The Legal Status of Abortion

Among the countries of the world, the legal status of induced abortion ranges from complete prohibition to elective abortion at the request of the pregnant woman.¹ The situation in 2013 can be summarized as follows. Approximately 26% of the world's 7 billion people lived in countries where abortion was prohibited without exception or where it was permitted only to save the life of the pregnant woman. These included most of the Muslim countries of Asia, almost two-thirds of the countries of Latin America, a majority of the countries of Africa, and one country in Europe (Ireland).* Approximately 14% lived under statutes authorizing abortion on broader medical grounds, such as to avert a threat to the woman's physical or mental health rather than to her life, and sometimes on eugenic, or fetal, indication (known genetic or other impairment of the fetus or increased risk of such impairment) or juridical indication (e.g. rape, incest) as well. Twenty-two per cent resided in countries where abortion is permitted to protect a woman's health and where social factors, such as inadequate income, substandard housing, and unmarried status, could be taken into consideration in the evaluation of the threat to the woman's health (social–medical indication); or where adverse social conditions alone, without reference to health, could justify termination of pregnancy. Important countries in this group were Great Britain, India, and Japan.

Countries allowing abortion on request without specifying reasons—sometimes limited to the first trimester of pregnancy—accounted for 39% of the world's people. Abortions on medical grounds are usually permitted beyond the gestational limit prescribed for elective abortions, and parental consent may be required if the pregnant woman is a minor. This category includes a heterogeneous list of countries: Austria, Canada, the People's Republic of China, Cuba, Denmark, France, Germany, Italy, The Netherlands, Norway, Singapore, South Africa, Spain, the republics of the former Soviet Union, Sweden, Tunisia, Turkey, the United States, Uruguay, Vietnam, and most of the formerly socialist republics of Eastern and Central Europe.

Several of the categories in the preceding paragraphs cover a range of situations. A statute authorizing abortion to avert a threat to the pregnant woman's mental health may be interpreted strictly or may allow most women to obtain abortions. Social indications are usually defined or interpreted broadly to allow almost any woman to terminate a pregnancy within gestation limits, as in Great Britain, India, and Japan.

The abortion statutes of many countries are not strictly enforced, and occasional abortions on medical grounds are probably tolerated in almost all countries. It is well known that in some countries with restrictive laws, abortions can be obtained openly and without interference from the authorities when performed by private physicians, as in Korea and parts of South America. Abortions may even be performed in public hospitals, as in Cuba before their legalization in 1979 and in Mozambique. Conversely, legal authorization of abortion does not guarantee that the procedure is actually available to all women who may want their pregnancies terminated. Lack of medical personnel and facilities, and conservative attitudes among physicians may effectively curtail access to abortion, especially for economically or socially deprived women, as in parts of Ghana, India, and the United States.

In some countries, restrictions are at least occasionally enforced on women as well as providers. In Chile, women are reported to be serving prison sentences for having an abortion, women accused of abortion are incarcerated in El Salvador,² and in Nepal many women were incarcerated before the law was liberalized in 2002.³

Where abortion is permitted on request or on broad grounds, other governmental policies may affect its availability. Almost all developed countries cover all or most of the cost of abortion in their national health services or insurance,⁴ the major exception being the United States, where states vary widely in their abortion policies. The more liberal states cover abortion services under their public insurance for low-income women (Medicaid), and for other women coverage is usually provided by private insurance. In the most conservative states, Medicaid excludes abortion coverage except in cases of rape, incest, and threat to the life of the pregnant woman, and private insurance is prohibited from paying for abortion. In the United States, studies have found that having to pay for abortion services without financial help means that about one-quarter of poor women who would have abortions are unable to do so.^5,6

Many countries have other restrictions that affect women seeking abortions. These include a waiting period between counseling or first provider contact and the procedure, required pre-procedure counseling with specified content, and parental consent or notification for minors. Four countries with relatively unrestrictive laws require spousal authorization for married women.¹† These provisions reflect moral or religious opposition to abortion, concern that women might act impulsively and later regret their decision, and, in a few cases, concern about low birth rates. Abortions for sex selection are outlawed in China and Nepal because of concerns about an unbalanced sex ratio of births.

Other restrictions on abortion affect the facilities and clinicians who provide the services. These include requiring providers to be physicians, requiring them to have certain qualifications such as specified training or hospital privileges, allowing abortions to be performed only in hospitals or in qualified facilities, and limiting the advertising of abortion services. In most cases, these provisions reflect attempts to ensure the safety of abortion, sometimes based on outdated assumptions about the risks of the procedure. In the United States, apparently in an attempt to make services less accessible and more expensive, some states allow abortions to be performed only in ambulatory surgery centers or hospitals, even early abortions performed by medication (mifepristone). A few states allow abortions to be performed only by physicians with admitting privileges in local hospitals. Attempts to require all abortions to be performed in hospitals were found by the Supreme Court to be unconstitutional because they restrict access without contributing to safety. The effects of restricting services are felt mainly by low-income women.

*Andorra, Malta, and San Marino also have restrictive laws †Japan, Korea, Taiwan, and Turkey

The above text is an extract from a detailed chapter on the Epidemiologic Aspects of Induced Abortion by Stanley K Henshaw, PhD – to read the full chapter click on this link

References:

1. Center for Reproductive Rights: The World’s Abortion Laws Map, 2013 Update (Fact Sheet). http://reproductiverights.org/sites/crr.civicactions.net/files/documents/AbortionMap_Factsheet_2013.pdf
2. Center for Reproductive Rights: Letter to the United Nations Committee against Torture, March 7, 2012 http://reproductiverights.org/sites/crr.civicactions.net/files/documents/crr_ElSalvador_Shadow_Letter_CAT_8.15.12v1.pdf
3. Boland R, Katzive L: Developments in laws on induced abortion: 1998-2007. Int Fam Plann Perspect 2008;34:110
4. International Planned Parenthood Federation, European Network: Abortion Legislation in Europe (updated May 2012). http://archive-org.com/page/1066391/2012-12-25/http://www.ippfen.org/NR/rdonlyres/ED17CA78-43A8-4A49-ABE7-64A836C0413E/0/Abortionlegislation_May2012corr.pdf
5. Cook PJ, Parnell AM, Moore M, Pagnini D: The effects of short-term variation in abortion funding on pregnancy outcomes. J Health Econom 1999;18(2):241–57
6. Henshaw SK, Joyce TJ, Dennis A, Finer LB, Blanchard K: Restrictions on Medicaid Funding for Abortions: A Literature Review. New York: Guttmacher Institute, 2009