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A Global Review of Laws on Induced Abortion, 1985–1997 by Anika Rahman, Laura Katzive and Stanley K

A Global Review of Laws on Induced Abortion, 1985–1997 by Anika Rahman, Laura Katzive and Stanley K

ARTICLES

A Global Review of on Induced , 1985–1997 By Anika Rahman, Laura Katzive and Stanley K. Henshaw

and the Annual Review of Population Context: The legal status of induced abortion helps determine the availability of safe, afford- (published by the Popula- able abortion services in a country, which in turn influences rates of maternal mortality and mor- tion Fund and the Harvard Law School). bidity. It is important, therefore, for professionals to know both the current status of abor- In addition, we derived extensive infor- tion laws worldwide and the extent to which those laws are changing. mation regarding the interpretation of na- Methods: Abortion-related laws in 152 nations and dependent territories with populations of tional laws from a series of books entitled one million or more were reviewed, and changes in these laws since 1985 were documented. Abortion Policies: A Global Review, which were published between 1992 and 1995 by Results: Currently, 61% of the world’s people live in countries where induced abortion is per- the Population Division of the United Na- mitted either for a wide range of reasons or without restriction as to reason; in contrast, 25% re- tions Department for Economic and Social side in nations where abortion is generally prohibited. However, even in countries with highly re- Information and Policy Analysis. Finally, strictive laws, induced abortion is usually permitted when the woman’s is endangered; in previously published works on abortion contrast, even in nations with very liberal laws, access may be limited by re- laws in Commonwealth countries2 and on strictions, requirements that third parties authorize an abortion or limitations on the types of fa- abortion laws in Francophone countries3 cilities that perform induced . Since 1985, 19 nations have significantly liberalized their also provided valuable information. abortion laws; only one country has substantially curtailed legal access to abortion. Determining the legal status of abortion Conclusions: A global trend toward liberalization of abortion laws observed before 1985 ap- in any given nation is a complex task. pears to have continued in more recent years. Nevertheless, women’s ability to obtain abortion Laws regarding abortion are addressed in services is affected not just by the laws in force in a particular country, but also by how these multiple statutes, codes and regulations, laws are interpreted, how they are enforced and what the attitude of the medical community is all of which apply simultaneously. Where toward abortion. International Planning Perspectives, 1998, 24(2):56–64. abortion is generally available, numerous types of laws—including judicial opin- ions, social security laws and health lthough the legal status of induced willing to risk prosecution by codes—regulate it as a medical procedure. abortion is not the only factor in- helping them. Moreover, fear of prosecu- Where abortion is criminalized, it is usu- Afluencing women’s ability to ac- tion may even affect ’ treatment ally addressed in the penal code. Yet most cess abortion services, it remains a key de- of women with complications arising from governments, even those that criminalize terminant. Where access to abortion is spontaneous abortion or from unsafe clan- the procedure, permit abortion under at restricted by law, medically trained prac- destine abortion, and may cause women least some circumstances, and they may titioners are usually less willing to provide to delay seeking care. Where abortion is set forth these exceptions to the penal code the service, the cost of the service in pri- legal, maternal morbidity and mortality in separate laws and decrees. vate facilities may be high and services are generally are lower, often because abor- Abortion’s legal status is also affected by rarely available in public hospitals (which tions are performed by trained medical general principles that apply to any type of are often the only source of safe medical professionals, are safer and more avail- law. For example, although the penal codes care for low-income women). able, and cost less. of some nations explicitly prohibit all abor- In addition, in such countries, because In this article, we update and expand on tions, other sections of these codes permit training in abortion procedures often is earlier work1 to briefly summarize the laws the “defense of necessity.”* Thus, in such not routinely provided to physicians, out- governing abortion in most countries nations, an abortion necessary to save the moded medical procedures may be used around the world, and discuss all major life of a pregnant woman would be legal. to perform the service and the provision changes in abortion laws since 1985 in coun- of contraceptive services after an abortion tries with populations of more than one mil- Anika Rahman is director of the International Program and may be overlooked. Women with an un- lion. Whenever possible, our analysis is Laura Katzive is a legal fellow at the Center for Repro- ductive Law and Policy, . Stanley K. Henshaw wanted also may not know a based on the texts of national laws. In some is deputy director of research with The Alan Guttmacher cases, we obtained translations and other Institute, New York. The authors would like to thank Eliz- abeth Roff and Taylor Haas for their research assistance *A general legal principle that, in the context of abortion, information from such sources as the In- and Rebecca Cook and Laura Bliss for their helpful com- excuses from criminal liability a who acts rea- ternational Digest of Health Legislation (pub- ments. The work upon which this article is based was sup- sonably to save her own life or the life of another. lished by the World Health Organization) ported in part by a grant from the Wallace Global Fund.

56 International Perspectives Overview of Current Laws Some countries permit abortion on ad- cerned or so constitutes a serious threat of We classified the laws of 152 nations and ditional grounds not appearing in Table 1. permanent impairment of her physical dependent territories with a minimum For example, , in addition to permit- health that termination… is necessary to population of one million into five cate- ting abortion on , juridical and ensure her life or physical health.”8 gories indicating the circumstances under fetal impairment grounds, allows abortion Laws that permit abortion to protect a which a pregnant woman could legally when the pregnant woman is unmarried, woman’s mental health are in force in 20 obtain an abortion—to save her life, to pre- under “marriage age” or older than 40.5 countries and affect approximately 4% of serve her physical health, to safeguard her The most restrictive laws are those that the world’s population. In most of these mental health, on socioeconomic grounds either ban abortion entirely or permit it only nations, legislation explicitly recognizes and without restrictions as to reason. to save the life of the pregnant woman. Such mental health grounds for abortion. How- Rather than rely upon varying and un- laws define abortion as a criminal offense, ever, several one-time British colonies, in- predictable standards of interpretation, with penalties for the provider and often for cluding , Gambia, and such as general medical practice or legal the woman as well. Twenty-five percent of , have retained Great opinions issued by attorneys general, we the world’s population lives in the 54 coun- Britain’s former, restrictive , categorized these laws based on a literal tries—located mainly in and Latin as it was interpreted in a 1938 English case reading of the statutes, as they are inter- America—that have laws of this type. (Rex v. Bourne) that permitted a legal abor- preted in known binding judicial opinions These laws allow for saving the life of the tion if continuing the pregnancy would and ministerial regulations. woman in two ways. Many explicitly ex- render the woman a “mental wreck.”9 In many countries, laws are interpreted empt from punishment providers who per- While the Bourne principle is theoreti- more liberally than would be suggested by form an abortion when a woman’s life is cally applicable in other Commonwealth their literal interpretation; in others, they in danger. For example, ’s penal countries that do not have superseding are interpreted more restrictively. In addi- code states that “a person is not criminal- legislation or judicial interpretations, tion, the extent of enforcement may vary ly responsible for performing in good faith physicians in those nations generally will within countries. Therefore, our classifica- and with reasonable care and skill a surgi- not perform abortions on mental health tions do not necessarily indicate the extent cal operation upon . . . an unborn child for grounds in the absence of explicit gov- to which legal abortion services are per- the preservation of the mother’s life, if the ernment recognition of such grounds.10 mitted in practice or are actually available. performance of the operation is reasonable, The interpretation of “mental health” For example, although abortion is legally having regard to the patient’s state at the varies around the world. It can encompass permitted in on numerous grounds, time, and to all circumstances in the case.”6 the psychological distress suffered by a the law is specific about the types of facili- Other nations recognize the defense of woman who is raped, the mental distress ties and medical practitioners necessary to necessity. In a number of countries in this caused by socioeconomic circumstances undertake a legal abortion procedure. category, such as Congo (Brazzaville) and or a woman’s psychological anguish over Hence, legal abortion services are unavail- , the penal codes permit the defense a medical opinion that a is at risk of able in many rural areas, and a majority of of necessity for a range of criminal acts, in- being impaired. For example, India’s abortions provided are believed to be per- cluding abortion, although they rarely Medical Termination of Pregnancy Act, formed in facilities and by personnel not au- specify the life-threatening conditions that which permits abortion on socioeconom- thorized by law. In contrast, would justify abortion. Moreover, even ic grounds, recognizes that the anguish of permits abortion only to save a woman’s when women and providers act within an unwanted pregnancy resulting from life, yet the availability of menstrual regu- these principles, they may still be subject contraceptive failure could constitute a lation* services there ensures that abortion to criminal prosecution. The principles “grave to the mental health of the within eight weeks of a woman’s last men- may be raised as a defense to such prose- pregnant woman,” and could thus justi- strual period is widely available.4 cution; the success of the defense is likely fy an abortion.11 Countries in the first category of Table 1 to be based upon the particular facts of the Twenty percent of the world’s popula- (page 58) have the most restrictive laws. situation and the manner in which they are tion lives in the six countries that permit Those in each subsequent category recog- received by the presiding judge or officer. abortion on socioeconomic grounds. Such nize additional legal grounds for abortion. Twenty-three countries, home to 10% of laws, which typically permit considera- This progressive scheme is not affected by the world’s population, have somewhat tion of a woman’s economic resources, her two other grounds for obtaining legal abor- less restrictive laws that permit abortion age, her marital status, and the number of tions—“juridical grounds” (when preg- to protect the pregnant woman’s physi- her living children, are generally inter- nancy results from or ) and “fetal cal health. These sometimes require that preted liberally. In some of these countries impairment grounds” (when there is a the threatened injury to health be serious (, and ), the strong probability that the fetus has devel- or permanent. ’s penal code, for ex- law allows the effect of the continued oped or will develop a serious anomaly). ample, lists abortion as a but states pregnancy on a woman’s living children These supplementary grounds for abortion that an abortion performed by a physician to be considered; in the others (, may be specified in their own right or may with the woman’s consent is “not pun- India and ), socioeconomic concerns be regarded as factors affecting a woman’s ishable” when it is the “sole means of sav- are placed within the framework of pro- mental health or ing the life of the pregnant woman or of tecting the woman’s health.12 when the law permits consideration of such avoiding grave and permanent harm to Finally, the least restrictive abortion conditions. Because nations that recognize her health.”7 A similar provision in Zim- laws—those that permit abortion without juridical or fetal impairment grounds may babwe’s Termination of Pregnancy Act al- fall into any of the first four categories in lows a pregnancy to be ended by a med- *Menstrual regulation is the aspiration evacuation of the , which can be performed manually with a syringe Table 1, we separately identify all such na- ical practitioner when its continuation “so and a hollow flexible plastic tube and is generally done tions in the table. endangers the life of the woman con- without confirmation of pregnancy.

Volume 24, Number 2, June 1998 57 A Global Review of Laws on Induced Abortion

Table 1. Countries, by restrictiveness of abortion law, according to region, 1997

Abortion The Americas Central Asia, East and South Asia Sub-Saharan restrictiveness and the Caribbean the and the Pacific Africa and North Africa

To save the –R Bangladesh Ireland woman’s life –ND –SA Mali Central African Rep. –ND –PA Congo (Brazzaville) Papua New Côte d’Ivoire –SA/PA Dem. Rep. of United Arab Congo–F –R Emirates–SA/PA –R –SA/PA Guinea-Bissau–SA/PA Tanzania –PA/R/F

Physical –R (limited) –SA/PA/F –R/I/F/PA –R/F/I –SA health –R/I –SA Rep. of Korea–SA/R/I/F –SA/PA –R –R –R/I (limited) –R/I/F Peru –R Guinea

Mental Jamaica–PA –F/R/I –F/R/I health Trinidad & Tobago –SA/F/R/I –F/R/I –PA/F/R Gambia –F/R/I Israel–F/R/I –F/R –F/R/I Sierra Leone –F/I

Socioeconomic India–PA/R/F Finland–R/F Zambia grounds Japan–SA Great Britain–F Taiwan–SA/PA/I/F

Without restriction –L * †–PA * * as to reason *–PA * –PA/L † –PV * * * –PV Kazakstan* N. Korea–L † Kyrgyz Rep.* ‡ Bosnia-Herze- * –L govina*–PA * * Tur key*–SA/PA *–PA * Czech Rep.*–PA * *–PA * *–PA † *–PA * §–PA * * Macedonia*–PA * –PV *–PA † Russian Fed.* Slovak Rep.*–PA *–PA ** * *–PA

*Gestational limit of 12 weeks. †Gestational limit of 14 weeks. ‡Gestational limit of 24 weeks. §Gestational limit of 90 days. **Gestational limit of 18 weeks. Notes: For gestational limits, duration of preg- nancy is calculated from the last menstrual period, which is generally considered to occur two weeks prior to conception. Thus, statutory gestational limits calculated from the date of conception have been extended by two weeks. ND=Existence of defense of necessity is highly doubtful. SA=Spousal authorization required. PA=Parental authorization required. R=Abortion allowed in cases of rape. I=Abortion allowed in cases of incest. F=Abortion allowed in case of fetal impairment. L=Law does not indicate gestational limit. PV=Law does not limit previability abortions. restriction as to reason—are found in 49 Several of these nations impose con- makes the final determination about countries that are home to 41% of the straints other than gestational limits on whether she will have an abortion. world’s population. China, the most pop- women who seek abortion services. For Several nations, including Australia, ulous nation, falls within this category, as example, Belgium requires that the preg- Canada, Mexico, Switzerland and the do most industrialized nations, including nant woman be in a state of “distress;” in United States, have a federal system of France, Germany, Italy, the Russian Fed- Italy, a woman must reflect upon her de- government in which each constituent eration and the United States. Many of cision for one week before terminating her portion of the federation—usually a local these nations, however, impose a gesta- pregnancy.13 We nevertheless classify state—may regulate abortion differently. tional limit on the period during which these countries in the “least restrictive” Local abortion regulations in Canada, women can readily access abortions. category because the woman herself Switzerland and the United States are sub-

58 International Family Planning Perspectives ject to federal limitations concerning the though, the need for the husband’s au- and ways to get help with social degree to which abortion can be restrict- thorization can be bypassed. For example, problems resulting from a pregnancy. In ed by local governments; in contrast, in Morocco requires spousal authorization, the United States, the Supreme Court in Australia and Mexico, laws regarding but the chief medical officer of a province 1992 upheld a state law requiring that abortion may vary throughout the nation. or prefecture may override the husband’s women seeking abortions be informed of In Table 1, we classify the legal status of refusal if a physician is able to demon- the nature and risks of the procedure and and Mexico in terms strate that the procedure is necessary to the likely gestational age of the fetus, and of the abortion law that affects the largest protect the woman’s health.16 be offered a brochure containing pictures part of the population. In addition, parental authorization for of and alternatives to abortion.21 a minor’s abortion is required in 28 na- In some cases, the information provid- Other Legal Restrictions tions. In several, though, including Den- ed to women attempts to be neutral by in- A nation’s laws often contain conditions mark, Italy and Norway, a minor may cluding a discussion of the risks of preg- that must be observed for an abortion to forgo parental authorization if she seeks nancy and . However, some be classified as legal. These additional re- authorization from a court or hospital counseling requirements seek to discour- strictions may include limits on gesta- committee instead.17 age abortion. Germany’s law is a striking tional age or on the type of medical facil- A number of nations also require abor- example of biased counseling: A woman ity in which the procedure may be tion providers to obtain approval from seeking an abortion is required to under- performed, requirements for third-party other doctors or professionals prior to per- go counseling aimed at dissuading her authorizations or for waiting periods, and forming an abortion. Benin and Lebanon, from terminating her pregnancy.22 mandatory counseling for and registration for example, impose on physicians a duty Counseling requirements are often ac- of the abortion. Governments justify the to consult with other doctors and to cer- companied by mandatory waiting peri- imposition of such constraints by citing tify that an abortion is necessary to save ods. In Germany, an abortion may only be concerns about the safety of abortion ser- the woman’s life. Even in countries with performed three days after counseling;23 vices, an interest in the protection of the relatively liberal laws, such as Great likewise, the U.S. Supreme Court upheld viable fetus, spousal and parental inter- Britain, two physicians must certify that a state’s mandatory 24-hour waiting pe- ests, and moral or ethical concerns. an abortion is legally justified. Laws vary riod, and a number of other U.S. states •Gestational age. Gestational age limits for in the number of concurring opinions they have similar requirements.24 Similarly, in abortion on request range from fetal via- require to approve the procedure. Israel Belgium, a woman may not have an abor- bility in the United States, Puerto Rico and and Panama, for instance, require ap- tion until six days after a physician has in- the Netherlands and 24 weeks in Singa- proval by a hospital committee or a panel formed her of the procedure’s risks and pore to 12 weeks in 33 nations (Table 1).14 of physicians.18 of alternatives to abortion.25 There is, however, no uniform method of •Medical facilities and personnel. Most na- •Restrictions on information. It is common calculating gestational age. In most coun- tions’ laws specify the types of medical fa- for countries to limit advertisements re- tries, the duration of the pregnancy is cal- cilities in which abortions may be per- garding abortion. Where restrictions on culated from the first day of the last men- formed and the categories of health abortion itself are minimal, as in France strual period. In others, pregnancy is providers permitted to perform this pro- and Greece, the policy may result from the deemed to begin on the estimated date of cedure. In Great Britain, India and South belief that medical care should be non- conception—about two weeks later. Often, Africa, for example, abortion services are commercial. Such restrictions on infor- the law does not specify which method of restricted to government hospitals or to mation generally distinguish commercial calculation should be used—thus poten- other authorized facilities. Bel- advertising for abortion services from in- tially allowing the law to be applied dif- gium requires only that abortions be per- formation directed toward medical pro- ferently depending on the method of cal- formed under “good medical conditions” fessionals. Where abortion is rarely per- culation used by the provider. For in a facility with adequate means of pro- mitted, an advertising ban is often a consistency, the gestational limits indi- viding the woman with counseling and in- component of the attempt to restrict abor- cated in Table 1 were all calculated from formation on the public support to which tion. For example, in several nations in the last menstrual period. she would be entitled should she deliver West and Central Africa, including In nations where abortions are available and elect either to keep the baby or put it Cameroon, Chad and Côte d’Ivoire, “in- until a particular gestational age, abortions up for adoption.19 citement to abortion” through the sale, dis- are still permissible after the prescribed Similarly, while laws may require that tribution or display of information is a gestational age, but only under limited cir- only licensed physicians perform abortions, criminal offense.26 cumstances. Several nations, such as Bel- a few nations—including Botswana and •Fees. Finally, while many governments gium, France, and Great Britain, permit an Cameroon—specify only that a registered that allow abortion on broad legal abortion at any time to protect a woman’s or qualified “medical practitioner” must grounds include it in their national health life or health or on fetal impairment perform the procedure. Costa Rican law insurance coverage, some are selective in grounds. Others, such as the Russian Fed- stipulates that if no physician is available, their funding of abortion services. Austria eration and South Africa, permit abortion a may perform an abortion. And and Lithuania only subsidize abortions on mental health or socioeconomic in Bangladesh, family welfare personnel performed for medical reasons. Other grounds beyond the gestational age limit, may perform menstrual regulations.20 grounds for subsidizing abortion include but before a specified point later in the •Mandatory counseling. Counseling re- rape (in Bulgaria) and the woman’s sta- pregnancy.15 quirements generally demand that a preg- tus as a minor (in Israel).27 A number of •Third-party authorization. Fourteen coun- nant woman be provided with information Central and Eastern European nations tries require a husband to authorize his about the risks of abortion, sources of sup- have instituted fees for abortion services wife’s abortion (Table 1). In some of these, port for married and unmarried mothers, since changing to a market .

Volume 24, Number 2, June 1998 59 A Global Review of Laws on Induced Abortion •Central Asia, North Africa and the Middle an attempt to reconcile the abortion laws Table 2. Countries that liberalized or restrict- East. In 1985, Algeria revised its public of the former East and West German re- ed their abortion law between January 1985 and December 1997, by region health laws to expand the grounds for publics, Germany adopted a law that legal abortion to include preservation of broadened the circumstances under which Region Country the woman’s mental health when it is “se- abortion is available in what was West Liberalized riously jeopardized” by the continued Germany, while restricting the circum- The Americas/ Canada* pregnancy. Abortion on this ground must stances in the former . The Caribbean 30 Central Asia/Middle Algeria occur prior to the viability of the fetus. new law provides that abortion cannot be East/North Africa •East and South Asia and the Pacific. Over- prosecuted during the first 14 weeks of East & South Asia/ Cambodia,* Malaysia, all, abortion laws in this region have been pregnancy and is available without limi- Pacific Mongolia,* Pakistan Europe Albania,* Belgium,* Bulgaria,* liberalized, with four countries having tation as to reason, but also adds several ,*,† Germany,* broadened their grounds for legal abor- new procedural requirements, including Greece,* Hungary,* Romania,* Spain tion: In 1989, Malaysia amended its penal mandatory counseling intended to dis- Sub-Saharan Africa Botswana, Burkina Faso, code to permit abortion within 120 days suade the woman from having an abortion. Ghana, South Africa* of conception when the continued preg- In addition, most abortions are no longer Restricted 35 Europe Poland nancy poses a threat to the woman’s life covered by national health insurance. or to her physical or mental health greater •Sub-Saharan Africa. The few changes that *Abortion now available without restriction during the first trimester. †Since 1993, the and the Slovak Republic. than would the termination of the preg- have occurred in Sub-Saharan Africa have nancy; in the same year, Mongolia amend- been in the direction of liberalization. ed its health law to permit most abortions Ghana amended its criminal code in 1985 Recent Trends during the first 12 weeks of , and to allow abortion to protect a woman’s Although induced abortion was almost at any time thereafter if the procedure is physical or mental health and on juridi- universally illegal in the first half of the medically necessary; in 1990, as part of an cal and fetal impairment grounds. In 1991, 20th century, laws were liberalized be- effort to render its penal code more com- Botswana amended its penal code to per- tween 1950 and 1985 in almost all indus- patible with Islamic law, Pakistan made mit abortion during the first 16 weeks of trialized nations and in a number of other abortion legal when the procedure con- gestation to preserve a woman’s life or nations around world.28 Table 2 docu- stituted “necessary treatment;” and in physical or mental health, as well as on ju- ments the most significant revisions, both 1997, Cambodia enacted a new abortion ridical and fetal impairment grounds; in liberalizing and restrictive, in abortion law making services permissible with no 1996, Burkina Faso amended its penal laws that have occurred between January justification required during the first three code to authorize abortion to protect a 1, 1985, and December 31, 1997, by indi- months of pregnancy.31 woman’s life or health and on juridical cating those legal changes that would •Europe. In the European region, change and fetal impairment grounds; and in the change a nation’s classification in Table 1 has been consistent with the global trend same year, South Africa enacted a new from one category to another. toward liberalization of abortion laws. abortion law (one of the most liberal in Overall, 19 countries have reduced re- Several formerly Communist nations re- Africa) that permits abortion with no jus- strictions on abortion, including 12 that visited their abortion laws. In Albania, tification required during the first 12 have made first-trimester abortion avail- Bulgaria, the former Czechoslovakia, weeks of pregnancy, within 20 weeks on able without restriction as to reason. Only Hungary and Romania, new laws permit numerous grounds and at any time if there one country has moved to a more restric- most abortions during the first 12 or 14 is a risk to the woman’s life or of severe tive category. This suggests that the liber- weeks of pregnancy.32 In Poland, where fetal impairment.36 alizing trend evident before 1985 has con- abortion had been permitted on socioe- Although not reflected in Table 2, recent tinued in recent years. In the last two years conomic grounds, the law was revised in events in other countries also merit mention. alone, two countries moved to permit 1993 to permit abortion only when a preg- •In 1989, Chile repealed a health code pro- abortion without restriction as to reason. nancy threatened the woman’s life or vision that permitted an abortion on “ther- However, draft bills that seek to limit abor- health and on juridical and fetal impair- apeutic” grounds; abortion is currently il- tion are currently under consideration in ment grounds. A more liberal law enact- legal on all grounds.37 a number of nations around the world. ed in 1996 was overturned by the Consti- •Similarly, El Salvador amended its Penal •The Americas. In North America, the most tutional Court in 1997.33 Code in 1997 to eliminate all exceptions significant change occurred in Canada, Abortion laws in Western Europe have to its prohibition on abortion.38 where the nation’s highest court struck also changed since 1985. In 1990, Belgium •In a 1994 case challenging Colombia’s re- down a national abortion law in 1988. No amended its penal code to permit a strictive abortion law, the Constitutional Canadian federal criminal law has re- woman in a state of “distress” to obtain an Court held that the is consti- placed the voided abortion law. While abortion before the end of the 12th week tutionally protected from the moment of abortion regulations have been introduced of gestation. In 1986, Greece liberalized its conception.39 in the provinces, those that tend to crim- abortion law, removing most restrictions •Although Indonesia enacted legislation inalize abortion are likely to be struck on abortion during the first 12 weeks of in 1992 to expand the circumstances under down as an unconstitutional infringement pregnancy. Finally, in 1985, the Spanish na- which an abortion is legal, the effect of on the federal government’s exclusive tional legislature amended the penal code such reform has been to further restrict power to enact criminal law. For example, to permit abortion when necessary to abortion services, because the former law in 1993, Canada’s Supreme Court nullified avert a “serious risk” to a woman’s phys- had been interpreted liberally.40 a provincial law that prohibited abortions ical or mental health.34 •Ireland’s Supreme Court held in 1992 from being performed in facilities other Furthermore, Germany has made sev- that a constitutional provision protecting than hospitals.29 eral changes in its abortion law. In 1995, in the right to life of the unborn did not pre-

60 International Family Planning Perspectives vent a 14-year-old rape victim from legal- times) nonexistent, the literal wording of countries, however, attempt to enforce ly traveling to to obtain an abor- laws paints an imperfect picture of their abortion restrictions not only against tion. Holding that abortion was not pro- impact on medical practice and on the ac- providers but also against women who hibited when there was a “real and tual availability of legal abortion services. have abortions. In Nepal, for example, substantial risk to the life” of the woman, Moreover, the attitudes of the is considered criminal the Court ruled that the girl could obtain community and the inadequacies of a under most circumstances, and is pun- an abortion because the procedure was country’s health care system may limit ishable by prison terms for both the necessary to prevent her from committing abortion availability even where services woman and the provider. While the exact suicide. In a subsequent referendum, a would be legally permissible. number who have served prison terms for proposed law excluding the risk of suicide abortion is unavailable, it is estimated that as a threat to life justifying abortion failed Varying Interpretations two-thirds of the women presently incar- to pass.41 While the right of Irish women There are many places where restrictive cerated in Nepal have been convicted of to travel to obtain an abortion under lim- laws have gradually been reinterpreted to undergoing an illegal abortion. Such ited circumstances is now firmly estab- allow abortion under a wider range of cir- women are disproportionately poor, since lished, abortion services remain essen- cumstances. In many postcolonial nations, wealthy women can discreetly obtain tially unavailable in Ireland. inherited restrictive laws have been modi- medically safe abortions in urban private •In Mexico, where abortion is regulated at fied by executive decrees. For example, , with little fear of prosecution. the state level, liberalization in some states while Mozambique retained Portugal’s for- (Some travel to India, where the abortion has coincided with restriction in others. For mer restrictive abortion law (which when law is less restrictive.) Women with few example, in 1985, reformed its penal enacted in 1886 prohibited all abortions ex- resources, however, turn to traditional code to permit abortion on fetal impairment cept those necessary to save the life of the birth attendants or attempt to induce an grounds, while in 1994, amend- woman), a 1981 Ministry of Health decree abortion themselves, risking both physi- ed its state constitution to protect the right permits abortions in hospitals for women cal injury and criminal prosecution.49 to life from the moment of conception.42 whose health is at risk or who become preg- In Chile, where abortion is illegal under •In its 1992 decision Panned Parenthood v. nant while using an .45 all circumstances, women who seek med- Casey, the U.S. Supreme Court recognized Similarly, because Haiti incorporated the ical treatment in public hospitals after that women seeking an abortion prior to French Penal Code of 1810 into its own being gravely injured during an unsafe must be able to do so with criminal law, abortion is legally forbidden abortion (either self-induced or performed minimal government intrusion, but held absent a threat to the woman’s life, but it by a nonmedical provider) are likely to that state restrictions designed to persuade is also officially permitted to preserve the face prosecution; certain hospitals rou- a woman to choose childbirth were per- woman’s physical health and on juridical tinely report such women to the police. An missible if they did not place an “undue and fetal impairment grounds. And In- estimated 1,000 abortion prosecutions oc- burden” on a woman’s ability to access an donesia observed an abortion law imposed curred per year during the mid-1980s. abortion. (This standard allows more re- upon it in 1918 by its Dutch colonizers— While prison sentences for women who strictions on a woman’s right to choose to one that prohibited abortion under all cir- have undergone abortions average only have an abortion than did the 1973 Roe v. cumstances—until the early 1970s, when 41 days, the penal code provides for five- Wade decision.) The result over the last five the Chief Justice of the Indonesian High year sentences, and pretrial detention may years has been an increase in state-level re- Court declared that medical professionals extend to several months. As in Nepal, strictions on abortion, such as mandatory would not be prosecuted for performing however, wealthy Chilean women can ob- counseling and waiting periods.43 abortions if their training and methods tain abortions in private clinics, where Efforts to liberalize abortion laws are un- were appropriate. Thus, before the law they are likely to receive safe services and derway in a number of nations, such as in was changed in 1992, some abortions were are unlikely to be reported to the police.50 Great Britain, Nepal, Northern Ireland, Por- tolerated in Indonesia.46 Prosecution of abortion patients has also tugal, Sri Lanka and Switzerland. In Nepal, In Switzerland, a national law permits been reported in Namibia, where abortion for example, where abortion is currently abortion if the woman’s life or health is is permitted on mental health grounds. prohibited under most circumstances, the threatened by the pregnancy, but it is in- While Namibia’s law is relatively liberal, parliament is considering a bill that would terpreted liberally in some cantons to the law’s procedural prerequisites—in- allow menstrual regulation on request up allow most abortions, while in other can- cluding approval requirements from mul- to 12 weeks. On the other hand, in other tons no abortions at all are permitted.47 tiple physicians—make abortion legally countries, attempts are being made to re- Among the 20 countries that allow abor- available only to wealthy and educated strict women’s access to abortion. For ex- tions for mental health reasons, national women, with poor and rural women often ample, in the former , where abortion statistics suggest that in Hong resorting to unauthorized procedures. since 1955 abortion laws had been among Kong, Israel and New Zealand, such pro- While the number of women prosecuted the most liberal, several national legisla- visions are interpreted to allow most for undergoing an abortion is unavailable, tures, including those of Belarus and the women seeking abortions to obtain them, press reports suggest that women seeking Russian Federation, have been consider- while in most of the others, relatively few clandestine abortions face a very real risk.51 ing restrictive abortion legislation.44 legal abortions are allowed.48 Other Factors Affecting Access Factors Affecting Availability Enforcement The legal status of abortion is not the Because laws are subject to widely vary- Restrictive abortion laws are difficult to only—or even necessarily the most im- ing interpretations by governmental au- enforce because in the absence of victims, portant—factor determining the avail- thorities and by medical personnel and authorities find it difficult to learn of vio- ability of safe abortion services. Much de- because enforcement is uneven or (some- lations and locate willing witnesses. Some pends on the attitude of the medical

Volume 24, Number 2, June 1998 61 A Global Review of Laws on Induced Abortion community and the public. In Nigeria, for now the case. In many countries that allow provided to abortion patients, all of which example, where abortion is permitted only abortion to save the woman’s life or in results in improved . if the woman’s life is in danger, the need case of rape or incest, no or very few abor- Given the global trend toward legal- for safe abortions is recognized by physi- tions are performed because of conserva- ization of abortion laws, the availability cians, and many private doctors offer the tive attitudes and complicated procedur- of safe services has been enhanced. How- service. Similarly, safe abortion services al requirements for obtaining approval. ever, a more complete picture of world- were provided openly by physicians in On the other hand, in some countries wide access to safe abortion services can parts of Belgium and the Netherlands be- government policy goes beyond permit- only be obtained after assessing both the fore those nations liberalized their laws.52 ting safe abortion to ensuring that services manner in which laws are interpreted and On the other hand, resistance by the med- are widely available. In Denmark, for ex- enforced and the attitudes of the medical ical community may make safe abortion ample, where the law states that a woman community toward induced abortion. services scarce even in circumstances where is “entitled” to undergo an abortion dur- it would be permitted. Physicians may take ing the first 12 weeks of pregnancy, coun- References a moral stance against abortion, refusing to ty health boards are responsible for pro- 1. Henshaw SK, Induced abortion: a world review, 1990, perform abortions even when the nation’s viding services, and each county has at Family Planning Perspectives, 1990, 22:76–89. law would allow it. This was the case in least one hospital with capacity to perform 2. Cook RJ and Dickens BM, Issues in Poland in 1991, when the Second National abortions. Abortions are free of charge for Law in the Commonwealth, London: Commonwealth Sec- retariat, 1986; and Cook RJ and Dickens BM, Emerging Congress of Polish Physicians declared women who obtain services in their own Issues in Commonwealth Abortion Laws, London: Com- abortion unethical when not necessary to counties. Similarly, France requires that monwealth Secretariat, 1982. protect a woman’s life and when pregnan- each local area have at least one public 3. Knoppers BM and Brault I, La Loi et L’Avortement dans 53 57 cy did not result from a criminal act. hospital that offers abortion services. les Pays Francophones, Montreal: Éditions Thémis, 1989. The ethical guidelines published by the In several countries, laws have been en- 4. Ramachandran P, India, in Sachdev P, ed., International Medical Council of the acted to counteract the violent tactics of Handbook on Abortion, New York: Greenwood Press, 1988, in 1992 are even more restrictive, declar- some citizens who oppose abortion. In pp. 244–245; and Akhter H, Bangladesh, in ibid., p. 39. ing that no circumstances exist under France, “obstruction of abortion services,” 5. Penal Law 5737–1977 (1994), art. 316, translated by A. which an abortion is medically justified. either by disrupting abortion facilities or by Greenfield, A.G. Publications, 1994. Thus, even if a doctor were to find some threatening providers or procurers of abor- 6. Penal Code (1945), art. 230. basis under Ireland’s restrictive abortion tion services, has been a criminal offense law for providing an abortion, doing so since 1993.58 The offense carries prison 7. Penal Code (1991), art. 119. might result in charges of medical mis- terms or fines (or both). There have been a 8. Termination of Pregnancy Act [Chapt. 15:10], Act 29 conduct and possible loss of the license to number of high-profile prosecutions under of 1977, §4. practice . In addition, the abor- this law.59 A similarly worded law enacted 9. R. v. Bourne, [1939] 1 K.B. 687, 694; [1938] All E.R. 617, tion laws of numerous countries, includ- in the United States in 1994 (known as the 619. ing Great Britain, Italy and Singapore, Freedom of Access to Entrances Act) 10. Population Division, United Nations (UN) Depart- have conscientious objection clauses.54 provides for prison terms and fines and cre- ment for Economic and Social Information and Policy 60 Analysis, Abortion Policies: A Global Review, Vol. III: Oman While the scope of these provisions re- ates a basis for private legal action. to Zimbabwe, New York: UN, 1995, p. 8. mains uncertain, they often permit med- ical and paramedical personnel who op- Conclusions 11. Medical Termination of Pregnancy Act, Act No. 34 of 1971, §3(2), Explanation I, reprinted in International Di- pose abortion on moral or religious Although women’s ability to choose abor- gest of Health Legislation, 1971, 22:965. grounds to declare their objection and be tion remains controversial, a majority of 12. Great Britain: (c 87) as amended by exempt from having to perform or assist the world’s women live in nations where Human Fertilization and Act 1990 (c37), in abortions in nonemergency situations. abortion is legal under many circum- §1(a); Taiwan: Eugenic Protection Law of 1984, chap. III, Physician and community opposition to stances. Moreover, in the past decade, the art. 9, translated in Annual Review of Population Law, 1984, abortion has left parts of Austria, Germany global trend toward the liberalization of Vol. 11, p. 345; Zambia: Termination of Pregnancy Act, Act No. 26 of 1972, art. 3(1)(a)(iii) reprinted in Interna- and the United States without abortion ser- abortion laws has apparently continued. tional Digest of Health Legislation, 1973, 24:448–49; Finland: vices, even though abortion is legally per- However, merely presenting the number Law No. 239 of 1970 on the interruption of pregnancy, mitted without restriction as to reason. of nations liberalizing or restricting their art. 1(2), translated in International Digest of Health Legis- In nations where abortion is allowed for laws may overstate the momentum to- lation, 1970, 21(4):699–700; India: Medical Termination health indications, medical providers may ward liberalization: Movements to restrict of Pregnancy Act, 1971, op. cit. (see reference 11); and Japan: Protection of Mothers’ Bodies Act, Law No. 105 read statutes narrowly. In Pakistan, for ex- abortion are active in many parts of the of June 26, 1996, chapt. III, art. 14(1). ample, physicians are cautious in their ap- world and have the support of influential 13. Belgium: Law of April 3, 1990, on the termination of plication of the abortion law, particularly religious authorities. pregnancy, ameding art. 350 of the Penal Code, translated in their reading of the term “necessary Abortion laws have an important in- in Annual Review of Population Law, 1990, Vol. 17, p. 336; treatment,” and will provide abortions fluence on the availability of safe and af- and Italy: Penal Code (Ulrico Hoepli, 1992), art. 5. only when the pregnant woman suffers fordable services. Where laws are liberal 14. United States and Puerto Rico: v. from a serious medical ailment, even and information about the location of Casey, 505 U.S. 833, 869–877 (1992); Netherlands: Ketting though the statute itself does not state that abortion services is more widely dissem- E, Netherlands, in Rolston E and Eggert A, eds., Abor- the “treatment” must be related to phys- inated, physicians are more likely to pro- tion in the New Europe, Westport: Greenwood Press, 1994, 55 pp. 173 & 180; and Singapore: Termination of Pregnan- ical health. Similarly, the laws of some vide services and usually are better cy Regulations of October 1, 1987, art. 3(2), reprinted in 56 countries (Ghana, for example ) permit- trained in modern methods of abortion. Annual Review of Population Law, 1990, Vol. 17, p. 348. ting abortion to preserve the woman’s In such nations, abortion services are also 15. Belgium: Law of April 3, 1990, amending art. 350 of mental health would allow more general offered in facilities, and con- the Penal Code, op. cit. (see reference 13); France: Public availability of abortion services than is traceptive services are more likely to be Health Code (Dalloz, 1995), art. L 162-12; Great Britain:

62 International Family Planning Perspectives Abortion Act 1967 (c 87) as amended by Human Fertiliza- 29. R v. Morgentaler, Smoling, and Scott, [1988] 1 S.C.R. 30, 43. Planned Parenthood v. Casey, 505 U.S. 833, 869-77 tion and Embryology Act 1990 (c37), §1(d); Russian Fed- 79-80; and The Queen v. Morgentaler, [1993] 3 S.C.R. 463, (1992); and CRLP, 1997, op. cit. (see reference 24). eration—formerly Union of Soviet Socialist Republics 516. 44. S. Thapa, Technical Advisor, Family Health Division, (USSR): Decree of Dec. 31, 1987, of USSR Ministry of 30. Act No. 85-05 on health protection and promotion, Ministry of Health, Kathmandu, Nepal, personal com- Health, §§1–2, translated in Annual Review of Population Feb. 16, 1985, translated in International Digest of Health munication, Feb. 19, 1998; E. Kotchkina, director, Gen- Law, 1988, Vol. 15, p. 39; and South Africa: on Ter- Legislation, 1985, 36(4):909. der Expertise Project, Moscow Center for Gender Stud- mination of Pregnancy, Act. No. 92, Nov. 12, 1996, art. 2(b). ies, Moscow, , personal communication, Feb. 18, 31. Malaysia: Act A727 of 1989 reprinted in Annual Re- 16. 1998; and E. Gapova, Centre for Gender Studies, Euro- Crown Decree No. 181-66 of July 1, 1967, art. 453, view of Population Law, 1989, Vol. 16, p. 32; Mongolia: De- translated in International Digest of Health Legislation, 1968, pean Humanities University, Minsk, Belarus, personal cree No. 200 of Dec. 23, 1989, §56, reprinted in Interna- communication, Feb. 22, 1998. 19:217. tional Digest of Health Legislation, 1993, 44(1):42; Pakistan: 17. Denmark: Law No. 350 of June 13, 1973, on the in- Ordinance VII, Sept. 5, 1990, §338, reprinted in Annual 45. Hardy E et al., Comparison of women having clan- terruption of pregnancy, Chapt. 3, §6, translated in In- Review of Population Law, 1990, Vol. 17, p. 345–346; and destine and hospital abortions: Maputo, Mozambique, ternational Digest of Health Legislation, 1973, 24: 773; Italy: Cambodia: Royal Kram No. NS/SKM/0196/06 of Nov. Reproductive Health Matters, 1997, 9:108–09. Penal Code (Ulrico Hoepli, 1992), art. 12; and Norway: 12, 1997, Art. 8. 46. Haiti: Population Division, UN Department for Eco- Law No. 50 of June 13, 1975, on the termination of preg- 32. Albania: International Planned Parenthood Federa- nomic and Social Information and Policy Analysis, 1993, nancy, as amended by Law No. 66 of June 16, 1978, §4, trans- tion European Network, Abortion Legislation in Europe, Feb. op. cit. (see reference 18), p. 45; and Indonesia: Hull TH, lated in International Digest of Health Legislation, 1979, 1997; Bulgaria: Decree No. 2 of Feb. 1, 1990 on the condi- Sarwono SW and Widyantoro N, 1993, op. cit. (see ref- 30(1):126. tions and procedures for the artificial termination of preg- erence 40). 18. Benin: Population Division, UN Department for Eco- nancy, translated in Annual Review of Population Law, 1990, 47. Dondénaz M et al., Interruptions de grossesse en Su- nomic and Social Information and Policy Analysis, Abor- Vol. 17, p. 340; Czech Republic: Law No. 66 of Oct. 20, 1986, isse 1991–1994, Bulletin des medecins suisses, 1996, tion Policies: A Global Review, Vol. I: Afghanistan to France, concerning the artificial termination of pregnancy, trans- 77:308–314. New York: UN, 1992, p. 50; and Lebanon: Population Di- lated in International Digest of Health Legislation, 1988, 48. Henshaw SK, 1990, op. cit. (see reference 1). vision, UN Department for Economic and Social Infor- 39(3):642; Hungary: Law No. 79 of Dec. 17, 1992, on the pro- mation and Policy Analysis, Abortion Policies: A Global Re- tection of the life of the fetus, translated in International Di- 49. Thapa P, Thapa S and Shrestha, N, A hospital-based view, Vol. II: Gabon to Norway, New York: UN, 1993, p. 102; gest of Health Legislation, 1993, 44(2):249; Romania: Decree- study of abortion in Nepal, Studies in Family Planning, Great Britain: Abortion Act 1967 (c 87) as amended by Law No. 1 of Dec. 26, 1989, translated in International Digest 1992, 23(5):311; and Goodwin J, Prisoners of biology, On Human Fertilization and Embryology Act 1990 (c37), §1; of Health Legislation, 1992, 43(3):530; and Slovak Republic: the Issues, 1996, 5(4):17. Israel: Penal Law 5737-1977 (1994), art. 315, translated by Law on Abortion, No. 73 of Oct. 23, 1986, translated in An- 50. Casas-Becerra L, Women prosecuted and imprisoned A. Greenfield, A.G. Publications, 1994; and Panama: Res- nual Review of Population Law, 1986, Vol. 13, p. 39. for , Reproductive Health Matters, 1997, olution No. 1, Ministry of Health, April 21, 1989, translated 33. Law of Jan. 7, 1993, on family planning, protection 9:29–30. in Annual Review of Population Law , 1989, Vol. 16, p. 34. of human fetuses, and the conditions under which preg- 51. Committee on the Elimination of All Forms of Dis- 19. Great Britain: Abortion Act 1967 (c 87) as amended by nancy termination is possible, translated in Internation- crimination Against Women, Consideration of Reports Sub- Human Fertilization and Embryology Act 1990 (c37), §1; al Digest of Health Legislation, 1993, 44(2):253; and Repro- mitted by States Parties Under Article 18 of the Convention India: Medical Termination of Pregnancy Act, 1971, op. ductive Freedom News, June 6, 1997, VI(10):7. on the Elimination of All Forms of Discrimination Against cit. (see reference 11), §4; South Africa: Choice on Ter- 34. Belgium: Law of April 3, 1990, op. cit. (see reference Women: Namibia, Article 12.5, CEDAW/C/NAM/1, 1997. mination of Pregnancy, Act. No. 92, Nov. 12, 1996, art. 3; 13); Greece: Law No. 1609 of June 28, 1986, on voluntary and Belgium: Law of April 3, 1990, amending art. 350 of 52. Nigeria: Okonofua F, Preventing in termination of pregnancy, etc., translated in Internation- the Penal Code, op. cit. (see reference 13). Nigeria, African Journal of Reproductive Health, 1997, al Digest of Health Legislation, 1986, 37(4):793; and Spain: 1:25–36; Belgium: Temmerman M, Amy J, and Thiery M, 20. Organic Law No. 9, July 5, 1985, translated in International Botswana: Penal Code (Amendment) Act of Oct. 11, Belgium, in Sachdev P, 1988, op. cit. (see reference 4), pp. Digest of Health Legislation, 1985, 36(3):614. 1991, reprinted in Annual Review of Population Law, 1991, 49–50; and the Netherlands: Ketting E, 1994, op. cit. (see Vol. 18, p. 322; Cameroon: Penal Code (1969), art. 339(2); 35. Assistance to Pregnant Women and Amend- reference 14). Costa Rica: Penal Code (Porvenir, 1988), art. 121; and ment Law of Aug. 21, 1995, translated in International Di- Bangladesh: Akhter H, 1988, op. cit. (see reference 4), p. 39. 53. Population Division, UN Department for Econom- gest of Health Legislation, 1996, 47(1):34; and Funk N, The ic and Social Information and Policy Analysis, 1995, op. 21. Planned Parenthood v. Casey, 505 U.S. 833, 881–884 status of women in new market : abortion cit. (see reference 10) p. 38. (1992). counselling and the 1995 German Abortion Law, Con- necticut Journal of International Law, 1996, 12:33 & 42. 54. Ireland: Tiedemann J, The abortion controversy in 22. Penal Code (C.H. Beck, 1997) §219. the Republic of Ireland and Northern Ireland and its po- 36. Ghana: Criminal Code (Amendment), 1985, Feb. 22, 23. Ibid., §218a. tential effect on unification, Loyola of Los Angeles Inter- 1985, amending Criminal Code (29), 1960, §§58–59; national and Comparative Law Journal, 1995, 17:737–760; 24. Planned Parenthood v. Casey, 505 U.S. 833, 885–887 Botswana: Penal Code...1991, op. cit. (see reference 20); Great Britain: Abortion Act 1967 (c 87) as amended by (1992); and Center for Reproductive Law and Policy Burkina Faso: IPPF, 1997, op. cit. (see reference 26), p. 8; Human Fertilization and Embryology Act 1990 (c37), (CRLP), The status of a woman’s right to choose abor- and South Africa: Choice on Termination of Pregnancy, §4(1); Italy: Penal Code (Ulrico Hoepli, 1992), art. 9; and tion, Reproductive Freedom in the States, Jan. 15, 1997. Act. No. 92, Nov. 12, 1996, art. 2. Singapore: Shin M, Singapore, in Library of Congress, 25. Law of April 3, 1990, amending art. 350 of the Penal 37. Act No. 18.826 of Aug. 24, 1989, translated in Annu- ed., Report for Congress: Abortion Laws and Policies in Se- Code, op. cit. (see reference 13). al Review of Population Laws, 1989, Vol. 16, p. 28. lected Foreign Countries, , DC: Library of Con- gress, 1996, pp. 112 & 114. 26. International Planned Parenthood Federation (IPPF), 38. Decree No. 1030, Jan. 20, 1998, Chap. II, §§ 133–37. Le Conférence de Cotonou: Élimination des barrières ju- 55. Rahman A, A view towards women’s reproductive 39. Constitutional Court, Decision C-133/94, March 17, ridiques à la santé sexuelle et reproductive en Afrique rights perspective on selected laws and policies in Pak- 1994. francophone, 1997, pp. 9, 15, 22 & 23. istan, Whittier Law Review, 1994, 15(4): 981, 994–995. 40. Hull TH, Sarwono SW and Widyantoro N, Induced 56. 27. Austria: Population Division, UN Department for CRLP and International Federation of Women abortion in Indonesia, Studies in Family Planning, 1993, Economic and Social Information and Policy Analysis, Lawyers (Kenya Chapter), Women of the World: Laws and 24:241. 1992, op. cit. (see reference 18), p. 33; Lithuania: Inter- Policies Affecting their Reproductive Lives, New York: CRLP, national Planned Parenthood Federation (IPPF) Euro- 41. Attorney General v. X and Others, [1992] 1 I.R. 1, 53; 1997, p. 39. pean Network, Abortion Legislation in Europe, London: and Hamilton L, Matters of life and , Fordham Law 57. Denmark: Rasmussen N, Denmark, in Rolston E and IPPF, Feb. 1997; Bulgaria: Population Division, UN De- Review, 1996, 65:543, 557. Eggert A, 1994, op. cit. (see reference 14), p.75; France: partment for Economic and Social Information and Pol- Decree No. 88-59 of Jan. 18, 1988, . . . concerning public 42. Grupo de Informacíon en Reproducíon Elegida, icy Analysis, 1992, op. cit. (see reference 18), p. 63; and hospital establishments required to carry out voluntary Nuevas Estrategias para Abordar el Tema de los Derechos Re- Israel: Sabatello EF, Estimates of demand for abortion terminations of pregnancy, translated in International Di- productivas, : Grupo de Informacíon en Re- among Soviet immigrants in Israel, Studies in Family Plan- gest of Health Legislation, 1989, 40(1):79. producíon Elegida, 1995, p. 53; and Madrigal I, Cambios ning, 1992, 23:268–271. en la tipification y penalizacion del aborto en el estado 58. Act No. 93-121 of Jan. 27, 1993, concerning diverse 28. Henshaw SK, 1990, op. cit. (see reference 1). de Chihuahua, 1997, unpublished. measures of social order.

Volume 24, Number 2, June 1998 63 A Global Review of Laws on Induced Abortion

59. Dassonville A, La Cour de cassation rejette les ar- rio, incluso en naciones con leyes muy libera- tant au moins un million d’habitants a été exa- guments des commandos anti-IVG, Le Monde, Nov. 29, les, el acceso puede estar limitado por restric- minée, et son évolution documentée depuis 1985. 1996; and Aulagnon M, Les commandos anti-avortement ciones respecto al período de la gestación, por Résultats: 61% de la population du monde vi- ont échoué dons leur volonté de fragiliser la loi, Le Monde, Apr. 20, 1996. requisitos de que una tercera parte autorice un vent aujourd’hui dans des pays où l’avortement aborto o por limitaciones respecto al tipo de ins- provoqué est admis pour un large éventail de 60. Freedom of Access to Clinic Entrances Act of 1994, May 26, 1994. talaciones para realizar abortos inducidos. raisons ou sans justification requise. Par contre, Desde 1985, 19 naciones han liberalizado sig- 25% résident dans des nations où la procédure Resumen nificativamente sus leyes sobre aborto; sólo un est généralement interdite. Même dans les pays Contexto: El estado legal del aborto inducido país ha reducido el acceso legal al aborto. soumis à des législations particulièrement res- ayuda a determinar la disponibilidad de servi- Conclusiones: La tendencia global hacia la li- trictives, toutefois, l’avortement provoqué est cios seguros y asequibles en un país, lo cual a su beralización de las leyes de aborto observada généralement admis lorsque la poursuite de la vez influye en los índices de mortalidad y mor- antes de 1985 parece continuar en los últimos grossesse mettrait autrement la vie de la femme bilidad maternas. Es importante, por lo tanto, años. Sin embargo, la capacidad de las mujeres en danger. Même dans les nations dotées de lois para los profesionales de salud conocer el esta- de obtener servicios de aborto se ve afectada no fort tolérantes, par contre, l’accès à la procé- tus actual de las leyes de aborto a nivel mundial solamente por las leyes de un país concreto, sino dure peut être limité par des restrictions d’âge y en qué medida estas leyes están cambiando. también por la forma en que son interpretadas gestationnel, des exigences d’autorisation de Métodos: Las leyes relacionadas con aborto estas leyes, cómo se respetan y cuál es la acti- tiers ou d’autres restrictions quant aux types en 152 naciones y territorios dependientes con tud de la comunidad médica hacia el aborto. d’établissements autorisés à la pratiquer. De- poblaciones de un millón de habitantes o más puis 1985, 19 nations ont considérablement li- han sido revisadas y se han documentado los Résumé béralisé leurs lois sur l’avortement; un seul pays cambios producidos en estas leyes desde 1985. Contexte: Le statut légal de l’avortement pro- y a réduit l’accès légal. Resultados: Actualmente, el 61% de la po- voqué permet de déterminer la disponibilité de Conclusions: La tendance mondiale de libé- blación mundial vive en países donde el abor- services d’avortement sûrs et abordables dans ralisation des lois sur l’avortement observée to inducido está permitido bien ante una am- un pays, et cette accessibilité influence à son avant 1985 semble s’être poursuivie ces der- plia variedad de razones o sin que se requiera tour les taux de mortalité et de morbidité ma- nières années. L’aptitude des femmes à obte- justificación alguna; en contraste, el 25 % re- ternelle. Il est dès lors important pour les pro- nir la procédure est cependant affectée, non side en naciones donde el aborto está general- fessionnels de la santé de connaître à la fois seulement par la législation en vigueur dans mente prohibido. Sin embargo, incluso en pa- l’état courant des lois sur l’avortement dans un pays particulier, mais encore par la manière íses con leyes altamente restrictivas, el aborto le monde et leur évolution. dont cette législation est interprétée et exécu- inducido por lo general es permitido cuando la Méthodes: La législation régissant l’avortement tée, et aussi par l’attitude des cercles médicaux vida de la mujer está en peligro; por el contra- dans 152 nations et territoires dépendants comp- à l’égard de l’avortement.

64 International Family Planning Perspectives

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