Beyond “foreign vs Portuguese”: migrant-origin inequities in abortion care in Portugal, 2015–2024

Background

Abortion care offers a key opportunity for effective contraception and prevention of repeat unintended pregnancies. In Portugal, the proportion of abortions among foreign women nearly rose from 18.2% in 2014 to 39.6% in 2024 while national indicators suggest worsening post-abortion contraceptive follow-up. Evidence on reproductive inequities by migratory status remains scarce in Europe.

Methods

We conducted a repeated cross-sectional study using national abortion registry data for all legal abortions performed in women aged 15–49 years in Portugal, 2015–2024. The primary exposure was nationality (Portuguese vs foreign), with secondary analyses by migrant-origin group. Outcomes were repeat abortion and post-abortion contraception (classified as LARC, no-method, other methods). Adjusted prevalence ratios (aPR) were estimated using Poisson regression controlling for age, education, employment, cohabitation, parity and calendar year. Time trends were modelled using segmented regression.

Results

No-method contraceptive uptake after abortion rose from 4.4% in 2015 to 10.0% in 2024, with no overall difference between Portuguese and foreign women (aPR 1.04, 95%CI 1.00–1.08). Repeat abortion was more frequent among foreign women (32.3% vs 28.6%; aPR 1.10, 95%CI 1.08–1.12), but this gap narrowed over time. Migrant-origin group analyses showed heterogeneity: women from Portuguese-speaking African countries had higher repeat abortion (aPR 1.37, 95%CI 1.34–1.41) but lower no-method uptake (aPR 0.73, 95%CI 0.68–0.79), whereas Brazilian women had lower repeat abortion (aPR 0.69, 95%CI 0.66–0.72) and higher LARC use (aPR 1.23, 95%CI 1.20–1.27).

Conclusions

Contrasting patterns across migrant-origin groups point to distinct pathways of reproductive inequity obscured by a single “foreign vs Portuguese” lens. Health services in European countries with growing migrant populations require culturally tailored strategies to ensure equitable reproductive care.

Key messages

• Effective post-abortion contraception can help reduce unintended pregnancies and strengthen family planning.

• Different migrant-origin groups need tailored, equitable abortion and contraceptive care.