In the Netherlands, any woman can legally have a safe abortion until 24 weeks after conception when needed. What constitutes a need is not clearly defined, which allows women, their doctors and the courts to interpret this law liberally. The result? One of the lowest abortion rates in the world.

Photo by Manny Becerra/Unsplash

This April, Adora Perez stepped out of the Kings County Jail, a free woman for the first time in four years. The 31-year-old mother of eight was the first woman jailed in California for the death of her stillborn baby. A doctor had discovered methamphetamine in her stillborn’s system, which could have contributed to his death, according to the doctor. Perez pleaded no contest to voluntary manslaughter, which got her an 11-year prison sentence in June 2018. According to the Los Angeles Times, prosecutors had presented the plea to her as her only option to avoid spending the rest of her life in jail and failed to admit that California laws don’t allow women to be charged with killing their fetus.

She would probably have spent the full 11 years in prison, had a Los Angeles Times reporter not alerted the public to a strikingly similar case: Chelsea Baker had grown up in the same small Central Valley town as Perez, also struggled with methamphetamine addiction, and delivered a stillborn at the same hospital two years after Perez. The hospital called authorities again, but this time, lawyers of the ACLU (American Civil Liberties Union) averted a similar outcome and eventually ended up overturning Perez’ sentence, too.

“Suffering a miscarriage or a stillbirth can be deeply personal and traumatic,” Rob Bonta, the California Attorney General, said in a statement. “We owe it to all Californians to ensure the pain of loss is not compounded by violation of privacy and unjust prosecution… We do not criminalize people for the loss of a pregnancy. My office will continue to stand up for the rights of pregnant people in California and beyond.”

Since the U.S. Supreme Court moved to overturn Roe v. Wade and is criminalizing abortions once again, conservative states have already passed laws to tighten restrictions. “Pregnancy criminalization has more than tripled across the country in recent years to include more than 1,300 cases from 2006 through 2020,” the National Advocates for Pregnant Women states. “From the 1973 Roe v. Wade ruling through 2020, NAPW has documented more than 1,700 cases of arrests, prosecutions, detentions, or forced medical interventions carried out against pregnant people.”

Last September, Florida governor Ron de Santis signed a bill banning abortions after 15 weeks with no exceptions for cases of incest, rape or human trafficking. This April, Oklahoma’s governor Kevin Stitt signed a bill that would make performing an abortion a felony except in a medical emergency, saying, “We want Oklahoma to be the most pro-life state in the country. We want to outlaw abortion in the state of Oklahoma.” And the Louisiana State Legislature has advanced a bill that treats abortion flatly as homicide, with no exception for rape, incest, or medical emergencies endangering the mother’s life. “This is a bill to immediately end abortion in the state of Louisiana. No compromises, no more waiting,” said Pastor Brian Gunter,

So, the question is worth asking: Do such bills actually “end abortion”? Do they save lives? Does criminalizing pregnant women work? Or is making abortions more accessible actually the best way to reduce them?

The truth is, countries with the most restrictive abortion laws have the highest rates of abortion, according to a report by the Guttmacher Institute. In Pakistan, where abortions are almost always illegal, there are an estimated 50 abortions per 1,000 women — one of the highest rates in the world. Of the roughly 56 million abortions every year, nearly 50 million happen in developing countries. “Lack of access to safe, timely, affordable and respectful abortion care is a critical public health and human rights issue,” according to the WHO.

Compare that to the Netherlands, where any woman who needs one can legally have a safe abortion until 24 weeks after conception.In that country, just eight out of 1,000 pregnancies are terminated — half the rate in the U.S. and one of the lowest rates in the world.

What constitutes the “need” for an abortion is not clearly defined — the law trusts women, their doctors and the courts to interpret this law as they see fit. Almost all Dutch clinics that offer abortions are non-profits, and health insurance usually covers the cost.

The fact that this system is working so well has prompted the Netherlands to liberalize its abortion laws even further. This spring, it abandoned the regulation that forced women to wait five days between consulting their doctor and making the decision. In March of this year, it allowed general practitioners to prescribe the “morning-after-pill.”

These policy shifts are based in science. “More liberal abortion laws don’t lead to an increase in abortion numbers,” says Alicia Baier, an OB-GYN in Berlin and co-founder of the advocacy group Doctors for Choice, which advocates for more liberal abortion laws. In a discussion with Bavaria’s conservative Christian minister for families, Ulrike Scharf, Baier pointed out that restrictive measures like mandatory wait times have never been proven to work. “The World Health Organization states clearly that punitive measures do not decrease abortions. They only make them less safe, hamper access, and delay the procedure,” she said. “Pregnancy termination is safest the earliest it is performed.”

Historically, outlawing abortion primarily makes abortion unsafe for low-income women, as the affluent can travel to obtain safe care, even in the U.S. The WHO calls unsafe abortions “a leading — but preventable — cause of maternal deaths and morbidities. It can lead to physical and mental health complications and social and financial burdens for women, communities and health systems.” It has recently published data showing that “nearly half of all abortions are unsafe,” with “developing countries bear the burden of 97% of these unsafe abortions.”

Safe, legal, and rare

Switzerland is another country that saw abortion rates plummet after it legalized the procedure. Before 2002, it only allowed abortion for specific medical conditions, but the Swiss laws changed in 2002 to allow abortions during the first 12 weeks of pregnancy after counseling, an approach accepted by 72 percent of voters. Abortion rates dropped from around 12 per 1,000 women age 15 to 44 in the 1970s to around eight in the 1990s. After legalization, the rates kept dropping, to around seven in the 2000s, 6.5 in 2013 and 5.4 in 2020 — a remarkable achievement compared to the United Kingdom (17.5), France (15 in 2009) and the United States (16 in 2008). (The average annual worldwide abortion rate is 28 per 1,000 women of childbearing age.)

Of course, legalization alone isn’t likely to lower abortion rates. Sexual health experts point to three main factors: education, contraception and a relatively high socioeconomic level. Both Switzerland and the Netherlands have adopted the mantra “safe, legal and rare.”

Health experts agree that the easiest way to prevent abortions is to prevent unwanted pregnancies. This is why Switzerland, the Netherlands, Canada and most European countries have made the prevention of unwanted pregnancies a priority. The U.S., by contrast, where several conservative states have banned sex education from the curriculum and where reproductive care is unaffordable for many women, leads the industrialized world in unwanted pregnancies — nearly half are unintended, and they disproportionately affect poor and uneducated women.

In Switzerland and the Netherlands — where almost every school teaches sex education, and contraception (including morning-after pills) is easily accessible and affordable or even free — the rate of unwanted pregnancies is just 28 percent, a little over half the rate in the U.S.

“Driving to the Netherlands”

“Driving to the Netherlands” was an expression I sometimes heard when growing up in Germany. It referred to abortion, or more specifically, to the women who could afford to drive across the border to get one. Since it is a largely progressive European country, some foreigners are surprised to learn that abortion is generally illegal in Germany unless a woman can prove in mandatory counseling that she is emotionally or physically unable to carry the pregnancy to term. Baier is one of the few German gynecologists who openly admit to performing abortions. Only an estimated one out of ten gynecologists perform the procedure, and even fewer dare to say so publicly.

Decisions around contraception are very personal, so allow me to get personal for a minute. I grew up Catholic, and I understand and respect the belief that life begins at conception. I respect this belief so much that for me, personally, an intrauterine device (UID) that might occasionally lead to the shedding of an already fertilized egg, was not an option. But, again, this is personal. I’m not God, so I don’t know when life begins. Nobody knows for sure, so I want to veer on the safe side, but I can’t make this decision for anybody else. My mom dragged me to the OB-GYN when I was 13 years old, long before I even thought about having sex, and she convinced him to prescribe me contraception pills, “just in case,” much to my embarrassment at the time. That is because my mom had an unwanted pregnancy (me) when she was 19 and was intimately familiar with the hardships of having a child while still being a teenager herself. My parents openly told me in child-like language how babies were made when I asked. (It was the “when mommy and daddy love each other very much” talk, not the birds and the bees.) I proudly shared my newly acquired knowledge with the other fourth-graders and still remember their chins dropping, because they could hardly believe what they just heard.

I’m digressing, but my point is: I was lucky in so many ways. Very lucky and privileged.

And I have no business judging anybody else.

Since moving to the U.S., I have spoken to many members of the anti-abortion movement. Here is what I don’t get: If the goal truly is to protect lives, there are numerous proven ways to save the lives of mothers and children.

What “Pro-Life” could mean

The United States has the highest maternal mortality rate of any developed country and while it is decreasing worldwide, it keeps increasing in the U.S. (An average of 23.8 maternal deaths per 100,000 live births in the U.S. compared with 5 in the Netherlands and Switzerland.) If Christians are worried about the most vulnerable among us, how come conservative U.S. states have the worst maternity death rates, with Louisiana (58.1), Georgia (48.8), Arkansas (37.5), Alabama (36,4), and Texas (34.5) leading the statistics? Black mothers have the highest risk (55.3), nearly three times the maternal death rate for non-Hispanic White women. A woman in Texas is about ten times more likely to die in childbirth than a woman in Sweden or Germany, a black woman more than thirty times. Why? Because the same states that want to force women to carry pregnancies to term, have slashed the measures that let give mothers access to affordable health insurance, maternity care, and they have closed many of the public health clinics that were often the only affordable option in underserved areas. Houston, we have a problem.

The same states have the worst infant mortality rates. Mississippi, Louisiana, Alabama, Georgia, Arkansas, Kentucky, Florida and Texas lead that sad statistic with more than 5 infant deaths per 1,000 live births (compared with 2.2 in the Netherlands and 3.1 in Switzerland). What about that “sacred gift worthy of protection“?

The same politicians who argue so vehemently for the protection of unborn life are often the same who want to eliminate affordable healthcare for all, which pays for prenatal care and the first years of health care for the young child. Alabama, by the way, is also the state with the highest rate of cervical cancer in the U.S. — not least because it hampers preventative health care for low-income women. Instead, it tortures women after miscarriages with legal threats.

If one wants to prevent abortions, making contraception free or at least affordable is the fastest way to achieve this goal. So, why do lawmakers allow exceptions for Christian employers who routinely exclude contraception costs from health care while paying for viagra?

And lastly, if one indeed does believe, despite all the evidence, that criminalizing mothers helps, it begs the question: Why not criminalize the fathers, too? According to the knowledge I had as an 8-year-old, men are at least partly responsible for any pregnancy.

Why force women who do carry their pregnancies to term after having been raped, to share custody with their rapist, which happens far more frequently than I believed until I spoke with half a dozen women who had to bear such court decisions?

Why is a rapist who rapes an 11-year-old in Ohio likely to get away with a much lesser sentence (if any at all) than the 11-year-old who cannot carry this pregnancy to term or the doctor willing to perform that abortion?

And lastly, while anti-abortion activists argue that the personal freedom of a woman ends when her decision impacts another life, then what about the 45,000 firearm deaths in the U.S. every year, of which about a tenth are children? Does the personal freedom of gun owners not end when its guns are the leading cause of death for American kids?

For someone to call themselves pro-life, they need to favor ALL life.

Adora Perez’s case fits a troubling statistic: She grew up in a small railroad town in the Central Valley, and according to testimony from family members, suffered molestation and sexual abuse as a child and teenager. She was 14 when she first became pregnant and 16 when she started smoking meth. The father of her eight children, whom she met when she was 21, was abusive and beat her repeatedly even during her pregnancies, family members said. The father of her children, by the way, and her abusers seem to have faced no consequences for their actions. Despite numerous attempts at rehab, Perez kept falling back into drug addiction.

It’s probably fair to say that Adora Perez needed her life and childhood protected early on when she was raped as a minor.

Her life, too, is a sacred gift worthy of protection.