Abortion Restrictions And Their Impact On Women’s Health Systems Worldwide
Women across the world experience completely different realities when it comes to abortion. The basis of the level of access they have, or do not have, is dependent on their geographical location in the world. The effects of all this have led to what is now considered a global crisis for women’s health.
The Global Landscape of Abortion Laws
As of today, the state of abortion’s regulation around the globe can be best described as a mosaic. Seventy-five states of the world allow abortion on demand. This covers 34% of the women of childbearing age worldwide. But there are also 18 states that ban abortion completely. This applies to overall 5% of the woman of childbearing age. Then there are states that fall somewhere in between. There could be wide social and economic reasons that constitute exceptions while allowing abortion only if the life of the woman itself was in danger.
The past three decades have seen significant movement toward liberalizing abortion laws. Since 1994, more than 60 countries have reformed their laws to expand abortion access. In 1994, 40 countries prohibited abortion under all circumstances; by 2023, this number had dropped to just 18. Particularly notable is that between 2019 and 2023, 12 countries liberalized their laws to permit abortion on request—nearly as many as did so in the entire 25-year period from 1994 to 2018, showing global evidence on how limiting access to safe abortion harms women’s health.
Yet this progress is not universal. A small number of countries have moved in the opposite direction. The United States, El Salvador, Nicaragua, and Poland have all removed legal grounds for abortion in recent years. These rollbacks affect approximately 92 million women of reproductive age, straining women’s health systems worldwide.
The Deadly Toll of Unsafe Abortion
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The consequences of restrictive abortion laws are measured in lives lost and health destroyed, with a clear impact of restrictive abortion laws on maternal mortality and morbidity. According to the World Health Organization, approximately 23,000 women die from unsafe abortions each year. Another estimate places this number at 39,000 deaths annually. Beyond deaths, approximately 7 million women are admitted to hospitals every year due to complications from unsafe abortion, including hemorrhage, infections, septic shock, and organ perforation, overwhelming women’s health systems.
An additional 9 million women face complications from unsafe abortion each year, suffering life-long injuries, severe disabilities, heavy bleeding, damage to internal organs, or losing the ability to become pregnant in the future. For those who survive, approximately 5 million will experience long-term health complications that burden women’s health systems.
The regional disparities are stark. Sub-Saharan Africa bears the heaviest burden, with 77% of all abortions in the region classified as unsafe, compared to the global average of 45%. The region experiences 6.2 million unsafe abortions per year. Death rates from unsafe abortion reach over 200 per 100,000 abortions in regions where unsafe abortions are common, compared to less than 1 per 100,000 where abortion is safe and legal, underscoring the impact of restrictive abortion laws on maternal mortality and morbidity.
Unsafe abortion complications include incomplete abortion, septic abortion, peritonitis, perforation of the uterus and intestines, renal failure, septicemia, septic shock, and acute respiratory distress syndrome. Women who experience these complications often require emergency evacuation and curettage, laparotomy, hysterectomy, or intestinal repair, placing immense pressure on women’s health systems.
How Restrictive Laws Drive Women to Dangerous Practices
A critical finding from global research is that abortion restrictions do not reduce the number of abortions—they only make them less safe. Women seek abortions at similar rates in countries where it is legal and where it is banned; the difference is that in restrictive settings abortions are much more likely to be unsafe and clandestine, reflecting the relationship between abortion laws and access to reproductive health services.
When safe and legal abortion services are unavailable, women resort to whatever methods they can access. In developing countries with restrictive laws, these methods range from procedures performed by untrained practitioners to self-induced abortions using dangerous substances or physical trauma. Some women attempt abortion through ingesting toxic substances like cresol, phenol, or soap, or through abdominal trauma such as massage, jumping from heights, or self-inflicted blows, as shown by global evidence on how limiting access to safe abortion harms women’s health.
In countries where abortion is highly restricted, such as those in Sub-Saharan Africa, women face the highest likelihood of experiencing the least safe abortions—those performed by untrained providers using non-recommended methods. These procedures have the highest probability of being incomplete or leading to medical complications requiring immediate medical treatment, disrupting women’s health systems.
Impact on Maternal Health Outcomes
The health implications of abortion restrictions extend beyond those directly related to the procedure. Studies show that maternal mortality rates are lower in countries with more flexible abortion access laws, directly linking to the impact of restrictive abortion laws on maternal mortality and morbidity. A modeling study in the United States estimated that a total abortion ban would lead to about 210 additional maternal deaths annually, with a 21% increase in pregnancy-related deaths overall and a 33% increase among Black women.
States with restrictive abortion policies demonstrate poorer overall maternal health indicators. Compared to states with protective policies, those with restrictions have fewer maternity care resources, more maternity care deserts, poorer Medicaid coverage, and higher rates of maternal mortality (24.2 versus 15.9 maternal deaths per 100,000 live births). These disparities are particularly pronounced among Black women, with 49.2 deaths per 100,000 live births in restrictive states compared to 39.3 in protected states, with human rights implications of restrictive abortion laws for women’s reproductive health.
Abortion restrictions also harm women who experience pregnancy complications. When abortion is criminalized or heavily restricted, healthcare providers become cautious about providing care for miscarriage management, ectopic pregnancies, and other emergencies due to fear of prosecution. This hesitation leads to delays in care, increased complications, and preventable deaths, affecting the relationship between abortion laws and access to reproductive health services.
Mental Health Consequences
The psychological toll of abortion restrictions is significant and measurable. Research examining the implementation of severe abortion restrictions in Texas found an increase of 6.8 percentage points in frequent mental distress among women compared to men, and 5.3 percentage points compared to women in states without such restrictions, with the largest effects among women aged 18 to 29, part of broader global evidence on how limiting access to safe abortion harms women’s health.
Studies consistently show that being denied a wanted abortion is associated with worse mental health outcomes than receiving one. Women denied abortions experience increased rates of anxiety, depression, and worry about accessing needed pregnancy care, legal ramifications, and logistical difficulties, while women who obtain wanted abortions most often report relief even years later.
Importantly, research demonstrates that having an abortion is not linked to long-term mental health problems. Rather, the restrictions themselves—and the barriers they create—drive the negative mental health outcomes, straining women’s health systems.
Economic Consequences for Women and Families
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The economic impact of abortion denial is profound and long-lasting. Women denied wanted abortions experience significant economic hardship compared to those who receive abortions, including higher likelihood of living below the poverty level, lacking money for basic needs, and raising children alone, with clear human rights implications of restrictive abortion laws for women’s reproductive health.
These economic consequences persist for years. Women denied abortions are more likely to experience reductions in full-time employment, increased incidence of poverty, and greater reliance on public assistance; credit record studies show increases in overdue debt and reduced available credit following denial.
The economic burden extends beyond individual women. Analyses estimate that abortion restrictions cost the United States economy tens of billions of dollars annually in lost earnings and productivity, with one report putting the total impact of reproductive rights restrictions at around $173 billion per year, impacting women’s health systems.
Strain on Healthcare Systems
Abortion restrictions place enormous strain on women’s health systems, affecting far more than just abortion services. Millions of women each year require hospital admission for complications from unsafe abortion, and the annual cost of treating major complications in developing countries is estimated in the hundreds of millions of dollars.
In regions with restrictive laws, healthcare facilities must dedicate significant resources to post-abortion care. For example, a study in the Democratic Republic of Congo found that most post-abortion care patients had likely induced abortions, with a large share experiencing moderate or severe complications and many being treated with outdated methods and inadequate pain relief, exemplifying the impact of restrictive abortion laws on maternal mortality and morbidity.
Healthcare systems in restrictive environments face additional challenges. Poor patients and unmarried women have higher odds of severe or moderate complications, and fragile health systems may fail to provide timely, adequate care, leading to preventable deaths and long-term health problems in women’s health systems.
Impact on Medical Training and Workforce
Abortion restrictions have severe consequences for medical education and the healthcare workforce. When abortions are criminalized, obstetrics and gynecology providers lose opportunities to train in pregnancy termination, which directly translates to lower quality care for patients needing miscarriage management, especially in emergencies, affecting women’s health systems.
After the overturning of Roe v. Wade, researchers estimate that nearly half of obstetrics and gynecology residents in the United States are now in programs where abortion training is severely limited or unavailable, with projected declines in the share of trainees receiving procedural abortion training.
Healthcare providers report that restrictive abortion laws reduce chances to observe and perform abortion procedures during training, force them to navigate constantly changing legal rules, and contribute to skill loss over time. Many medical students and residents avoid training in restrictive states, and some practicing physicians leave such regions due to fear of prosecution, worsening maternity care deserts and the relationship between abortion laws and access to reproductive health services.
Disproportionate Impact on Marginalized Communities
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Abortion restrictions do not affect all women equally. They disproportionately harm women of color, low-income women, rural women, young people, and other marginalized groups, who already face higher rates of unintended pregnancy and structural barriers to care, with profound human rights implications of restrictive abortion laws for women’s reproductive health.
In the United States, Black and Latina women are overrepresented among abortion patients relative to their share of women of reproductive age, and about half of abortion patients live below the federal poverty line.
Women of color have fewer financial resources and transportation options to travel for care, are less likely to be able to cover emergency expenses, and may face language barriers and immigration-related fears, making out-of-state travel particularly difficult in restrictive contexts.
Research shows that restricted abortion access limits women’s ability to obtain timely abortion services, with especially strong effects for Black women and those with lower educational attainment, thereby exacerbating existing health and social inequalities, as per global evidence on how limiting access to safe abortion harms women’s health.
Stigma and Its Consequences
Abortion stigma—the shared understanding that abortion is morally wrong or socially unacceptable—affects both women seeking care and the professionals who provide it. A global survey of providers across dozens of countries found that stigma is widespread and often more intense in settings with restrictive laws, impacting women’s health systems.
Healthcare providers describe stigma as being treated differently from other professionals, facing disapproval and disrespect, being labeled negatively, and experiencing social isolation in their communities and workplaces.
The impact of stigma on providers is severe. A large majority of abortion care providers report some level of burnout, and higher stigma is associated with greater job strain and intentions to leave practice, threatening continuity and quality of abortion services.
Broader Health System Effects
The ripple effects of abortion restrictions extend throughout entire women’s health systems. When bans are enforced, patients face increased difficulty accessing surgical management of miscarriage, and clinicians may delay or withhold care for pregnancy complications because they fear legal consequences.
Restrictions also affect access to medications. Reports from post-Dobbs settings describe pharmacists refusing to dispense drugs such as methotrexate, misoprostol, and mifepristone—even when prescribed for autoimmune disease or ectopic pregnancy—simply because they are associated with abortion.
Policies that target abortion alone can undermine wider sexual and reproductive healthcare. Studies in U.S. clinics show that abortion-related restrictions reduced contraceptive counseling and made it harder for providers to offer person-centered, comprehensive reproductive health services, revealing the relationship between abortion laws and access to reproductive health services.
Global Efforts and Solutions
Despite the challenges, progress is being made in many parts of the world. The World Health Organization’s 2022 abortion care guideline provides evidence-based recommendations that emphasize abortion as essential healthcare and call for access on request, without unnecessary authorizations or grounds-based restrictions, addressing the impact of restrictive abortion laws on maternal mortality and morbidity.
Several countries have successfully expanded safe abortion access. Ethiopia, for instance, authorized nurses and midwives to provide first-trimester abortions, sharply increasing the share of procedures delivered by midlevel providers, while Ghana updated its guidance to promote effective medication abortion regimens.
In settings where legal reform is difficult, harm-reduction approaches are emerging. Wider use of misoprostol for self-managed abortion, along with accurate information on correct use, has helped make clandestine abortions safer in some regions, particularly in Latin America, countering global evidence on how limiting access to safe abortion harms women’s health.
Expanding post-abortion care services has proven effective in reducing mortality, even under restrictive laws. Post-abortion care is legal everywhere, and improving its availability and quality can save lives and limit long-term complications in women’s health systems.
The Way Forward
The evidence is clear: restrictive abortion laws do not reduce the number of abortions but instead drive women toward unsafe procedures that endanger their lives and health. Countries with more liberal abortion laws tend to have lower maternal mortality and better health outcomes for women, while safe, legal abortion provided under proper medical conditions carries an extremely low risk of death, with significant human rights implications of restrictive abortion laws for women’s reproductive health.
Addressing this global health crisis requires legal reform to liberalize abortion laws, backed by investments in high-quality services, trained providers, and the removal of logistical and financial barriers to care. Women’s health systems need adequate resources and political support to provide both safe abortion and comprehensive post-abortion services.
Finally, ensuring broad access to modern contraception can reduce unintended pregnancies and the demand for abortion, but contraception alone is not enough; safe abortion will always remain a necessary part of comprehensive reproductive health care.
