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Abortion Law Around the World: Progress and Pushback
There is a global trend
toward the liberalization
of abortion laws driven
by women’s rights, public
health, and human rights
advocat es. This trend re-
flects the rec ognition of
women’s access to legal
abortion services as a mat-
ter of women’s rights and
self-determination and an
understanding of the dire
public health implications
of criminalizing abortion.
Nonetheless, legal strate-
gies to introduce barriers
that impede access to legal
abortion services, such as
mandatory waiting periods,
biased counseling require-
ments, and the unregulated
practiceof conscientiousob-
jection, are emerging in re-
sponse to this trend. These
barriers stigmatize and de-
mean women and compro-
mise their health.
Public health evidence
and human rights guaran-
tees provide a compelling
rationale for challenging
abortion bans and these
restrictions. (Am J Public
Health. 2013;103:585–589.
doi:10.2105/AJPH.2012.
301197)
Louise Finer, LLM, and Johanna B. Fine, JD, MIA
ACCORDING TO THE MOST RE-
cent research, the legal framework
in 68 countries worldwide cur-
rently prohibits abortion entirely
or permits it only to save a wom-
an’s life. Conversely, 60 countries
allow a woman to decide whether
to terminate a pregnancy. A fur-
ther 57 countries permit abortion
to protect a woman’s life and
health, and an additional 14 per-
mit abortion for socioeconomic
motives.
1
These figures indicate
that roughly 39% of the world’s
population lives in countries with
highly restrictive laws governing
abortion.
2
Following World War II, abor-
tion was highly restricted through-
outmostoftheworld.
3
Since the
1950s, when the liberalization of
abortion laws began in Eastern
and Central Europe, an unmistak-
able global trend toward easing
legal restrictions on abortion has
ensued. The landmark decision
of Roe v. Wade in the United States
can be seen against the backdrop
of liberalization of abortion laws
in the developed world through
the 1960s and 1970s.
4
Between
1950 and 1985, nearly all indus-
trialized countries—and several
others—liberalized their abortion
laws.
5
Furthermore, since 1994,
when 179 countries committed to
preventing unsafe abortion under
the International Conference on
Population and Development
Programme of Action, more than
25 countries have liberalized their
abortion laws. During the same
period, only a handful have tight-
ened legal restrictions on abortion.
6
Despite some notable excep-
tions,
7
nearly all countries in the
global north and central and eastern
Asia currently have liberal abortion
laws, authorizing the service with-
out restrictions as to reason during
certain gestational limits or on
broad grounds, such as for socio-
economic reasons. By contrast,
countries in the global south gen-
erally have restrictive abortion
laws on the books, with abortion
criminalized except for limited cir-
cumstances, such as if a woman’s
health or life is at risk, or in cases of
rape, incest, or fetal impairment.
8
The legal framework for abor-
tion in a given country can be
derived from multiple sources, in-
cluding statutes enacted by legis-
latures, regulations created by ad-
ministrative agencies, and court
decisions. Many of these laws and
policies apply concurrently. Al-
though abortion is a medical pro-
cedure, it has historically been
addressed in penal codes and
characterized as a crime. Penal
codes generally set out criminal
sanctions for the abortion pro-
vider and in some instances also
for the woman undergoing the
abortion. However, these same
penal codes normally recognize
exceptions under which perform-
ing an abortion does not carry any
criminal penalties.
9
The liberalization of abortion
laws using legal means has gener-
ally been achieved by amending
criminal bans to specify certain
circumstances in which there is
no legal penalty for abortion.
Thus, countries in the first wave
of liberalization, in Central and
Eastern Europe, saw the intro-
duction of specific circumstances
in which abortion carried no
criminal sanction.
10
In addition,
although most countries (including
those with liberal abortion laws)
still maintain penal code provisions
delineating the circumstances in
which abortion is a crime, penal
code provisions have been in-
creasingly replaced or supple-
mented by public health codes,
court decisions, and other regula-
tions and laws addressing the
provision of reproductive health
care.
11
In 2010, for example, Spain
(one of the few European coun-
tries that had maintained a restric-
tive abortion law) enacted a law
on sexual and reproductive health
that eliminated a penal code pro-
vision punishing women for ille-
gally procuring abortions and rec-
ognized their right to abortion
without restrictions as to reason
during certain gestational limits and
thereafter on specific grounds.
12
Active campaigning from the
women’s rights, public health, and
human rights fields has worked
to considerable effect,
13
with
achievements in law reform re-
flecting both the recognition of the
dire public health implications of
criminalizing abortion and the
identification of women’s access
to lawful termination of a preg-
nancy as a question of women’s
rights and self-determination.
Concurrently, international stan-
dards on the protection of women’s
reproductive rights and their ap-
plication to abortion have devel-
oped considerably.
14
This trend
persists despite the recent emer-
gence of an increasingly organized
and vehement opposition that seeks
to restrict abortion laws and im-
pose barriers to women’s access
to abortion globally.
Despite the overall global trend
of easing legal restrictions on
abortion, legal strategies have
emerged to introduce new types
of barriers that impede women’s
ABORTION LAW AROUND THE WORLD
April 2013, Vol 103, No. 4 |American Journal of Public Health Finer and Fine |Peer Reviewed |Word Abortion Laws |585
access to legal abortion services.
An increasingly global and coor-
dinated movement—which prona-
talist and religious concerns have
fueled in direct response to the
worldwide trend toward abortion
law liberalization—has instigated
such strategies. Although in some
countries progressive or retro-
gressive steps can be classified
simply, in others political tugs-of-
war have led to measures that pull
the specific elements of the legal
status of abortion back and forth.
Retrogressive steps have been
added that introduce new barriers
to abortion access rather than al-
tering the overall legal status of
abortion, making the achievement
of broader reform unrealistic be-
cause of the political context or
established legal framework.
In Poland, for example, a liberal
abortion law in place until the fall
of the Soviet Union was restricted
in 1993.
15
In 1996, the law was
again liberalized, but subsequent
efforts, through amendments to
the law and a ruling from the
constitutional court, again restricted
the law.
16
The Polish parliament
narrowly rejected a bill that would
have introduced an absolute ban
on abortion in 2011.
17
Strategies to restrict abortion
access have increasingly focused
on introducing procedural bar-
riers, through law or policy, that
limit the availability of abortion
services. Such barriers—intro-
duced primarily in countries with
liberal abortion laws, including the
United States and Central and
Eastern Europe countries—include
mandatory and biased counseling
requirements,
18
waiting periods,
19
third-party consent and notifica-
tion requirements,
20
limitations
on the range of abortion options
(e.g., restrictions on medical abor-
tion, including specific bans on
misoprostol
21
), and limitations on
abortion funding.
Currently, 26 US states have
a waiting period, which is nor-
mally 24 hours,
22
and nine states
require counseling that provides
inaccurate information about neg-
ative mental health consequences
of abortion.
23
In 2011, the Rus-
sian parliament established a man-
datory waiting period for abor-
tions and considered several other
procedural barriers to abortion.
24
In 2009, the Slovak Republic in-
troduced several procedural bar-
riers to abortion access, including
a mandatory counseling require-
ment, a 48-hour waiting period, an d
the extension of the parental con-
sent requirement to all minors
25
when previously it had applied only
to girls younger than 16 years.
26
A further impediment to abor-
tion access results from the un-
regulated conscientious objection
of health care providers and
others. The right to refuse to per-
form services because of moral or
religious objections is governed by
national laws that vary in the
scope of limits of conscientious
objection and that invite differing
interpretations.
27
Although insuf-
ficient research has been con-
ducted into the prevalence of un-
regulated conscientious objection,
case law and limited research
shows that it is increasingly invoked
in countries where opposition to
recent liberalization is strong (e.g.,
Colombia)
28
and where there are
attempts to reverse the legalization
of abortion (e.g., Poland).
29
A
growing body of jurisprudence
delineates the justifiable limits on
the exercise of conscientious objec-
tion in this context, including when
pharmacists, nurses, judges, and
health care institutions invoke it.
30
ABORTION LAW AND
PUBLIC HEALTH
The World Health Organiza-
tion has identified unsafe abortion
as a serious public health problem
since 1967
31
and affirms in its
most recent technical guidance the
scale of this public health im-
pact.
32
World Health Organiza-
tion evidence shows that when
faced with an unplanned preg-
nancy and irrespective of legal
conditions, women all over the
world are highly likely to have an
induced abortion. Legal restric-
tions that limit the grounds on
which a woman may terminate
a pregnancy increase the percent-
age of unlawful and unsafe pro-
cedures.
33
The maternal mortality
ratio per 100 000 live births ow-
ing to unsafe abortion is generally
higher in countries with major re-
strictions and lower in countries
where abortion is available without
restrictions as to reason or under
broad conditions.
34
Thus, the pub-
lic health impact of unsafe abortion
is directly linked to its legal status.
Abortion’s legal status affects its
access in numerous ways, both
directly and indirectly. Criminali-
zation renders the procedure ille-
gal and, for many women, unsafe.
In addition, criminalization and
other legal restrictions can indi-
rectly produce a chilling effect that
makes even legal abortions diffi-
cult to access.
35
A recent report
of the United Nations high com-
missioner for human rights to the
United Nations Human Rights
Council in examining the prevent-
able causes of maternal mortality
and morbidity finds that restrictive
abortion laws lead to health
providers’, police’s, and others’
responses that discourage care-
seeking behavior.
36
These re-
sponses include withholding care
until a woman confesses to having
had an illegal abortion and
reporting women who have sym-
ptoms of a spontaneous or in-
duced abortion to the police be-
cause of perceived or real pressure
or legal requirements.
37
In countries that permit abor-
tion only on narrow legal grounds,
information about legal services is
often unavailable. Consequently,
some women presume that they
are not entitled to a legal abortion
although this may not be the
case.
38
Health providers may also
lack training in safe abortion pro-
cedures, have insufficient infor-
mation to be able to act within the
law, or be reluctant to interpret
legal grounds. The lack of care
protocols and effective procedures
to guide health providers’
decision-making to ensure laws
are correctly interpreted has led
to devastating consequences for
women seeking abortions.
39
Moreover, health providers’fears
of criminal sanction promote a
restrictive interpretation of laws
and, as a result, more unsafe abor-
tions or delays that have secondary
health consequences.
40
Procedural barriers, such as the
mandatory waiting periods and bi-
ased counseling requirements we
have mentioned, can delay care
and hinder access to safe services,
which in turn demean women as
competent decision-makers and in-
crease health risks.
41
Notably, however, the technical
advancement of medical abortion,
particularly through the use of
misoprostol, has been a revolu-
tionary development in reducing
rates of abortion-related morbidity
and mortality.
42
Misoprostol was
originally marketed to prevent
and treat gastric ulcers, but it is
also a safe and effective means
of pregnancy termination.
43
Women worldwide, particularly
in Latin America, are increasingly
self-administering misoprostol
off-label to terminate their preg-
nancies.
44
Thus, in settings with
restrictive abortion laws or signi-
ficant access barriers, women are
increasingly able to self-induce
safe abortions.
45
Moreover, as
ABORTION LAW AROUND THE WORLD
586 |Word Abortion Laws |Peer Reviewed |Finer and Fine American Journal of Public Health |April 2013, Vol 103, No. 4
misoprostol can be stored at room
temperature and administered by
nonphysicians, it has increased
women’s access to safe abortion
services in many resource-limited
settings.
46
Nonetheless, not only does evi-
dence clearly illustrate the nega-
tive public health impact of exces-
sive abortion restrictions, but it
also supports the case for abortion
law liberalization. According to
South Africa’s National Committee
of Confidential Inquires into Ma-
ternal Deaths, liberalization in the
country
47
in 1996 led to a 91%
decline in abortion-related mater-
nal mortality between 1994 and
1998---2001. One study showed
an “immediate positive impact
on morbidity,”
48
in particular
arising from infection, and another
concluded that a “cautious assess-
ment of the magnitude of the re-
duction [in maternal mortality]
confirms that it is large.”
49
Evidence from Nepal, where
revisions to the country’s legal
code in 2002 granted women
the right to terminate a pregnancy
up to 12 weeks without restriction
as to reason and later on specific
grounds, suggests that liberaliza-
tion has contributed to a decline
in complications from unsafe
abortion.
50
Following the liber-
alization of Romania’s abortion
law in 1989, maternal mortality
dramatically decreased.
51
In the
United States, in the years following
the Roe v. Wade decision, maternal
mortality significantly declined as
a result of the decrease in unsafe
abortions, clearly demonstrating
the public health impact of Roe v.
Wade’s implementation.
52
CONCLUSIONS
Evidence of the public health
implications of excessive legal re-
strictions on abortion cannot be
ignored. Authoritative research
conducted in the wake of liber-
alization provides a further ratio-
nale for contesting such restric-
tions on public health grounds.
This public health rationale has
supported many efforts toward
abortion law reform in such
countries as Colombia, Ethiopia,
and Guyana.
However, those who seek to
maintain or introduce restrictive
legal regimes for abortion contest
the public health evidence that
supports the case for lifting exces-
sive legal restrictions on abortion.
Such efforts either deliberately
avoid the facts or rely on de-
bunked public health evidence to
motivate ideology-driven agendas.
In the United States, for example,
several states have mandated
counseling for women seeking
abortion services and required
them to receive information about
purported negative mental health
consequences of abortion or a link
between abortion and increased
risk of breast cancer in an attempt
to coerce women to continue un-
wanted pregnancies.
53
These ef-
forts overlook, or ignore, authori-
tative studies that debunk the
myth of a connection between
having an abortion and increased
mental health risks and disprove
any link between abortion and an
increased risk of breast cancer.
54
Other purported justifications
for abortion restrictions on public
health grounds misrepresent and
oversimplify risks and other con-
siderations related to women’s
health during pregnancy. In Russia,
for example, recent restrictions on
abortions after 12 weeks of preg-
nancy have been justified by
pointing to an increased risk of
maternal mortality resulting from
later term abortions.
55
Although
abortion does indeed carry a
greater risk of potential complica-
tions the later it is performed, this
apparent concern for women’s
lives is seen to be disingenuous
when examined in the light of
studies showing that the risk of
death associated with childbirth is
far greater than is the risk associ-
ated with legal abortion.
56
The argument that forcing
women to carry pregnancies to
term will reverse trends of demo-
graphic decline also underpins
restrictions on women’s access to
abortion in countries such as Rus-
sia.
57
There is no evidence of
a connection between restrictions
on access to abortion and in-
creased birth rates. As we have
discussed, women who wish to
terminate their pregnancies will
seek this service whether it is legal
or not. When abortion services
are highly restricted, women are
often forced to procure unsafe
abortions, which may jeopardize
their health and lives.
Excessive legal restrictions have
myriad repercussions in addition
to whether abortion services are
available. Excessive restrictions
stigmatize women seeking abor-
tions and discriminate against
those who lack the knowledge
and understanding of legal
grounds for abortion and vulner-
able groups, such as poor and
rural women and girls. Further
research should be conducted
into the regional and subnational
discrepancies in abortion access
resulting from excessive legal re-
strictions. Where legal restrictions
render abortion inaccessible or
difficult to access, wealthier
women and those based in urban
areas may be the only ones able
to access private services or travel
to obtain abortion services.
58
Such restrictions on abortion
also create systemic problems
leading to practices that are in-
evitably unsafe. Where abortion
is prohibited, public health and
safety regulations for its provision
cannot exist; thus the training and
licensing of health providers is
limited.
59
On these and other
grounds, the United Nations special
rapporteur on the right to health has
characterized the criminalization
of abortion as incompatible with
the right to the highest attainable
standard of health.
60
We believe that, with time, the
public health impact of new kinds
of legal and policy barriers intro-
duced to restrict abortion access
will become evident. Evidence
already shows that mandatory
waiting periods compromise
women’s health by delaying care
and women’s ability to access safe
and legal abortion services,
61
but
further research is essential. Al-
though the risks associated with
abortion are small, waiting periods
cause greater numbers of women
to delay the procedure until the
second trimester of pregnancy,
when the risk of complications rises
geometrically.
62
Similarly, the co-
ercive nature of biased counseling
requirements providing medically
inaccurate information could lead
women to make decisions that
jeopardize both their physical and
mental health. Such restrictions
demean and stigmatize women.
63
The public health implications
of excessive legal restrictions on
abortion are devastating. Reliable
public health evidence and the
application of human rights guar-
antees provide a compelling ratio-
nale for challenging abortion bans
and other restrictions.
64
The wave
of liberalization of abortion laws
responded to public health evi-
dence and, more recently, human
rights arguments. The ideologi-
cally and religiously motivated
backlash against abortion is in-
creasingly resorting to misrepre-
sentations and avoidance of public
health evidence, and it is under-
mining human rights standards
applicable in this context. The
movement that has so successfully
ABORTION LAW AROUND THE WORLD
April 2013, Vol 103, No. 4 |American Journal of Public Health Finer and Fine |Peer Reviewed |Word Abortion Laws |587
campaigned for abortion liber-
alization must continue to assert
these strong grounds or face
pushback on the gains achieved. j
About the Authors
At the time of the research and writing,
Louise Finer and Johanna B. Fine were with
the Center for Reproductive Rights, New
York, NY.
Correspondence should be sent to Louise
Finer, ManagingEditor, Reproductive Health
Matters, 444 Highgate Studios, 53-79
Highgate Road, London NW5 1TL, UK
(e-mail: louisefiner@gmail.com). Reprints
can be ordered at http://www.ajph.org by
clicking the “Reprints”link.
This commentary was accepted
December 21, 2012.
Contributors
L. Finer and J. B. Fine contributed equally
to the research and writing of the
commentary.
Acknowledgments
We wish to thank Kathryn Meyer for her
help preparing the commentary.
Endnotes
1. Center for Reproductive Rights,
“The World’s Abortion Laws 2012,”
http://worldabortionlaws.com (accessed
September 20, 2012).
2. Center for Reproductive Rights, The
World’s Abortion Laws 2011 (New York,
2011).
3. Stanley K. Henshaw, “Induced Abor-
tion: A World Review, 1990,”Family Plan-
ning Perspectives 22, no. 2 (1990): 76---89.
4. P. 753 in Julia L. Ernst, Laura
Katzive, and Erica Smock, “The Global
Pattern of U.S. Initiatives Curtailing
Women’s Reproductive Rights: A Per-
spective on the Increasingly Anti-Choice
Mosaic,”Journal of Constitutional Law 6,
no. 4 (2004): 752---795.
5. P. 60 in Anika Rahman, Laura Kat-
zive, and Stanley K. Henshaw, “AGlobal
Review of Laws on Induced Abortion,
1985---1997,”International Family Plan-
ning Perspe ctives 24, no. 2 (1998): 56---64.
6. Rahman et al., “Global Review of Laws;
Reed Boland and Laura Katzive, “Develop-
ments in Laws on Induced Abortion: 1998---
2007,”International Family Planning Per-
spectives 34, no. 3 (2008):110---120; Center
for Reproductive Rights, Abortion World-
wide: 17 Years of Reform (New York, 2011),
http://reproductiverights.org/sites/crr.
civicactions.net/files/documents/pub_bp_
17_years.pdf (accessed September 20,
2012); Rebecca J. Cook, Bernard M. Dickens,
and Laura E. Bliss, “International Devel-
opments in Abortion Law From 1988
to 1998,”American Journal of Public
Health 89, no. 4 (1999): 579---586.
7. For example, Poland, Malta, and the
Republic of Korea.
8. Center for Reproductive Rights,
“World’s Abortion Laws 2012.”
9. Boland and Katzive, “Developments
in Laws: 1998---2007,”110.
10. Henshaw, “Induced Abortion:
1990,”78.
11. Boland and Katzive, “Developments
in Laws: 1998---2007,”110.
12. Ley Orgánica 2/2010, de salud
sexual y reproductiva y de la interrupción
voluntaria del embarazo [Organic law 2/
2010, on sexual and reproductive health
and the voluntary interruption of preg-
nancy], B.O.E. (Spain), no. 55 (March 4,
2010): 21001---21014.
13. Boland and Katzive, “Developments
in Laws: 1998---2007,”117; Cook et al.,
“International Developments from 1988
to 1998,”584; Rebecca J. Cook and
Bernard M. Dickens, “Human Rights Dy-
namics of Abortion Law Reform,”Human
Rights Quarterly 25, no. 1 (2003):1---59;
Leila Hessini, “Global Progress in Abortion
Advocacy and Policy: An Assessment of
the Decade Since ICPD,”Reproductive
Health Matters 13, no. 25 (2005): 88---100.
14. Ernst et al., “Global Pattern of U.S.
Initiatives,”753. The Protocol to the
African Charter on Human and Peoples’
Rights on the Rights of Women in Africa
explicitly recognizes that the right to
health includes access to safe and legal
abortion. It requires states’parties to
“ensure that the right to health of women,
including sexual and reproductive health
is respected and promoted”by taking
appropriate measures to authorize abor-
tion “in cases of sexual assault, rape,
incest, and where the continued preg-
nancy endangers the mental and physical
health of the mother or the life of the
mother or the foetus”(p. 15---16). Protocol
to the African Charter on Human and
Peoples’Rights on the Rights of Women
in Africa, 2nd Ordinary Sess., Assembly of
the Union, adopted July 11, 2003, art. 14,
CAB/LEG/66.6 (entered into force No-
vember 25, 2005).
15. Law of January 7, 1993 on Family
Planning, Human Embryo Protection, and
Conditions of Legal Pregnancy Termina-
tion. This law permits abortion when
a pregnancy threatens the life or health of
the woman, when there is justified suspi-
cion that the pregnancy resulted from
a“criminal act,”or in cases of fetal
impairment.
16. In 1996, Poland’s abortion law was
liberalized to permit abortion on social
and economic grounds. Act of August 30,
1996. However, the constitutional court
invalidated the revised law the following
year. Ruling of the Constitutional
Tribunal of May 28, 1997, sign. of the
records K 26/96 (Pol.) (unofficial trans-
lation). In December 1997, the parliament
enacted new legislation eliminating social
and economic grounds for abortion. Law
of January 7, 1993 on Family Planning,
Human Embryo Protection, and Condi-
tions of Legal Pregnancy Termination
amended as of December 23, 1997 (Pol.)
(unofficial translation provided by Feder-
ation for Women and Family Planning).
17. “Sejm odrzuci1obywatelski projekt
zakazuja˛ cy aborcji,”Gazeta Wyborcza,
August 31, 2011, http://wia dom osci.
gazeta.pl/wiadomosci/1,114873,
10209867,
Sejm_odrzucil_obywatelski_projekt_
zakazujacy_aborcji.html (accessed Sep-
tember 20, 2012).
18. Some laws require that women re-
ceive counseling before undergoing an
abortion. Rather than providing a neutral
discussion of the nature and risks of
abortion, such counseling can be intended
to discourage women from undergoing an
abortion by providing inaccurate infor-
mation. Rahman et al., “Global Review:
1985---1997,”59.
19. Some laws establish waiting or
reflection periods during which women
must wait one to several days before
being permitted to undergo an abortion.
Cook et al., “International Develop-
ments: 1988 to
1998,”584.
20. “Some laws require a woman or
girl to obtain the consent of her spouse
or parent before undergoing an abor-
tion, whereas others require abortion
providers to secure approval from an-
other physician, medical committee or
court before performing an abortion”
(p.73).ReedBoland,“Second Trimester
Abortion Laws Globally: Actuality,
Trends and Recommendations,”Repro-
ductive Health Matters 18, no. 36
(2010): 67---89.
21. For example, in 2002, the Philip-
pines’Food and Drug Administration
issued a circular prohibiting the distribu-
tion, sale, and use of misoprostol. Bureau
of Food and Drugs Advisory 2002---02
(August 12, 2002) (on file with the Center
for Reproductive Rights).
22. Guttmacher Institute, “State Policies
in Brief: Counseling and Waiting Periods
for Abortion”; 2012, http://www.
guttmacher.org/statecenter/spibs/spib_
MWPA.pdf (accessed September 20,
2012).
23. Guttmacher Institute, “News in
Context: State Legislative Trends at Mid-
year 2012,”http://www.guttmacher.org/
media/inthenews/2012/07/10/index.
html (accessed September 20, 2012).
24. “Federelnii Zakon Rossiiskoi Feder-
atzii ot 21 noiabria 2011 g. N 323-F3:
‘Ob osnovah ohranai grajdan v Rossiiskoi
Federatzii,’” http://www.rg.ru/2011/11/
23/zdorovie-dok.html (accessed Septem-
ber 20, 2012). According to article 55,
§3, if a woman is in her 4th to 7th week of
pregnancy or 11th to 12th week of
pregnancy, she must observe a waiting
period of 48 hours before she can access
abortion services. For a woman in the 8th
to 10th weeks of pregnancy, the waiting
period is seven days. Additionally, on
February 6, 2012, the Russian govern-
ment issued a decree, the Social Ground
for Artificial Termination of Pregnancy,
signed by Prime Minister Vladimir Putin.
This decree establishes that the only
social ground for abortion between the
12th and 22nd weeks of pregnancy is
rape. Previously, abortion was authorized
for four social indications during this
period. “Postanovlenie Praviteltva Rossiis-
koi Federacii ot 6 fevralia 2012 g. N 98 g.
Moskva: ‘O socialnio, pokazanii dlia
iskusstvenogo preriavania beremen-
nosti,’” http://www.rg.ru/2012/02/15/
98-dok.html (accessed September 20,
2012).
25. Act No. 576/2004 Coll. of Laws on
Health Care, Health Care-Related Ser-
vices, and Amending and Supplementing
Certain Acts as Amended by Act No.
345/2009 Coll. of Laws, 2004 (Slovak).
26. Act No. 73/1986 Coll. on Artificial
Termination of Pregnancy as Amended by
Act No. 419/1991 Coll., 1986 (Slovak).
27. Judith Bueno de Mesquita and
Louise Finer, “Conscientious Objection:
Protecting Sexual and Reproductive Health
Rights.”University of Essex; 2008, http://
www.essex.ac.uk/hrc/research/projects/
rth/docs/Conscientious_objection_final.
pdf (accessed September 20, 2012);
Bernard M. Dickens and Rebecca J. Cook,
“Conscientious Commitment to Women’s
Health,”International Journal of Gynecol-
ogy and Obstetrics 113, no. 2 (2011):
163---166; Rebecca J. Cook, Monica Ara-
ngo Olaya, and Bernard M. Dickens,
“Healthcare Responsibilities and Consci-
entious Objection,”International Journal
of Gynaecology and Obstetrics 104, no. 3
(2009): 249---252.
28. Previously, abortion was prohibited
with no explicit exceptions. Penal Code,
promulgated by Law 599 of 2000
(Colombia). Following a ruling by the
constitutional court of Colombia, abortion
is now permitted to save a woman’s life or
mental or physical health or in cases of
rape, incest, or severe fetal impairment.
Women’s Link Worldwide, “C-355/
2005: Excerpts of the Constitutional
Court’s Ruling That Liberalized Abortion
in Colombia”; 2007, http://www.
womenslinkworldwide.org/pdf_pubs/
pub_c3552006.pdf (accessed September
20, 2012). Judges have subsequently in-
voked conscientious objection when re-
fusing to hear appeals in connection with
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the denial of legal abortion services. See,
for example, the tutela claim rejected by
Judge José Yañez Moncada in Yolanda
Perez Ascanio v. Saludvida EPS, Juzgado
Décimo Civil Municipal de Cúcuta,
Colombia, quoted in Corte Constitucional
de Colombia, September 3, 2007. “T-
171/07”(Colombia).
29. RRv Poland, No. 27617/04 Eur. Ct.
H. R. (2011).
30. See, for example, Corte Constitucio-
nal de Colombia, May 28, 2009, “T-388/
09/Acción de Tutela”(Colombia) in
which the constitutional court of Colom-
bia noted that judicial authorities cannot
refuse a woman an abortion on the basis
of conscience claims. It also noted that
institutions cannot refuse a woman an
abortion on the basis of conscience claims.
It indicated that only the physician di-
rectly performing the abortion can object
to the provision of services and to do so,
he or she must submit a written statement
explaining the objection and refer
a woman to a physician who is willing and
able to perform the abortion. See also
Pichon and Sajous v. France, No. 49853/
99, Eur. Ct. H. R., Admissibility Decision
(October 2, 2001) (holding that “as long as
the sale of contraceptives is legal and
occurs on medical prescription nowhere
other than in a pharmacy, the applicants
cannot give precedence to their religious
beliefs and impose them on others as
justification for their refusal to sell such
products”[p. 4]).
31. World Health Assembly, “Health
Aspects of Population Dynamics,”WHA
20.41; 1967, http://whqlibdoc.who.int/
wha_eb_handbooks/9241652063_
Vol1_(part1-2).pdf (accessed September
20, 2012).
32. WorldHealthOrganization,“Safe
Abortion: Technical and Policy Guid-
ance for Health Systems,”2nd ed. (Ge-
neva, 2012), http://www.who.int/
reproductivehealth/publications/
unsafe_abortion/9789241548434/en
(accessed September 20, 2012).
33. World Health Organization, “Unsafe
Abortion: Global and Regional Estimates
of the Incidence of Unsafe Abortion and
Associated Mortality in 2008”(Geneva,
2011), http://whqlibdoc.who.int/
publications/2011/
9789241501118_eng.pdf (accessed
September 20, 2012); Gilda Sedgh, S.
Singh, I.H. Shah, E. Ahman, S.K. Henshaw,
and A. Bankole, “Induced Abortion: In-
cidence and Trends Worldwide From
1995 to 2008,”Lancet 379, no. 9816
(2012): 625---632.
34. World Health Organization, “Safe
Abortion: Technical and Policy Guid-
ance,”23.
35. Tysia˛ c v. Poland, No. 5410/03 Eur.
Ct. H.R. (2007); A, B and C v. Ireland,No.
25579/05 Eur. Ct. H.R. (2010).
36. Office of the United Nations High
Commissioner for Human Rights, “Tech-
nical Guidance on the Application of
Human Rights-Based Approach to Imple-
mentation of Policies and Programmes to
Reduce Preventable Maternal Morbidity
and Mortality,”para. 56, U.N. Doc. A/
HRC/21/22 (July 2, 2012).
37. Heathe Luz McNaughton, E.M.
Mitchell, E.G. Hernandez, K. Padilla, and
M.M. Blandon, “Patient Privacy and Con-
flicting Legal and Ethical Obligations in El
Salvador,”American Journal of Public
Health 96, no. 11 (2006): 1927---1933.
38. Center for Reproductive Rights,
“Briefing Paper: A Technical Guide to
Understanding the Legal and Policy
Framework on Termination of Pregnancy
in Uganda”(New York, NY, 2012), http://
reproductiverights.org/sites/crr.
civicactions.net/files/documents/
crr_Uganda
BriefingPaper_v5.pdf (accessed Septem-
ber 20, 2012). “The single most critical
finding of our research is that Uganda’s
laws and policies are more expansive
than most believe, and the current legal
and policy framework offers ample op-
portunities for increasing access to safe
abortion services”(p. 6).
39. Tysia˛ c v. Poland, No. 5410/03 Eur.
Ct. H.R. (2007); L.C. v. Peru, CEDAW
Committee, Commc’n No. 22/2009, U.N.
Doc. CEDAW/C/50/D/22/2009
(2011); K.L. v. Peru, Human Rights Com-
mittee, Commc’n No. 1153/2003, U.N.
Doc. CCPR/C/85/D/1153/2003
(2005); Corte Suprema de Justicia de la
Nación (National Supreme Court of Jus-
tice), March 13, 2012, “F., A. L. s/ medida
autosatisfactiva,”(Argentina).
40. Tysia˛ c v. Poland, No. 5410/03 Eur.
Ct. H.R. (2007); A, B and C v. Ireland, No.
25579/05 Eur. Ct. H.R. (2010); L.C. v.
Peru, CEDAW Committee, Commc’n No.
22/2009, U.N. Doc. CEDAW/C/50/D/
22/2009 (2011).
41. World Health Organization, “Safe
Abortion: Technical and Policy Guid-
ance,”96---97.
42. Guttmacher Institute, “In Brief: Facts
on Induced Abortion Worldwide”; 2012,
http://www.guttmacher.org/pubs/fb_IAW.
pdf (accessed December 21, 2012).
43. Joanna N. Erdman, “Harm Reduc-
tion, Human Rights, and Access to In-
formation on Safe Abortion,”Interna-
tional Journal of Gynecology and Obstetrics
118, no. 1 (2012): 83---86; Beverley
Winikoff and Wendy Sheldon, “Use of
Medicines Changing the Face of Abor-
tion,”International Perspectives on Sexual
and Reproductive Health 38, no. 3 (2012):
164---166.
44. Erdman, “Harm Reduction,”83---86;
Winikoff and Sheldon, “Use of Medi-
cines,”164---166.
45. Winikoff and Sheldon, “Use of
Medicines,”164---166.
46. Ibid.
47. Before 1996, abortion was legal
only to protect life and health or in the
cases of rape, incest, other unlawful in-
tercourse, and some fetal impairments. In
1996, the law was liberalized to permit
the service without restrictions pertaining
to the woman’s motive during the first
trimester and thereafter on numerous
grounds. Choice on Termination of Preg-
nancy, Act 92 of 1996 (South Africa).
48. P. 355 in Rachel Jewkes, H. Rees, K.
Dickson, H. Brown, and J. Levin, “The
Impact of Age on the Epidemiology of
Incomplete Abortions in South Africa
After Legislative Change,”BJOG: An In-
ternational Journal of Obstetrics and Gy-
naecology 112, no. 3 (March 2005): 355---
359.
49. Guttmacher Institute, “Making
Abortion Services Accessible in the Wake
of Legal Reforms: A Framework and Six
Case Studies”(New York, NY, 2012),
http://www.guttmacher.org/pubs/
abortion-services-laws.pdf (accessed Sep-
tember 20, 2012).
50. Ibid., 27, 38.
51. Patricia Stephenson, Marsden Wag-
ner, Mihaela Badea, and Florina Serba-
nescu, “Commentary: The Public Health
Consequences of Restricted Induced
Abortion—Lessons From Romania,”
American Journal of Public Health 82, no.
10 (1992): 1328---1331. “The maternal
mortality rate fell by 50% in the first year
following the change in the law”(p.
1329).
52. Willard Cates, David A. Grimes, and
Kenneth F. Schulz, “Comment: The Public
Health Impact of Legal Abortion: 30
Years Later,”Perspectives on Sexual and
Reproductive Health 35, no. 1 (2003): 25---
28; Council on Scientific Affairs, “Induced
Termination of Pregnancy Before and
After Roe v Wade: Trends in the Mortality
and Morbidity of Women,”Journal of the
American Medical Association 268, no.
22: (1992): 3231---3239.
53. Guttmacher Institute, State Policies in
Brief.
54. National Collaborating Centre for
Mental Health, Induced Abortion and
Mental Health. Academy of Medical Royal
Colleges; 2011, http://www.nccmh.org.
uk/publications_SR_abortion_in_MH.
html (accessed September 20, 2012).
“When a woman has an unwanted preg-
nancy, rates of mental health problems
will be largely unaffected whether she has
an abortion or goes on to give birth”(p.
123); American Psychological Associa-
tion Task Force on Mental Health and
Abortion, “Report of the APA Task
Force on Mental Health and Abortion”;
2008, http://www.apa.org/pi/wpo/
mental-health-abortion-report.pdf
(accessed September 20, 2012). “This Task
ForceonMentalHealthandAbortion
concludes that the most methodologically
sound research indicates that among
women who have a single, legal, first-
trimester abortion of an unplanned preg-
nancy for nontherapeutic reasons, the rela-
tive risks of mental health problems are no
greater than the risks among women who
deliver an unplanned pregnancy”(p. 92);
World Health Organization, “Safe Abor-
tion: Technical and Policy Guidance,”49.
55. See, for example, “Abort—bezplatno:
Socailnaih osnovonii dlia prepaivania
bremennosti stalo menshem,”http://
www.rg.ru/2012/02/17/abort.html
(accessed September 20, 2012); “Min-
zdrav ogranichil pokazania k poednemy
abortu,”http://ryazan.kp.ru/online/news/
1083714 (accessed September 20, 2012).
56. Elizabeth Raymond and David A.
Grimes, “The Comparative Safety of Le-
gally Induced Abortion and Childbirth in
the United States,”Obstetrics & Gynecol-
ogy 119, no. 2 (2012): 215---219.
57. Steve Gutterman and Sonya Hepin-
stall, “Church-Backed Abortion Bill
Sparks Protest in Russia,”Reuters, No-
vember 8, 2011, http://www.reuters.
com/article/2011/11/08/russia-abortion-
idUSL5E7M323R20111108 (accessed
September 20, 2012); Arash Ahmadi,
“Turkey PM Erdogan Sparks Row Over
Abortion,”BBC, June 1, 2012, http://www.
bbc.co.uk/news/world-europe-18297760
(accessed September 21, 2012).
58. Agata Chelstowska, “Stigmatisation
and Commercialization of Abortion Ser-
vices in Poland: Turning Sin Into Gold,”
Reproductive Health Matters 19, no. 37
(2011): 98---106.
59. Special rapporteur on the right of
everyone to the enjoyment of the highest
attainable standard of physical and men-
tal health, “Interim Report of the Special
Rapporteur on the Right of Everyone to
the Enjoyment of the Highest Attainable
Standard of Physical and Mental Health,
Transmitted by Note of the Secretary-
General,”para. 28, U.N. Doc A/66/254;
August 3, 2011, by Anand Grover.
60. Ibid.
61. World Health Organization, “Safe
Abortion: Technical and Policy Guid-
ance,”96.
62. Ted Joyce and Robert Kaestner,
“The Impact of Mississippi’s Mandatory
Delay Law on the Timing of Abortion,”
Family Planning Perspectives 32, no. 1
(2000): 4---13.
63. World Health Organization, “Safe
Abortion: Technical and Policy Guid-
ance,”97.
64. Ibid., 23; SRRH, Interim rep. of the
Special Rapporteur, U.N. Doc. A/66/254
(2011).
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