The denial of the right to access safe and legal abortion services

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The systemic denial of women’s right to access safe and legal abortion services, and/or the criminalization of abortion is one of the most severe examples of institutional violence in regards of sexual and reproductive health and rights.

Women’s right to comprehensive sexual and reproductive health services, including abortion, is rooted in international human rights standards, which guarantee the rights to life, health, privacy and non-discrimination. These rights are seriously violated when governments make abortion services inaccessible to women who need them.  According to international legislation, governments can be held accountable for highly restrictive abortion laws and for failure to ensure access to abortion when it is legal. When women are forced to resort to unsafe abortions, governments are responsible for the high death rates and the dangerous health consequences.

Women’s ability to access safe and legal abortions is restricted in law or in practice in a significant number of countries in the world.  In fact, even where abortion is legal, women often have limited access to safe abortion services due to  lack of proper regulation, health services, stigma and/or political will.

When women are forced by restrictive abortion laws to carry to term an unwanted pregnancy or one that puts their health and life at risk, they are subjected to cruel, inhuman and degrading treatment, as stated by various Human Rights Bodies (such as the Human Rights Committee, the Committee on Economic Social and Cultural Rights, The Committee Against Torture, and so on.

This especially concerns the countries that prohibit abortion on all grounds including when a woman’s life and health are in danger or even in cases of rape or incest, subjecting them to cruel, inhuman and degrading treatment, particularly if women are then criminalized and incarcerated. Such is the case in countries like El Salvador, Chile, Nicaragua, Honduras, Haiti, Suriname and Malta.

Some governments seek to defend their denial of access to abortion services with reference to lack of resources.  This is not justifiable.  It is generally much more expensive to treat complications from unsafe abortion than to provide medically safe abortions.  While abortion is generally a low-cost procedure, particularly early in the pregnancy when manual vacuum aspiration or pharmaceutical techniques can be used, the costs of treating women for complications from unsafe abortions can be substantial.

The U.N. Human Rights Committee and the Committee on the Elimination of Discrimination against Women have repeatedly expressed concern about the relationship between restrictive abortion laws, clandestine abortions, and threats to women’s lives.  The committees have recommended the review or amendment of punitive and restrictive abortion laws.

One of these salient cases due to the number of imprisoned women for abortion related charges is El Salvador. El Salvador has criminalized abortion in all circumstances—even when necessary to save a woman’s life—imposing harsh criminal penalties on both women and physicians. The ban has resulted in the wrongful imprisonment of numbers of women who have suffered pregnancy-related complications and miscarriages. They have been charged for having an abortion and wrongfully convicted of homicide. This constitutes institutional violence, since it is the State perpetuating and condoning violence against women, and an assault on women’s right to liberty.

The right to liberty is also threatened when women are deterred from seeking medical care if they fear being reported to police authorities by doctors or other medical professionals who suspect unlawful behavior.

In February 2011, the United Nations Special Rapporteur on Violence against Women emphasized that the El Salvador’s absolute ban on abortion puts women and adolescent girls at risk, because many of them, when facing the need to end a pregnancy, may resort to illegal and clandestine abortions. This data on abortion, however, is only an estimate—given that the procedure is illegal, it is impossible to obtain reliable data.


  • Approximately 13 percent of maternal deaths worldwide are attributable to unsafe abortion—around 47000 deaths annually. Millions of women suffer chronic complications. [1]
  • Restrictive abortion laws are not associated with lower abortion rates. The abortion rate is 29 per 1,000 women of childbearing age in Africa and 32 per 1,000 in Latin America—regions in which abortion is illegal under most circumstances in the majority of countries. The rate is 12 per 1,000 in Western Europe, where abortion is generally permitted on broad grounds.[2]
  • Where abortion is permitted on broad legal grounds, it is generally safe, and where it is highly restricted, it is generally unsafe. Low and mid-income countries with relatively liberal abortion laws are associated with fewer negative health consequences from abortion than countries with highly restrictive laws.[3]


Key figures by selected countries

El Salvador:

Despite its restrictive legislation, an estimated 246,275 abortions took place between 1995 and 2000, with 11.1% of them resulting in the death of the pregnant woman.[4] According to data from the Ministry of Health’s Information, Monitoring and Evaluation Unit, 19,290 abortions between January 2005 and December 2008 were performed, 27.6% of which were on adolescents.

Dominican Republic:

Despite a recent presidential decision to ease the Dominican Republic’s ban on abortion fundamentalist organizations are challenging the constitutionality of the law to avoid the decriminalization at least in those grounds (rape, malformations and when the women´s life is at risk).


President Michelle Bachelet has announced plans to end a total ban on abortions and has tabled a bill in Congress to legalize abortion in cases of rape or when there is a threat to the mother’s or the baby’s life. Abortion is punishable in Chile by up to five years in jail.


The former President Armando Guebuza signed a revised version of the penal code into law, permitting some types of abortion. Under the provision, women can now terminate a pregnancy until the 12th week of pregnancy. Extraordinary circumstances, such as rape or threats to the mother’s life, can permit abortion until the 16th week.

South Africa

The annual number of abortion-related deaths fell by 91 % after the liberalization of the abortion law. [5]


Abortion was made legal on broad grounds in 2002, it appears that abortion-related complications are on the decline: A recent study in eight districts found that abortion-related complications accounted for 54% of all facility-treated maternal illnesses in 1998, but for only 28% in 2008–2009. [6]

Between 1997 and 2008, the grounds on which abortion may be legally performed were broadened in 17 countries: Benin, Bhutan, Cambodia, Chad, Colombia, Ethiopia, Guinea, Iran, Mali, Nepal, Niger, Portugal, Saint Lucia, Swaziland, Switzerland, Thailand and Togo. Mexico City and parts of Australia (Capital Territory, Victoria, Tasmania and Western Australia) also liberalized their abortion laws. In contrast, El Salvador and Nicaragua changed their already restrictive laws to prohibit abortion entirely, while Poland withdrew socioeconomic reasons as a legal ground for abortion.[7]



[2] Sedgh G et al., Induced abortion worldwide in 2008: levels and trends, Lancet, 2012,

[3] Jewkes R and Rees H, Dramatic decline in abortion mortality due to the Choice on Termination of Pregnancy Act, South African Medical Journal, 2005, 95

[4] This according to the research done by AgrupaciónCiudadanapor la DespenalizacióndelAborto in 2010.

[5] Idem

[6]  Pradhan A et al., Nepal Maternal Mortality and Morbidity Study 2008/2009: Summary of Preliminary Findings, Kathmandu, Nepal: Family Health Division, Department of Health Services, Ministry of Health, 2009.