Recent coverage of the abortion providers' strike in Spain and the attacks on women's clinics there made use of the term "abortion tourism." LifeSiteNews, an anti-choice web site, refers to Barcelona, Spain as "Europe's abortion mecca, where people from all over the continent can travel to evade restrictions on late-term abortions." There was also sensationalist media coverage in Spain with disparaging references to "abortion tourists from other countries."

In November of 2007, LifeSiteNews also reported that "foreign women will be allowed to have abortions in Sweden up to 18 weeks gestation starting in January 2008 under changes to legislation passed by the Swedish parliament…Until now, abortion in Sweden has been reserved for Swedish citizens and residents, but since most European Union countries already allow foreign women access to abortion, the Swedish government has decided to follow suit…Several Christian Democrat members of parliament have warned that the new law could lead to 'abortion tourism.' "

There has always been abortion tourism. The term refers to travel undertaken in order to access to safe abortion care — which is a long-standing crisis in the US as well as internationally.

In her May 2003 on abortion beyond borders, the Guttmacher Institute's Susan Cohen provided some relevant history: "New York legalized abortion, without a residency requirement, in 1970, which immediately put New York City on the map as an option for those women who could afford to travel. Before that it was an open secret that affluent American women would travel to London to obtain safe, legal procedure."

As a young woman growing up in New York City in those years, I vividly remember many pregnant friends who also went to Mexico, Sweden, Japan, and Puerto Rico for their safe abortions. Of course, it was, as Cohen notes, "poor women, mostly young and minority, who [could not travel and] suffered the health consequences [of unsafe, illegal abortions], and maternal mortality rates were high. Women of means had more options."

Tragically, not much has changed. The race, ethnic, and class disparities of abortion access in the US are well-known and this theme is universal.

In October 2007, the Global Safe Abortion Conference in London discussed this issue in the context of "abortion journeys" — the long, distressing, often expensive journeys that women are forced to undertake in order to access safe abortion due to restrictive legislation in their home countries. Writing about the discussion at the conference, Grace Davies noted, "These journeys — abortion tourism — are a tragic reality for women around the world, from Kenya to Poland. In fact, the term ‘abortion tourism' highlights one of the central characteristic of the phenomenon. In highly restrictive situations, class and socio-economic status play a huge role in whether or not a woman can access safe abortion."

The examples presented at the Global Safe Abortion Conference were instructive — and heart-breaking. At the conference, Claudia Diaz Olavarrieta reported on the research she had conducted in Mexico before the landmark decision of last April legalizing abortion in Mexico City. She reported that "Mexican women traveling to the US for safe abortion care were typically well-educated and wealthy, did not cross the border illegally, and as such did not have to resort to unsafe clandestine or self-induced attempted abortions…they also typically came from wealthier [more cosmopolitan] Mexico City rather than poorer northern and eastern states."

"The girls with money go off to Europe or to the US and come back just fine from their ‘appendix operations,' but the poor girls are subjected to all kinds of barbarities," stated a passionate supporter of legal abortion in Mexico City at the time that the momentous new law was being passed. Meanwhile, an opponent of the new life-saving law angrily stated that "people from all over the country will be coming [to Mexico City] for abortions. It's going to be abortion tourism. It will be chaos."

Perhaps the opponent of the new law should be asking why women are forced to travel to Mexico City for their safe abortions. Is it because of sexist laws and attitudes about women that make it impossible for them to obtain safe medical care in their own pueblos and communities? Could it be that these woman and girls are "simply" trying to save their lives, health, families, and futures?

Similar issues surrounding abortion tourism in Ireland were also explored at the conference. According to the Irish Family Planning Association and the Safe and Legal Abortion Rights Campaign in Ireland, "approximately 200 women per week travel to the United Kingdom from Ireland and Northern Ireland," where abortion is greatly restricted and virtually illegal. "Economics play a part…abortion remains a class issue," emphasized Goretti Horgan of Alliance for Choice Northern Ireland.

A minimum of "1000, 000 Irish women" have been compelled to travel to England for abortions over the last 20 years.

At a 1996 workshop on reproductive freedom held at a conference at the University of Connecticut School of Law, Ursula Nowakowska of Poland reported on the effects of her country's 1993 anti-abortion law. The law, "permitting abortions only if the life of the mother was seriously threatened or if there was severe deformation of the fetus," is essentially a farce, an insult, and a danger to women's lives and dignity, as are the restrictive anti-abortion laws in other countries. "…Women have gone to Western Europe or further east to obtain abortions" — Poland's version of abortion tourism. "Most Polish women go to Poland's East and South neighboring countries: Ukraine, Lithuania, Russia, Bielorus, Czech Republic, and Slovakia… Fewer women can afford to seek abortion care in Western countries, as the abortion services there are more expensive, but the care is of much higher quality." For the Polish women who have the financial resources, they go to "Germany, Belgium, and Austria." A February 2008 report posted in the ASTRA bulletin on sexual and reproductive rights indicated that at least 31,000 Polish women underwent abortions in the United Kingdom in 2007, a 30% growth in the number of Polish women from recent years.

Yet another example is Portugal. Portugal decriminalized first-trimester abortion last year, "leading to the easing of one of Europe's most restrictive abortion laws." It is estimated that "perhaps 20,000 or more illegal abortions a year take place and thousands of women end up in hospitals with complications…Many thousands each year, unsurprisingly, choose instead to cross the border" to more liberal Spain-abortion tourism for Portuguese women. Figures for the number of women who left the country in recent years to access safe abortion care aren't available, although in 2006, "about 4,000 Portuguese women went for abortions to…one clinic in Spain…near the Portuguese border."

In the United States, despite the legalization of abortion 35 years ago and where restrictions on abortion are nothing short of a war against women's lives, "access to abortion has been severely eroded" — leading to the current US version of abortion tourism. According to the National Abortion Federation, "88% of all US counties have no identifiable abortion provider. In non-metropolitan areas, the figure rises to 97%. As a result, among many other barriers to safe abortion care, nearly a quarter of US women wanting abortions have to travel 50 miles or more to reach the nearest abortion provider." During my 18 years as the executive director of Aradia Women's Health Center in Seattle, Washington, our clinic consistently saw women from throughout the state, as well as Alaska, Idaho, Wyoming, Montana, Iowa, Texas, California, Oregon, and Mexico.

As a response to these ongoing problems, the innovative Abortion Access Project has launched the Least Access States Initiative, targeting women in Mississippi, Kentucky, West Virginia, and Arkansas, who "share a troubling commonality — they all live in states with the least accessible abortion services in the US." This is admirable and difficult work, as it will be daunting to ensure that women of these least-served states are eventually able to more freely exercise their rights.

So who dies from lack of abortion access? Who suffers? Who is forced to continue an unwanted pregnancy, or desperately turns to underground, unscrupulous, and deceptive clinics? Who cannot become an "abortion tourist" and travel within or outside of one's country for safe abortion care? The universal theme is clear — it is disproportionately women or girls who are young and/or poor, indigenous, of color, an immigrant, a refugee, and/or geographically isolated. It is only women with fiscal resources who are able to travel the long distances to another state or country for safe abortion care.

The current abortion laws of many countries are completely inadequate to meet the needs of women and girls seeking safe abortion care. Therefore, pregnant women and girls who are able to do are virtually forced to become abortion tourists. Although the term is often used in sexist and disparaging ways, what it really points to is that women's reproductive health needs are being ignored. Women are too frequently being deprived of their right to access safe, compassioante, and professional abortion services close to home, or at the very least in their own state or country.

So our work goes on. We must continue to strive to liberalize abortion laws, reduce restrictions, destigmatize abortion — to view abortion as a human right and a moral choice for all women and girls — and must increase the pool of trained and compassionate abortion providers. We must continue the struggle to ensure that women and girls, of every class, race, and country, truly have access to safe, legal, timely, local, and community-based abortion care.