A woman participates in a march on the International Day of Action for the Decriminalization of Abortion, on September 28, 2012 in San Salvador.
Photo by Jose Cabezas/Getty

What happens without legal abortion

In 2008, a woman known as Manuela, a 33-year-old mother of two, sought emergency care at a rural hospital in El Salvador. She was suffering a miscarriage, slipping in and out of consciousness and hemorrhaging. Doctors treated her as if she had attempted an abortion and immediately called the police. She was shackled to her hospital bed and accused of murder.

“The reality is restrictive abortion laws result in 22 million clandestine, unsafe abortions annually.”
Nancy Northup, Center for Reproductive Rights
Manuela was sentenced to 30 years in prison without ever having a chance to meet with her lawyer, without an opportunity to speak in her own defense, and without the right to appeal the decision. After several months in prison, Manuela was diagnosed with advanced Hodgkin’s lymphoma — a disease that likely led to the miscarriage. She died in prison in 2010.

These are the very real and harmful consequences of severe abortion restrictions in countries like El Salvador—and they are bucking a 20-year global trend to expand access to safe and legal abortion.

Over the last two decades, 35 countries have liberalized their abortion laws, according to a new report and updated World’s Abortion Laws map from the Center for Reproductive Rights. This trend was catalyzed in 1994 at the U.N. International Conference on Population and Development where 179 governments recognized that unsafe abortion was “a major public health concern” and committed to take measures to prevent it. 

A global movement for women’s rights picked up the charge to reduce deaths and disability from unsafe abortion. Because of the work of grassroots activists, public interest lawyers, human rights advocates, public health researchers, and committed officeholders, step-by-step progress has been made.

That progress is critical. The reality is restrictive abortion laws result in 22 million clandestine, unsafe abortions annually—killing nearly 50,000 women each year.

Abortion rates and maternal mortality due to unsafe abortion are the lowest in the world in Western Europe, where abortion is generally available without restriction as to reason in the early months of pregnancy and treated as a covered medical service. In countries where abortion is legal, maternal morbidity and mortality due to unsafe abortion are generally lower because trained professionals provide abortions at affordable costs.

In 2002, Nepal broadly legalized abortion through the first 12 weeks of pregnancy, and thereafter in specified circumstances. Since that time, the rate of maternal deaths and disability decreased—in fact, maternal morbidity from abortion-related complications that were treated in facilities fell from 54% to 28% between 1998 and 2009, according to the Nepal Ministry of Health.

“A woman’s access to critical health care is a fundamental human right that shouldn’t vary depending on where she lives.”
South Africa made abortion legal in 1996, which led to a 91% decline in abortion-related maternal mortality between 1994 and 2001, according to a government-commissioned report.

The progress in Nepal, South Africa, and 33 other countries over the last 20 years has demonstrated an important global commitment to women’s human rights and to putting an end to the horrors of unsafe abortion.

However, a handful of countries have lagged behind, clinging to draconian laws that place the health and lives of the women living within their borders at grave risk, forcing women to choose between carrying unintended or dangerous pregnancies to term or seeking an illegal abortion—risking severe injury, imprisonment and death.

A woman’s access to critical health care is a fundamental human right that shouldn’t vary depending on where she lives. Thirty-five nations have moved in the right direction. It’s time for the rest of the world to catch up.

Nancy Northup is President and CEO at the Center for Reproductive Rights.


What happens without legal abortion