Countries Abortion Profile

Georgia

1. Law related to Abortion

Brief history of the law:

As is the case with all the former Soviet republics, Georgia was subject to the liberal abortion legislation and regulations issued by the former USSR. Abortion on request was available within the first 12 weeks of gestation since the Soviet Supreme Council decree issued in November 1955. With several additions and modifications, this 1955 law remained in force essentially unchanged. In 1987, early abortions by electric vacuum aspiration after obligatory pregnancy testing were authorized by the Order of the Minister of Health of the USSR. Additional regulations were issued to permit induced abortion during the first 28 weeks of gestation on medical and social grounds (USSR MOH, 1982; USSR MOH 1987) and to briefly legalize “commercial” abortions in private clinics and “for-fee” sections in state hospitals (legalized in March 1988 and outlawed in December 1988 by the USSR MOH) 

After independence (1991) additional regulations were issued to permit induced abortion during the first 22 weeks of pregnancy on medical and social grounds by Georgia MOH in 2000, and 2007.

Under the current law, induced abortion is available without restrictions during the first 12 weeks of gestation. Beyond this gestational age, abortion is available only on medical and selected socioeconomic grounds.

Short summary of conditions within the law

  • To protect  woman’s life                       legal during 1st and 2nd trimester only             
  • To preserve physical health                 legal during 1st and 2nd trimester only    
  • To preserve mental health                    legal during 1st and 2nd trimester only    
  • Rape or incest                                    legal during 1st and 2nd trimester only  
  • Fetal impairment                                 legal during 1st and 2nd trimester only    
  • Socio-economic factors                      legal during 1st and 2nd trimester only    
  • Available on request                            legal during 1st trimester only

Analysis of it being restrictive if at all - None.

2. Policy

None.

3. Second Trimester Abortion

4. Practice

Abortion services are provided by either ob/gyn or reproductologists in the state-certified clinics.

5. Reproductive Health Perspective

Georgia is signatory to ICPD. After the Rose Revolution in November 2003 the new government reaffirmed Georgia's commitment to ICPD Programme of Action and the MDGs and accelerated the process of reforms aimed at reducing poverty and improving the population's social and health status.

Georgia is signatory to the Convention on the Elimination of All Forms of Discrimination against Women. Georgia acceded to the Convention in accordance with a decision of its Parliament of 22 September 1994, thereby assuming the obligation to implement its requirements.

6. Abortion Statistics

Induced abortion rate among women aged 15-44 years

  • Total abortion rate per woman                                                    3.1 (RHS, Georgia, 2005)               
  • General abortion rate per 1,000 women                                      104 (RHS, Georgia, 2005)
  • Abortion ratio per 100 live births                                                  40.5(MOH,2006)                         
  • Age specific abortion rate (per 1,000 women) age 15-19              6.0 (MOH, 2005)1

                                                                                                           13 (RHS, Georgia, 2005)2

1 -Abortions occurring between January 2002 and December 2004, include spontaneous abortions

2 -Abortions occurring between March 2002 and February 2005

Total number of abortions (indicate source; period)        19,161 (total number for 2006, MOH) 3

                                                                                  345/19,161 (1.8%) first abortions

                                                                                  6,720/19,161 (35%) mini-abortion

  • 1st TM                 18,930   
  • 2nd TM                 231
  • safe                     19,153
  • unsafe                  8 illegal, criminal abortions
  • married women     N/A
  • unmarried women   N/A
  • adolescents             <14 years – 3 abortions

                                         15-19 years – 1451 abortions

  • Septic abortions       N/A                                                 

3 – Countrywide data for 2007 currently is not available (official statistics differ from the real figures due to weak registration and surveillance systems); 

4 - “Mini-abortion” is a procedure that is performed by either electric vacuum aspiration or manual vacuum aspiration in the earliest stages of gestation (in women whose menstrual period is no more than 20 days overdue, roughly corresponding to a maximum of 6 weeks of pregnancy).

7. Public sector

Abortion services available
1st Trimester available              yes
2nd Trimester available             yes
Cost :                                    

1st trimester abortion:

EVA, MVA, D&C - GEL 30-120 (varies from clinic to clinic);
MA -GEL 120 (currently available only in one clinic in Tbilisi)
                                                                                   
2nd trimester abortion: GEL 300-700

Exchange rate : 1USD = 1.4 GEL (August, 2008).

8. Private sector

Abortion services available:
1st Trimester available              yes
2nd Trimester available             yes
Cost                                         

1st trimester abortion: EVA, MVA, D&C - GEL 30-120 (varies from clinic to clinic);
2nd trimester abortion: GEL 300-700

Exchange rate : 1USD = 1.4 GEL (August, 2008).

9. Methods used

D&C, EVA, MVA, MA with Mife+Miso (≤ LMP, regimen used), MA with Miso alone (≤ LMP, regimen used), MA with Methotrexate+Miso (≤ LMP, regimen used)
 
D&C, EVA, MVA are used for termination of 1st trimester pregnancy, EVA and MVA are used up to 10 weeks of gestation; 10-12 weeks pregnancy is terminated by D&C.
 
MA is available only in one clinic in Tbilisi; though there are sporadic services in some big cities of Georgia (Batumi, Kutaisi, Zestafoni, Rustavi). Despite of initially approved regimen (600mg mife + 400μg miso in clinic administration after 48h for abortion up to 56 days), based on their own experience and WHO recommendations clinic staff in Tbilisi provide abortion services using the regimen of 200mg mife +400μg miso up to 63 days LMP.  Since 2007 Gynuity Health Projects in collaboration with three clinics in Tbilisi, Georgia has been conducting a double-blind randomized study of 400μg versus 800μg buccal misoprostol following 200mg mifepristone for abortion up to 63 days from last menstrual period. Currently, MA services are available in collaborating clinics in Tbilisi.  .
 
Neither MA with Miso alone, nor MA with Methotrexate+Miso is used.
 
2nd Trimester with Ethacridine lactate, Misoprostol, D&E, Hysterectomy
 
Ethacridine lactate; and D&E  are used for termination of 2nd trimester pregnancy.

10. Provider level allowed for surgical and medical abortion

Ob/gyn; reproductologists.

11. Abortion related morbidity mortality statistics

Abortion related maternal mortality rate -2.1 (MOH, 2005)
(official statistics on abortion-related mortality in Georgia are scarce; 37% of maternal death in 2004 were due to sepsis, including some that were abortion related (UNFPA, 2006))
 
The prevalence of post abortion complications was lower in 2005 than it was in 1999; only 6.3% of pregnancy terminations was followed by early or late complications in 2000-2005 compared to 10% in 1994-1999; a 37% decline (RHS, Georgia, 2005).
Despite the decrease in abortion morbidity that can be attributed to an increase in the level of abortions which are performed through either manual or vacuum aspiration and are followed by fewer complications, the rates of early complications and late complications are relatively high compare to those reported for first trimester abortions in developed countries.

12. Manufacture and/or availability through import of abortion equipment (MVA syringes, EVA equipment)

MVA syringes and Karman canulas  are currently imported by the company “Family Doctor;”
MVA syringe price is USD 100; Karman canula USD 2.

13. Manufacture/ import of Mifepristone, Misoprostol

Two Russian mife products are registered in Georgia. Pentcrofton – Pentcroft Pharma; and Mifepristone – Mirpharma. Both products are imported/distributed by the “Family doctor.”
The price per pill – 55 GEL (~ USD 40);
 
Misoprostol (Cytotec) is in the process of registration, Phizer representative in Georgia expects that it will be available in pharmacies by the end of 2008.
 
Currently Misoprostol is available at black market; price for 14 miso pills – 21 GEL (~ USD 15).

14. Facility and provider certification norms in brief

Induced abortion can be performed either by obstetrician/gynecologists or reproductologists by either vacuum aspiration or sharp curettage; abortion procedures are permitted only in medical facilities that are state-certified for performing abortion. Outpatient medical facilities (e.g. women’s consultation clinics) can perform induced abortion only by vacuum aspiration.

15. Information available in national service delivery standards

Neither national service delivery standards, nor guidelines/protocols are available.

16. Informal / illegal providers – if present who are they

No data.

17. Population urban/ rural: Demography of the country, with an analysis of availability of abortion services ratio to population

Slightly more than half (51%) of the population resides in urban areas, including almost 1.1 million in Tbilisi
 
Population growth rate -0.325% (2008 est.)
Birth rate 10.62 births/1,000 population
Death rate 9.51 deaths/1,000 population (2008 est.)
Total abortion rate among women aged 15-44 years: Urban - 2.8
Total abortion rate among women aged 15-44 years: Rural - 3.5

18. Role of government

Currently no abortion service delivery or training programmes are funded by state.

19. Role of religion/ religious leaders

Georgian Apostolic Autocephalous Orthodox Church keeps neutral position regarding family planning and abortion.

20. Local Ob Gyn societies

Georgian Ob/Gyn Association (GOGA) is supportive (In November 2005, a meeting was conducted with service providers through the Georgian Ob/Gyn Association (GOGA) and Ministry of Labour, Health and Social Affairs (MoLHSA) to discuss the WHO Safe Abortion Guidelines and integration into the Georgian CME curriculum).

21. Current status and potential of research

Since 1988 Zhordania Institute of Human Reproduction, WHO collaborating center in Georgia has been conducting medical abortion and post-coital contraception clinical studies.
Gynuity Health Projects in collaboration with three clinics in Tbilisi Georgia has been conducting medical abortion study “A double-blind randomized study of 400 mcg versus 800 mcg buccal misoprostol following 200mg mifepristone for abortion up to 63 days from last menstrual period.

22. Awareness amongst community members

Awareness on MVA/EVA, medical abortion (among women) - no reliable data.
Awareness on MVA/EVA, medical abortion (among medical providers) - no reliable data.

23. Role of member organization/ individual

Role of Gynuity Health Projects in Georgia: making RH technologies more convenient, acceptable, safe and accessible; provision of trainings in MA; conducting clinical studies; testing new and improved MA regimens; provide technical assistance to improve service and service-delivery options.