In the last three decades, countries around the world have made it easier to legally get an abortion. In some parts of the United States, however, it’s gotten harder. Just this month, Mexico’s supreme court ruled to decriminalize the practice. Argentina’s Senate legalized abortion in December. Meanwhile, New Zealand, Thailand and Ireland have all taken steps to ease abortion restrictions in recent years.

The United States Supreme Court made abortion legal in 1973. But over the last few decades, access to the procedure has increasingly declined in more than a dozen states around the country that have since passed laws making it more difficult for people to get an abortion.

The most restrictive law to date is in Texas, a state with nearly 30 million people. The new law that came into effect in September outlaws most abortions once a fetal heartbeat can be detected, which is usually around six weeks into a pregnancy. There are exceptions for medical emergencies, though those are not clearly defined in the law, and no exceptions for pregnancies resulting from rape or incest.

The United States Supreme Court has ruled to keep the new Texas law in place while legal challenges continue. Anti-abortion activists have hailed the decision as a major victory toward their efforts to overturn Roe v. Wade and outlaw abortion in other parts of the country. Similar legislation to ban most abortions has been proposed in Florida.

A Washington Post analysis looked at how the United States overall, as well as the new Texas abortion law, compare to other parts of the world.

Legality is one thing. Access on the ground can look very different. Many European countries limit on-request abortions to the first trimester, more restrictive than much of the United States. Anti-abortion groups say U.S. laws are too liberal when compared with the rest of the world.

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“Currently, the U.S. is an extreme outlier in abortion law and policy,” said Denise Harle, senior counsel for the Alliance Defending Freedom, a nonprofit organization that supports anti-abortion policies. She added that the United States is one of the few countries that allows the abortion of a child “who can hear her mother’s heartbeat.”

The United States is one of less than a dozen countries that allows abortions after 20 weeks of pregnancy on any grounds. “I think very few Americans realize just how radical and out-of-step America’s abortion laws are in comparison to the rest of the world,” said Angelina Nguyen, an associate scholar at the Charlotte Lozier Institute.

But in Europe, many countries offer broad exceptions after the first three months for socioeconomic reasons like unemployment, medical issues like fetal impairment, or social issues like the age of the mother.

Mark Levels, a professor of health at Maastricht University who studied the development of abortion laws over four decades, said that in places like the Netherlands where abortion on request is available until the fetus is viable, most abortions still take place in the first trimester.

He attributed this fact to the combination of widespread availability of effective contraceptives, like birth control pills, and a culture that openly talks about sex and provides sexual education. “If you really want to ban abortion, the one thing that you can do is provide contraceptives freely and openly, and be open about it,” Levels told The Post.

Yet liberal abortion laws do not necessarily mean abortions are easily accessible. There are countries with procedural barriers including doctor approval, parental consent and mandatory waiting periods. In Germany, women must receive counseling and wait three days to get an abortion. In the Netherlands, the waiting period is five days so that, according to a government website, “you can think carefully about your decision.”

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“The enabling legal environment is really just the first step toward enabling people to actually exercise reproductive autonomy and to access safe abortion care,” said Katherine Mayall, the director of strategic initiatives at the Center for Reproductive Rights, which advocates for expanded abortion access worldwide.

“Making access to abortion a reality for people across the globe requires so much more,” Mayall added. This includes policies that cover the cost of abortion services and integrate it into the health care system and societal measures that destigmatize the procedure.

Even countries where abortion is legal, or decriminalized, women can still face obstacles to access. A 2020 study found that in Italy, where abortion is legal, access can still be limited because over 70% of gynecologists are registered as conscientious objectors. This designation allows them to refuse abortions due to moral or religious beliefs. And while abortion was decriminalized in South Korea in January, it is not clear if the procedure is widely available to those seeking it.

Still overall, when it comes to the legality of abortion, countries around the globe that have changed their legislation on this issue have largely pushed to increase access in the last three decades.

Even as fewer restrictions are being put in place around the world, data shows that “a lot of countries with the most liberal abortion laws have lower abortion rates,” Mayall noted, because those same countries often also have more widespread access to contraceptive services and sexual education. “Restrictive abortion laws don’t lead to fewer abortions, they only lead to more unsafe abortions,” she said.

As Argentina was debating last year whether to pass a law legalizing the practice, the health minister at the time, Ginés González García, said that more than 3,000 women had died in Argentina since the early 1980s as a result of underground abortions.

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In the Americas, the United States is one of the least restrictive in the region when it comes to abortion access. But as conservative states push to pass legislation making access to abortion more difficult, countries in Latin America have had a “green wave” toward liberalization.

In addition to recent legal changes in Mexico and Argentina, Colombia’s constitutional court is expected to soon rule on whether abortion should be decriminalized. Ecuador decriminalized it in cases of rape in April.

Across many Latin American countries, contraception can be easier to access than in the United States. Brazil, Colombia and Nicaragua, where abortion is either banned or only allowed under some circumstances, have some of the highest contraception prevalence rates in the world, according to the latest statistics from the World Bank.

Paula Avila-Guillen, executive director of the Women’s Equality Center, compared the new Texas law “to the total abortion bans that El Salvador and Honduras have. And both of those laws were passed 20 years ago.” While Texas hasn’t banned abortion outright, very few women are aware they are pregnant at six weeks, especially if it was unintended.

The Texas law also incentivizes the public to report and sue those who are breaking it, with the possibility of a $10,000 reward, raising the stakes for medical providers and abortion rights advocates.

“It’s been very overwhelming just trying to figure out how to get people the care that they need,” said Zaena Zamora, executive director of the Frontera Fund, an advocacy group based in the Rio Grande Valley on the Mexican border that helps women pay for and travel to abortions. Zamora added, “I’m concerned about the viability of my organization. I don’t want to get sued into the ground so that I can’t do my work.”

Zamora said she suspected that if abortions become more available in Mexico, she could see a lot of people going there from Texas for care. But she noted that many of the people she helps are undocumented.

“They can’t go into Mexico because they won’t be able to come back.”