ABORTION LAWS A SURVEY OF CURRENT WORLD LEGISLATION WORLD HEALTH ORGANIZATION GENEVA 1971 This survey of existing legislation on abortion is based on such source material as was available, for each of the countries concerned, at the Head- quarters of the World Health Organization up to the end of September 1970. As with all such surveys, it is not intended to provide an exhaustive coverage of world legislation in the field in question, but to give typical examples of the form that such legislation has taken. O World Health Organization 1971 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. Nevertheless governmental agencies or learned and professional societies may reproduce data or excerpts or illustrations from them without requesting an authorization from the World Health Organization. For rights of reproduction or translation of WHO publications in toto, application should be made to the Division of Editorial and Reference Services, World Health Organization, Geneva, Switzerland. The World Health Organization welcomes such applications. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country or terri- tory or of its authorities or concerning the delimitation of its frontiers. PRINTED IN PRANCE CONTENTS Page Introduction ........................................................... 4 General survey of 1eg:islation .......................................... 6 Legislation in different areas of the world Africa ............................................................. 22 America ........................................................... 24 Asia .............................................................. 31 Western and Southern Europe ....................................... 38 Eastern Europe ................................................... 47 Scandinavia ........................................................ 59 Australia and New Zealand ......................................... 67 References ............................................................. 69 Introduction " Abortion is the dread secret of our society. It has been relegated for so long to the darkest corners of fear and mythology that an unwritten compact virtually requires that it remain untouched and undiscussed " - so writes Lader in the introductory remarks of his 1966 work on abor- tion.60 While it was in fact true until quite recently that the number of papers devoted to the problem was comparatively small, this is no longer the case, as witnessed by G. K. af Geijerstam's annotated biblio- graphy of induced abortion, which includes some 1175 reference^.^^ Of the latter, a large number relate to studies of the legislation, either in a particular country or region or even more comprehensive in scope. Among the regional or general studies, particular mention should be made of those published by R. Roemer, C. Tietze, K.-H. Mehlan, M. Potts, A. F. Guttmacher, H. P. David, P. 0. Hubinont, 0.Akinla and I. R. Nazer. In addition, various international conferences have dealt with the prob- lem in recent years, as, for example, the United Nations World Popula- tion Conference, held in Belgrade in 1965,109 the Eighth International Conference of the International Planned Parenthood Federation, held in Santiago, Chile, in 1967,41 the international conference convened'by the Association for the Study of Abortion at Hot Springs, Virginia, in 1968,40 and the Pakistan International Family Planning Conference at Dacca in 1969,98 to cite only the most recent of these meetings. It is no doubt a truism to affirm that the fact that a large number of countries have not faced up to the problem of abortion is solely due to religious and moral obstacles to any discussion of the question. More- over, in practice, the physician himself is confronted with problems of professional ethics or conscience which may, even where the legislation is particularly flexible, militate against his carrying out the pertinent provisions. On the other hand, in countries where the law is framed in uncompromising terms, the physician may be faced with dramatic situations in which the performance of an abortion, even if clearly jus- tifiable, may have formidable consequences. It may be remarked that whenever countries introduce more liberal legislation on abortion, the argument most frequently advanced to explain the change of attitude is the need to combat criminal abortion more effectively. It is well known that in those countries where abortion legislation is most restrictive, the number of illegal abortions can be counted in hundreds of thousands. It is a notorious fact that a woman resolved to have an abortion will not be diverted from her objective, in spite of its illegality, after being refused by a physician. In such cases, she inevitably has recourse to the services of a professional abortionist, with all the dangers that this involves. Many authors have, moreover, pointed out that even where the legislation on abortion is liberal in cha- racter, the number of illegal abortions may remain high. ABORTION LAWS 5 The liberalization of abortion legislation or, on the other hand, the imposition of restrictive legislation, may have quite striking demographic consequences. Tc cite an example, a country which in 1966 imposed more rigid criteris. than previously for legal abortion showed a tripling in the birth rate a year later. While it can be stated, in general, that the current world tendency is towards a liberalization of the legisla- tion on abortion, certain countries have in contrast moved in the opposite direction, either on account of the abuses arising from an excessively free interpretation of the provisions in force or because of a desire to avoid a diminution in the birth rate. If one studies the evolution of legislative provisions on abortion, one finds that the problem is generally first dealt with in the penal legisla- tion. Usually repressive to begin with, this legislation may later evolve to provide for cases in which abortion is not punishable and, in particular, those where it is justified on medical grounds, i.e. to safeguard the life or health of the woman. For those countries envisaging a further libe- ralization of their legislation on the subject, the next stage is the intro- duction of specific provisions laying down the indications and contra- indications and the procedure to be followed for obtaining authorization of abortion. The parallel obligation to provide advice on contraception is frequently included in such enactments. Provision is even made in some cases for sterilization. Mention should be made at this point of an aspect which is not without interest, namely the influence of legislation promulgated in a particular country on that of other countries. This was, for example, the case with Icelandic legislation for the other Scandinavian countries, French law for numerous African and Asian countries, and United Kingdom law for the Com~nonwealthcountries. Ethiopian legislation shows the unmistakable influence of the Swiss Penal Code. Certain initiatives within countries having a federal system may also play an important role; this was, foc example, the case in the United States of America, where the Model Penal Code drawn up by the American Law Institute influenced the legislation of many of the States. A comparati~~esurvey of legislation on abortion in the different countries could be undertaken by three different approaches, viz., an examination based on geographical areas, an analysis of the existing situation based on the different ways in which it evolved and, finally, an examination based on the nature of the indications (and contraindica- tions) for legal abortion. The latter approach was in fact that adopted by Roemer 93 in 21 recent comprehensive study of the problem. A dis- tinction can indeed be made between those enactments which do not allow abortion under any circumstances, those which permit abortion solely on medical grounds, those which also recognize medico-social and ethical indications and, finally, those which further extend the indica- tions to include social and economic circumstances. Those cases where the pregnant wornan may have her pregnancy terminated on request could be added to this classification. If, however, one analyses the situation obtaining in most countries which do provide for " abortion 6 COMPARATIVE HEALTH LEGISLATION on demand ", one notes that the net effect of the contraindications pres- cribed in the legislation is that requests for abortion are, in practice, not infrequently refused. The first of the three approaches indicated above, i.e. that based on geographical region, will be adopted in the present study. It is however proposed to discuss, in an introductory section, the grounds on which abortion is permitted, the contraindications to abortion, the procedures to be followed in order to obtain authorization for the operation, the conditions under which the latter is to be performed, the formalities governing the reporting and registration of legal abortions and, finally, any special provisions applicable to citizens of foreign countries. This study should not be regarded as implying the adoption of any particular stand vis-his the problem of abortion, its sole purpose being to provide a survey of the world legislation