The past fifty years have been characterized by an unmistakable trend toward the liberalization of abortion laws, particularly in the industrialized world. Amid ongoing debate over the procedure, the trend has coincided with a drop in abortion rates worldwide. As nations across the globe have expanded the grounds on which women can access reproductive health services, the quality and safety of abortion care has improved, as has maternal survival.
Abortion rates are relatively similar between countries with highly restrictive abortion laws and those where the procedure is permitted without restriction, at between 34 and 37 per 1,000 women annually [PDF], but the safety of the procedure diverges widely: almost 90 percent of abortions in countries with liberal abortion laws are considered safe, compared with only 25 percent of those in countries in which abortion is banned. The average abortion rate globally has dropped five percentage points since 1994, and up to nineteen percentage points in industrialized countries. According to the World Health Organization (WHO), approximately 8 percent of maternal deaths worldwide are due to complications from unsafe abortions, almost all occurring in developing countries.
Abortion Law Around the World
Although the legal status of abortion varies considerably by region, almost every country permits abortion under at least some circumstances; globally, only six countries ban abortion entirely. Most industrialized countries allow the procedure without restriction. About 125 countries have some restrictions, typically permitting abortion only in limited situations, including for socioeconomic reasons, risks to the physical or mental health of the woman, or the presence of fetal anomalies.
Access to safe abortion has been established as a human right by numerous international frameworks, the UN Human Rights Committee, and regional human rights courts, including the European Court of Human Rights, the Inter-American Court of Human Rights, and the African Commission on Human and Peoples’ Rights. At the 1994 International Conference on Population and Development in Cairo, 179 governments signed a program of action [PDF] that included a commitment to prevent unsafe abortion. The WHO first recognized unsafe abortion as a public health problem in 1967, and in 2003 it developed technical and policy guidelines that include a recommendation that states pass abortion laws to protect women’s health. According to the UN Population Fund, addressing the unmet need for family planning would both considerably reduce maternal mortality and reduce abortion by up to 70 percent in the developing world.
How the United States Compares
In the 1970s, the United States became one of the first countries to liberalize its abortion laws, along with several Western European nations. In 1973, the U.S. Supreme Court held in Roe v. Wade that the Constitution guarantees women the right to choose to have an abortion. In 1992, Planned Parenthood v. Casey reaffirmed this right but permitted regulations, such as waiting periods and parental consent requirements.
Since the Casey decision, state laws regulating abortion in the United States have varied widely. A growing number of states have passed legislation to prohibit abortion after just six weeks or to regulate abortion providers, leading to the closure of more than 160 clinics and leaving six states with only a single abortion provider. A law passed in Alabama in May would ban abortion in virtually all cases, with no exceptions for cases of rape or incest; if allowed to take effect, it would render the state home to one of the most restrictive abortion laws in the world.
The global trend in abortion law has been toward liberalization. Since 2000, twenty-nine countries have changed their abortion laws, and all but one—Nicaragua—expanded the legal grounds on which women can access abortion services. In the past year alone, Ireland legalized abortion by referendum and South Korea’s high court declared the country’s abortion ban unconstitutional. Although most countries have taken steps to expand grounds for abortion, some—including El Salvador, Poland, and the United States—are enacting policies to tighten restrictions.
China liberalized its abortion law in the 1950s and promoted the practice under its one-child policy, which was enacted in 1979 in an effort to curb population growth by restricting families to one child. The policy, under which abortion services were made widely available, came with severe coercive measures—including fines, compulsory sterilization, and abortion—to deter unauthorized births. China raised this long-standing limit to a two-child policy in 2016, along with other incentives to encourage population growth amid a rapidly aging population. Activists fear that the government, seeking to control demographics, could once again use coercive measures to impose restrictions on women.
Postcolonial Kenya’s abortion law was rooted in the British penal code, which criminalized abortion. When Kenya adopted a new constitution in 2010, it expanded the grounds [PDF] on which women could obtain an abortion to include emergency cases, or those in which the health of the mother is at stake. In June 2019, a court extended the exceptions to include cases of rape. As other former European colonies reevaluate their abortion statutes, many are expanding the grounds for abortion. For instance, Benin, Burkina Faso, Chad, Guinea, Mali, and Niger—nations whose restrictive abortion laws were holdovers from the 1810 Napoleonic Code imposed by France—have all made abortion legal in cases of rape, incest, and fetal abnormality.
In 2018, the Irish parliament legalized the termination of pregnancy before twelve weeks, as well as in cases in which the health of the mother is at stake. Previously, Ireland had one of the most restrictive abortion laws in Europe, codified in a 1983 constitutional amendment that effectively banned the practice. The 2012 death of Savita Halappanavar after she was denied an emergency abortion reignited public debate and protest and prompted a countrywide referendum to overturn the amendment; the referendum passed with 66 percent of the vote. Although abortion is now legal in the Republic of Ireland, it remains illegal in Northern Ireland; the United Kingdom’s 1967 Abortion Act grants doctors in England, Scotland, and Wales the authority to perform abortions, but the law does not extend to Northern Ireland.
Zambia is one of the few countries in Africa where abortion is permitted for economic and social reasons, but, despite having a liberal law, structural and cultural barriers make it difficult for Zambian women to obtain abortions. Zambia has less than one practicing medical doctor per ten thousand inhabitants, and for the more than 60 percent of Zambians living in rural areas, health professionals are few and far between. The law stipulates that only a registered medical practitioner [PDF], and not a nurse or midwife, can perform an abortion, rendering safe access out of reach for most. Zambia is plagued by a high rate of abortion-related maternal mortality, with about 30 percent of maternal deaths caused by abortion complications.
El Salvador is one of only two countries to have imposed new restrictions on abortion since the 1994 Cairo Declaration, which recognized reproductive health as critical to development. (The other is Nicaragua.) During its reexamination of the penal code after a devastating thirteen-year civil war, El Salvador amended its abortion law—which already banned the procedure in most cases—to eliminate all exceptions, thereby imposing a blanket ban. Though a handful of other countries have equally restrictive abortion laws, El Salvador is unique in the severity of its enforcement: doctors are mandated to report suspected abortions, and there is even a special division of the prosecutor’s office that is tasked with investigating them. Between 2000 and 2011, more than 129 women were prosecuted for suspected abortion, and at least 13 remain in jail, some serving decades-long sentences.
Poland bans abortion with relatively few exceptions compared to its European neighbors, allowing it only in cases of rape or serious fetal abnormality, or to preserve the life and health of the mother. In 2016, when the government considered a bill to remove all exceptions from the prohibition, 150,000 women took to the streets in a nationwide strike, and the legislation was overwhelmingly rejected. Similar bills in Lithuania and Russia were ultimately tabled. In other Eastern European nations—including Armenia, Georgia, Macedonia, Russia, and Slovakia—recent legislation imposes preconditions on patients seeking abortions [PDF], such as mandatory waiting periods or counseling.