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Public funding for abortion where broadly legal

  • Daniel Grossman
    Correspondence
    Corresponding author. Tel.: +1 510 986 8941; fax: +1 510 986 8960.
    Affiliations
    Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA

    Ibis Reproductive Health, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA
    Search for articles by this author
  • Kate Grindlay
    Affiliations
    Ibis Reproductive Health, 17 Dunster Street, Suite 201, Cambridge, MA, 02138, USA
    Search for articles by this author
  • Bridgit Burns
    Affiliations
    Ibis Reproductive Health, 17 Dunster Street, Suite 201, Cambridge, MA, 02138, USA
    Search for articles by this author

      Abstract

      Objective

      The objective was to investigate public funding policies for abortion in countries with liberal or liberally interpreted laws (defined as permitting abortion for economic or social reasons or upon request).

      Study design

      In May 2011–February 2012 and June 2013–December 2014, we researched online resources and conducted an email-based survey among reproductive health experts to determine countries' public funding policies for abortion. We categorized countries as follows: full funding for abortion (provided for free at government facilities, covered under state-funded health insurance); partial funding (partially covered by the government, covered for certain populations based on income or nonincome criteria, or less expensive in public facilities); funding for exceptional cases (rape/incest/fetal impairment, health/life of the woman or other limited cases) and no public funding.

      Results

      We obtained data for all 80 countries meeting inclusion criteria. Among the world's female population aged 15–49 in countries with liberal/liberally interpreted abortion laws, 46% lived in countries with full funding for abortion (34 countries), 41% lived in countries with partial funding (25 countries), and 13% lived in countries with no funding or funding for exceptional cases only (21 countries). Thirty-one of 40 high-income countries provided full funding for abortion (n=20) or partial funding (n=11); 28 of 40 low- to middle-income countries provided full (n=14) or partial funding for abortion (n=14). Of those countries that did not provide public funding for abortion, most provided full coverage of maternity care.

      Conclusion

      Nearly half of countries with liberal/liberally interpreted abortion laws had public funding for abortion, including most countries that liberalized their abortion law in the past 20 years. Outliers remain, however, including among developed countries where access to abortion may be limited due to affordability.

      Implications

      Since cost of services affects access, country policies regarding public funding for services should be monitored, and advocacy should prioritize ensuring the affordability of care for low-income women.

      Keywords

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      References

        • Grimes DA
        • Benson J
        • Singh S
        • Romero M
        • Ganatra B
        • Okonofua FE
        • et al.
        Unsafe abortion: the preventable pandemic.
        Lancet. 2006; 368: 1908-1919
        • Say L
        • Chou D
        • Gemmill A
        • Tuncalp O
        • Moller AB
        • Daniels J
        • et al.
        Global causes of maternal death: a WHO systematic analysis.
        Glob Health. 2014; 2: e323-e333
        • Kassebaum NJ
        • Bertozzi-Villa A
        • Coggeshall MS
        • Shackelford KA
        • Steiner C
        • Heuton KR
        • et al.
        Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the global burden of disease study 2013.
        Lancet. 2014; 384: 980-1004
        • Singh S
        • Maddow-Zimet I
        Facility-based treatment for medical complications resulting from unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26 countries.
        BJOG. 2015; https://doi.org/10.1111/1471-0528.13552
        • Sedgh G
        • Singh S
        • Shah IH
        • Ahman E
        • Henshaw SK
        • Bankole A
        Induced abortion: incidence and trends worldwide from 1995 to 2008.
        Lancet. 2012; 379: 625-632
        • Sedgh G
        • Bearak J
        • Singh S
        • Bankole A
        • Popinchalk A
        • Ganatra B
        • et al.
        Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends.
        Lancet. 2016; https://doi.org/10.1016/S0140-6736(16)30380–4
        • Sippel S
        ICPD beyond 2014: moving beyond missed opportunities and compromises in the fulfilment of sexual and reproductive health and rights.
        Glob Public Health. 2014; 9: 620-630
        • Johnson BR
        • Horga M
        • Fajans P
        A strategic assessment of abortion and contraception in Romania.
        Reprod Health Matters. 2004; 12: 184-194
        • Jewkes R
        • Rees H
        • Dickson K
        • Brown H
        • Levin J
        The impact of age on the epidemiology of incomplete abortions in South Africa after legislative change.
        BJOG. 2005; 112: 355-359
        • Varkey P
        • Balakrishna PP
        • Prasad JH
        • Abraham S
        • Joseph A
        The reality of unsafe abortion in a rural community in South India.
        Reprod Health Matters. 2000; 8: 83-91
        • Constant D
        • Grossman D
        • Lince N
        • Harries J
        Self-induction of abortion among women accessing second-trimester abortion services in the public sector, western Cape Province, South Africa: an exploratory study.
        S Afr Med J. 2014; 104: 302-305
        • Jones RK
        How commonly do US abortion patients report attempts to self-induce?.
        Am J Obstet Gynecol. 2011; 204: 23.e1-23.e4
        • Grossman D
        • Holt K
        • Pena M
        • Lara D
        • Veatch M
        • Cordova D
        • et al.
        Self-induction of abortion among women in the United States.
        Reprod Health Matters. 2010; 18: 136-146
        • Phillips KA
        • Grossman D
        • Weitz TA
        • Trussell J
        Bringing evidence to the debate on abortion coverage in health reform legislation: findings from a national survey in the United States.
        Contraception. 2010; 82: 129-130
        • Dalvie SS
        Second trimester abortions in India.
        Reprod Health Matters. 2008; 16: 37-45
        • Misicka S
        Abortions to remain covered by health insurance.
        Date: 2014
        (Available from:) ([cited 2016 January 19])
      1. United Nations Population Division Department of Economic and Social Affairs. Abortion policies: a global review. United Nations.
        (Available from:) ([cited 2015 April 29])
        • Chowdhury SN
        • Moni D
        A situation analysis of the menstrual regulation programme in Bangladesh.
        Reprod Health Matters. 2004; 12: 95-104
        • Morhee R
        • Morhee E
        Overview of the law and availability of abortion services in Ghana.
        Ghana Med J. 2006; 40: 80-86
        • Aniteye P
        • Mayhew S
        Attitudes and experiences of women admitted to hospital with abortion complications in Ghana.
        Afr J Reprod Health. 2011; 15: 47-55
        • Ustá M
        • Mitchell E
        • Gebreselassie H
        • Brookman-Amissah E
        • Kwizera A
        Who is excluded when abortion access is restricted to twelve weeks? Evidence from Maputo, Mozambique.
        Reprod Health Matters. 2008; 16: 14-17
      2. United Nations Population Division Department of Economic and Social Affairs. World population prospects: the 2015 revision.
        Date: 2016
        (Available from:) ([cited 2016 June 8])
        • World Bank
        Country and lending groups.
        Date: 2016
        (Available from:) ([cited 2016 January 19])
        • Larcher D
        • Wolinska A
        European pricing and reimbursement handbook.
        1st ed. 2011 ([cited 2016 January 19]; Available from: http://www.bakermckenzie.com/files/Uploads/Documents/Germany/LifeSciences/EuropeanPricingReimbursement.pdf)
        • Finer LB
        • Zolna MR
        Unintended pregnancy in the United States: incidence and disparities, 2006.
        Contraception. 2011; 84: 478-485
        • Salganicoff A
        • Beamesderfer A
        • Kurani N
        • Sobel L
        Coverage for abortion services and the ACA.
        Date: 2014
        (Available from:) ([cited 2015 April 29])
      3. Center for reproductive rights. Abortion worldwide: 20 years of reform.
        Date: 2014
        (Available from:) ([cited 2016 January 19])
      4. Lakshmi Dhikta v. Government of Nepal, writ no. 0757, Jestha, 2066 (supreme court of Nepal), 0757.
        2009
      5. Women in the world staff. North Korea reportedly bans IUD implantation and abortion.
        Women in the World, 2015 ([cited 2016 January 21]; Available from: http://nytlive.nytimes.com/womenintheworld/2015/10/16/north-korea-reportedly-bans-iud-implantation-and-abortion/)
        • World Health Organization
        Universal health coverage.
        2014 ([(cited 2015 April 29); Available from: http://www.who.int/mediacentre/factsheets/fs395/en/])