Health

The Surprising Countries Where It’s Easier To Get An Abortion Than The U.S.

CREDIT: AP Photo/Binod Joshi

Women in Nepal march during a rally to observe International Women's Day

In order to argue that abortion bans are simply common sense, anti-abortion advocates often point out that even liberal European countries cut off access to the procedure before the United States does — making the point that the U.S. has particularly extreme laws that fall outside the status quo. It’s a framework that GOP presidential candidate Rand Paul revived last week, when he mused whether the entire Democratic Party supports abortion “all the way up until the day of birth.”

But focusing the conversation on later abortions obscures the fact that the vast majority of terminations take place in the first trimester; here in the U.S., a full one-third of abortions occur in the very first six weeks of pregnancy. When trying to assess reproductive rights here, the question then becomes: How easy is it to get an abortion at the point when most women want to have an abortion?

When you look at it that way, it becomes clear that the United States’ policies certainly aren’t more permissive than other countries’. Although elective abortion is technically legal until the point of viability under Roe v. Wade — which makes our laws seem relatively liberal on the international stage — abortion is not necessarily accessible in practice. Plus, as the world has been making progress on expanding reproductive rights, the U.S. has been moving in the opposite direction.

Around the world, it has been getting easier to have an abortion. Although much of the globe does restrict legal access to the procedure, there’s been a clear trend toward liberalizing the policies in this area. According to the Center for Reproductive Rights, which tracks the world’s abortion laws, more than 30 countries have expanded the conditions under which women can access legal abortion over the past two decades.

“We do not see this trend slowing down,” Katy Mayall, the global advocacy adviser for the Center for Reproductive Rights, told ThinkProgress. “With the enshrinement of the importance of access to abortion services within international human rights norms, there’s been a really strong push globally to make sure that women aren’t dying from unsafe abortions.”

In 1994, the International Conference on Population and Development was held in Cairo, marking the first time that women’s lives were placed at the center of global development work. At that United Nations conference, countries from around the world explicitly recognized that preventing unsafe abortions — which kill an estimated 47,000 women each year — is a public health imperative. The policy recommendations that came out of Cairo continue to inform global health leaders’ work in this space, and there are now several international agreements that hold up the right to safely end a pregnancy as a method of reducing maternal mortality.

So, over the past 20 years, diverse regions of the world — ranging from Nepal to Ethiopia to South Africa to Mexico City — have started falling in line.

“From my point of view, the United States is very much out of step with what’s happening in the rest of the globe,” Dr. Anu Kumar, the executive vice president of development at Ipas, an international reproductive health organization, told ThinkProgress. “We see places around the world that are really changing. And the reason they’re doing it is because it’s in accordance with international agreements.”

Kumar’s organization has been very involved with helping to facilitate this shift in Nepal, which used to be one of the countries that banned abortion in all circumstances and aggressively prosecuted women for ending their pregnancies. Because too many women were dying from illegal abortions, however, the country legalized the procedure in 2002. Since then, the government has worked to integrate abortion into the rest of women’s health services, becoming somewhat of a model for how to successfully ensure safe access to the procedure.

Kumar, who has traveled to Nepal several times, describes it as a “rural, remote, mountainous country” and says it’s “hard to overstate how poor this country is.” Nonetheless, Nepal has pursued effective public health policies that reproductive rights advocates here in the U.S. can only dream about.

There are now trained abortion providers in all 75 districts in Nepal. There’s a group of 50,000 female health volunteers who help counsel women faced with an unplanned pregnancy. There’s a “safe abortion logo” that lets women know which facilities will help them terminate a pregnancy. Abortions are offered in the same clinics that provide other routine health services, like prenatal care and vaccinations. Abortion-inducing pills are widely available, and midwives have been trained to administer them so women don’t need to be dependent on doctors, who are much harder to find.

When the government threw its support behind these dramatic policy changes, there was little resistance stemming from any moral issues with abortion. “It’s not a matter of religion. It’s a matter of women’s lives,” Kumar said simply. “The motivation of the Nepali government was to preserve the health and lives of Nepali women.”

That’s very different than the situation here in the United States, where abortion has been segregated from the rest of the medical field and pushed into standalone clinics. Nearly 90 percent of U.S. counties do not have an abortion provider, and there are increasingly complicated restrictions being placed on doctors that make it difficult for medical professionals to perform abortions even if they have the training to do so.

Other countries far outside of Europe also take a more progressive stance on abortion than the United States does. Another impoverished country, Ethiopia, successfully liberalized its abortion laws in 2005 to remove legal barriers for minors seeking abortion services. Ethiopia’s new policy assumes that teenagers faced with an unplanned pregnancy need easy abortion access because they may be “physically or psychologically unprepared to raise a child.”

That’s not how it works here. In many states, minors seeking an abortion either have to obtain parental consent or go through a difficult legal process to ask permission from a judge — and states are working to make their policies even tighter. Alabama even appoints lawyers to represent teenagers’ fetuses and argue against their abortion rights in court. Some minors are told that they must give birth because they’re too “immature” to choose to have an abortion.

And the barriers to abortion services in the most powerful nation in the world are hardly limited to strict parental notification laws. The U.S. represents one of just a few countries that’s been placing additional restrictions on abortion throughout the past several decades. Since 2010, states have enacted a record-breaking number of laws designed to make it more difficult for women to obtain this medical service — driving abortion clinics out of business, requiring women to make multiple trips to a clinic, making it too difficult to prescribe the abortion pill, outlawing specific surgical abortion methods, and ultimately loading up OB-GYNs with so much red tape that some of them end up choosing to stop providing abortions altogether.

According to the Guttmacher Institute, a think tank that tracks state-level abortion policy, this trend has only continued so far this year, as GOP-controlled states continue to successfully advance legislation to narrow the window during which women may legally end a pregnancy.

abortion restrictions guttmacher

“While we do have a federal constitutional right, states are taking aim at that in different ways and really trying to chip away at that right in a piecemeal fashion,” Amanda Allen, the state legislative counsel at the Center for Reproductive Rights, told ThinkProgress. She described the political activity since the 2010 elections as “a sustained assault on reproductive rights.”

Proponents of abortion rights in the U.S. have attempted to adopt some of the same strategies that have facilitated progress in this area abroad. In Texas, where legislators have passed multiple policies devastating the reproductive health infrastructure and forcing dozens of clinics to close, activists are now arguing that the state has created a human rights crisis. Delegates from the National Latina Institute for Reproductive Health and the Center for Reproductive Rights traveled to Geneva last year to present this argument to the UN’s Human Rights Committee.

However, unlike many other nations, lawmakers in the U.S. don’t necessarily feel pressured to bring their policies in line with international human rights norms regarding women’s health. According to Kumar, the human rights principles are “less well known and less valued” here than they are overseas, and Americans aren’t very familiar with fundamental treaties like the Universal Declaration of Human Rights. That makes it harder to push for the same kinds of reforms — like expanding the pool of abortion providers to include nurses and midwives — that are becoming more common around the world.

“One thing we can do, as American citizens, is really open our eyes to what’s happening around us. I think it’s really important for us to learn from other places and be part of the global community — and when you’re part of the global community, you see just how out of step the United States really is,” Kumar said. “Both the international rights community and the public health literature support reproductive rights. There’s no question about that. We can continue to ignore that in the U.S., and we can continue to moralize about it and politicize it, but it just defies common sense.”