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Comparing U.S. abortion policies to China, North Korea and western Europe oversimplifies a complex web of state- and nation-specific abortion laws, and uses outdated information.
China and North Korea have records of coercing abortions to curb population growth or maintain "ethnic purity." This isn’t happening in the U.S. Neither nation has clear or publicly updated abortion policies, but the countries appear to be tightening restrictions on the procedure or outlawing it altogether.
Gestational limits for elective abortions are stricter in some western European countries than in some U.S. states. But it’s often easier for women to access abortion care in European nations than it is in the U.S., as some governments cover abortion costs and have far-reaching exceptions that include the mother’s mental health status, income, or both.
Former Vice President Mike Pence has been outspoken against abortion and used the anniversary of the U.S. Supreme Court’s decision to overturn Roe v. Wade to exhort his Republican presidential rivals to take the fight further.
The U.S. should have a 15-week national abortion ban, he said at the annual Faith and Freedom Coalition Conference in Washington, D.C., arguing that U.S. laws are too loose.
"The fact is, today abortion law in the United States is more aligned with China and North Korea than with Western nations in Europe," Pence said June 23.
Experts say China and North Korea have historically used abortion coercively to curb population growth and retain ethnic purity. U.S. abortion policy permits nothing of the sort. A Pence campaign spokesperson said "based on available reports," North Korea has no abortion restrictions, and China restricts only sex-selective abortions.
Since the Supreme Court’s 2022 decision, U.S. abortion policy has been left to the states — and 25 have banned abortion or tightened restrictions. This has created a complex web of laws that lack the homogeneity Pence’s statement suggests.
Pence didn’t say during his address which U.S. state laws he was referring to. But when we asked his presidential campaign, it pointed us to laws in states that don’t restrict abortion access or have restrictions after the point of viability — typically about 24 weeks into pregnancy.
Pence also didn’t specify which European countries he was using in his comparison.
Although some western European countries do have stricter restrictions on gestational limits for abortion compared with a number of U.S. states, the comparison isn’t cut and dried; countries differ on limits, requirements, exceptions and access.
Some European countries, such as Germany and Denmark, offer exceptions that many U.S. states lack, including for a woman’s mental health and/or her socioeconomic status if income, housing, or both, pose hardships.
But some nations have other barriers. Germany grants exceptions to abortions after 12 weeks when the mother’s mental health is poor. But it also has a mandatory waiting period and requires patients to seek counseling before they can get abortions. In Italy, where abortion is permitted during a pregnancy’s first 90 days, doctors with religious concerns or other conscientious objections can legally refuse abortion care.
Still, many of these countries have integrated abortion services into their health care systems and fully fund the procedure through public health insurance or other government programs.
The nonprofit Center for Reproductive Rights, which conducts international analyses of abortion policies and advocates for abortion access, told PolitiFact that in U.S. states where abortion remains legal, the laws and practices do resemble those in many Western European countries. These nations include Iceland, the Netherlands and Sweden, along with many U.S. allies outside Europe such as Canada, New Zealand and Australia.
China’s and North Korea’s abortion policies, meanwhile, aren’t clear. We found that the reports supporting Pence’s characterization are outdated. Although both countries have historically allowed abortion later in pregnancy, experts said these policies appear to be shifting.
Abortion is generally accessible in China — and is provided through clinics as well as public and private hospitals. But the country appears to be changing its stance to deter abortions that aren’t considered "medically necessary."
In the 1950s, China became one of the first nations to legalize abortion. It promoted the procedure under its one-child-per-family policy, enacted in 1979 to curb population growth. The policy included coercive measures to deter unauthorized births, including fines, compulsory sterilization and abortion.
Things started changing in 2016, when China raised its per-family limit to two children. To counterbalance an aging population and encourage births, the nation added other incentives such as improved maternity leave policies, according to the Council on Foreign Relations, a New York-based think tank.
In 2018, one Chinese province required women more than 14 weeks pregnant to have three medical professionals confirm an abortion’s medical necessity. The move was an attempt to prevent sex-selective abortions, which are illegal in China; other provinces have implemented similar rules in the past.
"In 2021, (China) increased the limit to three children," CFR said in a report comparing global abortion laws, "and China’s State Council issued guidelines on women’s development that called to reduce ‘non-medically necessary abortions.’"
In January 2022, China’s family planning agency said it would "intervene" when unmarried women and teenagers seek abortions and would launch public health programs to encourage people to have more children.
China so far hasn't changed the law to halt abortions, but the South China Morning Post reported, "Many see these policies as yet another form of government interference in women’s bodily autonomy and families’ private lives, after the notorious measures taken during the one-child policy era."
Vague laws and a secretive government make understanding North Korea’s abortion laws difficult. Obscure websites point to a 1950 North Korean criminal code that broadly allowed abortion in the nation "for important reasons" but provided no further details. We found a summary of this law on an archived United Nations webpage and asked the U.N. for more information. The organization didn’t respond.
Available data suggests the practice of the law is outdated.
As recently as 2015, North Korean authorities started issuing directives that bar doctors from performing birth control procedures and abortions, according to Radio Free Asia, a news site that covers Asian countries whose governments prohibit free press access. The change was part of an effort to reverse the country’s falling birth rate, the organization reported. (North Korea’s birth rate ranks 120th out of 228 countries, according to the U.S. government’s World Factbook.) The World Health Organization included the Radio Free Asia report in its fact sheet on North Korea’s abortion policy.
But U.S. agencies and human rights organizations say the country has a record of forced sterilizations and abortions, particularly in prisons.
The Korea Institute for National Unification, a think tank funded by the South Korean government, publishes annual reports on human rights abuses in North Korea. Its reports detail forced abortions in detention facilities, typically involving pregnant women who were deported to North Korea. According to a 2022 U.S. State Department analysis, defectors said security officials subject women to abortions for political purposes, to cover up human rights abuses and to "protect" Korean ethnic purity.
In its 2022 analysis on North Korea’s human rights issues, the Korea Institute for National Unification said North Korea’s law on medical care "prohibits abortions except for those necessary to protect the mother." It noted that, because North Korean women have limited access to reproductive health services, abortions often happen in secret.
"Many testimonies have been collected reporting that, because abortions are illegal, they are performed by retired doctors at their homes or by private doctors at patients’ homes, rather than in hospitals," the report said.
How nations in Europe compare with U.S. states depends entirely on which countries and states we’re talking about.
This is more restrictive than laws in some U.S. states where abortion is not explicitly prohibited at any stage of pregnancy, including Alaska, Colorado, New Jersey, New Mexico, Oregon and Vermont, reported the Guttmacher Institute, an abortion-rights research group.
Many U.S. states, including California, Illinois and New York, allow abortions up to the point of viability, which is when the fetus can survive outside the womb, with varying exceptions for fatal fetal anomalies and the mother’s health and life. This is the same limit imposed by laws in the Netherlands and the United Kingdom.
Abortions later in pregnancy are rare, however. In the U.S., less than 1% of abortions are performed at or after 21 weeks. Abortions performed at this point are usually for urgent medical reasons, including severe maternal or fetal complications.
"People cannot opt for an abortion instead of childbirth when they are full term," Laurie Sobel, associate director of women’s health policy at KFF previously told PolitiFact.
European countries also have a broad range of exceptions to their abortion restrictions.
In Germany, abortion is legal until 12 weeks, and until 22 weeks if it’s necessary for a woman’s physical or mental health or for present or future living conditions, The New York Times reported in 2022.
In Denmark, abortion can be allowed past the country’s 12-week limit for factors that include the pregnant woman’s health, age, occupation, income or housing. But women must apply with the country’s Abortion Council and explain their reasons to get abortions beyond that limit.
We found European countries impose other barriers beyond gestational limits. Some require multiple doctors to agree that an abortion meets requirements. Some require parental consent.
U.S. abortion law and practice diverge from western European countries in three key areas, the Center for Reproductive Rights said:
The majority of these European countries
provide abortion care funding;
include abortion entitlements in federal legislation and;
are widening abortion access rather than restricting it.
"In the past 30 years, there has been an overwhelming global trend towards liberalization of abortion laws and guaranteeing greater access to safe and legal abortion services," said Margaret Harpin, legal adviser at the Center for Reproductive Rights. "Since 1994, only four countries, including the U.S., have removed legal grounds for abortion, while more than 60 countries have liberalized their abortion laws to expand the grounds for legal abortion."
Pence claimed U.S. abortion law is "more aligned with China and North Korea than with Western nations in Europe."
This oversimplifies a complex web of global abortion laws, ignores exceptions and accessibility and relies on outdated information about abortion policies in China and North Korea. The claim also ignores that both countries have participated in coerced abortions for their own goals — something that U.S. abortion policy doesn’t come close to permitting.
Some western European countries have stricter gestational limits for "elective" abortions than some U.S. states. But abortion access is often easier for many women in some of those countries, with costs covered, and far-reaching exceptions that include mental health and income.
China and North Korea don’t have clear or publicly updated abortion policies, but recent reports suggest that the countries are tightening restrictions on the procedure or outlawing it altogether.
Pence’s claim contains an element of truth but ignores critical facts that would give a different impression. We rate it Mostly False.
C-SPAN, Faith & Freedom Coalition Conference, June 23, 2023
PolitiFact, How state abortion laws changed after the Dobbs decision reversed Roe v. Wade, June 21, 2023
Center for Reproductive Rights, The World's Abortion Laws, Accessed June 26, 2023
Center for Reproductive Rights, U.S. Abortion Laws in Global Context, Sept. 20, 2022
Kaiser Family Foundation, States with Gestational Limits for Abortion, as of June 6, 2023
World Health Organization, Global Abortion Policies Database, Accessed June 27, 2023
Human Rights Watch, France Expands Abortion Access in Two Key Moves, March 1, 2022
Guttmacher Institute, An Overview of Abortion Laws, Accessed June 27, 2023
PolitiFact, Anti-abortion group exaggerates how states regulate late-term abortions, July 12, 2022
The New York Times, On Abortion Law, the U.S. Is Unusual. Without Roe, It Would Be, Too, Updated May 4, 2022
Harvard.edu, DENMARK. Law No. 350, Accessed June 27, 2023
Government of the Netherlands, I am thinking about getting an abortion. What should I do?, Accessed June 27, 2023
CAIRN International, Abortion around the world. An overview of legislation, measures, trends, and consequences, Volume 73, Issue 2, 2018
Council on Foreign Relations, China’s Baby Blues: When Better Policies for Women Backfire, July 5, 2018
Council on Foreign Relations, Abortion Law: Global Comparisons, June 24, 2022
Radio Free Asia, North Korea Forbids Doctors To Perform Abortions, Implant Birth Control Devices, Oct. 14, 2015
World Health Organization, ABORTION POLICY LANDSCAPE Democratic People’s Republic of Korea, Accessed June 27, 2023
The Korea Institute for National Unification, White Paper on Human Rights North Korea, Accessed June 27, 2023
The Korea Institute for National Unification, White Paper on Human Rights in North Korea 2022, May 4, 2023
Central Intelligence Agency World Factbook, Korea, North, Update June 20, 2023
Council on Foreign Relations, Abortion Law: Global Comparisons, Updated June 24, 2022
ForeignPolicy.com, Roe Abolition Makes U.S. a Global Outlier, June 24, 2022
U.S. State Department, 2022 Country Reports on Human Rights Practices: North Korea, Accessed June 27, 2023
The New York Times, On Abortion Law, the U.S. Is Unusual. Without Roe, It Would Be, Too, Updated May 4, 2022
The Washington Post, How abortion laws in the U.S. compare with those in other countries, May 3, 2022
The Washington Post, Is the United States one of seven countries that ‘allow elective abortions after 20 weeks of pregnancy?’, Oct. 9, 2017
Email interview, Devin O’Malley spokesperson for Mike Pence’s presidential campaign, June 26, 2023
Email interview with The Center for Reproductive Rights, June 26 - July 5, 2023
Email/phone interview, Brookings Institution Foreign Policy, June 27, 2023
Email interview, Isabel Guarnieri communications manager At the Guttmacher Institute, June 27-28, 2023
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