Abortion Policy Environments and Maternal Mortality in the European Union: Construction of an EU-specific Abortion Policy Index

Abstract

Introduction: Access to safe abortion is recognised by the World Health Organization (WHO) as an essential component of reproductive health care, yet access varies considerably across the European Union (EU). Existing comparative frameworks lack transparency or fail to capture the multidimensionality of abortion policy. Aim: This study aimed to develop and validate an EU-specific Abortion Policy Index (EU API) to systematically compare abortion policy environments across all 27 EU Member States. Methods The Guttmacher abortion policy hostility framework was adapted to the EU context using a four-step modification model, resulting in 12 indicators grounded in the WHO Abortion Care Guidelines. For all Member States, an EU API score was calculated. Convergent validity was assessed through Pearson correlation with the European Abortion Policy Atlas and a regression analysis explored associations with maternal mortality ratios. Results: Most Member States scored in the restrictive range, only France achieved the maximum supportive score. The EU API correlated strongly with the European Abortion Policy Atlas (r = 0.782, p < 0.001), supporting convergent validity. No statistically significant association was found between EU API scores and mean maternal mortality ratios (b = -0.025, p = 0.607), likely reflecting the limited variance of maternal mortality ratios within the EU context. Conclusion: The EU API provides a transparent, reproducible and theoretically grounded tool for comparative abortion policy analysis. It documents persistent inequalities in access across the EU and contributes a new measurement instrument to reproductive health policy research, with potential for adaptation to other regional settings.