Policy status of abortion
The policy environment concerning abortion
Policies are defined as including abortion laws but also regulations, guidelines, financial provisions, and customary practices affecting the delivery of abortion and postabortion care. These policies may be written or unwritten (e.g., informal guidelines) and may clarify how program services should be operationalized and provided at the health system level.
Evaluators can rate the policies on abortion care in terms of four levels of restrictiveness:
- Policies that encourage wide availability of abortion care, with few restrictions on access;
- Policies that allow abortion care to be provided, but with some restrictive provisions;
- Policies that significantly restrict access to abortion care; and
- Policies that prohibit provision of abortion care, except in relatively rare situations.
Similarly, evaluators can classify the level of support for postabortion care by four levels:
- Policies that are highly favorable towards the treatment of complications from abortion, including complications from illegal abortion;
- Policies that are moderately favorable towards postabortion care;
- Policies concerning postabortion care that are virtually non-existent, and care provided is ad hoc and highly variable; and
- Policies that limit women‘s access to postabortion care.
Information on current policies
Penal codes; special statutes; court decisions; public health regulations and administrative codes; medical and nursing standards; and health care facility protocols
Note: While some policies are written and widely disseminated, others are informally developed and implemented by health facilities and providers as a matter of customary practice. For these informal policies, interviews with health care providers and administrators may enable one to determine the prevailing policies in a given geographical setting.
Laws specifically addressing when a pregnant woman can have an abortion based on the circumstances of her pregnancy provide an initial indication of the policy environment. Currently, about 62 percent of the world‘s population live in the 64 countries that legally permit abortion either without restriction as to reason or on broad socioeconomic grounds. The remaining 38 percent live in countries that have varying degrees of restriction (CRLP, 1999).
Yet abortion and postabortion care-related laws can be highly misleading with regard to what authorities actually tolerate or encourage, which may be either more or less restrictive than the laws alone would indicate. In some countries, “menstrual regulation,” or early abortion when pregnancy has not been confirmed, is officially sanctioned and widely available, even though laws on the books are highly restrictive with respect to “abortion.” In other countries, abortion is legal for a wide range of circumstances, but policies significantly restrict access. For this reason, one must often go beyond the official regulations and determine the actual policy toward abortion.
A range of institutions and individuals (e.g., clinical providers, administrative health care personnel, professional associations, judicial authorities) may create and implement policies, which may vary by geographic area or from one health care system/facility to another. Furthermore, policies with a major impact on postabortion care and abortion care may not be formally spelled out, but rather may be developed and carried out on an ad hoc basis.
Examples of the content included in abortion-related policies include:
- Circumstances under which a pregnant woman is permitted to have an abortion, including her age, marital status, circumstances of the pregnancy, and length of the pregnancy;
- Types of health care facilities authorized to provide induced abortion or postabortion care;
- Types of health care providers authorized to provide induced abortion or postabortion care;
- Funding of abortion-related services (e.g., availability of publicly funded subsidies for services, availability of sliding-scale fees, requirements for patient purchase of medications and supplies);
- Waiting periods, provider signatures, spousal or parental consent, and other procedural requirements prior to service delivery; and
- Types of clinical instruments and medications approved.
access, policy, postabortion care