A comparison of reproduction policy across countries: A new international database

The International Reproduction Policy Database (IRPD) is an innovative database on reproduction policies in 31 countries from 1980 to 2020. It can be used to map trends and country differences regarding reproductive welfare. IRPD was developed as part of the Emmy Noether Research Group “Varieties of Reproduction Regimes” at the Wissenschaftszentrum Berlin für Sozialforschung (WZB Berlin Social Science Research Centre), funded by the German Research Foundation (DFG). We define reproduction policies as laws, regulations, directives and guidelines the state or its executive bodies employ to intervene in reproductive processes. In other words, we analyse the state’s influence on when and how people can conceive children, enter into or avert a pregnancy, carry it to term or terminate it, and which social groups are supported in their reproductive decisions. To date, such differences between countries have hardly been systematically analysed. IRPD covers five policy areas that shape reproductive processes throughout the life course: sexuality education in schools, contraception, abortion, medically assisted reproduction and pregnancy care. The database is conceptually designed to allow long-term comparisons between reproductive fields and countries. We operationalised the government measures in terms of the specifics of the respective policy fields and their comparability (see also Table 1).

Data collection for IRPD took place between December 2022 and April 2023. The basis for the data is national government activity in 31 countries¹ during the period 1980 to 2020. We collected the data using a standardised online questionnaire tested in advance by international researchers from the five policy fields considered. We used their feedback to improve the questionnaire. During data collection, one expert per country entered the information into the questionnaire.

We selected the country experts based on their comprehensive expertise in at least one of the policy fields. When completing the questionnaire, they were asked to refer to official documents such as legal texts, directives, regulations or court decisions to ensure the greatest possible transparency and focus on government activity. The source documents are stored together with the data set and are available (usually in the respective national language) for follow-up analyses.

Based on the completed online questionnaires – and following our data preparation and coding – we provide IRPD as a dataset that can map the five reproduction fields along comparative dimensions. The final IRPD dataset includes a variety of quantitative policy indicators with novel, comprehensive and detailed data on reproduction policies the research community can use to analyse various research questions.

IRPD allows the visualisation of the states’ regulatory structures, permissiveness and generosity regarding the provision of reproductive welfare. It includes indicators of the legal framework and state-provided resources, enabling a distinction between “access” and “financing”: Access describes the conditions under which individuals can access resources; financing describes the extent to which the healthcare system covers the costs individuals would have using the reproductive services. The following section describes the five policy areas along the dimensions regarding the indicators contained in IRPD. Table 1 provides a list of the categories for which indicators were collected.

Regarding national government activity in school-based sexuality education, we consider two categories of regulatory framework. First, the regulation of sexuality education as a school subject, where it is relevant whether sexuality education is compulsory or whether parents have the right to withhold their children from it. Second, we consider the provision of information and training for teachers and ask whether national authorities are obliged to provide guidelines or materials for teaching, and whether there are national guidelines for teacher training in sexuality education.

We operationalise the state-provided resources in sexuality education in schools as the content intended for sexuality education, using indicators on whether and which of 10 predefined topics are included in the national curricula. The topics include the teaching of adolescent development, the prevention of sexually transmitted infections and variations in sexual orientation. For this policy area, we do not operationalise the funding subdimension because there are no individual costs for sexuality education in schools, which could vary between countries.

Regarding contraception, we consider the regulatory framework based on three categories. First, we ask whether there are national guidelines that regulate the authorisation or prohibition of contraceptives. The second category concerns whether a national authority monitors access to contraceptives. The third category relates to the regulation of contraception through national guidelines for medical practise, which includes questions about who is authorised to advise on contraceptives and who is authorised to prescribe them.

To gain insight into the provision of resources in this policy area, we asked the experts about access and funding of nine different contraceptives (including condoms, intrauterine devices and contraceptive pills). We operationalise access regarding the contraceptives available in a country and whether the state restricts access for certain groups of people. We consider six different groups that may be excluded, including minors and migrants. Furthermore, we consider the dimension of contraceptive funding using indicators of cost coverage by the healthcare system. We also record whether the coverage of costs is restricted for these people groups.

We record the regulatory conditions in the field of pregnancy termination in two categories: the legal status of abortion and the provision of information on abortion. To operationalise the legal status, we ask, among other things, whether abortions are regulated at the national or subnational level, which types of abortions (surgical or medical) are legally valid and to what extent doctors have the right to refuse to perform abortions. Furthermore, we operationalise whether any national regulations oblige the state to provide (medically correct) information on abortion.

The subdimension of access in this policy area comprises two categories: access requirements and procedural conditions. First, we operationalise the access requirements for abortion in a country using a predefined list of seven legal grounds for abortion (including life-threatening circumstances for pregnant women, abortion on request). The second indicator of access requirements is the week of pregnancy up to which an abortion is legal. The procedural conditions specify which conditions must be met before an abortion can be performed, e.g., mandatory pregnancy advice or waiting times. In this policy area, funding refers to the conditions and extent to which public healthcare systems cover the costs of an abortion.

In medically assisted reproduction (MAR), we record the regulatory framework in three categories. First, we ask which legal provisions regulate assisted reproductive treatments and which types of treatments are legal within this framework. Second, the category on the legality of gamete donation includes, for example, whether legislation regulates the donation of egg and sperm cells by third parties. Third, we record the legal regulations of parentage regulations following MAR treatments, e.g., who is legally recognised as a parent in the case of surrogacy.

The subdimension of access to MAR contains indicators of which procedures (e.g., ICSI, IVF) are available in a country, which requirements must be met in order to receive these treatments and which people groups do not have access, e.g., same-sex couples. In addition, we provide indicators of whether there are restrictions on gamete donations regarding age and number of donations an individual can make. We operationalise funding as the extent to which public healthcare covers the costs of MAR treatment and the conditions that must be met by the patient for their costs to be covered.

We describe the regulatory framework for pregnancy care along three categories. The first category of routine care includes whether there is a general programme of pregnancy care and the extent to which routine examinations are part of this programme. The second category includes indicators of what medical personnel are required for high-risk pregnancies and other pregnancies, to what extent the expectant parent can choose the place of birth and whether accompanying people are allowed to be present at the birth. Third, we ask whether public authorities must provide medically accurate information about prenatal care.

The subdimension of access to prenatal care includes, first, routine care and obstetric care, e.g., how many routine examinations are foreseen for each trimester, what prenatal tests are available and under what conditions a caesarean section can be performed. Second, we ask which medical staff are primarily responsible for pregnancy care (e.g., midwives or gynaecologists). The dimension of financing of pregnancy care records whether and to what extent public healthcare covers the costs of the care programme (e.g., routine examinations, prenatal tests, births outside a hospital).

The IRPD’s rich data on school-based sexuality education, contraception, abortion, MAR and pregnancy care provide for the first time a comprehensive account of reproduction policies recording international patterns and trends. This section highlights some potential applications of the data in different research areas.

First, IRPD can be used to analyse political science questions about the emergence of reproduction policies, e.g., the influence of institutional and political constellations. This allows researchers to analyse the role of the political system or individual actors in political decision-making processes regarding reproduction policy reforms. One theory from morality policy research that could apply to reproduction policy is that normative convictions are more important than instrumental interests (Knill, 2013). The long period of 40 years covered by IRPD also makes it possible to study when major changes in the regulation of reproduction policy fields took place in the various countries and whether it is possible to observe an international convergence of policies.

IRPD data are also a rich empirical source for analysing interrelationships between reproduction policy fields over time. For example, policy developments in the fields of abortion and MAR which are based on similar legal and ethical issues, such as the beginning of life, the status of the unborn and the responsibility of the state, can be analysed (van de Wiel, 2022). These issues reflect central lines of political conflict in the 21st century, whose regulatory solutions can be analysed comparatively with IRPD.

Furthermore, IRPD can help analyse the reciprocal relationships between political attitudes in the population and reproduction policies. A relevant research question here is the extent to which political attitudes lead to reproduction policy reforms (Norrander & Wilcox, 1999). Conversely, it is of interest how such changes affect political attitudes towards gender relations, sexual orientation and family forms (Abou-Chadi & Finnigan, 2019; Loll & Hall, 2019).

IRPD can also be used to analyse the effects of reproduction policies on social stratification. In particular, indicators on state-provided reproduction policy resources are essential for such questions, as access conditions and funding opportunities directly affect the individual reproductive decisions of people from different social backgrounds (Smith et al., 2022). Demographic research can also benefit from the data, as it depicts the regulatory context within which people decide whether, how and when to have children over the course of their lives.

IRPD provides an important empirical basis for research on reproduction. Its design allows analyses and comparisons not only within and between the various policy areas but also between countries and over a long period of time during which a wide range of reforms took place. The database thus offers the opportunity to analyse many questions on reproduction policy for the first time.

¹Australia, Austria, Belgium, Bulgaria, Canada, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Japan, Latvia, Lithuania, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, Ukraine, United Kingdom, United States. The IRPD also contains data on the GDR from 1980 to 1990.