The impact of criminalisation on abortion-related outcomes: a synthesis of legal and health evidence

Abstract

Abortion is criminalised to at least some degree in most countries. International human rights bodies have recognised that criminalisation results in the provision of poor-quality healthcare goods and services, is associated with lack of registration and unavailability of essential medicines including mifepristone and misoprostol, obstructs the provision of abortion information, obstructs training for abortion provision, is associated with delayed and unsafe abortion, and does not achieve its apparent aims of ether protecting abortion seekers from unsafe abortion or preventing abortion. Human rights bodies recommend decriminalisation, which is generally associated with reduced stigma, improved quality of care, and improved access to safe abortion. Drawing on insights from reproductive health, law, policy, and human rights, this review addresses knowledge gaps related to the health and non-health outcomes of criminalisation of abortion. This review identified evidence of the impacts of criminalisation of people seeking to access abortion and on abortion providers and considered whether, and if so how, this demonstrates the incompatibility of criminalisation with substantive requirements of international human rights law. Our analysis shows that criminalisation is associated with negative implications for health outcomes, health systems, and human rights enjoyment. It provides a further underpinning from empirical evidence of the harms of criminalisation that have already been identified by human rights bodies. It also provides additional evidence to support the WHO’s recommendation for full decriminalisation of abortion.

The WHO abortion care guideline: Law and policy—Past, present, and future

“…| 1121 ERDMAN studies in 14 countries captures a diversity of criminal abortion law but demonstrates a consistent adverse impact on health and well-being. 16 It is an adage that criminalization increases unsafe abortion and its health and social harms along lines of social inequality, which the evidence confirms, but the studies also explain the causal pathways of the intervention toward this end. Among the most important of these findings is the "chilling effect" of criminalization on clinical care, including health workers who delay or deny access to legal care, a health workforce underskilled or unskilled in abortion care, and a health system without mifepristone and misoprostol as essential medicines.…”

“…In Recommendation 1, the WHO “recommend[s] the full decriminalization of abortion”, which the remarks define as removing abortion from all penal and criminal laws, not applying other criminal offenses to abortion, and ensuring there are no criminal penalties for having or providing an abortion or related care including information and support. The reviewed evidence from 22 studies in 14 countries captures a diversity of criminal abortion law but demonstrates a consistent adverse impact on health and well‐being 16 . It is an adage that criminalization increases unsafe abortion and its health and social harms along lines of social inequality, which the evidence confirms, but the studies also explain the causal pathways of the intervention toward this end.…”

Why a good law is not always good enough: a global review of restrictions to supportive laws for sexual and reproductive health and rights

“…International human rights standards state that postabortion care must always be available, regardless of whether abortion is legal 4. Even where there is a legal guarantee to postabortion care, a law that criminalises abortion may deter women and providers from seeking or providing not only safe abortion services but also postabortion care 29 30…”

“…4 Even where there is a legal guarantee to postabortion care, a law that criminalises abortion may deter women and providers from seeking or providing not only safe abortion services but also postabortion care. 29 30 …”

Towards a Feminist Global Health Policy: Power, intersectionality, and transformation

“…Throughout history, interconnected sexist, racist and capitalist aspirations at the political level have impacted the realisation of SRHR [10,29]. Policies undermining SRHR provide the state with power over an individual's sexuality and bodily autonomy, like in the case of abortion and its widespread criminalisation, the criminalisation of HIV transmission, or several cases of forced sterilisation of Indigenous women [30][31][32]. Based on an intersectional understanding, reproductive justice considers underlying power regimes and the complexity of SRHR by acknowledging multiple and intertwined layers of discrimination, inequities and lack of access to basic services [29].…”