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Table 3 Overall conclusions on the impact of grounds on health professionals

From: The impact of ‘grounds’ on abortion-related outcomes: a synthesis of legal and health evidence

Outcome

Overall conclusion of evidence (A)

Application of HR standards (B)

Conclusion evidence + HR (C)

Workload implications

Overall, the findings from 5 studies suggest that grounds and grounds-based laws may have workload implications including: difficulties in interpreting and applying the law, preparing detailed files for court reviews, stress and fear of legal repercussions, and a frustration with the system when a diagnosis of a non-lethal foetal malformation can be made but abortion is not permitted.

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, and by protecting healthcare professionals providing abortion care).

Workload implications arising from grounds-based laws significant burdens on healthcare professionals providing abortion care, with negative implications for both their rights and the rights of persons seeking to access comprehensive abortion care.

Referral to another provider

Overall findings from 1 study suggest that grounds-based laws may contribute to referrals to another provider; physicians must make referrals to providers in another state to circumvent existing obstacles including ethics committees and other protracted processes.

Grounds-based laws engage states’ obligation to respect, protect and fulfil the rights to life and health (by protecting people seeking abortion).

Referrals to a provider in another jurisdiction may mitigate difficulties of access produced by grounds-based laws for those with resources and capacity to undertake travel.

Imposition on conscience or ethics

Overall, the findings from 2 studies indicate that grounds and grounds-based laws may contribute to providers experiencing an imposition on their conscience or ethics in two ways, either by a) resulting in the questioning of whether or not a provider should provide a legal abortion, or b) by preventing providers from giving women diagnosed with a foetal malformations an option to end their pregnancy.

Grounds-based laws engage states’ obligation to respect, protect and fulfil the rights to life and health (by protecting healthcare professionals providing abortion care).

Grounds-based laws may result in providers being required to deny abortion where provision would align with their conscience or ethics, or to declare a ground to have been satisfied in order to ensure safe abortion provision even where it may not strictly satisfy the requirements of the law. In both cases, there are negative implications for the provider.

Stigmatia sation

Overall, the findings from 1 study indicate that grounds-based laws may contribute to stigmatisation of healthcare providers who ultimately choose not to involve themselves in abortion care for this reason.

Grounds-based laws engage states’ obligation to respect, protect and fulfil the rights to life and health (by protecting healthcare professionals providing abortion care).

Decisions about whether to provide abortion care can have stigmatising and career limiting effects where grounds-based laws differentiate between the lawfulness of ‘reasons’ for accessing abortion, with negative implications for both providers’ rights and the rights of persons seeking to access abortion.

System costs

Overall, the findings from 5 studies suggest that grounds and grounds-based laws may contribute to system costs by indirectly contributing to continuation of pregnancy and maternal mortality, and directly by imposing costs on court systems, increased workloads of healthcare professionals, and by delaying care for pregnant women with severe health conditions.

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 abortion regulation is evidence-based and proportionate, and by protecting people seeking abortion).

Grounds-based laws are associated with poor health outcomes and system costs and thus with exposure of abortion seekers to substantial costs and risks, with negative implications for rights.

Impact on provider-patient relationship

No studies identified

N/A

N/A