Global Restrictions in Abortion Access

While dozens of countries have liberalized laws governing access to abortion over the past quarter-century, a handful of nations have reversed course, including the U.S. Today, two in five women of reproductive age live in countries with restrictive abortion laws, and even in countries where abortion is broadly legal, access varies dramatically based on individual circumstances.

Where is abortion access heading globally, and what factors are influencing trajectories in different regions? What can we learn from the strategies making significant impacts in different global contexts? When and how has abortion—a very private issue—become a matter of foreign policy?

Our 2024 fall Buffett Symposium convened leading strategists, researchers, medical practitioners, and human rights advocates from Colombia, Ireland, Kenya, Poland, and the U.S. to discuss abortion access around the world. These leaders explored the dynamics behind increased liberalization and ongoing challenges to access, offering insights on movements for and in opposition to safe and legal abortion.

The daylong program's initial panel focused on global restrictions in abortion access. In recent decades, only four countries have restricted or reversed the legality of abortion: El Salvador, Nicaragua, Poland, and the U.S. The panelists who joined us to discuss these outliers in global trends toward liberalization were:

• Krystyna Kacpura, President of the Foundation for Women and Family Planning (FEDERA) in Poland

• Katherine Mayall, Director of Strategic Initiatives within the Legal Strategies, Innovation & Research unit of the Center for Reproductive Rights

• Caitlin Bernard, Assistant Professor of Clinical Obstetrics & Gynecology at the Indiana University School of Medicine and one of only two physicians still performing abortions in Indiana

• Moderator Katie Watson, Professor of Obstetrics & Gynecology at the Northwestern University Feinberg School of Medicine

Key Takeaways

• Abortion access continues to be politicized and criminalized, despite being an essential health care issue. In Poland, the restrictive abortion law proved difficult to repeal due to a politicized and protracted legislative process. Reforms are dependent on political events such as the next presidential elections in 2025, rather than on medical advice and public health needs.

• Grassroots organizations, health care providers, and women seeking abortions have devised workarounds to ensure access to abortion care despite legal restrictions. These efforts include travelling to other states or countries where abortion is legal, and providing support to vulnerable groups such as refugees. However, these makeshift solutions are precarious and unsustainable and have caused delays that affect the health and well-being of women and adolescent girls.

• Abortion service providers face harassment, targeting, and legal risks, which impede their work and undermine health care. For example, in the United States, state-level restrictions have led to clinic closures, forcing providers to leave certain states. Supporting and protecting these providers is essential for ensuring continued access to safe abortions.

• Lessons from restrictions on abortion access offer an opportunity to reimagine supportive policies. Restrictions often impose arbitrary gestational limits such as six-week bans or conscience clauses to try to make people reconsider seeking an abortion, which hinder access and delay medical care. Several panelists argued that having no abortion law would be preferable, leaving abortion as a purely medical decision between patients and physicians, free from political interference.

⁠⁠Read the symposium synthesis report produced by Foreign Policy >>⁠