Women and girls in almost a third of European countries have problems accessing abortion care and some are even forced to continue pregnancies against their will, reveals the European Abortion Policies Atlas, published today on International Safe Abortion Day.

“It is startling how governments are cynically manipulating [the law] to prevent women’s access to abortion,” said Caroline Hickson, regional director of the International Planned Parenthood Federation European Network (IPPF EN), co-author of the Atlas with the European Parliamentary Forum for Sexual and Reproductive Rights (EPF).

The Atlas, the first in-depth analysis of abortion policies across Europe, scores 52 countries and territories according to their legal frameworks on access to safe abortion care. It marks 38 of them from ‘medium’ to ‘exceptionally poor’.

In June, the European Parliament adopted an “historic” report calling on EU countries to ensure that women have universal access to safe and legal abortion, but the reality on the ground is very different.

Neil Datta, secretary of the EPF, said that the abortion situation across Europe is still “mixed”. “While international media has recently rightly focused on Texas and the broader US in terms of restricted abortion access, the situation in Europe also deserves specific attention,” he said.

The Atlas shows that the national health systems in 21 countries treat abortion like any other medical service, but 14 countries still regulate abortion through their penal code, which stigmatises the procedure.

The EPF and IPPF EN have called on governments to urgently modernise their abortion laws; ensure that abortion care is covered by their national health system; remove unnecessary obstacles; and provide accurate information about abortion care.

“The backlash against advancing women’s rights is very strong,” said Dutch MEP Sophie in 't Veld, who described the report’s findings as “alarming”.

Recent research released by the EPF shows that since 2009 more than $700m has been spent in Europe on ‘anti-gender’ activities against sexual and reproductive rights – with more than half (about $430m) coming from European sources, overshadowing $180m from Russia and $80m from the US.

‘Legislative and administrative patchwork’

The Atlas reveals that legislation on abortion throughout the region is a “diverse legislative and administrative patchwork”, the result being that women’s experience of abortion care “largely depends upon their postcode”.

Although some states are making advances on reproductive freedom – such as San Marino, which this week voted to legalise abortion care in a groundbreaking referendum after a 20-year fight – other countries are constantly backsliding, such as Poland.

A new bill on abortion is awaiting debate in the Polish parliament; if adopted, it would criminalise women for having an abortion and medical staff for performing one. This mirrors the law in El Salvador, where women risk criminal penalties for having an abortion even if their life is in danger.

The other extreme example in Europe is Malta, where abortion is illegal in all circumstances

According to the Atlas, 32 countries do not include abortion within their national health system’s financial coverage. This penalises all women and girls, but specifically the vulnerable – for example, those on low incomes, inhabitants of rural areas, Roma, sex workers and undocumented migrants.

There are 19 countries that force women to endure medically unnecessary requirements before they can access abortion care (such as compulsory and sometimes biased counselling, forced waiting periods).

A safe, voluntary termination should not be treated as a crime. And yet 16 countries regulate abortion primarily through their criminal and/or penal code.

Also, 26 countries allow health workers to deny care on the basis of their personal beliefs, thus potentially placing women in serious danger; and 18 countries fail to provide clear and accurate information about abortion.