Health, Abortion, And Pregnancy: Navigating Laws And Care

Abortion is a highly debated topic, with varying laws and social norms across the globe. In recent years, there has been a global trend towards the liberalization of abortion laws, with over 60 countries and territories relaxing restrictions. However, the issue remains contentious, especially in countries with restrictive abortion laws or where abortion is criminalized, such as the United States, Sierra Leone, Poland, and Morocco. The criminalization of abortion creates barriers for those seeking abortions, and often forces individuals to resort to unsafe methods, leading to maternal deaths, disabilities, and other health complications. Restrictive laws also disproportionately impact marginalized communities, who face additional social, economic, and political obstacles in accessing reproductive healthcare. The debate surrounding abortion centers on the belief in bodily autonomy and reproductive rights, with human rights organizations advocating for the decriminalization of abortion and access to safe and legal abortion services.

The criminalisation of abortion

Abortion is a common health intervention, with around 73 million induced abortions taking place worldwide each year. It is a simple procedure that can be safely and effectively managed by a wide range of health workers using medication or surgery. In the first 12 weeks of pregnancy, a medical abortion can be safely self-managed by the pregnant person outside of a healthcare facility.

Despite this, abortion is commonly regulated through criminal law, remaining a criminal offence in most countries. This means penalties can be imposed on those who have abortions, provide abortion services, assist with accessing abortion, or even provide information about abortion. Decriminalisation is a necessary step towards the legalisation of abortion, but further legal changes may be required to ensure abortion is available and accessible.

A systematic review of studies published between 2010 and 2019 demonstrated the impacts of criminalising abortion. The evidence showed that criminalisation delayed access to abortion and imposed a range of burdens on women, including unnecessary travel and cost, delayed or no access to post-abortion care, distress, and stigma. Criminalisation also contributed to a lower availability of trained abortion providers and increased bureaucracy within health systems.

Numerous human rights bodies and mandate holders support the full decriminalisation of abortion, including the CEDAW Committee, the CESCR, the United Nations Human Rights Committee, and the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. According to international human rights law, states must not require health workers to report cases of women or girls who have had abortions and must provide post-abortion care without the risk of criminal sanction. States also have a responsibility to take steps to reduce maternal morbidity and mortality and protect women and girls from the risks associated with resorting to unsafe abortions due to the criminalisation of the procedure.

Barriers to accessing abortion

Abortion is a common health intervention, and when carried out using a method recommended by the WHO, it is very safe. However, when people with unintended pregnancies face barriers to obtaining a safe and timely abortion, they often resort to unsafe methods. It is estimated that 25 million unsafe abortions take place every year, leading to maternal deaths and disabilities.

There are several barriers that prevent people from seeking abortions, including criminalisation, social stigma, and intersectional discrimination and marginalisation. These barriers can be further exacerbated by restrictive legislation, which can make it even more difficult for people to access safe and legal abortions.

Criminalisation of abortion

In some countries, such as the United States, Sierra Leone, Poland, and Morocco, abortion is criminalised. This means that people seeking an abortion or helping someone obtain an abortion can face legal consequences, including life imprisonment in some cases. Additionally, there may be laws in place that penalise people who assist others in seeking an abortion.

Restrictive laws and regulations

Restrictive abortion laws and regulations can create significant obstacles for people seeking abortions. These include bans on abortion at arbitrary gestational ages, requirements for mandatory counselling and waiting periods, ultrasound requirements, mandated parental involvement, and facility and staffing requirements known as Targeted Regulations of Abortion Provider (TRAP) laws. Such restrictions can make it difficult for people to access safe and timely abortions, particularly those from marginalised communities.

Financial barriers

Financial barriers can also pose significant challenges for people seeking abortions. The cost of the procedure, travel expenses, lost wages, and childcare costs can be significant, especially for those with low incomes. Insurance coverage restrictions further compound these financial barriers, as many public and private insurance plans do not cover abortion care.

Stigma and discrimination

Stigma and discrimination are powerful barriers to accessing abortion. Social stigma, religiously reinforced conservative attitudes, and intersectional discrimination can make it difficult for people to seek and obtain abortions. Additionally, healthcare workers may refuse to provide abortions based on personal conscience or religious beliefs, further limiting access.

Limited access to information and services

Limited access to accurate information and reproductive health services can also create barriers to abortion access. This includes a lack of information about abortion options, as well as limited clinic options and long wait times for appointments. In some cases, people may have to travel long distances or cross state lines to obtain an abortion, which can be burdensome and stigmatising.

Impact of barriers

The impact of these barriers can be significant, leading to delays in obtaining care, negative mental health outcomes, and even considering unsafe self-induced abortions. It is important to address these barriers to ensure that people can access safe and legal abortions and protect their health and well-being.

Abortion as a human right

Abortion is a common health intervention, with an estimated one in four pregnancies ending in abortion each year. It is a safe procedure when carried out by someone with the necessary skills and using a method recommended by the World Health Organization (WHO). However, around 45% of abortions are unsafe, and unsafe abortions are a critical public health and human rights issue.

Abortion is a basic healthcare need for millions of women, girls, and people who can become pregnant. It is also a human rights issue. Restrictive abortion laws and policies violate the human rights of those who can become pregnant, particularly those from marginalized communities. These laws and policies include the criminalization of abortion, social stigma, and intersectional discrimination and marginalization. Such barriers prevent people from seeking abortions and force them to resort to unsafe procedures, which can lead to fatal consequences such as maternal deaths and disabilities.

The right to abortion is connected to many rights enshrined in the Universal Declaration of Human Rights, such as the right to nondiscrimination, the right to health, and the right to be free from torture, discrimination, and cruel, inhuman, and degrading treatment. Restricting or banning access to abortion jeopardizes these rights and can result in more illegal and unsafe abortions, increasing the risk of maternal mortality and morbidity.

According to the World Health Organization, complications from pregnancy and childbirth are the leading cause of death for girls and young women aged 15 to 19, and children aged 10 to 14 are at a higher risk of health complications and death from pregnancy than adults. Restrictive abortion policies push pregnant people, especially those living in poverty or rural areas, out of the healthcare system and into unsafe, unregulated settings.

Laws and policies that ensure access to abortion must be passed to guarantee social, economic, gender, and reproductive justice for those who can become pregnant. Everyone has the right to bodily autonomy and reproductive autonomy, and states have the obligation to provide safe and legal abortion access as part of their core human rights responsibilities.

Abortion laws by country/state

Abortion laws vary widely among countries and territories, and they have changed over time. There is an overwhelming trend towards the liberalization of abortion laws, with more than 60 countries and territories having liberalized their abortion laws over the past 30 years. However, there are still countries with restrictive abortion laws, and only two countries have abortion laws that vary significantly at the state level.

Abortion Laws by Country

In some countries, abortion is freely available on request, while others have regulations or restrictions of various kinds, or even outright prohibition in all circumstances. Many countries that allow abortion have gestational limits for the procedure, with the majority being up to 12 weeks for abortion on request, up to 24 weeks for rape, incest, or socioeconomic reasons, and more for fetal impairment or risk to the woman's health or life. France is the first country to explicitly protect abortion rights in its constitution, while Yugoslavia implicitly inscribed abortion rights to its constitution in 1974.

According to a United Nations (UN) report, abortion is allowed in 98% of countries to save a woman's life. Other commonly accepted reasons are preserving physical (72%) or mental health (69%), in cases of rape or incest (61%), and in cases of fetal impairment (61%). Performing an abortion for economic or social reasons is accepted in 37% of countries, while performing abortion only on the basis of a woman's request is allowed in 34% of countries, including Canada, most European countries, and China.

Abortion Laws by State

In the United States, the Supreme Court's decision in Dobbs v. Jackson Women's Health Organization in 2022 overturned Roe v. Wade and eliminated the federal constitutional right to abortion. As a result, abortion laws and policies now vary by state. Currently, abortion is illegal in 13 states, with 21 states banning abortion or restricting it earlier in pregnancy than the standard set by Roe v. Wade. However, abortion remains legal in some states as courts determine whether these laws can take effect, and several states have added new protections since Dobbs.

Global Trend Towards Liberalization

The global trend towards the liberalization of abortion laws is evident, with an increasing number of countries recognizing abortion rights as fundamental human rights. However, there are still variations in abortion laws by country and state, with some regions imposing stricter restrictions on abortion access.

The consequences of unsafe abortions

Unsafe abortions are a critical public health and human rights issue, with around 45% of abortions worldwide falling into this category. They are a leading cause of maternal mortality, with the World Health Organization (WHO) estimating that 47,000 women and girls die each year from unsafe abortions. A further 5 million suffer long-term disabilities, including secondary infertility.

Unsafe abortions are defined by the WHO as those performed by untrained persons, using dangerous and invasive methods, or in environments that do not meet minimal medical standards. They are often the result of restrictive abortion laws, which force individuals to seek out clandestine and unsafe means of terminating a pregnancy. The consequences of unsafe abortions can be dire, with physical health risks including:

• Incomplete abortion, where not all pregnancy tissue is removed or expelled from the uterus
• Haemorrhage, or heavy bleeding
• Uterine perforation, caused by a sharp object piercing the uterus
• Damage to the genital tract and internal organs, due to the insertion of dangerous objects into the vagina or anus

In addition to the physical risks, unsafe abortions can also lead to mental health complications and social and financial burdens for those involved. The stigma associated with abortion, particularly in countries where it is criminalised or restricted, further compounds these issues. The lack of access to safe, legal, and affordable abortion care not only violates human rights but also results in preventable deaths and disabilities.

The impact of unsafe abortions is most severely felt in developing countries, where the vast majority of unsafe abortions occur. In these countries, weak health systems, lack of trained personnel, and inadequate supplies further contribute to the high health risks and costs associated with unsafe abortions. The secrecy and stigma surrounding abortion in these contexts often lead to women choosing secrecy over their own safety, resulting in severe and sometimes fatal complications.

Frequently asked questions