Written by Patty Skuster, Senior Legal Advisor, Ipas
While governments around the world reform laws to make abortion less restrictive;, self-administered abortion—the termination of pregnancy without formal supervision by a health care provider, often with pills—remains unapproved in most countries. The Political Oversight Program at Temple University School of Law, USA and Ipas has released new evidence showing how Abortion laws around the world apply to self-administered abortions.
The practice of self-administered abortion has been on the rise for several decades and is an even more important means of terminating a pregnancy amid Covid-19 as facilities and health providers are strained and travel is restricted. Increasingly, people who want to terminate a pregnancy, you do this by taking pills directly through drug sellers, pharmacies or online and without the supervision of a healthcare professionalregardless of the legal framework in which they live. Self-administered abortion can be clinically safe, and the evidence supporting the clinical safety of self-administered abortion continues to grow. The World Health Organization recommends self-administered abortion early in pregnancy with clinically proven medications as long as the pregnant woman has a source of accurate information and access to a health care provider if needed.
Self-administered abortion offers promise for abortion care, especially in the midst of a global pandemic. Pregnant women can terminate their pregnancies safely without the supervision of a trained health care provider, which may be the best option if visiting a health care provider is undesirable or impossible. During Covid-19, self-care is essential for a range of health needs. But abortion laws around the world require abortions to be performed by a health care provider, with criminal penalties for people who self-administer abortions or people who assist them.
The new data, depicted on a map, was created through an analysis of key features of abortion laws as they relate to self-administered abortion in 180 countries and 40 subnational jurisdictions. The data can be used by researchers and advocates working to understand how abortion laws relate to self-administered abortions and working for reform.
through it World Health Organization Global Political Abortion Databaseresearchers identified and compiled text relevant to the regulation of self-administered abortions. We then coded each law to reveal how the laws apply to self-administered abortion, using the following definition of practice:supply of drugs from pharmacies, drug sellers or through online services or other outlets, without a prescription from a clinician, followed by [individual’s] self-management of the abortion process, including seeking care for any complications;.”
We have codified the laws according to:
- Which health providers are legally allowed to provide abortion care because self-administered abortion occurs without formal supervision by a health professional
- Where abortion is legally permitted, because self-administered abortion tends to take place outside a health facility
- What tests were required, because some laws require an examination at a health facility that is subject to sanctions for participating in an illegal abortion, to determine whether a person who administers the abortion themselves and the people who assist them are criminalized by the law
What the evidence shows
We used political surveillance to construct a global understanding of how abortion laws around the world relate to self-administered abortion. Although the methods do not clarify how the laws are interpreted or enforced, we have created the data for further research and analysis by researchers and advocates seeking to understand how abortion laws relate to self-administered abortions. For example, the data can help us understand specifically how liberal abortion laws relate to self-administered abortions:
- Fifty-seven countries (and a handful of subnational jurisdictions, which are omitted for this analysis) allow abortion for economic, social, or any reason
- Self-administered abortion is not performed by a health professional, but of those 57 countries with liberal laws, 42 require a specific health professional to perform an abortion for the abortion to be legal. One empowers a lay health worker.
- The laws of 14 countries do not specify what type of health care provider is required, but three of them criminalize people who perform abortions who have no medical training or do so outside of medical practice.
- Of the remaining 11 countries that do not specify who is authorized to provide an abortion, seven require the abortion to be performed in a specific health facility.
- In this study, researchers found no requirements that would limit self-administered abortion in early pregnancy in only four countries: Bolivia, the Czech Republic, Denmark, and Turkey.
How to use the data
Researchers and advocates can use this comprehensive overview of how abortion laws relate to self-administered abortion to highlight the problem of criminalizing self-administered abortion and further understand the relationship between abortion law and practice. For example, United Nations human rights treaty bodies recommended to states removing specific legal barriers to abortion care; but they are silent on legal barriers to self-administered abortion, such as the requirements that a health professional must provide the abortion. Advocates can use the data in their work with condition monitors, as well as national governments, to further develop standards for self-administered abortions.
Advocates can also draw attention to the need to decriminalize abortion and raise awareness in legal frameworks, using data from this project. Advocates and government officials working to loosen restrictions on abortion laws can be better informed about how to avoid requirements that criminalize self-administered abortions. In addition, empirical researchers could design comparative studies that examine the relationships between abortion laws and abortion practice across jurisdictions to equip advocates and policymakers with evidence for shaping legislation to improve health outcomes.
Bridging the gap between law and practice
The researchers hope that the data developed through this project can draw attention to the problem of the gap between abortion law and practice. While people have self-administered abortions for millennia, increasing numbers are doing so, and the global abortion field is devoting attention and resources to the increasing use of clinically proven abortion drugs, which has improved the safety of self-administered abortions. At the same time, governments are taking steps to liberalize abortion laws, but as laws change, they continue to criminalize self-administered abortions. By generating data on how laws around the world relate to self-administered abortion, we aim to aid efforts to understand and support the decriminalization of self-administered abortion.
Please note that blog posts are not peer-reviewed and do not necessarily reflect the views of SRHM as an organization.
