barriers in abortion laws and policies

7/27/2019 Barriers in Abortion Laws and Policies

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Legal and Policy Barriers to

Abortion Access

Patty Skuster

Senior Policy Advisor

Ipas


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Right to Health: ICESCR Committee

The realization of a womans right to health

requires the removal of all barriers interfering

with access to health services, education andinformation, including in the area of sexual and

reproductive health (including safe abortion).


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Criminalization of

abortion Spousal consent

requirements

Medical provider

authorization Committee approval

Facilities

requirements

others

Abortion Law

Childs Rights Law

Health Provider ActHealth Law


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Parental consent

Conscientiousobjection without

limits

Medical provider

authorization others

Standards and

Guidelines

Reproductive HealthPolicy


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Spousal consent

Parental consent Conscientious

objection without

limits

Medical providerauthorization

others

Custom, tradition

Stereotypes

Training

Codes of Ethics


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As lawyers and human rights

advocates, we can address barriersto safe abortion through law and

policy


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Common Legal, Policy and Practice

Barriers to Abortion

Limited legal grounds

Provider authorization

Multiple signatures Parental involvement

Spousal consent

Committee, judicial or law enforcement

authorization

Conscientious objection


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Law or Policy?


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Characteristics of laws

vs

Characteristics of policies


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Common Legal, Policy and Practice

Barriers to Abortion

Limited legal grounds

Provider authorization

Multiple signatures Parental involvement

Spousal consent

Committee, judicial or law enforcement

authorization

Conscientious objection


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Standards and Guidelines

Facilitate access to safe abortion care to the full

extent of the law. They should cover:

types of abortion service

where and by whom they can be

provided; essential equipment, instruments,

medications, supplies and facility

capabilities;

Referral mechanisms;


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Standards and Guidelines

Facilitate access to safe abortion care to the full

extent of the law. They should cover:

respect for womens informed decision-

making, autonomy, confidentiality and

privacy, with attention to the specialneeds of adolescents;

special provisions for women who have

suffered rape; and conscientious objection


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End.


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1. Restrictions on Providers


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Mid-Level Providers

Mid-level providers such as nurses, midwives and other

skilled health workers can be successfully trained to

deliver quality abortion care abortion care. Authorizing

mid-level providers to deliver abortion care issupported by the World Health Organization; studies

have shown that skilled mid-level health workers who

are not physicians can deliver quality abortion care up

to 12 weeks of pregnancy.


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Right to Health

Health facilities, goods and services must be of

sufficient quantity (availability) and accessible to

everyone without discrimination (accessibility),

particularly for vulnerable or marginalizedpeople. When only doctors are authorized to

perform abortion, safe services are not available

or accessible, particularly for women in ruralareas.


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Mid-Level ProvidersCountries where mid-level providers are authorized to

provide abortion include:

- South Africa, which allows registered midwives to

perform abortions

- Cambodia, where midlevel medical practitioners andmidwives can perform abortion

- Ethiopia, which includes health officers, midwives,

clinical nurses, public health nurses, and laboratory

technicians

- Bangladesh, where paramedical personnel are

authorized.


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Example: Mid-Level Providers

SOUTH AFRICA. Choice on Termination of Pregnancy Act, 1996.

2.(1) A pregnancy may be terminated-

(a) upon request of a woman during the first 12 weeks of the

gestation period of her pregnancy;

.

(2) The termination of a pregnancy may only be carried out by a

medical practitioner, except for a pregnancy referred to in

subsection (1)(a), which may also be carried out by a

registered midwife who has completed the prescribed training

course.


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2. Third-party authorization

requirements

Multiple doctors or committee approval

Parental notification and consent

Spousal consent


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NAMIBIA. The Abortion and Sterilization Act (1975), as amended through

Act 48 of 1982.

3. (1) Abortion may be procured by a medical practitioner only, and then

only--

(a) where the continued pregnancy endangers the life of the woman

concerned or constitutes serious threat to her physical health, and two other

medical practitioners have certified in writing that, in their opinion, the

continued pregnancy so endangers the life of the woman concerned or so

constitutes a serious threat to her physical health and abortion is necessary

to ensure the life or physical health of the woman;

Barrier: Multiple Providers

Approval


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Barrier: Multiple Providers

ApprovalZAMBIA. Termination of Pregnancy Act, 13 October

1972

Section 3. (1) Subject to the provisions of this section, a person shall

not be guilty of an offence under the law relating to abortion when a

pregnancy is terminated by a registered medical practitioner if he and

two other registered medical practitioners, one of whom has

specialised in the branch of medicine in which the patient is

specifically required to be examined before a conclusion could be

reached that the abortion should be recommended, are of theopinion, formed in good faith


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Involvement of Parents or Partners


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The Committee on the rights of the Child General Comment 4,

on adolescent health and development:

Health-care providers have an obligation to keep confidential

medical information concerning adolescents, bearing in mind the

basic principles of the Convention. Such information may only

be disclosed with the consent of the adolescent, or in the samesituations applying of an adults confidentiality. Adolescents

deemed mature enough to receive counseling without the

presence of a parent or other person are entitled to privacy and

may request confidential services, including treatment.


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CEDAW Committee General Recommendation

24 on Women and Health

States parties should not restrict womens

access to health services or to the clinics that

provide those services on the ground thatwomen do not have the authorization of

husbands, partners, parents or health

authorities, because they are unmarried orbecause they are women.


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Example: South Africa

In the case of a pregnant minor, a medical

practitioner or a registered midwife, as the case

may be, shall advise such minor to consult with

her parents, guardian, family members orfriends before the pregnancy is terminated:

Provided that the termination of the pregnancy

shall not be denied because such minor choosesnot to consult them.


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Example: Partner Consent in Ghana

Guiding Principles for the implementation of CAC services

The Guiding Principles on how the law should be

implemented in order to ensure womens access to

comprehensive abortion care to which they are entitled under

the law are as follows:

General principles

Partner or spousal consent is encouraged but not mandatory

when requesting an abortion


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3. Provider Refusal/

Conscientious Objection


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International human rights protect freedom of

thought, conscience and religion, but this right issubject to limitations necessary to protect health or

the fundamental rights of others.

Governments have a duty to provide health care

services and prevent health care providers from

interfering with access. Governments must ensure

that health care providers refusal to provide

abortion services will not interfere with a womansright to health.

(ICCPR, ICESCR)


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Provider Refusal/ Conscientious

ObjectionLimits:

1. Health care providers must refer

2. Only medical providers directly involved in the

provision of abortion have the right to refuse .

4. Only people can object to providing abortion care.

5. Provider has duty to perform when a womans life is

in danger.


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/


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Provider Refusal/ Conscientious

Objection Singapore and the UK: a physician has a duty to

participate in such treatment which is immediately

necessary to save the life or to prevent grave permanent

injury to the physical or mental health of a pregnant

woman.


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4. Rape Reporting Requirements


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Rape Reporting Requirements

Rape is unreported because of:

- Stigma

- Fear of not being believed

- Problems of physical access to the police

- Fear of retaliation by the perpetrator and fear

of the legal process.- Lack of confidence in the judicial system
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Ethiopia S&Gs: women who request

termination of pregnancy after rape and incest

are not required to submit evidence of rape and

incest and/or identify the offender in order to

obtain an abortion services.

Ghana S&Gs: legal evidence of defilement, rape

or incest is not required in order for the client to

obtain an abortion.
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Case Studies

1. Identify potential human rights violations

that arise in the case study.

2. What commom legal, administrative or

procedural barriers could prevent the

pregnant woman from accessing safe

abortion?

3. What standards must be in place to ensureshe would be able to access safe, legal

abortion?


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Resources

Regulation of Abortion Care: Drafting to

Promote Access

World Health Organization, Safe abortion:

technical and policy guidance for health systems

barriers in abortion laws and policies

Documents