According to WHO guidelines, if a doctor conscientiously objects to providing an abortion, then that country’s health system must refer a patient to an alternative health care provider. But mandatory referrals are a poor fix and conscientiously objecting health care professionals are also often reluctant to reliably refer patients to someone who will provide necessary care. Hoctor says this systemic failure to ensure backup providers is one of the main reasons behind poor access in certain European countries, including Italy.
Conscientious objection is on the rise in some countries, especially in Croatia, Romania, and Slovakia. Others, including Sweden, Finland, and Bulgaria, have outlawed it, ensuring that abortion access is seen as part of the duty of a health care provider.
But research has found that the most common reason behind traveling for abortion care—as seen in Ireland—is a country’s gestational age limit. While the WHO recommends against prohibiting abortion on the basis of gestational age, in more than 20 European countries, abortion access is capped at 12 weeks. In some places, the limit is even tighter; Croatia and Portugal, for example, have a 10-week limit.
Many people often need an abortion past their country’s limit due to a failed medication abortion, cost, or other barriers—or not realizing they were pregnant. Research has found that when people are refused an abortion due to gestational age limits, it can result in the unwanted continuation of pregnancy, particularly for people with cognitive impairments.
In many countries with a 12-week limit there are also convoluted exceptions that allow for an abortion to happen at a later point. Take Greece. Its 12-week limit shifts to 19 weeks in cases of rape or incest, to 24 weeks if the fetus has an abnormality, and is removed completely if there is a risk to the mother’s life or a chance of serious permanent damage to the mother’s physical or mental health. But on request, there are only a handful of countries in Europe where you can get a second trimester abortion—such as the Netherlands, England and Wales, and Spain—which means some countries are flooded with requests from people looking for care after the 12-week limit.
In some countries that have tight limits, abortion access can depend on how strictly the law is interpreted. In Germany abortion is illegal, but pregnant people can still obtain an abortion at up to 12 weeks if they agree to counseling, or later than this if the pregnancy poses a danger to the health of the mother. In England, the opposite is true; it has a liberal law, but it is enforced. In June 2023, the English public were served a harsh reminder that abortion beyond 24 weeks is still a criminal offense, when a woman was given a 28-month prison sentence for lying to procure abortion pills after the legal limit had passed.
And then there’s the issue of expense. If you have the funds to travel, the costs won’t stop there: Non-residents must pay over €1,000 to receive an abortion in the Netherlands, for example. Even for people not traveling abroad for an abortion, in 31 countries in Europe abortion isn’t included in national health care coverage, meaning that costs pose a significant barrier and disproportionately affect marginalized people. Refugees and people with disabilities, as well as those unable to afford travel, are already more hindered by a country’s restrictions.
Hoctor warns against disregarding the waves of progress for reproductive rights in the past year, partly due to what’s happening in America right now. Europe might not be the utopia some see it as, but progress continues to be made. Waiting periods have been trashed in Spain, gestational age limits expanded in France, the need for a two-doctor sign-off scrapped in Finland. “It’s really important that we document the progress that is happening,” Hoctor says. But the fight for reproductive rights continues, not just in the US—but in every country around the world. “Across the board, there’s room for improvement, in every country in the region.”