Mandatory spousal authorisation for abortion: characteristics of countries in which it exists and the potential for modernisation of the law.

Purpose: Spousal authorisation for abortion (SA) is in direct conflict with the right to bodily autonomy. The World Health Organisation guideline on abortion specifically recommends that abortion should be available on request without third-party authorisation. The objectives of this study were to: a) determine which countries insist by law on SA, b) describe shared characteristics of these countries, c) assess the impact of such legislation on access to abortion and d) evaluate the chances of repeal of such laws.

Methods: Interrogation of known databases on global abortion laws. Grouping of countries with SA laws according to their characteristics. A literature review of material on how mandatory SA relates to reproductive rights.

Results: Fifteen countries were found to require SA. Nine of these countries have low freedom and democracy scores. Three South Eastern Asian countries, Japan, South Korea and Taiwan, have high freedom and democracy scores and no dominant religion. Broader studies on third-party authorisation for abortion show delayed access to abortion and emphasise the general principle that it is the healthcare seeker alone whose consent should be required for a health intervention. A qualitative study from Türkiye showed specifically how SA requirements could impair access to abortion.

Conclusions: Twelve of the countries do not appear to have the necessary government or societal conditions necessary for abortion law modernisation in the near future. In contrast, Japan, South Korea and Taiwan are prime candidates for immediate liberalisation of their abortion laws.