Global Comparison on Abortion Law
The U.S. Supreme Court reevaluated the landmark case of Roe v. Wade, which had established the constitutional right to abortion for nearly half a century. How do U.S. abortion regulations differ from those in other parts of the world?
Global Comparison on Abortion Law
Over the past five decades, there has been a clear trend towards the relaxation of abortion laws, particularly in developed nations. The World Health Organization (WHO) reports that approximately seventy-three million abortions occur worldwide each year, equating to approximately thirty-nine abortions per one thousand women on a global scale—a rate that has remained relatively constant since 1990.
Notably, abortion rates have diverged between nations with more lenient regulations and those with stricter ones: From 1990–94 to 2015–19, countries with generally permissive abortion laws (excluding China and India) witnessed a 43 percent decrease in the average abortion rate. Conversely, in nations with stringent restrictions on abortion, the average abortion rate rose by approximately 12 percent.
Abortion Rates Have Decreased in Countries Where It Is Legal
Estimated abortion rate per 1,000 women aged 15–49
Abortion Law and Global Impact
In a world where reproductive health services have expanded their scope, the quality and safety of abortion care have witnessed significant enhancements, contributing to improved maternal survival rates.
Nonetheless, the safety of abortion procedures varies substantially between countries that maintain generally liberal abortion laws and those with stringent restrictions. Nearly 90 percent of abortions in countries with permissive abortion laws are classified as safe, in contrast to only 25 percent of abortions in nations where abortion is prohibited [PDF].
The World Health Organization (WHO) reports that approximately 5–13 percent of maternal deaths globally result from complications arising from unsafe abortions, with the vast majority occurring in developing countries.
Challenges and Opposition:
Despite progress, strong opposition to abortion persists among certain groups. In recent years, several countries, particularly autocratic regimes, have opposed the expansion of women’s and reproductive rights. A significant victory for abortion opponents in the United States occurred in June 2022 with the Dobbs v. Jackson Women’s Health Organization Supreme Court ruling, which overturned the 1973 decision of Roe v. Wade, guaranteeing the constitutional right to abortion. Following the Dobbs ruling, twenty-one states have taken steps to either ban or restrict abortion access.
Global Abortion Legislation:
The legal status of abortion varies considerably by region, with the majority of countries permitting abortion under specific circumstances. Globally, twenty-two countries prohibit abortion entirely, while most industrialized nations allow the procedure without significant restrictions. Approximately one hundred countries have imposed various restrictions, usually permitting abortion only in limited situations, such as when there are socioeconomic concerns, risks to a woman’s physical or mental health, or the presence of fetal anomalies. However, the legal language regarding exemptions for fetal impairment can often be vague, leading to uncertainty among medical professionals about the legality of certain abortion procedures.
Abortion Laws Around the World
Access to abortion as of September 2023
Numerous international frameworks, as well as human rights bodies like the UN Human Rights Committee and regional human rights courts such as the European Court of Human Rights, the Inter-American Court of Human Rights, and the African Commission on Human and Peoples’ Rights, have affirmed safe abortion access as a fundamental human right. During the 1994 International Conference on Population and Development in Cairo, 179 governments committed to a program of action [PDF], which included a pledge to prevent unsafe abortions. Furthermore, in 2015, the United Nations’ 2030 Agenda for Sustainable Development expanded its objectives to encompass universal access to reproductive healthcare services.
The World Health Organization (WHO) recognized unsafe abortion as a public health concern for the first time in 1967. In 2003, it developed technical and policy guidelines that recommend the establishment of abortion laws aimed at safeguarding women’s health. According to the United Nations Population Fund, addressing the unmet need for family planning holds the potential to significantly reduce maternal mortality and decrease abortion rates by up to 70 percent in the developing world.
How does the United States compare?
The Supreme Court’s ruling on June 24, 2022, which overturned Roe v. Wade, marked a significant departure from nearly half a century of precedent that had established a constitutional right to abortion. In the 1973 Roe decision, the Court affirmed that the Constitution guarantees the right to choose to have an abortion, albeit with the allowance for regulations after the first trimester of pregnancy.
This landmark decision made the United States one of the pioneering countries in the liberalization of abortion laws, a trend also seen in several Western European nations. Subsequently, in 1992, Planned Parenthood v. Casey reaffirmed the right to an abortion but permitted the introduction of additional restrictions, such as waiting periods and parental consent requirements.
Over the years, states have introduced and enforced a range of laws governing abortions. Some have enacted legislation to safeguard abortion access, while others have imposed more stringent regulations on abortion providers and attempted to restrict abortion at earlier stages of pregnancy. In recent times, many states have passed increasingly strict abortion laws, with some going as far as prohibiting the procedure after just six weeks of pregnancy.
Certain states with stringent abortion restrictions, such as Idaho, Oklahoma, and Texas, have enacted “vigilante laws” that empower members of the public to bring legal actions against abortion providers and individuals suspected of participating in or facilitating abortions. Over the past year, more than sixty Planned Parenthood facilities and medical offices have been compelled to either close their doors or shift their focus to services other than abortion. Some providers have relocated to states with less restrictive laws, leaving several states with only a single abortion provider.
The reversal of Roe allows the thirteen states with “trigger laws” to either automatically ban abortion or do so swiftly through state action. While these state laws typically exempt abortions in cases of life-threatening pregnancies, many do not extend the same exemptions to pregnancies resulting from rape or incest. The Supreme Court’s decision has been met with applause from Republican lawmakers and anti-abortion advocates, while Democratic lawmakers and proponents of abortion rights have strongly criticized it.
What have been recent trends?
The global trajectory of abortion laws has leaned toward liberalization. Over the past three decades, more than sixty countries have revised their abortion regulations, with all but four—namely, the United States, El Salvador, Nicaragua, and Poland—broadening the legal criteria for women to access abortion services.
In the period since 2020, Argentina and Thailand have legalized abortion within specific gestational limits, South Korea has decriminalized abortion, and New Zealand has eased its abortion restrictions. Most recently, as part of a growing “green wave” in Latin America, Colombia has legalized abortion on demand for up to twenty-four weeks of pregnancy, and Mexico has decriminalized the procedure, eliminating the ban from the federal penal code. While the majority of countries have moved to expand the grounds for abortion, some, including Honduras and the United States, are implementing policies aimed at tightening restrictions.
Access to Abortion Has Increased Globally
Changes in abortion law from 1994 to 2023
hina: In the 1950s, China relaxed its abortion regulations and encouraged the practice as part of its one-child policy, initiated in 1979 to manage population growth. This policy, which offered widespread access to abortion services, was enforced through strict measures, including fines, mandatory sterilization, and abortion to prevent unauthorized births.
In 2016, China expanded the policy to a two-child limit, introducing incentives to counteract its aging population. In 2021, the limit was further raised to three children, with the State Council issuing guidelines promoting a reduction in “non–medically necessary abortions.”
Kenya: Following its colonial history, Kenya’s abortion laws were originally rooted in the British penal code, which prohibited abortion. However, in 2010, when Kenya adopted a new constitution, it broadened the circumstances [PDF] under which women could seek an abortion, including emergency situations and those posing a threat to the mother’s health.
In June 2019, the exceptions were extended to encompass cases of rape. Similar changes are taking place in other former European colonies, such as Burkina Faso, Chad, Guinea, Mali, and Niger, which have modified their restrictive abortion laws, inherited from the 1810 Napoleonic Code imposed by France, to allow abortion in cases of rape, incest, or fetal abnormalities.
Ireland: In 2018, the Irish parliament passed a law allowing the termination of pregnancy before twelve weeks and in cases where the mother’s health is at risk. Prior to this change, Ireland had some of the strictest abortion regulations in Europe, as specified in a 1983 constitutional amendment that effectively prohibited the practice.
The public debate and protests following the 2012 death of Savita Halappanavar, who was denied an emergency abortion, led to a nationwide referendum to repeal the amendment. The referendum was successful, with 66 percent of the vote in favor.
In 2019, abortion was also legalized in Northern Ireland, a part of the United Kingdom (UK). This change followed a UK Parliament decision to extend the UK’s 1967 Abortion Act, granting doctors in England, Scotland, and Wales the authority to perform abortions, to Northern Ireland.
Zambia: Zambia is one of the few African countries where abortion is allowed for economic and social reasons. However, despite having relatively liberal abortion laws, Zambian women face significant structural and cultural barriers in accessing abortions.
In 2018, Zambia had just one practicing medical doctor for every twelve thousand inhabitants. For the 55 percent of Zambians residing in rural areas, access to health professionals is limited. The law stipulates that only a registered medical practitioner, not a nurse or midwife, can perform abortions, making safe access difficult for most. Zambia continues to grapple with a high rate of maternal mortality related to abortion, with around 30 percent of maternal deaths resulting from abortion complications.
Honduras: Honduras, a Central American country, has some of the world’s strictest abortion laws, which have been in place since 1985. In 2021, the ban was incorporated into the country’s constitution, requiring a minimum three-quarters majority in the National Congress to change any abortion-related law.
UN experts estimate that between fifty thousand and eighty thousand unsafe abortions occur in Honduras annually. Neighboring countries El Salvador and Nicaragua also have prohibitions on abortion, making them the only two nations to impose new abortion restrictions since the 1994 Cairo Declaration, which recognized reproductive health as essential for development.
Poland: In 2020, Poland’s Constitutional Tribunal declared abortions due to fetal impairment unconstitutional, effectively making the country’s abortion laws one of the strictest in Europe. This decision resulted in a near-total ban on abortions, as the majority of them performed in Poland prior to the ruling were due to fetal abnormalities.
In response, hundreds of thousands of people took to the streets to protest the decision, though it remains in effect. Polish law still permits abortions in cases of rape, incest, and life-threatening pregnancies, but doctors have reportedly been hesitant to perform legal abortions since the ruling. Doctors could face up to three years in prison if they perform abortions hastily or without sufficient justification according to government regulations.