dated

International Work-shop

SRH FinalReport


Dissemination (1)

M35APR/11

M36MAY/11

M36MAY/11

M34MAR/11

M36MAY/11

Booklet Papers Presentations InternationalWork-shop

SRH Final

Report


Dissemination (2)

M34

APR/11

M36MAY/11

M36MAY/11

Stakeholders contacts

SRH core survey module(EHIS and/or HBSC)

SRH indicators in ECHI lists

(Position paper)


The State of Reproductive Health and Fertility in the European Union• General recommendations1.SRH should remain a high priority in

national and EU-wide policy.2.Efforts to reduce inequalities in SRH.3.SRH indicators should be regularly

collected and validates in a standardised way across all MS.

4.Institutional support from EU should be given to MS with poor SRH data.

The State of Reproductive Health and Fertility in the European Union• General recommendations5. Vulnerable groups (teenages, socially

disadvantaged, migrants) SRH data has to collected, so that inequalities can be assessed.

6. SRH research is needed: sexual education, STD risk, gender-based violence, migrant populations.

The State of Reproductive Health and Fertility in the European Union• Teenage SRH data: birth rate, annual change and % of all live births,

women aged 1-19 years, in 2009 (source: Eurostat)

Member States Per 1000 women Average annual change (%) since 1996

% of all live births

Bulgaria 46.7 - 0.5 12.1

Estonia 20.4 - 3.3 5.4

Portugal 15.3 -2.0 4.3

Romania 39.5 - 0.1 11.4

The Netherlands 5.3 - 0.3 1.4

European Union 15.0 - 1.3 4.2

The State of Reproductive Health and Fertility in the European Union• Teenage SRH recommendations7.National and international strataegies

must be conceived and implemented to lower teenage pregnancies rates.

8. Research should focus on the reasons behind the currently observed variations, their significance and how bwst to reduce them.

The State of Reproductive Health and Fertility in the European Union• Oral contraceptive and contraceptive prevalence

ratesMember State Oral contraceptives

rateContraceptive prevalence rate

Estonia (2004) 27.7 83.1

Finland (2007) 31 95.5Malta (2010) 15.6 85.8

Poland 26.9 75.7

Portugal (2006) 65.4 n.a

The Netherlands 40 n.a

The State of Reproductive Health and Fertility in the European Union• Contraception9. Data about current rates of contraceptive

prevalence of different methods should be regularly collected according to standardise procedures with surveys covering bothh man and woman. Data should include information about new methods of contraception as they become available

The State of Reproductive Health and Fertility in the European Union• Contaception10. All women and man within the EU

should have access to reliable and affordable method(s) of contrraception of their choice. Tthis includes the access to energency contraception in case of need.

11. Reserach is needed to determine how the different policies for the reimbursement and distribution of diferent contraceptives affect their use.

The State of Reproductive Health and Fertility in the European Union• Childbearing data (2008)

Member State

Mean Age at childbirth

Total fertility rate

Parental leave

Maternity leave

Paternlty leave

Ireland 31.2 2.10 14 weeks per parent

42 weeks 3 days

Portugal 29.7 1.27 6 months 180 days 20 days

France 29.9 2.01 1 year 6 weeks before + 10 weeks afrer birth

11 days

Sweden 30.7 1.91 15 months(2 months by one of the parents)

480 days At least 2 months

mandatory

The State of Reproductive Health and Fertility in the European Union• Childbearing

It seems that gender equity, a wide-range of social support for childbearing (kindergarten, maternal and parental allowances) have a greater effect than financial incentives and measures.

Sweden: 60/240 for the fatherMigrants with higher ferility rates

The State of Reproductive Health and Fertility in the European Union• Childbearing12. All women and man in the EU are free

to determine for themselves the timing and desired size of their family.

13. Childbearing policies should ensure equity of access for disadvantaged and marginalised groups within the population.

The State of Reproductive Health and Fertility in the European UnionAssisted Reproductive Technology dataMember State Surrogacy Reimbursement % of

deliveries after ART

Bulgaria (2009) No No 1.4

Denmark (2007) No Partially 4.1

France (2004) No 4 cycles, women < 40 y

Germany No 3 cycles 1.8

Portugal No 3 cycles 0.9

United Kingdom

Legal Depends 1.7

The State of Reproductive Health and Fertility in the European UnionAssisted Reproductive Technology (ART)14. Womana and man should be aware of the

disadvantage of postponing mothehood until later in life.

15. Each MS should have arelatory structure that allows apropiate access to ART, and the monitoring of quality.

16. Single embryo transfer should be the rule, to avoid multiple pregnancies.

The State of Reproductive Health and Fertility in the European UnionNumber of legal induced abortion per 1000

women aged 15-49 years (2008)Member State Number Per 1000

Estonia 8 420 25.1

Romania 127 909 23.4

Bulgaria 36 593 20.0

Slovakia 10 869 7.7

Portugal 18 911 7.5

The Netherlands 28 470 7.34

European Union 1 200 224 10.0

The State of Reproductive Health and Fertility in the European UnionInduced abortion17. Acess to safe and affordable induced

abortion is still required.18. Data should be collected to ascertain how

often women have to cross country borders to access to an abortion.

19. Reserach into methods for reducing the need for abortion, particularly repeat abortion, is needed.

Documents

The State of Reproductive Health and Fertility in the ... · To create a comprehensive Report that describes, in man and woman, the current state of SRH – fertility included –