Abortion in the Republic of Macedonia is legal on request during the first ten weeks of pregnancy. After ten weeks, it is permitted in cases where the woman's health or life is in danger, when the child is expected to have severe defects, when the pregnancy results from a crime, or the woman's health is affected by difficult circumstances. The woman and her spouse must be counseled on harmful consequences and pregnancy prevention. Abortions can only be performed by an obstetrician-gynecologist in a health organization that meets certain minimum standards. Before 2013, such abortions could be approved by a Commission consisting of an obstetrician-gynecologist, a general physician or internal medicine specialist, and a social worker or psychologist. Since a controversial anti-abortion law was passed in 2013, requests for abortions after 10 weeks must be filed with the health ministry, and a woman who seeks one must affirm that she underwent counseling, informed her partner and met with a gynecologist.
The 1977 law regulating abortion, enacted when Macedonia was part of Yugoslavia, was not significantly altered until 2013. The abortion law of 2013 was passed in an urgent parliamentary procedure that limited debate, a move that was criticized by six Members of the European Parliament, and was called a restriction of women's rights by the opposition.
The government of Macedonia, backed by the Macedonian Orthodox Church, has also conducted advertising campaigns against abortion, aimed at increasing the country's birth rate.
At its peak in 1986, the abortion rate in the Republic of Macedonia was 70.6 abortions per 1,000 women aged 15-44; the rate fell after independence, to 28.5 by 1996. As of 2010, the abortion rate was 11.1 abortions per 1000 women aged 15–44.