Instrumentalising women’s reproductive vulnerability for political gain: where in the world does it stop?

A move to restrict abortion in Norway is a particularly stark example of the readiness with which women’s reproductive vulnerability is traded as a kind of political capital

There is an extraordinary piece of instrumentalisation of women’s health for political gain going on in an unlikely quarter, just now.

Norway has both a relatively good record on women’s rights, and a balanced and popular abortion law with no popular or parliamentary mandate for change. It also has low and falling abortion rates, 80% of which are conducted as a woman’s choice under 9 weeks, and just 4%—far more tightly regulated than, for example, in either Sweden or the UK—in the second trimester.

Nevertheless, Norway’s prime minister Erna Solberg has recently promised a debate about further restricting abortion in the second trimester. The move has been met with widespread public opprobrium, and frank incomprehension from the Norwegian society of obstetrics and gynaecology, who criticise the move for the uncertainty and distress it will cause many women of childbearing age—regardless of how their own pregnancies or the results of this debate turn out. How could this happen?

Solberg’s loosely-worded offer to put abortion on the party-political negotiating table is not grounded in Norwegian popular or parliamentary opposition to the existing abortion law, but in a party political impasse of her own. It so happens that a minority party on whose support Solberg’s government currently depends, the Christian Democratic party (KrF), which opposes abortion, has recently emerged from an internal left-versus-right power struggle with a narrow victory for the right, and hence is being courted by Solberg as a potential coalition partner.

The KrF has a history of strong opposition to abortion, but knows its views are not widely shared. It currently enjoys barely 4% of the popular vote, but even when, 20 years ago, the party was stronger—strong enough to field both a prime minister and health secretary—it did not seek to change the abortion law fundamentally, realising this had no chance of parliamentary success. Instead, the KrF has with some success taken opportunities to restrict abortion wherever possible.

For example, when first trimester anomaly screening, now established in the UK and the rest of the Nordic countries, was debated in the Norwegian parliament, KrF played an important role in voting the measure down, ensuring women in Norway did not have publicly funded access to early diagnosis and therefore to first trimester, “self-determined” abortion, in the case of fetal anomaly. The ironic result, given Norway’s strong social democratic tradition, is that up to 80% of women in Norway’s major cities now pay privately for screening, while rural communities simply have no access.

But now that Solberg’s government is keen to engage them in coalition, KrF is also demanding further restriction, in particular of what it misnames “The Down’s paragraph,” paragraph 2c, relating to abortion for fetal anomaly. The KrF is demanding a total ban on 2nd trimester abortion except for fatal anomaly, a prospect which is particularly menacing for women who already lack publically funded access to early diagnostic information.

Norwegian abortion law is by no means either especially liberal or especially conservative, in international comparison. It is currently weighted strongly in favour of women’s freedom of choice in the first trimester, with unrestricted abortion up to 12 weeks accounting for 12000-13000 abortions per year, a number which is low in international comparison, and declining. After 12 weeks, the law is weighted firmly towards fetal protection, requiring application to a board, on grounds of risk of harm to a woman’s physical or psychological health (paragraph 2a), difficult life circumstances (paragraph 2b), health-compromising fetal  anomaly (2c), rape or incest (2d) or mental disability (2e). Such cases account for only a small fraction of abortions (600-700 cases) performed between 12 and 18 weeks in Norway each year, with 90-95% of applications upheld. While considerable emphasis is still placed on the woman’s own evaluation of the situation until 18 weeks, fetal protection is a dominant consideration from week 18 and until week 22, when the fetus by definition is considered viable.

Norway’s current provision for abortion for fetal anomaly is broadly in line with, or more restrictive than, most European countries. Fewer than 10% of these abortions currently relate to Down syndrome. The tightening of paragraph 2c to accept only lethal malformations as legal grounds for abortion, would imply that only 10-20% of the abortions currently carried out under clause under 2c would be allowed.

Why would the outcome of the internal political wrangling of a minority party in Norway, and its effect on that country’s government, matter to the international medical community? Because it is a particularly stark example from an unlikely quarter of the readiness with which women’s most sensitive and difficult personal health issues are traded as a kind of political capital. The KrF’s endeavor is unlikely to succeed, because the Norwegian parliament and population are unlikely to allow it, but harm is already done.

Where does this leave pregnant women in Norway? The threat, were the KrF to achieve their goal, is that any pregnant woman might find herself trapped with a second trimester anomaly diagnosis and no choice but to carry the pregnancy to term unless the anomaly were fatal. Never mind that it may never happen, the government is in the meantime asking women to subsidize its political gain with their fear. Facing a decision about abortion at any stage and for any reason, but especially for fetal anomaly, is an agonizing prospect for any woman and family. For a government with no democratic mandate for change to instrumentalise women’s reproductive vulnerability is, we suggest, a betrayal.

Sandy Goldbeck-Wood, editor in chief, BMJ Sexual and Reproductive Health.

Pål Øian, professor and consultant, Department of Obstetrics and Gynaecology, The University Hospital of North Norway and Women’s Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT – The Arctic University of Norway, Tromsø, Norway.

Ole-Erik Iversen, professor emeritus, senior consultant, Institute of Clinical Science, University of Bergen, Women’s Clinic, Haukeland University Hospital, Bergen, Norway

Ganesh Acharya, is a professor and head of division of obstetrics and gynaecology, Department of Clinical Science, Intervention & Technology, Karolinska Institutet and senior consultant obstetrician & gynaecologist, Karolinska University Hospital, Stockholm, Sweden. He is editor in chief of Acta Obstetricia et Gynecologica Scandinavica.

Competing interests: None declared