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A Review of Abortion Laws in Western-European Countries. A Health Policy 118 (2014) 95–104 Contents lists available at ScienceDirect Health Policy journa l homepage: www.elsevier.com/locate/healthpol A review of abortion laws in Western-European countries. A cross-national comparison of legal developments between 1960 and 2010 a,∗ b c Mark Levels , Roderick Sluiter , Ariana Need a School of Business and Economics, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands b Department of Sociology, Radboud University Nijmegen, PO Box 9104, 6500 HE Nijmegen, The Netherlands c Institute for Innovation and Governance Studies, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands a r t i c l e i n f o a b s t r a c t Article history: The extent to which women have had access to legal abortions has changed dramatically Received 13 July 2013 in Western-Europe between 1960 and 2010. In most countries, abortion laws developed Received in revised form 19 March 2014 from completely banning abortion to allowing its availability on request. Both the tim- Accepted 30 June 2014 ing and the substance of the various legal developments differed dramatically between countries. Existing comparative studies on abortion laws in Western-European countries Keywords: lack detail, usually focus either on first-trimester abortions or second trimester abortions, Induced abortion cover a limited time-span and are sometimes inconsistent with one another. Combining Legal status information from various primary and secondary sources, we show how and when the Health care reform conditions for legally obtaining abortion during the entire gestation period in 20 major Family planning policies Western-European countries have changed between 1960 and 2010. We also construct a cross-nationally comparable classification of procedural barriers that limit abortion access. Our cross-national comparison shows that Western-Europe witnessed a general trend towards decreased restrictiveness of abortion laws. However, legal approaches to regu- lating abortion are highly different in detail. Abortion access remains limited, sometimes even in countries where abortion is legally available without restrictions relating to reasons. © 2014 Elsevier Ireland Ltd. All rights reserved. 1. Introduction characterized as liberalization of abortion laws. The process of liberalizing abortion laws differed markedly between Abortion laws in Western-European countries root from various countries, as the legislative processes that are asso- Penal Codes that criminalized abortion under all cir- ciated with changing abortion laws took place in highly cumstances. However, during the past fifty years, most differing political and social contexts. This article aims countries have replaced Penal Code provisions pertaining to provide a comprehensive review of national develop- to abortion by laws that specify circumstances in which ments in abortion laws in 20 Western-European countries abortions can be legally obtained [1]. Almost all Western- between 1960 and 2010. It contains a concise but complete European countries have completed a process that can be description of all relevant legal changes and judicial deci- sions that determined the legality of abortion in European countries in the last fifty years. In addition, we classify his- ∗ torical and current abortion laws in the various Western- Corresponding author. Tel.: +31 43 388 36 19; fax: +31 43 388 49 14. European countries in a way that allows for a cross-national E-mail addresses: [email protected] (M. Levels), [email protected] (R. Sluiter), [email protected] (A. Need). comparison of the long-term trends in abortion law reform. http://dx.doi.org/10.1016/j.healthpol.2014.06.008 0168-8510/© 2014 Elsevier Ireland Ltd. All rights reserved. 96 M. Levels et al. / Health Policy 118 (2014) 95–104 We also describe the societal and political contexts of the the treatment by a second physician and the obligation for legal developments, and identify relevant actors. pregnant women to receive pre-abortion counseling. The existing body of literature about the legal status To overcome these problems, this study presents a of abortion in Western-European countries has important cross-national comparison of abortion laws that combines limitations. First, commonly used designs have impor- the level of detail provided by case studies with the high tant drawbacks. Most existing studies describe the extent comparability of cross-national comparisons. We describe to which abortion is permitted in a number of multiple how the conditions for legally obtaining an abortion and countries at a single point in time [2–6]. These studies the procedural barriers changed in 20 major Western- provide an up-to-date comparative foundation for explana- European countries between 1960 and 2010. tory studies [7,8] and policy initiatives on reproductive To allow for cross-nationally comparing the legal devel- health and women’s rights but we cannot learn from opments, we propose a categorization that builds on them how abortion legislation evolves. To address ques- earlier cross-national comparisons, but updates the exist- tions regarding legal developments, information about the ing categorizations on some crucial points. Of course, way abortion laws have developed over time in various it is impossible to devise a cross-nationally comparable countries is essential. Available case studies describe how categorization of laws without losing information about the legal status of abortion has developed over time in sin- idiosyncrasies of national laws, as a generalized classifi- gle countries [9–18]. These studies often contain detailed cation cannot encapsulate the subtleties typical for the and elaborate descriptions of the legal proceedings in the abortion law in a certain country. To provide complete various countries, but cannot be straightforwardly used for information about the national abortion laws and to make cross-national comparisons. Existing cross-national stud- transparent how we made decisions in our categorization, ies of developments over time usually classify laws in a way the development of national laws and the specific provi- that allows for the cross-national comparison of the legal sions in each of the national laws are provided in the Online status of abortion [1,19–24], but mostly cover a limited Supplement. Furthermore, to understand how and why time-span, typically about a decade. As the development of abortion laws have evolved the way they did, we provide abortion laws mostly is a long-term, gradual process, stud- a review of the relevant research findings to identify the ies that focus on a short time risk missing out on important most important actors that influenced the process of legal developments outside the observation window. reforms in Western Europe, as well as the social, politi- Second, used sources on abortion laws are sometimes cal and legal contexts within which these actors sought to contradictory. First, legal developments are sometimes facilitate or frustrate abortion law reforms. We focus on reported in different years by different studies. For exam- Western European countries, because (1) legislative devel- ple, while most scholars place the legalization of abortion opments in these countries have comparable origins as in France in 1975 [19,24], at least one study reports that they mostly result from democratic legislative and juridi- in France abortion was made legally available on request cal procedures and (2) the variation of abortion laws in as early as 1953 [25]. Also, scholars sometimes interpret Western-European countries covers the full legal spectrum laws differently. For example, one study classifies the Dutch of permissiveness. Laws vary between the most restrictive abortion law of 1981 as allowing women to have an abor- to the most liberal law imaginable. However, even the most tion in case the life of the pregnant woman is at risk, liberal laws impose some restrictions. or to preserve her physical or mental health [20]. Others [3,24,26,27] argue that abortion is available on request. The 2. Materials and methods confusion might be caused by differences between the let- ter and the spirit of the law. Dutch law requires women to To comprise the overview of cross-nationally compa- state that they are in a situation of serious distress (that rable information about Western-European abortion laws cannot be resolved by any other means than abortion), by between 1960 and 2010, we first built a corpus that com- which it appears as if preserving the mental health is a legal bines information from five main sources. First, the most ground for abortion. However, there is no third party that obvious sources of primary information about the legal needs to certify whether women are actually in a state of developments in different countries are the official texts of distress. Therefore, abortion is de facto available on request. national abortion laws. The legal texts are published in the Literature on abortion laws is filled with little inconsisten- official language(s) of the country that codifies them, mak- cies like the ones described here. ing the information less accessible to scholars not proficient Finally, existing studies arguably are too focused. Most in that particular tongue. Second, English translations of comparisons of abortion policies discuss the legal grounds almost all relevant laws (Penal Codes and health-related for obtaining legal abortions. Certainly, the legality of laws) that were passed between 1948 and 1999 are dis- abortion
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