Biomed & Phormacother ( 1991)45.

229-231

0 Elsevier. Paris

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en~ark after C
LB Knudsen
Danish National Board of Health, SundheaMyretsen. Postboks 2020, DK4012 Copenhagen K. Denmark

Summary - During the months following the accident in Chernobyl. Denmark experienced an increasing rate of induced abortion, especially in regions with the largest measured increase in radiation. As the increase in radiation in Datmtark was so low that almost no increasedrisk of birth defects was expected, the pub& debate and anxiety among the pregaant women and their husbands caused more fetal deaths in Denmark than the accident. This underlines the importance of public debate, the role of the mass media and of the way in which National Health authorities participate in this debate. Chernobyi / abortions R&urn4 - Avortements Mgaux au Danemark. Au cows des mois ayanr suivi laccident de Tchernobyl. Ie Donemork a connu une proportion accrue davortements provoques particuliPrement dans Ies r&ions ou Iaugmentation en radiooctivit& mesur& Ptait la plus importante. Compte tenu du fait quau Danemark laugmentation en radioactivit4 &air si faible qtton nattendait pratiquement aucun accroissement du risque danomalie d la naissance. Ie &bat public et Ianxil pr&abznt parmi les femmes enceintes et leurs maris ont * provoque Y plus de morts f@tales au Danemark que Iacci&nt en question. Ces faits soul&tent iimportance du d&at public, le r&e des mass media et la maniple dent les autorites sanitaires participent d ce dgbat. Tcbernobyl I avortement

Introduction
In the months following the accident at Chernobyl, a rather heavy concern was expressed in Denmark about the possibility of adverse reproductive outcome due to radiation. This concern raised some discussion in the media, even if the amount of fallout in Denmark was not very high. Rumours from Denmark as well as from other countries about anxiety among pregnant women prompted an investigation in Denmark related to the routinely collected data on induced abortions [I]. In the present paper, I will primarily present the results of this investigation. The reasons for studying the induced abortions were that these data were available a short while after the accident, and there was an interest in determining a possible effect of anxiety rather than of real knowledge regarding any damage to the fetus.

Material and methods

Since October 1st 1973. every woman in Denmark has had a right to have her pregnancy interrupted before the end of week 12. All interruptions are performed at hospital, free of charge. For each interruption performed, the hospital has an obligation to complete and send a notifi~tion form to the National Board of Health, where data from these noti~catjons are the basis of the National Register of Legally Induced Abortions. The register contains the unique personal identification number of the woman, here age, marital status, number and type of previous pregnancies, municipality of residence, identification of the hospital performing the operation, duration of hospitalization, which methods were used and whether any complications were noticed after the operation. From this register annual statistics have been published. both as National Board of Health publications [3] and as specific articles in the Danish Medical Bulletin [2].

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LB Knudsen Figure 1 shows the relation between monthly figures in 1986 and in 1985.
120 -

For the present analysis, only data from the Registry on Le@ly Induced Abortions have been used.

the

The data material was divided according to the womans county of residence, of which we have 16 in Denmark. For each year the age-specific rates of induced abortion are followed statistically. That year (1986) we combined these figures with the monthly movements in numbers.

1986/85

110lOO-

1985

esults 90. The number of legally-induced abortions for 1986 totalled 20 067, which was just a little more than the 19 919 interruptions registered in 1985. The number in 1985 was the lowest since 1975, when we reached a peak of 27 884 induced abortions. Related to the number of women of fertile age (15-49 years) the figures equal 15.7 induced abortions per 1 000 women both in 1985 and 1986, compared to 23.7 in 1975. The rate of abortion still showed differences in level. according to both age and county of residence. The total rate of abortions was highest in the metropolitan area, especially the municipality of Copenhagen, and lowest in the western parts of Denmark. The number of induced abortions during January and February 1986 constituted = 95% of the figures of the year before. This indicated a continuing falling rate. March and April indicated the same development, whereas May, June and July suddenly showed figures at the same level as, or up to 7% higher than the corresponding months in 1985. The magnitude of the change can be illustrated by the fo!lowing: the number of interruptions in June and July together were = 230 more in 1986 than expected, compared to the level of 1985. Even if this is considered as only a minor change, we suspected that this increased level may have been caused by anxiety among pregnant women about delivering a child with a birth defect. To investigate this aspect further, we compared the number of induced abortions each month in 1986 with monthly figures for the 4 previous years. If we consider the monthly variation during the 5 years (1982-1986) it is obvious that the variation observed in May, June and July 1986 is not specifically high. Also in previous years changes of the same level have been observed.

Fig 1.Number of legally-induced abortions in Denmark for each month of 1986 compared to the same month in 1985 (1985 = 100).

But during 1986 we observed remarkable differences in the development on a county level. While the total annual number of abortions was almost unchanged from 1985 to 1986 (only increasing by 0.7%). the changes in the counties varied from a decrease of 12.3% (Viborg county) to increases as large as 5-7% (Arhus county and Frederiksberg municipality). Especially in the Southern part of Jutland (Sanderjylland county) increased radiation was measured, and the region was often referred to in the media when the risks after the fallout were discussed. In 1986 a total of 591 women living in Sgnderjylland county had their pregnancy interrupted, compared to 614 in 1985, a total decrease of 3.7%. But the monthly figures were different: the numbers in May, June and July were 22% higher than in 1985, in spite of the total decrease over the year. Also in a neighbouring county to the north (Ribe) a similar pattern was seen: a total decrease of 6.8%, but a 5% increase during the 3 months in question. No other county had the same pattern.

iscussion
From this rather simple analysis we concluded that the observed greater variance in development at a county level in 1986 could possibly be partly

explained by the animated public debate and concern expressed about the possible damage to the fetuses, especially in very early pregnancy.

Legally-induced abortions in Denmark after Chernobyl It must be remembered that these abortions were induced within the first 12 weeks of gestation. Also remarkable is that these figures only concern the free abortion. ie interruptions performed without any prenatal diagnosis, eg amniocentesis or ultrasound detection of a malformation. Official calculations in Denmark estimated that there would be an almost non-existing increase in the risk of birth defects due to the amount of increased radiation. But still, the discussion and anxiety seem to have caused a greater number of fetal deaths than could ever be expected from the accident. This effect should be considered very seriously with the regard to the role of the mass media and how the Health Authorities participate in the public debate. The Danish reaction was evident, even

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though the Danish Health Authorities reacted rather quickly and gave a decent explanation about the almost non-existent risk to the fetus.

References
1 Knudsen LB, Tanska I (1987) Legally induced abortions in Denmark 1986. Ugeskr Laeg 149, 2944 (in Danish) 2 Knudsen LB, Tanska I (1990) Legally induced abortions in Denmark 1989. Ugeskr Laeg 152. 2440 (in Danish) 3 National Board of Health, Copenhagen (1989) Statistics on Contraception and Induced Abortions 1988. Vitalstatistik I:25:1989 (in Danish)