Context: The legal status of induced abortion helps determine the availability of safe, affordable abortion services in a country, which in turn influences rates of maternal mortality and morbidity. It is important, therefore, for health professionals to know both the current status of abortion laws worldwide and the extent to which those laws are changing.
Methods: Abortion-related laws in 152 nations and dependent territories with populations of one million or more were reviewed, and changes in these laws since 1985 were documented.
Results: Currently, 61% of the world's people live in countries where induced abortion is permitted either for a wide range of reasons or without restriction as to reason; in contrast, 25% reside in nations where abortion is generally prohibited. However, even in countries with highly restrictive laws, induced abortion is usually permitted when the woman's life is endangered; in contrast, even in nations with very liberal laws, access may be limited by gestational age restrictions, requirements that third parties authorize an abortion or limitations on the types of facilities that perform induced abortions. Since 1985, 19 nations have significantly liberalized their abortion laws; only one country has substantially curtailed legal access to abortion.
Conclusions: A global trend toward liberalization of abortion laws observed before 1985 appears to have continued in more recent years. Nevertheless, women's ability to obtain abortion services is affected not just by the laws in force in a particular country, but also by how these laws are interpreted, how they are enforced and what the attitude of the medical community is toward abortion.
International Family Planning Perspectives, 24(2):56-64.
Although the legal status of induced abortion is not the only factor influencing women's ability to access abortion services, it remains a key determinant. Where access to abortion is restricted by law, medically trained practitioners are usually less willing to provide the service, the cost of the service in private facilities may be high and services are rarely available in public hospitals (which are often the only source of safe medical care for low-income women).
In addition, in such countries, because training in abortion procedures often is not routinely provided to physicians, outmoded medical procedures may be used to perform the service and the provision of contraceptive services after an abortion may be overlooked. Women with an unwanted pregnancy also may not know a physician willing to risk prosecution by helping them. Moreover, fear of prosecution may even affect physicians' treatment of women with complications arising from spontaneous abortion or from unsafe clandestine abortion, and may cause women to delay seeking care. Where abortion is legal, maternal morbidity and mortality generally are lower, often because abortions are performed by trained medical professionals, are safer and more available, and cost less.
In this article, we update and expand on earlier work1 to briefly summarize the laws governing abortion in most countries around the world, and discuss all major changes in abortion laws since 1985 in countries with populations of more than one million. Whenever possible, our analysis is based on the texts of national laws. In some cases, we obtained translations and other information from such sources as the International Digest of Health Legislation (published by the World Health Organization) and the Annual Review of Population Law (published by the United Nations Population Fund and the Harvard Law School).
In addition, we derived extensive information regarding the interpretation of national laws from a series of books entitled Abortion Policies: A Global Review, which were published between 1992 and 1995 by the Population Division of the United Nations Department for Economic and Social Information and Policy Analysis. Finally, previously published works on abortion laws in Commonwealth countries2 and on abortion laws in Francophone countries3 also provided valuable information.
Determining the legal status of abortion in any given nation is a complex task. Laws regarding abortion are addressed in multiple statutes, codes and regulations, all of which apply simultaneously. Where abortion is generally available, numerous types of laws-including judicial opinions, social security laws and health codes-regulate it as a medical procedure. Where abortion is criminalized, it is usually addressed in the penal code. Yet most governments, even those that criminalize the procedure, permit abortion under at least some circumstances, and they may set forth these exceptions to the penal code in separate laws and decrees.
Abortion's legal status is also affected by general principles that apply to any type of law. For example, although the penal codes of some nations explicitly prohibit all abortions, other sections of these codes permit the "defense of necessity."* Thus, in such nations, an abortion necessary to save the life of a pregnant woman would be legal.
Overview of Current Laws
We classified the laws of 152 nations and dependent territories with a minimum population of one million into five categories indicating the circumstances under which a pregnant woman could legally obtain an abortion-to save her life, to preserve her physical health, to safeguard her mental health, on socioeconomic grounds and without restrictions as to reason. Rather than rely upon varying and unpredictable standards of interpretation, such as general medical practice or legal opinions issued by attorneys general, we categorized these laws based on a literal reading of the statutes, as they are interpreted in known binding judicial opinions and ministerial regulations.
In many countries, laws are interpreted more liberally than would be suggested by their literal interpretation; in others, they are interpreted more restrictively. In addition, the extent of enforcement may vary within countries. Therefore, our classifications do not necessarily indicate the extent to which legal abortion services are permitted in practice or are actually available. For example, although abortion is legally permitted in India on numerous grounds, the law is specific about the types of facilities and medical practitioners necessary to undertake a legal abortion procedure. Hence, legal abortion services are unavailable in many rural areas, and a majority of abortions provided are believed to be performed in facilities and by personnel not authorized by law. In contrast, Bangladesh permits abortion only to save a woman's life, yet the availability of menstrual regulation* services there ensures that abortion within eight weeks of a woman's last menstrual period is widely available.4
Countries in the first category of Table 1 (page 58) have the most restrictive laws. Those in each subsequent category recognize additional legal grounds for abortion. This progressive scheme is not affected by two other grounds for obtaining legal abortions-"juridical grounds" (when pregnancy results from rape or incest) and "fetal impairment grounds" (when there is a strong probability that the fetus has developed or will develop a serious anomaly). These supplementary grounds for abortion may be specified in their own right or may be regarded as factors affecting a woman's mental health or socioeconomic status when the law permits consideration of such conditions. Because nations that recognize juridical or fetal impairment grounds may fall into any of the first four categories in Table 1, we separately identify all such nations in the table.
Some countries permit abortion on additional grounds not appearing in Table 1. For example, Israel, in addition to permitting abortion on mental health, juridical and fetal impairment grounds, allows abortion when the pregnant woman is unmarried, under "marriage age" or older than 40.5
The most restrictive laws are those that either ban abortion entirely or permit it only to save the life of the pregnant woman. Such laws define abortion as a criminal offense, with penalties for the provider and often for the woman as well. Twenty-five percent of the world's population lives in the 54 countries-located mainly in Africa and Latin America-that have laws of this type.
These laws allow for saving the life of the woman in two ways. Many explicitly exempt from punishment providers who perform an abortion when a woman's life is in danger. For example, Tanzania's penal code states that "a person is not criminally responsible for performing in good faith and with reasonable care and skill a surgical operation upon . . . an unborn child for the preservation of the mother's life, if the performance of the operation is reasonable, having regard to the patient's state at the time, and to all circumstances in the case."6
Ashcroft Strikes Out
