A Global Milestone

In 2019, Iceland passed a new law on the termination of pregnancy. Passed with a solid majority and the support of a cross-political coalition, the new law provides pregnant people with the right to decide on a termination, without having to get prior permission from medical personnel, as had previously been the case. The law was a huge step forward to ensure the protection of sexual and reproductive rights in Iceland, but there still remains room for improvement, for example with regard to the rights of trans people and the access of uninsured people to the service. The success of the legislation was also remarkable for the cross-political support it enjoyed, largely based on women’s solidarity as 18 of 22 women in parliament, from nearly all parties, supported the law.

Background to abortion in Iceland

Passed in the spring of 2019, the Termination of Pregnancy Act no. 43/2019 came into effect on September 1 of that same year. It is the third act on termination of pregnancy passed in Iceland, with the first being an act on guidelines for women on preventing pregnancy and on abortion, from 1935, which was then amended in 1938. While formally allowing abortion based on social conditions, in practice the law was very restrictive and women’s rights movements organized against it from at least the 1960s onwards. The law was replaced in 1975 with an act on advice and consultation on sex, childbirth, abortion, and sterilization. Despite the best efforts of the women’s rights movement at the time, the law did not make abortion available on request, but instead required a pregnant woman to attend a counseling session and submit an application for termination of pregnancy, on either medical or social grounds, that then had to be approved by two healthcare professionals in order to be granted.

While the permission was rarely denied in recent years, and the practice was to only require counseling after screening for certain risk factors (Ómarsdóttir and Rögnvaldsdóttir, 2015), applicants had to meet other criteria. These included a strict time limit, as the termination had to be conducted by the end of the 12^th week of pregnancy (with an appeal process available until the end of the 16^th week). Exceptions were available if the life of the mother or fetus were at risk. The new law, which removed the need to accept counseling, apply, or provide a reason, was thus a monumental shift in the legislative framework governing access to abortion in Iceland. The law’s stated objective “is to ensure that the right to self-determination of women who request terminations of pregnancy is respected by granting them secure access to the health services.“ It was hailed by the feminist movement as a landmark legislation but criticized for infringing disabled people’s right to life as the time limit coincides with the timing of pre-natal screening for various disabilities.

The 2019 law allows the termination of pregnancy until the end of the 22^nd week of pregnancy (21 weeks plus six days), on the request of the woman (the law uses binary language and only considers women, not pregnant people who may identify themselves with another sex). After that time, termination is allowed only if the pregnant woman’s life would be endangered by continuing the pregnancy, or if the fetus is not viable, which must be confirmed by two physicians. The law provides assurances of access to those women who are covered by the national Health Insurance Act. The impact of the law has still not been studied extensively, and while the Directorate of Health maintains a Register of Terminations of Pregnancy, the numbers are not comparable between the old law and the new.

Access to abortion: Possibilities for discrimination in the implementation of the law

The legal framework around abortion in Iceland is among the most liberal in the world at the time of this writing (late 2022). The service is free of charge to those who qualify. There do remain some limits to access, however.

• The law is written in a gender binary language that excludes trans men and non-binary people who may become pregnant. While it is uncertain that people from these groups would be denied service, their rights are not automatically included.
• The law covers only those legally living in Iceland and insured by the national Health Insurance Act, which applies automatically and universally six months after legally registering residence in the country. This would most likely mean that a person located in Iceland who needs an abortion and does not meet these conditions would get the service but would have to pay for it out of pocket, as low as €150 for a medical procedure, but up to €3500 for a surgical procedure.
• On a similar note, it is unclear whether a person holding a European Health Insurance Card (a person insured elsewhere in the European Economic Area) would have access to abortion services while in Iceland, particularly if abortion is not legal or insured under their home country’s medical insurance system.
• Article 4 of the Icelandic law allows a healthcare worker to refuse to terminate a pregnancy on the grounds of healthcare workers’ rights. While the same article states that measures must be taken to ensure a woman’s ability to exercise her right to abortion, this may not be possible in some rural areas where there are few healthcare workers and travelling may not be an option for economic or health reasons.
• While a large proportion of Icelanders live close to a hospital, those in rural areas may face limitations on their ability to exercise their right to an abortion. Article 6 of the new law only provides assurances that “access to healthcare services” are “guaranteed in all healthcare jurisdictions in Iceland … at least up to the end of the 12th week of pregnancy.” This means that for those requiring the service later in pregnancy, time consuming and costly travel may be necessary, and data indicate that those living in the rural parts of Iceland have fewer abortions than the national average.

As this discussion demonstrates, the legal framework is sound, but there are distinct possibilities for discrimination in the implantation of the law. The most obvious issue to remedy would be to address the assumption that only people identifying as women can be pregnant and need access to abortion. This should be obvious in light of the fact that Iceland has passed a gender autonomy law that allows for gender-neutral registration. The requirement that to access abortion, one must be covered by the Health Insurance Act, can also be an onerous one in times of increased (informal) migration.

Getting to this law

The 1975 law that made abortion accessible to Icelandic women in practice was generally accepted in society, although objections arose occasionally throughout its validity. A small group of catholic protesters gathered outside the national hospital’s maternity ward once per week for years, and a single MP proposed restricting the law even further a number of times in the 1980s and 1990s, arguing that the “blood sacrificed” was very costly to a small nation like the Icelanders. Despite his efforts, the law remained unchanged and from around 1980, the team at the national hospital, where most abortions were performed, strove to enable pregnant women to make the right decisions for them, rather than to restrict their access to healthcare.

Increased resistance to abortion in the international system, as well as backlash against reproductive health and rights in general, started to cause concern among women’s rights activists in Iceland in the mid-2010s. A book, Rof: Frásagnir kvenna af fóstureyðingum, by Ómarsdóttir and Rögnvaldsdóttir was published in 2015, on the law’s 40th anniversary. It was a collection of stories of women who had abortions under the law. Data collection for the book gained national attention and social movements and public figures started to talk about the restrictive nature of the law governing abortion. In March 2016, the Minister of Welfare appointed a committee to review and revise the law. The committee delivered its report in 2017, proposing to abolish the requirement that the pregnant person get permission to undergo the procedure, and to extend the right to an abortion to 22 weeks of pregnancy, among other things. With the process starting after a wave of scandals shook the Icelandic political system, three ministers, from different political parties, handled the portfolio during the time the issue was in process. This may have contributed to the cross-partisan support for the law.

The proposed law was submitted to parliament in the legislative term 2018-2019. It was submitted as a cabinet proposal, and as such should have had the support of all members of the three government parties. The proposal was, nonetheless, hotly contested and in the end most of the men of the conservative Independence Party voted against it, alongside the populist Center Party and People’s Party. The opposition to the law was in many ways predictable, and the conservative argument against it is discussed in detail by Sigvaldason and Ómarsdóttir, who demonstrate that the opposition to the law is similar to that which was dominant in the 1970s; that women having the right to decide for themselves would cause them jeopardy; that it was futile to change the law since it functioned well enough already, and; that this new law would have the perverse effect of leading to the abortion of healthy fetuses. While these voices were loud while the bill was debated, they were clearly in the minority.

A cross-partisan coalition voted overwhelmingly to pass the law, reflecting an extensive consultation process within the parliament on behalf of the Minister of Health, and the diligence of the Chair of the committee on social affairs. It was also evident here that gender mattered – an overwhelming majority of women in the parliament, or 18 of 22, supported the proposal. On the other hand, only 22 of 41 men approved it. Parties reaching across the political spectrum from the far left to the center-right supported the law with no exceptions. On the right, the story is quite different. The conservative Independence Party was split on the issue. The populist Centre Party’s seven male MPs voted against the law, whereas its only female MP abstained. Finally, both of the People’s Party’s MPs voted against.

Conclusion: Room for improvement

The 2019 law on abortion in Iceland is among the most progressive legislations in the world, but as has been demonstrated here there are still some issues that need to be addressed. The debate on the new law shed light on divided attitudes towards bodily autonomy and it can be argued that it re-awakened a long-dormant debate on reproductive rights, but early surveys suggested that there was strong support for the new law and the extended access to abortion it provided. While information is still limited about the impact of the new law, despite the worries of its opponents, there is no indication that late-term abortions are growing in numbers, and 83% of abortions in 2020 were done before the 10^th week of pregnancy. The law does therefore not appear to have the impact its opponents feared, but rather has strengthened women’s bodily autonomy – and hopefully will do so for other pregnant people as well.