Table 2 Impact of PR on the abortion seeker (A + B + C)
Outcome | Overall conclusion of evidence (A) | Application of HR standards (B) | Conclusion evidence + HR (C) |
|---|---|---|---|
Delayed abortion | Overall, evidence from three studies suggests that provider restrictions may result in delayed abortions One study indirectly examines provider restrictions on delayed abortion by demonstrating how expansion of health worker roles (and thereby reducing provider restrictions) improve timely access to first trimester surgical and medical abortion Evidence from two studies suggests that government mandated abortion counselling increases the administrative and logistical burdens for providers and women, and may increase abortion delays | Provider restrictions engage states’ obligation to respect, protect and fulfil rights to life and health (by taking steps to reduce maternal mortality and morbidity including addressing unsafe abortion, and by ensuring abortion regulation is evidence-based and proportionate) | Delayed access to abortion care can have negative impacts on the right to life, health, and to physical and mental integrity. Provider restrictions that are not justified by evidence (e.g., of competence, effectiveness, acceptability) interfere disproportionately with rights |
Continuation of pregnancy | No evidence identified | Provider restrictions engage states’ obligations to protect, respect and fulfil the right to health (by ensuring abortion regulation is evidence-based and proportionate) and the right to decide on the number and spacing of children. They may also result in violations of the state’s obligation to ensure abortion is available where the life and health of the pregnant person is at risk, or where carrying a pregnancy to term would cause her substantial pain or suffering, including where the pregnancy is the result of rape or incest or where the pregnancy is not viable | If provider restrictions not based in evidence result in undesired continuation of pregnancy, this has negative impacts for rights to health, physical and mental integrity, privacy, and potentially the right to be free from torture, inhuman and degrading treatment or punishment |
Opportunity costs | Overall evidence from seven studies suggests that provider restrictions increase opportunity costs for abortion seekers Provider restrictions may be linked to opportunity costs such as increased financial costs, need for travel, waiting times, additional clinic contacts, emotional distress, and undesired surgical interventions | Provider restrictions engage states’ obligation to respect, protect and fulfil rights to life and health (by ensuring where it is lawful, abortion is safe and accessible, by ensuring abortion regulation is evidence-based and proportionate), and the right to equality and non-discrimination | Provider restrictions that are not justified by evidence (e.g., of competence, effectiveness, acceptability) interfere disproportionately with rights to health and to physical and mental integrity. Provider restrictions can particularly affect marginalized women and women in rural areas with negative implications for their right to equality and non-discrimination in access to healthcare |
Unlawful abortion | No evidence identified | Provider restrictions engage states’ obligation to respect, protect and fulfil rights to life and health (by taking steps to reduce maternal mortality and morbidity including addressing unsafe abortion, and by protecting people seeking abortion) | If provider restrictions not based in evidence result in inaccessibility of lawful abortion and recourse to unlawful abortion, which may be unsafe, this has negative impacts for rights to health, physical and mental integrity, and privacy |
SMA | Overall evidence from one study suggests that provider restrictions, when they limit access to care, may be linked to unsafe self-managed abortion | Provider restrictions engage states’ obligation to respect, protect and fulfil rights to life and health (by taking steps to reduce maternal mortality and morbidity including addressing unsafe abortion, by ensuring abortion regulation is evidence-based and proportionate, and by protecting people seeking abortion) | Where provider restrictions lead abortion seekers to self-manage their abortions outside the formal health system, and where such self-managed abortion is unsafe, the provider restrictions have negative implications for rights |
Referral to another provider | No evidence identified | N/A | Where provider restrictions preclude a healthcare provider from providing abortion care, immediate referral to a qualified and willing provider may ensure lawful abortion is safe and accessible for the abortion seeker |