Tag Archives: Europe

Republicans’ abortion bans are nothing like those in Europe

Originally published in Vox.com on June 6, 2023.
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Republicans scrambling to address mounting backlash to abortion bans have landed on what they hope they can market as a moderate political compromise: limiting abortion after 12 weeks of pregnancy.

Over the last month, Republicans in North Carolina and Nebraska have passed 12-week abortion bans, a dramatic reduction in access for states that previously allowed abortion up until 20 weeks and 22 weeks, respectively.

North Carolina’s ban would permit abortion for rape victims through 20 weeks, for life-threatening fetal anomalies through 24 weeks, and to protect the life of the mother throughout. Nebraska’s new ban would permit exceptions for rape and to save the life of the mother, but not for fatal fetal anomalies. (Health of pregnant person exceptions have been notoriously confusing for doctors in practice, who fear criminal sanctions for violating the vague statutes.)

Republican politicians are casting these new 12-week bans as “mainstream,” comparing them to even more extreme GOP-led states that have banned virtually all abortion, and pointing to other countries, particularly in Europe, that also impose gestational age limits at 12 weeks.

The rhetorical strategy of invoking other countries to justify banning abortion will sound familiar to those who followed the overturn of Roe v. Wade. In that case, Dobbs v. Jackson, Mississippi lawmakers defended their 15-week abortion ban by pointing out that most European countries have even earlier restrictions.

In the Dobbs Supreme Court hearing itself, Justice John G. Roberts claimed the proposed 15-week ban mirrors “the standard that the vast majority of other countries have.” In his majority opinion, Justice Samuel Alito cited a study published by a leading anti-abortion group that argued the US was out of step with the rest of the world in terms of abortion after 20 weeks.

The study, published by the think tank arm of the Susan B. Anthony Pro-Life America, said 47 out of 50 European nations limit “elective” abortion before 15 weeks, meaning before then doctors are not required to attest to a particular justification for the abortion.

But differences between the US and European countries are more complex than that simple comparison suggests. In practice, abortion limits in the United States are far more restrictive than what exists in most of the Western world, including in nations with gestational age limits at 12 weeks, like Germany, Denmark, Belgium, and Italy.

This distinction between “elective” abortions (or “abortion on demand,” as it’s more provocatively called) and “therapeutic” abortions, which are done for medical reasons, might seem like a key distinction between the US and Europe. But in practice, the line is much blurrier. All abortions are ultimately elective — no one is forced to end a pregnancy, even if a doctor recommends it. Plenty of elective abortions are done for therapeutic reasons.

Moreover, European countries that have 12-week limits on “elective” abortions still make it fairly easy for women to get abortions later on, with relatively broad exceptions for mental health or socioeconomic circumstances. Republicans have aggressively fought against similar exceptions, and in particular have worked to bar consideration of mental health risk — even the risk of suicide if a pregnancy continues — as a factor.

And in other ways, European countries make it easier to get an abortion than in even relatively permissive jurisdictions in the United States. Across Europe, abortion services are covered under national health insurance, meaning the cost of accessing care is a far lower barrier for pregnant people facing time constraints.

By contrast, in the US, cost is one of the biggest hurdles to ending a pregnancy. Even though more than 90 percent of abortions occur within the first 13 weeks, roughly 75 percent of all US abortion patients are low-income according to 2014 numbers, and researchers find Americans needing care in the second trimester tend to be those with less education, Black women, and women who have experienced “multiple disruptive events” in the past year, such as losing a job.

Republican lawmakers are also bucking international trends in working to aggressively restrict access to telehealth abortion care and medication abortion generally — which allows patients, especially those who live in remote and rural areas, to get the abortion services they seek on a faster timeline. Both North Carolina and Nebraska have fully banned abortion via telehealth, despite research affirming its safety and efficacy.

Across the globe, the clear trend has been to expand access to abortion, decriminalize the procedure, and loosen restrictions. While restrictive policies, including earlier gestational limits, still present barriers for international abortion care, per the Center for Reproductive Rights, nearly 60 countries have liberalized their laws and policies on abortion since 1994. Only four — the US, El Salvador, Nicaragua, and Poland — have further restricted rights.

Even with earlier gestational limits, abortion in Europe is broadly affordable and accessible. This is not the paradigm Republicans are proposing in the United States. They are fighting to keep abortion expensive, particularly for low-income patients who rely on Medicaid; to limit the reasons like mental health for which patients can access legal abortion; and to restrict access to care, all while imposing bans on telemedicine, ramping up criminal penalties for providers, and shortening the legal timeline for pregnant people to raise funds, arrange travel, and book mandatory medical appointments.

Understanding international abortion access in practice

Republicans have been eager to point to countries that restrict “elective” abortion after 12 weeks to justify the supposedly mainstream nature of their new bans. But in 21 countries across Europe, the cost of abortion care is fully paid for by federal governments, making first-trimester abortions simply easier to do. Abortions in the US can easily exceed $500 out of pocket, and only 17 states currently cover abortion under their Medicaid programs, which they must do with state funds, not federal dollars, as Congress prohibits it.

Another difference is that abortion exceptions for “health of the pregnant woman” in Europe take into account mental health, too. In Germany, for example, while abortion is permitted upon request throughout the first 12 weeks, someone can seek legal abortion through 22 weeks if it would help them “avert the danger of grave impairment to [their] physical or mental health.”

In Britain, which allows legal abortion up to 24 weeks, it’s similarly clarified that a pregnant person can access care if it’s determined that ending the pregnancy would cause less damage to the patient’s physical or mental health than continuing to carry.

“This is always granted [by doctors] under the correct assumption that continuing a pregnancy is always more dangerous than terminating, and that continuing an unwanted pregnancy is always detrimental to a person’s mental health,” said Maria Lewandowska, a reproductive and sexual health researcher at London School of Hygiene and Tropical Medicine.

Any doctor can provide this authorization, she said, and in practice, patients often get approval directly from doctors at abortion clinics. Advocates in the UK have been encouraging the government to authorize nurses and midwives to grant this permission, too.

Some countries don’t explicitly state “mental health” in their statute, but recognize that maternal health includes psychological health. The author of France’s 1975 abortion law clarified during legislative hearings that “the very term ‘health’ covers, it seems to me, the mental aspect as well as the physical aspect.” The World Health Organization’s definition of “health” includes “mental health.” In Canada, leaders make no formal distinction between physical and mental health, which Joyce Arthur, executive director of the Abortion Rights Coalition of Canada, says allows providers to “better integrate abortion care into the broader health care system.”

Meanwhile, research on the psychological harm associated with carrying unwanted pregnancies continues to mount. The Turnaway Study, a longitudinal study on the effects of unwanted pregnancy on patients’ lives, found that the mental health of women able to end unwanted pregnancies was significantly better than that of women forced to carry to term. Another report published in 2022 found that suicide is a leading cause of death for pregnant people during pregnancy and the first year following it.

Anti-abortion activists in the US, for their part, continue to dismiss these studies. “Having an abortion will not mitigate mental health issues,” said Laura Echevarria, a spokesperson for the National Right to Life Committee, which has lobbied state legislatures to exclude mental health.

In addition to providing exceptions for mental health and paying for abortion care, pregnant people in European countries can also seek legal abortion beyond their country’s 12- or 14-week limit for broad socioeconomic reasons, like feeling too young or too old to have children, feeling consumed by existing children, being a single parent, or lacking a stable housing or financial situation. The Center for Reproductive Rights counts at least 16 European countries that permit abortion on socioeconomic grounds.

In Denmark, for example, though the country has a 12-week ban on paper, it’s considered relatively feasible for residents to get approval for abortion beyond that. In 2021, 803 pregnant people applied to get an abortion in Denmark beyond 12 weeks, and 750 were approved.

Thousands of pregnant women living in countries with 12-week abortion bans travel internationally to end their pregnancies

Even with broader grounds for legal exceptions and greater financial assistance available in countries with earlier gestational age limits, first-trimester bans in Europe still force thousands of pregnant people to travel internationally every year to end their unwanted pregnancies. (A French parliamentary report from 2020 estimated that as many as 4,000 French women traveled abroad for abortion annually due to gestational limits. In 2022, French legislators extended their limit to 14 weeks.)

One study published in March looked at people who traveled from countries like Austria, Bulgaria, France, Germany, and Italy to the Netherlands or England for later abortion care. Over half of the pregnant people surveyed hadn’t learned they were even pregnant until they were at least 14 weeks along, when they had already surpassed the limits in their home countries.

The reasons participants cited for not knowing they were pregnant hold strong relevance for pregnant people in the US living in states with new 12- or six-week bans. The participants all said they would have preferred earlier abortion care but didn’t know they were pregnant due to reasons like irregular periods, lack of clear pregnancy signs, misinformation by doctors about contraception, or their gestational age.

While European passports make travel to other EU countries relatively easy, pregnant people then have to shoulder the cost of travel and the abortion, as national governments only fund abortion care for their own residents. Feminist activists help fundraise for pan-European surgical abortion, as well as the distribution of medication abortion to regions where it’s illegal, but second-trimester abortions for non-Dutch residents can cost up to 1,100 euros. Abortion travel also delays care, which increases a pregnant person’s health risks.

Twelve-week bans in the US won’t end the need for abortion care in the second trimester, because there will always be women who lack the knowledge that they’re pregnant before then. But if Republicans wanted to reduce the need for abortion after 12 weeks, they could back straightforward policies to make the procedure more accessible and affordable.

The Forgotten Side of the Immigration Debate

Originally published in the Baltimore Sun on March 8th, 2013.
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Recently, I returned home from a three-week stay in Guanajuato, Mexico. I lived with a gracious Mexican family, took Spanish classes and had the chance to immerse myself in Mexican culture. Mexican society was beautiful and vibrant — full of ideas, art and religion. Needless to say, the crude stereotypes of drug cartels and kidnappings were hardly relevant or applicable to my experience, or the experience of anyone I met.

As my trip wound down, I said to my host parents, “Por favor, vengan a visitar a mi familia en los Estados Unidos!” I wanted them to come see my house and meet my family in Pennsylvania. They smiled sadly and told me that would not be likely, because of the difficult hurdles and high costs of obtaining tourist visas.

They are right, of course. While it is not impossible, it is much harder for Mexicans than for, say, Canadians and Europeans to travel to the United States — because Mexico is not part of the U.S. Visa Waiver Program. This program allows individuals to travel without a visa to the United States for stays of 90 days or less.

Indeed, I also did not need to apply for a visa to travel to Mexico for my visit. But for most countries in the world, and for not-unfounded reasons, potential visitors need to go through various steps in an often arduous process. They must do an interview at a consulate office abroad; they need to file paperwork that shows they have significant ties that keep them at home; and they need to show proof that they are not likely to become a burden on the public system if they travel to the U.S. In essence, if you are not part of the Visa Waiver Program, the burden of proof is on you.

“It’s kind of a crap shoot [for Mexicans], it takes a long time, and it’s expensive,” said Eleanor Sohnen, a policy analyst at the Migration Policy Institute. Whether or not they are ultimately granted a visa, prospective visitors must still pay the nonrefundable $160 application fee, or about 2,037 pesos. “They are often declared ineligible, so they may be dissuaded from even trying at all,” Ms. Sohnen said.

Just how difficult it is for applicants from Mexico (or any other country) to visit the United States is challenging to address, because the State Department does not publish the number of applications it receives for non-immigrant visas, only the number of visas ultimately issued. Thus there is no clear number available to the public of how many applicants were denied.

Back home in the U.S., I now find “comprehensive immigration reform” splashed across the front pages of the major newspapers. They are full of discussions about tighter border controls, crackdowns on employers, paths to citizenship, bipartisan consensus, the DREAM Act, the Latino vote and changing demographics. I read all of it closely to try and understand exactly if and how my host family would be affected by these proposed changes.

It seems to me that the conversation is leaving out those individuals from Mexico who are not looking to come to the United States to work, to study or to live. To the extent that they are included in the national discussion, it’s merely to point out symptoms of a problem we need to address with those who overstay their visas. With all the talk of enhanced security on the borders, I can’t help but remember how easily I was able to cross their border to explore and to learn. I remember how American music frequently blasts on their radios and how my host mom’s favorite television shows were “Bones” and “NCIS” (translated into Spanish). American culture is alive and present in Mexico, but the vast majority of Mexicans that could theoretically visit America will likely never have that chance.

I would think that with our country’s economic woes, there must be something we can do to address our fundamental immigration problems while still encouraging tourism from Mexican citizens. The system as it stands now discourages it.

To be sure, many of the 11 million illegal immigrants in this country entered legally and then overstayed their visas. I recognize this is an enormous and expensive problem. But I find it hard to believe that the only way we can sufficiently limit the number of undocumented workers in the United States is by making it extremely hard for most Mexicans to visit. We certainly have the minds and ingenuity to create a system that ensures those who travel on tourist visas return to their host country, and that eases the process of applying for and obtaining tourist visas.

I am not suggesting Mexico be added now to the Visa Waiver Program but that we do look more closely at the hurdles to travel that many well-intentioned Mexicans face. Include them in the national immigration reform discussion. The increased tourism would economically benefit our country, as would affording others the same freedoms to travel that we so often take for granted.

I’d like to one day welcome into my home my host parents — two hard-working individuals who have no desire to move to America.