A Global Review of Laws on Induced Abortion, 1985-1997. (ARTICLES).(Statistical Data Included)

Context: The legal status of induced abortion helps determine the availability of sate, affordable abortion services in a country, which in turn influences rates of maternal mortality and morbidity. It is important, therefore, for health professionals to know both the current status of abortion laws worldwide and the extent to which those laws are changing.

Methods: Abortion-related laws in 152 nations and dependent territories with populations of one million or more were reviewed, and changes in these laws since 1985 were documented.

Results: Currently, 61% of the world's people live in countries where induced abortion is permitted either for a wide range of reasons or without restriction as to reason; in contrast, 25% reside in nations where abortion is generally prohibited. However, even in countries with highly restrictive laws, induced abortion is usually permitted when the woman's life is endangered; in contrast, even in nations with very liberal laws, access may be limited by gestational age restrictions, requirements that third parties authorize an abortion or limitations on the types of facilities that perform induced abortions. Since 1985, 19 nations have significantly liberalized their abortion laws; only one country has substantially curtailed legal access to abortion.

Conclusions: A global trend toward liberalization of abortion laws observed before 1985 appears to have continued in more recent years. Nevertheless, women's ability to obtain abortion services is affected not just by the laws in force in a particular country, but also by how these laws are interpreted, how they are enforced and what the attitude of the medical community is toward abortion.

Although the legal status of induced abortion is not the only factor influencing women's ability to access abortion services, it remains a key determinant. Where access to abortion is restricted by law, medically trained practitioners are usually less willing to provide the service, the cost of the service in private facilities may be high and services are rarely available in public hospitals (which are often the only source of safe medical care for low-income women).

In addition, in such countries, because training in abortion procedures often is not routinely provided to physicians, outmoded medical procedures may be used to perform the service and the provision of contraceptive services after an abortion may be overlooked. Women with an unwanted pregnancy also may not know a physician willing to risk prosecution by helping them. Moreover, fear of prosecution may even affect physicians' treatment of women with complications arising from spontaneous abortion or from unsafe clandestine abortion, and may cause women to delay seeking care. Where abortion is legal, maternal morbidity and mortality generally are lower, often because abortions are performed by trained medical professionals, are safer and more available, and cost less.

In this article, we update and expand on earlier work (1) to briefly summarize the laws governing abortion in most countries around the world, and discuss all major changes in abortion laws since 1985 in countries with populations of more than one million. Whenever possible, our analysis is based on the texts of national laws. In some cases, we obtained translations and other information from such sources as the International Digest of Health Legislation (published by the World Health Organization) and the Annual Review of Population Law (published by the United Nations Population Fund and the Harvard Law School).