Netherlands abortion policy grounds on which abortion is permitted



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ABORTION POLICY


Grounds on which abortion is permitted:
To save the life of the woman Yes

To preserve physical health Yes

To preserve mental health Yes

Rape or incest Yes

Foetal impairment Yes

Economic or social reasons Yes

Available on request Yes
Additional requirements:
A five day waiting period is required between the initial consultation and the performance of an induced abortion. An abortion must be performed in a licensed hospital or clinic. The cost of an induced abortion is subsidized by the Government.


REPRODUCTIVE HEALTH CONTEXT

Government view on fertility level: Satisfactory


Government intervention concerning fertility level: No intervention
Government policy on contraceptive use: Indirect support provided
Percentage of currently married women using

modern contraception (aged 18-42, 1993): 76


Total fertility rate (1995-2000): 1.5
Age-specific fertility rate (per 1,000 women aged 15-19, 1995-2000): 4
Government has expressed particular concern about:

Morbidity and mortality resulting from induced abortion No

Complications of childbearing and childbirth No
Maternal mortality ratio (per 100,000 live births, 1990):

National 12

Developed countries 27
Female life expectancy at birth (1995-2000): 80.7


BACKGROUND

Under the Penal Code of the Netherlands (1886), the performance of abortions was classified as an offence against life and persons convicted of the offence were subject to imprisonment. However, because proof that the foetus was alive at the time of the abortion was a requirement for conviction under the law and such proof was difficult to obtain, it was nearly impossible to convict anyone of performing an abortion. In 1911, the abortion law in the Netherlands was amended to overcome this obstacle to conviction by making it an offence to treat a woman, whether she was pregnant or not, so as to indicate to her or produce the expectation that an abortion would be performed. In practice, it was illegal in all circumstances except when performed to save the life of the pregnant woman. During the 1970s, several attempts were made to liberalize the abortion law, but they were not successful owing to strong opposition from various sources. However, the existing law was not strictly enforced and abortion services were readily available.


On 1 May 1981, a far reaching abortion law was adopted in the Netherlands which repealed the restrictive abortion provisions. Under the law, abortion is permitted virtually on request at any time between implantation and viability if performed by a physician in a hospital or clinic licensed to perform abortions. Upon consulting a physician, a woman seeking an abortion must be counselled by the physician to ensure that the decision to terminate a pregnancy is taken carefully and reached only if the distress in which the pregnant woman finds herself leaves her no other choice. This counselling is to include the provision of sound information on ways other than abortion of dealing with her distressed condition. After receiving the counseling, the woman must wait six days before the abortion can be performed and, following the abortion, she must be given access to adequate after care, including information on methods of preventing unwanted pregnancies. The six day waiting period may be waived if the woman’s life is threatened. An abortion performed after 13 weeks of pregnancy can only be carried out in a hospital or clinic that meets special requirements and has received special approval.
Under article 20 of the law, a physician who has a conscientious objection to providing abortions or arranging for their provision shall immediately inform a woman seeking an abortion of this fact. He or she also has a duty to provide other physicians with information concerning the woman’s condition if requested to do so, provided that the woman has given consent.
A physician who, knowing that a pregnancy is of more than 13 weeks’ duration, performs an abortion in a clinic unlicensed to perform abortions of such duration is subject to one year’s imprisonment or payment of a fine. The law also imposes penalties on a physician who performs an abortion before the end of the six day waiting period, or who fails to inform a woman of his or her decision concerning whether to assist with the abortion within the stipulated period of time.
Although the abortion law was liberalized in 1981, the regulation governing its practice was not formally adopted until 1984. Prior to the liberalization of the law, abortion was widely available through private non profit clinics and in some hospitals, mainly as a result of the widespread acceptance of family planning within the society.
In the Netherlands, family planning was traditionally discouraged because it was regarded as being contrary to the objectives of marriage and as promoting promiscuity. As a result, the practice did not receive the backing and support of the Government or a majority of the population, including health professionals. Contraceptives were not readily available and could not be advertised in the Netherlands until 1969.
Moreover, physicians were reluctant to provide family planning services for fear of having to share in the responsibility for an unwanted pregnancy which might occur from contraceptive failure and which might in turn necessitate an induced abortion. This situation contributed to keeping the crude birth rate at the relatively high level of 20.7 per 1,000 during the mid-1960s.
The introduction of the pill in 1964 and its proven high reliability led to the widespread acceptance and practice of family planning. Since about 1965, family planning services have routinely been offered as part of general health-care services.
Since November 1984, women in the Netherlands have been able to obtain abortions free of charge under the government sponsored national health insurance system. The Exceptional Medical Expenses Fund covers the cost of abortions performed in clinics. Payment by this fund has not resulted in a rise in abortions, but rather has caused a shift in the balance of providers from hospitals to clinics. Although foreigners are not prohibited from having an abortion in the Netherlands, they are required to pay for it.
A sizeable proportion of women undergoing induced abortion in the Netherlands are foreign born. In 1984, out of a total of 43,200 induced abortions performed in the Netherlands, 18,700 were for residents in the Netherlands, and the balance were for women from neighbouring countries. In 1990, the abortion rate for Netherlands nationals was 5.2 per 1,000 women aged 15 44, and the abortion rate per 100 live births was 9.6, an incidence that is one of the lowest in the world. The incidence of induced abortion has been relatively stable in the Netherlands, mainly due to the high contraceptive prevalence rate (over 75 per cent). However, the population most at risk for an unwanted pregnancy are women in the age group 20-30. More than one third are typically married and have mainly used condoms, rhythm or withdrawal as their preferred contraceptive methods. Following an induced abortion, most women choose the pill, intrauterine device or sterilization.







Source: Population Policy Data Bank maintained by the Population Division of the Department for Economic and Social Affairs of the United Nations Secretariat. For additional sources, see list of references.





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