by Fien De Meyer, Kim Beernaert, Sarah Van de Velde, Sigrid Sterckx, Kristof Van Assche
PLOS One, 18 June 2025 https://doi.org/10.1371/journal.pone.0325434 Open access
Abstract
Aim: This study explores the views of obstetricians on a potential extension of the 12-week limit on elective abortion in Belgium. It aims to investigate perspectives from a distinct group of providers who already have experience with later abortion, albeit provided on medical grounds. These insights could help identify and navigate perceived challenges and opportunities of extending the abortion time limit.
Methods: We conducted semi-structured qualitative interviews with 23 hospital obstetricians who are involved in abortion on medical grounds in Flanders, Belgium. We coded and thematically analyzed interview transcripts with NVivo software.
Results: We discerned three major themes in obstetricians’ views: 1) Concerns about later abortion techniques; 2) Psychosocial hardships justifying later abortion; and 3) Fetal viability and feticide considerations. Minor themes were: 4) Limited impact on abortion for fetal anomaly; 5) Abortion travel and associated harms; and 6) Sex-selective abortion.
Conclusion: Flemish hospital obstetricians highlighted both moral and technical challenges associated with extending the abortion time limit, primarily relating to surgical abortion methods and the organization of care. This study finds that, if an extended limit were to be adopted, additional policies and safeguards would facilitate implementation and foster interest among obstetricians in providing services. These include education and technical training of providers in later abortion care, centralization of provision, appropriate facilities, prepared teams, values workshops, and adequate state financing.
Introduction:
Timing is crucial for abortion access. Laws and policies often restrict abortion through gestational age limits, commonly prohibiting access beyond the first trimester. In Belgium, elective abortion – abortion upon request, i.e., where the person is not required to provide any justification under the law – is permitted up to 12 weeks after conception. Beyond 12 weeks, abortion is only permitted for severe medical conditions, specifically when there is “a particularly serious and incurable fetal condition” or “a serious threat to the woman’s health”. Each year, between 400 and 500 Belgian women travel to the Netherlands for abortions up to 22 weeks. In 2019, a legislative proposal to extend Belgium’s gestational age limit to 18 weeks garnered support from several political parties, yet failed to pass into law.
In the Belgian region of Flanders, abortion clinics support extending the limit, but obstetricians (who are primarily involved in terminating pregnancies for severe health conditions) are more critical. No prior research has studied abortion providers’ views and attitudes towards a potential abortion time limit extension in Belgium. Internationally, health professionals’ perspectives on (providing) abortion after the first trimester are under-explored. Studies from South Africa, where elective abortion is also legal up to 12 weeks, suggest that while abortion providers recognize the importance of later-stage abortion access, they feel uncomfortable about providing it. In particular, there is little research on obstetricians’ views on legalizing elective abortion beyond 12 weeks. In many countries, obstetricians routinely manage abortions after the first trimester, albeit exclusively for medical reasons. Their insights could highlight practical challenges and inform service organization if the law changes.
This study explores Belgian hospital obstetricians’ views on legalizing elective abortion beyond the first trimester of pregnancy (after 12 weeks). We aim to understand potential concerns and explore how an extended limit might affect the obstetric profession. These findings could guide policymakers and healthcare providers on this issue.
Major themes were:
- Concerns about later abortion techniques,
- Psychosocial hardships justifying later abortion,
- Fetal viability and feticide considerations.
Minor themes were:
- Limited impact on abortion for fetal anomaly,
- Travel to obtain an abortion and associated harms,
- Sex selective abortion.
Conclusion
In considering a possible extension of Belgium’s 12-week elective abortion limit, obstetricians in Flanders primarily highlighted medical, moral, and logistical concerns. They less often addressed the social and structural factors influencing later abortion trajectories and impacting patient experiences. Our qualitative findings, supported by the literature, point to the need for implementation safeguards should a time limit extension be adopted, including the training of staff, appropriate and centralized facilities, specialized instruments, and sufficient caseloads to maintain expertise. We argue that greater attention to the lived experiences of abortion-seekers could broaden obstetricians’ perspectives and potentially increase their willingness to provide care before or after the current limit….