Health

The Last Places in Europe Where It’s Illegal to Get an Abortion

European microstates are some of the richest countries on the continent, but human rights, including abortion, are curtailed.

by Sarah Souli; illustrated by Cathryn Virginia
Aug 19 2019, 4:59pm

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Lara hadn’t wanted to see the baby.

It wasn’t supposed to be hers, anyway; when she accidentally got pregnant at 18, she had decided the child would be raised by her aunt while she went off to university. The first few months of the pregnancy were normal: doctor’s visits, ultrasounds, the abrupt abandonment of cigarettes and beer. Then, around five months into her gestation, the pain and bleeding started. At the emergency room, a surprising diagnostic—fatally missed by her primary gynecologist—was announced. The baby was lacking two nerve bundles in its neck. A few days later, a second test with Lara’s gynecologist revealed a diagnosis of Down syndrome. The baby, doctors briskly explained to Lara, would be born “a vegetable.”

“[My pregnancy] was so complicated, and [these issues] were detected so late, I had a serious risk of death,” Lara, whose last name has been withheld to protect her identity, now 23, explained while sitting in a village bar in the tiny country of Andorra. It was twilight, and the Pyrenees mountains were turning violet behind her, a bit of late-spring snow still visible at their peaks. Around us, people were clinking beer bottles and playing cards.

It’s estimated that thousands of women, like Lara, have clandestinely traveled from Andorra to Spain or France for abortions in the past few decades, though official numbers don’t exist.

Along with the microstates of San Marino (in Italy), Liechtenstein (between Switzerland and Austria), and Monaco (in France), Andorra is one of the last places in Europe, along with Malta, Poland, and Northern Ireland, where abortion is criminalized. Even in cases of rape, incest, or fetal deformity, abortion is outlawed in Andorra, San Marino, and Liechtenstein, though in those situations, women in Monaco are permitted to abort. Both nationals and residents of these microstates have no choice but to travel elsewhere for access to what the Council of Europe, the continent’s leading human rights organization, calls a human right.

Lara’s father managed to scrape together €3,000 (around $3,350) to cover the cost of the procedure, plus transportation and lodging, and drove her three hours away to Barcelona. There, doctors performed an abortion late in her pregnancy that was both painful and traumatic, exacerbated, Lara said, by her Andorran gynecologist, who instructed her Spanish doctors to show her the baby after her chemically induced delivery.

“She was dead,” Lara, now 23, recounted. “Obviously I know from the lack of oxygen, but she was so purple. I still have the image in my mind; sometimes it wakes me up at night. Since I was little I’ve been scared of the dark, but since this, it’s gotten so much worse. I sleep with a stuffed animal now.” Her abortion followed her to work, where she was unable to keep up with her employer’s demands; to court, where she was prosecuted; and into the meaty passages of her brain, where she sank into a depression that lasted three years.

“The women in Andorra are treated as second-class citizens,” said Vanessa Mendoza Cortés, the president of Stop Violències (Stop Violence), a prominent women’s rights group in Andorra that is fighting, among other things, for the decriminalization of abortion. “When we ask for our rights, we are treated as crazy, as radical.”

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Andorra flag encircled by Spain and France flags

With a population of around 76,000 in an area roughly two and a half times the size of Washington, DC, Andorra is mostly known for its tax-free shopping, pristine ski slopes, and the largest spa complex in Europe; it has the aggressively capitalistic vibe of an outdoor mall that places it squarely in modern, neoliberal Europe. Compared with the increasingly restrictive abortion laws in some parts of the United States and in Latin American countries, Europe tends to pride itself on its socially liberal policies—state-sponsored paternity leave, universal healthcare—that most countries across the Atlantic are sorely lacking. Microstates are a blemish on the smug skirts of continental Europe. The dismal reality is that women’s bodies, no matter where in the world they happen to be, are swaddled in a layer of man-made politics.

Surrounded by democratic countries, Europe’s microstates are political relics of a bygone era. Since the 13th century, Andorra has been ruled as a co-principality between a Catholic bishop (currently Joan-Enric Vives of Urgell) and the French head of state (now Emmanuel Macron). Monaco and Liechtenstein are both governed by powerful monarchs, and San Marino, which was formed in the 4th century as a refuge for Catholics escaping persecution, has political institutions used in Renaissance-era Italian city-states before Italy unified in the 19th century.

“They are all very conservative, not just in the way the institutions have survived but also in terms of these [social] issues,” explained Wouter Veenendaal, an assistant professor of political science at Leiden University and the coauthor of Democracy in Small States: Persisting Against All Odds. “If you look at the introduction of female suffrage, these countries were among the last ones to allow women to vote. In Liechtenstein, women [won] the right to vote only in 1984.” In Andorra, divorce was finally legalized in 1995.

The issue of abortion is often presented as a preservation of these microstates’ unique historical character and their religious roots. “[These countries] are seen as having a very strong connection to the Catholic church and state,” Veenendaal said. On most moral questions—euthanasia, gay marriage, women’s rights, drugs—European microstates veer to the right. While discrimination based on sexuality is banned in microstates, and most offer civil partnerships, inconsistencies exist. Gay people in Liechtenstein, for example, are still banned from donating blood.

In the past few years, abortion has become a linchpin for the question of continued sovereignty for microstates. “They have this feeling of being very vulnerable small states, and being protective of their own identity,” said Veenendaal. “When the EU sometimes attacks these microstates for having antidemocratic institutions and monarchies, you immediately see the reaction of the political elite is that the EU should not try to undermine their sovereignty.”

Liechtenstein’s Prince Aloi, the acting head of state and heir to a $7 billion fortune, threatened to veto the results of a double referendum on abortion in 2011; 52.3 percent of Liechtensteiners voted against decriminalizing abortion at 12 weeks in cases of fetal deformity. In light of the prince’s vocal admonishment of the abortion referendum, a second referendum was passed to curtail the monarchy’s power. At that, his father, Prince Hans-Adam II, threatened to leave the country and take his name with him (the country is named after their family). Last year, when the pro-choice movement began to grow more vocal in Andorra, the Church intervened, threatening to remove the bishop and end the co-principality.

“Abortion is a red line for the Episcopal bishop and something for us that is very difficult to change,” said Maria Ubach, the Andorran minister of foreign affairs. “Our size and our fragility are very important. Any institutional change could have some important political consequences.” The Andorran government has tied the issue of legalizing abortion to the country’s sovereignty. Though the bishop himself has never publicly stated this, the Andorran government is fearful that if the French co-prince signs an abortion law into effect, the bishop will leave the country. In 2009, then French president Nicolas Sarkozy publicly threatened to abdicate as co-prince if Andorra didn’t change its notoriously opaque banking laws; the country eventually acquiesced in 2016, though it’s unclear if it was solely due to Sarkozy’s political clout.

The worst-case scenario of losing a co-prince would be a complete dismantling of the political system, leading to a loss of independence and the country’s collapse, as Prince Hans-Adam II threatened. It’s somewhat of a straw-man argument. Before divorce was legalized in 1995 in Andorra, it was considered a menace to the Catholic Church and society; but Andorra still stands in all her divorcée glory. The EU, UN, and NATO have diplomatic relations with all European microstates, meaning invasion or redrawing of borders is unlikely. And they are financially independent. “These microstates are the richest countries in Europe, some of them by far,” Veenendaal said. “The EU can’t exert an economic pressure on them.”

There is also no historical precedent to indicate that either the borders or the sovereignty of these countries would be threatened if women were granted the right to abort. To the contrary: Monaco, which loosened abortion restrictions in 2009 despite intense protest from Catholic dignitaries, remains intact. Activists in Andorra aren’t even asking for a full lift of abortion laws—they are taking things incrementally, and advocating for abortion in the case of rape and fetal deformity. As with the draconian abortion laws of Chile, El Salvador, or the U.S. state of Alabama, abortion in microstates is not essentially about politics or religion. It’s about controlling women’s bodies.

“We need to ask what’s more important: the fundamental rights of women or politics?” said Ot Guillamet Fages, a sociology student at the University of Barcelona who is researching Andorran perceptions about abortion. “And the politicians are prioritizing politics.”

That women can simply leave their small countries for abortions presents an attractive, albeit bad-faith, loophole for politicians to justify these archaic laws. “No woman is really living in a difficult situation, as far as I am informed,” Ubach said, noting that women can just go “a few kilometers” for an abortion. Crossing the border for health reasons is not in itself rare. “It’s very normal for people to go to the doctor in Barcelona, because we don’t have specialized doctors here,” explained Mendoza Cortés. But traveling is forced upon pregnant women as their only option. It can be painful—Lara remembers lying flat on her back clutching her abdomen for the three-hour drive back home after her abortion—and can exacerbate feelings of guilt and fear associated with clandestine activity.

“As an Andorran woman, I want my state to be able to protect me. We want to be able to exercise our rights here, not to go somewhere else,” said Cristina Valen Estevez, an educator and a member of Andorra’s Social Democratic Party, adding that she feels “totally behind other European countries.”

In 2005, the Andorran government introduced a new article in the penal code that imposes a sentence of up to two and a half years in prison for women convicted of having abortions—doctors who perform the procedure can receive up to 12 years if the abortion results in the woman’s death. Prison sentences are also imposed by the penal code in San Marino and Liechtenstein.

Lara was prosecuted under this law in 2016, after her gynecologist denounced her to the police for “intent to commit homicide.” She got lucky: The judge was a family friend, and offered her the lightest sentence—either eight months in prison or four years of conditional probation. As part of this probation, Lara was obliged to get a contraceptive implant. Back at our sidewalk table, she pushed a spot on her biceps and the implant rippled under her skin.

The vast majority of Andorran women who get abortions aren’t prosecuted under the criminal law. The last known case of a woman being jailed for an abortion was in 1987, when a seven-months pregnant woman shot herself in the stomach—a case that’s still talked about in hushed tones in the country.

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The 2005 criminal law was introduced on the basis of the Andorran constitution, which protects life in “all its stages.” It’s a loosely worded article that can be interpreted, as it often is in Catholicism, as including fertilization. But earlier this year, the government began steps to legalize the use of harvested embryos for in vitro fertilization. Ubach noted that if the embryo has severe defects, or the woman is older than 50, it can be destroyed.

“This is a country of contradiction,” said Elisabet Zoppetti Núñez, an Andorran lawyer. It seems that the destruction of embryos becomes problematic to officials only when they’re already in a woman’s body.

Because European microstates are so small, and the majority of the population is comparatively wealthy, there’s a misconception by both local lawmakers and the international public that it’s too minuscule an issue to take seriously. In Andorra, where the minimum wage is €1,017 ($1,135) per month, however, that’s far from the truth. An early abortion in Spain or France costs between €300 and €1,000 ($335–$1,116), depending on how far advanced the fetus is, whether local or general anesthesia is being used, and whether it’s performed in a private clinic or a public hospital. Women often have to take several days off work to recover, and pay for their transportation, food, medicine, and accommodation. If they need psychological support post-operation, that’s also partly out of pocket. The situation is further complicated in the case of minors, who might be pressured into carrying to term and giving their baby up for adoption.

“As an Andorran woman, I want my state to be able to protect me. We want to be able to exercise our rights here, not to go somewhere else,” said Cristina Valen Estevez, an educator and a member of Andorra’s Social Democratic Party, adding that she feels “totally behind other European countries.”

In one particularly egregious case in 2012, an 11-year-old girl was raped (the age of consent is 14 in Andorra). Her rapist was not prosecuted, because, Núñez said, the judge decided “it would ruin his life—never mind that the girl’s life is ruined.” The girl was placed under the state’s social services, where she was never given the option of abortion. Instead, she carried the child to full term, giving birth when she was 12. Even in Liechtenstein, where, again, abortion is illegal even in cases of rape, incest, or fetal deformity, unmarried girls under 14 (which is also the age of consent there) are permitted to abort.

The Andorran government does not keep official statistics on the number of women who travel to Spain and France for abortions in the years since laws were liberalized in those countries in 1985 and 1975, respectively. They only know numbers for Andorran women who aborted in public Spanish hospitals, which are obliged to share their records with foreign governments. In 2017, 107 women aborted in public Spanish hospitals, but dozens more abort in France and private clinics.

“I’m a nurse—I worked for a long time in the health center,” said Antonia Escoda Alegret, the president of Accio Feminista (Feminist Action), another women’s rights group in Andorra. “We knew all the addresses where we could send someone, even if it wasn’t official.” Another woman, who asked to remain anonymous, recalled her own mother’s abortion back in the 1970s, before France or Spain legalized abortion and everyone went to England. Some years later, she needed an abortion herself and went to Toulouse—an experience that wasn’t particularly traumatic, she noted, thanks to her mother’s own history.

The years lessen the pain, but for some, the emotional toll lingers. Back in the bar, Lara took a drag on her cigarette before showing me a small tattoo. She tells people it’s for her younger sister, but that’s not the whole truth. It’s also for her daughter—tiny, lilac, and somewhere in the sky.

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