The Spanish government recently announced that it plans to introduce restrictions on abortion in Spain. This move has been supported by the Ministry of Justice. From the beginning of this reform the debate about abortion has been focused mainly on its ethical and legal perspective, discussing primarily when the foetus has the right to life, and whether the pregnant woman’s rights over her own body may justify an abortion. Thus, the new law has led to a public debate about whether women who may need an abortion will be criminalised, adding unnecessary suffering to a situation that is already traumatic.
In fact, abortion is mainly a public health matter. In its latest guidelines, the World Health Organization stated that putting legal obstacles and restricting access to safe abortion does not reduce the number of abortions performed, and also forces the women that may need an abortion to look for illegal paths that may put their health at risk. Furthermore, countries with more restrictive access laws have higher maternal mortality as a result of illegal and unsafe abortions. Treating the complications of unsuccessful abortions will also divert the already limited resources of Spanish public health services from other health programmes.
As the new regulation partially ignores the medical issues of abortion, it will also further complicate the already complex work of health professionals who perform prenatal diagnosis. One of the assumptions of the new law is that health professionals would have to determine whether an abortion is legal, by deciding if any fetal malformation is compatible with life.
The intention of the government is mainly to protect the life of the newborn. But it could have chosen to reduce the rate of abortions in the Spanish population by promoting and supporting preventive policies that have already proved to be useful to reduce these rates, such as improving sex education, improving access to contraception, or supporting pregnant women with economic difficulties, instead of putting up barriers to accessing a safe abortion. Nowadays, these policies, focused on sexual education, are not always accepted by the most conservative sector of Spanish society which supports the current government.
However, as the new law has already been approved, health professionals involved in the practice of abortion, not only in Spain but in other countries where a less restrictive law exists, should be prepared to deal with the consequences that this new policy will have on the health of the population, especially on the more disadvantaged ones. As the number of maternal deaths due to unsafe abortions is expected to rise, data will need to be collected and made public in order to evaluate the real efficacy of the new policy.
Competing interests: I declare that I have read and understood the BMJ Group policy on declaration of interests and I have no relevant interests to declare.
Jacobo Mendioroz has worked on the epidemiology of congenital malformations and is currently working at the Department of Epidemiology and Preventive Medicine at the Hospital Vall d’Hebron in Barcelona.