Highly restrictive laws that prohibit abortion – such as in Malta – have severe and harmful implications on women’s health and well-being, according to a Council of Europe paper published today.

The report by the Commissioner for Human Rights of the Council of Europe says most women in such countries who decide to end a pregnancy, travel abroad to obtain safe services or undergo an illegal, clandestine abortion at home.

The paper on women’s sexual and reproductive health and rights comes less than a month after Commissioner Nils Muiž-nieks said he was “taken aback” by the lack of public debate about abortion in Malta.

Malta had one of the most restrictive regimes in the Council of Europe on abortion, and it was almost a taboo subject, he said.

The report gives an overview of EU States’ obligations, shines a light on some national examples and international jurisprudence, and provides some 40 recommendations aimed at helping States address shortcomings.

Among other things, the report calls for reforming highly restrictive laws by ensuring that abortion is legal on a woman’s request in early pregnancy and thereafter, throughout pregnancy, to protect women’s health and lives.

Another recommendation is that States ensure that abortion counselling is never mandatory, biased or directive.

More than four-fifths of Council of Europe member states have legalised abortion on a woman’s request, for reasons of distress or on broad socioeconomic grounds.

The report says that in eight cases in Europe, laws on abortion have yet to be reformed.

Andorra, Ireland, Liechtenstein, Malta, Monaco, Northern Ireland, Poland and San Marino all retain highly restrictive laws that forbid women’s access to abortion except in extremely limited circumstances.

Andorra and Malta prohibit abortion in all situations.

Abortion is legal in Ireland only to avert substantial risk to a woman’s life, and in San Marino, life-saving care is permitted as a criminal law exception.

Because of the legal consequences, women who resort to a clandestine abortion are often afraid to seek post-abortion care when complications arise, which carries potentially severe health consequences.

In Liechtenstein, it is legal in cases of serious risks to a woman’s life, if the woman is aged under 14 or if the pregnancy is the result of rape, sexual coercion or sexual abuse of a defenceless or mentally impaired person.

“The health and human rights implications of these laws are acute,” the report says.

“Most women in these member states who decide to end a pregnancy fall outside of any relevant exceptions and are therefore prohibited from obtaining safe abortion care in their home jurisdictions.

“As a result, many travel to other member states in order to access safe and legal services.

“Others undergo illegal and clandestine abortions in their home countries – increasingly by obtaining and taking the abortion pill. Where a woman is unable to travel to another country to obtain safe abortion care, or is reluctant to undergo a clandestine abortion, she may be left with no choice but to carry a pregnancy to term against her will.”

Because of the legal consequences, women who resort to a clandestine abortion are often afraid to seek post-abortion care when complications arise, which carries potentially severe health consequences.

These consequences and feelings of isolation, fear, humiliation and stigmatisation can have a broad range of physical, psychological, financial and social impacts on women, with implications for their health and well-being, according to the paper.

Some suggestions

▪ Guarantee affordability, availability and accessibility of modern contraception.

▪ Ensure all women’s access to safe, legal abortion care.

▪ Ensure refusals of care by healthcare workers do not jeopardise women’s timely access to sexual and reproductive healthcare.

▪ Ensure all women have access to effective remedies in cases of violations of their sexual and reproductive health and rights.