This is a guide to help us learn about the diversity of abortion policy around the globe. It a resource which I hope will help many of us clarify our own policy preferences and become better advocates or neighbors in how we discuss this topic with one another.
What It Is
This is a tool to help us look outside of our country (the United States) and to reflect upon what we like and don’t like about how other nations handle this social question. It is easy to co-sign a slogan but it is a lot harder to articulate with precision which policy or law we might truly prefer in practice.
Recent polling suggests that the majority of Americans, regardless of political party affiliation, fall between the two extremes of abortion advocacy represented in the pro-life/pro-choice movements. Most of us, it turns out, neither want to outlaw abortion entirely nor allow for it to be practiced without restrictions. I am sure that within this group there are still substantial differences of opinion but it can be hard to articulate or identify what our true policy preferences are when we are only offered a small number of positions or sides to choose from.
Aside from helping us better understand our own positions in a theoretical or personal sense, I hope this guide will help us evaluate the current debates and rhetoric surrounding the future of Roe v Wade. While we understandably place a lot of emphasis on the role of this specific legal ruling and precedent, federal legislative solutions may be a more lasting, stabilizing path for our national future.
We are all better served by an honest dialogue that looks realistically at our desired policy methods and end goals. I believe the more details and policy options we consider the easier it will be to find areas of common ground, compromise, or at least gain more respect for differing ideas and positions.
I hope that this guide, by exploring a wide range of current global policies, will help you form a vocabulary and specificity of opinion to make our future debates on this subject more productive.
What It is Not
This guide is not meant to be comprehensive. I am not an expert in abortion policy and I hope that whatever you take away leads you to further study, research, and deeper thought. My guide is a place to start, not a place to end. I offer more detailed examples for the more permissive categories because there is much wider variation in specific policies and outcomes as the abortion laws become less restrictive.
This is not a discussion of abortion ethics. I believe that you can find most abortions unethical, sinful, or just plain wrong and yet still be in favor of various policy solutions which allow for legalized abortion in one form or another. I also believe that even if you have no ethical concerns with abortion you can still be in favor of certain types of abortion restrictions or regulations for a variety of social, medical, and political reasons. The civic policies we support do not always need to match exactly with our personal morals, choices, or ethics.
How I Measure
This guide is divided into the five core abortion policy categories identified by the Center for Reproductive Rights and widely used by international organizations:
- Prohibited All Together
- To Save A Women’s Life
- To Preserve Health
- Broad Social and Economic Grounds
- On Request (Gestational Limits Vary)
The sections are arranged from most to least restrictive policy category. You can directly access each section of this guide by clicking on the above category links. I also end this guide with a list of questions to ponder in response to the information presented here.
If you read enough articles on this subject you many notice some nations are classified differently depending on the source. For example, countries with total bans can informally leave room for medical intervention to save the life of the mother and therefore can be reported as both having no exceptions or limited exceptions. I use the classifications provided by the Center for Reproductive Rights as they make these decisions based on the text of current abortion laws in effect.
The United States, for reference, is currently classified by this methodology as the least restrictive fifth category, On Request. That classification stems from the permissive rights allowed under Roe.
I include the CRR definitions for each category at the beginning of every section. The CRR website and their interactive online map is a helpful and comprehensive place to start in learning about the current laws for each country. I did look for a pro-life advocacy alternative for comparison but I had a hard time finding an option to highlight of similar quality and accuracy.
This guide only discusses a sampling of nations for each category. Each entry seeks to explain the current policy/laws (as of May 2022) and examine commonly noted strengths, weaknesses, and areas of debate for every policy approach.
It can be hard to find agreement between competing views on the base abortion rate in each country, let alone on the statistical relationship between policy and outcomes. It is also not uncommon to see pro-life/pro-choice organizations use the same data set to make polar opposite arguments (suggesting the data is always in favor of their preferences).
Please note that the age range for abortion rate calculations can vary by country (some define women of child bearing age as 15-44 while others define them as ages 15-49) which might slightly skew the results when comparing one country to another. If I could not find a reliable estimate on total abortion rate in the country (legal and illegal combined) I do not list it, but that doesn’t mean the listed abortion rates are definitive or without controversy.
I try my best, as a novice, to balance these concerns and disputes.
May this guide add to the accuracy, depth, and sincerity for how we discuss abortion policy moving forward as a nation.
Prohibited All Together
“The laws of the countries in this category do not permit abortion under any circumstances, including when the woman’s life or health is at risk. 24 countries globally fall within this category. 90 million (5%) women of reproductive age live in countries that prohibit abortion altogether.”
Abortions in El Salvador are completely illegal with no exceptions and carry a penalty of 2-8 years for women and those who help them and up to 12 years in prison for healthcare workers/abortionists or any other persons who perform the abortion. Licensed medical professionals receive the harshest punishments under the penal code. However, women accused of having illegal abortions can also be prosecuted for homicide or aggravated homicide, resulting in prison terms up to 30-50 years. All told, the penalty is one of the harshest in the world.
Michelle Obermann, a professor at Santa Clara Law School, suggests at least 139 women have been prosecuted in the past 22 years for abortion related crimes, 36 of whom were charged and sentenced with homicide. To put that number into perspective, at least 5000 abortions every year are estimated to be performed illegally in El Salvador.
As the above video explores, many of the women accused of homicide via abortion claim they actually miscarried their babies. Doctors are asked to report suspicious deaths of infants and it can be difficult to tell when a still birth or premature labor was caused naturally or induced by the most common illegal method of abortion: the drugs misoprostol/mifepristone.
In several high profile cases, convictions have been acquitted in retrial. The national Supreme Court has also lowered, commuted, and pardoned the sentences of women convicted of aggravated homicide in recent years on humanitarian grounds of justice or equity, often after the women served several years in prison. A high profile case of three of the women jailed when above documentary was made were released in December 2021 via presidential order and another woman was released in February 2022. It is believed at least 13 women are currently in prison on charges related to abortion or miscarriage, including one woman who was sentenced to 30 years in prison just last week.
Pro-life advocates allege that most (if not all) of these women committed intentional acts of infanticide after their babies were born alive, claiming that incriminating and unsympathetic details of each case are left out of the mainstream reporting (including the above CBS report) and in reproductive rights advocacy around the world. Both perspectives on these cases suggest judges unfairly favored the cause of the other side. No women are known to be serving current sentences for soliciting or performing abortions alone, suggesting this part of the penal code is not frequently enforced.
From 1973 to 1998 El Salvador did allow for a few legal exemptions (maternal life, severe fetal anomaly, and rape or incest), but a bill supported by the Catholic Church removed those exemptions and instituted the penalty of jail time for mothers. In 1999 they amended Article 1 of the constitution to state: “El Salvador recognizes the human person as the origin and the end of the activity of the State, which is organized to attain justice, judicial security, and the common good. In that same manner, it recognizes as a human person every human being since the moment of conception.”
It is estimated by the WHO that 11% of mothers in El Salvador who seek an illegal abortion die as a result, but even more deaths are associated with terminal or life threatening illnesses that are not treated for fear of harming the unborn child, untreated ectopic pregnancies, and maternal suicide (often of teenage girls). El Salvador in particular is known for high levels of unplanned pregnancies, especially teen pregnancy, many of which are attributed to gang rape and other abusive behavior.
Available evidence suggests the policy change in 1998-1999 did not reduce the abortion rate in the country, although there is no clear consensus of a current abortion rate. The Ministry of Health estimated there were 19,290 abortions in El Salvador between 2005 and 2008, for example, but this is believed to be an undercount and they have not released new data in over a decade. Average abortion rates for Central America (comprised mostly of countries with complete or narrowly limited bans) range between 25–28 per 1000 women aged 15-49 with an estimated 25% of pregnancies ending in abortion. Around 2000 women marched in the capital protesting for expanded abortion rights this past March but it is hard to gauge the popularity of their message in the country.
Malta is the only member of the European Union to prohibit abortion without any exceptions, as determined by a criminal code prohibition from 1724. The tiny Catholic nation of around 525,000 remains over 90% opposed to abortion with 66.9% against decriminalization, although at least 300 women a year (some estimate up to twice that) are estimated to seek abortions abroad or through the use of abortion pills, mostly mailed from overseas. Those who procure an abortion for any reason can be prosecuted for up to 3 years in prison, and doctors who perform an abortion can be imprisoned for up to 4 years.
However, the abortion law is rarely used, with three convictions against women since 2000 and no charges filed (although there were at least three investigations) since 2014. The longest jail sentence in that time was for 2 years.
Pro-life defenders of laws like these or ones with narrow exceptions point to low prosecution rates as proof that these policies do not harm or unfairly target pregnant women or their healthcare providers while acting as an appropriate deterrent for elective abortions at all stages of pregnancy. In fact, the Ministry of Health in Malta continually insists that no women have been harmed by their abortion laws, especially referring to a custom allowing doctors the necessary moral freedom to seek the preservation of life of the mother and the child in the case of medical emergencies or to terminate an ectopic pregnancy as needed, although this exception is not formally protected by law. Pro-life advocates also note the higher rate of children born with downs syndrome and other more serious neural diseases as a sign of how these laws protect vulnerable lives.
Abortion rights advocates question the continued need for these laws if they are not intended to be enforced but still make it harder for pregnant women to express concerns or seek help (or for doctors to offer patients life saving care). As Marlene Farrugia, an independent lawmaker in Malta who proposed a bill to decriminalize abortion in 2021, explained her objection to the complete prohibition, “Decriminalising abortion is not the same as promoting it. By criminalising women, stigmatising the subject of abortion and keeping this discussion a taboo, we are not saving lives and we are not helping the cause of making abortion obsolete.” They also point to the vitriol and anger expressed toward the few advocates willing to speak about these ideas in public, including a recent assault on a woman holding a pro-choice sign in public. Their concern is that a society where women can not speak freely about abortion is a society that is more dangerous for women in a time of crisis.
Decriminalizing abortion is not equivalent to legalizing abortion or changing the regulations for the practice, but both sides suggest it can act as a first step toward expanding abortion rights. For now the laws in Malta remain unchanged.
Other countries where abortion is prohibited without exceptions include Egypt, Iraq, the Philippines, Laos, Senegal, Madagascar, Nicaragua, Honduras, the Dominican Republic, Haiti, Andorra, and Suriname. These countries use varying degrees of criminalization for both the pregnant mother and the person who performs or aids in procuring the means for an abortion. For example, in Egypt women face a penalty of 6 months to 3 years in prison, while a doctor can be sentenced to 3-12 years in prison. Whereas in the Philippines women who seek an abortion for any reason can be sentenced to 3-6 years in prison and doctors or midwives who perform an abortion up to 6 years.
In most of these countries the frequency of prosecution remains very low compared to the estimated numbers of illegal abortions in each country, but the fear and stigma for seeking an abortion is high and may contribute to poor maternal health outcomes. Like in El Salvador, it is hard to get definitive answers on the true rate of abortion in countries with total bans or to assess the causal impact a total ban has on those rates as well as maternal and infant health.
To Save A Women’s Life
“The laws of the countries in this category permit abortion when the woman’s life is at risk. 42 countries fall within this category. 360 million (22%) women of reproductive age live in countries that allow abortion to save the life of the woman.”
In Brazil abortions are banned with the exception of saving the life of the mother or in the event of rape. Illegal abortions carry penalties of 1-3 years for the mother and 1-4 years for the doctor or other person who helps perform or provide the means for an abortion. The current law dates back to 1940 and has seen few changes, although a 2012 Supreme Court ruling expanded access and legalized abortions when a fetus has anencephaly.
As the above news report discusses, recent procedural changes in 2020 made it harder for victims of rape to secure abortions by requiring that every rape be reported to police, even against the wishes of the victim, as well as by requiring an ultrasound prior to termination of the pregnancy. In referencing the 10 year old rape victim who’s case motivated these changes, Archbishop Walmor Oliveira de Azevedo Belo Horizonte, the president of National Conference of Bishops of Brazil (CNBB), said, “Sexual violence is terrible, but the violence of the abortion is unjustifiable, considering all existing resources available to guarantee the lives of both children.”
In spite of these restrictions abortion is popular in Brazil. It is estimated 1 in 5 Brazilian women had at least one abortion by age 40 and according to the AP, “In 2018, a health ministry official said the government estimated some 1 million induced abortions annually, with unsafe procedures causing more than 250,000 hospitalizations and 200 deaths.”
Abortion is prosecuted in Brazil and nearly a third of abortion related crimes are referred through reports to the police by healthcare workers. In 2007, for example, an abortion provider and 1500 female patients were mass prosecuted for the crime of abortion in cases. The charges against patients were dropped but four staff members received prison sentences ranging from 4-7 years. Following that case international observers saw increased interest by Brazilian law enforcement in cracking down on illegal abortion providers and the women they serve.
A 2014 mass arrest of 55 people involved with illegal abortion clinics captured international headlines after two women were found dead in Rio following complications with their illegal abortion. Stories like this frame the prosecutions as defending the women of Brazil, protecting them from unsanitary or dangerous procedures and counterfeit drugs masquerading as health care.
The prosecution of women in Brazil remains low (possibly several dozen a year on average) given the known rate of illegal abortions performed in the country, however the rise in documented prosecutions since 2007 raises questions about the future of abortion policy and enforcement in the country. Of the women who are prosecuted they are more likely to be disadvantaged:
“55 percent were non-white women, more than half had finished only primary school, and only 8 percent graduated from high school. Seventy-eight percent of the women were single. The impact of criminalization on young women is even more dramatic: 29 percent of women in Rio de Janeiro state are under the age of 24, yet 45 percent of the women charged as criminals for an illegal abortion were under 24. Most of the young women prosecuted were between the ages of 18 and 23. Eighty-four (20.2 percent) of the cases investigated were handled by the juvenile system”
Brazil offers an poignant example for how abortion laws that were long neglected as mere deterrents can turn into active criminal cases and prosecutions with gradual shifts in domestic cultural and political power. Brazil’s record also highlights how countries with strict abortion laws and a willingness to prosecute both providers and mothers can still see high national abortion rates.
In the upcoming 2022 presidential election abortion is expected be a featured issue, with the current President Jair Bolsonaro accusing his opponent of supporting a “genocide of the innocents” for favoring abortion decriminalization. In defending his pro-life record Bolsonaro also asserted, “This is a Christian government that defends the family, respects the Armed Forces and the people”.
Former President and current opposition candidate Luiz Inácio Lula da Silva (who was controversially convicted on corruption charges in 2018 but since freed from jail allowed to run again) previously said he was personally against abortion but called the procedure a “public health issue” and asked, “What do we do if it [abortion] exists and we know that normally the victims of abortion are people who receive no kind of assistance?”. The election is in October and may decide whether Brazil follows in the liberalization of other Latin American nations like Argentina and Columbia or works to further restrict access and potentially increase prosecutions for abortion in the country.
Nations in this category can vary on the circumstances in which they formally allow for abortions to protect the life of the mother. Some of the other countries that offer formal exceptions to protect the life of the mother include Chile, Venezuela, Mexico, Libya, Tanzania, Nigeria, United Arab Emirates, Iran and Indonesia. Mexico is an especially interesting case. While many of the local laws still include abortion bans punishable by time in prison with only an exception for the life of the mother, a 2021 court ruling effectively decriminalized abortion in Mexico and changed the trajectory of the country on this issue.
Although there are cases like Brazil where nations are seeking additional restrictions to pre-existing abortion laws, far more countries are experiencing widespread liberalization, either through decriminalization or by legalizing abortion up to certain gestational ages. Even more striking is to consider the type of regimes that are tightening vs liberalizing abortion policies, as there is a noticeable correlation with democratic backsliding and increased abortion restrictions.
To Preserve Health
“The laws of countries in this category permit abortion on the basis of health or therapeutic grounds. 225 million (14%) of women of reproductive age live in countries that allow abortion on health grounds.”
In Poland abortion is not legal but they have formal exceptions for cases of rape or incest and to preserve the life of the mother. A controversial court ruling in October of 2020 removed a third exception allowing for abortions in cases of severe fetal abnormalities by stating that the exception was unconstitutional, even though it was previously legal for 27 years.
The now illegal exception made up 98% of the approximate 1100 legal abortions per year performed in Poland prior to the ruling, adding to charges that this ruling change was a deliberate attempt to create a de facto near total abortion ban. In spite of the provision allowing for abortion in cases of rape, less than five legal abortions a year were carried out for this reason between 2010 and 2020, partially because the process involves obtaining permission from a prosecutor prior to termination and Poland has a very narrow legal definition of rape.
The new law banning abortions for fetal abnormalities went into effect in January of 2021 and Polish society is still weighing what these changes will mean for the country moving forward.
Prior to the recent changes Poland already had one of the most restrictive set of abortion laws in Europe, as influenced by the Catholic Church following the collapse of the communist government in 1993. It is also believed that Poland already saw large numbers of illegal abortions before 2021 with up to 80,000-200,000 Polish women seeking abortion care annually, either illegally or in other European countries.
Ever since the 2020 court ruling by the Constitutional Tribunal Poland has experienced domestic unrest, as covered by the above documentary. First, during a wave a of protests immediately following the ruling and then another following the death of two women who were alleged victims of overly cautious interventions caused by the new abortion restrictions.
Some of those demonstrations included protests at and inside of churches, seen by some analysts as a sign of the weakening influence of the local Catholic Church in Poland which has stood united behind the conservative political leadership in recent years. But others point to growing discontent among younger Catholics who wish to seek political solutions separate from personal religious convictions. According to some polls, 54% of the country supported the protesters and up to 69% of the country believe abortion should be legalized beyond what is currently in effect today (pro-life supporters suggest most of these citizens only support a return to the original 1993 policy and nothing more).
The new changes in abortion policy are connected to the ascendancy of the nationalist and conservative political movement known as the Law and Justice Party (PiS), which represents around 37% of the country, rules on the basis of plurality, and holds a true majority in the lower legislative body. Like other countries facing this kind of fraction and unrest, abortion was not the only social policy at the center of initiatives led by the Law and Justice Party (PiS) after they first came to power in 2015. Other issues like religious liberty, lgbtq rights, EU Membership, freedom of the press, and now the war in Ukraine are intertwined with the political debate over abortion laws. The changes are also the result of a deliberate project by the PiS to reorder the Polish legal system and make it more favorable to achieving their desired policy outcomes.
The sudden legal changes and new restrictions to abortion law have led to domestic confusion over what is illegal and what will be considered punishable as a crime. For example:
“Risky pregnancies and foetal abnormalities often coexist, and abortion in the case of the latter could end up in criminal prosecution since the law was adopted at the beginning of this year. Doctors report living in constant fear of a life-saving abortion being challenged once the risk has been averted. Confusion around what’s legal also persists among women: self-induced pharmacological abortion is not penalised, but distributing the medicines (whether for profit or not) is treated as a criminal offence. In January, a young man was sentenced to six months in prison for paying for abortion pills for his partner. In March, a patient who reported to her doctor about having undergone a pharmacological abortion was told that “it might be a case for the prosecutor”. Two weeks ago, an unnamed activist with Aborcyjny Dream Team – a group dedicated to supporting women gain access to safe abortion – was indicted on charges of medication brokering.“
There is also uncertainty over whether the health of the mother provision extends to mental health in extreme cases, with some doctors fearing they may be prosecuted and face the penalty of up to 3 years in prison should they grant an exception the government later finds objectionable. Currently there is no criminal punishment for women who seek illegal abortions in Poland, but some some fringe supporters of PiS unsuccessfully proposed legislation to add criminal charges for mothers in 2021.
Defenders of the new restrictions point to the continued exceptions for rape, incest, and life of the mother as examples of compromise and stress the belief that they wish to save the life of the mother as well as the developing child as often as possible. They also note that the 2020 change in law protected unborn children diagnosed with down syndrome, a measure which has gained more favor than disapproval in Poland in spite of disagreement over extending that kind of protection to all fetal conditions. Other supporters of the nationalist Law and Justice Party believe the current law is not strict enough and hope that abortion will be completely banned in Poland in the future.
In Israel abortion is not a right but it is allowed in a large number of circumstances when approved by a committee of three people, made up of two doctors and one social worker, at least one of whom must be a woman. The current process was created in 1977 and allows for abortions “if the woman is under 18 or over 40; if the fetus is not viable or would have severe medical problems if brought to term; if the pregnancy is the result of rape, incest or an “illicit union” (including not being married or having a relationship outside of marriage); and if the woman’s mental or physical health is at risk.”
On average 98% of the women who apply for an abortion on these grounds are approved and as of 2014 most women who apply through a public hospital receive state funded abortions at no personal expense. There is a separate, smaller group of committees and medical facilities that handle abortions after 24 weeks. These later term abortions make up 1.6% of the total abortions in Israel, while 85% of abortions occur within the first trimester.
Some advocates in Israel believe this is not permissive enough and prefer a system without committees for the majority of women, while others are happy with the status quo or wish to see more religious guidance in the process. Current proposed reforms (as discussed in the above video) include less invasive questions throughout the committee process or even the removal of the committee process entirely.
On par with other developed nations, the abortion rate in Israel has steadily declined for 35 years even with the legal committee process and state funded abortions in place and they currently have an abortion rate of 8.4 per 1000 women aged 15-49.
Advocates for reforms say changes to the law will bring about a less humiliating and more honest process where, for example, married women might be less inclined to lie about the identity of the father just to qualify for one of the the specific exceptions. Supporters of the current process prefer a system where abortion remains a procedure requiring third party approval and careful consideration, in spite of the typically permissive outcomes. Reformers point to the high approval rate as a sign that the committees are not needed, while supporters see that as evidence of the process working fairly and effectively.
Because not all women qualify for a legal abortion or want to discuss their intentions through the committee system illegal abortions still take place. Estimates vary but the number of illicit abortions could be as high as 15,000 a year, almost identical to the number of legal abortions performed through the committee system. There are no criminal penalties for women who obtain an illegal abortion. Doctors or others who perform an illegal abortion can be fined or face up to 5 years in prison but there are no known prosecuted cases referencing this law.
While abortion policy is a matter of debate in Israel it is often viewed as much less controversial and divisive than in countries like Brazil, Poland, or the United States. Both “sides” of the debate approve of legalized abortion in most of the already legal circumstances, a unifying view grounded in Jewish teaching, but they disagree about the best approach for educating pregnant women on their options and the ideal process for allowing women to obtain abortions in the future.
Other countries in this category – which ranges widely in terms of national attitudes and specific laws – include Peru, Angola, Ghana, Saudi Arabia, Jordan and Thailand.
“These laws are generally interpreted liberally to permit abortion under a broad range of circumstances. These countries often consider a woman’s actual or reasonably foreseeable environment and her social or economic circumstances in considering the potential impact of pregnancy and childbearing. 386 million (23%) of women of reproductive age live in countries that allow abortion on broad social or economic grounds.”
India, one of the most populous nations on earth, now allows for abortions up to 24 weeks with doctor approval for a wide array of circumstances and also allows for terminations beyond 24 weeks for select cases involving fetal abnormalities or medical emergencies. The tiered system requires that all legal abortions are approved by one doctor up to 20 weeks. Women eligible for that consideration include victims of rape and incest, married women with failed contraception or a change in marital status mid pregnancy, women with disabilities, illnesses, or who are otherwise severely impacted physically or mentally by the pregnancy, minors, those impacted by humanitarian disasters, and in the event of severe fetal defects.
From 20 to 24 weeks a smaller group of women can have an abortion approved by two doctors, and beyond 24 weeks three doctors, a gynecologist, a pediatrician, and a radiologist, must approve any terminations only related to severe cases of fetal abnormality. Abortions performed outside of these exceptions are considered a crime and are punishable up to three years in prison.
The Modi government passed an amendment of the 1971 Medical Termination of Pregnancy Act (MTP) to extend legal abortions from 20 to 24 weeks and beyond, which offers an interesting departure from the pattern of conservative nationalist governments moving to reverse abortion policies. The above video is from 2020 and discusses the initial announcement of this policy change, signed into law in 2021.
A significant reason for this change is the large black market for illegal abortions in India. A staggering 6 to 13 women a day are estimated to die from illegal abortions in India, making it the third highest cause of maternal mortality in the country. One in seven of all unintended pregnancies in the world are believed to take place in India and the country sees 6.4-15.6 million abortions each year, 67% of which are classified as unsafe. This translates to an annual abortion rate up to 47 per 1000 women aged 15-49. 2-4% of those annual abortions are also believed to be gender selective (in favor of boys) and typically sought illegally. The 2021 law change seeks to address the root cause of unsafe abortions, both through extended legal abortion access and by relieving some of the cultural stigma associated with abortion in the country through a new confidentiality clause designed to protect women who seek legal abortions from harassment.
However, the current law still does not offer legal abortion for some of the most common situations that sustain the black market, most especially abortion for healthy single women at any stage of gestation and the problem of incomplete access to birth control and abortion facilities in rural areas. Also, while the MTP has been in place for 50 years, as many as 80% of Indian women still didn’t know that abortion is legal up to 20 (now 24) weeks in many circumstances. And because legal abortions are dependent on the approval of doctors, the implementation of legally mandated exceptions is very inconsistent throughout the country, especially in rural areas. Tackling the gap between the current law and the cultural knowledge and acceptance of the law appears to be a significant factor in reducing the demand for the illegal abortion market moving forward.
Abortion rights activists argue that no law which depends on the approval of someone else (in this case 1, 2, or 3 doctors) will ever be a sufficient way to address the bodily autonomy of women. Defenders of the system in India point to the relatively progressive nature of the restrictions and suggest this approach is a good compromise between those who see abortion as a healthcare right and those who believe a pregnancy must be protected regardless of circumstance. That said, it can be hard to fit the discussions in India about abortion into a pro-life/pro-choice duality more easily recognized in Western or traditionally Christian nations.
Similar to India, Finland requires the approval of two doctors for all women who seek an abortion up to 13 weeks, or an appeal to the National Supervisory Authority for Welfare and Health (Valvira) for any abortion beyond that point in gestation. Abortions through the 12th week of pregnancy are allowed when, “childbirth would pose a danger to your health; you are under 17 or over 40 years old; you have already given birth to four children; you are unable to take care of the child due to an illness; or giving birth to or taking care of the child would be a considerable strain for you. The reason may be family relationships, financial situation, work situation, housing or plans for the future.”
All abortions also require hospitalization, even if medically induced. The mentality behind this policy is to keep the legal justifications broad through the first trimester so as to encourage early termination whenever a pregnancy is considered unplanned or unsustainable. Unique circumstances are considered after 13 weeks, especially for fetal abnormalities or if the mother has a “compelling reason.” These legal abortions are paid for by the state.
As a result Finland has the lowest abortion rate in nordic countries at 7.7 per 1000 woman aged 15-49, a rate which is less than half of the current abortion rate in neighboring Sweden. They also have the lowest maternal mortality rate in the world, as the above video discusses. Over 97% of abortions in Finland are medically induced, a proportionally high number likely accounted for the rarity of later term abortions when medical induction is no longer possible. Overall the abortion rate is slowly decreasing.
A 2020 initiative to broaden Finland’s abortion laws (which date to 1970) and allow for abortions without the approval of a doctor or mandated hospitalization up through 12 weeks gained 50,000 signatures and was sent to the parliament. While it did not pass, the measure was a sign of changing attitudes toward preserving the status quo in Finland.
Even though Finland’s laws are more restrictive than those of India at first glance, the abortion rate in Finland is far lower and the incidence of illegal abortion is negligible. So many factors influence these outcomes beyond the size and cultural differences of both nations, including average wealth, education, government services like healthcare and parental support, and access to birth control and abortion in those early weeks of pregnancy. This shows that policy alone does not determine a specific abortion rate or outcome, rather the policy goes hand in hand with many other demographic, religious, political, economic, and cultural influences specific to each nation.
The Abortion Act of 1967 made abortion accessible in England, Wales, and Scotland and currently allows for exceptions up to 23 weeks and 6 days of pregnancy if two medical doctors agree the baby would pose a greater risk to the physical or mental health of the woman than a termination. Abortions are permitted for fetal abnormalities and preserving the life or physical and mental health of the mother at any stage of pregnancy but also require two doctors agree prior to termination. Northern Ireland has separate laws and is not covered by this act.
Technically abortion outside of the allowed exceptions is still illegal in the UK a carries a sentence up to life in prison, but the legal exceptions and their application are so generous that the incidence of illegal abortions are low. Criminal cases are not brought against mothers or abortion providers (many of whom operate within the National Health Service) except in Northern Ireland prior to the separate decriminalization of most cases there in 2019.
Abortion rights advocates believe the de facto on demand policies are not strong enough and seek a formal decriminalization of abortion in the UK and the right to seek termination without approval from doctors, whereas anti-abortion groups within Great Britain argue for more restrictions and legal protections for the unborn. A recent court case appealing for protections of fetal diagnoses of downs syndrome was dismissed in 2021, as covered in the above video. In 2020 1.5% of all abortions in the UK were approved due to diagnosed fetal abnormalities or projected serious disabilities.
The abortion rate in the UK is currently the highest ever recorded at 18.2 per 1000 woman aged 15-44 and has steadily increased over time in contrast to many peer nations. Last year 99% of all abortions in the UK were paid for by the NHS. Around 71% of the British public supports continued access for legal abortions in most circumstances, but up to 60% believe the current law allowing most exceptions up to 24 weeks is too permissive. Great Britain is also a popular destination for women from nations seeking legal abortions not currently allowed under their home country which is another source of debate.
Other countries in this category include Japan, Ethiopia, and Zambia
On Request (Gestational Limits Vary)
“601 million (36%) women of reproductive age live in countries that allow abortion on request. 72 countries globally fall within this category. The most common gestational limit for countries in this category is 12 weeks. Gestational limits are calculated from the first day of the last menstrual period, which is considered to occur two weeks prior to conception. Where laws specify that gestational age limits are calculated from the date of conception, these limits have been extended by two weeks.”
Canada decriminalized all abortions in 1988 and now has no federal abortion law. This means that abortion is legal without federal mandates and treated as a medical procedure. Like other medical procedures, the national government does not guarantee abortion providers will operate in all regions or at any specific point of gestation.
While abortion is legal and it is considered a charter right via case law, like the United States there is no federal legislation that protects that right and equal access is not guaranteed or protected. Individual provinces and cities can determine the gestational cut off for surgical abortions and these regulations range from 12-24 weeks.
Only 1 in 6 hospitals in Canada perform abortions, with half of those medical facilities in Quebec. This means that access to abortion is not consistent throughout the country and rural or indigenous communities often do not have abortion providers nearby. Government funding of abortion also changes from place to place and facility to facility. Abortion pills are also not covered by the Canadian healthcare system even though they are typically considered preferable to surgical abortion in the early weeks of pregnancy.
Many progressive politicians believe the government should do more, by passing federal legislation making access to abortion a legal right, by ensuring all communities have equal access to full reproductive healthcare including abortion, by setting federal standards for surgical abortion, and by fully funding abortions and abortion pills through the health system. According to a recent poll 72% of Canadians favor current policies in the country but 78% also want the government to pass a legal right to abortion.
Conservative pro-life organizations in Canada point to the fact that Canada is the only democracy in the world to not have any kind of federal law that protects developing infants in the womb in any circumstance. The pro-life movement in Canada is therefore focused on lobbying for more layers of regulations to abortion procedures, including federal bans on late-term and sex selective abortions or adding requirements for counseling and a wait period prior to allowing an abortion at all stages.
However, this view is not shared by the majority of Canadians regardless of political beliefs as only around 11% support more abortion restrictions in the country. The Conservative Party in Canada may be represented by a new, well funded, and growing number of anti-abortion social conservative MPs but those MPs are not representative even of their own party. There are also a few liberal MPs that openly support the pro-life movement in Canada although, again, they are not representative of the majority.
In 2020 slightly more than 74,000 abortions were performed legally in Canada with 86.8% occurring in the first 12 weeks. Canada has seen a steady decrease in both the total number of abortions and their abortion rate over the last decade. Their current abortion rate per every 1000 women age 15-44 is estimated to be 10.1, compared to the current rate in the United States of 11.4.
In Germany abortions are illegal and punishable under the criminal code, but they are allowed up to the 12th week of pregnancy so long as a doctor first verifies the mother received government approved counseling three days or more prior to the procedure. Abortions performed for medical reasons, including the life of the mother and severe fetal defects, or if they are the result of a crime are legal at any stage of pregnancy. Unless abortions are carried out for the medical or criminal act exceptions they are all privately funded and not a formal part of the state healthcare system. Catholic hospitals and other religious doctors or medical institutions in the country can choose to not offer abortions as an ethical matter of conscious.
A few months ago the German government began the process to end a 90 year policy enacted by the Nazis, who equated abortion with treason, that prohibited any speech outside of a doctors office, including on the internet, deemed to promote abortion. The statute was interpreted to include simply stating that abortions were offered at specific medical facilities, as the above video discusses. The most recent punishments for breaking this law were fines issued in 2019.
Last year 94,600 abortions were performed legally in Germany equating to an abortion rate as low as 5.9 per every 1000 women aged 15-49, the second lowest in Europe behind Switzerland, which has similar limits and outcomes. In fact, in Switzerland abortions are legal on demand up to 12 weeks after a consultation with a doctor with exceptions allowed beyond that timeframe, are all paid for by the national health service, and yet they routinely share the lowest rate in Europe.
The combination of the old provision outlawing the “promotion” of abortion and the lack of an established right for abortions allowed under current law means that access is not equal throughout the country and can be especially hard to procure in their more conservative southern states like Bavaria where doctors and hospitals often refuse to perform abortions on the grounds of personal or institutional violations of conscious. Still, the policy overall is still viewed as largely effective.
Progressive activists in the country wish to see abortion fully decriminalized in Germany and possibly with fewer restrictions on process, even though most women in the country who wish to get an abortion can technically do so under current laws. Conservatives prefer to defend the status quo.
South Korea is just one of many countries that has seen a dramatic change in liberalizing their abortion policy in recent years. A Constitutional Court ruling in 2019 determined specific provisions of the 66 year old abortion law that delineated criminal punishment for both mothers and abortion providers was deemed unconstitutional. The justices gave the government a deadline to pass revised legislation by December 31, 2020, but after heated debate from both sides no law changes passed, including the initial proposal discussed in the above video. On January 1, 2021 abortion prior to 22 weeks was officially decriminalized by default. According to Statista, legal abortion policies saw a sudden jump of 18 points after the court ruling, with a steady 79% of the population now favoring some form of legal process to offer abortions in the country without criminal penalties.
As of March 2021, abortion consultations were included among the medical services offered by the National Health Insurance Service for a reasonable out of pocket fee. That said, lacking a revised law there is still a lot of confusion about what is and is not legal in South Korea, as well as which kind of abortions women are entitled to procure. Clinics vary on gestational cut offs for abortion and some charge very high fees the later in the pregnancy an abortion is performed. While the consultation is covered by health insurance, the abortion is not in most cases.
The inability of the legislature to pass a new law following a groundbreaking court ruling has harmed the ability of the country to move forward or offer policy clarity and stability on this issue. The legislation outlined in the above video, legalizing abortion on demand up to 14 weeks and allowing for minor exceptions through 24 weeks (as well as denoting separate medical exceptions) is still being considered.
Prior to the court ruling the abortion rate for woman aged 15-44 in South Korea sharply decreased while the procedure was still illegal and women faced a penalty of up to 1 year in prison, from around 29.3 in 2005, to 15.8 in 2010, to 4.8 in 2017, attributed to a widespread increase in the use of many different forms of birth control. Still, in 2017 over 50,000 abortions were performed in South Korea, most illegally at the time. It is uncertain how the changes in legality and abortion policy might impact the abortion rate in the country for the future.
Most abortions are legal in China at any stage, but as of 2018 women now have to fill out a form outlining their future family planning intentions prior to termination. Sex selective abortions were also banned in 2015. China, among other regimes, stood apart from the other nations in the On Demand category for their willingness to not just permit abortions but also mandate them under penalty of law.
Although China was not alone in seeing abortion and coercive reproductive procedures as a solution to uncontrolled population growth in the mid to late 20th century, the communist Chinese government offers one of the most egregious examples of governments forcing women to get abortions vs encouraging the procedure as an elective choice.
The one child policy may have ended in 2015, and the government is now encouraging families to have up to three children, but the acceptance of abortion has remained prevalent in Chinese society especially among younger adults. Over 9 million abortions take place in China every year, yielding an abortion rate between 28-36 abortions per 1000 women aged 15-49 depending on the count used.
Facing demographic decline resulting from the one child policy, China is now considering new restrictions to reverse engineer their population troubles through a different type of family planning controls by reducing the number of abortions not deemed medically necessary. They are particularly interested in targeting abortions by unmarried single women to encourage marriage and childbirth instead.
However, this new reticence surrounding abortion does not extend to all people groups as the government is reportedly using forced IUDs, sterilization, and abortions to curb births among Uighurs and other ethnic or religious minorities as part of a “demographic genocide“. As the above video highlights, forced abortion is still favored by the Chinese government as a way to suppress undesired population growth. The signaled change in abortion policy for other regions or dominant ethnicities within the China does not seem representative of a change in national ethics but rather a change in pragmatic methods for accomplishing a similar goal of coercive population control.
There are many other countries in this category, including South Africa, Turkey, Tunisia, Australia, New Zealand, Columbia, Spain, Noway, Sweden, France, and Russia. On average, in my estimation, the rates seem to range from around 10-20 abortions per 1000 women of childbearing age and there is a general trend downward over time connected to expanded access and use of birth control, although some countries like Russia routinely see much higher but also decreasing rates of abortion.
While somewhat counterintuitive, many experts point to a noticeable trend for abortion rates to decrease as abortion becomes more legal. Pro-life advocates dispute the notion that legalizing abortion does not lead to increases in abortion, as well as reported negative impacts of abortion bans or estimates of illegal abortions under those bans. It’s important to note that countries with more permissive abortion policies also tend to be wealthier and offer more comprehensive access to all forms of reproductive healthcare, all factors that might influence the abortion rate regardless of specific laws.
The policies for these On Demand countries also vary in terms of gestation limits and other restrictions or exceptions. Each country does something slightly differently and sees varying outcomes not clearly tied to their specific laws. What binds them together in this category is the ability granted to women to choose an abortion at some part of the pregnancy without needing to obtain the permission of the government during that period of time.
As you sift through all of the information in this guide and the linked resources, here are several questions I am asking myself about abortion policies around the world and how that relates to my own preferences:
- Which of the above categories or countries do you want to learn more about? Which type of laws do you agree with and why?
- Should abortion carry criminal penalties at any time? If so, which penalties, for whom, and on what grounds?
- At what age of gestation, if any, should abortion be considered illegal? Does your answer change the type or timing for criminal punishments you support? If not, why?
- Alternatively: At what gestational age should abortion be legal? Are some stages early enough in the pregnancy to warrant on demand abortions for any reason? When does that change, if ever? If it changes, which exceptions also have just or practical cause?
- What happens if women do not discover a pregnancy until close to the cutoff you prefer or if they cannot easily date their gestation? Would that change your answer?
- Do women ever have a fundamental right to choose an abortion? If so, when and how? Should laws directly protect that right?
- What rights, if any, does a developing child have? Does the fetal age matter in extending these rights or protections?
- What do you think of laws that require written approval from a doctor, sometimes from a panel of doctors, prior to allowing abortions? Which models for this kind of system might you support? If you are against it, why?
- What about mandated abortion counseling or consultations with doctors that still give women the final choice but require a specific type of informed consent prior to an abortion?
- Do you approve of mandated wait or “cool down” times between when a woman initially seeks information about abortion and when she has the procedure?
- What specific exceptions should be made for later term abortions beyond the gestational limits you support, if any? If those exceptions are broad, does that change how you think about your preferred gestational limit? How should those exceptions be monitored or approved?
- Which fetal anomalies or diseases should be exempted from abortion restrictions? Is that a decision to be made without intervention from the state and purely in a private capacity? Should doctors be able to overrule patients or refuse care? Should some disabilities be legally protected in the womb on discrimination grounds? If so, which ones?
- What should be allowed in cases where a pregnancy is the result of a crime?
- When legal, should access to abortion care be equal within a country? If so, how should that be achieved? Should the state finance abortions to help make that possible? Is it fair or good for different standards or sets of abortion laws and access in different regions of the same country?
- Is abortion a form of healthcare? Is it a medical procedure/process? If not, how would you classify it?
- Are you concerned about healthcare workers reporting private citizens to the police? Should women who choose abortion be afraid to seek medical care for this reason?
- Where abortion is outlawed or difficult to procure, what should we make of continued illegal and potentially unsafe abortions? What responsibility does our broader society, public health officials, and federal laws have to address that phenomenon?
- What do we make of the frequent and historical connection between nationalist political movements and anti-abortion laws or restrictions? Does that bother you? If so, how might that change the way you think of the legal mandate to regulate abortion, if at all.
- What do you think about government mandated abortions? How do you protect against an abuse of state power to force abortions?
- Is it ever a good idea to grant the state custody of the womb? What other ways could that power be abused?
- Do you support conscience clauses to protect medical providers that are uncomfortable with performing abortions? If so, what does that look like in practice? What happens if those laws make it harder for women to access abortion in some places but not others? Is that ok?
- Is it fair to mandate via legislation ethical choices to complex problems that match our personal religion or morals but limit and contradict the convictions of other citizens? If so, when? How do we do that without suppressing the moral conscience and choice of the people who disagree?
- Why do you think some countries continue to see reduced abortion rates regardless of specific policy while others are steady or see an increase? Do you think actual abortion rates (legal plus illegal) are strongly correlated to abortion policy? If not, how does that change the way you see the issue from a policy perspective?
- Do you think non abortion related public policies are a factor in determining the abortion rate? If so, which ones? Do you currently vote for politicians that advance policies which might help achieve an outcome you support? If not, why not?
- Which is more important to you, for the laws to exactly reflect your preferred policies and ethics or for the real-life outcomes to match your intended policy goals?
- What is the point of laws that are not enforced? Is that a concern? Should abortion laws, like ones that suggest punishment up to life in prison for illegal abortions, be changed to reflect common practice? Is there a danger to keep them in place even if cases are not currently prosecuted on those terms? Should laws that carry harsh penalties stay in place as deterrents or for moral signaling even if you don’t wish them to be used in practice? Is it fair for people to live in fear of criminal punishments the government has no intention to prosecute?
- If abortion is murder, the killing of innocent life, then shouldn’t the punishment be equivalent to murder? But if hardly any country in the world treats it like murder legally, even with harsh laws in place, or if the pro-life advocates around the globe mostly say they don’t want women punished for obtaining one, then is it actually a case of legal murder? And if it is not actually legal murder, how does that change the way you want it be legislated?
- What else on this topic will you commit to learning about before the next election? How might this information change how you think or talk about the issue? Could it change who you will vote for or if you will vote?
- Where are you willing to compromise? What part of this topic do you think is open for continued policy debate?
- Who can you work with to achieve the social outcomes you support in the future? Can you find common cause with anyone who disagrees with you on the ethics of abortion but who might agree with you on pieces of your preferred abortion policy? What might that look like?
This blog is a huge service to folks who are tired of the same talking points in the battle of “pro-life vs pro-choice.” It doesn’t have to be black and white because in reality – it isn’t! There is so much here: it’s rich in research, links to additional resources, plus questions for further critical thinking on the topic. Those are just a few of the many takeaways from this excellent piece!