Abortion time limits
A briefing paper from the BMA
Part three - International comparisons
Abortion law in other countries
In discussions surrounding abortion there are sometimes misperceptions about abortion rates and legal permissibility of abortion in the UK in comparison with other countries. Some take the view, incorrectly, that abortion in the UK is particularly prevalent and that the law is very liberal in comparison to other countries. In June 2002 the United Nations published a detailed overview of countries’ policies on abortion worldwide - Abortion Policies: A Global Review [Go to reference 97] and the BBC analysed policies in Europe; [Go to reference 98] both of these analyses suggest that this is not the case.
France
In France [Go to reference 99] abortion can take place to save the life of the woman, to preserve physical and mental health, for rape or incest, fetal impairment, economic or social reasons, and it is available on request in some circumstances.
Under Law No. 79-1204 of 31 December 1979, abortion is available on request - the law requires a woman seeking an abortion to state that she is 'in a situation of distress'; the decision to have an abortion, however, is entirely the decision of the woman. Abortion on these grounds must be performed before the end of the twelfth week of pregnancy by a physician in an approved hospital. [Go to reference 100] Beyond this stage abortion may be performed only if the pregnancy poses a grave danger to the woman’s health or there is a strong probability that the expected child will suffer from a particularly severe illness recognised as incurable. In this case, two physicians must certify that there is a risk to the health of the woman or fetus.
Germany
In Germany [Go to reference 101] abortion can take place to save the life of the woman, to preserve physical and mental health, for rape or incest, fetal impairment, economic or social reasons, and it is available on request in some circumstances.
Abortion is available on request in the first 12 weeks of pregnancy if the pregnant woman finds herself in a 'situation of distress and conflict.' The pregnant woman must undergo counselling by someone other than the physician performing the abortion and wait three days until the abortion is performed, before she makes the final decision. Abortions are also available up to 22 weeks of pregnancy if the woman is in 'exceptional distress' (section 218a(4) Penal Code), and at any time during pregnancy to prevent a threat to the pregnant woman’s life or a serious threat to her physical or mental health.
The Netherlands
In the Netherlands [Go to references 102, 103] abortion can take place to save the life of the woman, to preserve physical and mental health, for rape or incest, fetal impairment, economic or social reasons, and it is available on request in some circumstances. The Netherlands has one of the lowest abortion rates in comparison to other countries that permit abortion. The Netherlands Ministry of Foreign Affairs states that the reason for this low rate 'is closely related to the widespread use of contraceptives in this country.' [Go to reference 104].
Under the Pregnancy Termination Act 1984 (PTA) abortion is available on request up to the point of viability – the absolute limit being 24 weeks (although in practice it tends to be just over 21 weeks). Such abortions must be performed by a doctor in a licensed hospital or clinic. A woman seeking an abortion must discuss her decision, and possible alternatives, with her doctor, and the doctor must establish that the decision has been taken voluntarily and after careful consideration. After this discussion, the woman must wait at least five days before the abortion can be performed if the abortion is taking place more than 16 days after menstruation was due.
Czech Republic
In the Czech Republic [Go to reference 105] abortion can take place to save the life of the woman, to preserve physical and mental health, for rape or incest, fetal impairment, economic or social reasons, and it is available on request in some circumstances.
Under Law No. 86/1950 (the Penal Code, sections 227-229), and subsequent amendments, a woman makes a written request to her gynaecologist for the 'artificial termination of pregnancy'. The gynaecologists will then inform her of the possible consequences of the procedure and of the available methods of birth control. 'If gestation is under 12 weeks and no health contraindications for the procedure exist, the doctor specifies the health centre where the procedure is to be performed. If gestation is over 12 weeks or if there are other contraindications, the request is reviewed by a medical committee. Women who have had an abortion within six months are not permitted to undergo the procedure unless they have had two deliveries, are at least 35 years of age or the pregnancy was the result of a rape. Beyond the first trimester, the pregnancy can be terminated only if the woman’s life or health is endangered or in the case of suspected fetal impairment…
'Through the years, abortion has remained the preferred method of birth control in the Czech Republic. Part of the reason was that abortion was free but contraceptives were not, and contraceptives were also difficult to obtain. The new 1986 law attempts to reduce the use of abortion by providing contraception (excluding condoms) free of charge and discouraging abortion by charging a fee for abortions performed after eight weeks of gestation. The fee can be waived only if the abortion is medically indicated.' [Go to reference 106] Although between 1986 and 1987 there was an increase in the number of abortions performed, this was followed by a 65% drop in the number of abortions performed between 1989 and 2004.
Russia
In Russia [Go to reference 107] abortion can take place to save the life of the woman, preserve physical and mental health, for rape or incest, fetal impairment, economic or social reasons, and it is available on request up to 12 weeks’ gestation. Russia is often cited as having one of the highest abortion rates in the world with an estimated 13 terminations for every 10 live births in 2003. [Go to reference 108] Abortion is considered to be one of the main methods of fertility control, although this may be changing (see table below). Between 1988 and 2001, modern contraceptive use increased in Russia by 74%, while the abortion rate declined by 61%. [Go to reference 109].
Source: Westoff C, unpublished data, 2003.
An abortion requires the consent of the pregnant woman; it is authorised if performed by a licensed physician in a hospital or other recognised medical institution. Abortion is available on request during the first 12 weeks of gestation. Thereafter, abortion between 12 and 22 weeks of pregnancy is permitted for rape, imprisonment of the pregnant woman or her husband, death or severe disability of husband, and a court ruling stripping a woman of parental rights (previously there had been 13 special circumstances, including divorce, poverty and poor housing). [Go to reference 110].
Abortion rates
The United Nations summarises a selection of abortion rates as follows:
* Based on the Republic of Ireland residents who obtained abortions in England.
Abortions per 1,000 women aged 15-44 [Go to reference 111]
The United Nations has evaluated the policies of a number of countries comparing abortion rates with availability and uptake of modern contraception among married women. Its findings are as follows:
“The percentage of currently married women aged 15-49 years that use modern contraception provides an indication of the actual availability of contraceptives.
- Use of contraception is inversely associated with abortion at the aggregate level.
- A low availability of modern contraceptives tends to be correlated with high abortion rates.
- Conversely, when modern contraceptive methods are widely available and are used effectively, abortion rates tend to be relatively lower.
- At the individual level, the use of contraception is positively associated with the practice of abortion. Women that have used a contraceptive method are at some time, on average, more likely to resort to abortion than those that have never used any contraceptive method. However, women that have had an abortion are more likely to use contraception than women that have never done so. It has been suggested that contraceptive use increases after an abortion because of the provision of contraceptives and counselling in abortion clinics.' [Go to reference 112]
Recent estimates [Go to reference 113] suggest that 41% of the estimated 46 million abortions that take place worldwide are performed illegally.
In the 2003 United Nations report - World Population Policies 2003, [Go to reference 114] the following key points emerge:
- 'Abortion to save the woman’s life is permitted in nearly all developed (96 per cent) and developing (99 per cent) countries.'
- Other grounds for abortion are to preserve the physical health of the women (64 per cent of countries), to preserve mental health (62 per cent), in case of rape or incest (45 per cent), fetal impairment (41 per cent), economic or social reasons (34 per cent), and on request (28 per cent).
- The grounds on which abortion is permitted vary greatly among development regions (see figure below). For example, abortion is permitted upon request in 67 per cent of developed countries, but 15 per cent of developing countries, and for economic and social reasons in 77 per cent of developed countries and 19 per cent of developing countries.'
Abortion 'on request'
In terms of abortion 'on request', the United Nations Population Division Department of Economic and Social Affairs reports several countries where abortion is 'available on request' up to certain gestational limits, including Australia, Austria, Belgium, Canada, Denmark, France, Germany, Italy, Sweden and USA. [Go to reference 115] It is reported that abortion is not available on request in countries such as New Zealand, Spain, Switzerland and the UK.
Given the diversity in legal systems, terminology, and the gap that sometimes arises between policy and practice, it is difficult to map where and to what extent abortion is actually 'available on request' in practice. The United Nations has classified countries where abortion is 'available on request” as being where '…a pregnant woman seeking an abortion is not required to justify her desire to have an abortion under the law. She needs only to find a physician who is willing to perform the abortion. In a number of countries, such as Albania, Belgium and France, she may be required to state that she is in a situation of crisis or distress. This requirement, however, is purely a formality and the decision to have the abortion is still completely her own so long as she finds a physician who agrees to perform the abortion… Even in countries where abortion is allowed on request, time limits are usually set for the performance of the abortion, often within the first trimester. After this stage of pregnancy, the woman must present a valid ground for the abortion to be permitted.'
Upper time limits for abortions
Reviewing legislation on the upper time limits for abortion in a number of countries it is clear that countries adopt a variety of upper time limits and that a number of countries do not set any legal upper limits. It is also clear, however, that there is frequently a difference between what is legally permissible and what is available in practice. Although technically legally permissible in some countries up to certain time periods, the restrictiveness of the grounds for abortion and the cultural attitude to later abortions means that later abortions are not necessarily accepted or available in practice.
An outline of some countries’ upper abortion limits can be found below:
no upper limit
- Croatia - to prevent grave permanent injury to the physical or mental health of the pregnant woman; risk to the life of the pregnant woman; rape or incest; or severe fetal abnormality.
- England, Scotland and Wales – to prevent grave permanent injury to the physical or mental health of the pregnant woman; risk to the life of the pregnant woman; or severe fetal abnormality.
- France - to prevent grave permanent injury to the physical or mental health of the pregnant woman; risk to the life of the pregnant woman; or child will suffer from a particularly severe illness recognised as incurable.
- Germany – to prevent a threat to the pregnant woman’s life or a serious threat to her physical or mental health.
- Italy - to prevent grave permanent injury to the physical or mental health of the pregnant woman; risk to the life of the pregnant woman; or severe fetal abnormality.
- Switzerland – to prevent grave permanent injury to the physical or mental health of the pregnant woman; or risk to the life of the pregnant woman.
- Turkey - to prevent grave permanent injury to the physical or mental health of the pregnant woman; risk to the life of the pregnant woman; or severe fetal abnormality.
- England, Scotland and Wales – if the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family.
- Finland – for severe fetal abnormality.
- Germany – for 'exceptional distress'.
- Russia - for rape, imprisonment of the pregnant woman or her husband, death or severe disability of husband, and a court ruling stripping a woman of parental rights.
- Spain – for severe fetal abnormality.
In a note available on the United Nations website, the United Nations Population Fund (UNFPA) notes that: [Go to reference 116]
- 'Restrictive abortion laws do not prevent abortion but force women to seek illegal and usually unsafe abortions. In Latin America, where abortion is almost completely illegal, the rate is between 30 to 60 per 1,000. In the Netherlands, with Europe's most liberal abortion law, only five out of 1,000 women opt for abortion. The average for Western Europe is 14 abortions per 1,000 women.
- Some 99 per cent of the estimated 585,000 maternal deaths worldwide annually occur in poorer countries. Of these deaths, 13 per cent are a result of complications from unsafe abortions.
- More women resort to abortion where family planning services and sex education are poor.
- Unsafe abortions account for some 25-50 per cent of maternal deaths in refugee situations.'