**5. Conclusion**

*Induced Abortion and Spontaneous Early Pregnancy Loss - Focus on Management*

pattern, as it was documented in the Czech Republic [13].

Analysis of the link between contraceptive use of modern methods and individual characteristics has brought findings that are consistent with other studies, in particular as regards the educational attainment [16, 23, 24, 37]. Our results also confirmed that highly educated women are more likely to use modern contraception in all analysed countries across all abortion patterns. Moreover, young women are the most receptive to use hormonal contraceptives. While the proportions of users of contraceptive methods vary considerably particularly between the Czech Republic and France on one side and Bulgaria on the other, the characteristics of the users of modern effective methods were found to be similar. Therefore, the causes of these variations might be partly explained by the macrolevel factors [38]. Variations observed in contraceptive prevalence and in the mix of methods are determined both by the socio-demographic characteristics of the respondents and by macro-level factors such as legislation, reproductive health care system, family planning programme, or cultural factors and religiosity. Social and cultural expectations as well as access and availability may be the leading factors in behavioural change concerning traditional contraceptive use [16]. Differences in contraceptive use across Europe can also attribute to differences in gender inequality [24]. Particularly, country levels of gender equality are linked to the East-West divide in the type of contraceptive method used. Moreover, family policies may also play a role in decision-making about the method of contraceptive use. Facilitating the reconciliation of paid work and family life seems to enhance reproductive health [39, 40]. More attention for family policies may encourage modern contraceptive use [16]. This is particularly relevant for Eastern European countries like Romania and Bulgaria where development of family policies lags behind other Eastern European countries like Slovenia or the Czech

graphic transition.

use of effective birth control methods is not sufficient to encourage the shift in reproduction pattern. Van de Kaa [11] identified modern contraceptives as the means that made possible not only the low fertility but they also acted as a catalyst of changes in reproductive pattern within the concept of second demo-

On the contrary, other four Eastern European countries, the Czech Republic, Lithuania, Slovakia, and Slovenia, that formerly registered high abortion rate, contributed to form the new 'low abortion pattern' characterised by low abortion rates across all age group of women. This pattern is based on the increased use of efficient modern contraceptive methods and could be also found in Italy, Belgium, and Germany. During the 1990s, fertility decline occurred in the Czech Republic, Lithuania, Slovakia, and Slovenia and did not result in any an increase in unmet need for family planning as no increase in abortion rate was observed. Instead, a decline in abortion in all age group of women was registered. Both young and older women improved their contraceptive behaviour although the highest increase in use of the pill was registered among young women below the age of 25 years. As a result, young women do not rely on abortion when planning childbearing but rather prevent unintended pregnancy. So once there were conditions for effective family planning, the abortion rate could rapidly fall without any legislative restrictions on access to abortions [15]. The increase in contraceptive use has been sufficient to encompass both the sharp decline in abortion and the trend towards fertility postponement. The spread of modern contraceptive methods facilitates fertility changes and may result in altering norms regarding fertility regulation, but also in reverse, attitudes with regard to contraceptive use may be shifted [11]. Accordingly, significant improvements in contraceptive practice in these Eastern European countries might encourage shaping of a new reproduction pattern, that is, late fertility

**36**

Republic [41].

The main results could be summed up as follows: (1) The East-West divide in abortion behaviour was distorted, but not fully eliminated. Besides the former Eastern and Western abortion patterns, the new 'low abortion' pattern has emerged. (2) Within the EU countries, convergent trends towards lower abortion level were identified since 1990. However, as regards the structure of abortions, a pattern of divergence has been apparent due to differences in the transition to modern contraception use. (3) The use of modern methods of contraception rather depends on structural macro-level factors and contextual incentives and barriers as the impact of individual characteristics on the use of contraception does not differ much between countries under study.
