Table 3 Impact of PR on the abortion provider (A + B + C)
Outcome | Overall conclusion of evidence (A) | Application of HR standards (B) | Conclusion evidence + HR (C) |
|---|---|---|---|
Workload implications | Overall evidence from six studies suggests that provider restrictions have workload implications Four of the five studies examined this indirectly, by demonstrating the benefit in task sharing abortion care with health workers who are not physicians. One study directly examined workload implications from provider restrictions with mandated counselling All studies reported that provider restrictions may be linked with a range of workload implications including issues surrounding sustainability of staffing, logistical and financial costs, organizational changes, increased workload and stress among providers | Provider restrictions engage states’ obligation to respect, protect and fulfil rights to life and health (by ensuring abortion regulation is evidence-based and proportionate, and by protecting healthcare professionals providing abortion care) | Workload implications arising from provider restrictions that are not justified by evidence (e.g., of competence, effectiveness, acceptability) may place significant burdens on healthcare professionals providing abortion care, with negative implications for both their rights and the rights of persons seeking to access abortion |
System costs | Overall, evidence from five papers suggests that provider restrictions contribute to increased system costs Provider restrictions contribute to costs at the individual, provider and systems level. For individuals, these costs are typically associated with increased time in obtaining care. At the provider and system level, provider restrictions may be associated with system inefficiencies that increase administrative burden, workload and staff time | Provider restrictions engage states’ obligation to respect, protect and fulfil rights to life and health (by ensuring abortion regulation is evidence-based and proportionate, and by ensuring that where it is lawful abortion is safe and accessible) | Provider restrictions are linked with system costs. Where these restrictions are not justified by evidence (e.g., of competence, effectiveness, acceptability) they interfere disproportionately with rights to health and to physical and mental integrity |
Perceived imposition on personal ethics or conscience | Overall, evidence from one study suggests that provider restrictions by means of mandated counselling may have a perceived imposition on providers’ personal ethics or conscience | Provider restrictions engage states’ obligation to respect, protect and fulfil rights to life and health (by ensuring abortion regulation is evidence-based and proportionate, and by protecting healthcare professionals providing abortion care) | Provider restrictions that are not justified by evidence (e.g., of competence, effectiveness, acceptability) may interfere with the right of healthcare providers to thought, conscience or belief by prohibiting them conscientiously from providing abortion care and reducing or hindering access to lawful abortion |
Perceived impact on relationship with patient | Overall, evidence from one study suggests that provider restrictions by means of mandated counselling are perceived by some providers to have a negative impact on the provider-patient relationship | Provider restrictions engage states’ obligation to respect, protect and fulfil rights to life and health (by ensuring abortion regulation is evidence-based and proportionate, and by protecting healthcare professionals providing abortion care) | 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 |
Stigmatization | No evidence identified | Provider restrictions engage states’ obligation to respect, protect and fulfil rights to life and health (by protecting healthcare professionals providing abortion care) | Provider restrictions may intensify or exacerbate abortion-related stigma for healthcare providers permitted to provide abortion care. Stigma may result in decisions to opt out of or minimize abortion care provision, with consequences for the availability of lawful abortion |