Taking Stock of Abortion Laws Across Europe

Anna Wilkowska-Landowska

A new Council of Europe report reiterates what we already know - availability of legal abortion reduces the rate of unsafe abortion.

After almost two years of discussions between member states’ representatives, the Committee on Equal Opportunities for Women and Men of the Council of Europe have prepared a report entitled "Access to safe and legal abortion in Europe."

The report confirms what is
already known, that the situation in Europe regarding abortion is very
diverse. Abortion is legal in the vast majority
of the Council of Europe member states. In most of the Council of Europe
member states (except
Andorra and Malta), the law permits abortion in order to save women’s
life. Abortion on request is – in
theory – available in all Council of Europe member states, but not in
Andorra, Ireland, Malta, Monaco and

According to information provided
by the International
Planned Parenthood Federation (IPPF),
abortion rates are generally
on the decline in Europe, particularly in the countries of Central and Eastern Europe (based on data
from World
Health Organization Regional Office for Europe

in the European region the number of abortions per 1000 live births
was 412.33 in 2005 and 391.56 in 2006; and in the Commonwealth of Independent
States – the number of abortions per 1000 live births equaled 603.87
in 2005 and 557.3 in 2006). In the European Union, the figures remain
rather stable (the number of abortions per 1000 live births was 252.54
in 2005 and 246.4 in 2006).

Legislation varies considerably
from country to country in Europe, ranging  from complete liberalization
to abortion being available only in extreme circumstances, such as rape,
severe malformation of the fetus or if the woman’s life is at risk. Abortion is generally available without restriction as to reason up to the 12th
week and up to 18 weeks in Sweden.  It is legal up to 22 weeks in most of the Caucasian
countries for social or medical reasons; up to 24 weeks in the Netherlands
and the United Kingdom in the event of social, medical or economic constraints.  It is available
only under certain conditions in Cyprus, Luxembourg, Poland, Portugal
(the situation is, however, changing in Portugal, where a referendum
was held in February 2007, and resulted in a liberalized abortion legislation)
and Spain.  Abortion is available only if the mother’s life is in danger in Ireland and Northern
Ireland and not at all in Malta.

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Where access to abortion is
so heavily restricted, it frequently results in women having to risk
unsafe, illegal abortions, or facing financial difficulties resulting
from the only available alternative: travelling to a country where abortion
is available upon request. In other countries, although the abortion
law may not be heavily restrictive, in practice it is often subject
to limited interpretation. In Slovakia, many healthcare professionals
uphold "conscientious objection” and therefore refuse to perform
abortions. This should
never be a reason for refusing to refer a client for further help elsewhere.

The Committee on Equal Opportunities
for Women and Men declares in its report that the aim should be to avoid
abortions as much as possible. And the best way to avoid abortions is
to avoid unwanted pregnancies by offering accessible and affordable
contraception, and sex education for young adults (including in schools).
The availability of affordable contraception has lowered abortion rates
over the years, in particular in Central and Eastern Europe (in some
countries, e.g. the then Soviet Union, abortion was used instead of
contraception for decades).

Making methods of contraception available,
however, is not enough to prevent abortions. It is also important to
enable women to choose a suitable contraception of their own choice.

In order to avoid unwanted pregnancies, banning abortions is not be a solution. Women facing unintended pregnancy can only sometimes be persuaded to have a child, but most of them will
try to have an abortion even if abortion is illegal in their country.
Some will travel to other countries. The European
Parliamentary Forum on Population and Development
indicates that, according to the statistics
of the Irish
Family Planning Association
in the year 2006, 5042 Irish women went to Britain for an abortion.
In Poland, where underground private abortion services are robust, as
is "abortion tourism," women travel to neighboring countries, including
Austria, Belarus, Belgium, the Czech Republic, Germany, Lithuania, the
Netherlands, the Russian Federation, Slovakia and Ukraine, to have an
abortion. But those who cannot afford to travel will resort to unsafe "backstreet" abortions or will even try to
terminate their pregnancies themselves, at great risk to their health
and even life (according to European Parliamentary Forum on Population
and Development, the estimated number of unsafe abortions in Europe
varies from 500,000 to 800,000 annually).

Restrictive legislation may
also lead to the development of an "abortion underground." Some NGOs
in Poland, where abortion is allowed only in the event of rape, incest
or danger to the life or health of the mother, have complained about
both women’s limited access to abortion – the judgment of the European
Court of Human Rights in the case of Tysiąc v. Poland  confirmed that an ultimate decision on whether or not to carry a pregnancy to term
has to be a matter for the woman, and that women’s right to control
their own bodies must be recognized (see Even Legal Abortion
Is Hard to Access in Poland
These associations estimate that some 180,000 clandestine abortions
are carried out in Poland every year.

It is often argued that giving
women the legal right to abortion will only increase the number of abortions. But in fact, legal restrictions do not contribute
at all to reduction of abortion rates and, rather the opposite, very
often lead to increasing numbers of unsafe abortions. For example, the
Netherlands and Belgium are among those countries in Europe with the
lowest abortion rates in Europe – no wonder, as these countries have
abortion legislation and services best developed. But unfortunately
this is not the case for the whole of the European Union, and also many
countries outside the EU.

Therefore, the report states
that member states of the Council of Europe should be invited to: first
of all decriminalize abortion, if they have not already done so; guarantee
women’s effective exercise of their right to abortion; allow women freedom
of choice and offer the conditions of a free choice; lift restrictions
which hinder, de jure or de facto, access to safe abortion, and in particular
take the necessary steps to create the appropriate conditions for health,
medical and psychological care and offer suitable financial cover; ensure
that women have access to contraception at a reasonable cost, of a suitable
nature for them, and chosen by them; introduce compulsory sex education
for young people (in schools), so as to avoid as many unwanted pregnancies
(and therefore abortions) as possible.

News Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

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Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”

Culture & Conversation Family

‘Abortion and Parenting Needs Can Coexist’: A Q&A With Parker Dockray

Carole Joffe

"Why should someone have to go to one place for abortion care or funding, and to another place—one that is often anti-abortion—to get diapers and parenting resources? Why can’t they find that support all in one place?"

In May 2015, the longstanding and well-regarded pregnancy support talkline Backline launched a new venture. The Oakland-based organization opened All-Options Pregnancy Resource Center, a Bloomington, Indiana, drop-in center that offers adoption information, abortion referrals, and parenting support. Its mission: to break down silos and show that it is possible to support all options and all families under one roof—even in red-state Indiana, where Republican vice presidential candidate Gov. Mike Pence signed one of the country’s most restrictive anti-abortion laws.

To be sure, All-Options is hardly the first organization to point out the overlap between women terminating pregnancies and those continuing them. For years, the reproductive justice movement has insisted that the defense of abortion must be linked to a larger human rights framework that assures that all women have the right to have children and supportive conditions in which to parent them. More than 20 years ago, Rachel Atkins, then the director of the Vermont Women’s Center, famously described for a New York Times reporter the women in the center’s waiting room: “The country really suffers from thinking that there are two different kinds of women—women who have abortions and women who have babies. They’re the same women at different times.”

While this concept of linking the needs of all pregnant women—not just those seeking an abortion—is not new, there are actually remarkably few agencies that have put this insight into practice. So, more than a year after All-Options’ opening, Rewire checked in with Backline Executive Director Parker Dockray about the All-Options philosophy, the center’s local impact, and what others might consider if they are interested in creating similar programs.

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Rewire: What led you and Shelly Dodson (All-Options’ on-site director and an Indiana native) to create this organization?

PD: In both politics and practice, abortion is so often isolated and separated from other reproductive experiences. It’s incredibly hard to find organizations that provide parenting or pregnancy loss support, for example, and are also comfortable and competent in supporting people around abortion.

On the flip side, many abortion or family planning organizations don’t provide much support for women who want to continue a pregnancy or parents who are struggling to make ends meet. And yet we know that 60 percent of women having an abortion already have at least one child; in our daily lives, these issues are fundamentally connected. So why should someone have to go to one place for abortion care or funding, and to another place—one that is often anti-abortion—to get diapers and parenting resources? Why can’t they find that support all in one place? That’s what All-Options is about.

We see the All-Options model as a game-changer not only for clients, but also for volunteers and community supporters. All-Options allows us to transcend the stale pro-choice/pro-life debate and invites people to be curious and compassionate about how abortion and parenting needs can coexist .… Our hope is that All-Options can be a catalyst for reproductive justice and help to build a movement that truly supports people in all their options and experiences.

Rewire: What has been the experience of your first year of operations?

PD: We’ve been blown away with the response from clients, volunteers, donors, and partner organizations …. In the past year, we’ve seen close to 600 people for 2,400 total visits. Most people initially come to All-Options—and keep coming back—for diapers and other parenting support. But we’ve also provided hundreds of free pregnancy tests, thousands of condoms, and more than $20,000 in abortion funding.

Our Hoosier Abortion Fund is the only community-based, statewide fund in Indiana and the first to join the National Network of Abortion Funds. So far, we’ve been able to support 60 people in accessing abortion care in Indiana or neighboring states by contributing to their medical care or transportation expenses.

Rewire: Explain some more about the centrality of diaper giveaways in your program.

PD: Diaper need is one of the most prevalent yet invisible forms of poverty. Even though we knew that in theory, seeing so many families who are struggling to provide adequate diapers for their children has been heartbreaking. Many people are surprised to learn that federal programs like [the Special Supplemental Nutrition Program for Women, Infants, and Children or WIC] and food stamps can’t be used to pay for diapers. And most places that distribute diapers, including crisis pregnancy centers (CPCs), only give out five to ten diapers per week.

All-Options follows the recommendation of the National Diaper Bank Network in giving families a full pack of diapers each week. We’ve given out more than 4,000 packs (150,000 diapers) this year—and we still have 80 families on our waiting list! Trying to address this overwhelming need in a sustainable way is one of our biggest challenges.

Rewire: What kind of reception has All-Options had in the community? Have there been negative encounters with anti-choice groups?

PD: Diapers and abortion funding are the two pillars of our work. But diapers have been a critical entry point for us. We’ve gotten support and donations from local restaurants, elected officials, and sororities at Indiana University. We’ve been covered in the local press. Even the local CPC refers people to us for diapers! So it’s been an important way to build trust and visibility in the community because we are meeting a concrete need for local families.

While All-Options hasn’t necessarily become allies with places that are actively anti-abortion, we do get lots of referrals from places I might describe as “abortion-agnostic”—food banks, domestic violence agencies, or homeless shelters that do not have a position on abortion per se, but they want their clients to get nonjudgmental support for all their options and needs.

As we gain visibility and expand to new places, we know we may see more opposition. A few of our clients have expressed disapproval about our support of abortion, but more often they are surprised and curious. It’s just so unusual to find a place that offers you free diapers, baby clothes, condoms, and abortion referrals.

Rewire: What advice would you give to others who are interested in opening such an “all-options” venture in a conservative state?

PD: We are in a planning process right now to figure out how to best replicate and expand the centers starting in 2017. We know we want to open another center or two (or three), but a big part of our plan will be providing a toolkit and other resources to help people use the all-options approach.

The best advice we have is to start where you are. Who else is already doing this work locally, and how can you work together? If you are an abortion fund or clinic, how can you also support the parenting needs of the women you serve? Is there a diaper bank in your area that you could refer to or partner with? Could you give out new baby packages for people who are continuing a pregnancy or have a WIC eligibility worker on-site once a month? If you are involved with a childbirth or parenting organization, can you build a relationship with your local abortion fund?

How can you make it known that you are a safe space to discuss all options and experiences? How can you and your organization show up in your community for diaper need and abortion coverage and a living wage?

Help people connect the dots. That’s how we start to change the conversation and create support.

This interview has been edited for length and clarity.

CORRECTION: This article has been updated to clarify the spelling of Shelly Dodson’s name.


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