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 p lace 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 abortion s. The aim of this study is to present jointly the evolution of abortions i n 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 th rough 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. Dat a were obtained from reports published by the offices of abortion surveilla nce in England and Wales, The Netherlands and Spain. Results: The rates inc reased constantly throughout the study period. From 1974 to 1985, a total o f 204,736 Spanish women aborted in England and Wales and The Netherlands. A fter the law was passed, 34,895 Spanish women had abortions in those countr ies over the period 1986-1995. During 1987-1995, 340,214 Spanish women term inated their pregnancies in Spain. The regression coefficients before and a fter the passing of the law were beta = 0.3538 (0.307-0.400) and beta = 0.3 19 (0.243-0.394) respectively; no difference was observed. Conclusions: Dur ing the study period a significant proportion of reproductive-aged Spanish women had abortions in England and Wales and The Netherlands. Decriminalisa tion has had no observed effect on the trends in abortion, but rather it ha s benefited Spanish women by making abortion available locally and, therefo re, reducing the inequalities implied by lack of access to proper health ca re services. These data demonstrate the impact of the liberalisation of abo rtion on the trends of procedures performed in other countries.