As of 2026, four countries ban abortion in all circumstances with no legal exceptions: El Salvador, Nicaragua, Honduras, and the Dominican Republic. Roughly 40 more countries that ban abortion permit it only when the pregnant woman’s life is in immediate danger, which in daily medical practice functions as a near-total prohibition. Vatican City maintains an absolute ban under Canon Law but has essentially no resident population it applies to. The list has actually shrunk in the last few years, with Malta adding a narrow life-saving exception in 2023 and Andorra moving toward decriminalization in late 2025.
The Four Countries With No Exceptions
Each of these four reached its total ban by a different route, but the laws share one feature: ending a pregnancy is a crime regardless of the reason, including a direct threat to the woman’s life.
El Salvador
El Salvador’s legislature stripped every existing exception out of the Penal Code in 1998. Article 133 punishes a woman who consents to her own abortion, or anyone who performs one with her consent, with two to eight years in prison. Article 134 raises the sentence to three to ten years when the procedure is performed without the woman’s consent.1National Center for Biotechnology Information. Patient Privacy and Conflicting Legal and Ethical Obligations in El Salvador: Reporting of Unlawful Abortions There is no carve-out for rape, severe fetal abnormality, or risk to the woman’s health.
The sharper edge of Salvadoran enforcement is prosecutorial charge-stacking. Women who have miscarriages or obstetric emergencies have been charged with aggravated homicide, which carries up to 50 years. Medical staff are expected to report suspected terminations to authorities, so hospitals become part of the enforcement apparatus. In Beatriz and others v. El Salvador, decided by the Inter-American Court of Human Rights in December 2024, the Court found that this “context of legal uncertainty” led Salvadoran doctors to delay life-saving care for a critically ill patient out of fear of prosecution.
Nicaragua
Nicaragua eliminated its longstanding therapeutic exception in 2006, with the total ban codified in the current Penal Code (Law No. 641, enacted in 2007). Article 143 sets one to three years in prison for performing an abortion with the woman’s consent. The sentence rises to three to six years without consent, and six to eight years when violence or intimidation is involved.2Legal Information Institute. Codigo Penal de Nicaragua Articulos 143 a 145
Doctors face a second penalty on top of prison. A physician who performs the procedure with the patient’s consent is barred from practicing for two to five years, with the disqualification rising to as long as seven years when the procedure was performed without consent.2Legal Information Institute. Codigo Penal de Nicaragua Articulos 143 a 145
Honduras
Honduras put its ban into the constitution itself. An amendment to Article 67 prohibits “any form of interruption of the life of the unborn” and recognizes life from the moment of conception. The amendment is engineered to resist repeal: it requires a three-fourths supermajority (96 votes in Congress) to modify, and the text declares that any future constitutional provision to the contrary is automatically void. The Penal Code sentences a woman convicted of intentionally ending her pregnancy to three to six years in prison, and providers to as much as ten years.
Dominican Republic
The Dominican ban is also constitutional. Article 37 of the Constitution reads: “The right to life is inviolable from conception until death.”3Constitute Project. Dominican Republic 2015 Constitution The criminal code backs this up with sentences of up to two years for the woman and up to twenty years for a medical professional who performs the procedure. In 2024, the Dominican Senate approved a new criminal code on first review that kept the total ban intact, signaling no legislative appetite for change.
Vatican City
Vatican City is a theocratic state where Canon Law carries legal force. Canon 1397 § 2 imposes automatic excommunication on anyone who procures a completed abortion, taking effect at the moment of the act without a formal church proceeding.4The Holy See. Code of Canon Law – Book VI – Penal Sanctions in the Church Vatican City has almost no permanent residents of reproductive age, so the practical significance is symbolic.
Countries That Allow Abortion Only to Save the Woman’s Life
A much larger group of about 40 countries, spread across sub-Saharan Africa, the Middle East, Southeast Asia, and parts of Latin America, permits the procedure only when continuing the pregnancy would kill the woman. The paper distinction between “total ban” and “life-saving exception only” matters a great deal in theory. In a hospital, with doctors facing prison for a judgment call, the line gets much thinner.
Nigeria
Nigeria has a dual legal system: the Criminal Code applies in the south and the Penal Code in the north. Both criminalize abortion but allow the procedure when performed in good faith to preserve the mother’s life. The Criminal Code adds that a surgical operation done for the patient’s benefit is not criminal if it was reasonable under the circumstances. Providers who perform abortions outside the exception face up to fourteen years in prison.
The Middle East and North Africa
Most countries across the Middle East and North Africa permit abortion when the woman’s life is in danger. Some extend the exception to serious risks to her physical health; others draw the line strictly at mortal danger. Many of these laws trace back to colonial-era penal codes that were never substantially updated. Approval typically requires sign-off from a committee of medical professionals, and sometimes religious authorities.
Brazil Is Not in This Group
Brazil is often lumped in with life-of-the-mother-only countries, but its framework is slightly broader. Article 128 of the Penal Code exempts a doctor from punishment when there is no other way to save the woman’s life and also when the pregnancy resulted from rape.5Legal Information Institute. Brazil Code – Decreto Federal n. 2.848/1940 – Codigo Penal Brasileiro In 2012, the Supreme Federal Court ruled in ADPF 54 that terminating a pregnancy involving an anencephalic fetus is not a criminal act. Brazil’s law remains highly restrictive, but it does not belong on the life-only list.
What the Penalties Actually Look Like
Sentences vary widely, but the pattern in restrictive countries is to punish both patients and providers harshly enough to deter either from acting.
- El Salvador: two to eight years for the woman or anyone assisting with her consent, and up to 12 years for providers. Prosecutors have charged women experiencing miscarriages with aggravated homicide, which carries up to 50 years.
- Nicaragua: one to three years for performing the procedure with consent, rising to six to eight years when violence or intimidation is involved. Health professionals also face two to seven years of professional disqualification on top of their prison term.2Legal Information Institute. Codigo Penal de Nicaragua Articulos 143 a 145
- Honduras: three to six years for the woman and up to ten years for providers, with increases possible when violence or coercion is involved.
- Dominican Republic: up to two years for the woman and up to twenty years for the medical professional who performs the procedure.
- Nigeria: up to fourteen years for anyone who causes a miscarriage outside the life-saving exception.
- Poland: up to three years for anyone who terminates a pregnancy outside the remaining exceptions, though the pregnant woman herself is exempt from criminal liability.
Medical license revocation is a parallel penalty in most of these countries, running from temporary suspension to permanent loss of practice depending on jurisdiction and offense.
Where the List Is Shrinking
Two European jurisdictions long cited as examples of total prohibitions have changed course.
Malta
Until 2023, Malta was the only European Union member state with a complete ban, codified in Articles 241 through 243 of its Criminal Code.6Leġiżlazzjoni Malta. Malta Code 9 – Criminal Code Parliament added Article 243B, creating an exception when a medical intervention is needed to save a pregnant woman whose life is at immediate risk, or whose health is in grave jeopardy that could lead to death. The exception applies only before fetal viability, in a licensed hospital, and only when a medical team has confirmed the necessity. Malta still criminalizes elective abortion, but it can no longer be grouped with El Salvador and Nicaragua.
Andorra
Andorra, the small European principality co-headed by the Catholic Bishop of Urgell, has long maintained one of the continent’s strictest abortion bans. As of late 2025, its Parliament was considering legislation to decriminalize the procedure by removing penalties for women and doctors. The bill would stop short of authorizing abortions on Andorran soil; instead, the government plans to fund travel for women seeking the procedure in France or Spain. If enacted, no country in Europe would retain an absolute prohibition.
How International Courts Have Pushed Back
Regional human rights courts have increasingly ruled that absolute bans violate the rights of pregnant women under international treaties, and those rulings are reshaping how some countries apply their laws.
The most important recent decision is Beatriz and others v. El Salvador, handed down by the Inter-American Court of Human Rights in December 2024. Beatriz was a woman with lupus and kidney failure whose pregnancy involved an anencephalic fetus incompatible with life outside the womb. Salvadoran doctors delayed treatment for weeks despite the certainty that the fetus would not survive and the serious threat to Beatriz’s own health. The Court found that El Salvador violated her rights to health, personal integrity, privacy, and freedom from violence, calling the denial and delay of care “obstetric violence.” It ordered El Salvador to adopt clear regulatory protocols for high-risk pregnancies and to train health personnel and judicial officials in maternal health standards.
In Europe, the European Court of Human Rights has repeatedly addressed Poland’s near-total ban. Poland’s Constitutional Tribunal ruled in October 2020 that the exception for severe fetal abnormalities was unconstitutional, cutting out the most commonly used legal ground for the procedure. Exceptions for danger to the woman’s life or health, and for pregnancy resulting from a crime, still exist on paper, but in cases such as M.L. v. Poland the ECHR has found that access to even those exceptions has been obstructed in practice.7European Court of Human Rights. CASE OF ML v. POLAND
How These Laws Affect Medical Care
The most consequential effect of a total ban is not the prosecution of women who seek abortions. It is the paralysis of doctors treating obstetric emergencies. When a physician faces years in prison for a wrong call made during a medical crisis, the predictable response is to wait until the patient’s condition deteriorates to a point no prosecutor could second-guess. That delay kills people.
The same pattern repeats in countries whose exception is limited to saving the woman’s life. Doctors have to make a near-impossible legal determination in real time: exactly when does a serious condition become life-threatening enough to satisfy a prosecutor? No clinical guideline answers a legal question with that precision, so the life-saving exception often fails the patients it was designed to protect.
The World Health Organization reports that in regions where unsafe abortions are common, death rates exceed 200 per 100,000 procedures, compared to negligible mortality from safe, legal abortions. Globally, an estimated 8 percent of maternal deaths are linked to abortion.8World Health Organization. Abortion The procedures do not stop when they are criminalized. They move out of hospitals, and the women most affected are those without the money to travel somewhere the law is different.