Table 2 Overall conclusions on the impact of grounds on abortion seekers 

Delayed abortion

Overall, the findings from 6 studies indicate that grounds-based laws may contribute to abortion delays in different ways due to inconsistencies in interpretation and implementation of the legal grounds. Abortion delays can occur when: abortion medications are seized by customs; the process of obtaining a legal abortion through local ethics committees or courts is protracted; women’s rape claims are questioned; healthcare providers misapply the right to conscientious objection; there is disagreement among healthcare providers about severity of foetal anomaly; medical professionals wait until the health condition is severe enough that the woman’s condition is deemed life threatening.

Grounds-based laws engage states’ obligation to respect, protect and fulfil the rights to life and health (by taking steps to reduce maternal mortality and morbidity including by addressing unsafe abortion, by protecting people seeking abortion, and by ensuring abortion regulation is evidence-based and proportionate).

Grounds-based laws can result in delayed access to abortion care, including waiting until health conditions deteriorate to satisfy a ‘ground’. Such delays may be associated with unsafe abortion or increased risks of maternal mortality or morbidity. Where such delays increase risks of maternal mortality or morbidity, they have negative implications for rights.

Continuation of pregnancy

Overall, the findings from 2 studies indicate that grounds-based laws may indirectly contribute to continuation of pregnancy and thus increased fertility. When grounds-based laws are removed, and 1st trimester abortion is allowed on request, these studies demonstrated a decrease in fertility, possibly due to a reduction in unplanned births.

Grounds-based laws engage states’ obligation to respect, protect and fulfil the rights to life and health (by taking steps to reduce maternal mortality and morbidity including by addressing unsafe abortion, by ensuring that where it is lawful abortion is safe and accessible), and the right to decide the number and spacing of children. Grounds-based laws can also be a violation 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.

Grounds-based laws may result in continuation of pregnancy and unwanted birth. Grounds that have a disproportionately negative effect on the health and physical and mental integrity of abortion seekers, including on a woman’s ability to decide whether or not to continue with pregnancy, have negative implications for rights. Failure to ensure grounds do not result in denial of therapeutic abortion has negative implications for rights.

Opportunity costs

Overall, the findings from 15 studies, suggest that grounds-based laws may contribute to opportunity costs in several ways including: the need to travel for an abortion, increased financial costs, emotional stress and trauma, fear of/experienced judgement and stigma, bureaucratic and costly protracted legal processes, increased morbidity, being subjected to “interrogations” and having one’s rape claim questioned, unsafe abortions, having to carry an unwanted pregnancy or a pregnancy with severe malformations, to term. The findings from some of these studies point to an inconsistency in how grounds are interpreted and applied, which sometimes leads to unpredictability and inequity in terms of abortion access and healthcare quality for the abortion seeker. The findings from other studies indicate that certain grounds, such as health and rape grounds, are consistently interpreted very restrictively, which ultimately leads to the denial of an abortion.

Grounds-based laws engage states’ obligation to respect, protect and fulfil the rights to life and health (by ensuring that where it is lawful abortion is safe and accessible, by protecting people seeking abortion, and by ensuring abortion regulation is evidence-based and proportionate).

Grounds-based laws may operate in a way that imposes significant opportunity costs on people seeking abortion, and in a way that makes lawful abortion inaccessible in practice.

Unlawful abortion

Overall, evidence from 3 studies suggest that grounds-based laws may contribute to unlawful abortion.

Grounds-based laws engage states’ obligation to respect, protect and fulfil the rights to life and health (by taking steps to reduce maternal mortality and morbidity including by addressing unsafe abortion, and by protecting people seeking abortion).

Grounds-based laws may be associated with recourse to unlawful abortion. Where such unlawful abortions increase risks of maternal mortality or morbidity, grounds have negative implications for rights.

SMA

Overall, evidence from 2 studies suggest that grounds-based laws may contribute to self-managed abortion.

Grounds-based laws engage states’ obligation to respect, protect and fulfil the rights to life and health (by taking steps to reduce maternal mortality and morbidity including by addressing unsafe abortion, and by protecting people seeking abortion).

Grounds-based laws may be associated with recourse to unlawful abortion, including unlawful self-managed abortion. Where such unlawful abortions increase risks of maternal mortality or morbidity grounds have negative implications for rights.

Reproductive coercion

Overall, the findings from 2 studies suggest that grounds-based laws may contribute to reproductive coercion through the denial of an abortion.

Grounds-based laws engage states’ obligation to respect, protect and fulfil the rights to life and health (by ensuring abortion regulation is evidence-based and proportionate, by ensuring that provider refusal does not hinder access to abortion, and by ensuring that where it is lawful abortion is safe and accessible), the right to decide the number and spacing of children.

Grounds-based laws can also violate 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.

Grounds-based laws that contribute to reproductive coercion through the denial of lawful abortion (as a result of unnecessary procedures or non-rights compliant interpretation and application), denial of therapeutic abortion, and denial of abortion in case of rape or incest have negative implications for rights.

Disproportionate impact

Overall, the findings from 5 studies suggest that grounds and grounds-based laws may have a disproportionate, negative impact on women with fewer resources, rural women and women with lower education, as well as those seeking abortion due to rape and on health grounds.

Grounds-based laws engage states’ obligation to respect, protect and fulfil the right to equality and non-discrimination. Grounds-based laws can also violate 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.

Grounds-based laws impact disproportionally on certain groups of women, including women who seek abortion following rape or therapeutic indication. This disproportionate impact has negative implications for the right to equality and non-discrimination in the provision of sexual and reproductive healthcare.

Family disharmony

No evidence identified

N/A

N/A

Exposure to violence or exploitation

No evidence identified

Grounds-based law may engage states’ obligation to respect, protect and fulfil the rights to privacy, health, and life.

Grounds-based approaches to the provision of abortion may require the disclosure of personal information to persons or institutions without clinical justification. In some cases, disclosure of such information may expose abortion seekers to risks of interpersonal violence, ostracisation or other harms (e.g., where a claim must be disclosed in order to access abortion) with negative implications for her right to privacy, health, and potentially right to life.