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Abortion Liberalization in World Society, 1960–2009

Elizabeth H. Boyle, Minzee Kim, and Wesley Longhofer

Introduction

Numerous once‐controversial issues concerning women (such as property rights, suffrage, equal inheritance, and protection from domestic violence) are now widely accepted around the world. The issue of abortion is not among them. Powerful and effective opposition has countered a modest global trend toward abortion liberalization. Recent policy reforms in the United States, Nicaragua, and many other countries demonstrate that purposely terminating pregnancies remains a highly controversial issue even after 50 years of mobilization.

The disagreement surrounding abortion sets the issue apart from many others studied by world society theorists, who highlight how scripts held in world society and embodied in international organizations and other global actors lead nation‐states to adopt very similar policies. One of the primary contributions of world society theory is to explain why ideas and related policies spread rapidly despite vast cultural and resource differences across countries. That is, the theory emphasizes how priorities and approaches become taken for granted in the international community. For example, a government today cannot argue that women lack the intellectual capacity of men and therefore should not be allowed to vote, although this type of argument was commonplace a century ago. In the case of abortion, however, very little is taken for granted. Certain ideas concerning the practice have legitimacy because they link to global scripts, yet no single approach dominates. Examining this critical case allows us to better theorize the way world society plays into policy making in the context of high contestation and weak institutionalization.

In this article, with information on 128 countries, we examine the initial and subsequent adoption of abortion liberalization policies (allowing abortion in the case of rape, fetal impairment, or to protect the mental health of the pregnant woman). We deploy an event history analysis of the period 1960–2009 to test the importance of three dominant frames concerning abortion: a women’s rights frame, a medical frame, and a religious, natural family frame. We find that actors related to the medical frame (health international nongovernmental organizations [INGOs] and physicians) show a consistent association with initial abortion liberalization. This suggests the importance of a professional, scientific discourse when global institutionalization is weak. In addition, women’s rights indicators signal the importance of local strategic actors: women in parliament matter more than women’s international nongovernmental organizations (WINGOs) and treaty ratification. Finally, a history of Catholicism tends to be negatively associated with abortion liberalization. While this is not surprising to anyone who follows debates concerning abortion, the outsized role of the Catholic Church, which tends to be collectivistic and traditional in its orientation, is not well explained by the current state of world society theory.

Background

[…] [A]bortion politics at the global level include three ideational frames. A women’s rights‐based frame is linked to human rights and their consecration in world society. This framework emerges from the broad principle of individualization because it recognizes women apart from the roles they play in corporate bodies (citizen, mother, Catholic) and views them as existentially equal to each other and to men across collective boundaries. An example of the women’s rights frame is the International Women’s Health Coalition’s (2008) declaration that “a woman’s ability to exercise her rights to control her body, to self‐determination, and to health depends, in part, on her right to determine whether to carry a pregnancy to term.”

An alternative scientific medicalized frame emerges from the appropriation of abortion discourses by doctors. The medicalization framework is rationalistic, drawing on physicians’ professional expertise. It highlights doctors’ unique competence in understanding pregnancies and in properly diagnosing and responding to complications related to them. Because doctors ostensibly know best, this frame also highlights the potentially grave consequences of state policies that interfere with doctor‐patient relationships or threaten criminal penalties for physicians carrying out their professional duties. For example, when the World Medical Association (2009) passed an emergency resolution urging Nicaragua to repeal its 2006 antiabortion law, the association highlighted the life and health of women and fetuses and also expressed concern that the new law improperly placed physicians at risk of imprisonment or suspension from medical practice for following professional guidelines concerning abortions.

Finally, a natural family frame arises from the global moral authority of the Catholic Church and is spread through the church’s organizational structure and through transnational evangelical organizations, such as Human Life International. The natural family frame challenges individualization by emphasizing women’s essential responsibilities as child‐bearers and mothers over their aspirations as individuals. For example, in Pope Paul VI’s (1974) letter concerning the United Nation’s International Women’s Year, he lauds women not as individuals but for their importance to families and reproduction: “And since the fundamental and life‐giving cell of human society remains the family, according to the very plan of God, woman will preserve and develop, principally in the family community, in full co‐responsibility with man, her task of welcoming, giving and raising life, in a growing development of its potential powers.” The natural family frame also challenges rationalization by privileging religious rather than scientific understandings of fetal development. Again quoting Pope Paul VI in 1974: “To all those collaborating in the preparation of International Women’s Year, … we indicate as a solid point of reference the figure of the Blessed Virgin.” By drawing women’s dignity from her place in the collective family unit and her links to the Blessed Virgin Mary, the Catholic Church (at least initially) adopted a framing of the abortion issue that is unique from either a rights or a science discourse.

In comparison to the other two frames, this frame is less consistent with general world society principles. Actors deploying the natural family frame appear to be aware of this. Defensive posturing, for example, is evident in a 1994 blog posting by the head of the Catholic League for Religious and Civil Rights: “Would anyone ever have imagined that those opposed to the ruthless decimation of the next generation by abortion – supposedly required on the pretext that the world is, or will be, ‘overpopulated’ – would be the ones automatically assumed to be the ‘bad guys’?” In addition, these activists today are more likely to frame their arguments in terms more consistent with the other two types of frames, for example, by highlighting a fetus’ human right to life and by deploying particular scientific claims concerning fetal development. World society theory implicitly suggests that frames like the natural family frame should lose authority over time with activists seeking alternative frames more closely aligned with global principles.

In sum, the three frames are organized around different foundational principles and are promoted by different actors. While the ideas they foster are institutionalized in some realms, their applicability in the abortion sphere is highly contested. In this sphere, no institutionalized script is taken for granted.

The history of women’s rights, medical, and natural family framings of abortion

Contestations among actors deploying the three frames have developed over the course of many decades. Here, we detail the historic interplay of the three major frameworks at the global level. This history suggests that there is no unified global consensus on abortion today because of the intense contestation between those promoting the women’s rights frame and those promoting a natural family frame. As we show in our statistical analysis, this has implications for the diffusion of abortion liberalization policies; the less politicized medical frame ultimately seems most influential.

In the early to mid‐1900s, abortion was not a global issue. In wealthy countries, abortions were generally illegal, but doctors could perform them for “therapeutic” reasons. Consequently, a medical framework deferential to physicians was dominant in these countries. For example, women’s physical and mental health was a major point of discussion in the United States in the decades before Roe v. Wade. Furthermore, the Roe v. Wade decision itself was rooted in a medical understanding of pregnancy and, in particular, the professional autonomy of physicians.

Abortion first entered the global arena indirectly through discourses concerning population control. The 1960s and 1970s were fraught with concern over the population “bomb” – the moment at which the human population would outstrip the food supply. The United States led the charge to spread population control programs throughout the developing world. The common understanding was that population reduction was essential for poverty reduction and economic growth. Because the United States was a leader in spreading the population control message, the medical framework for understanding abortion appeared early in global discourses and was transmitted to developing countries. The limited targeting of population programs exclusively toward developing countries eventually led to resistance from many of those countries, with charges that population control (and incidentally abortion) was an imperialistic imposition.

The Catholic Church also objected to the new population control efforts. In 1968, Pope Paul VI issued a papal encyclical (Humanae Vitae) that reiterated the Catholic Church’s view opposing all forms of “artificial” birth control. Pope Paul VI was very clear that “above all, all direct abortion, even for therapeutic reasons, [is] to be absolutely excluded as [a] … means of regulating the number of children.” Because at the time the primary method of sharing the encyclical was to read or paraphrase it during Catholic Masses, its influence on public policy was most likely indirect.

Women’s rights groups, while generally supportive of access to birth control, were also critical of population control initiatives. They objected to the goal of reducing population, believing the more important goal was an individualistic one: enhancing women’s abilities to determine the size of their families and the spacing of their children. Within the women’s movement, north/south coalitions were formed emphasizing contraception’s potentially positive impact on maternal mortality as well as women’s empowerment. In general, the 1970s was an important period for women’s rights; it was the United Nations’ Decade of the Woman, and it culminated with the adoption of the international Convention for the Elimination of all forms of Discrimination against Women (CEDAW) in 1979. CEDAW called for the protection of reproductive rights but did not include specific language on abortion.

An important turning point, which simultaneously undercut the population control agenda and made abortion a global issue in its own right, was the International Conference on Population and Development in Mexico City in 1984. Here, the Ronald Reagan administration announced a new policy prohibiting U.S. funding for any organization outside the United States that provided abortions or advice concerning abortions. Reagan had previously dismissed population concerns, expressed skepticism concerning the need for birth control, and declared abortion murder. The United States, which liberalized abortion via Roe v. Wade in 1973, began actively discouraging abortion globally in the 1980s. Population control experts and feminists, uneasy allies to be sure, came together in opposition.

Perhaps bolstered by Reagan’s actions and an increasingly vocal transnational evangelical movement, the Catholic Church strongly countered abortion liberalization at the next International Conference on Population and Development in Cairo in 1994. Women’s rights organizations pushed for language in the conference document relating to abortion. However, the church leveraged the Holy See’s position as a permanent observer in the United Nations to form strategic alliances with Catholic and Muslim countries and block consensus on the issue. Strong opposition to abortion in the U.S. Congress ensured that President William (Bill) Clinton stayed out of the controversy and focused more on other issues. In contrast to the voices of the Catholic Church and the women’s movement, there was no organized input from physicians. In the end, the principles emanating from the Cairo conference included ensuring access to abortion, but only under circumstances where abortion was legal. There was no call to liberalize abortion laws.

Subsequent to the Cairo conference, the Catholic Church was criticized for its unwillingness to compromise. The contingent from the Holy See attending the Fourth UN Conference on Women held in Beijing the following year operated with more subtlety. Nevertheless, its impact was felt. Although the principles articulated at the Beijing conference singled out unsafe abortion as both a public health and a human rights problem, they once again did not explicitly call for the legalization of abortion. To date, the Cairo and Beijing conferences represent the pinnacle of the global dispute over abortion.

By the late 1990s, it appears that both transnational religious organizations and women’s rights organizations were turning their primary attention to other issues. When Kofi Annan, then‐president of the United Nations, created the Millennium Development Goals, reproductive rights were not included. There was no international conference on population and development in 2004; lower‐profile regional meetings were held instead. Within the natural family movement, when conservative religious leaders came together in a World Congress of Families in 2000, they indicated that abortion was only a secondary concern. It is impossible to know whether or how the very public discord at the Cairo and Beijing conferences entered into these later developments, but today there is no cohesive, institutionalized global framework regarding abortion. Nevertheless, many countries did legalize abortion over the period. Thus, the history of abortion policies raises the important questions of how, when, and why policies diffuse when principles are contested in world society.

Results

In 1970, just 10%–15% of countries had laws that permitted abortions in the cases of rape, mental health, or fetal impairment (see Figure 32.1). That increased to around 50% of countries for each allowance by 2009. Although this is consistent with the idea that policies diffuse globally as they become institutionalized, in some ways, the spread of abortion policies is atypical. Specifically, the rates at which countries were adopting abortion allowances were much faster from 1970 to 1987 than from 1991 to present.

Graph illustrating the percentage of sovereign nations legalizing grounds for abortion, displaying 3 ascending curves for rape/incest (solid), mental health (light-shaded), and fetal impairment (dotted). — **Figure 32.1** Percentage of sovereign nations legalizing grounds for abortion.

The decreasing rate of adoption over time suggests that the trend toward abortion liberalization may be slowing rather than turning into a “norm cascade.” Allowing abortion on the grounds of the woman’s mental health is especially notable; the percentage of countries that allow abortions to protect the mental health of the woman has actually decreased in recent years. For example, in 2009, Fiji’s new Crime Code explicitly eliminated the mental health consideration for abortion. Stories from other countries also imply some retrenchment away from abortion liberalization but in ways that are too subtle to be captured by our dependent variables. For example, in 2003, Russian president Vladimir Putin reduced the number of possible socioeconomic justifications for abortion (e.g., if the father is disabled or deceased) from 13 to four. Whether these policy changes are isolated incidents or signal a new trend remains to be seen.

Discussion and Conclusion

We summarize our findings in Figure 32.2. Indicators of a scientific, rationalized frame at both the global and national levels show a consistent association with initial abortion allowances. At the global level, health INGOs were strongly correlated with the adoption of the first of any of the three forms of abortion liberalization (in the case of rape, to protect the pregnant woman’s mental health, or because of fetal impairment), signaling a connection between embeddedness in a global scientific network and policy diffusion. At the national level, abortion liberalization policies were associated with the number of physicians in a country. Women in parliament also appear influential in the adoption of allowances liberalizing abortion. This domestic indicator of women’s empowerment was more influential in predicting abortion liberalization than global women’s rights networks.

A world map with superimposed flow diagram starting from science, rights, and natural family with arrows pointing to world society (professionals, INGOs, other global actors) leading to nation-states. — **Figure 32.2** Weak institutionalization in the case of abortion policy diffusion.

Historically, government officials have accepted medical justifications as a nonpolitical basis for intervention in nation‐state affairs. Indeed, in the case of abortion, the scientific discourse of medicine has been less politicized and less controversial than either the women’s rights or religious frames. For example, while representatives of the International Planned Parenthood Federation and the Catholic Church were in open opposition to each other at the Cairo conference in 1994, physicians stayed mostly on the sidelines. Within countries, physicians have portrayed modest abortion liberalization as a reasonable compromise between two intransigent positions, such as when Chilean doctors Faúndes and Barzelatto wrote The Human Drama of Abortion (2006). In light of our findings, it would be fruitful for future research to consider whether the impact of science‐related discourses is primarily about professional expertise, the unique legitimacy of physicians, perceptions that medicine is non‐controversial, or some combination of these factors. It will also be important to determine whether the effect of physicians and health INGOs is mediated by institutionalized relationships within countries between doctors and the state.

Turning to the next factor: the impact of women’s rights indicators points to the importance of interested actors in local positions of authority. Women’s rights matter for abortion liberalization, but primarily when linked to domestic political opportunities through women in parliament. The ratification of CEDAW had no impact on the adoption of abortion policies. WINGOs were influential but not independently of women in parliament. This suggests, first, that local strategic actors are the most effective carriers of a women’s rights discourse on this controversial issue. In other words, a women’s rights perspective on abortion is not so taken for granted that national policy makers unthinkingly incorporate it into their legal codes. Although the principle of women’s rights is institutionalized in the global system, our findings suggest that local actors and strategic action are more influential in actually affecting policy. Second, our results add weight to previous findings that the presence of female policy makers increases the likelihood that decision‐making bodies will address women’s issues. This may be especially important in the case of abortion politics because abortion rights are uniquely female.

Surprisingly, nations’ historic ties to the Catholic Church were not associated with the adoption of the first allowance beyond saving the life of the pregnant woman. This first allowance was typically an allowance for abortion in the case of rape. Catholic countries were as likely as other countries to adopt rape as a ground for abortion when other factors were controlled. There are a number of possible explanations for this. One is that, since the Catholic Church forbids both rape and abortion, church officials in some countries express stronger opposition to grounds for abortion other than rape. Another possibility is that the church’s opposition to abortion in the case of rape has somewhat less legitimacy than its position on other types of abortion allowances. In international discussions of rape as a war crime, the church has been a highly visible opponent of access to abortion for the rape victims. Local abortion advocates may use this position to portray the church as unsympathetic to rape victims, reducing the impact of the church’s position for this policy.

Overall, because controversy at the global level has prevented a single institutionalized script from emerging, we find that local contextual factors are salient when it comes to abortion allowances. The multiple ideational frames – women’s rights, scientific/medical, and natural family – appear to affect countries differently, depending on which frames are most closely linked to key domestic actors. Our findings extend the theory of institutional logics by suggesting that local actors are especially powerful when no single understanding holds sway.

Part V Questions