Does the liberalisation of abortion laws increase the number of abortions?: The case study of Spain

Background: Over the course of the 1980s a public debate on abortion took place in Spain culminating in a more permissive social climate and, in 1985, the partial decriminalisation of abortion. Before this, women were forced to abort illegally or abroad in countries which had decriminalised abortions. The aim of this study is to present jointly the evolution of abortions in Spanish women in England and Wales between 1974 and 1995, The Netherlands between 1980 and 1995 and Spain since the start of the register in 1987 through to 1995 and to compare trends both before and after the law in Spain. Methods: Incidence rates were calculated in each of the countries studied and the slopes of the curves for 1974-1984 and 1987-1995 were compared. Data were obtained from reports published by the offices of abortion surveillance in England and Wales, The Netherlands and Spain. Results: The rates increased constantly throughout the study period. From 1974 to 1985, a total of 204,736 Spanish women aborted in England and Wales and The Netherlands. After the law was passed, 34,895 Spanish women had abortions in those countries over the period 1986-1995. During 1987-1995, 340,214 Spanish women terminated their pregnancies in Spain. The regression coefficients before and after the passing of the law were beta = 0.3538 (0.307-0.400) and beta = 0.319 (0.243-0.394) respectively; no difference was observed. Conclusions: During the study period a significant proportion of reproductive-aged Spanish women had abortions in England and Wales and The Netherlands. Decriminalisation has had no observed effect on the trends in abortion, but rather it has benefited Spanish women by making abortion available locally and, therefore, reducing the inequalities implied by lack of access to proper health care services. These data demonstrate the impact of the liberalisation of abortion on the trends of procedures performed in other countries.