Association Between Legal Status and the Consequences of Abortion

Legal Status of Abortion in the World. A recent review of abortion legislation in the world (Center for Reproductive Rights, 2007) shows that the law permits abortion to save the life or to preserve the physical health of the pregnant woman in 63% of the 190 countries or territories with a population that exceeds one million. In addition, in 47% of these countries the law explicitly permits abortion for the preservation of the woman’s mental health.

In 37% of the countries, abortion is also allowed for socioeconomic reasons, and in 29% (39.3% of the world’s population) women do not need any justification to obtain a legal abortion, at least during the first 12 weeks of pregnancy. Abortion is permitted only to save a woman’s life or prohibited altogether in 69 countries inhabited by 26% of the world’s population (Center for Reproductive Rights, 2007).

Abortion laws tend to be more restrictive in developing countries. While in 87% of developed countries abortion is permitted upon request or for socioeconomic reasons, only 15% of developing countries have laws that are equally permissive. Laws tend to be more restrictive in Latin America and Africa than in other world regions (Table 1).

Table 1. Grounds on which abortion is permitted in 190 countries

In general, in addition to the circumstances in which abortion can be legally done, abortion laws establish other conditions that must be fulfilled, such as upper gestational age limit, the qualifications of the health professional(s) who can carry out abortions, and the facilities in which abortions can be performed, as well as requirements for informed consent, counseling, and waiting periods.

Legal Status and Abortion Rate. It is likely that the intention of legislators who sanction restrictive abortion laws is to inhibit its practice. Con­sidering that the highest incidence of abortion is ob­served in countries of Eastern Europe and Vietnam (60-100 per 1000 women of childbearing age) where abortion laws are rather liberal, and that countries in Latin America, where abortion is severely restricted, have moderate abortion rates (30-50), it would appear that the legislators in the latter group of countries have achieved their purpose.

However, abortion rates are five to ten times lower in Western European countries, such as the Netherlands and Germany (6-10), where abortion is broadly permitted and easily accessible (Henshaw et al., 1999). All in all, there are strong indications that legal prohibition is not an effective tool for reducing the incidence of abortion.

Abortion Law and Maternal Mortality. Whereas virtually all legal abortions are safe, the vast majority of illegal abortions are unsafe. The negative consequences of the criminalization of abortion were dra­matically illustrated by the increase in maternal mortality observed in Romania following the prohibition of both abortion and contraception in November of 1965. The abortion-related maternal mortality rate, which was below 20 per 100 000 live births in 1965, increased approximately eightfold to almost 150 per 100 000 live births between 1966 and 1988 (Stephenson et al., 1992).