Better Access Leads to Lower Abortion Rates: the Netherlands’ Approach to Women’s Rights and Reproductive Health.
In the United States, individual states push for more restrictive abortion laws while presidential administrations determine the ease of access to contraceptives.[1] Texas banned abortions after six weeks of pregnancy[2] while Mississippi made abortion illegal in most cases after fifteen weeks and asked the US Supreme Court to overrule Roe v. Wade.[3] The Trump administration canceled the Obama administration’s federal program to prevent teen pregnancy.[4] With all these changes, it has become clear that restrictive abortion laws and unrealistic expectations of teenage abstinence do not lower the rates of abortion.[5] Currently, the United States permits abortions later than many other countries, allowing abortions until fetal viability.[6] But, while many countries ease restrictions on abortion, the United States is moving towards more restrictions.[7]
Abortion laws vary widely from country to country; some countries allow abortions broadly[8], some ban abortions at certain stages, and others prohibit abortions altogether.[9] When countries restrict access to abortion, they neither address the causes of unintended pregnancies nor prevent abortions.[10] Instead, restrictive abortion laws lead to a greater number of unsafe abortions that have higher risks and complications,[11] including the death of the mother.[12] Countries with the most restrictive abortion laws have been found to have the highest rates of abortion.[13] Restricting access to abortion also forces women to obtain them at a later stage where complications are more likely to occur.[14]
Abortion rates are also directly related to access to contraceptives because women who did not intend to become pregnant are more likely to seek abortions.[15] Contrary to arguments made by abstinence-only advocates, access to birth control reduces unintended pregnancies and abortion rates.[16]
The Netherlands has one of the lowest abortion rates in the world despite the fact that abortions are banned after fetal viability (typically 24 weeks of gestation), similar to the current US abortion law established by Roe v. Wade, and the country mandates a five-day “cooling-off” period before access to abortion procedures.[17] In the Netherlands, unsafe abortions are rarely seen in practice[18], and most abortions are performed during the first trimester[19] when abortion is the safest.[20] The Netherlands is a leading country for women’s rights and reproductive health, and its approach serves as an example because of its liberal abortion laws coupled with wide access to safe abortion care and contraceptives for people of all ages.[21]
Instead of banning abortions at earlier stages, liberal abortion laws and wide access to safe abortions and family planning resources lower abortion rates and help prevent stigmatization of abortion and contraceptives, reducing the causes of unintended pregnancies and delayed abortions.[22] Abortion services are safest where they have a long history of being legal.[23] Similarly, consistent access to contraceptives and more informative sexual health education lead to a decline in unintended pregnancies.[24] After the Obama administration’s Teen Pregnancy Prevention Program was set in motion in 2010, there was a steep decline in teen pregnancy and birth rate.[25] When the Trump administration canceled the program, considerable research, money, and progress were lost.[26] The Biden administration made efforts to expand access to family planning healthcare services[27], but there is still wide variation in how individual states approach abortion laws and sex education.[28]
Even the Netherlands is not perfect when it comes to women’s reproductive rights because of its mandatory cooling-off period for pregnant women to “think carefully about their decision”[29] although these women have often already gone through an extensive decision or referral process.[30] Nevertheless, Netherlands’ approach to accessible safe abortion procedures and contraceptives sheds light on how countries can lower unintended pregnancies, risks and complications of delayed abortions, and abortion rates through measures that do not restrict the rights of women or increase the number of unsafe abortions.[31] Better access to abortion care and contraceptives are more effective ways to reduce unintended pregnancies and abortion rates than restrictive abortion laws.[32] Pregnant women have difficulty finding safe abortion care even in the countries where abortion is legal, including the United States.[33] Abortion care remains largely inaccessible due to the lack of abortion clinics, the negative attitudes towards it, and the unwillingness of practitioners to refer pregnant women to the right care.[34]
Joy Su is a staff member of Fordham International Law Journal Volume XLV.
This is a student blog post and in no way represents the views of the Fordham International Law Journal.
—
[1] See Heidi Przybyla, Notes, emails reveal Trump Appointees’ war to end HHS teen pregnancy program, NBC News (Mar. 20, 2018, 12:50 AM), https://www.nbcnews.com/politics/politics-news/notes-emails-reveal-trump-appointees-war-end-hhs-teen-pregnancy-n857686.
[2] See Reese Oxner & Eleanor Klibanoff, After Supreme Court’s ruling on Texas Law, abortion-rights supporters see no clear path to victory, Tex. Trib. (Dec. 16, 2021 12.00 PM), https://www.texastribune.org/2021/12/16/texas-abortion-law-legal-fight/.
[3] See Adeel Hassan, What to Know About the Mississippi Abortion Law Challenging Roe v. Wade, N.Y. Times (Dec. 1, 2021), https://www.nytimes.com/article/mississippi-abortion-law.html; US out of step with much of the world on abortion, Fr. 24 (Mar. 12, 2021, 5:00 AM), https://www.france24.com/en/live-news/20211203-us-out-of-step-with-much-of-the-world-on-abortion.
[4] See Przybyla, supra note 1.
[5] See Fatima Juarez et al., Unintended Pregnancy and Induced Abortion in Mexico: Causes and Consequences, Guttmacher Inst., https://www.guttmacher.org/report/unintended-pregnancy-and-induced-abortion-mexico-causes-and-consequences (last visited Jan. 6, 2022).
[6] The United States and countries like Britain, Canada, and China allow abortions to be carried out until fetal viability or later, but of the 67 countries that allow abortion on request, most of them set the limit at 12 weeks. See Fr. 24, supra note 3.
[7] See id.
[8] See Daniela Santamariña et al., How abortion laws in the U.S. compare with those in other countries, Wash. Post (Dec. 2, 2021, 2:00 PM), https://www.washingtonpost.com/world/interactive/2021/us-abortion-laws-worldwide/.
[9] See Rachel B. Vogelstein & Rebecca Turkington, Abortion Law: Global Comparison, Council on Foreign Rels. (Oct. 28, 2019, 8:00 AM), https://www.cfr.org/article/abortion-law-global-comparisons.
[10] See id.
[11] See Abortion, World Health Org. (Nov. 25, 2021), https://www.who.int/news-room/fact-sheets/detail/abortion.
[12] See Abortion Rates by Country, World Population Rev., https://worldpopulationreview.com/country-rankings/abortion-rates-by-country.
[13] See Maggie Fox, Abortion rates go down when countries make it legal: report, NBC News (Mar. 21, 2018, 7:52 AM), https://www.nbcnews.com/health/health-care/abortion-rates-go-down-when-countries-make-it-legal-report-n858476; Abortion Rates by Country, supra note 12.
[14] See Fox, supra note 13.
[15] See id.
[16] See id.
[17] See id.; Which Countries have the Highest Abortion Rates?, 132 Healthwise, https://www.132healthwise.com/which-countries-have-the-highest-abortion-rates.php (last visited Jan. 6, 2022); The World’s Abortion Laws, Ctr. for Reproductive Rts., https://maps.reproductiverights.org/worldabortionlaws?country=NLD (last visited Jan. 6, 2022); Lisa Juanola & Irene de Vries, The Dutch approach to abortion: leading or lagging in guaranteeing women’s rights?, KIT Royal Tropical Inst. (Sept. 28 2020), https://www.kit.nl/the-dutch-approach-to-abortion-leading-or-lagging-in-guaranteeing-womens-rights/.
[18] See Juanola & de Vries, supra note 17.
[19] In the Netherlands, 18 percent of abortions were carried out after 13 weeks and the estimate was possibly higher because of the numbers of nonresidents seeking abortion care in the Netherlands. See generally Nine out of 10 abortions are done before 12 weeks in many high-income countries, BMJ (Sept. 4, 2019), https://www.bmj.com/company/newsroom/nine-out-of-10-abortions-done-before-12-weeks-in-many-high-income-countries/.
[20] See generally Lianne Holten et.al, Permeability of abortion care in the Netherlands: a qualitative analysis of women’s experiences, health professional perspectives, and the internet resource of Women on Web, NCBI (May 12, 2021), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8118432/.
[21] See id.
[22] See generally id.
[23] See Fox, supra note 13.
[24] See Juanola & de Vries, supra note 17.
[25] See Przybyla, supra note 1.
[26] See Przybyla, supra note 1.
[27] See, e.g., SIECUS Applauds the Biden Administration on the Release of a Progressive Budget for FY22, SIECUS (May 28, 2021), https://siecus.org/siecus-applauds-the-biden-administration-on-the-release-of-a-progressive-budget-for-fy22/.
[28] See, e.g., Claire Lampen, It isn’t required in 19 states to teach teens about condoms, Daily Dot (May 21, 2021, 9:50 AM), https://www.dailydot.com/irl/abstinence-only-education/.
[29] See Daniela Santamariña et al., How abortion laws in the U.S. compare with those in other countries, Wash. Post (Dec. 2, 2021, 2:00 PM), https://www.washingtonpost.com/world/interactive/2021/us-abortion-laws-worldwide/.
[30] When countries (including the Netherlands) have restrictive laws, women often do not know under what circumstances abortion is allowed and the resources available to them, further restricting their rights. See Juanola & de Vries, supra note 17.
[31] See Juanola & de Vries, supra note 17.
[32] See id.
[33] See id.; US out of step with much of the world on abortion, Fr. 24 (Mar. 12, 2021, 5:00 AM), https://www.france24.com/en/live-news/20211203-us-out-of-step-with-much-of-the-world-on-abortion.
[34] See Juanola & de Vries, supra note 17.