Academic journal article Bulletin of the World Health Organization

A Global Database of Abortion Laws, Policies, Health Standards and Guidelines

Academic journal article Bulletin of the World Health Organization

A Global Database of Abortion Laws, Policies, Health Standards and Guidelines

Article excerpt

In June 2017 the United Nations Development Programme/United Nations Population Fund/United Nations Children's Fund/World Health Organization (WHO)/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) in collaboration with the Population Division of the United Nations Department of Economic and Social Affairs (UN DESA) launched a new, open-access Global Abortion Policies Database (available at two different web interfaces: http://www.srhr.org/ abortion-policies; esa.un.org/gapp). The online database contains comprehensive information on the abortion laws, policies, health standards and guidelines for WHO and United Nations (UN) Member States. It is intended for use by policy-makers, human rights bodies, nongovernmental organizations, public health researchers and civil society.

The database is designed to further strengthen global and national efforts to eliminate unsafe abortion by facilitating comparative and country-specific analyses of abortion laws and policies, placing them in the context of information and recommendations from WHO technical and policy guidance on safe abortion. (1,2) The main objectives of the database are to promote greater transparency of abortion laws and policies and State accountability for the protection of women and girls' health and human rights.

Backdrop to abortion policies

The association between restrictive abortion laws and unsafe abortion has been well documented. (3,4) According to an analysis by UN DESA, the average rate of unsafe abortion is estimated to be more than four times higher in countries with more restrictive abortion laws than in countries with less restrictive laws. (5) Restrictive abortion laws are also associated with higher levels of maternal mortality. The average maternal mortality ratio is three times higher in countries with more restrictive abortion laws (223 maternal deaths per 100 000 live births) compared to countries with less restrictive laws (77 maternal deaths per 100 000 live births). (5) Restrictive legal grounds for abortion are only one of many policy barriers that affect women and girls' access to safe abortion. Other barriers include policies that limit provision of abortion care to obstetricians and gynaecologists working at high-level care facilities; conscientious objection by health-care providers; requirements for third-party authorization(s); unnecessary medical tests; mandatory counselling; and mandatory waiting periods. (1)

Restrictive abortion laws and policies create risks to women and girls' health by deterring them from seeking care and hindering providers from delivering services within the formal health system. (1) Such laws and policies cause delays for women receiving care by creating complex and burdensome administrative procedures, increasing the costs of safe abortion services and limiting the availability of services and their equitable sociogeographic distribution. (1) Such delays can also result in pregnancy advancing beyond legally allowed gestational limits, thus making women ineligible to receive safe services. (1) Restrictions on access to safe abortion create inequalities both within and between countries, making access to safe abortion a privilege of the rich and leaving poor women little choice but to resort to illegal and usually unsafe practices and providers. (1)

Consensus to eliminate unsafe abortion

WHO first recognized unsafe abortion as a serious public health problem in 1967. (6) The problem was reaffirmed in the Programme of Action of the International Conference on Population and Development in 1994, which underscored the need for States to address the health consequences of unsafe abortion and to provide safe abortion where it is not against the law. (7) Recognizing the public health challenge posed by unsafe abortion, WHO produced technical and policy guidance on safe abortion for health systems in 2003. …

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