A Global Synthesis of National and Subnational Abortion Laws and Policies and Their Impact on Women’s Health

Background Human intervention to terminate a pregnancy, while medically effected through a range of pharmaceutical, surgical, and other approaches, is generally referred to in English as “abortion.” It is a fundamental aspect of reproductive healthcare and its availability, regulation, and limits (cultural, familial, legal) are well-documented determinants of women’s and girls’ health worldwide. Despite its routine nature in many health systems, it remains a deeply sensitive issue shaped by cultural, legal, religious, and political factors. Globally, an estimated 73 million abortions occur annually, yet access to safe and timely care is highly variable. In settings where abortion is legal and integrated into healthcare services, it is one of the safest medical procedures. Conversely, restrictive policies force individuals to seek unsafe alternatives, contributing to preventable maternal deaths and long-term health complications. Laws and regulations play a pivotal role in shaping access, but these are influenced by societal norms and often create inequities within and between countries. Methods A systematic review was conducted to identify, collate, and analyse publicly available abortion policies and legislation in English from 1980 to 2025. Data sources included peer-reviewed literature, legal databases, national government portals, and grey literature from global health organisations. Policies were screened, extracted, and appraised using a structured framework. A thematic and contextual analysis was undertaken to explore the legal, operational, and governance components of abortion policies and their implications for access and equity. ResultsPolicies from over 100 countries were included, demonstrating significant global variation. Liberal frameworks, such as those in Iceland, Sweden, England, and New Zealand, were associated with early, safe access through broad on-demand gestational limits and integrated care. Restrictive or grounds-based models, common in parts of Eastern Europe, the Middle East, and Latin America, relied on multi-clinician approvals, waiting periods, and documentation, creating delays and inequities. Federated systems, including the United States and Australia, showed marked regional disparities. Criminal penalties in several countries had a chilling effect, driving cross-border travel and unsafe abortion. Conclusion Global abortion policies vary widely, with many failing to translate legal rights into equitable, practical access. Evidence-informed reforms that integrate health systems research and cultural context are urgently needed to reduce preventable harm and promote reproductive justice.