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No, the US Isn’t an Extreme Outlier on Abortion

Sure, other countries restrict abortion earlier in pregnancy than the US. They also have broad social safety nets that support families.

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Stop me if you’ve heard this one before: The United States is one of just seven countries worldwide, alongside China and North Korea, that allow “elective” abortions after 20 weeks of pregnancy. This line has been used on the Senate floor, in Trump administration policy statements, and dissents from court rulings to paint the US as extreme in terms of abortion leniency. (Two of the other countries on that list are Canada and the Netherlands, but Republican lawmakers oddly never mention those.)

The factoid was cited this summer in the Supreme Court brief from Mississippi Attorney General Lynn Fitch to defend the state’s 15-week abortion ban. The law has never taken effect because it’s unconstitutional under Roe v. Wade, but Fitch explicitly asked the high court to overturn Roe in the case it’s hearing on Wednesday.

The “seven countries” claim is technically true on paper, but not in practice: The US is more restrictive than anti-abortion activists suggest, and many other countries with nominal bans before 20 weeks have broad exceptions and, crucially, vast social safety nets that support children and families. This is where the US is truly the exception, said Melissa Murray, professor at New York University School of Law and an expert in reproductive rights and family law.

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“These other countries have more robust supports for families that make the whole question of whether to continue a pregnancy just an entirely different calculus for a pregnant person,” Murray said. Since the US doesn’t have universal healthcare, marriage is how some people get their health insurance here, and married couples get bigger tax breaks for their kids than do single parents. “In our country, marriage is the way that we patch up what is a tattered social safety net,” she said. No amount of free diapers from the anti-abortion Christian safety net will fix this.

Most people who have abortions in the US do so primarily for economic reasons. Maybe they can’t afford to take unpaid time off work to recover from childbirth and care for a newborn. This is a concern in the US, which is one of just six countries in the world that doesn’t guarantee paid leave after the birth of a child, while the global average is 29 weeks. Democratic lawmakers are currently sparring over whether to pass a paltry four weeks of leave.

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Or maybe Americans can’t afford childcare for another baby—another budgeting factor, given that the US spends an average of $500 annually on early childcare, when other wealthy countries spend an average of $14,436 per toddler per year. Not until Congress passed the American Rescue Plan this year did families get child tax credits delivered monthly rather than a rebate at tax time, a benefit that most other developed countries have offered for decades.

Many of the other countries people compare to the US have universal healthcare that covers both birth control and abortion. (The UK’s National Health Service provides free abortions at its government-run clinics and hospitals.) Meanwhile, about 29 million people in the US don’t have health insurance, and people who are covered still face barriers like state and employer plans that exclude abortion and pharmacists who refuse to fill their birth control prescriptions. Nearly 8 million women of reproductive age have Medicaid, a type of federal health insurance that bans abortion coverage outside of rape, incest, and threat to their lives.

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What’s more, the Supreme Court is permitting more restrictions on abortion, while most of the world is going the other direction. “I don’t think it’s wrong to say that the United States is an outlier, but it’s an outlier in exactly the opposite way,” she said, noting that the U.S. is one of just three countries to restrict access to abortion in the past 20 years, alongside Poland and Nicaragua.

Anti-abortion lawmakers don’t actually want limit abortion in order to emulate Europe—they want to ban abortion outright and are disingenuously pointing to Europe as an excuse, said Mary Ziegler, a law professor at Florida State University and the author of Abortion and the Law in America: Roe v. Wade to the Present. “If they were serious and said, ‘OK, we’re going to actually do what Europe does and we’re going to have a ban at 15 weeks with health exceptions, and we’re going to have universal health insurance [that covers abortion],’ do I think people would probably be OK with that even if Roe was overturned? Ultimately, yes,” Ziegler said. “But that’s not what they’re saying.”

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Ultimately, painting a 15-week abortion ban as more in line with the rest of the world sounds somewhat reasonable to people who don’t know, or can’t be bothered to consider, the context in which people decide if and when to have children—especially when the apparent alternative is the six-week ban currently in effect in Texas, under the law known as SB 8. “Pre-SB 8, the 15-week ban in Mississippi did not seem reasonable,” Murray said. “A 15-week ban is patently unconstitutional. And yet the comparison between SB 8 and HB 1510 makes it seem as though what Mississippi is doing is somehow moderate, and it’s not.”

Just 6 to 7 percent of abortions take place at or after 15 weeks, which is a small portion of the total, but it equates to tens of thousands of people: between 54,000 and 63,000 people have abortions after 15 weeks every year, according to the Guttmacher institute. More and more pro-choice supporters understand that people may seek abortions after the first trimester because they’ve learned about either personal or fetal health issues, but less talked about are those who discover their pregnancies late and then must navigate a web of systemic barriers to get care at a shrinking number of abortion clinics, all while the clock is ticking. The obstacles include misinformation about how and where to get care, lack of paid time off from work, mandated waiting periods of 24 to 72 hours, childcare, lodging, and paying hundreds or thousands of dollars out of pocket for the procedure which often isn’t covered by insurance, if they even have it.

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Gathering the money needed takes time and an amicus brief from a group of abortion funds and practical support networks argues that, for their clients, people who are often living on low incomes and are disproportionately people of color, a 15-week ban amounts to total ban on abortion. The funds argue in the brief that: “The longer it takes someone to secure the money to pay for an abortion, the more the procedure will cost, which can trap an abortion patient in a cycle of fundraising and delay,” and “for these individuals, banning abortion at this stage of pregnancy is tantamount to requiring them to carry an unwanted pregnancy to term.” Given all of the hurdles that people seeking abortions face in the US, it’s actually humanitarian that states currently can’t ban abortion before fetal viability.

If the Court upholds Mississippi’s 15-week ban next summer, as it’s likely to do, other states will follow and continue to push the limits and move the goalposts on banning abortion. The Court may not write the words “Roe is overturned,” but Roe will be effectively gone for thousands more people across the country. Remember this when anyone suggests that the Mississippi law is simply bringing us in line with other advanced democracies, or that it’s some kind of a sensible compromise.