A new study of the 80 countries with liberal or liberally interpreted abortion laws finds that the vast majority (74%) either fully cover (34 countries) or partially cover (25 countries) abortion using public funding. Among the world's female population aged 15–49 in countries with liberal/liberally interpreted abortion laws, 87% lived in countries with full funding or partial funding. In contrast, the United States is one of only 10 countries that only cover abortion in exceptional cases such as rape, incest, or threat to the pregnant woman’s life. An additional 11 countries provide no public funding at all for abortion. The study was published online in the journal Contraception.

The researchers from Ibis and Advancing New Standards in Reproductive Health (ANSIRH) at the University of California San Francisco (UCSF) surveyed reproductive health experts from each of the countries and searched for published data on country policies. The study findings generally represent the policy as of 2013-2014, except for two countries with older data, and the researchers caution that these policies may change over time.

Dr. Daniel Grossman, director of ANSIRH and Senior Advisor at Ibis, who is the lead author of the paper, said, “By restricting federal insurance coverage and funding for abortion, the US is a stark outlier among countries where abortion is legal—especially among high-income nations. Women in the US, including those with low incomes, should have access to the highest quality of care, including the full range of reproductive health services. This research indicates there is a global consensus that abortion care should be covered like other health care.”

The Hyde Amendment is the US policy passed each year by Congress that denies coverage for abortion care for women who receive health insurance through the federal government, except in the cases of rape, incest or life endangerment. Similar restrictions withhold coverage from federal employees and their dependents, military service members, Peace Corps volunteers, Native Americans, women in federal prisons and detention centers, including those detained for immigration purposes, and low-income women in the District of Columbia. Seventeen US states fill this gap and use their own funding to cover abortion care for low-income women; in the remaining states, these women, many of whom are struggling to make ends meet, must pay out of pocket for care, a significant barrier to access for many. Previous research by Ibis and ANSIRH in the US has found that some women are pushed later in pregnancy before they obtain an abortion because it takes them time to raise money for the procedure, and some women attempt to end a pregnancy on their own because of the financial barriers they face accessing clinic-based care.

Ibis’s Kate Grindlay said, “We found that most countries that recently liberalized their abortion law also chose to provide public funding for the procedure. For example, in this hemisphere, Uruguay, as well as Mexico City, legalized abortion in the first trimester in the past decade, and in both cases the service is available free of charge in public hospitals or covered by national insurance.”

Dr. Grossman added, “We also found that most countries that did not provide public funding for abortion or provided funding only in exceptional cases did provide public funding for maternity care. That’s true in the United States, where Medicaid covers prenatal care and delivery for low-income women—but not abortion. This leaves women—and particularly women of color and women struggling to make ends meet—with fewer options.”

Private insurance coverage of abortion has also been restricted in the United States by both federal and state policy makers. Under the Affordable Care Act, insurance companies that offer abortion coverage in plans available through state Marketplaces must collect two premium payments and keep the funds for the abortion benefit in a separate account. About half of US states limit coverage of abortion in Marketplace insurance plans to exceptional circumstances, and ten states restrict private insurance coverage of abortion in all private insurance plans written in the state. To read more, you can access the article on the journal’s website, or request a copy here.