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Is U.S. a liberal outlier on abortion, as Supreme Court opinion says?

Abortion rights advocates and antiabortion advocates demonstrate outside the Supreme Court on May 3. (Jabin Botsford/The Washington Post)

The Supreme Court opinion handed down Friday that overturned Roe v. Wade included a claim often repeated by antiabortion advocates: that abortion rules in the United States are among the world’s most permissive.

While that is technically the case, there is much more to the story in practice.

Supreme Court ruling leaves states free to outlaw abortion

The justices voted 6 to 3 to uphold a Mississippi law banning most abortions beyond 15 weeks of pregnancy. At the time the state set that limit in 2018, only six countries besides the United States “permit[ted] nontherapeutic or elective abortion-on-demand after the twentieth week of gestation,” Justice Samuel A. Alito Jr. wrote in his opinion, quoting findings by the Mississippi state legislature.

In a footnote, Alito cites research by the Charlotte Lozier Institute, which opposes abortion rights, and a 2017 Washington Post article. He notes that two more countries have since joined that group, citing the Center for Reproductive Rights, which advocates for expanded abortion access. The list: Canada, China, Guinea-Bissau, Iceland, the Netherlands, North Korea, Singapore, the United States and Vietnam.

Read the full decision for Dobbs v. Jackson Women’s Health Organization

A draft opinion by Alito, leaked last month, which was the focus of an earlier version of this article, contained the same language.

The Post article cited in the opinion, and other Post reporting published more recently, found that few countries allow abortion beyond 15 weeks without restriction — but that many, especially in Europe, permit abortions beyond that cutoff under a wide range of exceptions, including mental health and economic hardship. In the United States, on the other hand, many people do not have access to abortion at any stage, due to the absence of clinics under restrictive state laws.

The world map remains murky when it comes to how countries regulate abortions beyond the first trimester of pregnancy. Overall, the global trend is shifting toward the liberalization of abortion laws, rather than the addition of restrictions.

How abortion laws in the U.S. compare with those in other countries

Katherine Mayall, director of strategic initiatives at the Center for Reproductive Rights, which the court document cites, told The Post at the time of the draft opinion leak that she had “very serious concerns about using the tally method” for assessing how permissive countries’ abortion laws are.

In many places, “the exemptions are so broad” that abortion is available well beyond apparent legal cutoffs.

Abortions in England, Wales and Scotland, for example, are permitted until 24 weeks of pregnancy. They were not included in the list cited by the court, however, because the law requires that two doctors first approve the abortion, which in practice is a formality, Mayall said.

“The decision to have an abortion is yours alone,” the U.K. National Health Service says on its abortion webpage.

In many countries, abortion is protected by law, not court decision

In Britain, pregnancies can be terminated up until birth in cases where there is a severe risk to the woman’s life or the child would be seriously disabled if born. Across Europe, many countries have barred abortions after 12 or 15 weeks. But many also have in place exemptions for women who say carrying the pregnancy to term would hurt them socioeconomically or harm their mental or physical heath.

Often, the more relevant question is whether a woman actually has access to abortion, rather than if the law permits one, as has been the case in the United States, Mayall said.

Stephen Billy, executive director of the antiabortion Charlotte Lozier Institute, which the leaked Supreme Court opinion also cites, said he disagreed.

“The fact that other countries have exceptions doesn’t change the fact that they have limitations on elective abortions that are in law,” he said. That democratic “policymaking process” has been “precluded by Roe v. Wade” and its legalization of abortion nationwide, he said.

Leading U.S. antiabortion activists say their next frontier will be pushing for a nationwide abortion ban. Most Americans support upholding Roe v. Wade by a roughly 2-to-1 majority, according to a Washington Post-ABC News poll conducted in April. Fifty-seven percent also said they opposed banning abortions after 15 weeks of pregnancy.

Majority of Americans say Supreme Court should uphold Roe, Post-ABC poll finds

In its updated guidance released in March, the World Health Organization recommends against using “gestational age limits” — which are the subject of political and ethical debate — when formulating abortion laws.

Focus on cutoffs “obscures how some women are far more affected by abortion restrictions and barriers to access than others,” argued Anu Kumar, president of Ipas, an international organization focused on safe abortion and access to contraception.