sis of a written report from the physician who had examined the woman. The remaining 15 percent of the terminations were performed on the authority of a certificate signed by two physicians. The latter type of local authorization accounted for one-fourth of all cases in 1966, one-half in 1969, and more than four out of five in 1972 (106), perhaps because the time-consuming procedures of the National Board of Health resulted in a higher proportion of second trimester abortions, thus increasing the risk to life and health associated with the procedure.

Following the enactment of the liberalized abortion law, the rate of legal abortions in Sweden increased from 0.4 per 1,000 women, 15-44 years of age, during the period 19391943 to 3.7 per 1,000 a decade later. Subsequently, the trend was reversed and the rate dropped below 2.5 per 1,000 women during the seven years 1957-1963; the upward trend was resumed in 1962 and continued until by 1972 a rate of 15.2 per 1,000 women of reproductive age was reached.

Developments in Denmark were similar to those in Sweden, with higher rates and ratios in Denmark until 1967 and 1966, respectively, and lower rates and ratios during the most recent years. Marked increases in abortion rates and ratios over the past several years have also been reported from Norway, and especially from Finland.

UNITED KINGDOM

One of the more recent additions to the roster of European countries with extended indications for legal abortion is the United Kingdom. According to the Common Law, which is the basis of the British legal system, abortion prior to quickening was not a crime, while abortion after quickening was a misdemeanor. In 1803, abortion became a statutory offense and a felony, but its performance was less severely

1.9

1.9

12

1.2

White

Back & other

xx

X

X

xx

X

X

X

35

2.4

19671.44

829.200

42

punished prior to quickening than thereafter. The Offenses Against the Person Act of 1861 made "unlawfully" induced abortion a felony, regardless of the duration of the pregnancy. The Act did not define "unlawfully" and made no provision for the termination of pregnancy on medical grounds. However, in 1938, in Rex v. Bourne, the judge ruled that abortion need not be unlawful if done in good faith to preserve the mother's life. The jury was further instructed that: "If the doctor is of the opinion... that the probable consequences... will be to make the woman a physical and mental wreck, the jury is quite entitled to take the view that the doctor... is operating for the purpose of preserving the life of the mother" (113, pp. 199-200). Bourne, who had performed an abortion for a young girl who had been repeatedly raped, was acquitted, and a legal precedent was

set.

Nevertheless, the attitudes and practices of the medical profession in Great Britain remained conservative, especially with regard to nonprivate patients. About 2,300 abortions were reported by the National Health Service (NHS) hospitals in England and Wales in 1961; about 3,300 in 1964; and 9,700 in 1967. The total number of legal abortions, including those reported from NHS hospitals and an estimate of those performed in the private sector, almost doubled from 14,300 in 1961 to 27,200 in 1967 (33). Over the same period, the abortion rate rose from 1.6 to 2.9 per 1,000 women aged 1544 years, and the abortion ratio from 17 to 33 per 1,000 live births.

The rate and ratio of legal abortions in England in 1967 were about ten times as high as the corresponding figures estimated for the United States in the same year, when the first three states liberalized their abortion laws, and were roughly equal to the rate and ratio in Sweden three or four years earlier, with the important difference that almost two-thirds of the legal abortions in

Abortions on social indication only. ExIcludes abortions on medical indication: 800 in 1957, 600 in 1958, 2,000 in 1968, 1,200 in 1969 and 1970, 1,100 in 1971. Refs. 63A, 64, 100

The symbol X in this and any other table indicates one of the following: (a) data not available or not located, (b) category not in source, (c) rate or ratio not computed because denominator not available or not located, (d) inadequate number of cases, or (e) entry considered irrelevant.

Residents only. Ref. 98.

Twelve months ending 30 June. Ref. 15.

Refs 22, 41, 136.

Ref. 32.

19 Annual averages. "Estimates by Danish National Health Service for fiscal years ending 31 March.

The figures for the private sector and, hence, the totals as well, are estimates by the authors of Ref. 33.

"National Health Service

14 Abortions performed under the 1967 Abortion Act. Refs. 110, 113, 114, 121, 124126.

15 Preliminary.

Ref. 39.

Refs. 51, 53, 55.

18 Licensed hospitals Ref. 61.
"Refs 62. 72

Estimates by Muramatsu, Ref. 78.

21 Total induced abortions (legal plus illegal).

"Estimates based on survey of 6,300 ever-married women in 1971. Refs. 50, 75. 23 Ref. 34.

"Corrected for underreporting.
"Including Puerto Ricans.

Estimate of illegal abortions based on

trends of legal abortions and live births, 19701972. Ref. 117.

Abortions performed under the national family planning program. Ref. 120 According to Ref. 128, 13,000 legal abortions were per formed in 1971 in all institutions under the Ministry of Health.

Abortion ratio per 1,000 live births. Ref 94. Other entries derived.

"Abortion rate per 1,000 population. Ref 99. Other entries derived.

"Hospital survey. Ref. 49.

42 Estimate based on surveys, Ref. 13
"Hospital survey and national estimates

derived from the survey. Ref. 114.

"National estimate derived from survey

in urban areas of North Carolina, using randomized response technique. Ref. 1

Ref. 129

Ref. 130.

"Estimate based on total legal abortions reported (485,800) and distribution by state of residence for 93 percent of them. Ref. 129. Hospital survey. Ref. 74

Ref. 128.

England were done in the private sector and had to be paid for, whereas in Sweden all were done in public hospitals free of charge.

In October 1967, after a long and bitter legislative struggle, Parliament enacted a liberalized abortion statute, authorizing abortion if two physicians

.. are of the opinion, formed in good faith: that the continuance of the pregnancy would involve risk to the life of the pregnant woman or of injury to the physical or mental health of the pregnant woman or any existing children of her family, greater than if the pregnancy were terminated; [or] that there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped (123, p. 887).

The Act provides further that in determining whether or not there is such risk of injury to health, "account may be taken of the pregnant woman's actual or reasonably foreseeable environment." Abortions may be performed in NHS hospitals or in facilities approved by the Minister of Health. The latter category includes mainly private nursing homes. The Act, which came into force on 27 April 1968, applies to England, Wales and Scotland, but not to Northern Ireland (122).

The British Abortion Act of 1967 contained a number of revolutionary innovations. Potentially most important are the words "greater than if the pregnancy were terminated," qualifying the "risk to life or of injury to physical or mental health" if the pregnancy were continued. Although this clause was inserted at a late stage of the legislative process, at the request of the opponents of liberalization, it has been interpreted as justifying abortion in order to secure a relatively small improvement in the woman's medical condition, since the risk to life, in early pregnancy at least, is substantially less than the risk normally

associated with pregnancy and childbirth (2). Another important passage is contained in the words "or any existing children of her family." Couched in medical terms, this phrase constitutes a recognition of the fact that not only the mother, but also her entire family, may be adversely affected by the birth of an unwanted child. It should also be noted that the Act does not establish administrative machinery to authorize the termination of pregnancy. The determination is made by two physicians, in whose judgment the required conditions are met.

The number of legal abortions performed on resident women in England and Wales under the provisions of the Abortion Act of 1967 increased from 22,300 in 1968 (27 April-31 December) to 108,600 in 1972. The abortion rates per 1,000 women aged 15-44 years and the abortion ratios per 1,000 live births have been similar in recent years to those reported from Denmark, Norway, Sweden, and the United States.

WESTERN EUROPE

Table 1 shows no entry for any of the continental countries of western Europe, all of which have restrictive abortion laws. Although these laws are not uniformly enforced and are liberally interpreted in such places as the Netherlands and in some of the Swiss cantons, notably Geneva, there are no statistics from which rates and ratios of legal abortions could be computed. The incidence of illegal abortion is thought to be high in most of the countries but reliable estimates are not available (43).

EASTERN EUROPE

In the countries of eastern Europe abortion policies have undergone several major changes since 1920, when the USSR legalized abortion on request (24, 113). The USSR reversed this liberal policy in 1936 by limiting legal abortion to a list of

Currently married women, aged 20-49. N = 6,500. Ref. 135.

Currently married women, aged 15-49. N 8,800. Ref. 56.

Because the number of induced abortions reported by the respondents as having occurred in 1960-1965 represented about 55 percent of the number reported by hospitals, it was assumed that women with "unjustified" long intervals between births had concealed their abortion experience. Five or more years were considered a long interval for women under age 30 years and seven or more years for women aged 30 or older, except when the respondent reported (1) at least one induced abortion, (2) a condition usually causing sterility or subfertility. (3) several spontaneous abortions or ectopic pregnancies. (4) use of an effective method of contraception, or (5) marital separation during the period in ques

XXX

053

XXX

451

tion. It was further assumed that the mean number of abortions was the same for women reporting experience with abortion and for those who concealed it.

Currently married women, aged 20-49 N 3,200 Ref. 69.

It was assumed that all women not ans wering the questions relating to abortion (12 percent) had in fact had abortions and that the mean number of abortions was the same for the women reporting abortions and for the nonrespondents.

Currently married women, aged 15-49. N2,200. Ref. 19.

'Currently married women, aged 15-49. N = 2,600 in 1963; 3,300 in 1968. Ref. 87.

White women of all marital statuses. aged 36 and older, mostly urban and welleducated. N 1,300. Refs. 59, 110.