Where is the worst place for abortions?

GlobalPost

Editor's note: Ever since the US Supreme Court handed down the Roe v. Wade decision in 1973, abortion has been legal in every state of the union.

But that's to say nothing of the rest of the world. We asked GlobalPost correspondents from Cairo to Caracas to assess abortion rights where they are.

United States

At the time of Roe v. Wade, women all over the US rejoiced that it would no longer be necessary to risk death with an illegal procedure or make a mad dash to New York — which in 1970 legalized abortion up to the 24th week of pregnancy.

Today, abortion is, for the majority of Americans, a settled question. According to a recent survey by the Pew Research Center, 63 percent of Americans oppose overturning Roe v. Wade.

But the controversy lives on. With the rise of the Tea Party in 2009, nearly every major political candidate is vetted on his or her stance toward abortion.

Conservative groups have ensured that no federal funds may be used for abortion, and have mounted an active campaign to defund reproductive care providers such as Planned Parenthood.

The furor may be testimony to the power of a small conservative minority to influence the political debate, but is unlikely to change the status quo. Candidates with a hard-line anti-abortion stance, such as Senate hopefuls Richard Mourdock of Indiana or Todd Akin of Missouri, lost soundly in recent elections.

The public has spoken.

Jean MacKenzie in Buzzards Bay, Mass.

Latin America

Latin America could be the worst place in the world for a woman wishing to terminate an unwanted pregnancy.

Five of the six nations with blanket bans on abortion are in the region, according to New York’s Center for Reproductive Rights: Chile, the Dominican Republic, El Salvador, Honduras and Nicaragua.

Meanwhile, abortion on demand in the first weeks of pregnancy is only available in Cuba, Guyana, the US territory of Puerto Rico, Mexico City and, since last October, Uruguay.

Peru also recently accepted recommendations from the United Nations’ Human Rights Council that it guarantee the right, established in law but in practice frequently flouted, to allow abortions for women pregnant from rape.

If the issue of abortion seems divisive in the United States, then it may be even more so in Latin America, with both the Catholic Church and, increasingly, evangelical Christians heavily influencing public policies regarding reproductive rights.

The result is that an estimated 1 million women a year in Latin America and the Caribbean need hospital treatment as a result of complications from backstreet abortions.

Simeon Tegel in Lima

Despite 14 years of left-wing government under President Hugo Chavez’s self-styled socialist revolution, Venezuela’s abortion laws remain governed by the ideology of the Catholic Church, with the practice being banned here unless the mother’s life is in danger. Voluntary abortion is punishable by up to two years in prison, though there is little chance of conviction.

Women in need of abortions either pay inflated prices to doctors on a black market or take under-the-counter pills bought for a few dollars at home. This, according to the Central University of Venezuela, leads to about 16 percent of all maternal deaths.

“Abortion isn’t a hypothetical situation, it’s a reality, it’s being done by women every day … our sisters, our neighbours; it’s a reality that we have to deal with,” said campaigner Tatiana Rojas, of the group Skirts in Revolution, in a television interview in November, adding that rich and poor were impacted very differently.

“[Wealthy women] can access foreign treatment or pay a private clinic,” she said, “whereas poor women are exposed to a clandestine market, irregular clinics, [or] they perform it upon themselves.”

Campaigns, however, have failed to gain any traction here. Skirts in Revolution’s abortion helpline was off the hook last week, its website is down and the group has not updated its Twitter feed for two months. In Venezuela, campaigns such as this are often overshadowed by a loud-mouthed political polarization rarely seen in the Western world.

— Girish Gupta in Caracas

Africa

South Africa liberalized abortion in 1997, after the first post-apartheid government passed a law allowing any woman of any age to get an abortion with no reason required during the first 12 weeks of pregnancy.

Up to 20 weeks, it is legal if there are extenuating circumstances, such as socio-economic or health reasons, or if the pregnancy was the result of rape.

The annual number of abortion-related deaths dropped by 91 percent in the years that followed. But access is a serious and some say worsening problem.

South Africa has a shortage of state facilities able to provide abortion services, and for many women government clinics aren't readily accessible, making it easier to get an illegal procedure.

Advertisements for dodgy clinics are rife in the townships and downtowns of big cities. A significant number of women aren't even aware that abortion is legal.

South Africa is the only country in southern Africa, and one of only three on the entire continent (along with Cape Verde and Tunisia), where abortion is legal without restriction as to the reason. Zambia permits abortion on socio-economic grounds, though there, too, unsafe abortions remain common, and a major cause of maternal death.

Erin Conway-Smith in Johannesburg

The earliest known description of an abortion is said to come from an ancient Egyptian medical text, which outlined a procedure where the female inserted into her vagina a type of plant coated with honey and dates. But today, a procedure like that is punishable by law.

Egypt’s penal code bans abortions in all circumstances, while allowing flexibility in certain — and sometimes difficult to prove — circumstances of “necessity.”

A doctor can abort if the woman’s life is in danger, but must write a detailed report explaining the circumstances. If a woman’s health is at risk, the treating doctor is required to obtain written approval from other specialists in order to carry out the procedure.

The legal obstacles have led some doctors to stop performing abortions for fear of criminal prosecution, leaving Egyptian women to seek out alternative methods — some dangerous and some self-induced. A woman herself can be imprisoned for up to three years for performing an abortion on her on fetus.

Rights groups are fighting back to have abortion decriminalized and for the government to carry out a nationwide survey on the number of unsafe abortions. There is currently no national database. But a government survey in 2005 said at least 1 in 5 births in Egypt are unplanned.

Still pro-choice advocates in Egypt face an uphill battle against religious officials who are growing in prominence under Egypt's new Islamist government. The country’s premier religious institution, Al Azhar, has declared abortion “an intervention against God’s will.”

Erin Cunningham in Cairo

Asia

China is, in many respects, the world leader in abortions. It was the first country to legalize mifepristone — the abortion pill — in 1988.

Abortions are cheap (around $88) and widely available. And Chinese clinics perform more abortions per year — at least 13 million in 2011 — than anywhere else on Earth.

Compared to the US, there is relatively little cultural opposition to the practice. But what is controversial is the policy that lies behind it. The one-child policy, which restricts most couples to having only one child, has led to numerous instances of forced abortions, particularly in the Chinese countryside.

Last June, the case of a seven-month-pregnant woman who was held down and forcibly given an abortion because she could not pay the $6,300 fine sparked outrage across China, leading to calls from academics and officials to abandon the one-child policy.

Yet change still does not seem imminent. Wang Xia, the head of China's family-planning commission, said that restrictions on having children will not be abolished anytime soon. "The policy should be a long-term one,” she said.

Benjamin Carlson in Hong Kong

India legalized abortion in 1971. Prior to that, abortion doctors could be sentenced to up to three years in prison, while women undergoing abortions could do as much as seven years of hard time.

Currently, under the Medical Termination of Pregnancy act, no girl under the age of 18 may seek an abortion without the permission of a parent or guardian. An adult woman may seek an abortion up to 12 weeks after conception if her doctor deems that taking the pregnancy to term presents a risk to the life of the mother or the threat of grave injury. Pregnancies that are the result of rape or the failure of contraception both qualify as presenting a strong risk to the mother's mental health. Abortion is also legal up to 12 weeks after conception if the doctor deems that there is a strong chance that the child would suffer from “such physical or mental abnormalities as to be seriously handicapped,” according to the law.

Those same conditions apply up to 20 weeks, if two doctors agree that they apply to the case.

Partly due to India's concerns over its massive population, in practice, those rules are flouted so frequently that one might say abortion is effectively allowed in India up to 12 weeks after conception without any restrictions. The leading reason for termination is all-too likely female feticide, which UNICEF estimates is a $250 million industry for (law-flouting) ultrasound labs and abortion doctors.

Jason Overdorf in New Delhi

In the poorer regions of North Korea, a growing number of women are turning to illegal and risky back-alley abortions, or under-the-radar operations performed after bribing the country's rickety hospitals. Contraceptives are difficult to find in the hermit state. Meanwhile, sex outside of marriage is not uncommon. Ever since the economy was crippled in the 1990s, prostitution has been on the rise, too, creating a greater need for abortion services.

For the most part, North Korea has banned abortion, unless the government approves the procedure by special request. What does that mean, exactly? Well, the government keeps it vague, but the reality is dark. Defectors have reported witnessing forced abortions in the country's prison camps. They're often carried out in cases where the mother is Korean and the father is Chinese — a stigma for a regime that takes pride in pure blood.

In South Korea, the situation is different. Pragmatic concerns over low birth rates, combined with a powerful Protestant lobby, mean that abortion is illegal except in cases of rape, incest, and severe genetic disorders. Last April, the South Korean Constitutional Court even upheld a 60-year-old abortion ban. Government data estimated that more than 340,000 abortions were conducted in 2005, the most recent year data are available — 95 percent of them illegally.

Abortions here are incredibly common, with countless doctors willing to perform them in clean and safe clinics for jacked-up fees given the risks. Police, too, seem to tolerate the underground market, in the same way prostitution is outlawed but rampant in Seoul. One middle-aged South Korean mother of two tells me she and three of her friends aborted their fetuses and don't feel any taboo talking openly about it.

Geoffrey Cain in Seoul

Southeast Asia remains a hostile place for women seeking abortions. Only communist Vietnam and secular Singapore allow women to terminate pregnancies at will. Throughout the rest of region — in which varied societies take moral cues from Buddhism, Catholicism or Islam — abortion is largely prohibited. In the Muslim-majority nations Malaysia and Indonesia, the government even forces women to carry out pregnancies caused by rape.

But no Southeast Asian nation can match the Philippines when it comes to fervid debates over women's reproductive rights. Obeying the Vatican, bishops and priests in the heavily Catholic nation have sought to equate condoms and birth control pills with abortion. In recent weeks, their movement was derailed by a hard-won new law, more than 10 years in the making, that allows government-sponsored contraception. Abortion is still highly forbidden in the Philippines; suggesting a change to this standard still amounts to political suicide.

But just because abortions are illegal doesn't mean Southeast Asian women aren't having them. In September, a GlobalPost investigation uncovered herbal abortion cocktails sold for $3.60 outside one of Manila's most revered churches. As many as 2 million abortions per year may occur in populous Indonesia, according to the Guttmacher Institute, which monitors reproductive health. Many of these underground operations end in death, according to the institute, which calls Indonesia's abortions a "common occurrence" that are "often unsafe."

Patrick Winn in Bangkok

Europe

The European Union has no common abortion policy but all of its 27 member nations, except Malta, allow abortions in some circumstances. Restrictions placed on the procedure vary from country to country.

Britain's abortion laws are relatively liberal with women able to end pregnancies of up to 24 weeks on medical, psychological or social grounds.

Most other countries, including France and Germany, permit abortion on request, or when the woman is "in distress," up to 12 weeks into the pregnancy. For abortions beyond 12 weeks, special approval must be sought. In some EU countries, government health-care systems cover some or all of the costs.

Ireland has some of the strictest abortion legislation. The procedure is legal only in cases where the woman's life is clearly endangered. Calls for changes in the law have intensified since the death in October of Savita Halappanavar, 31, after medical staff refused to carry out an abortion despite the risk to her life.

Poland limits abortions to rape victims and cases where there is a serious health risk.

Spain's conservative government has pushed to tighten Spanish abortion laws after the previous Socialist administration legalized it in 2010.

The World Health Organization says abortion statistics are generally low in Western Europe, but remain high in the East, even though numbers have fallen since Soviet times when abortion was used as a form of birth control. In 2003, there were more abortions than live births.

A WHO review in 2007 showed that in Armenia, Azerbaijan and Georgia, each woman will on average have close to three abortions in her lifetime.

Recently concerns have been raised that abortion is being used selectively on female fetuses in some parts of Europe — notably Albania, Kosovo and Montenegro.

Barry Neild in London; Paul Ames in Brussels

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