The case of an American woman trapped in Malta, unable to terminate a doomed pregnancy, brings into relief potential consequences of abortion bans.

Andrea Prudente from Washington state, at 16 weeks pregnant, went with her partner to Malta on a babymoon. But that turned into a nightmare when her water broke early and she began to bleed heavily. Though doctors told her the fetus has no chance of survival, they refused to terminate the pregnancy because the fetus still had a heartbeat, despite the risk that Prudente develop sepsis or hemorrhage.

Prudente's partner Jay Weeldreyer told the Times of Malta that they felt they were being "held hostage" as they waited for the fetus to die.

In the 27 EU member states, abortion is completely illegal in Malta, while Poland has a near-total ban. However, these two countries are outliers.

From Ireland to Spain, many EU countries have been overhauling abortion laws, rolling back measures that made it difficult — or illegal — to access safe care for the procedure. 

"The trend across Europe is squarely and overwhelmingly toward the legalization of abortion, toward the removal of legal and policy barriers," says Leah Hoctor, the senior regional director for Europe at the Center for Reproductive Rights.

Prudente finally secured emergency medical evacuation to Mallorca, Spain, so the pregnancy could be terminated, potentially saving her life.

The case highlights how in Europe, abortion is not accessible to everyone. 

According to Caroline Hickson, the regional director of the International Planned Parenthood Federation European Network, all but five of the 52 European countries the group surveyed in 2021 impose medically unnecessary procedures such as compulsory waiting periods.

Hickson describes diverging trends, in which some countries have overturned long-standing abortion bans. Yet, particularly in Central and Eastern Europe, she said, "regression on women's rights, and particularly on their reproductive rights, actually goes hand in hand with regression on the rule of law and democracy."

Spain: Access to be expanded

On Tuesday, Spain's Council of Ministers council approved a draft law that removes the requirement for 16- and 17-year-olds to obtain parental consent to terminate a pregnancy.

If approved, the new law would also eliminate a three-day "reflection period" before an abortion. It would also include reproductive health provisions such as granting leave after abortion. In a first for Europe, the law would also institute menstrual leave for people with severe period symptoms. 

Hoctor says all this shows that the proposal is "indicative of this trend across the region to really improve, modernize abortion laws," before adding, "We very much hope that the legislation will be adopted by the legislature in Spain."

But doctors who refuse to carry out an abortion procedure would still be able to join a registry of objectors. This "denial of care" barrier is present in numerous other European countries, Hickson indicates.

Although some may consider 16 or 17 young, Hickson says, "young women need to be able to access a confidential medical service when they need it," citing potentially difficult family situations.

She attributes the new law to an upsurge in women's activism and to the democratic socialist alliance currently governing Spain. Access to abortion "very much follows the wider political swing of a given country," she points out.

Poland: Near-total ban

This is also evident in Poland. In contrast to European countries that have expanded access to abortion in recent decades, Poland's Constitutional Tribunal — itself a focus of EU concern — in January 2021 issued a ruling that imposed a near-total ban.

Abortion is now only permitted in cases where pregnancy threatens the life or health of the pregnant person, or in cases of rape or incest.

The ruling spurred massive public protest, with more than 1,000 women challenging it at the European Court of Human Rights. The Council of Europe commissioner for human rights and nine leading human rights organizations have filed third-party interventions on behalf of these women.

"As an outlier in the European region, Poland is the only EU member state in recent decades to remove a ground for legal abortion from its law," Hoctor says. "Poland is really out of step with the general trend."

Both Hoctor and Hickson express concern that the ban also applies to Ukrainian refugees in Poland, some of whom are survivors of sexual violence.

When refugee women or girls cross the EU border into Poland, Slovakia or Hungary, "they are moving into some of the most restrictive contexts in the region on abortion," Hoctor says.

Hungary: Interlocking obstacles

Although abortion is legal in Hungary, Hoctor says the law is still very restrictive in terms of imposing a mandatory waiting period, stringent counseling requirements and a range of other barriers, including the fact that abortion care is not covered under public health insurance or subsidization schemes. 

Hickson describes Hungary as among numerous European countries whose abortion policies "impose a lot of interconnecting barriers that in practice make it much more difficult to access." 

In Hungary, abortion restrictions are also strongly connected to right-wing populist Viktor Orban's agenda, Hickson says.

Ireland: Referendum reflects reforms

Ireland has overhauled its abortion laws since a 1983 constitutional amendment — which was riding Catholic sentiment — prohibited abortion. In a 2018 referendum, the public voted overwhelmingly to overturn the ban.

"It was a real recognition by the Irish people and by the Irish state of the need to treat abortion as essential health care," Hoctor says.

"While the change in Ireland was phenomenal and incredibly important, a number of barriers to access are still retained in the legislation," she adds, indicating that a review process currently underway could ameliorate the situation.

Reflecting on the situation in Europe as a whole, particularly considering developments restricting abortion in the United States, Hickson says: "We need to acknowledge that, yes, progress is fragile, and we should never rest."

Edited by: Stephanie Burnett