In this study, we set out to determine the impact of two major laws on health outcomes in Spain, namely: RDL16/2012 which tied health care more to social security entitlements and disentitled a number of migrants from previously guaranteed right to universal access to health care; and Organic Law 2/2010, which allowed for the voluntary interruption of pregnancy, generally up to fourteen weeks of pregnancy. We commenced with an analysis of Spain’s obligations under international human rights law, regarding the right to health. We found that RDL 16/2012 was a regressive measure, which runs counter to the progressive realization of the right to health contemplated by international law. Accordingly, the law was a breach of Spain’s obligations under international law. We then assessed the impact of the law on four health outcomes, namely: self-rated health, mental health, cervical screening, and mammogram screening. We found that not in all cases was the law associated with poorer outcomes. Statistically significant poorer outcomes in the post-law period were only observed with respect to self-rated health among women from Spain and the Global North, mental health among women from the Global North and mammogram screening among African women. It is African women however who appeared to fare the worst overall, having a greater proportion of its population reporting worse outcomes in the post-law period with respect to all but one outcome variable, namely mental health. We then assessed whether Organic Law 2/2010 which is a more progressive law, would lead to substantially greater abortions, which is a debate which usually arises whenever more liberal abortion laws are put in place. We found that this type of assessment is best done at disaggregated nationality level. While we found that the law reform coincided with different movements in abortion rates, such as an overall spike in 2011, one year after its implementation, we did not find any statistically significant impact on abortion rates in the overall population. However, when nationality was contemplated, in at least one case, that is, among women from Asia/Oceania, the law was found to have a significant impact. However, with abortion rates already trending down among these women, it remains to be seen whether the impact will continue over the long term. Importantly, although no significant association was observed, we found that in the post-law period, African and Eastern European women had strong downward trends in their abortion rates, while EU-West and Global North women had upwards trends. We suggest that these differences are likely due to greater barriers in access to abortions experienced by African and Eastern European women, which is linked to their overall lower socio-economic status. Finally, given that our earlier findings implicate social factors in affecting abortion numbers, and given that Organic Law 2/2010 liberalized elective abortions, we assessed what social factors affect the likelihood of an elective abortion, and whether they differ based on nationality and or change over time. Generally, we found that the same factors affect the odds of an elective abortion across different nationalities and that these factors do not necessarily vary with time, but it is the magnitude of the effect which tends to differ. Generally being younger (less than 35 years), less educated, a user of contraceptives is associated with greater odds of an elective abortion. Finally, we found an overall decrease in abortion rates mostly attributable to migrants and a lower likelihood, post-2011, of an elective abortion. These findings suggest that liberal abortion laws are not expected to increase abortion numbers, likely due to improvements in contraceptives and family planning measures, but further research is required in this regard.
| Date of Award | 17 May 2023 |
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| Original language | English |
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| Supervisor | Jeroen Spijker (Director) & Ignacio Permanyer Ugartemendia (Director) |
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