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 Country Overviews Laws on Induced Abortion for Participating Countries
7. On reqest 6. Socio-economic reasons 5. Foetal impairment 4. Rape or incest 3. To preserve mental health 2. To preserve physical health 1. To save woman's life 0. No grounds permitted |
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Bangladesh 
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Overview While induced abortion in Bangladesh is legal only to save the life of the pregnant woman, menstrual regulation (MR) up to the twelfth week since last menstrual period (LMP) is legal and widely accessible. Family Welfare Visitors (FWVs), often based at the primary care level, play a critical role in making MR services available to women. FWVs have a minimum of 10 years of schooling plus an additional 18 months of education in family planning and maternal and child health. In addition, they can elect to take a three-month course in MR service delivery, including training in client counseling and follow-up services. Since the introduction of MR services in 1977, the rate of severe infections and fatalities from unsafe abortion has decreased significantly. Unsafe MR occurs in Bangladesh as a result of poor training of providers, inadequate supplies and substandard facilities, as well as economic, cultural, and informational barriers limiting women’s access to safe MR services. The government recognizes these barriers and has expressed a commitment to ensuring adequate training and supplies to minimize unsafe abortion and MR. | |||||||
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Cambodia
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Overview Cambodia liberalized its restrictive abortion policy in November 1997; abortion is now allowed up to 14 weeks without restrictions. Only medical doctors, medium medical practitioners and midwives who have received authorization from the Ministry of Health may perform abortions. Abortions must be provided in facilities that have been inspected and approved by the Ministry of Health. However, government-trained midwives are able to bring prenatal and emergency obstetrical care directly to women’s homes. Midwives are now one of the main components of the government’s health care system. Cambodian women prefer midwives as providers for most of their maternal care, due in part to their accessibility. | |||||||
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India
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Overview The Medical Termination of Pregnancy (MTP) Act of 1971 liberalized the indications for which abortion is legal in India to include termination of pregnancy resulting from rape or from contraceptive failure. The Government intended for this Act to reduce the incidence of unsafe abortion and consequent maternal morbidity and mortality. However, abortion providers are limited to highly trained physicians who tend to be inaccessible to rural women. Thus, 30 years after this groundbreaking legislation, an estimated 90 percent of women seeking abortion still turn to uncertified providers, often resulting in complications or death. Discussions about amending the existing MTP Act to decentralize abortion services and allow Ayurvedic Practitioners and BSc Nurses to provide abortions are currently underway. | |||||||
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Kenya
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Overview Kenyan law restricts abortion except to save the life of the woman, although interpretations vary. Modern contraceptive use is 33 percent and unplanned or unwanted pregnancies are common. Unsafe, clandestine abortion contributes significantly to Kenya's high maternal mortality ratio (590/100,000) and women suffering complications from unsafe abortions constitute a significant portion of the gynaecology ward admissions. While it is widely known that safe abortions can be obtained in private hospitals and clinics, the overall pattern of high rates of abortion-related mortality and morbidity has not improved. In recent years, this bleak picture has led some within the medical and legal professions to propose review and reform of the laws governing abortion; a wider debate is now underway. To date, the role of midlevel providers in abortion care has been primarily to enhance much needed postabortion care (PAC) services. A variety of pilot programs have successfully involved clinical officers and midwives in strengthening and expanding comprehensive PAC services in both public and private sector venues. The success of these efforts has prompted the Ministry of Health to include provision of PAC services by midlevel providers as a key element in the national reproductive health strategy. | |||||||
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Mozambique
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Overview In Mozambique, abortion is legal only to save the life of the woman, although interpretations vary and the existing law is not strictly enforced. If the abortion is performed in a hospital, if a physician completes an abortion begun outside of the medical setting or if the abortion involves a married woman, courts generally will not prosecute. Initiatives are underway to involve mid-level providers in abortion care. The government is concerned about the level of maternal mortality related to abortion. | |||||||
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South Africa
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Overview Passed in December of 1996, South Africa's Choice of Termination of Pregnancy (CTOP) Act gives women of any age or marital status the right to terminate an unwanted pregnancy. Pregnancies up to and including 12 weeks can be terminated on request while those from 13 weeks through to 20 weeks can be terminated at a medical practitioner’s discretion in consultation with the pregnant woman. Pregnancies over 20 weeks gestation may be terminated under specific conditions. Medical doctors can perform abortions at all stages; registered nurse-midwives who have completed a prescribed training course can only perform abortions on pregnancies up to and including 12 weeks. Though access to safe abortion services has increased dramatically since 1997, access remains difficult for many women in South Africa. Provider attitudes, perceived attitudes of the communities, and fear of harassment contribute to inadequate service delivery. | |||||||
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Sweden
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Overview According to Sweden's 1974 Abortion Act, a woman is entitled to an abortion until the end of the 18th week of pregnancy. Abortion beyond the 18th week is allowed only for special reasons, such as fetal injuries or serious maternal physical and mental health problems, and only after approval from the National Board of Health and Welfare; elective abortions are not approved after the 22nd week of pregnancy. Only a specialist in gynecology or a doctor under training to become a specialist is allowed to perform abortions and only at general hospitals. In 1999 the number of births in Sweden was 88,300 and the number of abortion was 30,700, of which 93 percent were first trimester abortions. Around 60 percent of first trimester abortions are performed by vacuum aspiration, while 40 percent are medical. Registered nurses or nurse-midwives can assist the doctor in surgical abortions like in other obstetric surgery. Recently, midwives took a larger role in medical abortion in terms of counseling and care of the woman during the procedure. In some areas, midwives provide information about available abortion methods and are able to administer the drugs to women who choose pharmaceutical abortion. Care and management of medical abortion clients has gradually been shifted from doctors to midlevel providers. However, midwives providing elective abortion services must have a doctor’s supervision. | |||||||
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United States
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Overview In 1973, with the case of Roe v. Wade, the Supreme Court of the United States determined that a woman's right to terminate her pregnancy is constitutionally protected. In 1992, however, the Supreme Court weakened abortion rights by allowing states to pass certain restrictions. Consequently, some states now require mandatory waiting periods, spousal involvement, parental consent for minors or pre-abortion counseling designed to dissuade women from choosing abortion. Restrictions have also been placed on abortion coverage in state health insurance programs. Currently, approximately 86 percent of all U.S. counties have no abortion provider, and 32 percent of women of reproductive age live in these counties. Midlevel providers in the U.S. include certified nurse midwives, nurse practitioners, nurse clinicians, and physician assistants. Interpretation of state laws and regulations is particularly important as 44 states provide that only a physician may perform an abortion. Midlevel providers perform abortions in only five states. Laws that restrict midlevel practice refer specifically to "performing abortions" and do not specify management of other conditions, such as complications resulting from abortions. Because manual vacuum aspiration (MVA) is easily learned and well within the scope of practice of many midlevel practitioners, it is hoped that they will be trained in this skill and become increasingly involved in the management of incomplete abortions. The introduction of mifepristone and its very positive and public advertising campaign brings an opportunity for midlevel providers to emphasize their logical role as abortion providers. | |||||||
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Vietnam
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Overview Abortion has been legal in Vietnam since 1945 and available on request since 1960. While Vietnam has one of the highest abortion rates in the world at 45 per 100 live births, the abortion rate is declining. Midwives and assistant doctors may provide abortion at commune health (primary care) centers. Midwives certified to perform abortions must have a secondary school education, three years of nurse or midwife training, and an additional two months of training in abortion care. Despite having trained abortion providers at the commune level, unsafe abortion continues to occur in Vietnam. Not all trained providers are able to perform safe abortions due to inadequate refresher training, outdated equipment or unsanitary facilities. Additionally, private-sector abortion service delivery is difficult to regulate, and many private providers are untrained. The Vietnamese government is committed to reducing the number of unwanted pregnancies and improving the quality of abortion care. | |||||||
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Zambia
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Overview Zambia has one of the most liberal abortion laws in Sub-Saharan Africa. According to the 1972 Termination of Pregnancy Act, abortion is permitted to save the woman’s life, preserve the mental and physical health of the woman, to prevent the suffering of a child at risk of being born with substantial physical or mental abnormalities and for economic or social reasons (for example, if continuation of the pregnancy involves a risk of injury to the physical or mental health of existing children). Despite this liberal law, abortion services are confined to one hospital, and unwanted pregnancy and unsafe abortion remain a significant problem in Zambia. The general public and the medical community are largely unaware of the liberal law, and within medical circles there has been little movement to increase awareness. Until 1997, midwives and nurses involved in abortion care only assisted during procedures or offered counseling to the patient. However, the 1997 Nurses and Midwives Act has significantly expanded the scope of practice for nurses and midwives in many areas; nurses and midwives now offer PAC services to patients, including the treatment of abortion complications or incomplete abortion using MVA. However, nurses and midwives are not allowed to provide induced abortions REFERENCES Akhter, Halida Hanum. 2001. Bangladesh Country Report presented at the conference Expanding Access: Advancing the Roles of Midlevel Providers in Menstrual Regulation and Elective Abortion Care. December 2-6, 2001. South Africa. Alan Guttmacher Institute. 1999. Sharing Responsibility: Women, Society, and Abortion Worldwide. Alan Guttmacher Institute: New York, NY. Central Intelligence Agency. 2000. The World Factbook. Central Intelligence Agency: Washington, DC. Center for Reproductive Law & Policy. 2001. The World’s Abortion Laws. Center for Reproductive Law & Policy: New York, NY. Engenderhealth. 2001. Cambodia: The RACHA Program. Engenderhealth: New York, NY. Jonsson, Ing-Marie, Catharina Zätterström, and Kajsa Sundström. 2001. Midwives’ Role in Management of Medical Abortion. Sweden Country Report presented at the conference Expanding Access: Advancing the Roles of Midlevel Providers in Menstrual Regulation and Elective Abortion Care. December 2-6, 2001. South Africa. Khe, Nguyen Duy and Dang Thi Nghia. 2001. Vietnam Country Report presented at the conference Expanding Access: Advancing the Roles of Midlevel Providers in Menstrual Regulation and Elective Abortion Care. December 2-6, 2001. South Africa.Kruse, Beth. 2001. United States Country Report presented at the conference Expanding Access: Advancing the Roles of Midlevel Providers in Menstrual Regulation and Elective Abortion Care. December 2-6, 2001. South Africa. M’tonga, Velepi and Martha Ndhlovu. 2001. Zambia Country Report presented at the conference Expanding Access: Advancing the Roles of Midlevel Providers in Menstrual Regulation and Elective Abortion Care. December 2-6, 2001. South Africa. Oguttu, Monica and Dr. Peter Odongo. 2001. Kenya Country Report presented at the conference Expanding Access: Advancing the Roles of Midlevel Providers in Menstrual Regulation and Elective Abortion Care. December 2-6, 2001. South Africa.Population Action International. 2001.The Population Action International Report Card. Washington, DC: Population Action International. Population Reference Bureau. 2000. Quick Facts. Population Reference Bureau: Washington, DC. Prakasamma, M. 2001. Expanding Women’s Access to Menstrual Regulation and Elective Abortion Care. India Country Report presented at the conference Expanding Access: Advancing the Roles of Midlevel Providers in Menstrual Regulation and Elective Abortion Care. December 2-6 2001. South AfricaRen, Neang. 2001. Cambodia Country Report presented at the conference Expanding Access: Advancing the Roles of Midlevel Providers in Menstrual Regulation and Elective Abortion Care. December 2-6, 2001. South Africa.Ross, John, John Stover, Amy Willard. 1999. Profiles for Family Planning and Reproductive Health Programs. Futures Group International: Washington, DC. Sihanouk, Norodom, King of Cambodia. 1997. Kram on Abortion: November 12, 1997. Government of Cambodia. United Nations Population Fund. 2001. State of the World’s Population. United Nations Population Fund: New York, NY. United Nations. 1999. World Abortion Policies. United Nations: New York, NY. United Nations. 1993. Abortion Policies: A Global Review. Volume 2: Gabon to Norway. United Nations: New York, NY. United States Agency for International Development. 2000. Congressional Presentation. United States Agency for International Development: Washington, DC. World Health Organization. 2000. World Health Report. World Health Organization: Geneva, Switzerland. World Health Organization. 1999. Abortion in Vietnam: An Assesment of Policy, Programme, and Research Issues. World Health Organization: Geneva, Switzerland. World Health Organization. 1998.Unsafe Abortion. World Health Organization: Geneva, Switzerland. | |||||||
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