Czechs Favor Pill Over Abortion

July 06, 1994|By Michele Kayal | Michele Kayal,Special to The Sun

PRAGUE, Czech Republic -- Five years ago, Eastern Europe had revolutions in its streets. Now it's having them in its pharmacies.

Contraception, so long spurned in this part of the world as unhealthy, uncomfortable and just a great bother, is now in vogue as couples in the former East Bloc abandon abortion as their primary means of birth control.

"I don't want to have babies now, and I wouldn't like to have an abortion," said a 28-year-old advertising sales representative who has had one abortion and began using birth-control pills 20 months ago.

"I don't have any problems [with the pills], and I like the package."

The number of women on birth-control pills in the Czech Republic has tripled since 1991, and 5,000 women a month are beginning to take them, according to Czech officials.

Sales of condoms have doubled, and Norplant, a birth-control implant that lasts five years, won 15 devotees and another 60 potential users when it was introduced here this year.

In response, the number of abortions dipped below 100,000 for the first time in 1993, a 23 percent drop over the previous year. The ratio of abortions to live births -- a key measure -- has plunged 30 percent from its peak of nearly 1-to-1 in 1989, the year the country opened to the West.

"It's because of the better level of contraception," said Dr. Radim Uzel, director of the Czech Family Planning Association, which distributes Swiss birth-control pills free of charge.

"It's the only explanation. The sex life is the same."

In the past, women veered away from the available Czech-made pills, which were rumored to cause all manner of disorders from vomiting to menstrual disruption to cancer.

Czech condoms were "thick" and "lumpy," according to men and women, and were also at risk of vandalism by bored shop assistants, who, legend has it, often passed the time running pins through the boxes.

Czech intrauterine devices (IUDs) often caused hemorrhaging and, because of the Communist emphasis on population growth asan indicator of the country's health, they were only available to women who already had at least one child.

Even today, tubal ligation can be obtained legally only by women over 35 who have at least three children.

Official propaganda

Gynecologists also supported official propaganda that a woman could have a healthy child only before the age of 25, and routinely sent away protection-conscious young women.

"I knew girls at the university who wanted pills, and the gynecologist said, 'No, you're at a good age. You should have children now,' " said Zuzana Kamberska of the Institute of Health Information and Statistics.

Instead, a woman solved an unwanted pregnancy with a wedding ring or an abortion -- or two or three or four.

Abortion became legal in Czechoslovakia in 1958, and, in 1986, the government began promoting the suction method as a new, convenient form of birth control.

All abortions were free. Contraception was not.

"It was acceptable to use abortion as a method of contraception," said Dr. Zdenek Stembera at Prague's Institute for Mother and Child Care. "This is the thinking we must change."

Thinking took a turn with the simultaneous arrival of the market economy and Western pharmaceutical firms, who made high-quality products abundant.

"We really had to create demand from the women," said Dr. Vladimir Finisterle, marketing manager for the Swiss Cilag International AG.

"Nobody knew about contraception, and the ideas were so far from the reality. Even the gynecologists didn't know about the new technologies."

L Cilag is a subsidiary of New Jersey-based Johnson & Johnson.

About 8 percent of Czech women now use birth-control pills -- about a third the percentage in Western Europe -- but the increase has been steady.

5 years' protection

Once-free abortions now cost $120, or about half the average monthly salary.

At $2 for a one-month supply (about one-quarter what the companies charge in Western Europe), the pills offer women five years of protection for the price of one abortion.

Poland and Hungary, which also maintained "abortion cultures," have seen a similar, though less dramatic, trend.

Both countries have posted double-digit decreases in abortion since last year, mostly because of new laws won by the revived Roman Catholic Church that ban abortion except in cases of rape or endangered health.

With abortion less of an option, contraception has increased and pharmaceutical representatives say they expect demand to keep growing.

Hungarians in particular have turned to condoms as a "female friendly" method.

In Poland, birth-control pills are making steady progress, although the Catholic Church's grip in that country has limited the rise in use to about 1 percent a year.

Church less influential

In the Czech Republic, where the Catholic Church is much less influential, 85 percent of the population supports relatively unrestricted abortion, according to recent surveys, and economic concerns have had the largest influence on contraception use.

"Young people have to be interested in contraception now," said Dr. Libor Pavlosek, 25, a project manager at Prague's National Center for Health Promotion.

"They are afraid to have children without the possibility of giving them what children need."

Inflation approached 20 percent last year, and the government continued canceling benefits to families, such as guaranteed apartments. Parents in Prague now must pay for kindergarten and day care that were once free.

And motherhood, which used to be glorified with medals and early retirement based on the number of offspring, seems to have lost some of its appeal.

"There's something you can do now besides get married," said Libora Indruchova, a 28-year-old television executive who uses a German birth-control pill.

"You can travel. And there are many women who want to build their careers."

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