The right to abortion in the world: a fight still far from being won

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Today, the right to abortion remains highly unequal across the world. The laws vary widely, ranging from authorization on request to total prohibition of access. This fundamental human right (sexual and reproductive rights, but also the right to health given the health dangers of clandestine abortions) is therefore often prohibited depending on political, social and cultural contexts (sometimes refused in the name of the right to life), and even where it is freely authorized, it can be socially disparaged or be the object of stigmatization by those who have benefited from it.

Abortion is a medical procedure that allows an unwanted pregnancy to end before its term. It therefore involves the expulsion of the embryo or fetus from the uterus during the gestation period. According to the Guttmacher Institute, approximately 121 million unintended pregnancies occurred each year between 2015 and 2019, and 61% of them ended in abortion. This means 73 million abortions per year worldwide. In each country, a specific legal framework defines the conditions under which these abortions can take place.

We speak of abortion when the abortion is caused for non-medical reasons, is decided after reflection by the person concerned and is induced voluntarily and legally. Both chemical and chirurgical termination of pregnancy mean abortions for medical reasons: either because the continuation of the pregnancy may prove to be dangerous for the health of the person, or that the fetus (or embryo) is affected by malformations, or a serious or incurable disease.

There are currently two methods to carry out an abortion. The first so-called “drug-induced” method performs an abortion without anesthesia or surgery and is possible during the start of pregnancy, in the case of an early abortion. Here, abortion consists of taking two drugs continuously under medical supervision. The first (mifepristone or RU 486) will terminate the pregnancy and the second (composed of misoprostol) which is given about 48 hours later, will increase the contractions and completely expel the embryo. The second method, the surgical (or instrumental) method, is usually done in a hospital since it requires anesthesia, (local or general) – it can be extremely painful. During the procedure, the doctor dilates the uterine cervix and passes a cannula (small tube) through it in order to aspirate the embryo present in the uterus. The entire operation takes about 20 minutes. Ideally, there should be a follow-up consultation after the abortion (medical or surgical) to ensure that the pregnancy is terminated and that the mother does not experience further complications.

Apart from the conditions set by the law, we talk about clandestine abortion which poses a major danger for a mother who wishes to do so. Today, unintended pregnancy rates are the highest in countries that restrict access to abortion and the lowest in countries where abortion is largely legal, forcing people in the least tolerant countries of having these unsafe abortions. Abortion is risky when the pregnancy is terminated either by people without the necessary skills or in an environment that does not meet the minimum medical standards. The person concerned, initially in a situation of distress, incurs severe psychological and biological suffering, or even, depending on the lack of means, a risk of dying. According to the World Health Organization (WHO), 25 million abortions per year take place underground, and each year between 4.7% and 13.2% of maternal deaths can be attributed to unsafe abortion. In this sense, the condemnation of abortion is immoral insofar as it leads to this type of clandestine and murderous practices.

It seems important to mention how the right to abortion is a choice, and a right that is both fundamental and necessary for equality between women and men. Women¹ have the right to control their own bodies and their reproduction and it cannot be transferred to their families or to the state. Thus the reasons for having recourse to abortion are specific to it and always remain legitimate. The United Nations Human Rights Committee has considered access to abortion and the prevention of maternal mortality among the human rights. The committee argues that to enable a breakthrough that is crucial for women’s health and bodily autonomy, it is imperative that states uphold this right by providing safe, legal and effective access to abortion regardless of the motive(s) of the person who is in pregnancy. Furthermore, the Center for Reproductive Rights (CRR) maintains that preventable maternal deaths are a violation of the right to life, and that the right to life begins at birth, which refocuses the fundamental freedoms of women at the core of the ethical debates.

Yet globally, abortion laws continue to vary among countries with sometimes severe restrictions. In addition, certain economic obstacles, cultural policies or other restrictions due to conscientious objections, prevent effective access to abortion. Here, we have grouped the countries of the world under four progressive categories: the countries where abortion is prohibited and considered as a crime, where illegal and dangerous abortions take place, and the people wishing for an abortion must escape social control and health risk; the countries where abortion is prohibited, except under certain very specific conditions; the countries with legal abortion, but subject to practical restrictions; the countries with legal abortion, although sometimes under pressure, even in Europe and the United States where the legislation is more liberal.

In addition to being generally unequal, this right is threatened by the emergence of a conservative wave that calls into question the right of women to freely choose whether or not to have a child and that stigmatizes those who seek to have an abortion. Moreover, the global Covid-19 pandemic has had a negative impact on reproductive health: around the world, some politicians have exploited the current crisis and tried to complicate or even block essential and urgent access to abortion.

Our approach here is to establish an inventory of abortion in the world, which is why we have chosen to map the information gathered in this report. The latter will accompany the reading of the card by providing some legal and practical details in order to best represent the rights and needs of people wishing to have an abortion today.

Countries where abortion is illegal under all circumstances 

The right to a safe and legal abortion is a fundamental human right protected by numerous international and regional treaties and by national constitutions. These instruments are the base of a safe abortion within a constellation of rights, including the right to life, liberty, privacy, equality and non-discrimination.

Nevertheless, abortion is still a major issue in many societies today, and continues to embody the struggle of thousands of people because its access is still very unequal and remains illegal in too many countries. This not only violates everyone’s right to freely dispose of their body, but it has disastrous consequences for reproductive health and gender inequalities.

In terms of numbers, we can highlight that 41% of human beings in the world live under restrictive laws. The inability to access safe and legal abortion care still affects 700 million people of reproductive age. According to the WHO, the restriction of this fundamental right causes the death of 23,000 people each year as a result of unsafe abortion.

Some African countries have inherited the restrictive legislative framework from colonizing countries, whose laws and the Penal Code define the access to abortion and possible sanctions, causing the continent to be governed by repressive laws where abortion is totally prohibited. Abortion is illegal in three countries: Lebanon, Libya and Burundi. For example, Articles 539 to 546 of the Lebanese Penal Code, which date from 1943, prohibit abortion. According to the law, a person who has an abortion can be jailed for six months to three years, while the doctor who performs the procedure can be sentenced to one to three years in prison.

In 25 African countries, abortion is allowed if the mother’s life is in danger and nine countries include cases of rape and incest: Burkina Faso, Sudan, Zimbabwe, Cameroon, Botswana, Ghana , Liberia, Namibia and Seychelles. In 11 countries, abortion is legal in case of malformation of the fetus, including : Burkina Faso, Botswana, Ghana, Liberia, Namibia and Seychelles. But in practice, victims have to denounce the perpetrator of the sexual abuse, which is not easy and most often generates a strong social and moral stigma on them. These different factors, combined with an almost non-existent legal service offer, force them to resort to clandestine practices.

In Latin America, abortion laws are restrictive and the freedom to abort is not guaranteed. The weight of the Catholic Church and the strong patriarchal culture are obstacles to legislative change and progress. Abortion is totally banned in 6 out of 34 countries, or 7% of the region’s population. This includes Haiti, Honduras, Nicaragua, the Dominican Republic, El Salvador and Suriname.

In the 2000s, there were attempts to extend the right to abortion for three reasons : to preserve the health of the person concerned, in cases of rape and of fetal malformation. These attempts have failed in Honduras, El Salvador and the Dominican Republic under the weight of conservative movements. To a certain extent, it is possible to speak of a questioning of acquired rights through changes in the Criminal Code or the Constitution. For example, laws have tightened in Nicaragua, where therapeutic abortion was allowed until 2006 but is now banned. As well as in El Salvador, where abortion was allowed to save the life of the person and in case of malformation of the fetus, but is now punished with heavy prison sentences. Here are two cases that illustrate this situation, Teodora Vasquez and Maira Figueroa, who each spent ten years in prison for a miscarriage, considered by the courts as a homicide. They have been sentenced to thirty years in prison before seeing their sentence commuted.

Although some countries allow conditional abortion such as for rape or incest, this right is often more theoretical than real. The cases where people obtain the authorization to abort are rare, whether it is because they have exceeded the legal time limit, by ignorance of the law, by pressure of the religious authorities, or by refusal of the legal authorities or health professionals.

In Europe, the subject of abortion has again raised tensions in recent years. Even today in the European Union, Malta completely prohibits abortion, even in cases that pose imminent danger to the mother’s life. On the island, 91% of the population claim to be Catholic, the clergy are still very influential and exert real pressure on political parties and civil society by developing censorship of information on abortion. For the government, it would be a question of implementing a birth rate policy under the guise of religiosity. This retardation can also be explained by the place accorded to the child in Maltese society where life is considered to begin at conception.

In Andorra, abortion is prohibited even in cases of rape, incest or malformation of the fetus. This is often presented from an external point of view as a way to preserve the uniqueness of these micro-states and their religious roots. In 2005, the Andorran government introduced a new article in the Penal Code which provides for a prison sentence of up to two and a half years for those convicted of abortion. It also affects doctors who perform abortion, who can risk up to twelve years in prison if the abortion results in the death of the patient. Prison sentences are also present in the Penal Code in San Marino and Liechtenstein.

The same concern arises in the United States, under the ultra-conservative government of Donald Trump. Most notably, the state of Alabama has the strictest abortion law in the US. This law prohibits abortion at all stages of pregnancy and makes doctors liable to terms of imprisonment of up to ninety-nine years in prison, unless the life of the pregnant person is at stake or in case of fetal abnormality. Since this law has been implemented, even abortions in case of  rape are prohibited.

Countries where abortion is illegal except in certain cases

Many countries prohibit abortion on request, but, as discussed above, under certain conditions, although there is not much access to it, it is possible to abort. States do make exceptions to their prohibition in the event where the person’s life and health (whether it is physical or mental) as well as the health of the fetus are at risk, or it depends on the circumstances of the pregnancy, if it results from sexual assault or incest.

Risks to the life of the pregnant person

When there is danger to the life of the pregnant person, some states may make exceptions to their laws which prohibit abortion. Religion, especially Christianity, is often cited as the main obstacle to abortion. A number of predominantly Catholic countries like El Salvador, Malta and the Vatican have a total abortion ban. As for Islam, although almost 80% of the people of the Middle East and North Africa live in countries where the right to abortion is restricted, the life of the mother remains a priority. 55% of them therefore live in countries where abortion is only authorized to save the mother’s life (Afghanistan, Pakistan, Yemen, Oman, Iran, Iraq,…) and 24% where abortion is only allowed to preserve the physical or mental health of the mother. In Egypt, for example, article 61 of the Penal Code explains that “no penalty shall be imposed on a perpetrator of a crime he had to commit by the necessity of protecting him/herself from a third party from a grievous danger to one’s person […]”. Although most often these reasons justify performing an abortion only when the life of the pregnant person is in danger, it happens that in Egypt this condition is interpreted to include cases of pregnancy likely to induce a high risk for the health of the person, and even cases of fetal impairment. In many other states, this motive of “saving the mother’s life” is the only one that allows for an abortion, such as the Solomon Islands, the Marshall Islands, Papua New Guinea, Tonga, East Timor, etc.

Risks to the physical or mental health of the person

In other cases, legal texts may sometimes specify that abortion is authorized “to preserve the physical health of the woman”, in the event of “risk of serious harm to the physical health of the woman” or of “immense danger to women’s health”. The lack of precision in laws often leaves room for interpretation. The WHO definitions should then serve as a reference. The WHO provides the following definitions: health is “a state of complete physical, mental and social well-being and not simply the absence of disease or infirmity”. Mental health is “more than just the absence of mental disorders or disabilities. Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.” Several states allow the practice of abortion when there is a threat to the health of the person wishing to have an abortion, however, there is not always a distinction between physical and mental health, leaving room for more or less restrictions. Given the influence of the social and economic environment on the pregnant person’s health, some abortion laws clearly state that, real or foreseeable, this environment must be taken into account in the assessment of threats to her health. In Benin, for example, it is mentioned in article 14 of the Maputo Protocol, of which it is a signatory, that people have the right to exercise control over their fertility and that the States signatory to the protocol take all appropriate measures to protect reproductive rights, particularly by authorizing safe abortion, in cases of sexual assault, rape, incest and when the pregnancy endangers the mental and physical health of the person or the life of the person or the fetus.

Risks to the mental health of the person can be categorized into other reasons, for example the cases of rape or the tensions related to the psychological or socio-economic circumstances. In Thailand, “The therapeutic termination of pregnancy […] shall be performed on the following conditions: […] In case of necessity due to the mental health problem of the pregnant woman, which has to be certified or approved by at least one medical practitioner other than the one who will perform the medical termination of pregnancy. […] For this purpose there shall be clear medical indications that the pregnant woman has physical health or mental health problem and the examination and diagnosis shall be recorded in the medical record and kept as evidence.”² 

Pregnancies caused by rape, incest or sexual assault

Another exception to the ban on abortion for some states is pregnancy that happens after some form of sexual assault. This can mean rape or incest, but sometimes also misappropriation of an underage (sexual intercourse with an underage). It can also be pregnancy after sex with a person with a mental handicap or mental illness, or sex obtained under threat, in these cases the formulation “if the pregnancy is the result of an act against the law” can then be used. Brazil specifies: “The penalty is increased […] if the pregnant woman is under the age of fourteen, insane or mentally retarded, or if her consent has been obtained through fraud, serious threats or violence.”³

While in principle it is allowed to abort in case of rape, in practice, access is only facilitated if the persons concerned can benefit from the service by simple declaration to the service provider instead of having to meet administrative conditions. The fact that people sometimes have to denounce their abuser in order to have access to abortion discourages them. In addition, many people are not necessarily aware of their rights. In Burkina Faso, abortion is authorized by law only to protect the health of the pregnant person, in cases of rape, incest, or severe fetal malformation. However, knowledge of the legal status of abortion is low: only one-third of Burkinabè knows that abortion is allowed in some cases. Having an illegal abortion is considered a criminal act, the majority of people who terminates their pregnancy, whether legally or not, do so in secret, for fear of prosecution and to avoid the social stigmatization that comes with this practice of an abortion.

Risks to the fetus

Next is the risk of fetal impairment as a condition of an abortion. Some countries specify the type and degree of impairment necessary to justify this ground. There is usually no limit to the length of the pregnancy. Some countries do not explicitly consider the risks to the fetus but include this criterion in the wording “to preserve physical health”. Chile allows abortion in three cases: risk to the life of the pregnant person, rape and non-viability of the fetus. It is the same for Benin, “when the unborn child has a condition of particular gravity at the time of diagnosis”⁴. We speak here rather of ITG (Therapeutic Pregnancy Interruption) or IMG (Medical Pregnancy Interruption).

Socio-economic reasons

Socio-economic reasons may also come into force in the circumstances which allow or not to resort to an abortion in countries where it is prohibited. These remain quite difficult to determine and once again allow relatively free interpretations. The reasons in question may take into account circumstances such as the resources of the person wishing to have an abortion, their age, their marital status or the number of living children. Like the mental health reason, when a socio-economic reason is recognized, it is added or overlapped with others (health, circumstances of pregnancy). Ethiopia is an example of a country that takes into account the socio-economic situation of the pregnant person when authorizing or not to have recourse to an abortion, “the Court shall mitigate the punishment under Article 180, where the pregnancy has been terminated on account of an extreme poverty.”⁵ Regarding the age, in Hong Kong, abortion is only allowed in cases where the pregnancy poses a risk to the pregnant person and/or the fetus, as well as in cases of rape, or if the pregnant person is under 16 and up to 24 weeks.

Finally, there are other conditions which make it possible to authorize an abortion, in particular an inability to take care of the child (for example in Namibia: “the woman, due to a permanent mental handicap – or deficiency – is unable to consider the consequences and assume parental responsibility as a result of the sexual intercourse”⁶) or if this new pregnancy would represent a risk for living children (for example in Zambia: “there exists a risk that the child to be born will suffer from a physical or mental defect of such a nature”⁷).

Fortunately, there are exceptions for certain states which allow their residents to legally access abortion, permitting them to terminate their pregnancy without too much danger to their life. However, in the majority of these countries, there is little information, and stigmatizations are seemingly systematic, so even when people could benefit from it, they do not take the steps in this direction. These exceptions to the ban may give hope for future legalization.

Countries where abortion is legal but restricted 

For financial reasons

Even in countries where abortion is permitted, this basic right may be limited for a variety of reasons, including financial reasons. This economic restriction tends to hamper a number of people in their choice to dispose of their body as they see fit. Indeed, people in precarious situations will not be able to claim abortion, which should nevertheless be accessible to everyone. The freedom of decision should be priceless.

The right to abortion at the federal level has been recognized in the United States since the Supreme Court ruling (Roe v. Wade) passed in 1973 recognizing that the fetus is not viable before the 24th week of pregnancy. However, the President of the United States Donald Trump, in 2017, repealed a decision by Barack Obama which allowed public funding of family planning clinics. A decree was also signed, banning the funding of foreign NGOs practicing or actively supporting the legalization of abortion. As a result, eleven states prohibit private medical insurance from reimbursing abortions, and six US states (Kentucky, Mississippi, Missouri, North Dakota, South Dakota, and West Virginia) have only one clinic providing abortion services. This leaves twenty-seven major cities in the United States and much of rural America completely “deserted” in terms of abortion services.

People with low incomes are mostly adolescents, people of color or refugees. They are also those who get hit the hardest by financial restrictions on abortion, because it is more difficult for them to pay the fees, to travel abroad or to take time off work. Knowing that 42% of people requesting an abortion lives below the poverty line, these costly measures sometimes make intervention impossible.

The province of New Brunswick in Canada is the only Canadian province where abortion services are not reimbursed when performed outside of hospitals. People who want to have an abortion covered by health insurance must therefore turn to one of the three hospitals (two in Moncton and the third in Bathurst) offering this service, otherwise people wishing to have an abortion will have to pay between 700$ and 850$, a considerable sum. Abortions performed in private clinics are therefore the responsibility of the patients, and this goes against Canadian health law which requires that all necessary medical services be covered by the health insurance plan of the province.

On 21st July 2015, Portugal passed a bill restricting the right to abortion. Among the notable changes, the costs of the operation are now the responsibility of the patient and no longer of the state, a real step backwards for this country. In addition, people wishing to have recourse to this practice receive details of the allowances to which they would be entitled by refusing abortion, which may be perceived as an incentive on the part of the government still under religious supervision. Patients wishing to have an abortion must also undergo a psychological follow-up before the act to be sure that it is “the right decision”.

In Germany, abortion is decriminalized only under certain conditions : the abortion must be performed before the twelfth week of pregnancy, the pregnant person must go to a compulsory pre-abortion consultation, where they have access to official information and must then allow three days of mandatory “reflection period”. In addition, the Germans must pay the amount of the abortion, that is to say between 250 and 500€, which represents a budget not without consequences and an exception within the European Union. It should be noted, however, that in cases of low wages, the intervention is covered by the Land⁸.

Due to conscientious objection

In some states, although the law allows abortion, they are rarely performed because of the refusal of doctors. In terms of moral, religious and/or social convictions, a majority of practitioners use the conscientious objection clause in order not to perform abortion. Italy is an example. The law of 22nd May 1978 authorizes abortion in Italy if the following conditions are met : it is requested by the person, the continuation of the pregnancy would cause great danger to her physical or mental health, she has consulted a doctor and abortion is induced within the first 90 days of pregnancy. However, 71% of practitioners refuse against 10% on average in Europe. The consequence of these refusals is that many people find themselves in a situation similar to those living in countries where abortion is prohibited. Their argument is therefore a conscientious objection, which is defined as “The exercise of freedom of conscience”⁹. This authorization therefore prevents them from practising acts that would go against their moral, ethical and/or religious convictions. Article 7 of the law creates an obligation for regions, hospitals, and nursing homes to “ensure the completion” of the abortion procedure. However, the law does not specify any concrete measures. Moreover, when staff refuse using this clause, they are under no obligation to redirect the person wishing to have an abortion to people or facilities that can help them, contrary to the WHO recommendations. Conscientious objectors are therefore not obliged to provide a minimum service in terms of information on access to abortion, a problem since this leads some people to believe that abortion, a fundamental right, is a deviant practice.

Also in Italy, there are geographic inequalities with real “medical deserts” in which abortions are not available at all. People then have to travel to other regions, or even abroad, to be able to have an abortion. The fact that the majority of medical personnel refuse to perform abortion has an impact both on those who wish to have one and on the individual who perform it. Indeed, health professionals sometimes suffer constant attacks and can be victims of harassment from their peers. They also suffer from cumulative direct and indirect discrimination, concerning workload, distribution of tasks and career advancement. For people wishing to benefit from these services, the consequences are of course serious, there is a high rate of clandestine abortions, especially in the regions of southern Italy, as well as a phenomenon of “abortion tourism” in certain areas, such as Tuscany. Italy was condemned by the Committee on Economic, Social and Cultural Rights of the Council of Europe in 2013 and 2016 on the issue of access to abortion. In March 2017, the UN Human Rights Committee recommended that Italy guarantees access to abortion on its territory, and was particularly concerned about the number of conscientious objectors and the rate of clandestine abortions.

Due to the stigma of cultural, religious and/or social stigma of abortion

The stigma associated with abortion is the discrediting of people who have had or are planning to have abortion. This stigma comes through feelings of shame about their own sexual practices or having misplaced their trust in a partner. It can result in rejection by their family and/or community. Some people can internalize the stigma of abortion so deeply that they feel judged, even by those who support their decisions. This stigma can also lead some people to carry their pregnancy to term, and therefore to have to assume the economic and mental burdens along with the birth.

Often, abortion is stigmatized because it goes against the “ideals of femininity”. Motherhood and sexual purity are two ideals that exist in our patriarchal societies and in many forms. According to this way of thinking, the woman¹⁰ who wants to carry out an abortion refuses her role and is therefore not a “real” woman, that is, a person who should only have sex with the intention of procreating. Abortion is therefore stigmatized because it is proof that a woman has had “non-reproductive” sex and that she seeks to exercise control over her sexuality.

The stigmatization of which the people concerned are victims is therefore mainly of a religious nature since for some communities, abortion would call into question the “ideal” vision of the family or even the place and role of women in society. In Ireland, despite the recent legalization of abortion (Law of 13 December 2018 before which this act was punishable by fourteen years in prison), the issue of abortion remains an extremely taboo subject and the access to abortion is very complicated in this country with a strong Catholic tradition.

Abortion is also stigmatized by the attribution of the status of person to the fetus. Pro-life or anti-abortion groups have fueled this ethical debate by using numerous representations of the fetus and insisted on the independence of the fetus from the mother, which amounts to interpreting that abortion is equivalent to a murder.

The manipulation of these images and symbols has several consequences: in the political sphere, this stigma of abortion is heavily affected by legislative initiatives which establish a personality in the fetus and wish to reduce the number of weeks during which abortion is authorized. Over time, these groups influence society and cultural values. By viewing abortion as murder, this stigma is imposed on the mother and clinicians, who are sometimes threatened and are therefore seen as murderers. For example, Quebec Life Coalition is a powerful Quebec pro-life association which aims to fight against abortion, comparing it to a crime against humanity.

Abortion is also stigmatized today because it is viewed as dirty or unhealthy for the person seeking it. Because of the lack of knowledge about the medical process it represents, abortion is sometimes, in the collective imagination, associated with very dangerous practices (usually where it is illegal). Following the same rhetoric, some pro-life speeches place great emphasis on the pain inflicted on people who have an abortion, locking them into the status of victims.

For the under-aged 

Some countries require parental consent for any minor wishing to have an abortion. These measures are an obstacle to the individual freedom of young people wishing to freely dispose of their bodies. Moreover, these situations can lead them to encounter real relationship difficulties with their parents.

Most European countries have laws obligating minors to obtain parental consent, or at least inform them,  in order to procede with the abortion. In most of these countries however, this rule can be countered if a specific committee decides that ignoring this rule might be more beneficial to the minor, in the case of domestic violence or disownment for example. Some countries propose to differentiate younger minors from the older ones, often regarding the age range 16 to 18 as not needing parental restrictions.

That is the case in Spain: the country is currently debating whether persons between the ages of 16 and 18 should have the right to the procedures without parental consent, that the legislation allowed since 2010, to avoid “any intrafamilial violence, threats, mistreatments, or any resulting situation of distress or abandonment”. A 2005 law brought forth by Mariano Rajoy’s government once again prohibits those in this age range from benefiting from this freedom. As such, many of the  young Spanish  perform their abortions in secrecy.

For countries where abortions are illegal or limited for minors, a large number of young people are forced to go to neighbouring countries where legislations are more liberal. The United States notably has differing legislations on the matter depending on the State. The majority of States make the implication of a minor’s parent in their abortion mandatory: a single parent’s consent generally suffices, in the 24 to 48 hours before the procedure. A number of States however make the participation of both parents compulsory, with, in addition, a proof of their parenthood. The United States Supreme Court has nevertheless established that States cannot grant parents an absolute veto on their child’s decision and has allowed for procedures of judiciary bypassing that would enable the court’s approval of the abortion for the minor without the parents knowing or consenting. Be that as it may, certain States have imposed specific criteria to determine if the exemption of parental authority can be issued. These criteria include the minor’s “emotional stability” and their comprehension of the possible consequences of an abortion. In some instances, the judge will even go as far as using the “clear and convincing proof” judicial norm to determine if a minor is mature enough and if abortion is in thier interest before waiving the need for parental authority.

Because of Laws

Despite its legal nature, the access to abortion can be limited by legislative restrictions, even in Occidental European countries. In Finland for example, often depicted as a progressist country in the matter of gender equality, the law supervising abortion is surprisingly strict, even if not often, or not at all implemented in reality: abortion would then be legal only for people under 17 years old , over 40 years old and having already 4 children and for those whose pregnancy would endanger their safety, or those who would not be able to care for the child because of a disease or financial instability. 

In the United Kingdom, abortion was legalised in 1967 but still requires the consent of two doctors who must agree that the intervention is adapted to the patient’s situation. The decision to undergo an abortion then depends more on the will of doctors than of the people concerned.  Furthermore, one must go to a clinic to obtain the abortion pill, even though this constraint has temporarily been abridged during the Covid-19 crisis thanks to an emergency policy authorizing people to take the pill at home. Finally, the Law of 1967 as not extended to Northern Ireland where abortion is still limited.

In Germany, abortion is still illegal in theory, whereas it is authorised before the twelfth week of pregnancy and after an imposed thinking period of three days; as for cases of rape or for medical reasons. Moreover, the high stigma on abortion, the very low reimbursement and the lack of doctors willing to provide it, drive a lot of German people to go to France to have an abortion. Furthermore, the German Penal Code, prohibits publicity for abortion and even the simple fact for a doctor to provide information about it on their website. Thereby, numerous “pro-life” activists harass and threaten doctors who provide abortion with penal proceedings.

Some countries impose to have the partner’s consent to access abortion, a patriarchal coercion that goes against women’s¹¹ independence and autonomy and their freedom to dispose of their body. It is the case of Turkey, but also of Japan, who paradoxically was one of the first country in the world to legalise abortion in 1948 and where this right is not questioned much by the population. Despite the consensus about chirurgical abortion, chemical abortion is not available since abortion pills are illegal and having the partner’s consent stays mandatory before accessing any abortion method. Abortion is not covered by Japanese health-insurance, while its price can vary from 100,000 to 200,000 yens (equivalent to 800 to 1,600 euros).

In other countries, abortion is a right but not a reality. It is the case of the four African countries which legalise abortion (South- Africa, Cape Verde, Mozambique, Tunisia), where there still is a confusion around the legal character of the practice. In Tunisia, abortion is, in theory, authorised until the 3rd month of pregnancy and after if suspected danger for the pregnant person of the foetus, after a doctor’s report.  However, abortion stays largely inaccessible and clandestine home-made abortions are common practice, especially because of an ignorance of the law. People who decide to have an abortion have to face public judgment, and the disregard of doctors and society.   

Likewise, South-Africa allows abortion on demand since 1997, during the first three months of pregnancy and beyond for medical reasons with the approbation of medical professionals.   Yet, lots of doctors and about half of centres providing abortion services are using conscientious objection to refuse their implementation. Public opinion but also medical professionals’ opinion and even politicians’ discourse are still widely charged of wrong information and a strong stigma on abortion. People living in rural areas are even more discriminated in the access to abortion services. As in Tunisia, ignorance of the law presses lots of people to undergo clandestine, self-inflicted abortions, in terrible conditions causing the death of hundred of people each year.

Finally, in Mozambique, despite the legalisation of abortion since 2014 for the first 12 weeks of pregnancy (16 in case of rape or incest), written consent of 2 doctors is still mandatory to have an abortion. Furthermore, a large portion of public opinion and medical professionals stays opposed to this right. The health care system has been very slow to adapt to the change in legislation, medical directives being defined only in 2017, three years after the law passed. Therefore, numerous citizens still do not know how to access abortion and clandestine abortion is still performed despite the legalisation.

Countries where abortion is legal on demand

Lastly, model countries do exist when it comes to acces to abortion, even though it would be overstated to say that this right is never questioned and truly accessible to all. 

Europe

Europe is the easiest continent to have an abortion, since it is legalized in most of its countries. For some of these however it is rather new (2014 for Luxembourg, 2010 for Cyprus, 2019 for Ireland). The maximum time limit to abort varies from 10 weeks up to 24 in the Netherlands and the United Kingdom. Yet, public opinion still seems to present a strong opposition to the right to abortion in certain – particularly catholic – countries like Ireland. It is unfortunate that a reflexion period is mandated in several countries like in Germany, Belgium, Slovakia, the Netherlands or even in Portugal. Furthermore, the European Court of Human Rights has still not stated its position on abortion.

Russia was the first country in the world to legalise abortion in 1920, under Lenin, before forbidding it in 1936 under Stalin and re-authorising it permanently in 1955. Today, abortion is easily available in any city at a low-cost, and as far as twelve weeks, extendable up to 22 weeks in cases of rape and limitless if the pregnancy puts the life of the mother or fetus in danger.

In France, abortion has been legal ever since the 1975 Veil Law, until 12 weeks of pregnancy or more if a medical purpose comes into place. The fees have been entirely covered by health care since 1983. In 2017, the reflexion period was removed and instead a numerical offense of obstruction of abortion was adopted, which condems any online attempt to dissuade a person from aborting or spreading false information on abortion with two years in prison and 30,000 euros in fines. However, there still exists a conscience clause that would allow a doctor not to perform an abortion if it goes agaisnt their ethic or religious beliefs.

In Belgium, abortion was depenalised in 1990. Abortion can be practiced up to 12 weeks of pregnancy, 22 in the case of rape, and at any time under medical indication. Yet, it wasn’t until 2018 that the notion of “state of distress” of an individual was removed as a criteria to receive an abortion.

North America

In the United States, the right to abortion has been recognised since 1973 and is protected by the fourth amendment. If abortion is authorised within all States, with the exception of Alabama, the legislation around its practice may differ from State to State.

According to the ranking made by the Institute for Women’s Policy Research (IWPR), the best State in regards to the respect of reproductive rights and planned parenthood is Oregon, where there are no restrictive laws on abortion (reflexion period, mandatory parental consent…) nor is there a time limit to abort. The State additionally offers public funding for abortions. Oregon is followed by Vermont which, alike, has no restrictive laws or time limit, and possesses a public fund to finance necessary medical abortions. In a similar way, California is one of the best States to access abortions since, according to this ranking, 99% of people live in a county offering abortion services. Abortion is authorised until the stage of fetal viability, which is around 23 weeks. Other States including Washington, New Mexico, New York, Hawai, Connecticut, New Jersey, Alaska or even Nevada, are to be cited as abortion is not restricted by laws and services are offered on nearly their entire territory. 

Canada is one of the few countries in the world with no federal restrictions on abortion: it is legally offered and without restriction since 1988, and it is considered equivalent to any other medical procedure, with no time limit. It is estimated nonetheless that 90% of abortions are performed in the first trimester of pregnancy (from 0 to 12 weeks). The abortions for those over 24 weeks are usually refered to the United States. For minors, abortions are authorised from age 14 without parental consent. Nervertheless, the access to abortion is unequal between provinces. The provinces with the easiest access to abortion services seem to be Quebec and British Columbia. As a matter of fact, these two have passed laws limiting anti-choice manifesters, services are offered on their entire territory by several medical structures and abortion is covered by the public health system, whether it is performed in a hospital or a private clinic. In Quebec, the province with the most medical structures currently practicing abortion, the waiting time to get an appointment is very short, often under 24 hours. In other Canadian provinces, these services are mostly located in urban centers whereas a majority of the population lives in rural and remote communities. The lack of medical structures thus requires that  some people travel hundreds of kilometres or even crossing over to other provinces. In Saskatchewan, the waiting time to get an appointment can reach to over 6 weeks, and in Manitoba, more than three weeks. 

Asia

Asian countries with the most accessibility to abortion seem to be China, North Korea, Mongolia, Singapore, Tadjikistan, Turkmenistan, Vietnam, Kyrgyzstan and Kazakhstan.

In Kyrgyzstan for example, abortions are authorised until 12 weeks of pregnancy, with the prospect of requesting a procedure up to 22 weeks in, for “social reasons”. This request must be approved by a commission of medical and social professionals. The abortion is furhter possible at any moment during the term in case of a medical necessity.

In Turkmenistan, abortions are legal up to 12 weeks of pregnancy and anytime between 12 to 28 weeks for judiciary, genetic, medical, social or vital reasons, as well as under special authorisation granted by a committee of local medical practitioners.

Furthermore, it is noteworthy that in certain countries of the continent (China, India, Nepal, Vietnam, North Korea, Taiwan), selective abortions are implimented on female fetuses due to cultural, social and religious valorisation of males and as a result of certain policies like China’s one-child policy (1979-2015) or even the Vietnamese family planning policy.

Africa

Africa is one of the most restrictive zones regarding abortion. As mentionned above, four countries have legalised abortions (South Africa, Mozambique, Cap Verde and Tunisia) amongst which none seem to guarantee a real access to abortion procedures. 

Océanie
Abortion is authorised in all Australian States ever since 2019, the date on which New South Wales became the last State to decriminalise abortion. From one State to another State, the time limit to abort varies from 16 to 23 weeks, or even longer upon approval of two doctors. Trying to persuade or oppositely dissuade a person from aborting is an offense punishable by two years of prison and New South Wales has even started imposing, since 2018, a prohibition to demonstrate against abortions around hospitals and clinics.

In New Zealand, abortion is authorised since March 2020 up to 20 weeks of pregnancy or even beyond upon approval of two doctors. Prior to this recent law, abortion was considered a crime and people who resorted to it could, in theory, face up to fourteen years in prison, albeit in practice the sentence was not applied. Moreover, abortion is free of charge for New Zealanders. 

South America

Only three Latin American countries authorise abortion: Cuba, Guyana and Uruguay. South Americans of other countries are forced to abort illegally or travel long distances to gain access to an abortion, often in Uruguay for its neighbooring countries.

Cuba became Latin America’s first country to legalise abortion in 1965 until the tenth week. Abortions can also be performed after this time upon approval of sanitary authorities. In theory, parental consent is necessary for minors but, in practice, solutions have been found for minors in need.

In Guyana, abortions are allowed until the eight pregnancy week without any conditions, but from the eight to the twelfth, in case of health risks either for the mother or for the fetus, or if the pregnancy continues despite having used contraception, and from the twelfth to the sixteenth week if the pregnancy is potentially highly risky for the mother or the fetus.

As for Uruguay, abortion has been legal since 2012 until 12 weeks of pregnancy and 14 in case of rape, despite the requirement to consult three medical practitioners and an imposed reflection period of five days before undergoing the procedure. In spite of this legislation, several abortive pills are available outside the medical field on the black market, and certain clinics refuse to practice surgical abortions (consciencious ojection). Uruguayan health professionals are required by law to inform people wishing to abort of the inherent risks of the procedure as well as other alternatives. Furthermore, a psychological aid should be provided.

Conclusion

The access to abortion is thus a right that is far from being acquired worldwide. There remain countries that prohibit abortion in any situation and in which people having abortions are at risk of heavy sentences for daring to terminate an unwanted pregnancy. Other states are not as radical and even though abortions are still recognised as illegal, some exceptions can be made under specific conditions, notably when life is threatened, when the pregnant person’s physical or mental health is at risk, for socio-economic reasons, or if the pregnancy is the result of sexual assault. For countries where abortions are authorised on simple demand, there are undoubtedly and fortunately some where theory and practice meet, but also others where the reality is far from being so simple. Numerous factors mentioned throughout this paper restrain this access, so as to threaten this right and force people to put their lives in danger to terminate their pregnancies: it can be financial, cultural, religious reasons, or simply the law that defines criteria so specific that it condemns many to clandestinity.

It is still important today to fight for this right to be accessible to all. Moreover, it is primordial that every person has access to the necessary information to understand that their bodies belong to no one else but themselves, that they are the only ones who know what is best for themselves and it is time that the whole of society understands that it is useless to chastise a person who does not want a child because nobody can judge anyone else’s motivations. Let us remind ourselves that restricting access to abortions does not reduce their numbers, it just makes them more dangerous. When they are performed with the guidance of a qualified medical professional, in hygienic conditions, abortions are counted amongst the most safe medical procedures. Nevertheless, once they are restrained or criminalised, those wishing to abort are bound to seek more perilous ways, going as far as risking their lives. Your body, your choice.

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To quote this article:

CANDELLIER, C. CHAPOT, M. COTTAIS, C. GIRARD, I. (2020). The right to abortion in the world: a fight still far from being won. Generation for Rights Over the World. growthinktank.org. [online] 28 Sept. 2020.

Translated by Maryame Camara, Yael Deswarte & Jessie Lee

©Illustration by Léa Felten