Denial of abortion in legal settings

Abstract

BackgroundFactors such as poverty, stigma, lack of knowledge about the legal status of abortion, and geographical distance from a provider may prevent women from accessing safe abortion services, even where abortion is legal. Data on the consequences of abortion denial outside of the US, however, are scarce.MethodsIn this article we present data from studies among women seeking legal abortion services in four countries (Colombia, Nepal, South Africa and Tunisia) to assess sociodemographic characteristics of legal abortion seekers, as well as the frequency and reasons that women are denied abortion care.ResultsThe proportion of women denied abortion services and the reasons for which they were denied varied widely by country. In Colombia, 2% of women surveyed did not receive the abortions they were seeking; in South Africa, 45% of women did not receive abortions on the day they were seeking abortion services. In both Tunisia and Nepal, 26% of women were denied their wanted abortions.ConclusionsThe denial of legal abortion services may have serious consequences for women's health and wellbeing. Additional evidence on the risk factors for presenting later in pregnancy, predictors of seeking unsafe illegal abortion, and the health consequences of illegal abortion and childbirth after an unwanted pregnancy is needed. Such data would assist the development of programmes and policies aimed at increasing access to and utilisation of safe abortion services where abortion is legal, and harm reduction models for women who are unable to access legal abortion services.

“I need to terminate this pregnancy even if it will take my life”: a qualitative study of the effect of being denied legal abortion on women’s lives in Nepal

“…Of these, 80 women or 26 % (51 from government hospital and 29 from NGO clinic) did not receive the abortions they were seeking; 43 (24 from government hospital and 19 from NGO clinic) were turned away for advanced gestational age (14 % of the women seeking services) and 37 (27 from government hospital and 10 NGO clinic) for other reasons such medical contraindications, small gestation size (less than 6 weeks) and ultrasonography not available at the time of service (12 % of the women seeking services). The characteristics of these women have been described elsewhere [ 21 ]. Of the 43 women who were denied for advanced gestational age, 25 women were selected purposively based in part on their place of residence, caste and ethnicity and level of education to have diversity in the sample for participation.…”

“…This study provides new and important information about the experiences of women who seek abortion services in Nepal. Our findings point to the need for systematic, quantitative evidence on the risk factors for presenting later in pregnancy, predictors of seeking unsafe illegal abortion, and the health consequences of illegal abortion and childbirth after an unwanted pregnancy [ 18 – 21 ]. Such data could help to identify strategies to improve access to abortion services in Nepal and similar settings in which abortion is legal.…”

Accessing medical and surgical first-trimester abortion services: women's experiences and costs from an operations research study in KwaZulu-Natal Province, South Africa

“…Abortion-related costs may exacerbate other existing barriers to accessing safe, legal services [9][10][11][12][13], and may prevent access altogether in some cases. Two recent studies from South Africa indicate that not being able to afford the fee for accessing abortion services at an NGO provider was a reason for being turned away from the service [14,15].…”

Articulating reproductive justice through reparative justice: case studies of abortion in Great Britain and South Africa

“…Research shows that a significant number of women do not receive the abortion care that they requested (Gerdts et al 2014). There are frequently delays in the delivery of services and long queues at facilities (Trueman and Magwentshu 2013).…”