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Criminalizing abortion does not prevent abortion but rather just affects the health of women

Please address correspondence to Marge Berer. This article has been cited by other articles in PMC. Abstract The aim of this paper is to provide a panoramic view of laws and policies on abortion around the world, giving a range of country-based examples.

Abortion Law and Policy Around the World

It shows that the plethora of convoluted laws and restrictions surrounding abortion do not make any legal or public health sense. From this perspective, few existing laws are fit for purpose. However, the road to law reform is long and difficult.

In order to achieve the right to safe abortion, advocates will need to study the political, health system, legal, juridical, and socio-cultural realities surrounding existing law and policy in their countries, and decide what kind of law they want if any. The biggest challenge is to determine what is possible to achieve, build a critical mass of support, and work together with legal experts, parliamentarians, health professionals, and women themselves to change the law—so that everyone with an unwanted pregnancy who seeks an abortion can have it, as early as possible and as late as necessary.

Toward a definition of decriminalization of abortion In simple terms, the decriminalization of abortion means removing specific criminal sanctions against abortion from the law, and changing the law and related policies and regulations to achieve the following: Some history Abortion was legally restricted in almost every country by the end of the nineteenth century.

The most important sources of such laws were the imperial countries of Europe—Britain, France, Portugal, Spain, and Italy—who imposed their own laws forbidding abortion on their colonies.

In addition, the laws of several North African and Middle Eastern countries have been influenced by French civil law; and Islamic law: Abortion was dangerous and abortionists were killing a lot of women.

Hence, the laws had a public health intention to protect women—who nevertheless sought abortions and risked their lives in doing so, as they still do today if they have no other choice.

Toward a definition of decriminalization of abortion

Abortion was considered a sin or a form of transgression of morality, and the laws were intended to punish and act as a deterrent. Abortion was restricted to protect fetal life in some or all circumstances. While some prosecutions for unsafe abortions that cause injury or death still take place, far more often existing laws are being used against those having and providing safe abortions outside the law today.

Ironically, it is restrictive abortion laws—leftovers from another age—that are responsible for the deaths and millions of injuries to women who cannot afford to pay for a safe illegal abortion. This paper provides a panoramic view of current laws and policies on abortion in order to show that, from a global perspective, few of these laws makes any legal or public health sense. The fact is that the more restrictive the law, the more it is flouted, within and across borders.

Perhaps most importantly, controlling fertility has become both technically feasible and acceptable in almost all cultures today. Yet despite 100 years of campaigning for safe abortion, the use of contraception has been completely decriminalized while abortion has not. Countries with almost no deaths from unsafe abortion are those that allow abortion on request without restriction.

This is proof that that the best way to consign unsafe abortion to history is by removing all legal restrictions and providing universal access to safe abortion. But the question remains, how do we get from where things are now to where they could and should be?

Attempts to move from almost total criminalization to partial let alone total decriminalization of abortion have been slow and fraught with difficulties. Nevertheless, the need for abortion is one of the defining experiences of having a uterus.

Moreover, a growing number of governments, in both the Global North and more recently the Global South, have begun to acknowledge that preventing unsafe abortions is part of their commitment to reducing avoidable maternal deaths and their obligations under international human rights law. While some people still wish that this could be achieved through a higher prevalence of contraceptive use or post-abortion care alone, the facts are against it.

Those facts include both the occurrence of contraceptive failure among those who do use a method and the failure to use contraception, both of which are common events and sexual behaviors.

The role of international human rights bodies in calling for law reform A new layer of involvement in advocacy for safe abortion, based on an analysis of how existing laws affect women and girls and whether they meet international human rights standards, has emerged in recent years.

United Nations human rights bodies—including the Human Rights Committee, the Committee on the Elimination of Discrimination against Women, the Committee on Economic, Social and Political Rights, the Working Group on discrimination against women in law and practice, and the Special Rapporteurs on the right to the highest attainable standard of health, the rights of women in Africa, and torture—have played an increasingly visible role in calling for progressive abortion law reform.

The ACHPR called in January 2016 for the decriminalization of abortion across Africa, in line with the Maputo Protocol, and renewed that call in January 2017, making waves across the region.

Interestingly, no human rights body has gone so far as to call for abortion to be permitted at the request of the woman, yet many have called for abortion to be decriminalized. Do these mean the same thing? In simplistic terms, they might be differentiated like this: In that sense, abortion is legal on one or more grounds mostly as exceptions to the law in all but a few countries today, while Canada stands out as the only country to date that, through a Supreme Court decision in 1988, effectively decriminalized abortion altogether.

However, this distinction is often not what is meant. Instead, the two terms are used interchangeably—that is, abortion may be legalized or decriminalized on some or all grounds. No one is likely to be able to change this lack of differentiation in terminology.

  • Abortion was dangerous and abortionists were killing a lot of women;
  • Ironically, it is restrictive abortion laws—leftovers from another age—that are responsible for the deaths and millions of injuries to women who cannot afford to pay for a safe illegal abortion.

Nevertheless, it is crucial when recommending abortion law reform to be clear what exactly is and is not intended. I will come back to this later in the paper, after exploring the complexity of the changes being called for, no matter which of the two terms is used. The law on abortion in countries today Criminal restrictions on the practice of abortion are contained in statute law—in other words, laws passed by legislatures, sometimes as part of criminal or penal codes, which consolidate a group of criminal statutes.

In the UK, for example, abortion was criminalized in sections 58 and 59 of the Offences against the Person Act of 1861, with one aspect further defined in the Infant Life Preservation Act of 1929, and then allowed on certain grounds and conditions in Great Britain but not Northern Ireland in the 1967 Abortion Act, which was then amended further in the Human Fertilisation and Embryology Act of 1990.

In the 1967 Abortion Act, legal grounds for abortion are set out as exceptions to the criminal law, yet the 1861 act is still in force and still being used to prosecute illegal abortions today.

That act allows abortion on request during the first 12 weeks of pregnancy, and until week 24 in cases of rape, incest, or risk to health of the fetus or the woman or girl, but it was not finally signed into law. The number of countries in 2002 that permitted each of these grounds varied greatly by region.

A few also allow it to protect existing children or because of contraceptive failure. In addition to statute law, other ways to liberalize, restrict, or regulate access to abortion, which also have legal standing, include the following: Reed Boland has found that the distinction between laws and regulations governing abortion is not always clear and that some countries, usually those where abortion laws are highly restrictive, have issued no regulations at all.

In the most complex cases, there are multiple texts over many years which may contain conflicting provisions and obscure and outdated language. According to a recently published paper by Amanda Cleeve et al. Moreover, while Uganda has a national reproductive health policy, it is not supported in law and is not being implemented. In 2015, in order to clarify this situation, the minister of health and other stakeholders developed Standards and Evidence-based Criminalizing abortion does not prevent abortion but rather just affects the health of women on the Prevention of Unsafe Abortion.

These included details of who can provide abortions, and where and how, and assigned health service responsibilities, such as level of care and post-abortion care. However, the guidelines were withdrawn in January 2016 due to religious and political opposition. In Morocco, the abortion law was established in 1920 when Morocco was a French protectorate.

In Turkey, for example, in 1983, in response to population growth, the government passed a law allowing fertility regulation, termination of pregnancy on request up to 10 weeks after conception, and sterilization. Since 2012, he has been calling abortion murder, expressing opposition to the provision of abortion services and threatening to restrict the law. Women protested against these threats in such large numbers in 2012 that to date there have been no changes to the law itself.

But administrative changes were made in order to make the procedure for booking an appointment for an abortion—which is still primarily provided by gynecologists in hospitals—more difficult. These changes have made it nearly impossible to obtain an abortion in a state hospital; indeed, some state hospitals have stopped providing abortions altogether. Although comparative data are not available, a 2016 study found that of 431 state hospitals with departments of obstetrics and gynecology, only 7.

Of the 58 teaching and research hospitals with departments of obstetrics and gynecology, only 17. Overall, 53 of 81 provinces in Turkey did not have a state hospital that provided abortions without restriction as to reason, although this is permitted under the law.

In contrast to Turkey, Ethiopia is an example of the success of that support. Law reform for the better—slowly but surely In 2005, Ethiopia liberalized its abortion law. Previously, abortion was allowed only to save the life of the woman or protect her physical health.

The current law allows abortion in cases of rape, incest, or fetal impairment, as well as if the life or physical health of the woman is in danger, if she has a physical or mental disability, or if she is a minor who is physically or mentally unprepared for childbirth. In 2006, the government published national standards and guidelines on safe abortion that permitted the use of misoprostol, with or without mifepristone, in accordance with WHO guidance.

Reasons for not being comfortable were mainly religious, but also included personal values and a lack of training. The study also uncovered a lack of medical equipment and trained personnel, and bureaucratic problems at clinical sites. Between 2008 and 2014, the proportion of abortions provided in health facilities almost doubled.

While a substantial number of abortions continue to occur outside of health facilities, the proportion is falling, showing that change is possible but also that it takes time. In Argentina, Bolivia, Brazil, Colombia, and Costa Rica, higher courts have been instrumental in interpreting the constitutionality and scope of specific grounds for abortion, though their judgments are not always implemented.

In countries such as Peru, guidelines issued by hospitals or by governments at federal or state levels govern the enforcement of permitted grounds. As a result, and thanks to the advent of new technology, women have begun to take matters into their own hands. An uncounted number of women, probably in the millions, has been obtaining and using misoprostol to self-induce abortion widely available for gastric ulcers from a range of sources—pharmacies, websites, black market—since its abortifacient effectiveness was first discovered in the late 1980s.

This practice, begun in Brazil, has spread to many other countries and regions.

  • Rabat and Kuala Lumpur;
  • Poland has had the worst of it;
  • Regulations govern who provides abortions and where.

In response, legal restrictions and regulations on access to medical abortion pills have been imposed by countries such as Brazil and Egypt in an effort to stop the unstoppable.

Moreover, in the past decade, feminist groups have set up safe abortion information hotlines in at least 20 countries, and health professionals are providing information and access to abortion pills via telemedicine, including Women Help Women, Women on Web, safe2choose, the Tabbot Foundation in Australia, and TelAbortion in the United States. Health professionals are willing to be involved before and after, but not in the abortion.

It can be that simple although it does restrict access to aspiration and surgical methods. Abortion law as a political football and a weapon against women While the overall trend globally is toward more progressive laws, some countries where the rightwing has taken power have gone backward.

Stalin made abortion illegal when he took over from Lenin, and then after 1945, abortion was again permitted on broad grounds across the Soviet Union and in its satellite countries in Eastern Europe and West Asia, while under Vladimir Putin a long list of restrictions has been imposed, greatly reducing the number of grounds on which abortion is permitted.

It would have banned retail sales and limited the list of organizations permitted to buy medical abortion pills wholesale. It would also have banned abortions in private clinics and removed payment for them from state insurance policies.

The bill was withdrawn after strong public protest that was coordinated by the Russian Association for Population and Development; however, attempts at further restriction are likely to continue. Poland has had the worst of it. The purported aim was to reduce the number of legal abortions on grounds of fetal anomaly. Keeping laws and policies that benefit women in clear sight Cuba was the first country in Latin America and the Caribbean to reform its abortion law in favor of women, with a law that remains unique.

Since 1965, abortion has been available on request up to the tenth week of pregnancy through the national health system. The Penal Code, adopted in 1979, says that an abortion is considered illegal only if it is without the consent of the pregnant criminalizing abortion does not prevent abortion but rather just affects the health of women, is unsafe, or is provided for profit.

Under this law, abortion became the primary mode of birth control in the country. The law was reformed in 1996 to omit all references to eugenics.

  • Abortion was restricted to protect fetal life in some or all circumstances;
  • Stalin made abortion illegal when he took over from Lenin, and then after 1945, abortion was again permitted on broad grounds across the Soviet Union and in its satellite countries in Eastern Europe and West Asia, while under Vladimir Putin a long list of restrictions has been imposed, greatly reducing the number of grounds on which abortion is permitted;
  • But there are general criminal laws that allow the punishment of wrongdoing—such as forcing a woman to have an abortion against her will, giving her medical abortion pills without her knowledge, or causing injury or death through a dangerous procedure;
  • Safe abortion information hotlines;
  • Wording becomes critical to supporting good practice;
  • Technical and policy guidance for health systems.

Abortion is now permitted to protect health, which includes socioeconomic reasons, and in cases of sexual offenses. Abortion was and remains the main form of fertility control. The great majority of abortions fall under the health protection indication. Nearly all abortions are in the first trimester.