Pregnancy Terminations in Portugal Spike to 18-Year High: What It Means for Women's Healthcare Access

The Portugal Directorate-General of Health (DGS) has recorded 18,601 pregnancy terminations in 2024, marking a 5% increase from the previous year and the highest figure since 2011. The uptick reverses a decade-long decline and raises questions about contraceptive access, mental health support, and regional disparities in reproductive healthcare across the country.

Why This Matters

• Access gaps exposed: More than 2,500 women residing in Portugal traveled to Spain between 2019 and 2023 to terminate pregnancies, signaling systemic barriers at home.

• SNS coverage remains patchy: Only 28 of 40 eligible public hospital units were performing the procedure by year-end 2024.

• Legal but stigmatized: Portugal permits termination on request up to 10 weeks gestation—one of the shortest windows in Europe—and lacks formal regulation of conscientious objection by clinicians.

• Mental health link: Specialists warn that insufficient access to psychotherapy amplifies emotional distress for women undergoing the procedure, yet counseling remains optional and unevenly provided.

Termination by Choice Dominates

Of the 18,601 procedures recorded, 18,079 (97.2%) were performed under the woman's voluntary request within the first 10 weeks of pregnancy. This figure represents a 5.5% rise compared to 2023 and a 13% jump from 2022. The second most common reason—severe illness or congenital malformation of the fetus—accounted for just 2.3% of cases. Legal grounds such as rape or risk to the woman's life or health remain statistically marginal.

The majority of procedures (67.6%) took place in the public sector, predominantly using the medicinal method. However, private clinics overwhelmingly favor surgical intervention, with 81.5% of their cases handled that way. The average gestational age at termination was 7.4 weeks.

Regional Imbalances Persist

Lisbon and the Tagus Valley alone absorbed more than half of all procedures in 2024, underscoring the concentration of services in urban centers. By contrast, rural regions and the Azores archipelago face persistent shortages. International NGO Amnistia Internacional reported in June 2025 that conditions in the Azores had deteriorated, with women forced to travel to the mainland or abroad.

The Portugal National Health Service (SNS) has struggled to expand geographic coverage despite legal obligations. Of the 40 hospital units eligible to offer termination services, 12 remained non-operational at the close of 2024. This patchwork availability compels some women to seek care in neighboring Spain, where legislation permits abortion on request up to 14 weeks.

Mental Health Access Remains a "Brick Wall"

The spike in terminations coincides with a broader crisis in mental healthcare. Albino Oliveira-Maia, president-elect of the Portugal Society of Psychiatry and Mental Health, told the Lusa news agency that "a significant portion of people suffering from mental illness lack access to treatment, either because they don't seek help or because they can't find it when they do."

Miguel Ricou, president of the Council of Clinical and Health Psychology Specialization at the Portuguese Order of Psychologists, described the dynamic as "hitting a wall." He explained that many women seek psychological support during the mandatory three-day reflection period before termination but encounter long wait times or no available slots. By the time an appointment materializes, the woman may no longer be in the same emotional state or even eligible under the 10-week limit.

Portuguese law mandates that health facilities offering termination services provide psychological and social support, yet enforcement is inconsistent. In some regions, such as the Azores, psychology consultations are framed as compulsory during the reflection period; elsewhere, they are presented as optional and often unavailable.

Contraceptive Counseling as a Second Chance

Following a termination, women must be referred to a family planning consultation and offered contraceptive advice. Studies show that women who undergo the procedure are more likely than the general population to adopt long-acting reversible contraceptives afterward, suggesting the moment serves as a critical intervention point.

Yet experts caution that this system works only if the woman receives timely, high-quality counseling. Family doctors, overwhelmed by patient loads and lacking mental health training, often resort to prescribing psychotropic medication rather than referring patients to specialists. Sales of psychopharmaceuticals in Portugal reached 29.4 M packages in 2025—the highest in a decade—with National Health Service (SNS) costs topping €152 M, according to Infarmed, the national medicines authority.

Europe's Shortest Window

Portugal's 10-week limit for abortion on request is among the most restrictive in Western Europe. By comparison, France permits termination up to 14 weeks, Sweden up to 18 weeks, and the Netherlands up to 24 weeks under certain conditions. The European Parliament voted in December 2025 to establish a fund covering abortion travel costs for women in countries with near-total bans, a measure that does not apply to Portugal but highlights the continent's growing focus on reproductive rights.

Despite the legal framework, conscientious objection by healthcare providers remains unregulated in Portugal. Clinicians may refuse to participate without formal oversight, creating unpredictable service gaps. Advocacy groups have called for a national registry of objectors to ensure coverage, but no legislation has been introduced.

Impact on Residents and Expats

For women living in Portugal—whether citizens or foreign residents—the findings carry practical consequences:

• Plan early: The 10-week window is tight. Delays in recognizing pregnancy, booking consultations, or navigating bureaucracy can push women beyond the legal threshold.

• Regional roulette: Access varies sharply by district. Women in rural areas or the islands should anticipate the need to travel or arrange private care.

• Mental health is not automatic: Psychological support is a legal right but not always available. Request it explicitly and escalate through the Health Regulatory Entity (ERS) if denied.

• Cross-border care is common: Traveling to Spain is a well-worn path, particularly from northern Portugal. Costs are typically lower than private clinics at home, and the gestational window is longer.

Broader Health System Strains Affecting Reproductive Services

The termination data emerges against a backdrop of mounting pressures on the SNS. The 2025/2026 winter module report documented 9 weeks of excess mortality—4,685 deaths above expected levels through April 8—a 21% surplus driven by flu, extreme cold, and strained emergency departments. These systemic pressures directly impact reproductive healthcare delivery, contributing to delays in termination services and reduced capacity for psychological support.

Health Minister Ana Paula Martins has pledged to "continue reforming, correct what is not working, strengthen the SNS as a more just, efficient, and closer public system, and evolve, once and for all, into a true national health system." She confirmed that a new surgery and consultation access system (SINACC) will launch August 1, replacing the current SIGIC platform. Patients will be able to track their queue position and, if delays exceed legal limits, opt for referral to private or social-sector providers. This system is expected to improve access to reproductive healthcare services as well.