Countries Abortion Profile

Macedonia, the Former Yugoslav Republic of

1. Law related to Abortion

The legal aspects of abortion in Macedonia are presented in the Law on Pregnancy Termination as amended in years 1972, 1976 and 1995 (Published in Official Journal of Socialist Republic of Macedonia). The law guarantees the right of every woman of age to freely decide on their pregnancy by the 10th gestation week. This right may be limited in cases when there are conditions that may be detrimental to the pregnant woman’s health.

The Low foresees the following three additional conditions or exemptions for termination of pregnancy:

  • To protect a pregnant women’s health, termination of pregnancy shall not be performed after the tenth week from the date of conception,
  • Termination of pregnancy shall not be performed before the tenth week from the date of conception if the procedure can be detrimental to the women’s health,
  • Termination of pregnancy shall not be performed if it has been les than a year since the termination of the previous pregnancy.

Exemptions from the above conditions may be made under following conditions:

  • When based on a medical indicator, pregnancy is considered to be a threat to a women’s life or can seriously harm a women’s health during pregnancy, delivery and in the post-delivery period
  • When, on the basis of medical findings, it is presumed that the child will be delivered with serious physical and psychological defects
  • When conception was a result of a criminal act, and
  • When it is concluded that during the pregnancy or after delivery a women can suffer from serious personal, domestic, financial or other difficulties that can affect her health

The law on Termination of pregnancy has been enacted for 30 years and requires modernization such as bringing it in line with the current legal language, reforms in the health system as well as determination of special social and health conditions whatever the termination of pregnancy will be partially or fully reimbursed from the National Health Insurance Fund.

Short summary of conditions within the law:
  • Abortion must be carried out only by gynecologist-obstetric specialist or gynecologist undergoing specialization in the hospitals under monitoring of the gynecologist-obstetric specialist
  • Abortion can be performed in gynecological hospitals or another authorized health-care facility that has a gynecological-obstetrical unit.
  • Abortion in private gynecological cabinets is illegal
  • Parental or guardian consent required for minors under 18
  • Special authorization by a commission (which consists of a gynaecologist-obstetrician, a specialist in internal medicine and a social worker or nurse) for termination of pregnancy after 10 weeks is required
  • The women can appeal to the Commission of Second Instance if Commission of First Instance rejects her request
  • The gynecologist is obliged to inform women of family planning services and to advice her to contraceptive methods. There are no written national protocols or guidelines on abortion counseling
  • Minimum lab tests – Blood group (incl. RH). HBV, HCV and HIV tests are required within some private obstetrical hospitals.

2. Policy

Macedonia is one of most liberal country regarding abortion.
There is a formal population policy addressing decreasing fertility trend in the past several years.
In 2008 "National Strategy for Demographic Development of Republic of Macedonia 2008-2013" was adopted. Following it’s adoption, a number of legal and policy changes were introduced aimed at achieving one of it’s key strategic objectives – an increase in the natural population growth:

  • Revision of the Low on Child Protection
  • Revision of the Low on Termination on Pregnancy
  • Developing a Sexual and Reproductive Health Strategy (SRHS).

SRHS was prepared in 2009-2010 and is in the process of adopting. Family planning and Safe abortion are two important strategic fields.
Due to decreasing population growth, pronatalist policy and an initiative for a new, more restrictive legislation regarding abortion started in 2008. Public discussions regarding abortion policy was very intensive in 2009 which caused very strong NGO movement. Participants in the debate typically align themselves with a pro-life or pro-choice position. But, no changes in policy environment was done so far.

3. Second Trimester Abortion

4. Practice

Specialist in Gynecology and Obstetrics received training in abortion issue during their specialization which last four year, and are only health providers allowed to perform abortion.

5. Reproductive Health Perspective

  • Republic of Macedonia is signatory of CEDAW from 1993.
  • In 2004 Macedonian is signatory of World Leaders Statement in Support of ICPD.

6. Abortion Statistics

  • Over the last decade the total number of registered abortion in Macedonia has continuously decreased (from 48 abortions per 100 live births in 1996 to 25 per 100 live births in 2008). The drop in abortion rate may be a result of low registration, especially in the period of privatization in the health sector and opening of gynecology clinics which are not covered by the system of regular reporting of services performed, rather than of raised awareness of the population in terms of accepting more rational and more humane methods of family planning.
  • No disaggregated data are available according to socio-demographic characteristics and abortion/gestation characteristics.

7. Public sector

8. Private Sector

9. Methods used

10. Provider level allowed for surgical and medical abortion

Only specialists in Ob Gyn working at hospitals (secondary and tertiary level) are allowed to perform surgical abortion.
Ob Gyn specialists working in primary health care level are not allowed to perform surgical abortion.
No other health profiles (general practitioners, nurses) are allowed to perform abortion.
Medical abortion is not registered yet.

11. Abortion related morbidity mortality statistics

There is no report on maternal death due to abortion in the last ten years. Morbidity data related to abortion is not available.

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

13. Manufacture/ import of Mifepristone, Misoprostol

Medical abortion drugs (Mifepristone and Misoprostol) are not registered and available yet.

14. Facility and provider certification norms in brief

Facility requirements for abortion performing is defined in the recently prepared National Guideline on Safe Abortion (in 2009), but it is still not announced in Official Gazette.

15. Information available in national service delivery standards

National Guideline on Safe Abortion based on WHO recommendations was developed in 2009 and approved by Macedonian Ob&Gyn Association. It is based on women’s right to choose different abortion technique, pain management procedure, health facility and post abortion contraception. The scope of the guideline:
a) Clinical abortion care

  • Pre abortion care
  • Recommended abortion technique (first and second trimester for surgical and medical abortion)
  • Pain management
  • Infection prevention
  • Abortion after 22 gestational weeks
  • Post abortion contraception
  • Post abortion care

b) Essential medications and equipment required for each method;
c) Emergency post abortion care in case of post abortion complications
d) List of additional annexes:

  •  Lab and ultrasound parameters for pregnancy confirmation;
  • Abortion recording document;
  •  Informed consent list (should be signed by client personally).

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

No data of illegal abortions are available. No cases of illegal abortion complications are reported.

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

There are 15 gynecological public hospitals and 3 private hospitals (both located in city of Skopje) throughout Macedonia that provide abortions. Hospital health care at the obstetrics wards is provided by a total of 178 physicians, of whom 32 are employed in private hospitals.

All of them are located within the different geographical regions of the country that allow access even for those who are living in the most rural areas. Living in the rural areas is not seen as a barrier to access for abortion although sometimes women from the rural areas have to travel to the bigger cities to get the abortion which is usually not faraway from the places they live.

18. Role of government

Role of government: more supportive and enabling, than restrictive. In 2008 due to decreasing fertility rate, Government started to run pronatalist policy in order to stimulate the population growth, but without restriction regarding abortion.

19. Role of religion/ religious leaders

In 2008 the Macedonian Church became restrictive regarding abortion; prominent church leaders released several articles in the daily newspaper which stimulated rich public debate about abortion issue and women rights. Active participants in the debate typically align themselves with a pro-life or pro-choice position.

20. Local Ob Gyn societies

Macedonian Ob Gyn Society is supportive toward abortion, as no contraception method is 100% effective, so there will always be some unplanned pregnancies; in certain situations abortion is necessary for the sake of preserving the physical and mental health of the woman. The women in the Republic of Macedonia who need abortion do have the right to safe practices that are easily available and carried out by well trained providers in adequate conditions, as well as the right to choose themselves the most appropriate abortion method.

21. Current status and potential of research

22. Awareness amongst community members

23. Role of member organization/ individual